Hormone Balance

” Today’s truth is this: There is no magic hormone or combination of hormones that can be indiscriminately used by all women. Each woman is an individual and hormonal balance must be the ultimate goal for all women”

Joseph Collins, MD

I am oftentimes asked about hormone replacement therapy and specifically bio-identical hormone replacement therapy. In fact, many of my patients come to see me for relief with their natural hormonal decline.

I thought it a good idea to put together some of the most frequently asked questions about hormone replacement therapy that I get asked.

What do we know about the non-bioidentical synthetic hormone replacements?

The government sponsored women’s health initiative program halted its study on estrogen plus progestin (synthetic progestin plus conjugated horse estrogen) on July 9, 2002. This was three years early because of an increased risk of breast cancer in women taking these hormones. Analysis of the study also revealed that heart attack risk began increasing in the progestin group early in the study which was conducted on 16000 women who had not had a hysterectomy. Participants in the study were either given conjugated horse estrogens plus a synthetic progestin or a placebo.

Research data shows that the use of bio-identical hormones coincides with high predisposition toward certain illnesses.

Findings of the Study

The study revealed the following results:

Additional Studies

Additional studies, such as Heart and Estrogen/Progestin Replacement Study (HERS II) agree with the findings of the women’s health initiative trial. Several other studies have shown recently that progestins (synthetic progesterone) have an unfavorable effect on lipid levels and may promote cardiovascular disease.

Women taking progestins show an increase in cardiovascular disease risk

In defense of the pharmaceutical company manufacturing the product used in this trial, low dose oral estrogen has been suggested instead of the much higher doses used in the studies.

Other problems with non bio-identical synthetic hormones include:

hormones and skin health are closely linked

What do we know about bio-identical natural hormone replenishment?

These are some of the reasons you should consider natural hormone replenishment/replacement:

Natural Hormones

Natural hormone replacement means using hormones that are biologically identical to what your body makes. Customized natural hormone replacement is the safest way to replace hormones. Hormone replacement shouldn’t be considered without a thorough understanding of how all your body’s hormones interact with each other.

“It is impossible to achieve optimum health without a properly functioning hormonal system”

– David Brownstein, MD -The miracle of natural hormones

Transdermal delivery of estrogen is safer than oral delivery.

Transdermal delivery of the hormone estrogen has been found to be safer than oral delivery.

Oral estrogen can


Effects seen with natural progesterone, but not with progestins:

Natural progesterone, a female hormone, has been noted to help lower blood pressure.

It is clear that natural progesterone offers a safer approach to HRT than progestins

Do you need progesterone if you have had a complete hysterectomy?

The answer is simply yes, since progesterone has many positive effects on your body listed above.

Are there cancer issues with HRT?

Non bio-identical progesterone and non-bioidentical estrogen may increase the risk of endometrial and breast cancer.

Bio-identical Hormones vs Non-bioidentical Hormones

Contrary to non bio-identical progesterone and non-bioidentical estrogen, bio-identical progesterone and bio-identical estriol are considered protective against breast cancer:

Due to the possible protective effects of estriol, a combination cream such as bi-est (estradiol and estriol) or tri-est (estrone and estradiol and estriol) together with natural progesterone replenishment seems to be the safest way to replenish sex-hormonal deficiencies.

How do the metabolites of estrogen help in establishing your cancer risk?

What can raise your 2-OH estrone (good) levels?

Flax and cruciferous vegetables like cabbage can help raise 2-OH estrone, a by-product of natural estrogen.
After all, the Hippocratic Oath that all doctors sign states “first do no harm”

Concerns Over the Effects of Transdermal Bio-equivalent Hormone Replenishment

There is no evidence that transdermal bio-equivalent hormone replenishment does any harm whatsoever.  Is there evidence that oral HRT can be dangerous if used AFTER the initial period when oral HRT is mostly used to relieve symptoms? YES (Particularly for the older group of women who are at increased risk for cardiovascular disease)

It seems also from subgroup analysis of WHI that initially in the first few years of taking oral estrogen synthetics, that there is an improvement in cardiovascular risk (a decrease in coronary calcium score). However, the longer you use the oral synthetics the more likely your cardiovascular risk might increase for reasons stated previously.

“The problem with popular thinking is that it doesn’t require you to think at all.”

Kevin Myers

What should every woman know about her hormones?

Maintaining a healthy hormone balance, which includes natural estrogen, is absolutely vital for any woman.

Maintaining a healthy hormone balance, which includes natural estrogen, is absolutely vital for any woman. What successful hormone treatment depends on is the careful monitoring of all hormone levels and making sure that the replacement hormones are not foreign to the body. For femore than a decade, integrative and preventive medicine specialists have been advocating this view, but still it seems as though it hasn’t quite filtered into conventional practice yet.

What are the key hormones that affect women’s health and wellbeing?

Key hormones that affect women’s health and wellbeing include estrogen, progesterone, testosterone, Dehydroepiandrosterone (DHEA), pregnenolone, melatonin, and cortisol.

Benefits of Estrogen

Benefits of Progesterone

Benefits of Testosterone

Benefits of Dehydroepiandrosterone (DHEA)

Benefits of Pregnenolone

Benefits of Melatonin

Benefits of Cortisol

Comments on hormones


The body makes three main estrogens:

Estradiol is 12 times stronger than estrone and 80 times stronger than estriol.

There are over 400 functions of oestrogen in your body.

These are the main functions of estradiol:

What problems can arise from estrogen imbalance?

Too high levels of estradiol are associated with breast and uterine cancer.

Low levels of estrogen can cause the following symptoms:

How can we get estrogen back in balance (what are the treatment options)?

In anti-aging medicine, we never replenish estrogen without replenishing progesterone first.

Bio-identical transdermal estrogen is much safer than oral estrogen due to:

Supplementing Estrogen

When using hormones like estrogen it is highly recommended to assist the body to metabolise oestrogen to the healthy 2-hydroxy-estrone rather than the potentially dangerous 16- or 4-hydroxy-estrone. This can be done by supplementing with:

hormones can be metabolized safer by including cruciferous vegetables in your diet

Roasted Broccoli with Parmesan Cheese


Androgens are often called “male hormones”. They are testosterone, DHEA and androstenedione. Testosterone is made in the adrenal glands and ovaries. It is important to measure both free and bound testosterone since only about 1% is freely available, the rest is bound to SHBG (sex hormone binding globulin) which carries the testosterone in your blood.

Testosterone has a myriad of functions in the human body:

What problems may arise from testosterone imbalance?

Low levels of testosterone result in a decrease in motivation, loss of muscle mass, decreased libido, excessive body fat, loss of muscle tone.

Excessive testosterone can cause masculinising effects such as male pattern hair loss, acne and excessive hair growth.

How can we get testosterone back in balance (what are the treatment options)?

Natural testosterone is the preferred method to supplement. Methyltestosterone (synthetic) has been suggested to be carcinogenic to the liver. Natural testosterone is effective as a pill or a cream however, rotation of the site of application is important to prevent hair growth. Also remember the skin has an enzyme, aromatase, which can change the applied testosterone to estradiol. Natural aromatase inhibitors include zinc, progesterone and chrysin. There are natural treatments like nettle root that also increase the free testosterone from SHBG (mentioned earlier). Injectable testosterone is also available but is mostly used in andropause.

Importance of Progesterone

What problems may arise from progesterone imbalance?

Progesterone deficiency occurs before estrogen deficiency in the perimenopause, and the risk for breast cancer goes up as the progesterone level goes down. Progesterone has antiproliferative effects on the breast and uterus. In antiaging medicine we never replenish estrogen without replenishing progesterone first. Progesterone is protective against breast cancer, unlike progestins which potentially increase your risk for breast cancer. It is also recommended by anti-aging physicians to supplement progesterone even in hysterectomized women.

How can we get progesterone back in balance (what are the treatment options)?

Bio-identical progesterone in transdermal or oral micronized form.

How do our hormones change as we age? How do hormonal shifts affect the way we age (what physical changes can be attributed to hormonal flux?)?

Bone production

Osteoporosis is a debilitating, crippling disease that’s preventable. As you grow older, you burn up, swell up and dry out, due to inflammation, dehydration, and calcium seeping out of your bones and settling in your brain and blood vessels.

Growth and repair

Without sufficient hormones, the body’s ability to renew itself, heal and repair damage slows down, which speeds up aging.

Heart health

Estrogen protects your heart. This benefit is lost when estrogen levels are low. The safest way to replace estrogen is through bio-identical hormones, absorbed either through the skin or the vagina. This way, there’s no risk of blood clotting as happens with estrogen taken orally. There’s also no risk of inflammation, no blood pressure problems, no effect on the mood-stabilising brain chemical, tryptophan, and no weight gain.

Prevention of memory loss and Alzheimer’s

The brain is especially dependent on the hormone pregnenolone to replenish brain cells and for clear, quick thinking.

A longer life

Women who replace their hormones live longer than those who don’t.

HRT is somewhat controversial. How do you know if you are a suitable candidate?

One of the most widely publicised investigations of the health effects of synthetic estrogen and progestin, called the Women’s Health Initiative Randomized Controlled Trial, was stopped in 2002 due to a sharp spike in the number of breast cancer cases among the otherwise healthy participants receiving these hormones. The study also found an increase in the incidence of coronary heart disease, stroke and pulmonary embolism, and established that the use of synthetic synthetic estrogen and progestin caused more harm than benefit

Since then, it’s almost become an accepted fact that HRT with synthetic hormones is risky business, because it significantly ups a woman’s chances of developing breast cancer. But that might be due to one (or both) of two possible reasons. Firstly, the hormone levels might not be monitored and balanced carefully enough, which means that the level of estrogen goes up so high that cancer does become a risk. Secondly, neither the replacement estrogen nor the replacement progesterone used in conventional HRT is bio-identical. They are synthetic molecules, which are foreign and unnatural to the body, which may trigger unwanted responses that could lead to cancer.

Alternatives to Hormone Replacement Therapy

When it comes to hormone replacement therapy, one size doesn’t fit all. You need to do what is right for your body, which is why customised natural hormone therapy is the best way to replace your hormones safely. This is because your hormone response is as unique as your fingerprints.

How you respond to hormone restoration therapy depends on your genes, stress levels, health condition, your environment and lifestyle, the nutritional supplements you use and your diet. Since no two women are the same, or share the same lifestyle, no two women should follow identical treatment plans.

“Bio-identical” hormone replacement therapy (BHRT) is a modification of conventional hormone replacement therapy that involves use of supplemental doses of hormones, with three important criteria:

A good approach to the safe use of hormones includes the following:

Resources and other information sources:

  1. Depression. University of Maryland-Medical Centre: www.umm.edu/altmed/ articles/depression-000047.htm
  2. La Valle JB, et al. Cracking the metabolic code. Basic Health Publications, Laguna Beach: 2004
  3. Lichten EM. Textbook of Bio-identical Hormones. Foundation for anti-aging research LLC: 2007
  4. Miller PL, et al. Life Extension Revolution. Bantam Books, New York: 2005
  5. Wartian Smith P. HRT: The answers. Healthy Living Books, Traverse City: 2003
  6. Wartian Smith P. What you must know about women’s hormones. Square One, New York; 2010:159
  7. Wright E. Neuroendocrinology in Clinical Practice: The link between Neurotransmitters and Hormones. Neuroscience. www.neurorelief.com/index.php?option=com=content&task
  8. Writing Group for the Women’s Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative Randomized Controlled Trial. JAMA. 2002;288(3):321-33Frequently asked questions about hormones

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