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

September 18, 2009

Many of you are wondering about hormone replacement therapy and have all kinds of questions. I can really appreciate that because there really are lots of questions to ask and lots of questions to be answered. We want to try to address all of the different kinds of hormones that are available, the different dosing issues, combinations of hormones, delivery methods of hormones, and some pros and cons and benefits and risks of hormones. That is kind of the territory at which I think most all the questions lie.

So lets start first with all of the different kinds of hormones. And by the way, we are talking about hormones here, we are not talking about herbs that have constituents called phytoestrogens. We are talking about hormones, and there are hormones of all kinds. Some are made from a natural substance and some are made from a natural substance and then turned into various kinds of hormones, and some are semi-synthetic or synthetic.

Let's start with hormones that are made from a natural substance. Starting with even Premarin, the kind of hormone or estrogen that has been around for the very longest amount of time. It's called Premarin. It's actually made from a "gamoosh" you might say of hormones found in the urine of pregnant mares. And that is why they call it Premarin. Pre-Mare-In. Pregnant Mare's Urine. So, these are technically a natural substance, but they aren't identical to the human hormones, so therefore we call them semi-synthetic really.

There are also hormones that are made from a natural substance and in these cases, plants. They extract two different ingredients out of either Mexican wild yam or soybeans. And then they turn that substance in a manufacturing laboratory, into a hormone. Now, we can turn that into a hormone that is not chemically identical to the human hormones, or we can turn those constituents into a hormone that is identical to the human hormones. And those hormones are ones that often receive a lot of press and attention often, and are called bioidentical hormones. A bioidentical hormone is a hormone that is derived from a plant constituent, but turned into a hormone that is biochemically identical to the woman's hormones. Thus, bioidentical, or biochemically identical.

But you can also take these same constituents out of a plant and turn them into a hormone that is not biochemically identical. And many pharmaceutical options are these kinds of hormones. And again, I kind of call those more quasi-synthetic. So, so far we have the Premarin which is from the estrogens in pregnant mares' urine, not biochemically identical. We have bioidentical, plant derived, chemically identical to human hormones. And we have plant derived that are not chemically identical to human hormones. And then we have just bona fide synthetics that are also made by pharmaceutical companies. Those are essentially kind of the four different categories of the different kinds of hormones that are available to women. And some of those are actually available to men as well. Testosterone, for example. We have a bioidentical testosterone and we have a synthetic testosterone. And the bioidentical testosterone available to women is currently only available from a compounding pharmacy.

For example, we can prescribe testosterone to women and to men. It's just that there's not a bioidentical testosterone product available to women and there's not even a synthetic testosterone prescription available to women as a stand alone prescription. The pharmaceutical companies have not been allowed to produce a testosterone-only product for women yet. They have been allowed to produce that for men. So for women, when we want to prescribe testosterone, we have to go to a compounding pharmacy. And we can prescribe either the bioidentical testosterone or the methyltestosterone. And we prescribe those in pills or in creams. Testosterone is an important hormone when it comes to sexual function. We use a bioidentical testosterone cream from a compounding pharmacy, which is a specialty pharmacy, and we put that in a cream, according to a certain dose, and it is applied to the external genital area right before sex to enhance arousal and orgasm. We can also put this bioidentical testosterone or synthetic testosterone into a specially prepared compounded combination of hormones: estrogens, progesterone, and testosterone, for addressing sexual function as well as other menopause symptoms. When we want to prescribe testosterone to a woman, we have to currently use a compounding pharmacy with one exception: there is a synthetic estrogen with a synthetic testosterone called Estratest, made by a pharmaceutical company.

Read Part II of this entry »