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