Options Instead of
Hormone Replacement Therapy (HRT)
Ever since the massive Women’s Health Initiative
Study was released in 2002 there has been
controversy about whether synthetic hormone
replacement therapy (“HRT”) has potential
detrimental side effects.
Recent information progagated by the pharmaceutical
companies suggests to physicians that any potential
problems encountered with synthetic hormone
replacement therapy might have been caused by the
progestin component and not the estrogen component
of synthetic HRT and suggests that physicians
prescribe unopposed estrogen therapy.
We do not believe that giving any woman estrogen in
any form without balancing the progesterone to
estrogen ratio is in any way beneficial, and we will
not prescribe estrogen-only therapy.
Unopposed estrogen therapy means that the estrogenic
effects of estrogen are not balanced by natural
progesterone. It has been known for years that in
optimum health, the ratio of progesterone to
estradiol and perhaps to estrone, should be balanced
according to scientific measurement of these
components. We now have serologic and salivary
testing which are both helpful in determining the
levels of the reproductive hormones.
A word of clarification is needed when speaking
about progesterone, since many physicians and
clinicians misspeak this topic. Firstly, the word
progesterone only applies to natural progesterone, a
steroid hormone found in the human body, and
bio-identical to the plant sterol form in several
sources of phyto-progesterone (phyto means
plant-derived). Physicians often misspeak
“progesterone” when they are actually referring to
progestin, or to medroxyprogesterone, both of which
are synthetic and NOT bio-identical to the human
body’s form of progesterone.
Progestin isn’t even related to the body’s molecular
structure called progesterone.
The progestin molecule was created synthetically by
the pharmaceutical companies to stimulate the lining
of the uterus. This molecule is in no way even
structurally related to the natural progesterone
molecule. Many people propagate the mis-information
that progesterone is dangerous, when actually they
mean that progestin can be dangerous. Progestin is
synthetic, while progesterone is natural, yet many
clinicians misspeak these terms.
Instances in which we will not use even natural
hormonal therapy include people with a personal
history of breast or ovarian cancers. In such
situations, we perform detailed adrenal testing and
then treat the person nutritionally in order to
stimulate their adrenal glands, which are capable of
producing all estrogens, progesterone, testosterone,
DHEA-S, DHEA, and other steroid and catecholamine
hormones.
Adrenal gland function is found to be low in the
majority of folks we see. Low adrenal function can
cause a myriad of symptoms, such as fatigue, pain,
inflammation, sugar craving, low blood glucose,
sleep disturbance, weight changes, allergies and
chemical sensitivities.
We start your evaluation utilizing the latest blood
testing including cortisol, DHEA-S, sensitive
estradiol, free progesterone, free testosterone, and
the pituitary testing of levels of ACTH, FSH, and LH.
If we don’t uncover the detailed information that we
need in order to solve the problem, we will then
proceed to salivary testing.
Saliva is a traditional method used to evaluate the
adrenal and gonadal axis. Even Medicare covers
salivary testing, so we can say that if Medicare
covers it, it has to be considered mainstream
traditional. Saliva contains levels of hormones
which are not bound to the proteins present in
blood. Therefore, we can get accurate levels of
“free” hormones in saliva, including estrone,
estriol, estradiol, progesterone, testosterone,
cortisols, DHEA, and DHEA-S.
Saliva testing is especially valuable in evaluating
adrenal function, because the stress of the needle
stick is avoided. Cortisol levels rise in response
to painful or stressful stimuli, and many times the
serum (blood) levels are elevated due to the stress
of venipuncture.
Another valuable test to investigate adrenal
function is to analyze a specific portion of a
person’s hair. Many physicians believe that hair
testing is not accurate. However, hair testing is
utilized to screen people for drug-use, and is used
extensively in Forensic Medicine. Therefore we find
it to be quite useful in many situations.
Insurances will not pay for hair testing, and it
costs about 150. dollars.
We know that the adrenal glands function by
utilizing the heavy metal minerals sodium,
potassium, calcium, magnesium, and others. Indeed,
in medical school we are taught that adrenal
failure, known as Addison’s Disease, can be detected
many times in bloodwork which will show low sodium (hyponatremia)
and high potassium (hyperkalemia). We rarely see
adrenal failure. However, we frequently see adrenal
dysfunction, and since hair contains most minerals
in the body, hair analysis can be quite helpful to
create a more scientific approach to nutritional
therapies.
Many times, correcting mineral imbalances such as
lead/mercury/copper/arsenic/etc. toxicities, while
replacing the deficient minerals, will activate the
adrenal glands. We accomplish this activation of
the adrenals by utilizing nutritional supplements,
diet, exercise, and sleep.
Many people are low in the essential heavy metals
known as minerals due to poor food quality (fields
which are exhausted may not contain minerals which
can be absorbed by the plants grown in those
fields), malabsorption due to deficient stomach acid
(can be caused by chronic use of antacids, H-2
blockers, proton pump inhibitors), or presence of
toxic metals such as aluminum, mercury, cadmium,
copper, arsenic, lead, and others.
As you can see, when we discuss hormonal replacement
therapy, we have to address the
hypothalamic-pituitary-thyroid-adrenal-gonadal, and
gut axises. This type of complicated analysis is
just the sort of challenge that a competent
Internist (Internal Medicine Specialist) enjoys.
Correcting complicated imbalances in the human body
does take time. For many folks, relief of symptoms
will occur in the first 3 months, however, in many
instances it may take a year or so to correct the
problem.
We are up for the challenge. Are you?
