Bioidentical Hormone Replacement Therapy (BHRT)
[Webinar Replay] In this 30 minute talk we will help you navigate the pros, cons and different types of hormone replacement so you can know what and if it is right for you.
What are hormones and why do I need them?
Hormones control some of our most basic bodily functions. Our immune health, mood, energy, libido, weight and sleep all depend on a complex cascade of synchronized hormone secretions from glands in our endocrine system. Even our skin and hair health are based in hormones and show the changes of aging as hormones decrease in the second half of our life.
Natural aging, stress, poor or inadequate sleep and inflammation are other reasons your hormones could get out of balance. And when hormones are low or out of balance, one can suffer from numerous symptoms, including fatigue, hot flashes, thinning hair, low libido, weight gain, bloating, brain fog, mood dysregulation and more.
Who might benefit from BHRT?
Many BHRT patients are (peri-)menopausal women or men in dealing with symptoms of andropause, or have had significant stressors, illness or other disruptions that have compromised their body’s ability to produce balanced hormone cascades throughout their body.
It can also be beneficial for conditions such as osteoporosis, insulin resistance, and fibromyalgia. BHRT is being researched and thought to have cardiovascular health benefits as well.
At InHealthRVA, bioidentical hormone replacement therapy (BHRT) is used in conjunction with identifying and treating other root causes that can contribute to hormone dysregulation or may have overlapping symptoms as low hormones. BHRT can be a game-changer, but a common problem with conventional hormone replacement is failing to check and provide guidance for patients on how to deal with the causes of hormone dysregulation.
What is BHRT?
Bioidentical hormones are processed hormones made from plant estrogens. Estradiol, progesterone, and testosterone are the hormones most commonly used in treatment. Bioidentical hormones mimic the hormones produced by your body’s glands and are thought to be safer than synthetic hormone replacement therapy (HRT) (some of which is produced using the urine from a pregnant horse).
BHRT can come in various forms, including pills, creams, patches, gels, injections, or pellets. They are typically not available at regular pharmacies but need to be ordered and compounded at a specialty pharmacy from a practitioner who specializes in BHRT.
How do I know if I would benefit from BHRT?
First we ask about your health and symptoms. If hormone imbalances are suspected, we confirm it with testing prior to initiating therapy. At InHealthRVA we utilize blood testing and the DUTCH test (Dried Urine Test for Complete Hormones) to help us diagnose and treat hormonal dysregulation. We look at estrogens, progesterones, testosterones, adrenal cortisol production and circadian patterns as well as other markers that reflect or affect hormone balance and health (gut, nutrients, inflammation and more).
One of the many reasons we love DUTCH testing is because it also allows us to monitor how your hormones are being metabolized. One concern with hormone replacement is it could be putting some women at increased risk of reproductive cancers (breast, uterine and ovarian) that are sensitive to these hormones. DUTCH testing allows us to track if you are properly metabolizing hormones, and if not, add extra detox metabolism support to ensure their safety.
BHRT dosing starts low and is increased mindfully and gradually. Regular visits and follow up testing allows us to ensure that you are getting optimal dosing as well as to follow up and ameliorate any other root causes to hormone and health disruptions. These areas include diet, gut microbiome imbalances, food reactivities, stress, inflammation, toxins, sleep and exercise.
We don’t want to simply medicate you, we want you to heal and to feel truly well!
Case Study Example
J.L. was a 37 year old patient complaining of constipation, fatigue, and dry skin. She had been to her regular PCP and was told that her TSH and free T4 were normal.
After seeing her, we decided to check her T3 (active thyroid hormone), reverse T3 (inactive thyroid hormone), and thyroid antibodies. As it turned out, she had low/normal free T3, elevated reverse T3. Her thyroid antibodies were elevated and so she was diagnosed with Hashimoto’s, an autoimmune disease against the thyroid.
T4 (thyroxine) is the inactive thyroid hormone secreted from the thyroid. It needs to be converted to T3 (triiodothyronine) throughout the body, where it is needed to enact its potent metabolic effects. T4 conversion to T3 can be blocked by issues such as inflammation or dysregulations of another hormone, cortisol (secreted from our adrenal glands).
RT3 (Reverse T3) is an inactive ‘dummy’ hormone. Our body increases RT3 under inflammation, to essentially slow us down. So if your thyroid hormone levels are normal, but your RT3 is high, the sum balance may be suboptimal thyroid action.
Thyroid antibodies (thyroglobulin and thyroid peroxidase antibodies) are evidence of an autoimmune attack on your thyroid, or Hashimoto’s disease. They are produced when our body’s immune system mistakenly identifies ‘self’ as the enemy and produces antibodies against it. Eventually, your thyroid will be overly damaged by this antibody attack and not be able to carry out its function of secreting thyroid hormones.
While in conventional medicine they do nothing to address this autoimmune attack, in Functional and Integrative medicine we work to identify its environmental triggers and by limiting them, slow down and minimize it.
LDN (low dose naltrexone) may also help suppress the autoimmune activity against the thyroid. Research shows us that LDN therapy can up-regulate T regulatory cells, a type of immune cell that helps help calm autoimmune activity in the immune system.
Eventually, thyroid hormone replacement therapy will be needed with Hashimoto’s, but by eliminating environmental triggers and other factors leading to or exacerbating it, we can slow its progress and greatly improve treatment outcomes and your overall health!
It was this patient’s preference to use a bioidentical desiccated thyroid medication to treat her, rather than a synthetic version. Diet and lifestyle management helped her tremendously, and she was happy to have answers after knowing something was not quite right with her body and not getting answers at her regular endocrinologist and PCP.
Do you or someone you know need help figuring out their optimal hormone balance?
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References:
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Pataky MW, Young WF, Nair KS. Hormonal and metabolic changes of aging and the influence of lifestyle modifications. Mayo Clin Proc. 2021 Mar;96(3):788-814. doi: 10.1016/j.mayocp.2020.07.033. PMID: 33673927; PMCID: PMC8020896.
Prevalence and impact of thyroid disease. American Thyroid Association. Accessed July 27, 2022. https://ww.thyroid.org/media-main/press-room
Silvestris E, Lovero D, Palmirotta R. Nutrition and female fertility: an interdependent correlation. Front Endocrinol. 2019;10:346. doi:10.3389/fendo.2019/00346