Introduction to Hormone Replacement Therapy

An imbalance of hormones can cause a range of psychological and physiological symptoms. People generally produce fewer hormones as they age, and hormonal deficiencies may also result from environmental and nutritional factors. Restoring hormones to their proper balance often improves a person's health and overall happiness. Physicians achieve this goal with hormone replacement therapy (HRT), which supplements a person's natural supply of hormones such as estrogen and testosterone. Men and women may both receive HRT, although the specific benefits and effectiveness differ between the sexes.

Overview

HRT may refer to any type of therapy in which the patient receives hormones as medical treatment. This includes supplements of naturally-occurring hormones as well as the substitution of similar hormones. HRT generally has three forms, including HRT for menopause, androgen replacement therapy and HRT for transgender people.

The purpose of HRT for menopause is to reduce the symptoms caused by a reduction in the levels of estrogen and progesterone in the bloodstream. This commonly occurs during menopause, although women who have their ovaries removed also have a lower estrogen level.

Androgen replacement therapy (ART) is primarily used to supplement a man's natural testosterone. This is generally the result of hypogonadism, in which a man's testes don't produce sufficient amounts of testosterone. Various conditions such as cancer can cause hypogonadism, and it's also a natural part of the aging process.

HRT is also an essential part of changing to another gender. The female-to-male transgender process requires HRT with testosterone and the male-to-female process requires HRT with estrogen. People with chromosomal abnormalities that prevent them from being distinctly identified as male or female may also receive HRT.

Bio-identical hormone replacement therapy (BHRT) is a type of HRT that uses hormones that are molecularly identical to the ones used in traditional HRT. The goal of this form of HRT is generally to achieve a desired hormone level, as measured by blood or saliva testing. Hormones commonly used in BHRT include estradiol, estrone and progesterone, which are commonly available in manufactured products and products compounded at a pharmacy. BHRT may use dehydroepiandrosterone and testosterone, although the availability of these products is more limited in North America. Estriol is also available in Europe for BHRT.

Administration

Physicians may administer HRT with a variety of methods including pellets, pills, patches and creams. They will routinely adjust the specific dosage and approach to provide maximum benefits with minimal side effects. It's therefore essential for patients to report any side effects when receiving HRT.

Pellets

Pellets are inserted under the skin, where they release a consistent dose of hormones over a period of time, typically at least four months. This administration method is most often used in BHRT with pellets that contain hormones from natural sources such as plants. Pellets create smaller fluctuations in hormone levels compared to other administration methods, which can result in a roller coaster effect as the hormone level rises and falls.

Pills

HRT that uses estrogen often relies on pills to administer this hormone. These pills typically contain progestin as well unless the woman has had a hysterectomy. Estrogen HRT can generally be divided into continuous therapies and cyclic therapies. A continuous method involves taking pills with estrogen and progestin every day, which may cause irregular bleeding.

A cyclic method involves taking a pill containing estrogen for 25 days out of the month and another pill with progestin for 10 to 14 days out of the month. This method can cause monthly bleeding due to the withdrawal of estrogen. HRT specialists generally recommend limiting HRT for menopause to a period of five years at the lowest dose needed to treat the symptoms. Some pills used in HRT contain raloxifene, which is an estrogen-like compound known as a selective estrogen receptor modulator.

Patches and Creams

Therapists also use patches to deliver a variety of hormones, including estrogen and testosterone. The patch then delivers the hormone into the bloodstream at a specific rate. The patch is typically applied by the patient to the buttocks or abdomen for up to one week. The patient may then remove the old patch and apply a new one. A patch remains on at all times, even while bathing or swimming.

Patches that deliver estrogen can cause monthly bleeding, just as it does in pill form. A patch that provides ART for postmenopausal women and women who have become menopausal due to surgery has been approved in Europe. However, the FDA has not yet approved it for use in the United States. Cream that contains estrogen can treat urinary problems and vaginal dryness by inserting it into the vagina or around the vulva.

Estrogen and Progestin

Estrogen is the primary female sex hormone, which plays an essential role in regulating a woman's menstrual cycle along with other related compounds. Progestin is a synthetic hormone that belongs to a class of hormones known as progesterones. It is commonly used in HRT to prevent a proliferation of endometrial cells, medically known as endometrial hyperplasia. This condition often occurs when estrogen is used by itself in HRT. Progestin is also used by itself or in combination with estrogen to prevent conception.


hormone therapy