Bioidentical Hormone Therapy

Hormone deficiency: menopause, andropause, somatopause and Bio-Identical Hormones 

In women menopause is the cessation of hormone production (estrogen, progesterone and even testosterone) that occurs at about age 45 to 50 years old.  In men, it is called andropause and is a cessation of testosterone production.  It occurs at a much wider range between 40 and 60 years old.  Somatopause relates to decrease production of growth hormone, which starts at about 30 years old and continues throughout life.  It occurs in females and males. 

The most common symptoms of menopause are night sweats, depression, and hot flashes.  Additional signs are weight gain, earlier death and dementia.  Andropause results in loss of muscle mass, weight gain, loss of the youthful shape of mass in the shoulders, larger abdomen and trunk size, moodiness, depression, loss of energy and sex drive.  Both andropause and menopause contribute to mental decline, increased body fat, cardiovascular disease and cancer mortality.

A well documented study was the WHI, Woman’s Health Initiative published in April, 2004 in the Journal of American Medical Association.  The problem with the study was they only used synthetic hormones, and not bio-identical hormones.  This resulted in increase in breast cancer and cardiovascular disease.  Numerous studies show just the opposite using bio-identical hormones, namely decreased cardiovascular disease, breast cancer and dementia.  

Bio-identical hormones are plant derived but the chemical compounds are identical to those of humans.  An example of synthetic hormone is Premarin, which is derived from pregnant mare urine, thus pre-mar-in.  There are about 30 compounds that are unnatural to the human being.  Provera is a synthetic progesterone and has been linked to increased cardiovascular disease and breast cancer.  Unfortunately, many doctors stopped prescribing HRT (hormone replacement therapy) because of this study. 

The hormones we are concerned with in women are estrogen, progesterone, and testosterone and in men only testosterone.  While we find more estrogen in women and more testosterone in men, the difference is the amounts.  Women have more estrogen and men more testosterone.  However, at age 50, men may have more estrogen than women.  Women have a reduction in estrogen production and in men, testosterone is converted into estrogen.  Both sexes have a decline in testosterone. 

These problems of hormone deficiency can be treated with HRT, hormone replacement therapy, and only bio-identical hormones should be used.  For women estrogen and testosterone can be replaced with compounded creams, tailoring the doses individually to the patient.  An even better solution is the estrogen/testosterone pellets.  These are inserted into the lower abdomen or upper buttocks through a very small incision and will last 4-5 months in the female.  Women also need bio-identical progesterone replacement, which is given by oral capsule.  In the male, only testosterone is replaced, and it lasts 5-6 months.  

Testosterone creams are not advocated for the male because of the increase in DHT (dihydrotestosterone), which causes prostate enlargement and hair loss.  If this occurs, it can be treated with Avodart, if necessary.  Oral testosterone may cause liver damage.  The pellets do not have these problems. 

Prior to treatment, lab tests must be done to determine the patient’s hormone levels.  Additionally, men must have a PSA drawn to determine prostate health.  These lab tests will be repeated prior to the next treatment, then thereafter about once a year. 

Hormonal balance is one of the primary factors in age control, and it is impossible to feel or look as good following menopause or andropause unless HRT with bio-identical hormones is used.

E. Ronald Finger, MD, FACS

Finger and Associates Plastic Surgery Center

Savannah, GA