The Cow, the Horse, and the Human

One of my first forays into compounding pharmacy was through the use of bioidentical hormone replacement. Being perfectly honest, I really had no idea what this meant when I started. I knew technically how to compound estradiol, progesterone, testosterone, etc. into creams, capsules, and suppositories, but I didn’t know WHY a practitioner would use them over a commercially available hormone “drug” produced by a pharmaceutical company. After all, I had been a pharmacist at a chain pharmacy for over 5 years before joining my dad’s business and had dispensed countless numbers of prescriptions for estrogens and progestins. Pharmacy school taught us that this was the patient’s only choice… mass produced estrogens and progestins (substances “similar” to progesterone). They were abundant in the marketplace not only for birth control purposes but for hormone replacement as well… and they still are. But just because they are readily available doesn’t mean they are the best way to go. Boy, if I only knew then what I know now! Personally, I know my own health journey may have looked very different over these last 30 years. But I am not here to bore you with those personal details. What I’d like to do is explain the different types of hormones available

The Cow

I want to make sure to explain some definitions that are often misunderstood when it comes to the world of hormones because it is very important not to mix them up. The term natural refers to “existing in or caused by nature”. The term synthetic means “formed through a chemical process by human involvement”. Finally, bioidentical is “having the same molecular structure as a substance produced in the body”. Not everything that is natural is good for you (would you like some arsenic with your tea today?), and not everything that is synthetic is bad for you. In fact, most bioidentical hormones are actually synthesized in a lab. In the case of sex hormones, the lab starts with a naturally occurring plant (usually soy or yam) that has a similar chemical structure to the hormone desired, and then works its organic chemistry magic to alter the structure until the end product is bioidentical to the hormone found in the human body. And just by writing that sentence I am now having PTSD thinking about organic chemistry class in college! Examples of other common bioidentical hormones that have been used for decades include insulin given to a diabetic patient and Synthroid® which is a thyroid hormone. Maybe you have heard of those. Anyway, why do bioidentical hormones (including the sex hormones) have to be synthesized? The answer is an easy one. You can’t simply extract a hormone from a human like you do milk from a dairy cow.

The Horse

There are hormones produced by drug companies that are technically “natural”, as in they are literally derived from the urine of pregnant horse mares. Yes, you read that correctly. Unfortunately, the estrogens that are very normal, natural, and bioidentical to a horse, are absolutely NOT bioidentical to the estrogens found in the HUMAN body. They are similar in structure to what you have so they MIMIC what your own hormones do, but since they aren’t exactly the same (bioidentical), they can only do so much and over time will cause more harm than good. There are also other “drugs” on the market that have been synthesized to look like a hormone, but also are not identical to what you have in your body. They are “hormone like”.  The reasons for this are simple…. follow the money. The big drug companies can’t patent something that Mother Nature already invented.

The Human

Bottom line is that it is very important that you, the human, always use BIOIDENTICAL forms of hormones so that they are exactly what your own body makes. Why? If you think of a lock + key scenario, the hormone is the key and the hormone receptor (located inside cells in your body) is the lock. Non-bioidentical hormones don’t fit into the lock correctly, thus they give incomplete messages to these receptors, which then fail to produce the correct hormonal response. This can lead to trouble immediately or over time. For example, there is a “progesterone-like” drug called medroxyprogesterone (MPA). MPA can cause insomnia and anxiety, while naturally occurring progesterone (and likewise bioidentical progesterone) has sedative properties, improves the quality of sleep, and reduces anxiety. MPA also adversely affects lipid profiles, while progesterone itself does not and actually can improve cholesterol levels. The good news is that there are several choices for bioidentical hormone replacement in the traditional pharmacy, notably Estradiol (one of 3 that women have) and progesterone. Estradiol comes in several forms including oral tablets (NOT RECOMMENDED – more on this subject later), topical patches, and topical gels. Progesterone comes as an oral capsule in 2 different strengths. For some women the limited choices of commercially available forms of bioidentical hormones will not meet their needs. HAVE NO FEAR, COMPOUNDING IS HERE! A compounding pharmacy can custom make bioidentical hormones in a variety of strengths and dosage forms (i.e. oral, sub-lingual, topical creams, vaginal creams, etc.).