The subject of bio-identical hormones has been a hot topic for about 5 years. But the pioneer of bio-identical hormones, Dr. John Lee, began his quest over 20 years ago. Honestly, Suzanne Somers, Dr. Phil and especially Oprah Winfrey have done a lot to get people talking about bio-identical hormones.
What does it mean? Bio-identical means literally "chemically identical" to the hormones your body produces. Your ovary naturally produces 3 estrogens: estradiol, estrone, and estriol, progesterone and testosterone. So, a drug that is plain estradiol is bio-identical. There are numerous estradiol products that have been available for years; the oral tablet Estrace®, Vivelle Dot® patches, Estrace® vaginal cream, to name a few, are all bio-identical and available at any pharmacy. Progesterone get's a little trickier, there is only one bio-identical progesterone at any pharmacy, Prometrium®, available in 100 mg and 200 mg oral tablets. There are NO bio-identical testosterones available at the local retail pharmacy. There is only one FDA approved testosterone for women, Estratest®, which is esterified estrogen combined with methyltestosterone. It comes in 2 doses. This is not bio-identical, since the estrogen your body makes is not esterified, and the testosterone your body makes does not have a methyl compound.
So, are bio-identical hormones better? That's the multi-billion dollar question that is rocking the pharmaceutical industry these days. The makers of non bio-identical hormones are not going to take this fight lying down. Their whole company depends on it. I think this question for them revolves around money, but for you is about many different things. If people like me quit writing prescriptions for their products, and focus on bio-identical products, then that cost's them a lot of money. So they are going to spend a lot of money to tell you that the whole bio-identical movement is hogwash. And the makers of bio-identical hormones are going to be coming out of the woodwork to market to you. I think simply speaking, a drug that is exactly like the hormone your body naturally produces probably has the potential to give you less side effects. And that is a huge deal to women, and I think this gets minimized everyday. I would rather have my patients feel less side effects and feel more benefits while they are taking a medication I prescribe. Are bio-identical hormones safer? That is a much trickier question. I think all hormones carry risks, whether they are synthetic or bio-identical . I think there are some smaller studies and years of clinical practice that show that some of the risks of bio-identical hormones may be lower than synthetics. But it will be a lot of years and billions of dollars of research later down the road to answer that question fully, if that is even possible.
So, back to bio-identical hormones. You really can't discuss bio-identical hormones without discussing compounding pharmacies. Think back to what I said before, several estradiol products are available anywhere, only one progesterone, and NO testosterones at any retail pharmacy. Yet, I know everyone reading this knows of someone on testosterone, or progesterone cream. How do they get it? They have it compounded, or made for them, at a compounding pharmacy. Someone like me, writes a prescription for a patient, and tells them to fill it at a compounding pharmacy, so it can be made exactly for the patient as I specify in the prescription. Here's where we talk about money again - money lost to a pharmaceutical company, and the money spent by you or your insurance company. Every prescription I write that is filled at a compounding pharmacy is money out of some pharmaceutical company's profit, and like I said before, they are not going to take this lying down, so they attack it. Then, some insurance companies, for sure Aetna, choose not to cover any medication at a compounding pharmacy, so now the cost is completely on the patient. Is it worth it? I guess it depends on the patient. If you need testosterone, and you don't want it added to estrogen and with a methyl compound, honestly the only way to get it is have it compounded. If you want progesterone, and you don't want an oral tablet, but a topical cream, you need to have it compounded. If you are needing to be on estrogen, progesterone and testosterone, you can have them all mixed together in one pill or topical cream at the compounding pharmacy. That's pretty convenient. For me as a prescriber, I don't have to be limited by the dosages that are made by a pharmaceutical company. What if i want 150 mg of progesterone? I can compound it. Tailor made medicines customized to each patient I see - I think that is pretty cool. But not everyone needs it. Some people do just fine on patches, or estradiol vaginal cream that is available at any pharmacy, so there are multiple ways to get women bio-identical hormones. With the rising cost of medication co pays these days, even if you have to pay cash for bio-identical hormones at a compounding pharmacy, the cost is similar to a co pay. Also, not every compounding pharmacy bills insurance companies, some are cash only. And not every compounding pharmacy will combine more than one medication per cream, so there may be three separate costs if you are on three different hormones, it just depends where you take your prescription.
If you find a doctor that doesn't "believe" in bio-identical hormones, I think he just doesn't believe in the movement. Obviously, that doctor, and many others that say they don't prescribe bio-identical hormones, know they exist. They probably have prescribed them everyday if they prescribe patches or vaginal estradiol. I think what they are saying is they don't believe they are any better, or safer than synthetics. And they definitely don't like Oprah educating their patients. And honestly, I was one of them 7 years ago. But, I really opened my mind to learning what it all meant, and it really isn't crazy, jungle medicine. It's just learning hormones from the textbooks and not from the drug reps; It's getting back to basics.
I can't have a page on bio-identical hormones without talking about over the counter progesterone cream. It is a subject that has baffled me so much that I contacted the FDA myself to try to understand it. Progesterone is a prescription drug, but there are probably hundreds of brands of progesterone cream over the counter. Well, I asked the FDA why, if progesterone requires a prescription, is it available over the counter. To tell you what the FDA told me, "We are the FDA, we can do what we want". They have allowed 20 mg of progesterone cream per pump to be available over the counter. Not sure why, but they did. So, yes, most brands of progesterone cream available over the counter are probably very similar to what I prescribe at the compounding pharmacy. If I write for a dosage higher than 40mg per day, it is probably more cost effective to pick it up at the compounding pharmacy. You will be buying several bottles at the health food store for one month if your dosage is higher than 40mg per day.
I think the best thing about the bio-identical hormone movement is we are having a conversation with each patient about what is right for them in the treatment of hormone imbalances. When I graduated from NP school in 1997, everyone im menopause received hormones (usually Premarin®) for life without any discussion. I like that women are researching hormones, discussing their symptoms, learning all the options, and making informed decisions. I always joke with my patients that for someone like myself that somewhat specializes in hormone imbalances, I probably prescribe less hormones than some of my colleagues who use only synthetics. For sure I prescribe less estrogen, since I test estrogen, and only offer estrogen if someone is estrogen deficient. I think it goes back to testing thoroughly for many different deficiencies - vitamin, thyroid, female hormones...and treating them all simultaneously.