Thursday, May 19, 2011

Bio-identical Hormone Replacement

Bio-identical Hormone Replacement for:
Fatigue, weight gain, depression, decreased muscle mass, decreased libido, PMS, apathy, erectile dysfunction, hot flushes, vaginal dryness, hair loss, memory loss, mood swings, night sweats, irritable, bone loss, thin skin.

Do you just not feel as good as you believe you should? You simply don’t have that “get up and go” that you had a few years ago? Have you gained weight (especially around the middle), lost your desire for sex, feel more fatigued, have interrupted sleep, feel anxious or short tempered more than you used to, don’t handle stress as well as you are used to handling? These are all signs of hormonal imbalance. Hormones can be imbalanced during birth control pill use (synthetic hormones in birth control pills can cause hormone imbalance) peri-menopause (anywhere from 2 or more years before menopause), menopause (12 months without a menstrual cycle), and for the men simply aging as well can cause hormone imbalance (3). I have treated several teenage girls with bio-identical low dose progesterone 2 weeks out of the month pulsed with there menstrual cycle and had great results with balancing their PMS symptoms.
As women age our ovaries become less active and we produce less estrogen. During this aging process progesterone also declines. Since the majority of the symptoms of menopause are related to declining hormone levels, doesn’t it make since to replace those hormones with bio-identical hormones derived from plant sources? These hormones have the identical molecular make-up as our endogenous estradiol, progesterone, and testosterone. The synthetic hormone Premarin is an estrogen made from pregnant mare’s urine!! PRE-MAR-IN….I may not be a doctor, but I am certain that pregnant mare’s urine is NOT bio-identical to humans, although it may be just what the veterinarian ordered for a horse going though menopause! Studies have shown that women have and increase in breast cancer when using high doses of synthetic estrogens. (3). Bio-identical hormones are dosed on an individual basis (there are no “one size fits all” dosing), and therefore the patient receives physiological versus super physiological doses of the hormones needed. The bio-identical hormones I prescribe are 10-20 times lower in strength than the estrogens in birth control pills!
Using Bio-identical hormone replacement with cream, pills or pellets will relieve the symptoms of peri-menopause, menopause, PMS greatly. Bio-identicals have been proven to reduce the risk of heart disease, osteoporosis, memory loss and cancer (2, 3).
And for the men, bio-identical testosterone can increase libido, help with erectile dysfunction, increase muscle mass, stronger bones, improve energy (3, 4). All from either testosterone cream, gel or pellets placed under the skin to dissolve over 3-4 months. I use tesosterone in women with great results. And can personally attest to the testosterone pellets!
I have had incredible response with bio-identical progesterone in cream or pill form. My patients report more regular cycles, less cramping, shorter cycles, less PMS and an overall feeling of less anxiety. Progesterone is a calming hormone and when we are low on it, it is possible to have more anxiety and less restful sleep. I use creams and capsules for my patients that are compounded at special compounding pharmacies. The creams bypass the first pass effect in the liver and may deliver more active hormone. I prefer to use creams, but if a woman is postmenopausal or having insomnia related to hormone imbalance I may give a capsule to help her sleep at night since progesterone is calming. It also has a mild diuretic effect that women appreciate. I always pulse the dosing with the menstrual cycle or 3 weeks out of the month for post-menopausal women. (1, 3)
DHEA is a precursor to testosterone and estrogen in our bodies. I have had good results if a patient is low in testosterone and DHEA I will begin a low dose DHEA 5-10 mg for women and 25-50 mg for men for a few months to see if testosterone levels increase and low androgen symptoms begin to resolve.
Vitex Chaste berry twice daily has decreased PMS symptoms of agitation, irritable, anxiety, and even increased libido in some of my patients. We use a Metagenics brand that has chaste berry, cohosh, and ashwaghanda in it. And I can speak from experience that PMS symptoms are greatly reduced. I even have one patient that wrote a blog on it in Nashville Parenting magazine after only one month of use. I usually tell patients to give it 3 months to begin to decrease symptoms.
Finding a practitioner that is skilled in BHRT is key to resolving your symptoms. If your practitioner is not willing to work with you then find another one! This is your health and I can attest that as health care providers we are not taught the use of bio-identical hormones, or nutritional medicine at all for that matter! My women’s health class was given a multi page article on the “dangers of bio-identical hormones” and how the practice was basically hocus pocus (I can’t remember the term used). Clearly, the instructor that handed that article out has big pharma in their back pocket. And come to find out, that is true!! There is absolutely nothing wrong with pharmaceuticals if needed, and there isn’t a natural way to get the same and most likely better result! I was once told by an MD in Atlanta, Dr. Eldridge Taylor who wrote the book, “Are your Hormones Making You Sick”, that “Doctors are down on things they are not up on”!! That goes for any healthcare provider!!
Testing is critical to finding out your hormone levels! I prefer ZRT saliva testing. Unfortunately, insurance has made serum blood testing standard of care, and therefore insurance is more likely to pay for serum blood testing. Saliva testing actually tests the true DNA that is in the tissues (that’s why we do saliva DNA tests). I prefer those results, and they run around $299.00 for a complete panel including thyroid with a blood spot finger stick. Insurance is getting better at reimbursing patients for their cost. There are also urine tests that I have not used as of yet.
Getting hormones in balance is much more than testing and ordering up some bio-identical hormones. We have to begin to look at food sensitivities, toxins in our bodies by stating a detox program and eating as organic and “real” food as much as possible. Environmental toxins need to be addressed: the cleaning supplies you use, the makeup we buy, lotions, hair dyes, nail polish, light bulbs they are just a few of the toxic things our body absorbs daily!! And we wonder why there is an epidemic of autoimmune disease! I diagnose at least 5-8 Hashimoto’s patients weekly!! Clean is a fabulous book by Dr. Junger that addresses the toxic world we live in and offers reasonable ways to begin to clean up our bodies that are riddled with toxins and killing us slowly. If you don’t believe me, take a look at any waiting room at any doctor’s office on a daily basis! Look at the people that are barely getting by, all the while drinking those diet cokes, eating that processed food from fast food chains and taking more and more medications that most likely could be greatly decreased by simply putting the nutrients back in their bodies that they have depleted. We are treating symptoms and not the cause of the problem!!
If you are experiencing signs of hormonal imbalance and are interested in testing and treatment then by all means make an appointment and come see us at Cool Springs Family Medicine! I would love to work with your and begin the journey of balancing not only your hormones but your health with our wellness center offering colon hydrotherapy, infrared sauna, hyperbaric treatments, acupuncture as well as a complete supplement store. I used to tell my yoga students at True North Yoga that the hardest part of class is simply SHOWING UP! Not always true with healthcare, but it’s you first step to wellness!

Dani Williamson, MSN, FNP
Integrative Family Medicine  


1. Leonetti HB, et al. transdermal progesterone cream for vasomotor symptoms and postmenopausal bone loss. Obstet Gyecol 1999: 225-228.
2. Lee JR. Osteoporosis reversal with transdermal progesterone. Lancet 1990;336:1327.
3. Wright JV, Lenard L. Stay Young and Sexith Bio-identical Horones: the Science Explained. Smart Publications, Petaluma, California, 2010.
4. Katznelson L, et al. Increase in bone density and lean body mass during testosterone administration in men with acquired hypogonadism. J Clin Endocrinol Metab 1996;81:4358-4365.

Integrative Family Medicine