Implementing Bioidentical Hormone Therapy in Practice With Specialty Lab Testing

What do fatigue, mood abnormalities, sleep problems, and weight changes have in common? Hormone imbalance! Although dealing with imbalanced hormones is far from a walk in the park, it is surprisingly common, especially in women, where it affects nearly 80% at some point in life. For those who are looking to replete or fix this imbalance, bioidentical hormone therapy is a great option for those not interested in traditional therapy, which relies on synthetic hormones or hormones from the urine of pregnant horses. In fact, 1 to 2.5 million women in the U.S. over age 40 are using compounded bioidentical hormones, highlighting their prevalence in hormonal therapy. In this article, we will discuss what bioidentical hormone therapy is, its benefits and risks, and what to expect when receiving this treatment.

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What is Bioidentical Hormone Therapy?

Bioidentical hormone therapy (BHRT) uses hormones designed to mimic those produced by our endocrine glands to help manage hormone imbalance symptoms most often associated with perimenopause or menopause. Essentially, it involves using hormones such as estrogen, progesterone, and testosterone, which originate from plants and are later altered. They come in two main forms: FDA-approved standardized dosages and custom-made ones tailored by a pharmacist to match a specific prescription (3).

Understanding Hormone Imbalance

Maintaining hormonal balance plays an indispensable role in ensuring our overall health. Factors contributing to hormonal fluctuations range widely, with stress, insufficient nutrition, and inflammation being key players in this complex dance. A misstep in this process, such as chronic stress leading to adrenal dysfunction or a nutrition deficit causing thyroid imbalances, can offset the body's natural rhythm. Notably, these imbalances are more than just inconveniences - they are a significant health concern. Experiencing a hormonal imbalance can directly affect the quality of life, causing symptoms like fatigue, mood swings, and unwanted weight gain. More alarming, if these imbalances are left unchecked, they can escalate into more serious conditions, such as increasing the risk of breast cancer.

Common Symptoms of Hormone Imbalance

Hormonal imbalances may manifest in a multitude of symptoms, varying according to the specific imbalance. Key symptoms may involve your metabolism, with potential indications such as fluctuating heartbeat, unusual weight gain or loss, fatigue, changes in bowel movements, numbness and tingling in hands, abnormal blood cholesterol levels, mood disorders, temperature intolerance, changes in skin and hair texture, irregular body fat distribution, and extreme thirst (5).

For individuals assigned female at birth, hormonal imbalances can additionally lead to acne, hair loss, heavy or irregular periods, excess body hair, hot flashes, infertility, loss of sexual interest, and vaginal issues like atrophy and dryness. Conversely, for individuals assigned male at birth, symptoms may include loss of body hair, erectile dysfunction, enlarged breast tissue, infertility, loss of sexual interest, and decrease in muscle mass (5).

Hormonal imbalances can also cause weight gain, especially in conditions such as hypothyroidism, Cushing's syndrome, and menopause. Likewise, they can result in anxiety, notably in conditions like hyperthyroidism and adult-onset growth hormone deficiency. These imbalances could be a result of natural life changes like pregnancy and menopause or factors such as stress, medication, and steroid use. Chronic hormone-related conditions can stem from issues such as tumors, damage to an endocrine gland, and autoimmune conditions (5). 

The Role of Bioidentical Hormone Therapy

As stated, BHRT can play an important role in counteracting the effects of hormonal imbalance or decline. Repleting these hormones can potentially help to reduce or resolve the symptoms noted in the above section. Some notable differences emerge when comparing bioidentical hormone therapy to traditional hormone replacement therapy. Bioidentical hormones are often marketed as a safer, more effective, natural, and personalized alternative to conventional therapy. Despite these claims, it’s important to be aware that evidence remains limited, and they are not universally supported. Moreover, the lack of FDA oversight for these compounded hormones poses possible safety and purity concerns (3).

While some bioidentical hormones include the same ingredients found in FDA-approved counterparts, others contain additional hormones that lack adequate testing and are not included in any FDA-approved products. It's important to note that BHRT may not be safe for individuals with a high risk of or existing conditions like blood clotting disorders, heart or cardiovascular disease, breast cancer, or stroke (3).

The Bioidentical Hormone Therapy Protocol

BHRT starts with a detailed initial consultation. Here, your healthcare provider takes a deep dive into your health history, symptoms, and general health. Up next is hormone testing, using methods like blood, saliva, or urine tests, which creates a clear picture of your hormone levels. This information acts as a roadmap for treatment, pointing out any imbalances and guiding the way forward. Following this, a custom hormone treatment plan is crafted. Throughout this journey, your provider's engagement is vital, monitoring results and adjusting your plan as your body responds to the treatment (3).

Hormone Testing Methods

As discussed, hormone testing utilizes blood, urine, or saliva samples depending on the symptoms observed. This testing process assesses levels of various hormones, including estrogen, testosterone, cortisol, and thyroid hormones. Specific tests like blood testing or urine testing can detect gender-specific hormones, making it important to tailor these tests based on the patient's sex. Saliva tests are also employed to evaluate hormone levels, such as those from estradiol, progesterone, and testosterone. Depending on the initial results, additional tests, including stimulation or suppression tests, may be recommended to delve deeper into the hormonal imbalance.

Top Comprehensive Hormone Panels Used on Rupa Health

Functional medicine labs offer a variety of tests that can help tailor treatment to patients needs, allowing providers to optimize management strategies.

Female Hormone Panel

This panel provides a comprehensive evaluation for detecting hormonal imbalances that may contribute to a range of symptoms in women, including mood swings, irregular menstrual cycles, and fatigue. This test is commonly used for patients who are being monitored for gender-related BHRT. 

Female Wellness Panel

A more extensive test than the Female Hormone Panel, the Female Wellness Panel includes a CBC, CMP, hormone panel, thyroid panel, and other important biomarkers that assess general wellness, offering a complete picture regarding hormone imbalance and other factors that may impact health. 

Male Hormone Panel

This panel provides a thorough investigation of male hormonal balance, assessing hormones like testosterone which can influence mood, energy levels, and libido in men. This test is commonly used for patients who are being monitored for gender-related BHRT. 

Male Wellness Panel

A more extensive test than the Male Hormone Panel, the Male Wellness Panel includes a CBC, CMP, hormone panel, thyroid panel, and other important biomarkers that assess general wellness, offering a complete picture regarding hormone imbalance and other factors that may impact health. 

DUTCH Plus

The DUTCH Plus test provides an in-depth analysis of sex and adrenal hormones, including their metabolites. Regarding BHRT, this test can help to identify hormonal imbalances, optimize dosing strategies, and monitor therapy effectiveness. 

Interpreting Hormone Test Results

Interpreting hormone test results involves understanding hormone reference ranges, which are typical values based on a large group of healthy individuals and can vary depending on the lab and the individual's unique factors. Analyzing hormone ratios and patterns is an important part of assessing hormonal balance, as patterns of elevation or suppression can indicate specific issues such as adrenal fatigue or hyperthyroidism. Specifically, menopause will usually result in lower estrogen levels and higher LH. Low testosterone levels in men can sometimes be regarded as male-menopause. Remember that a single "abnormal" result does not necessarily mean you are unwell, just as a "normal" result doesn't guarantee perfect health; these terms are simply relative to the established reference range. It’s important to interpret your results with your symptoms. Lastly, hormone test results can be influenced by factors like diet, stress, vigorous exercise, and current medications, so it's important to take this into consideration when assessing your results.

Implementing Bioidentical Hormone Therapy

BHRT comes in various administration forms, such as pills, patches, creams, gels, shots, and implanted pellets. During the therapy, providers closely monitor hormone levels through blood, urine, or saliva tests, making dose adjustments as needed to achieve desired outcomes. Overall, the main goal of hormone therapy is to have you on the lowest dose to achieve improvement in your symptoms, staying on the medication for the shortest amount of time possible. It's important to note that the effectiveness of BHRT can vary, with some individuals experiencing relief in weeks, but typically it takes about three months for the full benefits to materialize. Also worth noting is the FDA’s stance against using hormone levels to influence dosing in women, as levels fluctuate frequently (3). 

The Importance of Lifestyle Factors and Hormone Balance

Living a balanced lifestyle is key to maintaining optimal hormone levels in our body. Prioritizing stress management techniques, such as regular exercise, adequate sleep, and mindful relaxation, can greatly support hormone regulation. When it comes to diet, anti-inflammatory foods and a rich variety of fruits, vegetables, and lean proteins, brimming with essential vitamins and minerals, work wonders for hormone health. Regular exercise, apart from reducing stress, stimulates the production of certain compounds that aid in hormone balance and overall health. Quality sleep is a non-negotiable factor, playing an essential role in restoration and hormonal balance in the body. Maintaining gut health is also important, as it affects metabolic function and influences hormone balance. Lastly, reducing exposure to environmental toxins can be an effective way to manage and optimize hormone levels.

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Summary

In summary, BHRT is a method of hormone replacement frequently used by men and women. This type of therapy differs from conventional therapy as it uses hormones that are chemically similar to the ones the body produces. Hormone replacement can help to reduce the symptom burden from many conditions, such as age-related changes from menopause. It is important to understand that, like any treatment, BHRT carries a possible risk of side effects or safety concerns and should be discussed with your doctor.