Everything You Need to Know About Hormone Therapy

SYMPTOMS OF DEFICIENCY

TESTOSTERONE

  • Testosterone is a powerful anabolic hormone produced by the sex organs (testes / ovaries) and some from the adrenal glands. It is the most abundant hormone in both men and women. It plays a key function in overall health and well-being, mood, behavior, and in the prevention of frailty diseases like osteoporosis. As we age, the production and utilization of testosterone can become diminished. Testosterone optimization is a critical component of preventative medicine that can improve overall well-being, quality of life, and longevity.

  • Increases energy level

    Improved muscle strength

    Improves libido (sex drive)

    Increases bone density

    Improves skin tone and collagen production

    Protects against cardiovascular disease (heart attack and stroke)

    Increases endurance

    Improves exercise tolerance

    Lowers insulin resistance

    Improves metabolism

    Decreases body fat (visceral and subcutaneous)

    Enhances cognition & memory

    Protection from prostate cancer

    Reduces anxiety and depression

    Improvement in overall quality of life

  • Heart disease

    Stroke

    Type 2 diabetes

    Coronary artery disease

    Prostate cancer

    Obesity

    Chronic inflammation

    Alzheimer’s Disease

    Osteoporosis

    Metabolic syndrome*

    *Metabolic Syndrome = Combination of high blood pressure, high blood sugar, excess body fat, and high cholesterol

  • Injectable : Testosterone can be injected into the muscle (usually the glutes, thighs, or shoulder) or in the subcutaneous fat. Injections can be administered daily, bi-weekly, or weekly. In some patients it is difficult to maintain optimal levels with weekly injections as levels will peak sharply and then decline slowly over a seven-day period leaving some to feel a drop at the end of the cycle (“rollercoaster effect”). Soreness at the injection site is inevitable but usually tolerable. Injectable preparations are typically the most cost-effective.

    Cream : Testosterone cream is applied daily and is absorbed through the skin. The major benefits of skin applications are ease of use and steady daily levels when dosed correctly. Topical applications come in many different forms/bases and strengths. Therefore, if an individual has tried a cream previously and stopped because, “it didn’t work,” it was probably the wrong base, strength, or application site. For optimal absorption, men apply the cream to the scrotum twice daily. For women, the cream is applied to the outer labia once daily, typically before bedtime. Another acceptable site is the inner upper arm. Women also have the option of a vaginal troche (looks like a tic-tac) that is essentially the cream in solid form—this is inserted into the vagina. **Please note** – Testosterone cream can be transferred to others. If you are using testosterone cream, wash your hands thoroughly after application.

    Oral administration for men : There is an oral form of testosterone that is now FDA approved called Jatenzo. It comes in three different strength preparations and is typically taken twice daily. It has not been shown to achieve optimal levels for men. Additionally, men experienced side effects such as headache, nausea and decrease in HDL (“good cholesterol”). For these reasons, we do not recommend oral testosterone for men.

    Oral administration for women : Oral capsules are metabolized differently in women and can be a good option for women who want the benefits of testosterone without the libido boost. These are prescribed from one of our compounding pharmacies.

  • Common

    Testicular atrophy (a.k.a. shrinkage)

    Decreased sperm production

    Infertility – which can be irreversible

    Erythropoiesis – increase in red blood cell, hematocrit, and hemoglobin

    Rare

    Fluid retention – typically transient / short-lived

    Nipple tenderness

    Acne

    Hair loss (male-pattern baldness)

    Hair growth

    Aggression – in higher doses

    **MOST side effects can be corrected by decreasing the dose or stopping therapy altogether. Other medications can also be used to counter unwanted side effects.**

  • Avoid testosterone if :

    • You have ACTIVE prostate cancer.

    • Are pregnant or plan to become pregnant.

    • You are breastfeeding.

    Special Precautions

    • If you have RECOVERED from prostate cancer

    • If you have a history of Deep Vein Thrombosis (DVT), blood clot, or thrombophilia (a.k.a. blood clotting disorder)

    • If you have UNTREATED Obstructive Sleep Apnea (OSA)

    • If you have had a recent heart attack or stroke

THYROID

  • Thyroid hormone is a metabolic hormone released from the thyroid gland which is located in the neck. Thyroid hormone affects every function of the body because it controls metabolism. It regulates the entry of oxygen into the cells, controls metabolic rate, body temperature, heart rate, hair growth, ovulation, skin turnover, and growth and development. The thyroid cascade in the body is as follows: Pituitary → TSH (Thyroid Stimulating Hormone) → Thyroid gland → release of T4 → conversion into T3 → interaction of T3 with peripheral tissues. Some T4 also converts into metabolically inactive Reverse T3, more so with age.

    1. Inadequate production of T4.

    2. Inadequate conversion of T4 into T3.

    3. Poor interaction of T3 at the cellular level (usually due to receptor site downregulation) despite normal thyroid blood levels.

    These reasons are often why thyroid hypofunction either goes undiagnosed or symptoms do not improve on traditional therapy (such as with Levothyroxine/Synthroid – which is only T4). Often, a combination of both T4 and T3 are needed to improve symptoms.

  • Protection against diabetes

    Protection against cognitive decline

    Decreased fatigue

    Increased weight loss

    Decreased cholesterol

    Decreased memory loss and brain fog

    Temperature regulation

    Protection against cardiovascular disease

    Optimal metabolism

    Regulates cerebral function (reasoning, learning, emotions, etc.)

    Increased lipolysis (burns fat & decreases cholesterol)

    Regulates blood sugar

    Restores normal menstruation and fertility in PCOS

    Decreases inflammation

  • Fatigue

    Morning grogginess

    Lower than normal resting (basal) body temperature

    Hair loss or hair thinning

    Cold extremities

    Constipation

    Greater susceptibility to cold and other viruses

    Headaches

    High cholesterol

    Menstrual irregularities and anovulatory (lack of ovulation) cycles

    Brittle nails

    Increased body fat

    Loss of energy

    Loss of motivation

    Decreased cognition and memory

    Depression

    Depression and mood swings

    Dry skin and dry brittle hair

  • Thyroid is taken in pill form orally. A combination of both T4 and T3 is required in order to optimize thyroid and decrease symptoms.

    Dosing begins small and increases incrementally over time, with large dose changes occurring about every 6 weeks. Dosing begins with once daily in the morning and then increases to twice daily dosing with the second dose in the afternoon.

    Things to keep in mind when taking thyroid:

    • Take on an empty stomach, 30-60 minutes before food and other supplements/vitamins. We find it can be easier to take your other supplements at night to avoid any interaction with thyroid.

    • Try not to take thyroid after 4 PM.

    • Sweating

    • Heart palpitations

    • Increased heart rate

    • Nervousness

    **Please note: the side effects listed are typical symptoms of “hyperthyroidism” (an autoimmune condition originating in the body) and not thyroid replacement.

ESTROGEN

  • Estrogen is a hormone made primarily in the ovaries. Some testosterone is also converted to estrogen through an enzyme process known as aromatization. “Estrogens” are the primary female sex hormones. The three major estrogens are estradiol, estriol, and estrone. Of the three, estradiol, commonly referred to as E2 is the most physiologically and biologically active.

    50% of the benefit men get from testosterone is from it’s conversion into estradiol.

  • We only use bioidentical estradiol. All studies that demonstrated harmful effects of estradiol used synthetic estrogen, commonly referred to as Premarin (derived from horses urine). Every study in which bioidentical estradiol was administered, it only showed benefit. Some of the benefits as stated in the literature are shown below.

  • Protection against:

    Heart disease and stroke

    Osteoporosis (builds bone)

    Alzheimer’s disease

    Vaginal atrophy

    Urinary incontinence

    UTI’s (urinary tract infections)

    Macular degeneration

    Colon cancer

    Cataracts

    Hot flashes

    Temperature dysregulation

    Mood disorders

    Type II Diabetes

    Other benefits:

    Decreased insulin levels and improvement in glycemic control

    Increased carbohydrate metabolism

    Decrease in visceral fat (fat around the organs)

    Increase in HDL (“good” cholesterol)

    30-50% lower all-cause mortality rate

  • Mental fogginess

    Forgetfulness

    Depression

    Anxiety

    Mood changes

    Insomnia

    Hot flashes

    Night sweats

    Day-long fatigue

    Decreased libido

    Difficulty reaching climax

    Painful intercourse

    Dry eyes, skin, hair and vagina

    Sagging breasts and loss of fullness

    Bladder symptoms

    Breakthrough bleeding

    Hair loss

  • Mood swings

    Depression

    Breast swelling, fibrocystic breasts

    Sweet cravings

    Heavy or irregular menses

    Pelvic cramps

    Sleep disturbances (insomnia or heavy fatigue)

    Uterine fibroids

    Weight gain (around hips and thighs)

    Acne

    Water retention (edema)

  • Oral

    Oral estradiol has proven to be the most effective and most beneficial form of estrogen replacement. It is the only estrogen (there are different types) that increases HDL (“good” cholesterol), improves all lipid markers, and increases SHBG (sex hormone binding globulin) which is protective in women. The oral form also increases fatty-acid esters which are known to provide lubrication to all mucosal areas of the body and prevent oxidation (anti-oxidant). Oral estradiol will also reverse plaque deposition in the arterial walls (the most prominent causative factor for heart attack and stroke).

    *Oral estradiol should be avoided if you have a history of Deep Vein Thrombosis (DVT) or Thrombophilia (clotting disorder). Instead, you can use transdermal cream.

    Transdermal

    Cream: Estradiol cream can be applied to the labia, inside the vagina, or to the upper inner arm. This is a good option for someone with a history of blood clots or or a clotting disorder.

    Troche: A troche is a tic-tac shaped tablet that is inserted into the vagina to prevent vaginal atrophy. The estradiol troche is a great option for women who are interested in improving vaginal symptoms and preventing Urinary Tract Infections (UTIs). The troche is applied inside the vagina once every night.

    Patch: Estradiol patches do not stick very well and do not deliver the medication in adequate amounts to provide any symptomatic relief.

  • Side effects of estradiol can include breast tenderness, bleeding, and fluid retention. These can all be corrected by either decreasing the dose or increasing progesterone supplementation.

  • Breast cancer : If you have a history of breast cancer, discuss this with your MTN HLTH provider.

    Blood clots/clotting disorder : Oral estradiol should be avoided in those with a history of DVT (Deep Vein Thrombosis) or Thrombophilia (clotting disorder) — instead, use transdermal application.

PROGESTERONE

  • Progesterone, primarily a female hormone, is made in the ovaries and in the placenta during pregnancy. Like two dancers, progesterone and estrogen both work together and oppose each other. When, our bodies do not produce enough progesterone to keep estrogen levels in check, it sets us up for an estrogen-dominant environment, which has a myriad of negative side effects, both short-term and long-term. Weight gain, water retention, PMS, mood swings, endometriosis, fibrocystic breasts, and heightened risk of breast cancer are some of the symptoms experienced by women who are in an estrogen-dominant state.

  • We only use bioidentical progesterone. All studies that demonstrated harmful effects of progesterone used synthetic progesterone, commonly referred to as Provera. These are also known as Progestins. Every study in which bioidentical progesterone was administered, it only showed benefit. Some of the benefits as stated in the literature are shown below.

  • Stimulates osteoblasts to build bone

    Prevents osteoporosis

    Protects against uterine, breast, and ovarian cancer

    Protects against fibrocystic disease

    Prevents and protects against ovarian cysts

    Protects against coronary artery disease

    Reduces fluid retention and bloating

    Decreases headaches (especially menstrual headaches)

    Treats migraines

    Normalizes blood clotting

    Lowers LDL cholesterol

    Improves sleep and corrects circadian rhythm

    Stabilizes mood

    Enhances the benefits of estrogen

    Increases the breakdown of fat

    Lowers blood pressure

    Maintains endometrium of the uterus and prevents endometrial cancer

    Has strong calming and antidepressant effects

    Inhibits cholesterol build up

    Increases metabolic rate

  • Acne

    Amenorrhea (no periods)

    Heavy and frequent periods

    Spotting a few days before the period

    Breakthrough bleeding

    Anxiety

    Arthritis

    Breakthrough bleeding

    Breast tenderness

    Cramps

    Decreased libido

    Difficulty reaching climax

    Depression

    Endometriosis or fibroids

    Food cravings

    PMS

    Water retention

    Headaches

    Hot flashes

    Insomnia

    Mood swings

    Weight gain

  • Mood swings

    Depression

    Breast swelling, fibrocystic breasts

    Sweet cravings

    Heavy or irregular menses

    Pelvic cramps

    Sleep disturbances (insomnia or heavy fatigue)

    Uterine fibroids

    Weight gain (around hips and thighs)

    Acne

    Water retention (edema)

  • Oral

    Oral estradiol has proven to be the most effective and most beneficial form of estrogen replacement. It is the only estrogen (there are different types) that increases HDL (“good” cholesterol), improves all lipid markers, and increases SHBG (sex hormone binding globulin) which is protective in women. The oral form also increases fatty-acid esters which are known to provide lubrication to all mucosal areas of the body and prevent oxidation (anti-oxidant). Oral estradiol will also reverse plaque deposition in the arterial walls (the most prominent causative factor for heart attack and stroke).

    *Oral estradiol should be avoided if you have a history of Deep Vein Thrombosis (DVT) or Thrombophilia (clotting disorder). Instead, you can use transdermal cream.

    Transdermal

    Cream: Estradiol cream can be applied to the labia, inside the vagina, or to the upper inner arm. This is a good option for someone with a history of blood clots or or a clotting disorder.

    Troche: A troche is a tic-tac shaped tablet that is inserted into the vagina to prevent vaginal atrophy. The estradiol troche is a great option for women who are interested in improving vaginal symptoms and preventing Urinary Tract Infections (UTIs). The troche is applied inside the vagina once every night.

    Patch: Estradiol patches do not stick very well and do not deliver the medication in adequate amounts to provide any symptomatic relief.

  • Side effects of estradiol can include breast tenderness, bleeding, and fluid retention. These can all be corrected by either decreasing the dose or increasing progesterone supplementation.

    • If you have a history of breast cancer

    • Oral estradiol should be avoided in those with a history of DVT (Deep Vein Thrombosis) or Thrombophilia (clotting disorder) — instead, use transdermal application

DHEA

  • DHEA (Dehydroepiandrosterone) is a steroid hormone. About 90% is produced in the adrenal glands. It is a precursor to other important hormones including: testosterone, estrogen, and progesterone. However, DHEA has its own actions reported to include anti-inflammatory, anti-cancer, anti-obesity, anti-diabetogenic and anti-aging functions.

  • Improved energy levels

    Lowers insulin levels, helping to stabilize blood sugar

    Decreases visceral fat

    Lowers cortisol levels

    Enhances immune system response which decrease the production of free radicals by monocytes, resulting in a possible decreased risk of infections, malignant tumors or cancers

    Plays a role in conversion of fat to lean muscle

    Reduces platelet aggregation

    Modest decrease in cardiac risk for men

    It binds to GABA and NMDA receptors, creating a positive impact upon depression, memory and cognition, by opening calcium channels

    Assists in improving symptoms associated with some learning disabilities, obesity and autoimmune diseases such as chronic fatigue syndrome, arthritis, lupus, Epstein-Barr, and adrenal insufficiency

    May play a role in treating or preventing osteoporosis

    An estrogen-like effect on the brain, by increasing beta-endorphin levels after initial therapy

    In some animal studies DHEA has slowed the aging process

  • DHEA levels decrease progressively as we age from a peak at age 25. Many people over the age of 40 produce inadequate levels of DHEA. Levels are typically low in those with chronic diseases such as obesity, diabetes, immune deficiencies, cancer, high blood pressure, heart disease and AIDS. Elevated insulin levels decrease DHEA levels; one reason why hyperinsulinemia increases vascular disease.

  • Low DHEA levels may be the result of menopause or andropause, excess alcohol consumption, birth control pills, poor thyroid function, lack of exercise, obesity, aging, smoking, and chronic stress.

  • Managing stress reduces the stress hormone cortisol, resulting in improved levels of DHEA. Meditation, for example, can be a powerful tool for stress management. Some studies also suggest that replenishing DHEA levels to youthful levels will reduce the production of cortisol, the stress hormone. In fact, this may be the best reason to take DHEA as part of a preventive-aging program.

  • The goal is to return the DHEA level to that of a 25-35 year old. The optimal time of administration is in the morning and/or midday. DHEA is fat-soluble and is better absorbed with a meal.

    Men taking DHEA : Prevailing wisdom advises cautious use of DHEA in men with existing prostate disease, theorizing that it may increase testosterone levels. The current evidence does not support this. If a male has a normal PSA level, the use of DHEA may potentially be of benefit in preventing prostate cancer.

    Women taking DHEA : DHEA supplementation in female patients can raise testosterone levels and may raise estrogen levels. Women taking DHEA should also be taking Progesterone to improve breast protection.

  • Side effects are dose-related, and blood levels should be monitored. These can include:

    • Acne

    • Hirsutism (hair growth)

    *Side effects can be mitigated by lowering the dose or stopping therapy altogether.

  • Avoid DHEA if :

    • You have ACTIVE prostate cancer.

    • Are pregnant or plan to become pregnant.

    • You are breastfeeding.

    Special Precautions

    • If you have RECOVERED from prostate cancer

    • If you have a history of Deep Vein Thrombosis (DVT), blood clot, or thrombophilia (a.k.a. blood clotting disorder)

    • If you have UNTREATED Obstructive Sleep Apnea (OSA)

    • If you have had a recent heart attack or stroke