What Is The Deal With Bioidentical Hormones
Many of my patients ask about bio-identical hormones for treatment of menopausal symptoms, and it is easy to be confused with so much conflicting information available online and in product advertising. Hopefully this information will clarify some of the confusing information that we all hear!
First of all, the term “bio-identical” is not a scientific or medical term, but refers to hormones that look biologically identical to those produced by humans. Women produce three kinds of estrogen prior to menopause, the predominant one being estradiol. Any estrogen product that is called “estradiol” is by definition bio-identical. Our ovaries also produce a hormone called progesterone each month after ovulation and in pregnancy, as well as testosterone. While testosterone is often thought of as the “male hormone” and men have much higher levels than women, testosterone is a really important hormone for us, too.
Let’s dig into these terms a bit more. Any progesterone product is by definition bio-identical. My patients often tell us that they don’t want “synthetic hormones” and prefer something “natural.” Unfortunately, these terms are really marketing terms with no real meaning. All hormones including bio-identical hormones are synthetic; that is they are made in a lab to look exactly like human hormones. Some come from a plant source, hence the term “natural” that may be used in their advertising, but they are not taken out of the ground and put in a bottle; they are synthesized in a lab to be made useful to humans. The only truly “natural” human hormones would be taken out of one human and used in another, which is luckily not the source of any hormones used for menopausal relief! Bio-identical hormones (estradiol, progesterone, and testosterone) are available from specialty pharmacies called compounding pharmacies that mix hormones to various specifications, and estradiol and progesterone are also now available from all regular pharmacies like Walgreens and CVS. Estradiol and testosterone are also available in sub-cutaneous pellet form.
Estradiol and progesterone are available under a variety of brand names from regular commercial pharmacies, and I use both commercial and compounding pharmacies according to patient preference. Hormone pellets are also a great option. A frequent misconception is that before one can take bioidentical hormones a lot of expensive lab testing is necessary to establish the correct dose and that those levels must be followed regularly. In fact, levels of estrogen, testosterone and progesterone can generally be evaluated as accurately by listening to the patient’s history as by lab testing. We rarely measure hormone levels to follow dosing. We listen to the patient and dose accordingly using data from thousands of other patients in the past. It’s useful to check hormonal labs at baseline to make sure that we know where we are starting, but rarely do you need a regular blood test to follow hormone levels- your symptoms will usually tell us what is going on.
I always prescribe bio-identical hormones (estradiol, progesterone, and testosterone) to treat menopause symptoms if hormone therapy is indicated, and believe that hormone replacement is a great option for reducing menopause symptoms in many women. But using a compounding pharmacy is an option, not a necessity, and beware of expensive lab tests that may be profitable to the provider ordering the test, and of terms like “natural” which suggest that a product is better or safer. The lab we use in our office is in-network with all major insurance.
Bio-identical hormones can dramatically improve the quality of life for women suffering from hormone loss which is inevitable with age. Testosterone begins to drop as early as our 30’s and can lead to multiple symptoms including fatigue, muscle loss, fat gain, and loss of libido. Progesterone also drops as early as our 30’s and is almost undetectable after menopause since it is made by the ovaries after ovulation. Estrogen fluctuates throughout our cycles and drops to almost undetectable levels after menopause, causing hot flashes, night sweats, vaginal dryness, brain fog, and a multitude of other unpleasant symptoms. Replacing these hormones back to levels seen in our 30’s can make us feel like ourselves again.
These hormones are available in a number of delivery systems that I would love to discuss with you. An in-depth hormone consultation usually takes about an hour. But in short, estrogen and testosterone are most effective and safest when delivered across or under the skin, in the form of a subcutaneous pellet (which lasts for 3-4 months), a cream or a patch. Progesterone is a larger molecule that is not absorbed as well through the skin, so it is generally given by mouth at night, and has a great side effect of causing sleepiness!
Here are a few surprising but true facts about bio-identical hormones:
- Multiple studies have shown that estradiol is NOT associated with causing breast cancer, although it will cause more rapid growth or spread of existing cancer.
- Multiple studies have shown that estradiol given non-orally shows NO increase in blood clotting risk and DECEASES the incidence of heart disease, osteoporosis, Alzheimer’s disease and colon cancer.
- Progesterone is a great alternative to sleeping pills and is essentially risk free!
- Testosterone in pellet form has been proven to help increase our muscle: fat ratio as well as preventing bone loss, and DOES NOT cause acne, hair growth, or other unpleasant symptoms in the vast majority of women when doses correctly.
Come see me in person or by Zoom to talk more about how bio-identical hormones can help you! I can tell you for sure, they changed my life for the better by about 100%, and can do the same for you!