Bioidentical Hormone Therapy

This blog was originally posted, October 5, 2023, by Kristen Reynolds, MD, on our previous website.

I’ve been providing bioidentical hormone replacement therapy (bHRT) for patients, both men and women, for 15 years. It is shocking to me that hormone replacement is still controversial in conventional health care. Hormones are crucial for all stages of life and when they are in balance, we are healthy!

The Women’s Health Initiative (WHI) which came out in 2002 did a terrible disservice to HRT. It was a large but flawed study for many reasons. The New York Times actually did a decent overview of some of the problems with the WHI in this article published in February 2023: https://www.nytimes.com/2023/02/01/magazine/menopause-hot-flashes-hormone-therapy.html

Hormones are not only necessary for libido, female cycles, and pregnancy, they are also necessary for metabolism, inflammation, brain clarity, heart health, vibrant skin and muscle and bone mass. Let’s be clear. Hormones are necessary for life!

All sex hormones are anti-inflammatory, and we know that inflammation is the root cause of essentially all diseases of aging. One of my favorite quotes from a recent hormone balancing conference was “the two game-changers when it comes to inflammation are low dose naltrexone (LDN) and bioidentical hormone replacement, in both men and women.” (more on LDN in a future post)

The most common reason that women seek bHRT is for the real and debilitating symptoms of perimenopause, including hot flashes, night sweats, disrupted sleep, fatigue, mood disorders, weight gain and irritability. bHRT is wonderful in helping to alleviate these symptoms, and the risk of breast cancer from bHRT use is LOW. In fact, the right hormones (bioidentical and balanced correctly) have been shown to DECREASE the risk of cancer.

An NIH study of 7 million post-menopausal women published in May 2022 showed that women on bHRT live 20% longer, neurodegenerative diseases are reduced, and they have statistically less breast, ovarian, uterine, lung and colorectal cancer. However, you need to use the correct estrogen and progesterone replacement. Oral estrogen is associated with risks; use transdermal estrogen only. “Progestins” have risks; use bioidentical progesterone only. https://www.medrxiv.org/content/10.1101/2022.05.25.22275595v1

Let’s talk metabolism, the chemical reactions in the body that turn food into energy and in turn drive whether you feel well or unwell. Healthy metabolism controls weight, blood sugars and insulin levels. Insulin levels must be perfect for optimal health. Elevated insulin leads to inflammation, and inflammation is part of every chronic illness. Remember that insulin, leptin, thyroid hormone, and cortisol and are hormones too, and we need to make sure these are in balance. Testosterone (in men and women), plays an important role in decreasing insulin resistance, balancing cholesterol, optimizing metabolism and even improving cognition.

Cognition leads us to the important topic of brain health. Hormones are crucial for brain health. Did you know that testosterone is neuroprotective? The same holds true for estrogen and progesterone (but the right kind! Not the estrogen from horse urine and the fake progestogens used in the Women’s Health Initiative). In Europe they use IV progesterone for traumatic brain injury and stroke because it is so neuroprotective!

Studies show that women on the RIGHT estrogen replacement have a 50% decreased risk of Alzheimer’s disease compared to women not using estrogen replacement, and timing matters (starting HRT around the time of menopause is best). Can you imagine cutting your risk of dementia in HALF? That is huge.

In addition, the hippocampus aka the “physiologic center of the soul”, important for memories and motivation, is larger in postmenopausal women using hormone replacement therapy as compared to never users. bHRT has also been shown to suppress the APOE-4 Alzheimer’s gene.

Hormones are also super important for cardiovascular health. More on that later.

Those who know me know that “sarcopenia” is one of my favorite words. “Sarco” means muscle and “penia” means loss. Muscle loss or sarcopenia is an ongoing battle after age 40. Hormones are critical for maintaining muscle mass and bone density.

Finally, we cannot forget the importance of the gut. Meet a new term in functional medicine: the Estrobolome – “the collection of bacteria in the gut which is capable of metabolizing and modulating the body's circulating estrogen.” The estrobolome affects estrogen levels, which in turn can impact weight, libido and mood. And guess what? The first place we start in functional medicine is the gut.

Please consider coming in to address all the things that affect health: nutrition, exercise, sleep, stress management, relationships, oxygenation, detoxification, hormone balancing and gut health. Let’s “test not guess” (check hormone levels) and consider additional interventions for replacement with bHRT when needed. A holistic approach works, and we are here to help!

In Health,

Kristen Reynolds