Like it or not, we’re programmed to die young.
Menopause, andropause…these natural hormonal transitions alert our bodies to the fact that we’re no longer fertile. Our health withers in response, as sure as the sun rises and sets. And we begin to age rapidly.
At least, that’s how it used to be. As with many bodily things, we have begun to defy our genetically hardwired fates. And we live longer because of it.
Obviously, I think that’s a great thing. I certainly didn’t want to die at 35 years old. No one does. But since we’re programmed to die young, survival requires us to outsmart our hormonal system. And that requires a very delicate balancing act that most people get wrong–especially when they try to do it themselves.
The endocrine system and the hormones it generates are vastly complicated, and your body regulates them both tightly. So tricking your body into youth entails a long list of considerations.
But that doesn’t mean it can’t be done. Obviously, it can. And I’m going to tell you how.
What your doctor doesn’t know can hurt you
In the November 2012 issue, I wrote about the benefits of testosterone for both men and women. So this month, I thought it would be a good idea to fill in a few more blanks for the ladies.
Specifically, I’d like to discuss estrogen, progesterone, and testosterone replacement for women. These hormones are critical tools in the anti-aging arsenal. And if you’re well balanced in all of these areas, I can almost guarantee you’ll feel years younger. And look it, too.
Striking this balance requires knowing your baselines. In order to do this, I would recommend you ask your doctor for a few key blood tests.
Unfortunately, most conventional doctors have probably never even heard of a lot of these tests–let alone familiarized themselves with optimal result ranges. That’s why they always tell you that everything’s normal, when in fact, there really is something amiss.
That’s also why it’s so important to work with a knowledgeable holistic practitioner. With this battery of tests, you can be assured of getting a good picture of what your endocrine system is doing. You really need the full spectrum.
The first of these is a test for total estrogens. This gives you an indication of how depleted you are overall. But generally, I don’t aim for any particular level when designing a woman’s HRT plan. It’s always better to treat the patient, not the number, when it comes to estrogen levels.
It is important, however, to maintain a healthy estrogen ratio. And more specific tests will paint a detailed picture of any imbalances you may be dealing with.
There are three types of estrogen in your body– estradiol, estrone, and estriol. In order to design a safe and effective HRT plan, you need to know about all of them.
Balance is especially important when it comes to estradiol and estrone. In the simplest terms, estrone is the form of estrogen that leads to cancer, while estradiol is the nicer estrogen that generally doesn’t. Estriol, meanwhile, is a metabolite of estradiol, and is the weakest and most abundant of the three.
Ideally, estradiol and estrone should be in a 1:1 ratio. Higher amounts of estradiol can also be healthy. But you never want estrone to be the dominant estrogen.
You’ll also want to test for progesterone, as well as total and free testosterone. These hormones are especially important for balancing estrogen and restoring sex drive.
Total testosterone levels should generally fall between 20 and 80 ng/dl. (Though I find closer to 80 is usually ideal.) But as with estrogen, ideal progesterone levels are going to be individual to you. There’s no particular target level.
Two good reasons to reject HRT…
and why it’s essential for everyone else
As you’ve probably noticed, I am a big fan of post- menopausal hormone replacement…as long as there are no strong risk factors.
The only group who should absolutely avoid hormone replacement therapy (HRT) is women with genetic markers for any sort of estrogen related cancers (such as Brca 1 or 2 or Her-2 positive patients) or those that have had an estrogen-related cancer.
Genetics generally have a very small hand in cancer development–but women with these markers are the exception. Their risk of developing breast cancer is dramatically higher than the rest of the population. And throwing estrogen into the equation could easily fast track a diagnosis, like throwing gasoline onto a fire.
In these cases, the risks of HRT simply don’t outweigh the potential benefits.
As for women who have had female relatives with breast cancer, I feel that if that cancer wasn’t linked to one of the above mentioned genetic markers, then it’s probably fine.
Let’s face it, one in eight women will have breast cancer in this country–and that number continues to rise. So really, it’s likely that every woman is related to someone who has had breast cancer. So I just don’t think this subject is controversial.
Skeptics need only look at the latest research. A recent study followed women receiving HRT for 10 years. It found that after a decade of randomized treatment, women on HRT after menopause had a significantly reduced risk of mortality, heart failure, or myocardial infarction.
Most importantly, this benefit came without any apparent increase in risk of cancer, venous thromboembolism, or stroke.1
That said, if you’re still apprehensive about hormone replacement, HRT may not be right for you.
The mind is very powerful. If you’re not comfortable with a treatment plan, I truly believe that this can have an adverse effect on your body. And it can create problems that might not have surfaced otherwise. Should you have any serious reservations, I would definitely suggest choosing a different anti- aging strategy.
But otherwise, let’s move on to some details.
The right cream can stop the clock
When I’m meeting a woman for the first time, it’s so easy to tell when she’s on HRT. Her skin is so much less wrinkled. Her face appears brighter. There’s just an overall sense of well-being that exudes from her.
And this makes sense…because she’s tricked her body into staying at its natural prime indefinitely.
Don’t get me wrong, I’m not like Suzanne Somers, who advocates that a woman should have her period forever. She may in fact be right. But until this approach is studied more rigorously, I’m not likely to recommend it anytime soon.
I can certainly see her point–it is natural to routinely shed the endometrial lining. But without ovulation, I’m just not sure that it’s necessary. So monthly menstruation isn’t part of my patients’ protocols–which probably comes as a relief.
When I think of HRT, I simply think of bio-identical hormones taken in doses that are adjusted according to the periodic blood tests I mentioned above.
I usually start with a topical cream applied to the inner thigh. Some practitioners use a vaginal cream. It really is up to the patient and the comfort level of the practitioner. (I will usually prescribe an estriol cream for vaginal use, as it’s the safest estrogen and very effective at preventing vaginal dryness and discomfort.)
Once I have reviewed all of my patient’s blood tests, I’ll recommend a dose depending on the levels of the estrogens, progesterone, and testosterone. The compounding pharmacy will then be able to make a cream up for you.
Since these are compounded formulas, they can be all in one, all separate, two together…it really doesn’t matter, as long as you take them properly. Also, since every woman is different, the best application sites and delivery systems will vary.
You will be able to find something that works for you. Just be open and have a honest dialogue with your doctor.
Balancing and replacing hormones is a tricky business and it’s important to get dosing right (which is why you really need to work with a doctor). But don’t be put off if your symptoms don’t disappear immediately. You have to start somewhere.
Beware estrogen’s “triple threat”
I usually start with 5 mg of bi-estrogen (a combination of estradiol and estriol). There was a time when more practitioners would prescribe tri-estrogen. (This is a combination of all three estrogens–estradiol, estriol, and estrone.) This approach is more bio-identical in that it more accurately reflects natural estrogen profiles.
But it’s just as effective, and considerably safer, to stick with the two healthier estrogens instead. There’s really no reason to raise estrone (so-called “bad” estrogen) levels.
In fact, this is a common complication of conventional HRT. Even the plant-based pharmaceuticals (such as the estrogen patch Vivelle(r), which the conventional community calls “bio- identical”) are really just estradiol. And when I test patients’ blood levels, I have found that the body readily converts this to estrone.
Obviously, I shy away from working with these drugs for that reason. So, if you’re currently using them, I advise you to run to your doctor’s office for an estrogen panel. And then take swift action to correct any imbalances.
Luckily, there are nutritional supplements that you can take to ensure that your estrogen profile is in balance–most notably, indole 3 carbinol (I3C) and DIM. (These are the active phytochemicals in cruciferous veggies like broccoli and kale.)
But if your hormone dosages are correct, then you probably won’t need much
Real balance requires a bigger picture
Progesterone replacement is critical for counteracting estrogen’s less desirable effects–most notably, it wards off cancer in the uterine lining. This makes it especially helpful for any woman who has not had a hysterectomy.
There are some practitioners who will cycle progesterone in order to mimic the natural menstrual cycle, as mentioned earlier. But again, I tend to have women use it every day–at a starting dose of 100 mg–as both a balancing agent and cancer preventative.
Last but not least, there’s the addition of testosterone. As you might recall from the November issue, most women report a decreased interest in sex after menopause. Low testosterone is a big reason why.
But aside from improving your sex drive, the right dose of testosterone can boost your mental ability and help to keep you leaner. Male or female, these are all critical bases to cover in the anti-aging game–which is why all my HRT protocols start with at least 1 mg of testosterone.
The dose ratio of all of these components is correct when all of your menopausal symptoms disappear. Once my patients find their “happy” dose, I generally test hormone levels three times per year– but until then, these tests should be frequent.
To find a knowledgeable holistic practitioner familiar with natural hormone replacement therapy, contact the American College for Advancement in Medicine at www.acam.org or call 1-800-532-3688.
The International and American Assocations of Clinical Nutritionists (IAACN) can also be a good resource. You can contact them through their website at www.iaacn.org or by calling 972-407-9089 between 9 a.m. and 4 p.m. CST, Monday through Friday.
1. “Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomised trial.” BMJ 2012;345:e6409