Hormone Replacement Therapy (For All Women)
This is perhaps the most complicated subject I’ve encountered. Hormones are anything but simple.
Now that I’ve have both ovaries removed, I’m in what’s called “surgical menopause.” So my body no longer produces its own hormones. And since I’m not yet at the age of menopause, it’s particularly dangerous for me to go without any hormones. It’s also incredibly debilitating to be without them. I had to wait 3 days after my last surgery to begin using a hormone patch, and I honestly thought I was dying. Granted, I’d just had two back-to-back surgeries, but the total and abrupt hormone depletion is no joke. Hormone depletion zaps your energy, cognitive functioning, sex drive, and effects things like organ function and muscle tone. I REALLY care about these things. But hormone replacement therapy (or HRT) is very much an art form, and testing the levels is tricky and often imprecise, depending on how your hormones are administered (i.e. transdermal is easier to test than orally-administered hormones; here’s an article on the difference between oral and transdermal).
I knew I wanted bioidentical hormones, but beyond that it was all a bit confusing (and I don’t pretend to have it all figured out yet). But I became a devotee the minute I slapped the obnoxiously-branded hormone patch on my butt post-surgery. I was like a wilted flower that had just been given fresh water, and I started to perk up a bit immediately — that’s how fast it works.
Bottomline: Ask for bio-identical, sequential hormones (estrogen every day, progesterone 12 days a month; you will bleed monthly). Consider a cream or a troche (lozenge with fast sublingual delivery). Avoid pills and combined continuous patches. Unopposed estrogen (without progesterone) is dangerous, so get both.
Dosing: Hormone dosing is an art form. They will try to give you very low doses, but sources I trust recommend higher doses of bio-identical hormones (synthetic hormones are the ones linked to cancer, particularly with unopposed estrogen). I’m taking 2 mg estrogen daily (cream or troche), 100 mg progesterone 12 days per month (troche), 1 mg testosterone daily (cream), all bio-identical from a compounding pharmacy. (Your insurance likely will not cover the compounded formulas.) I’ll continue to update this page as that dosing shifts.
A few things of note:
Patches need to be changed weekly (in most cases) whereas transdermal creams or gels are applied daily. I started out with the Climara Pro patch with estradiol (estrogen) and levonorgestrel (progestin). The estrogen is bio-identical, but the progestin is not. It’s also combined continuous, as opposed to sequential (with varying levels and progesterone only 2 weeks per month, which more closely mimics how our bodies operate naturally). The inferiority of combined continuous hormones, coupled with the visible branding on the patch, have led me to seek out an alternative. I plan to take this for the rest of my life (some women taper off eventually, but I plan to continue so I can enjoy the benefits), so getting it right matters.
Our ovaries produce not only estrogen and progesterone, but also testosterone. And that ovarian testosterone contributes to maintaining sex drive, muscle tone, and cognitive functioning. (Read more about it here.) And yet, most doctors will not proactively suggest that you add testosterone into the mix, nor are there any patches/pills that offer all three hormones. So you must take matters into your own hands. Ask your doctor for a testosterone cream (which you’ll likely need to get at a compounding pharmacy). I’m still fighting with my insurance (Blue Shield of California) to cover the cream (they do cover the patch). Just like I felt an instant boost when I applied the patch, I felt a similar boost in energy when I started applying the testosterone cream — so it’s worth the effort (and money). I apply a 1mg cream daily
Consider the Wiley Protocol, a controversial, bioidentical, rhythmic (meaning it varies over the course of each month, as opposed to being static) hormone protocol, which replaces your hormones with a formula that mimics the hormonal cycle of a young 20 year-old woman. I’d recommend discussing it with your endocrinologist (mine is willing to try to replicate and experiment with it on me to see how I feel, but I’m still trying to reach the company or find a doctor that can share more info with my doctor — if you have the formula or a prescribing doctor that would be willing to speak to another medical colleague about it, let me know!) Check out T.S. Wiley’s interview with Dave Asprey on the Bulletproof Executive for a more in-depth explanation.
I recommend reading Dr. Winnifred Cutler’s book, Hormones and Your Health, for a good explanation of HRT research and the importance of bio-identical, sequential dosing. She is a reproductive biologist and has been researching this for decades.
My thyroid was also disrupted during this process, which further depleted my energy levels (it’s a wonder I’ve been able to get out of bed in the morning). My treatments at Q360 have been helping with this, as have the liquid minerals I’ve added to my routine (they were totally depleted), and I’ve started using the Japanese toothpaste and switched to Kangen water, both of which further aid in thyroid regulation (see my explanation of both here). You can ask your doctor for a more in-depth thyroid panel than the basic one that is ordered. I’ve also started running a diffuser with myrtle oil, which has thyroid-regulating benefits (and it smells lovely).