(Part 3 of a 5-part series)

Steroid hormones work in the nucleus of the cell. Once they are absorbed, they do not leave the cell. This is called cell binding. Sex hormone-binding globulin (SHBG) is a glycoprotein that binds to sex hormones, specifically testosterone and estradiol (one of the three estrogens). SHBG is reduced by weight, stress, Provera, growth hormone, insulin, and poor nutrition (alcohol, low fiber, high fat). SHBG is increased by oral estrogens, pregnancy, thyroid hormone, and fiber. Binding can make serum testing or regular blood testing unreliable. You don’t know how much of the hormone is free in the blood stream. You cannot replace a hormone accurately if you don’t know how much is really deficient. Estrogen, progesterone, testosterone, and DHEA are derived from cholesterol. They are fat-soluble and not soluble in plasma (or the blood being tested at the lab). The majority of free steroid hormones are absorbed into the extracellular (area outside of the cell) space in the first pass through a capillary bed. Only FREE hormones exhibit effect in target cell. 99% of unabsorbed steroid hormones are bound in the liver, and are therefore not measurable in the blood stream.

Salivary testing correlates best with free hormone levels in capillary serum, and therefore, with tissue levels. There is no SHBG found in the salivary gland, so the results are consistent levels despite stress and other factors that change levels of SHGB. Lipophilic (fat soluble) substances pass into salivary gland by passive diffusion. The salivary gland mimics hormone diffusion into body tissues.

Go www.salivatest.com for the reasons to have saliva testing for your hormones rather than blood testing.

In the first 9 months of 2010 alone, there were over 250 papers using saliva testing on PubMed.com (the clearing house that most of us as medical providers and researchers go to for the latest research so we can practice evidence-based medicine). It IS the standard of care for steroid hormone testing.

Bio-Identical Hormones give back what is missing to achieve balance in the face of stress, menopause, or other hormone imbalance. Hormones given back to the body need to be identical to what is missing in:

• Substance
• Dose
• Duration

This rules out most pharmaceutical agents and herbals, because they are not identical to what is missing in the body even if they are natural. We have a special relationship with the plant kingdom so we will be synergistic with herbals. However, pharmaceuticals made from horse urine are also natural…and not good for the treatment of hormone imbalance in human beings.

We already replace the following deficiencies and diseases with accurate testing of deficiency and bioidentical hormone treatment in the following conditions:

• Diabetes (insulin)
• Hypothyroid (synthroid)
• Electrolyte deficiencies

We don’t just rely on symptoms to make the diagnosis of these, then why should we with hormone therapy for PMS and menopause?

This is what is wrong with Oprah’s shows and Suzanne Sommers’ book. Blood levels and symptoms alone are being used to follow the HRT. Ms. Sommers uses the Wiley Protocol, which requires escalating levels of estrogen at a rapid rate. The theory is to overwhelm the body with the missing hormone in order to achieve that sense of well-being that has been missing for so long. If any monitoring is done, it is done through blood draws. However, when the blood level is up to normal, the blood is saturated, not the tissue. This is not indicative of what is going on in the cell and usually reflects an OVERDOSE of the hormone; which will make you feel fabulous for about 6 months and then you will crash. A hormone overdose, even if it IS bioidentical,  increases more receptors, which creates more hunger for the hormone, which makes more receptors, which makes the hunger go up, which makes more receptors…end result is Suzanne Sommers who is taking 30 times more than she needs to! Don’t start the roller coaster. It creates a hormone addiction in your body that must then be fed constantly.

Here are some FAQs I hear:

What about oral estrogen and testosterone? Why use creams?

The first pass through the liver during the metabolic process increases the production of carcinogenic estrogen and stimulates clotting factors, which contributes to the increased risk of thrombo-phlebitis and stroke. Transdermal application goes into the venous system but avoids the first pass portal system in the liver. The BHRT goes to the heart first, and then through the liver. Vaginal use of BHRT creams will also allow some to go through portal system on the first pass. The better solution is to apply only to the upper body.

What about Prometrium?

Prometrium is a natural progesterone in oil (micronized progesterone). Anyone with a known or unknown (many people don’t know they have one until they take this medication) peanut allergy can react poorly. The thing about Prometrium is that the liver metabolism is unpredictable. About 20% of patient discontinue using Prometrium because of the long side-effect profile.

Can I stop my estrogen if I have been on it for a long time?

Yes, but you should only do so under the careful supervision of a trained BHRT medical provider. You should never be stopped abruptly. You should always taper using a compounded cream. And you should be aware that the women who suffer the most in any hormone transition are the ones with adrenal and thyroid issues and those who still eat sugar. SUGAR is the most common reason women get hot flushes.

What about over the counter progesterone creams?

These can sometimes be all you need if you are estrogen dominant and low on progesterone. However, not all OTC creams are created equal. At Fern Life Center, we carry one that we recommend and ask our patients not to switch because they will notice abrupt changes between brands. Here are some tips:

• Avoid wild yam cream (can’t convert to progesterone in human).
• Avoid creams in tubs or jars (too hard to dose accurately).
• Only use USP progesterone.
• Best are metered dose pump creams.
• Cream should be smooth. If gritty, the progesterone is cheaper, larger grain, and will be less effective.

How to Apply Creams

• Apply to clean skin.
• Inner forearm and upper arms.
• Rub in until gone.
• Areas of thicker fat absorb slower or breakdown before absorption into bloodstream (abdomen).
• Inner thighs ok as an alternative.
• Ok to rub progesterone only near breasts for fibrocystic breast changes (but only under supervision of medical provider).
• Keep cream away from spouse and kids. Be mindful of towels and pillow cases.

What about Pellets?

• Levels go too high and overdoses hormones. The saliva testing sky high. Hard to follow.
• Levels peak at 1 month overdose and then fall below baseline at months 4-5.

What about the Wiley Protocol?

• Uses rapidly escalating doses.
• People feel wonderful at first and then awful after 4-6 months.
• Make sure your pharmacist is not Wiley certified. He or she will tell you that the dose you are taking of BHRT is too low.
• This is meant to get you euphoric on a hormone ADDICTION.

Next week I will talk about adrenal fatigue as part 4 of this 5 part series on BHRT. Remember that you cannot achieve hormone balance if your pancreas, adrenals, thyroid, and brain are not in the game too!

Here’s to your health…