Sarah Lewis, PharmD
What is hormonal therapy?
Hormonal therapy is a treatment that corrects hormone levels by adjusting them up or down. Hormones are part of your endocrine system and act as chemical messengers in your body to control different bodily functions. For example, insulin is a hormone that helps regulate your metabolism and how your body uses food for energy.
Your doctor may prescribe hormonal therapy to increase hormone levels that are too low. Hormonal therapy can also block hormones or remove the source of hormones when their levels are too high.
Hormonal therapy is only one method used to treat many diseases and conditions. Discuss all of your treatments with your doctor to understand which options are right for you.
Types of hormonal therapy
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The types of hormonal therapy include:
Hormone replacement involves adding hormones to the body when levels are too low. The hormone is a prescribed medication that can be delivered in the form of a pill or other substance, such as a gel or patch.
Hormone blocking is therapy designed to block or decrease the actions of hormones. This also involves taking medications.
Hormone source removal is the removal of the source of excessive hormone production with surgery or radiation. This may include removal of an entire gland, such as the thyroid. In this case, you will also need hormone replacement to provide a normal level of hormones in the body.
Why is hormonal therapy used?
Your doctor may recommend hormonal therapy to treat certain diseases and conditions of the endocrine system including:
Addison’s disease, which is decreased production of adrenal hormones. Adrenal hormones help regulate your body’s water and salt balance, blood pressure, and stress response.
Birth control. Hormone-mediated birth control is a combination of synthetic progesterone and estrogen.
Cancers that depend on hormones to grow, such as prostate cancer and certain types of breast cancers
Certain cancers that require removal of all or part of a gland such as the thyroid
Diabetes, which is decreased production of insulin that results in an inability of the body to properly use sugar for energy
Hyperaldosteronism, which is increased production of the hormone aldosterone. Your doctor may manage hyperaldosteronism due to overactive adrenal glands with hormone blocking therapy. Treatment of hyperaldosteronism caused by an adrenal adenoma (tumor) may include removal of the adrenal gland.
Hyperinsulinemia, or high insulin, caused by a tumor in the pancreas
Hypoparathyroidism, or underactive parathyroid. Parathyroid hormones help regulate calcium in your body.
Hyperparathyroidism, or overactive parathyroid. Certain people with few or no symptoms may receive hormone blocking therapy. Doctors generally use surgery to treat hyperparathyroidism due to a noncancerous adenoma or enlarged parathyroid glands in anyone younger than 50 years.
Hypopituitarism, or underactive pituitary. Pituitary hormones help regulate growth, blood pressure, and reproduction.
Hyperpituitarism, or overactive pituitary. Doctors usually use surgery to treat hyperpituitarism caused by hormone-secreting tumors of the pituitary gland. Some pituitary tumors do not produce hormones (nonsecretory). These tumors tend to cause low levels of hormones, but your doctor may still recommend removal.
Hypothyroidism, or underactive thyroid. Thyroid hormones help regulate your metabolism and how you use energy.
Hyperthyroidism, or overactive thyroid. Your doctor may treat hyperthyroidism with blocking therapy. However, treatment of hyperthyroidism may include thyroid gland removal for thyroid nodules, thyroid cancer, and when thyroid-blocking medications do not work.
Hypogonadism, or low levels of sex hormones, including low testosterone in men
Infertility. Hormonal therapy can stimulate the release of eggs from the ovaries in women. Hormonal therapy is also used for some causes of male infertility.
Menopause. Hormone replacement therapy is sometimes used to relieve the uncomfortable symptoms of menopause.
Transgender patients to block the unwanted secondary sexual characteristics
Who prescribes hormonal therapy?
The following doctors commonly prescribe hormonal therapy medications:
Endocrinologists are internal medicine doctors who specialize in the treatment of endocrine disorders.
Obstetrician and gynecologists (Ob/Gyns) specialize in general women's medical care and conditions and diseases of the female reproductive system.
Oncologists are internal medicine doctors who specialize in treating cancer.
Other doctors and providers who prescribe hormonal therapy include:
Family medicine doctors provide comprehensive healthcare to adults and children. Some family medicine doctors also provide prenatal care and deliver babies.
Internists provide comprehensive healthcare to adults. Internal medicine doctors do not perform surgery or deliver babies.
Midwives, including certified nurse-midwives (CNMs) and certified midwives (CMs). These types of midwives are healthcare professionals who provide prenatal, labor, and delivery care, and some gynecologic care, including menopause treatments. The ability of a midwife to prescribe hormonal therapy varies by state.
How is hormonal therapy delivered?
Your provider will prescribe hormonal therapy medications by mouth, patches you wear on your skin, or by injection.
Hormonal therapy in the form of surgery or radiation therapy is performed in a hospital or outpatient setting. Your provider will determine which type of treatment is best for you and how long you need to stay in the hospital or surgical center based on several factors. Factors include your diagnosis, age, medical history, general health, and possibly your personal preference.
Learn about the different hormonal therapy procedures for your condition. Ask why your doctor or provider will use a certain type for you.
Will I feel pain?
Hormonal therapy taken as pills is painless. Hormonal therapy given as shots may cause temporary soreness at the injection site. Let your doctor know if the discomfort does not pass quickly.
Hormonal therapy that involves radiation therapy or surgery may cause some discomfort. Your comfort and relaxation is important to both you and your care team. Your care team will give you sufficient anesthetic, pain and sedative medications so that you stay comfortable. Tell your doctor or care team if you are uncomfortable.
What are the risks and potential complications of hormonal therapy?
Most hormonal medication therapy is monitored with periodic blood tests. This helps your doctor make sure that you take the right amount of the hormonal drug.
Ideal doses vary from person to person. If the dose of hormonal medication is too small for you, it will not do its job correctly. If the dose is too high, it may cause side effects. Either of these situations can be serious and potentially life threatening.
Risks and potential complications of hormonal therapy include:
Complications from too little of a hormonal medication
Side effects from too much of a hormonal medication
Side effects not related to dose. For example, insulin injections can cause skin changes that are not related to the dose. These changes include abnormal bumps, dents or thickening of your skin.
Side effects related to length of treatment. For example, menopausal hormonal therapy carries risks, such as blood clots and stroke. These risks may increase the longer you take menopausal hormonal therapy.
Unexpected side effects
Your healthcare provider is best one to advise you about the risks and complications of your hormonal therapy. Risks and potential complications of hormonal therapy radiation and surgery include:
Adverse reaction or problems related to sedation or medications, such as an allergic reaction and problems with breathing
Exposure to ionizing radiation, which may harm normal tissues while treating diseased tissues
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before, during, and after hormonal therapy
Informing your doctor or radiologist if you are nursing or if there is any possibility of pregnancy
Keeping all scheduled appointments, including laboratory testing to monitor hormone levels
Notifying your doctor right away of any concerns or symptoms, such as chest pain, palpitations, bleeding, fever, or increase in pain
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my hormonal therapy procedure?
You are an important member of your own healthcare team. The steps you take before hormonal therapy can improve your comfort and outcome. You can prepare by answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
If surgery is planned, you can prepare by:
Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Taking or stopping medications exactly as directed. This often includes not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners before surgery.
Questions to ask your doctor
Facing hormonal therapy can be stressful. It is common for patients to forget some of their questions during a brief doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before hormonal therapy and between appointments.
It is also a good idea to bring a list of questions to your appointments. Questions can include:
Why do I need hormonal therapy? Are there any other options for diagnosing or treating my condition?
Will I need medications, radiation therapy, or surgery?
How long will radiation therapy or surgery take? When will I go home?
What restrictions will I have after radiation therapy or surgery? When can I return to work and other activities?
What kind of assistance will I need at home? Will I need a ride home?
What side effects might I have with hormonal therapy?
What medications will I need before and after radiation therapy or surgery? How should I take my usual medications?
How will you treat my pain and side effects?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after hormonal therapy?
Hormonal therapy may cure your condition or reduce your symptoms so you can lead an active, normal life. Hormonal therapy may also reduce the risk of a more serious condition in some cases. For example, hormonal therapy can prevent the spread of prostate cancer to other areas of the body.
Hormonal therapy requires long-term or lifelong follow-up. You will need regular blood tests to measure levels of hormones in your body. Your doctor must also monitor your condition regularly with physical exams and possibly other tests.
When should I call my doctor?
Contact your doctor for questions and concerns between appointments. It is important to call your doctor if you have any new symptoms, even if they seem minor.
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- The Endocrine System: Diseases, Types of Hormones & More. The Endocrine Society. http://www.hormone.org/Endo101/index.cfm.
- Growth Disorders. The Endocrine Society. http://www.hormone.org/Growth/growth.cfm.
- Growth Hormone Excess & Deficiency Treatment: Hormone Therapy. The Endocrine Society. http://www.hormone.org/Growth/treatment.cfm.
- Hyperthyroidism. The Endocrine Society. http://www.hormone.org/Thyroid/hyperthyroidism.cfm.
- Pituitary Disorders Treatment Options. The Endocrine Society. http://www.hormone.org/Pituitary/treatment.cfm.
- Primary Hyperparathyroidism. The Endocrine Society. http://www.hormone.org/Other/upload/primary-hyperparathyroidiam-bilingual-030110.pdf.