Hormone Replacement Therapy

Consider the following scenario:
As an advanced practice nurse at a community health clinic, you often treat female (and
sometimes male patients) with hormone deficiencies. One of your patients requests that you
prescribe supplemental hormones. This poses the questions: How will you determine what
kind of treatment to suggest? What patient factors should you consider? Are supplemental
hormones the best option for the patient, or would they benefit from alternative
treatments?
To prepare:
Review Chapter 56 of the Arcangelo and Peterson text, as well as the Holloway and
Makinen and Huhtaniemi articles in the Learning Resources.
Review the provided scenario and reflect on whether or not you would support hormone
replacement therapy.
Locate and review additional articles about research on hormone replacement therapy for
women and/or men. Consider the strengths and limitations of hormone replacement
therapy.
Based on your research of the strengths and limitations, again reflect on whether or not
you would support hormone replacement therapy.
Consider whether you would prescribe supplemental hormones or recommend alternative
treatments to patients with hormone deficiencies.
Write a description of the strengths and limitations of hormone replacement therapy.
Based on these strengths and limitations, explain why you would or why you would not
support hormone replacement therapy. Explain whether you would prescribe supplemental
hormones or recommend alternative treatments to patients with hormone deficiencies and
why.
Make mention of generic names of drugs.
Use current resources not older than 5 years.
Arcangelo, V. P., & Peterson, A. M. (Eds.). (2013). Pharmacotherapeutics for advanced
practice: A practical approach (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins.
Chapter 56, “Menopause and Menopausal Hormone Therapy” (pp. 884-895)
Holloway, D. (2010). Clinical update on hormone replacement therapy. British Journal of
Nursing, 19(8), 496-504.
M’kinen, J. I., & Huhtaniemi, I. (2011). Androgen replacement therapy in late-onset
hypogonadism: Current concepts and controversies-A mini-review. Gerontology, 57(3),
193-202.

Hormone Replacement Therapy

Replacement therapy can either be in the form of progestin combined with estrogen
(HRT) or estrogen alone (ERT- Estrogen Replacement Therapy). These regimes provide
differing long-and short-term risks and benefits (Mäkinen & Huhtaniemi, 2011). Hence, there is
a need to promote an individualized and judicious approach. While hormone replacement

HORMONE REPLACEMENT THERAPY 2
therapy alleviates the challenges associated with menopause in women, it maintains roles such as
muscle strength and mass in men.

Strengths and limitations

In men, HRT restores sexual function and when the levels of testosterone are increased to
normal, the sex drive is increased. HRT also helps in improving mood and memory in some men.
It prevents bone loss and lowers the levels of cholesterol. The energy levels are increased and
some men become leaner. In women, HRT prevents bone loss that eventually leads to
osteoporosis, relives menopause symptoms including hot flashes, and lowers colon cancer risk.
In addition, there are reduced risks for vision loss as a result of deterioration of the macula, and
macular degeneration (Mäkinen & Huhtaniemi, 2011).
In men, HRT is associated with side effects such as sleep problems, fluid retention, and
acne. Some men experience low sperm counts that eventually lead to infertility. Men also suffer
an increased red blood cell count. Prostate tissue growth is stimulated by HRT. Usually, an
enlarged prostate is associated with symptoms such as frequent urination and trouble urinating.
In men with an already enlarged prostate, HRT is not recommended. It is also not
recommendable for men with prostate cancer. Regardless of the fact that HRT does not cause
prostate cancer, it may worsen it by increasing tumor growth. Women who use HRT have
increased endometrial cancer risk and increased blood pressure. There are also increased risks for
stroke, blood clots, gallbladder disease, and more invasive, larger breast cancers.

Reasons for or not supporting

HRT is associated with many negative effects including the risk of ovarian cancer,
endometrial cancer, blood clots, heart attack, stroke, breast cancer, and pain in breasts

HORMONE REPLACEMENT THERAPY 3
(Holloway, 2010). In addition to the fact that HRT presents numerous possible risks, there are
other treatment options that can be used instead of HRT. These alternatives are equally effective.

Alternative treatments or supplemental hormones

Alterative treatments should be recommended to the patient instead of the supplemental
hormones. Some of the alternative treatments include complimentary and herbal medicines, and
behavior modification. Women experiencing menopausal symptoms can use herbal options to rid
themselves from the hot flushes. Soy can be used since it contains estrogen and it can be used as
a supplement or food. Red clover and black cohosh also eases postmenopausal symptoms.
There should also be a change in lifestyle so as to ease the challenges that come with old
age. For example, engaging in regular exercise reduces hot flushes and improves sleep.
According to Arcangelo and Peterson (2013), a person should also cut on spicy food, alcohol,
and caffeine. Staying cool at night goes a long way in relieving night sweats and hot flushes.
Giving up on smoking helps in reducing hot flushes and the risk of developing critical health
conditions including cancer, stroke, and heart disease.
Tibolene is a man-made hormone and an effective alternative to HRT. It has a
combination of progestogen and eostrogen and a person only needs to take one tablet. Some of
the antidepressants that can be used include serotonin-noradrenaline reuptake inhibitors and
selective serotonin reuptake inhibitors. Some of the effective medications include clonidine,
gabapentin and pregabalin.
From the foregoing discussion, it has established that HRT has benefits in both women
and men. However, it is associated with immense risks. To avoid these risks, alternative
treatments can be used.

HORMONE REPLACEMENT THERAPY 4

References

Arcangelo, V. P., & Peterson, A. M. (Eds.). (2013). Pharmacotherapeutics for advanced
practice: A practical approach (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins.
Chapter 56, “Menopause and Menopausal Hormone Therapy” (pp. 884–895)
Holloway, D. (2010). Clinical update on hormone replacement therapy. British Journal of
Nursing, 19(8), 496–504.
Mäkinen, J. I., & Huhtaniemi, I. (2011). Androgen replacement therapy in late-onset
hypogonadism: Current concepts and controversies—A mini-review. Gerontology, 57(3),
193–202.

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