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Balancing Act

By Peter Schmid, DO
Posted On Jul 12, 2011

In the quest to anti-age, the key, say experts, is restoring hormones to optimal levels

WORDS: Lisette Hilton

Catherine Pake, of Portland, Ore., was 55 when she began wondering if she’d ever enjoy life again. Plagued with sinus infections, headaches, weakness and more, Catherine spent years going to different health care providers in search of answers.

“I had to quit work, and most of my days I was lying in bed,” Catherine says. “I had to give up socializing, exercising with friends, coffee, alcohol, my job. I… had not gone through menopause yet.”

In May 2008, she went to see Naina Sachdev, MD, who is board-certified in anti-aging and regenerative medicine. Dr. Sachdev, based outside of Portland, Ore., ordered tests to evaluate Catherine’s hormone levels. Noting low levels of specific hormones, Dr. Sachdev began treating Catherine with bio-identical hormones, including thyroid, estrogen, progesterone and testosterone. The physician also treated her for adrenal exhausation.

By fall 2009, Catherine was starting to feel stronger. Today, she’s back to working part-time and enjoying sports, friends and family. “When I exercise, sometimes I feel like I cannot get enough, it feels so good,” explains Catherine, now 58.

That Was Then

Hormone replacement therapy (HRT) has changed since the Women’s Health Initiative found that the very hormones that women were taking to alleviate their menopausal symptoms might have been doing more harm than good. The study found that taking the synthetic combination of oral estrogen and progestin for five years or longer lowered the risks of broken bones, heart disease and colorectal cancer. But, it boosted women’s risks of stroke, blood clots and breast cancer. That was then. And those were synthetic hormones, which critics say fatally flawed the study.

Experts say the approach to replacing hormones has evolved with bio-identical hormones. While long-term studies on bio-identical hormone replacement therapy (BHRT) are not yet concluded, these experts say that by using bio-identical, versus synthetic, hormones, they are more likely to safely and effectively achieve hormonal balance, relieving symptoms and, potentially, warding off age-related disease.

Off Balance

Hormonal balance is important. Estrogen alone has more than 350 functions in the body, according to Dr. Sachdev. And estrogen is but one of the hormones that begins to decline as we age. Other major hormones that commonly fall out of optimal balance include testosterone, progesterone, dehydroepiandrosterone (DHEA), growth hormone and thyroid, just to name a few.

Natural declines in hormones can result in mood and mental performance issues, anxiety, sleep disturbance, diminished sex drive, aging skin, loss of lean muscle mass, weakened bones and inflammatory issues that can lead to cardiac risk factors, such as high blood pressure, as well as cancer. Women often turn to therapy before they reach menopause, when these and other symptoms start to affect their quality as a decreased libido, when their hormones get out of balance. This therapy can help them as well, experts say.

Get Real

BHRT, according to Dr. Sachdev, is believed to be safer than synthetic hormones, in part, because it uses
hormones that are identical to those naturally found in the body.

“The difference is that synthetic HRT tends to use hormones that are not identical biochemically to the ones made by the body, and we tend to take synthetic HRT orally, and in much higher dosing,” says Dr. Sachdev. “Bio-identical hormones are generally given [topically or under the tongue], to avoid having to be metabolized by the liver detoxification pathways.”

Bypassing the liver’s pathway is an important benefit, according to Lena Edwards, MD, who is fellowship-trained in anti-aging and regenerative medicine, as well as in integrative cancer therapy.

“Once an oral medication is swallowed, it goes into the liver and turns into other things. Most of the time, it’s that metabolizing that causes the side effects. When you’re applying a hormone topically, you’re bypassing the liver’s metabolizing effect,” says Dr. Edwards, who practices in Lexington, Ky.

Another important difference, according to Dr. Sachdev, is that BHRT dosing tends to be lower than the levels used with synthetic hormones. “We’re simply trying to replenish to optimal ranges of each hormone,” she says. For most women, that means returning to the hormone levels they had at age 40.

Physicians customize the therapy to each patient’s imbalances. They also use diet, exercise and supplements to help patients achieve a better quality of life and overall health.

Safety Dance

Whether BHRT is actually safer than synthetic HRT has not yet been proven or disproven in clinical studies. Smaller studies on individual bioidentical hormones have conflicting results and often focus on orally administered bio-identical hormones.

If used incorrectly, BHRT can cause side effects, according to Dr. Edwards.

“I have seen many patients who have been overdosed or placed on hormone regimens that were not properly balanced. The results were often devastating for the patient… heavy and unrelenting vaginal bleeding, chronic insomnia, severe depression, severe hair loss on the scalp or hair growth on the face, scarring acne, worsening of fibrocystic breasts or uterine fibroids. In men, testosterone over-replacement can cause obstructive sleep apnea, a rise in the red blood cell count (called ‘polycythemia’), and conversion into other hormones such as estrogen (breast enlargement, testicular atrophy, increased risk of heart disease) and dihydrotestosterone (prostate enlargement and hair loss),” she says.

Still, Dr. Edwards says BHRT is safe when administered properly.

“I have been prescribing BHRT for over a decade, and I have never had a patient experience an adverse outcome on BHRT,” says Dr. Edwards. “However, it is important to keep in mind that just because BHRT is considered more ‘natural’ does not mean that the therapy should be taken lightly.”

As for Catherine’s first-hand experience with BHRT, “I have not felt this good in 20 years,” she says.