Bio-Identical Hormones

By Carol Chuang, MS, CNS, CMTA, CHC

In recent years, celebrities like Oprah Winfrey and Suzanne Somers have brought bio-identical hormone replacement therapy (BHRT) onto center stage. Ms. Somers testified how bio-identical hormones relieved her menopause symptoms and made her feel more youthful and energetic. Men in their 50s and 60s also wonder if bio-identical hormones can help combat andropause, the male version of menopause that is associated with emotional and physical changes as they age. 

What exactly is BHRT and why is it important? Why is BHRT often necessary today when our ancestors did not need it? What are some indications or symptoms that men and women should look for to see if they need BHRT? How to use BHRT safely and effectively?

Significance Of BHRT

Bio-identical hormones have been around for decades but many conventional doctors do not know about them as American medical schools only teach synthetic hormone therapy. Not coincidentally, these schools also receive major funding from the pharmaceutical companies that profit from these patented drugs. Doctors who offer BHRT generally learn about this option through independent research and studies.

Over the years, many aspects of BHRT safety have been researched in depth and numerous studies have found that it has many advantages over the synthetic hormones. The great appeal of bio-identical hormones is that they are natural and our bodies can metabolize them as they were designed to do, minimizing side effects. Moreover, the dosage of bio-identical hormones can be matched individually based on the person's needs, as opposed to a one-size-fits-all, mass-produced, synthetic hormone product.

• There is solid evidence that BHRT helps reduce the risk of Alzheimer's disease. According to a report from the National Institute on Aging, 45 percent of people who live to be 65 years old will have Alzheimer's by the time they are 85.
• BHRT offers protection and risk reduction against cardiovascular disease.
• BHRT reduces the risk of bone loss in both men and women.
• BHRT helps relieve menopausal symptoms, including hot flashes, depression, mood swings, irritability, inability to sleep, and forgetfulness.
• BHRT helps men feel better as they age too. When men go into their 50s and 60s, due to a gradual decline in testosterone, many men may begin to notice changes such as a decline in sex drive, muscle mass and tone (even with considerable exercise), memory and cognitive function, worsening mood, and loss of enthusiasm about many things that used to be of considerable interest.

Factors That Precipitate The Need For BHRT

Why is BHRT often necessary today when our ancestors did not need it?

1. Our Modern Day Diet

In the last century, with the advent of commercial agriculture and factory farming of animals, western civilizations no longer adhere to the dietary patterns of our hunter-gatherer ancestors. Today, fewer and fewer people follow a traditional diet of foods that are unprocessed, unrefined, natural, and pesticide- and hormone-free. Instead, what most of us eat - pizza, donuts, cakes, and commercial meats - is either highly processed, refined, full of chemicals and preservatives, or sub-par in nutrients.

Believe it or not, human genome has hardly changed in the past 40,000 years. Our nutritional requirements remain almost identical to the indigenous populations living in different parts of the world before the advent of modern agriculture. Therefore, if we are not providing proper nutritional balance to the body, literally every aspect of our lives, be it mental, emotional, physical, and biochemical, can be adversely affected. 

A study was done comparing testosterone levels among Danish organic farmers and Danish university students. It observed men in their 40s who practiced organic farming, ate their own produce, and followed an organic way of life for at least 20 years, versus male university students in their early twenties who ate the average Danish diet, which is probably still better than the standard American diet. Guess who had higher testosterone levels? The organic farmers!

Additionally, it is well known that Asian women who follow a traditional diet do not get menopausal symptoms. In the event that they do, the symptoms are rather mild.

If you want your diet to resemble more of your early ancestors, you need to:

• Avoid foods made with refined carbohydrates (white flour and white rice) and sugar. With the exception of berries, watch out for most fruits and fruit juices as they contain rather high sugar content.
• Cut out caffeine.
• Avoid processed foods and fast foods.
• Avoid all foods made with soy and soybean oil, except fermented soy products such as soy sauce, miso, tempeh, and natto. Soy contains phytoestrogens (plant estrogens) that may disrupt our own hormonal balance, however, fermented soy has substantially lower phytoestrogen content.
• Eat enough protein and good fats, such as free-range eggs, grass-fed animals, pasture butter, avocados, coconut oil, olive oil, and palm oil. Stay away from bad fats including hydrogenated oils, canola oil, corn oil, cottonseed oil, and vegetable oil.
• Eat a variety of organic vegetables.

2. Prevalence Of Type 2 Diabetes

One third of Americans have a genetic tendency to develop type 2 diabetes. These people have gone through decades of increasing insulin resistance before getting the disease. The increase in insulin resistance means the body has to make more and more insulin to overcome the resistance so that sugar can be efficiently taken into the cells where it gets burned for energy. 

The problem with increasing insulin production is that it converts more testosterone into estrogen. In men, this imbalance can create problems like prostate enlargement and even prostate cancer. In spite of this, men should not take a medication to reduce estrogen because it can often drive the estrogen too low, which affects bone density. The best thing to do is to regain insulin sensitivity by: 

• Going on a special diet that is low glycemic and does not affect blood sugar.
• Losing weight as abdominal fat tissue results in higher conversion of testosterone to estrogen.
• Doing high intensity interval exercise several times a week to reduce body fat.
• Incorporating supplements such as vitamin D3 and omega-3 fatty acids.

3. Sleep Habits

Studies show that female night shift workers are more prone to breast cancer largely due to the disruption of melatonin (the sleep hormone) production. Melatonin rises from early evening until the middle of the night, then it gradually declines. Evening production of melatonin is dependent upon being able to sleep in a dark room and is negatively impacted by bright light, such as TV or computer screen. Without melatonin coming in at the right time, you will be missing out on this powerful antioxidant that helps inbibit cancer cell growth. 

That means, if your work or social schedule keeps you caught in a perpetual jet lag and you are constantly sleeping less than 7-8 hours, don't be surprised that your estrogen and testosterone levels may decline too. Best bed time is between 10 to 11 pm and it is always a good habit to go to bed at around the same time every day.

4. Lack Of Exercise

As we age, we produce less testosterone and estrogen. That's why men and women over 40 may begin to experience unpleasant symptoms from reduced hormones. However, when we exercise, in particular, high intensity intervals as well as resistance training, the body produces more human growth hormone, estrogen, and testosterone. These are anti-aging hormones that increase muscle mass and bone density, and reduce body fat. Hence, if you are inactive or if you are not engaging in these sorts of exercises several times a week, you are missing out on their amazing benefits to keep you young and healthy.

5. Stress

High levels of stress increase the production of cortisol (the stress hormone) by the adrenal glands. After all, there is nothing wrong with a little stress here and there as the human body is superbly built to handle the occasional stress. 

Unfortunately, modern hectic lifestyles often dictate prolonged, chronic stress. This results in the adrenals becoming over worked as they have to constantly crank out more and more cortisol. Over time, elevated cortisol leads to decreased levels of DHEA, testosterone, and estrogen. It also leads to increased blood sugar and insulin production, a precursor to insulin resistance and type 2 diabetes.

6. Environmental Toxins

About 70,000 new synthetic chemicals were introduced into our environment during the 20th century. Although 80 percent of these new chemicals have never been screened for their effects on human health, numerous studies confirm that toxins such as bisphenol-A, DDT, dioxins, formaldehyde, PCB's, PDBE's, parabens, phthalates, pesticides, and heavy metals have a wide range of detrimental effects on our bodies. 

Few people are aware that these chemicals are particularly disruptive to our hormonal system. They have similar molecular structures as our own hormones and can mimic the body's own natural chemical messengers, elevate the levels of estrogen, jam signals, spread disinformation, damage DNA, and alter gene expression. Once they have been inhaled, ingested, or absorbed through the skin, they settle into the body's fat tissues and remain there.

Excess estrogen caused by environmental toxins increases the risk of developing hormone-related cancers in breasts, ovaries, prostate, and testes. In women, it can lead to weight gain, endometriosis, fibrocystic breast, and infertility. In men it can lower testosterone levels, lead to lower sperm counts, infertility, impotency, prostate enlargement, loss of muscle strength, and weight gain.

Additionally, more and more research shows that environmental toxins suppress the thyroid gland too. This gland is the body's master control of metabolism. When your thyroid is underactive, you may gain weight, become fatigued and sluggish, and feel depressed. 

Everyone is vulnerable from environmental toxins, particularly the developing human fetus.  Therefore, it is crucial to avoid or limit exposure to evnironmental toxins in your daily life. Watch out for toxic chemicals in cosmetics, lipsticks, perfumes, nail polishes, lotions, shampoos, hair products and treatments, toothpastes, mouthwashes, deooderants, birth control pills, household cleaners, bleaches, dry cleaning solvents, air fresheners, pesticides, herbicides, paints, plastics, new carpets, and dental amalgam fillings, to name a few.

Do You Need BHRT?

Starting at about age 35, almost all women experience a natural falling off of hormone production. Progesterone declines first - at a rate approximately 120 times faster than estrogen decline, resulting in a prominent symptom of hormone imbalance known as estrogen dominance. This is most noticeable among peri-menopausal women and can lead to a wide range of symptoms like hot flashes, mood swings, and insomnia as well as fibroids, endometriosis, hypothyroidism, and breast cancer. On the other hand, some women may instead have low levels of estrogen production or an imbalance of the different types of estrogen.

In men, testosterone levels begin to gradually decline in the late 30s or early 40s. A deficit in testosterone can manifest in the form of depression, reduced sexual desire, and a loss of sense of well-being. Studies show that it is also associated with increased risk of heart disease and prostate cancer.

If some of these symptoms sound familiar to you, you may be a candidate for BHRT. However, before you opt for it, you should consider making some lifestyle changes by cleaning up your diet, incorporating regular exercise, improving your sleep habits, finding better ways to manage or reduce stress, and avoiding environmental toxins. Many times, your symptoms will simply diminish.

Using BHRT Safely And Effectively

The greatest success with BHRT is an individualized approach. Find a healthcare practitioner who is knowledgeable with BHRT. 

• You first begin with a lab test of your hormone levels as it is never wise to prescribe without testing. Although a blood serum test is considered the "gold standard" by conventional doctors, saliva testing is far more accurate than blood when measuring bioavailable or "free" hormones. 24-hour urine testing, however, has an added advantage over saliva of being able to keep track of the metabolites, which are by-products of our hormone metabolism.
• Based on the test result and your symptoms, your healthcare practitioner will prescribe bioidentical hormones that are prepared at a registered compounding pharmacy. The most effective routes of delivery are either sublingual (under the tongue) or through the mucous epithelial membranes (vagina or anus). Oral supplementation is the worst option as the hormones have to be first transported to the liver instead of where they should go to.
• You will be monitored closely by your healthcare practitioner through periodic follow-up hormone lab tests to ensure you get symptom relief and that all your hormones are in optimal balance.

© 2012 Carol Chuang

About the Author

Carol Chuang earned a Master of Science degree in Nutrition from Huntington College of Health Sciences. She is a Certified Nutrition Specialist from the American College of Nutrition, a Certified Health Counselor from the Institute for Integrative Nutrition, a Certified Metabolic Typing Advisor, and a Certified Functional Diagnostic Nutritionist. She is also board certified by the American Association of Drugless Practitioners.

Carol is a Professional Member of the American College of Nutrition and the Price-Pottenger Nutrition Foundation. Apart from having her private practice counseling individual clients, she writes a monthly nutrition newsletter, and conducts regular seminars on various topics of nutrition and wellness.