Everything About Hormone Optimization
Are you struggling with weight gain, decreased sex drive, thinning hair, and more? You might be dealing with low hormones. HYDRO Infusions’ hormone optimization is a great way to get your body back to working order and your hormones to peak levels. But what exactly is hormone optimization, and how does it help? Here’s everything about hormone optimization.
What is Hormone Optimization?
It's a more accurate way of describing what we've called Hormone Replacement Therapy or HRT. We are not necessarily replacing hormones.
A treatment plan will typically either replace or boost hormone production in the body to offset the symptoms associated with hormonal imbalance. This is carried out by scientifically replacing lost or unproduced hormones with “bio-identical” hormones that can be synthesized in a lab.
Either way… hormone optimization is used to decrease and minimize the effect of aging and lower hormone production, as well as to offset some of the side effects associated with certain diseases or conditions.
Does Insurance cover Hormone Optimization?
No health plan is created equal. Each plan takes into account a variety of factors, from types of treatment to types of providers to which types of medication are covered. The best practice is to call your insurance company directly to ask about the specific types of treatment you’re considering.
Some insurers draw the line between what they will and will not cover concerning hormone replacement therapy based on whether the specific therapy is FDA approved. Many bioidentical hormone therapies or procedures are not FDA approved and are thus not often covered by insurance. Preventative medicine and bioidentical hormone replacement is a unique practice and is considered a form of alternative medicine. Even though the physicians and nurses are board certified as medical doctors, nurses, nurse practitioners, and/or physician assistants, insurance does not recognize bioidentical hormone replacement as necessary medicine BUT rather more like plastic surgery (aesthetic medicine). Therefore, bioidentical hormone replacement is not covered by health insurance in most cases.
Common Signs/Symptoms of Hormone Imbalance:
Frequent Urination
Increased Thirst
Increased Hunger
Depression
Nervousness, Anxiety, Or Irritability
Blurred Vision
Infertility
Thinning Hair Or Fine, Brittle Hair
Dry Skin
Puffy Face
Rounded Face
Decreased Sex Drive
Weight Gain
Hump Of Fat Between The Shoulders
Unexplained And Sometimes Sudden Weight Loss
Fatigue
Muscle Weakness
Muscle Aches, Tenderness, And Stiffness
Pain, Stiffness, Or Swelling In Your Joints
Increased Or Decreased Heart Rate
Sweating
Increased Sensitivity To Cold Or Heat
Constipation Or More Frequent Bowel Movements
Ways to Replace or boost Hormones
There are many routes to administer hormone therapy:
Oral
Sublingual (Under the Tongue)
Topical/Transdermal/Transvaginal gels, patches, creams
Intramuscular Injections
Subcutaneous Injections
Pellet Insertion
Always make sure to discuss the risks and benefits of each route with your provider as they are not all created equal. There are always inherent risks with each method of administration that can include everything from increased chance of Cancer, Transmission of hormones to others, biweekly injections, or procedure complications. These risks need to be evaluated concerning the overall benefit the patient will receive.
What are Normal Labs?
In most cases, normal lab values are a range of values that 95% of a healthy population falls into. In the context of lab test results, “normal” does not mean usual, typical, or ordinary. Instead, “normal” refers to how these values line up on a graph and form a range. The word “normal” here means a “normal distribution”, or set, of lab values. When we graph this, it looks like a symmetrical, bell-shaped curve. There are different ways to create a reference range or reference interval. Some tests need to have more than one reference range because of factors that affect the results. For example, men and women have separate ranges for total testosterone levels.
The main factors that determine whether multiple reference ranges are necessary are:
Age
Sex
Reproductive status (puberty, menstrual cycle, stage of pregnancy, and menopause)
Race (e.g. prostate-specific antigen in African Americans)
The time of day a sample is collected (e.g. random vs. first-morning spot urine sample)
What are “Abnormal” Lab Values?
Just because your lab value is outside the normal range does not mean that you necessarily have a disease or disorder. Indeed, and by definition, 5% of healthy individuals will have levels outside of the normal range.
Conversely, a normal lab value does not guarantee the absence of a disease or disease process. Your healthcare providers must examine your lab results in relation to one another. They should also take into account your medical and family history as well as any previous test results (to identify trends).
It’s also important that the lab result is interpreted concerning why the test was ordered. a provider may interpret the same test differently for two patients if one has no history or another has a significant medical disorder. The provider may be inclined to retest the patient with no history, but continue or change medical therapy to the patient with an established disease.
Why do Lab Reference Ranges Vary?
There is no universal reference range for most lab tests, ranges will vary from lab to lab. This means that it is possible to get a normal result from one lab and an abnormal result for the same test from another lab, and vice versa.
Reference ranges should be established for each marker by every lab. But the reality is that few labs carry out their own reference interval studies. Recruiting a healthy reference group and getting their informed consent is expensive and time-intensive, so most labs opt to instead use the reference ranges provided by the test manufacturers.
Reference ranges do not leave much room for nuance and gray areas. Health is not a black-and-white phenomenon but instead exists on a spectrum.
Reference ranges do not take into account the uniqueness of day-to-day, year-to-year variation in each person’s biology, environment, and genetics. Instead, they are arbitrary cutoffs based on how lab values are spread out across a “healthy” population, which is hard to define. A reference population may still contain people with an undiagnosed disease or condition that affects their lab test results.
This is commonly seen in testosterone level ranges in women who tend to show an overall low “reference range”. This is thought to be related to the average age of women being tested being over 50 and in menopause. The average range of a female in menopause is and should be considered significantly different than a menstruating 25-year-old. However, these values simply don't exist in most labs.
What is Testosterone?
It's the principal male sex hormone that is produced by Leydig's cells of the testes in response to the luteinizing hormone secreted by the pituitary gland. It is also produced in small amounts by the ovaries and the adrenal cortex in both males and females. Its chief function is to stimulate the development of the male reproductive organs, including the prostate, and the secondary sex characteristics: the development of the penis and testes, and the deepening of the voice during puberty.
The appearance of facial and pubic hair starts at puberty; later in life, it may also play a role in balding. Muscle size and strength. Bone growth and strength. Sex drive (libido) and sperm production. It may also help maintain a normal mood.
If you thought testosterone was only important in men, you'd be mistaken. As I mentioned earlier… testosterone is produced in the ovaries and adrenal glands. It's one of several androgens in females. These hormones are thought to have important effects on: ovarian function, bone strength, sexual behavior, including normal libido.
The proper balance between testosterone and estrogen is important for the ovaries to work normally. While the specifics are uncertain, it's possible that androgens also play an important role in normal brain function (including mood, sex drive, and cognitive function).
What is Estrogen?
It's a generic term for any of the estrus-producing compounds including Estrone (E1), estradiol (E2), and estriol (E3). The estrogens are formed in the ovary, adrenal cortex, testis, and fetoplacental unit, and are responsible for female secondary sex characteristic development, and during the menstrual cycle, act on the female genitalia to produce an environment suitable for fertilization, implantation, and nutrition of the early embryo.
In men, the hormone estradiol, or E2, is particularly impactful to male sexuality. Estradiol in men is fundamental for modulating libido, erectile function, and spermatogenesis. Estradiol synthesis is increased in areas linked to intimate function. Estrogen receptors, including the estrogen receptor aromatase, are abundant in the testis, penis, and brain. Aromatase is the enzyme in charge of converting or aromatizing testosterone to estrogens.
What is Progesterone?
Progesterone is a sex hormone that is the principal progestational agent; it plays a major part in the menstrual cycle. During the maturation of the secondary oocyte (ovum), estrogen, the principal female sex hormone, is produced at a high rate. At ovulation estrogen production is sharply reduced, and the ovary then creates within itself a special endocrine structure called the corpus luteum whose sole function is to produce progesterone.
Unless fertilization takes place, the corpus luteum disappears when it has performed its function. The progesterone it has produced is promptly carried by the blood to the uterus, as was the estrogen previously. Both hormones now work to prepare the uterus for possible conception.
Progesterone and Pregnancy?
In pregnancy, progesterone acts in a way that protects the embryo and fosters the growth of the placenta. Decreasing the frequency of uterine contractions helps to prevent the expulsion of the implanted zygote. It also promotes secretory changes in the mucosa of the fallopian tubes, thereby helping to provide nutrition for the fertilized ovum as it travels through the tube on its way to the uterus.
Another function of progesterone is the promotion of the development of the mammary glands in preparation for lactation. Prolactin, from the anterior lobe of the pituitary gland, stimulates the production of milk, and progesterone prepares the glands for milk secretion. Diminished secretion of progesterone can lead to menstrual difficulties in nonpregnant women and spontaneous abortion in pregnant women.
What is the use of Progesterone Supplementation?
Progesterone is used medically in the treatment of dysfunctional uterine bleeding and abnormalities of the menstrual cycle, as part of postmenopausal hormone replacement therapy, as a test for endogenous estrogen production, and as an adjunct in the treatment of infertility associated with partial or complete ovarian failure; administered orally, intramuscularly, or intravaginally.
I most commonly use progesterone in postmenopausal hormone replacement therapy in women who still have intact uterus and ovaries to protect against cancer.
What is SHBG (Sex Hormone Binding Globulin)?
Sex hormone-binding globulin (SHBG) is a protein that binds to the sex hormones testosterone and estrogen. Binding these hormones help control their release from the body’s tissues into the bloodstream. SHBG also transports other substances in the blood such as cholesterol, triglycerides, and thyroid hormones.
Your SHBG levels can have a profound effect on your Testosterone. For example, high levels of SHBG may limit testosterone production by preventing testosterone from being released from male testes or female ovaries. This protein also has an impact on other aspects of health including cardiovascular disease risk factors such as obesity and insulin resistance.
Testosterone and Women?
Testosterone is one of the most abundant hormones in females and is incredibly important for maintaining female health. A drop in a woman’s testosterone levels can occur as early as 20. Most reductions in testosterone production started around the age of 35. Optimizing a woman’s testosterone levels can have wide-ranging benefits not only for a woman’s health but is an essential part of preventative medicine.
The use of testosterone in women dates back to 1939 becoming popularized in women with hysterectomies. The use of testosterone pellets antedated the use of transdermal preparations. Subcutaneous testosterone pellet therapy has been used on five continents for nearly 80 years.
Testosterone supplementation may positively influence sexuality, general health, and quality of life. It has a wide range of effects via androgen receptors, found throughout the body, including the brain, skin, adipose tissue, vascular system, and bone. Exogenous testosterone positively affects bone density, body composition, energy levels, and psychological well-being.
Estrogen and Men?
Men are often unaware that estrogen (estradiol) plays a critical role in their day-to-day health. Estrogen is found in small-but-critical concentrations in men. It needs to be in balance with the rest of your hormones, especially testosterone, for you to feel well. One of the primary causes of low estrogen is low testosterone.
Men’s bodies produce estradiol, a form of estrogen, as a by-product of the breakdown of testosterone through an enzyme called aromatase. Aromatase is found in estrogen-producing tissue, such as the adrenal glands, the brain, fatty tissue, and even the testicles.
The production of estrogen in a male body is a completely normal and necessary process. Estrogen is required for the healthy physiologic functions of your brain and other important organs, including:
Erectile function and sex interest
Maintenance of bone health
Regulation of fat mass vs. lean mass
Brain functions
Lipid metabolism
Skin metabolism
What is the Aromatization of Testosterone?
Aromatization is a chemical reaction that converts testosterone into estrogen and androstenedione into estrone. Aromatization occurs within the body due to an enzyme known as aromatase that makes it easier for testosterone to be converted into estrogen.
Aromatization is a multistep reaction that involves the oxidation of a methyl group. The aromatase enzyme allows these steps to occur more readily. In regards to hormone balance, when aromatization occurs, the concentration of testosterone decreases, and the concentration of estrogen increases until an equilibrium is reached.
When is Aromatization a Problem?
Aromatization is thought to be an important method by which men produce healthy levels of estrogen. A problem can occur when testosterone levels are elevated, specifically when undergoing testosterone replacement therapy.
Aromatase readily converts more testosterone into estrogen, which can lead to estrogen accumulation. This can cause a boost in feminine traits such as weight gain, fluid retention, and a condition known as gynecomastia which is the development of breast tissue due to too much estrogen. You can see where this would be a problem in most men.
What Can We Do About Aromatization?
We can use aromatase inhibitors that work by rendering aromatase less effective at doing its job and subsequently lowering the levels of estrogen. They come in two different types: steroidal and non-steroidal aromatase inhibitors. Steroidal aromatase inhibitors are immensely potent because they essentially shut down aromatase and inactivate it. Inactivating aromatase permanently can be a necessary step to take if estrogen levels could worsen your health, such as in the situation with estrogen-sensitive breast cancer. Because these aromatase inhibitors are irreversible, they tend to be utilized more sparingly.
Non-steroidal aromatase inhibitors act similarly to steroidal inhibitors; however, they do not bind covalently with the active site of the enzyme. This allows non-steroidal aromatase inhibitors to be reversible and is a major reason why these drugs tend to be the first-line treatment.
Forms of Testosterone
Testosterone replacement therapy is available in several forms. All can improve testosterone levels:
Skin patch (transdermal): Androderm is a skin patch worn on the arm or upper body. It's applied once a day.
Gels: AndroGel and Testim come in packets of clear testosterone gel. Testosterone is absorbed directly through the skin when you apply the gel once a day. AndroGel, Axiron, and Fortesta also come in a pump. Natesto is a gel applied inside the nose.
Mouth patch: Striant is a tablet that sticks to the upper gums above the incisor. Applied twice a day, it continuously releases testosterone into the blood through the oral tissues.
Injections and implants: Testosterone can also be injected directly into the muscles, or implanted as pellets in the soft tissues. Your body slowly absorbs the testosterone into the bloodstream.
IM (Intramuscular) Testosterone vs Pellets
IM is an Intramuscular injection of a substance (testosterone) deep into the muscle. This is commonly done at least once a week though preferred more frequently. Most TRT clients will be placed on a twice-a-week schedule. Pellets are implants the size of a grain of rice or tic tac under the skin in the hip above the glutes or lower flanks. This is a quick in-office procedure completed with local numbing of the area.
The less frequent attention required by the pellet may be appealing if you have a busy life or are not interested in regular injections. As with any drug, testosterone levels will fluctuate with therapy. Because the intramuscular injection is taken weekly or biweekly, it delivers a less steady level of testosterone than pellets. The pellets dissolve over 3-6 months and deliver a more sustained steady dose.
What are Bioidentical Hormones?
HYDRO Infusions is a BioTE Certified Provider. Bioidentical hormones are generally non-synthetic and plant-based man-made hormones derived from plant estrogens in Yams and Soybeans that are chemically identical to those the human body produces. Bio-identical Hormones are commercially available, prepackaged, standardized doses of bioidentical hormones approved by the Food and Drug Administration (FDA).
Estrogen, progesterone, and testosterone are among those most commonly replicated and used in treatment. These are then used as a treatment for men and women whose own hormones are low or out of balance. Bioidentical hormone pellets are the only type of treatment providing sustained hormone levels for three to six months.
Hormone Optimization at HYDRO Infusions
Hormone optimization works to get your hormones back to peak levels. With multiple treatment options available, we can help you combat decreased sex drive, weight gain, muscle weakness, and other symptoms. If you think hormone optimization can help your wellness goals, talk to HYDRO Infusions. Our hormone specialists will answer your questions and work with you to develop a customized care plan.
