Longevity Clinic BioIdentical Hormone Therapies – Bellevue
Do You Have A Hormone Deficiency?
Thierry Hertoghe M.D. developed this symptom questionnaire and self-test to help you determine if your levels of hormones are below normal (read his book). Your doctor will help you understand these hormones better your first visit. We believe in the principle of doctor as teacher and we want you to understand how your body works and how the treatments will help you.
Your physician at Femme Clinique can help you simultaneously balance your hormones and help you determine the most beneficial supplements to support your therapy using a combination of prescription medications and nutritional and lifestyle coaching. We strongly believe in prevention and will help you determine the most effective and safest approach to enhancing your life and delaying the effects of aging.
The more symptoms you have in a category the more likely you have a deficiency of that hormone. Keep in mind that hormone excess can inhibit other hormones so you need an experienced physician to provide your with the correct lab testing and treatment protocols. We feel the safest approach to hormone replacement is balancing multiple hormones instead of just trying to balance one hormone as is done in traditional hormone replacement with horse hormones (estrogen only).
Using 24 hour urine hormone testing we can diagnose deficiencies of these hormones in a very holistic way (see hormone chart). In regular blood and saliva tests we only see snapshots. With a 24 hour urine collection we can check over 30 different hormones and help optimize hormone related cancer and bone health markers.
Hormone Deficiency Symptoms
Estrogen Deficiency Symptoms
- Hair loss on the top of your head
- Thin vertical wrinkles around your lips
- Your breasts are sagging
- Your face is too hairy
- Your eyes feel dry and easily are irritated
- You have hot flashes
- You feel tired constantly
- You feel depressed
- Your menstrual flow is light
- Your menstrual cycles are irregular, short, or long
- Women without periods: you don’t feel like making love much
Over 20 estrogens are known and three are used clinically. These three estrogens are estrone (E1), estradiol (E2), and estriol (E3). Estradiol is the most potent estrogen produced by the ovaries.
Estrogens are also made from testosterone and other “male” hormones produced in the adrenal glands. Obese women tend to convert more of their testosterone to estrogen. This can lead to a poor testosterone to estrogen ratio in women and related symptoms of decreased libido and increased risk of osteoporosis.
Most of your estrogens are bound to proteins, preventing them from being active in your body. Using 24 hour hormone testing, we can measure the active hormones which are the most important because they tell us about the hormones’ activity in your body.
It is important to balance the different estrogen levels because this has been shown to reduce cancer risk. One of the products of estrogen breakdown (metabolism) is 2-methoxy-estradiol, a methylated estrogen. 2-methoxy-estradiol has been shown to have anti-cancer benefits.
In addition, it is important to balance estrogen with other hormones like testosterone. In a retrospective, observational study that included 508 women in 2005, researchers found that “the addition of testosterone to conventional hormone therapy for postmenopausal women does not increase and may indeed reduce the hormone therapy-associated breast cancer risk-thereby returning the incidence to the normal rates observed in the general, untreated population.”
Growth Hormone Deficiency Symptoms In Women
- Your hair is thinning
- Your are cheeks sagging
- Your gums are receding
- Your abdomen is flabby
- Your muscles are slack
- Your skin is thin and /or dry
- You have poor recovery after physical activity
- You feel exhausted
- You dislike the world and tend to isolate yourself
- You continuously feel anxious
“Growth hormone-releasing hormone (GHRH), growth hormone, and insulinlike growth factor 1 have potent effects on brain function, their levels decrease with advancing age, and they likely play a role in the pathogenesis of Alzheimer disease.”
Human Growth Hormone (HGH) is produced in your anterior pituitary gland in pulses throughout the day. The largest of these GH pulses is about an hour after you fall asleep.
HGH production can be stimulated by other hormones. The main signal for HGH production in your body is growth hormone releasing hormone (GHRH).
The effects of GHRH on cognitive (brain) function in adults with mild brain impairment and healthy older adults were studied in 2012. The results of this controlled trial were published in the journal Neurology and showed that brain function could be improved even in “normal” healthy adults with benefits including increased acuity and memory. We use this similar approach with our patients using secretagogues. Secretagogues help balance hormone levels by stimulating the production of other hormones. HCG has a similar effect on progesterone and estrogen levels in women. Sermorelin in a peptide that stimulates growth hormone production similar to GHRH.
Growth hormone has many effects on your body:
- Improves bone health
- Increases muscle mass
- Promotes fat burning
- Maintains growth of organs except brain
- Helps regulate blood sugar levels
- Supports pancreatic function
- Boosts immune function
There are some concerns about HGH and cancer risk.Our growth hormone levels are highest when we are younger and then decline with age. Our cancer risks increase as we age. Since growth hormone levels decline as we age and cancer risks increase it would make sense that growth hormone deficiency may increase cancer risk. Despite these theoretical risks and benefits, we feel that it is all about balance.
For example, in brain function, balance is very important:
“Data suggest that not only absolute levels of sex hormones but also the balance between estrogen and testosterone and their metabolites may be important for cognitive function in women.”
Despite the potential risks and benefits of growth hormone therapies, there is evidence that maintaining optimal growth hormone levels (IGF-1) can decrease your overall healthcare costs (and overall mortality risks):
“Subjects with low in contrast to intermediate IGF-I exhibited 30.6% higher annual total costs 5 years after baseline examination, corresponding to a difference in adjusted costs of EUR436.61.”
Progesterone Deficiency Symptoms
- Your breasts are large
- Your close friends complain that you often seem nervous and agitated
- You feel anxious often
- You sleep lightly and restlessly
- The following questions apply if you’ve not yet reached menopause or are on hormone replacement therapy:
- Your breasts are swollen and tender or painful before your period
- Your lower belly is swollen
- You’re irritable and aggressive
- You loose your self-control
- You have heavy periods
- Your periods are continuously painful
“Progesterone had no effect on undisturbed sleep but restored normal sleep when sleep was disturbed (while currently available hypnotics tend to inhibit deep sleep), acting as a “physiologic” regulator rather than as a hypnotic drug.”
A 2011 study on the use of progesterone in post-menopausal women found that progesterone can help improve sleep only if your body needs it. Progesterone deficiency can cause anxiety and anger, which can be exacerbated by anemia from extended periods in younger women.
During ovulation, progesterone is secreted from the ovary and during the second 2 weeks of the cycle. During menopause women make less progesterone than ovulating women. It is a myth that progesterone is not needed for women who have had a hysterectomy because progesterone effects the entire body. The bone, nerves, brain, white blood cells, lungs, uterus, breast and colon all have progesterone receptors.
Progesterone can improve sleep, mood, and many other aspects of your life. It is all about balance.
Testosterone Deficiency Symptoms
- Your face has gotten slack and more wrinkled
- You’ve lost tone in your muscles
- Your tend to gain fat in the belly area
- You’re constantly tired
- You feel like making love less often than you used to
“Over 50% of women are believed to be affected by female sexual dysfunction (FSD).”
Testosterone therapy for women has been in use for over 80 years. Uses was have included treatments sexual dysfunction, abnormal uterine bleeding, dysmenorrhea, menopausal symptoms, chronic mastitis and lactation, and breast, uterine, and ovarian tumors.
Testosterone replacement for menopausal women, whether from surgery or aging, can improve sexual desire and libido. Most research shows that testosterone therapy is safe, when done correctly.
The North American Menopause Society position on testosterone therapy in postmenopausal women with decreased sexual desire may benefit for testosterone therapy. They recommend testosterone therapy with estrogen therapy at the same time.
Low Libido in Women
Testosterone therapy improves arousability, sexual desire and fantasy, frequency of sexual activity and orgasm, and satisfaction and pleasure from the sexual act.
Female Hypoactive Sexual Desire Disorder (HSDD)
Over 16 million women aged 50 and older have low sexual desire. Hypoactive sexual desire disorder (HSDD) is common and symptoms include decreased sexual desire that causes relationship or personal problems. HSDD is common in women who have had their ovaries removed. Women receiving testosterone therapy typically notice great improvement in sexual satisfaction.
Breast Cancer Risk and Testosterone Therapy
A 2009 study in the Journal of Sexual Medicine, with 637 women using testosterone over 18 years, found that testosterone therapy had no impact on breast cancer risk.
Osteoporosis and Low Testosterone In Women
Testosterone (T) improves the ability of estrogen to improve bone health. A 2008 study on post-menopausal women receiving hormone replacement therapy found that women receiving testosterone saw greater improvement in bone density than with estrogen (E) replacement alone. “The favourable estrogenic effects on lipids were preserved in women treated with T, in association with beneficial changes in body composition.” They also noted that the, “addition of testosterone resulted in a significantly greater improvement compared to E for sexual activity (P < 0.03), satisfaction (P < 0.03), pleasure (P < 0.01), orgasm (P < 0.035) and relevancy (P < 0.05).” In the statistical world, those are some nice looking P values. The smaller the P value, in this case, the more likely it is you will see the same benefit.
Heart Disease and Low Testosterone in Women
Testosterone therapy improves heart function, blood sugar regulation, and muscle strength in women with advanced chronic heart failure. The heart is a muscle and all the blood vessels are lined with smooth muscle. Testosterone has been shown to be a effective and safe therapy for elderly women with chronic heart failure.
Depression and Low Testosterone in Women
“Inadequate response to antidepressant monotherapy in women with major depressive disorder is common.”
Low doses of testosterone in women have been used with good success in the treatment of depression. Remember, depression is not a symptom of a Prozac® deficiency but rather the symptom of an imbalance.
With our approach to balancing hormone levels, side effects of testosterone therapy are uncommon. With excessive testosterone levels you may notice acne or increased body hair. This is why we always start with a very low dose and increase as needed.
DHEA Deficiency Symptoms
- Your hair is dry
- Your skin and eyes are dry
- Your muscles are flabby
- Your belly is getting fat
- You don’t have much hair in your armpits
- You don’t have much hair in your pubic area
- You don’t have much padding in your pubic area
- Your body doesn’t have much of a special scent during sexual arousal
- You can’t tolerate noise
- Your libido is low
Oral vs. Transdermal DHEA
DHEA, also known dyhdroepiandrosterone, is very abundant in our bodies at younger ages but as you age your levels decline. DHEA is converted into pheromones by our bodies so one symptom of deficiency is lack of special scent during sexual arousal. The best way to take DHEA is transdermally in order to bypass the liver. DHEA is one of the most plentiful hormones in our bodies when we are younger. Its decline in your body can have a significant impact on libido and youthful appearance.
Thyroid Deficiency Symptoms
- You’re sensitive to cold
- Your hands and feet are always cold
- In the morning your face is puffy and your eyelids are swollen
- You put on weight easily
- You have dry skin
- You have trouble getting up in the morning
- You feel more tired at rest than when you’re active
- You’re constipated
- You’re joints are stiff in the morning
- You feel like you’re living in slow motion
Thyroid Deficiencies Are Common In Women
Low thyroid is more common in women than men. The test most often ordered to screen for thyroid problems is called TSH, thyroid stimulating hormone, and is practically useless in evaluating function. This is because TSH is just the signal from the brain to the thyroid. We want to know how much thyroid hormone is actually being made. To do this we measure T3 and T4 and other blood levels and often find that the levels are out of balance despite being treated with synthetic thyroid hormones.
Thyroid hormones are meant to be released slowly over several hours but more thyroid medications just give a big spike. With combination, T4 and T3, natural thyroid hormones can potentially provide more sustained levels. In addition, autoimmune thyroid is very common in women and often leads to sudden surges of thyroid hormones being released during the “attack phase”. Patients may notice this as sudden increases in heart rate and a feeling of anxiety.
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