The Vital Role Of Hormone Therapy In Managing Disease
Our health care system is facing unprecedented challenges with the recent pandemic of coronavirus and ensuing SARS Cov2, or COVID-19, and it is vital health care providers keep their patients active and healthy so as to not overburden a vulnerable system.
As an acute care nurse practitioner researching and practicing advanced endocrinology concepts over the past 12 years, I have recognized an overarching theme: Hormones are active and play a vital role in every single body system. The far-reaching impact of restoring hormone homeostasis on health-related quality of life is an often-misunderstood phenomenon in both the healthcare and lay communities.
With the additional burden of stress, these uncertain times adds to an already encumbered psyche, classifying hormone therapies as inessential will have dire consequences.
Hormones aren’t just for hot flashes and ED.
A myth our health care providers must often unravel is the concept that hormone therapy (HT) for women is used simply to abate hot flashes, vaginal dryness and other nasty symptoms of hormone fluctuations; and testosterone replacement therapy (TRT) in men is primarily to assist in sexual function. Nothing could be further from the truth. In fact, these “side effects” of HT and TRT are what we call a bonus. Hormones play a vital role in all body systems. Androgen receptors are found in virtually every tissue in both women and men from the brain, breast, heart and bones, indicating the role they play in normal tissue homeostasis as well as pathologies such as breast cancer, osteoporosis, neuropsychological and neuro-cognitive decline as well as cardiovascular and a plethora of other disease processes.
In addition to improving overall sense of well-being, energy levels, libido and quality of life (QOL), HT has been shown to prevent osteoporosis, reduce cardiovascular disease risk, reduce hypertension, increase muscle mass, increase muscle strength, increase bone density, reduce visceral fat, reduce total cholesterol levels, induce glucose homeostasis, increase metabolism, manage PMS, reduce severity and frequency of migraine headaches, improve cognition, improve memory, prevent Alzheimer’s disease and improve Parkinson’s symptoms, thus having a positive impact on health-related QOL.
Its benefits can be psychological.
Androgen and estrogen replacement has been shown to improve mood, lift anxiety and depression and improve sleep patterns. The hippocampus and amygdala, critical regions in the brain owing to incidence of depression, are rich with androgen receptors, a key explanation of clinical response with androgen therapy. Sleep deprivation has the most significant compounding effect and exacerbates the depression, anxiety, moodiness and impaired cognitive function a person may be experiencing with absent or sub-optimal hormones. The presence of depression, anxiety and altered mood states is a widespread, worldwide phenomenon, crossing cultural and ethnic lines. Depression and anxiety are twice as likely to occur in women as in men, are a leading cause of dysfunction and disability in women and noted in several studies to be a key component of decreased QOL and sense of well-being. The differences between men and women in depression rates have also been observed worldwide, and these documented sex differences have led to the scholarly observation that hormone fluctuations are a major contributor. Depression in men is an often-overlooked diagnosis, and men with suboptimal testosterone are more than twice as likely to suffer mental health issues than their optimized counterparts.
It can also affect cardiovascular disease.
Cardiovascular disease is of utmost concern with regards to an overburdened healthcare system. Heart disease rates and heart attacks have soared in recent years, despite the judicious use of statins.
Hundreds of studies reveal the essential role sex hormones play in cardiovascular disease prevention and stabilization. Further, many recent studies have demonstrated the detrimental effects of discontinuing hormone therapy in women. A landmark study reviewed the number of excess deaths from avoidance of HT, namely estrogen.
This study came on the heels of HT avoidance post-publication of the Women’s Health Initiative (WHI) trial when the media portrayed “hormones” as bad for women. Providers stopped prescribing based on the misinterpretation of the WHI data by the media, and the results revealed a staggering 91,610 excess, avoidable, deaths in women who had had a hysterectomy and not been given HT to manage the deficiencies. The number did not include women globally with hormone decline who had not had a hysterectomy.
Other studies revealed discontinuing estrogen in women was associated with increased risk of cardiac and stroke death in the first post treatment year. Rapid withdrawal of estrogen and discontinuation of HT may result in vasoconstriction and potentially adverse arterial changes and cardiovascular events, as the vasodilatory effects of estrogen suddenly cease.
Declining estrogen may also modulate cardiac rhythm, perhaps via calcium ion channels or by preventing long QT interval. Acute withdrawal of estrogen may predispose to fatal arrhythmias.
Increased cardiovascular death risks question the safety of HT discontinuation practice to evaluate whether a woman could manage without HT. Further, women who stayed on their HT had a vastly reduced mortality rate compared with women who stopped treatment.
Low serum testosterone is associated with several cardiovascular risk factors including dyslipidemia, adverse clotting profiles, obesity and insulin resistance. Testosterone has been reported to improve symptoms of angina and delay time to the ischemic threshold in unselected men with coronary disease. In men, endogenous testosterone concentrations are inversely related to mortality due to cardiovascular disease and all causes. Low testosterone may be a predictive marker for those at high risk of cardiovascular disease, and low testosterone is an independent predictor of the severity of CAD.
To read the full article, click here.
