Bioidentical Hormones

As I flicked through the TV channels one evening, as a hormone specialist doctor, my attention was drawn to a heated discussion on CNN’s Larry King Live about synthetic hormones versus natural bioidentical hormones.

Along with doctors debating the merits of bioidentical(natural) hormone replacement therapy (HRT), the show’s guests included the celebrity author and health advocate Suzanne Somers. Her newest book is Ageless: The Naked Truth About Bioidentical Hormones (Crown). I watched in amazement as one medical doctor—whose ties to a pharmaceutical company that sells synthetic hormones were disclosed during the show—argued (unconvincingly, I thought) that there is no difference between synthetic and bioidentical hormones. I was impressed at how knowledgeably Somers defended bioidentical hormones, countering the doctor’s misinformation with the facts.

As a hormone specialist doctor and Naturopathic Medical Doctor at my Stengler Center for Integrative Medicine clinic, I often prescribe bioidentical hormones for my own patients—male and female—so I arranged to interview Somers myself. Why do I value her opinion? Her book is based on an in depth interviews with 16 doctors who are experts in bioidentical HRT…she uses this therapy herself…and she is a breast cancer survivor who has been cancer-free for six years after her lumpectomy and radiation, despite having had no chemotherapy. While I do not agree with every recommendation in Somers’s controversial new book, most of the information is valid and helpful.

A low-hormone epidemic?

Hormones are powerful chemical messengers secreted by the endocrine glands. Hormones affect the activity of every organ in the body…the cardiovascular, nervous, immune and reproductive systems…and growth patterns and sleep cycles. Any hormonal deficiency can compromise vitality. Some people require HRT to combat obesity, to recover from disease or depression, or simply to achieve optimal health.

Many women in their 40s, 50s and beyond live in a state of hormonal imbalance brought on by birth control pills, menopause, poor diet, stress, illness or exposure to toxins. Result: An array of problems, ranging from the annoying (hot flashes and memory lapses)…to the energy-sapping (insomnia, fatigue and weight gain)…to the debilitating (osteoporosis and depression).

Compared with women, men are less prone to hormonal imbalances—yet men’s risk is still very substantial. An article published in 2005 in the Annual Review of Medicine concluded that approximately 30% of men in their 60s and 70% of men in their 70s have low levels of free testosterone. (The “free” level is the amount of a hormone that is not bound to protein and so is available to interact with cells.)

I see a significant number of male patients whose hormonal deficiencies have triggered weight gain, joint pain, erectile dysfunction, fatigue and/or depression. (I was not surprised when Somers told me that both her husband and adult son experienced tremendous improvement in energy and mood from bioidentical HRT that included testosterone.) It is normal for hormone production to decline gradually as we get older. What is not normal is any sudden, rapid or extreme drop in hormone levels—as often occurs when chronic illness, chronic stress and/or an unhealthy lifestyle strains the endocrine system. As the first line of treatment, I advocate dietary improvements, nutritional supplements and other natural remedies. However, for patients who have very low hormone levels, severe symptoms or a chronic disease (such as heart disease, osteoporosis or arthritis), bioidentical HRT is sometimes necessary.

Hormones should be administered by a qualified doctor…at the lowest effective dose…and for the shortest time possible, though some patients do require lifelong HRT.

Why bioidentical hormones are best

The term “bioidentical hormones” refers to hormones that are exactly the same in structure and function as those produced by the human body. Substances derived from plant or animal tissues are modified (on a molecular level) in a laboratory until they precisely match the natural human hormones. Synthetic hormones, in contrast, are not identical in structure and function to those produced by the human endocrine system. For example, birth control pills are composed of chemically synthesized hormones—usually estrogen and progestin (a type of synthetic progesterone)—that are molecularly different from natural human hormones. Actually, the concept of a “natural” source can be confusing.

The synthetic estrogen-replacement drug Premarin is derived from a natural source—the urine of a pregnant horse—but the drug contains estrogens found naturally only in horses and not in humans. Synthetic estrogen-replacement drugs increase the risk of several potentially fatal diseases, especially when combined with progestin. In 2002, a large-scale study called the Women’s Health Initiative revealed that postmenopausal women who used synthetic estrogen and progestin had a significantly increased risk of breast cancer, coronary artery disease, stroke and blood clots. In response to this alarming news, many doctors immediately recommended that patients stop synthetic HRT. Interestingly, statistics for the year that followed showed a drop of 7% in breast cancer overall and a decline of 12% in estrogen receptor–positive breast cancers (which are more likely to occur when estrogen levels are high) among women ages 50 to 69. No comprehensive studies have yet explored whether bioidentical hormones are safer than synthetic ones. However, anecdotal evidence indicates that serious side effects from bioidentical HRT are uncommon. Hormones work by attaching to cell receptors (molecules on a cell’s surface that allow other substances to affect cell activity). Because these cell receptors are designed to interact with the body’s natural hormones, bioidentical hormones provide the best fit. Synthetic hormones do not fit as well—and therefore may be more likely to cause problems at a cellular level.

Evidence: Premarin has been shown in test tube studies to damage cell DNA, according to a study published in 2001 in Chemical Research Toxicology.

Unfortunately, many medical doctors are uninformed about bioidentical HRT—perhaps because bioidentical hormones are not marketed or promoted by the pharmaceutical industry. (To be patented, a pharmaceutical product must not duplicate any substance found in nature, so bioidentical hormones do not yield the large profits that many drugs do.) Still, I am encouraged by the increasing number of doctors who now recommend bioidentical hormones. Suzanne Somers recently spoke at the convention of the American College for Advancement in Medicine (ACAM), addressing 6,000 physicians—primarily medical doctors—who were already prescribing or were interested in prescribing bioidentical HRT. To locate practitioners in your area, call ACAM at 888-439-6891 or visit www.acam.org…then contact the physicians directly to ask if they prescribe bioidentical hormones.

Diagnosing deficiencies

To diagnose a hormonal deficiency, it is necessary to consider symptoms as well as the results of laboratory testing. For instance, blood tests may not pick up mild cases of low thyroid hormone, so I look for telltale symptoms, including fatigue, hair and eyebrow loss, dry skin and poor memory. Many such patients get relief by using bioidentical thyroid HRT, even when lab test results appeared normal. Conversely, some patients with hormonal deficiencies may not have obvious symptoms. Without treatment, they may develop serious health problems. For example, low testosterone (in men and women) increases the risk of heart disease and depression. In such cases, laboratory testing is vital. Because hormone levels fluctuate, the most accurate tests use multiple samples and/or a sample collected at a specific time of the day or month. I recommend annual testing (usually covered by insurance) for anyone over age 40…with a chronic disease…or with symptoms of a hormonal imbalance.

Three types of tests are available

Saliva testing accurately measures the free hormone levels of cortisol… dehydroepiandrosterone (DHEA)…the three estrogens…progesterone…and testosterone.

Urine testing can measure free levels of more than a dozen hormones, as well as metabolite (metabolized hormone) levels that provide additional information about endocrine function.

Blood testing measures free levels of testosterone and the three thyroid hormones.

On the market now

If your tests indicate a deficiency or if you now use synthetic HRT, ask your doctor about bioidentical HRT. The Food and Drug Administration has approved these prescription products…

Estrogen (generic name estradiol), available in tablet form (Estrace), as a skin patch (Estraderm, Vivelle, Climara) and as a vaginal ring (Estring).

Growth hormone, (generic name somatropin), given by injection (Genotropin, Norditropin, Humatrope).

Progesterone, in capsule form (Prometrium).

Testosterone, as a topical ointment (AndroGel).

Thyroid hormone in tablet form (Armour Thyroid, Nature-Throid, Cytomel).

The following bioidentical hormones are available without a prescription, although I strongly advise using them under the guidance of a doctor…

DHEA, sold in capsule or tablet form.

Pregnenolone, in capsule or tablet form.

Progesterone, as a topical cream.

One non prescription bioidentical hormone is generally safe to use without a doctor’s guidance…

Melatonin, sold as a liquid, capsule or sublingual (under the tongue) tablet.

For dosages adjusted to your precise needs, get bioidentical HRT prescriptions filled at a compounding pharmacy. Check the Yellow Pages or contact the International Academy of Compounding Pharmacists (800-927-4227, www.iacprx.org).

As Suzanne Somers said to me, the endocrine system is like an orchestra. A slight imbalance is like a few wrong notes from a trumpet. When a deficiency is great or when several hormones are involved, it’s as if the entire violin section is out of tune. Bioidentical HRT may help to keep you in fine fiddle.

Reprinted with permission of Bottom Line/Natural Healing