Bioidentical Hormone Replacement Therapy – It’s All About Balance

Bioidentical Hormone Replacement Therapy – It’s All About Balance

by Kimberly Borghese, APRN, FNP-BC, IFMCP, certified in bioidentical hormone replacement therapy.

Hormone replacement therapy (HRT) has been increasing in popularity as an anti-aging treatment with good reason. Testosterone and estrogen replacement therapy can mitigate the effects of aging, reduce the risks of many chronic conditions, and resolve many life-disrupting symptoms. The latest treatments use bioidentical hormones, which reduce certain risks associated with synthetic hormones.

When it comes to optimizing hormones, balance is key. At Zenestar, we pride ourselves in practicing safe and effective hormone balancing. Our approach takes a holistic view of the individual, their lifestyle and environment. Before replacing hormones, we work to discover why an individual’s hormones are imbalanced in the first place. We then evaluate ways to reach the best possible outcome and carefully monitor and follow-up with our patients to adjust and improve the therapy.

Although we are going to focus on sex hormones in this article, there are many more hormones in your body that work with your sex hormones to produce a variety of effects.

What are hormones?

Hormones are chemical messengers that control and coordinate activities throughout the body. They control growth, development, metabolism, sexual function, mood, hunger, and control the function of organs. Hormones are powerful. Tiny amounts of hormones can trigger large responses in the body. That is why too much or too little of a certain hormone can cause serious negative effects.

Hormones are meant to be active in small doses and for short periods of time. This allows your body to stay sensitive to them and not be exposed to damaging effects. For example, estrogen and its metabolites can damage DNA and therefore the body must remove them once they have served their purpose.

To maintain an optimal  hormone balance your body releases hormones in cycles or pulses and then metabolizes them. Many hormones are metabolized through the liver and eliminated through the body’s gastrointestinal system. Therefore, it is important that these systems are working well and that they are evaluated as part of assessing hormone balance. When we use hormones as therapy, we use the smallest amount to do the job, keeping values within physiologic ranges. We then monitor patients closely for side effects, symptom improvement, and interrelated lab values.

We use laboratory tests to measure the hormone levels in your body.  But we don’t just test sex hormones because there are many other biomarkers that need to be evaluated when checking for hormone imbalance.  We check adrenal function, thyroid hormones, glucose, insulin, lipids, liver function, toxins, genomics, nutrients, hormone metabolites and more as part of a complete evaluation.

There is so much going on in the story of hormones. Your brain, gut, gonads, thyroid, pancreas, liver, adrenals, and immune system are all interconnected. You cannot consider one without considering the others. In addition, your unique hereditary makeup and the way it is expressed through your relationship with the environment underlies all the workings of these hormonal systems.

For the body to thrive, hormones must be in proper balance.

What causes hormone imbalance?

The top root causes of hormone imbalance are:

  • Aging
  • Stress
  • Poor nutrition/diet
  • Environmental toxins
  • Inflammation
  • Hereditary predisposition
  • Lack of sleep and Altered circadian rhythms

What are the symptoms of hormone imbalance?

The four biggest sex hormone imbalances we see are estrogen dominance or progesterone deficiency, low testosterone, PCOS, and low overall hormones related to menopause or hysterectomy with removal of ovaries.


Estrogen dominance/progesterone deficiency

  • Heavy periods
  • Irregular periods
  • Painful periods
  • PMS/moodiness
  • Migraines
  • Uterine fibroids
  • Infertility
  • Fibrocystic breasts
  • Breast swelling and tenderness
  • Weight gain
  • Anxiety
  • Low libido
  • Low thyroid symptoms (estrogen excess)

Low estrogen

  • Low libido
  • Aging dry skin
  • Brain fog/memory loss
  • Bone loss
  • Fatigue
  • Depression
  • Hot flashes
  • Sleep disturbances
  • Vaginal dryness
  • Painful intercourse
  • Night sweats
  • Headaches
  • Yeast infections
  • Heart palpitations


  • Metabolic syndrome (high blood sugar, high blood pressure, high cholesterol, obesity)
  • Hair loss from your scalp
  • Hair growth in unexpected places
  • Oily and acne prone skin
  • Infertility or repeat miscarriages
  • Weight gain
  • Menstrual problems
  • Depression and/or mood swings

Low testosterone (Men and Women)

  • Fatigue
  • Memory problems
  • Decreased libido
  • Muscle weakness
  • Heart palpitations
  • Bone loss
  • Incontinence
  • Depression
  • Low motivation
  • Thinning skin
  • Vaginal dryness
  • Aches and pains
  • Erectile dysfunction
  • Decreased muscle mass

Anti-aging effects of hormones

  • Protects brain function
  • Protects cardiovascular system
  • Maintains lean body mass
  • Maintains bone
  • Prevents menopausal skin aging

How do we treat hormone imbalance?

After we have completed a comprehensive evaluation of a client’s history, symptoms, and labs, we work with the client to develop a plan that is personalized, appropriate, and meets the client’s health goals. In functional medicine, we use a pneumonic PTSD to determine the causes of hormone imbalance and the best way to treat it. PTSD evaluates: (1) the Production of hormones, (2) the Transport of hormones, (3) the cells’ Sensitivity to hormones, and (4) how Detoxification is working. Using this information we can formulate a therapeutic plan that considers the physiology of your hormones.

Although there is a time and place for it, we do not always have to go straight to testosterone replacement therapy or estrogen replacement therapy as a first-line anti-aging treatment. There are many ways to help balance hormones such as nutrient optimization and diet, stress reduction, healing the gut, and herbal supplementation.

We put a large emphasis on nutrition in our functional medicine practice. A healthy diet is critical for healthy hormone function.  For production and metabolization of hormones, your body needs fats, cholesterol, protein derivatives such as amino acids and peptides, and cofactors (vitamins and minerals). In addition, some foods and herbs can upregulate or downregulate metabolic pathways involved in the metabolization of and detoxification of hormones.

Often, we do both at the same time. We want our clients to have relief from their symptoms as soon as possible, so while we are treating them with hormones, we are also addressing the root cause. Once we have fixed the cause, we can slowly take the clients off the hormones to see how their properly functioning body does and if it can maintain its own balance. If they still need the hormones, we will happily provide what is needed and do the proper follow up and monitoring to ensure positive outcomes.

When we do use hormones, we use bioidentical hormones which your body recognizes, and which do not clog up receptors. Some of the benefits of BHRT are:

  • Reduced risk of Alzheimer’s disease, heart disease, osteoporosis, depression endometrial and breast cancer
  • Improved energy, sleep, mood, concentration, memory, libido, cholesterol levels, lean body mass
  • Reduced hot flashes, and vaginal dryness, night sweats, and other symptoms of low estrogen, testosterone, and progesterone

Synthetic hormones, by contrast, have several negative side effects including blood clots, hypertension, increased risk of heart disease, stroke, and cancer.

When is the best time to be evaluated for bioidentical hormones?

Testosterone and estrogen begin to decrease starting at age 30. Hormone imbalances can start at a young age and sadly we are seeing more imbalances in our patients as our polluted environment and poor food quality disrupt our endocrine system. Many of my functional medicine clients had a clear hormone imbalance much earlier in life that led them to have hysterectomies, if only they had known about functional medicine then. The best time is when you first begin having symptoms. Getting balanced promptly will help you keep your health optimal and if there is an underlying reason for the imbalance, addressing it will prevent other potential conditions down the road.

If you are having symptoms of hormone imbalance or If you would like to learn more about how you can optimize your hormones, please contact us at (702) 987-0400.