Dr. Betty Lacy, M.D.

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Hormones are an important part of brain health in both women and men. As we age, most all hormones diminish in value, including estrogen, testosterone, DHEA, pregnenolone, and progesterone. Hormones are not “one size fits all”. Your evaluation will take into account your individual risk and benefit of hormonal therapy for you Brain-Body Health.


Hormones specifically, estrogen has been controversial in medicine for many years. When I was in medical school, most all postmenopausal women were taking estrogen. Then came the Women Health Initiative Study of 2001(WHI), a study of 17,000 postmenopausal women age 50-79- revealed an increase in breast cancer with Prempro, a combination of Premarin and Provera (artificial Progesterone). The incidence of breast cancer was 8/10,000. However, with Premarin alone, that risk was less @ 7/10,000. I remember this study well because I was going through menopause at that time and stopped hormone therapy. We were all scared and confused by the WHI report. A few years later, investigators began to realize that those early interpretations had been wrong, at least partially. Yes, women 60 and older who started hormones more than a decade into menopause had higher rates of death and disease. but they did not take into account dementia, and this was not true for women who entered menopause less than 10 years before beginning treatment. And in an 18-year follow up study to WHI in JAMA 2017, women 50-59 who took HRT had a lower mortality rate than was found among the control group, who were not taking hormones. In other words, women 50-59 on HRT were less likely to die of heart disease, cancer or other causes than women who were not taking hormones! Even vaginal estrogen is showing some benefit of lower heart disease and hip fractures.

We now have evidence that Estradiol is good for the brain, bones, vaginal and cardiovascular health. We know that there are estrogen receptors on every single organ in the body. Recent studies from the North American Menopause Society(NAMS) of 2017, (1,7) have modified past trends in stopping Estradiol therapy. Considering time-limited treatment for the first 6 years of menopause has shown some benefits. Experts in the field of neuroscience have pointed out that the brain benefits of estrogen are significant. Hippocampal volume, the memory centers of the brain, and synaptic activity all increase with Estradiol. With menopause, women’s estrogen levels drop from a mean level of 200pg/ml, premenopausal, to below 20pg/ml during menopause. This drop in Estradiol is thought to be one of the potential reasons women develop Alzheimer’s disease in greater numbers than men. What is clear is that lack of estrogen impacts brain health and is thought to be one of the root causes of Alzheimer's Disease. Statistics supporting this are based on women who have had an oophorectomy (ovaries removed) before 40 and show an increase in Alzheimer's Disease.

The jury is still out on the final decision about Estrogen use post-menopausally, but in brain health circles we are beginning to use Estrogen to help optimize the brain. Beginning treatment with bioidentical hormones (BHRT) may lessen the risk of dementia and cognitive decline. Indeed, BHRT is part of Dr. Bredesen's ReCode program of 36 factors that reversed dementia. Whether to go on hormones or not is a decision to not take lightly. It is an individual by individual decision to be made with your health care professional, along with looking closely at your risk and benefit of dementia, our current health and biomarkers.


Although I have focused so far on estrogen, testosterone, an androgenic (male) hormone, is found in both men and women. It plays an important role in brain health. Testosterone is well known to increase muscle mass, bone density and help prevent erectile dysfunction, and improve libido. Low levels of testosterone contribute to low energy, depression, erectile dysfunction, cognitive decline and Alzheimer's Disease. Testosterone improves attention and spatial memory. Like estrogen, testosterone decreases with age in men and women. Testosterone levels improve with addition Zinc and Vitamin D, weight loss and resistance training. Testosterone levels are lowered with Vitamin A supplementation. Intermittent fasting can boost testosterone by improving hormonal health.

As part of Dr. Betty’s Brain Health Program, Hormone levels will be checked on both men and women.

For more information on hormones:

1) http://www.menopause.org/docs/default-source/2017/nams-2017-hormone-therapy-position-statement.pdf

2) Evolving Past Alzheimer’s is for people who are worried about memory impairment in themselves or loves ones. Nate Bergman a functional medicine doctor hosts this podcast. It is one of my go-to podcasts. This line is to his episode with Ann Hathaway MD who is an expert on memory impairment and BHRT https://evolvingpast.com/blog/bioidentical_hormone_replacement_cognitive_decline/

3) Here is Ann Hathaway’s link to her practice. A functional medicine OB-GYN doctor and Bredesen trained, She is based in Northern California. I have been to a number of her lectures on the connection between brain health and estrogen. https://annhathawaymd.com/

4) A great article on Testosterone and why replacing it is important for the body and brain.: https://www.renewmetoday.com/low-testosterone-levels-affecting-brain/

5) How levels of sex hormones vary is dependent on a protein called Sex Hormone Binding Globulin. This is a great article explaining why if it is high or how your hormones will not be optimized. https;//naturalbiohealth.com/2015/05/06/shbg-critical-to-your-health

6) Dr. Erika Schwartz is one of my favorite doctors. She is outspoken on many health issues, especially for women. She has a number of videos that are informative on her website: https://www.drerika.com/. She also is the author of many books. Her newest is, “ The New Hormone Solution”. Another book entitled .”Don’t Let Your Doctor Kill You”, is about reclaiming our health. A leader in the self-empowerment/citizen scientist movement in health care, exemplified in Dr. Sachin Patel’s saying, “The new doctor is the patient”.

7) aarp.org/magazine August/September 2018, "What Doctors Don't Tell You About Menopause" p.38

Betty Lacy, M.D.

Dr. Lacy specializes in the field of brain health, cognitive resiliency, genetics, and mental health. Learn More >

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