Bioidentical hormone therapy has become common today as both women and men are realizing its many benefits. They sleep better, have more energy and lose weight.Restoring and balancing hormones also improves mood and libido, reduces the risk of diabetes and relieves PMS, hot flashes, depression and anxiety. It improves memory and helps get rid of brain fog.
After you have decided that you need hormones, now what? Where does one begin and make an informed decision for your health?
Bioidentical hormones have the exact molecular structure as hormones produced by your body, so when you restore them, your body knows what to do with them. Just as a key fits perfectly into the right keyhole, bioidentical hormones do the same in your cells. Research shows that hormonal decline is associated with loss of body function and increase in disease. Studies demonstrate that bioidentical hormone replacement therapy can improve sleep, fatigue, mood, cognitive function, bone mass, sexual function, muscle strength and body composition, and decrease inflammation. Therefore, we don’t lose our hormones because we age; we age because we lose our hormones.
While there are several methods of delivering bioidentical hormones to your body, today we will discuss several ways of delivering them.
Capsules can deliver the exact dose that is prescribed by your doctor. You don’t have to rely on a “one size fits all” pill – you can take the dose that is needed for your health needs and symptoms. Capsules allow your doctor to individualize your dose and make it easy to adjust your dose as you work with your doctor to find the right dose to alleviate your symptoms. However, once swallowed, the dose runs through the liver can be reduced due to first pass metabolism, a normal process by which your liver can metabolize drugs out of the system.
Creams, which deliver the hormones directly into your blood stream through your skin, may allow for lower absorption of hormones than capsules but there is no first pass metabolism. Absorption depends upon time of year (humid or dry) and condition of your skin (hydrated, dry, irritated). All body sites are not as equally permeable. Application sites for the cream must be rotated, for instance, absorption could be different between the inner arm and inner thigh. The higher the dose you need, the more cream you have to apply to your body. So, if you are needing a higher dose, then capsules may be the best fit for you
Troches are lozenges that can be dissolved in the mouth, under the tongue or in the cheek. They can be absorbed in 15-20 minutes and is not usually affected by first pass metabolism.
Choosing between capsules, creams or troches depends on a few factors: a) the dose needed, b) the patient’s preference, and c) what works best. For those patients who have experience with bioidentical hormones in both caps and creams, may have found better results by taking them orally or in a dissolvable troche.
With capsules and creams, the physician can increase the dose immediately if the patient still has symptoms of a hormone deficiency. If the dose is too high, then skipping a dose for a few days is usually all that is needed to eliminate the symptoms.
Pellet therapy involves implants that are placed under the skin that release hormones into your body. The pellets, which are a little larger than a grain of rice, contain hormones (estradiol or testosterone) which are pressed into very small cylinders. (Progesterone cannot be used in pellets because it dissolves too quickly)
These pellets are then inserted under the skin through a small incision (either the lower abdomen or upper buttocks) with local anesthesia. The incision is then closed with sutures or sterile tape strips. These pellets will be broken down by the body and absorbed, delivering the hormones for up to 3 to 5 months. Patients can begin to feel relief starting anywhere from 2 days to 2 weeks after implantation.
Pellet therapy has its limitations and is sub-optimal if the dose is calculated and delivered incorrectly. If too much is given, it cannot be removed. It requires frequent visits to the doctor and pellet placement.
These implants are supposed to release small doses of hormones consistently, however this is not always the result. For example, If the dose is too low, then patients could take supplemental hormones, however it would be challenging for a physician to know how much to add and the dosing would be guesswork. If the dose is too high, there have been instances where patients become so irritable with too much testosterone that it is difficult for the patient to interact with others. This would indicate a leave of absence from pellets at this time.
To avoid the pellets from working their way out of the body, there are post-op instructions one must follow. After insertion, vigorous physical activity, bathing and swimming should be avoided for approximately 5 days. A shower may be taken as long as the incision isn’t scrubbed until it is well healed, after about a week.
Discomfort at the injection site for the first week; Minor bleeding; Bruising; Swelling; Discoloration of the skin; Infection; pellet extrusion; and Redness and itching at the implant site.
Hormones can be tricky for a doctor to dose, so they must be knowledgeable and experienced with prescribing bioidentical hormone therapy. While it may sound more convenient to have pellets inserted once every few months rather than take pills or apply creams, a few doctors still need to know what they are doing. Pellet therapy seems to be a fad right now, “everyone is doing it,” but are they doing it right?
Your health is our concern and if you need our help, we are here to serve. Just give us a call and allow us to work with your healthcare team.