Bioidentical Hormones and Naturopathic Medicine – Part 1
Hello, I’m Doctor Kyle Cronin and I’m honored to speak today about my experience using bioidentical hormones in women’s health as a practicing naturopathic physician.
A little background. I graduated from National College of naturopathic medicine in Portland, Oregon back in 1981. When I went through school, as naturopathic physicians, we are taught a lot in terms of how the physiology works and then how the body will heal itself in that physiology, and then our strong suit is knowing all these various natural therapeutics medicines and ways that we can help support the body in healing itself.
So back when I was learning about women’s health and hormones, we learned that there were many estrogens. As a good example, the ovaries make estradiol, which is “E2” the adrenals make an estrogen called estrone, or “E1”. These are very strong estrogens and the body’s job, then, your body goes, “oh my goodness, that’s a lot of estrogen and so it has the liver right here under your right ribcage, the livers job, which it does about 500 different jobs, it’s so it’s a very busy organ (I love the liver), but basically the liver has to convert these really strong estrogens to a mild estrogen called estriol or “E3”.
And so we learned all this process and how that would work with the physiology of women’s health and how different homeopathy, botanicals, physical medicine, dietary measures would all be useful in helping the body with these hormonal balances. And when I then went into practice, at that time, there were really no longterm already out there, female naturopathic physicians as role models. Those of us were just coming up, had just sort of graduated. And so I was happily surprised when it came to the valley and kind of the more current woman to practice there as a young doc that, you know, people came in and they said, well, we want to see you. And I said, “Well, I’m right out, you know, I’m just out of school” “No, you’re a woman and you’re practicing naturopathic medicine. We want to see you.” So I go back for whatever; menopause or PMS or infertility or all these things. And I’d go back in the notes and all the things that I had learned that are historical from my teachers for generations …they worked! It was so exciting.
I was really quite pleased because here it was unfolding that it was a very satisfactory medicine practice. I was thrilled and I feel very blessed for that. At that current time, the hormone replacement was Premarin, which is the horse estrogen that they would then synthesize and come coupled with synthetic tags and tails. So Premarin was used in a cycling format with Provera and so you would have Premarin and then you would have Provera for the last two weeks with that.
And it would bring the hormonal menstrual cycle back and women would come in and say, I just got rid of my flows I don’t want these things back again. And so I remembered speaking. We had lovely MD friends that were practicing with what they’re taught with that and they were frustrated. Then it changed and because they had so much frustration from women so that they would use it as a, not cycling but a continuous. And so that’s kind of how it moved into being continuous hormone replacement therapy. At that time, the tools that I had were still mostly only homeopathic, dietary, acupuncture, physical medicine, botanicals, nutritional supplements all work wonderfully for helping relieve symptoms of menopause. But we really hadn’t quite caught up yet for how to use bioidentical hormones.
Bioidentical Hormones and Naturopathic Medicine – Part 2
More on hormones: I first heard about bioidentical hormones from national public radio, they spoke about France using Estriol, which remember is that liver clearance? Very mild. It’s like 80 times milder, considered nontoxic relative to estradiol, which is a strong estrogen and they’re using it in Europe. And I’m like, “Oh my goodness, I would love some of that,” but couldn’t get my hands on it. So eventually this wonderful a woman, a pharmacist, managed to get it into Arizona. And I started working with using a little bit of bioidentical, which means a hormone that is synthesized usually from a soy, but it’s made to be absolutely as if your own body made that molecule so it’s identical and the body completely understands and can read that chemical hormone. So basically, we had estriol suddenly available and started to be able to use it maybe 25 years ago now.
And at the same, around that similar time, a little bit later, there was a hormone test that researchers had been doing for about 50 years. I say about that, where, it’s a urine test. And because it was looking at hormones in the urine, you could see the breakdown of all these different estrogens that I had learned about in school in conventional medicine, when they’re looking usually just simple for hormone levels. Of course, it will be a blood test and the blood estradiol is actually, the only thing you can really see, well in the blood test. The urine test started to be available. I could watch how hormones; either how the woman was making her own hormones, or, if she was taking something, how it was being metabolized in the system. And I began to see that this test really gave a lot more accurate way to safely use hormones.
They also added, which is wonderful, (I love adrenal hormone measurements in the urine), not just the different estrogens and progesterone, but it will also check things like DHEA, cortisol, cortisone, and their breakdown products, testosterone about six of its breakdown products and something called pregnenolone. Over the years of using the test and using the various bioidentical hormones, what I’ve learned is that when women are going through menopause, they really just need a little bit of hormone replacement for symptoms over maybe five years and then they’re done. What I’ve found from watching the testing and from all of the intake and feedback with women over many years, is that you can’t just suddenly cut people off of hormones because these hormones are managing your whole metabolism, your metabolic physiology, so if it would be as if someone had to use thyroid hormone and then they say, okay, you get thyroid hormone from 50 to 55 and you’re done, and then suddenly they have all the symptoms and disease process that you would have from suddenly not having their thyroid continued. Well in the same way, when you’re looking at the use of these biodentical hormones for female hormones or adrenal hormones, you’ll notice that everybody has different amounts of hormones, so it is not one size fits all. You really do need to look and assess, where is the woman’s hormone level for a particular item and then find out whether they need it or not. There are some very fortunate women who I’ve known (I’ve had two patients over the years that had complete hysterectomies, so no ovaries), and yet their adrenal glands, which in postmenopause really takes over taking care of a lot of the hormonal balance. Their adrenal hormones were strong and they made all of the amounts of estrogen, progesterone, DHEA, testosterone, everything that they seem to need in a very nice balance.
Bioidentical Hormones and Naturopathic Medicine – Part 3
Now, we kind of come back to that idea about how they were originally doing prescriptions and cyclic versus continuous and now there is still currently controversy over how to use hormones. You have to realize that this whole hormonal field is very new. When I first went through school, they said, “DHEA, it’s the largest hormone made by the adrenal glands. We have no idea what it does [laughs], oh, okay!”
Over the years they’ve had really good information that it does support our stamina for health, anticancer, helping with a sense of wellbeing. In fact, there was one study that I had come across where women, or people in general, who had a little bit more of that DHEA, which is kind of the counterbalance to cortisol. Everybody hears about cortisol as an adrenal hormone. That’s our fight or flight response and one that we’re overstressing with.
DHEA, on the other hand, is kind of that, “Ah, you know, the bills are paid. I’m feeling pretty good. Let’s be creative. What do you want to do?”, hormone, So that’s kind of the DHEA side, whereas the cortisol is like this, “Oh my goodness, I have so many errands, I don’t know what to do next!” We have a balance within us on both of those and the more I watched about things like estrogen and progesterone, the more I learned that post-menopausal. It is very important to look at the balance about things like our cortisol and our DHEA. And of course testosterone that both men and women have. That’s very important for bone density and motivation and brain clarity. Well, I’ve continued to work with the 24-hour urine hormone test. It’s a little unwieldy because you do have to collect the urine for an entire day as opposed to just going and getting your blood drawn at that moment, but it is because of the metabolism of the hormones that you can really see the individual metabolism and safety and use.
I do not fall in the camp of wanting to have women have their cycles back, so I don’t use bioidentical hormones to try to create a period. My concern is that overuse of strong amounts of hormones for an extended period of time, I remember that that can be wear and tear for potential cancer. I’m looking for just enough of what I consider a baseline level that is the baseline for the body to help repair and heal itself for maintenance. So I’m a pretty light-handed prescriber. I would love to be able to do without them, but I find that most of us post-menopausal, we have run our adrenals ragged. They don’t usually support us as well as they could.
I have had people who have been in the camp where they were using bioidentical hormones and then we’re told to or even the Premarin and, then would be told to go off five or six years later they come out, they seek me and they say, “Well, yes, I was on hormones and then they took me off and ever since then, and then they’ll have a checklist of all these things that start to develop because the body just doesn’t have the spunk that it needs to help repair. So I am looking for the smallest amount possible that is more of what we’re using for physiologic repair, kind of like when we’re kids, we’re really not looking to support pregnancy with hormones anymore.
In fact, there was an interesting little tidbit that I tell patients: we are fortunate as women as, apparently, whales, in that we live past menopause. Many other mammals do not live past menopause. So if I need to help it a little bit so that I have the extra quality of life and a little bit more fun and longevity, it has moved me a bit into that longevity camp. I’m really not looking at hormones just from a “let’s get rid of hot flashes” mode anymore. I have wonderful tools that help the system to work with those side effects symptoms. Some women will get perimenopausal and menopausal. As it turns out, I’ve used the hormone testing and the bioidentical hormones more and more for repair of health and for longevity.