The pros and cons of bioidentical hormones: Some claim real health benefits, but doctors warn about health risks

David and Judy Wilkins pose for a portrait at their Kaysville home. The WIlkins have been taking...
KERA WILLIAMS/Standard-Examiner
Story by Katie M. Ellis
(Standard-Examiner correspondent)
Mon, Jul 9, 2012
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To be 20 again.

We hear it from those who miss the days of being thin and having energy and high spirits.

But you’re not going to hear it from those like Judy Wilkins of Kaysville, who feels like she is living her youth all over again after starting a natural hormone replacement regimen.

“My doctor did blood tests and said my hormones are at normal levels. They were for a 60-year-old, but I felt just as crappy as every other 60-year-old,” she said. “I needed to optimize my hormones. (After taking natural hormones), the aging process has slowed dramatically. My body thinks it’s 30 years old. Hormones changed my life.”

Proponents like Jennifer Garcia, a natural hormone specialist with Enlighten Hormones in Bountiful, say that, unlike synthetic hormones, natural hormones — also called bioidenticals — have the same chemical structure as hormones the body makes.

Bioidentical Hormone Replacement Therapy includes estrogen, testosterone and progesterone that come from plants, explains the website of another company, Preventative Medicine of Utah.

“Unlike synthetic hormones that are derived from animals or in test tubes and then modified by drug companies for patent protection and profit, BHRT is individualized, more natural and likely safer with fewer side effects,” according to the website.

But Dr. Timothy Graham, a medical doctor and assistant professor of medicine at the University of Utah, said bioidenticals can pose dangerous risks like heart problems, blood clots and stroke.

The treatment

Natural medical clinics, weight-loss clinics and traditional medical clinics offer bioidenticals.

Kim Boyer, a physician’s assistant for the Grand View location of the Ogden Clinic in Roy, said she offers natural hormones to help with symptoms of perimenopause and menopause in women.

Garcia and Aaron Butcher, physician’s assistant with Preventative Medicine of Utah in Clearfield, say natural hormones can also be used for those who have symptoms like fatigue, belly fat, loss of motivation, dry skin, brittle hair and nails, premenstrual syndrome, irritability, heavy menstrual bleeding or fluid retention.

Butcher said it is typical for those over 35 to need extra testosterone, estrogen, progesterone,

vitamin D, melatonin, thyroid and/or dehydroepiandrosterone.

“As you lose hormones, you age. To restore health, you must restore hormone levels,” he said.

Mainstream medicine looks for ranges, said Butcher, and doesn’t treat people within so-called normal ranges.

But, Garcia explains, “You may be normal but not at optimal levels. (For example,) when you are dieting and the thyroid is at its most optimal, it’s easier to lose weight because the hormone is functioning better.”

Those who administer bioidenticals say they tailor the therapy to the individual.

Said Butcher: “We differ from traditional medicine. Most medicine is based on sick care or disease management. We are restoring health and preventing disease. We basically take patients and treat them based on symptoms as individuals ...”

The benefits

Garcia said progesterone reduces the risk of breast cancer in menopausal women, and estrogen reduces bone loss and hot flashes.

Butcher adds that optimal hormone levels lead to a more enjoyable and longer life, and more muscle mass.

“People feel like themselves again. They start to lose weight. They have done everything with diet and exercise but still struggle. You fix that piece of the puzzle and things fall into place,” he said.

Thirty-nine year old Christian Kiser of Sunset said that is exactly what happened to her. She went to see Butcher after learning about him at Biofit Bootcamp in Clearfield.

“I knew something wasn’t right in my body. The doctors said I needed an antidepressant. I started believing the doctors and thought maybe it was just my body. Aaron was the first doctor to check my thyroid. It was completely off. I had been on Synthroid (thyroid medication) for years. (With natural hormones), my levels balanced.

“I can’t believe the difference. Naturally, my figure came back. I got my waistline back. I had thick legs. Now they are toned and defined. I have more energy and am more balanced and stable in my mood. I got off Synthroid, energy drinks and all other workout supplements,” she said.

Wilkins and her husband, David, both attest to the benefits of bioidenticals.

“My husband and I both retired last year and started with hormones,” she said. “He’s lost almost 70 pounds. When his hormones balanced, the weight fell off. I exercise and eat well, but my cholesterol was climbing. It was at 230. Now it’s dropped 100 points. Nothing changed except balancing my hormones. My energy levels came up.

“It’s definitely a missing piece of anyone’s health program. It instantly changed my brain chemistry. We’ve noticed that we are laughing, more playful. After retiring, we feel like we are kids playing hooky from work.”

The risks

Garcia said natural hormones may make you retain water or, in the case of testosterone, give you acne.

But Dr. Graham said the risks can be much worse:

“My position and that of most trained endocrinologists is that there is nothing special about bioidenticals compared to typically prescribed hormones. They can be dangerous and may not be needed. I’ve seen side effects that you would expect from an overdose of prescription hormones, including weight gain, hypertension, osteoporosis, Cushing’s Syndrome from unneeded glucocorticoid replacement, and heart problems like tachycardia and other cardiac arrhythmias from unneeded thyroid hormone replacement.

“Estrogen treatment can cause blood clots and life-threatening strokes, especially in smokers. The criteria used for bioidenticals are not based on medical fact. It’s a huge money-making endeavor for 95 percent of those who prescribe them and for the pharmacies that compound them. These hormones are frequently being used in a manner that is not FDA-approved.”

The hormones can be costly.

At Preventative Medicine of Utah, Butcher said, the office visit and lab work may be covered by insurance, but otherwise a patient can expect to pay around $160 for the office visit, $300 for lab work, and $20 to $50 a month for hormones.

Garcia said Enlighten Hormone patients make a $489 down payment and then pay $289 each month they choose to remain on hormones.

Grand View Clinic’s Boyer said all insurances have covered office visits and blood tests, but many will not cover prescriptions for bioidenticals.

Natural vs. synthetic

Dr. Mary Gallenberg, who answered a question about whether natural hormones are safer than synthetics on the Mayo Clinic’s website, concludes they are not.

“Bioidentical hormones are made from plant sources and once processed, are chemically identical to hormones made in the body. They have been promoted as safer and more effective than traditional hormone therapy. However, with no evidence that this is true, it should be assumed that bioidentical hormones have the same risks as conventional hormone therapy …

“Even though they come from plants, bioidentical hormones still need to be commercially processed to become bioidentical. Some FDA-approved products such as Estrace, Climara patch and Vivelle-Dot patch, which contain estrogens, and Prometrium, a natural progesterone, also are derived from plants.”

Graham agrees.

“A common selling point for bioidenticals is that they are somehow more natural. Ironically, there is nothing natural about these preparations. Most components are produced in the same industrial facilities as typically prescribed hormones,” he said.

Cautious use?

Boyer advocates being cautious with natural hormones, and using the lowest dose possible.

“Just because bioidentical hormones come from plants does not make them risk-free. I tell everyone that if we are going to appreciate the benefits of treatment, we need to respect the risks. Yearly mammograms and family risk factors all need to be considered when making choices,” she said.

She warns that high doses of thyroid hormone can cause bone loss, heart arrhythmias and increased anxiety. Too much testosterone can lead to aggressiveness and irritability, excess progesterone can cause sleepiness, and too much estrogen may cause breast tenderness or cysts or feed breast cancer.

She also recommends a compounded prescription and wouldn’t rely on it for weight loss.

“The flexibility of dosing options and using minimal amounts of estrogen makes compounded prescriptions preferable, in my opinion. Conjugated hormone options from pharmaceutical companies contain 10 more estrogens than women have in their body, which goes against the advice of less is best,” she said.

“I wish hormones worked for weight loss. Balancing estrogen with natural progesterone, however, does help with bloating and carbohydrate craving. We get better sleep and have more energy so we can exercise and keep excess sugar cravings under control.”

When prescribed in the right way, Boyer believes natural hormones can be useful in relieving the symptoms of menopause.

“For the past 10 years, I have found that treating the symptoms of perimenopause and menopause with bioidentical hormone balancing is a great option for women,” she said. “Irregular, heavy bleeding, insomnia and night sweats respond well to natural progesterone and women that have had a hysterectomy feel better with balancing their hormones, not just getting estrogen.

“Recent studies tell us that taking hormones for symptoms early in menopause is relatively safe, but dosages should remain as low as needed to resolve discomfort. It is also clear that absorbing the hormones through our skin is safer then taking pills.”

Graham warns that some symptoms treated with bioidentical hormones, like weight gain or fatigue, can also be signs of cancer, anemia, heart disease, diabetes or other serious conditions.

“Instead of bioidenticals, I recommend exercise, a healthy diet and seeing your physician for a full workup,” he said. “A board-certified specialist should assess individuals for real hormone deficiencies before putting them on potentially dangerous medications.”

 

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