It is difficult to remain aloof from the ongoing debate about hormone supplementation and the risk factors involved in estrogen supplementation and the abuses and consequences of "black market" testosterone and growth hormone supplementation. However, there is a place for proper hormone evaluation and assessment, as well as ongoing monitoring once the patient is placed on any kind of hormone therapy. Dr. Casañas is an internist and as such is well versed in endocrinology and the assessment and use of hormones for replenishment purposes and recognition of side effects.
Currently one segment of the debate seems to center around the use of pharmaceutical as opposed to bioequivalent hormone supplementation. Most practitioners in the integrative health sectors of medical practice would tend to favor the use of biologically equivalent replacements since these hormones generally are found in nature and are not manufactured synthetically (not xenobiotics).
It seems that a substantial amount of the side effects that have been recently documented and debated in the literature (and the jury as far as proper or long-term usage is not in yet), seems to indicate that the use of the pharmaceutical progesterone for example has the most side effects associated with perimenopausal supplementation as such.
Bioequivalent hormone replacement does not seem to possess the same general side effects, and sometimes efficacy seems to be debatable. At this point, our best approach is to continue to monitor patients’ subjective symptoms, as well as risk factors and ongoing intra-treatment assessment by blood testing or saliva testing. Nevertheless, progesterone supplementation can be the cornerstone of a weight loss program in some patients.
There are other hormone problems that can be assessed and treated more simply and adequately without controversy and implemented for other situations such as metabolic regulation, prevention of chronic disease, and age management, as follows:
Cortisol and dihydroepiandrosterone (DHEA). We assess all patients that are entering any kind of health maintenance, age management, or weight management program to obtain a cortisol and DHEA level since these are of paramount importance in controlling metabolism. In addition, due to our social stress burden and insomnia being an ubiquitous problem, cortisol is assessed since it is elevated during prolonged periods of insomnia, as well as prolonged periods of stress. Cortisol excess will lead to early dementia, as well as memory loss and is extremely toxic to frontal lobe cortical cells. In addition, it is an immune suppressant as well. In general DHEA can be used to counter cortisol exess.
On the other hand, cortisol deficiency is the end result of adrenal gland over-secretion, and as a result over prolonged periods of time it will be depleted. We utilize blood levels for assessment, as well as once replenished and/or if not in need of replenishment, we recommend adjuvants to the adrenal system function such as natural supplements such as Holy Basil and Relora.
It is the most crucial test for all weight loss patients and for general health and age management purposes. We implement a very sophisticated approach to thyroid assessment which includes various forms found in the blood (free T3, T4, Reverse T3, etc.) that are almost exceptionally never checked by most medical practices.
Whether we supplement with a natural thyroid or synthetic thyroid, if thyroid levels are normal or they are not candidates for supplementation, patients may be given nutraceutical boosters such as: Hops, Bacopa, zinc, selenium, etc. in order to augment their thyroid specifically and metabolic functions in general.
Dr. Casañas normally performs an age appropriate screening for these hormones. However, most weight loss patients who are over 30 years old benefit from at least progesterone screening. Dr. Casañas finds that one of the best “anti-aging” creams is topical estradiol. Dr. Casañas supplies adjuvants for estrogen utilization or the actual hormone when it is deficient in either the form of pharmaceutical or bioequivalent versions. Most important testing is the ratio of estrone/estradiol metabolites.
Progesterone is probably the most important hormone to assess in most cases. Dr. Casañas has found that progesterone deficiency is profoundly linked to insomnia, restlessness, and muscle contracture which are found in most perimenopausal women and some premenopausal women. Dr. Casañas prefers the natural form of progesterone, given transdermally, almost without exception over the synthetic pharmaceutical version (Provera).
Any patient over 30 years old will be screened for testosterone and it is always checked in any weight loss program. Testosterone will induce the recovery of muscle function, improve fatigue, and lead to a general sense of well-being in most males. Sometimes transdermal testosterone is used for women with low libido in whom other causes may be unapproachable.
Dr. Casañas feels that as in testosterone supplementation, considerable controversy has been generated by growth hormone (perhaps owing in part to publicity of illegal use and regulatory overzealousness), but it does have its place in the clinically appropriate context. Growth hormone deficiency may not be common, but there are some patients that definitely benefit from augmenting their own growth hormone production by the judicious use of amino acids and other supplements and carefully monitoring to determine at what point they might need the actual pharmaceutical as they get on in years. Dr. Casañas appreciates and harvests patients for long term following and this is the realm of functional medicine par excellence.
General Natural Adjuvants
Dr. Casañas has always used adjuvants with all hormone supplementations in order to augment their desired effect, as well as to decrease their side effects. For instance, the increased consumption of broccoli may decrease the formation of estrogen in male patients on testosterone therapy, as does the supplement called chrysin. The use of tribulus terrestris and low doses of DHEA for instance may be all that a male may need to increase his testosterone production or testosterone function without necessarily using a prescription agent.