Dr Amir Farid Isahak
This article taken from The Star online 13 April 2013
The acronym, HOT, which stands for hormone optimisation therapy, is about increasing levels of hormones which are within the ‘normal’ but low range, especially if accompanied by symptoms.
In my previous four articles, I explained the roles of one dozen hormones that are evaluated and corrected by wellness and anti-ageing doctors.
I have mentioned that when you go for your “executive profile” blood tests, only one hormone (TSH or T4) is tested. And when this is normal, you are told that you are okay.
Well, in fact, many other systems may be going haywire inside you. For example, for the sex hormones, most men past 50 don’t have a clue that they are andropausal (male menopause), unlike their female (menopausal) counterparts who know their status because their once regular menses have ceased.
In fact, many men in their 40’s already have low testosterone, some low enough to be defined as andropause.
How can you know that your body is healthy and working well if you don’t have a clue about the levels of all the important hormones in your body? For example, many of my patients were shocked to learn of their low HGH (growth/youth hormone) or testosterone levels. Without testing, they would not have a clue.
Many unhealthy men are also walking around with excess oestrogens, with some having more oestrogen (oestrodial) than their menopausal wives!
An anti-ageing hormone assessment would include at least 10 of the hormones mentioned in the last four articles. In future, when we understand more about the other hormones (and when testing becomes cheaper), many more will be included. The more of these hormones are corrected or optimised (if necessary), the better your health.
HRT – Hormone Replacement Therapy
I will not discuss the details of hormone therapy, but only the concepts. You should always get the advice of your doctor, and never self-medicate with hormones as the subject requires much understanding, and the wrong treatment can cause more problems for you.
In general, therapy should only be carried out by doctors who understand the subject well, after careful evaluation, and with regular reviews/follow-up.
Most of you are familiar with the term HRT, which means hormone replacement therapy. It should mean the replacement of any hormone (eg thyroid for hypothyroidism, insulin for diabetes), but the term has been hijacked by gynaecologists to become synonymous with female sex hormone HRT or simply female HRT.
Female HRT is further divided into ET/ERT (oestrogen therapy/replacement therapy), PT/PRT (progestogen therapy/replacement therapy, usually only in younger women with “oestrogen dominance”), and EPT/EPRT (combined oestrogen+progestogen therapy/replacement therapy, which is most common for menopause).
“Replacement” implies using something to replace what is deficient or absent. For women who undergo natural menopause, the decline is gradual and HRT is “optional” after weighing the pros and cons (made very confusing since even the experts disagree).
However, women who have their ovaries removed for whatever reason before natural menopause (ie surgically-induced menopause) should go on HRT because the oestrogen deprivation is sudden and drastic, and the residual oestrogen production by other tissues (eg fat) can be extremely low.
There is little controversy in the replacement/replenishment of thyroid hormones, insulin, cortisol and other hormones when these are deficient.
The controversy arises in female HRT because of unexpected adverse results after long-term studies; in the use of natural or “bio-identical” hormones as a solution to this; and in replenishing other hormones in patients who have “low normal” levels who want to improve their health.
Synthetic and horse oestrogens
All the studies, including the WHI (Women’s Health Initiative, US) and The Million Women Study (UK), which alerted the world that female HRT was not safe, only studied women who were on synthetic and/or horse hormones.
Although their conclusions are still being debated now, these studies virtually halted HRT.
It is a pity, because menopause carries many health risks, and women were deprived of the right solution.
Two to three decades ago, when I was a full-time gynaecologist, we did not have much choice of female HRT drugs. And the ones most promoted, and therefore the ones we were most familiar with, used CEE or conjugated equine oestrogens (ie oestrogens obtained from pregnant mare urine) as the oestrogen component.
The drug insert and reference books listed the active ingredient as CEE. However, since all this controversy, I notice that it is not listed as CEE anymore, but as “natural oestrogens”, which hides the fact that it comes from the horse, although it is indeed from nature!
It does provide some benefits, and is still widely used by doctors after 70 years in the market.
When female HRT was first introduced, doctors only used synthetic and/or horse oestrogens. Soon, they realised that the women were getting uterine cancers. So they added progestins (synthetic progestogens) in combination with the oestrogens. This combination reduced the womb cancers but increased the number of breast cancers instead.
Nobody of course bothered to study the bio-identical oestrogens and progesterone (natural human progestogen) because the drug companies cannot patent them.
Now we have other choices (apart from conventional synthetic/horse hormones) to treat menopausal problems, including herbal medicines, selective oestrogen receptor modulators (SERMs), selective tissue oestrogenic activity regulator (STEAR), and natural bio-identical hormones (for more on the subject, please refer to Hormones for health, Fit4life, Feb 17, 2013).
BHRT/ BIHRT – Bioidentical HRT
The controversy over BIH (bio-identical hormones) and their use in HRT (BIHRT or BHRT) continues unabated. The Malaysian Menopause Society (MMS) is bringing down Dr Tobias Johannes de Villers, the President of the International Menopause Society (IMS), to explain its stand against BIH, while the Society for Anti-Aging, Aesthetic & Regenerative Medicine Malaysia (SAAARMM) will also bring international experts to explain the benefits of BIH at their respective congresses in KL within the next few weeks.
Ironically, while MMS officially rejects BIH, its latest newsletter (April 2013) carries advertisements of both bio-identical and horse-derived hormones side by side.
Here I quote the position statement of the A4M (American Academy of Anti-Aging and Regenerative Medicine), the world’s largest medical anti-ageing organisation, which is adopted by our own SAAARMM: “It is the position of the A4M that the use of hormones in ageing patients to replenish these levels to a youthful physiologic state, when conducted by qualified physicians trained in the practice of treating age-related hormonal decline, constitutes a legitimate and important life-enhancing, life-extending medical application.
“Bio-Identical Hormones have the same chemical structure as hormones that are made in the human body. The term ‘bio-identical’ indicates that the chemical structure of the replacement hormone is identical to that of the hormone naturally found in the human body. In order for a replacement hormone to fully replicate the function of hormones, which were originally naturally produced, and present in the human body, the chemical structure must exactly match the original.
“Thus, BIHRT is a method by which replaced hormones follow normal metabolic pathways so that the essential active metabolites are formed in response to the treatment. It is the molecular differences between bio-identical and non-bio-identical that may prove to be the defining aspect in terms of their safety and failure to make this differentiation could be misconstrued.
“Regrettably, a number of articles recently appearing in various newspapers and magazines have falsely suggested that BIHRT is unsafe and ineffective.
“The goal of BIHRT is to optimise function and prevent morbidity with ageing and to enhance quality of life. With proper modification, adjustment and titration by an experienced anti-ageing physician, the benefits of BIHRT far outweigh the risks.” (Extracted from www.saarmm.org)
I fully endorse the above statements and have found BIHRT most useful in my own practice. There are many other doctors who have achieved better results with BIHRT compared to synthetic or horse HRT.
HOT – Hormone Optimisation Therapy
Now I would like to introduce a new acronym, HOT, which stands for hormone optimisation therapy. While the term hormone optimisation therapy is not new, I would like to stress that HRT was meant to replace/replenish severely deficient hormones (as in andropause, menopause and hypothyroidism) while HOT is about increasing levels of hormones which are within the “normal” but in the “low normal” range, especially if accompanied by symptoms.
What about those with “low normal” levels but who do not have symptoms? Well, actually, many don’t complain because they don’t realise or don’t know what they are missing.
Often, the deterioration in health occurs gradually, and there is a large overlap of symptoms attributed to other problems such that the patients may not complain about it, and doctors may not know if the “low normal” hormone levels are causing or contributing to sub-optimal health.
Many patients with “low normal” hormone levels (eg testosterone) report improved health and wellbeing after hormone optimisation (ie therapy to increase levels from low-normal to average or higher levels).
Anti-ageing doctors may be accused of over-treating if this concept is not understood by other doctors who just go by the lab results. Many people don’t realise that they should and could be much healthier than they are, if only they get their hormones checked and optimised.
Even if you live a healthy lifestyle, have adequate sleep, manage stress well, eat a healthy diet (plus supplements as necessary), exercise regularly (including building muscles and of course doing some qigong) and maintain your ideal weight, you should still check and optimise your hormones to achieve the best of health.