Dr. Rachna

Hormone Replacement Therapy

Hormone Replacement Therapy
Introduction to Bio-identical Hormones?

Just as levels of vitamins and minerals decline with age, the organs in women and men alike stop producing adequate amounts of hormones including estrogen, progesterone, testosterone, thyroid hormones, growth hormone, melatonin, DHEA, brain hormones and the list goes on.

From time immemorial women reached out for help from their doctors for sudden onset of unexplained strange symptoms of depression, crying spells, mood swings, hot flashes, brain fog etc in their late 30's-40's. poorly understood by their mostly male physicians, women were often labeled "Crazies" and referred to Psychiatrists who then treated them with anti-depressants, tranquilizers and sleeping pills etc to no avail. As more and more women reached out with similar symptoms warranted research which finally confirmed that the loss of female hormones at a particular stage of life was responsible for their symptoms and the term "Menopause" was coined. Research also showed that replacing estrogen and progesterone in these women helped tremendously with their symptoms. Which gave birth to a multibillion dollar industry of hormone replacement therapy commonly known as HRT. Synthetic estrogen called Premarin was produced on large scale to meet the demand by the pharmaceutical industry, the aftermath of freely available HRT ultimately had perilous outcomes in the form of increased incidence of breast and uterine cancer in women. Subsequently women were afraid to take and their physicians were afraid to prescribe HRT.

But it is scientifically proven that if we do not replace hormones, our brain, bones, heart, blood vessels, joints, skin, mood and most importantly, quality of life begin to deteriorate and we begin to age more rapidly.

What Are Bio-Identical Hormones?

Bio-identical hormones are gaining popularity again among women who do not want to suffer from the symptoms of menopause anymore. Bio-identical hormones are similar to the hormones produced in our body and are exactly identical in molecular structure. They are compounded from yam and soy by removing and adding extra molecules so they are recognized by your cells and tissues as your own.

Synthetic hormones have extra molecules which are not recognized by the body. They are not broken down by our body's enzymatic system and stay in the body for long periods of time as toxins and carcinogens. Although, soy and yam hormones, which are available over the counter, have many health benefits; they are barely recognized by human estrogen and progesterone receptors unless they are compounded. Therefore, they do not effectively reverse or treat the hormone deficiency.

How Are Bio-identical Hormones Dispensed?

Bio-identical hormones are compounded by prescription only through properly qualified practitioners. Healthcare providers evaluate hormone requirements through clinical symptoms, and possibly, blood or saliva tests. The prescription are customized to the exact amount of each hormone needed for balance in each individual.

Hormones, which are initially evaluated for replacement, include the three types of estrogens (estrone, estradiol, estriol), progesterone and testosterone. These can be taken orally, by patch or as a cream. Additional hormones which should be considered include cortisol, melatonin, DHEA, thyroid hormone and growth hormone.

What Are the Benefits and Risks of Bio-identical Hormones?

Bio-identical hormone replacement significantly reduces symptoms associated with drop in hormone levels before, during and after menopause including hot flashes, vaginal dryness, skin thinning, memory loss, concentration loss, anxiety, depression, weight gain, irritability, fatigue, insomnia, decreased sex drive, urine loss, muscle weakness and joint pain. In addition to symptomatic relief, bio-identical hormones protect the brain, heart, blood vessels, bones, skin, hair follicles and muscles from decline. Most patients who take bio-identical hormones feel emotionally and physically better within few weeks.

Are Bio-identical Hormones Safe?

So far, there is more data on synthetic hormones than bio-identical hormones because synthetic hormones are patented and drug companies pay for the studies. Bio-identical hormones are generic to the human body like vitamins. They cannot be patented and therefore drug companies have not been interested in conducting formal studies so far. We do know however, that bio-identical hormones have been used in Europe for over 60 years and European studies show that they are both safe and effective.

They have been shown to protect against heart disease, high cholesterol, osteoporosis, and mental decline. They do not increase the risk of breast cancer, and, in fact, there is data showing that they may protect against breast cancer. At precise doses that exactly replaces the need, there are no known side effects as they have the exact same action on the body as our own hormones.

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Andropause: And What About Men?

Although, the male andropause has not been widely recognized or talked about, increasing medical research has turned attention to the gradual hormone decline in males which generally presents with symptoms in the mid 40's to 50's. A recent World Health Organization (WHO) report, states that the male hormone, testosterone, drops about 3 percent annually starting around age 30. It is estimated that by age 50, 30 percent of men have testosterone levels low enough to cause symptoms of andropause and increased risk of disease and death.

Hormonal decline is not limited to just testosterone. Other natural hormonal levels can be deficient in andropause including human growth hormone (HGH or IGF-1), DHEA, thyroid hormone, melatonin, cortisol and others. Although, drop in the levels of hormones are a normal part of aging, they are accompanied by a gradual and undesired decline in sexuality, mood changes, weight gain and overall low energy. Declining hormones also increase the risk of more serious medical conditions (such as cardiovascular disease and osteoporosis).

What are the symptoms of Andropause?

By the time men are between the ages of 40 and 55, the drop in hormone levels gradually (unlike the sudden changes in menopause) produce changes in attitude, mood, confidence, memory, energy level, sex drive, muscle tone, muscle mass, muscle strength, abdominal fat and physical agility. Psychological stress, alcohol abuse, injuries, surgery, medications, and obesity can contribute to its onset.

Moreover, studies show that a drop in testosterone and growth hormone actually contributes to the risk of health problems like heart disease, osteoporosis and weak muscles leading to fraility. Since all this happens at a time of life when many men begin to question their values, accomplishments and direction in life, it's often not recognized that the changes are related to a silent disturbance in hormones levels.

What are the risks of hormone deficiencies?

Since all cells in the body have receptors for hormones, declining testosterone levels are a major contributor to deterioration of the brain, muscle, skin, bone, joints, vessels, heart and the quality of life. Each hormone has specific roles in the normal bodily functions. Specifically, testosterone builds protein and is essential for normal sexual behavior and producing erections. Additionally, each hormone affects numerous metabolic activities such as the production of blood cells in the bone marrow, bone formation, lipid metabolism, carbohydrate metabolism, liver function, brain function, prostate gland growth. Therefore, in addition to the symptoms described, declining hormones increase the risk of deterioration of organs , osteoporosis and cardiovascular disease.

Andropause and Osteoporosis

Osteoporosis is not just a disease of women. In men, lifestyle, nutrition and hormones such as testosterone and growth hormone play critical roles in the maintenance of bones. As these decline, between the ages of 40 and 70 years, male bone density falls by up to 15 percent. What's more important, approximately one in eight men over age 50 actually have osteoporosis, increasing fractures of the hip, wrist and spine. Therefore, the incidence of hip fractures rises exponentially in aging men, as it does in women, but starting about 5 to 10 years later.. After a hip fracture, up to one third of patients never regain full mobility.

Andropause and Cardiovascular risk

It is now well accepted that women's risk of atherosclerosis (hardening of the arteries) and cardiac events increases after menopause. New evidence suggests that a similar phenomenon occurs in men as their testosterone levels diminish with age. Research thus far point to a strong association between low-testosterone levels and an increase in cardiovascular risk in men.

How do you know if you are in Andropause?

Although, symptoms of andropause were first described in medical literature in the 1940's the term andropause was coined only recently, it is generally under diagnosed and under treated due to often vague symptoms which can vary a lot among individuals. Some men find it difficult to admit that there's even a problem. And often physicians do not think of low hormone levels as a possible culprit, attributing symptoms to medical conditions and normal aging. Accurate diagnosis and treatment requires a thorough clinical history, physical evaluation and lab work to measure hormone levels.

How do you treat Andropause?

Of course, any strategy to reduce the symptoms and risks of andropause should be based on lifestyle changes such as optimal diet, regular exercise, nutritional replacement, stress-management and the reduction of tobacco and alcohol intake as well as correction of Obesity. These critical factors affect hormone levels and their effects. Additionally, hormone replacement (i.e. testosterone, growth hormone, thyroid hormone, melatonin) should be considered for those who are experiencing clinical symptoms of hormone deficiency. No patient is too old to start hormone replacement therapy if it is indicated. As for any medication, hormones should be taken under a physician's care, with appropriate follow-up evaluations. They are dispensed by injection, creams, gels, patches and oral capsules. If you have an established prostate tumor or history of male breast cancer you would not be a suitable candidate for testosterone replacement therapy.

What is the role of Viagra/ Cialis in Andropause?

Testosterone replacement therapy works differently from use of Viagra or Cialis. The drugs act by increasing the blood supply in the penis only to maintain an erection during sex.Testosterone on the other hand produces a total body response, brain and all aspects of the sexual response including strong erectile quality and sexual desire more naturally.

What are the benefits or Risks of hormone replacement?

Clinical studies support the use of exercise, nutritional replacement, testosterone and growth hormone to treat the symptoms and prevent disease. Hormone replacement with testosterone and growth hormone has been shown to significantly improve sexual performance, libido, energy, mood, memory, brain function, heart disease, vessel disease, muscle strength, muscle tone, muscle mass, abdominal fat, bone density and overall sense of well-being. These effects are usually noted within just a few weeks.

A recent 2004 study in the New England Journal of Medicine concluded that there were no long term risks of replacement therapy which aims to restore normal hormone levels. Historically, testosterone use has been associated with aggression and hypersexuality. These effects stem from the misuse of testosterone by men such as body builders, who use testosterone at much higher doses than needed by the body to correct the deficiency.

Understanding Benefits

  • » Improvement in mood and sense of well-being
  • » Increased mental and physical energy
  • » Decreased anger, irritability, sadness, tiredness, nervousness
  • » Improved quality of sleep
  • » Improved libido and sexual performance
  • » An increase in lean body mass, a decline in fat mass
  • » An increase in muscle strength (hand grip, upper and lower extremities)
  • » Potentially, a decrease in the risk of heart disease

Understanding Risks

There are several conditions in which you should use testosterone replacement therapy with caution. These include:

  • » Breast cancer (in males)
  • » Prostate cancer

In some other cases testosterone replacement therapy may not be right for you. If one of the conditions below is applicable to you, your doctor will decide whether (in your specific case) testosterone replacement therapy is the right solution.

  • » Liver disease
  • » Heart or blood vessel disease
  • » Male Breast Cancer
  • » Prostate cancer (cautious approach)
  • » Edema (swelling of face, hands, feet, or lower legs)
  • » Enlarged prostate
  • » Kidney disease
  • » Diabetes mellitus

To help your doctor determine your best treatment plan, you should also discuss the following:

  • » If you have ever had any unusual or allergic reaction to androgens or anabolic steroids.
  • » If you are an adult male who plans to have children; high doses of androgens may cause infertility.
  • » If you are bedridden.
  • » If you are now taking any other prescription or nonprescription (OTC) medicine, especially anticoagulants (blood thinners).

Treatment of andropause consists of replacing lost hormones with bio-identical testosterone. By choosing hormones from sources that are bio-identical to our own body's naturally produced hormones, one can receive the optimal benefits of therapy while reducing the risks associated with chemical agents.

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Other Important Hormones

Thyroid Hormone

Thyroid gland is located in the neck below the larynx, commonly known as the voice box. The thyroid gland affects every function in the body because it controls metabolism and regulates the entry of oxygen into the cells thus controlling metabolic rate, body temperature, brain maturation in newborns, heart rate, hair growth, ovulation, skin turnover, growth and development. Additionally, thyroid hormone increases protein synthesis. Therefore having thyroid hormone in youthful range is critical for good health.

Thyroid stimulating hormone (TSH) is produced by the pituitary gland in the brain and stimulates the thyroid gland to produce thyroid hormone T4 ( thyroxin ). T4 is the primary hormone secreted from the thyroid gland but the most active form T3 is converted from T4 in the liver and other tissues. A toxic environment, smoking, stress, chronic antibiotic therapy, genetic disorders, nutritional disorders, hormonal imbalances and certain tumors affect the thyroid function.


When thyroid levels are too high, the condition is called hyperthyroidism. TSH production is suppressed and therefore the levels of TSH are low. Excess of thyroid hormone, especially T3, can produce anxiety, fatigue, cardiac arrhythmias, heart palpitation, high blood pressure, weight loss, heat intolerance, diarrhea, sweating, rapid bone growth and protruding eyes


Low thyroid levels causes hypothyroidism. This condition is more wide spread in women and elderly, with age thyroid levels diminish and conversion of T4 to T3 decreases. It is estimated that up to 40% of population suffers from underactive thyroid gland. There are three types of hypothyroidism include primary, secondary and tertiary.

Causes of Hyperthyroidism

  • » Iodine deficiency
  • » Heavy metal toxicity
  • » Environmental radiation
  • » Chronic Candida infection
  • » Certain foods suppress thyroid gland such as Brussels sprouts, spinach, cabbage, kale, mustard green, turnips, broccoli, cauliflower, soy and additionally fluoride and chlorine in tap water.

Common Symptoms of Hypothyroidism

  • » Fatigue and morning grogginess
  • » Lower than normal resting body temperatures
  • » Hair loss
  • » Cold extremities
  • » Constipation
  • » Greater susceptibility to infections
  • » Depression and mood swings
  • » Dry skin and dry brittle hair
  • » Headaches
  • » Menstrual abnormalities
  • » High lipids
  • » Finally Goiter ( enlarged thyroid gland )

Is there treatment for Thyroid problems?

Yes definitely, in most cases the condition is easily correctible. your physician will take a detail history and thorough physical exam as well as blood test. Based upon the findings the dosage of Thyroid hormone is titrated for individual need. Reversal of symptoms occurs rather quickly.

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DHEA is a steroid hormone produced in our body by the Adrenal glands, Gonads, Brain and other parts of nervous system. It is one of the most abundant hormone in our body and converts into testosterone, estrogen and progesterone. Other reported actions include anti-inflammatory, anti-neoplastic, anti-obesity, anti- diabetogenic and anti-aging. DHEA levels peak at the age of 25 and then gradually decrease to below 20% of the peak by age 70. some people after 40 produce very little or no DHEA. Levels are also low in people with chronic conditions such as obesity, diabetes, Immune deficiency, high blood pressure, heart disease etc. Low DHEA levels can also result from menopause and andropause, excess alcohol consumption, birth control pills, lack of exercise, hypothyroidism, obesity, smoking and natural aging. During stress excess production of stress hormone Cortisol can shut down the production of DHEA. Managing stress for example with meditation has been known to improve levels of DHEA.


Produced naturally in the body by pineal gland in the brain and controls the circadian rhythm which determines the 24 hour sleep/ wake cycle. The levels are higher at night and are suppressed by bright light and decline with age. Melatonin is derived from the essential amino acid L-tryptophan which is converted into a neurotransmitter Serotonin and then is further metabolized into melatonin at night.

As we age levels of melatonin decrease. that is one reason why elderly have difficulty sleeping at night while melatonin levels decline over many years they plummet after middle age. Melatonin may help fight cancers especially prostate, breast and colon. Melatonin has neuro-protective role also. Administration of melatonin after stroke may help keep brain damage to minimum. It is also a very powerful antioxidant for the brain tissue. it also enhances the activity of Glutathione and helps protect brain from oxidative stress. It has been found to be effective in migraine headaches by re-synchronizing biological rhythm to lifestyle thereby preventing migraines. For years melatonin has been popular in treating jetlag and insomnia. Daily supplementation in small doses taken one hour prior to sleeping can help in sleep patterns thereby improving quality of life.

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Human Growth Hormone( HGH)

Of all the intervention that anti-aging medicine has brought to patients who wish to slow the aging process, human growth hormone( HGH) is arguably the most profound and most controversial. It is produced abundantly by pituitary gland in the brain and is released in the blood stream periodically throughout the day although it is released in large amounts during stage 3 and 4 of the deep sleep. Human Growth Hormone obtained its name from the fact that HGH is necessary for children to grow in stature. At one time, this was believed to be the only role played by HGH. We now know differently. It appears that essentially every organ in the body depends on HGH for its proper growth and functioning. It also increases anabolic activity thereby increasing lean muscle mass and regulates metabolism of proteins, electrolytes, carbohydrates and controls how body uses fat.

HGH has been called the MASTER HORMONE because of its ability to affect all the other hormones and organs throughout the body. It has repairing and restorative abilities that can reverse tissue damage and facilitate re-growth of failing organs, something no other hormone can do. It has been reported that people who live to be 100 years or more have high levels of HGH. Adult Growth Hormone Deficiency has been described as a model for aging." normal aging" results in part from an insufficiency of HGH as opposed to true deficiency. almost one third of older folks have HGH deficiency and may benefit from replacement therapy.

Since use of Human Growth Hormone is strictly controlled by FDA and closely monitored our center does not provide treatment with Human Growth Hormone ( HGH ). However we address the issue of HGH deficiency by helping individuals increase the production of their own hormone through a balanced approach with diet, exercise, stress management and optimization of other hormones.

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