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Welcome! My name is Dr. Alan Terlinsky, a bioidentical hormone doctor, and I treat patients from Northern Virginia. Through hormone replacement therapy I can provide you with proper rebalancing or replacement of hormones in the body to improve your well-being. Hormone imbalance strains the body and contributes to the development of many serious diseases. Bioidentical hormones not only relieve symptoms of hormone imbalance but also can decrease your risk for chronic diseases such as cardiovascular disease, stroke, diabetes, and degenerative arthritis.
"We age because our hormones decline; our hormones don't decline because we age."
- Suzanne Somers in her book Ageless
"If you would replace a vitamin/mineral deficiency with a bioidentical vitamin/mineral, then you should replace a hormone deficiency with a bioidentical hormone."
- Sangeeta Pati, MD, Fellow of the American College of Obstetricians and Gynecologists
Every year after age 25, our organs produce fewer hormones, which are molecules your body makes to give signals to your cells for a variety of health-maintaining functions. Both men and women have the same hormones, although in different ratios, and therefore both are at risk for hormonal deficiencies and imbalances. Hormone replacement therapy has been used for decades to give back lost hormone levels and to treat symptoms caused by these imbalances; estrogen therapy has been used to treat symptoms of menopause since 1930.
Hormone therapy really took off in 1966, when Dr. Robert A. Wilson wrote a book called Feminine Forever that publicized the use of estrogen to treat the "completely preventable" condition of menopause. In 1977, however, Barbara Seaman's book Women and the Crisis in Sex Hormones alerted women to the risks of hormone therapy, including the potential increased risk for breast cancer and heart disease. During the 1980s and 1990s, many studies began to suggest that hormone replacement not only relieved symptoms of hormonal imbalance but also protected women against cardiovascular disease and osteoporosis, contrary to Seaman's book. In support of Women and the Crisis in Sex Hormones, the HERS study in 1998 found that women with heart disease who used hormones had worse outcomes than those who did not take hormones.
The back-and-forth battle about the safety of hormone replacement seemed to really stick on the unsafe side as a result of the findings from the Women's Health Initiative (WHI) study in 2002. This large study investigated the health effects of the widely-used Prempro, which is made of conjugated equine estrogen (CEE) and a progestin called medroxyprogesterone acetate (MPA/Provera). Based on the results from the study, researchers estimated that among 10,000 women taking Prempro for a year, compared to placebo, there would be:
All in all, 97.5% of women on hormone treatment had no events in the WHI study, but the increased risk for cardiovascular disease and breast cancer resulted in millions of women stopping their hormone treatments.
The outcome of the study was not a surprise to many people. The average age of the women in the study was 63; there was therefore a high rate of preexisting disease, which may have skewed the health risks. Further, the women involved in the study may not have been truly eligible for hormone replacement therapy. A large flaw in the study was that it did not take into account any physiological differences between the women and gave them identical doses of hormones. Everyone's different. Everyone has different hormonal needs and responds differently to hormone therapy. Also, the estrogen in the Prempro, called CEE or Premarin, does not have the same ratios of estrogens as human physiology, as seen in the table.
|10% E1||80% E1||50% E1|
|10% E2||10% E2||0.5% E2|
|80% E3||10% E3||NO E3|
Most importantly, the WHI study used Prempro, made from both synthetic estrogen and synthetic progesterone, but the culprit for the increased health risks was the synthetic progesterone. Another study found that using only synthetic estrogen (CEE) compared with placebo was actually beneficial and decreased risks for both coronary heart disease and breast cancer. Once the synthetic progesterone is added, the health effects of synthetic hormone replacement shift from benefit to risk.
Hormones are chemicals produced in your body and give signals to your cells for a variety of functions that help to maintain your health. By working together, hormones may stimulate or inhibit growth, activate or inhibit your immune system, regulate your metabolism, or control the reproductive cycle, depending on the particular hormones.
Physiologically, hormones act through somewhat of a "lock and key" mechanism with cells. Hormones in our body bind to specific receptors on our cells; the receptor is like a lock and the hormone is like a key. When a hormone binds to its own, unique receptor, the cell generates a response to that particular signal. The chemical structure of the hormone is analogous to ridges on a key. If a hormone has a slight variation in the chemical structure, it may very weakly bind or not bind at all to its receptor and therefore will not give the appropriate signal to the cell, just as an inexact copy of a key may fit into its lock but may not turn the lock.
This point is particularly significant when discussing the function of synthetic hormones, which are not exact copies of hormones found in your body. Synthetic hormones may give undesirable messages to cells, which may lead to increased risks of breast cancer and coronary heart disease as we saw before with synthetic progesterone. The WHI study, as well as almost all hormone replacement treatments in the 20th century, used synthetic hormones. Additional studies that found increased health risks focused on the synthetic hormones, too. Many of the increased health risks may be due to the inappropriate signals given by these inexact hormone replicas.
The bottom line is that giving the same signals as naturally-found, human hormones to produce the same cellular response requires using exact replicas of our hormones.
Sometimes called natural hormones, bioidentical hormones are chemically, structurally, and functionally the same as hormones naturally found in the human body. Take progesterone as an example. Here you can see the chemical structure of human progesterone compared with that of bioidentical progesterone and Provera/MPA, which is a synthetic, nonidentical progestin. As you would expect, the structures of human and bioidentical progesterone are identical, and they both would give the same signal to cells to elicit the same response. Provera, however, has a slightly different structure and may give similar but possibly undesirable messages to cells.
|Vaginal Atrophy||Colon Cancer|
|Urinary Incontinence||Heart Disease|
|Sexual Dysfunction||Cognitive Decline|
|Depression/Mood Swings||Tooth Loss|
|Skin Atrophy||Macular Degeneration|
In general, hormones in the body maintain your health. Hormone levels generally decline as we age, and health maintenance concerns arise. When hormone-producing glands do not function properly, hormones become imbalanced or deficient, and severe consequences develop. If hormones such as estrogen, testosterone, progesterone, DHEA, cortisol, growth hormone, thyroid hormone, or insulin are imbalanced or at improper levels (too high or too low), some of the symptoms that may occur include:
The table on the right shows examples of symptoms and diseases that can result from hormonal deficiencies and imbalances.
Bioidentical hormone replacement can:
|Bioidentical Progesterone||Synthetic Progesterone|
|Inhibits breast cells||Stimulates breast cells|
|Decreases cell adhesion||Increases cell adhesion|
|Suppresses cancer spread||Does not suppress cancer spread|
As discussed before with the WHI study, researchers suggested that the culprit of the increased health risks was in fact the synthetic progesterone. Many studies have compared the effects of synthetic progesterone and bioidentical progesterone, and the tables on the left show the general results.
|Bioidentical Progesterone||Synthetic Progesterone|
|Decreases LDL||Increases LDL|
|Increases HDL||Decreases HDL|
|Decreases atherosclerotic plaques||Increases atherosclerotic plaques|
|Increases blood vessel dilation||Decreases blood vessel dilation|
|Does not increase C-reactive protein||Increases C-reactive protein|
As you can see, bioidentical progesterone decreases not only the risk of breast cancer but also the risk for cardiovascular disease, whereas synthetic progesterone increases the risk for both. These results bolster the idea that bioidentical hormones are better, more beneficial, more physiological, and safer than their synthetic cousins. Click here to read more about the safety and effectiveness of bioidentical hormones.
Every person in need of bioidentical hormone replacement therapy has a unique hormonal imbalance, though the trend is generally the same; women lose estrogen during menopause, and men lose testosterone during andropause (testosterone is an "androgen"). In addition, every hormone therapy patient responds differently to a particular dose and method of supplementation (oral, patches, gels, etc.). Therefore, a fixed dosage and delivery route, as in many commercially available hormone treatments, simply does not suffice for an individual. A bioidentical hormone replacement therapy patient should have an individualized dose and route of delivery not only to suit their own personal needs but also to optimize the patient's response to the treatment over time.
Dr. Terlinsky's bioidentical hormone replacement therapy program for men and for women provides you with an individualized, custom treatment plan to replace and rebalance any hormonal deficiencies or imbalances you may have to eliminate your symptoms, help you feel better, and improve your overall well-being.
The best way to evaluate what Nu-Living program is most appropriate for you is to have a short phone conversation about your current state of health. So give us a call at (703) 379-7110. Or if you prefer, fill out our getting started form and we'll get in touch. We serve clients from the greater Washington, DC metro area and Northern Virginia.
Board certified in Internal Medicine and Nephrology, Dr. Terlinsky has over 25 years of active clinical experience. »
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