New Service Alert! We now offer hormone replacement therapy to optimize your wellness as we age using Biote Hormone Pellet therapy!
What is BHRT (Bioidentical Hormone Replacement Therapy)
Unless you are living under a rock, I suspect you have heard of “bioidentical” hormones—particularly if you are in the peri-or post-menopausal decades (believe it or not, that can start in your 40’s, and continue through your 7th decade!) But just what is the difference between traditional prescribed, FDA approved hormone replacement therapies and “bioidentical” and why might it matter?
What Exactly is a Bioidentical Hormone?
The term “bioidentical” means that a substance is chemically and structurally identical to the material the body naturally produces. Bioidentical hormone therapy used to treat female menopausal symptoms typically contains estradiol but can also include testosterone (yes, it’s well documented that your ovaries make far more testosterone than estrogen!). Unfortunately, despite this scientific awareness there are no FDA products available for female testosterone replacement in women.
Some prescribed FDA approved estrogen conjugates include estradiol and some utilize other variations of that base product (where they come from is a whole other lecture)!
Now don’t get me wrong. I do understand why we have an FDA approval process here in the US. It was originally designed to provide safety and efficacy of new products, and to provide purity guidance in manufacturing. BUT: The pharmaceutical industry cannot patent a structurally identical structure without adding something to it so almost all have some other binder. A single strain bioidentical product has no dollar value to them, and as thus, is neither studied or offered in its simplicity on the mass market. In addition, there can be up to a 30 margin of error in potency of any prescribed medication from batch to batch that is deemed “acceptable” by FDA standards? Seems like a fairly significant variance between recipes don’t you think?
But let’s be fair: the counter argument is that compounded drugs (such as bioidenticals) can also have a margin of error. Originally independent compounding pharmacies did not all monitor for variance—but the process is much more defined and reputable compounders are monitoring, testing, and more aware of variance now. While we discuss the bioidentical hormone arena it’s a good place to tell you that one reason I elected to partner with Biote as my source is that each batch (lot number) of pellets is piston pressed and tested for potency. The deviation standard is 3-10%--which is quite impressive, and nearly guarantees you’re getting an equal dose with EVERY VISIT!
I think it’s also important to keep in mind that compounding pharmacies are expected to comply with USP Standards for the preparation of these hormone therapies. Biote independently tests each lot of products for strength variability. And while compounded pharmacies may not be required to collect information on adverse events, Biote does gather information and has a robust community page in which certified practitioners can collaborate with one another on specific situations for best patient outcomes.
Compounded bioidentical hormone therapies are prepared by a compounding pharmacy according to a provider’s specifications with each person’s combination being unique to them. Using Biote pellets I’ll have the ability to do that as well. Your customized dose would be just what you need of each individual hormone (Estradiol and testosterone specifically). And since lot variance is so much lower, we should get much greater consistency. To date, there have been no well known randomized, controlled trials comparing compounded bioidentical hormone therapy with placebo or FDA-approved hormone therapies for menopausal symptoms. But we are gathering data every year and the future, your future, should be hopeful!
Is Bioidentical Hormone Therapy Safer or More Effective?
While some take home a message that bioidentical hormones are safer and more effective than synthetic hormones, we just don’t know. Why? Well, no pharmaceutical company is going to spend millions of dollars in a head-to-head trial for many reasons. But there is certainly data to support why it may be a good idea to optimize your levels for the very best life.
There is a tendency to think of bioidentical hormones as “all-natural”, they, like the hormones used in traditional hormone therapies, are manufactured in the laboratory (though they come from sweet potatoes and yams). Bioidentical hormone therapy may carry the same risks as traditional replacement therapy however when you go through the data, it certainly appears the benefit exceeds the challenges. The large studies that we have in the US which identified potential increased risk of blood clots, stroke, endometrial cancer and breast cancer (such as the Women’s Health Initiative and the Million Women Study) were in studies stopped early, with conclusive data that was poorly extrapolated, and later recanted. Those studies were also recanted (by one of the lead investigators no less!) as being so flawed in their design that conclusions should not be drawn from the original data. So where does that leave us? Well, it leaves us with medical providers who may or may not consider short term replacement therapy for their patients, but few who understand the long-term positive benefits found in many published studies (protective in heart disease, diabetes, Alzheimer’s disease, breast cancer and osteoporosis, just to name a few).
How are they delivered?
The method I will implore includes delivery of either estradiol and or testosterone via pellet (a small incision is placed in your precious derriere where it is slowly absorbed over time and re”filled” in 3-6 months (roughly a 15 minute procedure with lab results done about once a year once we have you dialed in). That means you don’t have to worry about daily pills, creams or shots, or application of patches. It eliminates the highs and lows of product delivery to your blood stream, and your body gets a more “normal” delivery of the good stuff. It does require time outside of the bath/hot tub/sauna/soaking or buttock exercise for a few days (3 days women/ 7 days men)—but you can get pelleted and go right back to work. No real down time.
If you know me, you know I’m conservative in my practice—but my goal is to optimize your hormones, including thyroid, if need be, as well as impart a healthy dose of education on how you can help yourself with only the most appropriate supplements as well as lifestyle changes to maximize the pleasure you have in day-to-day living for as many days as we have left.
Stay tuned to learn more about why you might consider BHRT for yourself and your partner, or why you may not be a candidate.