Scott: Are there any potential dangers with hormone replacement? What are some of the side effects or downsides of that?
Erin Lommen, ND: Good question. I think with hormone replacement in women, it became clear in 2002 there were lots of changes due to the World Health Initiative big study that was stopped, and what had commonly been accepted as safe and good proved not to be so much. I would say, and it's not just that form of hormone replacement, but any hormones being added have to really be thought out and individualized. Each person is different. Someone's breast cancer risk has to come into the equation.
What we know about hormones and their ability to convert and do various things, there are certain people I would say who wouldn't be good candidates for this type of hormone because we don't want to even entertain the risk in the body, whereas other people don't have those same factors.
Now how much risk is there with a natural hormone versus synthetic? My work has always been in physiologic dosing. What that means is that we only give as much as the body could make. That's quite a bit different than another practitioner you might be talking to that does pharmacologic dosing, which is a dosing that makes people feel better but exceeds what the body ever would have made. That's where my own philosophy and training comes in to say we've exceeded what we know the body's prepared to detoxify well, and we increase risk by doing those doses even if we're talking about the same bio-identical hormone.
That's one area that I don't think is talked about very much. You'll hear of somebody doing natural hormones. It matters philosophically and literally what dosing paradigms you're using, so again, if a man can only make so much testosterone, we're not going to double or triple that just because it feels good for a brief period. It causes problems later, too. But some of that is happening, and that would be my greatest concern with some of the hormone work being done.
Natural is better, obviously, than a synthetic molecule because the body knows how to break it down. That's why we like the bio-identical. It's still made in a laboratory, it's still a prescription-type hormone, but it doesn't have the same byproducts that can't be metabolized because those are usually the ones that cause the problems.
Scott: When you talk about dosing, how do you know, if someone comes in in their 40s or 50s, what their levels were 30 years ago, what their optimal levels were, and how do you know what level to shoot for?
Erin Lommen, ND: That's a great question. What we know is a general understanding of what the body is producing during these various decades of life. That's well-established for us. Then we use laboratory to look at where they are compared to that. An example is I'm not going to try to have my menopausal women look like 16 or 18-year-old women. I'm going to try to do the minimal amount of hormone that makes them feel really vital and robust without exceeding a physiologic dosing. We're not trying to exceed what would be expected, if that makes sense. So testing helps me, and then they have ranges established for us as to what's expected, what's optimal.