Bio-identical Hormone Therapy
Why Use "Bio-Identical" Hormones?
The severity of problems caused by the use of synthetic hormones led to a landmark decision in 2002 by the Women’s Health Initiative (WHI), a long term health study of postmenopaual women. After discovering that instances of breast cancer, heart disease and osteoporosis increased with the use of medroxyprogesterone and pregnant mare’s urine conjugated estrogens (Premarin), research was halted.
Bioidentical hormones were brought into the spotlight after women sought a safe alternative for synthetic hormone replacement therapy.
The difference between bioidentical and synthetic hormones starts at the molecular level. Bioidentical hormones have the same chemical structure as hormones made by the human body, and can replicate the actions of those made naturally.
Side effects and risk factors are minimized when your body recognizes its own molecular structure, fills its receptor cites efficiently, and can utilize, break down, and detoxify hormones effectively.
One Size Does Not Fit All!
Bio-identical hormones can be tailored to match each individual’s needs by a compounding pharmacist. Synthetic hormones, on the other hand, have an altered molecular structure that the body does not recognize completely, thus their actions are not straightforward and they are not detoxified from the body as easily.
Side effects are common with these types of hormones because they are foreign to the body. Synthetic hormones are prescribed as a “one size fits all", and cannot be specifically made for an individual.
Hormones that Dr. Sykurski may prescribe:
How Do You Test Hormone Levels?
The individualized approach of bio-identical hormone treatment requires a saliva hormone test. This will measure only active (free/unbound) hormone levels unlike serum tests, which reflect inactive (total/bound) levels. Measuring inactive hormone levels (ie, through blood testing) is not useful in assessing function or balance.
Overdosing of hormone supplementation is often seen when using serum (blood testing) to monitor topical hormones (often 4-5 times higher than is needed).
When testing the sex hormones through saliva, it is also important to assess adrenal status (DHEA and diurnal cortisols). Even if the chief complaints seem to be an imbalance of the sex hormones, the adrenal and sex hormone pathways are so closely linked that an imbalance in one area will affect the function and efficiency of the other.
Blood testing is reserved for assessing thyroid status.
Compounding Allows Choices for Hormone Delivery
The state of the art delivery system for bioidentical hormones is transdermal/topical. By applying hormones to the skin rather than ingesting it, the liver first-pass is averted, thus therapeutic levels can be reached with far less hormone. Studies have shown that measurement of transdermal hormones is best done through saliva rather than serum.
Other options for hormone delivery include: capsule (dry powder) form, sublingual (liquid), and troches (lozenges). The choice for medication delivery may depend on patient preference, or based on unique history of the patient that may make one delivery method superior over another.
What Hormones are Tested?
A good starting place for assessing hormonal status is to measure estradiol, progesterone, testosterone, DHEA, and morning cortisol. Remember: cortisol has a well established 24-hour diurnal rhythm, and the time of day when this is measured will reveal unique aspects of one’s health.
If there are complaints of sleep disruptions, a night cortisol should also be performed, and if there are suspected metabolic and blood sugar dysregulations, all cortisols should be tested (morning, noon, evening and night).
Are there Different Hormone Panels?
The minimum for assessing hormonal status and endocrine function is the five hormone panel: Estrogen (E2), Progesterone (Pg), Testosterone (T), DHEA and am Cortisol. When there are any sleep disruptions or high cancer risk profiles we also recommend the night Cortisol level. But in general as a basic guideline, an excellent starting place for men and women is the five hormone panel.
Below you will find the various panels offered and the associated symptoms.
1. Comprehensive Panel:
E2, Pg, T, DHEA, am, noon, early evening and late evening Cortisol.
This assessment is used for men and women who have many of the symptoms described below, and it combines a complete adrenal function panel in addition to an assessment of sex hormone levels. It is for compromised individuals who are having the short comprehensive and adrenal function symptoms. It is especially important to assess those mid-day Cortisol levels in individuals who are experiencing blood sugar dysregulation, hyperlipidemia, weight gain around the waist, bone loss, infertility, sensitivity to chemicals and increased joint pain.
2. Short Comprehensive Panel:
E2, Pg, T, DHEA, and am/pm Cortisol.
This assessment is used for both men and women who are having symptoms related to sex hormone deficiencies or excesses (E2, Pg and T) and will also render an abbreviated adrenal assessment with DHEA and am/pm Cortisol.
3. Basic Hormone Panel:
E2, Pg, T, DHEA, and am Cortisol.
This assessment is used for both men and women who are having any of the symptoms listed below (when there are any sleep disruptions or high cancer risk profiles we also recommend the night Cortisol level):
4. Adrenal Stress Panel:
DHEA & 4 diurnal Cortisols: am, noon, early evening and late evening.
Adrenal Stress Panel is used when individuals are complaining of:
5. Cortisol Panel:
4 Diurnal Cortisols: am, noon, evening and pm.
The Cortisol Panel is used when individuals are complaining of the same symptoms listed above in the Adrenal Stress Panel, however may not require DHEA testing.