Bioidentical Hormone Replacement Therapy (BHRT) can be an effective method for replacing diminished sex hormones such as estrogen and testosterone. This lecture by Dr. Tracy Tranchitella will discuss modes of delivery (e.g. oral, transdermal), best absorption, follow-up testing and more.
The full webinar can be viewed here:
During the course of the Webinar, individuals were able to ask questions of the speaker. Because of time constraints, not all the questions were able to be answered in real time.
Q: Would it be possible to get a list of truly qualified practitioners for BHRT in each state?
A: I don’t have that, but you might go to the Institute for Functional Medicine website to look for qualified practitioners. The have a “find a practitioner” application on the site that lists practitioners by state who have been through functional medicine training. Not all of them do BHRT but you can research their background.
Q: What are the differences in effectiveness between birth control and BHRT for women who have had a hysterectomy with a Single Salpingoophorectomy? What are the side effects of Birth Control vs side effects of BHRT?
A: BCPs are synthetic hormones while BHRT uses bio-identical hormones meaning they have the same molecular structure as the hormones you make endogenously. Side effects of birth control pills are usually listed on the packet insert that they come with and there are several different formulations. They are taken orally so you get a first-pass through the liver and an increase in binding proteins. Refer back to the “cons” of oral hormones in the lecture. BCPs suppress your own hormone production because it is replaced with the synthetic version. BHRT, if not taken orally, is much easier on the liver and is generally given in physiological dosages to mimic the amount your body makes naturally. If you are in surgically induced menopause, long term BHRT would be preferred as you are at no risk of getting pregnant and you still have one ovary that, depending on your age, may still be able to produce hormones.
Q: Wondering if there’s any way to convert subQ pellet doses into oral doses?
A: I would not advise oral hormones other than micronized progesterone. If you are on subQ pellets for estrogen, you might want to transition to an estradiol patch. You would have to speak to your doctor who does the SubQ hormones to determine dosage.
Q: Already sounds like you are pro SubQ form. Any recommended training for this?
A: I am pro-whatever works and is safe administration and dosage. I do not provide SubQ hormone pellets in my practice, but you might look into American Academy of Anti-Aging Medicine to see if they have any training programs.
Q: Do menopausal women need to take breaks with progesterone?
A: It really depends on dosage, delivery and duration of use. That being said, if you can get your patients to take a break for 3 days a month, it does help to maintain receptor sensitivity.
Q: For pcos what days would you take progesterone and how do you track ovulation/the luteal phase if periods are irregular?
A: I would recommend the Menstrual Cycle Mapping profile through ZRT that will measure estrogen, progesterone and LH. This test can reveal if you are ovulating and, if so, where in your cycle it is occurring. Knowing this is important so that you do not use progesterone too early which might have the effect of inhibiting ovulation. You should also look at thyroid and adrenal markers as well as fasting glucose, HbA1c and fasting insulin – most can be done through blood spot and saliva. Here is a link to Lab Tests Plus for the Menstrual Cycle Mapping profile. You can also read more about it and other blood spot testing on the ZRT Lab website.
Q: Could you please go over some OTC options (brand names) for these different delivery options?
A: The only OTC options for hormones are going to be for transdermal progesterone. You can find some topical and SL products through some of the large supplement distributors like Emerson and Fullscript. BioMatrix – Est-Adapt and Pro-Adapt.
Q: Does scrotal testosterone exacerbate testicular atrophy?
A: Testicular atrophy usually occurs with excessive testosterone dosing that inhibits endogenous production. Testosterone should only be used in men who are deficient and then it should be given in physiological dosages while monitoring levels and metabolites. This article with Abraham Morgentaler, M.D. provides a good overview.
Q: I have heard that you cannot use urine with BHRT, is that incorrect?
A: That’s a good question – because urine is an excretory fluid, it is likely that you will only find measurable levels of hormone in the urine if the dosages are high enough to warrant elimination. If we are looking to get hormone levels to a measurable level in the urine test, we could risk giving too much. There is definitely debate on the issue.
Q: Is normal circadian rhythm of testosterone important to emulate for men?
A: As you seem to know, testosterone is usually highest in the morning in men under 40. After 40, the difference in morning testosterone and afternoon tends to be insignificant. For the sake of convenience and having the benefit of higher testosterone during the active part of the day, exogenous use would be better in the morning.
Q: How long should you stay off all hormones before testing to get a good base-line test?
A: It depends on the form you are using and how long you have been using it. The slower they metabolize the longer hormones can stay in your system. If someone has been using high dosages of topical progesterone daily for 2 years, it could take at least a month for it to wash out. If someone has already been on hormones for a while and they are well-managed, I would just test for adequacy of dosing at that point and assess thyroid and adrenal markers.
Q: Is it beneficial to administer progesterone without estrogen vaginally in postmenopausal women?
A: It is really the estrogen that helps to restore the vaginal tissue. If you are administering progesterone vaginally to have a systemic effect, you do need some estrogen around to prime the progesterone receptors. Both hormones are needed to optimize the benefits of each of them.
Q: Is it possible to work with LabTests+ out of Canada? How would shipping cross borders work?
A: Yes – we can ship anywhere except New York. I would advise going to the website and email your questions. You should receive an answer within 24 hours.
Q: What is the ZRT chart you stated you could get on their website that was in a table form?