Dr. Aimee Shunney A Different kind of Doctor

Bio-identical Hormones Get Their Day
August 30th, 2012

As a Naturopathic Doctor (the only practitioners trained in the use of bio-identical hormones (BH) during their medical education), I have been studying and prescribing BH for 12 years, and spending just as much time trying to explain why they are, in most cases, a better choice than non-bio-identical hormones (NBH). I have found that much of the information available about BH (and hormone therapy in general) is confusing at best, and often misleading. In an effort to set the record straight, I have compiled the following answers to the most common questions I get asked about BH.

WHAT EXACTLY ARE BH?

BH are plant-based hormones that have the same molecular structure as those naturally occurring in men and women. They are made in the laboratory from beta-sitosterol from soy or diosgenin from wild yam. BH can be used to replace any NBH – estrogen, progesterone, testosterone, thyroid hormone, DHEA, cortisol, etc.

WHAT IS THE DIFFERENCE BETWEEN NATURAL, SYNTHETIC AND BIO-IDENTICAL HORMONES?

Those who say ‘Natural Hormones’ usually mean BH, but they are not necessarily the same. For example, Premarin is an estrogen that comes from horses, so it is natural, but it is not chemically identical to the estrogens our bodies make, and therefore, not bio-identical. Likewise, most people who say, ‘Synthetic Hormones’ usually mean those that are not bio-identical, but they are also incorrect. BH are synthetic because they are made in a laboratory.

ARE BH NEW?

No. Ovarian hormones were made in the lab as early as 1930. FDA-approved commercial versions have been available in the US since the 1960s.

WHY USE BH INSTEAD OF NBH?

NBH may act like environmental toxins because even though they can bind to our hormone receptors, they are foreign substances, and therefore, leave a different ‘metabolic footprint’ on the body. NBH may

  • be directly cytotoxic to estrogen-sensitive tissue
  • disrupt hormone balance because they are often much stronger than the bodies’ own hormones
  • alter binding of other hormones to the receptors
  • alter the liver’s metabolism

BH prescribing is also about mimicking what the body does naturally; we use similar hormones at similar times of the month in similar doses and ratios in an effort to reproduce natural hormone balance.

HOW DO I GET BH?

You can get BH in 3 ways.

1) A patented commercial preparation from a regular pharmacy by prescription, ie: Vivelle patch, Prometrium.
2) A non-patented preparation made by a special compounding pharmacy, also by prescription.
3) Progesterone cream and DHEA are available over the counter without a prescription.

WHAT ARE THE PROS AND CONS TO USING PATENTED COMMERCIAL BH PRODUCTS?

PRO: Commercial products have all been rigorously studied for FDA approval and there is ongoing oversight that ensures standardization of dosing and quality control. CON: They contain additives, preservatives, dyes and other potential allergens, which make them an unacceptable option for many people. They are also only available in certain forms and doses.

WHAT ARE THE PROS AND CONS TO USING COMPOUNDED BH PRODUCTS?

PRO:

1) Customized dosing.
2) Hypoallergenic.
3) Various delivery options: oral, topical, sublingual, vaginal, etc.
4) Comparable quality – in fact, the same USP-grade raw materials are used for compounded and commercial preparations.
5) Hormones can be combined for convenience.

CON: Since there is a lack of government oversight, you need to trust your compounding pharmacy. Preferably, work with a practitioner who has already done this for you.

I HAVE HEARD CONFLICTING INFORMATION ON HORMONE SAFETY. ARE HORMONES SAFE TO USE?

This is a HUGE topic, and the jury is still out. In the conventional medical realm, birth control pills, thyroid medication and testosterone are considered safe when used as intended. The most controversial area is the use of estrogen and progesterone replacement during the menopausal transition.

Current thinking says it is appropriate to consider hormone therapy for menopausal symptoms (hot flashes, insomnia, cognitive/memory decline, mood changes) that don’t respond to other measures, osteoporosis, or urogenital symptoms (vaginal dryness, painful sex, increased vaginal or urinary tract infections, or stress incontinence).

The debate continues regarding the benefits and risks of hormones on heart health and breast cancer. Be sure to discuss all potential risks of hormone therapy with your physician.

IS IT TRUE THAT COMPOUNDED BH ARE BETTER AND SAFER BECAUSE THEY ARE NOT DRUGS?

Technically a drug is something that is patented, made by a pharmaceutical company and approved by the FDA to treat a medical condition. In that sense, compounded BH are not drugs. However, there are still risks when using BH. There is an increasing body of evidence suggesting that BH have a better safety profile than NBH, probably due to the different metabolic consequences of BH vs. NBH discussed above.

WHAT DOES THE RESEARCH SAY ABOUT BH VS. NBH?

These studies are hard to come by because no pharmaceutical company will pay for them, and they pay for the vast majority of drug research in this country. Most of the research comparing NBH to BH has been on estrogen and progesterone, and they have shown that BH are as effective as NBH with lower side effect profiles. In addition, oral estrogen has been shown to have more negative effects than topical or vaginal estrogen.

DO I NEED TO TEST FOR HORMONAL IMBALANCE AND IF SO, HOW?

The concept of functional hormone imbalance is a newer idea that largely belongs to the realm of non-conventional medicine. Hormones change every day, from moment to moment. As such, hormone testing is far from perfect and many practitioners avoid it for this very reason. I think this is akin to throwing out the baby with the bathwater. Testing is important and very helpful! Although I don’t always follow traditional laboratory reference ranges, I believe that there are ways to interpret blood test results that help me treat and monitor hormone imbalance very effectively. I also like salivary testing to look at cortisol levels and adrenal health (which often plays an important role in hormone imbalance issues). A newer favorite of mine is urine hormone testing as it lets me see hormone levels over a 24-hour period as well as the way your body metabolizes those hormones. This is excellent info for complicated cases and assessing hormone-related cancer risk.

IS HORMONE SUPPLEMENTATION THE ONLY WAY TO CORRECT HORMONAL IMBALANCE?

Absolutely not! Naturopathic medical philosophy dictates that we address the underlying cause and not just the symptoms. Diet, exercise, stress, digestion, liver health and inflammation all have strong influences on hormonal balance. Ideally these issues should all be addressed before, or at least during, hormone therapy.

WHEN SHOULD TREATMENT WITH BH BE CONSIDERED?

While dietary and lifestyle changes, supplements and herbs can often resolve symptoms of hormonal imbalance, there are times when hormone replacement is the only option that provides sufficient relief. Hormone imbalance affects men and women of all ages.

Symptoms may include: difficult menopause, painful sex, low libido, arousal and orgasm issues, PMS and painful or irregular periods, fertility issues, acne, endometriosis, fibroids, ovarian cysts, abnormal hair growth, weight gain, muscle loss, insomnia, decreased libido, fatigue, thyroid dysfunction, bone loss, anxiety, depression, cognitive decline, etc. Men can experience much of the above as well as erectile dysfunction.

BH can also be used for both men and women to treat thyroid and adrenal dysfunction.

HOW DO I KNOW IF BH IS RIGHT FOR ME?

Start by finding a healthcare provider who can help you address not only your symptoms, but any underlying health issues that may be exacerbating your hormonal imbalance. Make sure they can evaluate hormonal AND non-hormonal treatments, and ask their office if they have special training in prescribing BH.

Dr. Aimée Shunney