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You need to know the difference between Bioidentical Hormone Replacement Therapy (BHRT) and Hormone Replacement Therapy (HRT) as they have different attributes. Photo: Shutterstock

How You Age May Depend on Hormonal Balance

we all wish for a magic solution to prevent the effects of ageing, so we go for all sorts of procedures that we think will help.

This includes hormone replacement therapy (HRT), which is made up of synthetic versions of oestrogen and progesterone hormones. While HRT has proven to be very useful, a Women’s Health Initiative study in 2002 raised doubts when HRT was found to increase the risk of heart disease and breast cancer.

Millions of women were left questioning whether the rewards were greater than the risks. Officially, the advice is that short-term use of one or two years does not add to your risk.

But after the study was published, those in the health industry reported a decline in the number of prescriptions in the United Kingdom and the United States, as well as a significant decline in the number of breast cancers. Coincidence? Perhaps. But it may be enough to make you think twice before accepting HRT to prevent anti-ageing.

Hormones decline with age

It is inevitable that hormone production declines drastically later in life. Oestrogen deficiency results in vaginal dryness and lack of progesterone, which comes from cholesterol, and is a building block from which all hormones can be made. During menopause, you may also experience symptoms of anxiety, bursts of anger, insomnia, and tight and aching muscles.

When you are stressed, the body will make cortisol, the stress hormone. The higher your stress level, the more cortisol is produced, and consequently, dehydroepiandrosterone, more commonly known as DHEA, is also lowered. Critically low levels of DHEA is a consistent indicator that you are ageing faster than your chronological age, which is why it has become a popular supplement. Low levels of DHEA also affect testosterone production.

Bioidentical Hormone Replacement Therapy (BHRT) vs Hormone Replacement Therapy (HRT)

Several women use hormonal replacement therapy as management for their respective hormonal imbalances. It is important to differentiate the two treatments, as they have different attributes.

BHRT is identical to the hormones of human beings while the conventional HRT is not. Dosages are individualised for patients receiving BHRT, while the conventional HRT has a fixed dose, regardless of the needs or age of each patient.

Close observation of the patient is a standard part of management when it concerns BHRT. Any BHRT can be given through a topical route, while for conventional HRT, the only topical option is the oestradiol patch. As the synthetic hormones in HRT are not identical to our own, they are very likely the culprits behind the problems they have been associated with. Let’s take a look at how the following hormones are important in slowing our ageing process.

DHEA – DHEA plays a big role in producing oestrogen and testosterone, and it also balances cortisol, the stress hormone. Low levels can reduce the effectiveness of the immune system, which becomes less responsive when you’re stressed.

Although DHEA is the most abundant hormone in the body, production for both men and women reaches its peak around 20 years of age; and reductes to half that rate by 40 years of age. By 65, you will only be producing 10–20% of your 20-year-old self.

Symptoms of DHEA deficiency include feeling burnt out, unable to cope with stress, insomnia and lack of drive or motivation. The daily production of DHEA can be accurately measured from both blood and saliva, and it is reported that your body naturally produces 35–60mg of DHEA a day.

Doctors may suggest supplement doses of between 15mg and 50mg, with a check about 90 days after starting. Another way to improve your DHEA level is to reduce your stress, thus, bringing down your cortisol levels. Exercise, be around people you like, watch your favourite shows and think positive.

Oestrogens – Oestrogen is the “chief female” hormone and comes in three forms – oestrone (E1), oestradial (E2) and oestriol (E3).

Oestradiol is the primary sex hormone of childbearing women. It is formed from developing ovarian follicles, and is responsible for female characteristics and sexual functioning. It contributes to most gynaecological problems such as endometriosis and fibroids. After the reproductive age, when a woman has achieved menopause, oestrone becomes the primary oestrogen. Oestrone is weaker than oestradiol.

During pregnancy, oestriol is the primary oestrogen. Oestriol is considered a weak oestrogen as well. It has been postulated that oestrone is a “bad” oestrogen and may be the cause of oestrogen’s cancer-causing properties, while oestriol is a “good” oestrogen and may protect against cancer.

When women hit menopausal age, these oestrogen hormones begin to decline, as the body is no longer preparing the womb for pregnancy. Blood flow during periods reduces and becomes irregular, before it stops completely. Symptoms of oestrogen deficiency include thinner, older skin with more wrinkles; vaginal dryness; irritability; forgetfulness; increased risk of urinary tract infections; decreased sex drive; and loss of bone mass.

If your problems lie with oestrogen, it might surprisingly not just be due to low levels alone. Instead, it might be a condition known as “oestrogen dominance”, where the body’s oestrogen is low, but progesterone levels are even lower. Symptoms include water retention, breast tenderness, mood swings, weight gain around the hips and thighs, depression and cravings for sweets.

If you are close to the menopausal stage, you may experience anovulatory periods, menstrual cycles where the ovary does not release egg cells. Because oestrogen comes in three levels, good bio-identical specialists run tests to determine the ratio of your oestrogen levels, then prescribe accordingly. Replacing low oestrogen without further investigation could be dangerous and runs the risk of cancer.

Progesterone – This hormone is an integral part of the hormone balance and is a precursor hormone to cortisol, aldosterone, oestrogen and testosterone. Progesterone is a very “calming” hormone, a natural antidepressant and diuretic.

It also helps to burn fat for energy, restores libido, decreases the risk of ovarian and uterine cancers, helps stimulate thyroid hormone action, has a diuretic effect, is brain protective and might be just as important as oestrogen.

This is possibly the reason why many specialists think that post-menopausal women should be optimising their progesterone levels, as none is being produced by the ovaries by then, and your body uses it to make all the rest of your hormones.

Symptoms of progesterone deficiency include anxiety, depression and mood swings; increased pain and inflammation; insomnia; and excessive menstruation. In HRT treatments, progesterone is replaced by a synthetic version known as progestin.

In France, researchers studied 80,000 women, some who used oestrogen-progestin and others who used oestrogen-progesterone in their treatments. The study indicated that those on progesterone saw no significant increase in cancer risk, whilst those on progestin, however, had their cancer risk raised by 69%. Taking oestrogen alone raised the risk by 29%.

A balanced hormone level is critical for the body to function well. Naturally, when it is out of sync, a wide range of symptoms tends to show up. Check with your doctor if you’ve been experiencing them for a period of time, and consider doing a hormone profile test to confirm the status of your hormone levels. If it is the right choice, you may want to consider BHRT.

In menopausal women, as they have higher levels of oestrone and oestradiol, while oestriol is low, they should be prescribed progesterone along with a combination of bio-identical oestradiol and oestriol. Consider also replacing DHEA, testosterone, cortisol, thyroid or melatonin to an optimal level.

Men go through hormonal changes too

Yes, guys, you may not get the hot flashes, but your hormones do change with time. The truth is, hormone production starts declining each decade after your 20s. By the time you’re in your 70s, you’re only producing a fraction of the amount you made in your youth.

Those changes you’ve been noticing (lack of energy, belly fat, loss of muscle mass and mood changes) are not coincidental. These changes are most likely associated with your hormones changing. And even your high cholesterol levels could be due to hormonal imbalances. Balancing testosterone may reduce your risk of age-related diseases.

Testosterone is not just for beefy muscles, good looks, or a booming sex drive. It keeps men healthy too. Hormones truly are the fountain of youth. They do a lot more than we give them credit for. Some of the changes you noticed with age may improve or even reverse with hormone restoration.



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