Synthetic vs. Bioidentical Hormones

Author: Dr. Dustin Moffitt, ND

Hormone Harmony

The endocrine system, which controls our hormones, is quite frail and susceptible to numerous impacts. Circumstances within our control, such as overeating, fatigue, and stress, can throw off
the balance of our hormones. Circumstances outside of our control, such as unknown environmental toxin exposure, menopause, having children, and genetic conditions, can also throw off the balance.

The Functional Approach

The fortunate side of the situation is most hormones can be measured with a simple blood test, and for most hormones, we know ideal numbers based on age, gender, and a few other health factors. Functional medicine practitioners work together with their co-learners (patients) to help identify the disbalance, what has caused this disbalance, and how to resolve it. Sometimes, temporary assistance is needed, as in the case of a sleep aid while working on hormones such as cortisol that control our sleep habits. Other times, it’s the need for a supplement, diet, exercise, or some other routine introduced into the equation.

Evolution of Hormones

Starling discovered in collaboration with the Physiologist W. M. Bayliss, secretin, the first hormone, in 1902. Three years later, when they introduced the hormone concept with recognition of chemical regulation, early regulatory physiology took a major step forward.

Hormones were first used for menopausal symptom relief in the 1930s, after Canadian Researcher James Collip developed a method to extract an orally active estrogen from the urine of pregnant women and marketed it as the active agent in a product called Emmenin. Research and development of synthetic and equine-derived hormones has provided the basis for most references on modern hormone replacement therapy (HRT). Current conventional practice, which is derived from this research, is to prescribe progestins and estrogens that are not molecularly the same as those found in the human body.

Even though bioidentical hormones were known to be effective and were available as early as the 1930s, the only way to avert their destruction by the digestive tract was to administer them
intramuscularly in a painful oil-based injection. Since pharmaceutical companies could not patent natural substances and the technology was not available to painlessly get bioidentical hormones into the body, researchers came up with an alternative.

Oral conjugated equine estrogens, were the first mass-produced hormones to become popular in the 1970s to address menopausal symptoms, but quickly became associated with endometrial cancer. Upon further research, it was found that the cancer risk was not as highly associated in women that had proper balances of estrogen and progesterone. This is when a synthetic form of progesterone was developed in the 1980s called progestin. To add to the confusion in HRT development, the term “progesterone” was used interchangeably with the term “progestin” in medical, nursing, and pharmaceutical literature. Prescribers often assumed them to be one in the same, although their effects on the human body were very different.

Synthetic progestins, man-made, (such as Premarin and Provera) do not have the same molecular structure as the hormones in your body, but your body converts them to a usable form. They tend to increase LDL and decrease HDL cholesterol concentrations, as well as decrease sex hormone-binding globulin (SHBG). This decrease in SHBG can result in an increase in free sex hormone levels and potentially increased androgenicity and cancer causing metabolites.

Some potentials of synthetic medications is that there tends to be very little variation in the active ingredients available, so typically when given a set dose, you receive extremely close to that dose. The exact thing could be said against them as well. Most synthetic available hormones on the market only come in set dose, so if your need tends to be more or less than the standard, then you are stuck with a sub-optimal dosage and possible side effects accompanying. Another added benefit of synthetic hormones is that they are mass produced and readily available at most local pharmacies, as well as covered by most insurance companies when used for the approved conditions. Bioidentical hormones are identical in structure or similar enough in structure that our body more readily recognizes them. Most of them on the market today are derived from wild yam extract and standardized to have certain amounts of the needed hormone (it’s estrogen, testosterone, and progesterone).

There is still a fair amount of manufacturing that goes into them, but subtle enough to keep the molecular structure intact. Bioidentical hormones are typically only prescribed by providers who have done additional training to be able to understand all the variables that can interplay. The benefits of bioidenticals are that they are compounded to be a precise amount of hormones specific to your labs, symptoms, and body. The down side is that most insurance companies will not pay for any kind of compounded medication, so expect to pay out of pocket. Bioidentical Hormone Replacement Therapy (BHRT) can be used in a variety of forms such as troches, lozenges, creams, patches, pills, pellets, and injectables.

Bioidentical hormones are not devoid of leading to cancer, however when done correctly with balance and finding the lowest effective dose, they can be quite safe. Known cancer containing metabolites are 2-hydroxyestrone (2-OHE1), 16α-hydroxyestrone (16α-OHE1), but these are found between protective metabolites. Our genetics and hormone enzymes all function as they should when diet, exercise, and needed nutrients are given. Sometimes, we can do everything right and still have issues, but this is often found via frequent lab work. When concerns rise, we can utilize hormones metabolite testing to state exactly where hormones are being sent.

Hormone replacement therapy can be a very useful tool to address fatigue, low libido, brain fog, hot flashes, night sweats, weight gain, and many more. Many of our patients on HRT have found their youthful quality of life has returned. Who doesn’t want to look and feel their greatest?! What other questions would you like us to answer? Send us an inquiry and we will be sure to address them.