By Dr. Mercola
Your hormones have far-reaching effects in your body, and hormone deficiencies can therefore wreak total havoc on your health. The effects, of course, are dependent on the severity of your deficiency, and which hormone is being under-produced.
One of the most commonly known hormone deficiency scenarios is menopause, when hormone replacement therapy (HRT) can help combat bothersome symptoms like hot flashes and mood changes.
But many doctors are also looking at hormone replacement as a general anti-aging strategy. Dr. Thierry Hertoghe,1 featured in the video above, is one of them.
Hormones also appear to influence age-related cognitive decline according to both previous and more recent research, which I’ll review in a moment. But first, I want to bring your attention to a critical point Dr. Hertoghe makes in his talk, which is that you can address many of your hormonal issues through proper diet.
In fact, addressing your food choices should be your first step, before you do anything else to reverse a deficiency.
To Balance Your Hormones, Address Your Diet FIRST
Here are some of the highlights from Dr. Hertoghe’s talk. I highly recommend taking 20 minutes to listen to it in its entirety, as he covers quite a bit of ground in a short amount of time:
- The Paleolithic diet, which includes fermented and cultured foods, promotes healthy hormone levels, even as you age.
- Unsprouted grains, sugar or fructose decrease seven of the 12 most important hormones.
- Alcohol decreases your human growth hormone (HGH), one of your most potent built-in anti-aging hormones. Having just one alcoholic drink per day can decrease your HGH by 75 percent.
- Magnesium supplements improve your sex hormone levels, including your testosterone and HGH.
- High-quality protein from meat and fish, as well as healthy fats such as egg yolk, lard, and butter, will improve progesterone and DHEA secretion, as will an otherwise healthy Paleolithic (read: unprocessed, nutrient-rich organic) diet.
Progesterone can also be increased by several nutritional supplements, including vitamin A. As a general rule, fat-soluble vitamins will have a beneficial effect on sex hormones.
Estrogen Found to Restore Memory in Aging Brains
Side effects of hormone deficiencies really run the gamut depending on the hormone in question. DHEA deficiency, for example, leads to premature aging and lowers your ability to handle both physical and mental stress.
Common premenopausal challenges include PMS and painful cramps, while the most common menopausal complaints include hot flashes and vaginal dryness. Physical signs of HGH deficiency include droopy eyelids, saggy facial skin, thinning hair, and abdominal fat. Other signs include anxiety and chronic exhaustion.
But as I mentioned at the outset, research suggests that what is typically thought of as “age-related cognitive decline” brought on by atrophy may actually be the result of estrogen deficiency.
Research published late last year shows that the health of your brain’s synapses is closely linked to cognitive decline, and that the female hormone estrogen actually restores synaptic health, thereby improving memory. As reported by Medical News Today:2
“Age-related cognitive decline and changes in the nervous system are closely linked, but up until recently, they were thought to result from the loss of neurons in areas such as the prefrontal cortex, the part of the brain important in working memory. A series of papers have shown that the “loss of neurons” concept is simply not true.”
The researchers studied the prefrontal cortex mitochondria of rhesus monkeys, and found that declining memory in aging monkeys was associated with a higher incidence of malformed mitochondria in the animals’ presynaptic terminals.
The mitochondria—which are the powerhouses that fuel your body’s cells, including your brain cells—were doughnut shaped rather than straight, causing a weaker contact between synapses. Interestingly, estrogen treatment reversed this mitochondrial malformation, and improved working memory. One of the study’s authors, John Morrison, PhD, said:
“We are increasingly convinced that maintenance of synaptic health as we age, rather than rescuing cognition later, is critically important in preventing age-related cognitive decline and Alzheimer’s disease.”
“We were excited to see that the occurrence of these donut-shaped mitochondria could be reversed with estrogen, which has known antioxidant effects,” co-author Yuko Hara, PhD added.
Hormone Replacement—A Complex Topic
For all its benefits, hormone replacement is perhaps one of the most challenging areas of medicine. It’s a very complex topic, made even more challenging by the fact that medical recommendations have fluctuated back and forth when it comes to replacing hormones like estrogen in women suffering from symptoms of menopause and surgically induced medical menopause following a hysterectomy.
In the past, hormone replacement therapy (HRT) was also widely prescribed for preventive purposes, based in part on early observational studies that had suggested it could help protect women against heart disease, weak bones, as well as dementia, which the study discussed above seems to confirm yet again. However, this analysis was done with non bioidentical human hormones.
All of that changed in 2002, when the 15-year long Women’s Health Initiative (WHI) abruptly ended its combination of estrogen and progestin therapy study, three years ahead of schedule. The reason?
Their data revealed higher rates of breast cancer, heart attacks, strokes, and blood clots in the population taking the hormones, compared to those receiving a placebo. By 2003, prescriptions had dropped by 38 percent. Between 2001 and 2011, estrogen replacement therapy in women aged 50-59 dwindled by a whopping 79 percent.
Then, a study published last year3 suggested that denouncing the use of HRT across the board may have been a mistake, especially for women having undergone a hysterectomy. It found that conjugated estrogen therapy (Premarin) for women in premature surgical menopause was associated with “a decisive reduction in all-cause mortality,” primarily by reducing deadly heart attacks and deaths from breast cancer. The researchers estimated that anywhere from 18,600 to as many as 91,600 women in medical menopause may have died prematurely over the last decade as a result of avoiding estrogen replacement.4,5
There’s no one blanket recommendation that will apply to everyone. It’s a highly individual situation, where you’d be well advised to work closely with a skilled endocrinologist, and ideally someone well versed in nutrition and complementary strategies. There are several factors to seriously evaluate when considering hormone replacement, including the following:
- Surgically-induced menopause vs. natural menopause vs. using HRT for preventive purposes
- Your age
- The form of hormone you take (bioidentical vs. synthetic)
- The manner in which you administer the hormone
New Guidelines Issued for Treatment of Menopausal Symptoms
The American Congress of Obstetricians and Gynecologists (ACOG) recently revised its guidelines for the treatment of menopausal symptoms.6,7 The new guidelines address two of the most common consequences of menopause: hot flashes and vaginal atrophy, which can result when your body stops producing estrogen. As reported by the New York Times:8
“The new bulletin… examines the various claims and scores of studies. It offers treatment recommendations based on the best available evidence for preserving the health and well-being of women experiencing menopausal symptoms… [E]strogen alone, or in combination with a natural or synthetic progesterone (progestin) for women who still have a uterus, is the ‘most effective therapy’ for curbing hot flushes… ‘Data do not support the use of progestin-only medications, testosterone or compounded bioidentical hormones,’ the report also said… [T]he guidelines recommend ‘against routine discontinuation of systemic estrogen at age 65.’”
Bioidentical Hormones Is Likely an Ideal Choice
It’s disappointing to see ACOG rejecting compounded bioidentical hormones, as in my view they are really the ideal choice. Your body recognizes these as “normal” as they’re virtually identical to the hormones produced in your body. This makes them far safer than synthetic prescription versions. Premarin (the most popular estrogen replacement) comes from horse estrogens and is not bioidentical. But I guess it’s not surprising that ACOG would promote hormones that will result in the greatest cash flow for the pharmaceutical companies…
There are three types of estrogens commonly used in bio-identical hormone replacement therapy: estrone, estradiol, and estriol. A common mixed formulation known as Tri-est includes 80 percent estriol with 10 percent each of estrone and estradiol.
Estriol is considered the safest of the three and is the most commonly prescribed. It has been used safely for decades, and I believe it’s particularly useful when you’ve had a hysterectomy. I also believe that menopausal hot flashes that do not resolve with phytoestrogens, such as black cohosh, are another valid indication for short-term estrogen use. However, if estrogen is used, it is nearly always wise to use it in conjunction with natural progesterone.
Why I Don’t Recommend Synthetic Hormone Replacement
Synthetic progestins (like Provera) are responsible for many, if not most, of the detrimental side effects of HRT. For example, one meta-analysis published in the British Medical Journal in January 20059 found that synthetic HRT is linked to an increased risk of stroke, typically ischemic (caused by blockages of blood flow to your brain). In fact, synthetic HRT boosts your risk of stroke by almost one-third, and your risk of fatal or disabling stroke by more than half. One of the trials reviewed in that meta-analysis also linked synthetic HRT with higher risks of both breast cancer and heart attack. The trial (which included almost 17,000 women over 50) also found taking HRT for five years doubled your risk of life-threatening blood clots. Other potential side effects of HRT include:
- High blood pressure
- Vaginal bleeding
- Skin rashes and acne
- Weight gain
How to Administer Bioidentical Hormones for Optimal Results
When it comes to administering bioidentical hormones, some delivery methods are clearly superior to others. Oral supplementation is perhaps your worst option, as your liver processes everything in your digestive tract first, before it enters your bloodstream, which will metabolize most of the swallowed hormones to inactive and potentially harmful derivatives.
Moreover, if you swallow hormones, only 10-15 percent will eventually reach the target tissues and you will need to take an oral dose that is 500 percent higher than you need. Virtually any method that bypasses your liver will therefore be more effective, but even here, there are some methods that stand out as being better than others:
- Hormone creams administered transdermally (i.e. applied to your skin) is one common alternative. However, since hormones are fat-soluble, they can build up in your fatty tissues when applied topically. This buildup in turn can disrupt other hormones. It’s also near impossible to accurately determine the dose when using a cream.
- Sublingual drops can be a good option, as it enters your blood stream directly and will not build up in your tissues like the cream can. It’s also much easier to determine the dose you’re taking, as each drop is about one milligram.
- Trans mucosal administration is a virtually ideal administration system, and the one I generally recommend, as applying the cream to your mucous epithelial membranes that line your vagina allows for more complete absorption.
The Complexities of Hormone Testing and Monitoring
For best results, your hormone levels should be monitored by blood, urine, or saliva, to ensure they reach a target level that corresponds to the reference ranges for healthy young women. Unfortunately, this monitoring is yet another factor that adds rather than detracts from the complexity of HRT.
Recent research indicates that if you apply topical (transdermal) progesterone, saliva testing will register approximately 10-fold greater compared to whole blood serum testing, and capillary blood levels are approximately 100-fold greater than what you find in whole blood.
According to the study, published in the journal Menopause,10 “high capillary blood and saliva levels indicate high absorption and transport of progesterone to tissues.” This means that if you rely on serum levels of progesterone to monitor your topical dose, you may be underestimating your tissue levels, which could lead to overdosing. To learn more, please listen to Mark Newman’s presentation of the findings below. This information is particularly important for clinicians who prescribe hormones.
Before Taking Hormones, Address Your Diet
Treating hormone imbalances requires a whole-body approach; the best approaches are often preventive and involve diet, exercise and other lifestyle-based strategies, as Dr. Hertoghe discusses. For instance, both estrogen and progesterone are necessary in the female cycle, and their balance is key for optimal health. Many premenopausal women have an imbalance of these hormones. If you have insufficient levels of progesterone to counter excessive estrogen, this imbalance can be further exacerbated by chronic stress. Therefore, your answer might not necessarily lie in taking hormones, but rather addressing your stress levels so that your body can normalize your hormone levels naturally.
A healthful diet, low in processed foods (which are high in health-harming sugars/fructose, grains, genetically engineered ingredients, trans fats, processed salt, and other chemical additives) and high in whole organic foods, along with regular exercise, can also go a long way to keeping your hormones balanced as you age.
It’s important to realize that processed foods—all those refined carbohydrates, and processed and heated fats, all serve to raise your estrogen to abnormal levels—as much as twice the normal, which are maintained for the better part of the adult lives of most American women. This is a MAJOR contributing cause of menopausal symptoms in the first place. Processed foods also decrease a number of other hormones critical to your health and wellbeing. Here’s a quick list of Dr. Hertoghe’s dietary recommendations to maintain healthy hormone levels:
Other Alternatives to Consider Before Taking Hormones for Menopause
Natural bioidentical hormones can offer relief from menopausal symptoms, but I recommend not using them as your first go-to option. Addressing your diet should be your first step. Other strategies you can try before resorting to bioidentical hormones include the following:
- Phytoestrogens: Consuming plenty of phytoestrogens (plant-estrogens) such as licorice and alfalfa before menopause can also help moderate your day-to-day estrogen levels so that when menopause comes, the drop won’t be so dramatic. Just don’t make the mistake of using unfermented soy, which can wreak havoc on your health in a number of different ways.
- Optimize your vitamin D levels: This is a must for gene regulation and optimal health.
- Polyphenols: Certain polyphenols have also been shown to have some HRT-like benefits without the drawbacks, and are associated with a lowered risk of heart disease. Royal Maca seems to be an amazing adaptogenic herbal solution for menopause that has helped many women. Be sure to avoid the inexpensive varieties, as they typically don’t work. If you chose this option, make sure to obtain the authentic version from Peru.
- Animal-based omega-3 fat: You’ll also want to get plenty high-quality animal-based omega-3 fats, such as krill oil.
- Black cohosh: While dismissed by ACOG as having no scientific foundation, Black cohosh may indeed help regulate body temperature and hot flashes in some women.