Jan 11
15
Just the other day, we overheard an earnest conversation between two perfectly normal looking individuals about how the lunar landing was a giant hoax. A hoax? Really? Our experience with people is decidedly different. If fifty people have to keep a secret, the chance of that being kept is about ten to the minus fifty. Heck, if two people have to keep a secret… Anyway, it seems much more plausible the lunar landing actually took place; and conspiracy theories aside, we are going with the consensus. The consensus, among all the rocket scientists at NASA and engineers at universities across the world, is that John Glenn stepped out of the lunar landing module July 20, 1969 and stepped onto the surface of the actual moon. And what does that have to do with bioidentical hormones? A lot, it would seem.
The first difficulty to overcome in understanding Menopausal Hormone Therapy (MHT) is the term itself: “bioidentical hormone”. Instinctively, the term implies that a bioidentical hormone works the same way as a native hormone; that it is biologically active; and more than mimics a hormone, it is exactly like it. The female sex hormones: estrogen, progesterone, and testosterone are synthesized primarily in the ovary. Their chemical structure has been well known for over five decades. A great deal of research has gone into characterizing the biology of the primary sex steroid of reproductive women, 17 beta-estradiol (E2). Estradiol can be taken orally or transdermally (applied to the skin or directly into the vagina). There is no dispute about the fact that estradiol safely and reliably relieves all of the bothersome symptoms of menopause (hot flashes, moodiness, insomnia, etc.), as well as, reduces the incidence of chronic illness that hastens death: cardiovascular disease, dementia, osteoporosis, and cancer. If it is taken orally, as a pill, it first passes through the liver and becomes modified to estrone (E1) or estriol (E3); therefore, the more active intended form, estradiol does not make it to the target tissues. If estradiol is taken through the skin, it bypasses the liver and goes directly to the targets as intended. If a symptomatic menopausal woman desires hormone therapy, it makes sense to utilize a treatment that preserves the natural hormone activity. 17 Beta-estradiol applied to the skin exerts an identical biological activity as naturally synthesized ovarian estrogen. If that was all that the term “bioidentical hormone” meant, there would be no dispute; but for most people, bioidentical means much more.
The majority of women link the term “bioidentical” with the terms “custom compounded” hormones that are sold at specialty compounding pharmacies. These products often contain a mixture of estrogens and progesterones; one of which is often 17 Beta-estradiol. The variation of the mixture in compounded hormones is based upon hormone testing of the saliva. These hormones are promoted as non-synthetic, more natural, and safer than regular prescription hormones. Here is where the experts’ consensus disagrees.
First of all, natural 17 Beta-estradiol is exclusively made within a woman’s ovary. It does not occur “naturally” anywhere else. 17 Beta-estradiol is not present within yams or soybeans. It is possible to make estradiol from precursor chemicals found within plant sources, and that is exactly what is done. “Making” estradiol means “synthesizing” it. Bioidentical hormone proponents term this making “bioengineering”, but it is, in truth, the same thing, synthetic. In other words, bioidentical hormones are synthesized. The other point of departure between Certified Menopause Practitioners and bioidentical proponents would be definition of terms. “Bioidentical” and “bioengineered” are simply made-up terms for the purpose of marketing that seem to imply added safety that is not really there. If a particular woman examines the plusses and minuses of menopausal hormone therapy and decides that FDA pharmaceutical-grade 17 Beta-estradiol transdermal therapy is not right for her because of too many risks, then bioidentical hormones are not a better or alternate choice because they have at least the same risks plus more.
Embedded in the bioidentical philosophy is testing hormone levels in saliva. It is proposed that saliva hormone levels should be monitored in order to obtain the right type and dose of hormone therapy. Nowhere in any medical or research textbook is there any suggestion that saliva estrogen levels are reflective of any known physiological importance. If saliva testing for hormones was important in any way, wouldn’t the Mayo Clinic have heard of it and offer saliva hormone tests to their patients? No? Is it too far north to have heard the news? How about Harvard and Mass. General Hospital? What about The University of Miami or Texas? Surely the progressive UCLA Medical Center would know how important saliva hormone testing would be for menopausal hormone therapy? Nope. None of them (or any other community hospital or university hospital) believes that saliva testing has anything to do with menopausal hormone therapy. Therefore, zero medical labs even offer saliva hormone testing. Is it a giant conspiracy just like all of those NASA scientists? Humm, I wonder? No, we’re going with the overwhelming consensus on this one too.
The bioidentical proponents frequently market their brand of hormones as “safer” and more “natural”. Everyone would instinctively agree that something more natural would probably be safer, if only that were the case. As mentioned above, there is only one “natural” source for human female 17 Beta-estradiol: a human female ovary. ALL the rest are synthesized to be duplicates of that 17 Beta-estradiol molecule. If all of the products, FDA approved and non-FDA approved estradiol, are synthetic; then by logic, they would ALL have equal claim to be “natural” and therefore equally “safe”. Let’s be frank, calling FDA approved 17 Beta-estradiol prescription products “synthetic” and therefore “unsafe” is unreasonable. The opposite view has more merit. Whenever custom compounded bioidentical hormones are tested by independent laboratories they fail in purity, consistency, and potency over 90% of the time; whereas, FDA approved pharmaceutical grade 17 Beta-estradiol fails less than 1%. Which one is safer? No question, FDA approved products are the hands-down preferred products for menopausal hormone therapy by virtually all of the Certified Menopause Practitioners.
Another point of difference between bioidentical proponents and the rest of the conventional hormone experts has to do with progesterone. Bioidentical philosophy includes a complicated theory concerning women who are “estrogen dominant”. In that theory, women, who have a myriad of symptoms ( headaches, breast tenderness, irregular periods, cancer, moodiness, poor immune system, low energy, insomnia, impaired memory, low endurance, and low sex drive), are suffering from estrogen dominance, which really means too low of progesterone. Again, conventional hormone experts and researchers have a hard time debating this concept with bioidentical proponents because the term “estrogen dominance” has no scientific meaning. How could a concept so fundamental to bioidentical hormone therapy have been missed by the roughly twenty thousand professional MDs and PhDs who do the scientific studies? We don’t think they did miss it; and furthermore, we don’t think they are covering it up in a conspiracy against the women of the world either; many of the experts are themselves women. Could anyone find a medical textbook, or an endocrinology textbook, or a reproductive textbook, or a basic physiology textbook that covers the subject of human female “estrogen dominance”? No. There are distinguished female reproductive endocrinologists all over the world who have never even heard the words “estrogen dominance”. One more time, we are going with the consensus. If estrogen dominance was a real thing then everyone would know about it, not just the few who write about it, and prescribe bioidentical custom compounded hormones. And, if you take away the estrogen dominance part of bioidentical custom compounded hormone theory, all of the progesterone components fall apart. There remains only one reason a woman would require progesterone for menopausal hormone therapy, and that would be to protect the uterus from unopposed estrogen. Whereas, transdermal estrogen therapy has advantages over oral estrogens; the same is not true of progesterone therapy. Transdermal progesterone has not yet been perfected as a topical product that gets reliably absorbed through the skin; therefore, oral progesterone is paired with transdermal estrogen for the majority of menopausal hormone therapy. The use of bioidentical transdermal progesterone may be unnecessary at best, or at worst, unsafe.
Well-informed bioidentical proponents choose to believe a separate set of “facts”; most of which come from unconventional sources. Buyer beware. Usually, there is a product attached to the information they dispense. We suppose, there are some bioidentical proponents who just like being the maverick, precisely vague, like those who believe the lunar landing was staged. Of course, neither of us was present on the moon to personally witness the landing, and we have not been present in the laboratories and clinics throughout the world where all of the estrogen hormone research has taken place. We believe it to be true by reason of scientific consensus and plausibility. We find conspiracy theories fascinating but ultimately unbelievable.
Bioidentical hormones are real hormones. They are synthesized from plant precursor compounds exactly the same way FDA prescription hormones are synthesized. If the bioidentical hormone mixture contains 17 Beta-estradiol it will relieve menopausal symptoms. However, they are not more natural and they are definitely not safer than FDA approved prescription hormones. Bioidentical hormones have at least the same risks as pharmaceutical grade hormones plus the added risks inherent in unknown consistency, mixture, purity, and dosage strength. Why take additional risks with bioidentical hormones, and why spend money on unnecessary saliva tests, when all of the major women’s health medical and scientific societies believe it is not advantageous.
