The controversy over hormone replacement risks has been going on for over 3 decades, now. What is uncontroversial, however, are the   seemingly contradictory opinions that arise over the same scientific data.  One month, is good and safe, the next month, a newspaper article describes it as ‘unsafe.’ 

Fact #1: Both women and men must have estrogen (estriol, estradiol, estrone),

testosterone and progesterone in the blood stream.  These hormones are necessary to maintain the health of essentially every organ and tissue in the body.  Neither good, nor bad, these hormones must be maintained in rather tight ratios, relative to each other, in order to maintain health.  These hormones are healthy and youthful if maintained in the appropriate ratios.  They can result in damage and disease if the ratios are not determined and monitored.

Problem #1: This is where the problem arises: does your physician test for these hormone levels, and does your physician understand the nature of hormone ratios? These hormones are present in your body during times of health, the levels are greatest during youth and decline steadily with age. As you age, the levels decrease, but the ratios can change to unhealthy ratios.

Fact #2:  Progesterone is the naturally occurring hormone, Progestin is not.  Clinical studies, looking at the safety of HRT in patients that already developed breast, ovarian and uterine cancer, demonstrated that estriol, estradiol, estrone and progesterone were safe to administer.  Progestin, on the other hand was a problem.  Note this well:  Progesterone is not the same thing as Progestin.

Problem #2: Most physicians will prescribe hormone replacement without baseline blood levels of these hormones.  This is when and why hormone replacement can be dangerous.  If these hormones, bio-identical or not, are administered without determining baseline and treatment hormone levels, dangerous ratios can and will result.

Fact #3: A Bio-identical hormone is a chemical messenger that is chemically identical, not ‘similar’ to the chemical messenger found in the human system.    Many of these hormones come from animal sources, some are chemically manufactured or are derived from other biological means. 

Problem #3: Estrogen and Progesterone must be maintained, in balance, to avoid PMS like symptoms, ‘bitchiness,’ and depression.  The problem is usually too little progesterone, although both estrogen and progesterone levels do decrease with age. Excess estrogen is often known as ‘estrogen dominance.’ The answer may be as simple as the administration of progesterone.  Breast cancer incidence increases with age,   just as estrogen, progesterone and testosterone levels decrease with age.  If these hormones cause cancer, why does cancer tend to occur at ages when the levels actually decrease?

Fact #4: Blood testing is the only reliable means to determine hormone levels in the blood.  These chemical messengers do their work through the blood stream, and it only makes common sense that determination of blood levels is the proper approach.  Unfortunately, many patients are sold on the idea that salivary levels are ‘superior’ in some way to blood levels.  One would be led to believe that spitting in a tube will give you more consistent results than a blood draw.  Having performed paired determinations of salivary levels and blood hormone levels, I have found that the salivary results are rarely consistent with the blood levels. 

Problem #4: Almost is not good enough.   In order to properly determine blood levels of these hormones, it is simply not good enough to perform hormone testing that lacks scientific validity.  Unfortunately, many patients (and some physicians) rely on salivary hormone testing as a guide. Salivary hormone testing is available without a doctor’s prescription, which is what makes it popular.  It is not reimbursable by most (if any) insurance carriers because salivary hormone testing has never demonstrated consistency in results.  Simply stated, the US Food and Drug Administration (FDA) has not approved salivary hormone testing because the results are unreliable and inconsistent.  The FDA does approve blood testing of the same hormones, and insurance carriers do cover the blood determinations. 

Fact #5:  Low blood testosterone and DHEA levels lead to loss of libido, depression and other illnesses.

Problem #5: As you age, DHEA, sometimes known as the ‘fountain of youth hormone,’ decreases. The body uses DHEA to produce progesterone, testosterone, estriol, estradiol as well as other hormones.  There is more DHEA in the blood stream than any other hormone.  Why is it, then, that physicians rarely test the blood for adequacy of this vital hormone?  

Summary:  Replacement of the naturally occurring hormones is safe.  There is little data to suggest that replacement of these hormones to restore proper hormone levels in appropriate ratios will do anything but reduce the risk of heart disease, reduce the risk of osteoporosis, and actually reduce the risk of cancer.