Hormone Replacement Therapy

What is hormone replacement therapy?

Hormone replacement therapy (also known as biosimilar or bioidentical hormone therapy) is a broad term used to describe the practice of stabilizing the body's natural hormone levels through the administration of various medications. Common conditions that require such treatment include menopause in women or low testosterone in men.

Who is it for?

This treatment method is typically for women who are experiecing some of the negative symptoms of menopause. It can also be used for men with low testosterone which itself can manifest in many ways such as erectile disfunction, low sex drive, obesity, hair loss, and decreased bone or muscle mass.

Treatment options

There are several methods used to treat irregular hormone levels depending on the underlying root cause and patient preference.

Hormone Pellet Therapy

This method has a smooth delivery of the hormone. These very small heat fused hormone pellets are placed under the skin in the fatty tissue. Men typically need pellets inserted every six months. Women need pellets every 4-6 months. Hormone level testing is done before therapy to determine necessity, and every 6 weeks for the first 6 months, then every 6 months thereafter if levels remain therapeutic. Inserted under the skin in the buttocks. The area is numbed, a small incision is placed and a special customized trocar is used to insert the hormone pellets. Both estradiol and testosterone pellets can be placed in this manner. However, not all pellets are created equal. Pellets are processed utilizing a "heat-fusion" method that makes them more uniform and more predictable in their hormone release pattern. The favorable thing about pellet therapy is the smooth stable release of hormone, and the need to only place them 2-3 times a year. No messy creams or gels, and no irregular hormone levels from oral or injectable administration.

Oral Routes

Oral hormone administration should be avoided except in the case of progesterone supplementation. Oral estrogens experience metabolic first pass effect and are broken down by the liver soon after ingestion. Oral testosterone, whether given alone, or in combination, undergoes similar first pass metabolism. Furthermore, methyl testosterone has been linked to hepatic carcinomas.

Injectable Routes

Injections of testosterone can be given every 7-14 days. The recommendation is to give them deep intramuscularly. For those faint of heart, the injection route may not be palatable. The typical form is Testosterone Cypionate, which is either in cottonseed oil or sesame seed oil. The injection technique may also give a "peak-and-valley" of testosterone levels, with the peak coming immediately 24 hrs after the injection with a slow progression towards the "valley" over the course of the week. This method doesn't keep a static level and may result in symptoms returning towards the end of the week.

Injectable Routes

Topical administration avoids first pass metabolism by the liver, however other issues arise. Besides having to apply to the skin on a daily basis, topical administration can be messy and problematic. In the instance of topical testosterone application, an enzyme exists in the skin that can metabolize it into 5-DHT. This can lead to undesirable side effects. In women, it can lead to undesirable hair growth.