Bioidentical Hormone Replacement Therapy

Hormones affect every facet of both men and women’s health from energy, mood, metabolism to longevity. Fertility, anxiety, depression, insomnia, migraines, anti-aging, low libido and disease prevention are all conditions in which balancing hormones are imperative.  For women  Peri-menopause, Menopause, Breast Health, and PMS are all areas of health that benefit from proper assessment.   For men Energy (more drive) & Vitality rely on hormone regulation.

The physicians at Skintology Health and Wellness Centre understand that your quality of health determines many successes in your life, including both personal and professional.

Unlike some of the pharmaceutical manufactured hormones, bioidenticals hormones (BHRT) are derived from plants – including yams and soy. The molecular structure of a bioidentical hormone is identical to that of the hormones our body produces naturally and exert the same effect on hormonal receptors. Bioidentical hormones can also be compounded to customize your individual specific hormone replacement needs.

Balancing hormones is also combination of ensuring the organs that produce your hormones such as your ovaries, testes, adrenal gland, and thyroid are well supported as well as the actual hormones themselves. It is also important to support the organs that are associated with hormone production, such as the liver which is responsible for conjugating and recirculating your hormones and your digestive system which determines how many of your nutrients you absorb to support hormone optimization.

At Skintology Health and Wellness Centre, our program is integrative and takes into consideration the health connections to optimizing hormones that exist including: nutrition, optimal digestion, the body’s ability to detoxify, chronic inflammation, adrenal gland health and thyroid health. We focus on assessments including  lab work with a goal of reaching “optimal levels” versus “normal levels”, especially if you are feeling less than your full potential.

Each program is customized to you, so that whether you have noticed that you just seem more “irritable” lately, can’t seem to budge your weight no matter how hard you try, have hot flashes , troubles sleeping, lost your interest in normal activities that once were your passions and or seem to have lost your “competitive edge”  there is a solution.

The Program Includes The Following:

Complimentary Initial Visit

As each person’s wellness is unique to them, it is important that we understand your whole health first.

You will meet with Dr. Upadhyay for your complimentary consultation to review your goals, lifestyle, hormones, nutrition and medical needs providing you with a head-to-toe medical evaluation.

You may bring along any lab work, bone density, mammograms, PAP smears, pelvic ultrasound or other diagnostic tests you have had done in the past year. Once we review your past lab reports, we may find it necessary to have you complete additional labs including hormone testing to determine your current hormone support needs.

Should you decide to move forward with our program, you will be given lab testing to complete so we can evaluate where your general health & hormones are to begin with.

Results Appointment

The Doctor’s report and plan will summarize all the clinical findings, get you started on the initial recommendations which may include nutritional suggestions, detoxification or other therapies help prepare you for optimal hormone absorption and care.

If it is determined that bioidentical hormone support is the right path for you, your physician will review this treatment with you.

The program is designed to address your hormone needs. If you have other health goals, specific separate visits or care may be suggested that is outside of the hormone program.  This may include:

  • Naturopathic Doctor

  • Holistic Nutritionist

  • Sex Therapist

  • Mindfulness Coach

Follow Up Appointment

We recommend a follow up every 3 months for the first year. This ensures your physician is following your progress and to make any changes, if needed.

All refills require a visit.

  • Description text goes hereSymptoms of hormone imbalances that BHRT may help include: hot flashes, night sweats, loss of libido, vaginal dryness, urinary problems including incontinence, gynecomastia ( male breasts), loss of morning erections or erectile dysfunction, PMS, painful periods, irregular periods, fertility issues, endometriosis, fibroids, ovarian cysts, abnormal hair growth, thyroid dysfunction, fatigue, sleep problems, mood swings, depression, memory loss, anxiety, decreased muscle tone, increased belly fat, weight gain, hair loss, , change in odor, dizziness, bloating/swelling, allergies, brittle nails, irritability, panic disorder, breast pain, joint pain, headaches, loss of concentration, itchy skin, digestive problems, irregular heart beat and osteoporosis.

  • Because all hormones interact with others, it is important in an effective hormone program to monitor not only the hormones prescribed but also other hormones that may be affected due to the hormone support. Side-effects are often related to the need to adjust your current hormone levels and are often minimal and manageable when restoring hormones to physiological levels (levels your body has seen before).  Some patients report breast tenderness or swollen joints when first starting bio-identical hormone replacement therapy; these and other adverse reactions can be remedied by reducing the dosage until symptoms resolve, then gradually resuming. To make HIHS or BHRT safe and effective we at Skintology Health and Wellness Centre focus on:

    Customization with optimal dosing and adjustments accordingly

    Use of the hormone in the safest route

    Correction of other imbalances associated with hormones

    Proper follow up visits with lab testing

    Ongoing communication between you and hormone doctor

  • When proper evaluation, prescription and monitoring are put in place, there are ways to use hormone support to be cancer protective. Research shows that human identical or bio-identical progesterone (synthetic progesterone ie. progestins) has a cancer protective effect.1  Estrogen is an important hormone, however in the improper form and or in excess, when not balanced with progesterone, will increase cancer risk.  If you have had cancer, have cancer or a family history, time will be taken to review the benefits and risks in your individual case. Proper hormone management also includes preventive testing.  For women testing includes but is not limited to: estrogen, progesterone, testosterone, LH, FSH, Prolactin, DHEA, Thyroid Indices, PAP tests, mammograms,  BMD and pelvic ultrasounds. While for men testing includes but is not limited to: testosterone, DHT, DHEA, Thyroid indices and PSA levels for men.

  • Hormone therapy has gone through an evolution of approaches, which has left many confused, including doctors. For decades hormones were prescribed to women for menopausal symptoms. The hormones initially used were synthetic versions.  In 2002The “landmark” Women’s Health Initiative (WHI) study was published, showing that when the synthetic hormones Premarin (conjugated equine estrogen) and Provera (progestin) were used there was an unacceptably high risk of breast cancer, cardiovascular disease including blood clots and stroke. Thus, the study was halted 3 years early and everyone was told that hormones were dangerous.  However, when we re-analyze the data in detail, what the results of the WHI indicate is that synthetic oral forms ( vs transdermal) forms of hormone replacement therapy (HRT) did seem to pose a risk. However the limitations of the study were that the women were older ie average age 63 and 10+ years post-menopausal where there would already be a significant increase risk of breast cancer, cardiovascular disease and stroke, and only synthetic versions were used. Thus the results of the WHI are not transferable to bio-identical hormone replacement therapies ( BHRT) or to younger healthier women.

    In 2007 The Mayo Clinic Cohort Study of Oophorectomy and Aging ( MCSO) was run and the results showed that estrogen protects brain function and the earlier you begin estrogen support the greater the reduced risk of dementia is in women who have lower levels of estrogen, in this case due to the removal of ovaries.1 This was supported by other studies and called the timing hypothesis.2,3

    The Kronos Early Estrogen Prevention Study ( KEEPS) was published in 2012, was a 4 year randomized trial that used low dose oral Premarin (conjugated equine estrogen), transdermal estradiol and Prometrium (bio-identical progesterone) .  This study was significant because it was run with lower doses of estrogen, younger ( ie average age 52) and healthier women vs the WHI.  The results showed a neutral blood pressure and favorable impact on cardiovascular health markers HDL, decreased LDL and increased TG.  In addition when a transdermal ( topical form) estradiol was used,  there was the benefit of improved blood sugar levels.  Thus the KEEPS showed many favourable effects of hormone therapy (improved hot flashes, night sweats, depression, libido , and bone density) in newly menopausal women and did not show any adverse effects such as breast cancer, endometrial cancer, myocardial infarction, or stroke. It is important to keep in mind that this study was only run over 4 years and included younger women.

    The BMJ- Danish study was a 16 year study run with 1006 healthy women with an average age of 50. In the 10 years of randomized treatment women who received hormone therapy (bio-identical estrogen and progestin) there was a significant reduction in mortality, heart failure, myocardial infarction, and there was no increased risk of cancer, blood clots or stroke.

    Conclusion

    More research is needed to assess human identical hormones or bio-identical hormones, the method of use, it’s benefits or risks and the impact of its use on different age categories. At this time what we know is that HRT do pose a risk of breast cancer, cardiovascular disease and stroke when introduced to an older age population. When bio-identical hormones are used on a younger population we see that there is not an increased risk of breast cancer, blood clots or heart disease. Hormone therapy when used earlier after menopause can significantly reduce the risk of mortality, heart failure, and myocardial infarction.  In addition, hormone therapy can help hot flashes, night sweats, osteoporosis, libido, memory, cognition, bone density and overall wellness.

    References

    1. Harman SM, Brinton EA, Cedars M, Lobo R, Manson JE, Merriam GR, Miller VM, Naftolin F, Santoro N., KEEPS: The Kronos Early Estrogen Prevention Study, Climacteric, 2005 Mar,8(1):3-12,PMID:15804727

    2. Rocca et al., Molecular and Cellular Endocrinology, 2014

    3. 2007 The Mayo Clinic Cohort Study of Oophorectomy and Aging (MCSO)

  • Some of the pharmaceutical manufactured hormones include: Estrogens (Premarin, Cenestin, Menest, OrthoEst, EstraTab, Estrogel, Estradot); Progestogens (Provera, Aygestin, DepoProvera, Prometrium birth control pills); Combinations (EstraTest, Activella, PremPRo, PremPhase, CombiPatch, ClimaraPro, FemHRT, many hormonal birth control methods), Testosterone (MethylTestosterone).

    Hormones can be compounded with variable dose ranges, according to your individual needs. Such as, bio-identical estradiol, estroil, progesterone,  DHEA, testosterone and thyroid.

  • Although we welcome referrals from your family doctor, a referral letter is NOT required for an initial consultation. The initial consultation is complimentary regardless if the appointment is made through a physician referral or by a patient calling in.

    Can I Get BHRT Anywhere?

  • BHRT require a prescription from a physician. This is important as hormones may come with benefits and risk which your hormone team can help determine in your case. It is also important that regular follow assessment visits, hormone testing, PAP tests, mammograms and ultrasounds be performed to ensure you are using hormones in a safe manner.

  • You can get your medical doctor to prescribe hormones for you. It is important to note that not every doctor will use Bioidentical Hormone Replacement (BHRT). It is optimal to work with a team that specializes in hormones and can give you the latest research information and strategies. Hormone balancing is a specialty in itself.

  • Your general practitioner medical doctor is a part of your whole health care team. It is important to maintain care with your medical doctor and have all your health care providers work as a team. Hormone balancing is a focus of certain doctors that are trained in this area. Your hormone doctor is happy to communicate with your medical doctor and provide tests, and or assessment records at your request.

  • It generally takes two to six months to achieve hormonal balance, keeping in mind that some people take longer and other people begin to feel better quite quickly i.e. within a few weeks. As each person is unique, adjustments will be made until you reach your state of hormonal balance.

  • You can begin hormone optimization anytime in your life, including if you still have your period, including if you have PMS, endometriosis, fertility concerns and or have difficult periods.  Many women have found that it helps to regulate their periods and helps them generally feel better overall.

  • It is possible that you may get your period back when using hormone support, especially if you have just recently found that your period has stopped.  You and your hormone doctor can decide what is right for you and adjust your hormone levels accordingly which may include not having a period

  • The wild yam crème that is often sold in health food stores contains wild yam which is a plant that contains diosgenin, which in the laboratory is used to make hormones like estrogen and dehydroepandrosterone ( DHEA).1 Wild yam is suggested to have some phytoprogesterone, phytoestrogen, and phytoDHEA activity, meaning that it has some weak “progesterone, estrogen and DHEA like” activity, but there is no scientific evidence that suggest it can be converted into the active hormones progesterone, estrogen or DHEA  in the body.2-5   This conversion can only take place in a laboratory. In some wild yam crème’s progesterone is added and thus it is not recommended.

  • Yes, birth control pills are a type of hormone therapy but are different from bio-identical hormone replacement therapy. Birth control pill hormones are not provided in a natural rhythm as the body’s own hormones. For optimal hormone balancing it is recommended to come off the birth control pill for 8 weeks to establish your natural hormone baseline.  If this is not possible to come off the birth hormone pill, our physician will discuss other options with you.

  • Yes all hormones are available by prescription only for your safety, so that they can be monitored for your optimal overall health.

  • Although we do live in a world of information technology, it is important for our physician to be able to assess your health completely. It is recommended to have office visits for refills or change of prescriptions. We are happy to answer simple questions by phone or email, however our experience has lead us to suggest an office visit if there are more questions or concern, as there is a more complete understanding of the total picture.

  • The only time when medications will interfere with bio-identical hormones is when the medications you’re taking contain hormones, like birth control and certain acne medications. In many cases, certain medications are no longer needed, once hormone levels are restored to a healthy balance. This generally happens because balancing hormones improves your overall health. It’s important to discuss your use of bioidentical hormone therapy with your doctor. We are happy to communicate with others on your health care team upon request

  • You and your Skintology Health and Wellness Centre physician will decide the best form of hormones to use. Hormones are self-administered daily (once or twice per day) or a few times per week via transdermal creams, oral capsules, vaginal suppository, intra nasal gel, patch or intramuscular injections

  • It is an individual’s choice how long one uses hormone support. Both you and your hormone doctor can decide what is right for you. Ideally the hormone support is used to continue supporting the natural decline in hormone levels with the aging process.

  • Not necessarily, it depends on how well your body responds to Bioidentical Hormone Replacement Therapy (BHRT). For optimal hormone function it is important for you to manage your diet, sleep patterns, exercise, and stress levels. We will address these issues as part of your treatment plan.

    Some patients can wean off various hormones once they become balanced and have fewer symptoms of menopause or andropause. There are also patients who can wean off adrenal and thyroid support once their adrenals or thyroid glands have healed. There is no single answer for everyone, it depends on your individual hormone stability and how well your diet and lifestyle will support everything else.

  • In general, supplementation by exogenous (external) hormones will result in decreased endogenous (internal) production.  However, the body tends to restore hormones to pre-treatment levels after treatment is stopped. If your own hormone production was low before treatment, it will most likely return to the same levels after treatment is stopped. As a result, most of the physical changes enabled by the program will gradually revert back to “normal” baseline.

  • Bio-identical hormones do have an impact on your health on their own, however this effect will be amplified if you are eating well. Your physician at Skintology Health and Wellness Centre will help to assist you in finding the right lifestyle changes including nutrition. Certain foods can help support the digestive system, the liver and hormone production which are all needed to function optimally for the best hormone balancing results.

  • Your physician at Skintology Health and Wellness Centre will help to determine if nutrient deficiencies exist, organ weakness including the adrenal gland or other supplement needs to compliment your Bio-identical Hormone Replacement Therapy. The physicians at Skintology Health and Wellness Centre recommend high quality supplements, if needed, to give you optimal bio-availability.

    References

    1. Schwartz, M.D., The Hormone Solution: Naturally alleviate symptoms of hormone Imbalance from adolescence through menopause

    2. Feldman HA, Longcope C, Derby CA, et al, Age trends in the level of serum testosterone and other hormones in middle-aged men; longitudinal results from the Massachusetts Male Aging Study. J Clin. Endocrinol Metab. 2002;87:589-598

    3. (5) Mulligan T, Frick M, Zuraw Q, et al. Prevalence of hypogonadism in males aged at least 45 years: the HIM study. Int. J. Clin. Pract. 2006;60:762-9

    4. Postmenopausal Hormone Therapy: An Endocrine Society Scientific Statement. JCEM July 1, 2010  95 no.7 Supplement 1

    5. Kleinman et al, JOEM 55, 465-470, 2013