Bioidentical Hormone Replacement Therapy (BHRT)

Testosterone

Mayo Clinic review of all articles from 1940-2014 using the following key words: testosterone, androgens, human, male, cardiovascular, stroke, cerebrovascular accident, myocardial infarction, heart attack, death, and mortality.  They identified over 200 articles and only 4 suggested increased cardiovascular (CV) risk with Testosterone (T) therapy.  2 retrospective analyses with serious methodological limitations, 1 placebo-controlled trial with few major adverse cardiac events, and 1 meta-analysis that included questionable studies and events. They also found several dozen that showed beneficial effects of normal testosterone levels on CV risk and mortality.  

​

​

Testosterone Therapy and Cardiovascular Risk: Advances & Controversies

Testosterone Therapy and Cardiovascular Risk: Advances and Controversies

Abraham Morgentaler, MD 

Martin M. Miner, MD 

Monica Caliber, MSc 

Andre T. Guay, MD †

Mohit Khera, MD 

Abdulmaged M. Traish, PhD 

Mayo Clinic Article

​

Testosterone therapy involves using testosterone replacement products, such as gels, patches, or injections, to increase testosterone levels in the body. Testosterone therapy can have benefits, but it also carries potential risks and side effects.

Benefits:

1. Increased muscle mass and strength: Testosterone therapy can help increase muscle mass and strength, particularly in men who have low testosterone levels due to aging or other medical conditions.

2. Improved bone density: Testosterone therapy can help improve bone density and reduce the risk of osteoporosis in some men.

3. Increased libido and sexual function: Testosterone therapy can help improve libido and sexual function in some men who have low testosterone levels.

4. Improved mood and energy levels: Testosterone therapy may help improve mood, energy levels, and overall sense of well-being in some men.

​

Risks:

1. Hormonal imbalances: Testosterone therapy can lead to hormonal imbalances that may cause negative side effects, such as increased estrogen levels or reduced sperm production.

2. Acne and other skin issues: Testosterone therapy can increase oil production in the skin, which may lead to acne or other skin issues.

3. Sleep apnea: Testosterone therapy may worsen sleep apnea, a condition in which a person stops breathing for brief periods during sleep.

4. Increased risk of prostate cancer: There is some evidence that testosterone therapy may increase the risk of prostate cancer, although more research is needed to confirm this.

5. Increased risk of blood clots and cardiovascular problems: Testosterone therapy may increase the risk of blood clots and other cardiovascular problems, particularly in men who have a history of heart disease or other risk factors.

6. Mood changes: Some men may experience mood changes, such as irritability or aggression, when taking testosterone therapy.

​

Testosterone replacement therapy (TRT) is a treatment used to increase testosterone levels in men who have low levels of the hormone. Here are some studies that have investigated the effects of testosterone hormone replacement therapy:

1. Effects on muscle mass and strength: Several studies have shown that TRT can increase muscle mass and strength in men with low testosterone levels. For example, a 2016 study published in the Journal of Clinical Endocrinology and Metabolism found that TRT increased muscle mass and strength in men with low testosterone levels.

2. Effects on bone density: Low testosterone levels are associated with decreased bone density, which can lead to osteoporosis and an increased risk of fractures. TRT has been shown to increase bone density in men with low testosterone levels. A 2017 study published in the Journal of Clinical Endocrinology and Metabolism found that TRT increased bone density in men with low testosterone levels.

3. Effects on sexual function: Testosterone plays a crucial role in male sexual function, and low testosterone levels can lead to decreased libido, erectile dysfunction, and other sexual problems. TRT has been shown to improve sexual function in men with low testosterone levels. A 2015 study published in the Journal of Sexual Medicine found that TRT improved sexual function in men with low testosterone levels and erectile dysfunction.

4. Effects on cognitive function: Testosterone has been linked to improved cognitive function, including memory, spatial abilities, and verbal fluency. TRT has been shown to improve cognitive function in men with low testosterone levels. A 2016 study published in the Journal of the American Medical Association found that TRT improved cognitive function in men with low testosterone levels.

​

There have been some studies that suggest testosterone replacement therapy (TRT) may help prevent or improve diabetes in certain populations. Here are a few examples:

1. A 2016 study published in the Journal of Diabetes Investigation found that TRT improved insulin sensitivity and glucose metabolism in men with low testosterone levels and type 2 diabetes. The study found that after 12 months of TRT, participants had lower fasting glucose and insulin levels, as well as improved glucose tolerance.

2. A 2018 study published in the Journal of Endocrinology and Metabolism found that TRT improved insulin sensitivity in older men with low testosterone levels. The study found that after six months of TRT, participants had improved insulin sensitivity and reduced abdominal fat mass, both of which are risk factors for type 2 diabetes.

3. A 2019 study published in the journal Diabetes, Obesity and Metabolism found that TRT improved insulin sensitivity and glucose metabolism in obese men with low testosterone levels. The study found that after six months of TRT, participants had improved insulin sensitivity and glucose metabolism, as well as reduced body fat and increased muscle mass.

​

It is important to note that while these studies suggest a potential benefit of TRT in preventing or improving diabetes, the evidence is not yet conclusive, and more research is needed to fully understand the relationship between testosterone and diabetes. Additionally, TRT is not recommended as a treatment for diabetes, and people with diabetes should work with their healthcare providers to develop an appropriate treatment plan.

​

​

Estrogen

​

Estrogen is a hormone that plays an important role in the development and maintenance of the female reproductive system, as well as other bodily functions. As women age, their natural estrogen levels decrease, which can lead to symptoms such as hot flashes, vaginal dryness, and mood changes.

​

Estrogen replacement therapy (ERT) is a treatment that involves taking estrogen in order to supplement the body's natural levels. ERT can be administered in various forms, including pills, patches, gels, or creams.

Some potential benefits of ERT include:

1. Relief of menopausal symptoms: ERT can help alleviate symptoms such as hot flashes, vaginal dryness, and mood swings.

2. Reduced risk of osteoporosis: Estrogen helps maintain bone density, so ERT may reduce the risk of osteoporosis in women.

3. Reduced risk of heart disease: Some studies suggest that ERT may reduce the risk of heart disease in women.

4. Improved skin and hair: Estrogen is known to improve skin elasticity and moisture content, and may also improve hair thickness and texture.

​

However, there are also some potential risks associated with ERT, including an increased risk of blood clots, stroke, and breast cancer. These risks vary depending on a woman's age, health history, and other factors.

As with any medical treatment, the decision to undergo ERT should be made in consultation with a healthcare provider, who can weigh the potential benefits and risks based on an individual's unique circumstances.

​

There have been numerous studies conducted on estrogen replacement therapy (ERT), which have explored its potential benefits and risks.

One study published in the New England Journal of Medicine in 2016 found that ERT significantly reduced the risk of fractures and bone loss in postmenopausal women. The study followed more than 10,000 women over a period of six years and concluded that ERT could be an effective treatment for osteoporosis.

​

Another study published in the Journal of the American Medical Association in 2019 found that ERT may reduce the risk of heart disease in younger women (aged 50-59) who have undergone menopause. The study followed over 43,000 women for an average of 18 years and found that those who underwent ERT had a lower risk of cardiovascular disease.

In addition, a meta-analysis published in the journal Menopause in 2018 found that ERT can be an effective treatment for menopausal symptoms such as hot flashes, vaginal dryness, and mood changes.

However, it is important to note that there are also potential risks associated with ERT, including an increased risk of blood clots, stroke, and breast cancer. These risks should be carefully considered in consultation with a healthcare provider before undergoing ERT.

​

Yes, there is a slightly increased risk of breast cancer associated with estrogen and hormone replacement therapy (HRT). The risk is higher for women who use combination therapy, which involves taking both estrogen and progestin, compared to estrogen-only therapy.

A large study called the Women's Health Initiative (WHI) found that women who used combination therapy for five or more years had a slightly increased risk of developing breast cancer. However, the risk decreased after women stopped using the therapy, and the overall risk remained low for most women.

​

It is important to note that the increased risk of breast cancer associated with hormone replacement therapy is small, and the benefits of the therapy may outweigh the risks for some women. In addition, the risk of breast cancer varies depending on factors such as age, family history, and other health factors.

​

There have been some studies that suggest that hormone replacement therapy (HRT) may have a protective effect against breast cancer mortality, including a study conducted in Finland.

The Finnish study, published in the journal Menopause in 2012, followed more than 22,000 women over a period of 10 years and found that those who underwent HRT had a lower risk of dying from breast cancer compared to those who did not undergo HRT. The study concluded that HRT may have a protective effect against breast cancer mortality, especially among women who had started HRT soon after menopause.

​

However, it is important to note that this study and others that suggest a protective effect of HRT on breast cancer mortality are not conclusive, and the overall evidence regarding HRT and breast cancer risk is mixed. 

​

Progesterone

​

​

​

Progesterone is a hormone that plays an important role in the female reproductive system, particularly in the regulation of the menstrual cycle and in maintaining a healthy pregnancy. Progesterone replacement therapy (PRT) involves taking progesterone to supplement the body's natural levels.

Some potential benefits of PRT include:

​

Relief of menopausal symptoms: PRT can help alleviate symptoms such as hot flashes, vaginal dryness, and mood changes.

​

Regulation of menstrual cycle: PRT can help regulate the menstrual cycle in women who have irregular periods or who have stopped menstruating due to menopause.

​

Improved bone density: Progesterone is known to help maintain bone density, so PRT may help reduce the risk of osteoporosis in women.

Reduced risk of endometrial cancer: PRT is often used in combination with estrogen replacement therapy to reduce the risk of endometrial cancer in women who have undergone menopause.

Improved mood: Progesterone has a calming effect on the brain and can help improve mood and reduce anxiety in some women.

​

Progesterone replacement therapy (PRT) can have potential side effects and risks, which should be taken into consideration when deciding whether to undergo this treatment.

Some of the potential downsides of PRT include:

​

1. Increased risk of blood clots: PRT may increase the risk of blood clots, which can lead to serious health problems such as stroke or heart attack.

2. Breast tenderness: PRT may cause breast tenderness or swelling, which can be uncomfortable.

3. Mood changes: While progesterone can have a calming effect on the brain, it can also cause mood changes such as irritability, depression, or anxiety in some women.

4. Headaches: PRT may cause headaches, which can be a side effect for some women.

5. Nausea: Some women may experience nausea or vomiting when taking progesterone.

6. Irregular vaginal bleeding: PRT can cause irregular vaginal bleeding, which may be a concern for some women.

7. Increased risk of breast cancer: There is some evidence that PRT, particularly when used in combination with estrogen replacement therapy, may increase the risk of breast cancer in some women.

​

Progesterone-only replacement therapy (PORT) is a type of hormone replacement therapy that involves taking progesterone alone, without the use of estrogen. This type of therapy may be used in women who have had a hysterectomy (removal of the uterus) or who cannot take estrogen due to other health reasons.

Some potential benefits of PORT include:

1. Regulation of menstrual cycle: Progesterone is known to regulate the menstrual cycle, so PORT may be used to help regulate periods in women who have irregular cycles or who have stopped menstruating.

2. Relief of menopausal symptoms: PORT may help alleviate symptoms such as hot flashes, mood changes, and sleep disturbances in women who have gone through menopause.

3. Improved bone density: Progesterone can help maintain bone density, so PORT may be used to reduce the risk of osteoporosis in women.

4. Reduced risk of endometrial cancer: Progesterone is often used in combination with estrogen replacement therapy to reduce the risk of endometrial cancer in women who have undergone menopause.

​

However, as with any medical treatment, there are potential risks and side effects associated with PORT, including irregular vaginal bleeding, breast tenderness, mood changes, and headaches. In addition, there may be an increased risk of blood clots or stroke associated with PORT, although the risk is generally lower compared to combination therapy with estrogen and progesterone.

​

DHEA

​

DHEA-S (dehydroepiandrosterone sulfate) is a hormone that is naturally produced by the adrenal glands. DHEA-S supplementation involves taking DHEA in the form of a supplement to increase levels in the body. Some potential benefits and risks of DHEA-S supplementation include:

Benefits:

1. Improved mood and well-being: DHEA-S has been shown to have antidepressant effects, and may help improve mood and overall well-being in some people.

2. Increased muscle mass and strength: DHEA-S may help increase muscle mass and strength, particularly in older adults.

3. Improved bone density: DHEA-S may help improve bone density and reduce the risk of osteoporosis in some people.

4. Enhanced immune function: DHEA-S may help improve immune function and reduce the risk of infection in some people.

Risks:

1. Hormonal imbalances: DHEA-S is a hormone that can interact with other hormones in the body, and supplementation can lead to hormonal imbalances that may cause negative side effects.

2. Acne and other skin issues: DHEA-S can increase oil production in the skin, which may lead to acne or other skin issues.

3. Hair loss: DHEA-S supplementation may cause hair loss or thinning in some people.

4. Increased risk of hormone-sensitive cancers: DHEA-S can stimulate the growth of some hormone-sensitive cancers, such as breast or prostate cancer.

5. Cardiovascular disease: There is some evidence that DHEA-S supplementation may increase the risk of cardiovascular disease, although more research is needed to confirm this.

​

HRT

​

Hormone replacement therapy (HRT) is a medical treatment that involves taking hormones, typically estrogen and progesterone, to alleviate symptoms of menopause or to replace hormones lost after surgery or other medical treatments. Although HRT can be effective in reducing symptoms such as hot flashes, night sweats, and vaginal dryness, it also carries potential risks and side effects. Some of the risks associated with HRT include:

1. Increased risk of breast cancer: There is evidence that HRT, particularly when used for more than five years, can increase the risk of breast cancer in some women.

2. Increased risk of stroke and blood clots: HRT may increase the risk of stroke, blood clots, and other cardiovascular problems in some women.

3. Increased risk of ovarian cancer: Long-term use of HRT may increase the risk of ovarian cancer in some women.

4. Gallbladder disease: HRT may increase the risk of developing gallbladder disease.

5. Mood changes: Some women may experience mood changes, such as depression or anxiety, when taking HRT.

6. Breast tenderness or swelling: HRT may cause breast tenderness or swelling, which can be uncomfortable.

7. Nausea and bloating: HRT may cause nausea and bloating in some women.

8. Vaginal bleeding: HRT can cause vaginal bleeding or spotting, particularly when first starting the treatment.

​

It is important to note that the risks and side effects of HRT may vary depending on the individual woman's age, health history, and other risk factors. Therefore, women considering HRT should discuss the potential risks and benefits with their healthcare provider to make an informed decision based on their individual circumstances. Regular check-ups and monitoring may also be necessary to ensure the therapy is effective and safe for the individual.