BioIdentical Hormone Replacement Therapy
Bioidentical Hormones (Biologically Identical Hormones)
Hormone replacement was a good idea when it started, but our knowledge base has advanced in the last 10 years, so that the way it used to be done is no longer the standard of care. Since the Women's Health Initiative stopped the Prem/Pro arm of its study several years ago, there has been confusion and fear amongst doctors and patients alike. To anti-aging doctors, the WHI study results were predictable anyway because of the results of the prior HERS study (Heart and Estrogen/Progestin Replacement Study) foreshadowed the results of the WHI. The basic problem, which it has taken several years for patients (first) and then doctors to begin to understand, is that synthetic steroid hormones are different from bioidentical hormones.
How could this have happened, and why does it take so long for the new (now 10 year old) information to get dispersed? When Robert A. Wilson, M.D. published Feminine Forever in 1966, it was a radical idea, that "estrogen" supplementation could keep women feminine and attractive, and was a predecessor of anti-aging hormone therapy theory; that is, if a good hormone goes down with age, then replace it to youthful levels. However the pharmaceutical companies got into the act and started the search for patentable molecules which were similar to hormone molecules found naturally in the body, but which were explicitly slightly different so that they could be patented. The assumption was that scientists and doctors were smart and had figured out "structure-function relationships" of the molecules: how the different parts of the structure of the molecule would affect bodily function. The effect was that doctors lumped all "estrogens" together, synthetic, natural and those from different species, calling them "estrogen"[note the singular tense]. Even now, doctors and even anti-aging doctors will talk about estrogen as if it were a chemical or molecule with specific, defined characteristics, when in fact it is a group of molecules with structural similarities but a variety of effects, some "estrogenic" and some other. Added to this, that mostly obstetrician-gynecologists used these drugs, estrogens and progestins, for effects on female reproductive organs, and birth control, resulted in a lack of appreciation of all the other organ systems which have estrogen and progesterone receptors and thus may be affected by the drugs they were prescribing.
If you look at the "steroid cascade," you will note the way steroids are metabolized from each other, and see how closely, for instance, estradiol is to testosterone (estradiol is a metabolite of testosterone requiring only one enzyme catalyst reaction to transform it). Then you will not be surprised that the effect of adding a methyl group (a carbon atom with 3 hydrogens) and an acetate group (like acetic acid) to bioidentical progesterone to make MPA (methyl progesterone acetate, brand name Provera) results in a similar but substantially different molecule. The HERS and WHI studies clearly showed these two molecules have different functions and side effects. So don't confuse synthetic or animal steroid hormones with biologically identical hormones!
Once a medical practice has become established and taught in medical school and is supported by pharmaceutical companies with their ability to fund large, impressive sounding if not biased studies, that practice doesn't change easily, as the practicing doctor usually doesn't have the time, knowledge or inclination to go against received medical tradition, even though most doctors practice in goodwill and concern for their patients. The changes now are due to anti-aging doctors understanding more about structure-function relationships of steroids, and the spread of this information amongst consumers and patients with the internet and publicists such as Suzanne Somers, in her books The Sexy Years and Ageless. It is also due to the availability of compounding pharmacies to place these non-patentable bioidentical hormones in creams and other preparations so they can be prescribed to patients. While pharmacies and apothecaries have compounded (mixed) substances for as long as there have been doctors, and before, you should be aware that one pharmaceutical company is trying to prevent compounding pharmacies from doing this anymore, by petitioning to the FDA in the name of safety! Would you be surprised to find out that this company is Wyeth, which produces Premarin (PREgnant MARes uRINe), Provera, and Prem/Pro? Why would they do this when their own studies showed that their products had safety problems? Could it be the 800 million dollars per year they have "lost" since their own WHI study backfired on them and doctors and women are not using their products any more? What is amazing is that they are still making 400 million dollars per year on these products. By the way, I have recently found out that the inhumane process of obtaining urine from Premarin mares occurs right here in Whatcom County, Washington.
So are bioidentical hormones safe? This varies, of course, on which hormone you are talking about. Some are more safe than others, and the safety depends on knowledgable use which is tuned to the individual's medical condition. But yes, these hormones can be used safely, and, more than this, antiaging doctors believe that in general most older people would experience less disease and better quality of life if they are appropriately replaced with bioidentical hormones. Dr. Pauli doesn't just replace hormones, but optimizes them, using blood levels and diet and nutraceuticals to bring about healthful levels of hormones and their metabolites.
I urge you to read about this and become knowledgable about the differences between bioidentical and synthetic steroid hormones, and to support compounding pharmacies' historical role of providing medicines, mixed or otherwise, as prescribed by physicians.
