A top doctor on the truth about hormone imbalances and how to tackle them – Tatler

Hormones are chemical messengers secreted by various glands in the body, and provide a delicate balance between metabolic functions. These include insulin, cortisol (steroid), adrenaline, thyroid, oestrogen/progesterone and testosterone, to name but a few. They are responsible for the body's core temperature, appetite/weight, reproductive cycle/libido, growth/development, sleep cycles, mood and stress levels. Any disruption can lead to key changes in many of the body's organs, leading to brain, skin, gut and cardiovascular symptoms.

Some sex hormone imbalances can quite literally change your persona, with levels of irritability, low mood and altered perception. This can happen for women in the menstrual cycle or menopause, and occasionally in men from the age of 40 onwards (but with more subtle effects).

There are many different treatments available, not all carry the health risks the media have portrayed, and to the contrary, may offer substantial benefits.

Male Hormone Replacement:

From the age of around 40, men's testosterone can reduce by two per cent every year. Over time, this may cross the threshold of deficiency, causing low mood, reduced libido and the redistribution of body fat/muscle, as well as diminishing bone density. However, there is still controversy over whether testosterone replacement therapy, on balance, provides more health benefits versus the risk of prostate/cardiac issues and blood clots, if it is not carefully monitored. A morning blood test (pre-10am) can help to identify your levels, and an endocrinologist should advise on supplementation. A better way to naturally provide more testosterone to the body, is through resistance training (a good personal trainer can help to avoid injury), good quality sleep, optimal weight and a healthy balanced diet (ensuring adequate nutritious vegetables, fats, protein, zinc, magnesium and vitamin D).

Female Hormone Replacement (HRT):

The menopause can happen early for some women, but most occur around the age of 50. The symptoms can vary widely and usually starts before the periods stop (peri-menopause), they can include: anxiety, mood swings, hair/skin issues, hot flushes and memory loss. It is often misdiagnosed as depression and incorrectly treated with antidepressants. Up to 75 per cent of women do not know enough about HRT to make an informed choice, and a review of the initial scaremongering studies have shown that used correctly, HRT can provide many benefits with very few risks. HRT has shown some reduction in Alzheimer dementia, diabetes, osteoporosis, heart attacks and bowel cancer. The oestrogen in HRT can also increase skin collagen and have anti-ageing properties. Obesity, alcohol and lack of exercise increases the risk of breast cancer considerably more than HRT.

The treatments are usually a combination of oestrogen and progesterone.

1. Synthetic HRT. It is regulated by the Medicines Authority (MHRA), is easy for compliance (a single oestrogen/progesterone tablet) and the risks of breast cancer and blood clots are very small if started around the time of menopause (50+) for seven to 10 years.2. 'Bio-identical' HRT. It is not regulated and despite being promoted as 'natural', it is not an exact science, has no safety/efficacy data and can be expensive, but is preferential to some patients.3. 'Body-identical' HRT. Consisting usually of an oestrogen patch and progesterone pill (surprisingly plant-based, derived from yams/soy). 'Body identical' HRT, is regulated by MHRA and has shown to be highly effective; it also significantly reduces the risks of blood clots and breast cancer seen with synthetic HRT.4. Natural options. Lifestyle changes through regular exercise, low alcohol, a Mediterranean diet, low refined carbs/sugar, vitamin D/calcium supplementation and quality sleep may all help to reduce the effects of menopause (but may only be modest). There are some 'natural' products which can be found in most chemists (eg black cohosh, red clover, gingko, St John's wort), but all have limited scope. Acupuncture and homeopathy has also been used, but with little evidence.

Some add-on treatments include: vaginal oestrogen creams and testosterone if libido or energy levels have not benefited from standard HRT (quite surprisingly, reproductive women produce four times more testosterone than oestrogen).

As you can see, it can be a complex area, even for many GPs. So you may want to see a GP or gynaecologist who has an interest in hormone replacement.

Dr Tim Lebens is a private GP in Central London, with a subspecialty in health optimisation and latest advances in medicine. You can follow him on Instagram @_modernmedicine

Although every effort has been made to ensure that all health advice is accurate and up to date, it is for information purposes only and should not replace a visit to your doctor or health care professional.

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A top doctor on the truth about hormone imbalances and how to tackle them - Tatler