Bioidentical Hormones & HRT
by JP Saleeby, MD
by JP Saleeby, MD
All the rage today is the use of bio-identical hormones. We are seeing bioidentical hormones use for the replacement of insulin, thyroid hormones, and gonadal (sex) hormones, and the trend continues to be natural. For our insulin dependent diabetics the last decade saw a transition away from using porcine based insulin derivatives to that of recombinant human forms. With thyroid disorders there are those doctors who would rather see their patients on a natural bio-identical thyroid replacement of bothT3 and T4 in the correct ratios, rather than the single synthetic-T4 drugs offered. And there are those physicians that would rather see their patients taking natural compounded sex hormones such as estrogen, progesterone and testosterone when the need arises rather than a synthetic blend offered by some pharmaceutical companies.
The big issues (that remain controversial with physicians on both camps) are efficacy, reported well designed double blinded studies, cost and side-effects. For me efficacy is a priori, by natural it goes without being said that what we replace in our bodies as the need arises should be of the same biochemical composition as what our own endocrine organs produce. Replacement with a synthetic in theory opens up a can of worms to all sorts of untoward effects both short term and long term (as yet unrecognized or unrealized). The paucity of controlled scientific studies for natural hormone therapy is due in part to the lack of financial support or underwriting of scientific trials on all things natural. But that fact is changing as more studies are being published and there is growing acceptance of research outside the USA. Cost is a factor as many natural and bioidentical therapies cost much less than the latest and greatest that the pharmaceutical industry has to offer. Side effects is the last contested point. If we take for a moment all the trouble realized with synthetic hormone therapy replacement for women in recent years with the use of horse estrogens and synthetic progestin compounds and the increase incidence of cancers, blood clotting disorders and gallbladder disease, it is no wonder many women choose the less insulting therapy found in bioidenticals . My philosophy is that the closer we get to replacing hormones with an almost exact replica of what our own bodies once produced is the ideal situation. Not only the biochemical components, but also the doses and timing (chronopharmacology) are important. Appropriate testing do discern the need for HRT is the first step. Once a deficiency is detected bioidentical hormone replacement (bHRT) is ultimately the best solution. You can read in greater detail the types of hormones that should be tested and what type of bHRT is offered on my medical blog site: www.DocSaleeby.blogspot.com.
For a limited time I will be offering free consultations for bHRT (a $300 value) to the first two new patients who qualify based on income and lack of health insurance status.