Natural vs. Medical Hormone Therapy: What You Need to Know

Chapter 1: the hormone lifespan of men and women, identifying what can go wrong and a BIG CLUE whether diet and supplements will be enough for you.

Hormones are SO complex and things can go wrong at so many stages. The main aim is to work out where you are in the hormone ‘lifespan’ and identify what mechanisms might be going wrong.

This is a free post for everyone to enjoy – and includes some really useful and important information. The next post in this Hormone Series will be free and then I will continue it for paid subscribers. So, do sign up if you want to keep following this series and other more in-depth posts based on over 30 years’ clinical experience.

The Hormone Lifespan of Women and Men

Women start to develop the main endocrine systems at puberty, which could be early or delayed for various reasons, but is usually between 10-13 years old, average age 11. They then get their first period around age 12-14 and continue the menarche for years – with all the menstrual issues that can occur there, think: heavy, scanty, painful, missing periods, PMS, PMDD, PCOS, mood changes, menstrual migraines, acne and more. Lovely.

Next, we hit perimenopause at around late forties or early fifties, although sometimes it can start as early as mid-thirties. This is when we start to lose the more stable pituitary-ovarian feedback loop, which causes all manner of problems for many, but certainly not all women. For most women, peri will last about 3-4 years, but it can take three months to over a decade for some!

About 5% of women won’t have any problems at all. The vast majority will have ‘just’ hot flushes because of oestrogen spikes – the loss of control of their normally-balanced oestrogen and progesterone cycles – and a small, but significant minority will have a much tougher time. The ones who suffer the most usually have had health issues beforehand that get worse as hormone levels change and adrenals can’t cope.

At perimenopause, there is a sudden and dramatic decline in health – it’s like the body’s not needed any more for bearing children, so it might as well give up! Much of this is because inflammation levels go up without the hormones to control them as well as before. So, post-menopause – a year of no periods – it’s about keeping inflammation down, protecting bone, heart health and ageing well – keeping what’s called ‘body resilience’ levels up. It’s certainly not just about keeping oestrogen levels up with HRT, although that can help.

With men, it’s a much more subtle transition, not so ‘off-a-cliff’ as women, much less of a rollercoaster. Boys enter puberty a little later than girls and start to be able to produce sperm at around thirteen. There can be some issues like gynecomastia – developing breast buds – or early or late puberty, but generally it’s pretty plain sailing for most men through adulthood.

At some point, many men will begin to lose their androgen dominance – male hormone levels will change, usually testosterone dropping and SHBG going up. This takes years, so it is not that noticeable, but men often start to get oestrogen dominant symptoms such as crying, being more emotional, developing ‘man boobs’ and gaining weight. The loss of testosterone makes them gain belly fat, lose muscle mass and stamina and they can become more sad, even depressed or irritable. They don’t want to do anything, they are grumpier, have less tolerance for things generally than they did. Their bodies can hurt all over, muscles feel tight and sore and nothing they do can relieve it, they feel weaker and just generally ‘meh’ a lot of the time. No wonder they feel sad and depressed!

Women can also feel like this, of course, as our testosterone levels can decline too.

For men, it usually becomes noticeable in their forties and fifties. Some men don’t lose androgen levels at all, whilst others might start dropping in their thirties. It is beginning to happen earlier generally for many men – again, this is usually when someone has other health issues beforehand – they lose what is termed ‘resiliency;’ they are ageing faster, in effect.

Hormone Therapy

The mainstream approach to most hormone conditions, in men or women, is to give hormone therapy as the pill, hormone blockers, HRT (hormone replacement therapy) or TRT (testosterone replacement therapy). There is definitely a place for that. But it varies wildly both geographically, between doctors and, sadly, between genders.

If you take the case of menopause/andropause, for example. Ironically, andropause (so-called male menopause) is not really picked up or looked for that much in mainstream medicine, but when it is, men tend to be given proper testing, bioidentical ‘safer’ TRT (testosterone replacement therapy) with growth hormone to stop atrophy of the testes, regular progress testing and tweaking of their prescription.

In women, things are very different. Women are over-medicalised, testing is hardly ever done to see which hormones are problematic, they are just given synthetic ‘not as safe’ HRT, not re-tested and told to keep on it for years to protect themselves – which there is actually very little evidence for. Not right that, is it? More evidence of gender bias in medicine, I’m afraid.

But how do you know when mainstream hormone meds are likely to be the right choice, or if natural diet and supplements are going to be enough? The $60m question!

KEY TIP: The truth is that all the supplements and diet changes in the world are not going to help much if a person’s ability to produce their own hormones is too low.

I have seen so many people take natural supplements like black cohosh, sage, magnesium etc and it helps a bit, but not really that much. Why is that? There are a few reasons and we’ll go though these more later, but the biggest clue is how outside the reference range on test results you are? At a certain point, all the natural interventions in the world will not be enough to make you feel better – and I was surprised when I learnt how low it is, to be honest!

Despite a LOT of marketing hype, the truth is that you can generally make ‘only’ about a 10-20% increase max in hormone levels with natural interventions like diet and supplements.

That’s pretty low isn’t it? I was surprised!

KEY TIP: In other words, if a person is ‘sub-optimal’ ie. within 10-20% below the average on hormone levels like oestrogen, progesterone, testosterone, natural diet and supplement interventions can be enough. BUT, if your test results show that you are more than 20% outside of the average reference range given, then you’re likely going to need some medical support first, or as well as natural stuff.

In this case, taking HRT/TRT can make a huge difference for people, bringing them back to life, if you like. Inflammation lowers, mood changes, they lose belly fat, they can think and function again. Yes, please!

Of course, you can do a combined approach, using natural and medical interventions for some people. But the trick is to work out what is going wrong with the hormone balance and correct it, rather than just throw hormone replacement therapy at it.

For example, you don’t want to just shove a teenage girl with period pain on the pill when it was a problem caused by a lack of essential fats (common), a 30 year old man on TRT, especially if he wants to have babies later (taking certain types can affect fertility/cause atrophy of the testes) when obesity or something is blocking testosterone for some reason or put an early-perimenopausal woman on long term HRT when it was because her cholesterol was too low to actually produce any hormones!

Generally, the younger a person is, the more there is likely to be an underlying mechanism causing the problem and hormone therapy is not as appropriate.

In essence, there is no doubt that hormone therapy can be useful IF it is measured, personalised, using safer types, and monitored effectively. It can be life changing for some people, and desperately needed. Note, though, that there is a lot of opinion and variation in this field of hormone therapy, a lot of differing views and there doesn’t seem to be a standardised approach much above stick ‘em on the pill or HRT/TRT, so it might be worth getting several opinions!

The trick is to weigh up the pros and cons in each person; every decision is unique and individual. If you are an older person and/or your glandular function is very low, medical hormone therapy is going to help you the most and quickest. In most, I’d say, that the better approach would be to find the mechanisms going wrong and correct them as much as possible. The aim might even be to help a person on hormone treatment to detox it more effectively to avoid oestrogen dominance or help them need less of it for a shorter amount of time. Each case is unique.

Top 12 Lifestyle Strategies

There are plenty of diet and lifestyle strategies that can be employed either on or off hormone therapy. We’ll go through these a lot more, but some approaches might include:

• manage insulin resistance
• check and treat hypothyroid
• check and treat PCOS
• prostaglandin balance
• weight loss
• weight gain
• support the gut microbiome
• lower inflammation
• support hepatic conjugation and detox of hormones
• exercises to raise growth hormone
• support the brain and vagus nerve
• ensure adrenal health, sleep and circadian rhythms

And many more besides! A lot of things affect hormone levels, as you can see. There are also tons of supplemental strategies to choose from, depending on what factors crop up in each individual case and what you are trying to achieve. Rather than just giving hormones, there is a lot behind the scenes that can be done and the approach depends on what mechanisms are going wrong for each person.  

OK, I hope you found that helpful. I’ll be back shortly with your next hormone series post, when we will begin to look at how hormones work – or don’t! What goes wrong and where do you start looking?

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