Home Women's Health Hormone therapy offers options

Hormone therapy offers options


“Feel younger and happier!” “Age healthier!” “Get your energy back!”

Search online for “hormone replacement” and those are just a few of the advertising claims you’ll see.

As men and women age, there’s a natural decrease in hormone levels. Today, thanks to pharmacology, it’s possible to replace some of our natural hormones.

However, doctors warn hormone therapy is no fountain of youth.

“It’s normal for even healthy men to lose about 1.6 percent of their testosterone per year, and other co-morbidities — diabetes, obesity or certain medications — can make it worse,” said Dr. Deepak Pruthi, an assistant professor of urology at UT Health San Antonio’s Long School of Medicine.

“Many men come to our clinic seeking testosterone, and I imagine all the commercials about things like energy, strength, muscles, sexual prowess and whatnot have increased patient interest,” he said. “But, the symptoms can be broad and vague. Weakness, decreased libido … there’s a broad network of causes, and in most people it’s a combination of things.”

While some males suffer unusually low testosterone, and can benefit significantly from therapy, the deficiency needs to be measured with blood-serum tests, Pruthi said.

And in many cases, lifestyle changes such as a healthier diet, weight loss and exercise can actually increase testosterone levels and decrease symptoms sometimes known as “male menopause.”

“There’s a lot of controversy. Testosterone replacement isn’t an innocuous treatment,” he said. “I would say hormone therapy should be a joint venture between physician and patient, and should have very clear goals.”

Dr. Randal Robinson, a specialist in obstetrics and gynecology at UT Health San Antonio, noted another caution for males — reduced sperm count.

“I see young couples for fertility issues,” he said.

Some young men who have taken anabolic steroids (a combination of natural and synthetic testosterone) learn too late their chances of fatherhood may be permanently harmed.

For women, replacing hormones naturally lost in aging has been clearly shown to mitigate some menopausal symptoms such as hot flashes, age-related bone loss and diminished collagen, Robinson said. However, in 2002, the National Institutes of Health’s Women’s Health Initiative indicated such therapy could also heighten the onset of cardiovascular disease and breast cancer.

Those results should be measured against other factors, the physician said.

“That caused a widespread panic in patients and providers, but the problem with that trial was the average age of patients was the middle 60s, so those women were already at increased risk of cardiovascular disease,” Robinson said.

Women under 60 who are within 10 years of menopause may still see real benefits from hormone replacement, he said. Like Pruthi, he stressed the importance of working closely with your medical professional to consider individual issues, to determine if the therapy is prudent.

“I use a more in-depth physical exam and a holistic approach,” said Dr. Marissa Zajac, an assistant professor in Developing Osteopathic Clinical Skills at University of the Incarnate Word School of Osteopathic Medicine.

“In my perspective,” she said, ”the body maintains a delicate balance in which all organ systems are involved. Even the gut microbiome and unique genetics play important roles. With all these major stakeholders, one can be off and it affects all systems.” She added she uses her clinical skills to determine structural and physical changes in order to find out what is causing the hormone imbalance.

Zajac noted in her integrative-medicine practice, this approach helped her evaluate common issues for perimenopausal women, or those going through the transition to menopause, such as fluid retention, swelling, and changes in connective tissue, differently than relying on blood tests or statistics.

“This allows for hormone therapy to be used for relief of symptoms for shorter time periods and at lower dosages. When other underlying issues are corrected, barriers to hormone health are removed,” she said.


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