Aging, in part, is associated with decreased hormone production and function.  Hormones can start to decline as early as in our 30’s or even earlier with certain conditions.  The Optimal U Program is a medically supervised and individualized program that includes bioidentical hormone optimization (BHO) to optimize hormone levels and reduce symptoms that may be caused by low hormones.

Declining hormones cause night sweats, hot flashes, poor sleep, fatigue, mood changes, irritability, anger, difficulty losing weight, poor exercise tolerance/recovery, more aches and pains, feeling weak, decreased muscle mass, foggy thinking (poor or slow cognition), difficulty concentrating, forgetfulness and word loss, low motivation, low libido, sexual dysfunction, cold hands and feet, hair/nail/skin changes for the worse and increase the risk of certain diseases and cancers.  Women may also notice irregular or heavy periods, vaginal dryness or pain with intercourse and urine leaking.  When menstruation stops for a year or longer this is menopause.  When symptoms start to occur but menstruation continues this is peri-menopause.  In men, declining hormone levels and action, especially testosterone, is called andropause.  Men may notice erectile dysfunction (low desire, difficulty with erections and ejaculation), frequent urination, decreased muscle mass, exercise tolerance, motivation and more.  Both women and men may feel a sense of decreased well-being.  Improvement of some of these symptoms may be achieved with bioidentical hormone optimization (BHO).  BHO is augmented by a healthy lifestyle – a good diet, regular exercise, limited alcohol and other positive lifestyle choices.  Some supplements such as Vitamins D3, K, essential fatty acids and melatonin are also recommended for some patients.

BHO may also help decrease the risk of diseases that develop with age.  Heart disease, stroke, bone fragility, certain types of cancer, cognitive impairment, macular degeneration and more are some diseases associated with aging.

Hormones are proteins or derivatives of cholesterol made in the brain, adrenal glands, testis, ovaries, pancreas, thyroid gland and certain tissues.  They are transported in blood to regulate the activity of cells or organs. BHO hormones are ones that decline as we age: estrogen, progesterone, testosterone, thyroid, DHEA and more.

Hormone terminology such as bioidentical, synthetic, natural, compounded, optimization can be confusing.  Bioidentical or biologically identical means the molecule is identical to the naturally produced hormone in the body.  Bioidentical hormones are available commercially (eg Prometrium® or Androgel® – more expensive, often covered by drug plans) and generically (progesterone and testosterone – less expensive, often covered by drug plans).  Synthetic means it is manufactured through a chemical process (eg Provera®).  Synthetic hormones may be close to what our natural hormones look like and even mimic function but even slight changes can cause bad side-effects or harm by for example over-stimulating receptor sites in an unnatural way.  Synthetic hormones are usually patented and therefore profit may play a large role in promoting, prescribing and research.  Natural means that it comes from a natural source and not manufactured but isn’t necessarily bioidentical.  Many bioidentical hormones are manufactured such as progesterone or estradiol from yams or soy and remain bioidentical to human hormones and thus are recognized favourably by the body and hormone receptors.  Other types of bioidentical hormones are compounded from natural sources such as thyroid hormone from bovine (beef) or porcine (pork) sources or compounded chemically but are bioidentical to our hormones.  Others yet, such as Premarin® which is natural from horse urine or Provera® which is synthetic, are not bioidentical and can cause significant negative side-effects as shown in research.  Another example is Synthroid^TM, a common thyroid replacement medication, which is synthetic and bioidentical thyroxine however only contains one type of thyroid hormone (T4) that may be poorly converted into the active type of thyroid hormone (T3) needed.  Hormone optimization, while not a new concept, challenges the tradition of settling for the lowest acceptable standard in blood level results – the “low normal” result.  Finally, compounding is the art of making custom made prescription medications specifically for an individual versus fixed-dose mass-manufactured medications.  U Cosmetic Partner of Dermapure Group uses Trutina Pharmacy for all compounding needs.  Some bioidentical hormone prescriptions are available at regular pharmacies in fixed doses (eg Prometrium® and Androgel®).  Trutina is a state of the art custom compounding facility using only FDA and Health Canada approved products and whose product testing and quality assurance exceeds current industry standards.  Trutina uses yam based formulations for their bioidentical hormones.  Trutina delivers the custom prescription direct to your home or office with signature via UPS, Purolator or Express Post with free delivery across Canada.

While a healthy lifestyle is most important for healthy aging, BHO may significantly improve age-related conditions and their symptoms. Bioidentical hormones have specific indications, benefits and side-effects.  Science and medicine show evidence that bioidentical hormones have a reduced level of risk compared to synthetic and/or non-bioidentical hormones and significant benefits.  The main hormones that may require optimization in women are progesterone, estrogen (if you are menopausal), testosterone and thyroid hormone.  The main hormones that may require optimization in men are testosterone and thyroid hormone.  Other hormones that may be beneficial to optimize in both sexes are DHEA, melatonin, growth hormone and a few others.  Again, BHO is not the holy grail, however it may help to minimize symptoms and decrease risk of certain diseases.

The following is an overview of specific bioidentical hormones for optimization:

Estradiol(E2)

·         General info: E2 is produced by the ovaries, secondarily by the adrenal glands and visceral (around organs) fat. E2 is NOT Premarin®. Small amounts produced in fat after menopause. ·         Benefits: protects against heart disease, stroke, osteoporosis, loss of teeth due to loss of jaw bone density, cognitive disorders, vaginal atrophy, urinary incontinence and bladder infections, colon cancer, macular degeneration and cataracts; prevents temperature dysregulation such as hot flashes; improves balance, skin, mood, fatigue and more, decreases visceral fat ·         Risks/side effects: breast tenderness, bleeding, fibroids, bloating (fluid retention), weight gain (fluid not fat), gall stones, headaches, mood swings, acne.  This can be from too much E2 or too much receptor sensitivity and is managed by starting with low doses and adding progesterone.  Thrombosis (blood clots), risk of breast cancer and gallstones were shown with synthetic estrogens such as Premarin® and/or birth control medications. Increases matrix metalloproteinases and CRP (both shown with Premarin® only), TG, SHBG, lower free testosterone of which the latter three can be balanced with the addition of testosterone. Endometrial cancer is a risk when estrogen is used alone without sufficient progesterone in women with a uterus. Hormone replacement is contraindicated in patients with hormone sensitive breast cancer, ovarian cancer, uterine cancer or endometriosis. ·         Summary: hormone replacement with bioidentical E2 is safe, promotes protection against many age-related symptoms and diseases including Alzheimer’s and protects the heart, eyes, bones, teeth and more.  All women on E2 should be on progesterone to protect the uterus and mitigate E2 side effects.

 

Progesterone(P)

·         General info: secreted by the ovary only, none produced in menopause, is beneficial in most women.  Progesterone is NOT Provera® or progestin or progestogen. ·         Benefits: decreases headaches and bloating associated with menstruation, decreases symptoms of PMS, peri-menopause, menopause; is a natural sleep aid, promotes sense of wellbeing; protects against uterine and breast cancer, osteoporosis, fibrocystic breast disease, ovarian cysts, heart disease and stroke; mitigates side effects of estrogen such as fluid retention, bloating, headache, bleeding, fibroids and synergistic to estrogen’s effect on bone and cholesterol ·         Risks/side effects: sleepiness, breast/nipple tenderness with oral progesterone only, endometrial growth and cancer IF not adequate enough progesterone ·         Summary: P is E2’s best buddy and promotes feelings of well-being; protects against uterine, breast cancer, osteoporosis in menopause, eliminates painful menstrual cramps, mood swings, heavy bleeding, bloating and menstrual migraines.

 Testosterone in Women

·         General info: like estrogen, produced in the ovaries, adrenal glands and in peripheral tissue, it is converted to E2 ·            Benefits: improved well-being and energy especially related to depression, strength, endurance, body composition, bone density, sexual function and responsiveness including increased clitoral sensitivity, skin thickness, texture and wrinkles, healing; decreases visceral and subcutaneous fat deposition, cellulite and cholesterol (decreased bad cholesterol and raises HDL); maintenance of muscle mass and therefore increased metabolism; protection against breast cancer, urinary symptoms and bone loss especially in older women, heart disease, stroke, diabetes and insulin resistance, high blood pressure, degenerative disc disease; memory enhancer and improves cognition; decreases inflammatory markers in the blood, ·         Risks/side effects: increased libido, abnormal hair growth more than acne (managed with dosage and/or spironolactone), voice deepening, contraindicated in breast, uterine, ovary, prostate cancers, unstable cardiovascular disease and liver disease ·         Summary: Side-effects not usually seen in low/moderate doses.  Not just for men, a look-good and feel-good hormone (especially for sexual health) for women as well

 Thyroid Hormone

·         General info: Thyroid hormone is active in the form of triiodothyronine (T3) not thyroxine (T4) which is what synthetic drugs mimic (eg levothyroxine, Synthroid®).  Over 200 symptoms are related to thyroid deficiency.  In general thyroid hormone regulates temperature, metabolism (ie weight), cerebral function and energy.  It affects all tissues, organs and systems. ·         Benefits: increases metabolism and lipolysis (reduction in fat and cholesterol); protects against heart disease, cognitive impairment and memory loss, fatigue, weight gain ·         Risks/side effects: sweating, palpitations, tremor, nervousness is rare with replacement thyroid, typical with Grave’s disease an autoimmune disorder causing thyroid hormone overproduction ·           Summary: many health, feel-good benefits; increased metabolism and warmth, protects against heart disease and improves brain metabolism and improves mental function, energy and depression

Testosterone in Men

·         General info: produced mainly in the testicles and a small amount in the adrenal glands, it is then converted to estradiol which is the main active form of testosterone in men ·         Benefits: increases metabolism and lipolysis (reduction in fat and cholesterol); protects against heart disease, cognitive impairment and memory loss, fatigue, weight gain: improved libido and all sexual/erection parameters ·         Risks/side effects: controlled substance and banned in performance athletes; testicular atrophy, decreased sperm count and infertility, erythrocytosis (increased red blood cells), transference to others – partners or kids, black box warning of blood clots, heart attack, stroke without evidence; hair loss/growth, prostate enlargement and can stimulate prostate cancer growth (does not cause the cancer), acne, increased libido, aggression with high doses ·         Summary: helps men to regain all positive aspects of younger years and protects against heart disease, osteoporosis, brain against the protein deposits seen in Alzheimer’s disease

DHEA

·         General info: most abundant hormone in the body, a building block for other sex hormones, like a weak testosterone, produced in the adrenal glands, testicles and brain ·         Benefits: decreases osteoporosis, heart disease by decreasing visceral fat and cholesterol, decreases platelet aggregation; boosts the immune system (pending FDA approval to treat lupus), anti-stress hormone; improves sexual vitality, mood and energy; protects brain cells, improves cognitive function, enhances memory function; improves insulin sensitive ie decreases risk of diabetes; improves physical strength, body composition, decreases effects of aging on skin; synergy with other hormones ·         Risks/side effects: in women: acne more than hair growth, male-pattern hair loss, menstrual irregularities, headaches, insomnia; in men: gynecomastia, breast tenderness, increased blood pressure, testicular wasting, increased aggression; may lower HDL (good cholesterol), long term use or use of amounts higher than normal levels might increase the risk of hormone-sensitive cancers-breast/ovary/uterus/prostate, blood sugar needs to be monitored in diabetes, contraindicated in hormone sensitive cancers, endometriosis, fibroids, liver disease ·         Summary: low DHEA can contribute to obesity, diabetes, immune issues, cancer, high blood pressure, heart disease; appropriate replacement amounts are great for the immune system and improving depression

General contraindications to hormone replacement include any hormone responsive cancer such as breast, uterine (metastatic) or prostate cancer, endometriosis, liver disease, pregnancy or planned pregnancy, breast feeding, healthcare provider resistance and patient concerns.

There is a lot of mis-information about hormones.  Bioidentical hormones are lumped in with previously studied non-bioidentical hormones such as Premarin® and Provera® which caused many negative outcomes.  In 1990, a landmark article published by Dr Daniel Rudman in the New England Journal of Medicine demonstrated findings consistent with the hypothesis that low levels of hormones contributed to age-related changes in the body.  Another study by Dr Mark Blackman, a hormone doctor, showed that all men and women studied benefitted from hormones.  There are many studies since that show bioidentical hormones are safer than non-bioidentical hormones.

The Optimal U program at U Cosmetic Partner of Dermapure Group starts with an initial consult to inform, assess and discuss your symptoms.  The cost of the initial consult is $450.00 plus tax.  If you want to proceed then you will be given a bloodwork requisition.  When results are received you will be scheduled to complete your assessment and then appropriate bioidentical hormones will be prescribed.  The following tests must be up to date prior to starting treatment and regularly updated as screening mandates – mammogram, pap smear and pelvic ultrasound for women or PSA and prostate exam for men.   The cost of the program is the initial consult fee of $450 + HST and three to four additional appointments at the cost of $250+ HST at approximately one, three and nine months to optimize your hormones. Repeat bloodwork will be done every one to three months until your symptoms are improved and blood levels are optimal and yearly thereafter.   There will be fees for phone ($75) and email follow up ($75) and prescription renewals ($40) outside of appointments.  Ideally for women, BHO is started within 10 years of menopause or any time before menopause. For men, treatment can be started after 40 years of age and when symptoms of low hormone levels are experienced.  Looking, feeling, functioning and living your best may be improved with bioidentical hormones.  Optimizing hormones is an off-label approach to the treatment of menopause, andropause and other chronic conditions.

Reference:

1. “Bioidentical Hormone Replacement Therapy for Men and Women” by Neal Rouzier, MD

Following is a short list of reference reading material (more available) to help you engage further in bioidentical hormone optimization and includes;

1. “Bioidentical Hormone Replacement Therapy for Men and Women” by Neal Rouzier, MD
2. “How to Achieve Healthy Aging 2nd Edit” by Neal Rouzier, MD
3. “Ageless: The Naked Truth About Bioidentical Hormones” by Suzanne Somers
4. “The Hormone Solution: Naturally Alleviate Symptoms of Hormone Imbalance from Adolescence Through Menopauase” by Erika Schwartz, MD
5. “Testosterone Therapy for Life – Recharge your Vitality, Sex Drive, Muscle Mass & Overall Health” & “Why Men Fake It: The Totally Unexpected Truth About Men and Sex” by Abraham Morgantaler. MD.
6. “The Testosterone Optimization Therapy Bible” – by Jay Campbell and Jim Campbell
7. Websites: www.trubalancehealthcare.com, www.drerika.com, www.worldlinkmedical.com, www.hormonedoc.com, www.trutinapharmacy.com and more…..

 

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