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Hormone replacement therapy
A Precision Medicine Approach
With aging, injury, surgery and through the disease process, endocrine organs which synthesize and secrete hormones decline. Therapeutic replacement of these hormones is known as hormone replacement. Using meta-analytic data pooling results from thirty studies involving 26,708 postmenopausal women, menopausal hormone replacement has been shown to reduce mortality by 39% in women who initiated hormones prior to age 59 (PMID 15209595). Hormone replacement in women has been a specialized area of clinical focus for Dr. Parker for ten years. Patients generally seek out her guidance for secondary or tertiary opinions regarding hormonal treatment options for perimenopause, menopause and, less commonly, post-menopause. Each case is considered on an individual basis. Safety and efficacy of care guide her hormone prescribing standards, and is consistent with the treatment goals and evolving risk assessment of the individual woman. She employs a prevention-based holistic approach for timely initiation and continued use of hormone replacement as an integral part of the whole-person approach to women in menopause.
Hormonal assessment of menopausal women and hypogonadal men is a specialty that is under-recognized. Dr. Parker does not rely on a particular protocol for hormonal prescribing practices. Rather, she reviews and critiques primary medical literature using an evidence-based perspective in order to serve the unique needs of each individual within the clinical setting. She has undergone extensive hormonal prescribing studies through the Age Management Medicine Group, the North American Menopause Society, the American Academy for Restorative Medicine, and has also trained with the American Academy of Anti-Aging Medicine with specific emphasis in hormonal replacement in men and women. She has had the distinct honor of clinical tutelage and mentorship with thought leaders in hormone replacement over several years of study, and she continues to refine her craft with ongoing education and research. Our clinic routinely review lab work which has been run using inappropriate assays, which contributes to improper assessment and confusing care of patients facing hormonal imbalances.
Dr. Parker practices the principle of Primum non nocere (Latin meaning First, Do No Harm, as listed as the first edict of the Hippocratic Oath of physicians) with conscientious prescribing techniques for all medications. She uses molecularly exact hormones, commonly known as bio-identical hormones, with a strong preference for FDA-approved versions of these applications. She believes it is important to emphasize that the popularized idea that custom-compounded bioidenticals have fewer risks when compared with Food and Drug Administration (FDA)-approved hormone treatments is unfounded. Conjugated equine estrogen hormones such as Premarin are not prescribed because they are predominantly comprised of estrone sulphate ( this medication is sourced from horses, which means it is not molecularly exact to ovarian-produced estradiol, and which binds to 17-beta estradiol receptors throughout the female body). It is well known that estrone is metabolized into 4-OHE1(E2), a carcinogenic metabolite which is responsible for much of the bad press against estrogen. FDA-approved products containing bioidentical hormones are produced in monitored facilities demonstrate a high quality of safety, efficiency and reproducibility of results in trials, and all of these reasons underscore her recommendation that prescribers use these products when addressing hormone replacement therapy. She sources alternatives to paraben-based hormone prescriptions, since parabens have been associated with breast tumors in women (PMID: 31918794).
Dr. Parker has strict criteria for pharmacies from which therapies are sourced, and a patient's insurance company is able to provide coverage for FDA-approved prescriptions on most items prescribed. Contrary to many anti-aging providers, Dr. Parker does not use or recommend pellet therapy based on the side effects(which are sometimes long-lasting) that can occur with their use. However, she does work with women who have used pellets with other providers and need to skillful prescribing and support to recover. Consumers should know that many private hormone therapy clinics with an internal pharmacy earn revenue on their hormone prescriptions, such as hormone pellets.
When Properly Prescribed, Potential Benefits of Hormone Replacement Therapy include:
- Neuroprotection
- Improved processing speed and memory
- Prevention of brain atrophy in phenotypically sensitive women at risk
- Relief of menopausal symptoms
- Metabolic regulation
- Cardiovascular support
- Bone and joint support
- Mood support
- Sleep support
- Vaginal support
- Tissue repair and regeneration
Contraindications to Menopausal Hormone Therapy include:
- Possibility of pregnancy
- Undiagnosed vaginal bleeding (requires assessment prior to possible treatment)
- Liver dysfunction or disease (must be evaluated in order to consider therapy)
- Known or suspected cancers
- Known protein C, protein S, or antithrombin deficiency, or other known thrombophilic disorders
- Active arterial thromboembolic disease (for example, stroke, heart attack, or a history of these conditions
- History of deep vein thrombosis or pulmonary embolism
- Known anaphylactic reaction or angioedema related to hormone therapy use
References:
Amin MM, Tabatabaeian M, Chavoshani A, Amjadi E, Hashemi M, Ebrahimpour K, Klishadi R, Khazaei S, Mansourian M. (2019) 'Paraben Content in Adjacent Normal-malignant Breast Tissues from Women with Breast Cancer', Biomed Environ Sci., 32(12):893-904.
Rosner, W., Hankinson, S.E., Sluss, P.M., Vesper, H.W., Wierman, M.E. (2013) ‘Challenges to the measurement of estradiol: an endocrine society position statement’, Journal of Clinical Endocrinology and Metabolism, 98(4), pp. 376-87.
Salpeter, S. R., Walsh, J. M., Greyber, E., Ormiston, T. M., & Salpeter, E. E. (2004) 'Mortality associated with hormone replacement therapy in younger and older women: a meta-analysis' Journal of general internal medicine, 19(7), 791–804.
Stanczyk, F.Z., Jurow, J., Hsing, A.W. (2010) ‘Limitations of direct immunoassays for measuring circulating estradiol levels in postmenopausal women and men in epidemiologic studies’, Cancer Epidemiology, Biomarkers & Prevention, 19(4), pp. 903–906.
Learn More
Find out whether you are an ideal candidate for Dr. Parker's precision medicine approach to hormone replacement therapy by scheduling an initial appointment with us.
Menopause: More options than 'the pill'
Synthetic estrogen & progestin contraceptives behave differently than ovarian hormones. Some forms of oral have been linked with cardiovascular disease and mood disturbance. If you have been prescribed oral contraceptives for menopause and have concerns, this is a safe place to discuss options.