Individualising Hormone Replacement Therapy
Posted February 5, 2019 by Kristy Russell
Written by Doctor Aparna Hegde
What is meant by the term hormone replacement treatment (HRT)? What are the hormones used?
Who needs HRT? How is HRT given? Why is an individualised approach necessary?
The term HRT is used in reference to supplementing the sex hormones testosterone, oestrogen, progesterone, DHEA and pregnenolone in both men and women to restore balance and optimise function. The basis of Anti-ageing medicine is a theory is that if hormonal balance is maintained, say to the level of a 30 year old, the effects of ageing are slowed down. This includes decline in brain function, loss of skin integrity, loss of bone density and cartilage, loss of lean muscle mass, loss of sexual function and progression of degenerative vascular changes that naturally occur with time in the human body.
There is not much high level evidence that supports this theory and so I revert to my rule of “the risks of treatment must be outweighed by the benefits”. I use HRT to strategically address the issues my patient is presenting with provided there are no contraindications such as a history of breast cancer. When the symptoms of hormonal imbalance or deficiency become significant enough to interfere with life, home, work or social commitments despite lifestyle changes to correct them, they require HRT. Suffice to say, I would exclude any serious pathology causing this imbalance such as a polycystic ovary syndrome first and incorporate strategies such as lifestyle changes and supplements that can be used to manipulate hormonal changes. Sometimes HRT is only required for a short period to alleviate symptoms while other changes such as improving detoxification pathways take time to make gains.
There are strict guidelines on HRT that is able to be prescribed under the Pharmaceutical Benefits Scheme (PBS). For example, testosterone blood level values have to meet specific criteria for men to be given supplementation. Furthermore, the HRT preparations available are limited to synthetic compounds or those derived from horse urine. Bio-identical hormones refer to preparations derived from plants that are identical to the structure and composition as those produced by the body and are not covered under the PBS.
HRT can be taken as injections, oral preparations or via the skin as patches, creams , gels, intra-vaginal tablets and pessaries and oral mucosal troches. The evidence points to skin delivery as being the safest and best delivery method as it bypasses the liver enabling the HRT dose and adverse metabolic effects to be minimised. This is the reason I tend to favour patches, intra-vaginal or skin delivery compounded preparations.
In men with complaints related to low testosterone such as irritability, brain fog, fatigue, lack of motivation, lack of libido and erectile problems, blood test results can be used to direct supplementation once significant causes such as xenobiotics and heavy metal overload have been ruled out. Testosterone supplementation can be given as injections or in topical preparations as cream or gel via the skin. Levels are monitored regularly to titrate the dose and ensure fertility and the endogenous testosterone production are not impacted. As previously mentioned, diet and exercise combined with herbal and nutritional supplementation can boost testosterone production without requiring HRT in some cases.
In younger women who are still menstruating, HRT can be used to help with symptoms of PCOS, pre-menstrual tension or stress, oestrogen dominance, thyroid and insulin resistance problems.
In peri-menopausal and menopausal women, HRT is used to control common symptoms associated with the decline in sex hormones such as hot flushes, sleep disturbance, mood changes, fatigue, lack of libido and brain fog.
In my experience, “one size does not fit all”. There are a number of variations in how hormones are metabolised in the body as well as the end effects in individuals. HRT content as well the delivery method must be tailored based on regular reviews of patient compliance, symptoms and test results for best care.
To address hormonal problems, the use of HRT or discuss your medical care with a functional medicine doctor, please make a long appointment with Dr Aparna Hegde at Azure Medical. These appointments are not bulk billed, however the clinic rates are very competitive in comparison to other functional medicine practices in Perth.
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