Wednesday, March 29, 2017

Bioidentical Hormones

Two weeks ago I attended a seminar on hormones in the aging male and female. The use of ‘bioidentical hormones” came up repeatedly. There is a lot of misinformation about this therapy, especially on the internet. So I thought I would address some of the confusion.

‘Bioidentical hormones’ are derived from steroidal phytochemicals in plants. For example, chemical extracts from wild yam can be converted in a laboratory into progesterone. Although they are created in a lab, they are structurally identical to human hormones.

However, ‘bioidentical hormones’ can cause wide-spread side effects unless used appropriately and monitored correctly.

Synthetic hormones are very different from ‘bioidentical hormones’ as they are patentable compounds that mimic human hormones but are not structurally identical. Therefore the side effects are more pronounced, including the risk of cancer.

Bioidentical estrogen and progesterone are often added to skin care products. As long as they are less than 3% of the total product, they do not have to be listed as an ingredient. They both attract water to the skin to create soft, smooth and wrinkle-free skin.

Any exogenous hormone taken for more than a couple of months will cause down-regulation of the hormone receptors for that particular hormone causing a relative hormone deficiency, even in the presence of excess levels of hormone.

Serum hormone testing will not detect the presence of ‘bioidentical hormones’ as many of them are “free” or unbound in the blood stream. As a result, lab tests can appear normal or low resulting in the perceived need for an increased dose. The only way to fully evaluate hormonal status is saliva or dried urine testing.

Synthetic hormones are protein-bound and can only be evaluated through serum testing. So salivary and dried urine testing are both ineffective at measuring synthetic hormone levels as well.

Men and women who are taking ‘bioidentical hormones’ will actively share it through passive transfer. This occurs with skin-to-skin contact or direct deposit of skin oils on shared surfaces. Spouses, children, and pets have the greatest risk due to regular, frequent exposure.

So if a male is on bioidentical testosterone his wife will eventually have elevated testosterone levels. If a women is on bioidentical estrogen or progesterone, her husband will absorb those female hormones. The number of cases of cross contamination is dramatically increasing in my practice.

If all of this wasn’t confusing enough, patients often are given synthetic hormones under the guise that they are bioidentical. On several occasions I was initially baffled by a salivary hormone test until I realized that the HRT was synthetic rather than bioidentical.

The Bottom Line:
‘Bioidentical hormone” therapy can provide dramatic, short-term relief for aging patients. However, after 2-3 months, the down-regulation of the hormone receptors negates any benefits. Nutritional support of the HPA axis (hypothalamus-pituitary-adrenal) is required to restore hormone balance long term.

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