Bioidentical Estrogens are Safe, Right?

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A client of ours, and one who is on our bioidentical hormone replacement therapy, sent me this article. I don’t have the name of the doctor who wrote it, but, it is actually better than most, although it tends to be rather simplistic in its arguments, but nonetheless, worth the read.
I’ve attached this article below and then I weigh in at the end.

“Let’s cut to the chase-bioidentical estrogens are safe, right?? It depends. Most of my menopause patients ask about bioidentical estrogens. Women
everywhere are talking about them. Oprah did a show on them. Suzanne Somers wrote books about them. And women in book clubs and boardrooms
are hearing bioidentical estrogens have all the benefits of pharmaceutical estrogen with none of the associated risks.

But is that really true? Read on.

What is Bioidentcal Estrogen?
Like every hormone in the body, estrogen has a specific chemical structure. It looks like chicken wire made from 18 carbon atoms with one, two
or three “OH” groups hanging off some of these carbon atoms. If it has one “OH” group, it is called estrone or E1. If it has two “OH” groups it is
called estradiol or E2. If it has three “OH” groups hanging off it, it is called estriol or E3. These are the three main biological estrogen molecules that
a woman’s body normally makes. Estradiol is the most potent one and before menopause, is the most abundant.

When people talk about bioidentical estrogens, which estrogens are they talking about?
While there are other bioidenticl hormones such as testosterone and progesterone, there are only three bioidentical estrogens:  estrone, estradiol, and
estriol. These three hormones can be found in chain drug stores and in compounding pharmacies.

How are bioidentical estrogens different from other estrogen products?
Most of the estrogen molecules that are purchased in a drug store have a similar chemical structure to E1, E2 and E3, but they are not identical to
them. Your body thinks non-bioidentical estrogens are close enough to bioidentical ones to respond to them. But they aren’t exactly the same; they
might be a little stronger, a little weaker, or just different.
Bioidentical estrogens are EXACTLY the same chemical structure as the biological ones the body normally makes. They may come from plants,
but they are not made in plants. You can’t squeeze a plant and get bioidentical estrogen out of it. The only plant they are made in is a chemical plant.
So they are not natural. That is why the term used to describe them is bioidentical. The body cannot turn plant estrogens into human estrogens. It
doesnt’ haves the necessary enzymes to do that.

Bioidentical estrogen is safer than non-bioidentical estrogen, Right?
Which weighs more: a pound of feathers or a pound of bricks? They both weigh a pound and are the same. In other words, bioidentical estrogens
might be weaker than some pharmaceutical estrogens, but if they are given in equivalent dosages so a person receives an equivalent amount, the
benefits and the risks should be the same.
The problem is that while there are many studies with non-bioidentical estrogen medications sold in traditional drugstores, there are very few
safety studies on bioidentical hormones. Most doctors believe that if it is given in the equivalent amount, the risk of estrogen is the same whether
it is bioidentical or a different molecule.

Is there any real advantage to bioidentical hormones?
For me, the major advantage of bioidentical hormones is that they can be measured in laboratory tests and you can know exactly how much is
in your bloodstream. Other estrogens cannot be measured as precisely.
Another benefit of bioidentical estrogens is that the dose can be mixed just for you. So if your needs happen to fall between the available dosages
of standard pharmaceutical estrogens, a special dosage or combination can be compounded just for you.
Finally, bioidentical estrogens can be compounded together with bioidentical progesterone and/or testosterone or other hormones and all can be
applied in one application rather than having to take more than one medication.

Bottom Line.
If you think estrogen is for you and your doctor or health care provider believes the benefits are greater than the risks for you, consider any
estrogen as a possible choice.
Many patients don’t realize that there are bioidentical estrogens available in traditional drugstores both as pills and patches and through other
forms. Those formulations must all pass national standards for manufacturing. Most bioidentical estrogens are mixed in the specific drugstore
you purchase them in and are not regulated as closely. Most do a great job. But there is a large difference in how closely they are regulated.”

This article is better and more open-minded than most articles out there. But there are several points where we differ:
1) There are many, many studies on bioidentical hormones. Don’t forget, BHRT has been done in Europe for over 25-30 years.
2)Most of the blood work for commercially-made hormones was done with blood serum testing, so the doses are too strong. So even though I hear doctors
say all the time, “estrogen is estrogen is estrogen”……’s the dosing and strength that is important.
3) The delivery system we like the best is the topical cream that goes directly into the bloodstream. There are known risks of blood clots and strokes
with oral estrogens.
4) Compounding labs are strictly regulated by their state Boards of Pharmacy. We, at our Piqua Medicine Shoppe and Compounding Pharmacy,
test our products constantly for potency.5) Doctors who use the traditional commercially-made estrogen products: the patches, etc. typically do NOT check existing hormone levels of their
clients. If one does not know how much of a given hormone one needs, then how can a doctor prescribe the appropriate amount for his client?
6) For us, it is ALL about balance of the hormones and dosing physiologically. It’s tough to balance hormones of women who are just on estrogen.
Our first line of defense for replenishing hormones is progesterone. We use progesterone for it protective benefits of the heart and brain. Then we look
at estrogen and testosterone.
7) Drug companies are looking for symptom management. WE are looking at replenishment of hormone levels and balance. This goes way beyond
symptom control to encompass anti-aging and disease prevention.

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