Introduction
Hormone therapy, also known as hormonal treatment or endocrine therapy, has become a cornerstone in the management of various health conditions. Hormones are chemical messengers produced by glands within the endocrine system. These messengers travel through the bloodstream, orchestrating and regulating crucial bodily functions. Whether it's metabolism, growth, mood, or reproduction, hormones maintain balance and ensure the body's overall well-being.
A range of hormonal combinations is available, each with different efficacy and side effects. Hormone therapy can be used in the form of hormone replacement therapy (HRT) and anti-hormone therapy. HRT involves supplementing hormones that the body may not produce in sufficient quantities. In people assigned female at birth (AFAB), this often includes oestrogen and progesterone, while in people assigned male at birth (AMAB), testosterone replacement may be employed. HRT is commonly used to address menopause and andropause.1
Anti-hormone therapy, on the other hand, aims to inhibit or block the effects of specific hormones. This approach is frequently used in the treatment of hormone-sensitive cancers, such as breast and prostate cancers. By disrupting the hormonal signals that drive cancer growth, anti-hormone therapy plays a crucial role in cancer management.
Indications for hormone therapy
Hormone therapy finds application in various medical scenarios, addressing a range of conditions. Let's explore the primary indications (reasons) for hormone therapy:
Menopause and hormone replacement therapy
Hormone replacement therapy (HRT) substitutes oestrogen and progesterone after the cessation of cyclic ovarian hormone production.2 Menopause hormone therapy (MHT) is indicated for people AFAB over 45 years old to manage menopausal symptoms. Hormone replacement therapy is also recommended for all people AFAB with POI or early menopause.3
Symptoms of menopause
Menopause brings about a range of symptoms such as hot flashes, mood swings, sleep disturbances, and vaginal dryness. HRT is often prescribed to alleviate these symptoms by restoring hormonal balance.
Benefits of HRT in menopause
HRT can not only bring several improvements to one’s quality of life, but it also reduces joint pain and delays the progression of menopausal osteoarthritis. HRT reduces or eliminates hot flushes and improves sleep quality, mood, and memory; it improves vaginal dryness and reduces pain during sexual intercourse. The decision to undergo HRT requires careful consideration and consultation with healthcare providers.1,4
Risks of HRT in menopause
While HRT can provide relief from menopausal symptoms, it comes with potential risks, including an increased risk of blood clots, stroke, and breast cancer. Fluid retention, nausea, leg cramps, and headaches may occur during the usage of oestrogens. Depression, anxiety, flatulence, and increased appetite are associated with HRT use. When using HRT, unwanted bleeding can also be caused by a decrease in hormone levels.5
Andropause and hormone replacement therapy
Andropause is the progressive decline of sex hormones, particularly testosterone, in people AMAB as they age. Several clinical studies have demonstrated the administration of supplemental testosterone as being beneficial and safe.6
Some symptoms of andropause are:
- fatigue
- reduced libido
- mood changes
- decreased muscle mass
Testosterone replacement therapy may be recommended to address these symptoms and restore vitality.
Benefits and risks of testosterone replacement
Testosterone replacement therapy can improve energy levels, mood, and sexual function in people AMAB experiencing andropause symptoms. However, it is not without risks; potential cardiovascular issues must be considered and monitored.
Hormone therapy in cancer treatment
Hormone therapy is a cancer treatment that slows or stops the growth of cancer that uses hormones to grow.
Hormone-sensitive cancers
Certain cancers, such as breast cancer and prostate cancer, are influenced by hormones. Hormone therapy is used to interfere with the hormonal signals that drive cancer growth.
Role of hormone therapy in cancer care
In breast cancer, hormone therapy may involve the use of drugs that block oestrogen receptors (anti-oestrogens) or reduce oestrogen production. In prostate cancer, androgen deprivation therapy is commonly employed to lower testosterone levels, inhibiting cancer growth.
Administration methods of hormone therapy
The choice of how hormones are administered depends on various factors, including the specific hormone being targeted and individual health considerations. Common methods of hormone therapy administration include
Route | Details |
Oral medications | Hormones can be delivered in the form of pills or tablets, making oral medications a convenient and widely used method |
Topical gels and patches | Transdermal administration through gels or patches allows hormones to be absorbed through the skin, providing a controlled and sustained release |
Injections | Hormones can be administered through injections, delivering a precise and often long-lasting dose |
Implants | Small pellets containing hormones can be implanted under the skin, releasing a steady and controlled amount over time |
Monitoring and potential side effects
Regular monitoring is a critical aspect of hormone therapy to assess its effectiveness and manage potential side effects. Healthcare providers conduct periodic hormone level and overall health assessments to ensure the treatment remains effective and safe. Side effects can vary depending on the type of hormone therapy but may include nausea, headaches, changes in mood, and alterations in sexual function.
Long-term considerations
Long-term use of hormone therapy may be associated with specific health risks, such as an increased risk of cardiovascular issues, blood clots, or certain cancers. Continuous monitoring and open communication with healthcare providers are essential for mitigating these risks.
Risks
While hormone therapy can offer substantial benefits, it is not without risks.
Several factors should be considered, such as:
- Individual variability in response: Individuals may respond differently to hormone therapy. Age, overall health, and genetic predispositions can influence how the body reacts to hormonal interventions
- Potential health risks: Long-term use of hormone therapy, especially in the case of HRT, may be associated with increased health risks. For example, postmenopausal individuals undergoing oestrogen and progestin therapy may face an elevated risk of breast cancer, stroke, and blood clots
- Consultation with healthcare providers: Making informed decisions about hormone therapy requires open and ongoing communication with healthcare providers. Personalised consultations help individuals weigh the benefits against the risks and make choices that align with their health goals
Summary
From alleviating the symptoms of menopause and andropause to playing a crucial role in cancer treatment, hormone therapy continues to evolve and shape the landscape of medical care. Individuals considering hormone therapy must engage in open discussions with their healthcare providers to make informed decisions tailored to their unique health needs.
Regular monitoring, a proactive approach to potential side effects, and a commitment to ongoing communication with healthcare professionals ensure that hormone therapy remains a safe and effective tool in enhancing the quality of life for those who choose this path.
References
- Vinogradova Y, Coupland C, Hippisley-Cox J. Use of hormone replacement therapy and risk of breast cancer: nested case-control studies using the QResearch and CPRD databases. BMJ [Internet]. 2020 Oct 28 [cited 2023 Dec 18];371:m3873. Available from: https://www.bmj.com/content/371/bmj.m3873
- Deli T, Orosz M, Jakab A. Hormone replacement therapy in cancer survivors – review of the literature. Pathol Oncol Res [Internet]. 2020 [cited 2023 Dec 18];26(1):63–78. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7109141/
- Armeni E, Paschou SA, Goulis DG, Lambrinoudaki I. Hormone therapy regimens for managing the menopause and premature ovarian insufficiency. Best Practice & Research Clinical Endocrinology & Metabolism [Internet]. 2021 Dec 1 [cited 2023 Dec 19];35(6):101561. Available from: https://www.sciencedirect.com/science/article/pii/S1521690X21000786
- Palacios S, Stevenson JC, Schaudig K, Lukasiewicz M, Graziottin A. Hormone therapy for first-line management of menopausal symptoms: Practical recommendations. Womens Health (Lond Engl) [Internet]. 2019 Jan [cited 2023 Dec 18];15:174550651986400. Available from: http://journals.sagepub.com/doi/10.1177/1745506519864009
- Fait T. Menopause hormone therapy: latest developments and clinical practice. Drugs Context [Internet]. 2019 Jan 2 [cited 2023 Dec 19];8:212551. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6317580/
- Brawer MK. Testosterone replacement in men with andropause: an overview. Rev Urol [Internet]. 2004 [cited 2023 Dec 20];6(Suppl 6):S9–15. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1472881