Transcription:
The Truth About Bio-Identical Hormone Optimization

Bill Klaproth (Host): Hormones decline as people age leading to many health issues. So, one way to address this is through bioidentical hormone optimization. So, what is it, who is a candidate, and what can it do for you? So, let's find out with Dr. Mark Lowney, medical director and owner of Studio Eros.

This is the Top Docs podcast. I'm your host, Bill Klaproth. Dr. Lowney, thank you so much for being here.

Dr Mark Lowney: Hey, Bill. How you doing? Thank you for having me on.

Bill Klaproth (Host): I am so interested to talk to you about this because I find this fascinating. So first off, can you explain to us what are bioidentical hormones or BHRT as they're known?

Dr Mark Lowney: Sure. I'm going to start by just letting everybody know that I've been practicing OB-GYN for 30 years. So, I've always been very interested in age management because basically what you're doing with hormone optimization is helping people age in the best possible way they can. So, specifically, when you're talking about bioidentical hormones, it's an opposition of synthetic hormones. So, that's the two biggest categories, are bioidentical and synthetic.

So for the first 10 years of my practice or so, I was mostly prescribing synthetic hormones because we didn't know any better. Over the past 15 years or so, bioidentical hormones is becoming its own science, its own entity, and more and more people are using it and rightfully so.

So, what bioidentical hormones are in a nutshell are the exact molecule that your ovaries in the women are testes in the men make. So, it's very natural to the body and is able to help you in incredible ways, and again, we'll talk a little bit more about what bioidenticals are as opposed to synthetic hormones. But in a nutshell, they have the exact molecular molecules that are made by your body.

Bill Klaproth (Host): Okay. This is interesting. First of all, I love the term age management. I've never heard that before, that just totally makes sense to me. So, are synthetic hormones man-made hormones then or come from an animal? What is a synthetic hormone?

Dr Mark Lowney: Classically, we'll talk about, in women, synthetic hormones that are out there are made, they're not natural. They actually come from pregnant mare's urine, that's where the word came from, Premarin. So Premarin and Provera, which are the gold standard synthetic hormones that are being still used today, actually come from animals. Whereas the bioidentical hormones are mostly plant-based, coming from yams.

So, I could get into why using bioidentical over synthetic. Basically, with synthetic hormones, okay, there was a big study done back in 2002. It was called the Women's Health Initiative Study. There was over 30,000 nurses from the New England area that were given these synthetic hormones. They had to stop the study three years into it because they noticed that some of these women were getting breast cancer and they had an increased incidence of heart attack and stroke because these synthetic hormones were causing inflammation. And with inflammation, you get disease, cardiovascular disease, cancer. As opposed to the bioidentical hormones, which are being used now, that we use exclusively, this has never happened. So in terms of safety profile, the bioidenticals are very, very safe.

Bill Klaproth (Host): Okay. So, there's probably people watching this, listening to this right now, thinking, "This sounds great. Is this right for me?" So, who is a good candidate for BHRT?

Dr Mark Lowney: Okay. So, you are never as healthy as the day you turned 21. So after 21, it's all downhill. We were able to do a snapshot of men and women's hormone panels when they were 21. You would see that their testosterone, their estradiol, their progesterone levels are optimized. They're at the best possible level. Also at this time, the receptor sites in the brain, on the skin, and the genitals are very healthy.

As we get older, two things happen. The ovaries start to shut down producing hormones, specifically testosterone, estradiol, and progesterone. In men, the testicles start to reduce the production of testosterone. Also, as we get older, the receptor sites on these target organs that we talked about, the brain, the skin, the heart, the penis, the vagina, the clitoris, then they're not as healthy as they were when you were in your 20s. So most people, when you hit the age of 40, you'll notice that you're starting to have the symptoms of menopause in women and andropause in men. And we can get into some of those symptoms if you want.

Bill Klaproth (Host): Well, yeah. So, why don't we do that? You said so, when we're younger, our hormones are at the optimal level. So, what we're basically trying to do with bioidentical hormones is reoptimize our level of hormones. Is that right?

Dr Mark Lowney: Correct. I'll give you a for instance. When women and men hit around age 40, 40, 45, they'll start to have the typical symptoms. In women, hot flashes, decreased energy, difficulties sleeping, decreased libido, brain fog, difficulty having intercourse, dry vagina, difficulty achieving orgasm. In men, they start to have, again, decreased energy, increased weight gain, decreased muscle mass, some men get erectile dysfunction. And if you take a look at their hormones in their 40s, for men, most men function well when their testosterone levels are between 800 to 1000, okay? Most men over the age of 40, their testosterone levels are between 300 and 500.

Now, if you go to your primary care doctor that isn't aware of bioidentical optimization, they'll say, "Oh, you're normal. As long as you're 301, that's considered a normal level." Once you drop under 300, then they'll start to talk to you about starting you on testosterone replacement therapy. Same thing in women. When women, sometime around age 40 to 50, their estradiol levels start to go down to zero, their testosterone levels start to go down to zero, their progesterone levels start to go down. And they come in again with the symptoms we talked about, decreased energy, weight gain, brain fog, sexual dysfunction. And what we do is we give them back their hormones using the bioidentical ones to bring their levels where they were when they were in their 20s. So, for instance, women will bring their estradiol levels back up to a 100; testosterone, 100 to 200; progesterone, 20 to 30, because they're completely depleted and they feel it, they don't feel good.

Bill Klaproth (Host): Right. Well, I'm thinking of my own decline here since I'm over 40. So, this is interesting. You say you give them back their hormones. So, how do you exactly optimize men and women with bioidentical hormone replacement?

Dr Mark Lowney: Sure. So, the first thing you want to do, obviously, is you want to take a history, physical, find out how they're feeling, okay? Then, we check some blood work. We want to get a baseline blood panel of all their hormones, including obviously testosterone, estradiol, progesterone, thyroid. We check vitamin D levels. We also do a lot of other testing for age management. We check inflammatory markers. We check cholesterol. We do a whole panel. So in men, we basically are checking their testosterone and estradiol. Women, we're checking their testosterone, estradiol, and progesterone and thyroid.

So once we get their baseline levels, then we introduce the hormones to them. So, there's a lot of different ways to give bioidentical hormones. There's creams, there's pills, there's injections, and then there's pellets. Pellets is our real go-to especially in women and men too. But with pellets, they look like little tiny Tic Tacs. We put them underneath the skin, usually in the hip roll area. And by doing this, we get a nice steady state hormone level for about three months. So with the pellets, you're coming in every three months to have testosterone and the estradiol in women. In men, it's just testosterone. And again, men could get pellets too, but it's all about the dosing.

So, dosing is really an art. There are certain guidelines you could use. Basically, the patient's baseline levels as well as their weight, as well as their symptoms. So when you put that all together and then you go ahead and dose them up, so I would say about 95% of my patients, they love the pellets because it's like set it and forget it. You give them the pellet and they're good for three months. They still have to take a progesterone pill at night, because they don't really have a really good pellet form for progesterone yet. Hopefully, they will soon. But the nice thing again about pellets is you get a hundred percent compliance. So the difficulty with most medications, the more you have to take it, the more times a day you have to take it, the less compliant you're going to be. If you put pellets in a person and see them, in women, it's every three months; men, it's every five to six months, you get a hundred percent compliance and patients feel great.

Bill Klaproth (Host): Set it and forget it. I like how you said that. So basically, these hormones replenish our depleted hormones, and that's how we achieve that higher level of optimization.

Dr Mark Lowney: Correct.

Bill Klaproth (Host): Okay. Another question for you that I have since you brought this up, you said you put people through a full panel, a full diagnostic panel. These are things when you go to the doctor for your regular annual exam that they don't necessarily do. You're digging in on a deeper scale. Is that correct?

Dr Mark Lowney: Yes, unless you have knowledge of age management medicine or anti-aging medicine. And again, I think more and more people are learning about this because it's all over the news and there's a lot more people that are taking these hormones. They're actually going up to their primary care doctors and saying, "Hey, how come you didn't start me on this?"

So, yeah, I guess there's more people are getting educated with bioidentical hormones, so I think we're going to see more and more of this. But yeah, typically, when you go to your primary care doctor, they'll check a blood count, they'll check a TSH, which is a baseline thyroid. They'll check a fasting cholesterol panel, and then maybe some electrolytes, maybe some liver function testing. And depending on, you know, if you're going in there for a well visit, if you're going in you're feeling sick, they may check some other things. But with us, what we do as Studio Eros is with everybody, we check all their hormone levels, like the ones we talked about, testosterone, progesterone, estradiol, thyroid. We also check their cholesterol panel. We check their liver function testing. In men, we check what's called the PSA, which makes sure their prostate healthy. And then, we try to optimize their hormones as well as if we see like their cholesterol is high, we'll talk to them about diet and exercise. There's some supplements you could take actually that could naturally help lower your cholesterol, so you don't have to go on a statin. Supplements like red yeast rice and CoQ10, niacin, fish oil, there's a lot of different things you could do out there, that are non-prescription based to lower your cholesterol.

Bill Klaproth (Host): Got it. All right. So, how does a patient get started with you then? Is it as simple as just making an appointment?

Dr Mark Lowney: Yeah, the best thing to do is to either call my office and I can leave you with the number or go to the website and there's a link on the website to make an appointment. My website is studioeros.us. And my phone number is (877) 577-5476. I do bioidentical hormones. I also have a full-time nurse practitioner. She's excellent and not only does she optimize hormones, but she also does a lot of sexual wellness procedures, which again is another podcast for another time where we could talk about how to enhance and optimize sexual function as you get older.

That probably

Bill Klaproth (Host): would be a very popular podcast and we should consider doing that for sure. So, another question I think that people would have is, is BHRT safe?

Dr Mark Lowney: Yes. We alluded to that Women's Health Initiative Study earlier about synthetic versus bioidenticals. And so far, there are no studies showing that bioidentical hormones are not safe. If you think about it, if you're just replacing the testosterone and the estradiol and the progesterone using the same molecular compound that your body makes, it has to be safe.

It's interesting because if you had a thyroid deficiency or if you had a pancreatic deficiency where you were diabetic, most doctors wouldn't think twice about putting you on a thyroid medication or putting you on insulin to correct those two problems, but they're a little bit afraid to put you on testosterone or estradiol or progesterone. And again, I think it all goes back to that 2002 study where the synthetic hormones were proven to be dangerous. And now, everybody lumps all hormones together. They don't divide them out between the synthetic and bioidentical.

So, I'm going to be 60 next year. I've personally been on bioidentical hormones now for 12 years. My wife's 56, she's been on them for about 10 years. And if you look at our cholesterol profiles and everything's great. I mean, my internist one time came up to me and said, "Oh, did you start on a statin?" And I said, "No, you know, I eat healthy, I exercise, I optimize my hormones, and I take a few supplements to keep my testosterone optimized, my cholesterol low." So, yeah, I mean, I practice what I preach, I have family members on it, most of my staff is on hormones. So, I guess the long-winded answer, yes, they're very safe.

Bill Klaproth (Host): Yeah. So, it sounds like age management, it's up to you. Age management is in your hands. And I thought what was really interesting is when you said what is considered normal for a person that is aging really might not be optimal. So even though you go to the doctor and, yep, everything's normal, that doesn't mean it's optimal. That's kind of my big takeaway away. Is that correct?

Dr Mark Lowney: That's so accurate because, again, we were talking a little bit about testosterone. If you're a male and you're a testosterone level is 301, you are normal, but you feel terrible. You're falling asleep, you're gaining weight. You may be experiencing an erectile dysfunction. You have no libido. You have no energy. You bring that person up to 800 to 1000, it's like you set the clock back 30 years. People feel great. I have women coming in that are in their 50s that haven't had sex in years because they have no desire to, and it hurts. I optimize them and they start to cry and they're like, "How come everybody isn't doing this? Why don't they put this in the water? This is incredible."

Bill Klaproth (Host): So, how long does bioidentical hormones take to start working? Is this like, "I'm going to put the pellet in and within two months, three months..." or how long before you really start noticing the difference?

Dr Mark Lowney: So, most people start feeling the effect of the BHRT the next day. And like I said, in women, it will last for three months, men five to six months. And then, the followup question a lot of people ask me is, "How long do you have to be on these?" And the question is, "Well, how long should you keep going to the gym? How long should you keep eating healthy?" Of course, it's for the rest of your life. This is a lifelong change. You're doing this just like you don't go to the gym once a month or for six months and then stop. You don't eat like a whole food, plant-based diet for six months and then stop. I mean, this is a lifestyle change. I tell patients as long as you want to feel good, keep taking it. The day you want to feel like crap again, stop

Bill Klaproth (Host): So, I would imagine then one of the next questions is do you then once a year reevaluate to make sure that the dosage, I guess, is correct? Is that how it works?

Dr Mark Lowney: Well again, with the pellet therapy, we see women every three months and men every five to six months. So at that visit, we ask them how they're feeling. And if most of the time we can make little adjustments just based upon their symptomatology, so if they'll say, "Yeah, I, was feeling really good, and then all of a sudden my libido's not as good as it used to be. Could you tweak up the testosterone a little bit?" Yes. So, we dose to effect during the year. And then every year, we check another followup hormone panel just to make sure that everything's in a safe range because you don't want to go super physiological because if you give too much, even though it's safe and it's bioidentical, there are side effects. For instance, with testosterone, you could start getting acne, you could get hair growth. So, you have to be careful. You have to know what you're doing. You have to keep an eye on people and, at least once a year, recheck their labs.

Bill Klaproth (Host): Got it. Okay. That sounds great. This has really been fascinating, Dr. Lowney. Thank you so much for your time. Anything else you want to add about BHRT?

Dr Mark Lowney: I would say the most important thing is to make sure that if you're going to consider it, go to somebody who's experienced, that knows what they're doing. Check their credentials because, like anything else you do, you want to make sure you're going to the right person and they're doing the right thing for you.

And secondly, don't be afraid. I would say the only absolute contraindications to go on hormones is people that have an active cancer going on. Not because the bioidentical hormones are going to make your cancer worse, but because I think, if you're being treated for an active breast cancer, an active prostate cancer, you really want to have your oncologist on board. And I do have patients that come in that have had breast cancer that go on bioidentical hormones. And I always say, "I have to have the blessing of your oncologist. I believe in it. I don't think you're going to get a recurrence with your breast cancer. I don't think that hormones cause breast cancer, bioidentical hormones that is." But make sure, and I do many, many, many times, I get the oncologist write me a letter saying, "Dr. Lowney, keep going. Patient feels great. I'm on board with this." So, that's the only other caveat. If you do have an active cancer in your body, make sure your oncologist is on board with your bioidentical hormones.

Bill Klaproth (Host): That sounds great. Dr. Lowney, thank you so much for your time. Once again, if someone wants to learn more or book an appointment with you, what should they do?

Dr Mark Lowney: So, my website is studioeros, E-R-O-S.us, or they could call me, our phone is (877) 577-5476.

Bill Klaproth (Host): Dr. Lowney, this has been fascinating. Thank you so much.

Dr Mark Lowney: Thank you. Looking forward to another podcast with you guys.

Bill Klaproth (Host): Absolutely. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is the Top Docs podcast. I'm Bill Klaproth. Thanks for listening.

Dr Mark Lowney: Thank you, Bill.