26 Jun Can I Lose that Stubborn Weight with BHRT?
Author: Nick Miller, Pharm.D
One of the primary concerns men and women have as they age is the accumulation of body fat, especially around the midsection. Not only is this weight gain unwanted and unsightly, it is also unhealthy. The prevalence of high caloric intake and sedentary lifestyles in our Western society is partly to blame, but that stubborn weight gain is also tied to the hormonal changes that we undergo in both menopause and andropause.
Hormones are messenger molecules. They transmit a message from one part of the body to the cells of another, stimulating those cells to act in a specific way. In humans, our hormonal production begins to fall around age 30. We produce increasingly less of these messenger molecules with each passing year, so the signals they are transmitting become increasingly less effective. These hormonal messages transmit directions for critical biological processes including cell growth and replication, energy metabolism, glucose utilization, and protein synthesis. In other words, as we age, our body becomes less efficient at maintaining itself at a cellular level. This hormonal decline is related to the tangible symptoms patients feel when going through midlife changes.
Hormone replacement is typically prescribed for women to alleviate the vasomotor symptoms of menopause, however we know there are numerous health benefits of BHRT for women. Optimization of estrogen, progesterone, DHEA and testosterone levels in female patients is important in women for whom body contouring is a concern. Estradiol implants do not significantly increase body weight or total body fat in postmenopausal women, and testosterone implants do not negatively affect body weight or total body fat. Estradiol implants were also shown to reduce abdominal body fat and improve body contouring in this population (Davis 2000).
It has been shown in male patients that testosterone levels are reduced as waist circumference increases, and low levels of testosterone are correlated with obesity. Testosterone replacement in men has many beneficial effects on body composition, including significant reduction of fat mass, weight, waist circumference and BMI (Traish 2014). Testosterone also regulates the synthesis of muscle tissue, and can increase muscle mass. One of the biggest obstacles to testosterone replacement is patient compliance. One study showed that patient compliance with transdermal testosterone gels was only 34.7% of patients at 6 months, and 15.4% at 12 months (Schoenfeld 2013). One of the best ways to combat the barrier of patient compliance with transdermal formulations is to offer them the pellet dosage form, where patient compliance is markedly higher.
The addition of bio-identical hormones can replace our body’s dwindling hormone production leading us to feel (and look!) similar to how we did when we were younger.
Davis SR, Walker KZ, Strauss BJ. Effects of estradiol with and without testosterone on body composition and relationships with lipids in postmenopausal women. Menopause. 2000;7(6):395-401.
Schoenfeld MJ, Shortridge E, Cui Z, Muram D. Medication adherence and treatment patterns for hypogonadal patients treated with topical testosterone therapy: a retrospective medical claims analysis. J Sex Med. 2013;10(5):1401-9.
Traish AM. Testosterone and weight loss: the evidence. Curr Opin Endocrinol Diabetes Obes. 2014;21(5):313-22.