The use of bioidentical hormones got a lot of press after Suzanne Somers (Three’s Company cast member and promoter of the ThighMaster™) began touting them as an alternative to synthetic hormone replacement. I wholeheartedly agree that bioidentical hormones are preferable to synthetic hormone replacement therapy (HRT). Recall the large experiment on the female population known as the “Women’s Health Initiative Postmenopausal Hormone Therapy Trials”. If you aren’t familiar with the results of that study, here is a summary provided by the National Institutes of Health:
Compared with the placebo, estrogen plus progestin resulted in:
•Increased risk of heart attack
•Increased risk of stroke
•Increased risk of blood clots
•Increased risk of breast cancer
•Reduced risk of colorectal cancer
•Fewer fractures
•No protection against mild cognitive impairment and increased risk of dementia (study included only women 65 and older)
Compared with the placebo, estrogen alone resulted in:
•No difference in risk for heart attack
•Increased risk of stroke
•Increased risk of blood clots
•Uncertain effect for breast cancer
•No difference in risk for colorectal cancer
•Reduced risk of fracture
(Findings about memory and cognitive function are not yet available.)
Just because synthetic hormones come with proven risk, it seems that people have decided bioidentical hormones are totally fine to take. Bioidentical hormones are crafted to be the exact molecular structure of the hormone(s) your body produces. Synthetic hormones, on the other hand are not. Synthetic hormones are typically a bit different from the exact structure that your body makes because that way it can be patented by the manufacturer.
The purpose of this article is not necessarily to compare and contrast synthetic from bioidentical HRT; but to alert you as to how the body responds when bioidentical (and synthetic) hormones are taken. Well, really to alert you on the downside consequences of taking ANY hormones. The physiology is simple and logical. It can be more in depth, but I’ll focus on the basics. By the way, I’m referring to the pathways of the most commonly replaced hormones, steroid (e.g.: estrogen, testosterone, progesterone, cortisol, DHEA, etc.) and thyroid hormones.
Most hormones work in the body via a negative feedback loop. This means that as the level of a hormone rises, a signal is mediated that ceases that hormone’s production and release; in order to prevent the production of the hormone from getting out of control. Let’s begin with an example using thyroid hormone.
The three main glands involved in thyroid hormone production are the hypothalamus, pituitary and thyroid. The hypothalamus releases “thyroid releasing hormone” (TRH), which stimulates the pituitary gland to release “thyroid stimulating hormone” (TSH), which in turn stimulates the thyroid gland to manufacture and release thyroid hormones (thyroxine or T4 and triiodothyronine or T3). Once the thyroid hormone begins to do its job throughout the body, production begins to decline, so as not to produce too many hormones. So, as the level of thyroid hormone increases, the levels of TRH and TSH decrease. It’s called a negative feedback loop because the rise in hormone levels results in a decreased production; as opposed to a positive feedback loop where a rise in hormone levels would produce an even greater rise in the level of that same hormone. The only example of a hormone that works on a positive feedback loop that I can think of is oxytocin.
Because these hormones work this way, you may be able to guess what happens when you are exposed to (i.e.: ingest) exogenous hormones. Exogenous (as opposed to endogenous) refers to those taken in from outside the body, and can be any type of hormone. So, if you take a hormone, you can be sure that those negative feedback loops will still function as usual. The result…your body stops (or significantly slows) its own production of these hormones. What’s wrong with that? Eventually, you’ll be dependent on these hormones as your glands have “gone to sleep”, because “someone” else is doing their job. It’s simply not necessary for the glands to have to do anything.
So if you stop taking them, it may be extremely difficult to get your body’s own production back up to par. Now, considering people often take hormones because they’re not producing enough on their own in the first place, you can imagine how difficult it would be to begin the production process after taking exogenous hormones and suppressing your hormone production even further. Therefore, people usually become completely dependent on hormones, bioidentical or not. In general, as long as you’re okay with taking a hormone for the rest of your life, there is no need to worry. However, most (if not all) of my patients shun that idea.
The next issue is that of hormone receptor insensitivity. Generally speaking, each hormone docks into a receptor on it’s target cell. It’s as if the receptor is the lock and the hormone is the key. Once the cell “door” opens, the hormone goes on to carry out it’s function (usually turning on or off genes). The problem with bombarding the cells with large doses of a hormone is that eventually it’s as if the cell decides to change the lock on the door. The result is that it is harder and harder for the hormone to open the cell door, and therefore more and more of the hormone is needed each successive time you want to make an effect on the cell/genes. It’s almost as if you need enough hormone to knock the cell door down, because it doesn’t want to open. This is especially prevalent with the use of hormone creams (usu. progesterone). However, if you make no lifestyle changes it typically happens with any hormone. That’s why people on thyroid hormone often have to continue increasing the dose to get the same effect; the same goes for those who take insulin. Have you ever known of diabetic or person with hypothyroidism (except for autoimmune thyroid disease/Hashimoto’s) that had to decrease their dose, without making lifestyle changes? So, taking a hormone for the rest of your life may not even do the trick, especially insulin. You may be familiar with how well diabetics fare without changing their lifestyle, and continually increasing their doses of insulin. By the way, hormone receptor sites often “run out” of the vitamin and minerals that are necessary to allow them to function properly, due to the constant bombardment of hormones they are subject to in these cases.
This is not to say that no one should be on HRT, bioidentical or synthetic. There is a time and place for everything. And when these hormones are necessary, they can be miraculous. The big question is: When are they necessary? That’s a debatable issue and can certainly vary between individuals. So I am not absolutely against HRT, though I definitely prefer bioidentical over synthetic when possible.
The point I’m trying to get across is that I wouldn’t recommend anyone start with HRT, unless they are in a very unmanageable state. In these instances, one option may be to start with HRT to “prime the pump” and then eventually wean off them. Unfortunately, with all the books written about HRT and the attention it gets these days, many people (and doctors) go straight for hormones (with or without lab tests). Don’t get me wrong, chances are you’ll feel like a million bucks if you take hormones that you are deficient in, or insensitive to. But don’t forget to ask the million dollar question just because you feel like a million bucks: How long does that last? Well, there is no single answer to that question because everybody’s condition and lifestyle is a bit different. But, from what I’ve seen, it lasts about six months at best, before they have to adjust the dose upward. You may eventually find yourself always having to increase the dose to get the same effect. And finally, your cells just may not respond adequately, despite the dose. That’s not say there is no hope though.
I’m currently working with a patient who had low testosterone and used testosterone replacement therapy for over a year. Sure enough, he had to continually increase the dose, until it eventually stopped giving him the results he needed (i.e.: absence of musculoskeletal pain, strength, libido, and an erection). In this case (and others), I determine if the hypothalamus, pituitary, gonads (when it comes to testosterone), and/or cell receptors need support. Fortunately, in the above mentioned case, the patient got immediate results that according to him, showed via the number of plates he kept adding on the machines at the gym.
In some cases, it may not be easy to get everything back up and running like new. But with the proper nutritional support and lifestyle improvements, it certainly is an attainable goal. The willingness of the patient to change their lifestyle and the length of time the person has been on hormones are two very important factors that will help to determine the outcome. Fortunately, I haven’t seen a “lost cause” yet; but I sure have seen people feeling miserable after the hormones stop giving the desired effect. Remember, there’s no such thing as a free lunch!
Not to go into politics…but I’m a big advocate of being able to buy supplements over-the-counter. Although I truly believe that hormones should only be dispensed through licensed health care practitioners who know how to use them.
PS: There are more problems associated with HRT (bioidentical or not) than what I mentioned above. For example, many men who take testosterone can eventually wind up converting it into estrogen (just about the opposite effect they are looking for)…that’s enough on that for now.
PSS: I’m not saying that bioidentical hormones are never necessary. They certainly can be in some instances…just consider the potential side-effects and work with a licensed, competent, qualified health care professional who knows how to use them appropriately. They can be very useful to “prime the pump” when other lifestyle changes are implemented.
Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology
I really enjoyed your information! It is wonderful to find like-minded practitioners out there.
I work for alternative doctors in the Houston TX area and we treat with bioidentical hormones. We find so many women in particular whose hormone production has been interfered with because of birth control pills, tubal ligation, hysterectomy or uterine ablation as well as the environmental factors that put estrogen into male and female bodies and throw them out of balance. We have found people of all ages by the tens of thousands with low hormone levels because either the glands were not functioning properly or had been altered.
Many people’s hormones, such as thyroid, have never been at adequate levels for them to be healthy.
The majority of women’s progesterone levels decline by age 35 because our ovaries have aged and this is the type imbalance that causes all female problems all the way to the cancers.
Liza – I’m glad you enjoyed the article. And I agree, it is wonderful to find like-minded practitioners. We’re out here, they just need to find us! Thank you very much for your informative comment.
Hi Rob,
Excellent article. One question that comes up frequently is
Are Bio-Identical Hormones Safe?
The 2002 WHI study showed that synthetic, chemically altered hormones such as Provera cause cancer and heart disase. However, Bio-Identical hormones are safe and effective, and do not cause breast cancer, as shown in the French Cohort study published in Climacteric, Dec 2002. For more on the Safety Of Bio-Identical Hormones click here:
jeffrey dach md
Hi Jeffrey, thanks for your comment. As you can see, my concern with bio-identical hormones is not that they are unsafe, the way synthetic hormones are unsafe. My feeling regarding bio-identical hormones is that they are often overused and used as the first approach in addressing hormonal imbalances. Personally, I feel bio-identical hormones should only be used as a last resort. Patients’ lifestyle (i.e.: blood sugar balance, stress levels, etc.) should be balanced first in order to address the underlying cause of the hormonal imbalance. Otherwise, it’s synonymous to “painting over the rust”. So unless the patient is at a “point of no return”, I NEVER start with bio-identical hormones. I look to support the hypothalamus, pituitary, and end-organ(s) of hormones production. The patient whose testosterone levels plummeted after being testosterone replacement therapy for over a year (mentioned at the end of my article) recently reported to me that his testosterone levels were remeasured and are now “kick-ass high”. They were well below normal, between 100-150 ng/dl; and after supporting his system nutritionally (without hormones) they’ve rebounded back up to above 500 ng/dl. I see this frequently; that is, hormones ceasing to work after being on them for a prolonged period of time, only to leave the patient back where they started (if not worse off than where they started). Thanks again for your comment.
I am a 64 year old female with depleted hormones. I had a heart attack in 2003, but have been fine since. I have had hot flashes for the past 10 years and they continue and have seemed to be getting worse. My mother, now deceased, from heart disease, had them too until she died at age 68. At least twice daily, I soak my blouses thoroughtly and am miserable from the heat I generate in my own body. I also wake up at night hot and sweaty. I thought that by now, at the age of 64, this should be over with. However, it continues. I have never used HRT , but now am thinking that bio identical hormonr therapy may make my quality of life better and, believe me, I am miserable now. My regular gynecologist does not prescribe bioidentical hormones, so I guess I will have to leave her and find another doctor that does. I will do anything at this point to feel better.
I am 57 years old and have been on bio-identical HRT for +- 4 years. I’ve never had a hormone test – is it necessary to have one before HRT is prescribed? My big concern is that I keep putting on weight even though I excersice and watch my diet. Before HRT I had hot flushes & feeling slightly depressed at times. Is it possible that HRT can cause weight gain? If this is the case and I want to stop HRT do I need to do it gradually or can I just stop using it? My doctor makes adjustments to the HRT everytime according to my symptoms. Sometimes I also have breast tenderness.
Hi Linda,
Whether or not it is necessary to have a hormone test before giving hormones might be a debatable topic. There may very well be some doctors that are extremely adept at using signs and symptoms in order to prescribe without actually measuring them. I personally would never do that, and also, I definitely consider some of my mentors “masters” when it comes to hormones; and all of them test – why go with signs and symptoms alone when there are so many great tests that can be run to give a true picture. A hormonal imbalance can certainly cause weight gain, whether it be estrogen, cortisol, insulin or thyroid hormone imbalances. So it’s hard to say whether or not the HRT was the reason for weight gain in your case, especially because I don’t know what your levels were before and after HRT. These are certainly questions you should be asking the prescribing doctor. You may simply need changes to the dose of what you are taking (again, hard to say in my position with the little information I have). I probably wouldn’t take someone off hormones cold-turkey, but then again, that depends on what they were on, and the dose. And don’t think that “female” hormones are everything, if you were my patient, I’d look into thyroid hormones, adrenal stress hormones (i.e.: cortisol), and the possibility of insulin resistance. These could all contribute to an ability to lose weight. Also realize that all hormones are interconnected and it may be a mistake to focus on just one or two. There is an intricate, dynamic balance that takes place in the endocrine system. I’d check you for other health markers (via blood), in addition to a thorough history and AK exam in the office. Hope this helps.
My best to you feeling better and reaching your goals,
Dr. Rob D’Aquila
In the case of the gentleman who was weaned off the bioidentical testosterone, what supplements etc. did you use to build his testosterone back up to high levels naturally? Thanks.
Gary
Hi Gary,
In the case of this gentleman, who is an individual as you know – meaning, this may not be the protocol that everyone needs who is looking to wean off bio-testosterone…
He took (very high-quality) tribulus – I say that because most tribulus on the market is “garbage”; support for his hypothalamus, pituitary, and gonads (“protomorphogen” glandulars), zinc, and a well-rounded blood sugar support supplement.
He was reluctant to take the blood sugar support supplement, presumably because of the cost. But my presumption was that his blood sugar was the original problem to begin with (he’s a vegetarian, and blood sugar issues seem to be very common in vegetarians). Sure enough, he came in a few months ago for a musculoskeletal complaint, and reported that his medical doctor wanted to put him on medication to regulate his blood sugar.
BTW – the reason blood sugar is key – or at least one reason – is because fluctuations in glucose and insulin will eventually result in an up-regulation of the enzyme aromatase, which will cause a male’s testosterone to be converted into estrogen.
Hope this helps,
Dr. Rob
Dr. I just started my bio-identical hormone therapy here in Austin ,Texas. I was on synthetic hormones for almost 2 yrs, but I was feeling so tired and my sex drive was gone, I wanted some relief and got on these hormones but now I have been breaking out with acne etc, also having some mentrual bleeding. Is it in your opinion better to get these hormone pellets inserted by a doctor that practices gynecology at the place where I went all they did was blood work and then started me on them, the doctor that does the pellet inserts is not a gynecologist. I am worried about my health and all the side effects that I wasn’t even told about when I got the process started. Please advice, I am having regrets and wondering if I did the right thing or should I look for another form of getting the bio-ientical hormones other than pellet inserts. Desperate for answers to my concerns. Thank you.
Please, What are the lifestyle changes you refer to in addition to the HRT? I was very hopeful about bio HRT but I just started taking bio HRT and the 1st night I had incredible breast pain and some muscle aches. There were no warnings or side effects on the Pharmacist which led me to your site. Are there any side effects that should be taken seriously?
I do have muscle flare ups (fibomyalgia) and high cholesterol levels, it was the cholesterol levels that made me start looking for alternative help other than statins which gave me horrible muscle joint flare ups. I am 51, work out 3 times a week, eat healthy, I had a complete hysterectomy 9 years ago, was on estrastest for a few years and decided to go off. I have been taking zoloft 50 mg and 5 mg ambien to sleep at night which has helped me for about 10 years now but my Dr is hopeful once we get the hormones balanced I can eventually go off those meds.
I own my own business which is very stressful and I have been having trouble handling the stress recently as well. There are times I feel like I am losing my mind but I have shared this with some woman friends and they are feeling the same, do I need Cortisol for the stress factor?
Thank you for answering my questions, God bless you
Hi Kathleen,
You should speak with the prescribing doctor about side effects and whether or not some of them are red flags. Hormones have very powerful effects on the body; the key is obviously getting the right balance.
When it comes to lifestyle changes – there usually needs to be an individual approach. However, in general, the lifestyle approach should always aim to lift as many (dis)stressors off the body as possible. That would include eating a healthy diet, with adequate amounts of protein – see this article for more on protein http://robdaquila.com/2010/10/08/dailyproteinrequirments/. Also, foods that cause sensitivities and/or allergies should be avoided. Other issues that should be dealt with are: gastrointestinal health, adrenal gland stress, toxic chemical and metal burdens, nutrient depletion, elimination/detoxification pathways, infections (protozoa, viral, bacterial and fungal) and general endocrine (gland) imbalances.
It’s difficult to prescribe a one-size fits all approach when it comes to health, because very often multiple people will have the same “problem”, signs, and/or symptoms with a totally different cause. But the basics for everyone would be covered well if the above mentioned issues were dealt with effectively.
As far as cortisol – I’ve never seen the need to use bio-identical cortisol, and would be very careful with it (as a doctor or a patient).
My best wishes,
Dr. Rob D’Aquila
Hello Monica, I am in a similar situation to you.
I am low Estrogen, Low Progesterone and LOw LH.
Normal FSH but 0.9 AMH!! low egg reserve .. I am 29!!
I am prescribed Bioidentical hormones which I am nervous to take. I have never experienced side effects like it.. burning in my stomach, insomnia, depression, etc…
I know my hormones went off balance when I was on fat burners and protein shakes with SOY!! and other toxins.. at the time I looked great so didn’t really see it!.. now I have had no periods for 3 years and we really want a baby.
Did you find a solution?.. I’m not sure what to do next..
I am 27 years old and am experiencing a number of symptoms. First, I’d like to tell you that I used to follow a very strict diet, cardio and weight training regiment consisting of a macro-nutrient breakdown of appropriate complex carbohydrates, fats and proteins. I have competed in several amature figure competitions so I have dropped significant amounts of weight and bodyfat, all the while building and maintaining lean muscle mass. Back in May I started intentionally putting on weight to gain muscle, I put on 30 lbs. A lot of this weight was unwanted but I knew it was part of “the game”… As I started to change my diet and training to lose the excess bodyfat I noticed that u was holding fat in my mid-section. I had not had a menstrual cycle in close to a year. I started retaining water throughout my entire body, gaining weight while still following a fairly strict diet. I noticed that if I would ingest larger than “normal” amounts of carbohydrates, especially refined sugar, processed foods, my entire body would swell. Since then, (September) I have been experiencing mild depression, more weight gain, (a total of about 35 lbs) lack of menstrual cycle, extreme food sensitivities, mood swings, excessive muscle swelling while weight training, intracellular water retention, difficulty concentrating, among others symptoms.
The research that ive done and some recent blood work indicate that I may be experiencing hormonal deficiencies; progesterone, thyroid, estrogen, etc. I would greatly appreciate any input that u may have. I am looking at seeing a specialist in BHRT.
Thank you for your time and consideration,
Monica
Hi Monica,
You may be experiencing the cumulative effects of “over-training syndrome”; which is essentially a culmination of metabolic effects that result in complete disarray of the endocrine system. Within the realm of the endocrine system, it sounds as if your adrenal glands have really suffered. They are usually the first to bear the brunt and then “all” the other glands follow in a downward spiral. The fact that you haven’t had a menstrual cycle in close to a year might be a big issue for you later in life – ammenorrhea for 1 year is a risk factor for developing osteoporosis. Find a very knowledgeable doctor… It’s hard to say if you absolutely need HRT (bio-id or not) based on what you said only. The tests and your symptoms would be the decision maker, so to speak. Recall that hormones measured through blood should be “free” – because it’s the free hormones that actually work at the cellular level – not the protein-bound hormones that are measured when a hormone is not prefixed with “free”. When you do a salivary hormone profile, it’s “automatically” free – that’s how they are in the saliva. It may be tough to get a good gauge on your “female” hormones because you’re not cycling, but regardless, they should be measured. Also, pituitary hormones are very important, in order to see how “far up” in the chain of command there is an issue.
I hope you find the care, attention, and treatment you need and deserve.
Best wishes,
Dr. Rob D’Aquila
Hi,
I just started on bio-identical progesterone replacement last week. I am pretty horrified, and looking for a better answer.
I’m almost 50 and hadn’t had a period in 10 months. Maybe a co-incidence, but last week I became terribly bloated, and started bleeding 4 days into the treatment. This is definately NOT the direction that I want to go!
To back up a little….I first saw my doctor starting about 4 months ago. He ordered blood tests and from those results put me on 2000 IU of D-3 and an iron supplement. He also started me on Cortrex and some adrenal support drops. At that time, I had only been about 6 months without a cycle, so he wanted to give it a few more months to make sure that I was truly in menopause.
I may need to back up a little more…I’ve been on about every anti-depressant that there is over the past 5 or 6 years, most recently Pristiq, with a Wellbutrin ‘kicker’. They keep me from being ‘over the top’, but mostly I have felt that they make me just not care as much – not a state that I want to spend the rest of my life in! Almost 2 years ago, I finished a 2-year time period on Depo-Provera as well. Two weeks ago – and a week before starting the progesterone cream – I decided enough was enough with the anti-depressants. (Got to be much too expensive, buying the Pristiq, plus the new Dr., and all the new supplements…) The doctor had wanted to take me off slowly…a better idea that what I did, I’m sure.
In the meantime, he gave me a saliva test kit, and the results from that showed that I was estrogen dominant and had low cortisol levels, and that brings me back to the beginning of this email…starting on the progesterone cream (30mg. – 1/2ml. two x per day) and increasing the adrenal support drops.
So I feel TERRIBLE (!!!) and went looking for an answer on the internet, and found you.
After reading your article, I know that I don’t want to go from being dependent on an anti-depressant, to being dependent on a hormone replacement, especially now, knowing that I will stop producing my own and stop getting results from the replacements!
What a nightmare – what can I do? Lifestyle changes? I give a lot of thought to my diet, I take good vitamins, get good excercise – nothing formal at a gym, but I take care of a farm-full of animals every day. I have gained a LOT of weight the past 2 years…from 135 to 170#, and I was hoping the HRT would help with that. Of course I’ve tried dieting…..it’s not something that I’ve been able to take care of that way.
Please help in any way that you can…nothing is working for me, and you can see that I’m not afraid to keep trying…
Thank you,
Deb
I started Bio- Equivalent Hormone Replacement over 1 year ago. I was in Menopause for over 5 yrs ( No Menstrual Cycle) but the hot flashes grew worse over the 5 years . I seen the commercial on TV for the HRC , all natural . So I thought that is for me! In days I was having pellets inserted. Only then after the inserted pellets did I learn that since I still have my uterus that I also needed to take progesterone. Hmmm really I thought , why wasn’t I told this before? Well you know now and we sell them here for $60.00 for 3 months supply. What will happen if I do not take it , I asked. You will bleed and might end up having a hysterectomy. Well good grief I sure don’t want that to happen.For 3 months I felt awesome. That ended after the 3 months , then I started to bleed , I called they said double up on the progesterone . OK , I did. The bleeding stoped for days then started again . It got heavy by each day that passed. They said something else is wrong with you. Hmmm Ok. I ended up in the Hospital to receive blood , because of so much bleeding . After many Doctors and test ( with no health insurance) I found out that I have Simple hyperplasia of endometrium , no atypia. This come from HRC. All the Doctors have told me this. I still after 8 months bleed . This has changed my life . I have lost my job, have a pile of Doctor & Hospital Bills and my state of mind is fragile .
I have changed my Diet to all organic Fresh Foods , NO Hormones in that. I have went totally Vegan . I really love it. This new diet has cleared up my sinus that I had suffered with for years , lowered my thyroid med.s to a mg that I have never seen in 12 years. Lost 15 pounds. The longer I’m on this Organic Vegan Diet the better I seem to feel . It has felt like the swelling has went down. I think that when I went through the change of life my body was make all the hormones that it then needed and, I was putting extra hormones in my body with the foods I was eating. With much research I have found out that all our meats our full of Growth Hormones .
Good luck with your journey .
Hi Deb,
Your bloating and bleeding for 4 days does not at all sound like a coincidence – but I can’t be sure. It sounds like you got your period. One problem with doctors using HRT (bio or not) is that they keep women menstruating “forever”, when that is not at all normal as you know. I’m not all saying that was the goal of your doctor, I’m just saying that it happens and it sounds like that happened to you.
Being on so many different anti-depressants etc. might indicate a (primarily) neurotransmitter-mediated issue. Neurotransmitters tend to take the lead in the hierarchy of biochemicals, as far as what is most important. I’d look into support for neurotransmitters based on your history.
Additionally, your issue of estrogen-dominance may be related to things other than a lack of progesterone. I won’t go into how to read a female hormone saliva profile, but it’s certainly possible that you have too much estrogen – period. That is, not too much in relation to progesterone, where simply giving progesterone “fixes” everything. Because it sounds like it didn’t. Very often, it’s not the body making too much estrogen, but a lack of clearing that estrogen from the system.
The weight gain could be a thyroid issue – but again, hard to say.
Lastly, it’s very difficult to tell you what to do without seeing the whole picture, etc.. Everyone has different needs, although there certainly are commonalities with many conditions or presentations. Information about blood sugar regulation can be found on my site, which is certainly something everyone needs to get in order if they want to be healthy and function well. You said you have a good diet, but it can still be an issue. Anyhow, I wish I could give you more things to do, but not knowing the whole picture is an issue.
I plan on writing more on ways people can balance hormones in general.
Good luck with everyone!
Dr. Rob D’Aquila
Fine article Dr. D’Aquila, thank you! I am an herbalist and am now in the “throws of menopause”. I stumbled upon Suzanne Somers book and read it and was still skeptical about bioidenticals and you have explained the body’s process in a very understandable way!
I want to urge people to trust in nature’s gifts of whole organic foods, and herbs, essential oils and homeopathic remedies, exercise, fresh air and laughter! It’s never too late to begin a healthy lifestyle.
Support sustainable living for yourself, your community and your earth!
Thank you for the informative article. I have had a total hysterectomy about 2 yrs ago. Initially, I was started on Climera Pro, a estrogen/progesterone patch. I used it for maybe about 6 months but stopped when I didn’t feel I was having much in the way of the traditional post menopause symptoms. Now I have noticed that I am very forgetful (enough to be concerned) and I am also very stiff and achy. What do you think the chances are these symptoms have to do with my hysterectomy and do you think bio identical will help? I am 44.
Thank you,
Cynthia
Hi Cynthia,
I’m glad you found the article informative. I’d say there is a 50/50 chance. But then again, I don’t know anything about your history other than what you told me. It’s even possible that 6 months of hormone replacement is the main contributor to your symptoms. If you were my patient; in addition to a full history, I’d run a full (blood) thyroid panel (and full blood chemistry), along with adrenal and “sex” hormone salivary profiles to see where your levels are. Loss of memory can be very thyroid specific, and being stiff and achy could be a calcium metabolism issue. If there is a calcium metabolism issue it could be related to many things, but certainly “female” hormones would play a role as estrogen plays a significant role in calcium metabolism.
My best to you,
Dr. Rob D’Aquila
Dr. Rob, Interesting article! I am 2+ yrs into menopause with only symptoms being night sweats a couple times a night and slight vaginal dryness. I otherwise feel great and make sure I strength train to protect bones. (I am a tad underweight) My question is: is there any reason for me to consider bioidenticals? My doctor prescribed vagi-fem but not sure if there are any side effects.
Hi Janet,
I’m glad you found my article interesting. It sounds as if you are doing better than most women in menopause. I don’t see why you’d consider bio-identicals with the way you describe your current health. If anything, you can get a work-up and have all your hormones measured along with other blood and perhaps bone-density tests. And as eluded to in the article, if you were my patient, I wouldn’t start with bio-identicals. They’d be a last resort, and again, especially because you don’t seem to be experiencing many symptoms. There are plenty of natural ways of going about it without bio-HRT – and considering the side effects that can come with it. Here’s a link to the side-effects of vagi-fem – http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000333/.
Take good care,
Dr. Rob D’Aquila
I am 53 years old and had a uterine ablations approximately 8 years ago. I have been having lots of mood swings, some heart palpitations, no libido whatsoever, vaginal dryness, dry skin and forgetfulness. I take thyroid medicine and have been doing so for many years. I have had complete blood work done and my testerone level was apparently bottomed out. My doctor recently started me on Estradiol and Testosterone injections every three weeks. I am a little afraid of taking these hormones and keep doubting whether to continue to do it or not. Can you give me some advice on this.
Hi Yvonne,
Sorry to hear about all that you’ve been through and continue to go through. I can’t give you “advice” about anything online because you’re not a patient, etc.. But some things to consider: a) the dose of your thyroid medication might need to be adjusted based on the symptoms of heart palpitations; b) there are many possible reasons that your testosterone level is low (e.g.: nutrient deficiencies, adrenal gland stress, hypothalamic/pituitary/gonadal axis dysfunction, liver dysfunction, etc.), and c) your thyroid may not be functioning optimally despite being on thyroid hormone.
Even if you were a patient in my office, I could not tell you to or not to take prescription medications (e.g.: injectable hormones) because my license as a DC does not allow me to. Although, I would be willing to consult with a patient’s prescribing physician about the matter – although in my experience that doesn’t go very far…
As you read in the article above, (bio-identical or synthetic) hormone replacement therapy can be appropriate in certain cases, but I never start with that. I start with diet and lifestyle; and then nutritional supplements to support systemic and metabolic health, in addition to in-office treatments.
In conclusion, it’s quite possible (and perhaps probable) that the original issue approximately 8 years ago was never dealt with to a degree that would lend to hormone balance. Ablation may be necessary for some women in certain situations. But if nothing was changed to correct the underlying imbalance that caused the “need” for ablation (excessive build-up or lack of shedding the uterine lining) in the first place, then the problems might continue to persist and show up as symptoms at a later date. And, it’s very possible that estrogen and testosterone imbalances were the original cause for the thyroid dysfunction.
I understand your fears about taking the hormone injections. There’s always the option of getting a second and even a third opinion.
My best to you,
Dr. Rob D’Aquila
Have you any experience with bio-identical hormones altering your ast level ?
Hi Teresa,
I have not in fact seen any direct relationship between the use of bio-identical hormones and serum AST levels. AST (also known as SGOT) is an enzyme that’s present in many tissues: heart, liver, muscle, kidney, brain, pancreas, spleen, lung. Damage or injury to any of those tissues may cause a rise in serum levels.
AST levels should also be looked at amongst “all” other blood markers to determine if there’s a pattern.
Best,
Dr. Rob D’Aquila
I am 64, and 5 1/2 yrs post breast cancer diagnosis. I had two positive biopsies in one breast and a positive lobular in situ in the other breast. I had taken prempro for 10 years. I have an oncologist that was aminiable to a wait and see situation, even tho two very good surgeons suggested a double mastectomy. I quit the prempro and started with a aromatase inhibitor (Arimidex) and six months later a MRI showed no more cancer and I have had a MRI every year since without any suspisous concerns. But this lack of estrogen has been very hard to deal with. I have hot flashes every couple of hours and all night long. I am very cautious about anything with estrogen, but the symptoms have all but finished my sex life, which I would like to have back. Will the bioidentical harmone treatment create a more likely reacurrance of the cancer, or do you think it is safe under my circumstances?
Hi Sue,
If bio-identical hormone replacement therapy (bHRT) is done properly and when “necessary” (which may be debatable); it shouldn’t cause harm. Also, recall that I consider bHRT to be a last resort and/or something to “prime the pump” temporarily while working to get the endocrine system functionally properly (via lifestyle and supplements). The way to get the endocrine system back on track will vary amongst individuals. Areas that need addressing might be: 1) adrenal gland function; 2) blood sugar balance; 3) liver (and possibly other organ) detoxification; 4) microbial balance in the digestive system; 5) thyroid function; 6) immune system regulation; and/or possibly more. You would obviously need to consult with your oncologist to determine if it’s right for you given the situation you are (or have been) in. Lastly, if a patient told me that an aromatase inhibitor “fixed” their problem; the first thing I would look at would be blood sugar and insulin balance, as insulin plays a major role in up-regulating the enzyme aromatase.
BTW – Sue, you are right in questioning whether or not estrogen replacement will cause issues with breast cancer. This is one scenario where you have to be extra careful. Again, your oncologist (or a second and third medical opinion) would be “best” to guide you. Without knowing all the details, what your tests say, and the fact that you are not a patient of mine says that I cannot intervene and give recommendations.
All the best,
Dr. Rob D’Aquila
My wife and I are looking for answers. Lynn was on Fenhrt for 4 years, she had a stroke Feb 15th. They can not find any reason for the stroke!. I have read about Femhrt and an increase of 41% of strokes in a study that was stopped.
She came out fine as her boss caught the symptoms and called 911. Major stroke but no side effects except she is tired by early afternoon.
Can you suggest anyone in the Des Moines Iowa area to see.
She has night sweats, mood change, anxiety, headache, and worrys about everything.
Medical or natural meds?
Hi Ken,
It’s terrible to hear about the scenario your wife (and you) have been through. Typically, when I refer and am not familiar with a doctor in the area where one is needed – I point people to the ICAK website – as that is my specialty. Although, no matter what specialty a person is in, it never guarantees any competence for any particular issue. Here’s the link – http://www.icakusa.com/.
Wish I could be of more help,
Dr. Rob D’Aquila
PS: If you find someone, I can let you know if I know or have heard of them
Dear Dr. D’Aquila,
I am on three years of hormone replacment. Right now
I have excessive bleeding and going in tomorrow for a
pelvic scan, I really want off these hormones. I have gained
close to 18 pounds. What is the best way to get off hormones. I did have the hormone test I am low on progesterone 2.5.
I would appreciate your input.
Yvonne
I have enjoyed reading your site, please keep me informed.
Thanks,
Eddwina
Hi Yvonne,
The best way to get off hormones is going to be different for everyone. It depends on so many factors, and the first place to begin is by measuring hormone levels. And hormone levels should generally be measured through saliva.
You’ll most likely need to work with a (competent) health care practitioner who is knowledgeable is this area.
Things that typically need addressing are:
1) hormone receptor site re-sensitization
2) liver detoxification
3) hypothalamic/pituitary/gonadal axis support
4) digestive support
5) adrenal support
6) thyroid support
Numbers 4-6 will usually vary the most between what type of support individuals need.
There certainly can be other outliers, but that’s a good place for most to start.
Good luck and I wish you the best,
Dr. Rob D’Aquila
I’m going to my local gp on Monday.
I am 69. The weight gain , hot flushes , memory lapses , and loss of sexual intrest , has me finally going for help. I am not takeing any medication . I have had a hystorectomy years ago ( at 41 ) . They found cancer cells on the uturus after the hystorectomy.
My question is ,,,what kind of test’s do I request from my gp?
Hi Brigitte,
(the long explanation…)
My second thought to your comment was” “How can I answer this question and be politically correct?”.
My guess is that if you asked anyone who knows me even remotely well; if I was arrogant; they’d say “No”.
As you know I am a chiropractor who practices natural, functional “medicine”. And many (definitely not all) of my patients also see medical doctors and get blood work ordered through their MD’s.
I’ll give you two recent examples that come to mind when I asked patients to bring me a copy of their blood work.
1) The original tests of a gentleman showed a significant gallbladder problem – that is, his bilirubin test was out of the reference range based on the standard tests. I immediately said, (not necessarily exactly, though I’ll use quotes): “You need to get another blood test which measures “direct” and “indirect” bilirubin to see where the problem may be stemming from”. He went back, got more blood work and still the tests were not ordered, just the same ones. I then saw another standard marker on the new test which was normal on the first, “alkaline phosphatase”, which was extremely high (the problem had gotten worse). The patient informed me that his doctor was still not concerned. After urging the patient to get imaging studies done on his gallbladder, because I suspected that at any moment he may have a “gallbladder attack” and need to be rushed to the emergency department where they’d routinely take out his gallbladder, he did so and got the imaging study. Sure enough, there were many gallstones, and he then went forward with a type of surgery known as an ERCP, which essentially finely slices the gallbladder to relieve the pressure of the bile/stones. Much better than having the gallbladder removed, but possibly avoidable had action been taken sooner. This patient is from out of town (Michigan), and so I only see him when he’s in NYC, I had very limited one-on-one contact with him throughout.
2) A woman brought in her tests that showed elevated TPO-antibodies which indicates that she had “Hashimoto’s Thyroiditis”. I said: (something like) “OK, so you know you have autoimmune disease” and she looked at me with horror saying: “NO!, what do you mean!”. I said: “Your tests clearly indicate that you have autoimmune thyroid disease; your doctor didn’t tell you that?”. She said “No!”
I can give you many more examples but don’t want to go overboard. Based on extensive experiences like this, I have very little faith in “average” GPs (or other “specialists”), and their ability to spot or prevent a problem (even when it’s in “black and white”).
In conclusion, because your symptoms seem to be one of a functional nature, I doubt that your “local gp” would order the presumably necessary tests to determine where to begin. What I see with patients is that their MD’s are only concerned about pathology (which is how they’re trained) – so I can’t “blame” them.
If you were my patient, I may or may not order more than standard blood tests, but I certainly would not rely on the interpretation of a “local gp”. Again, that’s simply my experience.
You may or may not need functional tests (e.g.: salivary hormones, functional stool tests, etc. etc. etc.). Most times I ask a patient to have certain tests run through their MD’s, they come back saying their MD’s didn’t think it was necessary. I now order my own lab tests for patients; and they prefer that.
You can start with FREE “sex” hormones run through blood, but even if those tests are out of range, it doesn’t necessarily point to where the true cause of imbalance lies.
“At then end of the day” – The problem essentially lies in your question: “What kind of tests do I request from my gp?”. You should not have to ask your health care practitioner what tests he/she should order. They should know. If you request tests based on my recommendation, what are the chances they’d be able to interpret them anyway.
BTW – if you had cancerous cells on your uterus 28 years ago, I might first look for malignancies in other areas of the body… not that I suspect them based on your symptoms.
Best wishes,
Dr. Rob D’Aquila
[...] symptoms. Additionally, simply treating symptoms of estrogen dominance and hormone imbalances with bio-identical hormones may not be the way to [...]
I just came across your site looking for information regarding Bio-identical hormone replacement therapy. As I began reading along I thought I would tell you ‘my story’.
I am 47. Had my first son at 35, second son one month shy of my 40th bday. While pregnant with my first son, I began experiencing heart palpitations. A few years after the birth of my second son I was diagnosed with Wolfe Parkinson White Syndrome. I am still menstruating although my cycle has changed – shorter in duration, more intense cramps and bleeding, stops completely in 2-3 days. A few months ago I began getting what seems like some sort of hormone blast (I had one of these a few days after the birth of my second son – my OB said it was my hormones readjusting)…heart races, sometimes WPW kicks in, hot flash, dry mouth, then after my heart starts to beat normal my body begins to shake uncontrollably – I feel cold to freezing. I have had all blood work done. Everything is normal. Thyroid, hormones, glucose levels, iron, etc. My doc thought perhaps I was hypoglycemic because if I am stressed and have not eaten enough the episode will occur – sugar test was normal. By mid day I am completely exhausted – to the point where I NEED to lay down. I am stressed out. I’m a stay at home mother who home schools my sons, 10 and 7. The tiredness is so severe at times that I feel as though I have NO reserve and laying down sometimes does not help right away. I also experience peri-menopause symptons – heart palps, night sweats, mood swings (mostly crying), weight gain. I have just been to a doctor who specializes in peri and meno – pause. She said everything I’m experiencing is peri at this time and suggested HRT. My primary doc says NO because of my WPW. I do take 1/2 – 1 tablet 25mg of atenolol when I have the heart racing episodes. Today I laid down, later afternoon, felt kind of funny after about an hour, went to get up and my heart began racing, then went to fast normal beats, then the body shakes – like shivering cold. The episode lasts anywhere from 15 to 45 min.
I should also tell you that this past winter (Dec. thru Mar.) I have not eaten well, nor exercised much. Typically I walk 30 minutes a day outdoors and do free weights.I have begun exercising again. 30 minute workout 5X a week. Started to eat healthier, more greens, lean protein, fresh fruits. Limit sugar. No caffeine. No alcohol. Sleep the best I can. Try to get 8 hours. I take a Women’s daily supplement, 1T of chlorophyl daily, began 1000mg of Vit D – one drop daily, and sublingual B12.
The fatigue is nearly debilitating. And I am experiencing depression now. Also, I live in the upstate New York – dark and long winter this year. Are there any flags as you read that my docs and myself may have overlooked. Would you suggest seeing a endocrinologist?
I appreciate any suggestions. Thank you,
Kolein
I’m glad I read your article. My doctor uses bioidentical hormones, and recommended them to me, for my borderline low testosterone. After reading your informative article, I know I won’t proceed with it. My question: Are you familiar with any studies done on the use of “Tongkat Ali extract” to raise testosterone levels? From the articles I’ve read about this herb, it seems to have a positive feedback loop. It increases the body’s own testosterone production by stimilating the secretion of luteinzing hormones, which in turn, stimulate the leydig cells of your testicules to produce testosterone.
Hi Kolein,
There’s obviously something “wrong”. Typically, when I see a woman “in trouble” experiencing symptoms of peri- or menopause, the adrenal glands are the culprit. And “you” can’t fix the adrenals, unless you fix blood sugar handling, and you can’t fix blood sugar if you don’t fix the diet (and often, but not always, include exercise). And you said your diet hasn’t been great recently. When a women goes into normal peri- and menopausal changes, her ovaries essentially “go to sleep” (which is normal); the other main reserves for “sex” hormones are the adrenals. So when they are stressed, women will often experience all the typical peri- and menopausal symptoms.
I basically never start with bioidenticals, though in some cases it may be necessary to “prime the pump”.
Your symptoms sound related to blood sugar, adrenal, and thyroid hormone imbalances. I can’t imagine that all your tests are “normal”, especially if functional (i.e.: not pathological) blood reference ranges are used for assessment. Also, it’s not always easy to pick up a blood sugar imbalance if only glucose is measured. HbA1c would be a better test to determine long-term blood sugar handling, along with an adrenal hormone analysis. And again, your symptoms sound like there certainly are blood sugar issues; in addition to possibly bouncing in and out of hyper and hypo- thyroid/adrenal hormone balance.
I can’t determine what type of practitioner (e.g.: endocrinologist) will be best for you. But I can say that a competent physician who understands functional medicine and endocrinology is what I’d be looking for. And a practitioner doesn’t have to be a medical doctor or medical specialist to understand functional endocrinology. They just need to study it well and know their “stuff”. And that very often includes chiropractors and naturopaths these days.
Good luck with your path to better health, and I wish I could offer more; but not being a patient of mine, and not examining and reading your lab tests is certainly an obstacle to determining what you most need.
Take good care,
Dr. Rob D’Aquila
Hi David,
Glad you enjoyed the article. I’m not at all familiar with “Tongkat Ali extract”. It’s not that I’m not interested in learning about new products and compounds. There’s just so many products that already exist and work quite well. I suppose if I find myself in a rut, I’ll branch out to new and “obscure” herbs, etc..
As far as the positive feedback loop effect – I don’t see how that’s possible. The endocrine system is “hard-wired” with negative feedback loops. That is, if more testosterone (etc.) is in the bloodstream, the hypothalamus and pituitary will stop producing hormones that stimulate the production of even more testosterone. If it were possible for a compound to override the negative feedback loops, I imagine the system would go completely “out of whack” and who knows what the end result would be.
The only hormone that I’m aware of that has a normally existing positive feedback loop mechanism is oxytocin.
Good luck with everything!
Dr. Rob D’Aquila
I’m 53 years old No major health problems execpt peri-osteo in which i was taking fosomax, but stopped taking it a couple years ago, because i didnt want to take it anymore. I’ve been diagnosed as hormonal, and my symptons are: trouble falling asleep and staying asleep, weight gain, light mood swings, and low sex-drive. I found alot of positive information on bioidentical hormone replacement, but after reading your article, I too would rather this be my last resort. I do exercise and try to eat healthy, but keep gaining weight anyways. Before I stopped my period about a year ago, I weighed 109 – 111, now I weigh 118-120. (5’2″) Is there any other way to get my hormones balanced naturally? Will eating the right diet do this? where do I find the right diet? Should I take Bhrt? Please help~~This is all so new to me.
Hi Debbie,
There certainly are ways to get hormones balanced other than using bioidentical hormones. In some cases they may be necessary, but in the patients I see, they are the exception. Eating well is definitely necessary to balance hormones, but usually diet alone is not sufficient to fix the entire problem. The right diet is somewhat individual in regards to what foods NOT to eat. However, it can be generalized that sugar and processed foods need to be avoided for (typically) all people trying to regain health, or even maintain health.
I don’t know enough about you to say whether or not you “should” take Bio-HRT; and I certainly couldn’t make specific recommendations without examining you and seeing test results. And again, I almost, if not always try a more conservative approach before starting with hormones.
Being that this is all new to you, I’d say you need to find a licensed, competent health care practitioner that you trust. Perhaps a referral is where to begin.
Good luck with everything,
Dr. Rob D’Aquila
hi im 50 years old i started bio identical hormones its been about 4 months i have pellet put in i also get a b-12 shot when i go back in june im not sure if that was the right thing to do .i was feeling better at first im feeling like im haveing the same sign again which is mood swings lots of weight gain very tired doing the day very depress i do take anti-depression pill which is zolft wellbrtuin in abmien to help with sleep.just dont feel like my self dont know what to do .can you gave me some advice
Hi Teresa,
I cannot give advice to anyone who is not a patient and signs a consent form, along with a HIPPA form.
Also, I don’t have much information to go on and speak generally about your symptoms. But obviously it sounds as if your treatment is not going the way you’d like it to.
If it were me, I’d speak to the prescribing physician and if I still didn’t get what I thought was a competent response or change in treatment, I’d seek another (competent) practitioner.
Wish I could be of more help.
Good luck with everything,
Dr. Rob D’Aquila
Hi Esmi,
It is my opinion that a person go to a doctor who is competent in using bio-identical hormones, endocrine physiology, and the best methods of testing and interpreting those tests. I can’t see why it would matter who gives you the hormones, assuming it is in their scope of practice to do so the way you are describing.
Personally, I’d use a sub-lingual route. But again, no matter what the route, it needs to be done properly. Creams are almost always a problem and the worst route.
Best of luck,
Dr. Rob D’Aquila
I am interested to know if its possible to balance hormones by using nutrition, homeopathy, herbal remedies, and practicing, Tai Chi or Qi Gong during/post the menopause? There is no hormonal imbalance, at present.
Same question for my mother who had a full hysterectomy, including the ovaries.
Many thanks
Hi Rainbow,
I/my patients do it “all” the time. I presume “nutrition” refers to diet and nutritional supplements. It may be more difficult for someone who has had a total hysterectomy. Although, she may also be far enough past menopause that the ovaries are less important for producing hormones than the adrenal glands.
Best wishes to you and your mother,
Dr. Rob D’Aquila
Hi Dr Rob
I have been using bHRT for about 6 months. I started taking it out of desperation. I wasn’t sleeping, had constant brain fuzz, couldn’t concentrate – basically, I was unable to function. I run my own business so I had to do something.
Mind this hasn’t been without problems and I have ended up with some serious breast cysts – had a couple of FNA’s but am not confident they won’t come back.
I find the information that I am receiving from the Drs a little confusing and perhaps quite conflicting.
However, your comments reminded me of my intial concerns. When do I stop? The Drs assure me that the doses I am taking will not keep my cycle going. I don’t want to be taking these things long term. My initial plan was to take it to help me over a hump – how do I know when the hump has passed?
Over the period that have been taking them, I have stopped on serveral occasions and the symptoms began to return. The first symptom that comes back when I stop and disappears when I start is waking up with a headache.
thanks
Jenny
I am about to have a hysterectomy one week from Monday, i am hearing all sorts of “stories” about my hormones going out of wack immeadiately following the procedure and all the different ways to replace these hormones – what would you suggest is the safest route to go…medication, bioidentical or herbs (natural – if this option is available).
Please help, becoming very nervous!!!!
Hi Meg,
It’s impossible to say what would be the best route for you at this juncture. We don’t even know how you’ll respond to the procedure; and won’t until the procedure is finished. If it were me, I’d get several opinions from competent practitioners who are familiar with and use different approaches – including lifestyle. I’d also try stress reduction techniques to calm the nervousness.
Good luck,
Dr. Rob D’Aquila
Hi Jenny,
Your concern of when and how to finish treatment is an important one. Some doctors don’t take this into consideration when beginning treatment. So in essence, sometimes there is no treatment “plan”. Does your doctor have one? Shouldn’t you be asking the question you posted to him/her?
Regarding the “hump” you speak of, there are really only two options. A) you surpass the “hump” or B) or you don’t. It’s hard to say how long a person will take to respond to treatment. And if a person is not on the right hormones, “delivery system” for those hormones, and/or doses – the treatment won’t work well. Lab tests can help determine progress, but your signs and symptoms obviously need to be taken into consideration; especially because the tests can all look normal, while the patient still has symptoms.
Here’s how I see it. If you never addressed the underlying problems that first caused the symptoms to appear – you may never get over it, and if you do get over it with hormones, that “hump” may reappear after you stop taking them.
Good luck,
Dr. Rob D’Aquila
What is your opinion on Bio identical Hormone therapy in pellet form? Have consultation next week and am very confused
Hi Maria,
I prefer sub-lingual pellets or sub-lingual liquids. It’s the creams that I wouldn’t touch with a 10-foot pole!
Good luck with the consult – always ask questions. Always get a prognosis and treatment plan. And of course, periodic re-evaluations.
Best,
Dr. Rob D’Aquila
I’m interested in knowing why you wouldn’t touch the bio id creams with a 10 foot pole? I just started them and am looking for answers on side effects. I am having a little ovarian tenderness and slight cramping. I’ve had 6 years of wild hot flashes, took the genetic test to find out I don’t have the breast cancer gene and started the bio id cream.
Kristi
Hi Kristi,
When it comes to creams – the typical response I see is overdose of the hormone. Once the person gets tested (appropriately), their levels show extremely elevated. Obviously, the amount of time that the person has been taking the cream will play a role as to how overdosed they actually become. Additionally, it’s said that the hormones tend to build up in the subcutaneous fat and the hormone gets released at random.
The problems with overdosing are basic imbalances of the hormone of itself, that hormone in relation to other hormones (proper ratios are thrown off – which will affect the way other hormones work), receptor site down-regulation of that hormone (which affects that hormone and can also affect the way other hormones work because some hormone’s action(s) are dependent on others), and then there is dealing with clearance or detox of the overdosed hormone.
Hope this helps,
Dr. Rob D’Aquila
Hello Dr D’Aquila,
I’m stunned that you have taken time to respond to so many posts. How incredibly compassionate of you! I know NYC well and can picture where your office is precisely. If I lived there, I’d be your patient! As it is, I live in LA and know Susanne’s doctors quite well. They both take the bio-identicals and have urged me to do the same. I’m terrified, as I’ve seen personality changes in both of them.
That said, I am suddenly in peri-menopause. I cry/rage/bloat/sweat/mood swings, etc. I went to my long-time Chinese herbalist and whatever he gave me seemed to work for the month I had the herbs, but one must return for a whole new customized prescription every month and that’s expensive and may be solely the placebo effect. I’m wondering about your opinion?
A New York doctor prescribed me diethylpropion and hydrochlorothiazide years ago for weight gain and I can easily wrangle another prescription – it works like a charm on the middle aged weight gain. But the heart palpitations are overwhelmingly terrifying (and apparently permanent) and the withdrawal symptoms are literally life-threatening, so I’d LOVE to find something that helps me lose the chub AND stabilizes my hormones. My cycle has always been just 24 days like clockwork – still is – although now it lasts for 9-10 days!!! this means I’m almost always in hormonal flux.
What do you recommend in general? I am an active woman (4 hours crew rowing per week), I eat right except for 5-6 days per month when I am so emotional I will drive past Whole Foods to buy cheap candy or cookies – and thus I never lose the spare 18 lb. I’m afraid to try HRT because I’m sure my ego will get addicted instantly. The alternative seems to be liposuction and then locking myself in a padded cell until this passes! Your perspective would be SO appreciated. Thank you for helping all of us.
Hi Susan,
I apologize for the time it’s taken me to respond to your comments and inquiries. It just so happens I’m traveling in LA right now.
If you’re ever in NYC, stop by! I’m two doors down from Carnegie Deli.
I have no idea who Suzanne Somers’ doctors are, and can’t comment as to there competence or individual recommendations.
As far as the Chinese herbal recommendations, it’s hard to say if they were appropriate, though it sounds like they helped you. Do keep in mind that it’s common to need more than one month of treatment in order to get everything balanced out; and the time-frame would also depend on the extent of the imbalances. Also, if it were me, I really wouldn’t care if it were a placebo effect or not, as long as I felt better. Then again, it would be nice to know that things are on the right track.
In general, I recommend the following:
1 – drink enough pure, clean water
2 – keep blood sugar metabolism optimal
3 – make sure digestion is optimal – i.e.: eliminating an overgrowth of any yeast, bacteria, viruses, and certainly parasites; eliminating food sensitivities; having a proper amount of HCl and enzymes; and making sure “leaky gut” is not an issue
4 – get liver and gallbladder function up to par
5 – eat adequate amounts of protein
6 – get stress hormones under control and balanced (whether too high or low)
7 – exercise if you’re lifestyle does not include enough activity
8 – make sure thyroid function is optimal
9 – get and keep the structure of the lower extremities and pelvis “in order”
10 – work out any underlying emotional issues (conscious or not) that may be causing physical symptoms.
11 – make sure the immune system is balanced
Many times all of these points don’t need to be addressed individually, however it may be necessary.
I hope this helps – and as you know, it’s hard to be specific with a person’s needs when I don’t have the full picture (e.g.: lab tests, exam, etc..). And I can’t offer specific recommendations to anyone who is not a patient.
Good luck Susan!
Dr. Rob D’Aquila
You say “change of lifestyle’, what would that change be? I understand a healthy lifestyle, that has not changed my low hormone levels. I do not eat sweets. I eat sprouted wheat bread, lots of fruit and greens, still have the outrages weight gain after going to the gym two or three times a week and having an active life with friends and small child still at home???
Hi Yvonne,
The change of lifestyle would depend on what the person needs. Nothing is cookie-cutter, at least from what I see. Everyone needs healthy blood sugar regulation, and fruit can be a problem for some. Wheat, whether sprouted or not, can definitely be a problem. And that’s whether or not a standard blood test finds true celiac disease. Everyone needs adequate protein and healthy fats. An active life is great, a healthy diet is great, but keep in mind that there can be an existing functional (i.e.: not technically a disease process) issue that needs to be dealt with – whether in the liver, the adrenals, the thyroid, the female endocrine system, the gut, etc..
Best,
Dr. Rob D’Aquila
I did the bio Identical Hormone replacement therapy for 1 year. My last pellet implant was in June. Back in April my husband noticed that I was hunching in my sleep. I was getting estrogen and testosterone and B12 shots. Are these possible side effects?
Dear Dr. Rob,
Your information is interesting, but I miss the most essential information: The dosage of BHRT applied.
As far as I know most, if not all, problems related to hormone replacement therapy are caused by application of (too) high doses.
For instance suppression of your own hormone production does not occur if low doses of BHRT are used. The same holds true for hormone receptor insensitivity. You also mention that yourself as you write ‘when bombarded with large doses of a hormone’.
So the answer needs not be to totally avoid using BHRT, but to make sure that doses are low enough to be safe to make sure that dependency does not occur.
For instance, what dose of testosterone does the patient you describe in your article use. And what kind. Without that essential information what you write is not of much use for the reader.
I use BHRT in low doses prescribed by a world-famous hormone specialist and anti-aging doctor called Dr. Thierry Hertoghe from Brussels in Belgium and trust his very extensive expertise and experience in this field.
I think it is good to not use hormone therapy if there are alternatives that work. I respect that approach, but as far as I know BHRT are safe when applied at appropriately low doses.
Best regards,
Jeroen Buis
Hi Jeroen,
Thank you for your excellent, very informative comment! You make great points, and I am very appreciative.
For the case I mentioned, it was a testosterone cream, and therefore “you” can be sure that it was overdosed, as that’s what happens when most if not all creams are used.
I certainly didn’t go into every possible scenario that could happen. As you know, I’d have to write an entire book on the subject, as others have.
The reason I focused on the downsides is because that’s the usual scenario I see with people. Additionally, this article is THE MOST read on my website, pointing more towards the extent of the problem.
I did qualify that there are certain times and applications when BHRT is helpful. I’m not at all against it. The problems arise when people don’t make the necessary lifestyle changes needed to fully help support their endocrine system and then begin BHRT expecting to “fix” all their problems. What I see is people looking for a magic bullet, not changing their lifestyle, going on BHRT and then falling apart. They suffer partly because of the dose, but also because they are perpetuating the problems with not changing their habits (mainly dietary and stress), and also using creams.
I totally agree that BHRT can be safe and is often necessary, especially if there is an antibody reaction by the immune system to the glands that produce the hormones that are needed. Additionally, synthetic HRT can be fine too, but I’ve only seen that with thyroid hormone.
Thanks so much again for your great comment and bringing more clarity to the issue. Hopefully all my readers see your comment.
Take good care,
Dr. Rob D’Aquila
Hi Kim,
I’ve never heard of “hunching in my sleep” as a side effect of hormone use. But anything is possible. One motto I practice with is: “anything can cause anything”. Good luck, and you should seek the help of a competent, licensed health care practitioner.
Dr. Rob D’Aquila
Hi Dr Rob, I have recently started Bio Identical Hormone Therapy (not widely re commended in Australia it seems) due to being post menopausal and having absolutely NO libido – I am only 47. All my hormone levels (measured via blood test) were way below the minimum normal level, and my testosterone was so low it was not measurable.
My GP was skeptical so I found a Dr who was pro BHT. 8 weeks in I have developed a very “sensitive” vagina and it seems larger or puffier. Is this normal? Right now I don’t want my husband to go near me which kind of negates the reason for starting the therapy in the first place!! Is this something that will balance itself out or is my prescription out of balance?
I appreciate your time and look forward to your feedback.
Hi Jo,
If your blood tests were “way below the minimum normal level”, then you can be sure there is a problem.
Your symptoms don’t sound as if they are “normal”. And as you said, it’s certainly not helping the reason you started BHRT.
I can’t make specific recommendations as far as treatment. However, if you were my patient, I’d take a thorough history and do a thorough exam along with more tests to try to determine a mechanism for why the levels are so low to begin with. There can be many and in any patient, they should always be addressed whether or not BHRT is working.
Hope this helps.
My best,
Dr. Rob D’Aquila
Hi Dr Rob
What constitutes a low dose? I have gone of the BHRT because I had side effects. The practicioners response was to increase the dose, which made things worse.
I am guessing that low dose is a dose to which there are no side effects.
Regards
Jenny
Hi Jenny,
It’s hard to say what a low dose is. It’s an issue of biochemical individuality. Testing hormone levels is certainly necessary to help determine the dose.
Side effects can be for many reasons. One of which can be fillers in the supplement, although that’s much more common in thyroid hormones.
If I saw side effects with a dose, I can’t imagine I’d increase, but then again, I don’t know your case history and presentation.
If I was taking them personally, I would start at the bare minimum and increase the dose until the desired effect was reached. But that’s with me. I can’t say with you. Additionally, I’d get all lifestyle changes in place first. Those would include diet and stress. And as mentioned, I prefer not to start with BHRT. But that also depends on how symptomatic the patient is, and how awry their physiology is to begin with.
Good luck,
Dr. Rob D’Aquila
Dr Rob,
So grateful to happen onto your site…was on the verge of spending 400 dollars to have hormone levels tested, then even more for the bioi hr. Like so many others, was desperate for a full nights sleep, return of libido, etc.
History: 58 years old, on climara patch 3 years, slowly weaned off as of feb.2011. have been administering low dose progesterone creme (over the counter, from health food store), and trying valarean root and D3 & lemon balm sleep formula. I guess my first step is off the cream? what can i do to support my system during this process? I strive to maintain a healthy lifestyle, ie healthy diet, exercise, yoga, prayer. Your input would be greatly appreciated. Deb G orange,CA
Dr. Rob,
I live in a small town, but within a 90 minute drive of three large cities in Middle Tennessee. My problem is in finding a competent practitioner that can assess all of these issues and guide me along the path to wellness. I have struggled with depression for most of my life, and have found very little help in traditional medicine. I am currently on cymbalta, but am so tired and foggy all of the time. I have tried several anti depressants as well as ADD medications. I have an appointment to see a doc about BHRT this week, as I am open to trying anything, but am very apprehensive about throwing more chemicals into my very sensitive system.
Ideally, I would like to find someone like yourself who looks at the whole body and how all the systems work together. I read about Dr.’s like yourself and others, but don’t know how to find one that is in my area. What types of questions do I ask? What should I be looking for?
Thanks so much for your time and commitment to health.
Sincerely,
Mandi
Hi Mandi,
Finding a competent practitioner to walk you through everything is important. So indeed, it is a problem if you can’t find one.
If I were looking for a practitioner, I’d ask them to describe the mechanisms and physiological processes that justify the recommendations. Also, I’d be VERY careful if no lifestyle recommendations are suggested.
I’d also ask what the plan is, and why/how it will work.
Your symptoms of being “foggy” and a history of being on psychotropic medications suggest neurological/neurotransmitter involvement in the brain. The brain is a commonly overlooked area that needs attention.
Lastly, a competent practitioner should be aware of how all the different systems in the body work together and affect one another.
Good luck and I hope you get help,
Dr. Rob
Hi Deb,
Glad you enjoy the site!
It’s always best to work with a competent practitioner. And it may not be a bad idea to have your levels measured to see what’s going on with your system. I often see liver clearance issues after people have been on creams or synthetics. And remember, sometimes bio hormones are OK. I just prefer to get the system up and functioning well first. That is: eliminate sources of inflammation (could be infections, toxins, foods etc.), get the digestive system working optimally (microbes, enzymes, gut repair, probiotics), make sure the liver, adrenals and thyroid are working well, and of course get blood sugar stable.
If the system isn’t up to par first – the hormones often work initially, but then the person slips further into ill health and it can be tough to recover.
Hope this helps,
Dr. Rob
Dr. Rob-
Thank you for your reply. I still wonder what type of practitioner I should be looking for. Chiropractic? Naturopathic? D.O.?
Thanks,
Mandi
Hi Mandi,
You’re welcome. Frankly, I don’t think the initials after the name matter. What matters is whether the practitioner is competent or not. He or she should understand functional endocrinology and its interactions with other systems (e.g.: neurological and immune) of the body.
Best of luck,
Dr. Rob
when a woman has a “radical hysterectomy” at age 23, gets off the synthetic hormone/estrogen replacement prescribed by the surgeon a year later (1974) and now at age 60 w/no ovaries in 37 years and no hrt ~ would she be a candidate for bio-identical hormone replacement therapy? the dr i have in mind is a specialist in it ~ does full blood panel work and states that statistically women who have a complete hysterectomy before age 45 “don’t live” as long as their normal life span would be. Hence the question: properly administered, after full blood work is done and competently analyzed, can bio identical hormone replacement therapy help stave off a premature demise for a woman who’s been without ovaries or hormone replacement for 37 years?
Thank you for your opinion on the matter.
Hi Sylvia,
She may in fact be a candidate. And she also would have been a candidate since the hysterectomy.
I personally would check hormone status via saliva, not blood. Free hormone levels are what work at the cellular level, and they’re much cheaper to be run via saliva.
There may already be a considerable amount of “damage” that has taken place if her hormones were very low since the hysterectomy. Those hormones affect many areas of the body.
Another area to consider supporting is the adrenal glands, as they produce “sex” hormones, and are especially important for peri- and menopausal women when hormone levels begin to drop off. The adrenals prevent the rapid decline in hormone levels, which is usually what causes all the symptoms and ill effects.
Hope this helps,
Dr. Rob D’Aquila
Dr. Rob,
I am a 30 year old woman and after being on birth control pills for several years I have completely lost my sex drive. My doctor told me that if I stopped the pills that things would go back to normal. No luck. I stopped my birth control in January and my libido is non existent. I have also developed bad acne since stopping the pills. I do not want to go back on birth control as I am worried about some of the long term effects associated with the pill. I have been looking into bio-identical HRT to get my libido functioning and eliminate my acne. Are there other, more safe options? It seems when I go to doctors they all promote the current “hot” treatment. I want to get back to normal but want to do it in a safe way. What are my options?
Thank you,
Jessy
Hi Jessy,
It’s not uncommon for people to have issues while on and after stopping birth control. It’s hard to say what the options are. The first thing to do is find the mechanism causing the issues. Low libido is often a result of low testosterone. The question is where and why is the problem there. No matter what type of treatment a patient goes with, diet and lifestyle should always be addressed in my experience. If those issues are not dealt with, the treatment usually won’t work or simply won’t last; and it’s possible that the main symptoms even go away, but others pop up. It’s always important to do lab tests, a good exam, history, and symptom survey to help identify what’s driving the problem.
Lastly, it’s not uncommon for the glands in the brain (hypothalamus and pituitary) to down-regulate after taking exogenous hormones.
Best of luck,
Dr. Rob
Hi!
I started BHRT in march 2011 with 1.25 Biest and 100mg progesterone and 10 mg DHEA orally once daily.
i did well for 4 months and then i started getting hotflashes, nodular acne on my face and anxiety and insomnia.
I started 2ml estradiol and 30 mg progesterone once daily at night time.
It has been 11 days and I still feel heart palpitations and anxiety during the day and early morning when i wake up.
how long does it take to get settled with the new regimen?
Would my acne get better?
When would my body get adjusted to one regimen?
How long can I take the estradiol?
What are the side effects of estradiol and what is considered a high dose?
I would appreciate your feedback.
tks.
Hi Femina,
You are asking very specific questions that are difficult to answer without seeing the entire picture: age, lab tests, history, exam, and symptom survey.
It sounds like it’s time for the prescribing doctor to run more tests and adjust your treatment protocol.
It’s also worth considering other issues that may be contributing to your symptoms, like thyroid and adrenal gland function.
Your age will also be a factor in determining treatment, and additionally, diet and lifestyle must be addressed.
The fact that you did well for 4 months, but are not anymore says to me that more tests may need to be run and you should ask your doctor about what to do; and if he/she feels it’s the right protocol even though you don’t feel good.
Have you done that?
There can be many side effects of estradiol which can be easily be found by searching the internet.
Best of luck,
Dr. Rob
Hi Dr. Wow, you blog is very informative. I flew to Nevada to get tested, hair analysis, saliva testing and blood tests all totalling about $1500. I am almost 63, total hysterectomy 2 years ago, Type II diabetic taking Glucophage (hate the stuff) and taking 150mg Avapro for BP. I recently started taking CoQ10 and my BP dropped about 40 points… yeah:)
After all the tests came back, I was told, Immune, thyroid and most everything was normal EXCEPT, I was almost non-existant on the Human Growth Hormone. I am heavy so I have an abundance of “bypass estrogen. This Doctor is the one who treated Suzane Summers. He started me on Progesterone and Testosterone creams to balance out the Estrogen and give me more energy. I have not yet started the injections of HGH. I am so sensitive to so many things I wanted to do one thing at a time.
I started with DHEA, the first dose about killed me. My heart pounded for so long I swear I would never sleep or relax again. Didn’t take another one. Next, the Testosterone and Progesterone Creams. By the second day, I had very bad bloating, indigestion, very jittery almost panicky feeling. There are terrible heart palpatations and pounding, shortness of breath or more like labored breathing. I am very very achey all over like when my Fibromyalgia acts up. I have been waking up with headaches. I gained 6 pounds in 7 days. I am already overweight and can’t afford any more weight.
My Chiro is concerned. His adjustments help some but I can’t seem to get this to STOP?? Am I reacting to the creams? I am very nervous about starting the VERY EXPENSIVE HGH injections and will that be worse side effects? What’s a girl to do??
Terri
I am asking for your professional opinion on these issues. I just don’t want to go down a road and not be able to get back.
Hi Terri,
You sound as if you are going through a lot and willing to do anything to help yourself, which I admire.
I can only give treatment advice to patients. However, if you read some of the comments of mine and others above, you’ll see my take on creams. Also, with all due respect, I personally would have very little faith in a doctor who is prescribing hormone creams if I had your condition. I don’t claim to know everything, this is what I’ve learned and seen with patients. Local applications for certain body parts may be appropriate, but again, I feel and see they are not appropriate for a systemic condition.
I also find that thyroid conditions are almost always “missed”. One of the main reasons is because Hashimoto’s thyroid disorder is overlooked. Hashimoto’s is ab autoimmune condition, which means it’s really an immune system “gone awry”. In these cases, the cause of immune dysregulation needs to be addressed. And thyroid hormone replacement therapy is sometimes necessary, although that alone won’t necessarily address the root cause. A patient will often have to address their general health, even if thyroid hormone replacement works well at the start of treatment. I have no idea if you have Hashimoto’s, and I certainly AM NOT diagnosing you. I am simply stating facts. Regarding Hashimoto’s, one test that shows negative antibodies does NOT rule out Hashimoto’s, because the antibodies are not always present. In cases where Hashimoto’s is suspected but antibodies are not found positive, a re-test should be run, even several times.
Autoimmune conditions are on the rise and when a person has an autoimmune disorder where the immune system has been identified as attacking a certain tissue, it’s always a good idea to check for antibodies to other tissues that the immune system may be attacking.
I hope you get the help and recovery you need,
My best to you,
Dr. Rob D’Aquila
Thank you for your reply regarding the hormone creams. I am inclined to agree with you 100% and have stopped as of today. The intense itching has slowed down some but the skip beat and pounding pulse are still present to a degree. I have only been on them for 5 days. I was also prescribed Human Growth Hormone injections as the saliva and blood tests show I basically am void of them. I am suppose to take one 50cc injection at bedtime. This is suppose to help with fighting my type II diabetes. Although, since my intense reactions to the creams, the HGH is sitting in my refridgerator. I just didn’t want to compound the matter.
I would value your opinion of the natural HGH. I got the creams and the HGH from a compound pharmacy in Nebraska…. suppose to be the best and naturally the purest. If I am void of HGH, is there any way I can get it back? Do you feel the injections are temporary… as you say to “prime the pump”. This is all very new and very scarey for me. I a such a “tender muffin” and really leary of so much stuff and “snake oils” I have friends that have gone to this clinic and the rave about it….. still skeptical me.
As for the Hashimotos and thyroid, I had Blood, urine, Hair analysis and saliva testing done and the thyroid was fine on all levels. I did the very high protien Atkins diet about 10 years ago and lost about 200 pounds. The trade off was massive kidney stones that required lithotripsy and type II diabetes. I would LOVE to eat primarily Vegan but all the Doctors swear I need all this protien. I honestly think all that protien is what gave me Diabetes.
At almost 63 and diabetic…. I am just looking for a CURE not a bandaide. I have been told I need to balance the hormones and the rest will fall into place. I ride my chopper 3 wheel bike at least a mile at night and walk on other nights. I eat primarily only grass fed poultry, fish and all organic veggie, eggs and raw milk cheese and almond milk. Great food, good exercise and still heavy with diabetes. I was so sure the hormones were the answer. I welcome any advise or suggestions you may want to toss my way. Thank you for being here to help others.
D’Aquila
Sir, I just came across your site looking for information regarding Bio-identical hormone replacement therapy; and I have enjoyed reading your site.
please keep me informed.
Thanks,
V/r
Amparo
Hello Dr Rob -
Just came across your website in search of BHRT info. After months of sleepless nights, mood swings and all the wonderful symptoms of menopause, I decided to take my MD’s advice and agreed to an appt with a menopause “specialist”. He took no tests, claiming that hormone levels change throughout the day, and any tests results would be based on the level of hormones at the time of the test and would likely not provide an accurate reading. He tried to talk me into conventional HRT, but having read so much about the risks, I refused to go that route. He then prescribed 180 ML Bi-Est 2.5 mg (7:3) with 6% Progesterone In EOC (whatever all that means) in a cream form. I took my first “dose” last night, and my second this morning. I now have a dull headache and am so cold, I can’t warm up. I also feel very jittery. Don’t know if this is related to the therapy. My concern is that he didn’t do any tests whatsoever, prescribed BHRT, but has no idea what specifically my needs are. I am 54 years old and just want to sleep. I really feel I could deal with the got flashes and moodiness far easier if I wasn’t so sleep deprived. I don’t want to take sleeping pills Even though I’m only 2 doses in- I’m seriously considering stopping. I’ve heard that accupunture can be really helpful for reducing symtoms. Is there any insight you could provide me with regards to this kind of treatment, and in your opinion, should I be seeking a new more thorough doctor? Also, does the BHRT formula prescribed make sense from your perspective? Thanks so much in advance for any help or guideance you can provide.
Hi Karen,
Well, first off, I have not found that testing changes to such a degree that would not make it useful. I am referring to saliva testing to be clear. Follow-up testing with changes that correlate (hopefully resolved) symptoms and hormone levels is enough for me to suggest they be run. This doctor may be quite skilled without testing, I am not ruling that out.
One thing I don’t like is when BHRT is administered through creams. They almost always overdose the patient, eventually leading to receptor site down-regulation and liver stress. This can clearly be seen on hormone testing. I will say though, just last week I had a patient who was on a hormone cream and her levels did not show overdose. It’s possible that creams are getting better but I don’t bother with them.
In some respect, I’d like to think that some sort of test(s) would be done to any patient. I can’t say there is no doctor out there who would be able to diagnose and prescribe successfully without ANY KIND of testing. Although I can say, if tests are available, why not use them. And let’s say hormone testing is invalid, one can still run blood tests for other basic markers.
This leads me to my next point. When a woman’s hormone levels naturally “drop-off” at peri/menopause and she experiences devastating symptoms, simply replacing them (bio or not) is typically not the answer from what I see. As I tell patient’s with PMS or peri/menopause symptoms, just because “everyone” experiences them – that doesn’t make it “normal”. I don’t feel females were inherently “designed” to suffer devastating symptoms once a month or later on in life. Then again, I didn’t “design” females.
What’s most often overlooked are the issues involving other organ/glands. This includes the GI tract, liver/gallbladder, immune system, thyroid, and certainly adrenals. All areas of the body need to be addressed, not just outright hormone levels. Doctors need to start asking the question “Why?”. Without asking this question, doctors can’t see the forest for the trees.
If I were in your shoes, I’d take up these issues with the prescribing doctor. I can’t say if you should see another doctor or not. I don’t know the person and their competence level. Additionally, I can’t say whether or not it’s the right prescription, because I don’t know enough about your case – i.e.: what your hormone levels are, and what other health issues originally caused you to “need” BHRT.
Good luck with your health – I hope you find some solutions,
Dr. Rob D’Aquila
Thank you so much for all the valuable information. It’s obvious that you truly care for what you do and for those who look to you for guidance. You take time to thoughfully respond to us who come with sincere issues, looking for a second opinion or your knowledgable perspective on what ails us. And you do it here for no self gain.
Thanks again. The world could use a few more like you.
Dr Dr Rob,
I’m 52. Very fit and healthy, but I suffer from migraines for 25 years. I take no medicines except for migraines, as needed. I can endure hot flashes, and mood swings, but there was a marked increase in my migraines which I considered hormonal. I sought a solution with bioidentical hormones. I’ve been taking bioidentical progesterone for 2 yrs now and now since my estradiol measures < 5, and testosterone 6; I have started the estrogen and testosterone this week. Meanwhile, my medical doctor has resolved my migraines with a preventive medicine. Your article concerns me. Three questions/advice, please:
1. I don't want to be on ANY medicine for a lifetime. HRT was not a last resort for me. I don't want to screw up my normal system functions. Should I get out now?
2. Is <5 Estradiol a problem that needs to be addressed?
3. Did the progesterone have a decreasing affect on the estrogen level?
Thank you, Maria
Hi Maria,
1) I don’t know enough about your case (history, symptoms, lab results, goals) to say whether or not you should continue with the treatment you’re on. And, I’m obviously not the prescribing doctor, nor am I your doctor, so it would be completely inappropriate for me to suggest a course of action.
2) Nothing can be taken out of context. I don’t know where you are regarding menstruation/peri-menopause/menopause so it’s hard to say. Additionally, no hormone should be singled out. All the hormones should be in balance with one another; and therefore ratios can be helpful in determining where the problem lies, if in fact there is one.
3) It is possible that (too much) progesterone could have an impact on estrogen levels. Although that’s hard to say considering I don’t know where you levels were to begin with.
Good luck,
Dr. Rob D’Aquila
Hi Dr. Rob. Your website is an absolute blessing. At age 61 and having my last period, almost hemorrhaging, at age 31 (I was under incredible stress at that time) I finally started on BHRT . I’ve been on it for about two weeks now. Changes have included breast tenderness and menstrual bleeding for about five days. My hormone levels for both prog. and estrog. were in the negative, lower than my doctor has ever seen. I had a tubal ligation back in 1979. I actually do feel more balanced after having depression for many years and no libido. I am overweight and do not exercise which I am working on now to change. After reading all of your information I am hoping I’ve made the right decision to be on BHRT. It is monitored by my doctor. This past May, after no previous history, I had to have a pacemaker put it. My doctor is closely monitoring me, starting me off on very low BHRT doses, including a very mild thyroid pill since I’ve not been able to loose weight. My cortisol levels are fine. My recent mammogram was good. What to you suggest?
Hi Donna,
Thank you for the nice comment about my website.
It sounds as if you went on bHRT because of the test results alone. Did you have other symptoms? What was the purpose? These are questions you should ask the prescribing physician.
Additionally, I don’t feel anyone should be put on thyroid hormone until all the appropriate lab work is done. There can be many reasons for an inability to lose weight.
Cortisol is best measured through a 4-sample saliva test – not through blood.
I suggest you monitor your menstrual bleeding considering how long it’s been since you’ve had your last period.
Also, it would be wise to check salivary cortisol and run a battery of thyroid tests to see if your thyroid is malfunctioning and if it is, find out why, through those tests.
Good luck,
Dr. Rob D’Aquila
Dear Rob,
Again I would like to thank you for your great generosity in responding to questions. I am a 56 year old woman with insulin resistance which is managed with 1500mg metformin daily. My periods have been erratic for 2 years and the last was in June this year. Due to the IR I have struggled with weight gain but for some years now it had been stable. I eat well and exercise moderately (hill walking for up to 8 hours per week). Since the beginning of the year I have had severe hot flushes (up to 15 a night) leading to severe sleep disturbance and exhaustion. My GP cautioned against HRT because of a history of bladder cancer. However I commenced bio-identical HRT a month ago (.25mg estrogen, 150mg progesterone – sub-lingual) and had almost instant relief from the hot flushes. However I have gained over 4kg in weight in that period (with no significant changes to diet or exercise), am experiencing sugar cravings for the first time in my life, my libido is parked in a freezer somewhere and I am even more exhausted than I was waking due to the hot flushes! I’m thinking that I need to consult an endocrinologist – would you agree?
Many thanks.
Hi Anne,
I’m glad to help in the capacity I can. Thank you for expressing your gratitude.
I would definitely agree that consulting an endocrinologist would be a good idea. And, don’t necessarily stop at just one. You can also consider a competent “functional medicine” doctor.
Additionally, I find it extremely rare that anyone’s symptoms (whatever they may be) get resolved without stabilizing their blood sugar. And considering that a peri/menopausal female needs strong adrenal glands to “take over” the job of the ovaries in hormone production; blood sugar definitely needs to be stabilized. I say this because you can’t “fix” the adrenals if you don’t “fix” the blood sugar. Focusing only on certain organs/glands can cause one to “miss the forest for the trees”.
I wish you well in your search for health and happiness!
Dr. Rob D’Aquila
Dear Dr. Rob,
I have learned so much from your website. Thanks for taking the time respond to those of us in bewildered states of life. I am 56 and had a complete hysterectomy at age 45 due to advanced endometriosis. They started me off on the patch after surgery, due to reactions to the adhesives, I was switched to estrogen pills. After experiencing no libido, testosterone pills were added. I took this regimen for years, then suddenly hot flashes plagued me and I was given monthly injections for years, never receiving progesterone. While on the shots I developed severe pelvic floor weakness and at times needed to be in bed. Physical therapy only made it worse until I found one who helped me learn to relax pelvic muscles instead of tightening them with Kegels. This helped a lot, still I was unable to carry anything and occasionally bedridden. 2 years ago the shots no longer worked for me, I developed a continual hot flash and my hormone blood work up showed zero, In addition I thought I was going crazy and began to hear the strangest things. My GYN advised me to start bio-identical hormones. I was interviewed by a specialized pharmacist who asked about pelvic floor weakness and if I was going crazy, with out me introducing the topics. I was started on Estradiol/ Progest cream 2x/day and testosterone/estradiol vaginal cream, which I take every other day. Within a week my physical therapist was ecstatic concerning pelvic floor muscle tone and I was relieved with the disappearance of strange noises. Occasionally I would have a hot flash. I take test. vaginal cream once every 2 days or it causes sexual nightmares and dark upper lip hair.
6 months ago blood work showed I had very low progesterone, so that was increased in my cream.
Now 2 years after starting BHRT I have a lot of hot flashes and unable to sleep. I do not sweat with mine, but develop what I call chimneys which are areas on the head, shoulders and back where an extreme amount of heat tries to escape. Also my hair is getting really thin and I am quite anxious, although thankfully not hearing things! I am thinking I’d better get in for a hormone test, sounds like I should ask for the saliva one instead of the blood draw.
My Questions:
1. Why do you not prefer the cream and what alternative is there?
2. It is frightening to think that my receptors may be closing their doors to BHRT, is there any other alternative besides increasing the dosage?
3. My GYN-PA says I’ll have to always be on BHRT to avoid the “crazy” part. What is your opinion? I am quite afraid of this aspect reoccurring.
4. I am concerned about transference to others. After applying the cream to arms or thigh, how long before it is no longer able to be absorbed by others?
5. And what about transference vaginally? Is it necessary to douche or something before intercourse? I don’t want my husband to be affected.
6. Why is the saliva test best?
I thank you again for making your wisdom available and very much appreciate your time with my questions!
Sincerely, Kathy
Hi Kathy,
I’m glad you learned so much from my site! Thanks for the comment. It sounds like you’ve certainly been “going through it”. As far as your questions:
1) Creams can build up in the subcutaneous fat and then cause the hormone to be dispersed at random. Additionally, almost every time a person takes a cream, they wind up overdosing on that hormone, which can easily be seen via saliva testing. So basically, it’s very hard to give specific doses with creams. Sublingual liquids or pellets are a preferred alternative.
2) Receptor down-regulation can be helped. There are certain nutrients that receptors require to function and they can “run out” if the receptor has been “working overtime”. The key however is to figure out what systems need balancing, and why there is a hormone imbalance to begin with. If that’s done well, hormones are not always necessary.
3) I’d like to think your GYN is wrong about “always” needing bHRT to control your mood. Very often, neurotransmitter support is necessary in mental/emotional symptoms. Also, emotional therapies may be warranted.
4) That’s a very good question, and was the topic of a “House” episode I recently watched. Although the gentleman wasn’t using bHRT cream in the episode…
I really do not know the answer to that question. Another drawback to using creams?
5) Again, I do not know the answer to that question.
6) Saliva is preferred because it measures “free” hormone levels. Free hormones are not bound to a protein, and the free hormone is what works on the cellular level, because it fits into the receptor. You can run free hormone levels via blood, but it’s quite expensive comparatively, and most physicians do not order “free” hormone levels in blood. They simply measure the protein-bound hormone which doesn’t tell enough of the story.
Good luck with everything!
Dr. Rob D’Aquila
Hello Dr.Rob,
I am 53 and a very intense athlete..I have been doing bioidentical creams for over five years now, and now have NO libido..It is really hurting my relationship with my husband , as you can imagine..I’m afraid that because I’ve been on bioidenticals for so long that my body won’t produce it’s own hormones any more.I don’t know what to do ..I really want my libido back.
Thank you ,
Renee
Hi Renee,
It’s very possible that your body is having trouble making its own hormones after five years of being on creams. Creams usually cause an overdose of the hormone as well. Libido typically has to do with testosterone. If you were my patient, I’d have your levels checked via saliva and see how to proceed from there.
My best,
Dr. Rob D’Aquila
Can you explain how HRT can be used to “prime the pump” when as you have explained due to negative feedback mechanisms providing exogenous hormones reduces the body’s ability to produce its own hormones?
Also, since starting on HRT (bioidentical) I have had terrible headaches. Any suggestions?? I am taking it to help with osteoporosis as well as menopausal symptoms. Do you know of any other “natural” treatments for osteoporosis other than obviously taking the relevant nutritional supplements.
Hi Janie,
I see hormones as being a good idea when levels are extremely low and/or nothing else is making a dent in the patient’s function. It’s almost as if you’re priming the target tissues to again become responsive to the message of the hormone(s).
It doesn’t sound like you have right balance considering the “terrible headaches” and also, liver function may be worth looking into. It’s possible that there is a form of estrogen dominance taking place.
Finding the right balance with estrogen should certainly help with bone density and quality.
Thyroid hormone levels also need to be considered.
Obviously vitamin D and K need to be considered along with the other important minerals. It’s also important not to overdose on the D however, as people often load up on it these days.
Elevated cortisol levels will certainly cause decreased bone density and that should be considered as well.
Hope this helps – good luck,
Dr. Rob D’Aquila
Hello there Dr.! I’m 47, I have hypothyroidism and went looking for help 3 years ago and was put on Progesterone (80 mg 2xday). I believe most of my symptoms were because I was over dosed on Armour Thyroid, I had many symptoms of that, but the docs just left it alone. I sure wish I hadn’t gone on the progesterone so quickly. Anyway, now I’m on a lower Armour dose and labs look good, (FT3, FT4 & TsH) but I’m having blurry vision,, fatigue, and temperatures too high. I went of Progesterone 6 months ago to test off of it and see how I was, and my levels were normal. But, my bladder freaked out, chronic spasms. Now I’ve tried going off of it again and am wondering if I need to “wean” off of it. Any suggestions?
Hi Marie,
It could definitely be a shock to your body if you simply stop taking a hormone; and that’s essentially what causes many problems for women going through peri/menopause – i.e.: a sudden drop in hormone levels.
Additionally, the symptoms of blurry vision, fatigue, and high temperatures would certainly indicate to me that the thyroid should be checked. Blurry vision can be the result of myxedema, or swelling due to increased deposition of tissue behind the eye. Fatigue is an obvious symptom of hypothyroidism, and high temperatures could also point to an overactive thyroid, or an excessive amount of thyroid hormone replacement.
Blurry vision can also be caused by blood sugar problems, and a high temperature can also indicate an infection.
You may want to get checked for Hashimoto’s Thyroiditis, as that’s the most common form of hypothyroidism in the US. Hashimoto’s often causes symptoms of both hypo and hyperthyroidism. There are many causes of thyroid dysfunction, and simply checking the levels of TSH is not enough to see the whole picture.
I hope this helps – good luck,
Dr. Rob D’Aquila
Hi Dr. Rob,
Thank you so much for your reply – almost a year ago now. It prompted me to seek a different doctor and I feel like I’m on a much better path now. So I wanted to follow up and let you know how it’s going.
You were absolutely correct in saying (concerning estrogen dominance) that it’s not the body making too much estrogen, but a lack of clearing that estrogen from the system that was my problem.
My new doctor has recognized this and I took a supplement (Meta I-3-C) for several months to clear the estrogen, along with supplements for thyroid, adrenal, and digestive support, and most recently, he’s added black cohosh.
He’s also done other testing including a blood test that confirmed that I’m truly (recently) in menopause now and also meridian testing that confirmed problems in the areas he’s already aware of, plus an Epstein-Barr virus that he is treating with a homeopathic therapy. He also had me do a great 28-day detox and I was able to lose15 pounds.
I do not have the energy or strength that I hope to recover yet, and my weight is still an issue, but overall, I’m in a much better place than I was last year at this time.
Thank you so much for your very generous help and suggestions. It meant a lot to me, and changed my course to something that’s working a lot better.
Hi Debra,
I’m so glad you’ve been so well! And thank you so much for sharing it with me and the other readers. I hope your story motivates others to see that there is light at the end of the tunnel if you put the time and effort in. It also helps to have a good doctor though.
Take care and feel free to comment and/or ask more questions.
Keep up the great work!
Dr. Rob D’Aquila
[...] Before I continue writing more posts about weight loss and detox, I wanted to share a comment from a reader, posted on my article titled “Unwanted side effects of (bioidentical) hormone replacement therapy“. [...]
I have a question about stopping bioidentical HRT. I am 28 and had testosterone pellets and progesterone pills ( day 14-28) for a year to year and a half. I stopped a few months ago and it seems my hormones have hit bottom. I am more emotional than usual ( swings) and I have never had these symptoms. Along with the emotions I had my first anxiety attack this week and it seems my level of anxiousness has increased. Is there a link with these symtoms and coming off bioidentical HRT? How can I naturally balance this in addition to diet and exercise? Thank you!!
Hi Julie,
There is definitely a link between stopping hormones having (new) symptoms occur. Your feedback loops are probably dysfunctional due to being on hormones for so long, based on what you’re describing. The only way to be certain would be to test your levels.
In addition to diet and exercise I’d personally give herbs and nutritional supplements to help the body get back on track. In addition, I’d probably look into emotions and how they are affecting you physically, and use flower essences and/or homeopathy in addition to in-office emotional release techniques.
And even though everyone has some emotional component to their situation, it’s possible that simply balancing your hormones will help with those symptoms.
Hope this helps,
Dr. Rob D’Aquila
Hi Dr. Rob
I am going to a anti aging doctor tomorrow. I was on bio identical creams 3 years ago but stopped after a few months because I sa no improvement. But I also made no lifestyle changes so that could have been a problem. My question is the options offered in administering BHRT. I know your take on creams but what is your opinion on troches and pellets? Thanks for this blog!!
Diana
Hi Diana,
Lifestyle changes are something that I always recommend…
Sublingual pellets or liquids are what I find to be the best delivery method. I haven’t considered creams in over 7 years.
I hope you have a great experience with your doctor tomorrow.
My best,
Dr. Rob D’Aquila
Dr. Rob,
My name is Karen. I am 55 and have been really run down for years. My blood test and saliva that I am rock bottom and making NO hormones really to speak of. Five days ago I started on troches given by a PA who specializes in Bio ID hormones. Estro- testost combo in AM and Progesterone at night. I am SO tired I cannot see straight. Like walking through mud all day, a bit depressed too. Is this something that will work itself out in time? She says it’s a low dose and I am not supposed to see her for another month! I will call on Monday but what do you think? Thanks Karen
Hi Karen,
It’s hard to say if it will work itself out in time – if what you were prescribed is what you need, then it should work itself out. You may need a higher dose, but it’s impossible for me to say for sure. Also, your adrenals and thyroid may be playing a role in the fatigue and depression. Typically patients see a change in symptoms within a week or two. Of course, lifestyle issues always need to be addressed.
Good luck,
Dr. Rob D’Aquila
Dear Dr. Rob, I am a 52 yr old female and I started the bi identical hormones approx 8 months ago. I had extensive blood work done and saliva tests and the doctor prescribed 30mg armour, 5mg melatonin, 0.5mg/ml test, hrt, 5mg dhea, 50mg/ml prog.hrt. The prog I admin as cream 6 days a week, the test cream 7 days. I went for a followup and he had to increase the progest cream and all seemed pretty good except the last 2 weeks I wake up every 2 hours with hot flashes. I was so desperate yesterday I went to the store and bought an over the counter black cohosh menopause pill. I’m very concerned now using the creams by what you’ve said. I went to a specialist I found from the Suzanne Sommers book that specializes in the bi identical hormones. Am I doing more harm to my body then good. I feel good otherwise except the sleep disruptions.
Hi Lori,
It’s difficult to say if you’re doing more harm than good. Although, from what I’ve seen, people get worse as they continue taking creams. I suppose it’s possible that creams have improved in the past 7-8 years since I’ve shunned them, but I really don’t know and don’t bother with creams.
It sounds like your only symptom was sleep issues, which could be caused by a number of things – usually adrenal and blood sugar, or an excessive histamine response. It sounds like the hot flashes were helped with the black cohosh…
Again, I can’t say right now if it’s causing more harm, but you know my stance on creams. Also, it doesn’t sound like this protocol helped your symptoms at all.
Lastly, I am very much against the approach of simply measuring levels of hormones and then prescribing based on the lab results. That may be appropriate if the patient has severe symptoms or signs, but it doesn’t at all get to the root of the problem causing the low levels to begin with. There isn’t much doctoring involved in that approach – I prefer to get to the root of problem.
Good luck,
Dr. Rob D’Aquila
Synthetic hormones are clearly the greatest crime perpetrated in this country. How many people have to die before we realize pharmaceutical corporations only make synthetics because they can’t profit from natural substances (we are unable to patent a natural substance).
However, if bio-identical are not the solution (I support your position, on how these interrupt your own ability to produce and “utilize”) then,
what is the solution to our modern messed up hormones, menopause symptoms and unbalanced biology?
Simply live a healthy lifestyle and correct any imbalances that are currently present. It’s individual to some degree, but it’s also fairly general. “Fix” the diet, blood sugar, GI tract, adrenals, detox, etc..
Hello Dr. Rob,
Thank you for the wonderful information, I am so glad I found your website!
For awhile I thought I was the only one that felt this way. I am 52 and have recently tested “borderline” positive for menopause. My Dr. had me on bithcontrol pills for the past 3 years to control the heavy bleeding I was experiencing for my fibroid. She has taken me off the BC pills and started me on the Bio Identicle Hormone Replacement therpy…. Testosterione cream, Biest Cream and Progesterone pills at bed time. I have been on them for 3 months now and actually feel worse than before, gained 15 lb and the bleeding has increased from once a month to twice a month. I have also been tested for cancer and the results were negative.
I exercise 3-4 times weekly and eat well. I have just recently gone off of all the hormones a few days ago, they don’t work for me!
Can you recommend another option perhaps diet and supplements plan to help me go through this naturally?
I just recently started taking adrenal support supplements, incorporated soy and flaxseed to my diet along with my other vitamin supplement program.
Thank you!
Linda Brechtel
Hi Linda,
It’s hard to say what need because I don’t what your levels are, and I also don’t know what the goals of the treatment are. I’d look into exactly what’s going on with adrenal function (4-sample cortisol and DHEA saliva test), as they are the glands that need to be ready to help with hormone production as the ovaries begin to slow their production in menopause.
Please check comments above for my stance on hormone creams.
It’s hard to say exactly why you had the reaction you did – but obviously something was wrong.
If you were my patient, I’d use in-office testing to see if soy was suitable for you – and even if it is OK, it should only be fermented soy (miso, tempeh, natto).
If your blood sugar isn’t well-balanced you’d want to consider fish oil instead of flax oil – click here – for my article on the difference.
I hope this helps,
Dr. Rob D’Aquila
Hi Dr. Rob,
I am an athlete and have been one for most of my life. By this I mean hardcore swimmer, runner , as well as lift weight. i also have had four children in 7 years and breast-fed each one for a year. So my hormones have definitely been through a roller-coaster.
However, I have taken as good of care as I could and have been able to “get my body back” after each child. I have been told that my body fat was too low at one point and tried to ease up on my running. Anyway, I feel as though i have always had to starve myself or eat very little in order to maintain weight.
My belief is that I have always had a sluggish thyroid and have recently been told by my regular doctor that I have hypothroidism and should start taking synthroid. Of course, being who I am I want to fix this as naturally as I can.
Something else I should mention is I am 31 and started taking DHEA as a supplement. I didnt really know as much about it as I should when I did this. I took this for about two months and noticed acne, irritalbilty, and emotional highs and lows, as well as shorter menstrual cycles (which I have never had).
So I stopped taking it. Then as a routine exam at the doctor, they took blood and found a high red blood cell count, high hemglobin, and high hemotacrit level which made them nervous. My TSH level was a 4.5, so they retested me again a week later. My hemogloblin and hemotacrit were still high normal but RBC were normal, but my TSH was 5.9. Anyway, as I have been a pretty healthy person all this has made me nervous.
I am definitely experiencing headaches and blurry vision as well as fatigue and no ambition to do anything, I still go to the gym everyday and have started myself on a regimen of kelp, selenium, B complex vitamin, as well as a thyroid complex that I got at the vitamin shoppe,
I believe that I messed myself up by taking the DHEA and that my levels of estrogen may either be high or I am not able to rid myself of it.
I guess my question to you is what type of doctor should I be searching for, a DO?? as well as how do you suggest a person detox estrogen or other hormones from their body?
Thank you for all your information. It has been very helpful.
Jessica
Hi Jessica,
I don’t know how high your RBC’s and other markers were, but sometimes that’s dehydration, which causes an increased concentration of the cells in the blood sample.
I was thinking thyroid as you wrote, and a TSH of 5.9 (and even 4.5) is definitely a sign of hypothyroidism. You need to get checked to see if you have Hashimoto’s Thyroiditis which is the most common form of hypothyroidism in the US. It’s an autoimmune condition and needs to be treated accordingly – although alternative and mainstream approaches are different, but sometimes they need to be combined. If it is Hashimoto’s, you seriously need to reconsider taking iodine, based on a lot of research.
I can’t say what type of doctor you need, as it really has to do with the individual’s competence and experience and not simply their credentials. Many people have a driver’s license and aren’t very good at driving.
With symptoms of headaches, blurry vision, fatigue, and lack of ambition, you should get this sorted out sooner that later. The blurry vision is most alarming to me.
Lastly, even though the DHEA caused problems, I doubt it would be enough to cause the symptoms you are experiencing, though anything is possible.
I offer phone consultations if you’re interested.
Take care,
Dr. Rob D’Aquila
Dr Rob I’m a 42 year old male who has been diagnosed with graves disease, what do you think of bioidentical hormones for that?
Hi Mark,
I wouldn’t think much of bioidenticals for that. I’d look into what’s causing the immune system dysfunction.
Take care,
Dr. Rob D’Aquila
Hello Dr. Rob,
I’ve just read your informative comments and also the questions from other women. Your answers are very accurate in promoting good lifestyle and serious consideration for any choices for hormone replacements.
As a 65 year old woman, I have had a horrendous gynaecological history necessitating many surgeries. With a hysterectomy at 27 for a 2 1/2 lb. (yes, that heavy and 10 cm. in size, leiomyosarcoma), I survived and within 12 years developed endometriosis that resulted in 2 separate oophorectomies 5 years apart. Naturally, these surgeries, plus an ovarian remnant hemorrhage necessitating yet another abdominal operation between the oophorectomies, resulted in surgical menopause and changes in my hormone levels from a young age. I’m a very healthy, active person who values so much this miracle of surviving my original cancer.
From 1992 until 2003, I used patch estrogen only hormone replacement therapy and discontinued their use due to the study that indicated one should not have long term therapy. By 2007, I was feeling many symptoms linked to hormone deficits, such as continued night sweats, insomnia, some anxiety with repeated thought patterns and also a sense of lacking a ‘female’ identity and definitely zero libido. I am single, so that latter symptom isn’t too much of a problem without a partner.
In 2007, I found a US Board Certified Anti-Aging Canadian GP who is specializing with female patients and prescribing Bio-Identical Hormones. I was tested with saliva analysis and was found to have zero levels of both estrogen and progesterone. With my prior surgeries, I was expecting this result. I began on both estradiol/ester and progesterone cremes and am at the lowest dose. Over about 4 months, I gradually noticed that the symptoms disappeared, much to my delight. Now, after 4 years of use, I am being pressured by both my regular GP and gynaecologist (who monitors my Calcium levels and bone density levels, which the latter having increased over the past two years!) to quit using these hormone cremes.
I keep asking them why would I given how horrid I felt after four years off the therapy and that I know that I’ll return to feeling that way again. If I feel so well, why put myself at risk for insomnia, night sweats, feeling ‘lost’ again and having some anxiety? I am being told this may not happen ‘this time’ as I am older. I was ‘older’ when it happened when I quit the therapy in 2003!
Honestly, I don’t believe them and think that what will instead happen is that they then will start prescribing other FDA approved medications such as sleeping pills and anti-anxiety meds for the symptoms that I am certain will arise. I am not a person who likes taking medications at all and because I feel so very well at my age, with no current health issues, it doesn’t make sense to me to quit these bio-identical hormones.
Also, I just realized that on my hormone cremes, I have not had another migraine headache! They used to be debilitating, and I am relieve that I they are not a problem anymore.
So, my dilemma is what to do. And if I am pressured enough by the doctors to quit the therapy, how should I wean myself off the HRT?
Sorry this is so lengthy, but as you can appreciate, I’ve given this much thought. Also, I was an RN by career, now retired.
Thank you for any suggestions.
Wendy
Hi Wendy,
I’m sorry to hear about all that you’ve been through – but happy to hear that you are currently feeling fine!
The main thing I don’t like about your scenario is that you don’t seem to trust your doctors. In my opinion, it’s extremely important to feel your doctors are trustworthy. You said “I don’t believe them” – that to me is a big problem.
If they want to take you off the hormones, they should have protocols in place to do this.
If I were weaning someone off hormones, it would depend on that individual patient’s situation. And I don’t know that I would in your case. I’d have to have a better idea of your health status including lab tests. I would do your best to get more information out of your current doctors, and I would also get a second and perhaps third opinion because of the trust issues that exist.
Good luck,
Dr. Rob D’Aquila
I am a 52y/o Insulin Dependent Diabetic of 32 years. I have no complications. I have a healthy lifestyle. I started hot flashes this past summer and noticed weight gain at my waist. I read about Bioidentical hormones and decided to start therapy under the direction of an MD. After 10 months of not menstruating I began having a period 13 days ago.(after taking the hormones for 3 weeks) I was told to double my progesterone. I took once double dose and felt sleepy and depressed. I went back to a regular dose. I kept bleeding so I was advised again to double the dose. I became nauseated, depressed, and fatigued. I was also placed on testosterone, DHEA, and armour thyroid when I began progesterone. I stopped all hormones 3 days ago. I am concerned that stopping abruptly could be unhealthy but I am afraid to take anymore. I continue feeling nauseated with ringing in my ears, dizziness and menstruating. Any advise.?
Thank you.
Mari
Hi Mari,
I’m not sure what your hormone levels were before starting the treatment, but it sounds as if you were about to enter menopause and the hormones pulled you out of it.
I would suggest getting a very good work-up with having your hormone levels checked appropriately through a doctor that is not going to prescribe based on symptoms alone. It sounds like a typical scenario where the patient gets the “kitchen sink” thrown at them without proper testing, and not figuring out the root cause of the problem.
Good luck,
Dr. Rob D’Aquila
Hello again, Dr. Rob,
I greatly appreciate your thoughtful reply to my comments above concerning my history and current status. Your comment about not trusting what I am being told by my general GP, as opposed to my anti-aging specialist, who was a well reputed GP, is absolutely correct. I will definitely make sure I am not pressured into a drastic change that will result in my feeling unwell. These days, quite honestly, I feel like I’m in my 40′s and often go out running for over an hour and biking for over 4 hours. As I work very diligently at my own health standards, I find it interesting that given I am well, the general GP and my gynaecologist keep trying to convince me that I don’t need to feel this way but rather feel like an older woman ‘should’ without any hormones at all. Isn’t hormone influence that which influences our sense of being feminine or masculine? After all, transgendered folks prove that hormone therapy can indeed alter how one feels about one’s sexuality. I just do not want to feel like a non-sex, which was one way that I did feel off my HRT for four years.
It’s difficult to find someone in the medical profession that isn’t opinionated either one way or the other, it seems there is no grey area with this topic of treatment or not. Also I do resent the fear based approach of comments like, “If you continue with HRT there is a strong link to cancer!” I am not supplied with any statistics or recent data about this with this strong statement. More confusion for the patient, I feel.
Any further comments would be appreciated again.
Wendy
Hi Wendy,
It’s great that you feel like you’re in your 40′s and are so active. And yes, hormones do affect our sense of gender. As far as cancer – there is a strong link to synthetic hormones and cancer. It is assumed that bioidenticals don’t pose that same risk, and it would make logical sense that they wouldn’t. However, no one really knows at this stage of the game…
Thanks for your comments and take care,
Dr. Rob D’Aquila
Hi, Dr. Rob,
My granddaughter is being diagnosed with Autism. She just turned 2. I have been researching bioidenticals and wonder if you have an opinion about using them in children? She has had bloodwork showing her thyroid to be low. She had an EEG and is scheduled for an MRI later this month.
thanks very much
Barbara
Hi Barbara,
That’s a tricky one. Personally, if I had an autistic child, I’d load him/her up on brain-supportive nutrients and herbs and see what results that brings first. Her thyroid being “low” doesn’t say much at all, because it gives no indication of why. There are over 20 reasons why someone might be hypothyroid, and giving hormone may or may not be appropriate.
Take care,
Dr. Rob D’Aquila
Hi, Dr. Rob…Thanks for responding to my question. We are wondering what brain-supportive nutrients and herbs you would recommend for our granddaughter’s Autism…
Thanks so much,
Barbara
Hi Dr. Rob
I am 30 years old and noticing that every month my periods get worse. Not worse in Menstrual flow, but fatigue, cramps, headaches, and mood swings. I can cry at the drop of a hat and 10 minutes later want out of my own skin. The feeling is horrible and wondering if BHRT would help? Hope you have some input.
Thanks so much
Debbie
Hi Debbie,
Please read all the comments above for my input. I recommend people find out the cause of their hormone imbalance before simply taking BHRT; esp. at age 30.
Good luck,
Dr. Rob D’Aquila
Hi Dr. Rob First off I enjoyed reading your article above and hope you can help me. I am 57 years old. About a year ago my Testosterone was under 200 . I went to a Dr for healthy living who did a very extensive blood panel(13 vials) and put me on bioidentical gel ..To use it 5 days on then 2 days off. my level rose to 600 then 3 months later to 750 then it dropped to 200 . I was told that the gel was not absorbing so he switched me to a cream. My level went back up to 600 but i get alot of fatigue and irritability and do not really like that. When my level was low I had fatigue and working out in the gym seemed like a chore The T helped with the working out that got easier but the fatigue seem to come and go but come more often. I was never an irritable person and can control it but dont like it. Is this a side effect?. Also when i ejaculate now its very little compared to before i started the testosterone. its seems the only thing that is better is that I get more erections. I sometimes just do not feel like my self and think maybe I should stop but if I stop what alternatives do I have. The long term effects you described above scare me. I am 5.5 weigh 124 eat very healthy do not eat gluten or wheat. Walk 5 k 4 times a week ride a bike 10 k 3x a week and work out in the gym 3x a week but had to stop weights as i strained a deltoid. One more thing I have also lately been getting stomach pains. Anything you can do to help would be greatly appreciated.
Jeff
Hi Jeff,
It’s very hard to be able to help you without knowing the entire story. After 13 vials of blood, I would expect some tests to be out of range – at least out of a functional range. If testosterone was the only treatment offered, I think it’s an incomplete treatment at best, and unnecessary at worst. Again, it’s hard to say without knowing the whole story.
Another thing I don’t understand is why your body suddenly stopped absorbing the gel after it had been working fine previously- that makes little sense to me…I don’t think your levels dropped because you weren’t absorbing it.
The irritability can definitely be a result of the treatment, esp. because you make it sound as if it was never a problem before – and the same goes for the volume of your ejaculate.
The alternatives to your treatment depend on exactly why you had the low testosterone to begin with.
I would have to evaluate all your tests and take your complete history to guide you better.
I offer phone consultations if you’re interested.
Take care,
Dr. Rob D’Aquila
I enjoyed reading this article , especially after reading countless others which promote hrt so easily. Even the endo I went to see suggested hrt a bit too easily .
I would like to know more about the patient mentioned above who was treated for low testosterone as I think I maybe am going through the same as him.
Hi Shaun,
I’m glad you enjoyed reading the article. Yes, in many cases endocrinologist’s and alternative practitioners prescribe HRT too quickly, and without other types of support.
The patient I mentioned mostly had blood sugar problems contributing to his low testosterone. The blood sugar issues were very much caused by being a vegetarian for years. Obviously he had receptor site down-regulation from the HRT as well.
Thanks for reading,
Dr. Rob D’Aquila