Making Health About Prevention And Optimization
At the end of the day, its crucial to take a preventative approach to your health. Optimize your health and wellness the best you can. It shouldnt be just about scrapping by when we have so much data and resources available to us.
At optimal levels, you perform and feel your best. Consequently, you get the maximum benefits that can last a lifetime and even expand it. Stay in front of your health. Technology and innovation has granted us the ability to do so. For instance, there is a ton of wearable technology that can give insight into your health. From there, you can use this data to determine what improvements work and what dont.
Surprisingly, Hormone Replacement Therapy, specifically estrogen-only therapy, actually lowers the risk of breast cancer . Taking this a step further, research shows that Hormone Replacement Therapy, especially done safely in symptomatic women starting at the brink of menopause, is not associated with hypertension, diabetes, stroke, and cancer-related deaths .
Estrogen, itself, is protective in many ways. It protects your bone, heart, brain, circulatory vessels, teeth, and eyes. It can also prevent an increase in abdominal fat caused by high cortisol .
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Assessing Responses To Thyroid Hormones
Many thyroid hormone users have a history of trying various meds. Some thyroid hormones make people feel wired, jittery or nervous. Others bring TSH into a normal range but do not alleviate symptoms. Some worked really well. All of these reactions provide insight into the mechanisms involved in the hypothyroidism.
What Makes Each Source Different
Overall, the differences between 1) synthetic, 2) animal-derived, and 3) our own hormones is that 1) the synthetics are bound to sodium that dissolves during transport through the GI tract, while 2) desiccated thyroid comes along with some of the proteins found in a porcine thyroid gland , and 3) our own gland secretes T3 and T4 directly into the bloodstream.
Another difference enables several companies to market different brands of T4, T3, and dessicated thyroid: they can have different inert ingredients and very minor differences in manufacturing.
These fillers can influence how well the hormones are absorbed in the GI tract, which might mean one brand of synthetic T3 may give you a little more T3 in bloodstream than another. Their inactive ingredients might also cause an allergic reaction.
As for animal-derived hormone, two different brands of desiccated thyroid might have slightly different number of micrograms of T4 and T3 in them, yielding a very minor difference in T3:T4 ratio and amount. But thats different from saying you cant trust one batch of the same brand of desiccated thyroid to be the same as the other. Thats no longer a problem in our modern day and age.
Every thyroid patient and doctor has to keep these differences in mind. They should realize that if one medication doesnt work that well, there are other options one could change between two brands of synthetic hormone, or switch between two brands of desiccated thyroid, or try any combination.
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All Thyroid Pharma Yields Bioidentical Hormones
The next basic feature that unites the all thyroid pharmaceuticals is that they all provide bioidentical hormones.
Bioidentical means that after they are absorbed and taken up into our bloodstream, they yield T4 or T3 hormones that are virtually identical in molecular structure to the hormones that we humans secrete from the thyroid gland.
These molecules also function in the same way as our own hormones would. After they enter blood, the T4 and T3 also get metabolized into all the other forms of thyroid hormone: RT3, two types of T2, and T1. This is naturally part of the bodys use and recycling of iodine.
and liothyronine are synthetic forms of human-secreted thyroid hormone molecules. Human-secreted thyroxine and triiodothyronine are also both levo-isomers, which means that they have a certain degree of counter-clockwise rotation between two rings in the molecule. Thyroid scientists have experimented with a wide range of possible molecular structures and rotations. They have found this particular shape to be the one the body naturally secretes, recognizes, prefers, and readily uses. )
They are UNlike other types of pharmaceuticals that are chemicals the human body sees as foreign.
Because they are bioidentical, all thyroid hormone medications are far more likely to be benign than harmful as long as we use them to provide what our body needs.
Compounding Interests: The Risks Of Bioidentical Hormones
According to an Endocrine Society Scientific Statement, patients need to be counseled about the risks of custom-compounded bioidentical hormones. The preferred treatments should have been vetted by the U.S. Food and Drug Administration, not Oprah.
Physicians may need to take time to explain to patients the potential risks of using bioidentical hormone formulations made by compounding pharmacies, say the authors of an Endocrine Society scientific statement.
Many practitioners and patients find the subject confusing because of misleading information from the Internet and endorsements for alternative menopausal replacement hormones from celebrities such as Oprah Winfrey and Suzanne Somers. The compounded formulations are touted as natural and tailored to an individuals needs, but bioidentical hormones is better understood as a marketing term to sell products that are not approved by the Food and Drug Administration , according to Nanette Santoro, MD, chair of the task force that wrote the scientific statement.
Patients need to understand that FDA-approved hormones from pharmaceutical companies offer protections of purity, controlled manufacturing processes, and evidence from clinical trials that products from less-regulated compounding pharmacies do not. In addition, many of the newer FDA-approved formulations can be described as bioidentical because they are the same molecules as hormones found in the body.
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What Are The Advantages Of Bioidentical Hormones
The most significant advantage of bioidentical hormones is that they are exact copies of your natural ones. Bioidentical hormones are more effective following the same biological pathways as your real hormones. Because they are the same as the hormones created naturally in your body, your body cannot tell the difference, reducing side effects and significantly increasing the benefits.
Bioidentical T3 & T4 Combination Therapy
Nonetheless, treating to optimize T3 levels at the high end of normal via active replacement of natural T3 hormone is not commonly done, despite studies that show that patients with clinical hypothyroidism receive more benefit by supplementing with the combination of oral T4 and T3. This makes intuitive sense because it is the latter hormone that provides the metabolically active form of thyroid. Common forms of such bioidentical T3 and T4 combination therapy include Armour® thyroid or Naturethyroid ®.
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Additional Information About Bio
Additional articles are cited below for additional learnings. Id like to thank Dr. Neal Rouzier, author of How to Achieve Healthy Aging for his help and support in the curation of the evidence based scientific support behind our approach to bio-identical hormone replacement therapy.
Other Scientific References
- Thyroid Therapy Does Not Lead to Bone LossLong-term high doses of thyroid had no adverse effect in causing osteoporosis or fractures. Cortland Forum 2001 July: 85-90
- Even exceptionally high doses of thyroid do not cause osteoporosis or fractures. Normal Metabolic Research 1995 November 27: 503-7
- Long-term thyroid replacement with high doses has no significant effect in bone density or fractures. Lancet 1992 July 4 340: 9-13
- In our study, we found significant association between low levels of T3, poor performance, and increased mortality. Journal of the American Medical Association 2004 Vol 292 :
- Fibromyalgia May Benefit from Treatment with T3 / T4 CombinationFibromyalgia is frequently seen in hypothyroidism. There is now evidence to support that fibromyalgia may be due to thyroid hormone resistance .. Medical Hypotheses 2003 August 21: 182-89
What Are Natural Hormones
Technically speaking, the only true natural hormones of the human body are those produced by the human body. When the term natural hormone is used, its referring to the fact that these hormones were first extracted from a natural source like plants.
Despite the term natural, both synthetic and bioidentical hormones are modified or manufactured in a lab, leading many to feel mislead by the term natural with bioidentical hormones. However, hormonal imbalances result from very minute changes in hormone levels. It wouldnt make sense then to simply pick up a yam , eat it and expect to be cured. Dosage matters and having the ability to extract a hormone, measure a set amount, and accurately supplement your hormonal deficiencies is essential. This extraction, measurement and packaging can only be performed in a safe, clean lab.
Synthetic hormones, on the other hand, are not derived from anything naturally occurring. They are made entirely in a lab. The problem with making something as complex as a hormone in a lab is that it can never match the complexity of a natural hormone. Look at it this way, hormones have conversations with cells, telling them to act a certain way. With synthetic hormones, itd be like trying to carry on a conversation with Siri from your phone, some things are going to be lost in translation even though it was created by humans. A bioidentical hormone however, is like having a conversation with another human.
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Understanding How Testosterone Medications Work
Ultimately, both synthetic and bioidentical forms of testosterone tend to impact the body in largely the same way, with some differences depending on the specific synthetic form used. Modified testosterone molecules undergo an enzymatic process upon entering the body that removes their additional parts and makes them fully bioavailable for use in the bodys many systems. Bioidentical testosterone enters the body already bioavailable, which is why some believe bioidentical medications may be more effective and well-tolerated. However, there is currently no definitive research regarding the efficacy or tolerability of bioidenticals vs. conventional testosterone treatment.
If youve been diagnosed with low testosterone, youll probably experience similar effects regardless of which testosterone medication you take. Depending on which symptoms you experience, you could notice the following changes when taking testosterone replacement therapy:
- Improved energy levels
- Improved sex drive and performance
With these benefits, its no wonder a growing number of men are seeking TRT.
Its important to note that neither of the terms bioidentical testosterone nor synthetic testosterone refer to the abuse of these medications, which is commonly known as illegal anabolic steroid use. Both treatment options discussed here are used within a purely therapeutic context for the medically supervised treatment of low testosterone.
Whats The Mechanism That Led To The Need For Medication In The First Place
If youve been following this series, you know that theres no single cause for low thyroid function. Do you have an autoimmune disease causing destruction of your thyroid gland? Do you have high levels of estrogen causing an increase in thyroid binding proteins and a decrease in free thyroid hormone? Do you have a systemic inflammatory condition affecting your ability to convert T4 to T3, or decreasing the sensitivity of the cells in your body to thyroid hormone?
In order to choose the right hormone, you have to know what the underlying mechanism causing the dysfunction is. Lets look at an example.
Say you have a problem converting T4 to T3. In this situation, your TSH may or may not be slightly elevated, but lets say it is, and your doctor prescribes Synthroid. Synthroid is a synthetic T4 hormone. Will this help you?
No. It wont help because your problem in this example isnt a lack of T4, its an inability to convert T4 to the active T3 form. You could take T4 all day long, and it wont do a thing unless your body can convert it.
The first step in this case would be to address the causes of the conversion problem , in the hopes that you may not need replacement hormone. If that doesnt work, though, what youd need in this situation is either a so-called bio-identical hormone that has a combination of T4 and T3, or a synthetic T3 hormone . These will deliver the T3 you need directly, bypassing the conversion problem.
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Does The Patient Have Sensitivities To The Fillers Used In The Medications
Another important consideration in choosing the right hormone is the fillers contained in each medication. Many popular thyroid medications contain common allergens such as cornstarch, lactose and even gluten. As I explained in a previous post, most hypothyroid patients have sensitivities to gluten, and many of them also react to corn and dairy .
Synthroid, which is one of the most popular medications prescribed for hypothyroidism, has both cornstarch and lactose as a filler. Cytomel, which is a popular synthetic T3 hormone, has modified food starch which contains gluten as a filler.
Even the natural porcine products like Armour suffer from issues with fillers. In 2008, the manufacturers of Armour reformulated the product, reducing the amount of dextrose & increasing the amount of methylcellulose in the filler. This may explain the explosion of reports by patients on internet forums and in doctors offices that the new form of Armour was either miraculous or horrible. Those that had sensitivities to dextrose were reacting less to the new form, and experiencing better results, while those that had sensitivities to methylcellulose were reacting more, and experiencing worse results.
The best choice in these situations is to ask your doctor to have a compounding pharmacy fill the prescription using fillers you arent sensitive to. Unfortunately, insurance companies sometimes refuse to cover this.
Where Are Bioidentical Hormones Sold
Unlike synthetic hormones, which are patented drugs and are available at conventional pharmacies, bioidentical hormones are typically acquired through specific types of pharmacies, called compounding pharmacies. These pharmacies have access to bulk chemicals from the United States Pharmacopeia , and they have the state-of-the-art equipment to ensure accurate formulation of hormone treatments from the bulk chemicals.
Bijuva Launched for Moderate to Severe Hot Flashes Due to Menopause
Bijuva is a bio-identical hormone therapy that combines estradiol and progesterone into a single capsule. Bijuva capsules became available in 2019 for the treatment of women with a uterus for the treatment of moderate to severe hot flashes) due to menopause. Bijvua carries a Boxed Warning regarding cardiovascular disorders, breast cancer, endometrial cancer, and probable dementia. Breast tenderness, headache, vaginal bleeding, vaginal discharge, and pelvic pain were the most common adverse reactions associated with Bijuva.
Based on a physicians prescription, compounding pharmacists can also prepare plant-derived bio-identical hormones in a variety of dosage forms, strengths, and combinations. This is, in fact, one of the purported benefits of bio-identical hormonesthey can be formulated at individualized doses and mixtures that are not available commercially.
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Bioidentical Hormone Therapy Vs Synthetic Hormone Therapy
You might hear about bioidentical hormone therapy as an alternative to synthetic hormone therapy for menopause symptom relief.
Bioidentical hormones have the same molecular structure as the hormones made by your body. Synthetic hormones do not have the same molecular structure as the hormones in your body, but your body converts them to a usable form.
Bioidentical hormones have developed a reputation as being natural, and therefore presumed to be safer than synthetic hormones. However, there is no evidence to support this claim. Both bioidentical and synthetic hormones are made in a laboratory the main difference is the raw ingredient. Bioidentical hormones are made from plant sources synthetic hormones are made from man-made chemical compounds. There is no evidence to show that bioidentical hormones are any safer or more effective than synthetic hormone therapy.
Bioidentical hormones can be produced by a pharmaceutical company or a compounding pharmacy. When bioidentical hormones are made for you by a compounding pharmacy, these hormones are called compounded hormones. Compounding pharmacies are not regulated by the Food & Drug Administration, unlike the pharmaceutical companies who can also make bioidentical hormone therapies. Without regulation, there is no way to ensure the safety of compounded hormones. Thus, there have been serious concerns about the consistency of these medications from batch to batch and pharmacy to pharmacy.
Risks Of Synthetic Hormones
In a series of studies conducted in 2002, the differences between synthetic and bioidentical hormone replacement therapy were identified, not in their intended function, but their side effects. Taking a natural form of progesterone and comparing it against a synthetic form, researchers saw that the synthetic form posed a much greater risk to the health of patients.
One of the main side effects of the synthetic progestins was an increased risk of developing Breast cancer. Synthetic forms have the potential to incite and increase estrogen related breast cell mitosis, this is to say the division and spreading of cells. This out of control cellular division is known as cancer. Synthetic hormones have also been shown to convert endogenous estrogens into stronger variants . These stronger, even toxic versions of estrogen can stimulate cancer formation.
Bioidentical progesterone however, has been shown to have the opposite effect of synthetic versions. Bioidentical hormones like progesterone inhibit breast cell division and have been said to stop breast cancer . Naturally derived progesterone has been described as having a protective role in the female body by preventing breast cancer, whereas synthetic forms of progesterone may actually incite breast cancer. While new research is always being conducted, recent discoveries seem to show that bioidentical hormones are a safer long term alternative to controversial synthetic forms.
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Are Hormones Good Or Bad
When I first graduated from medical school back in the early 2000s, I have to admit was thoroughly confused by whether hormone replacement therapy was good or bad, and I wasnt sure if I should recommend it. I also did not understand the differences between synthetic and bioidentical hormones. I thought they were basically all the same.
Most people, even practitioners, are confused by hormone replacement therapy and dont have a good understanding of the facts.
It wasnt until years later when I stumbled upon information from Dr. Neal Rouzier, MD that I began to understand the differences between synthetic hormone replacement and bioidentical hormone replacement therapy. A light when off in my brain finally and I began to realize that all hormones are NOT created equally.
Bioidentical hormones are made from plant based sources and are created to be recognized by the body as identical to what we make naturally.
The body recognizes these naturally derived compounds as the same as what we make on our own. Synthetic hormones are compounds that differ greatly from what our bodies naturally produce and are not recognized as the same. Synthetic hormones are the ones that have more risks and unfavorable side effects. There is a huge difference between bioidentical hormones and synthetic hormones.