Wednesday “Bubble:” Bioidentical “hormones”

Posted by on Feb 18, 2009 in bioidentical hormones | 12 comments

Quotation marks are used to signal the reader that something is important. Sometimes their use works counter to their intention. In this highly sarcastic editorial in Menopause Management, the esteemed Dr. Wolf H. Utian, president of the North American Menopause Society (NAMS), demonstrates what happens when quotation marks and information, go wrong.

The first indication that something was awry was a press release I received from NAMS confirming the Organization’s support of the FDA position on bioidenticals and reiterating their dangers. This release, like many others, was a direct response to informercial actress Suzanne Somers (who looks to be age 30) and her two-day miracles of plastic surgery bioidenticals sound-off on the Oprah Winfrey show last month.

No wonder the wagons have started to circle.

And yet, Dr. Utian’s assertion that supporters of bioidentical hormones be thrown into one categorical cult set out to acquire/garner the publicity around so-called “natural” therapies” does a huge disservice to the very women he proports to be protecting.

Warning that this new “cultlike” phenomenon of compounding bioidentical hormones will end in the courtroom and that folks should not anticipate supporting evidence from real experts, Dr. Utian states that the majority of the most significant national medical associations and societies are now coming out with statements of reservation about the bioidentical cult.

To healthcare practitioners everywhere, he warns that the responsibility to counsel women about risks and benefits of all pharmacotherapies is yours. You sign the prescription, you carry the liability. It’s time to tell women, “Buyers beware!”

I think it’s time to tell women to do their research, consult with an accredited practitioner, and follow your heart and head. I believe it’s time to take back our bodies and stop treating menopause like a disease for which “one size fits all.” And I think it’s time to tell government that we know the reach and influence of Big Pharma and that it time to question the rationale behind applying Western methodology to every type of integrative therapy in order measure its effectiveness.

Don’t drink the Kool-Aid

So, dear readers. Dismiss Suzanne Somers and her promise of youth forever. Don’t drink the Kool-Aid.  But do your homework, talk to real practitioners not cutting edgers trying to cash in on the latest craze, and assuage your symptoms responsibly.

I wrote about bioidentical hormones last June. I am reposting it now rather than sending you back in time. The more things “change,” the more they stay the  “same.”

Be safe. Be well.

Bioidenti what? [originally posted, June 13, 2008]

Bioidentical hormones (also known in many circles as “compounded biodentical hormones”) are compounds that have exactly the same chemical and molecular structure as hormones produced in the human body. The term is most often used in the context of estrogen and progesterone (and androgens), although any hormone can be made this way. Notably, there are a few of these agents that are actually FDA-regulated and available from retail and not compounding pharmacies (meaning that dosage and purity are theoretically on par with synthetic types).

There’s been a lot of hullaballoo over these products from many of the major associations that are involved in women’s health (e.g. The Endocrine Society, North American Menopause Society) primarily because: 1) they are not regulated by the FDA or have any oversight whatsoever and 2) potency is inconsistent. In fact, the FDA sent warning letters to nine pharmacies in January due to what the agency felt were unsupported claims about safety and effectiveness.

FDA does not just randomly go after pharmacists who practice traditional compounding and who don’t make false claims about their products. Traditional compounding, in fact, involves the preparation of a drug for a specific patient based on a doctor’s request.

Consequently, FDA action might have been driven, in party, by Wyeth Pharmaceuticals, who filed a Citizens Petition that claimed: 1 that compounding pharmacies were not actually compounding but “manufacturing” mimics of approved agents; 2) that they used a form of estrogen known as “estradiol” not commonly found in “traditional” hormone therapies; 3) that they were engaging in illegal promotional practices. (BTW, Wyeth manufactures several estrogen products, including Premarin, Prempro, and Premphase.) You can read the rest of the petition here.

It’s important to recognize that not all compounded products are bad. In fact, compounding pharmacies continue to provide options to patients with contraindications to commercially-produced therapies. An article in a large monograph sponsored by the North American Menopause Society explains that pharmacies were compounding micronized progesterone years before an agent (Prometrium) was approved in the US. It also goes on to highlight several advantages that compounded hormones might offer over conventional products, including greater dosing flexibility, lower doses for women who are especially sensitive and the avoidance of potential allergens.

Organizations such as the International Academy of Compounding Pharmacists (IACP) have become quite outspoken about what they consider to be the FDA’s interference in physician decisions to prescribe estriol to their patients. Congress has even introduced a bipartisan-sponsored bill (Resolution 342) to reverse the FDA’s decision on estriol. There’s a website that further explains these efforts.

In the meantime, if you decide you want to try bioidentical hormones, speak to your health practitioner. S/he can devise a regimen that best meets your needs (and not the needs of the masses) and may be able to recommend a credible compounding pharmacy. The IACP might also be able to assist with your search.


  1. 2-18-2009

    interesting post. i think the key here is the comfort level and trust in your healthcare practitioner. i worry about alternative therapies that go unchecked but i worry just as much about a one size fits all prescription practice.

    trying my best to find something “clever” to put in quotes, but at a loss.

  2. 2-18-2009

    Great post Liz. I think the key is doing your own research and being able to discuss the information intelligently with your healthcare practitioner. What might be right for my friend isn’t necessarily right for me. Also, just because something is deemed natural, it still requires research into what effects there may be.

  3. 2-18-2009

    I am always learning new things from you – thank you! I totally agree that we all need to do our homework and talk to the professionals in our lives that we trust. I’ve become a firm believer that there is no one solution and that all our experiences are different to some degree, but most of all, that there ARE some solutions.

  4. 2-18-2009

    Any, Lori and Wendy. Thanks for the comments. I agree that research and trust are key here. As is moving away from the “one size fits all” mentality.

  5. 2-18-2009

    regardless of the issue, but particularly with issues of health and fitness especially as it relates to appearance, it’s a good idea to ignore celebrity opinions.

  6. 2-18-2009

    Yeah. I found another rational voice about bioidentical hormones in the blogosphere! As a compounding pharmacist, I couldn’t agree with you more. I feel this issue is so important that I decided to start my own blog on the issue from a pharmacist’s perspective. If you don’t mind, I’d like to but a link to your site on my blog. Thanks and keep up the good work.

  7. 2-19-2009

    The Compounder – would love the link, thank you. And do let me know your website so I can visit. Thanks for the comment!

    Sal M : salient point. Thanks.

  8. 2-20-2009

    Great post Liz! You eloquently sum up my combined frustrations with the FDA, the Pharmas, the media (Oprah and Suzanne). I like the “bubble” analogy–smart!

  9. 2-20-2009

    Shelley: thanks for reading and your wonderful comment!

  10. 2-27-2009

    This post raises some great issues. Unfortunately, as far as the pharmaceutical giants are concerned, hormone therapy is another standardized box to check. Give the masses standard doses. Realistically, hormone therapy should be and individualized process, which is why trustworthy, high-quality compounding pharmacies are so vital.

    Great post!


  11. 2-27-2009

    Nathan – stay tuned. Monday’s post is all about bioidenticals written by a compounding pharmacist! Thanks for reading!

  12. 11-30-2009

    This blog does raise some issues. There is never a one size fits all solution to health, menapause or even andropause(aka male menopause). That is why you really have to educate yourself and find a physician who will work with you to create an individulaized program that is unique to your everchanging needs as you age. The compounding pharmacies are a great help in this process. Remember – we age because our hormones decline causing our core systems to cease to work as they should and our bodies to stop repairing itself. Replacement therapies are an excellent mean to staying healthy and vital but you should be careful to educate yourself and NEVER selfmedicate.

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