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Bioidentical Hormone Replacement Therapy: A Tool in Anti-Aging Medicine

Oct 01, 2014 08:45AM
by Rosina Cabo, PA-C

Many people hear anti-aging medicine and think it is a specialty of medicine that encompasses esthetic changes and gray hair reversals. While the name may connote such images, the role of anti-aging medicine extends beyond physical appearances. This medicine aims to maintain healthy bodies and minds during the natural aging process.

Anti-aging medicine focuses on prevention; it tackles the mechanism of aging and age-related diseases in individual patients, to create vigor, vitality and quality of life. Among one of the most effective modalities in rejuvenating an aging body is through the use of bioidentical hormones. According to Harvard Medical School, hormone therapy is still the most effective treatment for postmenopausal symptoms.

The goal of bioidentical hormone replacement therapy is to optimize essential hormone levels in those who are deficient or symptomatic in order to improve function, prevent morbidity with age and enrich quality of life. After establishing baseline levels, the therapy utilizes substances that are the same chemical structure as what the body naturally produces.

Technically, the body cannot distinguish bioidentical hormones from the ones the body makes, and consequently the hormones are allowed to form essential active metabolites which are then excreted in the same manner as endogenous hormones. Natural hormones are more bioavailable in the body and therefore easier to use making them more effective.

In contrast, synthetic hormones are structurally dissimilar from endogenous hormones. In effect, these substitutes waste energy by giving incomplete messages to cells which then fail to produce a balanced hormonal response. Non-bioidentical hormones fail to produce the desirable metabolites in the body, and thus can be confused with benefits of maintaining balanced levels. These synthetic hormones are metabolized into various forms of estrogen not detectable by laboratory tests.

An example of this phenomenon may be observed from the study that looked at women taking estrogen-only therapy with conjugated equine estrogens, known as Premarin; these women had a 78 percent increased risk for blood clots. Other women took progestin medroxyprogesterone acetate, also known as Provera, which showed interference with estrogen’s good effects on cholesterol as opposed to the effect being maintained by micronized, bioidentical progesterone.

Aside from the chemical composition, method of delivery is also important. Estrogen in pill form has to pass through the liver. First pass liver metabolism activates C-reactive protein and clotting factors. These stimulated factors are associated with heart disease and stroke. However, when estrogen is formulated as a transdermal patch or topically applied, the same blood levels are achieved without the liver effects.

In a clinical setting, bioidentical hormones are used to replenish levels to a physiologic state that decline as a result of disease and age. Estrogen is most commonly associated with being female, and three main forms are produced in the body: estrone, estradiol and estriol. Estrone predominates in postmenopausal women and is believed to increase a woman’s risk of breast cancer; estradiol provides benefits for cholesterol, bone structure, serotonin, energy, memory and nutrient absorption. Estriol is the weakest estrogen, known to significantly increase during pregnancy. It does provide protection against breast cancer. Additional potential benefits of bioidentical hormone therapy for women include reduced osteoporosis and restoration of bone strength, facilitate growth and repair, reduced hot flashes and vaginal dryness, better maintenance of muscle mass and strength, reduced risk of endometrial and breast cancer, reduced risk of depression, improved sleep, better mood, concentration and memory, improved libido, and fewer side effects than with synthetic hormones.

The best way to know if you have a hormone imbalance is to schedule an appointment with a trained anti-aging practitioner. They will measure your hormone levels, interpret the results and determine an individualized program to optimize your hormonal symphony. Throughout treatment, our levels will continue to be monitored to determine if any adjustments are necessary. A good rule of thumb for aging well is to maintain your health; which can be done effectively with bioidentical hormone therapy.


Rosina Cabo, PA-C, ABAAHP, FAARFM, MNM, CHHC is a board-certified physician assistant with additional board certification and fellowship training in anti-aging, regenerative, and functional medicine from the American Academy of Anti-Aging Medicine, as well as a Master of Science in Metabolic and Nutritional Medicine from the University of South Florida Medical School. She practices at GW Center for Integrative Medicine. See ad, page 2.


Sources: International Journal of Pharmaceutical Compounding (2000, 2001), Menopause, 2004.


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