Updated: Feb 8
Contrary to the popular belief that hormone replacement therapy is dangerous...properly dosed and monitored HRT is actually quite safe, and in many patients, life changing.
BUT...Balancing hormones isn't as simple as 'Plug and Play'....Hormone deficiency does not always mean hormone replacement...It's way more complicated than that...That's why women either can't find doctors who are willing to prescribe hormone replacement therapy or end up working with 'hormone experts' who only make things worse.
Here's the deal... No hormone is an island. Every hormone produced in the body affects every other hormone. For example, ...if cortisol is too high or too low, none of the other hormones will work correctly, even if the levels of the other hormones is normal....If estrogen levels are too high, which is the case in many women, then thyroid hormone will not work correctly...which means a lot of hypothyroid symptoms with 'normal' thyroid labs. ...If testosterone is converting into estrogen, then the testosterone deficiency doesn't mean there's something wrong with production...which means giving testosterone would be a bad idea! I could go on and on....
Now, here's where it gets really interesting...hormones like estrogen, progesterone, testosterone, DHEA, thyroid, and cortisol are affected by hundreds of other factors. These include things like age, other hormones (like insulin, growth hormone, and leptin), stress, diet, sleep, gut health, exercise, medications, and environmental factors....and the list goes on....
That's why treating hormone imbalances and hormone deficiencies with a 'plug and play' approach never works...and why women end up having symptoms and side effects on hormone replacement therapy.
Here's an example from one of my patients:
Carla was a 45 perimenopausal woman. She went to see a 'hormone expert' because she was struggling with fatigue, depression, and weight gain. Her friend, who was having different symptoms, was also was seeing the same doctor. The doctor ordered Carla's bloodwork (which happened to be the exact same bloodwork he ordered for her friend) and told her that all of her hormones were out of whack and she needed hormone replacement therapy. Here's what happened...
1. He put Carla on thyroid medication she never needed at doses so high she was never able to stop it. 2. He started her on testosterone pellets without first trying to figure out WHY her testosterone levels were low in the first place. 3. He never discussed her diet, exercise, stress, and other very important factors that would have affected what her hormones were doing. 4. He didn't order the right tests for most of her hormones and didn't even bother to accurately test her cortisol levels.
The result? Within 6 months, Carla had gained 15 pounds, was growing a beard, was having irregular vaginal bleeding, and was more exhausted...why? ...Because most doctors don't understand the complex relationships between hormones and the things that affect them...even some of the so called 'hormone experts'.
So, how do you know if your doctor knows what he/she is doing?? Well, if any of these describe you, then you don't...which means you need to strongly consider working with a real hormone expert instead:
1. Taking estrogen replacement alone, even if you don't have a uterus
2. Taking estrogen by mouth in any form
3. Getting your blood work tested before your hormone pellets are replaced.
4. Taking only levothyroxine T4 for hypothyroid symptoms.
5. Getting the same lab work done as every other patient (i.e. hormone franchise operations)
6. Get the same hormone replacement as every other patient (i.e. hormone franchise operations)
7. Having blood work drawn to monitor and adjust the doses of hormone creams
8. Taking only nutritional supplements as the only treatment for hormone imbalances
9. Being told that your hormone levels are 'perfect' even though you are having symptoms of excessive hormone doses
10. Having your hormones adjusted based on test results alone without your doctor asking you questions. Symptoms will always trump test results.
This is just the short list, but it's a place to start.