When I speak to patients in the pharmacy about their bioidentical hormone replacement therapy (BHRT) product, I like to make a differentiation between “tangible” benefits and “intangible” benefits to help explain the effects of their medication. I define tangible benefits as direct improvements in the patient’s life that they will be able to “feel”. In female patients, this typically includes relief from vasomotor symptoms (hot flashes, night sweats), low energy and vaginal dryness/atrophy. In males, these tangible benefits are often increased muscle tone, increased libido, and decreased fat around the midsection. However, some of the most important benefits of hormone replacement are their intangible effects.
Most patients are aware that estrogen replacement can help prevent bone loss (osteoporosis) as they age. Estrogen is a building hormone – it acts as a signal to your body’s cells to grow. This is important in skeletal health, as estrogen helps to build strong bones (with adequate calcium and vitamin D intake). Prevention of osteoporosis is one of the primary benefits of hormone replacement therapy in females, as a weaker skeleton can lead to hip fractures and other bone breaks. These fractures take a toll on the patient not only physically, but financially as well.
One of the other primary intangible benefits of estrogen replacement is the protective effect on the central nervous system. Estrogen has been shown in observational clinical trials to reduce the risk of developing Alzheimer’s disease by 54% (Morrison et. al. 1996), and also delays the onset of the disease , even in those who had a family history of Alzheimer’s (Tang et. al. 1996). Researchers have found that the longer the duration of estrogen replacement therapy, the lower the risk of developing Alzheimer’s (Zandi et. al. 2002).
In both male and female patients, replacement of testosterone often leads to increased mental clarity and focus, both tangible benefits. Testosterone also helps with cognitive function in men (Morley, 2003) and a strong correlation has been shown between low bioavailable testosterone levels and memory loss (Chu et. al. 2008). Researchers have also found that replacing testosterone may reverse (to a degree) cognitive dysfunction (Lyngdorf et. al. 2004).
These studies show evidence of the intangible benefits of hormone optimization in both male and female patients. When prescribed conservatively, formulated correctly, and dosed in congruence with the scientific literature, bioidentical hormone replacement therapy can improve a patient’s quality of life considerably.
Morrison, A., et al. “A prospective study of ERT and the risk of developing Alzheimer’s disease in the Baltimore longitudinal study of aging.” Abstract, Neurol 1996:46:A435-6
Tang, M.,et al. “Effect of oestregen during menopause on risk and age at onset of Alzheimer’s disease.” Lancet, 1996; 348 (9025):429-32
Zandi, P. et al. “Hormone replacement therapy incidence of Alzheimer’s disease in older.” JAMA 2002; 288 (17):2123-29
Morley, J. “Testosterone and behavior”. Clin geriatr Med 2003; 19:605-16
Chu, L., et al. “Bioavailable testosterone is associated with a reduced risk of amnestic mild cognitive impairment in older men.” Clin Endocrinol 2008; 68:589-98
Lyngdorf, P., et. al. “Epidemiology of erectile dysfunction and its risk factors: a practice-based study in Denmark.” Int Jour Impot Res 2004; 16:105-11