Is Hormone Replacement Therapy for You? 

By Murilo Lima, M.D.

Hormones are natural chemicals produced in the organs and tissues of the endocrine system. As we age, our body systems become less sensitive to the hormones our own body makes. The amount of hormones our body naturally produces may also decrease with age. Or our body may metabolize the hormones more slowly. The most common consequence of aging-related hormonal changes for women is menopause. Around age 50, women’s ovaries begin producing decreasing amounts of estrogen and progesterone; the pituitary gland tries to compensate by producing more follicle stimulating hormone (FSH).

While menopause is normal and happens to all women, some of the symptoms can be irritating or even dangerous. Symptoms might include hot flashes, vaginal dryness and atrophy leading to painful intercourse, decreased libido, insomnia, irritability, depression, mood swings, fatigue, and osteoporosis that can increase the likelihood of bone fractures. For decades physicians have prescribed long term use of an oral estrogen/progesterone combination to alleviate these symptoms. Nowadays, other options are available and all symptoms are taken into consideration when entertaining the idea of hormonal optimization while also balancing out the risks and the benefits.

Current guidelines indicate that it is acceptable to take estrogen and progesterone for a short time to help with the transition to menopause. There are also ongoing studies investigating the efficacy and safety of different estrogen and progesterone formulations that could potentially be used for longer periods of time.

Some alternatives that we suggest and can discuss with you are:
• Non-hormonal medications can treat hot flashes.
• Topical estrogen cream used vaginally can help with painful intercourse.
• Leading a healthy lifestyle that incorporates a balanced diet, regular physical activity and stress management helps alleviate many symptoms of menopause.
• It’s also important for all women to have regular bone-density screenings beginning at age 65 to catch osteoporosis early.
• Taking estrogen and progesterone for a short time to help with the transition to menopause.

For men, the reduction of hormone production and metabolism is called andropause. It’s not “male menopause,” exactly. Andropause doesn’t happen to all men. About 20 percent of men over age 60 and 30-50 percent of men over age 80 will experience andropause, a significant decline in testosterone production. The symptoms of andropause might include a decrease in muscle mass and overall strength, a decrease in bone mineral density and a corresponding increased risk of osteoporosis, low libido and erectile dysfunction, a decreased energy and depression and cognitive impairment.

Men experiencing any of these symptoms should discuss having testosterone levels tested and all men should consider bone-density tests at age 70. To help men with symptoms, if levels are low and/or symptoms are present, testosterone replacement might be an option. Just like with any medication, there can be risks associated with testosterone replacement and therapy must be customized for each patient. Being treated with testosterone means that you need regular prostate exams as well as frequent monitoring of your prostate-specific antigen (PSA) levels and hematocrit. A healthy lifestyle with regular exercise and a balanced diet can be just as helpful in fighting symptoms of andropause as they are for menopause.

It can be easy to dismiss changes in mood, weight, and menstrual patterns to the normal hormonal fluctuations of aging, but they can also be the result of thyroid disease, which affects 30 million Americans of all ages. The thyroid, a small, butterfly-shaped gland located at the front of the neck, produces hormones that control the rate of processes like metabolism, body temperature and muscle strength. Physical exams should begin including checks of thyroid stimulating hormone (TSH), but they recommend a simple blood test for everyone over 60 or anyone with symptoms of thyroid disease. If needed, treatments for underactive or overactive thyroid are generally very well tolerated.

If you think you are experiencing symptoms of a hormone imbalance, it’s essential to talk with your primary care doctor about treating any symptoms you experience — and just as important to prevent or manage symptoms by taking good care of yourself. It is also important to have a doctor who takes the time to listen to your comments and discusses your over all health. At Lima MD Direct Primary Care & MedSpa, we offer a revolutionary concept to put patients and doctors in charge of your health…NOT insurance companies. Direct Primary Care is the single best alternative to regular “fee per care” medicine. It is a medical practice that does not deal with insurance companies, and focuses on providing convenient, affordable and the highest quality medical care directly to patients without any third parties being involved.

The contract of care is straight between the patient and the doctor. Transparency is key. The high quality, evidence-based medicine will be provided to you directly by a board-certified PHYSICIAN (Dr. Murilo Lima), at an affordable cost. The low monthly membership fee will include virtually unlimited access to your doctor for all your medically related needs.

Be mindful that Direct Primary Care is not a health insurance! Our patients are strongly encouraged to acquire a “catastrophic” high deductible health insurance for hospitalizations and emergencies. Come talk to us at Lima MD Direct Primary Care & MedSpa or visit our website for more information about our membership plans.

LIMA MD
239-738-2626 | www.lima-md.com
17595 South Tamiami Trail, Suite 100
Fort Myers, FL 33908