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BHRT Mini-Review Series from Dr. Rouzier

BHRT Mini-Review Series from Dr. Rouzier: Misconception and Concerns About Bioidentical Hormones

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As the popularity of bioidentical hormones continues to spread, more men and women are finding that balancing hormones improves vitality, health and well-being. But what does the research demonstrate? We’ve hand-selected nine articles with summaries and responses from Dr. Neal Rouzier’s library. The article reviewed in this post comes from the March 2012 issue of The Journal of Clinical Endocrinology and Metabolism.

Misconception and concerns about bioidentical hormones used for custom-compounded hormone therapy

(Bhavnani BR, Stancyzk FZ. J Clin Endocrinol Metab. 2012 Mar;97(3):756-759)

Article Summary: As a review of BHRT dosage, forms, and claims are outlined in this article, the authors explain there is concern that the unregulated BHRT may be overdosed, treated with ineffective products, or contain unknown risks. The authors’ objective was to explain how BHRT may not be identical to hormones naturally produced in the body and that the lack of regulation could cause adverse effects in postmenopausal women.

Neal Rouzier, MDNEAL ROUZIER, M.D.

Neal’s Response: I absolutely agree with the conclusions of these authors and that is the main criticism of the bioidentical industry. The main risk that I perceive of compounded BHRT is failure to achieve therapeutic levels of HRT to guarantee therapeutic endpoints. Symptoms may improve for patients on BHRT; however, the doses used and the levels achieved may not provide cardiovascular, musculoskeletal, breast or uterine protection, which defeats the purpose of HRT replacement.

Most patients that come to me from other BHRT practitioners are taking subtherapeutic amounts. Their prescriptions provide very low serum levels of HRT that will not be protective at all, and that pertains to hormones E2, P4, testosterone, DHEA and thyroid. (The author’s comments about overdosing and unknown risks are over-hyped, as I haven’t seen any overdoses of estriol in the ER lately. If saliva testing shows overdose, it does not correlate with an overdose when testing serum levels, which are more meaningful for hormone therapy.)

My main criticism of the bioidentical industry is the lack of emphasis to maintaining scientific standards that have demonstrated scientific efficacy of HRT as carried out in the studies. When I prescribe compounded BHRT, I copy and maintain the same standards and levels as seen in the scientific literature that utilizes pharmaceutical BHRT, something that this author probably does not understand. I also have experienced many patients that come to me on conventional bioidentical therapy that do not have efficacious or therapeutic levels of conventional bioidentical hormones, and that does not provide much health benefit either.

What’s Your Take?
Tell us what you think of this research on bioidentical hormone therapy. Remember to check back regularly for more of these reviews from Neal’s library, and feel free to share additional articles or links to studies on bioidentical hormones.

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