If you enjoyed Part I in our series about hormone replacement therapy (HRT), today’s post will complete the picture, especially with respect to what’s involved in HRT itself.
Hormone replacement therapy involves taking one or more sex hormones — estrogen, progesterone, testosterone. While we use the term “sex hormones,” these hormones are also important for heart, brain, bone, and immune system health and for mental health. Having adequate, balanced hormone levels along with healthy hormone receptors, reduces the risk of cardiovascular disease, diabetes, breast cancer, prostate cancer, and dementia. Optimizing hormones reduces risk factors for many of the chronic conditions that increase with age.
HRT can be delivered via different routes, including oral (pills), injection, topically (creams or patches), or inserted into the skin as tiny pellets. The mode of delivery is determined with your doctor based on your specific needs and preferences. Pellet therapies injected into the skin can be done every three months in your doctor’s office. Pills or creams are administered daily and do not require any in-office procedures.
Knowing What to Expect: Improved Health and Wellbeing
With hormone replacement therapy, patients often feel the effects within a few short weeks, but it may take several months before you receive the full benefits. When hormones are replenished to physiological normal ranges, a few key changes take place. First, patients commonly have a better overall sense of “wellbeing.”
Next, changes in sexual desire often return, and hot flashes resolve. All of this may happen within the first two to three months. Over a longer period, improvements in skin tone and hair texture become apparent, making patients look younger. While hormones, are not the fountain of youth, they certainly help a person look and feel younger. Men find themselves feeling stronger, leaner, happier, and more motivated.
Using Hormone Replacement Therapy as the Icing on the Cake
In my practice, I often recommend that patients consider hormone replacement therapy as an adjunct to a healthy lifestyle. Adding hormones should be the icing on the cake. You don’t put the icing on the cake before you bake it. In my opinion, HRT should be considered only after a person is eating well, is physically active, and has had appropriate lab tests that check for underlying factors that may be causing some of the same symptoms that often lead a person to seek HRT.
For example, I often see women who are having hot flashes and waking up three to four times a night. When we run the labs, we see elevated cortisol, inflammatory markers out of range, high blood sugar, and low B vitamin levels. After we support a healthy cortisol response, reduce inflammation, balance blood sugar, and optimize B vitamins, the hot flashes typically resolve, and sleep improves.
Now, if I had just provided hormones, the hot flashes would have likely improved as well as the sleep, only to have those same issues resurface in a few short months. If I had failed to balance blood sugar and cortisol, I would have had to prescribe increasing doses of hormones, never actually getting to the root cause.
Hormones can have a strong and positive impact, but they should be used as icing on the cake. This approach delivers lasting results with the safest and lowest dose of hormones. Many people who take hormones have what is termed the “honeymoon” stage initially, only to start feeling bad again. By taking care of the root causes of underlying metabolic dysfunction, the benefits of HRT can be long lasting.
My Approach to Hormone Replacement Therapy
Prior to hormone replacement therapy, I perform a thorough physical exam and consider your health history, paying close attention to digestive health, sleep patterns, blood sugar dysregulation, and adrenal health. I order lab tests to screen for deficiencies of vitamins, minerals, and essential fatty acids (EFAs); blood sugar levels; inflammatory markers; and liver health. Digestion, sleep, blood sugar, and adrenal health all need to be optimized first.
Tests before beginning HRT include a cursory examination of hormones including cortisol, dehydroepiandrosterone (DHEA, which is a precursor for testosterone and estrogen), progesterone, testosterone, luteinizing hormone (LH), follicle stimulating hormone (FSH), and pregnenolone. These tests determine current levels of hormones, and the results can be used as a baseline. Tests are repeated initially in three months and then depend on patient response thereafter. Prior to starting hormone therapy, a history is taken. Based on family history, certain hormones may be excluded.
If you are receiving hormone replacement therapy, it is important to support the liver to properly metabolize the hormone into non-harmful metabolites. Hormones are metabolized or broken down by the body, mostly in the liver. Genetics, environment, and diet can influence hormone breakdown, creating harmful reactive hormone metabolites.
If you think you may benefit from hormone replacement therapy, I strongly encourage you to see a doctor who takes a similar approach — a diagnosis and treatment plan that doesn’t start with HRT but ends with it. Otherwise, you’re likely to get a quick fix that doesn’t last and that results in having to continually increase hormone supplementation to alleviate symptoms. Address any deficiencies and restore overall health first. Use HRT as icing on the cake.
Disclaimer: The information in this blog post is provided for general informational purposes only and may not reflect current medical thinking or practices. No information contained in this post should be construed as medical advice from Dr. Matt Lewis, D.C., DACBN, CFMP®, nor is this post intended to be a substitute for medical counsel on any subject matter. No reader of this post should act or refrain from acting on the basis of any information included in, or accessible through, this post without seeking the appropriate medical advice on the particular facts and circumstances at issue from a licensed medical professional in the recipient’s state, country or other appropriate licensing jurisdiction.
About the Author: Dr. Matt Lewis, D.C., DACBN, CFMP®, specializes in diagnosing and treating the underlying causes of the symptoms related to chronic and unexplained illness through nutrition, lifestyle, chiropractic, and other natural approaches to whole-health healing in Tampa, Florida. He earned his B.S. in Biology from Shenandoah University, his Doctorate in Chiropractic from Life University, his Diplomate status in Clinical Nutrition from the American Clinical Board of Nutrition, his CFMP® from Functional Medicine University, and his certification as a Digestive Health Specialist (DHS) through the Food Enzyme Institute. Dr. Lewis’ passion for health and wellness stems from his own personal experience. With a family history of autoimmune conditions and diabetes, and his own lab tests showing his genetic susceptibility to Hashimoto’s thyroiditis (autoimmune thyroid), he has learned how to restore his own health and vigor to prevent the onset of these and other illnesses and live an incredibly active life. Through this process, he acquired a deeper understanding of health and wellness, which he now offers his patients in Tampa.