It must be remembered that aging is a time dependent degenerative process that ultimately leads to death. Notably, it was Harman who first suggested that free radicals from oxidative processes in the cell were at the root of the aging process (Ref. 7). And it was Harman again (Ref. 8) who suggested that it was the mitochondria that were responsible for producing energy that were at the receiving end of oxidative damage. Mitochondria are the small particles within the cell responsible for producing energy. To clarify, this according to him determined how long our “biological clock” would tick and how old we would turn.
Authors who promoted bioidentical hormone replacement
Certainly, Suzanne Somers’ work (Ref. 1 and 2) has done a lot to focus attention to this gentle and yet powerful method of resetting the clock with bioidentical hormones. In Germany and Europe Dr. Volker Rimkus, a gynecologist (now retired), has published about the use of natural estradiol and natural progesterone to restore the hormone balance of the body in both women and men (see Ref.3 and 4). Moreover, Cliff Richard, the British rock star is one of the prominent people who watches his eats and lifestyle preserving his youthfulness for longer.
How to optimize your life expectancy
Anti-aging physicians specialize in this newest branch of medicine. They tell us that we need to do to age gracefully:
1. Detoxify the body
2. Eliminate MSG (monosodium glutamate, thanks to www.msgtruth.org for this link) and all look-alikes from our food intake
3. We need to get rid of heavy metal poisons in our body (mercury, lead, cadmium). Chelation therapy achieves this.
4. We need supplements with vitamins, minerals and fish oil and a well balanced diet
5. We need regular exercise (that fits into a regular routine), but also relaxation and enough regenerating sleep
6. When all of this is done, we will benefit from bioidentical hormone replacement, if this is what our blood tests indicate need
Do hormone tests early, before andropause and menopause
Truly, in middle aged men and women there may not be a hormone dysbalance, but we should not assume anything. In this day and age our environment and nutrition are so poor or even toxic that our hormones can be out of balance. By all means, this can be determined by blood tests.
For one thing, Dr. Rimkus examined a group of middle aged women who felt well and also a group of middle aged men to determine what their normal hormone ranges would be. For this reason, he developed normal hormone ranges for both women and men (see table below, which is in Standard International Units or SI units, the ones used in Europe).
Normal Blood Test Ranges for Hormone Replacement in Women and Men (SI units, mostly in Europe and many other countries)
|Estradiol levels:||120-180 pg/ml||30-60 pg/ml|
|Progesterone levels:||10-30 ng/ml||3-10 ng/ml|
|FSH levels:||15-30 IU/L||(5-15 IU/L)|
|Modified according to Dr. Rimkus (Ref. 3 and 4)|
With this in mind, for North American residents where traditionally the Conventional Units are used, I converted the European units into North American units in the following table.
Normal Blood Test Ranges for Hormone Replacement in Women and Men (Conventional units, as used in the US)
|Estradiol levels:||32.7-49 pmol/L||8.2-16.34 pmol/L|
|Progesterone levels:||3.14-9.43 nmol/L||0.94-3.14 nmol/L|
|FSH levels:||15-30 mIU/ml||(5-15 IU/L mIU/ml)|
Discussion of what normal hormone levels are
Those familiar with bioidentical hormone replacement will find these levels lower than many labs report for youthful hormone ranges. But Dr. Lee points out in his books (Ref.6) that there is no point to push too high with hormone replacement. In addition, he also is against forcing women who have been menopausal to get periods again. On page 83 of Ref. 6 he stated: “There is no reason for postmenopausal women to have periods. Menstruating past the age of menopause is not going to make you look or feel younger, nor will it slow the aging process.” Truly, to complicate the issue, Dr. Lee points out in Ref. 6 that there is good evidence that blood tests do not reflect tissue levels as accurately as saliva tests do. The normal levels for saliva tests have their own normal ranges, which are lower than the ones listed above.
Dr. Rimkus was a leading force regarding hormone replacement in Germany
As far as I know Dr. Rimkus was the first to find that estrogen and progesterone in combination can be used for men as hormone replacement treatment. However, the doses for men are about 3 to 4 times less than for women (Ref.3 and 4). In addition, he also found that capsules with estrogen and progesterone in olive oil are well absorbed through the gut and lymphatic channels (see below). Another key point, small amounts of zinc gluconate (35mg) and copper gluconate (0.05mg) are added to the capsules to stimulate enzyme activity. Dr. Rimkus did this to convert progesterone into other essential hormones, namely testosterone, cortisol and aldosterone) He calls this the “Rimkus capsule” and recommends to take it twice per day with an individually prescribed amount of estrogen/progesterone combination.
Male bioidentical hormone replacement
Likewise, he suggests repeating the three blood tests indicated in the table above after two months (except that in males testosterone is tested instead of FSH). A normal bioavailable testosterone level is 4.0-16.0 nmol/L , where 10 to 12 is more desirable as a therapeutic goal. Tha is to say, the hormone strength is fine tuned based on the follow-up measurements. Initially PSA and bioavailable testosterone levels are determined in men (simple blood tests) and the testosterone test is repeated in intervals every couple of month until the levels are stable. The PSA level initially and yearly thereafter is a precaution to monitor for prostate cancer. However, studied showed that this is not a complication of bio-identical hormone replacement. Nevertheless, it is a good medical practice.
Female bioidentical hormone replacement
It is important to realize that under the influence of estrogen and progesterone the FSH level (follicle stimulating hormone) will come down to a normal range. FSH is a stimulating hormone from the pituitary gland, as indicated in the above table. It must be remembered that in a woman the goal is to bring the FSH level back into a range below 30 IU/L, in a man below 15 IU/L. However, the clinical wellbeing of the patient is the more important indicator in judging the progress with regard to bioidentical hormone replacement of a patient.
Importance of baseline hormone tests
Similarly, it is important to take accurate baseline hormone tests before any treatment is started. The actual hormone values will tell the treating physician how much natural hormone will be required to achieve a normal hormone balance. For the patient it is also reassuring to know that there is a correlation between having symptoms (when the levels are abnormal) and having feelings of wellbeing (when hormone levels are within the ranges indicated).
Synthetic hormones are dangerous
It is important to realize in this context that synthetic hormones such as the birth control pill or HRT in menopause will show abnormally low estrogen and progesterone values (Dr. Rimkus, Ref. 3). In this case, it seems that the body knows that these artificial hormone products are not identical to the original bioidentical hormones. To put it differently, this explains all of the dangerous side-effects from commercially available hormone modifications produced by the drug manufacturers such as breast cancer, strokes, heart attacks. Only bioidentical hormones will raise the level of low estrogen, progesterone or testosterone.
Here is a useful table where the effects of estradiol and of progesterone in women and men are listed (modified from Ref. 3 and 4). A lack of either estrogen or progesterone will lead to a state where some of these properties are missing.
Important Properties of Bioidentical Estrogen and Progesterone in Women and Men
|Estradiol effects:||Progesterone Effects:|
|inactivates free radicals||builds up lining of uterus (secretory phase, 2nd half of cycle)|
|apoptosis (meaning “tumor starving”)||mobilizes energy from fat|
|cardiovascular protection||supports thyroid gland|
|promoting hair growth on scalp||stimulates urine production|
|stimulates collagen and bone growth||antithrombotic effect (protects from blood clots)|
|maintains libido and potency||has antidepressant effect|
|fertility hormone||stabilizes zinc and copper (important for proper enzyme function)|
|preserves neurotransmitters and prevents Alzheimer’s||protects myelin sheaths (prevents multiple sclerosis)|
|myelin sheath protection and brain cell preservation||stimulates fibroblasts and osteoblasts (bone and collagen)|
|prevents cataracts||has pain relieving effect|
|protects skin, mucous membranes, prevents atrophy of genitals||5-alpha-reductase inhibitor (scalp hair growth, prostate protection)|
|prevents otosclerosis (old age hearing loss)||promotes natural sleep|
|prevents depression of aging (involutional depression)||reduces cholesterol naturally|
|preserves cognitive functioning||protects from mature onset diabetes (type 2 DM)|
|regulates fat metabolism||supports libido and potency|
|eliminates hot flashes||supports apoptosis; enables embryo to survive|
|Modified according to Dr. Rimkus (Ref. 3 and 4)|
Men can be estrogen and progesterone deficient
Here is a link showing 45 effects that are known about progesterone.
It must be remembered, there is a metabolic pathway from cholesterol to the various hormones including the enzymes that need to be present to make this happen. Another key point, in this context it needs to be pointed out that DHEA can be converted into testosterone or estrogen, but not into progesterone, cortisol or aldosterone.
Conversely, in North America it seems to not yet be generally accepted that men can be estrogen deficient and/or progesterone deficient. Dr. Rimkus has published his experience in treating more than 1000 hormone deficient men for over 10 years with estrogen/progesterone combinations dissolved in olive oil. These capsules at a dosage of between 0.15mg to 0.25mg of natural estradiol mixed with about 50 mg of progesterone twice per day by mouth was the only bioidentical hormone replacement.
Bypassing the portal vein system
Certainly, because steroid hormones are oil soluble, absorption in the gut bypasses the portal system and chylomicron particles with oily enclosures leave the gut via lymphatic vessels and enter the bloodstream through the main thoracic duct. This joins the left subclavian vein, enters the heart, allows the hormones to circulate through the body and reach all of the estrogen and progesterone receptors before the first liver passage removes the remnants. However, there are now compounding pharmacies also in the US that offer hormones in a form that can enter the body from the gut by biolymphatic absorption bypassing the liver so that the full amount of hormones is available to the organs.
Oily bioidentical hormone replacement capsules
According to Dr. Rimkus (Ref. 3 and 4) this is the way evolution has made us to accept natural hormones. The only difference is that the hormone glands secrete the hormones via their lymphatic drainage into the lymphatic system and thoracic duct from inside, while the bioidentical hormones from the oily capsules reach the thoracic duct via absorption from the gut.
Bioidentical estrogen/progesterone combination capsules effective
As a matter of fact, the ultimate proof that absorption was adequate came through research by Dr. Rimkus in the 1990’s when he could demonstrate effective hormone replacement by doing blood levels after replacement therapy with his bioidentical estrogen/progesterone combination capsules. He showed that when therapeutic levels were reached (as shown in the table above), patients felt well. Truly, for postmenopausal women the Rimkus capsule would contain between 0.5 mg and 1 mg estradiol and 50 to 100 mg of progesterone. One of these capsules is taken twice per day by the postmenopausal woman, if the baseline blood test indicated a low level and elevated FSH level.
Follow-up hormone tests
Two months after starting this the blood tests are repeated and the dosage may have to be adjusted up or down. Surprisingly, in postmenopausal women an interesting progesterone effect was observed: within one year of using the Rimkus capsule the periods subsided, because of what he calls a conversion of estrogen receptors into progesterone receptors within the lining of the uterus (called endometrium). Indeed, in 20 years of treating women he did not have a single case of ovarian or uterine cancer; treating men for 10 years he did not have any case of prostate cancer with their treatment protocol (keep in mind that these are bioidentical hormones that the body knows, not synthetic hormones).
Differences of the European bioidentical hormone replacement and the US system
Interestingly, in North America treatment is usually done with DHEA capsules at 25 mg for women and 25-50 mg for men, which is combined with bioidentical hormone creams that are absorbed through the skin (estrogen and/or progesterone creams for women and testosterone cream for men). The end result seems to be the same, a normalization of the hormone system. However, Dr. Rimkus cautions that progesterone levels and estrogen levels in men can be low with this method, which can lead to heart attacks and cancer despite a feeling of wellbeing from testosterone replacement. For this reason, he states that the physician should test estradiol and progesterone levels in both women and men and replace what is missing.
Other hormone experts agree that all major hormones need testing in men and women
Dr. Ron Rothberg and Dr. Thierry Hertoghe among other speakers at an anti-aging conference (Ref. 9) confirmed that all the major hormones need to be tested by blood tests and or saliva testing and what is missing needs to be replaced to allow the body’s hormone balance to return. In the same way, the heart attack and stroke risk returns to very low levels encountered in the mid 30’s. Also, cancer risks are extremely low on bio-identical hormone replacement and disabilities from arthritis are not seen. In like manner, with continued physical activity the lining of the arteries produces nitric oxide, which keeps the person younger for longer.
False belief that testosterone would cause prostate cancer
Physicians were thinking for several decades that testosterone replacement in men would cause prostate cancer. But it is important to realize that Dr. Morgentaler, a professor of urology at Harvard University, has written a book on this subject (Ref. 5). This explains that low testosterone is killing men through various means (heart attacks, not only prostate cancer, but other cancers as well). He also pointed out that bioidentical testosterone will eliminate this and can be safely taken for life. To put it differently, this will often eliminate the need for Viagra, as testosterone will restore normal sexual function. The key with any hormone replacement is to measure blood levels from time to time, so that the patient’s level is within the normal range (in this case the bioavailable testosterone level).
Progesterone deficiency likely the cause of heart attacks in men
By all means, the reason for higher heart attack rates in men with low testosterone is likely that they are often deficient in progesterone. This is the precursor of testosterone. Another key point is that overweight or obese men may have high estrogen levels. With the Rimkus method of hormone replacement the male will automatically make his own testosterone through conversion as indicated in this link. Indeed, the small amount of added estradiol helps protect the heart as well.
The Yin and Yang of bioidentical hormone replacement
Dr. Rimkus calls this the Yin (estradiol) and Yang (progesterone) of natural hormone replacement (Ref. 3 and 4). In this case, in North America we are more cautious as with age some of the converting enzymes are no longer working properly, so it is perhaps better to replace the hormones that are deficient directly.
In fact, bioidentical hormone replacement for women and men as described above leads to longevity by adding about 10 to 15 years to your life, if started early enough.
1. Suzanne Somers: “Breakthrough” Eight Steps to Wellness– Life-altering Secrets from Today’s Cutting-edge Doctors”, Crown Publishers, 2008
2. Suzanne Somers: “Ageless – the naked truth about bioidentical hormones”, Three Rivers Press, NY, 2006
3. Dr. Volker Rimkus: “Die Rimkus-Methode – Eine natürliche Hormonersatztherapie fuer die Frau”, Verlag Mainz, 2006 (in German)
4. Dr. Volker Rimkus: “Die Rimkus-Methode – Eine natürliche Hormonersatztherapie fuer den Mann”, Verlag Mainz, 2006 (in German)
5. Abraham Morgentaler, MD “Testosterone for Life – Recharge your vitality, sex drive, muscle mass and overall health”, McGraw-Hill, 2008
6. Dr. John R. Lee and Virginia Hopkins: “Hormone Balance Made Simple – The Essential How-to Guide to Symptoms, Dosage, Timing, and More”. Wellness Central, NY, 2006
7. D. Harman: “Aging: A theory based on free radical and radiation chemistry.” J. Gerontol. 1956; 11: 298-300.
8. D. Harman: “The biological clock: the mitochondria?” J. Am. Geriatr. Soc. 12972; 20: 145-147.
9. 19th Annual World Congress on Anti-Aging and Aesthetic Medicine in Las Vegas (December 8-10, 2011)