The Truth About Bioidentical Hormones

By J. Ron Eaker, M.D.

In 2008, I surveyed vast information regarding the uses, types, benefits and risks of hormone replacement therapy and wrote, A Woman’s Guide to Hormone Health. To this day, the hormone replacement field reamins torn over the hormone controversy. Even with large studies available, it is often still difficult to find information that is coherent, consistent and believable. Information concerning hormone health remains scattered and confusing. Therefore, I want to take a moment and throw some light on the myths and misperceptions surrounding natural or bioidentical home preparations.

First, let’s start with some definitions. Bioidentical hormone therapy is often called “natural hormone therapy” because bioidenical hormones act in the body just like the homormes we poduce. Let’s begin by eliminating the term “natural” altogether because at best the word  “natural” means nothing and at worst, it means multiple things to multiple people. When I refer to bioidentical hormones, I am simply referring to hormone medications regardless of their source that are equivalent to the hormones produced by the ovaries. These hromones include estriol, estradiol, estrone, progesterone and testosterone. These bioidentical hormones are prescription medicines that treat the symptoms of menopause. Bioidentical estradiol and progesterone are commercially available and can be found in various forms such as creams, pills, gels and patches in virtually any pharmacy.  The other bioidentical hormones can be mixed and matched and placed in a variety of concoctions such as troches, creams, suppositories and capsules by a compounding pharmacy.  Some would say that the number one reason or the only reason for using hormones of any kind is to treat symptoms. The debate rages on as to the utility of hormones for certain conditions and it is vital for you to talk with your doctor about your specific situation.

Let me say from the outset, that I like the bioidentical estradiol and progesterone, as I feel from both my own experience and the literature that supports fewer side effects and better tolerability. However, there is nothing intrinsically evil about synthetic hormones so I feel it is valuable to explore and explode a few misperceptions surrounding bioidenticals.

Myth: Bioidentical hormones treat more than menopause.

Fact: Several compounding pharmacies make a substantial profit from selling bioidentical hormones and have propagated the idea that bioidenticals can do things they absolutely can’t.  For example, I have seen ads saying bioidentical hormone mixtures can help folks lose weight, prevent Alzheimer’s disease, reduce the risk of breast cancer and slow the aging process. These claims are blatantly false and have no substantiation in medical literature. In fact, some pharmacies have been shut down or fined by the FDA for making grossly inappropriate claims about the hormones they compound.

Myth: Compounded hormones are safer than other hormones.

Fact: The FDA does not regulate pharmacies that make compounding hormones so often their products are not tested for quality, purity and potency. As such, bioidentical preparations can vary substantially from batch to batch.  There hasn’t been any data  submitted to the FDA demonstrating that estriol, a commonly used bioidentical is safe and effective.  The FDA stated in 2008 that pharmacies should not compound products containing estriol unless the prescriber has submitted a valid investigational new drug application. Additionally, custom compounded hormones don’t inform patients of the black box warning carried on all FDA-approved hormone products and therefore individuals aren’t warned of the increased risks of myocardial infarction, stroke, invasive breast cancer, pulmonary embolism and deep vein thrombosis in postmenopausal women. The bottom line is that women should consider all the risks of bioidentical hormones and other hormones, even though all the risks are relatively small.

Myth: Salivary testing is better than blood testing to tell a woman “what exactly she needs.” 

Fact: This myth was popularized by that noted “medical expert,” Suzanne Somers in one of her gaggle of books. There is no scientific basis for using saliva testing to adjust hormone levels. Free serum hormone concentrations in a midlife woman’s body changes from day to day depending on diet, time of day, the specific hormone being tested and other variables. The dosing of compounded progesterone is particularly difficult to assess because the levels in serum, saliva and tissue are markedly different. It is not necessary to test hormone levels to treat symptoms. The take home message is be a wise consumer, do your homework and talk with your doctor to meet your unique needs.