Much more concern and confusion now centres on HRT (hormone replacement therapy), which is composed of synthetic versions of the ‘female’ hormones, oestrogen and progesterone. The apparent panacea turned out to have a dark side, when HRT was found to actually raise the risk of heart disease and breast cancer following the large Women’s Health Initiative study in 2002.1 This has left millions of women in their forties and fifties in a dilemma. Do you plump for the benefits of HRT and hope to avoid the side effects? Or do you stay off it and hope to find something else? Official medical advice is that short-term use – two years – is not linked with an added risk. Even so, many have stopped taking it. In the wake of the 2002 study, the number of prescriptions in the UK and in the US has halved. In the years since there has also been a significant decline in the number of breast cancers.2
Natural vs Synthetic Hormones
There is a solution that is widely used in the US but little known in the UK. It involves the same hormones found in regular HRT but they come in a subtly different form known as ‘bio-identical’, which means that they are exactly the same as the ones your body was making until it reached the menopause, or the andropause in the case of men. The ones used in HRT are not identical, and this is very probably the reason for the problems they have caused; for example, a type of oestrogen still widely used (over 500,000 prescriptions were issued in England alone in 2010) is known as conjugated oestrogen and comes from the urine of pregnant mares, so it contains types of oestrogen normally only found in horses. The best-known brand is Premarin, and this was used in the Women’s Health Initiative trial.
The replacement for progesterone that is used in regular HRT is known as progestin (or progestagen), and the best-known brand is Provera. It also has a significantly different chemical structure from progesterone. This is linked to the very different effects the two have: progesterone is the hormone made in large amounts during pregnancy, it is also a diuretic, and it decreases the risk of blood clots, has antidepressant effects and helps to build bone. Progestins can cause miscarriages, fluid retention and blood clots, and it is linked with mood swings and can reduce bone density.
Hormones Decline with Age
The fact is that hormone levels do often decline dramatically later in life. Testosterone deficiency can result in lack of sex drive, lack of motivation and depression in both men and women. Lack of oestrogen results in vaginal dryness and lack of progesterone, from which all these hormones can be made, results in lack of everything. Also, progesterone dampens down adrenal hormones so a common effect of progesterone deficiency is more anxiety, bursts of anger, insomnia, tight and aching muscles, all of which are often found in the menopause.
As you can see from the diagram below progesterone is the ‘mother’ of all hormones, itself made from cholesterol. (Beware statin enthusiasts – driving down cholesterol too low eg below 3.5mmol/l could lead to hormone deficiency.)
The body will always make cortisol – the stress hormone – in preference to anything else because it is to do with our immediate survival. This may not actually be the case when you get stressed watching the news but your body thinks it is so. Consequently, DHEA levels go low. The more stressed you are the higher the cortisol and the lower the DHEA, until you are completely burnt out in which case both go low. This in turn means that there is less DHEA to manufacture testosterone. Chronically low amounts of DHEA is one of the consistent indicators that you are ageing faster than your chronological age, which is why it has become a popular supplement.
DHEA – do you need it?
DHEA is the most abundant hormone in the body, but production for both men and women peaks at age 20 and it is reduced to half that rate by age 40, and by the time you are 65 you will only be producing 10–20 per cent of your youthful level. It’s part of the pathway that produces the sex hormones, so it is likely to have an impact there and it is also the hormone that balances cortisol, the stress hormone. This means that low levels can reduce the effectiveness of the immune system, which becomes less responsive when you’re stressed. So there is certainly a logical case for restoring your levels. DHEA supplements benefit mice, but there is not yet any hard proof that they slow down ageing in humans.
Symptoms of a deficiency include:
- Feeling burnt out
- Unable to cope with stress
- Lack of drive or motivation
Your body naturally produces 35–60mg of DHEA a day, which can be accurately measured in both saliva and blood. Practitioners are likely to prescribe between 15mg and 50mg. If you are taking DHEA, you should then re-check your level after about 90 days. I sometimes recommend it to people who are burnt out for one month only, at a dose of 25mg.
The other way to increase your DHEA level is to reduce your stress and so bring down your cortisol level. Some very simple exercises that can do this have been developed by the HeartMath Institute (see my report on HeartMath They are designed to eliminate negative thought loops and to promote sustained positive emotional states. In one study with 45 volunteers, the 15 who did the exercises ......
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