Tom Ballard, ND's blog

Hormone Replacement: Bio-Identical, synthetic, or…? (part 2)
November 25, 2008, 9:47 am
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Do you need hormone supplementation?


In the “me too!” rush for bio-identical hormones, some doctors and patients are not stopping to ask if they need to be supplementing hormones at all.


In the best of circumstances a patient would undergo reliable laboratory testing to both diagnose hormone deficiencies and monitor dosages. However, this is not always done. Bio-Identical hormones are often prescribed (or self-prescribed) based on symptoms or because the person believes they have an anti-aging effect.


Advocates for hormone supplementation look at studies that show a decline in hormone production as humans’ age. For instance, the statistics show a 2-3 percent decline each year starting in the forth decade. This leads some, like Suzanne Somers, to advocate for making up for this “deficiency” by supplementation. But, is this a deficiency? There are many other explanations, such as that the decline in hormones is a natural process that helps the body cope with the post-reproductive years. For instance, some evidence shows that a decline in testosterone protects men from prostate cancer. Likewise, lower estrogen may protect women form breast and uterine cancer.


It is difficult, I believe, to put much stock in population studies on hormone levels. First of all, the studies are quite small. Secondly, as in most studies of this kind, researchers looked at what they considered “normal” men and women. But, is “normal” the same as “healthy”? Is the person that eats fast-food meat and dairy products which are known to contain synthetic estrogens truly healthy? How reliable are small population studies on people who, for the most part, are undernourished and loaded with synthetic hormones?


No studies have compared truly healthy individuals – those exercising regularly and eating organic, low-processed food – to those eating the standard American diet (SAD). Perhaps declining testosterone levels are more a factor of lifestyle than age.


An additional problem is that most hormone studies are performed on blood. However, doctors disagree on whether blood, urine, or saliva is the best measurement tool. It is important to note also that so little is known about normal ranges of hormones that published ranges are quite wide. To accurately assess hormone levels you would need to be tested at least once a year starting at birth.


Population studies also rarely compare time, day and seasonal variations. Cholesterol levels tend to go up in the winter, cortisone will be low in the evening. Hormones levels are generally cyclic through the month and even through the day. Scientists have only just begun to look at these variables.


Stress and sugary foods exert profound influences not only on cortisone, but on insulin, testosterone and estrogen. These are usually not factored in to population studies. Indeed, how do you find two individuals who have “the same” amount of stress?


So far, the majority of studies on hormones do not take into consideration time of day, seasonal variations, the level of stress, diet, or the health of the test subject. Therefore, conclusion made on the basis of these studies should be made judiciously. This is especially true of hormones, since their influence is so widespread throughout the body. Yes, estrogen may reduce skin dryness, but also increase cancer risk. The man taking testosterone may feel renewed vigor (which is perhaps psychological) but not be aware of a slow growing prostate cancer. Jumping from “hormones declines with age” to prescribing hormones is not a thoughtful approach to medicine.


First do no harm

Most physicians take the Hippocratic Oath. One of the tenets of that oath is to ‘first do no harm. Hormone replacement therapy, even with bio-identical hormones, does not pass this test. No long-term safely studies have been performed. We simply do not know the results of taking hormones, even if the person is found to be low.


The exception would be where there is a clear demonstration of glandular failure and hormone deficiency. For instance, if the thyroid gland is removed due to cancer, then thyroid hormone would be necessary to sustain life. This is not the circumstance for most people taking thyroid, estrogen, testosterone and growth hormone.


A good example of the dangers of hormone replacement is Premarin. Premarin is a type of estrogen. It was prescribed to millions of menopausal women over the past forty years. It was considered the standard of care, despite having no supportive scientific studies on its effectiveness or safety. In the past few years studies started emerging showing supplemental estrogen increased the risk of breast and uterine cancer. The standards of care are now up for grabs. Some doctors still prescribe Premarin, others are practicing “first do no harm.” Unfortunately, some men are now choosing to be the test animals for testosterone supplementation.


Despite what advocates claim, there is little evidence that bio-identical hormones are safe or hold less of a risk than other types of hormones. The jury is still out on that claim and until it is settled the potential risks outweigh the potential benefits in most cases. Do no harm.


Treat the cause

In cases where hormone levels are low, is taking hormones the right prescription? In naturopathic medicine we believe in treating the cause. That means that if a hormone is low, then the gland controlling that hormone needs attention. Is it receiving the nutrients it requires? Is there a block in the hormone production process, such as can happen with toxic chemicals?


Thyroid hormone production offers a good example of the danger of not addressing the cause. First, the thyroid gland requires iodine, tyrosine (a protein), zinc, and selenium. Secondly, thyroid hormone is first produced in an inactive form (T4) that must be converted to the active form (T3). This process is blocked by lead, mercury, solvents, plastics, and pesticides. If the patient with low T3 is prescribed either natural thyroid (usually pig thyroid) or synthetic T3 he/she will feel better, but the underlying problem will not have been addressed. That patient’s nutritional status and/or toxin level will become a silent problem that continues to undermine that person’s health. For instance, the same toxins blocking the T4 to T3 conversion may obstruct the production of estrogen or testosterone.


I see patients regularly with high cholesterol and low estrogen. Usually these patients are not consuming a high cholesterol diet. Why is their cholesterol high? Because it is not being converted efficiently into estrogen, testosterone and adrenal hormones. Taking these hormones may make the person feel better, but ignore this underlying problem of cholesterol conversion.


Cholesterol is the core molecule in the manufacture of estrogen, progesterone, testosterone and cortisone. Think of the cholesterol as a bucket of water attached to a hose that flows into another bucket. Normally the open hose allows water to flow into the second bucket, but if you clamp that hose there is no flow. In your body, the first bucket is cholesterol, the second hormones, and the hose is a series of enzymes that converts cholesterol into hormones. If those enzymes are blocked by a deficiency of necessary vitamins and minerals or because of toxins, then the hormone bucket will be low.


My experience is that providing the necessary nutrients and detoxing unwanted metals and chemicals will allow glands to produce the desired identical hormones. Certainly there are exceptions to this, but mostly it works well. When a practitioner prescribes a hormone as the first line of treatment, then the underlying cause is missed and the patient will likely suffer, even thought they may initially feel fine.


Unfortunately too many practitioners prescribe hormones such as thyroid, estrogen and testosterone, ether bio-identical or not, instead of exploring the possibility of nutritional deficiencies or environmental toxin accumulation.


Your body, your choice

Your health depends on a delicate balance of many factors such as glandular production of hormones. While we understand a great deal about the functioning of this system, there are many unknowns including the best ways to measure them, what constitutes healthy levels, and when to supplement. The long-term consequences of hormone supplementation are unknown.


Bio-identical hormones, despite the claims, are synthetic hormones. They offer the potential of fewer side effects and greater effectiveness, however this potential is unproven. They also have a potential for the same side effects, disruption of normal hormone balance, and increased rates of certain cancers.


The conscientious patient follows the safe and logical traditions of naturopathic medicine to do no harm and address the causes of disease. While sometimes necessary, more often hormone deficiencies and imbalances can be corrected with therapeutic nutrition and detoxification of environmental toxins.


Tom Ballard, RN, ND


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