Over the past several decades, hormone replacement therapy (HRT) has been concurrently at the forefront of medical science, and the focal point of public interest, while being effectively prepared and administered to millions of patients. While researchers and physicians have been making great strides in knowledge and treatment, Oprah has talked about it, Suzanne Summers has written about it, and Empower Pharmacy has provided HRT as a means help patients get back on the road to good health and wellness.
In general, HRT is the method used to treat the symptoms of menopause and other hormonal imbalances in both sexes. However, HRT is most often spoken of (and will be so here) as female hormone replacement, which is traditionally contrasted with testosterone replacement therapy (TRT). Nevertheless, it should be made very clear that both HRT and TRT may be required by and administered to either gender. More specifically, custom HRT is a method of providing specific hormones (which often involves combinations of hormones) in the exact dosages required to meet a patient’s uniquely individual needs. The method by which hormones are customized is called ‘compounding’.1
In the 1930s, Canadian researcher, biochemist, educator, and co-discoverer of insulin, James Bertram Collip turned his attention to endocrinology.2 It was during this decade that he pioneered the isolation and study of the ovarian and gonadotrophic hormones, more specifically by extracting estrogen from the urine of pregnant women. Although initially used to treat menopause symptoms such as hot flashes and vaginal dryness, by the 1960s Collip’s findings had captured the imagination of millions.
Since the 1962 introduction of Premarin, the first estrogen pill, manufacturers of sex hormones have generated a marketing and cultural suspicion that hormone replacement therapy may do harm than good. Estrogen's heyday started with a 1966 book for the masses, titled ’Feminine Forever’ by Manhattan gynecologist Robert Wilson whose strong financial ties to hormone makers gave him a clearly biased perspective. The book shocked the world by calling menopausal women "castrates" if they didn't take hormones. Through his nationwide tours Wilson won women over with scientific-sounding promises of youth, beauty, and better sex. The U.S. Food and Drug Administration (FDA) banned Wilson from certain types of research for making such unsubstantiated claims. After the book, millions of postmenopausal women were taking the "Youth Pill" for all of life’s ills. Other books and magazine articles followed, pushing estrogen as a salvation for older women and suggesting that it might prevent cancer. Hormone manufacturers even produced films to educate doctors about hormone treatments, many of which contained utter misinformation, some of which still persists today. All media forms falsely reported that hormones improved every woman’s quality of life. However, in the later part of the 1990’s, a number of women were questioning the use of HRT. Some of the common questions that arose were: “Did all women need it?” and “Why were all women put on the same dose and not different dosages?” In 2002, the results of an extensive women’s study by the Women’s Health Initiative (WHI) looked at the effects of HRT (both Premarin and Prempro). Its findings overwhelmed the medical community by establishing that HRT in fact did not decrease a woman’s chances of getting heart disease, but rather definitively increased her risk of blood clotting, stroke, and breast cancer.3
Today we are far more knowledgeable regarding HRT diagnoses, and discerning which populations should receive and benefit from it. Lastly, unlike HRT of the past, modern day HRT administration is followed up by continuous monitoring and the repeated tweaking of hormonal levels to provide the necessary safeguards.
Functions of HRT
Hormone replacement therapy is the method used to treat not only the symptoms of menopause, but all other hormonal imbalances as well. A hormone will only act on a part of the body if it ‘fits’, and can therefore be thought of as a type of ‘key’. Its target site (such as a cell) has specially shaped receptors which are analogous to ‘locks’ on their cell walls. If the key(hormone) fits the lock (receptor site), then the hormone will work by impacting the target site (cell), and altering the function of its tissue and/or organ. The primary affected glands include:
- Pituitary gland- inside the brain, oversees the other glands and keeps hormone levels in check. It can also bring about a change in hormone production somewhere else in the system by releasing its own ‘stimulating’ hormones.
- Thyroid gland- inside the neck, controls the rate of metabolism.
- Parathyroid glands- inside the neck surrounding the thyroid gland, control the level of calcium in the bloodstream.
- Adrenal glands- atop each kidney, make a number of different hormones, such as adrenaline and cortisol in times of stress, as well as sex hormones.
- Pancreas- inside the abdomen, an organ of digestion which makes insulin to control the amount of sugar in the bloodstream.
- Ovaries- inside the female pelvis, make female sex hormones like estrogen.
- Testes- inside the male scrotum, make male sex hormones like testosterone.
Some common problems of the endocrine system that may be addressed by HRT include: diabetes- too much sugar in the blood caused by problems with insulin production; premenstrual syndrome- symptoms include cramping, bloating, breast tenderness and mood swings; and thyroid problems- when the gland is overactive (hyperthyroidism) or underactive (hypothyroidism).
How Hormone Replacement Works
The endocrine glands receive feedback from the hypothalamus - a small but important part of the brain which contains several small nuclei with a diversity of functions. It plays an important role in both the nervous and endocrine systems. All vertebrate brains contain a hypothalamus, which in humans, it is roughly the size of an almond and located just below the thalamus and right above the brain stem. Linked to another small and vital gland called the pituitary gland, the hypothalamus controls certain metabolic processes and other activities of the autonomic nervous system by synthesizing and secreting neurohormones, often called hypothalamic-releasing hormones. These hypothalamic releasing hormones control and regulate the major endocrine glands (pituitary, pineal, thymus, thyroid, adrenals, and pancreas) as well as within the sex organs (male testes and female ovaries). Hormones are your body's chemical messengers, they travel throughout the bloodstream to specific cells, tissues, and organs where they work at varying speeds inducing a wide range of homeostatic and other physiological processes central to which are:
- The release of 8 major hormones by the pituitary gland
- Growth and development
- Cellular repair
- Body temperature
- Hunger, thirst and food, and water intake
- Sexual behavior and reproductive functions
- Daily cycles in physiological state and behavior also known as circadian rhythm
- Mediation of emotional responses and mood
- Circulatory and respiratory function
The goal of HRT is to optimize function, prevent morbidity with aging, and to enhance quality of life. With proper modification, adjustment, and titration by an experienced anti-aging physician, the benefits of HRT far outweigh the risks. Anti-aging physicians remain steadfastly at the helm advancing hormone replacement therapy, thereby providing crucial research data to ultimately negate the controversy and confirm the safety and efficacy of HRT.
Types of Hormone Replacement Therapy
Millions of women, from every age and background, experience some form of hormone-related health condition during their lifetimes. For many women, help comes in the form of hormone replacement therapy.
Hormones produced by our pharmacy have the exact same chemical structure as naturally occurring human hormones. Consequently, your body recognizes them and allows them to mimic the function of the hormones the body produces on its own. HRT may be useful for relieving the symptoms of a variety of conditions common among women of all ages, including:
- Premenstrual Syndrome (PMS)
- Irregular menstrual cycle
- Hot flashes
- Post-partum depression
- Decreased libido
- Weight gain
- Fibrocystic breasts
- Vaginal Dryness
- Painful sexual intercourse
- Sleep disturbances
- Night sweats
Mass-Produced HRT Formulations Are Useful But Limited
There are many mass-produced hormone treatments on the market today. However, every woman's body, and her individual hormonal makeup, is different and each requiring a unique balance of hormones. That's why more women are turning to custom compounded HRT from Empower Pharmacy for their hormone replacement needs. We specialize in preparing a variety of custom supplements, and we can compound a customized HRT solution to suit your very specific hormone needs.
Working with both you and your physician, your Empower Pharmacy compounding pharmacist will assist in evaluating your serum or saliva tests and hormone evaluation worksheet. By studying and interpreting your results, your care team will determine an individualized course of treatment for you. Then, with your healthcare provider's prescription, we can prepare hormones in a variety of strengths and preparations including:
- Sublingual drops or troches
- Gels and foams
- Topical or vaginal creams
- 1. United States Pharmacopeia, Chapter 795. Pharmaceutical Compounding-Nonsterile Preparations. Revision Bulletin, Official January 1, 2014. http://www.usp.org/sites/default/files/usp_pdf/EN/gc795.pdf
- 2. Historica Canada, People, James Bertram Collip 2008 July. Bliss M. http://thecanadianencyclopedia.com/en/article/james-bertram-collip/
- 3. Int J Fertil Womens Med. 2003 May-Jun;48(3):106-10; discussion 137-8. Impact of WHI conclusions and ACOG guidelines on clinical practice. Gass M.