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?