Bioidentical HRT trialed as part of PD treatment

By Karen Hales, Neurology Solutions Contributing Writer

For the past two years Neurology Solutions Movement Disorders Center has trialed approximately 80 Parkinson’s disease (PD) patients with bioidentical hormone replacement therapy (HRT) as part of their treatment plan. With this protocol, Neurology Solutions is striving to bring the patients’ hormone levels closer to the hormone profile of their youth and investigate its impact on mobility, motor fluctuations, cognition, mood and quality of life.

Bioidentical HRT uses hormones that are identical to the estrogens and testosterone found in the human body. Research has shown hormone therapy may benefit certain symptoms associated with PD. Testosterone deficiency is common in older individuals and has symptoms that directly overlap with non-motor symptoms of PD, such as muscular atrophy, loss of libido, anxiety, depression and fatigue. These symptoms do not necessarily respond to antidepressant therapy or traditional PD therapies.

Recent literature also has shown two forms of bioidentical estrogen, estradiol and estriol, may affect the progression of PD. These sex hormones, especially estriol, significantly exert anti-aggregation and fibril-destabilizing effects on alpha-synuclein (a-synuclein), a small unstructured protein that has the tendency to aggregate, forming fibrils, a hallmark of many neurological diseases.

Studies have indicated estradiol and estriol may have a neuroprotective quality in PD and could be valuable preventive and therapeutic agents in the fight against neurological conditions including PD, dementia and multiple system atrophy.

Participants in the program have primarily included patients who also use Deep Brain Stimulation (DBS) therapy in their disease management due to frequency and length of DBS appointments. This has allowed Neurology Solutions to closely monitor hormone levels for side effects and safely gauge whether adjustments should be made to hormone supplements, as HRT is individualized medicine. Monthly hormone labs also were obtained to monitor treatment. Until hormone levels were optimized and stabilized, the patients participating in the trial were seen a minimum of once per month.

Approximately 50 percent of patients who have participated in Neurology Solutions’ HRT program report they find the treatment worthwhile with benefits including improved energy level, cognitive performance, muscular tone, libido and less depression. Furthermore 10 to 15 percent of those patients see “remarkable” results, including better physical mobility, according to Neurology Solutions Medical Director Dr. Robert Izor.

The remainder did not realize significant or measurable results, either because hormone levels were not optimized for that particular patient, or the individual was not responsive to treatment or did not wish to continue the therapy long enough to show results. Some patients discontinued therapy prior to hormone optimization due to frequency of visits required to optimize levels, requirement of monthly lab work, which was typically covered by insurance, or cost of hormones, which typically varied between $30-50 per month.

Stay tuned for additional information and a Q & A on Neurology Solutions’ hormone therapy program. If you are interested in exploring hormone therapy as a potential treatment option, please contact Neurology Solutions or call 512-865-6310 for information and to make an appointment.

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