Bioidentical Hormones

18 August 2016

The Endocrine Group at Fertility Associates see many women who have previously used or are currently using bioidentical hormones.

What are bioidentical hormones?

“Bioidentical” is a marketing term, not a scientific term.  This term refers to hormones that are made (in a laboratory) to be the same chemical composition as the hormones your body produces.  They are then mixed together by a compounding pharmacist into a lozenge, cream or troche.    In fact the dominant oestrogen used in bioidentical hormones is oestradiol – the same oestrogen used in FDA approved hormone treatment. 

What is in bioidentical hormones?

Typically these preparations contain 2 or 3 different types of oestrogen.  They can also contain testosterone, DHEA, and hydrocortisone.   They can be paired with progesterone cream or an oral progesterone tablet called utrogestan. 

Is there testing?

Yes the alternative hormone industry use salivary hormone testing to diagnose a hormone deficiency.    The medical evidence shows us that salivary hormone testing is frequently inaccurate and often bears no relationship to actual hormone levels (which are more accurately measured by serum –blood - testing).  In addition it is expensive. 

What are the concerns?

There are a number of concerns:

  1. These products contain active hormones.  Like all active substances they have some effects that are positive and some that are negative.   Therefore they have the same potential for side effects as conventionally prescribed medicines.
  2. These products are unregulated. There is no requirement for the same testing or safety data (knowledge about side effects) that there is for conventional hormone replacement therapy or other medicines.    This means that users cannot be accurately advised about the risks of using these products.  There is no requirement to report any adverse effects of these products.  
  3. There is no consistency of dosing. As these products are mixed by compounding pharmacists, today’s tablet is not necessarily the same as tomorrow’s tablet.   FDA testing of bioidentical hormones in the USA demonstrated an almost 40% failure rate of product consistency and accuracy
  4. These products are expensive. We have fully funded well-researched options available.
  5. Doctors may not feel safe prescribing these compounds. Doctors are medico-legally responsible for what we prescribe, and therefore need to be able to inform their patients of the risks associated with a recommended treatment, including a prescribed medicine.  This is not possible without research about the effectiveness and safety of treatments.   
Do we have evidence of harm?

Yes, we have been professionally involved in the following cases:

  1. Cancer of the lining of the womb while using bioidentical oestrogens and progesterone creams.
  2. Testosterone levels in the male range as a result of compounded testosterone cream use.
  3. Thyroid over-activity using whole thyroid.
  4. Development of Cushings syndrome (cortisol excess) causing weight gain, hypertension and glucose elevation as a result of treatment with compounded bioidentical hormones containing hydrocortisone.
Further Reading

There are numerous guidelines from international groups to support these statements available on the internet.  Here are some recommended websites:

The Endocrine Group 

Our Endocrinologists pictured below. (L to R) Doctors Megan Ogilvie, Stella Milsom and Susannah O'Sullivan all have special expertise in reproductive health, including problems relating to absent or irregular periods, infertility, menopause and polycystic ovarian syndrome (PCOS).  Find out more.