Consideration of bone density scores compared with age related scores and HRT is important whether the BMD score is low and abnormal but also when it is abnormally high. I offer the following recommendations concerning bone density and hormone review before making recommendations regarding HRT.
In doing bone densities on my patients, I have found a certain element of people who exhibit a paradoxical response to hormones. These patients typically have a normal estradiol and low/ normal progesterone level but yet have a high response to bone density. Their BMD scores fall well above the normal range. These patient’s subsequently have a high potential for developing breast cancer. Therefore, HRT recommendation for these patients is to balance the effects of high endogeneous estradiol with a supplemented natural compound of progesterone. This idea follows the effects of the tumor accelerator and P53 genetic response.
The rationale I use as the basis for hormone supplementation recommendations is in reference to how it affects the patients risk for developing breast cancer, the degree of difficulty in the interpretation of the mammogram as well as the consideration of osteoporosis. Close monitoring of mammograms for breast density changes in patients taking any HRT is very important. My experience has been that patients on synthetic forms of estrogens or natural estradiol without any supplemented progesterone and have very dense glands on mammography, thus rendering the interpretation of the mammograms much more difficult for early detection as well as increasing their potential for developing a breast cancer.
I believe one of the best ways to clinically evaluate hormones is the saliva test. The saliva test is more accurate than the blood test for hormone evaluation because the saliva provides a measure of the unbound (bioavailable) to protein molecules.
The course of action I recommend for these patient’s should be to have a saliva test and then to recommend HRT of a comounded natural (bioidentical source) of one of the three estrogens, specifically estriol and progesterone depending on current hormone levels following the saliva evaluation.
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