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Dr. Charles Lively takes another look at hormone replacement data - Odessa American: Medically Speaking

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Dr. Charles Lively takes another look at hormone replacement data

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Posted: Friday, May 22, 2015 8:45 am

   In the last article in the Odessa American, I noted that due to a wide spread fear of hormone replacement 70% of women on therapy stopped taking their hormones.  Clinical researchers from Cleveland Clinic estimated this contributed to an estimated 90,000 deaths from their stopping the hormones.

   Retrospectively, and obviously, there was clearly benefit to taking the hormones.  During this study 2 synthetic hormones were used:  conjugated equine estrogens and medroxy progesterone acetate.  These were taken orally.  Prior to this Woman’s Health Initiative study approximately 30,000 articles/studies regarding hormone replacement were cited, mostly favorable to hormone replacement. The negative spin of the data came as a shock to both physician and patient.   

Since 2002 doctors have been looking at alternatives and ways of improving symptoms related to declining hormones while also decreasing some risks.  While oral estrogen has proven beneficial we know it may increase triglycerides and clotting factors in some patients.  It can also increase some inflammatory chemicals and c-reactive protein and interleukin-6 that play a role in vascular disease.  Oral estrogen must pass through the liver before it enters the blood stream and as a result the liver produces proteins that bind some of the body’s other hormones and thereby reduce the availability of said hormones to the body’s tissues (sex hormone binding globulin, cortisol binding globulin and thyroid binding globulin).  Having said all of this, remember it was the stopping of the oral man-made estrogen that contributed to the deaths of 90,000 women.  These oral estrogens are clearly beneficial but there are other alternatives that don’t require a trip through the liver, producing the crummy stuff, before entering the blood stream.   

Transdermal patches, creams, gels and sprays are effective and most use bio-identical hormones.  The limitation is the skin itself.  Sometimes the skin works too well in protecting us from things outside and may not permit absorption of the hormone into the body.  This challenge can be minimized by subdermal hormone pellets.  Subdermal pellets have been around since the 1930’s that is about 80 years.  The hormones are extracted from yams (sweet potatoes).  The pellets are composed of natural estradiol or testosterone and stearic acid to compose the pellet.  All 3 of these ingredients are found in the body.  The body, therefore, recognizes the ingredients.  The body does identify the pellet as a foreign object that must be dissolved.  It does this by surrounding the pellet with capillaries, or tiny blood vessels.  With each beat of the heart, blood is rushing through those capillaries and dissolving minute, continuous but effective amounts of hormone providing it to the rest of the body.  In both men and women, physiologic testosterone replacement needs to have relatively constant blood levels without daily spikes.  Subdermal pellets do this best.    Oral versus subdermal.  Let’s examine the efficiency of the two different routes of delivery.  A typical oral dose of estradiol is 1 to 2 mg a day.  This would be 30 to 60 mg intake in a month or 120 to 240 mg in 4 months.  A subdermal dose is typically 12.5 to 15 mg in 4 months.  The oral route is therefore, 10 to 20 times the subdermal (pellets).  At present, this is the most physiologic way of delivering natural estrogen and natural testosterone to the body when ovary and testicular function are in decline.  I was proceeding to explain this to a patient.  I guessit was having been a chemistry teacher in the past that gets me excited, she stopped and said, “Look, I know this works”.  “You don’t have to explain, because Dr. Ben Finch used to place the pellets for years and prior to that Dr. Keith Oeschlager managed my pellet therapy”.   

Here is some news for men.  We know there are a lot of E.D. ads on TV.  Erectile dysfunction is the forecast of a future cardiac event, typically within 8 years.  This is due to the arteries in the penis are typically 1 to 3 mm in diameter and the coronary arteries are 3 to 5 mm.  The largest organ in the body is the endothelium.  This is the lining of every blood vessel in the body.  Declining testosterone reduces the nitric oxide levels in this organ (the lining of the blood vessels) this among other oxidative stressors and additional factors will then take you to the big cardiac/stroke event.  Now, that should scare the crud out of you.  Men, here is some better news.  The positive effects of Bio-identical testosterone include:

  *improved erectile ability

  *prostate protection

  *cardiovascular protection

  *lower cholesterol

  *increased HDL (good cholesterol)

  *increased energy    

  *feeling of over-all well-being

  *reducing body fat

  *builds muscle mass

  *reduced anxiety and irritability

  *cognitive clarity

   Ladies, the beneficial effects of Bio-identical testosterone to you are much similar minus the first 2 items that don’t apply.   

This article hardly scratches the surface and when I see men or women in my clinic to discuss the issues of hormone management it can’t be done in 8 minutes allotted by our third party insurance system.  I hope this article aids the reader in additional understanding as hormonal balance is important to all.  

Dr. Charles Lively has been practicing in Odessa for 23 years.  He evaluates and treats both men and women for hormone imbalance.   

Dr. Charles Lively is board-certified in women’s health care. For more information or to schedule an appointment, call (432) 580-9168.

Odessa, TX

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