Bio-identical estrogens have been shown to be clinically effective:
Testosterone and dehydroepiandrosterone (DHEA) may be added to a woman's HRT to alleviate recalcitrant menopausal symptoms and further protect against osteoporosis, loss of immune function, obesity, and diabetes. A decline in serum testosterone is associated with hysterectomy, and there are age-related gender-independent declines in DHEA and DHEA-sulfate. Additionally, ERT may cause relative ovarian and adrenal androgen deficiency, creating a rationale for concurrent physiologic androgen replacement.
*Despite studies reporting the risks associated with synthetic hormones, conjugated equine estrogens remain the most frequently prescribed form of ERT. Published clinical trials have reported that the risk of breast cancer is increased by long-term use of conjugated equine estrogens1,2, and further increases when the synthetic progestin medroxyprogesterone acetate is added to the regimen.3,4
Men frequently experience declines in testosterone levels that correlate with the hormonal changes that women experience at menopause; however, men typically have a slower and more subtle hormonal decline, and develop symptoms over a period of time. When hormones are replaced or restored back to physiological levels considered normal for younger males, men may experience a dramatic reversal of these changes.10
Goals of Testosterone Replacement Therapy in Men (>50 Years):
Natural testosterone must not be confused with synthetic derivatives or "anabolic steroids," which, when used by athletes and body builders, have caused disastrous effects, even resulting in heart problems and cancer.
Andropause therapy may also include dehydroepiandrosterone (DHEA), dihydrotestosterone (DHT), chrysin, zinc, selenium and other supplements.
Thyroid hormone helps the body convert food into energy and heat, regulates body temperature, and impacts many other hormonal systems in the body. More than half of all people affected by thyroid disease are unaware of their condition, and may have many symptoms but not be diagnosed for years. Symptoms of hypothyroidism may include fatigue, cold and heat intolerance, hypotension, fluid retention, dry skin and/or hair, constipation, headaches and/or migraines, low sexual desire, infertility, irregular menstrual periods, aching muscles and joints, depression, anxiety, low self-esteem, slowed metabolism and decreased heart rate, memory and concentration impairment, enlarged tongue, deep voice, swollen neck, PMS, weight gain and hypoglycemia. Hypothyroidism is a leading cause of high cholesterol and triglycerides, and severe hypothyroidism can cause symptoms similar to Alzheimer's disease.
Thyroid hormone exists in two major forms:
Although both T4 and T3 are secreted by the normal thyroid gland, most patients are treated only with levothyroxine (synthetic T4). Some hypothyroid patients remain symptomatic, and a combination of levothyroxine and T3 may be required for optimal thyroid replacement therapy. However, the only commercially available form of T3 for replacement therapy is synthetic liothyronine sodium. Liothyronine is an immediate release formulation which is rapidly absorbed and may result in higher than normal T3 concentrations throughout the body causing serious side effects, including heart palpitations. Research indicates there is a need for sustained-release T3 preparations in order to avoid adverse effects.
A randomized, double-blind, crossover study compared the effects of thyroid hormone replacement with T4 alone versus the use of T4 plus T3 in patients with hypothyroidism. Two-thirds of patients preferred T4 plus T3, and tended to be less depressed than after treatment with T4 alone. This study concluded that including T3 in thyroid hormone replacement improved cognitive performance, mood, physical status, and neuropsychological function in hypothyroid patients. 11,12
Patients and their physicians may wish to consider the inclusion of sustained-release T3 in the treatment of hypothyroidism, particularly when the response to levothyroxine (T4) has not been complete.
The role of thyroid hormone and consideration of its impact on multiple body systems is emerging as a critical component of balanced hormone replacement for men and women.