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| Natural vs. Synthetic Hormone Replacement | |
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Hormones
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Hormone Replacement Therapies There are many types and dosage forms of hormone replacement therapy available for men and women. Hormone replacement can be taken in the form of an injection, patch, pill, sublingual troche, pellet implant or transdermal cream. Each method has its own benefits and risks. If you're using hormone therapy but are having difficulty with it, talk to your doctor or pharmacist about other methods or dosages. It often takes several months of adjusting to find the optimum hormone combination for each patient. |
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Natural Natural hormones, also referred to as bio-Identical, are considered "natural" because the original source is from a plant. Wild yam and soybean plants contain precursor molecules that can be chemically processed into steroid hormones such as progesterone, estradiol and testosterone. Patient demand for natural (bio-identical) hormones, which has consistently been addressed by compounding pharmacies, has gained the attention of some manufacturers. Bio-identical hormones now available from manufacturers include Estrace, Climara, Vivelle, Fempatch, Androgel, Androderm and Prometrium. Pharmacists licensed by their respective state boards to compound,can also formulate hormones using chemicals approved for use in the United States. Compounded dosage forms are available in transdermal creams, sublingual troches, pellet implants, suppositories, delayed release capsules or tablets and injectables. A patient using a compounded product can receive the exact amount of hormone needed instead of being locked into strengths made commercially. |
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Synthetic Synthetic hormones can be patented which can allow a single company to corner the market. Beginning in the late 1800's, U.S. law allowed patenting only on products that were not natural substances. Synthetic hormones include the following; Provera (med-roxyprogesterone), Estinyl (ethinyl estradiol), Testred (methyltestosterone), Halotestin (fluoxymesterone), Prem-pro and Estratest. An example when a doctor may prefer synthetic hormones is the case of a patient with previous or family history of estrogen dependent tumors. Synthetic progestin or testosterone does not convert to estrogen once in the human body, however a small percent of natural progesterone or testosterone can convert. |
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Creams & Gels Can be premesured in topical syringes by pharmacist. Bypass GI tract where stomach acid interferes with absorption. Bypass liver initially so more hormone reaches target tissues and there is less potential for liver toxity. Metabolites of estrogen have actually been suggested to cause vasomotor symptoms themselves by acting as anti-estrogens. Cons: Can't wash off or swim for several hours after applying. Perceived by some as messy and/or sticky. |
Troches Bypass GI tract (more reaches target tissue). Bypass liver initially (more reaches target tissues, less potential for liver toxicity). Ease of use, can carry single dose. Cons: Some hormones have bitter after-taste. Can take a while to dissolve in mouth. Patches Convenience of not having to remember to take medication daily. More even release of medication than with oral dose or creams. Cons: Allergy to patch adhesive. Too much adhesive for some patients, too little for others depending on skin type. |
Pellet Implants Convenience of not having to remember to take medication.
Bypass liver initially. May be helpful to women who achieve adequate estrogen levels with oral dosage forms but continue to have vasomotor symptoms due to estrogen being converted to anti-estrogen substances to the liver. Cons: Requires office visit for implantation every 3 to 6 months. Temporary soreness at implantation site (upper quadrant of buttocks). Although used extensively in Europe, pellets are not recognized as conventional therapy in the U. S. for women and are consequently not covered by some insurance plans.
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Dr. Whitaker's Guide to Natural Hormone Replacement Natural Women, Natural Menopause Hormones of Desire Testosterone Syndrome The Sexy Years Are Your Hormones Making You Sick?
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Pellet Implants: Ceana Nezhat, M.D. Neil Gladstone, M.D. Steve Morganstern, M.D. Steven A. Rabin, M.D., FACOG Andrew Dott, M.D. Michael Wolfson, M.D. Bio-Identical Hormone Replacement: Robert Goldman, M.D. Steven A. Rabin, M.D., FACOG |
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