Bio-identical Hormones

“Feel Good Medicine”

Dra. Maria Zweig, MD


Hormones as they are produced by our bodies, naturally diminish as we get older, producing several signs of aging. These hormone levels however, can be balanced and maintained to improve physiological health. For both women and men, it may improve the quality of life, and promote better health without causing harm.


Which hormones am I referring to?

  1. Estrogen or, Estradiol– Non-synthetic.
  2. Bio-identical Testosterone not DHEA nor synthetic.
  3. Progesterone natural non-synthetic.

The hormonal optimization can be achieved via implants positioned under the skin that last in women around 3-4 months and 4-5 months for men. Hormones identical to those produced by the body, Bio-identical while having a safe consistent absorption. One can achieve stable blood levels between 3-7 days and remain stable for the duration of treatment, avoiding high and low peaks characteristic of other routes of administration. The implants are placed in the office under local anesthesia, without pain in about 5-15 minutes.


At what age do hormone levels begin to change?


  • From age 25-30 the body begins to lose testosterone, and both sexes are affected by this reduction.
  • After pregnancy there is a sudden and dramatic decrease in progesterone, which causes moms to be susceptible to postpartum depression.
  • In pre-menopausal ages in the 40s, 3 hormones are affected, with upper and lower fluctuations being observed.
  • In post-menopause, hormones drop dramatically and this persists for the next three decades of our lives.
  • In cases of surgical menopause, by removal of the ovaries, the decrease of the three hormones are even more dramatic and difficult for patients resulting in severe symptoms.


What are the symptoms of low testosterone?


Symptoms of low testosterone in women

Women will lose 50% of testosterone production between 20-40 years of age


Women who suffer from “Low T” look a –

  • Increased risk ofAlzheimer
  • Increased risk of cardiovascular disease
  • Increased risk of fractures Osteoporosis
  • Increased risk of diabetes
  • Possible increasebreast cancer risk

In women, testosterone protects the bones, brain, heart, and breasts. When this hormone begins to decrease one begins to notice a weight gain and difficulty in losing it, despite diet and exercise. There is also a decrease in muscle mass. We notice in the arms, belly, and legs – everything starts to hang a little more. Less stamina, daily fatigue, less enjoyment from exercise and other physical activities. In the afternoon we are finished! It causes our bones to become more brittle and less strong – contributes to diseases such as Osteopenia and Osteoporosis. Decreased sexual desire, interest and enjoyment. Women on birth control pills or other contraceptives that stop ovulation, usually see a decrease in sexual desire due to diminishing levels of this very important hormone.

The benefits of treating women with Bio-identical testosterone are:

  • Increased libido
  • Protection of the heart
  • Lower levels of bad cholesterol- LDL
  • Increasedenergy
  • Improved sleep
  • Sensationof feeling better
  • Reducedbody fat
  • Stronger bones and muscles
  • Alleviation ofdepression
  • Reduced “Mental Confusion ‘

Symptoms of low testosterone in men

Men of 30-70 years are going to lose 1-3% of their total annual production of testosterone.


Men who suffer from “Low T” look –

  • Increased risk for Alzheimer’s
  • Increased risk of cardiovascular disease
  • Increased risk of fracture Osteoporosis
  • Increased risk ofprostate cancer
  • Increased Diabetes Risk
  • Increased risk of losing muscle mass

Men who have “Low T” will notice a decrease in energy and vitality, and weight gain, especially around the waist. Loss of muscle mass, a feeling of not being in a state of optimum health or feeling more muted. Your sexual function may be affected. They may notice an absence or decrease in erection in the morning before sunrise. They also may notice difficulty maintaining an erection, or sexual desire.


The benefits of Bio-identical testosterone in men:

  • Improves erectile function
  • Protection of the prostate
  • Protection of cardiovascular health
  • Increases good cholesterol, HDL
  • Increasesenergy and the feeling of feeling good
  • Reduced body fat
  • Increase muscle mass
  • Reduce anxiety and irritability
  • Cognitive clarity (mental,memory, function)

What are the symptoms / effects when estrogen levels fall?

Symtoms of low Estrogen “low-E” in women 

Estrogen dominates our lives for 4 decades, keeps us in good health and makes us feel good, young and healthy. The loss of estrogen produced by our body, estradiol, during the ages following menopause causes a range of symptoms that impair quality of life and causes serious illnesses such as increased cardiovascular disease and osteoporosis.


Relief of symptoms with estradiol replacement include:

  • Hot flashes
  • Head pain
  • Insomnia
  • Palpitations
  • Pain in joints / bones
  • Pain during sex
  • Irritability
  • Poor memory / lack of concentration
  • Depression
  • Lack of energy
  • Urinary symptoms – incontinence, frequent urinary infections, blood in the urine, painful urination without infection

Estrogen is very important for our skin and hair. Promotes increase in skin collagen, which helps with the thickness and elasticity of the same. Helps reduce wrinkles. The hair and nails also receive a “boost” from estrogen.


Symptoms of low Estrogen in men


In men the estrogen is not replaced as usually 5% of bodies total testosterone is physiologically converted into estrogen. If too much of the testosterone is converted to estrogen then men will usually complain about feeling “moody” and experience an increased tenderness is their breast accompanied with growth. This outcome however, can be easily treated..

However, you one cannot lower the levels of estradiol to zero in men as this is what causes the “RAGE” or increased aggressiveness that is disproportionate among some “body builders”, athletes and other synthetic anabolic steroid users without good monitoring. This is what occasionally results in tragedies of aggression against their partners.

What is the difference between Bio-identical hormone and synthetic?


Security, more consistent effect, increased efficiency, reduced health risk, and fewer side effects.

For example, there is evidence that synthetic progestin’s take away some of the benefits of replacing estrogen and increase cardiovascular and breast cancer risk, situations that occur when natural progesterone is used. Another example, synthetic testosterone may raise bad cholesterol and lower good cholesterol. Animal studies have shown a negative effect on the heart muscle and increased vaso-spasm. Bio-identical testosterone has demonstrated the opposite effect. – Anti-angina effects in humans, decreased bad cholesterol, increased good and no increase in thromboembolic effect.


Purpose of using progesterone?


Progesterone is only produced during pregnancy in the ovaries, so after menopause levels are 0. Men do not produce this hormone and SHOULD NOT USE IT.

You should only use natural progesterone, to avoid negative effects of synthetic progesterone on the heart, blood vessels, cholesterol and brain. Side effects associated with synthetic progesterone include: “bloating”, weight gain, depression, headache, fatigue, increase in breast cancer, etc. Natural progesterone, micronized progesterone, has no such problems, in fact its effects are the opposite! Progesterone is given oral, sublingual or intra-vaginal as it is not absorbed well dermally (skin). Progesterone is an excellent treatment for “PMS” as it will reduce symptoms related to menstrual periods, such as excessive bleeding, headache and feeling of fluid retention. It is also used to regulate menstruation when they become irregular.

During the first three months of pregnancy, before pregnancy becomes responsible for progesterone production, it is vital to maintain the pregnancy. Inadequacies during this period can cause pregnancy loss, natural progesterone is also used as treatment under these conditions. Progesterone protects the uterus against cancer. All women who used estrogen therapy at menopause need to use progesterone.


Why is my better to use bioidentical hormones in a “pellet” – a subcutaneous implant – vs. Creams or oral use?


There is evidence that the use of oral estrogen is associated with increased risk of thromboembolic events, which are mitigated by the use of the transdermal. Also the use of transdermal hormones prevent these passage through the liver, reducing risk of side effects.

  • Testosterone is not absorbed well orally, and one does not see optimal effects.
  • The hormone patches also show sub-optimal absorption, decreasing benefit and increasing side effects and risks.
  • Progesterone cream is poorly absorbed and therefore cannot be relied upon.
  • Hormone therapy cream (estradiol and testosterone) lasts about 8 hours, so you have to apply 2 times a day. There are more fluctuations and less predictable effects.


Should we do hormone levels?

Yes, it is very important to first make an assessment to find out how best to treat the person. If treatment is started, it is important not only to verify the results before starting treatment, but also to do laboratory levels at 4 weeks in men and six weeks for women.

After four weeks they are performed annually.


What is measured and which laboratories tests will I need?

In women

FSH, Estradiol, Testosterone Total, and thyroid hormones (TSH, T4, T3, TPO). Other general health parameters as cholesterol, sugar, vitamin D, B12, and other metabolic parameters are also measured.

In men

Total testosterone and free estradiol, PSA (prostate) and thyroid hormones (TSH, T4, T3, TPO). Other general health parameters such as cholesterol, CBC, sugar, vitamin D, B12 and other metabolic parameters are also measured.


The hormonal stabilization in women and men, depends on a partnership between physician and patient. We must listen to the patient because often it is she/he who will indicate if something goes wrong and how to fix it. Labs are important and will help to formulate a treatment, but clinic checkups will ensure the best outcome and patient satisfaction. It is important to note that to achieve a better quality of life it is essential to adapt healthy lifestyles and commitment which should be followed for life.