Dr. Dagstani utilizes only bio-identical hormones in treating patients with hormonal deficiencies; not only are they safer and more effective than synthetic forms but they are the hormones which the brain fully recognizes and they allow the body to restore itself to its previous normal, vital state.
Why Hormones Decline
- Hormones decline as we age every year after the age of 40, often even earlier.
- Advances in healthcare, vaccinations, sanitation, food preservation techniques and others have drastically increased life span. However, the glands that produce our hormones do not regenerate but continue to decline, producing fewer hormones with each passing year.
- As we age, it becomes increasingly important for both men and women to keep their hormones balanced to protect against fatigue, mood swings, obesity, and other diseases, and to enjoy an overall healthier sense of well being.
What does “bio-identical” mean?
“Bio-identical” hormones are compounds which are manufactured in the lab to have exactly the same chemical and molecular structure as the hormones that are produced by the human body. Though any hormone can be made to be “bio-identical”, the term is most often used to describe formulations containing estrogens, progesterone, dhea, and/or testosterone.
By contrast, synthetic hormones are intentionally different. Drug companies cannot patent a bio-identical structure, so they most often invent synthetic hormones that are patentable (Premarin, Prempro, and Provera being the most widely used examples). Though bio-identical hormones have been in existence since the late 1930’s, many practitioners are unfamiliar with how to work with them.
Are bio-identical hormones better than synthetic hormones such as Premarin and Prempro?
We long ago concluded that the answer to this question is yes. But that doesn’t mean bio-identical hormones are perfect. The great appeal of bio-identical hormones is that they are natural and our bodies can metabolize them as it was designed to do, minimizing side effects. Synthetic hormones are quite strong, often producing intolerable side effects. Moreover, the compounded bio-identical hormones can be dosed to each individual’s need, which is impossible with limited doses, mass-produced products.
Are bio-identical hormones safer than synthetics?
European medical studies suggest that yes, bio-identical hormones are safer than synthetic versions. This makes perfect sensse, however, we must be cautious, because bio-identicals have not been heavily studied, especially for long-term use. And in any case, we recommend that no drug ever be viewed as completely safe.
Let us note here that the WHI studies on the effectiveness and health risks of HRT (hormone replacement therapy) were based on synthetic/horse-based hormones, and the average age of the women at enrollment was 63. These details did make a difference in their risk.
What are the differences between pellets, transdermals (creams/gels/patches), orals and injections?
Pellet Therapy
Pellet therapy has been available in the United States since 1939. It is a sustainable delivery method for bio-identical hormone therapy and is an ideal hormone treatment that helps balance body chemistry and restores health and vitality in women and men suffering the symptoms of hormonal imbalances. The long-lasting pellets (typically 3-5 months) make this hormone therapy treatment option the easiest, most convenient and typically most effective method available. Instead of dealing with a daily, weekly, or every other week hormone pill, cream, patch or shot schedule, you meet with a provider every three to five months for an easy pellet insertion. During the simple in-office procedure, the tiny pellets are inserted into the buttock area. The small incision site requires just a small bandage. The pellets, which separately contain estradiol or testosterone (used individuallly or in combination), react to the needs of your body by secreting additional amounts of the hormones just as your body naturally would during periods of stress or exercise. In addition, the body does not experience extreme highs and lows because hormone delivery is more consistently maintained. Many patients notice a difference within a few days, in particular estrogen effects, however, it can take up to four weeks or longer for the full effects to be felt.
Transdermal Therapy
The term “transdermal” refers to topical delivery through the skin, by the use of a gel, cream or patch. Transdermal hormones are usually applied to the skin in small daily doses in an effort to keep a steady level of hormones in the system at all times. This approach lessens the extreme “peaks and valleys” in hormone levels sometimes associated with injectable forms. With injectables, hormone levels rise dramatically initially and can reach a low-point a few days before the next shot is due, which can cause irritability, hot flashes, and low energy in some users. Transdermal application tends to be attractive to those individuals who are not comfortable with needles and injections.
Even with once-daily use of gels and creams, you can also experience significant peaks and valleys which can cause adverse events. Some forms of daily transdermal application, particularly the patch, are substantially more expensive than injectable forms of hormones. Patches often cause skin irritation and/or allergic reactions to users. Patches can fall off with excessive sweating, and they must be fully protected with plastic when swimming. Creams and gels can be transferred by direct skin contact so special care must be taken to avoid contact with partners, children and pets. In the United States, testosterone patches are not available for women, only estradiol patches.
Oral Pills
Orally delivered hormones (pills) will pass through the liver prior to entering the bloodstream. This is called “first pass” metabolism. This has been shown to increase the risk of blood clotting and increased risk of heart attack and stroke, even if the hormone is bio-identical. In addition, when the liver metabolizes hormones it increases a protein called SHBG (sex hormone binding globulin) which binds up free testosterone and estrogen. This essentially makes the hormones given ineffective.
Injectables
‘Depot’ drug formulations are created by mixing a substance with the drug that slows its release and prolongs the action of the drug. The two most frequently used forms in the US are the testosterone esters, testosterone cypionate and testosterone enanthate, which are almost interchangeable. These are only used in men as the doses would be too high for women.
The adverse side effects of injected testosterone esters are generally associated with high peak levels in the first few days after an injection followed by lows after the injection starts to wear off. Some side effects may be lessened by using a shorter dosing interval (weekly or every ten days instead of twice monthly with enanthate or cypionate.) 100 mg weekly gives a much lower peak level of testosterone than does 200 mg every two weeks, while still maintaining the same total dose of androgen. This benefit must be weighed against the discomfort and inconvenience of doubling the number of injections. Having “peaks and valleys” never allows the body to have sustained levels which would reset all the testosterone receptors causing the most positive effects on the body.
In the end, there are many forms of bio-identical hormones including pills, lozenges, creams, gels and pellets. After discussing your health background and your lifestyle needs, Dr. Dagstani will help you decide which form of replacement is best suited for you.
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