In this internet age, patients often ask intelligent questions that require me to research new areas of medicine. One of the sweetest, nicest patients I have had wanted me to help her with bio-identical hormones.
Sandra (name changes for privacy) has been on bio-identical hormones since going through menopause. Bio-identical hormones are not available at a regular pharmacy but have to be obtained from pharmacies called compounding pharmacies. They are identical to the hormones that are made by our own body.
Sandra wanted me to check her hormone levels and adjust her hormone dose. However, most medical schools and residency programs steer away from bio-identical hormones because they are not FDA approved. Although, it was tempting to refuse to deal with this subject, I decided to research the issue.
I read widely on the subject and even enrolled for a weekend seminar on this topic. What I learned has really opened my eyes and has been really surprising.
For example, I always wondered why the companies that made these hormones did not bother to get FDA approval for them. From my research I found that since these hormones are identical to human hormones, they cannot be patented. Therefore, the pharmaceutical companies patented the horse hormone but have not patented the human version.
Some medical societies such as the American Endocrine Society caution consumers to be careful when using these hormones. I have always wondered why the American Endocrine Society was against this use of bio-identical hormones. Are they not safe?
As I delved into this subject further, I found that some people had claimed that these hormones were completely safe. Just because the human body makes these hormones does not mean that they are completely safe. It is quite likely that these hormones also increase risk of stroke and blood clots and heart disease like FDA approved hormones do. That is why it is important to be careful when using these hormones as well.
Doing randomly controlled studies on bio-identical hormones is difficult because every compounding pharmacy uses a different cream base. The cream base has different chemicals in it that help the hormone to be absorbed from the skin. Every pharmacist has a slightly different cream base and so it is a little bit more difficult to do large clinical trials.
Since every compounding pharmacy is different, one needs to be careful to make sure that they use a reputable pharmacy. It helps to know the pharmacist to make sure that if there is a problem, one can discuss that with the pharmacist directly.
As I researched the issue, I learned that some women can be "Estrogen Dominant." After menopause, estrogen is produced by fat cells and can even be ingested from meats and contaminated water. This estrogen can cause weight gain and other problems.
Progesterone is a hormone that counters the effects of estrogen and decreases the risk of cancer, blood clots and weight gain that estrogen brings on. Therefore, women who are 'estrogen dominant' need to get some progesterone to balance the effects of estrogen.
This rationale is not supported by academic physicians who believe that progesterone is only meant for women who still have a uterus. Academics believe that progesterone decreases the risk of uterine cancer but does not help with anything else.
In order to find out if one is 'estrogen dominant' one needs to do saliva tests to determine the levels of estrogen and progesterone. It is believed that saliva tests are better than blood tests because they measure the active form of the hormone that is not bound to protein. However, academic programs have always done blood tests so they seem to be hesitant to start using saliva tests.
Since saliva tests are better at measuring the 'free', unbound, active version of the hormone, it makes sense that we should be doing saliva tests. Therefore, we have set up the protocols to make this test available in my clinic.
Sandra gentle urging spurred me on to do extensive research and change my practice to allow for the use of bio-identical hormones. How great it is to have wonderful, sweet patients like Sandra who make us expand our horizons!
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