Guide to Hormone Health

Bioidentical Hormone Replacement Therapy (BHRT)

The First Step Back to “You”

You may not have heard of bioidentical hormones before now, or you may be confused about the differences between “natural” bioidentical hormones and dangerous “synthetic” non-bioidentical hormones, such as Premarin and Prempro. At Dr. Randolph’s Ageless & Wellness Medical Center, we do our best to cut through the confusion and provide you with information you need to make the best decisions for your optimal health.

For two decades, Dr. Randolph has prescribed bioidentical hormone replacement therapy (BHRT) to thousands of women and men suffering from symptoms of hormone imbalance, such as hot flashes, night sweats, weight gain, brain fog, moodiness, worsened PMS, bloating, headaches, depression, fatigue, low libido and decreased sexual pleasure; but he did not always prescribe BHRT. Like most physicians in the United States, Dr. Randolph was trained in medical school to prescribe “synthetic” non-bioidentical hormones. He stopped prescribing “synthetic” hormones because of the high percentage of patients who came back complaining of side effects, some very troublesome, like low libido and weight gain, others of greater health significance, like tender or fibrocystic breasts and low thyroid disorders. Years before the landmark 2002 National Institutes of Health (NIH) Women’s Health Initiative (WHI) study revealed “synthetic” hormones were a serious health risk, Dr. Randolph had already researched and developed a safer alternative. His early training as a compounding pharmacist with a specialization in plant-based medicine (pharmacognosy) helped him recognize that bioidentical hormones can literally restore hormone balance at a cellular level. In the mid-1990s, Dr. Randolph began prescribing compounded bioidentical hormone treatments for his patients, finally opening his own on-site pharmacy in 1998. Although BHRT has been available for many years, not everyone is aware of how safe and effective this type of treatment is!

Understanding BHRT

Bioidentical hormones are derived from a plant molecule called “diosgenin” that is found in wild yam and soy, and then synthesized in a laboratory to be identical to naturally produced hormones. The lab process ensures that these hormones have the exact molecular structure and duplicate the exact same function as the hormones made by your body. When you use bioidentical hormones, the cells of your body recognize them as familiar and know how to put them to best use.

Bioidentical hormones are safe because, like your own hormones, they fit perfectly into the hormone receptor “locks” of the cells in the body where they do their work. And because they have a 100 percent relative binding affinity (RBA) for your internal hormone receptor sites, they do not trigger side effects. Just as the key to your car fits perfectly into the ignition and sparks the engine when turned, bioidentical hormones fit into your body’s hormone receptor locks and spark exactly the same response as the hormones produced in your ovaries, testes, adrenal glands, or hypothalamus. Medical research has proven that when BHRT is used to re-establish the body’s optimum hormone levels, positive effects happen at a cellular level. Which bioidentical hormones you need, and how much, will depend on your individual body chemistry or physiology. The objective of BHRT is to replace or rebalance hormones that are deficient or in excess, in order to restore optimum hormone balance.


What Are the “Sex Hormones”?

Most people know that the sex hormones, estrogen, progesterone, and testosterone, play important roles in human reproduction. What you may not know is that they also help regulate many other functions in the body, from sleep patterns, to your moods and memory, bone growth, muscle strength, and much more. To understand the many negative effects of an unbalanced hormone ratio – the most common of which is the condition of estrogen dominance, where there is too much estrogen relative to progesterone – it is important to first review the actions of these hormones inside the body. Their actions are complex, and you should know the basics, especially the functions of estrogen and progesterone.

Estrogen

The word “estrogen” is really shorthand for a group of several different but related hormones that perform similar functions: Estrone (E1), Estradiol (E2), and Estriol (E3). Estrogen circulates through the bloodstream and fits estrogen receptors throughout the body: in women, it affects not only the breasts and uterus, but also the brain, bone, liver, heart, and other tissues. Estrogen controls growth of the uterine lining during the first part of the menstrual cycle, causes changes in the breasts during adolescence and pregnancy, and regulates various other metabolic processes, including bone growth and cholesterol levels. Estrogen also plays a role for men in supporting healthy cholesterol, brain function, and bone health. In women, estrogen is produced in the ovaries, adrenal glands, and fat tissues. Men produce estrogen in the testes through a process involving an enzyme called aromatase that transforms testosterone into Estradiol (E2).

Progesterone

For too long, estrogen has been considered the star of the show when it comes to female hormones. Estrogen is responsible for the development of women’s “sex characteristics,” breasts, curvy hips, pubic hair, as well maintaining the menstrual cycle, and preparing the uterus for pregnancy. Progesterone, on the other hand, promotes regular sleep patterns, prevents bloating, maintains the libido, fosters a calming effect on the body, stimulates bone building, and thickens the uterine lining to promote survival of a fertilized egg (ovum). Although progesterone was discovered in the early 1930s, our understanding of its equally crucial role in the hormone story continues to unfold through current research. Many common hormone problems, such as PMS, irritability, and weight gain, are actually related to progesterone.

The truth is, you cannot understand progesterone without discussing estrogen, too. These two hormones operate like two sides of a seesaw, shifting up and down throughout the course of a woman’s monthly cycle. When your body produces the optimal amount of each, you feel healthy and balanced. As you get older, the amount of estrogen and progesterone your body produces can change from month to month and year to year. Due to the influence of stress and “environmental estrogens,” hormonal fluctuations can occur at any age (as early as a woman’s late 20s or early 30s) and can also affect men’s hormone levels.

When your progesterone gets low, that side of the seesaw hits the ground, and negative symptoms arise: for women, that typically means poor sleep, fatigue, anxiety, heavy periods, weight gain, uterine fibroids, irritability, and even rage. The result of low progesterone is a condition called “estrogen dominance.” This is what happens when the progesterone side of the seesaw gets “stuck” on the ground: the estrogen side is “elevated,” relatively speaking. It’s not (necessarily) that your estrogen level is high — it’s that your progesterone level is so low that estrogen effectively “dominates.”

Testosterone

Testosterone is the best-known of a group of sex hormones called “androgens.” We tend to think of testosterone as the “male hormone,” and indeed it is the primary hormone responsible for male physical and sexual development. However, women require testosterone, as well, to maintain healthy mood, sex drive, and healthy muscles and bones: the difference is in the quantity. Women naturally produce 0.25 milligrams of testosterone daily, while men may produce 4 to 7 milligrams: ten to forty times that amount! In women, testosterone is produced in the ovaries and adrenal glands, and in men, it is produced in the testes and adrenal glands. Women and men both reach their peak of testosterone levels in their 20s, and thereafter levels drop approximately one percent a year. With optimal levels of testosterone, both men and women benefit from increased energy, reduced fat, healthy libido, and a protective effect on the heart and blood vessels.


Women’s Hormone “LifeCycles”

Throughout your lifetime, your hormones have your body on “remote control”! They act as chemical messengers communicating to all the tissues in your body, including your brain, bone, heart, and more. When hormone production is optimal and levels are balanced, you feel great, have plenty of energy, easily maintain a healthy weight, desire and enjoy sex, and handle stress well. From her late teens to early 30s, a woman’s ratio of sex hormones is usually optimal. For the most part, if periods occur on a regular 28-day cycle, you can assume that your body, and particularly your ovaries, are producing plenty of all the required hormones. The 20’s, called the “Reproductive Years,” is typically the decade in a woman’s life when the delicate balance of all the three sex hormones produced by the ovaries—estrogen, progesterone and testosterone—is ideal. During these years, your internal remote control typically works perfectly.

However, as you move past your 20s and into your 30s, hormone imbalances and/or symptoms related to stress, lack of sleep, synthetic birth control, and other influences, can start to appear. Some young women may experience premenstrual syndrome, or PMS. Bloating, anxiety, irritability, back pain, nausea, cramping, and lethargy are some of the most common PMS symptoms. Even younger women in their late teens and twenties can suffer from “estrogen dominance,” especially if high stress levels result in a lack of ovulation, or “anovulatory” cycles. (Without ovulation, your body is lacking in progesterone.) Other common culprits of hormone imbalance in what should be a woman’s peak hormone-producing years are body fat and man-made environmental estrogens, called “xenoestrogens,” that are foreign to the body. Unfortunately, fat cells have a built-in ability to churn out estrogen, so if you have been 10 pounds or more overweight for one or more years, your body fat could be causing your estrogen levels to escalate to an unhealthy high.

Severe PMS, sleep disturbances, migraines, and unwanted belly fat are the red flags of hormone imbalance during the 30-something years of Pre-Menopause (“before menopause”), as are more serious health issues such as polycystic ovaries, endometriosis, and infertility that can manifest in vulnerable women well before the end of periods. As ovarian function wavers in the years approaching menopause, 40-something women in Peri-Menopause (“around menopause”) usually have regular cycles but can begin to experience erratic cycles as estrogen and progesterone levels fluctuate. This causes shifting levels of other key hormones, like DHEA, testosterone, and cortisol, which negatively impact overall hormonal imbalance. A whole new world of symptoms, from hot flashes and mood swings to high anxiety and low libido take women on a hormonal roller coaster ride. Now the search for symptom relief begins in earnest!

As the ovaries take their final bow, ovulation ends and Menopause begins after 12 consecutive months with no periods. When age-related declines in estrogen, progesterone, DHEA and testosterone levels kick in, the resulting imbalances trigger symptoms and long-term disease risks that women may be unprepared to manage. With less and less hormone to go around, their vital role in protecting the health of the breasts, bones, skin, brain, and heart is greatly diminished. As the adrenal glands pick up the slack in hormone production, reducing stress and restoring healthy levels with bioidentical hormones and natural supplements in the right amounts, becomes more important than ever.

Approximately one in every four American women will enter an abrupt, artificial Menopause, as the result of a complete hysterectomy. Many physicians commonly recommend a hysterectomy for women who have fibroid tumors, severe endometriosis, cancer, and/or constant, heavy bleeding. A “complete hysterectomy” involves surgical removal of the entire reproductive tract, including the uterus, fallopian tubes, and ovaries, whereas a “partial hysterectomy” only removes the uterus.

Once a woman has had a complete hysterectomy, her body will immediately enter menopause regardless of her biological age: there are no ovaries to produce any level of hormones. As a result, the body goes into a kind of shock, since the main source of estrogen, progesterone, and testosterone dries up overnight. Regrettably, too many physicians make the mistake of prescribing “only estrogen,” but estrogen alone is not enough. In fact, estrogen prescribed without progesterone to balance it will inevitably trigger “estrogen dominance,” along with potential risks for breast cancer, low thyroid, and other preventable diseases. Furthermore, an estrogen-only approach ignores the basic physiology of hormones and their interactive role in protecting the health and function of a woman’s vital organs. Though her uterus and ovaries have been removed, the breasts, bones, brain, and heart that remain still need their full range of hormones to function.

A woman who has a complete hysterectomy will require a new and balanced supply of all her sex hormones: estrogen, progesterone, and testosterone, as well as DHEA. In a partial hysterectomy, where the uterus is removed and the ovaries are left behind, the belief that ovarian production of hormones is not affected is a common error in thinking. The ovaries are significantly impacted because there are two primary pathways for blood flow to the ovaries: one through the aorta, and the second through the uterus. When the uterus is removed, the flow of blood to the ovaries lessens significantly, and total hormone production is reduced. While hormone imbalances may not be as severe as with complete hysterectomy, women who have partial procedures should be tested, treated, and monitored to ensure that hormone levels do not become imbalanced over time.

Artificial menopause can also occur as a result of radiation or chemotherapy, or by the administration of certain drugs that catalyze menopause for medical reasons such as to shrink fibroid tumors. Because there is no opportunity for gradual adjustment to the hormonal drop-off, the symptoms of artificial menopause can be sudden, severe, and debilitating and require a more immediate intervention of supplemental hormone therapy.

How do you know what type of supplementation you need for natural symptom relief?
Dr. Randolph has created specific guidelines to help you determine your individual supplementation needs, depending on your age, menstrual history, symptoms, and hormone test results (if you have them). Recommended supplements are based on specific criteria, including: age range, life cycle, and associated hormone level shifts, resulting type of imbalance/medical condition, and common symptoms. All hormonal supplements are bioidentical formulations that duplicate the natural physiology of hormones in the body. Ingredients as listed are derived from natural and/or plant-based substances.

What are the benefits?
The first question you should ask is: what can you expect from a natural hormone balancing regime? The answer is simple: relief from unwanted symptoms! You should expect fewer night sweats and hot flashes; improved libido (sex drive); improved moods, memory and sleep; renewed strength and energy; the ability to lose weight more easily; and a belly that goes from fat to flatter. When or if symptoms persist, adrenal support (to manage stress), additional bioidentical hormone supplementation, and/or a compounded formulation may also be required.


Estrogen Dominance

Everyone has a genetically pre-determined hormonal balance. For the typical teen starting menstruation, the balance of hormones produced in the body is a healthy ratio of estrogen to progesterone. This balance begins to shift before or around age 30, with production of both hormones declining. As you move past your 20s and into your 30s, hormone imbalances and/or symptoms related to stress, lack of sleep, synthetic birth control, can start to appear. As you reach your 40-something years it is not uncommon to find that symptoms begin in earnest as your aging ovaries gradually lose their ability to produce steady amounts of each sex hormone. Progesterone is the first hormone whose production declines. Typically beginning in your early to mid-30s, the ovaries begin to make more estrogen and less progesterone. This disruption of the ideal ratio between estrogen and progesterone triggers negative responses throughout your body and brain. The medical term for this phenomenon is “estrogen dominance.”

“Estrogen dominance” means that the ratio of estrogen to progesterone in the body is disproportionately high. To understand estrogen dominance, you have to understand the role of progesterone, as well. Estrogen and progesterone operate like sides of a seesaw, shifting up and down during a woman’s monthly cycle. When progesterone gets low, that “side” of the seesaw hits the ground, and this effect causes negative symptoms to arise: poor sleep, fatigue, anxiety, heavy periods, weight gain, uterine fibroids, irritability, and even rage. When the progesterone side of the seesaw gets “stuck” on the ground, the estrogen side is “elevated,” relative to progesterone. It’s not (necessarily) that your estrogen is high — it’s that your progesterone level drops so low that estrogen effectively “dominates.”

A contributing factor is xenoestrogens (man-made environmental estrogens) found in hormone-injected meats and poultry, certain pesticides, petrochemicals, herbicides, plastics, fuels, car exhausts, and drugs, as well as phthalates, or plastic-softening chemicals, which enter the body and add to the estrogen load. Lifestyle choices are also at fault: the wrong foods, too little exercise, too little sleep and too much stress can increase and accelerate estrogen load and dominance.

Estrogen dominance can short-circuit your internal remote control physically, emotionally, and mentally. Symptoms include fatigue, depression, low libido/poor sex drive, mood swings/increased irritability, PMS, hot flashes, night sweats, headaches/ migraines, abdominal weight gain, insomnia, osteoporosis, irregular bleeding, bloating and increased risk of breast, uterine, and prostate cancers. 

The hormone estrogen is an important key to a woman’s physical well-being; however, an overload of estrogen is destructive, causing a cascade of unpleasant symptoms and raising the risk of life-threatening diseases. As Dr. John Lee described the condition: “If estrogen is dominant and progesterone deficient, estrogen becomes toxic to the body.” Untreated estrogen dominance has been clinically-linked to an increased risk of breast and uterine cancers, osteoporosis, low thyroid and dementia.

Estrogen dominance is a serious health concern. Symptoms may include:

  • fatigue
  • depression
  • low libido
  • mood swings
  • hot flashes
  • night sweats
  • headaches/migraines
  • tender/fibrocystic breasts
  • weight gain
  • insomnia
  • bone loss
  • irregular bleeding
  • bloating

Disease risks from untreated estrogen dominance, as mentioned above, include:

  • breast, uterine and ovarian cancers
  • heart disease
  • blood clots and strokes
  • osteoporosis
  • hypothyroidism
  • Alzheimer’s disease 

How can you safely treat estrogen dominance and get back to “you”?
For most women, the first step towards restoring an optimal balance of hormones is a quality, over-the-counter, bioidentical progesterone cream that can act to eliminate your condition of estrogen dominance at a cellular level and begin to bring all your hormone levels into better balance. Lifestyle changes like regular exercise, stress-reduction strategies and a hormone-healthy diet are also fundamental to feeling and looking your best – at any age.

How do you know what type of supplementation you need for natural symptom relief?
Dr. Randolph has created specific guidelines to help you determine your individual supplementation needs and correct dosage. The type of supplementation you select depends on your age, menstrual history, symptoms, and hormone test results (if you have them). Recommended supplements are based on specific criteria, including: age range, life cycle, and associated hormone level shifts, resulting type of imbalance/ medical condition, and common symptoms. All hormonal supplements are bioidentical formulations that duplicate the natural physiology of hormones in the body. Ingredients as listed are derived from natural and/or plant-based substances.

What are the benefits to you?
The first question you should ask is: what can you expect from a natural hormone balancing regime? The answer is simple: relief from unwanted symptoms! You should expect fewer night sweats and hot flashes; improved libido (sex drive); improved moods, memory and sleep; renewed strength and energy; the ability to lose weight more easily; and a belly that goes from fat to flatter. When or if symptoms persist, adrenal support (to manage stress), additional bioidentical hormone supplementation, and/or a compounded formulation may also be required.


“LifeStyles” That Impact Your Hormones

Stress, Hormones & Health Risks

Everyone has heard that ‘stress kills,’ but what role do hormones play? The process is complex; but in brief, stress – especially stress that is chronic and goes on for more than three months – triggers changes in the strength and output of the adrenal glands. Short-term stress signals the adrenal glands to produce more of the hormone adrenaline to sustain us in an accident or emergency. The surge also signals fat cells to quickly release energy. But when we are under constant stress, the adrenal glands flood the body with extra cortisol to meet the extended demand. Over time, the adrenal glands may become exhausted, causing disruption of cortisol production, and the immune systems it supports. Cortisol levels that are too high, or too low, are red flags that you are “stressed out,” and probably burning the candle at both ends.

If you feel wired and tired at the same time, can’t get to sleep at night and can’t get up in the morning, use coffee and sweets to keep going — but keep falling behind — your adrenals may be out of balance. Of course there is always “good stress”: the weddings, birthdays and major milestones that make up the ‘spice of life.” However, when stress becomes “distress” the body goes into overdrive: pumping out cortisol until the pump wears out. Other hormone imbalances may crop up, allergies and insomnia may get worse, you get impatient and irritable, and every cough and flu bug seems to settle in you. Another hormonal pitfall of high cortisol is weight gain, especially fat deposits around the abdominal area. Excess fat cells trigger increased estrogen production. If you are a woman over the age of 30 who is already experiencing declining progesterone production, an influx of extra estrogen will exacerbate any underlying condition of estrogen dominance.

Weight Gain

When your estrogen and progesterone are not properly balanced due to age or other hormonal influences, you are predisposed (at a cellular level) to gain weight. For women, weight gain tends to occur around the waist, hips, buttocks, and thighs, and for men, weight settles in the belly (the classic “spare tire”). Weight-loss research proves that because of shifting hormone production, the average person will add one to two pounds around his or her mid-section each year between the ages of thirty-five and fifty-five without ever changing their eating or exercise habits. That means that even when you are doing your best to eat well and exercise frequently, you may still be fighting a losing battle if you have an underlying hormone imbalance! And when you don’t eat as healthfully or exercise as often as you should, it is only natural that age-related changes will cause additional weight gain. To add insult to injury, fat cells actually produce estrogen, thereby worsening a preexisting estrogen dominant condition! Estrogen dominance also causes an increase in thyroid-binding globulin, resulting in a condition of hypothyroidism. Because a primary function of the thyroid is to run the body’s metabolism, hypothyroidism causes your body’s metabolism to slow down. The result: more weight gain and a vicious cycle of ever-increasing estrogen dominance.

Nutritional Deficiencies

The Standard American Diet (SAD), also known as the “Western pattern diet,” is notoriously deficient in nutrients. The “sad” fact is that typical Americans are not getting all the nutrients they need from the foods they eat. Today, the average person eats three times the amount of cheese as someone in the 1970s, and as much as 22 teaspoons of sugar a day! We eat double the recommended amount of salt—mostly from processed foods. One easy solution is simply to increase the amounts of fruits and vegetables you eat. However, the industrialization of our food supply means that even when we make healthy choices, we get less nutrition than our ancestors did. Many modern foods contain significantly fewer nutrients than they did a century ago. Why? Studies have shown that fertilizers, pesticides, and other techniques applied in the pursuit of higher crop yields have led to diluted protein, vitamins, and minerals in many food crops. Research has linked nutrient deficiencies to a variety of heath concerns and conditions—and your diet directly affects your hormone balance! Even when you do your best to eat well, you may still need to counteract the effects of processed foods and boost your hormone balance by including vitamin supplementation to your daily regimen.

Environmental Estrogens/Xenohormones

Simply living in an industrialized nation puts us all at risk for hormone imbalances. Living in the United States, we are exposed to literally dozens of chemicals throughout our daily lives. When you think of “chemicals,” you probably imagine a bubbling chemistry set, or spraying your yard to eliminate weeds or pests. Unfortunately, the effects of chemicals exposure are much more pervasive than that! Environmental estrogens, also called “xenoestrogens,” or more generally, “xenohormones,” can be found in dry cleaning chemicals, plastics, meat and dairy products from animals injected with antibiotics or hormones, drinking water, cosmetics and personal care products, and of course, pesticides, herbicides, and industrial chemicals. The trouble is, synthetic chemicals are in everything, from the materials in your mattress to the paint on the walls and the fibers in your carpet. A common concern is “off-gassing,” or low-level fumes, from materials such as furniture glues and paint on your walls. All of these readily-available materials are tested, of course, and are permitted to be sold because the levels of chemicals in each product are considered low enough to be safe — but what about the overall effect of all these “tiny” amounts of chemical exposure? Many studies are now showing that cumulative effects are the real concern: there are few, if any, studies on the combined effects of common household chemical exposure on our bodies over time, and every person is exposed to different combinations. To support better hormone balance, you can better inform yourself about xenohormones and make some lifestyle changes. Start with avoiding plastics as much as possible, for example: use glass or stainless steel water bottles, and don’t heat food in plastic containers in the microwave. Check labels on cleaning products and cosmetics to avoid parabens, phthalates (artifical fragrances), and sulfates. Reduce chemical use in your home and yard with organic plant-based sprays. Drink filtered water, and choose organic fruits and vegetables when possible to reduce pesticide exposure. Little choices can add up!