The holidays bring their inevitable stressors both good and bad and we now find ourselves trying to put our lives back on track. Stress wreaks havoc on our hormonal balance and whether you are male or female, the impact can be significant to both your health and your general well-being.

The body is designed to maintain balance or homeostasis and stress causes increases in such hormones as cortisol which can throw the “good” hormones off kilter. When hormones are out of balance, the symptoms begin and we don’t feel well. Women may experience hot flashes, mood changes, decreased libido, aches, increased weight and changes in hair and skin. Men will often notice joint pain, fatigue, mood changes and even depression, decreased libido and changes in muscle strength and recovery. Long term hormone imbalances/deficits have been linked to elevated cholesterol, insulin resistance and diabetes, dementia and osteoporosis.

The use of bio-identical hormone replacement is a way to restore hormonal balance, well-being and health. There are treatment options available for both men and women and one of the most effective and popular treatments is the hormone subdermal implant. It delivers a continuous small amount of hormone throughout the day and most closely matches the body’s natural production of hormones. It can be done for men or women and makes hormone treatment easy and more effective. The highest rates of satisfaction with hormone therapy in my practice are typically those that choose the implants- there is no better way to increase libido!

So, as we head into a new year filled with all of our resolutions, it is the perfect time to address the hormonal changes that our stressful lives are creating. That weight loss goal, those feelings of calm, that work-out routine, will all be a lot easier if you deal first with what is out of order on the inside- your hormones!

Christine Farrell MSN, FNP-C is in private practice treating hormonal issues in men and women.

32144 Agoura Rd, suite 102, Westlake Village, CA 818-865-8500 for an appointment.

Hormone replacement is one of the most controversial topics in medicine and one of the most misunderstood. Baby boomers currently make up the majority of the US population and they (we) are all hitting the age of hormone depletion and the physical issues that go with it.

For women, menopause brings both physical and emotional changes that can be frightening and life altering. There are over 400 actions of estrogen alone in a woman’s body and the loss of this hormone can cause dramatic changes to health and wellness. Despite all of this, hormones have gotten a bad rap ever since the 2002 Women’s Health Initiative study. This study used Prempro (Oral Equine Estrogen plus Progestin, a synthetic Progesterone) in women 50-79 years old and showed increased breast cancer, heart disease and strokes. The follow-up portion of that study used estrogen alone (Premarin without the progestin) and found a significant decrease in heart disease in women if started in the first 10 years of menopause and actually found a 28% decrease in breast cancer in all age groups. Topical estrogen is more often used now and does not have the clotting risks associated with oral estrogens (ie; Prempro). So, estrogen isn’t the bad guy (or girl) we originally thought it was AND it helps to keep us healthy. It also helps to keep our memory sharp, fight depression, reduce body fat, keep us sexually active, and help us look and feel younger.

Though less often talked about, men experience hormone loss as they age also. From the time a man is 35 years old his Testosterone begins a slow decline as he ages. Most men at age 50 have approximately half of the Testosterone that they did when they were in their 20s. Isn’t this a normal phenomenon? Yes, but we must remember that in the early part of the century we only lived to around 50 years old so with our lifespan now heading into the 80s and 90s, we have many years to live without hormones and their health benefits.

Men typically experience more subtle symptoms, but they are still impacted by the changes. Most men experience fatigue, sleep issues, loss of muscle strength and recovery, increased joint pain, loss of motivation and decreased libido and/or changes in erectile function. There is also research that Testosterone is important for a man’s health as he ages. Cardiovascular disease, osteoporosis, diabetes and weight gain are all health risks associated with low testosterone. Low T is also now linked to Alzheimer’s disease and other neurologic diseases such as Parkinson’s. Once again, we see examples of hormones making us happier and healthier.

The old saying “If you have your health, you have everything” is certainly true and maybe with hormone replacement we can have it all- feeling good, staying healthy and looking good in the process!

Reference guide to understanding hormone deficiency and hormone replacement:

Menopause- the cessation of menstrual periods for 1 year accompanied by a drop in Estrogen and other hormones.

Women’s Health Initiative Study (WHI)- a 10 + year study done on over 27,000 women between the ages of 50-79 to study the effects of hormones. The study used PremPro a synthetic, oral hormone. (premarin – conjugated equine estrogens combined with Provera – medroxyprogesterone)

Estrogen- actually, a catch-all term for several hormones in a woman’s body. There are different types of estrogen: Estrone, Estradiol and Estriol Typically we are talking about Estradiol when we say Estrogen as it is the estrogen that has the greatest effect on the body and the one that we replace. Most newer hormone replacement medications (including bio-identical) use true Estradiol in a topical form.

Premarin- conjugated estrogens derived from pregnant mares (horses). The exact composition of Premarin is as follows: sodium estrone sulfate (49.3%), sodium equilin sulfate (22.4%), sodium 17α-dihydroequilin sulfate (13.8%), sodium 17α-estradiol sulfate (4.5%), sodium Δ8,9-dehydroestrone sulfate (3.5%), sodium equilenin sulfate (2.2%), sodium 17β-dihydroequilin sulfate (1.7%), sodium 17α-dihydroequilenin sulfate (1.2%), sodium 17β-estradiol sulfate (0.9%), and sodium 17β-dihydroequilenin sulfate (0.5%).[1] There are many different steroids in Premarin, even androgens and progestogens, but only the above-mentioned estrogens are present in sufficient amounts to produce clinically-relevant effects.[1]

Progesterone- a hormone secreted near the time of ovulation to help regulate the menstrual cycle and also to preserve pregnancy.

Progestin- a synthetic version of progesterone. There are multiple types, but in the Women’s Health Initiative Study, Medroxyprogesterone was the one determined to cause increased breast cancer.

Testosterone- the most dominant hormone found in men. It is produced by the testicles and decreases with age and stress. It is also found in women in lesser amounts. It is responsible for many actions, but is often associated with sexual function.

There has been much controversy and fear around hormones ever since the Women’s Health Initiative (WHI) published in 2002. The media ran with it and there has been no going back- until now. What you weren’t told is that the same study that has scared women away from estrogen had another part to it with a very different outcome.

What was spread across news shows and Women’s Health magazines was only a portion of the first part of the study that used Premarin (a type of estrogen from pregnant horses) combined with Provera (a synthetic form of Progesterone called a Progestin). This study did show an increase in breast cancer in all of the age groups and heart attacks in women over 60 who had never been on hormones before. What you didn’t hear in the media was the “Estrogen Only" arm of the study that did not include the synthetic Provera/ Progestin. This part of the study ran for over 10 years and included over 27,000 women. When only Premarin (estrogen) was given to the women, there was a 28% decrease in breast cancer in every age group. Women who started estrogen at the onset of menopause actually had an almost 50% decrease in heart disease and heart attacks and this benefit carried on into the older years. You see, estrogen wasn’t the bad guy (or girl) that we were told it was. Estrogen is actually your friend.

Estrogen has over 400 different actions on a woman’s body and we certainly feel the loss of its effect when we go through menopause! Our cholesterol goes up without proper estrogen and this is the cause of increased heart disease and strokes. Estrogen has been shown to help prevent the shrinking of the brain that causes our “brain fog” and later can lead to dementia. It helps to stabilize insulin levels which prevents type 2 diabetes and the dreaded mid-life weight gain. You have likely heard about the effects of estrogen in preventing osteoporosis and it also helps keep joints and muscles lubricated and less painful. Several autoimmune and neuromuscular diseases have also been shown to be triggered by the drop in estrogen that occurs at menopause.

Not only do we have all these increased health risks without estrogen, but we don’t typically feel or look our best either! Hot flashes, insomnia, vaginal dryness, etc can certainly make a girl feel less than sexy. There is a reason we don’t have these issues in our 20s- it’s the hormones! Hormones are actually the fountain of youth that we are all searching for.

There remains so much misinformation in the media and even in the medical community and women are suffering the consequences. We need an open and honest dialogue about menopause and hormone therapy- let’s get it started!!

There are many commercials these days about “low T” and a lot of buzz about Testosterone as the great sex enhancer for men. It is true that Testosterone is vital in keeping that part of a man’s life healthy and happy, but there is far more to the story.

Men actually have Testosterone, Estradiol and Progesterone just like women do, but obviously in different amounts with very different outcomes. As a man enters his late 40s and early 50s, there is an inevitable decline in his most dominant hormone- Testosterone. This causes the other hormones to take a larger role and men are often said to “mellow”. This is because as Testosterone drops, a man’s Estradiol can become more dominant causing fatigue, joint and muscle pain, depression, weight gain and low libido. This is especially true if a man is overweight as fat produces an increased amount of Estradiol. Stress can actually cause the Testosterone levels to drop earlier than they would normally and men may find they are having “low T” symptoms even in their early 40’s.

The truth is that most men are actually aware that there are subtle changes to their energy, focus, motivation, strength, and even libido, but they attribute it to normal aging. While this is partially accurate, it doesn’t have to be the end of youth and well-being. Studies are showing that keeping a man’s Testosterone levels in a youthful range will actually help to prevent several disease states including Alzheimer’s , Parkinson’s, Diabetes, Heart Disease and arthritis/osteoporosis. So, while libido and muscle building is important, nothing is as important as our overall health.

Relationships may also suffer when a man is suffering from lower Testosterone levels. Irritability is a common effect of low Testosterone as a man is often not sleeping well, and therefore tired and lacking focus. Low libido and erectile dysfunction hampers intimacy as well as a man’s feelings of self-esteem.

The current generation is caring for aging parents, paying for college and trying to fund a retirement account all at the same time. Many men are working longer hours, traveling more, managing family and this takes a physical toll (as well as an emotional one). While Testosterone can’t cure our crazy lives, it can at least give back some of the quality and excitement that many are missing and more importantly, keep men healthy and happier.

We learn about the birds and bees and what to expect when we are expecting, but no one tells us what we are in for when we lose our natural hormone levels! Somewhere around age 35, in both men and women, the slow decline begins. Our normal “sex hormones” (aptly named) begin to drop off, making us feel anything but sexy. Let us look at this seldom talked about fact of life.

In women, there is a change in hormones before menopause actually occurs and this is called peri-menopause. The word peri actually means “around” and describes what is actually happening to your body- you are getting nearer to menopause, but you aren’t there yet. The most common hormone deficiency during this time is progesterone and yet it is the most undertreated. Typical signs of a progesterone insufficiency are: heavier or irregular periods, painful breasts, insomnia, low libido, and your family being terrified of your mood swings. This phase of your hormone adventure can last 1-15 years so understanding it and seeking treatment are probably a good idea for your physical and emotional well-being (and for the well-being of those around you!)

As a woman, you then get to look forward to menopause when you essentially lose all of your remaining hormones. With this phase comes the hot flashes, night sweats, fatigue, weight gain, dry skin and dry other parts and low libido (kind of difficult to feel sexy with all that going on). There is now also an abundance of data on the importance of hormones to a woman’s physical health as well. Estrogen has over 400 actions in a woman’s body and the lack of it can cause increased coronary artery disease and heart attacks, insulin resistance and diabetes, dementia and osteoporosis. If breast cancer is a concern for you, then talk to your provider. Remember the 2002 Women’s Health Initiative Study that caused a media frenzy and told women that hormones would kill them? They actually did an estrogen only study showing a decrease in breast cancer in every age group. What this means is that the originally studied Prempro with estrogen and progestin (not progesterone) was causing cancer, but the estrogen alone actually decreased it by 23%. Of course, if you have a family history of concern or a personal history of cancer, you must discuss your risks with your provider.

Contrary to popular belief, men don’t get off easy with this hormone havoc. Notice all the “low T” commercials lately? Men are finally getting some attention in this area and rightly so. A man can feel low testosterone symptoms long before he ever loses his libido or erectile function. The usual symptoms are: fatigue, lack of motivation, irritability, joint and muscle aches and even night sweats. The libido issues may or may not accompany these other symptoms in the beginning, but left untreated, they eventually will. As with women, there is research on the health risks associated with low testosterone. Men have a higher rate of diabetes, Alzheimer’s, Parkinson’s and osteoporosis with low testosterone. Stress can exacerbate and speed up this process of Testosterone drop and in this day and age, few can say that they do not have excessive stress.

Testosterone isn’t just for the guys! Women naturally have Testosterone and this level can drop in women as well. Testosterone is important for lean muscle building and strength as well as bone building. Of course, having a great libido isn’t a bad thing either and it helps women as much as it does men.

Aging is inevitable, but that doesn’t mean you need to give up on health or well-being. The average age of death in the early 1900’s was 50 so nobody had to think about hormonal issues. Since we are now living to 80-90 and beyond, it only makes sense to do something to make it a lot more enjoyable (and look good in the process). This isn’t the end- it’s only the beginning of the next chapter, so enjoy!

Christine Farrell MSN, FNP-C is the owner of Bio-identical wellness in Westlake Village. She is an Associate Clinical Professor at UCLA, a member of the International Menopause Society and North American Menopause Society. She has been treating men and women of all ages for hormonal imbalances for over 10 years. Appointments can be scheduled by calling 818-865-8500.

We learn about the birds and bees and what to expect when we are expecting, but no one tells us what we are in for when we lose our natural hormone levels! Somewhere around age 35, in both men and women, the slow decline begins. Our normal “sex hormones” (aptly named) begin to drop off, making us feel anything but sexy. Let us look at this seldom talked about fact of life.

In women, there is a change in hormones before menopause actually occurs and this is called peri-menopause. The word peri actually means “around” and describes what is actually happening to your body- you are getting nearer to menopause, but you aren’t there yet. The most common hormone deficiency during this time is progesterone and yet it is the most undertreated. Typical signs of a progesterone insufficiency are: heavier or irregular periods, painful breasts, insomnia, low libido, and your family being terrified of your mood swings. This phase of your hormone adventure can last 1-15 years so understanding it and seeking treatment are probably a good idea for your physical and emotional well-being (and for the well-being of those around you!)

As a woman, you then get to look forward to menopause when you essentially lose all of your remaining hormones. With this phase comes the hot flashes, night sweats, fatigue, weight gain, dry skin and dry other parts and low libido (kind of difficult to feel sexy with all that going on). There is now also an abundance of data on the importance of hormones to a woman’s physical health as well. Estrogen has over 400 actions in a woman’s body and the lack of it can cause increased coronary artery disease and heart attacks, insulin resistance and diabetes, dementia and osteoporosis. If breast cancer is a concern for you, then talk to your provider. Remember the 2002 Women’s Health Initiative Study that caused a media frenzy and told women that hormones would kill them? They actually did an estrogen only study showing a decrease in breast cancer in every age group. What this means is that the originally studied Prempro with estrogen and progestin (not progesterone) was causing cancer, but the estrogen alone actually decreased it by 23%. Of course, if you have a family history of concern or a personal history of cancer, you must discuss your risks with your provider.

Contrary to popular belief, men don’t get off easy with this hormone havoc. Notice all the “low T” commercials lately? Men are finally getting some attention in this area and rightly so. A man can feel low testosterone symptoms long before he ever loses his libido or erectile function. The usual symptoms are: fatigue, lack of motivation, irritability, joint and muscle aches and even night sweats. The libido issues may or may not accompany these other symptoms in the beginning, but left untreated, they eventually will. As with women, there is research on the health risks associated with low testosterone. Men have a higher rate of diabetes, Alzheimer’s, Parkinson’s and osteoporosis with low testosterone. Stress can exacerbate and speed up this process of Testosterone drop and in this day and age, few can say that they do not have excessive stress.

Testosterone isn’t just for the guys! Women naturally have Testosterone and this level can drop in women as well. Testosterone is important for lean muscle building and strength as well as bone building. Of course, having a great libido isn’t a bad thing either and it helps women as much as it does men.

Aging is inevitable, but that doesn’t mean you need to give up on health or well-being. The average age of death in the early 1900’s was 50 so nobody had to think about hormonal issues. Since we are now living to 80-90 and beyond, it only makes sense to do something to make it a lot more enjoyable (and look good in the process). This isn’t the end- it’s only the beginning of the next chapter, so enjoy!

When Angelina Jolie made it public that she carried the cancer gene and had opted to have a mastectomy, the world took notice. She has recently had a total hysterectomy due to her genetically increased risk of ovarian cancer. The gene that she carries is called the BRCA gene and greatly increases one’s risk of breast and/or ovarian cancer. The problem doesn’t lie in knowing that you do have it, but in not knowing.

Not every person with a family history of cancer needs to be tested. Most cancers occur by chance and are known as sporadic cancers. This means that the person has no family history of cancer and yet, developed the disease. Familial cancer is someone who has one or more relatives with cancer, but there is no specific pattern of inheritance.

The cancer that requires testing is the hereditary cancer type. This means that an altered gene is passed from parent to child and they therefore have a greater risk of this cancer as well as the risk of developing it at a younger age.

How do you know whether you should be tested? It is important to discuss your history with a health care professional who has been trained in the testing for the BRCA gene(s), but the criteria are also listed here below:

A personal or family history of:

-Breast cancer diagnosed under the age of 50

-Ovarian cancer at any age

-Male breast cancer

-Two primary breast cancers

-Triple negative breast cancer (negative ER, PR, HER2)

-Pancreatic cancer with a breast or ovarian cancer

-Ashkenazi Jewish ancestry with a Hereditary Breast, Ovarian or Pancreatic cancer at any age

-Two or more relatives with breast cancer with one under the age of 50

-Three or more relatives with breast cancer at any age

-Previously defined BRCA mutation in your family

What is important here is the knowledge gained from the test and how it affects your health care management and the management of all of your children, siblings and other family members. Knowing you are positive for the gene means you have choices and insurance will now cover them (depending on your coverage). In the general population, the chances of breast cancer are approximately 8%, but if you are BRCA positive, it is up to 87%. If positive, the risk of ovarian cancer goes from a general population risk of less than 1% to up to 44%.

The testing is done in the office of a health care professional who has been trained in the testing and management of BRCA. It’s a quick test and the newer test, called My Risk, gives us more information than ever before with just one test.

If the test is positive, what do you do? Changing your surveillance is the first step. Mammograms plus breast MRI begin at 25 and are yearly. Pelvic exams are done twice a year and transvaginal ultrasound and CA-125 testing are done twice a year to detect ovarian cancer. There are certain medications that can decrease the risk and surgery is also an option. The most important part of knowing is that you now have options to actually prevent the cancer that could otherwise end your life. You can also notify the ones you love to protect them as well and help them get the proper management.

Most insurance companies will cover the testing if the patient meets criteria, but financial assistance is also available for those whose insurance doesn’t pay or who are uninsured. There are Federal and California laws in place to protect against discrimination based on genetic information, and the results of the test go only to the patient and their health care provider.

Knowledge truly is power in this case- the power to save your life or the lives of the ones you love.