Introduction to Hormone Replacement Therapy (HRT)
for Physicians and Health Professionals
It is my desire to make available to physicians, other health professionals and interested lay people detailed and clear information that they will hopefully find useful in their clinical practices and in their own personal lives.
I have been practicing Obstetrics and Gynecology for over thirty years. I was first taught female hormone physiology by Fred Benjamin, MD and Norma Gastillo, MD, who both worked at Queens General Hospital in the early 1970s. There was a newly available assay for FSH and the Hypothalamic-Pituitary-Ovarian relationships were being worked out. Drs. Benjamin and Gastillo were conducting clinical research and their clear vision and desire to do the best for their patients has been a gift to me for my entire career.
In 2001, while browsing the web, I discovered the American Board of Holistic Medicine and the American Holistic Medical Association. I ordered a set of review tapes and began my introduction to modern holistic medicine. In 2002, I delved into the resources of the North American Menopause Society and by October 2003, I became certified by that organization as a Menopausal Practitioner. I was now current with all possible menopausal therapies.
Two months later, I took over the practice of a gynecologist who was moving away. When I began seeing his patients, I found that many were taking biest and progesterone. I was familiar with progesterone, but had no idea how to obtain it. I had never heard of biest and called the patient’s pharmacy -- I was even more surprised to find that it was an 80%/20% blend of estriol and estradiol. When I took my OB/GYN board exam in 1977, the benefits of estriol were just being written about (but was never available in the marketplace). How was it possible that I had just studied all menopausal management materials from the North American Menopause Society and never, was there a single mention about the existence of bioidentical hormones and its consideration as a treatment option?
In April of 2004, I took a PCCA/ZRT labs sponsored course in bioidentical hormone use. They recommended compounded creams and patient evaluation by salivary hormone levels. After returning from the weekend course, Suzanne Somers was on every TV channel promoting her new book, The Sexy Years, and extolling the merits of bioidentical hormones. Dr. John Lee had been studying and lecturing about the importance of bioidentical progesterone for over 25 years. Suzanne Somers did more for public and physician awareness in three months than Dr. John Lee ever accomplished in his entire career.
A New Age
I have always viewed irregular bleeding and other gynecologic problems as primarily endocrine abnormalities, but proper therapies to address these issues have been gradually unfolding. Current knowledge of the underlying physiology has come a long way, with some of the biggest advances coming in only the last decade. Commercial laboratory tests have become so precise that levels can be ascertained for hormones that circulate in the blood at concentrations of only a few parts per trillion. Although synthesis of the steroid hormones is not new, the return of pharmacists who can prepare medications tailored to individual patients has made all the difference. We have reached a new age. The combination of advanced knowledge of hormonal physiology, advanced and precise laboratory testing and the availability of individually compounded hormone preparations creates an environment that allows treatments tailored to the individual patient.
The body’s hormone systems constitute a network, a web. Everything affects everything else. The entire hormonal system is interactive. Thyroid activity sets the metabolic pace. Cortisol affects hypothalamic production of releasing hormones, brain function and the conversion of
T-4 to T-3. Progesterone and testosterone affect thyroid activity and basal body temperature. Estrogen affects craving for carbohydrate foods, fat storage and metabolism, fluid balance and brain activity. The list of interactions goes on and on. More recently, the relationships between insulin, insulin resistance, and female hormone problems have been elucidated. Hormones such as Inhibin B, IGF-1, their receptors and carrier proteins, have come to prominence with better understanding of their roles in bleeding patterns, weight, fat, and cholesterol issues. There is a lot to know.
A few years ago, a friend and fellow gynecologist called me. He had a patient in his office who had read the new Suzanne Somers’ book and was interested in being treated with bioidentical hormones. He asked if I had a minute to tell him how to prescribe the hormones. I offered to spend a weekend with him to give him an introduction. He declined the offer.
My goal is to build the professional resources section of this site as a guide and teaching tool, so that physicians, PAs, nurse practitioners and pharmacists can begin a practice in bioidentical hormone use.
The entire field is quite large. Rather than wait until I am able to present the entire work, I am building this section gradually, as various topics are completed. Initially, I am presenting important, clinically relevant topics. To some extent, I am starting with essential, yet easier topics — giving readers the opportunity to “wet their feet” in bioidentical hormone management. As you become more experienced, you can delve further into the details of this interesting physiology and patient care.
Feel free to contact me with any questions at: firstname.lastname@example.org.