Aging Skin and Hormones -Is there a link?

ZRT Labs:
Hormones & The Skin
It certainly isn't news that hormones are involved in skin health. But it may be news that effects of declining estrogen levels are more obvious on the skin of the face than elsewhere on the body.
How so? Read on.
Lower Hormone Levels = Lower Skin Vitality
Women and their doctors have known for a long time that the decline in hormone levels as we age has a negative impact on skin properties, and we typically see skin thinning, wrinkling, discoloration, and dryness. This is because hormones are intrinsically involved with maintaining collagen content, skin lipid levels, elasticity, wound healing, and glycosaminoglycan content. Not only do hormones act at prolific receptor sites throughout the skin, but also several cellular components of skin including the sebaceous glands, fibroblasts, sweat gland cells, subcutaneous fat cells, and epidermal keratinocytes actively produce androgens and estrogens for local use.

Hormone Therapy-Important Things to Consider

Hello BLOG community!

I've been getting questions more and more these days surrounding all of the options in how to take hormone therapy and what's best for an individual.  And keeping the individual at the forefront of decision making in choice of therapy is definitely key.  The wide, wide, world of hormone therapy has opened up almost exponentially over my 20 years of providing personalized hormone therapy and  is now becoming more accepted in the medical mainstream.  In fact, I have many physicians, nurses, chiropractors, and nurse practitioners that I design custom compounded hormone therapies for each and every month.  

Lets face it, we are all aging, and feeling good is important especially when it comes to the plethora of symptoms that women and men can experience in the aging process. And just to refresh everyone, these are some of the common aging concerns that I hear about from patients seeking guidance on hormonal imbalance. 

WOMEN

fatigue, weight gain, sweats, brain fog, depressed mood, hot flashes, decreased sex drive, osteopenia or osteoporosis, insomnia, anxiety, diminished vitality, disinterest, PMS, PMDD, and mood swings.

MEN 

fatigue, depressed mood, lack of initiative, increased abdominal fat, brain fog, decreased stamina, decreased sex drive, erectile dysfunction, decreased self confidence, indecisiveness, sweats, hot flashes. 

These are some important points to consider when it comes to hormone replacement therapy and in making the decision about the best plan for YOU. 

1) Testing is important

I would personally never take any kind of hormone therapy without testing my levels of hormones.  The days of cookie-cutter, 'lets give this a try', shot gun approach type medicine are far in the past and we now have great tools to assess and address hormonal imbalances.  The most common options in testing are blood, saliva, or urine.  If your provider is unwilling to test your hormone levels, I would raise an eyebrow of suspicion and simply ask, "why not??"  If you want to test by saliva or urine, don't hesitate to reach out to me.  I can walk you through the simple process of testing which is a MOST EXCELLENT way to evaluate hormones and more.  It's how I test my own levels.

2) The type of hormone used is important

Do your homework.  For me, only bio-identical hormones will ever be used.  Bio-identical hormones are molecularly identical to what our body produces from a physiological standpoint.  Synthetic hormones, (birth control pills included), are not my preference because of the chemical makeup of the hormones, the sources of the synthetic hormones, and the side effect profile associated with synthetics.  If you don't believe me take a look at the common adverse side effect profile for Premarin and look at it's source 'pregnant-mare-urine' (yuck), thus the name Pre-mar(e)-in. Furthermore, synthetic hormones do not include a very important estrogen called Estriol (E3).  Bio-identical hormone replacement therapy allows those tested hormone levels to be addressed and restored directly to the needs of the individual.  That's personalized medicine at it's best. 

3) Delivery method of hormone replacement therapy is important

It seems that convenience is very important to people, but I would warn, cannot be placed out of order when it comes to some of the more important things that must be considered first, like delivery method of the hormones, the correlating metabolism of those hormones by delivery method, and the side effect potential.   The majority of patients I design hormone therapies for are receiving conservative daily doses of hormones as capsules, creams, and dissolvable oral troches, and there are many (especially men), who do patterned injections through commercial products on the market every week or two for their needed hormone dose.  I design and promote these options because there's a lot of patient control over the hormone dosing, there's important aspects correlating with how an individual metabolizes each hormone, and if discontinuation or reduction of dose is needed, it's as easy as withholding a dose, or reducing the dose, or prolonging the time until the next injection.  Liver metabolism is also very important and using delivery methods that are more protective to the liver over time can be significant.  Hormones are typically used for several years so this is critical for the long haul in using a replacement therapy.  Also, through the right testing options we can even assess if a person would likely benefit from a capsule over a cream in terms of how the receptors are affected with a particular hormone.  Amazing right?! Knowledge if Power!

I suppose that pellet therapy also needs to be included in this discussion. Although maybe considered convenient, pellets are little designed slow release hormone vectors about the size of a grain of rice that are inserted under the skin with local anesthesia and 'wear off' over a period of 3 to 6 months.  The supra physiologic (high) dosing contained in a hormone pellet raises concern because once that pellet is inserted, its in, and there's no going back when it's discovered that the dose didn't go so well for a person.   I've seen many patients over the years coming my way asking what to do for their horrible acne breakouts on the face, the increased facial hair, the aggressive feeling and irritability, the body rash, the scalp hair loss, and more after getting a pellet inserted.  Sadly, I have to tell them that they will have to have it removed (if possible), or wait until it wears off.  Which remember can be a matter of months, not days....Yikes!

Here's something else to think about with pellets. What if all of a sudden there's a lump discovered in the breast, or abnormal bleeding and the pellet has just been placed?  Polycythemia for men is also something to think about and needs to be monitored carefully.  Waiting for a wear off of the inserted pellet hormones is not something that's going to be reasonable for the recipient.  Also, ask for a copy of your hormone lab work and see where your levels are before having the next pellet inserted.  I've worked with patients and reviewed their chart only to find that the levels were still quite high at the 3 month mark or beyond and another pellet was placed anyway.  

4) Your hormone therapy provider/prescriber is important

Please make sure that you find a provider that is well educated in hormone therapy.  I've seen a lot of pop-up clinics come about over the years and when I start receiving the same prescription components, and the same dosing for each patient that comes through that clinic, I become especially concerned.  A weekend certificate class or symposium is not ideal.  You want a provider that is highly dedicated to this highly complex field of hormone therapy. Be careful with your provider choice.

5) Costs

Price is an important aspect to consider also when it comes to anti-aging and hormone therapies.  It's important for an individual to know that they can maintain the cost over a reasonable amount of time.  I commonly tell people that their hormone levels did not suddenly hit low levels overnight, nor will they automatically be restored overnight.  It takes adequate time of consistent dosing to get a good steady state effect and to see optimal benefits.   Believe me, I see and hear of some super pricey therapy options and then adding the lab work on top, and the maintenance fees, and follow up provider calls or office visits, etc., making it very cost prohibitive for a person. Compounded hormone therapies are typically very affordable because the personalized formulation contains multiple restorative hormone agents as an all-in-one therapy eliminating the need to buy separate prescriptions for each.  Over the years I've taken multiple therapies that a person has been using, and have found a way to combine the therapy into a single source of therapy.  That's always well received and appreciated. People are usually pleasantly surprised when I share the costs of maintaining therapy through compounding options such as capsules, creams, and troches.  

So, as you can see hormone therapy has a lot of important aspects that have to be considered. We are all trying to manage the budget as best we can for our good health and for our aging needs.  The best type of hormone replacement for each individual is the priority and having an understanding of each of the options is essential.  Please, please, please check out a book or two, do some research, ask about providers in your area, get a referral from a trusted friend, but ultimately determine what's best for you.  My desire is to get you thinking and to make you more informed about the plan you choose to go with.   If I can answer any questions or provide more information please email: drsonjaobryan@gmail.com 

Be Well!

Dr. Sonja O'Bryan, Pharm.D., ABAAHP,