Obstetrics & Gynaecology

Hormone Replacement Therapy

  • June 1, 2021
  • 4 minutes read

Hormones are protein messengers in our body. They are produced at one area and influence the function of other areas within our body.

Hormones include Insulin, Glucagon, Thyroid hormones T4 and T3, Estrogen, Progesterone, Testosterone, Adrenaline and Cortisol to name a few common ones. Many of these hormones are essential for life and any imbalance tends to lead to malfunction of the body. Hormonal imbalance is distressing. Hot flushes, insomnia, depression, fatigue, osteoporosis, poor sex drive & diminished energy may stem from low or unbalanced hormones in men and women. Unfortunately, hormonal assessment is not part of most routine health screening packages.

If you are not performing optimally, feeling tired despite adequate sleep and experiencing less joy daily, you may be suffering from a hormonal deficiency.

Hormone Therapy vs Hormone Replacement Therapy (HRT)

Hormone Therapy is a better term than Hormone Replacement Therapy as it gives the correct impression that hormones are used to correct the imbalances relative to other hormones and not necessarily to replace to youthful levels i.e. the intent to treat according to one’s current age and function. Hormone Therapy also gives the flexibility of the hormones being used for both genders and all ages and not be confined to those who are in their peri-menopausal or peri-andropausal years. After all, many of our body systems are governed by hormones. Sex hormones however are often considered low priority for therapy but it is clear to practitioners that hormonal therapy with estrogens, progesterones and testosterones do indeed improve the quality of life for the person concerned.

What are the benefits of hormone therapy?

Women who choose standard hormone therapy during natural (nonsurgical) menopause typically take estrogen and progestin, a man-made version of progesterone. It can also ease vaginal symptoms of menopause, such as dryness, itching, burning and discomfort with intercourse.

Long-term hormone therapy for the prevention of post-menopausal conditions is no longer routinely recommended. But women who take estrogen for short-term relief of menopausal symptoms may gain some protection against the following conditions:

  • Osteoporosis. Studies show that hormone therapy can prevent the bone loss that occurs after menopause, which decreases the risk of osteoporosis-related hip fractures.
  • Colorectal cancer. Studies show that hormone therapy can decrease the risk of colorectal cancer.
  • Heart disease. Some data suggest that estrogen can decrease risk of heart disease when taken early in your postmenopausal years.
  • For women who undergo menopause naturally, estrogen is typically prescribed along with progestin, a man-made version of progesterone. This is because estrogen without progestin can increase the risk of uterine cancer. Women who undergo menopause as the result of a hysterectomy are often given estrogen alone.

What are the risks of conventional hormone therapy in women?

In the largest clinical trial to date, the combination estrogen-progestin (Prempro) increased the risk of certain serious conditions. According to the study, over one year, 10,000 women taking estrogen plus progestin might experience:

  • Seven more cases of heart disease than women taking a placebo
  • Eight more cases of breast cancer than women taking a placebo
  • Eight more cases of stroke than women taking a placebo
  • Eighteen more cases of blood clots than women taking a placebo
  • An increase in abnormal mammograms, particularly false positives

The study found no increased risk of breast cancer or heart disease among women taking estrogen without progestin. Over one year, however, 10,000 women taking estrogen alone might experience:

  • Twelve more cases of stroke than women taking a placebo
  • Six more cases of blood clots in the legs than women taking a placebo
  • An increase in mammography abnormalities

Conventional HRT is available in various forms. It generally provides low dosages of one or more estrogens, and often also provides either progesterone or a chemical analogue, called a progestin. In women who have had a hysterectomy, an estrogen compound is usually given without any progesterone, therapy referred to as “unopposed estrogen therapy”. HRT may be delivered to the body via patches, tablets, creams, troches, IUD s, vaginal rings, gels or, more rarely, by injection. Dosage is often varied cyclically, with estrogens taken daily and progesterone or progestins taken for about two weeks every month or two; a method called “Sequentially Combined HRT” or SCHRT. An alternate method, a constant dosage with both types of hormones taken daily, is called “Continuous Combined HRT ” or CC HRT , and is a more recent innovation. Sometimes an androgen, generally testosterone, is added to treat diminished libido. It may also treat reduced energy and help reduce osteoporosis after menopause.

Hormone Therapy For Men

Androgen replacement therapy is a hormone treatment often prescribed to counter the effects of male decreased testicular function and can lessen the effects or delay the onset of normal male aging. Additionally, androgen replacement therapy is used for men who have lost their testicular function to disease, cancer, or other causes.

As men enter middle age they may notice changes caused by a relative decline in testosterone: fewer erections, fatigue, thinning skin, declining muscle mass and strength, more body fat. This dissatifaction with the changes of aging has led to the development of the idea of androgen replacement therapy. Declining androgens could also be detrimental to his fertility potential as it affects his semen quality and stimulating his production of testosterone assists in enhancing semen quality.

Male hormones are called androgens. Primary among them is the natural hormone testosterone, which is produced in the testes, ovaries and adrenals. Both sexes also produce an androgen precursor called dihydroepiandrostene (DHEAS ) from which the body can make androgens. Androgens cause the secondary sex characteristics of males: facial hair, thicker skin, low body fat, deeper voice, muscularity, penis and scrotal growth and darkening, broad shoulders, body hair, erection of the penis, etc. With increasing age, testosterone production declines, and many of these changes start to reverse.

Bio-identical Hormones

“Bio-identical” means biologically identical to human hormones i.e. exact replicas of what we make in our own bodies. Being bio-identical allows the body to metabolise these hormones in a natural way compared to other synthetic hormones which have generally a suppressive effect on one’s innate hormones.

Bio-identical hormones are found both within and without the pharmaceutical companies’ list of FDA approved medications. This is because some are already formulated with a patentable delivery system as while others are made individually through compounding pharmacies and thus are not patentable.

Bio-identical estradiol and progesterone given in a cream formulation enters the bloodstream as bio-identical estradiol or progesterone as it bypasses the liver.

One size doesn’t fit all particularly in women’s health as she often requires a combination of estrogen, progesterone and occasionally testosterone as compared to men. Compounded hormones can certainly help to customize treatment and these are mixed to order by a Compounding Pharmacy which uses hormones that are bought through either TGA or FDA approved wholesalers.

While undergoing bio-identical hormone therapy, one need to work with your clinician over a period of time to get the “right” dose which suits you and this generally takes 2 to 3 months on average and whilst on the treatments, you will be constantly monitored over time to ensure that you are responding well and safely to the therapy. Ideally, BHRT is done with lifestyle modifications such as stress management, exercise programmes and nutritional support in the form of dietary modifications and nutraceutical support. The aim is to achieve balance and reduce or remove the need for BHRT in the longer term. Remember excessive stress can negate even high doses of hormonal therapy.

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