Bioidentical Hormone Replacement Therapy

Bioidentical Hormone Replacement Therapy

One of the most important and powerful services offered at Beyer Functional Wellness is Hormone Replacement Therapy (more specifically, as used in our clinic, bioidentical hormone replacement therapy or “BHRT”), but we understand that there is much misunderstanding and/or misconceptions about both the therapeutic use of hormones, as well as the difference between the different types of hormone therapy available to you the patient, such as traditional/synthetic (HRT), bioidentical (BHRT), “compounding” etc.

So the purpose of this page is to help you better understand the important facets of the “hormone” issue, as it relates to you and your health. We believe the better informed a person is, the better chance they have at making good decisions and achieving optimal health and longevity.

What are Hormones?

Hormones are regulatory substances produced by the body and transported in tissue fluids such as blood to stimulate specific cells or tissues into action. They are chemical “messengers” within our body…arguably the most powerful and important messengers. Acting like chemical messengers, hormones deliver their message to their respective “receptors” on the cells. The receptors can be thought of as a “dock” that a ship or boat pulls into, only the dock (receptor) is shaped specially to allow a specific hormone, with a specific chemical structure to fit in. Also, as will be covered later on this page, the concept of hormone receptor sites is important because hormone problems can not only come about because of the hormone levels being either too high or low, but also because of problems with receptor sites, such as can be caused by what are known as endocrine disrupting compounds or “EDC’s”.

Why Consider Hormone Therapy?

Supported by scientific evidence, many hormone therapy trial results with women(as reported in respectable medical journals cited) have demonstrated the following:

Cardiovascular Benefits:

• A reduction of heart attacks(New England Journal of Medicine*2000;343(8):572-574) *hereafter cited as “NEJM”

• Reduced blood pressure (J Gen Intern Med 2004;19 (7): 791-804)

• Reduced incidence of coronary artery disease (NEJM 1991; 325:756-62)

• Reduction of bad cholesterol (LDL) and increase of good (HDL) (AHA Scientific Statement. Circulation 2001; 104:499-503)

• Protection against atherosclerosis (Circulation 2001; 104:499-503)
  
  

Increased Bone Density:

• This has been shown in the hip, spine, and total body (JAMA 2003; 290:1042-1048)

• A decrease in hip fractures of 35% (J Gen. Internal Medicine 2004; 19(7):791-804
  
  

Alzheimer’s Prevention:

• Hormone therapy was considered in one study as the “primary prevention” of AD for women (JAMA 2002; 288:2123-2129)

• 30% reduction of developing AD in women on hormone therapy (JAMA 2002; 288:2170)

• Risk of developing AD reduced to little more than half compared to nonusers of hormone therapy (JAMA 2002;288:2123-29)
  
  

Obesity/BMI Reduction:

• Central adiposity (body fat) reduced, as well as blood sugar better controlled (J Gen Intern Med 2004;19(7):791-804

• Reduced central obesity (Obesity Review 2004 Nov; 5(4);197-216

• Significantly lower BMIs as compared to women not using hormone therapy (JAMA 1996;275(1):46-49
  
  

All-Cause Mortality:

A study done by doctors at Yale evaluated the result of the widespread reduction in the use of HRT in women aged 50-59 post-hysterectomy. According to their calculations, estrogen avoidance may have led to as many as 90,000 preventable deaths and breast cancer in these women. According to the authors: “Estrogen therapy in younger postmenopausal women is associated with a decisive reduction in all-cause mortality”
(American Journal of Public Health: Sept. 2013, vol 103 No. 9, pp.1583-1588)

Sexual Health:

Many women are unaware that they (should) have a certain amount of testosterone. Unfortunately, too many doctors wrongly view testosterone as a “male” hormone and don’t measure it, or consider low levels as a possible contributing cause of women’s sexual health issues (low libido, decreased sexual pleasure, etc.). As stated in one study: “A persistent view of testosterone as the male hormone deprives many clinical androgen deficient women of effective treatment”. And from that same study: “Testosterone is an important component of female sexuality, enhancing interest in initiating sexual activity and response to sexual stimulation”. (J Reproductive medicine 2001; 46:281-296).

Menopause Support:

The International Menopause Society data states that menopause negatively impacts risk factors for cardiovascular disease (CVD) including changes in body fat distribution, blood sugar problems, elevated lipids, blood pressure increases, and vascular inflammation. This is in addition to the decreased quality of life as a result of hot flashes, vaginal dryness, decreased libido, sleep problems, etc. Properly implemented hormone therapy can significantly decrease serious menopause-related risk factors for CVD, and at the same time dramatically improve quality of life by addressing what is a completely treatable issue….the normal age-related decreased production of estrogen and progesterone, which can be compensated for with the judicious use of BHRT. There really is no reason to “suffer through” menopause, and also deny yourself of the health protective effects it can give.

Signs & Symptoms of Hormone Imbalances

In addition to benefiting the above issues, the following is a brief list of some of the more common signs/symptoms associated with a hormone imbalance…which is completely identifiable with the right lab work:

Estrogen Excess or Deficiency:

• Breast pain/cysts

• Lighter/Heavy/clotty/long/irregular cycles

• Fluid retention

• PMS

• Vaginal dryness

• Hormonal headaches

• Fibroids

• UTIs/incontinence/urinary urgency

• Anxiety/depression

• Low libido

• Endometriosis

• Acne

• Uterine fibroids

• Cramps

Testosterone Excess or Deficiency:

• Incontinence

• Acne/oily skin

• Loss of pubic hair

• Facial hair

• Lichen Sclerosis

• Impaired sexual function

• Nipple pain

• Vaginal dryness

• Ovarian cysts

• Loss of muscle tone

• Blood sugar problems

• Fatigue

• Aggression/irritability

Hormone Replacement Options

All hormones are not the same and have different actions! It is the molecular difference between non-biologically identical hormones and biologically identical ones that are responsible for their different actions in the human body. It is also especially important to note that different hormones do not have the same risk profile, especially in regard to cardiovascular, clotting, and breast cancer risk factors. Confusion about different types of Hormone Replacement Therapy (HRT) is due to the lack of clear distinction between the molecular formulas and the lack of focus on their significantly different effects on the body.

Molecularly Identical

This would be from hormones that are an exact molecular match to the hormones produced by your own body. Often called bioidentical, biologically identical, human identical, Bioidentical Hormone Replacement Therapy (BHRT). The term “bioidentical” does not indicate the source of the hormone but rather the chemical structure. Bioidentical hormones are originally derived from a molecule called diosgenin in either soy or yam. Through a series of chemical processes this plant molecule, which is structurally similar to a steroid hormone, is converted in a laboratory to the specific human hormone molecule.

The final product has no trace of the plant-just the pure biologically identical hormone. Bioidentical hormones convey the same action and effect, are metabolized into the same downstream metabolites, have the same binding affinity, and being the same structure as human hormones, are expected to restore normal physiology.

When we discover hormone imbalances in our patients, the BHRT option is how we correct the hormone problem at Beyer Functional Wellness! It’s natural, more effective, and without the risk factors associated with many other options, especially synthetic ones.

Animal Derived

This is hormone replacement comprised of hormones derived from animal sources that are molecularly identical to the animal hormones…not human hormones. A commonly used example is “Conjugated Equine Estrogen” (CEE), which is obtained from horse urine.

Non-Molecularly Identical

This is often called “synthetic” hormones. This is the traditional hormone replacement option used by medical doctors…it is a prescription pharmaceutical hormone and it is not the same as what your body produces, as is the case with BHRT.

Some examples of synthetic progesterone are the “Progestins” (such as “Medroxyprogesterone” or “Norgestrionone”)…These are NOT progesterone in structure or function. In fact, it is these synthetic “progestins” that were the actual culprits in studies (such as the now infamous Women’s Health Initiative or “WHI”), that showed an increased risk of breast cancer. It was the “partial story”, sensationalistic reporting of the increased rates of breast cancer in SOME (those getting the progestins) of the study participants that unfortunately scared so many women away from ANY/ALL types of HRT…even the participants who got CEE (which isn’t bioidentical), had decreased risk of breast cancer if it was without the synthetic progestins.

Likewise, the synthetic estrogens (“Ethinyl estradiol” as one example) do NOT function the same because the chemical structure is different. Also important to mention here is the realization that the delivery method (how the hormone gets into the body), can make a BIG difference! In the case of estrogen especially, a transdermal rather than oral route has shown to be significantly safer.

Plant Derived

These are “hormone-like” compounds found in plants, not molecularly identical to human hormones, but nonetheless can play an important role in naturally correcting a hormone imbalance. These are often called “phytohormones” or “botanical hormones”, and some examples are Soy, Black Cohosh, and Dong Quai.

An excellent book on the importance of EDCs that we recommend and encourage patients to read is: “Hormone Deception” by Dr. Lindsey Berkson.

Are Bioidentical Hormones Safe?

Twenty-five years of research and hundreds of published studies conducted in the US and Europe have demonstrated bioidentical hormones to be equally or more effective than non-bioidentical (synthetic prescription) hormones for symptoms. Published studies also indicate their safety. In the January 2009 issue of Postgraduate Medicine, Dr. Kent Holtorf published an article citing 196 research studies. He comments, “Physiological data and clinical outcomes demonstrate that bioidentical hormones are associated with lower risks, including the risk of breast cancer, cardiovascular disease, and are more efficacious (fancy doctor word for “effective”) than their synthetic and animal-derived counterparts. Until evidence is found to the contrary, bioidentical hormones remain the preferred method of hormone replacement therapy”.

What About Compound Hormones?

Compounded hormones contain the same hormones as their commercially available counterparts but offer several advantages. Each prescription is prepared based on the doctor's specifications, meeting the needs of each individual patient. Hormones can be prepared in the indicated delivery method including capsules, troches, gels, and creams.

Compounding pharmacists have been preparing medications with an excellent track record of safety and effectiveness prior to the advent of mass-produced pharmaceuticals. Our healthcare system could not function without the expertise of compounding pharmacies. According to the American Pharmacy Association and the National Association of Community Pharmacists, compounding is done in 90% of all hospital pharmacies and 80% of all independent pharmacies.

• Compounding pharmacies are regulated by each state’s pharmacy board and by the Pharmaceutical Compounding Accreditation Board

• Each state’s regulations require consistency in purity and dosage

• The hormones compounding pharmacists use are regulated by the U.S. Pharmacopoeia and the Code of Federal Regulations, which require purity testing

• The prescriptions filled at compounding pharmacies are not FDA-regulated or FDA-approved but do contain hormones that are FDA-approved

• The hormones used by compounding pharmacies are obtained from FDA-inspected and approved facilities

• Compounded hormones do not require FDA approval since they are not mass-produced. (FDA approval does NOT guarantee safety as evidenced by drug product recalls.)