How to use Bioidentical Hormone Replacement Therapy (BHRT)

Using Bioidentical Hormone Replacement Therapy (BHRT) by Joseph J Collins, RN, ND

Bioidentical Hormone Replacement Therapy (BHRT) may be indicated if the body is able to respond to lifestyle, diet, nutritional support, proper essential fatty acids (omega-3 oils), proper herbal therapies (the Hormone Specific Formulations), or precursors such as pregnenolone, DHEA. After trying hormone precursors for a month or two, and if hormone precursors are not enough to restore normal hormone levels (based on lab tests), and normal hormone function with relief of symptoms is not achieved, then Bioidentical Hormone Replacement Therapy (BHRT) is a very appropriate decision. BHRT guidelines for prescription hormones apply to estrogens, progesterone, testosterone cortisol and thyroid hormones.

Choose Best Delivery System: In compounding pharmacy, how a drug is administered is called the delivery system. The most popular delivery systems for bioidentical hormone replacement therapy include topical creams, topical gels, capsules, and troches.

Additionally, some compounding pharmacies may offer bioidentical tablets or custom made patches. Each delivery system has its own properties and actions on the body. 

Estrogens administered orally are more likely to be converted in the liver. So we see oral estradiol resulting in higher serum levels of estrone, and oral estriol (aka: 16-alpha-hydroxyestadiol) resulting in higher serum levels of 16-alph-hydroxyestrone. 

Since the goal is to raise estradiol and or estriol, and not estrone or 16-alpha-hydroxyesrone, it is best to use topical creams or gels to deliver estradiol and estriol.

If progesterone is administered orally, most of it becomes allopregnanolone, a metabolite that is more calming and sedating than progesterone. This is why some clinicians give oral progesterone at night (which is probably not the best way to use progesterone or to improve sleep, but as stated, there are other ways to restore healthy sleep. Now, oral progesterone is great for women with IBS or anxiety disorders, but it is really not a good idea for a woman who is struggling with depression. Oral progesterone appears to have a stronger appetite stimulating effect than topical progesterone – so keep that in mind.

Follow Hormone Health Guidelines: The Hormone Health Guidelines, including the Foundations of Hormone Health and the Hormone Specific Formulations, should still be used with bioidentical hormone replacement therapies (BHRT) to improve the function of the BHRT and the response of tissues to the BHRT. This will allow the prescriber to have better success, with lower amounts of hormones.

By using the formulations with BHRT healthcare professionals prescribing the BHRT notice that they are able to prescribe lower dosages of BHRT, and patients are having a much better response to the BHRT prescriptions. This is partly because cells that are well nourished respond better to hormones. In addition, the Hormone Specific Formulations were formulated in such as way that they improve tissue response to hormones – so lower – safer - dosages of BHRT have a better clinical response. They also decrease the development of hormone resistance by maintaining healthy function of the hormone receptors. If a patient requests that the dosage of BHRT be after it has been working for a while, make sure the patient is taking the appropriate Hormone Specific Formulations because the patient may be developing hormone resistance symptoms, which can be remediated with the appropriate formulation.

Maintain HPA Function: Another reason it is important to take at least a low dosage of the indicated Hormone Specific Formulations is because the formulation have each been designed to preserve hypothalamic-pituitary axes function. Hormone replacement can result in turning off endogenous production of hormones due to the increased hormone levels feeding back to the HPA. For example, it is important to stay on TestoGain™ while taking testosterone therapy to prevent the atrophy of testes because TestoGain™ has some gonadotrophic properties, which help maintain testes size in men. Another way to maintain HPA function is through once-a-day-dosing, as described above.

Next: Healthy Estrogen Detoxification