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When is Hormone Replacement Appropriate?

by Ralph J. Luciani D.O., M.S., PhD., M.D.(H)
Reprinted from Natural Living Magazine

Both the male and female body begin to alter their sex hormone status soon after the age of 40. Yes, men also have a "change of life" called andropause, similar to the female menopause. This is a natural part of the aging process, but the changes which occur can be devastating both physically and emotionally.

In there early 40's, women may notice more emotional lability with drastic mood swings. Anxiety, depression, sadness, panic are all symptoms which may occur and may not be obvious to most women as being due to hormone depletion. the usually recognized physical symptoms of hot flashes and menstrual irregularities may not be the first symptoms of a peri-menopausal state. It is the emotional component that can be elusive and puzzling. Men too can experience mood changes, depression and decreased libido. All these symptoms can be caused by a decrease in the more youthful levels of sex hormones; testosterone in the male, and estrogen, progesterone and testosterone in the female.

Anti-aging and rejuvenation therapy has the goal of making us feel like we were used to feeling when our hormones were more "normal" (i.e., more youthful levels). The question is, how do we replace these hormones that our bodies no longer produce in appropriate amounts? The answer can be complex since we know that prescription strength estradiol (such as Premarin) is associated with breast cancer in females.

Solutions For The Female Hormonal Problem

There are three forms of estrogen produced by the ovaries: Estradiol, Estrace and Estriol. Estradiol and Estrace are potent estrogens which increase the risk of breast cancer. Estriol, on the other hand, is a weaker estrogen which provides anti-aging benefits, but without the apparent risk of breast cancer.

Estradiol is the primary hormone secreted by the ovary, whereas Estrone is synthesized from Androstenedione and Estradiol. A small amount of Estriol is secreted by the ovary but most of the body's Estriol is converted from Estrone in the liver. Estriol is used extensively in Europe for estrogen replacement therapy, but rarely used in the United States. Not only is Estriol a safer form of estrogen regarding breast cancer, but it does not cause endometrial hyperplasia (build up of tissue in the uterus) as estrogen does. Being a weaker estrogen, most women require anywhere from 2 to 8 mgs daily of Estriol compared to 0.625 to 1.25 mgs of Premarin.

Estriol has been shown to be protective for osteoporosis as well as giving all the youthful benefits of smooth skin, increased vaginal secretions and better libido. There is also direct evidence from animal studies, and indirect evidence from human studies that Estriol can actually protect against breast cancer.

If hormone replacement with estrogen is indicated in my patients, I use the formula described by Dr. Jonathan Wright with is 80% Estriol, 10% Estradiol and 10% Estrone. This formula can be compounded by a compounding pharmacist into a capsule for oral administration, and may also be used as a vaginal or topical skin cream. Only natural plant source estrogens are used in these compounds.

DHEA can also boost estrogen levels, but I prefer not to depend on DHEA in the peri-menopausal stage because the production of estrogen or progesterone from DHEA varies from person to person.

If I do not feel that full replacement therapy is warranted, I will initially depend on herbal phytoestrogens or progesterone to help alleviate mild, early symptoms of menopause. These include Black Cohash, Dong Quai, Wild Mexican Yams, and nutrient support with B6 and Primrose Oil or Borage Oil. This approach works well early on in peri-menopause.

Most importantly in any home replacement program is striking the proper balance between estrogens and progesterone. If estrogen is inappropriately unopposed by progesterone, side effects of breast tenderness and mood swings can occur.

What About Testosterone?

Believe it or not, women need testosterone too. it helps prevent osteoporosis, but also improves lost libido considerably. Men's testosterone levels begin to fall slowly during life and the effects of lower testosterone can be felt more so after age 50. Lower levels can cause decreased energy, depression, dry skin and decreased libido. Increasing levels of testosterone can improve well being, libido, strength and endurance. DHEA again can help produce additional testosterone in males. Testosterone is available by injections, patch and oral capsules.

One precaution I always take with male hormone replacement is the addition of Saw Palmetto and Pygeum Africanum daily to prevent the transformation of Testosterone into Dehydrotestosterone which can cause prostate enlargement. All hormones should be replaced judiciously and only after tests have been done to evaluate levels. In summary, hormone replacement can be safely done and can have significant benefits for well being and health.