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Bioidentical Hormones Replacement – by Henry C. Sobo, MD

October 2, 2010

Synthetic pharmaceuticals prescribed as “hormone replacement” therapy have for years been among the most widely prescribed medications in The United States. They have been prescribed most often at menopause for symptoms such as hot flashes and night sweats, but also had been touted as a preventive measure for osteoporosis and other problems. There are side effects and concerns about the long term safety of taking these synthetic pharmaceutical hormone replacements. The possibility of the promotion of breast cancer development has caused many doctors to shy away from prescribing these treatments to their patients. Many women fearing consequences of being treated with hormones, refuse therapy they might otherwise benefit from. Concurrent with the move away from these synthetic hormone replacements, the field of Bioidentical hormone replacement has emerged. A greater public awareness of this issue has occurred with the publication of books on the subject by the actress Suzanne Somers who has become a public advocate for natural healing methods. Her appearances on the Oprah Winfrey show as well as bioidentical homorne use by other well known personalities have brought this medical question to the forefront of public consciousness.

The driving force behind interest in these substances is that people may receive the benefits of hormone replacement while trying to mitigate safety concerns.

Hormone therapy is helpful for more than just menopausal symptoms such as hot flashes. When hormone imbalances occur there is a long list of associated symptoms that may occur. These are important not just for women but for men as well.

Consider how many symptoms overlap between the sexes…

Women’s Symptoms
Low Libido
Sleep Disturbances
Aches & Pains
Fatigue – “Burned Out”
Thinning skin
Bone Loss
Decreased Stamina
Heart Palpitations
Thyroid insufficiency
Vaginal Dryness

Men’s Symptoms
Low Libido
Sleep Disturbances
Aches & Pains
Fatigue – “Burned Out”
Thinning Skin
Bone Loss
Decreased Stamina
Heart Palpitations
Prostate Problems
Decreased Erections

Clearly both men and women are affected by their hormones becoming imbalanced and/or deficient and both can be helped. It is worth mentioning one difference between Menopause which most everyone has heard of, and Andropause which is the term used for the male equivalent of menopause. Mens’ hormones drop during their forties and fifties, affecting them negatively but in a slower and more subtle way than how women are often affected. Women experience the very disturbing and urgent problem of night sweats and hot flashes. They will then rush to their doctors offices in search of a solution. Mens’ symptoms include a decreasing libido, and decreased sexual performance, accompanied by general aches and pains. All of these tend to be attributed to general aging, and thus have not been considered a real medical issue. It is worth noting that for many such men who are on common medications for cholesterol or blood pressure problems, they are suffering those medications’ subtle side effects. Those medication side effects are the very same symptoms of hormone deficiencies they are developing. Obviously that just worsens the problem.

It is only recently that men have been acknowledged as needing hormonal therapy. We now see television commercials appearing for “Low-T” Syndrome, which stands for testosterone.

Why bioidentical hormones?
Bioidentical hormones are made by a compounding pharmacy, which produces the same hormonal substance that the body naturally produces. Therefore, when a woman or man is prescribed these hormones, what they are receiving is a replenishment of something that is naturally made in the body, but which has become deficient, causing a great variety of symptoms.

The safety concerns regarding hormone replacement therapy have been identified based on clinical studies with women who have been prescribed synthetic pharmaceuticals, not bioidentical hormone replacement.

The following are documented risks of the synthetic progestin medroxyprogesterone: (to be very clear, this is not progesterone)

  • Phlebitis and thromboembolism (blood clot),
  • Fluid retention, weight gain, migraine headaches
  • Depression/stressfulness, insomnia, impaired blood sugar regulation
  • Acne, hair loss, or excess growth of hair
  • Loss of libido
  • PMS
  • Elevated blood pressure

Notice many of the side effects are exactly the symptoms that hormone therapy is supposed to treat!

Synthetic hormones do not mimic your body’s natural hormones. They mainly turn off the symptoms of menopause rather than rebalancing hormone levels.

Bioidentical hormones have a chemical structure identical to the hormone as it is produced by the human body. It is believed that this means they should be incorporated into the system in a gentler, safer way than synthetic hormones. There are areas on the body’s cells called receptors. These receptors allow the hormone to attach itself and be introduced into the cell. These receptors do not allow synthetic pharmaceuticals such as Prempro or Provera to attach to them and enter the cell in the way nature intended.

In his book, Natural Progesterone, John Lee, MD enumerates the following effects of natural progesterone (remember the synthetic “progestins” are not progesterone)

  • Natural diuretic
  • Natural antidepressant
  • Improved libido
  • Facilitates thyroid hormone action
  • Stimulates osteoblasts for bone building
  • Helps protect against the formation of fibrocystic breasts
  • Helps normalize blood sugar regulation
  • Helps prevent against clotting
  • Helps use fat for energy

These are just some of the positive effects of hormone balancing. It is worth noting also, that the prescription called into a compounding pharmacy by a physician is tailor made to the exact dose the doctor is prescribing for the individual patient. This is in contrast to a pharmaceutical drug made in the millions and shipped in bottles to all pharmacies and placing everyone on an average dose. Not only are bioidentical hormones prescribed individually, but it is the practice of these prescribing doctors to monitor the patient’s hormone levels and adjust doses, if need be, for the patient’s maximal results and benefit.

It will take a long time for differences in the safety profile of bioidentical hormones to be firmly scientifically established, but here are some reasons to consider they may very well be a smart approach.

First we have logic. Now admittedly, logic is not the same thing as statistical proof over years of study, but that doesn’t mean we shouldn’t employ logic in our approaches to caring for patients. It is simply more logical that replenishing a hormone your body makes itself and has become deficient in, might be accepted by the body, and be safer than a substance which is not known to the body which is in effect trying to trick the body into believing it has enough hormones to relieve symptoms.

Also at issue of course are the documented side effects which are listed on the insert to your prescription synthetics. Isn’t it logical to avoid what has been shown to clearly have these adverse effects? To be clear, it has not been proven that these negative effects will not occur with bioidentical hormone therapy, but on the other hand, they have neither been proven to have the same risks as synthetics. Is it not more prudent to avoid what has been shown to be dangerous and utilize an alternative which may plausibly impart a lesser risk?

In terms of the consideration as to whether to treat a person with any medical regimen there is the concept of the risk /benefit ratio. Simply put, what is the benefit of treatment compared with the risk of treatment. If the benefit is great and the risk is small, you treat the patient. If the risk is great and the benefit is small, then logically, the risk is too great to treat in seeking the small benefit. With regard to whether to use hormone replacement, fear of the risk causes many people to reject the treatment. However, there may not be a realistic assessment of the risk of not receiving treatment. If a person lacks proper sleep and rest because of night sweats and hot flashes, stressfulness and anxiety, there are significant health risks as a consequence of that. Improper sleep has been associated with quite serious consequences including a higher risk of obesity and heart disease. And so, a decision not to obtain hormone treatment because of the fear of the possibility of cancer causation may just put the person at higher risk of a disease that is much more likely to occur. Heart disease is the number one killer in our nation. And of course you have the attendant lifestyle differences and risks that occur if someone is not well rested. They are constantly dragging themselves through the day, tired, uncomfortable, stressed and grouchy. So although the decision to obtain treatment is not to be taken lightly, it should be kept in mind that there may be significant risks to lifestyle and health in not obtaining treatment.

Testing for and Treating Hormone Imbalance

What are the hormone imbalances that can be checked for?
This author routinely utilizes saliva testing as a preferred method for checking the bioactive levels of Estrogen, Progesterone, Testosterone, DHEA, and Cortisol. When these hormones are tested by blood they are testing hormones that are bound by proteins circulating in the system, and the numbers may not always accurately reflect the physiological activity of the hormone for that person. For this reason, many doctors prescribing synthetic hormones do it without even bothering to order or rely on these blood tests. When a person’s saliva is checked, the hormones that are detected are not bound by proteins and thus may reveal more accurate reflection of the bioactive hormone, that which creates the many effects of the hormones on the body. A proper check also takes into account not just the hormone levels but the balance between them. In particular, the balance between estrogen and progesterone is important. A concept of great importance describing what millions of women suffer from is the condition called Estrogen Dominance. This is when the estrogen hormones are relatively too high in comparison to the progesterone levels. And estrogen dominance can occur even when a women develops estrogen deficiency at the start of menopause causing symptoms like hot flashes. This is because even though the production of estrogen is dropping, the production of progesterone drops even more, resulting in comparatively more estrogen than progesterone circulating in the system. These women are candidates for receiving both estrogen and progesterone. It is the balance between them which needs to be addressed as well as their basic levels standing alone.

When estrogen becomes the dominant hormone and progesterone is deficient, estrogen can have the following harmful effects on the body:

  • Water retention
  • Breast swelling
  • Fibrocystic breasts
  • PMS
  • Decreased libido
  • Uterine fibroid
  • Weight gain
  • Cravings for sweets

The symptoms of estrogen dominance can be successfully treated with natural progesterone, with its many benefits as enumerated above.

Testosterone is for Both Men and Women

There is a misconception about testosterone. Many people will identify it as “the male hormone”. While it is true that testosterone levels are normally much higher in men than in women, women also need to be tested for testosterone. If a women is deficient (relative to the proper female levels) then the symptoms of hormone imbalance occur.

Along with improving symptoms such as weakness and fatigue, and depression, testosterone therapy may be protective against heart disease. Testosterone plays a role with regard to reverse cholesterol transport (RCT). Reverse cholesterol transport is how HDL (known as the good cholesterol) removes cholesterol from the arterial wall and returns it to the liver. In the testosterone-deficient state, reverse cholesterol transport cannot complete this process as effectively, and excess cholesterol cannot be removed from the arterial wall.

HDL and free testosterone levels often plummet in aging men and women. This combination of low HDL and low testosterone virtually guarantees a very elevated cardoiovascular risk in comparison to the more optimal profile.

Why Not Mainstream?

A further issue that should be addressed is an answer to the often asked question, “if bioidentical hormones are so good, why are they not more widely accepted and prescribed by most physicians?” John Lee, MD addressed this in his book by reviewing the relationship of pharmaceutical firms to the medical profession as a whole. The economics of drug development and promotion underlie our system of developing new treatments. Synthetic substances can be patented by pharmaceutical companies who have an army of company representatives who fan out across the country to tout the benefits to physicians whose offices they visit. Natural hormones cannot be patented because they are natural to the body. Thus, they do not have any multi-billion dollar corporation behind their use, and no pharmacy representatives to visit the tens of thousands of medical offices who could be enlightened about bioidentical hormones.

Another crucial way the pharmaceutical companies spread the word about their medications, is at medical conferences being held regularly across the country. These conferences, which doctors attend to get the latest medical information and for “continuing medical education” (CME) credits they must seek to maintain their licensure, are frequently underwritten by pharmaceutical companies. Often the conference speakers are leaders in the medical field who are paid consultants of pharmaceutical companies. Although they may adhere to rules about disclosing such existing relationships, the relationship still exists and has the potential to greatly influence medical thinking. Bioidentical hormones advocates simply do not have access to the same kind of ongoing promotion as pharmaceutical companies do.

Response to Treatment and Disease Prevention

Most people will see the benefits of bioidentical hormones quickly. Within several days a patient will begin to sleep better, and hot flashes and night sweats will start improving. Libido will begin to return and weight control will be noticeably affected over time.

Follow up by the physician should include monitoring of the person’s response, retesting for hormone levels after a reasonable period of time, and adjustment of the treatment on an individualized basis. The compounding pharmacy can then be instructed by the doctor to change prescriptions as per the unique need of each patient.

In making the decision to use bioidentical hormones, it is crucial to also recognize the importance of nutrition, fitness and lifestyle changes. Utilize natural supplements as a part of the journey to improved health and prevention of illness. If hormones are deficient and / or out of balance, the body will not respond as well as it could to improved nutrition, stress reduction, and exercise. But as hormone levels return to more youthful levels, improved nutrition, and fitness will likewise enable an individual to feel rejuvenated, enjoying greater energy, better overall well-being, and an improved opportunity for greater longevity.

The best results are always obtained when all the factors out of balance are attended to. The body then functions as a well directed symphony whose many pieces and complex interrelationships are allowed to flourish, resulting in the best possible health status.

Dr. Sobo is a Medical Doctor practicing Holistic/ Nutritional Medicine in Stamford, CT. More information about natural hormones and about Dr. Sobo’s practice can be found on the Internet at Dr. Sobo’s office phone number is 203-348-8805.


The information provided is for educational purposes only. It is not

intended to replace the advice of your physician or health care provider. You are encouraged to seek the advice of a competent health care provider before making any decisions that could affect your health.


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