Bioidentical Hormones

What are the most common problems reported by patients in mid-life? Lack of energy, weight gain, memory decline, mood swings, loss of libido, hot flashes, insomnia…..These are issues for both men and women. In spite of proper diet and exercise, there is no question that our bodies change as we age. One key factor in this metamorphosis is hormone decline.

Our hormones, such as thyroid hormone, insulin, cortisol, estrogen, testosterone, progesterone, and growth hormone act as messengers to our tissues, commanding them to perform their respective roles efficiently. As hormone levels decline, the integrity of the body also declines, and we witness some of the common degenerative disorders of aging.

One way to help combat this decline is to replace the missing hormones with specially compounded bio-identical hormones. These hormones are prepared by expert compounding pharmacists, using plant or natural sources, and are physiologically and biochemically identical to those once made by the body. Since the body recognizes these substances as “self,” they are metabolized and utilized naturally, unlike some synthetic pharmaceutical substances. Testing for hormone levels is done with serum or saliva, and the appropriate dosing is determined. The method of delivery varies from oral to inserted pellets to topical creams and/or injectables. The goal is to replace the hormones levels to more youthful physiologic ranges. The result is a perceived improved state of well-being, as well as stronger bones, brain, cardiovascular system and metabolism.

We Also Offer Hormone Pellets

Pellet implants are compounded bio-identical hormones that are surgically implanted into the patient for Hormone Replacement Therapy.  Pellets are tiny cylinders that are inserted into a numb area of subcutaneous fat, typically the hip or the abdomen, using a trocar.  This dosage form is one of the most physiologic dosage forms available and can last around 3-6 months, depending on the patient.

Pellets can be made using estradiol or testosterone.  Dosing is determined by Dr. Kathleen MacIsaac based on lab results and reported symptoms. 

Symptoms that Hormone Replacement Therapy may be right for you:

An Interview with Dr. MacIsaac about Bioidentical Hormone Replacement

Q:  Why do people typically come in to see you for bioidentical hormones?

Dr. Kate:  The most common symptoms are fatigue, lack of mental clarity, hot flashes, night sweats, insomnia, weight increases, mood fluctuations and low libido.  Aside from symptom relief, BiHRT has been shown to be effective management for osteoporosis, prevention of dementia and overall decreased risk of stroke and heart attack.

A lot of patients are generally in good health, they take care of themselves, eat well and are used to feeling well.  Then, as they reach their mid-40’s, they notice the symptoms mentioned above and all of the sudden they cannot easily find relief with simple dietary and exercise adjustments.   

Q:  What hormones are evaluated when someone comes in for a visit?

Dr. Kate:  Sex Hormones (Progesterone, Estrogens, DHEA, Testosterone), Insulin, Growth Hormone, Thyroid Hormones

Q: You recommend bioidentical hormones for men and women vs. synthetic hormones.  What is the difference?

Dr. Kate: As the name implies, the bioidentical hormones are identical in chemical structure to what the ovaries make in women and the testicles make in men.  The conventional, synthetic hormones are a totally different chemical structure and are not naturally found in the body.

Q:  A lot of people have heard negative things about hormone replacement from medical providers and the media.  What is your answer when people ask you about the safety of bioidentical hormones?

Dr. Kate: The studies that were released in the early 2000’s that have sparked fear in patients and the medical community were done with synthetic hormones, not bioidentical. These hormones do have negative side effects in the areas of cardiovascular risk factors, stroke and cancer.  More importantly, the women in the studies were not controlled for age, genetics or previous health history.  It was not taken into account that many of them may have had health issues and genetic predisposition to cardiovascular risk.  They were also older than is ideal to start bioidentical hormones for the first time.  These factors came together to paint an unfair picture of hormone replacement. 

Recent studies in the last 4-6 years, in peer-reviewed, American medical journals, show that there is a decreased risk of heart disease and stroke in women who are given bioidentical hormone replacement within 10 years of menopause.  The chances of cancer, osteoporosis, and dementia are reduced.

The same applies to men with bioidentical testosterone replacement.  When men are given hormone replacement, particularly testosterone, the result is an across the board decline in causes of death in all categories – diabetes, cancer, heart disease, etc.  Recent studies show that there is no increased risk of heart disease with testosterone.  For men, the hormones will increase mood, libido, decrease body fat, increase strength and endurance, improve mental clarity, and improve in bone density. 

Q:  How are these hormones made?

Dr. Kate: Bioidentical hormones are made by a compounding pharmacy so that they can address each patient’s need specifically.  Since they are compounded, they can be made in any form and dose that works for the individual.  For example, hormones can be given at any strength and in any of the following ways: transdermal creams, vaginal creams, sublingual drops or troches.  Testosterone can be given transdermaly or via injection. 

Q: How long do I have to stay on them?

Dr. Kate: Because the hormones are bioidentical and familiar to the body, they are safe and recommended indefinitely.  The newest research recommends starting them soon after hormones start declining in menopause or andropause, so that the body has the protective features of the hormones ongoing.

Q: How often do I have to come for a visit?

Dr. Kate: All hormones are assessed by blood work and review of systems.  Each case is individualized based on genetics, lifestyle and previous medical history that will be reviewed at the first visit.

When you first start the hormones, you will have the first follow up in 4-6 weeks to check the clinical response.  You should be feeling the effects by this point. First recheck of labs 3 months.  Sometimes things need to be slightly changed here and there.  Remember, when you were creating your own hormones, the levels would change from day to day, always helping to provide the body with what it needed, moment to moment.  In post-menopausal and andropause states, the dosing from the outside hormones is constant.  So regulating them is a dynamic process.  Once you’re doing well on them, you can come in less often.  

Q: What can I expect from bioidentical hormones?

Dr. Kate: From a symptom standpoint, you can expect better sleep, mood, mental clarity, strength, endurance, libido and overall sense of wellbeing, for women, a decrease in night sweats and hot flashes.