Hormone Replacement

Over the past several decades, hormone replacement therapy (HRT) has been concurrently at the forefront of medical science, and the focal point of public interest, while being effectively prepared and administered to millions of patients. While researchers and physicians have been making great strides in knowledge and treatment, Oprah has talked about it, Suzanne Summers has written about it, and our partner Pharmacies have provided HRT as a means help patients get back on the road to good health and wellness.

In general, HRT is the method used to treat the symptoms of menopause and other hormonal imbalances in both sexes. However, HRT is most often spoken of (and will be so here) as female hormone replacement, which is traditionally contrasted with testosterone replacement therapy (TRT). Nevertheless, it should be made very clear that both HRT and TRT may be required by and administered to either gender. More specifically, custom HRT is a method of providing specific hormones (which often involves combinations of hormones) in the exact dosages required to meet a patient’s uniquely individual needs. The method by which hormones are customized is called ‘compounding’.

What Are Hormones

Produced by the major endocrine glands (pituitary, pineal, thymus, thyroid, adrenals, and pancreas) as well as within the sex organs, hormones are your body's chemical messengers. They travel throughout the bloodstream to specific tissues and organs, where they work at varying speeds, inducing many different physiological processes central to which are: growth and development; metabolism; sexual functions; reproduction; and mood.

Furthermore, the male testes and the female ovaries produce largely gender-specific hormones, which perform an expansive range of functions. Collectively, these powerful chemicals are required in only miniscule amounts, yet incite major changes within cells, tissues, and organs throughout the body. The addition of too much or too little of a certain hormone can have serious consequences. For this reason, hormone therapy should only be conducted under physician supervision, after laboratory tests have been used to accurately measure the hormonal levels within your blood, urine, or saliva.

After puberty androgens, specifically testosterone, play a role in the regulation of the sex drive within both genders. Concordantly, deficiencies in testosterone or estrogen (as well as progesterone and DHEA which are also multi-faceted hormones) may cause a drop in sexual desire, whereas excessive amounts of these hormones may heighten sexual interest.

Male-Specific Hormones

Testosterone is a hormone produced within the testicles via a joint process, which also includes the endocrine system and the pituitary gland. This system is collectively known as the Hypothalamic-Pituitary-Testicular axis (HPTA). Testosterone serves as the male body’s primary natural hormone, and is largely responsible for the proper development of male sexual characteristics. Although often referred to as a sex hormone, testosterone actually governs several areas within the body including a man’s development from birth onward with responsibility for everything from initial structural gender differentiation, through pubertal changes and male potency (libido & sexual functioning), to the partitioning of bodily muscle and fat distribution. It is also an integral component in men’s sense of well-being, playing a major role in male physiological, biological, and sexual health, while influencing stress coping capacity, sperm production, mental acuity (clarity, memory & recall, concentration & focus), bone density, immune system support, and red blood cell production. Of course testosterone is present in both males and females; however, males typically produce between 4-7 mg per day , which is approximately ten times more than their estrogen-based female counterparts.

Female-Specific Hormones

Estrogens are the sex hormones produced primarily by a female's ovaries that stimulate the growth of a girl's sex organs, her breasts, pubic hair, and other secondary sex characteristics. There are three basic estrogens, namely estrone (E1), estradiol (E2), and estriol (E3), however progesterone (another female-centric hormone) is often considered an estrogen as well. Collectively, these estrogens regulate a diverse array of chemically induced processes within the female body among which are the menstrual cycle, intercourse preparation and during intercourse functions, as well as impact mood, sleep quality, body fat levels, water retention, etc. As with testosterone, estrogen is present with both genders; women produce appreciatively more at approximately 0.5 mg daily. Aging, illness, and certain cancer treatments can adversely affect the body's delicate hormonal balance, causing changes in sexual interest and functioning. The most familiar of these changes occurs when a women go through menopause. Estrogen production drops throughout this process as women exit their child-bearing years.

However, in the majority of women, ovarian hormones don't appear to play a significant role in their sex drive. A 2012 study published in the Journal of Obstetrics and Gynecology showed that ovaries, i.e. estrogen production, may not play a pivotal role in sexual ideation and function among older women. This cross-sectional study involved analysis of 1,352 women (57 to 85 years of age) from the National Social Life, Health, and Aging Project compared women with previous bilateral oophorectomy (removal of one or both of the ovaries) with women who retained their ovaries. The primary outcome of interest was self-report of sexual ideation, chosen because having thoughts about sexual experiences is not prohibited by either a partner or a woman's own physical limitations. Three hundred fifty-six (25.8%) women reported previous bilateral oophorectomy. Even after adjusting for current hormone therapy, age, education, and race, no significant difference in the report of sexual ideation was found between groups.

Hormone Replacement Therapy

Testosterone replacement therapy (TRT) is a regimen of physician prescribed synthetic testosterones used to treat hypogonadic (low testosterone) symptoms. Similarly, hormone replacement therapy (HRT) is a physician prescribed regimen of any type of hormone (which encompasses TRT) to treat hormonal deficiencies. Much confusion has arisen over the relaxed and sometimes generic verbiage used to describe the types of hormones used in HRT. This has become such a problem that most people don't know or realize exactly what they are talking about when they use certain hormone qualifying terms. For clarity: natural hormones are those which are produced by a living organism be it human, animal, or plant; endogenous hormones are those produced within the human body; and synthetic hormones are man-made hormones. Synthetic hormones made by pharmaceutical companies have side chains added to allow the companies to patent the hormones. Side chains may be added to a natural substance to create a synthetic product. These structural changes/differences are believed to be responsible for the side effects that are experienced when synthetic hormones are used in replacement therapy.

 The key to natural versus synthetic is the molecular structure of the hormone. In order for a replacement hormone to fully replicate the function and bodily acceptance of naturally produced and present in the human body (endogenous) hormones, the chemical structure must precisely match that of the original. The numerous hormones Pathway Healthcare prescribes have the exact same chemical structure as endogenous hormones.

Another source of confusion, both within the general population and the medical community, is encountered when reviewing studies of efficacy, safety, and side effects of various forms of hormone replacement therapy is that most studies have grouped all forms of estrogen under the blanket category of 'estrogen replacement therapy'. This grouping fails to differentiate estrogen from the various progestins, as well as from the hormone progesterone, both of which are specific types of molecular compounds possessing diverse chemical actions. In short there also exists, and quite uniquely so, 'progestin replacement therapy' and 'progesterone replacement therapy', either of which may be highly applicable based on individual patient requirements.

Restoring Hormonal Balance

HRT replaces deficient hormones with those that are chemically identical to those that the body naturally produces, but which have declined due to aging or illness. HRT has improved the quality of life for millions of women and men who suffer from hormonal imbalance. The ideal process for achieving hormonal balance includes: an assessment of hormone levels: complete evaluation of signs and symptoms; replacement of the deficient hormones in the most appropriate dose via the most effective route; and the monitoring to fine tuning of therapy. Estrogens, progesterone, and androgens are just the tip of the iceberg when it comes to achieving hormonal balance. Thyroid and adrenal function, as well as nutritional status, should also be evaluated and treated when indicated.

The uniqueness of each person makes it incumbent upon health care professionals and patients to work together to customize hormone therapy. Through this cooperation, hormones can be compounded in the required strengths and dosages, and administered via the most appropriate preparation to best meet each individual’s needs.

Functions of HRT

Hormone replacement therapy is the method used to treat not only the symptoms of menopause, but all other hormonal imbalances as well. A hormone will only act on a part of the body if it ‘fits’, and can therefore be thought of as a type of ‘key’. Its target site (such as a cell) has specially shaped receptors which are analogous to ‘locks’ on their cell walls. If the key(hormone) fits the lock (receptor site), then the hormone will work by impacting the target site (cell), and altering the function of its tissue and/or organ. The primary affected glands include:

  • Pituitary gland- inside the brain, oversees the other glands and keeps hormone levels in check. It can also bring about a change in hormone production somewhere else in the system by releasing its own ‘stimulating’ hormones.
  • Thyroid gland- inside the neck, controls the rate of metabolism.
  • Parathyroid glands- inside the neck surrounding the thyroid gland, control the level of calcium in the bloodstream.
  • Adrenal glands- atop each kidney, make a number of different hormones, such as adrenaline and cortisol in times of stress, as well as sex hormones.
  • Pancreas- inside the abdomen, an organ of digestion which makes insulin to control the amount of sugar in the bloodstream.
  • Ovaries- inside the female pelvis, make female sex hormones like estrogen.
  • Testes- inside the male scrotum, make male sex hormones like testosterone.

Some common problems of the endocrine system that may be addressed by HRT include: diabetes- too much sugar in the blood caused by problems with insulin production; premenstrual syndrome- symptoms include cramping, bloating, breast tenderness and mood swings; and thyroid problems- when the gland is overactive (hyperthyroidism) or underactive (hypothyroidism).

How Hormone Replacement Works

The endocrine glands receive feedback from the hypothalamus - a small but important part of the brain which contains several small nuclei with a diversity of functions. It plays an important role in both the nervous and endocrine systems. All vertebrate brains contain a hypothalamus, which in humans, it is roughly the size of an almond and located just below the thalamus and right above the brain stem. Linked to another small and vital gland called the pituitary gland, the hypothalamus controls certain metabolic processes and other activities of the autonomic nervous system by synthesizing and secreting neurohormones, often called hypothalamic-releasing hormones. These hypothalamic releasing hormones control and regulate the major endocrine glands (pituitary, pineal, thymus, thyroid, adrenals, and pancreas) as well as within the sex organs (male testes and female ovaries). Hormones are your body's chemical messengers, they travel throughout the bloodstream to specific cells, tissues, and organs where they work at varying speeds inducing a wide range of homeostatic and other physiological processes central to which are:

  • The release of 8 major hormones by the pituitary gland
  • Growth and development
  • Cellular repair
  • Body temperature
  • Hunger, thirst and food, and water intake
  • Sexual behavior and reproductive functions
  • Daily cycles in physiological state and behavior also known as circadian rhythm
  • Mediation of emotional responses and mood
  • Digestion
  • Circulatory and respiratory function

The goal of HRT is to optimize function, prevent morbidity with aging, and to enhance quality of life. With proper modification, adjustment, and titration by an experienced anti-aging physician, the benefits of HRT far outweigh the risks. Anti-aging physicians remain steadfastly at the helm advancing hormone replacement therapy, thereby providing crucial research data to ultimately negate the controversy and confirm the safety and efficacy of HRT.

Types of Hormone Replacement Therapy

Millions of women, from every age and background, experience some form of hormone-related health condition during their lifetimes. For many women, help comes in the form of hormone replacement therapy.

Hormones produced by our pharmacy have the exact same chemical structure as naturally occurring human hormones. Consequently, your body recognizes them and allows them to mimic the function of the hormones the body produces on its own. HRT may be useful for relieving the symptoms of a variety of conditions common among women of all ages, including:

  • Menopause
  • Premenstrual Syndrome (PMS)
  • Irregular menstrual cycle
  • Moodiness
  • Hot flashes
  • Infertility
  • Post-partum depression
  • Decreased libido
  • Weight gain
  • Endometriosis
  • Fibrocystic breasts
  • Vaginal Dryness
  • Painful sexual intercourse
  • Sleep disturbances
  • Night sweats

Mass-Produced HRT Formulations Are Useful But Limited

There are many mass-produced hormone treatments on the market today. However, every woman's body, and her individual hormonal makeup, is different and each requiring a unique balance of hormones. That's why more women are turning to custom compounded HRT for their hormone replacement needs. We specialize in prescribing a variety of custom supplements, and we can prescribe a customized HRT solution to suit your very specific hormone needs.

Dosage Forms

Working with our Partner Pharmacies we will assist in evaluating your serum or saliva tests. By studying and interpreting your results, we will determine an individualized course of treatment for you. Then, we will prescribe a custom compound in a variety of strengths and preparations including:

  • Injectables
  • Sublingual drops or troches
  • Capsules
  • Gels or foams
  • Suppositories
  • Topical or vaginal creams