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Menopause
and Natural Hormone Replacement Therapy
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NHRT - Natural Hormone Replacement - ANDROGENS |
Overview
Androgens are the hormones of desire - they are what make you
notice that cute guy across the room and makes you want him to
notice you! Testosterone especially is what powers your libido,
which is why this hormone has been getting a lot of press recently
as a way for post-menopausal women to regain some of their youthful
vigor and lust for life. But libido enhancement isn't the only
function of testosterone - a great deal of data suggests that
testosterone plays a key role in preventing osteoporosis, both
by protecting against bone loss and by stimulating bone formation,
as well as increasing muscle mass and tone, which is important
in maintaining bone strength. Additionally, studies have shown
that a combination of estrogen and androgen replacement produces
a significant increase in spinal bone mineral density vs. estrogen
replacement only.
Testosterone, however, isn't the only androgen at work in the
healthy pre-menopausal female body. DHEA is a precursor to testosterone
that is produced by the adrenal glands, skin, and brain, and which
can cascade into both testosterone and estrogen. DHEA has also
been getting a lot of play in alternative medicine circles as
the hormone of youth, able to not only restore sexual drive, but
youthful appearance, energy, memory, and reduced cholesterol levels.
Very limited research has been done on the long-term effects of
DHEA supplementation, and for this reason this section will focus
on testosterone replacement.
The medical community is now more open than it's ever been regarding
testosterone replacement, and some of the major medical journals
are engaging in discourse specifically on the effects of hysterectomy
w/ovary removal on women's sexual life and perceived well-being.
In fact, a recent editorial in the New England Journal of Medicine
postulates that:
| "the
reduction in androgens resulting from bilateral oophorectomy
is associated with sexual dysfunction in some women and that
testosterone replacement can reverse this decline in sexual
function and also improve psychological well-being. The potential
importance of these postulates is substantial. Recent survey
data suggest that the prevalence of sexual dysfunction among
women in the United States is approximately 40 percent. Many
of these women have had hysterectomies, about 600,000 of which
are performed here annually. Bilateral oophorectomy is performed
in conjunction with hysterectomy in about half of women 40
to 44 years of age who undergo the procedure and in almost
80 percent of women 45 to 54 years old...natural menopause
does not result in nearly the reduction in androgen production
that occurs after oophorectomy." |
The following table lists the major benefits and drawbacks of
combined estrogen/androgen therapy:
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Estrogen/Androgen
Hormone Replacement Therapy
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Benefits
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Drawbacks
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| Increased
Energy |
Acne
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| Increased
Libido |
Increased
Sexuality (over-stimulation) |
| Increased
Sexuality |
Mild
Hirsutism (facial hair growth) |
| Increased
Well Being |
Rare
Deepening Of Voice |
| Decreased
Breast Tenderness |
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| No
Change in Lipid Profile |
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| Increases
breast cancer risk |
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| Restrains
bone breakdown |
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Functions of Testosterone
As stated earlier, testosterone effects much more than libido,
and it is certainly not strictly a male hormone. While men produce
significantly more testosterone than women do, women naturally
produce testosterone and their bodies use it in a number of ways.
Testosterone is an anabolic hormone, which means that it also
works to build strong muscles, bones, and ligaments and counters
the tearing-down process that your body naturally experiences
when it undergoes stress or exercise. By the time you hit natural
menopause, your testosterone level has dropped about 50% from
what it was when you were a teenager. This can cause some of the
following symptoms, and certainly these can be quite apparent
in women who have undergone surgical menopause, since the ovaries
continue producing testosterone during natural menopause, and
this source of replenishment is removed in the surgically menopausal
woman:
Symptoms of Testosterone Deficiency
• Loss
Of Libido
• Depression
• Osteoporosis
• Fatigue
• Joint Pain
• Weight Loss
• Irritability
• Loss of Skin Tone
• Loss of Muscle Tone |
For
many women, the thought of testosterone replacement conjures a
vision of themselves with facial hair, crushing beer cans onto
their heads! This really isn't a significant concern - the dosages
given are very small in comparison with what it would take to
masculinize you. The following table illustrates the results of
a 1988 study on the masculizing side effects of testosterone replacement:
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Testosterone
Side Effects
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Side
Effect
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%
Women Affected
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Dosage
Of Testosterone
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| Mild
facial hirsutism (hair growth) |
15-20%
<5% |
150mg/month
75mg/month |
| Acne |
No
cases observed |
75-150mg/month |
| Deepening
of voice |
No
cases observed |
75-150mg/month |
Possible
other side effects may include aggressiveness, hair loss on the
head, nausea, headache, elevated liver enzymes, mineral imbalance,
fluid retention, elevated cholesterol, enlarged clitoris, and
anxiety.
The benefits of testosterone replacement include reducing hot
flashes (some women who don't get relief on estrogen alone do
get relief with estrogen/testosterone replacement); reduction
of breast pain related to estrogen use (mastalgia); and osteoporosis
prevention.
It should be noted that some alternative medicine practitioners
advocate testing DHEA and testosterone levels in answer to decreased
libido, and, if low, starting a course of DHEA supplementation
rather than testosterone replacement, since DHEA is a precursor
to testosterone, although there are no substantial studies to
back this line of reasoning.8 I my personal practice I would say
that about 30% of women get an increase in testosterone levels
when going on DHEA.
The following table lists some of the synthetic and natural testosterone
products currently on the market:
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Testosterone
Replacements
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Product/Manufacturer
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Bio-Identical
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Description
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| Estratest,
Estratest JS Solvay |
No |
Equine
estrogens and synthetic methyl testosterone |
| Menogen,
Menogen HS Breckenridge No esterified estrogens and methyl
testosterone |
No |
esterified estrogens and methyl testosterone |
| Methyltestosterone
Various manufacturers No N/A |
No |
Not
Available |
| Testosterone,
USP Compounding pharmacies |
Yes |
Micronized
powder in oil , Sub-Lingual drops or transdermal gel |
| What
is the Best Delivery System for Hormone Replacement Therapy?
|
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