So What IS The Truth About HRT (Hormone Replacement Therapy) - Part II
With Dr. Tori Hudson

December 3, 2009
Read Part I

Let's go back to delivery methods. We have these different kinds of hormones: semi-synthetic, synthetic, bioidentical, (bioidentical from a pharmaceutical company, or bioidentical from a compounding pharmacy.) That is one little clarification we should articulate again here because those are both the same and different. Pharmaceutical companies have a few select bioidentical hormones. There is Estradiol by itself, it comes either generic or Estrace in a pill, or we have the estrogen-only patches which are actually bioidentical estradiol. Vivelle and Climara and Menostar are examples of those. And then we have a bioidentical cream called Estrace cream. Those are all actually made by pharmaceutical companies. But the pharmaceutical companies only make available a small handful of doses and very select methods of delivery. Also with the pharmaceutical company comes their patented preservative, or binder, or filler or adhesive, because, you can not actually patent the bio-identical hormone itself. So you have to patent something special that you do to that hormone. We are left with the limitations of the pharmaceutical company bioidentical hormones in dosing, combinations delivery methods.

Now, at our clinic, and what most people who are really accustomed to prescribing bioidentical hormones do, is they use specialty compounding pharmacies. Because now, we can prescribe all customized and individual doses. Maybe you don't need just the .5, or the 1 or the 2 milligram that the pharmaceutical company makes. We think you would do just as well with .25 or we need to tweak it a little bit and give you .35. So, we can customize your dose and titrate the dose up or down. We can also customize a combination. No pharmaceutical company yet makes a combination of bioidentical estradiol with bioidentical progesterone. They also don't make a combination bio-identical estrogen/progesterone formula that has the testosterone in it. So we can now individually prepare a formulation that has not only the bioidentical hormones but the select interim specific doses that we want, and in specialty combinations. And we can use other hormones that we are interested in like estriol or DHEA that have their own added benefits. In addition, we can do this in pills, in capsules, in sublingual lozenges, in sublingual drops, in creams, in gels, in vaginal, in topical deliveries. We have so many more variability’s and circumstances and ways that we can help women by utilizing these compounding pharmacies than by just sticking with what the pharmaceutical companies provide. But they are, in fact, the same hormones, if we are talking about bioidentical hormones, the commercial pharmaceutical products and the compounded products have the same benefits and the same risks. It's just that we have a lot more flexibility, a lot more individualization, a lot more circumstances that we can help with these compounding of specialty formulations.

One other difference that we can talk a little bit more about, between the special compounded bioidentical hormones versus the pharmaceutical bioidentical hormones is that with the specialty pharmacy, we don't have the binder, the filler, the preservative or the adhesive. And we can also put it in a powder or an olive oil, or a peanut oil, even if we are just talking capsules. So, that's just one other added layer of a way that we can serve an individual situation. This is especially important for some people who are very sensitive to a preservative or an adhesive, or an additive. So that's another feature of utilizing the compounding pharmacies. The issue of compounded hormones has become a very hot topic because the more conservative organizations that have to do with obstetrics, gynecology and menopause are saying that these compounded hormones are not FDA approved. Therefore, you should only stick with the pharmaceutical company, either synthetics or semi-synthetics or bioidentical. My argument with that is that the estradiol at .5 milligrams from a pharmaceutical company versus the .5 milligrams from the compounding pharmacy is the same hormone, it is the same dose, they all get it from the same supply house. It is the same. So, that argument doesn't really fly with me.

What is a problem is there are some people being interviewed these days and writing popular books that say that these compounded hormones are safe and good and better, and all other hormones, especially synthetic and semi-synthetic are bad and dangerous and unsafe. And that really isn't fair actually. There are some advantages to bioidentical hormones according to the research. Whether they are pharmaceutical company or compounded, because they are all from the same source.

The advantages more lie in the progesterone rather than the estrogens. Synthetic progestin has been shown to have more unfriendly affects on some cholesterol features. It's been found to maybe contract coronary arteries, and it's maybe been found to have a more adverse affect on breast tissue, when compared to the bioidentical progesterone which has a more friendly affect on cholesterol, dilates the coronary arteries, and in two French studies, was not associated with increasing the risk of breast cancer where the synthetic progestin was. So this is actually a very important difference, we think, between the bioidentical, also called natural progesterone versus the synthetic progestin. And maybe all of our questions about breast issues are not so much to do with estrogens, but perhaps more to do with the different kinds of the progestins, meaning synthetic, versus progesterone, meaning bioidentical.

More to come...