Bioidentical hormone replacement therapy
HRT is most often prescribed to ease the symptoms of menopause, but it also can be used to treat a variety of conditions that women of all ages may experience.
These conditions affect millions of women. As the number of women seeking hormone-related treatment has grown, so has the mass production of pills, patches and creams by the drug industry. However, each woman’s body is different and has its own unique needs, but commercially manufactured products tend to be “one-size-fits-all,” and do not always account for the differences between individuals.
Pharmacy compounding is the art and science of preparing customized medications for patients. The advantage of compounded HRT is that it can be adapted specifically to fit each individual’s body and hormone levels. HRT can utilize hormones that have the exact chemical structure as the hormones in the human body. The body recognizes them and allows them to mimic the function of the hormones the body produces on its own.
Working closely with a woman and her healthcare provider, a compounding pharmacist can help a woman start and maintain a hormone replacement regimen that brings her hormones back into balance and closely mimics what her body has been doing naturally for years.
With a healthcare provider’s prescription, the pharmacist can prepare hormones in a variety of strengths and dosage forms, including:
- Topical or vaginal creams, gels, and foams
- Sublingual drops or troches
Richard Stenlake on Natural – Bio Identical Hormone Replacement Therapy NHRT
I’d like to talk to you about Natural Hormone Replacement.
Natural Hormone Replacement is cutting edge technology and as such is quite complex. Thus I would like you to listen pretty closely for more than one reason because your doctor may not be aware of Natural Hormone Replacement and it may be up to you to inform him.
NHR involves basically the use of natural hormones. And it’s not quite natural hormones, I’m sorry I’m stuffed for words there, but they’re bio-identical or exogenous hormones. Which means basically they’re identical to the hormones in your body replacing like with like.
After you have listened to this lecture, you will be able to understand what exogenous hormones are, how they’re used, what doses are used and why they are good for you.
My name is Richard Stenlake and I am a compounding chemist. I’ve been a pharmacist for over 30 years and I treat approximately 10,000 patients for NHR. Daily, I speak to doctors and patients and help doctors solve their problems and sort out many patient queries.
I have to go through a few things with you but I’d like to start out by talking about what is a compounding chemist and the different dosage forms that one needs to understand about before we can even start thinking about this.
Now a compounding chemist is basically your old fashion pharmacy. Just like when mum and dad were kids and they’d go down to the pharmacist, he’d prescribe stuff for them and he’d make it up. He’d make up your cough mixtures with stumodium, with seniger, with ammonium bicarbonate, with infusion bucu?, all these interesting, weird and wonderful little things that just don’t exist in pharmacies nowadays. The closet you’ll get to a compounding chemist nowadays is your average pharmacist might make up a cream a bit of salicylic acid in sorbolene for a bit of ceryasis or something like this but in the old days everything was made by the pharmacist. This was the time before manufacturing/laboratories were around and there weren’t pre-packaged products. I mean the pharmacies used to make the suppositories, the pessaries, the lozenges, the pills – the pills were around before tablets and this leads me on to the dosage form that we’re using for troches for NHR which is troches.
Troches are a pastel or a lozenge. They’re the floor runners to your cepacol’s and strepsil’s. Troches have been round since the turn of the century and were originally made for sore throats – as I said the floor runners of cepacols and strepsils. They were made with a very complex procedure of they had a ringer, an ironing board and all this sort of stuff and you had to make them out, roll them out, it was very complicated like making a cake. And when I first heard of troches there was quite a bit of digging to find out what it was all about because troches have come a long way since then. And I mean they were in the British Pharmacopoeia, US Pharmacopoeia, French Pharmacopoeia and all of European ones. I mean they have different names in different countries. They were called troches in France, pastel in Germany, “lozenge – some french word” somewhere else in Europe. They had different names but are all basically the same thing. Today the modern troche is bought up to the 21st Century. They are made in little packets and they’re made in the packets so they are basically moulded in the packet. Much the same way as a spicery mould is. It was found in the 80’s that troches offered transdermal absorption. Now I’m sure you’ve heard of transdermal absorption with Dr Lee and his progesterone cream for I’m sure at least a lot of you have – could I see – yeah I thought a few of you would know.
Rubbing onto the skin and its absorbed into the sub-tetanus fatty layers absorbs progesterone cream and hence into the blood stream or so the theory goes. However, with troches, it’s exactly the same principle – the lozenges pressed against the skin in the mouth which is much finer than any skin on the body and it goes through a very thin fatty layer into a very strong blood flow. So we get much better blood volumes by taking troches then we do with using creams. We have infact just finished a trial and the results will be out shortly.
So now we have established that we need troches to take hormones. Now we’ve got to look at what hormones we need to replace. There are basically 4 hormones – progesterone, estrogen, testosterone and DHEA. Now we’ve got to go a little bit deeper than this cause there is lot of preparations around for hormone replacement so we thought why is this better? Well just look around you, apart from having different hair colours, different eye colours, no 2 of us look the same. We all know we have different fingerprints so as we all look different externally, we are different internally. So how can a drug manufacturing company make a compound, maybe in 2 or 3 strengths, that is going to fit the entire world populous of females for hormone replacement? Think about that for a minute? No 2 of you are alike.
So no 2 of you have the same hormonal balance. And by hormonal balance I mean the same level of estrogen, progesterone, testosterone and DHEA. You’re going to absorb those 4 hormones at different rates. So you are going to need different doses to get to your ideal level which is different. That is why, when we talk about hormonal balance we need to have standardised doses particularly for you.
Now how do we ascertain what dose we need? Now this is all quite complex as we have to look at blood profiles cause we’ve got something to measure these things by because we are using bio-identical or same hormones as in your body so we can measure what hormones are in your body now. From that and going on what symptoms you have we can then gestate or postulate or whatever you like to say but it’s basically an educated guess on a basic starting formula. And it’s an educated guess because as I said each one of you will absorb it at a different rate and each one of you has a different level that’s going to get the hormonal balance. I mean by balance you’ve got to look at hormones as if they were a movie. Let’s just say it’s a movie. The main stars of the show are estrogen and progesterone; the major bit player is testosterone followed by a cast of thousands headed by DHEA. So if we can control those 4, mainly estrogen and progesterone – they’re like a see-saw, they have to be in complete balance like yin and yang. So we’ve got a blood profile, we’ve got your symptoms (and I’ll go through those in a minute), so we work out a basic starting dose. We then get you to take the troches and hopefully feel better and continue to take for 6-8 weeks. Then we’ll get another blood test done and we’ll have a look at the levels. How blood test B is compared to blood test A. how the symptoms at time of blood test B are different to the symptoms at time of blood test A and we can then start to fine tune this prescription of yours because it is specifically for you. It’s the difference between a home cooked meal and McDonald’s. This is for you. This is not something that comes off a drug company off the shelf – I can’t specify that enough. But this is tailor-made medication. So we look at your blood profile and look at your symptoms. The estrogen level might be fine and the progesterone level might be still down. Symptoms will tell us this. The testosterone level may be down so we have to adjust the dose – up the testosterone, decrease the progesterone, whatever. But we do all these things to get your profile back into balance.
Ok we’ve worked out the dosage but what are the symptoms? The symptoms we’re going to fix up. Now there’s plethora of hormone deficiency symptoms. There’s mood and personality changes, things like irritability, rage, unexplained tears, panic attacks, anxiety, impatience, depression and a general loss of confidence. Look at brain function we there is general loss of memory and basically a cotton wool head – a dizziness, a lack of concentration, forgetfulness, or these sort of things. I mean how many times have you walked into a room only to turn around and think ‘what the hell am I doing here? I came in here for something.’ This is infact a sign of an estrogen deficiency because estrogen is essential for women’s thoughts. I’ll go more into that later but that’s an estrogen sign.
Let’s look at physical symptoms, hot flushes, the night sweats, the palpitations – you know when your heart goes bang! bang! bang! The number of times that menopausal women have gone to their heart doctor just to get it checked out thinking they’re having heart attacks. And it’s not – it’s another hormonal symptom. Look at urinal frequency – incontinence – the number of times I hear the story of women being operated on for incontinence it’s purely and simply a hormonal problem – most of the time sometimes it’s not of course. But most of the time it’s just a hormonal problem. The loss of tone from the pelvic region, that’s tied in with the incontinence. There’s also other things like this itching all over, just like little insects crawling under the skin. Joint pain, you know, muscle aches and pains; dryness of the skin and hair; vaginal dryness; dry eyes; breast changes; sleep problems; insomnia; these are common – and look at the interest in sex – the libido, how that’s gone – I mean when is the last time you had a fantasy about sex and these sort of things. I mean this is not unusual and this is what should be bought out of the cupboard now. These are all hormone deficiency signs. You know, weight changes as well, eating disorders, constipation, and diarrhoea. These are all due to hormone deficiencies. Mainly due to estrogen, progesterone, testosterone. As I said the balance of estrogen and progesterone is most important. And testosterone is very important. I mean apart from libido which everyone thinks that testosterone, all its good for is libido. Not so. Cranky old man syndrome – that’s low testosterone. Also as we see that women need this in a lot smaller quantities. A little bit of testosterone in females goes a long way. I mean particularly you’ll find a lot of females after a hysterectomy, I mean aged 30 or 40 something like this, will go through massive depression and that’s due to testosterone and to think that there is not a testosterone product on the market today specifically tailored for women. This is the 21st century we’re talking about now. There is not a product on the market here in Australia. And that’s criminal, it should be around. There doing studies now down at Gene Howell foundation in Melbourne which you know their great but their selling the early uses for testosterone. You know it’s very important in osteoporosis and things like this as well.
As I said there a many and varied problems with hormone deficiency. The most problematic one we see is of course hot flushes which we can fix, you know clickerty-click. No time flat!
Ok now we’ve looked at the symptoms, let’s put the symptoms to the hormones. As I said the major hormones are estrogen, progesterone, and testosterone and to a minor part DHEA. They’re all together in hormonally balanced amounts. So the whole aim of hormone replacement therapy or natural hormone replacement therapy is to get your hormones back to age 30. Now you’re not going to be 30 again but you’re going to feel one hell of a lot better than you are now. Now this is a problem because we don’t know what your levels were at 30. As I said we’re all different. It’s going to take a different route to get to when you were 30. Depending on how good your menstrual life was, how long it will take to get to age 30 or there abouts. We’re aiming between 30 and 40, somewhere. Where you felt good. That’s what it’s all about.
Now the hormones, as we said, estrogen, progesterone, yin and yang – they have to act in complete sequenticity. Estrogen is not 1 hormone, estrogen is in fact 3 hormones – oestrone, oestradiol, and oestriol. Oestradiol is the major estrogen and also the strongest estrogen. It’s about 100 times stronger than oestriol and 10 times stronger than oestrone. But I only tell you this so that I can get round to another point mainly the form of estrogen that we like to use. It’s a form called triestrogen or triest. Triest is a combination of those 3 estrogens – its 80% oestriol, 10% oestrone and 10% oestradiol. Oestriol is the major estrogen secreted during pregnancy therefore logically one would think it has to be the safest of the estrogens. Estrogens as we know are carcinogenic causing cancer. There is a risk with estrogen unopposed estrogen and all these sort of things. I’ll go more into that later too. But if oestriol is the main hormone secreted during pregnancy, would it not then follow that if Mother Nature in her wisdom while a foetus is being produced, secretes oestriol as the major hormone, would this not then be the safest one? Think about it. I mean this is the most vulnerable time when the foetus is being produced. Remember when the felidermide disasters and all these sort of things. There’s disclaimers on every tablet – don’t take during the first 3 months of pregnancy! This is when your oestriol is being produced. So, would it not then be wise to use oestriol in all our estrogen components of the troches? Sure it would but there’s a catch. As there always is a catch. Murphy comes to the floor again. Oestriol is the weakest. As I said it’s 100 times weaker than oestradiol therefore in some cases you have to use buckets of it to get the affects you need. And the other catch is, it is expensive. Oestriol is the most expensive of the estrogens. So with that considered and unless there is an extreme risk of cancer in these sort of things, I wouldn’t recommend oestriol by itself but in the form of triest. Now this has got an added benefit as we can adjust it because there is only 10% oestradiol. 10% of oestradiol means that we can adjust by ½ mg at a time. Whereas if you are just using straight oestradiol, it is very strong. Oestradiol is very strong and estrogen effects with a little bit a smidgen of estrogen can throw you way over the edge and yet you won’t find commercially there’s not a triest product produced. There’s not one. They all use oestradiol except there is a couple of creams and things around, creams and pessaries that use oestriol but generally their not strong enough for mainstream hormone replacement. And oestradiol is used because it is cheaper. The drug companies can make more money out of that one. Or that’s my opinion anyway.
However, back to oestriol. Oestriol is used because it is easier to adjust. You can use a little bit, you know change it by increment of 500mg whereas with oestradiol your working of increments of 10mg and it’s very hard to get accurate at that level. So you’ve got the punch of oestradiol with the safety of oestriol using triest. So I always recommend we use triest except in some cases when people eat a lot of estrogen so then we’ll start off with oestradiol after we’ve tried the triest route, realise that doesn’t work, go to oestradiol, get the levels up, then come back to triest. I find this always works the best.
Now, what’s the next hormone we’ve got to consider, the next star of the team is progesterone. Now, progesterone is the hormone of pregnancy, ‘Pro’ meaning ‘for’ ‘gesterone’ meaning ‘gestation.’ It is essential for a full time pregnancy, and use to be used if there was an abortion likely to happen, ladies were pumped full of progesterone, not so much today as there are alto of things to use instead of this. However progesterone is the yang part of the yin right, and is the opposite of estrogen where as if estrogen’s a stimulant progesterone’s a depressant. Whereas estrogen retains fluid, progesterone gets rid of fluid. Estrogen is essential for your well-being I mean, estrogen is secreted in buckets during pregnancy. When everyone’s got the bloom of pregnancy what causes it, it caused by progesterone. There’s lots that can be said about progesterone but just remember that progesterone and estrogen have got to act like yin and yang, just always remember that.
Now, Testosterone. As I’ve said before testosterone is an essential antidepressant, and you wouldn’t believe what a good antidepressant testosterone is, it just works so exceptionally well. It’s also good as I said for libido; (everyone knows this). It’s also good to turn fat into muscle and it gives you that extra bit of stamina, I mean women need that extra bit of stamina, so you need the testosterone, you’ve got to get some muscle tone. I mean I don’t want you looking like Arnold Schwartsnagger, but you’ve got to have muscle tone. You got to be able to just do little chores, just do some gardening and this sort of stuff, if you’ve got muscle tone you’ve got more strength to do these sort of things, so that is essential too.
The fourth hormone we were talking about before is DHEA. Which is dehydroepiandrosdendione obviously that’s why it is called DHEA. DHEA is present normally during the ages of 20 and 30 it’s at maximum. I think, in my opinion DHEA is there basically in times of,- when you’re supposed to bring up your young, – is what I’m trying to say. During that normal period there, where between 20 and 30 most people have their children and we got to remember we’re animals, we’re just like a wolf a lion whatever. During that time when you’re supposed to be looking after your children, you’re supposed to be able to fight off the foe and be at your most agile and best. It’s still all Darwin’s theory of evolution, and to keep the species alive you’ve got to be fittest when you’re producing/reproducing, because this is when your young are at their vulnerable. You’re vulnerable because you’ve got to camp and look after them basically so you’ve got to be super alert. Basically DHEA makes you super alert. It’s a mother hormone it’s a precursor to testosterone, and oestradiol and it’s got its own beneficial effect. I mean it’s one of these sports enhancing drugs that they use far over the limits we are talking about. There’s perimeters for all these things, that’s why do the blood test so we can say we stay within perimeters, and this way they are all completely safe because these are the normal perimeters their used in. This is a form of anti-aging medicine, not to say you’re going to live longer you’ll still die at the same time, but you’ll die up here as opposed to down there, you’ll be feeling good, and that’s what it’s all about. Nature throws us on the scrap heap, as I said Darwin’s’ theory of evolution, we’re just turning this evolutionary clock back by using all the different hormones.
Okay, let’s just recap for a little while now. I’ve told you about natural hormone replacement, what the major hormones are, what the symptoms are, how to treat the symptoms, how to use the hormones in a troche or lozenge, and what hormone balance is and what we’re aiming for. Yeah, you got that?
Now, to go a bit further I think we should step back a couple of paces and have a look at PMS or pre-menstrual syndrome. Pre-menstrual syndrome is very similar to menopause in many ways, as it’s a hormone deficiency before menstrual flow, and it is, it’s as simple as that basically. It’s a hormone deficiency; the hormone that’s deficient is progesterone. Now, it’s not always the hormones that’s deficient, it can be progesterone receptors that are deficient. Progesterone receptors were discovered, oh, I think it was back in the 70’s or something with the introduction of electron microscopes. They could then see how hormones worked; there’s a receptor. Basically a receptor takes a hormone, if you can imagine a cell, and a nucleus in the centre, the receptor takes the hormone from the outside of the cell into the nucleus so it can then do its job. Right, now these cells or hormone receptors are all over the body and for progesterone they’re mainly in three areas, the hips, the chest and the head. Now, if these receptors aren’t working and this is the major problem usually with PMS, you’ll get symptoms. I mean how many of you girls are bloated before a period? , Your breasts enlarged, your hips got, you know, enlarged, you got cramping down in the uterine area, there because they’re, Well I’ll tell you how that works. You’ve got these progesterone receptors in hips and chest. Now just prior to menstruation there’s a major demand for progesterone and progesterone levels are at the highest just then. Also there is a high estrogen content there. Now if the receptors aren’t working the progesterone can’t do its job and this estrogen has to be quenched. So basically estrogen is sucked from the cells into the blood stream to quench the estrogen. Okay, the yin and yang, it’s still the same here. As it takes the progesterone from the cell into the blood stream each little cell has then got to refill with fluid basically, just to maintain itself so it doesn’t implode and just collapse and dies, this doesn’t happen they fill with fluid. So you basically get all these fluid filled little cells and you get thousands upon thousands upon thousands, millions of them, and this gives you your bloating. As I said estrogen retains fluid, this is how it retains fluid. So you get the bloating in the hips and the chest.
Now if you get this bloating in the head. Your head is encapsulated by a scull; it can’t bloat can it. Therefore it’s just got to exert pressure inside the scull.
Now, what’s inside the scull? – There’s a balance mechanism, your middle ear, isn’t that all there? So your balance goes out, so we get nauseous, we get headaches, we get migraines, we get dizzy, we’ve got to lie down, we feel pretty bloody yucky! That’s what PMS is all about, and it’s easily remedied with progesterone. Progesterone usually during the last two weeks of every cycle will you know stop PMS, but these symptoms when you go into estrogen dominance is what I’m trying to get through, this is what estrogen dominance is, so that you can relate to it. It’s in menopause, but that is estrogen dominance and it is treated basically with progesterone. It’s as simple as that, I mean you’ll find, you know, there are books written on PMS, but to get back to, there is also a lot of progesterone as I said in the head, progesterone receptors in the head. And they are located in the rage sector – I can’t think of the part of the brain it’s in – but this is the rage sector so you will find when these receptors aren’t working- what happens? – this rage comes out and in extreme cases you’ll get women, you know, killing people, killing their husband, doing whatever, I mean this is now excepted as a plea in the courts.
There is a Doctor in England, Dr Catarina Dalton who I saw a few years ago who has since retired, she has been using progesterone therapy for the last fifty years and she has just worked incredible things and basically what I know about progesterone I know from going to lectures of hers and reading her books. There is a great book, which you can give your daughters called once a month by Dr Catarina Dalton. If you want to know something see me later and I’ll tell you how to get it, what to do and what it’s all about. But this is a great book and she’s in fact got women off murder charges because of PMS. I mean PMS is treated with Prozac and god knows what which is ridiculous it’s not a mental disorder it’s a progesterone disorder. And anyway look back at these ladies that go to jail for various crimes or something they’ve committed pre menstrually, they’ll never get off for good behaviour, because once a month they’re lunatics, they’re completely out of control, and it’s not their fault.
Okay, so that’s basically what PMS is in nut shell, I mean you can write books on PMS and books have been written on PMS, but let’s now link PMS to menopause. Menopause is defined as 12 months without a period, now everything just doesn’t stop, suddenly one day you’re menstruating normally and then you go straight into menopause. It takes time, so it’s 12 months without a missed period, so therefore it usually takes about 2 years to go from normal cycling female into menopause. Now the period between that and menopause is called peri-menopause and peri-menopause is the period when the hormones start to dry up, it’s something like a tomato sauce bottle shake and shake the tomato sauce bottle none will come and then a lot will. So in other words, in some months you ovulate in other months you don’t. And as we get closer and closer to menopause the eggs dry up and then for 12 months not and egg is coming out and that means, okay, we are in another phase of life called menopause. Menopause is easy to treat. This period now called peri-menopause is very difficult. It’s not like the time when you had PMS and you’re just taking the progesterone for two weeks of the month, for because at this period these two years there’s a time when you’ll need estrogen and testosterone and progesterone. We’ve got to copy nature again and try and give you a synthetic cycle or synthetically create a cycle with natural hormones. I know that sounds like gobbley-gook but that’s what you’ve got to try and do.
Now it’s complex because normally going into menopause the three major hormones, estrogen, progesterone, testosterone. Testosterone is usually the first to dry up, followed by progesterone, followed lastly by estrogen. Right? Now that is the norm and the usual major problem we find is hot flushes, night sweats, that sort of thing. However, this is not always the way. It’s true in about 80% of the cases. That’s the way it happens. And we’ll just talk about that way at this point in time because it does get a bit complex. So if your happy to be 20% were estrogen is the first or second hormone to go and progesterone is the last one, or testosterone is the last one. It’s more an individual thing and is the minority – less than 10% of cases. So let’s just consider that testosterone is the first hormone to dry up then progesterone then estrogen. Now testosterone and progesterone drying up cause problems but not major problems. It’s the estrogen that causes major problems because estrogen, as I said before, in small amounts has big actions. Estrogen is the hormone that makes all the cells grow, right? As we get older, we get these wrinkles. That’s because the estrogen, or one of the major reasons, the estrogen is drying up and it’s not making the cells. I mean that why we also make an estrogen based cream which is better than, I feel anyway, better than all your alarm-cons? Or whatever, because we’ve got estrogen in it and we can put in around these areas here where there are lines and make them grow cells. These are prescription lines so they can’t be sold in a general store they’ve got to be sold on prescription. Anyway more about that, I’m glug wrestling.. I apologise.
So that’s all peri-menopause. Ladies are still menstruating but not irregularly. The further they go down the track the more irregular they are. So we’ve got to try and control this, this menstrual flow, to get some sort of regular cycle. So in this case we usually use testosterone and estrogen together in a troche and progesterone in another troche. They’ve got to be taken separately because the hormones fluctuate so much. They’re usually taken 3 weeks out of 4 in other words, we take estrogen and testosterone in one troche weeks 2,3 & 4 and just progesterone week 3 &4. Week 1 being normal menstrual flow. Now that sounds all very good but it is difficult as I said, because the months that one ovulates the estrogen is not essential because estrogen is still produced. So you’ve really got to listen to your body is what I’m trying to get to in peri-menopause and it’s a very difficult period. But I feel it’s very essential that progesterone is taken during this period of the cycle because if it’s not as I said, now testosterone and progesterone are usually the first hormones that are lost. Right? What’s left – estrogen. That means you are getting unopposed estrogen. Now this is the thing we learnt in the 70’s when they first started synthetic hormone replacement they used synthetic estrogens to stop the hot flushes. Fine the hot flushes stopped what happened? Uterine, breast cancer went up, unopposed estrogen. So therefore I think it’s very essential that during this 2 year period that progesterone is used for specifically this reason.
Now, anyway let’s assume we got through that everything’s fine and we’ve now got you into menopause. In menopause we measure the hormone levels we get the four hormones and you take them now continuously on a twice daily dose. As I said before we did a trial with the royal hospital for women at St Vincent’s Hospital a month or two ago now, the results are still coming out and we can tell you exactly how well these these things are absorbed, but at this point in time I feel that it is essential to take them twice daily. We did a kinetic study which is a study of the hormones in the blood and it appears to me that it is a twice daily dose and this will make everything fine.
Now we’ve also got to look, this is called menopause but men also go through a form of menopause its called andropasue. I mean it’s crazy, menopause for women and andopause for men?, anyway lack of androgens, that’s why it’s called andropause. Now, men are easy if you compare the hormones of men to the hormones of women it’s like a sling shot to a stealth missile I mean that’s the degree of complexity. So men basically need just replacement in testosterone and in DHEA. As men get older they get this cranky old man syndrome. Actually look at old men and old women as they walk down the street, They’ve both got white hair, and their bodies dropped, there’s these two pairs with white hair walkin’ down the street. It goes into a unisex, we all just, well as the hormones are all dried up we are basically a unisex, it’s going to happen to us. So that’s why I say we need to get back to hormones and get this antiaging thing going.
Now men as I said just need testosterone and DHEA in higher quantities than women and again on a twice daily dose and this will stop the aches and the pains, sleeping better, improved libido, better mental function, and just general wellbeing. As I said it’s a form of anti-aging and men need this for andropause and they’ll feel better too.
Now apart from the symptoms of menopause one should also consider a couple of other major factors cause you’ll say some ladies go through menopause and they get no symptoms, so okay why should they be treated? Two particularly good reasons, one called osteoporosis and the other called heart disease. Let’s look at heart disease. Men start to get heart disease in the 40’s women are fine. Women start to get heart disease in the 50’s if they don’t take hormone replacement, by the time, both men and women are in their 60’s the graphs are equal. So in ten years they’ve caught up to where men were and why? Because they don’t have the protection of estrogen. Men get protection out of testosterone women get protection out of estrogen. The major male hormone the major female hormone. Now this may sound strange, but if you look at a molecule of testosterone and a molecule of estrogen they’ve got very different sounding names, but they are very very similar. Oestradiol comes from testosterone. Oestrone comes from oestradiol. And estriol’s there somewhere but if you look at the molecule of testosterone and the molecule of oestradiol, you will be hard pressed unless you’re a bio chemist to pick the difference, and this is man and this is woman. This is black and this is white. And here I think is a good stage to digress just a little bit. Let’s look at the synthetic hormones that the manufacturers are giving you. They’re giving you, they may in fact give you synthetic oestradiol right and then they’ll give you not progesterone but progestogen. For several reasons, the main one being that progesterone is not patentable. The second main one being is you can’t give progesterone on a tablet or capsule because it gets broken down by the gastric juices etc etc. So therefore they’ve made up a progestogen. Which they say is as good as or better than progesterone. Now if you look at a molecule of progestogens against a molecule of progesterone there’s a huge side chain so they are easily distinguishable. Now do you get my drift? Progesterone, progestogen exactly the same! Oestradiol, testosterone opposites but look similar. What are the side effects you’re going to get from progestogens when they are the same as that? I rest my case. I mean this is why natural hormone replacement is better than synthetic hormone replacement, this is one of the reasons.
However back to the heart problems. So the estrogen protects females. Testosterone protects males. Now this is one of the side benefits too you will find
Once you get onto natural hormone replacement. You’ll find on synthetics that the blood pressure goes up. Cholesterol goes up, weight goes up. Not so with natural hormones, not so. Weight shall stay static blood pressure will come down, cholesterol will come down. Now not like an aspirin and a headache. You take an aspirin and the headache goes away. But they will come down. We’re treating things at cellular level. So it’s got to start form cellular level and work up. I mean this is not Band-Aid medication. Your cholesterol is up, so we’ll take something to lower your cholesterol. We don’t know what’s causing the cholesterol to go up, but we’ll just rip that cholesterol out of you so it’ll go down. That’s Band-Aid medication, we are getting to cause. We are fixing the cause of the problem not the result. Okay? Do you get the difference I’m trying to say there?
And also you’ll get protected from Osteoporosis. I mean when doses osteoporosis start. It hits one in two females and one in three males. Now why do you get osteoporosis? I mean you haven’t got to be a rocket scientist to work out that when your hormones dry up, your bones get brittle. So the hormones must do something to the bones mustn’t they? I mean osteoporosis doesn’t start until after your 50 or 60. You get the hump and all these things; you’ve seen the ads on TV. It’s the hormones. I mean you’ve been taking natural hormones all your life why stop now. Estrogen basically keeps osteoporosis in stasis. In other words stops it getting any worse, but doesn’t make it get any better. Look at Progesterone. Basically progesterone and they are also finding with testosterone now helps actually make bone so it makes bone. So if you keep your progesterone levels up you’re going to make more bone and replenish what’s gone out. I mean you’ve seen those graphs, they are horrific. You see a microscopes version of bone and you’ll see it’s like a honeycomb but then when you see an osteoporotic bone it’’ like a fish net. And you can see what’s going to happen, and I mean this is very painful. So that’s another one of the side benefits of this hormone therapy, it’s going to stop that happening. And that’s why I always recommend when you start this off it’s a good idea to get a bone scan and get one once a year and just see what’s happening. It happens, it works. I mean you don’t get osteoporosis when you’re 23, 33, 43 – why not? – Because the hormones are flowing.
I think I should close now by talking about hormones and cancer. As I said before there is always a risk and everyone is scared of breast cancer with estrogen therapies. As I said originally in the 70’s when they first started to get into hormone replacement therapy they used unopposed oestradiol and no progesterone. They then got better in the 80‘s and started to use progesterone.
And this stopped a lot of breast cancer, but breast cancer is still now rampant. And there’s a lot of questions out here. But heart disease and osteoporosis, being purely statistical are a much bigger risk than breast cancer. Now if we can reduce the risk once more again, by using triest as opposed to oestradiol, and producing progesterone instead of progestogens I think we’re reducing the risk again. I mean if there’s a risk I’d strongly recommend if you want to use something, and I’m never going to tell someone to use an estrogen, cause I don’t know it’s just my gut feeling, that oestriol is the safest and is not carcinogenic, but that is only my personal view I must stress there is no all-out proof, there is lots of anecdotal evidence out there but no proof that oestriol is not, but that I feel that it is.
So we use triest and progesterone in combination. Now get back to when we were also talking about perimenopause. Remember I mentioned there’s a two year period when you’re basically using unopposed estrogen, oestradiol. That’s why progesterone therapy I feel is essential in perimenopause so to summarize progesterone and estrogen as the form of triest must be taken together and I feel will reduce the risk of endometrial or breast cancer. These are my opinions and there’s other things I recommend one should take also. Melatonin is essential for women to take I mean melatonin is the thing you hear about jet lag. Melatonin is one of the best anti-cancer agents known to man, specifically breast cancer and I have this on good authority from a professor I have got to know over the years and have found respectful. This is his theory and I believe it. That melatonin is essential. I mean you get a good night’s sleep out of it too. Melatonin has lots of good things. It helps; it makes red blood cells it crosses the blood brain barrier and gets rid of hydroxyl free radicals, as it is a very potent anti-oxidant so it helps you think clearly. There has been research done with melatonin and Alzheimer’s, for exactly that reason, because it gets rid of the hydroxyl free radicals out of the brain. There are relatively few chemicals, molecules (they’re all chemicals) that cross the blood brain barrier and that can act as antioxidants, and melatonin is one of them.
1. Hormone Balance
Female hormones are complex. We all look different. No two fingerprints are alike and no two sets of hormones are alike. Now stop and think about the magnitude of that statement…….Look around. There are 20 -30 different formulae in this room……How many in this suburb……….this city……..the world????
So logically how can a pharmaceutical company manufacture for an average woman when no such model exists. Why do so many women drop off their PMT medication because of side effects? Well, you don’t need to be a rocket scientist to work that out.
The hormones that take you from puberty to menopause have to perform many duties and Mother Nature designed them to do just that. So the progesterone that makes sure that your monthly cycle is regular is the same hormone that is responsible for a harmonious pregnancy. Thus the hormones wear many hats and are responsible for many different jobs.
So all of you need a different mix of hormones and each hormone does several things.
What we are aiming for is a hormonal level of about 30 years of age, so the dose I give you will get you back by approximately 20 years. This is why this is a type of anti-aging medicine for as we age externally so to do we internally. Now as I said we are different now, so the levels at 30 are just as different and the absorption of the hormones vary from person to person.
So the aim is to get all your levels up, bit by bit until optimal level is reached and then play with the dose so that optimal effect is achieved with minimal dose. When this is attained all the hormones are in balance as they are at the physiological level that is ideal for you.
To make sure that all is right these levels are checked by comparing symptoms with blood levels. So at square one the complete blood profile is taken so that we know what ground zero is. In 6 – 8 weeks’ time the level is taken again to see how much it has progressed up the scale and to see how well you are absorbing your formula. Everyone absorbs at a different rate so perhaps the progesterone is absorbing well but testosterone and oestradiol are not. So the dose is fine-tuned or adjusted so that there is a larger proportion of estrogen and testosterone and a lesser quantity of progesterone available so that the levels grow in the right proportions specifically for you.
From time to time the blood profile is repeated so that optimum levels are attained and sustained so that the balance is exactly what you need. It is called a hormone balance as the scales are impacted upon by all the hormones and to get the balance level the correct proportions of each must be specific for you.
2. Main Hormones
The major hormones that are considered for Natural Hormone Replacement Therapy are estrogen, progesterone testosterone and DHEA. All of these hormones are essential for complete therapy as they are the hormones that are essential to attain that elusive fountain of youth. By that I’m not saying I am going to make you 30 again, but, I am saying that by following this simple blueprint supplied by Mother Nature, you will feel rejuvenated and years younger than you are today. And that’s a promise.
Each of these hormones has a specific job in female sexuality and when melded in harmony the final balance achieved will have you sitting on top of the world. Now let’s look at each hormone individually so that we can get a grip of what we are trying to achieve.
Estrogen : This is not one hormone but in fact three, namely oestrone, oestradiol and oestriol and although very similar they have different strengths and although oestrone and oestradiol change into each other oestriol is quite unique and this is a fact that will become very important in another part of this lecture. Oestradiol is by far the strongest estrogen and is ten times stronger than oestrone and one hundred times stronger than oestriol. The estrogens as a family are essential for female sexual characteristics such as the breasts, lack of facial hair and the subcutaneous fatty layer that is essential for all those voluptuous curves. They are essential for a normal menstrual cycle and the miracle of reproduction and a healthy pregnancy.
I prefer to use a combination of estrogens in my dosage schedule. The mix I like best is triest which is 10% oestrone, 10% oestradiol and 80% oestriol. This was popularised by Dr Jonathon Wright of Washington who has pioneered a lot of NHR. Now I like triest as it is much safer than oestradiol and being weaker it is easier to individually adjust doses for patient specific needs. Estrogens are very dose specific and if not within very finite individual lines the effects of over or under-dosage are most unpleasant and are to be avoided at all costs.
Progesterone: This is the other half of the star team of NHR as both estrogen and progesterone could be considered as the more essential players in the show called hormonal deficiency. In its own right progesterone is essential for a natural menstrual cycle and is the hormone of pregnancy (pro – for, gesterone – gestation) and is essential for a full term pregnancy. However it has many other effects being a natural diuretic and sedative, it is essential for bone re-growth, and for protection against the carcinogenic effects of some estrogens.
Progesterone must always balance the estrogenic part of the formula, for as stated before too much estrogen or too little progesterone is not pleasant. The ratio of progesterone to estrogen should be about 100:1 as this is the balance found in pre-menopausal women.
Testosterone: Normally when testosterone is mentioned females are on the defensive with thoughts of bulging muscles, a beard, a runaway libido, and a temper to match. Nothing could be further from the truth, for in females we are talking small numbers with respect to testosterone. The most important effect that we are looking from testosterone here is its anti-depressant action. Think of cranky old man syndrome and that’s what you get from too little testosterone. After a hysterectomy testosterone is essential as this is when you really feel down due to the sudden drop of testosterone, and so too, but to a lesser extent, with menopause.
Testosterone is essential for increased muscle tone, rebuilding bone and for libido. Although not a major player it is an essential part of the treatment and if in fact we look at the formulae of these three hormones you will see that they are very familiar but exert very different actions and each is essential.
DHEA : Dehydroepiandrosterone is also needed as, apart from its own rejuvenating action, being a precursor to both testosterone and oestradiol it can act as a buffer if the dose is not spot on. Thus it is very helpful in fine tuning a formula.
In its own right DHEA has been proclaimed as one of the major anti-aging hormones known to man. This is true in as much as it does make you feel a lot younger and through its testosterone like effects it does tighten you up and redistribute the body fat and convert fat to muscle. It is performance enhancing and thus improves stamina. There are many claims out there about the rejuvenation acquired by DHEA and a lot are quite true and it is also a major anti-cancer agent in its own right. Thus DHEA is an essential part of the equation for NHRT.
3. Results of Hormone Deficiency
These will be shown in many and varied ways and each symptom is due to a specific hormone deficiency. Let’s just look at some of the more common problems:
Mood or personality changes, things like irritability, rage, unexplained tears, panic attack, anxiety, impatience, depression and generally loss of confidence. Look at brain function where there is general loss of memory and “cotton-wool” head, dizziness, lack of concentration, forgetfulness and generally indecisive.
Let’s look at physical symptoms – things like hot flushes or night sweats, palpitations and the heart just fluttering or thumping, urinary frequency and incontinence and loss of muscle tone in the pelvic region, invisible insects crawling under the skin, joint pain and muscle aches and pains, vaginal dryness, and dryness of skin, hair and eyes, breast changes, and sleep problems such as insomnia.
And what about your interest in sex, those fantasies, enjoyment and orgasms, your responsiveness and lubrication, unusual lethargy and fatigue, weight changes and eating disorders, constipation and diarrhoea?
All of these symptoms are due to hormone(s) deficiency. Each symptom is specific to a specific hormone. For instance we had a lady who suffered from incontinence and was forced to wear pads as she had no bladder control whatsoever. She had been through several operations with varied success over a limited time but always ended back on pads. I recommended a dose that contained a specific amount of triest and she told me that after 3 days she was getting feeling back in the pelvic region and within one week had thrown away the pads. That was six months ago.
Thus with tailor made medication of bio-identical hormones the clock can be turned back and you can re-enter the human race.
4. Pre-menstrual Syndrome
I thought is was necessary to diversify, just a little, to talk about something that I know that you all must have experienced at some stage during your life and besides I’m sure that there are a few daughters out there, for whom this information will be beneficial. Besides what happens in PMS is very similar to what happens in menopause.
PMS is due to progesterone deficiency. A bold statement but true. That said let me explain a little further it is due to a progesterone or a progesterone receptor deficiency, both of which show the same symptoms, namely PMS.
What is a progesterone receptor? In simple terms a receptor is like a lock and progesterone is like a key. When the progesterone opens the lock the progesterone is transported to the nucleus of the cell so that it can do the job. While here I should tell you a little about the wild yam cream. The active ingredient in wild yam is disogenin which is chemically similar to progesterone thus it fits the lock but will not open it. Thus you get some progesterone like effects from wild yam but not enough to substitute it as a suitable replacement for progesterone.
When progesterone is at the nucleus it can exert its estrogenic effect specific to that cell (if it is a bone cell then it will make bone; if it is a cell in the rage centre in the brain it will have a calming effect).
Now the definition of PMS is symptoms before menstruation but a complete cessation of symptoms after menstruation. Symptoms before and after is menstrual magnification.