I am frequently asked questions about BHRT (Bioidentical hormone replacement therapy). Here are several of the most common questions and my answers. For more information about whether BHRT would be a good option for you, please call our office and schedule a consultation.
Q:Â What are bioidentical hormones?
A:Â Bioidentical hormones are hormones that are identical to those naturally made in your body. Examples are testosterone, estrogens, progesterone, thyroid hormones, DHEA, human growth hormone, even insulin.
Q:Â Why should I consider using bioidentical hormones?
A:Â As we age, or due to medical conditions such as menopause or having a hysterectomy or thyroid disease, or just normal ageing, our bodies may no longer produce these vital hormones or may not make enough. By supplementing them, we can restore the hormone levels to those of a normal healthy person, improving the way we feel and improving how our body functions.
Q:Â What are the benefits of bioidentical hormones?
A:Â Replacement of natural thyroid hormones relieves the symptoms of hypothyroidism; Replacement of estrogen, progesterone, and testosterone in women relieves the symptoms of menopause such as hot flashes and night sweats, improves memory and focus, boosts libido, improves skin and hair quality, strengthens bone density and muscle tone, may help with weight loss, improves sleep, improves anxiety and depression. In men, replacement of testosterone boosts energy and mood, improves libido and erections, builds muscle, improves mental focus, improves bone density, and may help with weight loss. Raising the levels of growth hormone can improve deep sleep quality, improve energy and strength, improve healing from injuries, improve immune function, strengthen bone, muscles, joints, assist with weight loss, improve libido, improve skin and hair quality.
Q:Â How do we restore hormone levels?
A:Â Hormones are available from conventional pharmacies as well as from special compounding pharmacies. Your doctor can write a prescription for them and, depending on which hormone, they are supplied as pills, creams that are rubbed into the skin, as patches that stick to the skin, as injections, or as pellets implanted under the skin.
Q:Â Are hormones safe?
A:Â Hormones are necessary for health. If the levels decline, our bodies begin to fail in many different ways. As long as hormones are prescribed at the correct dosages, they are safe. As with any medication, taking too much or too little will not produce optimal results.
Q:Â Do hormones cause cancer?
A: The answer is NO. Cancer is caused by many factors such as genetic mutation, radiation exposure, poor diet, smoking, chemical exposure, older age, and so on. Some cancers such as breast and prostate cancer may be hormone-sensitive, meaning that the cancer may grow faster when exposed to certain hormones such as estrogen(breast) or testosterone(prostate). However, the cancer itself is not caused by the hormone. We always screen women with mammograms and men with a blood test called PSA to check for any signs of breast or prostate cancer and we do not prescribe hormones which can promote cancer growth to patients with a history of cancer. Recent studies have shown that the risk of patients developing cancer is not increased when using bioidentical hormones. Certain synthetic hormones can increase the risk of certain cancers and should be avoided if possible.
Q: I recall hearing about a study that seemed to suggest adverse health risks from using hormone therapy. What is the truth about this?
A: In 2009 the Women’s Health Initiative researchers published a report on the health outcomes in a group of women treated with synthetic hormones called Premarin and Provera or just with Premarin. They found an increased rate of cardiovascular disease and a slightly increased risk of breast cancer in women who took these 2 drugs. It is important to understand that these 2 drugs are NOT bioidentical hormones. They are chemically altered hormones in the case of Provera and estrogens from a horse in the case of Premarin. Because they are not natural to the human body, they had adverse side effects on the women who used them. For this reason, we do not prescribe these synthetic hormone drugs to our patients.
Other studies (KEEPS Study, EPIC Study, and others) that looked at bioidentical hormone prescriptions such as natural estradiol and natural progesterone applied as creams or pellets or as a skin patch, do not show increased risks for cancer or cardiovascular diseases. In fact, they showed no difference in risk or even reduced risk compared to women who did not use any hormone replacement at all, indicating they are as safe as the placebo in these studies.
Q:Â Are there alternatives to bioidentical hormone replacement?
A:Â Yes, you could do nothing and let nature take its course. You will then experience the usual signs and symptoms of inadequate hormone levels and aging such as hair loss, skin aging, loss of bone density, loss of muscle and gain of fat, fatigue, loss of libido and erectile dysfunction, vaginal dryness, sagging breasts, osteoporosis, loss of cognitive function, aches and pains, poor mood, insomnia.
You could use conventional medications to treat some of the symptoms of hormone deficiency. Examples would be antidepressants for depression, drugs for osteoporosis, stimulants such as amphetamines for poor brain function, pain medicines for aches and pains, sleeping pills for insomnia, anxiety drugs, cholesterol reducing drugs. Of course, all synthetic drugs have side effects.
You can use synthetic hormones instead of bioidentical hormones. These are technically drugs and not natural hormones and they have side effects not found in bioidentical hormones such as increased risk of blood clots and stroke, increased risks of breast cancer, increased risk of heart attacks, risk of migraine headaches, weight gain, breast diseases.
Q:Â How do I get started with bioidentical hormone treatment?
A:Â Just as with any medical condition, you need to have a visit with a qualified doctor. Your doctor will take a thorough medical history and examine you, then order appropriate blood tests. You will then review the results of the tests with your doctor and decide together whether you have a deficiency of any hormones, discuss how they can be restored and start treatment in a way that works for you.
Q:Â If I start using bioidentical hormones do I have to continue?
A:Â No, you do not have to continue taking hormone therapy. From a health perspective, any benefits you may have experienced from hormone replacement will eventually fade away if you stop your treatment. Your body will return to the state it was in before you started hormone replacement.
Q:Â How soon will I notice benefits from my hormone therapy?
A:Â Everyone is different, but in general you should start to feel major improvements in your hormonal symptoms within a few days of starting your treatment. Over time, as we check blood levels and adjust your dose, you should eventually feel normal and like your old self again.
Q:Â How much does bioidentical hormone therapy cost?
A: The cost of bioidentical hormones is very reasonable. The cost depends on what type of therapy you are prescribed. For medicines obtained from a conventional pharmacy, the cost you pay is usually determined by your insurance. For those who choose not to use insurance, there are discount programs such as GoodRx which can help you buy your medicines at a discount. For some products such as compounded hormone creams, you will need to pay out of pocket. However, the cost of these medicines is generally around $50-$100 per month, depending on the type of cream. For injection therapy, such as testosterone (for men), your costs can be as low as $5 per weekly dose or even less, again depending on the pharmacy you use and your insurance coverage. Pellets are somewhat more expensive, but many patients often prefer the convenience of getting a hormone pellet every 4 months instead of daily medication. The cost of pellets depends on the number and type of hormone pellets used, so it will vary from patient to patient.
