Information On Estrogen Hormone Therapy
Overview of Feminizing Hormone TherapyUCSF Transgender CareUniversity of California – San FranciscoJuly, 2020
Hi, I’m Dr. Maddie Deutsch, Associate Professor of Clinical Family & Community Medicine at the University of California San Francisco , and Medical Director for UCSF Transgender Care. In this document I will review various aspects of feminizing hormone theray, including, choices, risks, and unknowns associated with feminizing hormone therapy.
As you prepare to begin treatment, now is a great time to think through what your goals are. Do you want to get started right away on a path to the maximum degree of medically appropriate feminizing effects? Or, do you want to begin at a lower dose and allow things to progress more slowly? Perhaps you are seeking less-than-maximal effects and would like to remain on a low dose for the long term. Thinking about your goals will help you communicate more effectively with your medical provider as you work together to map out your care plan.
Many people are eager for hormonal changes to take place rapidly which is totally understandable. It is important to remember that the extent of, and rate at which your changes take place, depend on many factors. These factors primarily include your genetics and the age at which you start taking hormones.
There are four areas where you can expect changes to occur as your hormone therapy progresses. Physical, emotional, sexual, and reproductive.
The first is physical.
Sexual changes
Hrt After Premature Early And Surgical Menopause
While most women experience natural menopausearound the age of 50, some women reach menopause much earlier or after surgery.In these cases, HRT should typically be started immediately.
Menopause that happens before the age of 40 is known as premature menopause, while between 40 and 45 it is known as early menopause. Women who experience premature or early menopause can have the same symptoms as women who experience typical menopause, but may also be at greater risk for psychological distress and a number of serious physiological health conditions. Meanwhile, women who undergo oophorectomysurgical removal of one or both ovariesprior to natural menopause can experience even more severe symptoms due to the extreme and sudden drop in hormones as well as significant long-term health risks. For all women who experience premature, early, or surgical menopause these risks include cardiovascular disease, osteoporosis, neurological disease, mood disorders, and premature death.
Due to these risks, it is typically recommended that women who experience premature, early, and surgical menopause start hormone replacement therapy as soon as possible. As the American Society For Reproductive Medicine, mincing no words, said of bilateral oophorectomy patients:
In these cases, there is little doubt that HRTis the right choice and should be initiated immediately.
How Long Should You Stay On Bioidentical Hormones
As we get older, our bodies begin to release fewer hormones, which can lead to a variety of unpleasant symptoms like fatigue, headaches, hot flashes, weight gain, and more. However, you may have heard about the risks of taking hormone replacements such as Prempro or Premarin, so youre just dealing with the symptoms. Fortunately, Metabolix Wellness Center in Clearwater, FL offers bioidentical hormone replacement therapy or BHRT, which could change your mind.
Bioidentical hormones are derived from plant extracts and have been modified to be structurally indistinguishable from the hormones our own bodies make. As such, they are safer and more effective than traditional hormone replacement therapy , which uses animal hormones that are similar, but not exact to our own. However, even with plant-based hormones, there are limits on how long you should be treated.
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How Long You Can Take Hrt
Experts recommend that menopausal women only take HRT if their symptoms are seriously troublesome. Most women in this group can take HRT for up to five years.
Other women who may have to take HRT are those who undergo surgical removal of their ovaries or have treatment that causes their ovaries to stop producing estrogen. Both situations can throw a woman into sudden menopause, no matter how young she is. And because ovarian hormones stop circulating so suddenly, the menopausal effects can be severe. Younger women who take HRT because of sudden usually take it longer than women who take HRT after natural menopause. Most women in this group can take HRT until they would naturally expect to enter menopause, which is around 52 years of age.
While HRT can be very effective, it does come at a risk for some serious side effects and health outcomes. Doses should be as low as possible to help ease the symptoms, and then taken for the shortest amount of time. For some women, this may be for a few months, for others, years.
If you are taking HRT for serious menopause symptoms, you may be reluctant to stop taking HRT, for fear the symptoms will return. This concern is valid. For some women, the symptoms do return, but you may have some control over what happens by how you stop HRT.
Other Options To Relieve Most Common Symptoms Of Menopause
When deciding whether to quit, think about why you started taking hormones. Maybe hot flashes drove you to it. Hot flashes can pass after a few years. If they don’t, they usually get less intense over time. The following may be enough to bring relief:
- Gabapentin, an anti-seizure medicine
- Dressing in layers, drinking cool drinks, avoiding spicy food and alcohol, and exercising daily
There are three options for vaginal dryness, pain, itching, and burning:
- Low-dose, prescription vaginal estrogen works best. You apply it as a cream, tablet, or ring into the vagina. Only a tiny bit is absorbed into the bloodstream, so the chance of health problems is much lower than with estrogen pills.
- Water- or silicone-based vaginal lubricants are put in the vagina or on the penis just before sex to reduce discomfort. You can buy them over the counter.
- Vaginal moisturizers, also available over the counter, keep tissues moist. You apply them three times a week, but not before sex.
For mood swings and depression:
- Antidepressants, especially selective serotonin reuptake inhibitors , can help mood.
- Daily exercise, plenty of sleep, and stress control techniques like yoga, deep breathing, or relaxation exercises can also help.
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Myths And Facts About Hormone Replacement Therapy Every Woman Should Know
If youve talked to friends, family, or conducted your own web search you may have ended up with conflicting information regarding hormone replacement. A mixture of information can make it challenging to separate fact from fiction. Read on to get the factual scoop on hormone replacement therapy and discuss it with your doctor. Our experts demolish common myths, so you have the facts to make an informed decision about your health.
Menopausal Hormone Therapy And Cancer Risk
For decades, women have used hormone therapy to ease symptoms of menopause, such as hot flashes and sweating. This is called menopausal hormone therapy, and you may see it abbreviated as HT or MHT. You may also hear it described as hormone replacement therapy , postmenopausal hormone therapy , or postmenopausal hormones .
In the past, many doctors and their patients believed that MHT didnt just help with hot flashes and other symptoms it had important health benefits. But well-conducted studies have led many doctors to conclude that the risks of MHT often outweigh the benefits.
This information covers only how MHT can affect a womans risk of getting certain cancers. It does not cover other possible risks of MHT such as heart disease or stroke.
You can use this information when you talk to your doctor about whether MHT is right for you.
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Does Hrt Cause Cancer
Some older research linked HRT to endometrial, breast, and ovarian cancer. However, this research did not look at all aspects of HRT.
The American Cancer Society point out that the risk may depend on the type of treatment and the type of cancer.
They report that while one type of HRT may increase the risk of breast cancer slightly, another type may reduce the risk.
Anyone who is thinking of using HRT should talk to their doctor about the specific risks and benefits.
What Are Hrt Pellets
HRT pellets are a blended mix of estrogen or testosterone and made from natural plant products. These plant materials have the same molecular structure as the hormones in our body. We can compound them into small pellets, which look like grains of rice. Once placed underneath the skin, the pellet will slowly release hormones directly into your bloodstream and provide balance.
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How Long Has Bioidentical Hrt Been Around
The practice of using bioidentical hormones to supplement hormone deficiencies is not new. They were first used to alleviate menopause symptoms in the 1930s, but when synthetic hormones proved easier to produce, they supplanted bioidentical hormones until health risks were identified with traditional HRT in the early 2000s. Bioidentical hormones have experienced a resurgence as a more natural way to replenish hormone levels.
Hormones That Are Replicated
Any hormone that is naturally produced by the body can be replicated in a compounding pharmacy using plant derivatives, usually from yams and soy products. The most commonly replaced hormones in BHRT are estrogen, progesterone, testosterone, DHEA, triiodothyronine , thyroxine , and melatonin. The specific hormones you will replace are dependent on a test that measures which ones are deficient. We will measure your hormone levels at your initial appointment through a blood, saliva, and/or urine test.
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How Long Should You Stay On Bioidentical Hormone Replacement Therapy
Despite the fact that BHRT uses plant derivatives rather than synthetic animal derivatives, the use of bioidentical hormones hasnt been studied as extensively as traditional HRT, so the effects of using them for long-term therapy arent yet known. Theres some evidence that because theyre natural and identical to the hormones your own body produces, they could be appropriate for continual use. However, because the evidence for this hasnt been established, you should only take bioidentical hormones until you achieve symptom relief.
That being said, its always a better idea to introduce medications to your system that are biologically identical to what your body already produces than taking medications that are foreign to your body. When we put foreign substances in our body, they produce side effects that are sometimes worse than the condition theyre treating. As such, while bioidentical hormones should not be used forever, they are a safer alternative to traditional HRT. Moreover, theyre more effective as well.
How Will I Know That My Hormone Therapy Is Working
Doctors cannot predict how long hormone therapy will be effective in suppressing the growth of any individual mans prostate cancer. Therefore, men who take hormone therapy for more than a few months are regularly tested to determine the level of PSA in their blood. An increase in PSA level may indicate that a mans cancer has started growing again. A PSA level that continues to increase while hormone therapy is successfully keeping androgen levels extremely low is an indicator that a mans prostate cancer has become resistant to the hormone therapy that is currently being used.
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What Types Of Hormone Therapy Are Used For Prostate Cancer
Hormone therapy for prostate cancer can block the production or use of androgens . Currently available treatments can do so in several ways:
- reducing androgen production by the testicles
- blocking the action of androgens throughout the body
- block androgen production throughout the body
Treatments that reduce androgen production by the testicles are the most commonly used hormone therapies for prostate cancer and the first type of hormone therapy that most men with prostate cancer receive. This form of hormone therapy includes:
Treatments that block the action of androgens in the body are typically used when ADT stops working. Such treatments include:
Treatments that block the production of androgens throughout the body include:
What Hormones Are Used To Treat The Symptoms Of Menopause
The hormones most commonly used to treat symptoms of menopause are estrogen and progesterone. . Often, these 2 hormones are used together, but some women are given estrogen alone. Its important to know which hormones you are talking about when looking at the risks.
Common estrogen preparations used to treat menopausal symptoms include conjugated equine estrogens and estradiol, but several forms or types of estrogen are available.
There are also many progestins available, but medroxyprogesterone acetate , is often used with an estrogen to treat menopausal symptoms. Some preparations contain both an estrogen and a progestin.
Androgens are also sometimes used to treat menopausal symptoms. This is not common, though, and because only a few studies have looked at this practice, it isnt clear how safe it is in the long run.
Tibolone is a synthetic hormone drug that can act like estrogen, progesterone, and testosterone in different tissues of the body. Because this drug isnt available in the US, its not discussed here.
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Can Everyone Benefit From Bioidentical Hrt
Anyone with a hormone imbalance may benefit from treatment, but as with all therapies, it is not for everyone. We will take a medical history at your first appointment and determine if you have any medical conditions that could interfere with how your body responds to hormones. There are some conditions that could worsen if hormone levels are increased. If we determine youre not a candidate for bioidentical hormone replacement therapy, we will provide you with other treatment options.
Some of the conditions that may exclude you from getting bioidentical hormone treatment include unexplained vaginal bleeding , blood clotting disorders, and some thyroid dysfunctions. Even these conditions may not prevent you from receiving all hormones. For example, people with blood clotting disorders should not receive estrogen, but other hormones may be acceptable. Be sure to disclose all health conditions, both prior and current, during your consultation to ensure the safety of our treatment.
Treatment To Lower Androgen Levels From The Adrenal Glands
LHRH agonists and antagonists can stop the testicles from making androgens, but cells in other parts of the body, such as the adrenal glands, and prostate cancer cells themselves, can still make male hormones, which can fuel cancer growth. Drugs are available that block the formation of androgens made by these cells.
Abiraterone blocks an enzyme called CYP17, which helps stop these cells from making androgens.
Abiraterone can be used in men with advanced prostate cancer that is either:
- High risk
- Castrate-resistant
This drug is taken as pills every day. It doesnt stop the testicles from making testosterone, so men who havent had an orchiectomy need to continue treatment with an LHRH agonist or antagonist. Because abiraterone also lowers the level of some other hormones in the body, prednisone needs to be taken during treatment as well to avoid certain side effects.
Ketoconazole , first used for treating fungal infections, also blocks production of androgens made in the adrenal glands, much like abiraterone. It’s most often used to treat men just diagnosed with advanced prostate cancer who have a lot of cancer in the body, as it offers a quick way to lower testosterone levels. It can also be tried if other forms of hormone therapy are no longer working.
Ketoconazole also can block the production of cortisol, an important steroid hormone in the body, so men treated with this drug often need to take a corticosteroid .
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Estrogen Side Effects And Risks
Hormone therapy is not without its risks. In fact, hormone therapy is not used as widely as it once was because research began revealing complications with long-term use, such as cancer and heart risks.
However, thanks to these studies, doctors and medical researchers have a better understanding of who will benefit most from estrogen therapy and who should try other treatments.
The risk factors and side effects associated with estrogen use include:
- Blood clots: Estrogen increases your risk of blood clots, which can cause stroke, heart attack, and even death.
- Cancer: Estrogen may increase your risk of certain cancers, specifically breast cancer. Talk with your doctor about your personal health history, your family history, and your risk of breast cancer.
- Birth defects: If youre using estrogen or hormone therapy and become pregnant, your pregnancy may end prematurely. If youre able to carry a pregnancy to full term, birth defects are common for babies born to women using estrogen.
- Dense breast tissue: Women who take estrogen may develop dense breast tissue. Dense tissue makes reading mammograms harder, so detecting breast cancer in its early stages may be difficult.
Intermittent Versus Continuous Hormone Therapy
Most prostate cancers treated with hormone therapy become resistant to this treatment over a period of months or years. Some doctors believe that constant androgen suppression might not be needed, so they advise intermittent treatment. The hope is that giving men a break from androgen suppression will also give them a break from side effects like decreased energy, sexual problems, and hot flashes.
In one form of intermittent hormone therapy, treatment is stopped once the PSA drops to a very low level. If the PSA level begins to rise, the drugs are started again. Another form of intermittent therapy uses hormone therapy for fixed periods of time for example, 6 months on followed by 6 months off.
At this time, it isnt clear how this approach compares to continuous hormone therapy. Some studies have found that continuous therapy might help men live longer, but other studies have not found such a difference.
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