There is a great deal of interest in the news and on the internet regarding bio-identical hormones for menopausal hormone replacement. Some purveyors tout their ability to cure everything from hang nails to cancer using bio-identical hormones. The truth is a little less dramatic, but these hormones do have a place in managing clinical problems that patients have suffered with for years.
Bio-identical hormones are naturally occurring hormones that exactly replicate the hormones your body makes. Hormones that can be synthesized include estrogen, progesterone, testosterone, and DHEA. These hormones are isolated from naturally occurring plant materials and compounded into forms such as capsules, creams or pellets that can be absorbed and used by your body just as natural hormones would be used.
As natural products, they are not subject to patents or regulation by the FDA, just like oxygen and glucose are not regulated by the FDA. While they have been extensively studied, they have not been promoted by any major drug company, or subjected to the rigorous analysis new drugs are subjected to. For this reason, most insurance companies do not cover treatment with bio-identical hormones.
While estrogen and progesterone are available as compounded bio-identical hormones, they are also available in prescription forms that are not only bio-identical, but also FDA approved and insurance covered. If you don’t experience side effects on the pharmacologic preparations, you don’t necessarily need compounded hormones. Some people claim that bio-identical hormones do not increase the risk of breast cancer, but that is not completely factual. Hormone responsive tumors are stimulated by any estrogen, even a bio-identical one.
The most common use for bio-identical hormones is testosterone replacement for women. The ovary naturally produces a small amount of testosterone during a woman’s reproductive life. After menopause, this testosterone production ceases, and most women don’t even notice it, since the amounts of testosterone produced are so small.
Some women however are markedly impaired by the loss of that normal amount of testosterone. They experience a loss of sex drive, loss of energy, generalized fatigue, reduced muscle tone, and weight gain. Blood work reveals either very low, or undetectable testosterone levels, and their symptoms are largely relieved by the use of small doses of testosterone.
Since there is no FDA approved pharmaceutical preparation of testosterone dosed properly for women, we have historically used bio-identical testosterone in small doses to treat women with testosterone deficiencies. These preparations include skin creams of various sorts that are compounded at low concentrations for women, injections of small doses of testosterone, and pellets of testosterone that are implanted under the skin under local anesthesia. The injections generally last a month and the pellets are absorbed over a period of 3-6 months while the creams are applied daily.
Dr. Holley offers bio-identical hormone pellets produced by a compounding pharmacy. The facility is compliant with all the laws and regulations regarding compounded drugs. They require a prescription for each individual patient, in compliance with the law, and dispense only to licensed physicians. We place the implants under sterile conditions and in moderate doses to minimize possible side effects. Some clinics charge thousands for these treatments. We are able to do them for between $200 and $300 depending on your needs.
We also offer monthly injections of estradiol and testosterone for patient who prefer that route. The injections are often covered by insurance where the pellets generally are not.
If your dose of testosterone is too high, it will cause oily skin, acne, hair loss on the scalp and excess hair on your face, and possible irritability and aggression. People have been known to have vivid and violent dreams and impulses when given high doses of testosterone. While our slow but cautious approach may lead to a long drawn out process of achieving the right dose for you, we feel it is wise to start low and go slow. We also monitor blood levels of hormone during your replacement to ensure absorption and distribution of the injection, cream or pellet you are using.
Expectations are important. If you are expecting bio-identical hormones to solve all your problems and make you feel like you are 19 again, you are destined for a disappointment. But if you are truly deficient in testosterone progesterone, DHEA, or estradiol, careful and judicious hormone replacement may improve your life and restore functions that are important to you.