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Welcome to the Bio-Identical Hormone Society! We've organized to further promote the return to principles of Nature in human endocrinology. We know that human hormone therapy should exactly replicate human molecular configurations, quantities, routes of administration, and inter-relationships with other hormones as found in healthy, normally functioning humans.

If you're not a physician, you might wonder why we need a medical society to promote the obvious. After all, shouldn't the goal of any human therapy be to restore normal, natural human function as exactly as possible?

If you're a physician, you know the reason. For nearly a century, medical therapies have been dominated by the use of patent medicines. We're taught to use them from our days in medical school. Years later, when we're out in practice, using patent medications as first-step therapy is built in, and seems perfectly normal.

If you're not a physician, you may be surprised to know that medical schools don't teach therapies using molecules normally present in our bodies or in Nature as first-line therapies. You might think medical schools would teach the use of alien, patent molecules only when human or otherwise Natural molecules fail.

Or you may not be surprised at all. But you may be surprised to know that the situation in endocrinology hormone diagnosis and therapy actually isn't as bad as it is in many other areas of medical therapeutics. The large majority of diabetics are now using bio-identical human insulin. The most often prescribed form of thyroid hormone is levothyroxine, a molecule identical to one of the two major thyroid hormones. (It's entirely true that this therapy omits the other major thyroid hormone as well as minor ones, but still, it's progress.) A major prescription form of male hormone therapy uses bio-identical testosterone. Another bio-identical hormone therapy uses erythropoietin (EPO), a kidney hormone which promotes red blood cell production. Some physicians prescribe growth hormone (GH), yet another bio-identical hormone.

However, much progress still needs to be made in therapeutic replacement of adrenal steroid hormones. The most commonly prescribed replacements are Prednisone, prednisolone and triamcinolone, (instead of bio-identical cortisol) and Florinef (instead of bio-identical aldosterone). The third major grouping of adrenal steroids, the "adrenal androgens" (whose major metabolite is DHEA) have no patentable, synthetic replacements yet, so they're simply ignored in most endocrinologic practice.

Actually, "progress" in replacement of adrenal steroids may be the wrong term. What's really needed here is "back to the future", to the late 1930s, 1940s and early 1950s, when bio-identical cortisol and adrenal cortical extract (ACE) were the dominant and effective adrenal steroid therapies.

Featured Abstract and Article

Free access to this important article is provided below the abstract.

The effects of compounded bioidentical transdermal hormone therapy on hemostatic, inflammatory, immune factors; cardiovascular biomarkers; quality-of-life measures; and health outcomes in perimenopausal and postmenopausal women.

Stephenson K(1), Neuenschwander PF, Kurdowska AK.

Int J Pharm Compd. 2013 Jan-Feb;17(1):74-85.

Menopause impacts 25 million women world wide each year, and the World Health Organization estimates 1.2 billion women will be postmenopausal by 2030. Menopause has been associated with symptoms of hot flashes, night sweats, dysphoric mood, sleep disturbance, and conditions of cardiovascular disease, depression, osteoporosis, osteoarthritis, depression, dementia, and frailty.

Conventional hormone replacement therapy results in increased thrombotic events, and an increased risk of breast cancer and dementia as evidenced in large prospective clinical trials including Heart and Estrogen/Progestin Replacement Study I and the Women's Health Initiative. A possible mechanism for these adverse events is the unfavorable net effects of conjugated equine estrogens and medroxyprogesterone acetate on the hemostatic balance and inflammatory and immune factors.

Physiologic sex steroid therapy with transdermal delivery for peri/postmenopausal women may offer a different risk/benefit profile, yet long-term studies of this treatment model are lacking. The objective of this study was to examine the long-term effects of compounded bioidentical transdermal sex steroid therapy including estriol, estradiol, progesterone, DHEA, and testosterone on cardiovascular biomarkers, hemostatic, inflammatory, immune signaling factors; quality-of-life measures; and health outcomes in peri/postmenopausal women within the context of a hormone restoration model of care. A prospective, cohort, closed-label study received approval from the Human Subjects Committee. Recruitment from outpatient clinics at an academic medical center and the community at large resulted in three hundred women giving signed consent. Seventy-five women who met strict inclusion/exclusion criteria were enrolled. Baseline hormone evaluation was performed along with baseline experimental measures. Following this, women received compounded transdermal bioidentical hormone therapy of BiEst (80% Estriol / 20% Estradiol), and/or Progesterone for eight weeks to meet established physiologic reference ranges for the luteal phase in premenopausal women. The luteal phase hormone ratios were selected based on animal and epidemiologic studies demonstrating favorable outcomes related to traumatic, ischemic, or neuronal injury. Follow-up testing was performed at eight weeks and adjustment to hormone regimens were made including addition of androgens of DHEA and Testosterone if indicated.

Experimental subjects were monitored for 36 months. Baseline, 2-month, and annual values were obtained for: blood pressure, body mass index, fasting glucose, Homeostasis Metabolic Assessment of Insulin Resistance (HOMA-IR), fasting triglycerides, total Factor VII, Factor VIII, fibrinogen, Antithrombin III, Plasminogen Activator Inhibitor1(PAL-1), C-reactive protein (CRP), Interleukin-6 (IL-6), Matrix Metalloproteinase-9 (MMP-9), Tumor Necrosis Factor-alpha (TNF), Insulin-like Growth Factor (IGF-1), and sex steroid levels. Psychosocial measures included: Greene Climacteric Scale, Visual Analog Pain Scale, Hamilton Anxiety Scale, Hamilton Depression Scale, Holmes Rahe Stress Scale, Job Strain, and Home Strain. Health outcome measures included the number of prescribed medications used, number of co-morbidities, and endometrial thickness in postmenopausal women with intact uteri. Subjects receiving compounded transdermal bioidentical hormone therapy showed significant favorable changes in: Greene Climacteric Scale scores, Hamilton Anxiety Scale, Hamilton Depression Scale, Visual Analog Pain Scale, fasting glucose, fasting triglycerides, MMP-9, C-reactive Protein, fibrinogen, Factor VII, Factor VIII, Insulin-Like Growth Factor 1, and health outcomes of co-morbidities and a number of prescribed medications. Antithrombin III levels were significantly decreased at 36 months. All other measures did not exhibit significant effects. Administration of compounded transdermal bioidentical hormone therapy in doses targeted to physiologic reference ranges administered in a daily dose significantly relieved menopausal symptoms in peri/postmenopausal women. Cardiovascular biomarkers, inflammatory factors, immune signaling factors, and health outcomes were favorably impacted, despite very high life stress, and home and work strain in study subjects. The therapy did not adversely alter the net prothrombotic potential, and there were no associated adverse events. This model of care warrants consideration as an effective and safe clinical therapy for peri/postmenopausal women especially in populations with high perceived stress and a history of stressful life events prior to, or during the menopausal transition.

PMID: 23627249 [PubMed - indexed for MEDLINE]

Author information: (1)Women's Wellness Center, Tyler, Texas, USA. doctorkenna@aol.com

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