An Analogy for Understanding Bioidentical Hormone Replacement
A few years ago, I was bitten twice in the foot by a black widow spider. I was rushed by ambulance to an emergency room where there was an on-call toxicologist. After several rounds of morphine and valium, neither of which relieved my pain, the toxicologist was paged. When he arrived, he went over treatment options for my partner and I.
“Normally, the symptoms should have subsided by now,” the doctor explained, “because it hasn’t, you should consider an antivenin.” Antivenin is created by milking venom from the desired snake, spider, or insect. The venom is then diluted and injected, usually into a horse, but sometimes a sheep or goat. The animal undergoes an immune response to the venom, producing antibodies against the venom’s active molecule which can then be harvested from the animal’s blood and used to treat patients, like myself, whose symptoms haven’t subsided naturally. There’s a catch, however. Some individuals may react to the antivenom with an immediate anaphylaxis or a delayed serum sickness. A small percentage of patients die from the antivenon treatment.
My partner did a quick cost benefit analysis and made what must have been a difficult call, given I was completely out of it, deciding for the antivenin. As expected, the serum provided immediate relief and I was released from the hospital a short time later. My point here is not to suggest that antivenin and hormone replacement drugs are identical, rather it is to suggest 1) that horse serum can be nasty stuff, 2) there are cost/benefits to be weighed with almost every type of medical treatment, and 3) deciding to use HRT is only the beginning of the maze when it comes to treating the symptoms of menopause.
Bioidentical versus Synthetic
Many experts argue that Premarin and Prempro are not ideal hormone replacement products because they’re derived from urine of pregnant horses. Some doctors prefer the synthetic estrogen, estradiol (found in Est0race, Climara, Estring), because it’s chemically identical to the kind made by women’s ovaries. This is why it is described as “bioidentical.” Between 2003 and 2008, prescriptions for bioidentical, estradiol-based products rose from 22 to 35 percent of the supplemental estrogen market, while those for Premarin tablets fell from 53 to 35 percent, according to IMS Health.
Some compounding labs will even customize estradiol creams or patches for individual patients. Is it any wonder that bioidentical HRT makes sense to many women? After all, who wants to ingest something derived from horse urine, whether it’s been proven effective or not?
Yet, whether bioidentical estrogen and progesterone are safer or superior is yet unproved. It’s entirely possible that they have the same risks that Prempro, the horse urine byproduct used in the controversial Women’s Health Inititative [WHI] study. There is some speculation that the body takes the estrogen it’s given and changes its form so that a woman may use estradiol only to have her body turn it into estrone sulfate, the main ingredient in Premarin and Prempro. This suggests that the main advantage touted by advocates of bioidentical HRT, is specious at best.
It’s all rather confusing, but one thing is for certain, not all hormones are equal as they relate to pharmacology and physiology, and instead of condemning all hormones equally, a la the WHI study, more research is needed so that we don’t have to rely on generalizations that are too big to be useful.