Bioidentical or Traditional HRT? The Facts We Need to Ask the Right Questions

Hi Friends! One of the most common questions I get from readers is this:

“Should I be using bioidentical hormones or the traditional HRT that my doctor prescribes?”

Let’s clear this up once and for all:

This is not the right question to be asking.
It is not an “either / or” situation.

Fortunately, your choices are much broader and more diverse than this question, and I’m going to help you see the differences in HRT so you have all the information to ask the RIGHT questions.

Most women ask this question for MANY very good reasons!

• There is so much conflicting information out there. Seriously. It should be illegal.
• Depending on how it’s worded, a Google search will give you completely conflicting answers. (Reason #157 why medicine by Google is NOT a good idea).
• Far too many terms used to describe forms of hormone replacement are overlapping, overgeneralizing, and inaccurate.

I am NOT going to tell you which form(s) of hormone replacement is best. This choice is up to you, your personal medical history, and your healthcare provider.

Remember, every woman is different. We each respond to hormones differently and may need to try different forms and doses to find the right fit. For some, HRT is not an appropriate or safe choice.

I AM going to clear up some of the confusion so that you can be fully armed with the facts, so you can ask yourself yourself and your healthcare provider the right questions.

So, buckle up, friends! Let’s break this down step by step.

The Terms that Lead to Confusion:

Unfortunately, there are commonly used terms for various forms of Hormone Replacement Therapy that are used interchangeably and inaccurately. This leads to so much misinformation and confusion. Why do they do this? My guess is marketing.

Terms that are used and abused that add to our confusion:

“Traditional HRT”

• The term “traditional” hormone replacement is often used, inaccurately, to describe any hormone prescribed by your doctor..
• AND most people, some healthcare providers, and the internet tell us that “traditional” HRT is “not bioidentical”. (Sigh). This, too, is false.
• There is a very common misconception that the FDA-approved hormones produced by pharmaceutical companies and prescribed by your healthcare provider are not bioidentical. This is False.

“Natural”

• SOMETIMES, the term “natural” is used to describe plant-derived bioidentical hormones.
• Sometimes “natural” is used to describe any bioidentical hormone.
• AND sometimes “natural” is used to describe bioidentical hormones from a compounding pharmacy or compounded products sold online.
• One word. Three very different applications. Ugh.

“Synthetic”

• SOMETIMES, non-plant-derived bioidentical hormones are referred to as “synthetic”. Why is this a problem?
• Because “synthetic” is also the term used for non-bioidentical hormones.
• Yep. Same term. Very different meanings.

I wish we could start a unified “re-branding” effort for the terms used to describe various forms of hormone replacement therapy.
The overuse and abuse of inaccurate terms lead to Confusion.

Confusion has no place in safe healthcare.

Let’s Look at the Facts

FACT #1

Today, MOST of the FDA-approved hormones prescribed by your doctors ARE Bioidentical.

I’m talking about the vast majority of the Pellets, Injections, Estradiol Transdermal Patches, Creams, and Oral Progesterone. Pharmaceutical companies manufacture these, and as Bioidentical Hormones, have the following properties:

• They are structurally and chemically identical to hormones created within the body. Therefore, in most cases, they are more easily identified and efficiently utilized by our bodies. There are two types of FDA approved bioidentical hormones: Plant Derived and Non-Plant Derived. Both are safe and effective – depending on the woman.
  • Plant-derived bioidentical hormones utilize sources including soy and yams.
    • Sometimes these plant-derived hormones are referred to as “Natural”.
    • Even these “natural” plant-derived hormones are chemically modified.
    • The specific plants contain compounds that are the precursors for the hormone. These compounds are then chemically converted in the lab to create bio-identical estrogen, progesterone, and testosterone in the various forms to be prescribed.
  • Non-plant-derived bioidentical hormones.
    • These non-plant-derived hormones are still bioidentical —> they are structurally and chemically identical to the hormones our bodies produce.

FACT #2

Not all bioidentical hormones are FDA approved.

To get FDA approval a drug has to jump through a lot of hoops including: cinical trials, manufacturing protocols, dosage verification . . . just to name a few.

Some of the great medications, including hormone therapies prescribed by our doctors or marketed on the internet are made in compounding pharmacies. Some of the products used in compounding pharmacies are FDA approved. Some are not. The dosages in compounded products are not verified by the FDA.

Let me be clear. These facts do not make these products, in any way, “bad”. This is where you need to do what’s right for you and make choices for your body that you feel comfortable with. To do this, ensure you have accurate information AND be certain you are working with a healtcare provider who listens to you and who you feel comfortable with. (Read my article about finding the right provider here).

I am currently using one product, prescribed by doctor, that I obtain through my local compounding pharmacy (my Estriol Face Cream, which you can read about here). I love it. I have no qualms using it. I am comfortable with my choice. (Also – I owe you guys an update on that! Be on the lookout!)

FACT #3

Not all hormones prescribed and FDA-approved are bioidentical.

These non-bioidentical hormones are referred to as “synthetic”. (See my rant on the overgeneralization of the term “synthetic” above.) These hormones are made to be similar to our naturally produced hormones, but are not structurally (think: “molecularly”) identical.

So, if we have a wide array of bio-identical hormones available, why would a physician prescribe non-bio-identical hormones? Let me climb up to my rooftop and shout this reply: “Because we are all different!” For many of us, bio-identical hormones work great, but for others, they may not. Having a variety of choices in hormone products to manage our symptoms is a good thing.

What’s not a good thing? Being confused about something so important to our well-being.

HRT Safety Note:

If you are being prescribed Estrogen (other than vaginal cream), and you have a Uterus, you must also take Progesterone to protect from uterine cancer. Oral route of Progesterone is considered to be the safest and most bio-available for this purpose.

Using These Facts to Move Forward:

So now that we’ve broken down this terminology overlap, I want you to remind yourself that the question of “traditional vs bioidentical” is invalid and doesn’t really exist. Instead, have an informed conversation with your healthcare provider, and ask about:

• Bioidentical hormones
  • plant-derived vs. non-plant-derived
• Non-bioidentical hormones
• Mode of delivery:
  • transdermal patch
  • topical cream
  • subdermal pellet
  • oral
  • injections
• If your doctor suggests a compounded product, have her/him review and discuss pros/cons (including price and insurance coverage) for your circumstances.

Also, I’m just going to put this little note right here . . .

Many women get great results with Testosterone therapy for low libido or hypoactive sexual desire disorder (HSDD). It has also been shown to improve energy levels and provide a general “zest”.
Please note that when our ovaries were fully functioning,
they produced ~ Testosterone.
As of this writing, testosterone therapy for women is not FDA approved. Therefore, it is not covered by insurance.

And yet . . . the FDA has approved chewable Viagra . . .

That is all I have to say about that.

Friends, we each deserve to feel our best. For some of us, this includes using HRT. Finding the right combination of HRT for your unique body can be life-changing! Using the wrong combination and dosage can wreak havoc. This is not a “one size fits all” approach. It is a journey that is different for every woman, and requires:

• Showing yourself grace and patience
• Doing your due diligence to gather all the facts
• Partnering with a healthcare provider who listens to you
• Being open to different approaches

I love helping women navigate this process. If you have any questions, please ask them in the comments, OR feel free to email me.

Have a wonderful Wednesday!