Bioidentical Hormone Replacement Therapy (BHRT)
For information on Gender-Affirming Hormone Therapy, click here
Most of the time when we think of the benefits of hormones, we think of them in terms of sexual health or as a remedy for menopause. However, one of the most potent effects of hormonal therapy reaches deep into the psyche and proves that hormone replacement has extensive benefits far beyond the reach and scope of what hormones have originally been used for.Hormones control many of the basic functions of our bodies. They are an internal communication network between the body’s cells and are responsible for such critical processes as growth and development, metabolism, sexual function, reproduction, and mood. They are vital to your overall health and well-being and once they decline or become imbalanced, these vital processes also decline or become imbalanced, which can lead to issues like weight gain, bone loss, cardiovascular disease, diabetes, thyroid disorders, and reproductive challenges.In short, hormone imbalances can affect your overall health, well-being, quality of life, how you age, and even how your body metabolizes/responds to other medications.
The importance of emotional health cannot for one minute be understated and although the medical community stresses its importance, it often gets placed last on the list of people’s health initiatives. This may be because the concept of mental and social well-being is less defined than that of physical well-being and, on top of this ambiguity, there is a stigma associated with admitting a need for and seeking out emotional health. This is truly unfortunate since emotional health is an integral part of our whole-body health. Research has repeatedly shown that emotional distress creates susceptibility for physical illness. Stress increases vulnerability to viral infection and workplace and everyday stress can create susceptibility to cardiovascular disease. This is all to say, you cannot have physical health without emotional health.
It’s crystal clear, through research and patient feedback, that optimal levels of hormones are crucial to psychological health. What isn’t clear is why imbalances or suboptimal levels are often ignored by the medical community as common symptoms of the aging process. Often, people with suboptimal levels of hormones are put on antidepressants or stimulants, which may help depressive symptoms short-term but leave the ultimate source untreated.
Emotional well-being is paramount to mental and physical health and hormones are foundational to emotional well-being. Research and patient testimonials continue to illustrate this causative and crucial link.
The popularity of BHRT has skyrocketed in recent years, as it promises a natural remedy to hormonal issues. When hormones are replaced to optimal levels, patients often feel better and experience beneficial outcomes like stronger bones, thicker skin, higher muscle mass, and an improved sense of well-being and quality of life. But what is BHRT, and what makes it different from other therapies for hormone replacement?
What are Bioidentical Hormones?
Although not all hormones are created equal, you may find that when speaking to your doctor about hormone therapy, the names are used interchangeably and without regard for source or structure. That’s why it’s important for you to know the disparities in hormonal therapy and how those variations can make a huge difference in how you feel and your overall long-term health.
While some people may term hormones as natural or synthetic, all hormones we take are derived or synthesized in a laboratory. The differences, however, are found in their exactness and structure. For the sake of understanding, we’ll refer to hormones as either bioidentical (having the same structure and response to the hormones found in our bodies) and synthetic (hormones created to somewhat mimic hormonal responses, yet not exact replicas of the hormones the body naturally creates).
Since 1941, various forms of hormones have been used. The most popular are Premarin®, which is synthesized from the urine of pregnant mares (contains a mix of estrogens [some unique to horses], steroids, and various other substances) and Progestin, a drug that loosely resembles progesterone, but because of its chemical differences, often translates very differently in the human body. Over the years of research, through studies and patient responses, these two hormones have been found to do more harm than good. Synthetic progestins increase the risk of developing breast cancer and synthetic hormones have also been shown to convert endogenous (your body’s) estrogens into stronger variants (16-hydroxyestrone). These stronger, even toxic versions of estrogen can stimulate cancer formation. Birth control pills use synthetic hormones, a fact most providers unfortunately don’t educate their patients on.
The Endocrine Society defines bioidentical hormones as “compounds that have exactly the same chemical and molecular structure as hormones that are produced in the human body.” This exactness allows the hormone receptors on cells to effectively bind and identify with the bioidentical hormone, similar to a lock and key mechanism.
Bioidentical hormones, like progesterone, actually inhibit breast cell division. In fact, bioidentical progesterone has been described as having a protective role in the female body by preventing breast cancer.
What are the different hormones used in BHRT?
Hormones are responsible for such critical processes as growth and development, metabolism, sexual function, reproduction, and mood. The hormones most commonly used in BHRT include Estrogen, Progesterone, Testosterone, Thyroid, and DHEA.
Estrogen and Progesterone:
Estrogen (estradiol) and progesterone play an important regulatory role in a woman’s overall sense of well-being. The risk of depression doubles or even quadruples during the menopausal transition. During this time, when estradiol and progesterone quickly decline, many women develop symptoms of depression, anxiety, and mood swings.
Estrogen plays an important role in the brain where it exerts neuroprotective actions. Its loss during aging and natural or surgical menopause is associated with mitochondrial dysfunction (decreased energy production), neuroinflammation (swelling within the brain and spinal cord), synaptic decline, cognitive impairment, and increased risk of age-related disorders. This loss can be detected early on in cognitive and behavioral indicators, such as foggy thinking, depression, and anxiety. Estrogen’s effect on mood is primarily due to its role in increasing serotonin and beta-endorphins which are associated with positive mood states, as well as acetylcholine, which is a memory neurotransmitter.
Like estrogen, progesterone receptors are also expressed throughout the brain and can be found in every type of brain cell. Progesterone is thought to promote emotional health by boosting serotonin and GABA, which both work to decrease irritability, calm anxiety, and promote a healthy sleep cycle. Also, a progesterone metabolite, allopregnanolone, is believed to be involved in regulating mood and anxiety. The research on this metabolite is early but indicates an antidepressant and anti-anxiety effect in the body. It is crucial to note that Progesterone and Progestin are NOT the same, progesterone is natural and provides many protective benefits without side effects while progestins are synthetic and associated with many negative side effects and long-term health risks.
Low levels of testosterone can cause significant mood swings. A 2016 study found that “low serum testosterone was associated with an 86% increased hazard of depression.” In fact, even borderline testosterone levels are associated with significantly higher rates of depression and/or depressive symptoms and supplementing testosterone has been shown to be an effective treatment. A 2019 review and meta-analysis of 27 randomized controlled trials found that “testosterone treatment appears to be effective and efficacious in reducing depressive symptoms.”
Thyroid deficiency inhibits the brain’s neurotransmitters, potentially leading to depression and mental fogginess. Thyroid hormones also influence blood glucose levels and the release of stress hormones, which also contributes to mood fluctuation. Hypothyroid patients usually meet several criteria for depression—such as concentration difficulties, lack of energy, low libido, and sometimes pessimism or sadness. Research shows that thyroid supplementation in both clinical hypothyroidism and subclinical thyroid levels (thyroid insufficiency without meeting criteria for hypothyroidism) improves these feelings of depression.
If your normal response to the question, “How are you?” is “I’m so tired,” you may want to have your thyroid checked. Suboptimal thyroid symptoms rear their ugly heads in many ways, but one of the most common and debilitating symptoms is a constant feeling of lethargy and exhaustion.
It is important to note, if your doctor is not specifically trained in BHRT, they may very likely not know how to assess for subclinical thyroid levels. For this reason, it is very important to speak with a provider who is trained in BHRT.
DHEA and DHEA(S) are the most abundant circulating steroids in humans. Biological actions of DHEA(S) in the brain involve neuroprotection, neurite growth (axons and dendrites), neurogenesis and neuronal survival, as well as antioxidant, anti-inflammatory, and anti-glucocorticoid effects. In addition, DHEA affects endorphin synthesis/release. In three double-blind, placebo-controlled studies of DHEA administration in major depressive disorders, patients reported a significant reduction in depressive symptomatology.
There are many different ways to go about hormone replacement, including:
- Oral tablets/capsules
- Gels and creams
At MBC, our Nurse Practitioners mainly use oral tablets/capsules for estradiol, progesterone, and thyroid and a versabase cream for testosterone. Injections and patches can be convenient but often do not provide consistent, optimal hormone levels like oral tablets/capsules and versabase creams. Discuss with your provider what form might suit you and your lifestyle best. Once you start bioidentical hormone replacement, your care team will check your levels monthly until they are optimal. Once your levels are within an optimal range and you are satisfied with the results, your levels will mostly be rechecked once a year or as needed.
Why People Use Bioidentical Hormones and Is BHRT Right for You?
As we get older our hormone levels naturally decline and in some instances go away all together. When combined with the mounting external stresses and the dramatic changes in the body, this can put a huge strain on our mental and emotional health. Research is showing more and more that hormonal declines are critical catalysts to this common decrease in feelings of well-being, as well as an increase in stress-related illnesses.
You might be asking yourself, is this common decline and subsequent deterioration necessary? Can we replace these all-important players in our body’s health and reap their benefits throughout our entire life and even into our twilight years?
The answer is YES, but not without controversy, pushback, and the common question, “Isn’t hormone replacement bad for you?”
It is in our nature to think that if a little bit helps, a lot will help more. When it comes to substances in the body, like hormones, this is not the case. Too high of levels can be just as deleterious as too low of levels.
Often too high of levels of a hormone are caused by disease states or other imbalances in the body. For example, too much thyroid can lead to hyperthyroidism (overactive thyroid). This occurs when your thyroid gland produces too much of the hormone thyroxine (T4), which can accelerate your body’s metabolism, causing unintentional weight loss and a rapid or irregular heartbeat. It is important to note however that hyperthyroidism is an autoimmune disorder and that taking thyroid hormone does not cause the side effects of hyperthyroidism.
In the case of estrogen, too high of levels can lead to abnormal bleeding, breast tenderness, increased vaginal discharge, and weight gain. Other signs of high estrogen include bloating, heavy periods, decreased sex drive, fatigue, mood swings, and depression.
In male bodies, too high of testosterone levels can also have negative effects including acne, aggression, early puberty, excessive “hairiness,” high blood pressure, high libido, high red blood cell count, increased risk-taking behaviors, and infertility and decreased sperm count.
In female bodies, too high of testosterone levels can lead to signs of virilization—the development of male physical characteristics (i.e. muscle bulk, body hair on the face, chest, or back, deepening of the voice).
Just as too much can wreak havoc, too little can cause enormous challenges too. As we age, we’re apt to suffer from a decrease in levels of hormones and as mentioned before this decline can have dire and long-lasting effects on our health. In fact, lower hormone levels can exacerbate and encourage the deleterious effects of aging even further. With that being said, this is not something that only happens later in life, young adults can also suffer from hormone deficiencies.
Lower levels of thyroid can, on the surface, cause a range of symptoms, such as fatigue, constipation, dry skin and brittle nails, aches and pains, and feeling down. At a more serious and prolonged level, sub-optimal levels can increase your risk for high cholesterol, high blood pressure, and heart disease.
Women with an estrogen deficiency experience hot flashes, night sweats, anxiety, mood swings, depression, memory problems, dry skin, painful intercourse, and loss of libido. Long-term complications of low estrogen levels can include cognitive decline, heart disease, osteoporosis, joint pain, and inflammation.
Men who experience a decrease in testosterone report sleep disturbances and insomnia, emotional changes such as depression, issues related to their sexual performance and libido, decreased strength, and weight gain. The side effect of having greater body fat and less muscle mass can potentially increase the risk of heart disease and diabetes.
Women also experience lower levels of testosterone as they age which can result in a lower libido, weight gain, and changes in mood. Over a longer period of time, these lower levels may also contribute to more serious issues like heart disease, poor memory, and a loss of bone density.
These are just a few of the hormones that can affect a person’s health, but as you can see, in just these few examples, lower levels are implicated in both short-term, bothersome symptoms, as well as severe complications and disease states.
Balance is Key:
Balance is crucial when achieving optimal health. You don’t want too high of levels and you most certainly don’t want too low of levels. Here at MBC, our Nurse Practitioners partner with you to guide an approach to achieving optimal levels, and consequently, optimal outcomes specifically for your overall well-being and health. We understand that in this type of medicine, one size does not fit all. Each human body is unique and therefore must be treated individually to accomplish the best possible outcome. Like in a symphony, with each instrument playing its part, our Nurse Practitioners work with you to make sure each hormone is adjusted to play the right notes at the right time.
Unfortunately, most providers are not well-educated on hormones. There are a lot of reasons for this, but the main reason is that hormones are often not included/covered in academia and most providers are trained to focus on lab values rather than the patient’s experience. This sadly results in providers getting stuck in a routine of treating/chasing lab values rather than treating the patient. Without additional continuing education it is difficult for many providers to fully grasp the benefits and low risk of BHRT and let go of their confirmation bias: what we hear and learn first sticks in the brain as true and what comes secondarily is rejected, even if the research shows it is true.
In addition to the many short-term benefits of BHRT, as listed above, there are also many long-term benefits, including protection against: Cardiovascular disease, Strokes, Alzheimer’s Disease and other cognitive disease processes, Breast cancer, Uterine cancer, Fibrocystic disease, Ovarian cysts, Ovarian cancer, Osteoporosis, Urinary incontinence, Vision problems, Migraines, Improved immune system, Diabetes, High cholesterol, and many more.
How Do I Get Started?
Most people, both young and old, can benefit from BHRT. One size does not fit all. If you have been experiencing any of the symptoms listed below, then you may benefit from BHRT:
- Fatigue, exhaustion, lack of energy, feeling weighed down, unable to do much outside of your job, feeling weak
- Sadness, depression, hopelessness, feeling unhappy, irritability, everything feeling like a chore
- Trouble concentrating, brain fog, memory issues
- Always feeling cold, hot flashes, excessive sweating
- Weight gain or loss, difficulty losing weight, significantly increased or decreased appetite
- Hair loss, thinning hair, brittle nails, excessive dry skin
- PMS, painful periods, excessive or persistent bleeding, breast and/or nipple tenderness, lack of a period
- Low sex drive, vaginal dryness, erectile dysfunction, painful intercourse
- Have been on multiple antidepressants and/or other medications without noticing much improvement
- Your doctor saying your labs are “within normal limits” despite you still not feeling your best (ESPECIALLY if they say “your thyroid is fine” but you are experiencing any of the symptoms above)
- Loss of well-being or feeling unsatisfied with your quality of life
Bioidentical Hormone Replacement Therapy can help address these symptoms. If you’re struggling with any of these symptoms or are curious about BHRT, please click here to learn more about eligibility and connect with our medical team today!
Medical Director & Psychiatric Nurse Practitioner
I received my Masters in Nursing and my Doctorate of Nursing Practice (DNP) from Rush University specializing in Psychiatry and am a board-certified Psychiatric-Mental Health Nurse Practitioner. I have experience at the inpatient, residential, and outpatient psychiatric levels of care. My passion is working with individuals and groups coping with any and all psychiatric disorders.
As a Psychiatric Nurse Practitioner, I strive to bring focus back to treating you as a whole rather than an isolated disorder. My focus in treatment is to provide a holistically dynamic integration of therapy and medication management with the goal of helping you lead a life unhindered by your mental health.
Pronouns – He/They