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Hormone Optimization

Hormone Replacement Therapy can improve your quality of life and  may extend your life.

Are you experiencing low energy, weight gain, loss of libido, or signs of aging? If so, it could be due to your hormones. Dr. Dinetz specializes in bio identical hormone replacement therapy for men and women with hormonal imbalances.
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As you age, your hormone levels naturally decline. This can lead to a wide range of symptoms, such as fatigue, mood changes, sleep issues, brain fog, insomnia, weight gain, changes in physical appearance, palpitations of the heart, and decreased libido. If you're experiencing such symptoms and want to improve your quality of life, hormone replacement therapy (HRT) may be a viable option. But before you start HRT, it's important to evaluate your entire hormone balance and determine the best treatment plan for you. In this blog post, we'll discuss how and what treatment options are available. Keep reading to learn more!

What are bio-identical hormones?

These are our sex hormones like estrogen, testosterone, and progesterone produced exactly in the structure of how our body makes it, often from Yam or similar plant base sources. It is well known in the medical community that contraception (birth control pills, hormonal IUD’s) and oral post-menopausal hormone therapy is not bioidentical but instead comes from horses so is synthetic. They arevactually extracted from Equine (horse) urine and then synthesized synthetically to make such things as estrogen in birth control pills which  many women are still taking in fact. These synthetic conjugated equine Estrogens (CEE) bind to our hormone receptors differently than would normally our own natural hormones.
Think of this like a lock and key mechanism, you put the key in the door that you think is the correct one  but you don't feel the ease of unlocking it. This is precisely what happens when a synthetic hormone binds to our cell receptors causing an imbalanced signal to our bodies.

Concerns with Non bioidentical hormones:

Aside from the ethical concerns involved there are a lot of issues with this form of hormone therapy compared with bioidenticals. These can lead to blood clots in predisposed women, weight gain, liver inflammation, cancer from synthetic progestins, and more. Oral birth control in younger women is a form of hormonal therapy that may even change your natural attraction to your current partner according to more recent research Here.

I heard about cancer links from hormones is that true? Are there any risks in bioidentical hormone therapy?

This would be false based on what we now know. There was a study about 20 years ago now called the women’s health initiative (WHI) that said estrogen combined with progestin (the synthetic progesterone) increased breast cancer. What was  interesting was that most doctors and the media only read the conclusions instead of what the paper actually showed. What the real interpretation  revealed was there was a decrease in breast cancer when estrogen was used alone without the synthetic progestins. In fact, natural progesterone has been well known to be anti-cancerous while its synthetic counterpart increases such incidence and should never be used. To date estrogens benefits outweigh any such risks especially with natural progesterone.

Lets go deeper to look at risk vs benefit of hormonal use in post menopause: The nurses Health Study (NHS). This large study showed no increase in breast cancer no matter the hormone women took, even longer than 10 years.
There have been numerous other studies that show not only that estrogen replacement therapy in age appropriate women to be safe but actually may decrease the incidence of cancer and diseases associated with aging dating back to the 50's at the National Cancer Institute.

Here is a sum of the data to clear things up: The majority of breast cancer victims were never on hormones and most women on hormonal therapy don’t develop cancer. Women who have been exposed to estrogen for longer periods in their life (earlier menarche and later menopause) have not consistently shown in increased incidence of cancer meaning estrogen exposure isn’t likely a cause, according to 4 studies that looked at this. Administration of estrogen has shown to have beneficial effects on breast cancer. University of London director of cancer research reported that 25% of advanced breast cancer patients given high-dose estrogen fared better than those who did not. Finally, a study from the University of Cagliari in Italy showed remission rate of 50% of breast cancer patients treated with Estrogen. Recently there have been further studies using testosterone to successfully treat breast cancer as well, which in the body, converts into estrogens.

Symptoms of having low estrogen and what such therapy has actually shown to help alleviate:

Palpitations (an early sign of menopause)
Dry eyes and mouth 
Urinary Tract Infections (UTI’s) 
Irregular bleeding 
Bloating often misdiagnosed as IBS
Swelling i.e. in face or legs
Joint pains and aches
Memory issues
Anxiety for no reason
Memory loss
Hot flashes/night sweats

Longevity implications of bioidentical hormone use:

Improved bone mineral density.
Rejuvenated skin and mucous membranes.
Improved sense of vitality and sex drive restoration.
Decreased markers of inflammation relating to cardiovascular disease or heart disease. 
Most recently there was a large study done on cognition and memory which backed up the increasing literature that restoring hormone levels can have healthy impacts on the brain. Here is the summary of their findings:

“The researchers concluded that all modes of hormone therapy (HT) delivery were associated with reduced risk of all Neurodegenerative diseases (NDD) including Alzheimers and Dementia. Even the use of oral estradiol, known to produce inflammatory liver markers, was associated with significantly reduced relative risk compared to non-HT users.

Longer duration of therapy (>1 year) was associated with greater protective effect than short-term therapy (<1 year). Formulations that contained the bioidentical hormones 17B-estradiol and/or progesterone (compared to synthetic formulations) were associated with a greater reduction of all NDD risk including Alzheimer’s regardless of route of delivery. The authors highlighted the need for precision HT to increase predictive safety and outcomes. (It should be noted that women who receive HT are known to be generally healthier, more educated, and socioeconomically advantaged relative to non-users, which could influence outcomes in observational studies.)” 

The literature is exponentially growing and showing that the benefit vs any risk is completely outweighed when it comes to bioidentical hormone use and aging in women. That is of course considering the proper screening that must occur prior to starting. First of all, mammograms while in some respects are controversial help to elicit breast cancer that thermography and ultrasounds do miss.

Furthermore colonoscopy and all age related screening is of necessity. We offer a simple solution at our practice: The Grail Test. This circulating free cancer cell detection can be used by those over 50 years of age with true risk to eliminate concern for up to 50 cancer types. Detecting such this early leads to often easier, quicker, and more successful treatment options.

When should a woman start?

This is a point that used to be more debated but it appears the consensus from the science and menopausal organizations is right at menopausal onset or perimenopause (The time a women starts to have hormonal decline and symptoms). Starting right after a woman is diagnosed may be ideal to help deal with sleep, anxiety or mood issues that often arise while also protecting bone health from osteoporosis. Starting at full on menopause which is after a woman hasn’t had a cycle in over 1 year, it has shown to result in the best outcomes since the hormones haven't been depleted for that long. For example, cognitive benefits while on post-menopausal hormonal therapy have been found most pronounced in women who were taking it the longest in a recent study. The consensus among menopausal societies and functional endocrinology competent doctors is generally to start within 10 years of menopause. This is referred to as a “therapeutic window.” 

While some sources may say when to stop therapy, given the aforementioned newer data and clinical knowledge of women’s prolonged success on it, it may be indefinitely but always becomes a conversation about what a patient’s priorities and needs are based on the evidence to support it with proper screening and check ups.

Are you interested in learning more about your hormones ? An advanced test evaluation can provide deep insights.
Contact our office today to schedule an appointment with Dr. Dinetz. Learn more about what does a microbiome test show and what it tells you about your overall health.

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Suite 604, Miami
Miami, FL 33133
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