Category: Regen. Orthopedics

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What are bioidentical hormones?

When we talk about bioidentical hormones usually we are referring to forms of testosterone, estrogen, progesterone, growth hormone and thyroid that are chemically identical to the declining levels of natural hormones in our bodies. They’re absorbed and metabolized well with the same positive effects as our natural hormones.

Universally, by the time people reach their 30s, both men and women benefit from testosterone and growth hormone optimization. Women also need estrogen and progesterone replacement depending on other circumstances and timing of menopause. Most people experience some form of hormone imbalance as they age due to various health conditions, environmental factors and nutritional deficiencies caused by poor diets. When left untreated, these imbalances can contribute to severe long-term conditions such as:

• Cancer
• Cardiovascular disease
• Dementia
• Emotional problems
• Hypercholesterolemia
• Hypertension
• Insulin resistance and diabetes
• Osteoporosis
• Weight gain and obesity

Fortunately, Bioidentical Hormone Optimization (BHO) can reverse the internal degenerative processes caused by hormone imbalance. Many patients quickly notice an improved mood and clearer thinking. Weeks later, testosterone drives other measurable body changes, like increased lean muscle mass, a more trim figure and changes in stubborn belly fat, and reduction in the dreaded “man boobs.” It’s time to optimize your life!

The key to any hormone optimization is to restore levels to therapeutic concentrations and to maintain them in the “sweet spot,” where people achieve noticeable symptom benefits while also reaping the hidden health rewards associated with each hormone. This should be medically supervised because if concentrations get too high, people can experience negative side effects.

In general, it’s a good idea to boost hormones naturally by balancing nutrition, diet, exercise and helping the body create more of what it was naturally designed to do. If hormone replacement is necessary, avoid swallowing testosterone and estrogen in traditional tablet form. This is because of the “first-pass” effect typical of orally ingested medications that enter the intestines and are delivered to the liver. When the liver encounters estrogen or testosterone, it produces a sex hormone-binding globulin (SHBG) that “binds” much of the hormone before it is delivered into the bloodstream. Progesterone is a unique exception to this scenario, with studies proving its replacement is well tolerated when administered in orally swallowed tablets.

Hormone optimization is achieved through treatments that increase your body’s natural production, or in cases where replacement is necessary people can choose creams, specially formulated oral tablets, weekly injections or minor surgical procedures involving pellet insertion. Each method of hormone delivery has pros and cons with plenty of opinions depending on who you talk to.

ViveWell providers are comfortable providing several proven and safe options for hormone replacement therapy. Based on your lifestyle, lab results and personal preferences, our team will help you determine which BHO treatments best fit your unique needs. Together we will create an excellent plan to optimize your body, so you can feel better.

How do I know if BHO is right for me?

Because hormone health literally underpins every process in your body, symptoms of unbalanced hormones can manifest in many different ways.

Symptoms of hormone dysregulation and hormone imbalance are diverse and several symptoms can be caused by more than one hormonal concern.

Yes. . . there’s a lot to list — but it goes to show just how important these hormones are.

Symptoms of estrogen deficiency:

• Depression
• Dry skin
• Forgetfulness
• Heart palpitations
• Hot flashes
• Increased allergies
• Insomnia
• Irritability
• Mood swings
• Night sweats
• Vaginal dryness
• Worsening PMS symptoms

Symptoms of testosterone deficiency:

• Anxiety
• Belly fat
• Depression
• Fatigue
• Headaches
• Loss of focus
• Low libido
• Memory loss
• Mood swings
• Muscle pain
• Sugar cravings
• Weight gain

Symptoms of progesterone deficiency:

• Breasts that are often sore
• Depression, anxiety or other mood changes
• Hot flashes
• Low blood sugar
• Low libido
• Migraines or headache
• Menstrual cycle absence
• Spotting between periods
• Vaginal dryness

. . .and more. In fact, the list is considerable when we keep in mind the interplay between key hormones, the environment, diet and lifestyle.

As we stated before, all people over the age of thirty should look into testosterone and growth hormone optimization. Women, especially if they experience any of the above symptoms, should consult with our team to explore additional BHO for estrogen and/or progesterone.

BHO treatment options

Topical creams

Hormones can be administered using topical creams, which are typically well tolerated. Traditionally, they are often applied to the body on the upper arms, thighs, behind the knees, at the bikini line or back of the neck. But it turns out, creams are best absorbed when applied to the genitals because of the type of skin and because key enzymes in the genital tissues maximize the benefits and effectiveness. Though it may sound weird or unusual to some people, research increasingly supports this practice and it’s becoming very popular.

For women

Vaginal estrogen has long been used in menopausal women because the mucus membrane provides excellent absorption and the local tissues get significant benefits along with the rest of the body (1). But did you know vaginal testosterone is important, too? It’s an excellent way for ladies of all ages to obtain the optimal whole body health benefits of testosterone, and it helps with vaginal health, improves libido and increases sexual satisfaction (1,2,3,4,5).

For men

Scrotal testosterone is emerging as a sustainable way to deliver adequate testosterone levels for long-term optimization therapy (6). Scrotal skin is thinner than skin elsewhere, providing for faster absorption of testosterone, improving sustained daily testosterone levels in several studies. Furthermore, scrotal tissue has higher levels of 5-alpha-reductase, which leads to higher DHT levels in the local tissues. DHT is important for libido, erectile strength and longer erections. However, DHT levels must be monitored, along with symptoms of hair loss (which is typically related to genetic factors as well) and PSA levels. Not all guys get a huge libido boost from testosterone injections or pellets. This method provides a direct, enjoyable boost to the area they want it.

Daily use of a medication causes a predictable rise and fall of the concentrations throughout the body. Critics of creams note that the hormone levels aren’t as consistent as other methods like injections or pellets. To be sure, absorption of creams may be complicated by sweat or limited by adhering to articles of clothing that rub against the skin soon after the cream is applied. They also have the added risk of accidental transference to other people.

Sublingual fast-burst tablet BHO

Another convenient method is rapidly dissolving tablets placed under your tongue (sublingual) to quickly deliver hormones into your bloodstream. With this approach, there is no “first-pass” effect typical of orally ingested hormones.

How does this work? Sublinguals need to maximize contact with the mucus membrane of the mouth under the tongue for at least 2 minutes. Positive results start within 20 minutes of absorption. Hormone concentration rises after taking the pill but then declines during the day. Though sublingual fast-burst tabs raise hormone blood levels, like topical creams, the fluctuations in hormone concentration aren’t as consistent as the natural physiological levels, which causes a slight reduction in optimal health benefits compared to other longer-released hormone treatments.

However, for the daily estrogen and testosterone doses used by women, many patients experience a noticeable improvement by taking once or twice daily fast-burst sublingual tablets. One notable drawback with the sublingual fast-burst tablets is patients need to refrain from eating, drinking and kissing for about an hour to make sure all of the hormones are absorbed, and there’s a risk of transference with kissing.

Bio-lymphatic Absorption (BLA) oral tablets

This proprietary oil blend tablet offers a medication delivery with the convenience of a tablet form that is swallowed. The BLA tablet delivery system is designed to offer better bioavailability by presenting micronized hormones to the lymphatic system, bypassing the liver and the “first pass” effect that creates SHBG. Fortunately, we can combine multiple hormones into a single tablet with convenient once-a-day dosing.

Like topical and sublingual fast-burst tablets, there is a daily rise and fall in hormone levels, which is not as stable as longer-lasting dosing methods. However, given the doses of hormones women use, this presents a convenient option for sustained improvements in personal health.

Testosterone injection

Men require higher doses of testosterone, often administered in a series of injections. This method provides gradual absorption and a sustained concentration of the hormone throughout the week. Improvements in the carrier oil, now often using grapeseed, allows for slower absorption, and lasting symptom improvement by maintaining more stable concentrations during the week. Because this therapy still involves a rise and fall in testosterone levels throughout the week, patients are monitored for side effects and dosage adjustments are commonly required to find the correct dose based on your body and experience.

Often, once a gentleman reaches a stable and safe testosterone dose we encourage our patients to become comfortable giving themselves injections so they can care for themselves at home (individuals may prefer injections once, twice or three times a week). We’ll need to recheck your labs a few times each year and check in with you before refilling the medication, but this is a sustainable way to optimize your testosterone if cream or pellets doesn’t fit your lifestyle or preference.

Bioidentical Hormone Optimization Pellet Therapy

Pellets are specially formulated “bioidentical hormones” sourced from compounds found in vegetables that provide long-term hormone optimization for several months. They offer dosing options for testosterone and estrogen in incredibly small, compacted pellets, roughly the size of a grain of rice. Pellet therapy is utilized in millions of satisfied patients and is very safe for continued use over many years.

ViveWell providers perform a minimally invasive surgical procedure using numbing medication and a small incision in the skin to place calculated pellet doses under the skin just below the belt, above the gluteal muscle (butt cheek). These pellets continually release hormones into your bloodstream for 3 to 5 months, depending on the dose and the patient’s athletic activity. More active patients have higher blood flow and will require more frequent dosing.

This procedure is a fantastic alternative to regular testosterone injections because pellets provide a more consistent, stable release of testosterone, ensuring that you will feel the benefits. Most people notice a difference in their sleep quality, mood, energy levels and libido in as little as 24-48 hours after testosterone pellets are placed. Often women will receive a combination of estrogen and testosterone pellets to provide sustained hormone balance for optimized health, a sense of wellness and energy.

Typically, if patients are starting out, we check hormone levels at 4 weeks after pellet insertion and will “boost” with a second pellet dose. Depending on a patient’s level of activity, men can expect to get a “maintenance” pellet insertion around 4-5 months, whereas women get a “maintenance” pellet insertion at 3 months.

Testosterone optimization and fertility

Replacing bioidentical hormones sends signals to the testes and ovaries that they no longer need to produce as much. This does decrease fertility for individuals interested in having children. In men, testosterone replacement can also lead to some decrease in testicular size. Fortunately, there are several options to discuss during your consultation if you want to experience the multitude of benefits of testosterone optimization while still preserving fertility and/or testicular size.

Can’t decide on which BHO therapy is right for you? It’s OK to start with one option and decide to try something else. Some people may want to do daily creams but switch to a pellet in anticipation of a long trip abroad over the summer or other reasons. We’ll work with you to adjust your plan as life changes.

References

1. Robinson, D., Toozs-Hobson, P., & Cardozo, L. (2013). The effect of hormones on the lower urinary tract. Menopause international, 19(4), 155–162. https://doi.org/10.1177/1754045313511398
2. Kim, M. M., & Kreydin, E. I. (2018). The Association of Serum Testosterone Levels and Urinary Incontinence in Women. The Journal of urology, 199(2), 522–527. https://doi.org/10.1016/j.juro.2017.08.093
3. Ninomiya, N., & Sekiguchi, Y. (2022). The study of the effectiveness of topical testosterone and estrogen for urinary tract symptoms of GSM. The Journal of Sexual Medicine, 19(5), S149. https://doi.org/10.1016/j.jsxm.2022.03.595
4. Maseroli, E., & Vignozzi, L. (2020). Testosterone and Vaginal Function. Sexual Medicine Reviews, 8(3), 379–392. https://doi.org/10.1016/j.sxmr.2020.03.003
5. Davis, S. R., Robinson, P. J., Jane, F., White, S., White, M., & Bell, R. J. (2018). Intravaginal Testosterone Improves Sexual Satisfaction and Vaginal Symptoms Associated With Aromatase Inhibitors. The Journal of Clinical Endocrinology & Metabolism, 103(11), 4146–4154. https://doi.org/10.1210/jc.2018-01345
6. Iyer, R., Mok, S. F., Savkovic, S., Turner, L., Fraser, G., Desai, R., Jayadev, V., Conway, A. J., & Handelsman, D. J. (2017). Pharmacokinetics of testosterone cream applied to scrotal skin. Andrology, 5(4), 725–731. https://doi.org/10.1111/andr.12357

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