Hormone Replacement Therapy

Seattle Hormone Replacement Therapy

Apollo Health Clinic


Hormone replacement therapy is a standard practice for treating perimenopause and aging in women. By using estrogen and progesterone – two major female hormones – doctors can treat common symptoms of menopause.

When a woman’s period stops, hormone levels fall, resulting in uncomfortable physical symptoms such as hot flashes, vaginal dryness, and conditions like osteoporosis. By replacing the hormones that your body has recently ceased to produce, HRT can be an effective treatment for symptoms of menopause.


Benefits of Bio-Identical Hormone Replacement Therapy

Two major forms of hormone replacement therapy exist, each with their own distinct advantages:

Systemic Hormone Therapy

Whether in a patch, gel, cream, or spray, systemic estrogen treatments remain an effective solution for menopausal hot flashes, night sweats, and vaginal symptoms. While the FDA keeps estrogen treatments on the list of effective treatments for osteoporosis, doctors typically recommend other treatments to treat osteoporosis.

Low-Dose Vaginal Products

Low-dose vaginal treatments of estrogen can effectively treat vaginal and urinary symptoms while minimizing absorption into the body, therefore are not an effective treatment for hot flashes, night sweats, or osteoporosis.

For women, topical compounded creams and vaginal suppositories of estrogens are used most commonly (they are called, Bi-est, Tri-est, or Estriol).
For men, Testosterone cypionate or propionate is compounded in the pharmacy and injected intramuscularly in the gluteus medius or thighs or applied as a topical compounded testosterone cream.

Who Should Consider Hormone Replacement Therapy?

While there are risks involved with systemic estrogen treatments, it is still the most effective treatment for menopausal symptoms. For those experiencing the following, hormone replacement therapy may be right for you:

Moderate to severe hot flashes
Loss of bone mass without satisfactory results from other treatments
Those experiencing premature menopause or premature ovarian insufficiency

Women who experience early menopause or those who have had their ovaries removed and don’t undergo HRT until age 45 have a higher risk of osteoporosis, coronary heat disease, earlier death, Parkinson’s-like symptoms, and anxiety/depression, but early menopause often lowers the risk of many types of breast cancer.

Your age, type of menopause, and time since menopause play a strong role in determining the risks involved with HRT. Speak with your doctor to learn more about your personal risks based on your medical history.


Estrogen Deficiency

Estrogen deficiency can be caused by Perimenopause and Menopause, or Premature ovarian decline.

Do you have any of the following symptoms?  (If you answer yes to more than one symptom, then you could be estrogen deficient.)

  • Acne
  • Anxiety
  • Arthritis Bladder problems (more infections, urinary leakage)
  • Brittle hair and nails
  • Chronic fatigue syndrome
  • Decrease in breast size
  • Decrease in dexterity
  • Decrease in memory
  • Decrease in sexual interest/ function
  • Depression
  • Diabetes
  • Difficulty losing weight, even with diet and exercise
  • Elevated blood pressure
  • Elevated cholesterol
  • Food cravings
  • Fibromyalgia
  • Heart attacks
  • Increase in facial hair
  • Increase in insulin resistance, which can lead to diabetes
  • Increase in tension headaches
  • Increased cholesterol
  • Infertility
  • Joint pain
  • Low energy, especially at the end of the day
  • More frequent migraines
  • More wrinkles (aging skin)
  • Oily skin
  • Osteoporosis/Osteopenia
  • Panic Attacks
  • Polycystic ovarian syndrome
  • Restless sleep
  • Stress incontinence
  • Strokes
  • Thinner skin
  • Thinning hair
  • Urinary tract infections
  • Vaginal Dryness
  • Vulvodynia (vaginal pain)
  • Weight gain around the middle

Estrogen excess

Estrogen excess typically occurs in younger women in ages 18-48 roughly and with “estrogen dominance” the progesterone-estrogen ratio is imbalanced.  This can be due to the body unable to breakdown estrogens via the liver and other pathways.

Symptoms of Excess Estrogen

(If you answer yes to more than one symptom, then you could be estrogen dominant)

  • Bloating
  • Cervical dysplasia
  • Decrease in sexual interest
  • Depression with anxiety or agitation
  • Elevated risk of developing breast cancer
  • Fatigue
  • Fibrocystic breasts
  • Headaches
  • Heavy periods
  • Hypothyroidism (high estrogen levels causes low thyroid hormone levels)
  • Increased risk of developing autoimmune diseases
  • Increased risk of developing uterine cancer
  • Irritability
  • Mood swings
  • Panic attacks
  • Poor sleep
  • Swollen breasts
  • Uterine fibroids (non-cancerous tumors of the uterus)
    Water retention
  • Weight gain (especially in the abdomen, hips, and thighs)

Progesterone Deficiency in Women

Symptoms of Progesterone Deficiency

Progesterone deficiency is caused by a variety of factors and can occur for women of all ages.  It is a very common hormone deficiency.

  • Anxiety
  • Decreased HDL levels
  • Decreased libido
  • Depression
  • Excessive menstruation (lasting longer than even days and very heavy bleeding)
  • Hypersensitivity
  • Insomnia
  • Migraine headaches prior to menstrual cycles
  • Mood swings
  • Nervousness
  • Osteoporosis
  • Pain and inflammation

Testosterone Replacement Therapy

Millions of men use prescription testosterone gels or injections to treat what the medical marketing industry calls “low T,” or testosterone deficiency in adult men.

The benefits of restoring testosterone levels are clear, though the methodology behind this treatment can be confusing and lead to problematic side effects.

By replacing lost or lowered levels of testosterone, adult males can feel more alert, energetic, mentally cognizant, and sexually functional. However, without careful guidance and professional treatment, these patients may face higher risks of cardiac problems.

Signs of Low Testosterone

  • Depression/anxiety
  • Compromised self-confidence
  • Trouble concentrating
  • Disturbed sleep
  • Lowered sex drive
  • Difficulty sustaining or achieving an erection
  • Decreased muscle or bone mass
  • Increased body fat
  • Fatigue
  • Flushing/hot flashes
  • Swollen and tender breasts

Risks Associated with Testosterone Replacement Therapy

A small number of men experience side effects associated with testosterone supplementation, though the evidence for long-term risks is mixed. Some researchers have found that men who undergo testosterone treatments experience fewer cardiovascular problems; others state men are at greater risk of cardiovascular complications as a result of testosterone replacement therapy. These risks are apparent with age, existing cardiovascular conditions, and greater risks of heart attack or stroke. Always undergo any testosterone replacement treatments under the strict supervision of a physician.


About the DUTCH Test

The DUTCH test, or Dried Urine Test for Comprehensive Hormones, measures hormones and hormone metabolites in a dried urine sample that can be self-administered from a patient’s home. Because the DUTCH test measures hormones metabolites in addition to hormones, the results are much more accurate and can provide your healthcare provider with a more complete picture of your body’s hormone production.

Because the test combines urine testing with blood and saliva hormone spot-testing, it’s possible to track variations between hormone releases throughout a 24-hour period, offering highly-accurate results without the need for supplementary testing.

The DUTCH test measures the following:

– Cortisol
– Cortisone
– Creatinine
– Tetrahydrocortisone
– a-tetrahydrocortisol
– b-tetrahydrocortisol
– DHEAs
– Progesterone, estrogen, and androgen metabolites
– 6-OH melatonin-sulfate

To learn more about the benefits of hormone replacement therapy (HRT), contact Dr. Samuel Madeira at Apollo Health Clinic by using the contact form.