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The Latest News on Hormone Therapy

Hormone Therapy effects on the heart

You already know that your weight, activity level, cholesterol, blood pressure, and blood glucose levels are all important risk factors when it comes to heart disease, but another factor, which is more hidden, is the function of your hormones.

Hormones are the chemical messengers in your body. They are, basically, the “on-off switch” for many of the cellular activities that influence these more well-known heart disease risk factors.

In fact, they have a great deal to do with how you feel, how your body functions, and whether you stay well, or get sick.

Hormones also play a major role in aging, and therefore, they have become a huge topic and big business.

In this issue of my Heart Health Report, we’ll take a look at the latest news about hormones, to learn how to keep them at the levels to help you conquer heart disease.

A Review: What are hormones?

Hormones are the chemical messengers of your body, and their functioning has a direct bearing on every aspect of your health.

The word hormone means, “to set in motion,” and that’s exactly what hormones do — they initiate various chemical processes in the body. Hormones regulate metabolism, tell us when to eat and sleep, determine how tall you will be, and even control moods and immune function.

As you age though, important changes in your hormones occur, and these impact every aspect of your body’s functioning. This includes how you feel, how you look and your vulnerability to disease.

Because of this, hormone replacement is a huge health topic. Traditionally, we think of this as relating only to women and menopause, but hormone replacement has become a hot topic in men’s health as well.

Estrogen and testosterone are two of the major hormones in the body. They are also the ones with which you are probably the most familiar, and both have a great impact on your body, including your heart.

Estrogen: A Woman’s Protection Against Heart Disease

Estrogen is the hormone that regulates the sexual and reproductive development that occurs in women, changes that occur most noticeably at puberty. At menopause, a women’s estrogen production dramatically declines, resulting in obvious symptoms like hot flashes and insomnia, but other changes occur as well. As the amount of female estrogen goes down, the cholesterol level shifts, and the harmful LDL-cholesterol level goes up, while the so-called “good” HDL cholesterol declines. Muscle mass also declines and her bones can become brittle, because estrogen plays a key role in bone growth.

When a women goes into premature menopause suddenly due to surgical removal of the ovaries, replacement hormones are prescribed. But, in menopause, estrogen levels decline gradually, and whether they should be replaced has been a controversial topic for decades.

There are several different types of hormone replacement therapy but they fall into two major types: Estrogen replacement therapy (ERT) and hormone replacement therapy (HRT), now commonly referred to as hormone therapy, or HRT. Together, this is known as HT, or hormone therapy.

A Woman’s Hormones and her Heart

A woman’s risk of heart disease begins to dramatically rise in her mid-fifties and sixties, approximately 10 years later than do men, and this is attributed to the decline in estrogen, which comes with menopause.

In 2002, the results of the Women’s Health Initiative, a large-scale study, was published. The study was expected to prove that HT would protect women, but, instead, the cardiology community was stunned when it showed that those who took hormones at a greater risk of heart attack, stroke, blood clots, breast cancer and dementia.

As a result, doctors stopped prescribing HT, or they did so at the very lowest levels; the idea of using hormones for heart protection was dropped altogether.

Over the years, from working with my patients, I’ve come to believe that this was an overreaction by the medical community, and a new comprehensive report, issued last year by the American College of Cardiology’s Cardiovascular Disease in Women, let by Cleveland Clinic Cardiologist Leslie Cho, agrees.

The follow-up over 13 years showed that age in which HT is prescribed plays a great deal in terms of influencing risk , and that risk was much lower in healthy women ages 50 to 59 then in those who were older, and also was safer if used within 10 years of menopause. However, in women with underlying heart disease, it could result in heart attacks and other adverse effects.

The report also covers systemic versus topical HT. Systemic HT refers to hormones that travel throughout the bloodstream and have an overall effect on the body, while topical hormones are estrogen products, including creams, suppositories and rings, are topical, given to women vaginally, and relieve vaginal dryness and discomfort during sex, do not appear to be linked to increased heart attack risk, and can be safely used by older women.

Dr. Cho’s team evaluated 19 randomized studies and came up with these recommendations:

Women shouldn’t begin taking systemic hormone therapy, in pill or patch form, after age 60, or more than 10 years after menopause begins.

  • They should take the lowest possible dose of hormones to ease bothersome symptoms, like hot flashes and disturbed sleep.
  • The need for HT should be reevaluated annually, if possible.
  • For healthy women at low risk of heart attack (less than 5 percent) all forms of hormone replacement are acceptable.
  • For women with a five to 10 percent risk of cardiovascular disease, or one or more of the following risk factors, transdermal patches are considered safer than oral HT. These risk factors are diabetes, smoking, high blood pressure, obesity, sedentary lifestyle or limited mobility, or who are at high risk for breast cancer..
  • Women at high risk of heart attack –greater then 10 percent – should avoid systemic hormone therapy if possible. This includes women with congenital heart disease, as well as those who have had, or are at risk, for blood clotting disorders, including those with coronary heart disease, those who have had or are at risk of stroke or heart attack, peripheral artery disease, deep vein thrombosis, or pulmonary thrombosis.
  • Women should be mindful that even low-dose systemic HT can raise blood pressure.

Testosterone: Hormone Replacement for Men

Testosterone is the sex hormone that is largely responsible for the sexual and reproductive development of men. But this hormone also plays a role in sperm production, fat distribution, as well as the maintenance of muscle strength and mass, and sex drive.

Testosterone, the sex hormone largely responsible for the sexual development and reproduction capabilities in men, plays a big role in overall health, as well as contributes to cardiac health as well.

Unlike estrogen, which in women declines abruptly in women at menopause, testosterone peaks in men far earlier – in their 30’s—and then begins a gradual diminishment, bringing on fatigue, depression and a diminished sex drives.

For years, doctors have been putting such men on replacement testosterone, which comes in many forms, including injection, patches and gel. In addition to improving sexual function and bone mineral density and increasing free-fat mass and strength, testosterone replacement has been shown to improve cholesterol profiles, blood glucose levels and also improve the performance of the heart during stress testing.

Over the years, testosterone replacement has become big business, with advertising warning men of the horror of “Low T,” as the ads called it, and prescriptions boomed.

But three medical studies, including a large scale one, urged caution, saying that testosterone therapy could lead to a doubling of risk for heart attack.

These studies in the FDA slapping a warning label on it, stipulating that it is only approved for men with low testosterone from hypogonadism, a condition in which the testes do not produce enough of the hormone.

On the other hand, some studies found no such heart attack risk, and others found that testosterone therapy can have benefits, such as those finding it may benefit men with heart failure, and University of Michigan, which showed that that more men than previously thought have low testosterone levels, which could be putting them at risk for chronic disease over time.

There are also signs that the reluctance towards testosterone therapy is being reevaluated. Last spring, the results of a large Cleveland Clinic trial showed that it had no cardiac risks, even when give to men at high heart disease risk.

This study, done in response to the FDA’s concern, was a randomized, double-blind study conducted at 316 clinical-trial sites in the U.S., which involved 5,246 men, from 45 to 80 years of age , who had preexisting or a high risk of cardiovascular disease. They also showed symptoms of low testosterone.

The results showed no significant difference in the men who received testosterone or a placebo (inactive substance) during the 22 months of the study, which was reassuring.

However, those receiving testosterone did show a higher occurrence of atrial fibrillation, acute kidney injury, and issues arising from blood clots in the veins. Current guidelines advocate caution in the case of men with blood clot issues.

I’ve seen testosterone therapy improve my health, and that of my patients in my practice.

First, you must be tested to determine your need for testosterone, and whether it is due to aging, in which case testosterone therapy may be helpful, or from some other medical cause.

Testing involves as blood test that measures both your total testosterone level and how much “free” testosterone there is in your body. “Free testosterone” is easier for your body to use, and may be more helpful in diagnosing certain medical conditions.

Second, if you are low in testosterone, you need to be careful about the method used to restore testosterone. Methods that restore the body’s testosterone levels carefully, and without up-and-down spikes, such as gel, are preferable to large dose injections.


If you have cardiovascular disease, you should talk to your doctor in view of recent studies that show testosterone therapy may be safe. But this decision should be made according to medical advice about your personal case.

Sidebar: What about Bioidentical Hormones?

Given the concerns over hormone replacements, some men and women have turned to bioidentical hormone therapy, believing that natural is always better. But is it?

The use of bioidentical hormones (also known as natural hormone therapy) dates back to the 1930’s, when estrogen extracted from pregnant women was used to provide relief from menopausal symptoms. This formulation was supplanted years late when a synthetic form of estrogen was developed. Made from the urine of pregnant mares, this was the type of hormone replacement used in the Women’s Health Initiative study.

But the risks that study identified has led people to search for an alternative, and this is where bioidentical hormones come in. The term “bioidentical” doesn’t have a precise medical definition. Generally, they are defined as compounds that have an exact chemical replica of those occurring naturally in humans. They are also known as bio-identical hormones, or bioidentical hormone replacement therapy (BHRT).

Such bioidentical hormones are not found in this form in nature, so these hormones (both estrogen and testosterone) are the synthesized, from a plant chemical extracted from yams and soy. Although bioidentical hormones were originally used to treat women, the field has broadened to include the treatment of men using replacement testosterone.

Some forms of bioidentical hormones are made by drug companies and are FDA approved. But the types of bioidentical hormones that are generally discussed in the media fall under the scope of alternative medicine. Generally, these preparations are manufactured in special pharmacies called compounding pharmacies, which are not FDA-approved because they aren’t standardized.

Generally, the results of a saliva test are used to identify hormone deficiencies and retests are performed to adjust dosages. For this reason, bioidentical hormones are marketed as being more individualized, and therefore superior to the “one-size-fits-all” hormones manufactured by drug companies.

But are bioidentical hormones actually better? Here are some points to remember about bioidentical hormones.

  • Bioidentical hormones are not necessarily any more it “natural” than conventional many forms of conventional hormonal formulations.
  • Although a saliva test can indicate hormonal deficiencies, the amount of hormones fluctuate throughout the day, so it does not provide accurate information to make medication adjustments.
  • Bioidentical hormones do not have the same body of clinical testing that conventional preparations do, so there is no credible scientific evidence to support any claims that they are any more safe or effective to conventional drugs.
  • Bioidentical hormones are also being marketed as “anti-aging” cures, and many doctors position themselves as such, but may be substituting quickie certificates for years of medical training. If you are considering them, consider seeing an endocrinologist, which is a doctor trained in dealing with hormones.


Bioidentical hormones can be a good choice if your doctor is reluctant to prescribe them, or if you are allergic to any of the ingredients used in traditional drug formulations, but and you don’t fall into any of the categories where they are contraindicated. They are also useful if you are allergic to any of the ingredients in the traditional drug medications.


Although these are natural hormones, they will work like other types of replacement hormones, so you should not take them if hormone use is contraindicated.

Remember, hormones are only part of the equation for good heart health. The other steps you take to reverse heart disease, like managing your blood pressure, lowering your blood pressure, preventing diabetes and staying lean and active, also play major roles in keeping your heart healthy. But if you want your body to work with peak efficiency, you do need to have to pay attention to your hormones.

Schedule a consultation today to learn more about how Dr. Crandall can help.


  1. Menopause and women’s cardiovascular health
  2. Heart Disease and Hormones – PMC
  3. Menopause and the Cardiovascular System
  4. The connection between menopause and cardiovascular disease
  5. Menopause and Heart Disease
  6. Menopause and heart and circulatory conditions – BHF
  7. Hormones and your heart
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