Bio-identical Hormones

Bio-identical HormonesThe term “bio-identical hormones (BHRT)” (sometimes referred to as “natural hormones”) are chemically identical to the hormones produced by women (primarily in the ovaries). The terms are often confused, as bio-identical and “natural,” are not meant to be one in the same because bioidentical hormones are synthesized, while some estrogens from a natural source, such as animal sources, are not considered bioidentical because many of their components are foreign to the human body.

The most common example is, Premarin®, which is an estrogen derived from the urine of mare’s Premarin could be considered “natural”; however, it is not structurally/chemically identical to human estrogen. The same is true for Provera, which is a synthetic progestin.

When I discuss the option of bio-identical hormone replacement therapy with my patients, I stress to them that I am referring to- human-identical hormones. Since bio-identical hormones have the exact chemical/molecular structure, they have the same exact function as those actively produced in a women’s body. Bio-identical hormone supplements follow the same pathways of metabolism within the body as those being already produced, or produced in the past.

Is a Synthetic Hormone any different from a Bioidentical Hormone?

Bioidentical hormones are the hormones that are intrinsically unique to humans in that they exist in the human body naturally.  Synthetic hormones are these very same human hormones except that the chemistry or chemical structure of the hormone is altered.

Why Chemically Alter a Human Hormone?

Natural substances like human hormones cannot be patented, and are therefore generally not as profitable to manufacture. In order for a medication to be patented this oftentimes requires some alteration in the chemical nature of a substance either something that is entirely synthetic or completely natural. Patents give exclusive marketing rights to the manufacturer.  The patent is necessary to protects profits.  Due to concessions granted to patent laws, only chemically altered substances can be patented.

Women produce various hormones:

  • Estrone – E1
  • 17-beta-estradiol – E2        Estrogens
  • Estriol – E3
  • Progesterone – Progestogens
  • Testosterone – Androgens
  • Other hormones- DHEA, thyroid, cortisol

Presently there are many options for supplementing with BHRT: estradiol, progesterone, and testosterone. Of additional importance, when optimizing health and well being, there are also options for replacing thyroid hormone, DHEA, and cortisol, if needed.

BHRT can be highly effective therapy, especially in women who are experiencing various forms of deficiency and imbalance at certain stages of their life. Hormone deficiencies span all stages of a women’s pre-reproductive, reproductive and post reproductive life. Patients can be teenagers or as far advanced in life as women in their menopausal years presenting with symptoms that are premenstrual, peri-menopausal or menopausal.

Management of these deficiencies and imbalances includes accurately assessing each individual patient’s hormone status based on:

  • Medical history
  • Family history
  • Risk assessments for various diseases and disease processes
  • Signs and symptoms
  • Lab work

A patient’s management protocol is individualized based on these proceeding assessments and supplementation is tailored toward any deficiencies and patients personal symptoms.

To confirm a patients appropriate combination of supplementation (or commonly referred to as “balance”) of bio-identical hormones for your body may take some time and adjustments to be considered optimal for each patient.

Follow-up may require additional laboratory testing or even several office visits ( at 8-12 week intervals) in order to effectively individualize treatment.

Once your optimal supplementation regimen is achieved, it is recommended for each patient to come in once a year to re-discuss and re-assess your current health status, ongoing management issues and confirm supplementation regimens are still optimal. Patients will find that therapy often requires ongoing adjustments to treatment especially after periods of undue stress, significant weight fluctuations or as individual body hormones change or shift.  In addition, this is an excellent time to review any new research findings currently ongoing that may optimize and impact your health.