The various risks and side effects of hormone replacement therapy cause patient confusion and possibly delay treatment that can prevent many lifestyle diseases. Things like heart attacks and cancer, plus the secondary side effects of facial hair and a deeper voice in women, can cause fear and confusion.
However, if you can explain these myths in a way your patients will understand, their health and compliance to the treatment not only increases, but you can offset many later health risks by getting HRT started early.
Myth of the Heart Attack from HRT
A small study several years ago showed when bodybuilders overused steroid supplements; they increased their risk
of heart attacks. It makes sense as several other studies have confirmed that when men with normal testosterone levels take testosterone supplements, they increase the risk of a heart attack, along with other various health problems, including liver failure.
However, the media exaggerated the story and used it to vilify all hormone replacement therapy. It left a generation of men believing that using testosterone supplements increase the risk of heart attacks. Although it has not stopped many men from choosing the supplements, it turned it into a mode for sexual satisfaction and muscle building rather than broader health reasons.
As time went on and other studies came out, the risk of a heart attack because of hypogonadism treatment was shown to be negligible, especially in the long term. The use of synthetic testosterone hormone therapy did not indicate a significant risk of a heart attack. Additionally, the use of bioidentical testosterone hormone replacement therapy shows a decrease in the risk of a heart attack and other heart disease factors.
In short, for men with normal testosterone levels, using testosterone supplements can increase your risk of a heart attack. For men with hypogonadism and low testosterone levels, bioidentical HRT can lower the risk of a heart attack.
A Woman’s Risk of Breast Cancer from HRT
Avoiding breast cancer is one of the most common reasons women have to avoid hormone replacement therapy. In the past, synthetic hormones for women focused on the production of chemicals similar to the various estrogens within a woman’s body. These do encourage breast cancer and other cancer growth. Many of the synthetic hormones products do increase a woman’s risk of breast cancer.
In various other studies, the correct dosage of bioidentical hormones that are matched to a woman’s particular need shows a reduction in the risk of cancer. According to one study, the risk of breast cancer is reduced significantly. Others show that liver, colorectal, and bladder cancers reduced using bioidentical hormone replacement therapy.
The difference is the origination of replacement therapy. Is it a synthetic molecule designed to be only close to what the body naturally produces or something bioidentical, which is identical to what the body produces and easily used for its intended purpose?
Will I Grow Facial Hair on HRT
As estrogen and progesterone levels in the woman’s body decrease, the testosterone can influence the growth of facial hair and body hair. In many women, the level of testosterone decreases with estrogen, but not all. Still, if it does not, the testosterone has more ability to interact with receptors the produce increased hair growth in both color and thickness. (add link to testosterone article)
One of the reasons women need to have all their hormone levels tested, including testosterone, is to balance the different hormones correctly. With the appropriate mix, facial hair does not increase, and all of the benefits remain.
It’s similar to voice concerns. As testosterone is responsible for the depth of a person’s voice, having more testosterone can lower the frequency at which the vocal cords vibrate. Although most women do not experience the rise in testosterone during menopause, the associated lowering of estrogen and progesterone makes testosterone more available to interact with hormonal receptors on cells and deepen their voice.
Using bioidentical hormones for HRT, the natural levels of hormones are maintained, and the body returns to the state of homeostasis.
Dealing with Patient Confusion Over HRT
Most patients who come into a doctor’s office will have horror stories of a friend or relative who took HRT and developed complications. They don’t want to experience a higher risk of cancer or heart attacks. They don’t want to have additional facial hair or lower voices.
Patients want to be listened to. By addressing the need for HRT, the first step is to listen to your patient story. Obtain the information from them of exactly what happened during the treatment. Were their friends or relatives taking synthetic hormones? Did they take the hormones as prescribed? Are there other complications, such as a sudden hysterectomy or other health problems that influence the risk factors?
As you explore these questions, you may find that other problems were associated, and the HRT took responsibility.
The next step in converting your patients into believers is to share the research in BHRT with them over the years. The difference between synthetic and bioidentical hormones is a huge step to reducing the fear many patients will have. They can be shown how bioidentical hormones work the same in the body as natural hormones, rather than merely mimicking their actions as synthetic does. (link to synthetic vs. bioidentical hormones)
For your patients, you have to tell a story. Engage with the other successes of how women felt better using BHRT. Letting your patients know they are not alone can overcome much resistance.
Avoid using studies. Most people are not able to read the studies; there’s an overriding belief amongst the general public that studies show only what you want them to. Because of the mass media manipulation of studies and the reporters’ exaggerations, studies are met with skepticism by many patients. Additionally, your patients may feel you are talking over their heads by using medical technobabble and are inventing the studies to fit your needs.
We agree this is not a fair portrayal of how the medical community works. Medical science has its foundation in these studies and should be trusted. We just want to make it clear that meeting them where they are is essential to gaining patient compliance when communicating with your patients.
Synthetic vs. Bioidentical Hormones
The use of properly dosed bioidentical hormones has been shown to reduce and eliminate many of the risks of hormone replacement therapy. Additionally, specific treatments help minimize side effects, especially when considering patient compliance and frequency of use.
As a doctor looking into the possibility of using bioidentical hormones, there’s been a lot of confusion over why the FDA does not support bioidentical hormones even though the literature shows that it is much safer. As we show in this article (link to bioidentical hormone article), it comes down to finances. Patented synthetic hormones require extensive testing and funding, which helps keep the FDA in business.
When looking at the safety of bioidentical hormones, several things stand out. As mentioned above, the risk of breast cancer is reduced using bioidentical hormones. The incidences of liver, colorectal, and bladder cancers remain as low as using synthetic hormones. Multiple other diseases, including bone, lung, and skin cancers, are reduced using bioidentical hormones.
Depression, anxiety, and dementia problems are significantly reduced using bioidentical hormones. While some studies show synthetic hormones can alter the levels of dopamine, serotonin, and norepinephrine in the brain, the use of bioidentical hormones do not. Additionally, the corticosteroids that help govern memory retention and pain recall also remain at healthy levels when using bioidentical hormones, but may be altered during the use of synthetic hormones.
Finally, using some of the application techniques for bioidentical hormones may increase patient compliance. The highest level of compliance in patients is the use of bioidentical pellet therapy. Pellets are designed to release the exact amount of hormones the patient needs and may last three to four months for women and five to six months for men.
By not having to take a daily pill, the stress on the liver is reduced. Pellet therapy delivers the hormone directly to the bloodstream, bypassing the liver’s processing required by oral supplementation. The use of creams, gels, and patches have consistency and dosing problems (link to underdosing article). Many people underdose themselves, with some doing it out of fear of overdosing. Creams also have the potential for poor absorption and the possibility to transfer the hormones to a loved one.
Finally, although hormone injections are more typical among men, compliance also varies more. Injections tend to be done in the same place on a person’s body, leading to uneven muscle growth and increasing the risk of skin cancer. Patients also often complain of the rollercoaster effect with the weekly ups and downs of their hormone levels.
Overall, bioidentical pellet therapy typically reduces a patient’s chance of complications such as cancer, heart attack, or facial hair, and requires minimal patient compliance.