Hormone Replacement Therapy

Male HRT
(read extract from
presentation given
by Dr Perring
in Monaco 2007)

Female HRT
(read extract from
recent article on HT)

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Introduction

HRT was first used for women as a way of replacing oestrogens depleted following the menopause. It was later realised that to avoid risks of cancer of the womb, progesterone was needed as well. The recognition that men also might benefit from replacement of hormones has been controversial until the last few years.

Symptoms of hormone deficiency in men and women arise from the beginning of the fifth decade. Extraneously administered hormones may reverse these symptoms and as long as blood levels and possible side-effects of the hormones are monitored their use will help retain youthful function indefinitely.

As young adults many of us took health for granted. At this age many hormones are at peak levels. However, by our mid-forties although a decline in hormone levels is not yet significant, lack of exercise, poor nutrition and 'living in the fast lane' lead to less certainty of good health. Early signs of future problems may be no more than a loss of resilience after a night out, reduced immunity to infection, weight gain, loss of muscle tone or disturbed sleep.

It is only in our fifties that reducing levels of hormones give rise to symptoms and signs. Tiredness, emotional flatness, loss of libido, aching joints, flushing or sweating attacks, poor skin texture and dryness of skin, hair and brittle nails are some of many possible indicators of hormone depletion. Reduced levels of hormones can be measured in the blood. Often levels can be corrected with accompanying recovery from the presenting symptoms.

It is in the context of maintaining a good quality of life into our 60s and 70s that Hormone Replacement Therapy (HRT) is recommended. By its use we may defer the onset of mental and physical deterioration and optimise health and well-being.

1. Traditional HRT has offered the replacement of oestrogens and progestagens (synthetic variants of the body’s own progesterone) since the 1950’s. The main benefits are the reduction of menopausal symptoms such as hot flushes, mood swings, and the maintenance of energy, libido, and bone density.

Adverse effects are a slightly increased risk of venous thrombosis and, with treatment continuing in excess of 5 years, of breast cancer. This risk of breast cancer is greater if there is a family history of this condition. The addition of progestagens to oestrogen therapy protects against endometrial cancer. Benefits of HRT are considered by most doctors to out-weigh the risks for the majority of women, but the decision to take HRT, and for how long, should be a shared decision with the patient taking into account side effects as well as the improved quality of life for the individual.

2. Non-Traditional HRT emphasises the benefit of using a variety of hormones, usually in smaller amounts, to orchestrate their overall effect on energy and well-being. These may include metabolic precursors of the sex hormones, DHEA (dehydroepiandrosterone) and pregnenolone, as well as testosterone, growth hormone, melatonin, and the thyroid hormones.

Natural HRT properly refers to the use of hormones which are identical in structure to those normally present in the body, hence ‘natural’ to the body. The term 'bio-identical' is now commonly used as the use of the term 'natural' (to indicate a plant or animal source) is confusing - what is significant is the molecular structure of the component steroid (all hormones are steroids) and its purity, and whether it be synthesised in the laboratory or derived from a plant or animal source is immaterial.

Oestrogens, in the form of oestradiol, oestrone and oestriol, can be given in the proportions naturally occurring in the body, with the addition of natural progesterone (which may be synthetically derived from a precursor substance, Diosgenin, present in Yams). Testosterone, DHEA, pregnenalone, growth hormone and melatonin may also be given in forms naturally present in the body.

3. Non-hormonal Treatments for the menopause and menopausal symptoms have become more popular as doubts about traditional forms of HRT have been publicised. They include herbal medicines, nutritional and other lifestyle adjustments.

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