Produced by the major endocrine glands (pituitary, pineal, thymus, thyroid, adrenals, and pancreas) as well as within the sex organs, hormones are your body's chemical messengers. They travel throughout the bloodstream to specific tissues and organs, where they work at varying speeds, inducing many different physiological processes central to which are: growth and development; metabolism; sexual functions; reproduction; and mood.
Furthermore, the male testes and the female ovaries produce largely gender-specific hormones, which perform an expansive range of functions. Collectively, these powerful chemicals are required in only miniscule amounts, yet incite major changes within cells, tissues, and organs throughout the body. The addition of too much or too little of a certain hormone can have serious consequences. For this reason, hormone therapy should only be conducted under physician supervision, after laboratory tests have been used to accurately measure the hormonal levels within your blood, urine, or saliva.
After puberty androgens, specifically testosterone, play a role in the regulation of the sex drive within both genders. Concordantly, deficiencies in testosterone or estrogen (as well as progesterone and DHEA which are also multi-faceted hormones) may cause a drop in sexual desire, whereas excessive amounts of these hormones may heighten sexual interest.1
Testosterone is a hormone produced within the testicles via a joint process, which also includes the endocrine system and the pituitary gland. This system is collectively known as the Hypothalamic-Pituitary-Testicular axis (HPTA).2 Testosterone serves as the male body’s primary natural hormone, and is largely responsible for the proper development of male sexual characteristics. Although often referred to as a sex hormone, testosterone actually governs several areas within the body including a man’s development from birth onward with responsibility for everything from initial structural gender differentiation, through pubertal changes and male potency (libido & sexual functioning), to the partitioning of bodily muscle and fat distribution.3 It is also an integral component in men’s sense of well-being, playing a major role in male physiological, biological, and sexual health, while influencing stress coping capacity,4 sperm production, mental acuity (clarity, memory & recall, concentration & focus),4 bone density,5 immune system support, and red blood cell production. Of course testosterone is present in both males and females; however, males typically produce between 4-7 mg per day , which is approximately ten times more than their estrogen-based female counterparts.
Estrogens are the sex hormones produced primarily by a female's ovaries that stimulate the growth of a girl's sex organs, her breasts, pubic hair, and other secondary sex characteristics. There are three basic estrogens, namely estrone (E1), estradiol (E2), and estriol (E3),6 however progesterone (another female-centric hormone) is often considered an estrogen as well.7 Collectively, these estrogens regulate a diverse array of chemically induced processes within the female body among which are the menstrual cycle, intercourse preparation and during intercourse functions, as well as impact mood, sleep quality, body fat levels, water retention, etc.8 As with testosterone, estrogen is present with both genders; women produce appreciatively more at approximately 0.5 mg daily.9 Aging, illness, and certain cancer treatments can adversely affect the body's delicate hormonal balance, causing changes in sexual interest and functioning.10 The most familiar of these changes occurs when a women go through menopause. Estrogen production drops throughout this process as women exit their child-bearing years.
However, in the majority of women, ovarian hormones don't appear to play a significant role in their sex drive. A 2012 study11 published in the Journal of Obstetrics and Gynecology showed that ovaries, i.e. estrogen production, may not play a pivotal role in sexual ideation and function among older women. This cross-sectional study involved analysis of 1,352 women (57 to 85 years of age) from the National Social Life, Health, and Aging Project compared women with previous bilateral oophorectomy (removal of one or both of the ovaries) with women who retained their ovaries. The primary outcome of interest was self-report of sexual ideation, chosen because having thoughts about sexual experiences is not prohibited by either a partner or a woman's own physical limitations. Three hundred fifty-six (25.8%) women reported previous bilateral oophorectomy. Even after adjusting for current hormone therapy, age, education, and race, no significant difference in the report of sexual ideation was found between groups.12
Hormone Replacement Therapy
Testosterone replacement therapy (TRT) is a regimen of physician prescribed synthetic testosterones used to treat hypogonadic (low testosterone) symptoms.1314 Similarly, hormone replacement therapy (HRT) is a physician prescribed regimen of any type of hormone (which encompasses TRT) to treat hormonal deficiencies. Much confusion has arisen over the relaxed and sometimes generic verbiage used to describe the types of hormones used in HRT. This has become such a problem that most people don't know or realize exactly what they are talking about when they use certain hormone qualifying terms.13 For clarity: natural hormones are those which are produced by a living organism be it human, animal, or plant; endogenous hormones are those produced within the human body; and synthetic hormones are man-made hormones.151617 Synthetic hormones made by pharmaceutical companies have side chains added to allow the companies to patent the hormones. Side chains may be added to a natural substance to create a synthetic product. These structural changes/differences are believed to be responsible for the side effects that are experienced when synthetic hormones are used in replacement therapy.18
The key to natural versus synthetic is the molecular structure of the hormone. In order for a replacement hormone to fully replicate the function and bodily acceptance of naturally produced and present in the human body (endogenous) hormones, the chemical structure must precisely match that of the original. 18The numerous hormones Empower Pharmacy produces have the exact same chemical structure as endogenous hormones.
Another source of confusion, both within the general population and the medical community, is encountered when reviewing studies of efficacy, safety, and side effects of various forms of hormone replacement therapy is that most studies have grouped all forms of estrogen under the blanket category of 'estrogen replacement therapy'.13 This grouping fails to differentiate estrogen from the various progestins, as well as from the hormone progesterone, both of which are specific types of molecular compounds possessing diverse chemical actions. In short there also exists, and quite uniquely so, 'progestin replacement therapy' and 'progesterone replacement therapy', either of which may be highly applicable based on individual patient requirements.
Restoring Hormonal Balance
HRT replaces deficient hormones with those that are chemically identical to those that the body naturally produces,13 but which have declined due to aging or illness. HRT has improved the quality of life for millions of women and men who suffer from hormonal imbalance.192014 The ideal process for achieving hormonal balance includes: an assessment of hormone levels13: complete evaluation of signs and symptoms; replacement of the deficient hormones in the most appropriate dose via the most effective route; and the monitoring to fine tuning of therapy. Estrogens, progesterone, and androgens are just the tip of the iceberg when it comes to achieving hormonal balance. Thyroid and adrenal function, as well as nutritional status, should also be evaluated and treated when indicated.
The uniqueness of each person makes it incumbent upon health care professionals and patients to work together to customize hormone therapy. Through this cooperation, hormones can be compounded in the required strengths and dosages, and administered via the most appropriate preparation to best meet each individual’s needs.
- 1. Hayes L et al. "Diurnal Variation of Cortisol, Testosterone, and Their Ratio in Apparently healthy Males". Sport Spa;9(1):5-13.
- 2. The Mayo Clinic Mayo Foundation for Medical Education and Research 'Male hypogonadism' http://www.mayoclinic.com/health/male-hypogonadism/DS00300/DSECTION=causes
- 3. Kucinskas L, just W. "Human male sex determination and sexual differentiation: Pathways, molecular interactions and genetic disorders". Medicina. 2005;41(8):633-640.
- 4. a. b. Beauchet O. "Testosterone and cognitive fucntion: current lcinical evidence of a relationship". European Journal of Endocrinology. 2006;155:773-781
- 5. Isidori AM, Giannetta E. Effects of testosterone on body composition, bone metabolism and serum lipid profile in middle-aged men: a meta-analysis". Clinical Endocrinology. 2005;63:280-93.
- 6. "Menopause". Fact Sheets. nebraska Department of Health and Human services, Office of Women's and Men's Health.
- 7. "Menstruation and the Menstrual Cycle". Fact Sheets. U.S. Department of Health and Human SErvices, Office on Women's Health. 21 Oct 2009.
- 8. Miller M, et al. "Theoretical basis for the benefit of postmenopausal estrogen substitution." Experimental Gerontology. 1999;34:587-604.
- 9. 5. Smith P. "A Comprehensive Look at Hormones and the Effects of hormone Replacement".What You Must Know About Women's Hormones: Your Guide to Natural Hormone Treatment for PMS, Menopause, Osteoporosis, PCOS, and More. Square One Publishers. 28 Nov 2009: Chapter 41.
- 10. 4.Obstet Gynecol. 2012 Oct;120(4):833-42. Sexual function in older women after oophorectomy. Erekson EA, Martin DK, Zhu K, Ciarleglio MM, Patel DA, Guess MK, Ratner ES.
- 11. Erekson E, et al. "Sexual function in older women after oophorectomy". Obstetrics and Gynecology. Oct 2012;120(4):833-42.
- 12. Obstet Gynecol. 2012 Oct;120(4):833-42. Sexual function in older women after oophorectomy. Erekson EA, Martin DK, Zhu K, Ciarleglio MM, Patel DA, Guess MK, Ratner ES.
- 13. a. b. c. d. e. J Clin Endocrinol Metab. 2012 Mar;97(3):756-9. Misconception and concerns about bioidentical hormones used for custom-compounded hormone therapy. Bhavnani BR, Stanczyk FZ.
- 14. a. b. Bhattacharya RK, Khera M, et al. "Effect of 12 months of testosterone replacement therapy on metabolic syndrome components in hypogonadal men: data from the Testin Registry in the US". BMC Endocrine Disorders. 2011;11(18).
- 15. Harvard Women’s Health Watch, August 2006. What are bioidentical hormones? http://www.health.harvard.edu/newsweek/What-are-bioidentical-hormones.htm
- 16. Mayo Clin Proc. 2011 Jul;86(7):673-80. Bioidentical hormone therapy Files JA, Ko MG, Pruthi S.
- 17. J Clin Endocrinol Metab. 2012 Mar;97(3):756-9. Misconception and concerns about bioidentical hormones used for custom-compounded hormone therapy. Bhavnani BR, Stanczyk FZ.
- 18. a. b. Rosano G et al. “Natural progesterone, but not medroyprogesterone acetate, enhances the beneficial effect of estrogen on exercise-induced myocardial ischemia in postmenopausal women. Journal of the American College of Cardiology. 2000 Dec;36(7):2154-9.
- 19. Miller M, et al. "Theoretical basis for the benefit of postmenopausal estrogen substitution." Experimental Gerontology. 1999;34:587-604.
- 20. Want C, Alexander G, et al. "Testosterone replacement therapy improves mood in hypogonadal men--a clinical research center study." Journal of Clinical Endocrinology & Metabolism. Oct 1996;81(10):3578-83.