Through my Facebook community, my inbox and in my practice I get a lot of great questions. Here are a few answers to some that have been asked a lot lately. I welcome these questions, so please keep sending them in via my site, Facebook or email.
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Now, on to your questions:
Q: Is bio-HRT for life? Thoughts on stepping down and off?
A: As time goes on we realize that hormones are indeed the juice of life and one of the primary reasons we feel great at 20 and not so much at 45. Since it is our goal to feel good and stay healthy as long as possible, to the end of life, hormones must be part of the replenishment programs we undertake to accomplish these goals along with diet, exercise, lifestyle and stress diminution (that is specifically for you).
Unfortunately, the hormone story is blemished by a poorly designed and implemented study the NIH and academic institutions performed in the 1990s ( the Women’s Health Initiative) that only looked at effects of non human identical hormone pills ( Premarin and Provera) on older women with pre-existing medical problems. As an outcome of the failed study (That was paid for by the drug company that made the drugs but omitted to study bioidentical hormones for reasons that are unclear, and in fear of legal retaliation) the academic institutions involved along with the NIH decreed that ALL hormones behave the same in our bodies and they are all bad.
That could not be further from the truth.
But in its wake millions of women suffer and doctors have become useless in helping them. Scientifically, and through common sense, the stance that all hormones behave the same is pure nonsense. Hormones that look identical to the hormones our bodies make behave much better when used to replenish our flagging hormones. Those types of hormones are known as bioidentical hormones or estradiol, progesterone and testosterone (Or now many refer to them as natural hormones).
When used correctly, separately, not put together in one preparation, and under the supervision of a physician who is open minded, knowledgeable, caring, your partner and not your adversary these hormones will keep you feeling great, protect you from heart disease ( the #1 killer of women), keep your bones strong and healthy, your cholesterol in check, your mind sharp, your weight in balance and your sex drive healthy indefinitely.
No study on bioidentical hormones has ever shown them to be dangerous to our bodies or require us to stop using them at any point in time. At the end of the day we are our own individual experiment so the decision to stay on hormones and for how long is ultimately yours. You can always stop for a while and see how you feel, if you have any concerns. Personally, I have been on bioidentical hormones for the past 16 years and have no intention of stopping.
Q: Can you tell me more about hypothyroidism, TSH, free T3/T4 levels to feel good?
A: Hypothyroidism or just plain low functioning thyroid is one of the most under diagnosed conditions in the overall population. Unfortunately the diagnosis of low thyroid is made in the conventional medical world by looking solely at the results of a very antiquated blood test called TSH which does not reflect the true state of available thyroid hormones at your tissue levels which is really all that matters.
The medical world is seriously divided between those who are committed to preventing you from getting sick from low thyroid and those who believe low thyroid can only be diagnosed by blood tests thus endangering your health in the long run.
The American Endocrine Society is the organization that keeps insisting that people get treated with only one type of thyroid hormone, Synthroid (T4), and only when their TSH is above 5 or even higher.
The problem is that this approach does not take into consideration symptoms and ignores the individual patient needs allowing for too much time to pass before proper treatment is instituted thus creating a population of sick people instead of preventing disease altogether.
I am of the belief that using your symptoms, measuring your basal metabolic rate and taking your temperature in the AM will help determine the state of your thyroid before you are so sick you need serious help. Those are some of the ways to prevent disease and treat you as an individual rather than a number.
Symptoms of low thyroid that are not picked up but if untreated lead to long term problems with heart, lung and other organs are cold intolerance, weight gain, loss of hair, loss of eyebrow hair, depression, fatigue and poor sleep quality just to name a few.
Treatment, in order to provide what our body needs in a balanced way must contain a combination of T3 and T4 and can be compounded or is also found in FDA approved form as in Cytomel (T3), Synthroid (T4) and their generic forms. Young and old should start with low doses of T3 and only if necessary add T4. T3 is the active thyroid hormone, it has a short half-life, which means it goes out of your system fast and does not suppress your thyroid function. It also gets to the cells where it is most needed.
Find a practitioner who knows how to diagnose and treat thyroid issues in prevention and wellness and work with them. For more information and articles I have written on the topic as well as useful links please go to www.drerika.com search box.
Q: I would like to know if low dose Estriol works for incontinence and skin (wrinkles). If recommended, what is the recommened dosage, when and how long to take and best method to administer on the body.
A: There is limited scientific evidence that estriol helps with incontinence. The best use for estriol for now is indeed for skin and other mucous membranes like the vagina. We use it in combination with DHEA to improve vaginal wall thickness and diminish symptoms of atrophic vaginitis and in a combination of estriol and other creams to reduce the appearance and depth of facial wrinkles. For incontinence the best is to improve general systemic estradiol levels and also to do Kiegel exercises pretty much all the time. I’m not exaggerating. It works.
Q: What is the best method of transport of hormones into a woman's body (creams, troche, injectables, pill) and should it be a static dose? or should we trick our body into thinking it is 26 again? For men the question would be cream or injectable?
A: The two methods of absorption that are most studied are oral and transdermal (cream or gel). Transdermal is clearly superior when we are talking about estradiol while progesterone is ok in oral and transdermal forms. There are FDA approved preparations for both these options. Constant delivery of hormones is not what occurs naturally since hormones are released in pulses in the human body. However, with the aging process the baseline hormone production diminishes and a modicum of baseline hormones works in some patients. Subcutaneous or pellet implant is an non proven, not scientifically sound way of administering hormones and since we have so many other options I would never encourage anyone to have hormones implanted into their bodies.
Testosterone does not get absorbed in oral preparations so transdermal gels and creams work and injectable cypionate in men is a good option. We use it with HCG to maintain levels between injections and prevent testicular shrinkage.
In women we use compounded creams from specific pharmacies we work with on a 4-6 times a week basis with dosing that is appropriate for women and does not produce any undesirable side effects.
To try to obtain levels of a 26 year old is probably as crazy as trying to look 26 when you are 50. Why not just attempt to get the best levels for your age that actually corresponds to you feeling your best.
Do your research and only work with trained professionals and not “quacks” who present themselves as experts but have no scientific or clinical training and practice medicine without a license. You will become a victim if you do not take care of yourself and follow snake oil salespeople.
As always, contact my office if you are unsure of what you are hearing or want to set up a phone or office consult.