The recent question posed by an iammodern reader is a great lead into the huge controversy surrounding Hormone Replacement Therapy (HRT). In general, Bioidential Hormone Relacement Therapy (BHRT) refers to the replacement of hormones that diminish with aging to restore a physiologic equilibrium. When done under the supervision of a qualified physician well trained in HRT, it can really improve the quality of life. Unfortunately, the huge debate over the safety of HRT has been ongoing for years.

The big controversy began around 2002 when the Women’s Health Initiative (WHI), a multi-center study of menopausal women was discontinued. The researchers stopped the study when they found an increased risk of invasive breast cancer and coronary heart disease that outweighed the benefits from the hormone replacement therapy. This immediately became sensationalized by the media followed by droves of women calling their doctor’s offices en masse panicked about their risk of being on the hormones. What the media did not tell the public at the time was that the WHI study was based on the use of oral, synthetic hormones rather than bioidential hormones.

By definition, bioidentical hormones mimic the chemical structure of hormones that the human body makes naturally. The term "bioidentical" indicates that the chemical structure of the replacement hormone is essentially identical to that of the natural human hormone. Therefore, it is metabolically processed in much the same way resulting in greater bio-availability and more effective utilization by the human body with less side effects than traditional HRT. The main reason for this is that oral HRT are metabolized by the liver causing hypertension, elevated cholesterol and even an increase in clotting factors and strokes.

The bottom line is: BHRT is safe and effective. It enhances quality of life and diminishes age related morbidity.

Endocrinologists and Anti-Aging physicians have been prescribing BHRT safely for decades. In fact, reports that date back as far as the 1900s show evidence that compounded creams were being made from human urine! Among the many benefits women derive from using BHRT include: fewer side effects than with synthetic hormones, improved cholesterol levels, decreased risk of endometrial and breast cancer, reduced hot flashes and vaginal dryness, better sleep, mood and concentration; and increased libido (I think this one is the reason I get so many "thank you" cards from patients…).

So the main argument boils down to Big Capitalistic Pharmaceutical Company vs. Small Compounding Pharmacy; Synthetic Mare derived Hormones vs. Natural, plant derived hormones that mimic Mother Nature and the human physiologic state.

How many women remember being on Prempro and going in for regular blood or saliva testing to monitor their unique levels of absorption? Laboratory testing is essential to the safe and scientific application of anti-aging BHRT. This is another very important fact that has been kept from the public. Physicians qualified to prescribe BHRT closely monitor their patients when administering treatment and modify/titrate the personalized prescriptions as needed. It’s not "one size fits all." Each patient’s hormone cream is customized to replenish what they are lacking based on specific laboratory testing. It’s the same concept as a diabetic patient on insulin that has routine blood glucose checks.

For huge drug companies such as Wyeth to continue lobbying and declaring war on an issue that is fundamentally a doctor-patient decision is ludicrous and unconscionable. Add to that the FDA’s plan to stop the compounding of BHRT due to the persistent pressure by goliaths such as Wyeth and we have quite a dilemma on our hands.

I firmly believe that ultimately, as research data increases, this dilemma will become history. Pharmaceutical giants will eventually recognize the error of their ways and, in true capitalistic style, will likely come up with a "very expensive, designer" BHRT themselves.

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