BIOIDENTICAL HORMONE THERAPY
When sex hormone levels decline due to menopause or aging, our bodies no longer can function as well as before. Use of replacement hormones has been shown to reduce symptoms of hormone deficiency and improve overall body function. Due to potentially serious side effects from synthetic female sex hormones (estrogens and progestins), many physicians and their women patients are unwilling to use the synthetics. Fortunately, there is an alternative in use of bioidentical hormone therapy. A bioidentical hormone is one that is chemically identical to those made in the body. When given in replacement doses, the likelihood of serious side effects is low. However, long-term high quality clinical studies of use of bioidentical hormones are lacking. Every person choosing to use bioidentical hormones should understand this fact and be willing to assume the potential risk of unknown safety issues.
Saliva hormone testing has been developed and shows good correlation with the levels of free unbound hormone in the blood. Only the small percentage of hormones that are unbound to protein carrier molecules in the blood are able to bind to receptor sites on cells and carry out their intended actions on the body. Measurement of the saliva hormone levels is therefore an excellent way to find out whether hormone levels are truly adequate. Testing saliva also is noninvasive, easily done at home, and can collect multiple specimens throughout the day. After starting therapy on bioidentical hormones, saliva hormone levels can be tested periodically until levels are in the normal range and a good clinical response occurs.
Women actually have three main estrogen hormones. These are estradiol, estrone and estriol. One, two or all three of these can be given as replacements. Estradiol is the most potent and is available as prescription tablets and skin patches. Progesterone is the hormone that promotes pregnancy and has a balancing effect on the estrogen. Having adequate levels of these hormones in the proper balance will minimize symptoms and improve well-being.
Testosterone is the male sex hormone. Low levels in men and women may lead to low sex drive, loss of sexual function, depression, loss of muscle mass and strength, increased abdominal fat, elevation of cholesterol, triglycerides and insulin, and may contribute to coronary artery disease. Use of testosterone as replacement therapy for both men and women can be very effective in reversing these negative effects of low levels. Men need to be tested with digital rectal exam and PSA (prostate specific antigen) blood levels to be sure that an early undetected prostate cancer is not present. Testosterone has a stimulating effect on prostate cancer and should not be given to men with this cancer.
Cortisol is the main stress hormone and can be tested by saliva levels also. Excessive levels of cortisol indicate chronic levels of high stress. This is very unhealthy and promotes obesity, inflammation and premature aging. Diet and lifestyle changes are usually helpful in lowering stress. Low cortisol levels are very common and contribute to chronic fatigue, arthritis, and depression. Replacement cortisol can be given but using supplements, herbs and stress reducing strategies can also raise cortisol levels into the normal range. A good reference to this topic is “Adrenal Fatigue: The 21 st Century Stress Syndrome” by James Wilson.
Many alternative physicians use compounding pharmacies to make a replacement hormone to the exact strength indicated by repeated saliva hormone levels. Most insurance companies will not pay for compounded medications unless there is no available alternative prescription drug. These two websites have a lot of additional information on this topic www.salivatest.com and www.johnleemd.com.
Daniel Blodgett MD