Monday, May 15, 2006

Bioidentical Hormones

Here is a recent interview that i did with Dr. Manny on Fox news

Q: What is the logic behind Hormone Replacement therapy in Menopausal Women?

A:Restoration of low thyroid, insulin and cortisol is the medical standard. So, it seems logical to also replace low estrogen, progesterone and testosterone; however the evidence leaves clinicians at a loss for clear direction, because of conflicting results from studies using varying types of hormones, routes and ages.

Q: What are the Normal Hormone Ratios?

A: These are three predominant estrogens in non-pregnant, premenopausal women. These are estrone (E1), estradiol (E2) and estriol (E3) at a ratio of E1 10-20%, E2 10-20% and E3 60-80%. This ratio is protective, since the bulk of estrogen is in the form of the weakest estrogen, E3, which is also the most clot and breast protective. E2 is the strongest estrogen and E1 is the storage form of estrogen, which also has the ability to stimulate breast proliferation and clots. E1 can be metabolized to methylated products, which are excreted safely by the liver, however if the liver systems are overwhelmed or methyl groups are deficient, E1 is converted to quinines (i.e 4-OH or 16-OH) which can be mutagenic and carcinogenic.

Q:What are Bio-identical hormones and how can they mimic protective ratios?

A: Horse-derived, soy and yam hormones do not fit into the human receptor exactly. Bio-identical hormones are exactly identical to the hormones of the human body, molecule by molecule. Since, they fit the hormone receptor like a key fits into its lock the body cannot distinguish between a bio-identical hormone and the hormones it makes itself. It must be clarified that Bio-identical hormones are often created through an artificial process from soy or yam hormones by removing any molecules that do not exist on the human hormone counterpart. They can also be made synthetically in the laboratory, for example there are pharmaceutical grade patches that contain bio-identical 17-beta estradiol.

Q: According to this principle how are Bio-identicals prescribed by doctors who use them today?

A: the goal is to reestablished the normal protective ratio, a 20: 80 ratio of E2 to E3 avoiding E1 altogether.
Transdermal estrogen mimics normal ratios better than oral, since oral estrogen first passes through the liver where 50% is converted into estrone sulfate (E1) before circulating to tissues. Transdermal estrogen enters the circulation at the ratio applied to the skin. A body of literature suggests that transdermal estrogen decreases thrombosis, blood pressure, triglycerides and vascular resistance as opposed to oral estrogen which increases thrombosis, blood pressure, CRP, triglycerides, gallstones and liver binding proteins.
Q: Going back to the large hormone replacement studies that four years ago raised questions about the health risks associated with traditional menopause hormones what has happened since then?

A: The WHI study was a large NIH sponsored study that greatly influenced the way in which American doctors prescribe hormones and the way in which American women receive them with millions of women stopping hormone replacement therapy (HRT) . Like with any medical study there were may problems. They should have studied quality of life.. They should have used estrogens in favorable ratios and transdermally. They should have used a bio- identical progesterone instead of a synthetic, non-bio-identical progestin which is known to be thrombogenic and carcinogenic.They should have started women on hormones before they developed significant vascular disease (by age 55) instead of at average age 63 and average age 71 in the memory study. Also , they should have insisted on media coverage of the positive findings they later found in the estrogen-only arm. Since that study many American women and their doctors have found an alternative in the Bio-identical approach. Unfortunately there are no large studies the size of the WHI study available yet but a large body of evidence points to the potential advantages bio-identical approach. There is no question that more studies on Bio-identicals are needed.

I am primarily a fertility physician and do not consult much on menopausal issues . I believe that one of the finest physicians in this area is Dr. Sangeeta Pati . She is a close friend and a great inspiration to many. Check Dr Pati's website at

No comments: