Hormone Therapies

Hormones are biological messengers that regulate numerous systems in the body, including metabolism, energy levels, body composition, bone health, muscle mass, sexual function, sleep, mood, and overall quality of life. The production of some hormones can decrease or stop completely as a result of aging, menopause, certain diseases, surgeries, or disorders of the endocrine system.

Hormone Replacement Therapy (HRT)Hormone replacement therapy is a general term for treatments aimed at replacing a hormone that the body cannot produce in sufficient quantities by administering it externally. The goal of treatment is not only to bring laboratory values within a certain range. Reducing symptoms associated with hormone deficiency, supporting the person's physical and psychological well-being, improving quality of life, and, in suitable patients, minimizing the negative long-term health effects of hormone deficiency are also important goals of treatment.

Hormone replacement therapies are not only treatments for older adults. They may be considered in a wide variety of situations, including premature decrease in hormone production, ovarian or testicular dysfunction, certain pituitary and endocrine diseases, surgical removal of the ovaries or testicles, and hormonal changes that occur during the natural aging process. Therefore, there is no specific starting age or upper age limit for hormone replacement therapy. The suitability of the treatment is determined by considering the individual's age, symptoms, hormone levels, overall health, medical history, and individual risk factors.

In hormone therapies, especially those used in women during menopause, the timing of initiation is crucial. Generally, the benefit-risk balance is considered more favorable in women who begin treatment within the first 10 years after the onset of menopause or before the age of 60, provided there are no significant contraindications. However, this does not mean that hormone therapy cannot be used after the age of 60 or that it must be discontinued at a certain age. The initiation and duration of treatment should be based on individual assessment.

In men, testosterone production may gradually decrease with age, and in some men, hormone levels may drop to low or low-normal levels before noticeable symptoms appear. Therefore, instead of waiting for the appearance of significant complaints, a more comprehensive approach to assessing hormonal health involves evaluating testosterone levels, free testosterone, SHBG, age, body composition, metabolic health, and other clinical factors together. In cases of significantly decreased hormone levels, correctable causes should be investigated first; in suitable patients, lifestyle modifications or hormone replacement therapy to maintain and optimize physiological hormone levels can be considered. 

The hormone, dose, and method of administration used in hormone replacement therapy are determined individually, taking into account the person's age, hormonal profile, clinical needs, and reproductive plans. In women, estrogen and progesterone, and in appropriate cases testosterone and DHEA, may be used; in men, testosterone and, in certain situations, DHEA may be used. Especially in young men who wish to preserve their fertility, external testosterone administration can suppress sperm production; therefore, instead of direct testosterone replacement, treatments that support the body's own testosterone production or regulate the hormonal axis, such as hCG, and in selected cases clomiphene or enclomiphene, may be preferred. For this reason, the aim of hormone therapy is not only to replace the deficient hormone externally, but also, in suitable patients, to preserve and optimize the body's own hormone production.

The fundamental approach in hormone replacement therapies is personalized treatment. Two individuals of the same age and gender can have significantly different hormonal needs and benefits from treatment. Therefore, hormone therapy should not be planned based solely on a single laboratory result. Symptoms, physical findings, hormone levels, existing illnesses, medications used, and individual risk factors should all be considered together.

Using the right hormone in the right patient, at the appropriate dose and method of administration, is the fundamental principle of hormone replacement therapy. Once treatment begins, it is important to regularly monitor clinical response and necessary laboratory parameters, and to adjust the treatment over time according to the individual's needs.

Before initiating hormone therapy, it is crucial to assess not only hormone levels but also the pathways through which these hormones are metabolized in the body. While serum hormone tests provide a basic assessment of hormonal status, dried urine hormone and metabolite tests can offer a much more detailed profile of steroid hormone metabolism.

In particular, it is possible to observe the ratios in which estrone and estradiol are converted into their 2-hydroxy (2-OH), 4-hydroxy (4-OH), and 16-hydroxy (16-OH) metabolites in estrogen metabolism. In addition, the methylation of catechol estrogens and the evaluation of relationships such as 2-methoxy/2-OH and 4-methoxy/4-OH can help to examine not only the quantity but also the metabolic pathways of estrogen metabolism in more detail.

This information becomes particularly valuable in personalizing hormone replacement therapy. Identifying a clear bias towards a specific metabolic pathway allows for a more holistic assessment of metabolic, nutritional, and lifestyle factors, as well as hormone dosage and administration method. Therefore, in a comprehensive hormone assessment, it is beneficial to utilize dried urine tests that show hormone metabolites, in addition to serum hormone measurements.

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All information presented here is for general informational and educational purposes only. This content is not intended to diagnose any disease, provide personalized medical assessments, or initiate, modify, or discontinue any treatment.

The information provided does not replace a doctor's examination, personal medical evaluation, or professional healthcare. Because health conditions and treatment needs vary from person to person, it is recommended that you consult your own doctor or relevant healthcare professional before starting any medication, supplement, treatment, or medical practice, or making any changes to your current treatment.

Because medical information and scientific data can change over time, the information presented here should not be assumed to be applicable to every individual or every clinical situation.

I wish you healthy days,

Dr. Ahmet Özyiğit, MD, MSc, PgDip, FAAMM, ABAARM
Longevity Physician

Elite Research and Surgical Hospital