By Dr. Mitchell Ghen
Last month I described in Part one of Hormones the importance and why everyone regardless of age should be interested in determining what their hormones levels are and that they should be brought to as close to youthful levels as possible. As a reminder if you suffer from any of the symptoms or signs below, you might be having these problems secondary to low hormone levels. These include fatigue, irritability, bladder problems with incontinence, joint and muscle aches, loss of muscle mass, breast tenderness, decreased libido, weak bones, mental confusion, cognition difficulties, dry vaginal mucosa, wrinkles on your face, hot flashes, poor sleep, or inability to basically get going in the morning.
There are three ways to test your hormone levels-blood, saliva and urine. Both blood and saliva represent a point in time and therefore need to be tested more often since hormones vary during the day. Yet these two methods are the easiest and cheapest. Saliva has advantage in that it is able to determine the free components of a hormone. Hormones circulate either being bound to sex hormone binding globulin in which event, they are totally inactive, or free which is where the hormone is able to do its job properly.
Urine has a distinct advantage over blood and saliva, in that it represents a 24 hour dynamic evaluation. And it can determine the downstream metabolites of these hormones. The importance of having knowledge of the downstream metabolites is that these are the items that can either improve your health or in certain instances worsen your health. Knowing the exact pathways of the hormones we are able to manipulate them with natural substances, therefore, protecting you from any problems.
Remember, hormones are reported out from the laboratory companies in normals that are associated with your age. We want to try to make our hormones as close to the youthful levels that we had at ages somewhere between 18 and 25 for a male and 18 to 32 for a female. In many cases, this is not possible, but still our goal is to maximize or better optimize hormone levels for appropriate intercellular communication.
Regardless, of the method by which your hormones are evaluated, please make sure that the whole cascade of them are examined. Leaving even one of the prime hormones in the pathway out may lead to some improper conclusions and therefore to a less than effective and safe treatment plan for you. The prime hormones to evaluate are: DH. E. A. (Dehydroepiandrosterone), Pregnenolone, Estradiol, Progesterone, Testosterone(and if by blood, free testosterone), SHBG(Sex hormone binding globulin), and Igf1. All of these play an integral part in your well being.
Four separate ways of delivering hormones will now be discussed-oral, troche, creams and pellets. For the most part pellets have a significant advantage over every other type of administration. First, they have been used since 1938. These pellets release hormones at a constant physiological rate, meaning that over the course of 4 to 6 months they release a certain amount every day all day long which is significantly superior to other forms of administration. They exhibit what is known as zero order kinetics, and do not irritate the liver as much as the other forms of delivery.
The pellets insertion procedure is easy, extremely safe, and takes less than five minutes. The patient is typically placed on a physician’s exam table on their left or right side and after prepping an area on the hip, Novocain is introduced into area. After the area is numb, a very small incision is made, one that does not require a stitch. The pellets are then introduced underneath the skin just in the subcutaneous fatty area.
Because pellets do not affect the liver, clotting factors are also not affected, and therefore the possibility of thickened blood is not a problem. Testosterone and estrogen pellets do not affect blood pressure either. And testosterone and estrogen pellets do not increase the risk of breast cancer as does oral estrogen. This has been studied in postmenopausal women; research showed that testosterone replacement did not cause increase in breast cell proliferation. In addition, testosterone pellets do not affect the menstrual cycle.
Pellets are made from either soy or yam and therefore are naturally derived. They are bio-identical hormones, which means that their chemical structure looks exactly like the hormones that are made by your body. Therefore, bio-identical hormones do not provoke an immune response as do the synthetic versions often prescribed by conventional physicians.
Creams can also be prescribed by a physician and made by a compounding pharmacy in a bio-identical way. Unfortunately, the drawback of creams are that they need to be applied daily and therefore the kinetics of delivery is quite different then the pellets. Ups and downs of hormone levels are to be expected.
For the most part one should steer clear of oral estrogen and testosterone due to their possible irritation of the liver. Injectable testosterone has the same problem and should only be used for a short period of time since liver damage and the potential of liver cancer exist with only the injectable form of testosterone.
Regardless of the method of delivery as described above, make sure that the hormones have been adequately distributed to non-detrimental metabolic pathways. This can be done with the good understanding of hormone physiology. So if you were prescribed hormones without additional nutraceuticals to make sure the hormones metabolites are safely discarded, you might want to look for a new healthcare provider.
So let’s summarize: testosterone , estrogen and progesterone can be for life, regardless of your age and or condition. If your testosterone is low replace it and use the precursor zinc to help the release of testosterone. Also make sure precursor hormones are checked simultaneously. These include DHEA and pregnenolone. Make sure your prescription is bio-identical and naturally derived. Make sure you understand the advantages and disadvantages of each of the delivery methods. As noted above, pellets of estrogen and testosterone seem to have the greatest advantage, however be aware that once inserted they cannot be removed, although they will dissolve in 4 to 6 months. Each testosterone pellet releases 0. 49 mg of testosterone per day. Therefore, women typically will get one pellet to match the 0. 5mg of testosterone that is made by ovaries as well as by adrenal glands daily. Men will require as many as 14 pellets to match the 6-9 mg per day the testicles release when they are working at their optimal. Progesterone, is often given by mouth especially if the woman has some sleep disturbance. Only oral progesterone allows the body to convert it to GABA, which is the neuro inhibitory hormone that can help improve the patient’s sleep.
What should one expect from long-term use of hormone therapy? Well, all those things that would normally accompany the youthful, healthier you!
Dr. Mitchell Ghen
The Doctor’s Doctor
Consultant to Physicians Worldwide
561. 508. 3095