Hormone Replacement Therapy: Looking at it with fresh eyes

By Jeffrey Pearson, D.O., F.A.O.A.S.M.

For decades, physicians and patients alike have been fearful of HRT, the logic being that – “if hormones are safe, then why do our bodies stop producing them? Clearly, they must turn evil after a certain age.” Alas, that is not true and enlightened physicians do their patients a service by recommending them for their patients at the appropriate time.

HRT is a means of replacing something necessary that gets lost. Best example would be an automobile – while it requires fuel to run, it also requires oil in the engine in order to prevent it from breaking down. Oil doesn’t suddenly “turn bad” after the first 100,000 miles. Neither do our hormones turn bad after a certain age.  While we run on food for fuel, our bodies require hormones to keep parts in repair.

What is a hormone? It’s a chemical messenger wherein a gland tells another part of the body to do something. Most people are familiar with insulin (which regulates sugars and fat) and thyroid hormone (which regulates metabolism). Likewise, estrogen and testosterone perform important functions in our bodies (and incidentally, men and women produce BOTH of these).

Yes, our bodies do stop making these latter two hormones usually in our early 50’s (some earlier, some later). However, it is NOT because they suddenly “turn evil.” Rather, it’s due to the simple fact that 100 years ago, we were dead.

Think about it. A white female baby born in 1910 had a life expectancy of 52 years of age, a white male baby lived an average of 49 years. Blacks fared much worse. Remember: they did not have antibiotics nor any good treatments for high blood pressure or cancer. People died early and often, hence we didn’t see cataract, joint replacements or other surgeries because our bodies weren’t around long enough to wear out.

Thanks to science – the discoveries of antibiotics and treatments for other diseases, we’ve extended the lifespan for both men and women by 30 years. However, this is artificial life extension and not due to natural evolution. So, while we have the ability to prolong life into the 80’s, 90’s and even 100’s, without a body’s hormones, our bodies continue to break down. Look around and you can see the result of this – elderly men and women with spine changes causing them to hunch forward, among other things. And, it’s totally preventable.

Everyone is familiar with the more common complaints of women going through “the change” – hot flashes, sleep problems, mood changes, for example. These are generally transient lasting months to a few years. The old doctor’s advice was “Don’t worry, dearie, you’ll get over them.”

However, the primary benefit to HRT is long-term protection against the body’s eventual breakdown. In women, hormones keep the “soft and squishy parts” soft and squishy.

Without estrogen, women’s bodies do not absorb calcium from the gut leading to osteoporosis (leading to fractures of spine, hips and wrists most commonly). Estrogen, when started at menopause, helps protect women from heart disease and some studies suggest that they might help stave off Alzheimer’s.

Testosterone has responsibilities for energy and endurance in men. In both men and women, it regulates sex drive (libido), brain function, muscle and bone mass, strength, and fat distribution.

“But surely there must be a downside to HRT, right?” That’s what was commonly believed, but recent studies have debunked many of the fears.

Let’s look at the fear that HRT can cause cancer. But first, SPOILER ALERT – WE ALL DIE! The longer that we live on this planet, the greater the chance that a cell in our bodies will mutate into something bad. Not many of us truly believe that, let’s say, if we were to smear estrogen onto a breast or testosterone onto a prostate that they would induce cancerous changes. For example, it’s well established that the men with the highest levels of testosterone never develop prostate cancer at the time – those, of course are teenage boys. And, furthermore, it’s the men with the lowest levels of testosterone who fare far poorer if they do develop prostate cancer.

However, if a breast or prostate were to develop a mutation that went on to become cancer, then HRT probably is not a good idea for those people. That’s an important distinction. In other words, hormones most likely do not cause cancer, but if a cancer were already to be present, they may feed them. (end of part 1 of article series)

[Copyright, Jeffrey Pearson, D.O., F.A.O.A.S.M.]

Dr. Pearson is a Board-certified Family Physician and a past recipient of the national “Patient Care Award for Excellence in Patient Education,’ sponsored by the Academy of Family Practice and the Society of Teachers of Family Medicine. He is the medical director of Medicine in Motion, in Carlsbad, CA.

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