Most recognize the importance of Vitamin D intake, calcium intake, diet, and exercise (weight bearing and muscle strengthening) in reducing the risk of osteoporosis as well as avoidance of alcohol and tobacco. However, the hormones estradiol and testosterone are also very important in maintaining bone health. We have known for several years that both estradiol and testosterone can help prevent osteoporosis but more recently, it has been recognized that both of these hormones can reverse to some extent, osteoporosis!

The simple answer is the fear and misconceptions surrounding the whole topic of HRT. In the Women’s Health Initiative Study (WHI), the following risks associated with “hormone” replacement sent us all running for cover: 41% increased risk of stroke, 29% increased risk of heart attack, 26% of breast cancer, 110% of blood clots, and 105% of dementia. However the only hormones investigated were Premarin and Provera, both synthetic and non bioidentical hormones.

Only bioidentical hormones, which have the exact molecular structure and 3D shape as the hormones we produce naturally, can join hormone receptors properly. This proper joining allows our cells to receive the correct message. Premarin and Provera are also taken by mouth. We have known for at least 20 years that oral hormone therapy is associated with increased risks of thrombosis, stroke, heart attack, and DVT because of the “First Pass Effect” (hormones absorbed by the gut first pass to the liver, where they result in the production of clotting factors). The exception to this increased clotting factor production, is the use of oral micronized progesterone. Bioidentical hormones, identical in every way to the hormones we produce naturally, are much safer and efficacious.

In a study performed by Dr. Studd, Bone Mineral Density testing was performed in a group of patients using estradiol and testosterone pellet therapy. Pellets are compressed cylinders of bioidentical estradiol and testosterone which are placed in the subcutaneous or fatty layer beneath the skin. Pellets therapy leads to steady state, physiologic blood levels (levels at which the body functions optimally) with minimal fluctuation. After 1 year of treatment, the bone mineral density was found to increase by as much as 8.3%. By comparison, the BMD with the use of the estradiol patch increased by up to 3.5%, with oral estrogens, 1-2%. It has been so rewarding to see improvements in BMD testing, in my patients using hormone pellets.

In addition, testosterone and estradiol help build cartilage in the joints and help to decrease bone, joint and muscle pain. Because testosterone does such a great job at decreasing inflammation, testosterone pellets are now being used in chronic pain centers across the U.S., just to treat chronic pain patients.

In 2010, more than 38 million prescriptions were written for HRT yet sadly only 1.4 million for an estrogen and testosterone! The fear engendered by the WHI Study has harmed many women who didn’t realize there were safer alternatives or any alternatives for that matter. (65% of women stopped their HRT after the WHI was published!) This study is now 17 years old, and most of my fellow gynecologists haven’t prescribed Premarin and Provera for many years.

Dr. Edward Friedman, a professor at University of Chicago sums it up very well:

How many women have suffered fractures and morbidity/mortality because they stopped their HRT from their own fear or the fear of their doctors? It’s time we begin counseling patients based on current literature and prevent a few more fractures.