Bioidentical hormone replacement: our expert answers your questions

1. What is BHRT?

BHRT stands for bioidentical hormone replacement therapy (also known as natural hormone replacement). The hormones are derived from yams and/or soy. Once they are extracted from their natural source, the hormones are refined so that they're identical to the human hormone molecule. BHRT fits the body's receptor like a key in a lock. Additionally, our bodies contain the right enzymes to break down and metabolize the hormones properly and efficiently. The idea of BHRT is to maintain proper hormone balance. Although 75 percent of our customers use BHRT for menopausal symptoms, we also compound hormones to help teens with acne, women with PMS and couples struggling with infertility.

2. What is the difference between BHRT and synthetic HRT?

HRT stands for hormone replacement therapy. It differs from BHRT in the type of hormone(s) used. Any type of hormone may be prescribed in HRT. Most commonly, doctors use hormones extracted from the urine of pregnant horses or hormones assembled in a laboratory. Neither is identical to the human hormone molecule. Improper ratios and different chemical structures account for treatment failures and a multitude of side effects.

3. What is the difference between over-the-counter (OTC) herbal products and BHRT?

OTC products are plant estrogens. They're not identical to the human hormone molecule. These products (soy, black cohosh, dong quai, red clover, etc.) are aimed at symptom control for the perimenopausal patient.

4. Will I gain weight once I start taking bioidentical hormones?

Women going through menopause gain an average of 10 pounds. Women on synthetic hormones typically gain 20 or more pounds. Women on BHRT typically gain less than 10 pounds.

5. Will I get my period again once I begin BHRT?

Once a woman has gone for 12 or more months without a period, generally her period will not return.

With perimenopausal patients, we cycle their medication, which helps periods fluctuating anywhere from every 2 weeks to 4 months become more regular. The periods will get lighter and eventually taper off as the patient gets older. Our pharmacy's Cycle Pak therapy, for example, allows a woman's period to stop on its own, without forcing or suppressing the cycle. This allows patients to age naturally while optimizing their health potential.

6. Will BHRT help my sex drive?

Many factors affect the sex drive during the aging process. Keeping the hormones (estrogen, progesterone and testosterone) in balance and at optimal levels plays an important role in maintaining a healthy sex drive.

Natural testosterone replacement therapy works well for both women and men. The most common form is a topical cream. At our pharmacy, we also make certain that our patients' adrenal and thyroid glands are functioning properly. Many symptoms of low adrenal and/or low thyroid function are similar to those of low testosterone, so it's important to ascertain the true cause of the problem.

7. How soon should I be able to tell a difference after I begin BHRT?

Although we have many patients who call after only 1-2 weeks and say, "I haven't felt this good in 10 years," we stress that it takes time to adjust hormone levels. During the first 30 days, the levels start to build, and we see mild alleviation of symptoms.

During the next 30 days, the hormones really start to kick in, and we see quite a difference. By 90 days, we have a good idea of where a patient's hormone levels and symptoms are. Then, we typically have a follow-up consultation, and we reevaluate lab results and patient symptoms.

8. Can I get BHRT anywhere?

No. Bioidentical hormone replacement therapy has to be compounded. Although all pharmacies may compound, not all of them do.

9. Do I need a prescription?

Yes, a prescription is needed for us to compound BHRT for a patient.

10. Will my insurance cover the prescription?

Most insurance companies do pay for BHRT.

11. What is compounding?

The definition of compounding is "the mixing of two or more ingredients to form a final product." When we compound prescriptions, we mix ingredients specific to each patient's needs. With regard to BHRT, the final product might be capsules, troches, creams, gels, sublingual drops, injections, tablet triturates, lollipops, suppositories or oral suspensions.

12. Do I need to have lab tests? Which ones?

Yes, we recommend having either a blood test or a saliva test. Women need to get results for total estrogen, progesterone, testosterone, sex hormone binding globulin and DHEA-S. Men need total testosterone, estradiol, PSA, DHEAS and prolactin. We recommend follow-up lab tests during the third month of therapy and then a follow-up consultation. At this point, if necessary, we may recommend a thyroid panel (Free T3, Free T4, Total T4, TSH and reverse T3) to evaluate thyroid function. You may need a saliva cortisol test to evaluate the adrenal glands. Lab tests help monitor therapy progress and response. It's not just individual hormone levels, but the balance of all the hormones and glands that helps us achieve optimal health and aging for patients.