Contrary to popular belief, hormone imbalances don’t only affect females going through menopause. According to medical professionals, they can also occur in women—and men—earlier in life.
“In medical school, we learned that hormonal imbalances usually occurred in patients in their 50s and 60s, and it’s still true that generally women spend around 30% to 40% of their lives in hormonal decline,” says Newark-based osteopathic physician Lisa DiRenzo, D.O., who specializes in functional medicine. In her practice, she’s seeing these changes in patients as young as their early 30s.
DiRenzo explains that many modern lifestyle factors can cause hormonal decline, including high stress levels; medications, including statins and antidepressants; the “sad American diet” and its impact on gut health; nutritional deficiencies and increased inflammation; or a premature hysterectomy. Andropause, a reduction in testosterone that can affect physical and mental wellness, naturally occurs in men as they age and may also be caused by testicular surgery, DiRenzo adds.
The most common symptoms of hormonal decline in women are fatigue; mood issues, such as anxiety and depression; hot flashes; vaginal dryness; insomnia; loss of bone density and muscle tone; decreased libido; night sweats; and weight gain, she notes.
Up until the late 1980s and early ’90s, doctors routinely prescribed synthetically manufactured oral estrogen and progestin (the synthetic form of progesterone) replacement therapy for women suffering from chronic and sometimes debilitating symptoms, DiRenzo says. But she notes this treatment became taboo when researchers discovered these synthetic hormones often caused inflammation, and clinical trials suggested links to an increased risk of breast and uterine cancers.
“We’ve learned a lot since then and have come a long way in treating hormonal imbalance more naturally,” she points out.
DiRenzo treats both men and women with bioidentical hormone replacement therapy (BHRT), which uses plant-derived compounds that are chemically identical to those the human body produces. These compounds are delivered into the body using a variety of methods, including cream, gel, patch, injection, pill, vaginal ring, and pellet.
More than 90% of DiRenzo’s patients receive sustained-release pellets composed of estrogen and testosterone, which are inserted under the skin in the outer upper buttocks. For men, the treatment is just testosterone. Compounding pharmacists produce these pellets by customizing dosages based on each patient’s specific needs “instead of mass-produced or one-size-fits-all hormone therapies,” she says.
Brandi Gregge, a board-certified family nurse practitioner, as well as the founder and aesthetic injector at Mint & Needle aesthetics boutique in Middletown and Lewes, says she also prefers the BHRT pellets because “they avoid fluctuations of hormone levels seen with other delivery methods.” She says her clients report 75% to 100% symptom relief.
DiRenzo cautions that women who have a uterus and get estrogen in any form should also take oral progesterone for regulation of menstrual periods and protection against uterine cancer or abnormalities of the uterine lining.
Some women are surprised to receive testosterone, which is usually associated with men, DiRenzo notes. But she says it is actually an “underrated female hormone” that can elevate mood, alleviate anxiety, contribute to building muscle, and help with sleep and night sweats. Gregge adds that testosterone can help build bone mass, especially in women with osteoporosis, as well as increase energy levels and enhance libido.
According to DiRenzo, BHRT has three main benefits: boosting the brain’s hormone receptors to prevent cognitive decline or brain fog, remodeling or rebuilding bone density, and providing cardiovascular protection. Progesterone also helps prevent cardiovascular incidents. Gregge says that BHRT can also treat age-related conditions such as diabetes, Alzheimer’s disease, and arthritis.
The frequency of follow-up pellet insertions depends on how often symptoms occur as well as individual results of regular blood tests to monitor hormone levels. At DiRenzo’s practice, the average time between insertions for women is about six months. At Mint & Needle, it is about three to five months for women and four to six months for men.
There are no age limits for BHRT, nor are there restrictions on how long patients can take the therapy or when they should stop, DiRenzo says. “If symptoms are managed and the quality of life improved, a patient can stay on the treatments for as long as [they like] or stop at any time. …For some women, symptoms may dissipate naturally as they age, while others may experience symptoms longer.”
While both professionals say BHRT is safe and effective for many women, they do not recommend it for individuals with a personal or close family history of uterine or breast cancer, blood clots, hormone allergies, or mutations in their BRCA genes that may make them more susceptible to breast cancer.
“Patients with cardiovascular disease should discuss treatment with their cardiologist,” DiRenzo adds.
Gregge explains that during the initial hormone-level adjustment period, some women may experience weight fluctuation; light vaginal bleeding, if postmenopausal; and, least commonly, shedding of hair.
At DiRenzo’s office, the cost of the initial consultation and pellet insertion for women ranges from $540 to $590. Follow-up insertions are $315 to $365. At Mint & Needle, the price is around $500 per insertion. Most insurance companies do not cover BHRT. However, some policies may cover routine bloodwork to monitor dosage requirements.
Beyond BHRT, DiRenzo suggests people can support their hormonal balance with simple diet and lifestyle changes. “I recommend that everyone maintain a well-balanced diet, avoid processed foods, limit caffeine and alcohol, and get more exercise,” she says.
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