Hormone Replacement Therapy Part 2


Restorative medicine or, more precisely, hormone restorative medicine is the restoration of optimal physiology.

Stack of pebble stones by a stream in a forestIt is a whole-body concept because it affects every organ cell from our head to our toes. It is concerning a new principle – the principle is that many diseases are the result of an imbalance of body chemistry and once we restore balance through physiology we can correct the cause of the majority of diseases. This message must be heard, and will be heard, because it is logical, it is rooted in science, and it is based on clinical results.

Restorative medicine approach, or bioidentical natural hormone balance, is effective for many diseases and conditions because they correct physiologic imblances, that is, there is a correction of imbalance of the body’s physiology with the correction of hormones, vitamins, and minerals. The concept is simple. All of nature wants to be in harmony. In the human body, this struggle causes symptoms and laboratory abnormalities, which ultimately lead to a breakdown in bodily functions and manifest as disease.

I believe people don’t feel their age; they feel the result of a decline in hormones, vitamins, nutrients, and increased toxins in their bodies.

The basic approach to bioidentical hormone balance is a prescription of multiple bioidentical hormones in a customized manner to simulate the optimal natural hormone production in our own bodies, to stimulate organs such as brain, skin, heart, immune system, bones, and joints.

All these organ systems depend on hormones.

Why are multiple hormones necessary? Because many of the hormones work together in a symphony. When you change the level of one, you impact the level of the other. The goal is to achieve a balance of hormones and this requires that you look at all the levels and make adjustments as needed.


In my practice, I only use a natural approach.

This means the hormones are biochemically identical to those produced by the human body. I do not feel that synthetic hormones, such as those derived from horse urine, for example, Premarin, or synthetic progestins, which are a synthetic progesterone, are useful for the body and I do not use them in my practice. The vitamins and all nutritional supplements that are part of my program are also natural. The word “optimum” is defined as the level of hormones in one-third of the highest normal range from testing laboratories for a healthy thirty-year-old for all steroid hormones, except estrogen and total testosterone in men.

In addition to the basic hormones, I also include various vitamins, nutritionals, minerals, and herbs to help balance each person’s body. These enhance the performance and efficacy of the hormones and the intent is to resolve the signs and symptoms of each individual. Of course, detoxification, diet, and exercise are important. For many patients, losing weight is the goal, but the fact that they have been feeling depressed or unwell for so long has prevented them from effectively losing pounds through exercise and a healthy eating plan. I also use IV therapy, IV ozone, pemf, far infrared sauna, MICROCURRENT and hyperbaric oxygen treatments .

Now let’s take a look at these various hormones and contrast some of them with their synthetic counterparts.


When we talk of hormones in women, most of us think of estrogen and a few more also include progesterone. In a normally functioning, premenopausal woman, estrogen is made from progesterone and/or androgens within the cells of the body. After menopause, estrogens are converted from the adrenal-produced androgens (DHEA), primarily in body fat. Estrogen and progesterone are, in many ways, antagonistic, yet it each sensitizes receptors for the other one. A key to hormonal balance is the knowledge that when estrogen becomes the dominant hormone and progesterone is deficient the estrogen becomes toxic to the body, thus progesterone has a balancing or mitigating effect on estrogen.

Estrogen is responsible for the maturation of young women of puberty. Estrogen causes the accumulation of fat that gives the female body its contour, but in excess or when it’s not balanced with progesterone, it can contribute to excess fat accumulation. When women consume considerably more calories than what is needed, estrogen reduction increases to supernormal levels and it sets the stage for estrogen dominant syndrome, an exaggerated estrogen decline at menopause. In the United States, and most industrial countries, our diets are high in saturated fats from animal proteins, refined starches, and processed foods. These excess calories lead to high estrogen levels in women as well as men and can wreak havoc in hormone balance.


In this context, it is worthwhile to compare the physiologic effects of estrogen versus progesterone.

Estrogen’s effects are:

Stimulates breast tissue, increases body fat, causes salt and water retention, depression, headaches, interferes with thyroid hormones, increases blood clotting, decreases sex drive, impairs blood sugar control, reduces vascular tone, increases the risk of autoimmune disease, and increases the risk of endometrial and breast cancer.

Progesterone effects:

Progesterone protects against fibrocystic breasts, disease, helps use fat for energy, is a natural diuretic, and natural antidepressant. It facilitates thyroid hormone action as well as normalizes blood clotting. It restores sex drive and normalizes blood sugar. It restores normal vascular tone and stimulates osteoblasts for bone building. It is also a precursor of corticosteroid and is useful as an antiinflammatory. Last, but not least, it prevents endometrial and breast cancer as well as fibroids.

It is clear that the excess estrogen, when unopposed or unbalanced by progesterone, is something not to be desired.

It becomes clear that many of estrogen’s undesirable side effects are effectively prevented by progesterone.

I propose a new syndrome, that of “Estrogen Dominance.”

This syndrome commonly occurs in industrialist countries in the following situations:

1. Estrogen replacement therapy;
2. Premenopause (early follicle depletion resulting in lack of ovulation and thus lack of progesterone well before the onset of menopause);
3. Exposure to xenoestrogens (foreign chemicals that have an estrogen effect in the body and cause early follicle depletion);
4. Birth control pills with excessive estrogen component;
5. Hysterectomy, which can induce subsequent ovarian dysfunction or atrophy;
6. Postmenopause, especially in overweight women;
7. Estrogen use in the meat industry.

A peculiarity of Western industrialized society is the prevalence of uterine fibroids, breast and/or uterine cancer, fibrocystic breasts, PMS, ovarian cancer, premenopausal bone loss, and a high incidence of osteoporosis in menopausal women. I believe that most of these are symptoms of estrogen dominance.

Therefore, symptoms that could be made worse by estrogen dominance include:

Breast tendernessDecreased sex driveDepressionFatigueFibrocystic breastsIrritabilityHeadachesMiscarriageFat gain, especially around the abdomen, thighs, and hipsPMSOsteoporosisHypothyroidismThyroid dysfunctionUterine fibroidsUterine cancerGallbladder diseaseWater retentionThyroiditisMemory lossRheumatoid arthritisAutoimmune disorders, such as lupus erythematosus

Acceleration of the aging process Allergies

The other hormones used in my program are discussed in separate pages. It has always best to use natural, and synthetic hormones are never used in this office. In certain instances, I prescribe estrogen therapy in the form of Biest, which is 80% estriol and 20% estradiol, or, at times, I just prescribe estriol. Although estrogen is a two-edged sword, whenever prescribing estrogen I check to see how each patient uniquely metabolizes estrogen. If he is metabolizing into a carcinogenic 4-hydroxyestrogen series, it is not used.

Testosterone is another naturally occurring hormone, which is absolutely necessary and critical for erectile function, libido, muscle mass, energy, mood, and bone formation.

Adrenal hormones such as DHEA are a natural hormone made by the adrenal glands. It is a natural substance made by the body and cannot be patented and made into a drug. As such, it is not FDA-approved, since the FDA does not approve a natural substance, only a synthetic substance.

More than 150 hormones are synthesized by the adrenal glands; however, the most abundant hormone made by them is DHEA. It goes into the bloodstream and from there travels all over the body and gets into all our cells where it is converted into male hormones known as androgens or female hormones known as estrogens. Whether DHEA gets converted predominantly to androgens or estrogens depends upon the person’s medical condition, age, and sex.

Every person has a unique biochemistry. The only hormone class that DHEA cannot make is progesterone and its sister hormones, cortisol and aldosterone. From the studies that have been done so far, DHEA has been shown to help disease by boosting your immune function, improving mood and energy as well as sex drive, and influences longevity.

Studies have also shown it to reduce the risk of cardiovascular disease and helps symptoms of lupus, rheumatoid arthritis, and multiple sclerosis, as well as diabetes.

Pregnenolone is a natural hormone, which cannot be patented and made into a drug. Back in the 1940s when researchers started experimenting with pregnenolone, they realized it could be helpful to people under stress and could increase the energy of those who were fatigued.

Pregnenolone is made in many organs and tissues in the body; the most common of these are the adrenal glands, liver, skin, and gonads, which are the testes and ovaries. The amount of pregnenolone made depends upon how much cholesterol is brought into the mitochondria. The mitochondria are the chemical factories of a cell that also produce the energy molecules for the body.

Pregnenolone can easily be converted into DHEA, another hormone that has been in the news lately. DHEA can then be converted into androgens, estrogens, and other steroids within the body.

There is one other pathway that pregnenolone can take, which distinguishes it from DHEA, and that is pregnenolone can be metabolized into progesterone, which DHEA can’t. Thus DHEA has been called the “mother” hormone and I guess pregnenolone would be called the “grandmother” hormone.

Because of the wide number of hormones that can be made by the body from pregnenolone, it has a long list of conditions that can be affected by supplementation. A few of these are brain function, including mood, memory, thinking, Alzheimer’s, sleep, chronic fatigue, immune system, lupus, multiple sclerosis, PMS, psoriasis, rheumatoid arthritis, scleroderma, and stress.

Melatonin is a natural hormone made from the pineal gland.

This helps set and control the internal clock that governs the natural rhythms of the body. Each night, the pineal gland produces melatonin, which helps us fall asleep. Researchers show melatonin’s role as a powerful antioxidant, anti-aging benefit, and immune-enhancing properties, such as usefulness as a natural substance in cancer.

It is an effective tool to prevent and cure jet lag and an ideal supplement to reset the biologic clock in shift workers as well as a great natural substance for those who have insomnia. Melatonin may also have a role in the treatment of prostatic enlargement in addition to cancer treatment, in lowering cholesterol levels and influencing reproduction, migraines, and more, and a delightful bonus, it can give us vivid dreams.


Dean Silver, M.D.

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