Bioidentical Hormones

The term ‘hormone’ comes from the Greek and is interpreted as “to excite.’ With appropriate levels of natural hormones, the body is excited into action. Hormones not only help athletes run faster, they help the body repair faster, think faster, and perform using less energy. Life without hormones is less life, less action and a more rapid demise.

What we have learned these last 50 years is that the natural levels of hormone drop precipitously as we age. The drop in hormones from 40 to 50 is 30% and with the menopause, women experience an 90% drop in estrogens and a 75% drop in testosterone. And men are now losing 25-40% of their ‘manly’ hormones from 35 to 50. No wonder we see so much depression, insomnia, hot flashes, decrease sex drive, and disease. Our bodies are falling apart without our life-sustaining hormones.

Now major natural hormones include, not only estrogen, progesterone and testosterone but also thyroid, DHEA, growth hormone, cortisol and insulin. For the purpose of this discussion, we will focus on only the natural sex hormones: estradiol, progesterone and testosterone.

Although natural estradiol, testosterone and progesterone were synthesized in the laboratories before the second World War, there was no cheap source for these products. Wyeth found estrone in pregnant mare urine and patented Premarin (PREgnant MARe urINe) after the war. Because it was cheap, it became the estrogen of choice even though there were at least 31 other protein products in the preparation. And women appreciated the profound effects this synthetic estrogen had on their hot flashes, vaginal dryness, insomnia, and memory lapses.

But all estrogens will cause a thickening of the uterine lining and menstrual bleeding if not curtailed by a progesterone. The progesterones available in the 1950’s were expensive or too weak to stop the bleeding, so Wyeth turned to a synthetic progestin made as a derivative from petroleum. Provera became the companion to Premarin and they became PremPro. And Wyeth knew that Provera had been termed ‘carcinogenic’ by most other civilized nations so it was only marketed aggressively in the United States and Canada. There was a point in time in the 1970-1990 that 70 million prescriptions for Premarin or Prempro were filled. These synthetic estrogens were the third most prescribed medication in the US and Canada.

But, although studies had shown increase risk for heart disease in women who prematurely had their ovaries removed (Nurses’ study), Wyeth attempted to influence the older menopausal market with the Federally supported Women’s Health Initiative. This study, terrible in design, added Prempro to 70 year old women with disasterous results. Not only did the incidence of breast cancer and heart disease increase dramatically, but the drug company hid the truth that Premarin alone had only mild increases. Provera was increasing the risk of breast cancer in thin women by up to 26 fold, yet, Wyeth continued to market Prempro but in a lower dose.

At the same time that this debauchery of the WHI was being performed, a movement in the United States was forming. Many doctors and their women patients decided to avoid the Premarin, Provera synthetic compounds for natural estradiol and natural progesterone. Compounding pharmacists had mixed these natural occurring chemicals in topical creams that increased absorption. And because they were ‘natural’ they avoided some of the inherent problems of Premarin and Provera.

Now, as a gynecologist for 35 years, I find that some women just do better with vaginal Premarin or prescription Estrace (estradiol) vaginal cream. These are covered by insurance plans. But for those who want a topical estradiol (not a synthetic estrogen), I use either the prescription estradiol patch (Vivelle) or compounded estradiol creams. And I use Provera only for women with extremely difficult and heavy menstrual bleeding: otherwise, it is natural progesterone either as prescription Prometrium or 4-10% natural topical creams.

The challenge we face today is that Wyeth, having lost 75% of their income from their stupidity, wants to interfere with a doctor’s right to prescribe compounded estradiol., They have gone so far as to petition the FDA to stop compounding hormones. Interestingly, Solvay who makes Androgel did not get involved even though they sell their product for $230 per month while compounded testosterone costs less than $60 per month.

The benefit in using natural hormones, is that we as physicians can monitor how they affect the blood levels. As Suzanne Somers accurately stated: “There are four steps to getting appropriate medical treatment. (1) Recognize your symptom. (2) Measure the decrease from ‘normal’ in your blood stream. (3) Take the natural hormone and re-measure to see that a normal range has been met. (4) See if your original complaint has been resolved. If not, go back to the doctor and get another answer.

Hormones we measure routinely:

• Calciferol (vitamin D 0,25 OH)
  
• Prolactin
  
• Human Growth Hormone(as IGF-1)
  
• Thyroid Stimulating Hormone (TSH)
  
• Adreno-Cortico-Tropic stimulating Hormone (ACTH)
  
• Follicle Stimulating Hormone (FSH)
  
• Luteining Hormone (LH)
  
• Cortisol
  
• DHEA- dehydroepiandrosterone-sulfate
  
• Estradiol, total
  
• Testosterone, total
  
• Progesteronex

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