Sex hormone replacement for men and women can be very helpful to help mitigate the aging process. One of the things contributing to the aging process is the fact that certain important “age related” genes are being turned on in our DNA, and other important “youth related” genes are being turned off. Many of these genes seem to be regulated by sex hormone levels. This would include testosterone in men, and estradiol as well as progesterone in women.
What’s crucially important when considering sex hormone replacement is to make sure you are receiving natural hormones. These are commonly referred to as “bio-identical” hormones. No other unnatural or synthetic sex hormone-like chemicals should ever be considered for human use.
Endocrinology classes in college, and obviously in medical school, teach that hormones and their receptors in human cells are like “locks and keys“. The receptors are designed to be stimulated by the appropriate natural hormones. Unnatural and synthetic sex hormone-like chemicals will have inappropriate and abnormal stimulation upon these natural receptors within our cells.
The reason these unnatural and synthetic sex hormone-like chemicals exist in the market has to do with the fact that pharmaceutical companies are not able to patent natural substances. So, pharmaceutical companies are not able to patent testosterone for men, or estradiol and progesterone for women. This is the main reason they create these unnatural substances, since they can patent them.
Regardless, a physician should never consider using such synthetic chemicals in a human patient. In fact, all hormones intended for human use should be “bio-identical,” and you shouldn’t even have to use such terminology. It should be taken for granted that all hormones used in humans would be natural.
Obviously, when testosterone is begun in a man, and when estradiol and progesterone are begun in a woman, the doctor should be doing the right thing. All women will undergo significant reductions in their estradiol and progesterone levels around the time of menopause. In some women, the progesterone levels actually start dropping much earlier, maybe in their 20s or 30s.
On the contrary, there are men, even later in life, who still have healthy levels of testosterone. But, of course, it is very common for men to have reductions in their testosterone level typically in their 50s and 60s and obviously thereafter. Sometimes, you can see reductions in testosterone in men even in their 20s or 30s.
When a younger woman has reductions in their progesterone, or when a younger man has reductions in their testosterone, it is crucial to find out what is wrong, and what is actually causing this problem. Because when such things are occurring, typically there are other problems in the body causing it.
Putting that aside, when testosterone is properly begun in a man, and when estradiol and progesterone are properly begun in a woman, it is imperative to make sure the patient receives appropriate doses. Underdosing is safe, although it will probably not give as much benefit. Overdosing is possibly unsafe, and all measures should be undertaken to prevent it from occurring.
In my experience, the vast majority of men and women on sex hormone replacement, even if it is with “bio-identical” hormones, end up getting overdosed, sometimes quite significantly. One of the main reasons for this is the fact that doctors assume that blood testing will provide proper information regarding tissue and cellular levels of sex hormones.
The truth is that this assumption is completely false. Blood levels of sex hormones only tell you what is being transported in the blood. They have nothing to do with tissue and cellular levels. Sex hormones move in the blood, but then they enter cells and work within those cells to turn on and off genes as was mentioned earlier.
The best way to determine tissue and cellular levels of sex hormones is with saliva testing, as well as with bloodspot testing. The doctor needs to know which are the premier labs for such testing and obviously how to interpret such testing. This takes appropriate training as well as sufficient experience.
The doctor also has to understand how sex hormones holistically interact with all the other hormones in the body, and with the body as a whole. So the doctor prescribing sex hormones needs to be an expert in all hormones, not just in sex hormones, and also needs to be an expert in metabolic medicine.
When appropriate levels of testosterone are given to men, and when appropriate levels of estradiol and progesterone are given to women, the rest of the body should react in a positive manner. Other hormone systems should improve, or definitely not worsen, while other connected metabolic processes should respond accordingly as well.
For men, testosterone can be safely administered by injection, as well as by topical and “pellet” forms. It should not be taken orally as this can increase the risk of certain cancers and cardiovascular problems. This occurs because when testosterone is taken orally and passes through the liver, it is modified into forms which increase these risks.
For women, estradiol can similarly be administered, by injection, by topical forms, as well as by “pellets.” It should not be taken orally for the same reasons that testosterone should not be taken orally in men.
Progesterone in women can be taken orally as well as topically. Evidently, when progesterone is taken orally and passes through the liver, this does not lead to substances which increase the risk of any health problems.
My personal recommendations for men is to begin with testosterone injections. Testosterone patches are expensive and cumbersome. Testosterone creams have issues with transference to other people as well as with difficulty in determining saliva levels. I do not recommend using testosterone “pellets,” since I think it is near impossible to determine tissue and cellular levels on such treatment.
My recommendations for women is to start with either estradiol injections or estradiol patches, and to start with oral progesterone. I try to avoid estradiol and progesterone creams in women for the same reason I try to avoid testosterone creams in men. I try to avoid estradiol “pellets” in women for the same reason I try to avoid testosterone “pellets” in men.
In closing, when sex hormone replacement is done appropriately, it can be very helpful to the patient. But, the truth is that the vast majority of doctors don’t have appropriate training and experience to provide such therapy to their patients. Sadly, they don’t recognize this, and falsely assume that providing such therapy is “no big deal”. So, it is crucially important for the patient to find a physician who truly knows what they’re doing, has the appropriate training and experience, and understands all the important nuances of sex hormone replacement.
