Aging is associated with decreased hormone production and receptor function. Hormones can start to decline in our 30’s or even earlier with certain conditions. Hormone optimization is a medically supervised, individualized program that uses bioidentical hormones to optimize hormone levels, enhance positive lifestyle choices and improve long-term disease prevention. 

 

Declining hormones cause night sweats, hot flashes, poor sleep, fatigue, mood changes, irritability, anger, difficulty losing weight, weight gain, poor exercise tolerance/recovery, more aches and pains, muscle weakness, 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 and more and as well 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. Menopause is diagnosed when menstruation stops for a year. When symptoms start to occur but menstruation continues this is peri-menopause. In men, declining hormone levels and function 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 these symptoms may be achieved with bioidentical hormone optimization (BHO). BHO is augmented by a healthy lifestyle. 

 

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

 

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 that decline as we age are estradiol, progesterone, testosterone, thyroid (free T3), DHEA and more. 

 

Hormone terminology such as bioidentical, synthetic, natural and compounded can be confusing. Bioidentical or biologically identical means the molecule is identical to the naturally produced hormone in the human body and functions the same as the hormones produced by the human body. Bioidentical hormones are available commercially (eg Prometrium®, Depo-Testosterone) and generically (progesterone and testosterone). Synthetic means it is manufactured through a chemical process. Bioidentical hormones can be synthesized from soy and yams (progesterone, estradiol, testosterone, thyroid, DHEA etc) or isolated from natural sources (such as bioidentical thyroid from dessicated pig thyroid or synthesized from bird feathers). Some synthetic hormones are completely different structures than human hormones (eg Provera® a synthetic progestin or Duavee® which contains Premarin (pregnant horse urine estrogen and a SERM-selective estrogen receptor modulator called bazedoxifene). These NON-bioidentical hormones can cause adverse side-effects or even harm. Side-effects listed on the Duavee® website include “blood clots, stroke, heart attack, cancer of the lining of the uterus, breast cancer, cancer of the ovary, dementia and more (https://www.duavee.com/important-safety-information). Non-bioidentical synthetic hormones (eg Provera®, Duavee ®) are usually patented and therefore profit may play a large role in promoting, prescribing and research. SynthroidTM, a common thyroid replacement medication, is synthetic and bioidentical thyroxine (T4) however, on its own, may poorly convert into the active type of thyroid hormone (T3) needed. Dessicated Thyroid is a biological ratio of T4/T3. T3 is the main active thyroid hormone and its presence enhances the conversion of T4 into T3. Hormone optimization, while not a new concept, challenges the tradition of settling for the lowest acceptable standard in blood level results. Compounding is the art of making custom made prescription medications specifically for an individual versus fixed-dose mass-manufactured medications. Trutina Pharmacy is used for compounding prescriptions and is a fully-accredited compounding facility using only FDA and Health Canada approved products and whose product testing and quality assurance exceeds current industry standards. Trutina delivers the custom prescription direct to your home or office with signature via UPS, Purolator or Express Post with free delivery across Canada. If you have a preferred compounding pharmacy, your prescriptions can be sent to that pharmacy. Some bioidentical hormone prescriptions are available at regular pharmacies in fixed doses (eg Prometrium®,). 

 

Science shows bioidentical hormones do not have the risks associated with non-bioidentical hormones (eg Premarin, Provera or other synthetic progestins which are not progesterone). The main hormones to optimize in women are progesterone, estradiol (if you are menopausal), testosterone and thyroid hormone. Hormones to optimize in men are testosterone and thyroid hormone. Other hormones that may be beneficial to optimize in both sexes are DHEA and melatonin. For women, another option to treat vaginal and urinary symptoms is local treatment with the radiofrequency device Plus 90. 

 

 

 

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 (dementia), vaginal atrophy, urinary incontinence and bladder infections, colon cancer, macular degeneration and cataracts; treats and prevents temperature dysregulation such as hot flashes; improves balance, skin, mood, fatigue and more, decreases visceral fat 

• Risks/side effects: headaches and mood issues, breakouts, breast tenderness, bleeding, bloating (fluid retention-temporary), weight gain (fluid not fat and temporary), progesterone mitigates these side effects, thrombosis (blood clots), risk of breast cancer and gallstones were shown with non-bioidentical hormones such as Premarin® and Provera®. Increases in matrix metalloproteinases and CRP, TG, SHBG, (shown with Premarin® only not bioidentical E2). Endometrial cancer is a risk when any estrogen is used alone without sufficient progesterone in women with a uterus. 

• NOTE: All women on E2 with a uterus should be on progesterone to protect endometrial tissue and mitigate E2 side effects. 

 

Progesterone(P4) 

• General info: secreted by the ovary only, none produced in menopause, is beneficial in most women. Progesterone is NOT Provera®, also used in PCOS 

• 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/daytime fatigue, nipple tenderness (rare), endometrial growth and cancer IF not on enough progesterone and taken daily. 

•  

Testosterone in Women 

• General info: like estradiol, produced in the ovaries, adrenal glands and in peripheral tissue 

• Benefits: improved well-being, mood, energy, strength, endurance, body composition-weight loss (fat)/weight gain (muscle), bone density, sexual function 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. 

• Risks/side effects: increased libido, hair growth (in area of application, face), acne (managed with dosage and/or spironolactone), voice deepening, transference to others especially pregnant women and children is dangerous. 

 

Thyroid Hormone 

• General info: Dessicated/bioidentical thyroid hormone (eg ERFA) is a mix of triiodothyronine (T3) with thyroxine (T4), not thyroxine (T4) alone, (Synthroid® or levothyroxine is T4 only). Over 200 symptoms are related to thyroid deficiency or receptor dysfunction. Thyroid hormone regulates temperature, metabolism (ie weight), brain function and energy. It affects all tissues, organs, systems and used in PCOS, high cholesterol management and more. 

• 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, diarrhea 

 

Testosterone in Men 

• General info: produced in the testicles (small amount in adrenal glands), endogenous testosterone is converted to estradiol, the main active form of testosterone in men 

• Benefits: increases metabolism, fat/lipid reduction, heart disease protection, cognitive impairment/memory loss, fatigue, weight gain (muscle), improved sexual function 

• Risks/side effects: banned in performance athletes, testicular atrophy, infertility, 

erythrocytosis (increased red blood cells), hair loss/growth, transference-especially pregnant women and children is dangerous, acne, increased libido, aggression 

 

DHEA 

• General info: produced in the adrenal glands, testicles and brain 

• Benefits: decreases osteoporosis, heart disease by decreasing visceral fat and cholesterol; boosts the immune system (FDA approved to treat lupus), improves sexual vitality, mood and energy; improves cognitive function, enhances memory function; improves insulin sensitivity 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, hair growth; in men: gynecomastia, breast tenderness, testicular wasting, increased aggression, infertility 

 

 

All steroid hormones (E2, P, Testosterone, DHEA) have a black box warning for increased risk of blood clots and increased risk of hormone sensitive/responsive cancer (breast, endometrial, ovarian, prostate cancer) and their use is contraindicated in the presence of those cancers as well as endometriosis, liver disease, unstable cardiovascular disease, pregnancy or planned pregnancy, breast feeding. These warnings are not based on the use of bio-identical hormones. These warnings are based on research findings with non bioidendital hormone (such as Premarin® and Provera®) that showed many negative outcomes. 

 

The BHO program starts with an initial consult ($525) followed by bloodwork and a hormone prescription. Regular screening must be up to date – mammogram, pap smear for women or PSA for men, colon cancer screening for both if applicable. Follow-up appointments ($295) are at approximately three, six and nine months. Yearly appointments ($395) thereafter. Fees will be charged outside of appts for phone/email follow up ($75) outside of the regular appointment and for non-appointment/pharmacy-requested prescription renewals ($40).  There is no tax on these fees and because this is a health-related treatment, these costs can be applied to your tax returns. 

 

Optimizing hormones is an off-label approach to the treatment of menopause, andropause and other chronic conditions. 

 

References: 

1. Screening-Breast screening Ontario call 1.800.668.9304 (Kingston 613-384-4284), Colon cancer screening call Health Care Connect at 811, for Pap testing call 811 or your local Health unit if you do not have a family doctor 
2. “Bioidentical Hormone Replacement Therapy for Men and Women” by Neal Rouzier, MD
3. “Estrogen Matters” Sept 2018 by Avrum Bluming, MD and Carol tavris, PhD
4. “How to Achieve Healthy Aging 2nd Edit” by Neal Rouzier, MD
5. “Ageless: The Naked Truth About Bioidentical Hormones” by Suzanne Somers
6. “The Hormone Solution: Naturally Alleviate Symptoms of Hormone Imbalance from Adolescence Through Menopauase” by Erika Schwartz, MD
7. “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.
8. “The Testosterone Optimization Therapy Bible” – by Jay Campbell and Jim Campbell
9. “Rethinking Hypothyroidism” Dec 2022 by Antonio C. Bianco, MD and past president of the American Thyroid Association and the Endocrine Society

LOVE BEING U!