Archive

Archive for April, 2010

The Latest in HRT With Dr. Tori Hudson Part II

April 21st, 2010
Comments Off

Let’s go back to delivery methods.  We have these different kinds of hormones: semi-synthetic, synthetic, bioidentical, (bioidentical from a pharmaceutical company, or bioidentical from a compounding pharmacy.) That is one little clarification we should articulate again here because those are both the same and different.  Pharmaceutical companies have a few select bioidentical hormones. There is Estradiol by itself, it comes either generic or Estrace in a pill, or we have the estrogen-only patches which are actually bioidentical estradiol. Vivelle and Climara and Menostar are examples of those.  And then we have a bioidentical cream called Estrace cream.  Those are all actually made by pharmaceutical companies.  But the pharmaceutical companies only make available a small handful of doses and very select methods of delivery.  Also with the pharmaceutical company comes their patented preservative, or binder, or filler or adhesive, because, you can not actually patent the bio-identical hormone itself.  So you have to patent something special that you do to that hormone.  We are left with the limitations of the pharmaceutical company bioidentical hormones in dosing, combinations delivery methods.

Now, at our clinic, and what most people who are really accustomed to prescribing bioidentical hormones do, is they use specialty compounding pharmacies.  Because now, we can prescribe all customized and individual doses.  Maybe you don’t need just the .5, or the 1 or the 2 milligram that the pharmaceutical company makes.  We think you would do just as well with .25 or we need to tweak it a little bit and give you .35.  So, we can customize your dose and titrate the dose up or down.  We can also customize a combination.  No pharmaceutical company yet makes a combination of bioidentical estradiol with bioidentical progesterone.  They also don’t make a combination bio-identical estrogen/progesterone formula that has the testosterone in it.  So we can now individually prepare a formulation that has not only the bioidentical hormones but the select interim specific doses that we want, and in specialty combinations. And we can use other hormones that we are interested in like estriol or DHEA that have their own added benefits.  In addition, we can do this in pills, in capsules, in sublingual lozenges, in sublingual drops, in creams, in gels, in vaginal, in topical deliveries.  We have so many more variability’s and circumstances and ways that we can help women by utilizing these compounding pharmacies than by just sticking with what the pharmaceutical companies provide.  But they are, in fact, the same hormones, if we are talking about bioidentical hormones, the commercial pharmaceutical products and the compounded products have the same benefits and the same risks.  It’s just that we have a lot more flexibility, a lot more individualization, a lot more circumstances that we can help with these compounding of specialty formulations.

Dr. Tori Hudson         For excellent HRT information go to:     http://drtorihudson.com/

Menopause

The Latest in HRT with Dr. Tori Hudson Part I

April 14th, 2010
Comments Off

Transcript from the DVD “Blitzed by Menopause”:

Many of you are wondering about hormone replacement therapy and have all kinds of questions. I can really appreciate that because there really are lots of questions to ask and lots of questions to be answered.  We want to try to address all of the different kinds of hormones that are available, the different dosing issues, combinations of hormones, delivery methods of hormones, and some pros and cons and benefits and risks of hormones.  That is kind of the territory at which I think most all the questions lie.

So lets start first with all of the different kinds of hormones.  And by the way, we are talking about hormones here, we are not talking about herbs that have constituents called phytoestrogens.  We are talking about hormones, and there are hormones of all kinds.  Some are made from a natural substance and some are made from a natural substance and then turned into various kinds of hormones, and some are semi-synthetic or synthetic.

Let’s start with hormones that are made from a natural substance.  Starting with even Premarin, the kind of hormone or estrogen that has been around for the very longest amount of time.  It’s called Premarin.  It’s actually made from a “gamoosh” you might say of hormones found in the urine of pregnant mares.  And that is why they call it Premarin. Pre-Mare-In.  Pregnant Mare’s Urine.  So, these are technically a natural substance, but they aren’t identical to the human hormones, so therefore we call them semi-synthetic really.

There are also hormones that are made from a natural substance and in these cases, plants.  They extract two different ingredients out of either Mexican wild yam or soybeans.  And then they turn that substance in a manufacturing laboratory, into a hormone.  Now, we can turn that into a hormone that is not chemically identical to the human hormones, or we can turn those constituents into a hormone that is identical to the human hormones. And those hormones are ones that often receive a lot of press and attention often, and are called bioidentical hormones. A bioidentical hormone is a hormone that is derived from a plant constituent, but turned into a hormone that is biochemically identical to the woman’s hormones.  Thus, bioidentical, or biochemically identical.

But you can also take these same constituents out of a plant and turn them into a hormone that is not biochemically identical.  And many pharmaceutical options are these kinds of hormones.  And again, I kind of call those more quasi-synthetic.  So, so far we have the Premarin which is from the estrogens in pregnant mares’ urine, not biochemically identical.  We have bioidentical, plant derived, chemically identical to human hormones.  And we have plant derived that are not chemically identical to human hormones.  And then we have just bona fide synthetics that are also made by pharmaceutical companies.  Those are essentially kind of the four different categories of the different kinds of hormones that are available to women.  And some of those are actually available to men as well.  Testosterone, for example.  We have a bioidentical testosterone and we have a synthetic testosterone.  And the bioidentical testosterone available to women is currently only available from a compounding pharmacy.

For example, we can prescribe testosterone to women and to men.  It’s just that there’s not a bioidentical testosterone product available to women and there’s not even a synthetic testosterone prescription available to women as a stand alone prescription.  The pharmaceutical companies have not been allowed to produce a testosterone-only product for women yet.  They have been allowed to produce that for men.  So for women, when we want to prescribe testosterone, we have to go to a compounding pharmacy. And we can prescribe either the bioidentical testosterone or the methyltestosterone.  And we prescribe those in pills or in creams.  Testosterone is an important hormone when it comes to sexual function.  We use a bioidentical testosterone cream from a compounding pharmacy, which is a specialty pharmacy, and we put that in a cream, according to a certain dose, and it is applied to the external genital area right before sex to enhance arousal and orgasm.  We can also put this bioidentical testosterone or synthetic testosterone into a specially prepared compounded combination of hormones: estrogens, progesterone, and testosterone, for addressing sexual function as well as other menopause symptoms.  When we want to prescribe testosterone to a woman, we have to currently use a compounding pharmacy with one exception: there is a synthetic estrogen with a synthetic testosterone called Estratest, made by a pharmaceutical company.

Part II coming soon…

Menopause

The Signs and Symptoms of Menopause with Dr. Tori Hudson Final

April 8th, 2010
Comments Off

Often women ask me the question is, “How long is this going to last, Dr. Hudson?” and “When is this going to end Dr. Hudson?” and I wish I could answer that question. “It’s only going to last this amount of time”, but the truth is I can not discern this.  It’s unpredictable.  It’s different for all of us.  The severity is different for each of us, the duration is different for each of us, which symptoms we have on this long list of potential symptoms is different for each of us.

But, on an average, according to the research, menopause symptoms for seventy five to ninety percent of women last four to seven years.  Now, there’s the ten to twenty five percent of women for whom that’s different.  And we don’t know if at year three, at year four or at year seven if you are going to be on your way out of these symptoms or are you going to be one of these ten to twenty five percent that is going to last longer.  There is no way to really know that.

We are trying to get some understanding.  If you’ve had severe PMS, it seems to have some prediction on menopause being more severe.  That’s one thing we seem to see a correlation with now.  But unfortunately, we can’t really predict what your menopause is going to be like, let alone, can we predict how long it’s going to last.  But we can work with the law of averages and try to give some reassurance. And most symptoms are temporary in most women.

The problem is there’s the women that are not “most women” and the problem is that there are a few symptoms that tend to be progressive, like vaginal dryness, vaginal thinning, urinary incontinence, that set of symptoms tends to get worse with time because that tissue gets more consequences as it is deprived of estrogen for a longer period of time.  But most other things, symptoms, not bone loss, not some of those things, but symptoms, most of those are temporary in most women.

So far we don’t have any strong connections as to what your mother’s menopause was like in telling us what our menopause is going to be like.  And also, a lot of forty, fifty something year old women now who are just going through this key menopause time have mothers that in their generation, many health problems were solved by removing the uterus and the ovaries.  We have more progressive surgeries now, many more medical options, so the doctors and patients don’t have to choose that as often.  But, for some of us, we don’t know what our mother’s menopause would have been like anyway because she went through it in a rather unnatural fashion by having suddenly her ovaries removed.  And of course hormones were prescribed more easily, less judiciously, you might say, back in those days as well.  It’s more selective now, more weighing the benefits and the risk and more desire on the part of the practitioner to use hormones for the shorter amount of time mostly in this sort of temporary window of symptoms.

For men, if your partner is going through menopause, you might wonder what you can do to be helpful.  And the first thing I think to maybe look at it in terms of your previous experience with your partner is, have you already been through years or months or decades of PMS? And how that has been going and what that has asked of you.  It’s similar.

You know I think many men can find it very difficult and challenging to have empathy and really understand what is going on with their partner during this time of menopause changes.  And I empathize with that.  It’s a challenge, because often you don’t know what to expect, and you don’t know if it’s you or if it’s them.  If it’s them is it some character defect or is it a health problem.  I would just really encourage men to try to learn as much as they can about menopause and I would encourage men to ask their wives and partners questions and really kind of try to bring forth your best inquisitive self.  You’re curious.  You are asking questions, you are wanting to understand.  I think that’s a useful approach because chances are, she’s not faking it.  Chances are, she’s not lying to you about what’s going on with her. Chances are she’s really needing some help.  And if she’s had a difficult time with PMS, and that’s already been challenging for the family, it’s very similar here.  The mood swings…if it’s been difficult to deal with a teenager and their hormonal changes, it’s very similar.  It requires us being more patient, it requires us being more caring, maybe even anticipating, much like you would if someone you knew didn’t feel well.  You just try to do a little TLC.  You try to do a little bit to help out here and there and even just the littlest things can make a really huge difference.  A little piece of dark chocolate under the pillow, or “can I help you with the dishes tonight”.  “It looks like you’ve had a really hard day”.  Just a little extra and I would gather that would come back in a favorable way to you.

And I know that we want things to be balanced in relationships and you don’t want to feel like you are always trying to compensate for what seems to be not going well with your partner but men have hormonal changes too and generally that comes a little bit later and looks a bit different.  But I think just this inquisitiveness, trying to learn yourself, bring forth your best questions and empathy, I think that’s what my advice would be.

Our thanks to Dr. Hudson. For more information visit us at: www.planetsweetpea.com.

Menopause, Signs & Symptoms , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,