The Skinny on Biodentical Hormones

As many of the baby boomers are approaching the menopause there is great interest in hormone replacement therapy.  Since the WHI (Women's Health Initiative) Study, women have become frightened to use estrogen and have been looking for alternatives to reduce their troubling menopausal symptoms. 

Following a period when physicians would prescribe estrogen as a panacea against heart disease, osteoporosis, Alzheimer's and hot flashes, women have lost confidence in the medical establishment when the study revealed that in fact estrogen use increases the risk of breast cancer and may in fact increase the incidence of heart attack in women.  When Suzanne Somer's book came out endorsing the use of "bioidentical hormones" women took notice. 

Are bioidentical hormones a better, safer alternative to the prescription drugs that your doctor may offer?  Bioidenticals are not "natural" hormones.  In reality, compounded bioidentical hormones and FDA approved bioidentical hormones all come from the same precursors.  They all begin as soy products or wild yam and then get coverted to the different hormones in a laboratory in Germany.  The claim that all bioidentical hormones are engineered to become the same chemical structure as natural female sex hormones is false.

The risks associated with hormone replacement are the same for FDA approved medications as for the bioidenticals with the exception that with the compounded batch it is not known how much or what a women is receiving.  They are not regulated or monitored by the FDA and are therefore lacking in tests for purity, safety, potency, and efficacy.  When the FDA did analyze compounded bioidentical hormones 34% failed one or more quality tests. 

Many clinicians who prescribe bioidentical hormones base the dosage on salivary hormone testing.  There is no scientific evidence that a correlation exists between a patient's symptoms and salivary hormones.  There are no published studies in the literature that show that salivary testing is a reliable measure on which to safely base dosing decisions.  The Endocrine Society and American College of Obstetricians and Gynecologists issued statements advising against salivary testing and their lack of reliability. 

In summary, bioidentical hormones cost more, the salivary testing costs more, the consultation often is more costly and no information is given to the patient regarding the risks and benefits of these hormone alternatives which are not monitored by the FDA.  The additional concern is the conflict of interest when the practitioner who prescribes them is the one who is selling them.  Let the buyer beware. 

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