BHRT Hormone Replacement Therapy Compounding

Hormone Replacement Therapy

Natural vs. Synthetic

Bio-identical hormones are “plant derived hormones” from precursors found in wild yam or soybean. They are modified in a laboratory to be identical to the hormones produced by the human body. They possess the same exact chemical structure as hormones produced by our body.

Synthetic hormones are “artificial” not found in nature. Chemically altered from human hormone and not identical in structure or activity to natural human hormones.

Establish your natural hormone levels by getting a baseline test in your late thirties or early perimenopause.

The manner of replacing the lost hormones varies according to the choices made by the patient and their physician. One choice is using the various synthetic hormones available. The alternative choice is to use “bio-identical” hormones. Should a person take a hormone that is identical to the one that the body produced throughout younger life; thereby being natural to the body, or take one that the body does not recognize as natural, but instead a foreign substance. Because it is foreign, it may possess many side effects or even unknown side effects.

BHRT also helps pinpoint a person’s exact hormone levels to determine what hormones are needed to balance their hormone deficiency. The differences between synthetic and biologically identical hormones are in their chemical structures and functionality. Biologically identical hormones have the same chemical structure as the hormones created naturally in the human body.

Why Hormone Replacement?

With natural aging comes the natural diminishment of our own body’s production of hormones. As the result, all of the general health we took for granted starts to diminish as well. Causing symptoms such as hot flashes, forgetfulness, anxiety, sleep disruption, low libido, and on and on. Here falls the need for “replacement” hormones. Maintaining this balance is the goal of any type of hormone replacement therapy (HRT). The hormones a woman produces until she reaches menopause protect her heart and bones. Once she is no longer producing these hormones, she is at risk of developing heart disease and osteoporosis. The risks continue to worsen the longer she is without these essential hormones.

Jonathan Wright, MD, evaluated women’s options for estrogen replacement. As estrogen levels begin to decline with menopause and searching for safer estrogen options, Wright reviewed the breast cancer research done by Henry Lemon, MD, in the 1960s. Lemon had studied estriol, the weakest of the three main endogenous estrogens, and discovered that women with breast cancer had significantly lower urinary estriol numbers than healthy controls. Lemon’s research got Wright thinking that combining estriol with estradiol might be protective against cancer. He put this idea into practice and created BiEst (bi-estrogen) and TriEst (tri-estrogen).

Why is HRT Compounded?

HRT is available only from a compounding pharmacy, and only with a valid prescription from a doctor. Pharmacy compounding is the art and science of preparing customized medications for patients.  Its practice dates back to the origins of pharmacy. The goal of a compounding pharmacy is the Triad, formed by doctor, pharmacist, and patient.  By working amongst all three, the compounding pharmacy can tailor-make the prescription to fit each individual patient.  The dosage strength and dosage form can be customized to a patients specific needs.  HRT can be compounded in capsules, topical and vaginal creams, gels, oral liquids, lozenges, vaginal and rectal suppositories, solutions, tablet triturates, rapid dissolve tablet, troches, mini troches, and other dosage forms.  Testosterone can be added if deemed necessary by the doctor and patient for libido problems. Conventional HRT has few standard dosage forms. hormone replacement is not available commercially.

What Are the Benefits with Natural HRT?

  • Identical in structure to hormones the human body produces
  • Provide protective benefits that were originally provided by the body’s naturally occurring hormones
  • Far fewer unwanted effects than synthetic hormones
  • Improved libido
  • Helps in the prevention of osteoporosis and restoration of bone strength
  • Protection against hear disease and stroke
  • Reduced hot flashes and reduced vaginal dryness
  • Muscle mass and strength are better maintained
  • Improvement in cholesterol levels
  • Risk of depression is reduced
  • Reduced risk of breast and endometrial cancer
  • Prevention of senility and Alzheimer’s Disease
  • Improved sleep
  • Mood, concentration, and memory become better
  • Over all quality of life is restored/improved
  • Side effects are usually dose related and correct when the proper dose is dispensed
  • Dosage is adjustable and individualized for the patient’s needs and goals
  • Multiple hormones can be combined in one dosage form
  • Several dosage forms available; capsules. topical and vaginal creams, gels, oral liquids, lozenges, troches, and more
  • Can bypass the digestive tract and liver with non-oral dosage forms

How Do You Get HRT?

  • Get HRT information and fill out medical history form
  • Discuss HRT prescription to B & B Pharmacy (call for a pharmacist consult 562.866.8363) or fax prescription and medical history form to B & B Pharmacy at 562.925.6208
  • Get recommendation from compounding pharmacist and coordinate with prescribing physician

One the patient and the physician have determined that the patient is a candidate for HRT our compounding pharmacists’ work directly with the patient and the physician to tailor a hormone regimen to “fit” the patient with the appropriate dosage strengths and dosage form. (Generally the physician is a general practitioner, gynecologist, or endocrinologist. If you do not have a physician, or yours is not familiar with HRT, you can contact a compounding pharmacist for further information) Our compounding pharmacist will have a consultation with the patient using the baseline hormone levels (if available), in some cases a saliva test, along with patient medical history, and patient goals. With that, they will derive the compound that seems appropriate for the patient and send a consultation report to the doctor with recommendations. After the doctor approves or makes changes to the recommendation, the patient starts a three week course and is reviewed by the pharmacist again before continuing therapy. Any adjustments in therapy or consultations are reported to the doctor for review/approval. It usually doesn’t take more than 2-3 months to find the appropriate hormone regimen. The doctor continues to follow the patient at their discretion. The pharmacist follows the hormone regimen regularly, with refills, and communicates any modifications with the physician.

The Human Hormones

There are four groups of hormones that are of major concern:

  1. Estrogens
  2. Progesterone
  3. Testosterone
  4. Dihydroepiandrosterone (DHEA)

The Estrogens include estrone (E1), estradiol (E2), and estriol (E3). Together they are referred to as Tri-Est. In some cases E2 and E3 are combined and referred to as Bi-Est. The plant source of these chemicals is the soybean.  These estrogens are prescribed for replacement therapy due to menopause, ovarian failure or for women who have had a hysterectomy with removal of their ovaries. There are benefits to prescribing the bio-identical hormone replacement of estrogen. When prescribed for menopause, estrogen can alleviate, in most cases hot flashes, vaginal and urinary tract dryness, sleeplessness and mood swings. There are also cardiovascular benefits to replacement therapy. Lastly, hormone replacement therapy can help osteoporosis if treatment is begun early enough.

BiEst and TriEst can be compounded into capsules, creams, gels, and troche (lozenge) forms—BiEst usually in an 80:20 estriol-to-estradiol ratio and TriEst in an 80:10:10 estriol-to-estradiol-to-estrone ratio. The use of BiEst and TriEst is common in complementary medicine, and in some circles it has become the de facto definition of bioidentical hormone replacement (BHRT).

(Dosing guidelines: Triest 0.3mg-3mg QD-BID)

Progesterone is derived from the Mexican yam or the soybean. Progesterone can be prescribed for infertility, luteal phase defect, PMS or in combination with estrogens for menopause. Progesterone comes primarily from the ovaries both before and after menopause, but it is also produced in both the brain and peripheral nerves. It prepares and maintains the uterus for pregnancy, by stimulating the uterine lining to thicken with rich, well vascularized tissue to support an embryo. Progesterone also affects the brain by producing a sense of calmness, and its sedating, anti-anxiety effect helps promote rejuvenating sleep.

(Dosing guidelines: Progesterone 25mg-800mg QD in divided doses QD-QID)

Testosterone is a hormone produced by both men and women. It promotes muscle growth, increases energies, elevates mood, strengths bones, helps relieve menopausal symptoms, increases sensitivity to sexual pleasure in nipples and genitals, and enhances sex drive. In women, testosterone is produced in the ovaries, adrenal glands, and to a lesser extent in the skin, brain, and liver. Adequate levels of testosterone can help to prevent heart disease, stroke, vascular disorders such as diabetic blindness, and Osteoporosis.

(Dosing guidelines: Testosterone 0.25mg-5mg for women daily, divided doses. Testosterone 2mg-100mg for men daily, divided doses)

DHEA (dehydroepiandrosterone) is produced in greater abundance by the adrenal glands than any other hormone. It is also produced to a lesser extent by the ovaries, testes, and brain. The body uses DHEA as a buffer hormone or as a storehouse from which the body can produce other hormones such as estrogens or testosterone when needed (DHEA is often referred to as the “mother hormone”). DHEA research has indicated that this hormone may have important therapeutic benefits is such areas as cardiovascular disease, autoimmune diseases, cancer, chronic fatigues, fibromyalgia, and may have anti-aging properties.

(Dosing guidelines: DHEA 2mg-100mg QD)

HRT and Health Risks

Cancer

There is a good reason to believe that the long term use of bio-identical low dose estrogen, balanced with bio-identical progesterone, would result in a very limited increase risk of breast cancer. Preliminary studies have shown that women who excrete the highest levels of estriol in their urine appear to have a lower risk of breast cancer. Progesterone plays many important roles in prevention of breast cancer. Bio-identical progesterone has been shown to reduce estrogen-receptor production on breast cells to decrease the production of estrogen within the first week or so of bio-identical progesterone use, since it initially increases estrogen receptors in the breasts. However, this effect is short-lived and goes away after several days. Dr. John Lee, a pioneer in bio-identical hormone research believes that bio-identical progesterone can benefit many women, especially if used during perimenopause, and will likely be found to decrease the risk for breast and other estrogen-responsive cancers that may well get their start during this time of life.

Cardiovascular Disease

There is a good reason to believe that the long term use of bio-identical low dose estrogen, balanced with bio-identical progesterone, would result in a very limited increase risk of breast cancer. Preliminary studies have shown that women who excrete the highest levels of estriol in their urine appear to have a lower risk of breast cancer. Progesterone plays many important roles in prevention of breast cancer. Bio-identical progesterone has been shown to reduce estrogen-receptor production on breast cells to decrease the production of estrogen within the first week or so of bio-identical progesterone use, since it initially increases estrogen receptors in the breasts. However, this effect is short-lived and goes away after several days. Dr. John Lee, a pioneer in bio-identical hormone research believes that bio-identical progesterone can benefit many women, especially if used during perimenopause, and will likely be found to decrease the risk for breast and other estrogen-responsive cancers that may well get their start during this time of life.

Osteoporosis

The gradual loss of bone slightly increases during menopause, and then reverts back a year or so thereafter. A woman who enters menopause prematurely, for any reason, is at increased risk for osteoporosis unless she gets adequate hormone replacement during the years when her body would normally have been producing higher levels of hormones. HRT with estriol is effective against degenerative osteoporosis. Epidemiological and clinical data indicate that progesterone is active in bone metabolism. Progesterone appears to act directly on bone by engaging an osteoblast receptor or indirectly through competition for a glucocorticoid osteoblast receptor. Progesterone seems to promote bone formation and/or increase bone turnover. It is possible through estrogen stimulated increased progesterone binding to the osteoblast receptor, that progesterone plays a role in the coupling of bone resorption with bone formation.

Saliva Testing for Hormones

Why test saliva? In the past 20-30 years a number of research studies have validated saliva as a diagnostic medium to measure the unbound, biologically-active fraction of steroid hormones in the bloodstream. Saliva is a natural ultra-filtrate of blood, and steroids not bound by carrier proteins in the blood freely diffuse into saliva. The majority (90-99%) of steroid hormones in the blood are bound tightly to carrier proteins (cortisol-binding globulin, sex-hormone binding globulin, albumin) rendering them unavailable to target tissues. Steroids are very small lipophillic (fat-loving) molecules that, when released from the binding proteins and red blood cells in the blood, freely diffuse into tissues, which include the salivary gland and saliva. The steroid hormones most extensively studied in saliva are: Estrogens (Estradiol, Estrone, and Estriol), Progesterone, androgens (DHEA-s, Testosterone) and Cortisol for assessment of adrenal function. Saliva testing is used to guide the compounding of the patients initial dose of HRT. It identifies the hidden hormonal imbalances (deficiency or excess) associated with patient symptoms of menopause and andropause as well as reproductive disorders, chronic illness and diseases of aging. B & B Pharmacy offers this simple test to patients who want to retake control of their lives with HRT.

Advantages of saliva vs. serum testing:

  • Saliva measures the free, “bioavailable” fraction of steroid hormones that have moved out of the bloodstream (blood and urine measure total levels) and into the tissue. This is known as bioavailability.
  • Saliva is the most reliable measurement of tissue uptake with topical hormone supplementation
  • Painless, noninvasive and needle-fee (stress of conventional blood draw can alter test results)
  • Private (home collection) convenient for both patient and doctor allows for optimal collection time
  • Hormones are stable in saliva at room temperature for weeks allowing for worldwide shipping
  • Transport of saliva samples to laboratory requires no special handling
  • Less expensive than convention blood testing