A New Approach to HRT for Women

By Christine Wideman, RN with Robert Grafton, MD

Hormone replacement therapy became controversial in 2002 after the Women’s Health Initiative identified cancer and other health risks connected to synthetic hormone replacement. Many consumers and physicians have since been searching for alternative therapies to prevent or mitigate the negative aspects of aging and menopause.

One Michigan physician has developed, and is offering, a bio-identical hormone replacement therapy. Dr. Grafton, a Rochester Hills, MI plastic surgeon, is one of a handful of physicians using bio-identical hormone treatments. His goal is to restore to women to the hormone levels they enjoyed in their thirties.

Dr. Grafton evaluates a woman’s reproductive hormone status by checking her levels of follicle-stimulating hormone, estrogen and testosterone. He also tests her thyroid levels.

“Bio-identical hormone therapy has been around since the 1930′s,” Dr. Grafton said. “It gives the body exactly what it is short of.” Instead of utilizing a ‘one-drug-fits all’ approach found with standard pharmaceuticals he prescribes a custom, individualized prescription for bio-identical hormones. With these individual results he customizes a unique prescription. A compounding pharmacy then creates a hormone pellet approximately 3/16″ in diameter which is inserted underneath the skin. The pharmacy utilizes bio-identical sources usually found in plants such as yams and soy according to Dr. Grafton.

The advantage of this type of administration, sub-cutaneous, is to avoid the oral route according to Dr. Grafton. Therefore, many of the previous negative side effects of HRT are prevented he said.

“The pellets provide a steady-state of hormone delivery which avoids the peaks and valleys associated with oral administration. Additionally, because this method bypasses the gastrointestinal tract and the liver, the stimulation of blood clotting factors are eliminated,” said Dr. Grafton.

This hormone absorption technique is both efficient and convenient because it lasts three to four months per dose rather than the chore of daily oral administration. Dr. Grafton uses local anesthetic to numb the area and makes a small incision to insert the pellet. They are usually placed in the buttock and are not noticeable. The pellets dissolve completely with no residual effects, according to Dr. Grafton.

Medical insurance does not cover the cost of this therapy yet. A treatment from Dr. Grafton costs between $450-$500 per dose. Many of his patients are satisfied with the results despite the cost. Dr. Grafton says that his patients report increased libido, and improvements in general health and well-being.

“People tell me they have improved mood, are mentally sharper, have improved metabolism and muscle tone and have more energy,” he said.

Hormone replacement therapy can be used with good results for both men and women, says Dr. Grafton. Although there have not been large controlled clinical trials to test this type of treatment at this time, he considers it to be safe. He has used the therapy himself for 8 years with gratifying results.

Christine Wideman, RN, has a degree in nursing and journalism.  She continues to work as a nurse and has written on a variety of topics for both local and national publications as a freelance journalist.

Dr. Robert Grafton is a Diplomate of the Canadian Board of Plastic and Reconstructive Surgery and earned his medical degree fom the University of Saskatchewan.  He has been practicing plastic and reconstructive surgery in Michigan since 1993.  He is an instructor at Michigan State University – Hurley Medical Center.

HRT for Men

With Robert Grafton, MD

When it comes to hormone replacement therapy, we often think about women, menopause, hot flashes, moodiness, bone loss and various other conditions that accompany the time in a woman’s life when HRT is necessary. However, when a man becomes more moody, loses muscle mass, puts on a few pounds, loses libido, we just chalk it up to old age and think there is nothing that can be done.

This just isn’t true.

In fact, hormone replacement – in this case, testosterone – is just as necessary for some men as estrogen replacement is for some women, according to Dr. Robert Grafton of Rochester Hills.

“Think about the crabby old man,” says Dr. Grafton. “You get the mental fogginess, the anxiety, you don’t sleep well, you have physical changes, each can be signs reflecting a loss of testosterone.”

According to Dr. Grafton, men are at the peak levels of testosterone at the age of 30, but testosterone levels decrease 10% each decade thereafter. The amount and severity is different with everyone but the only way to know how your hormonal levels are is to get a baseline value as part of a routine physical.

“You should check your levels in your 40s and if you notice certain levels are lower, and it is an issue get treatment, if not, then you are fine,” suggests Dr. Grafton. “Fifty year old men will get potbellys, skinny arms and have some breast growth, these are typical signs of decreased testosterone. If you haven’t gotten checked with these physical signs, you should.”

In some instances, Dr. Grafton points out that estrogen levels in men has increased due to diet. “Over the last 50 years we have had a decrease in testosterone, but an increase in Xeno-hormones; those that tend to be injected into beef, chicken, milk-producing cows, and our estrogen levels have gone up,” says Dr. Grafton. “Increased estrogen in our bodies is complicating the hormonal balance.”

There are an increasing amount of treatments now for men with low testosterone levels – from creams to pills and patches. These are generally synthetic hormones produced to be similar to your body’s hormones.

Dr. Grafton, and many other physicians, are now looking to treat their patients with biologically equivalent hormones that are engineered more like the hormones our body produces.

Testosterone has many benefits, points out Dr. Grafton. As a vasodilator, it opens your blood vessels, can help lower blood pressure, increase libido, raise your HDL (good cholesterol) and lower your LDL (bad cholesterol). With the many health benefits that go along with balanced hormonal levels, one can see the importance of knowing where you stand.

One treatment option is to have pellets of bioequivalent hormones injected under the skin, says Dr. Grafton. These pellets are similar to a small piece of rice and will last 4-6 months on average.

“These pellets are the same structure as what you’ve lost, put under the skin, and you don’t get the peaks and valleys that you can with other treatments,” says Dr. Grafton. “When you hit high peaks is when you get complications after injections.”

With the pellets, Dr. Grafton states they are released based on your body’s activity, you have a more balanced release. He adds that since the hormone replacement is necessary for the rest of one’s life, that the pellets simplify treatment compared to creams, patches and pills.

Normal hormone levels range between 200 and 1200, says Dr. Grafton, but he will generally start treatment on someone whose levels are under 650. “You want to be in the 80th percentile,” states Dr. Grafton. “You want normal levels, but you want optimal levels and you want to function to optimal capacity.”

As in every other health issue, good diet and exercise are the basic principles to adhere to, says Dr. Grafton. By using the bio-identical hormone pellets that are produced in compound pharmacies, you can simplify reatment and not have to worry about daily treatment regimens, he says.

So, if you are feeling some of the symptoms described, talk to you physician, have your hormone levels checked, and see what options fit the lifestyle that you want.

Natural Choices for Menopause

By Laura Kovalcik, D.O., The Downing Clinic

THE CHANGE

Women want solutions that are safe and that work. Often they suffer from hot flashes, mood changes, vaginal dryness, depression, bone loss, heavy and irregular periods, tender breasts, fluid retention, fatigue, thickening waistlines, poor sex drive, mental dullness, and just not feeling like themselves. They want vigor and youthful feelings again.

Starting around age 40, women may begin to have symptoms from hormone changes. During the 50’s, periods stop and hormone levels fall. Menopause begins when there is no period for a year. It is one of life’s great transitions, a marker for the end of fecundity. Some women breeze through it while others suffer emotional and physical upheaval.

TRADITIONAL HRT

For years, physicians obligingly prescribed strong prescription hormones to help reduce symptoms. Most often Premarin and Provera were prescribed. Premarin (made from pregnant horse urine) is many times stronger than human estrogens. Provera (synthetic progesterone substitute) does not protect the breast the way natural progesterone does. When The Women’s Health Initiative study in 2004 showed increased risks of breast cancer from these hormones, many women simply stopped taking them. Often they felt wretched, but neither they nor their physicians knew there were safer options. Bio-identical hormones have been safely used since the 1980’s, and herbal phytohormones have been around for generations.

BIO-IDENTICAL HRT

Three estrogens, and one progesterone, are made by the body. The estrogens are E1, estrone; E2, estradiol; and E3, estriol. When used for hormone replacement, Mexican wild yam or soy provide ring structures that are then completed in the lab to the same identical molecules the body produces. Hence, the term bio-identical hormones.

Estriol is a weak estrogen that competes for binding sites with the two stronger estrogens; estradiol and estrone. When estriol is on a receptor, it keeps the stronger two estrogens from stimulating that receptor. During reproductive years, estrogen is balanced by progesterone in a cyclic fashion. Whereas estrogen stimulates breast and uterine tissue to proliferate, progesterone opposes these effects.

Balanced human hormones speak to receptors in harmony with nature while artificial substitutes are unbalanced and send different and often harmful messages.

MOTHER NATURE DID IT RIGHT!

Jonathan Wright, M.D. first prescribed these same-as-the-body-makes hormones in the 1980’s for treatment of menopausal symptoms. Dr. Wright used estrogens in a balanced fashion mimicking Mother Nature. He always added progesterone to oppose and balance the estrogens. Dr. Wright used these bio-identical hormones for more than 20 years, treating thousands of women, and didn’t see an increase in breast cancer among his patients.

When a woman asks her physician for bio-identical hormones, she will receive a prescription for estrogen balanced with progesterone. Many different dosage forms exist, including capsules, creams, gels, troches. Often other hormones are used, including testosterone, DHEA, and pregnenolone. There is a wide variation in proper doses and needs for individual women, and risk factors need to be evaluated whenever hormones are used.

A key part to managing hormone therapy is routine hormone testing. This helps identify when one of the many hormones is out of balance – which will present symptoms.

HERBS

Women often seek herbal options such as black cohosh, damiana, false unicorn root, vitex agnes casti, dong quai, blue cohosh, red clover, licorice root, red raspberry leaf, motherwort, maca or sage to help with menopausal symptoms. Many of these herbs are active at the estrogen and progesterone receptors, but they are much weaker than the actual hormones. Some women combine herbs with bio-identical hormones, a good choice for women in their 60’s or 70’s. Other women rely upon established homeopathic formulas such as pulsatilla or sepia to help with symptoms. Today’s women have many good choices!

Looking and feeling great also depends upon a good diet along with physical exercise and time out for stress reduction and personal reflection. Women choosing fresh foods, lots of greens, colorful fruits and vegetables, nuts, seeds, olive oil, fish, poultry, lean meat, and whole grains, will fare the best. Especially helpful are flax seed, soy foods, leafy greens and the broccoli family.

Women today can truly live the poem written by Elizabeth Barrett Browning, “Grow old along with me, the best is yet to be; the last of life for which the first was made.” The natural choices available today combined with a healthy lifestyle will reward you with a truly enjoyable time of life.

Dr. Laura Kovalcik is board-certified in internal medicine. Her work at the The Downing Clinic focuses on internal and integrative medicine and bio-identical hormones and natural menopause treatments. She graduated from Michigan State University School of Osteopathic Medicine and completed her internship and residency at Genesys Regional Medical Center.