Many women and men feel the changes in hormones as early as their mid-thirties. The most common symptoms are depression, weight gain, poor libido, skin changes and vaginal dryness (in women). Women may experience these symptoms even if they still have their monthly cycles.

The first step in figuring out whether symptoms are related to hormone changes is to have hormone levels tested. I usually recommend checking some basic bloodwork and thyroid levels in addition to estrogen, progesterone, testosterone and DHEA levels. Normal hormone levels do not rule out a hormone problem. Some people with low-normal hormone levels may develop symptoms of hormone deficiency.

We check hormone levels with bloodwork or saliva tests. I often start with bloodwork as that is more likely to be covered by insurance. If the hormone levels are low, I offer patients several alternatives.

Men can use a medication called Clomid to increase their testosterone levels. Clomid is especially useful in young men because it does not reduce sperm count the way testosterone therapy does. If men choose to start testosterone therapy, I explain the pros and cons of testosterone injections, creams, patches and pellets. Men choose which of these are best based on their preference.

In women, I recommend bioidentical hormone replacement therapy when natural therapies do not alleviate menopausal symptoms. Bioidentical hormones differ from standard, synthetic hormones because they are the same molecular structure as the hormones the ovaries make. Bioidentical hormones have less side effects and less risk of blood clots and stroke than standard hormones. Less risk does not mean no risk, and I always discuss these pros and cons with my patients prior to prescribing.

 

Anne Hermann, MD is a board certified Internal Medicine physician trained at Columbia University, New York. She was first author in the study that demonstrated that bioidentical progesterone cream is absorbed as well as progesterone pills. (Over-the-counter progesterone cream produces significant drug exposure compared to a food and drug administration-approved oral progesterone product.*) As a research pioneer on bioidentical hormone therapy, Dr. Hermann has been treating men and women for 12 years in Tampa Bay. For additional information on hormone therapy, visit DoctorHermann.com. See ad right.

 

* Hermann AC, Nafziger AN, Victory J, Kulawy R, Rocci ML Jr, Bertino JS Jr.J Clin Pharmacol. 2005 Jun;45(6):614-9.