Hormone replacement therapy and the “amazing testosterone pellets” are quickly becoming the new trend in health care. Most people come in for hormone replacement for the desire to lose stubborn belly fat, increase sex drive, eliminate afternoon fatigue, and to build lean muscle. Currently, our society has a bad habit of believing getting “older” equates to fatigue, decreased sex drive, joint/muscle pain, and gaining weight. Lots of people accept this is how we are supposed to feel as we age. This perception is starting to change with the increase in hormone replacement therapy available in clinics and medspas. Increasing sex drive, building lean muscle, and a decrease in fatigue are creating an improvement of quality of life, which every human should strive for. All of these are remarkable motivation needs to become a healthier, better version of yourself. However, in this post, I want to discuss the astonishing health benefits from hormone replacement that most people don’t even think about or have a bias opinion on due to the hormone scare with the poorly, flawed research study the Women’s Health Initiative published in 2002.
When patients come in for their initial hormones consult, my first question is always “What makes you want to start hormone replacement therapy?” Like I said in the paragraph above, I usually get the same answers, “I want to lose weight” or “I have zero sex drive.” Hormone replacement therapy works wonders on those symptoms. However, hormone therapy does a lot more. Did you know the lifetime fracture risk for postmenopausal white women age 50 years is 54%? Over half of women and one fourth of men older than 50 years old will experience an osteoporosis-related fracture in their lifetime. That is over 1.5 MILLION osteoporotic fractures each year! The risk of hip fractures is equal to their combined risk of breast, uterine, and ovarian cancer. Data indicates that the death rate is higher for hip fractures than from 3 cancers. Osteoporosis affects more than 25 million Americans.
Now, that I have scared you about the long term devastating effects of osteoporosis, I have good news! Osteoporosis is a PREVENTABLE disease. Educating society about the importance of maximizing a young adult peak bone mass is of crucial importance. In one study, women and men who have received hormone therapy (HRT) have had significant improvement in bone mineral density. Bone mineral density increased by 2% in the hormone therapy group. It DECREASED 0.5% with the etidronate group (Bisphosphonates are drugs most primary care physicians will prescribe to a patient diagnosed with osteoporosis).
Moreover, osteoporosis is responsible for significant morbidity and mortality. HRT has been one of the more beneficial treatment options in increasing bone mineral density and reducing vertebral fractures in postmenopausal women. It is never too late to start estrogen treatment for bone protection. Estrogen has been considered by many researchers to be the choice for both prevention and treatment of postmenopausal osteoporosis. In another study, 9 months of HRT significantly increased bone mineral density compared with the placebo in clinically important skeletal regions. Estrogen increases and maintains bone mass. You can beat osteoporosis with improving diet, adequate amounts of Vitamin D and calcium, regular weight bearing exercises, and hormone therapy including testosterone, estrogen, and human growth hormone.
The “Amazing” Bisphosphonates ….
Now let’s talk about bisphosphonates. It bothers me as a health care provider this is still the mainstream therapy for patients diagnosed with osteoporosis. First, you are only allowed to take bisphosphonates for 5 years due to the increase chance of rare subtrochanteric femoral fractures, osteonecrosis of the jaw, and esophageal cancer. Bisphosphonates only slow bone loss. They do not even build bone. I can see you scratching your head now, and yes, in modern medicine the mainstay of osteoporosis treatment, bisphosphonates, do not re-build bone and come with a horrible side effect profile of abdominal pain, kidney stones, diarrhea, heartburn, irritability, muscle cramps, potential vision loss and the list goes on.
