The Truth About Bio-Identical Hormones

The Truth About Bio-Identical Hormones

Vivian F. DeNise,DO Integrative PhysicianPatients Medical

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Introducing our speaker:

Vivian DeNise, DOIntegrative Medicine


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Completed her medical degree at New York College of Osteopathic Medicine

Certifications in Integrative Medicine with the American Academy of Anti-Aging Medicine (A4M)


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Specialties include Hormonal Imbalances Nutritional Deficiency Thyroid Disorders Gastro-Intestinal Problems Detoxification And many more!


The Truth About Bio-Identical Hormones

Hormone Receptors

There are receptors everywhere in the body for estrogen, progesterone and

testosterone in both men and women.


Where are they?

BrainBone, Muscle, JointsHeartBlood VesselsBladderLiverKidneyGenitalsNervesSkin and Hair Follicles


What is our goal?

To achieve Balanced Hormone Optimization to that of a 25-30 year old level using Bio-Identical Hormones.


What are Natural (Bio-Identical) Hormones?

They are identical to the molecular structure of hormones produced by human female or males.

They are NOT: Xeno hormones Horse hormones Synthetic hormones


What Bio Identical Hormones Are

Atom for atom identical to human hormones Not horse hormones Not chemically altered

No increased risk for cancerLess risk for heart diseaseLess mortalityNeeded for Bone, Brain, Quality of

Life


The Hormonal Symphony

TestosteroneEstrogens,

ProgesteroneDHEA, PregnenaoloneCortisolThyroid: T3, T4Vitamin DGrowth Hormone


Your Libido is Affected By

Hormones Neurotransmitters Medications Emotions Diet Sleep


Female Hormones

Estrogens▪ Estrone=E1▪ Estradiol=E2▪ Estriol=E3

ProgesteroneTestosterone


Hormones


Definitions

PMS (Premenstrual Syndrome)- Cyclical mental and physical symptoms

preceding the menstrual cycle.


Definitions

Peri-menopause-Can begin to occur 10-20 years prior to menopause associated with cyclical changes in menses as well as mental/physical symptoms.▪ Early- changes occur rarely and resolve▪ Middle-changes occur often and for longer▪ Late-changes occur continuously.

Menopause-no menstrual bleeding for 1 year


Female Hormones

Deficiencies can start years before menopause in peri-menopause Poor sleep, anxiety,

PMS-Progesterone Low Libido, decreased

memory-Testosterone Low energy, hot flashes,

vaginal dryness-Estrogen


Bio Identical Hormone Replacement in Women

Balances Estrogens, Progesterone, and Testosterone

Every woman needs a unique balance

Not every woman needs estrogenProgesterone protects against breast

cancer

Unlike “progestins” natural progesterone does not have

androgenic or anti androgenic effects.


Estrogen Deficiency

Hot flashesNight sweatsFatigueVaginal DrynessPoor memory

and Foggy thinking

Low energy


Estrogen Deficiency

Depressed mood Decreased

concentration Decreased sexual

desire or libido Excessive daytime

sleepiness Stress incontinence and

UTI’s Osteoporosis,

Cardiovascular disease, Dementia www.patientsmedical.com

Excess Estrogen Side effects

Agitated Anxiety Weight gain Water retention Headaches Swollen or tender breasts Bloating Spotting or breakthrough

bleeding Mood swings Poor sleep Achy joints Excessive bleeding


Synthetic Estrogen

Increase blood pressure Increase triglycerides Increase estroneCause gallstonesElevate liver enzymes Increase SHBG (decreases

testosterone) Interrupt tyrptophan metabolism

and consequently serotonin metabolism

Causes blood clots to formwww.patientsmedical.com

What Transdermal E2 doesDecreases HbA1cDecreases total cholesterolDecreases LDLDecreases HS-CRPDecreases IL-6 and TNF-inflammatory

cytokines implicated in autoimmune, cardiovascular, osteoporosis and Alzheimer's

NO increase risk of stroke or venous thrombosis

Protects against bone losswww.patientsmedical.com

Progesterone

Usually the first hormone to become deficient in peri-menopause.


Progesterone deficiency symptoms

Agitation Irritability, aggressiveness Anxiety, anger Weight gain Water retention Headaches Swollen or tender breasts


Progesterone Deficiency Symptoms

BloatingSpotting or breakthrough bleedingMood swingsPoor sleep, insomniaAchy jointsExcessive bleedingEndometriosisFibrocystic breasts


Causes of Low Progesterone Impaired production Low LH Increased prolactin productionStressAntidepressantsExcessive arginine consumptionSugarSaturated fatDeficiency of vitamins A, B6, C, zincDecreased thyroid hormone


Synthetic Progesterone

Called progestinsProgestins do not reproduce the

same actions of natural progesterone


Side Effects of Synthetic Progesterone

Increases appetiteWeight gainFluid retention IrritabilityDepressionHeadacheDecreases energyBloatingBreast tendernessDecreases sexual interest


Side Effects of Synthetic Progesterone

AcneHair lossNausea Insomnia Interferes with the body’s own

production of progesteroneDoes not help balance estrogenRemains in the body longerCan cause spasm of coronary arteries


Wait there’s more…….

Stops the protective affects estrogen has on the heart

May make the symptoms of progesterone loss worse

Increases LDLDecreases HDLProtects only the uterus from cancerCounteracts many of the positive

effects of estrogen on serotonin


Bio-Identical Progesterone Replacement

OrallyTransdermal cream


Natural Progesterone Affects Not Seen With Progestins

Helps balance estrogenLeaves the body quickly Improves sleepNatural calming effectLowers high blood pressureHelps the body use and eliminate fatsLowers cholesterol


Natural Progesterone Affects Not Seen With Progestins (Continued)

May protect against breast cancer Increases scalp hair Helps balance fluids in the cells Increases metabolic rate Natural diureticNatural antidepressant Is anti-inflammatory


Natural Progesterone Affects Not Seen With Progestins (Continued)

Stimulates the production of new bone

Enhances the action of thyroid hormones

Improves libido Helps restore proper

cell oxygen levels Induces conversion of

E1 to the inactive E1S form

Promotes Th2 immunity

Is neuroprotective, promoting myelination


Progesterone Decreases Breast Cancer Risk


Synthetic progestins increase Breast Cancer Risk

Progesterone decreases Breast Cancer Risk

Effects of Too Much Progesterone Even with Adequate Estrogen

Increases fat storageElevates cortisol Increases insulin resistance Increases appetite and carbohydrate

cravingsRelaxes the smooth muscles of the

gut (This can cause bloating, fullness, and constipation. It can also contribute to gallstones.)


Testosterone Replacement in Women

Testosterone is needed for a sense of well being

Strength especially upper bodyLibidoUsually decreased in peri-menopausal

and menopausal womenBody composition Bone densityDHEA can increase Testosterone in

women but not in menwww.patientsmedical.com

Testosterone

Increases sexual interest

Increases sense of emotional well-being

Increases muscle mass and strength

Helps maintain memoryHelps skin from saggingDecreases excess body

fatHelps maintain bone

strengthElevates

norepinephrine in the brain (tricyclic affect)


Symptoms of Testosterone LossMuscle wastingWeight gainFatigueLow self-esteemDecreased HDLDry, thin skin, with

poor elasticityThinning and dry

hairDroopy eyelidsSagging cheeksThin lipsAnxiety


Causes of Low TestosteroneMenopauseChildbirthChemotherapyAdrenal stress or burnoutEndometriosisDepressionPsychological traumaBirth control pillsHMG-CoA-reductase inhibitors


Treatment of Low Testosterone Testosterone replacement P.O. or

transdermally. Use the bio-identical form.

Methyltestosterone has been associated with an increase in liver cancer.

If used transdermally must rotate sites. In order for testosterone to work well,

estradiol must also be optimized. Without enough estrogen, testosterone

cannot attach to brain receptors. If testosterone is given alone it can

increase plaque formation. www.patientsmedical.com

How Else Can Testosterone Levels Be Raised?

Decrease calorie intake Increase protein in the

dietTake the amino acids

arginine, leucine, glutamine

ExerciseGet enough sleepLose weightReduce stressTake zinc if deficient

(Zinc is needed for the metabolism of testosterone.)


Testosterone Replacement Therapy Decreases Breast Cancer

When used in conjunction with BHRT there is even a lower incidence of

breast cancer compared to HRT alone.


Follow-Up

Seen every 3 months or sooner if needed

Labs every 3 months initially and as needed depending on where patient is in life

May take up to 6 months to get full benefit


Other Factors

StressDietEnvironmental



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The Truth About Bio-Identical Hormones