Hormone Replacement Therapy (Ultimate 2019 Guide)

Regardless of where you currently are in life, there’s a chance you’ve heard about Hormone Replacement Therapy (HRT) and how it’s helped millions of people lead a more fulfilling, energized life, including in places like Phoenix, Arizona!

But what is Hormone Replacement Therapy? How does it work? If you’re unfamiliar with the details, it’s normal to feel some anxiety about it! After all, hormones are responsible for so many different things, so it’s definitely a big deal!

To help ease some of those anxieties and give you a more thorough understanding of Hormone Replacement Therapy, here is the ultimate guide to get you started!

What is Hormone Replacement Therapy?

Hormone replacement therapy replaces and balances different hormones to fix a variety of problems

First things first, knowing what HRT is will really help to bring things into focus and give you a foundational understanding.

Hormones are responsible for a wide range of functions in our body, so an imbalance can be extremely noticeable and frustrating. Just a few of the many areas that can be impacted by hormones include:

  • Sex and reproduction
  • Sleep
  • Growth and development
  • Stress
  • Mood (including swings)
  • Weight fluctuations
  • Body temperature (including hot flashes)
  • Hair growth

This is why hormone levels are extremely important for everyone, whether you are an adolescent going through puberty or you’re an adult approaching menopause. Hormones are there with us every step of the way.

Because of this importance, imbalances can lead to incredibly frustrating and even life-altering concerns. Whether you are looking to start a family or you simply need sufficient rest to function properly, hormones can really make or break your plans.

The main idea behind HRT, whether you are looking into bio-identical hormones or synthetic hormones, is to help correct imbalances that can be causing problems in your day-to-day life.

In addition to helping already existing concerns with imbalance, HRT has also been known to help on a preventative level. Testosterone replacement therapy can decrease the risk of diabetes, Alzheimers, erectile dysfunction, cardiovascular disease, obesity and high cholesterol while balancing women’s progesterone to estradiol and estrogen ratio can decrease the risk of breast cancer, stroke, cardiovascular disease, anxiety and insomnia.

Ultimately, there are a lot of different ways in which HRT can help re-stabilize your hormones and get you back on track.

Are You a Good Candidate?

While HRT is a fantastic treatment area that has helped many individuals, it’s always important to know whether you are a good candidate before seriously looking into a new medical option.

Firstly, it’s important to note that HRT is designed for individuals who are already experiencing struggles with imbalances. A patient with healthy balances shouldn’t look into HRT since their body is already functioning as intended and any intervention would actually throw these levels off.

Most commonly, patients are men and women over the age of 30. Infants and children are not generally candidates since their bodies are still forming and developing naturally and intervention isn’t really needed.

Women with a history of estrogen receptor or progesterone receptor positive breast cancer should also inform their physician prior to treatment. It’s possible that HRT could irritate this kind of patient and cause more problems than it can fix.

You should also be cautious if you have or have had:

  • Endometrial, uterine or ovarian cancer
  • Stroke
  • Liver disease
  • Blood clots
  • Unexplained vaginal bleeding

The best way to make sure you are a prime candidate is to discuss any concerns with your naturopathic doctor or endocrinologist so that you can make the most informed decision based on your unique circumstances.

What Can it Help With?

There are many symptoms and concerns related to hormone imbalance

As mentioned, the fact that hormones cover so many different functions in our bodies also means that HRT can address a range of different concerns and conditions.

A few of the Symptoms that can be helped by HRT include:

  • Anxiety
  • Brain fog
  • Irregular or heavy menstrual cycles
  • PMS
  • Fatigue
  • Motivation
  • Moods
  • Menopausal symptoms (hot flashes, vaginal dryness, pain with intercourse)
  • Weight fluctuations
  • Low libido

Additionally, some of the specific conditions that can be relieved by HRT include:

  • Menopause
  • Cardiovascular health
  • Insulin resistance
  • Hyperlipidemia
  • Estrogen dominance
  • PCOS
  • PTSD
  • Insomnia

All of this depends on the specific hormonal concerns of an individual patient since sex hormones will impact different parts of your body more than stress hormones, for instance.

Balancing Sex Hormones

To get more specific, sex hormones in particular can impact many different things (not just reproductive functions) and can very easily experience imbalance, especially with age.

Most of you have heard of sex hormones in reference to menopause, body building, PMS and sex drive, but this is just a minimal part of how sex hormones influence our daily life. 

Hromone levels generally begin to decline around the age of 30, leading to many unwanted symptoms. This decline can be attributed to modern standard lifestyle and diet, particularly in America. Additionally, the fac tthat we are living longer and evolution has not quite caught up plays a significant role.

This decline in hormones puts us into a sort of hibernation state where we need fewer calories for our daily functions. Long ago, this would have been extermely beneficial and led to elderly members in a tribe or group needing fewer resources, but this lifestyle is outdated.

Female Hormones

As everyone may know, female anatomy (especially in terms of reproduction) is fairly complicated. This is due to the menstrual cycle which causes a natural eb and flow of female sex hormones.

The Female Menstrual Cycle

A clear visual of the menstrual cycle

Estrogen

Estrogen is the primary female sex hormone. It helps to develop the female sexual characteristics and helps build the endometrial layer of the uterus during the follicular phase (first half) of the menstrual cycle.

Women have 3 forms of estrogen in the body. These estrogens each have a different function and must be balanced to achieve optimal health.

Estriol, or E3, is the gestational estrogen. Estriol is released during pregnancy, so levels are normally undetectable and it is mostly important during this specific point in a woman’s life.

Estradiol, or E2, is the primary form of estrogen. At the appropriate levels, it protects us against bone loss, heart disease, hot flashes, collagen loss and more.

Estrone, or E1, is the “bad” form of estrogen. This is a metabolite of Estradiol and is often elevated in obsese individuals and patients with poor liver for function. It is a common result of standard American diets. This “bad” estrogen increases risk of blood clots and cancer when out of balance!

Estrogen Excess (also known as Estrogen dominance) is becoming increasingly more common. Estrogen dominance is frequently seen in ovulating women, causing many unwanted symptoms such as PMS, heavy menses, weight gain, breast tenderness, mood swings and more. 

Estrogen deficiency, however, occurs during menopause and causes the majority of associated symptoms, including the dreaded hot flashes. Estrogen deficiency can also cause vaginal dryness, weight gain, low mood, brain fog and more. It also increases the risk of osteoporosis, cardiovascular complications, hyperlipidemia and tendon/ligament injury.

Progesterone

Progesterone’s primary function is to build the endometrial lining of the uterus in the luteal phase (second half) or the menstrual cycle and to support pregnancy. Many physicians fail to see any benefit of progesterone outside of this function.

Proper progesterone levels also improve sleep, daily energy, anxiety levels and menstrual regularity.

Additionally, progesterone helps to balance estrogen levels to prevent estrogen dominance. Optimal levels of progesterone should be greater than/equal to estradiol to promote good health and even decrease the risk of cancer.

In the case of HRT, estradiol should never be taken without progesterone to balance it’s levels!

Progesterone excess is nearly only seen in pregnancy, in which case it is physiologically appropriate. Excess of progesterone may cause daytime drowsiness, water retention and low mood.

Progesterone deficiency, however, is commonly seen in women of all ages. As seen in the diagram below, progesterone can be converted into cortisol (our stress hormone). Our modern lifestyle is full of little daily stresses (traffic, deadlines, family life, etc.). Each of these stressors stimulates the release of cortisol, which begins to pull from our progesterone.

This is called the progesterone steal. Our body will continue to pull from our progesterone to create more cortisol and maintain the proper amount (it’s more important to deal with stresses like, say, running from a tiger than to be prepared for pregnancy).

This is one reason why a woman’s menstrual cycle may come late during stressful months or why we may experience more fatigue, sleep distrubance, anxiety, PMS and more.

Sex Hormone Pathway

Understanding the sex hormone pathway helps understand how hormones interact

Testosterone

The final important sex hormone to discuss is testosterone. Many people think of teenage boys with acne and high libido or body builders when they think of testosterone, but what people don’t realize is that women need it as well.

Testosterone not only helps to build muscle mass and improve libido, but also to improve cognition, assertiveness, performance, insulin sensitivity, anxiety management and even pain.

Excess testosterone levels are often seen in women with PCOS (polycystic ovarian syndrome) which is becoming increasingly prevalent. Excess testosterone in women leads to acne, increased facial and body hair, deep voice, clotoral enlargement, estrogen dominance, hair loss and more.

On the other hand, testosterone deficiency is just as prevelent and is often left untreated. Lab reference ranges will often indicate that the lower limit of testosterone for women is 0.0. This is something I find outrageous since the side effects of testosterone deficiency and increased risk factors of cardiovascular disease, diabetes and dementia. 

Testosterone deficiency may also cause low libido, decreased muscle mass, low energy, decreased cognitive ability, low mood, decreased motivation, joint pain and decreased athletic performance, concerns that can impact both men and women.

What Are the Different Types of Hormone Replacement Therapy?

As touched upon earlier, the two main types of HRT are therapies that utilize bio-identical hormones and synthetic hormones.

Bio-identical hormones are molecularly identical to the hormones naturally produced in your body and have been shown to have a much lower risk profile than synthetic hormones.

Synthetic hormones, such as conjugated equine estrogens (CEE) and medroxyprogesterone (MPA) have been shown to have a higher risk for health concerns like breast cancer and cardiovascular disease.

Health risks will also vary based on route of administration for HRT. Injection and pellets are the most direct, pure way of administering both estrogen and testosterone. Plus, they have the fewest adverse effects and lowest risk.

Testosterone taken orally and topically may increase risk of liver cancer and adverse effects associated with elevated DHT like acne, hair loss and oily skin. Estrogens taken orally and topically have been shown to increase risk of blood clot.

What Are Some Common Side Effects?

As with any other treatment or procedure, HRT can come with some side effects. They are generally only seen if symptoms are too high or out of balance, but it’s always important to be aware.

Testosterone replacement therapy in men may also stimulate a higher production of red blood cells, making the blood thick and sticky. This can make it more difficult for the heart to pump, putting men at higher risk of blood clot or cardiovascular complications if not corrected.

If red blood cell production is increased while on testosterone therapy, it is easily corrected by a simple donation of blood 2+ times per year. Testosterone will naturally aromatize into estrogen in the body, so it is also important to always check estrogen levels in both men and women when providing testosterone replacement therapy.

There are two types of estrogen that are important to watch: estradiol and estrone. It is important that estradiol is at a healthy level for both men and women since it is protective for the heart, bones, vaginal lubrication, collagen production and erectile function. If estradiol is too high, Anastrazole may be taken to help suppress the conversion.

Estrone is a metabolite of estradiol that should be kept at equal or lesser levels when compared to estradiol. It is often elevated due to poor liver function and can be a result of obesity or estrogenic dietary influences like beer, soy, insecticides and heating food in plastics. Daily supplementation of Diindolylmethane (DIM), dietary changes and weight loss can help decrease levels of estrone.

Generally, men tolerate bio-identical HRT well without development of negative symptoms.  

For women, things can be a little more complicated. Ovulating women will often present with estrogen dominance that causes irregular menstrual cycles, PMS symptoms, mood swings, breast tenderness and weight gain. Progesterone can help balance hormones and treat these symptoms, but too high of a dose can cause daytime drowsiness and breast tenderness.

What Should You Ask Your Doctor?

Doctors are here to help answer questions about hormone replacement therapy

Of course, having a conversation or consultation with your doctor is absolutely vital for something as personal and individualized as HRT. Knowing the right questions to ask will make this conversation far more productive!

Always ask what lab values the physician will monitor over time and how frequently. For example, it is important to monitor free and total testosterone, red blood cells, hemoglobin, hematocrit, estradiol and estrone every 6 months in testosterone replacement therapy. It is also critical to monitor progesterone-to-estradiol ratios in women.

Other questions you should ask include:

  • What route of administration will the physician be prescribing?
  • Do they prescribe bio-identical hormones or synthetic hormones?
  • Based on my medical history, is there any reason I should be cautious with HRT?
  • Do you think it could help my specific symptoms?
  • Are there other treatments I should consider? What are their pros and cons for my specific situation?
  • Do you think I’ll have any side effects? Could my medications impact potential side effects?
  • What type of HRT would be best for me?

As mentioned, everyone is different and will have different experiences with HRT, so make sure you don’t rush into anything and are speaking to a responsible, patient and experienced doctor!

In Summary

Hormone Replacement Therapy can truly be a miracle to many individuals suffering from the frustrating and stubborn results of imbalanced hormones.

By understanding the basics of HRT, the details of important hormones like sex and stress hormones, knowing the side effects and having prepared questions for your doctor, you are ready to look into what HRT can do for you!

When thinking about HRT, you should specifically be sure to talk to your doctor about your levels regarding sex hormones since they are connected to so many different functions. Even though hormones like cortisol and insulin are also critical, sex hormones are responsible for a vast majority of the changes our bodies naturally go through as we age and develop.

Remember that it isn’t the solution for everybody and that a thorough, honest conversation with your doctor is necessary! Hopefully, HRT can solve a great deal of problems you’ve been dealing with and help you live a more fulfilling life. 
For more in-depth information, be sure to get my free e-book! What concerns are you hoping to solve with HRT?

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Hello, my name is Dr. Sarah Bennett, NMD! I am a naturopathic physician licensed in the state of Arizona currently practicing at my office in Scottsdale, AZ. I received my degree from South West College of Naturopathic Medicine, did a year residency at Keystone Natural Family medicine, and received additional training for aesthetics & anti-aging at National Laser Institute. My passion and fascination for natural medicine began during my undergraduate studies at Indiana State University where I was majoring in neuroscience. I saw how a preventative approach could help you live a long and youthful life. Since then I have dedicated my life to serving others understand the latest medical trends. I spend my spare time running, hiking, rock climbing, camping, testing out new diets, and reading books on latest medical trends / listening to podcasts to find the latest nuggets of knowledge to improve the quality of life for my patients. I look forward to serving you!

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