LEVER 7: What Hormones You Take
Understanding what your hormones are doing is highly useful information. The challenge lies in accurately measuring your hormone levels and interpreting the test results.
THE DUTCH TEST
Mark Newman, founder of Precision Analytical Laboratory in Oregon, is also the developer of the DUTCH Test, which stands for Dried Urine test for Comprehensive Hormones.
“I’ve had a really narrow focus my whole career, in that of hormone testing,” Mark says. “I’ve built and directed 24-hour urine testing, then some blood testing, and a whole lot of saliva testing, and over the years looked at the pros and cons of the three main tests.”
The DUTCH test, which uses dried urine, is innovative in a number of respects, and offers several benefits over older hormone tests — all of which have their drawbacks and limitations.
For example, a conventional (liquid sample) urine test gives you metabolites you simply can’t get in a blood or saliva test, but the collection method can be quite messy and inconvenient.
The DUTCH test has been commercially available for about four years, and I believe it’s the simplest, most elegant and informative go-to test for anyone considering bioidentical hormone therapy.
One of the biggest problems is that some hormones fluctuate throughout the day. Cortisol, for example, rises as soon as you get out of bed and then declines as the day wears on.
If your diurnal pattern is dysfunctional, meaning you’re low in the morning and high at night, you have a serious problem. But a 24-hour urine test cannot show you this.
That’s really the advantage of a saliva test, which is done several times over the course of a day. By taking multiple samples throughout the day, you can get a more accurate measure of your cortisol pattern. The drawback is the collection method, which can be time consuming and tedious.
The DUTCH test, on the other hand, captures all of that information and more in one simple test. Simply urinate on the filter paper on the collection device and let it dry.
Those test strips are then used to give you a complete hormone panel, including metabolites, (which can’t be measured in blood or saliva), effectively replacing multiple testing methods.
HORMONE REPLACEMENT THERAPY
Hormone replacement is a complex topic, and medical recommendations have fluctuated back and forth when it comes to replacing hormones like estrogen in women suffering from symptoms of menopause and surgically induced medical menopause following a hysterectomy.
In the past, Hormone Replacement Therapy (HRT) was also widely prescribed for preventive purposes, based in part on early observational studies that had suggested it could help protect women against heart disease, weak bones, and dementia.
In fact, many may not know this, but I was a paid speaker for the drug companies in the mid-80s, promoting the benefits of hormone replacement therapy. This was about 10 years before I converted to natural medicine and 15 years before the landmark studies showed the serious dangers of standard hormone replacement therapy.
The tide quickly turned a decade ago…
In July 2002, the 15-year long Women’s Health Initiative (WHI) abruptly ended its combination of estrogen and progestin therapy study, three years ahead of schedule, when their data revealed higher rates of breast cancer, heart attacks, strokes, and blood clots in the population taking the hormones, compared to those receiving a placebo.
The WHI findings triggered enormous changes in the use of hormone therapy, and by 2003, prescriptions had dropped by 38 percent.
Between 2001 and 2011, estrogen replacement therapy in women aged 50-59 subsequently dropped by a whopping 79 percent. Now, a new study1 suggests that denouncing the use of HRT across the board may have been a mistake, especially for women having undergone a hysterectomy.
This certainly makes sense, since your body needs estrogen and other sex hormones for optimal functioning. As reported by both Forbes and Time Magazine, anywhere from 18,600 to as many as 91,600 women in medical menopause may have died prematurely over the last decade as a result of avoiding estrogen replacement.
According to the study4, a conservative estimate of the true number of deaths caused by estrogen avoidance is likely to be around 50,000.
BE CAUTIOUS OF SYNTHETIC HORMONE REPLACEMENT
Synthetic progestins (like Provera) are responsible for many, if not most, of the detrimental side effects of HRT. For example, one meta-analysis published in the British Medical Journal in January 20057 found that synthetic HRT is linked to an increased risk of stroke, typically ischemic (caused by blockages of blood flow to your brain). In fact, synthetic HRT boosts your risk of stroke by almost one-third, and your risk of fatal or disabling stroke by more than half.
One of the trials reviewed in that meta analysis also linked synthetic HRT with higher risks of both breast cancer and heart attack. The trial (which included almost 17,000 women over 50), also found taking HRT for five years doubled your risk of life-threatening blood clots. Other potential side effects of HRT include:
- High blood pressure
- Vaginal bleeding
- Skin rashes and acne
- Weight gain
BEST TO USE BIOIDENTICAL HORMONES
Premarin (the most popular estrogen replacement) comes from horse estrogens and is not bioidentical. While it may sound “natural,” I recommend avoiding animal estrogens for hormone replacement, as there are excellent human bioidentical estrogen hormones easily available through any compounding pharmacist. Your body recognizes these as “normal” and virtually identical to the hormones produced in your body, which makes them far safer than synthetic prescription versions.
There are three types of estrogens commonly used in bioidentical hormone replacement therapy: estrone, estradiol, and estriol. A common mixed formulation known as Tri-est includes 80 percent estriol with 10 percent each of estrone and estradiol.
Estradiol is the primary human female hormone found in all premenopausal women, whereas estriol is produced in significant amounts during pregnancy. Estriol is considered the safest of the three and is the most commonly prescribed. It has been used safely for decades, and I believe it’s particularly useful when you’ve had a hysterectomy.
Unfortunately, there is still much unnecessary concern about bioidentical estrogen supplementation. What the FDA, most doctors, and patients do not realize is that bioidentical hormone supplements can actually optimize your health. That said, your hormone levels should ideally be monitored by either blood, urine, or saliva, to ensure they reach a target level that corresponds to the reference ranges for healthy young women. I also believe that menopausal hot flashes that do not resolve with phytoestrogens such as black cohosh, are another valid indication for short-term estrogen use. However, if estrogen is used, it is nearly always wise to use it in conjunction with natural progesterone.
As always seek expert advice before jumping into hormone replacement and we strongly suggest using as natural routes as possible.