Practitioners of BHRT (bio-identical hormone restoration therapy) generally favor topical forms of hormone therapy, because the real human sex steroid hormones are so easily absorbed through the skin. Once absorbed, these hormones circulate freely and function very well in the body.
MYSTERIOUS DISAPPEARING HORMONES:
Despite the obvious advantages of topical hormone therapy, every once in awhile, there’s a patient who seems unable to absorb hormones through the skin. They won’t experience the expected symptom relief, or will increase their dose multiple times, in an effort to gain symptom relief. Upon laboratory testing, we sometimes see that the circulating level of hormone is much lower than expected, even though we’ve calculated a physiologic dose correctly, and the patient reports following directions exactly.
When symptoms are not relieved, the culprit might be fatigue of the adrenal glands or blood sugar fluctuations. But sometimes when the lab values are actually low (not just symptoms, but actual lab values), then the problem may be with the skin itself. In my observation, skin can sometimes form a barrier that is “too good” instead of normal and semi-permeable.
Several times in the past few months, in my telephone consultations at the laboratory and in my own clinical practice, I have encountered cases of “mysterious disappearing hormones.” Sometimes topical hormones, given in a good human-size dose, fail to show up on lab testing. I say human-size dose because too often we see women given “horse-size” doses and/or actual horse hormones. The low hormone levels are accompanied by complaints of hot flashes and night sweats, PMS or peri-menopausal mood swings.
TWO SCENARIOS WHEN HORMONES SEEM TO DISAPPEAR:
More often than not in these “disappearing hormone” cases, the patient is also being treated for hypothyroidism. Of course untreated or under-treated hypothyroidism can have profound effects upon skin thickness, skin texture, and skin barrier functions. But even in cases where thyroid hormones have been titrated to restore full function, I still sometimes see dermal malabsorption.
A few months ago I spoke with a practitioner who has also had trouble with dermal malabsorption – but in her observation, the source of the skin problem might be genetic, not hypothyroid. She hypothesizes that Native American skin provides more of a barrier, and she had seen numerous cases where topical or transdermal hormone therapy had failed. Upon investigation, it turned out these patients had some fraction of Native American blood (as little as 1/8 in one case we discussed). I can’t remember her name, but I hope she gets a research grant to look into this hypothesis.
In both cases, the answer is simple: Assuming there is a good compounding pharmacist on call, just switch from skin cream to sublingual troche. The dosage is the same as you’d give topically/transdermally, because the route of administration is essentially the sameIf the patient has doubled or tripled the prescribed dose (which has happened to me), then you can ramp back down to your calculated “human physiologic” dose – because now it’s getting into the blood stream and it will work just fine!
TOPICAL/TRANSDERMAL vs. SUBLINGUAL:
I see a few downsides to using sublingual troches instead of topical creams. One is patients who are impatient: When they chew or swallow their troches, instead of allowing them to slowly dissolve, now you’ve got medication entering by the oral route of administration, with all the metabolites and liver strain that entails. And the pharmacokinetics of progesterone appear to speed up with sublingual administration as compared with topical, so there may be greater daily fluctuations in blood and tissue levels. Another problem is with follow-up testing; with sublingual troches, it is difficult to get the timing of saliva collection just right (because the saliva gets so saturated with each dose). So follow-up testing will need to be done with fingerstick bloodspot instead of saliva (please don’t waste your money on serum testing, because exogenous hormones pretty much don’t show up in serum until the poor person has been overloaded badly). And finally, there’s the problem of pronunciation. Just say “TRO-key” and you’ll sound like a pro.
I still feel much more comfortable prescribing topical BHRT, and adjusting the dose as needed. But it’s nice to have an alternative for the occasional case of “mysterious disappearing hormones.”
Blog Entry 09/22/09 by Dr. Deborah McKay, Naturopathic Physician, ZRT Lab Clinical Consultant
MYSTERIOUS DISAPPEARING HORMONES:
Despite the obvious advantages of topical hormone therapy, every once in awhile, there’s a patient who seems unable to absorb hormones through the skin. They won’t experience the expected symptom relief, or will increase their dose multiple times, in an effort to gain symptom relief. Upon laboratory testing, we sometimes see that the circulating level of hormone is much lower than expected, even though we’ve calculated a physiologic dose correctly, and the patient reports following directions exactly.
When symptoms are not relieved, the culprit might be fatigue of the adrenal glands or blood sugar fluctuations. But sometimes when the lab values are actually low (not just symptoms, but actual lab values), then the problem may be with the skin itself. In my observation, skin can sometimes form a barrier that is “too good” instead of normal and semi-permeable.
Several times in the past few months, in my telephone consultations at the laboratory and in my own clinical practice, I have encountered cases of “mysterious disappearing hormones.” Sometimes topical hormones, given in a good human-size dose, fail to show up on lab testing. I say human-size dose because too often we see women given “horse-size” doses and/or actual horse hormones. The low hormone levels are accompanied by complaints of hot flashes and night sweats, PMS or peri-menopausal mood swings.
TWO SCENARIOS WHEN HORMONES SEEM TO DISAPPEAR:
More often than not in these “disappearing hormone” cases, the patient is also being treated for hypothyroidism. Of course untreated or under-treated hypothyroidism can have profound effects upon skin thickness, skin texture, and skin barrier functions. But even in cases where thyroid hormones have been titrated to restore full function, I still sometimes see dermal malabsorption.
A few months ago I spoke with a practitioner who has also had trouble with dermal malabsorption – but in her observation, the source of the skin problem might be genetic, not hypothyroid. She hypothesizes that Native American skin provides more of a barrier, and she had seen numerous cases where topical or transdermal hormone therapy had failed. Upon investigation, it turned out these patients had some fraction of Native American blood (as little as 1/8 in one case we discussed). I can’t remember her name, but I hope she gets a research grant to look into this hypothesis.
In both cases, the answer is simple: Assuming there is a good compounding pharmacist on call, just switch from skin cream to sublingual troche. The dosage is the same as you’d give topically/transdermally, because the route of administration is essentially the sameIf the patient has doubled or tripled the prescribed dose (which has happened to me), then you can ramp back down to your calculated “human physiologic” dose – because now it’s getting into the blood stream and it will work just fine!
TOPICAL/TRANSDERMAL vs. SUBLINGUAL:
I see a few downsides to using sublingual troches instead of topical creams. One is patients who are impatient: When they chew or swallow their troches, instead of allowing them to slowly dissolve, now you’ve got medication entering by the oral route of administration, with all the metabolites and liver strain that entails. And the pharmacokinetics of progesterone appear to speed up with sublingual administration as compared with topical, so there may be greater daily fluctuations in blood and tissue levels. Another problem is with follow-up testing; with sublingual troches, it is difficult to get the timing of saliva collection just right (because the saliva gets so saturated with each dose). So follow-up testing will need to be done with fingerstick bloodspot instead of saliva (please don’t waste your money on serum testing, because exogenous hormones pretty much don’t show up in serum until the poor person has been overloaded badly). And finally, there’s the problem of pronunciation. Just say “TRO-key” and you’ll sound like a pro.
I still feel much more comfortable prescribing topical BHRT, and adjusting the dose as needed. But it’s nice to have an alternative for the occasional case of “mysterious disappearing hormones.”
Blog Entry 09/22/09 by Dr. Deborah McKay, Naturopathic Physician, ZRT Lab Clinical Consultant
Hormones fit onto their receptors just like a "lock and key", so any slight alteration of their chemical structure creates a "monster hormone". These resulting "monster hormones" are never found in the human body or anywhere else in nature. The reality is that these synthetically altered monster hormones should never have been approved for marketing and sale to the American People, and yet that is exactly what your mainstream medical doctor will offer you if you ask for hormones.
ReplyDeleteYears ago, after the invention of synthetic monster hormones, an information war was launched by the drug industry creating confusion in the public and even among medical professionals about the difference between natural human hormones and synthetic monster hormones. Because of this information war, we must now use the terminology, "bioidentical" hormones which really means human hormones in order to different these from the monster altered hormones.
How is a Synthetic Hormone Different from A Bioidentical Hormone? Bioidentical hormones are the hormones that exist in the human body naturally. Synthetic hormones are these very same human hormones that are chemically altered.
For more...
http://jeffreydach.com/2008/10/06/the-importance-of-bioidentical-hormones-by-jeffrey-dach-md.aspx