Hormone Therapy

Sometimes, due to various diseases or circumstances, the production of hormones can be altered. This can result in a hormonal imbalance that can present clinically with troubling signs and symptoms. In order to correct the deficiency of certain hormones, that has brought about worrying complaints, hormonal formulations can be given to the patient externally. Additionally, in cases of sex reassignment surgeries, hormonal therapy is needed to bring about a secondary puberty to help the patient transition to their new chosen sex. Sex hormones associated with the gender the transgender patient identifies with (notably testosterone in transgender men, and estrogen in transgender women) are administered. Sometimes hormone therapy aims to deprive an individual of a certain hormone, which may be in excess, to restore balance or prevent cell growth (as in certain cancers that express hormone receptors).

Following are some of the types of hormone therapies used most commonly:

• Hormone replacement therapy (HRT) or Menopausal Hormone Therapy (MHT): As women reach the natural end of their reproductive lives, perimenopause sets in, leading the way to menopause. In this stage of life, the sex hormone levels, such as those of estrogen and progesterone, in women begin to decline as one stops ovulating. However, with the dwindling hormone levels, a set of disconcerting symptoms set in. With the external use of medicines that boost estrogen, progesterone and sometimes even testosterone levels where needed, these uncomfortable symptoms can be assuaged. Besides addressing the troubling symptoms of menopause, estrogen therapy also has a cardioprotective and bone-protective role in postmenopausal women. Hormone replacement therapy has been proven to be of value in cases of premature or surgery-induced menopause (for example, after removal of both ovaries with an oophorectomy procedure) as well.
• Hormone therapy in cancer: Certain types of cancers express hormone-specific receptors in the tumour cells that proliferate even more greatly under the influence of this hormone. Therefore, in cases where lab studies find the presence of hormone-specific receptors in cancer cells, hormone deprivation (anti-hormone treatment) therapy can be useful in treating or preventing the return of the cancer. Examples include:
  • Androgen (testosterone) deprivation therapy in some prostate cancers
  • Estrogen deprivation therapy in oestrogen receptor-positive breast cancers 
• Transgender hormone therapy: Transgender patients who wish to undergo sex reassignment surgeries to transition into their identified gender undergo transgender hormone therapy. Transgender men receive the male sex hormone (masculinising hormone therapy) and transgender women receive the female sex hormone (feminizing hormone therapy).
• Hormone therapy in hypogonadism or intersex individuals: Some individuals are born with either an extra or missing sex chromosome. Examples include Klinefelter syndrome, where males are born with an extra female chromosome (47XXY) or Turner syndrome, where females are born with a deficient female chromosome (45XO). In such cases, individuals express physical and hormonal characteristics of the opposite sex. 
• Other hormone therapies: Essentially, the use of hormones or synthetic hormonal formulations in any medical treatment would also warrant the term of hormone therapy. Seemingly inane hormone therapies can include:
  • Insulin used in diabetes mellitus: Either type 1 diabetes mellitus (insulin-dependent diabetes mellitus) or advanced type 2 diabetes mellitus unable to be controlled with oral hypoglycemic agents (OHAs).
  • Thyroxine (LT4) used in hypothyroidism: In hypothyroidism, the thyroid gland is unable to synthesise the active thyroid hormone and therefore necessitates external provision as medicines.
  • Corticosteroids (glucocorticoids and mineralocorticoids) administered in adrenal gland insufficiency or Addison’s disease.
  • Oral contraceptive pills (OCPs): By extraneously giving the patient two hormones (oestrogen and progesterone) as combined pills in a manner that mimics the body’s ovarian hormone release, ovulation is suppressed.
  • Growth hormone therapy: In children with growth hormone deficiency, synthetic growth hormone may be used clinically.

Given that there are many different hormones and even more types of hormone therapies, there could be many benefits of undergoing hormone therapy. Following are some of the most common ones: 

• Reduces symptoms of menopause: HRT can aid in reducing the symptoms that show up during menopause, like hot flashes. Apart from that, in cases of early or premature menopause, HRT can help with keeping up bone strength and heart health - which is a role usually played by naturally occurring estrogen hormone in the body. This therapy can help prevent osteoporosis.
• Helps treat cancer: As mentioned above, hormone therapy can be used in the treatment of certain cancers like that of the prostate and breast. Naturally occurring hormones in the body are used by some cancers to grow. Hormone therapy helps stop or suppress the production of these hormones to limit the growth of the cancer. This treatment could carry certain side effects but the benefits may outweigh them still. It could be given in combination with or after other treatments like chemotherapy or radiation therapy.
• Acts as a method of birth control: Birth control pills are one of the most popular methods of birth control. There are two main types of contraceptive pills: combination pills (synthetic estrogen and progestin) and progestin-only pills. The pill can be 99% effective in preventing pregnancy with perfect use. Birth control pills are also prescribed for conditions like polycystic ovary syndrome and acne, which can be caused by a hormone imbalance. Hormonal contraceptives are also available in the form of a patch, injection, ring and more.
• Manages different health conditions: Hormone therapy can be used to correct other hormone imbalances in the body like in diabetes or thyroid disorders, both fairly common conditions that can have a major impact on your day-to-day activities and lead to severe complications if not managed well.

When external hormones are given to an individual, the body may react in many different ways, and some of them can be negative. Sometimes, like with birth control pills, the body begins to adjust to the additional hormones and some of the side effects go away. Other times, the side effects could be permanent. In case you notice any side effects, do let your doctor know so they can make any adjustments if necessary.

Following are some common side effects of hormone therapy, depending on the kind of hormone therapy and gender of the patient:

• Mood swings and depression
• Headaches
• Weight gain
• Joint pain or bone thinning
• Hair thinning
• Fatigue
• Constipation or diarrhea
• Symptoms of menopause like lighter or fewer periods, vaginal dryness, hot flashes, reduced sexual drive
• Difficulty in getting an erection