Clearing Up MoreHormone Replacement Therapy Confusion:Bioidentical HRT vs. Natural HRTExplanations and the Best of Both Worlds Assistant Professor, Urology and Director, Female Sexual Medicine Center, UCLA Medical Center If you’re a woman, chances are good you have lots of questions about Hormone Replacement Therapy (HRT). Through all the controversy and confusion, one thing that the public and medical community can agree on: supplementing a menopausal or peri-menopausal woman’s body with hormone therapy will make her feel better. It’s a very simple relationship – to remedy the effects of your body’s aging and gradual decrease of circulating estrogens (menopause), as doctors and health care providers, we can increase the amount of these circulating hormones to return to your original and healthy levels once again – thereby significantly reducing the symptoms associated with menopause. The public health issues of HRT that have surfaced over the past few years are as complicated as they are varied. Our purpose here is not to address those issues, but rather to clear up some of the emerging questions about bioidentical and natural HRT. Bioidentical HRT (BHRT) involves treatment with hormones that have the exact molecular structure as those made by your body. This is what makes them “natural”, and also what allows them to produce the same physiologic response as those that are naturally produced by your body. There are many people, both patients and physicians alike, who are confused about where bioidentical treatments come from, and why they are advantageous. In my own clinic, the Female Sexual Medicine Center, I’ve often witnessed that patients are more concerned about the source of hormones, rather than the effect of those hormone treatments. Bioidentical hormones originate from a variety of sources, including plants (soy and yams), animals (horses and pigs), or even, believe it or not, the laboratory (yes, this means bioidentical hormones can be synthetically produced, too). And even the bioidentical hormones extracted from soy or yams still need a few more steps of adjustment in a laboratory to finally reach their “natural”, or bioidentical, state. So, the bottom line is that, regardless of where the bioidentical hormone came from, it is exactly like the one your body naturally produces. Natural HRT (NHRT) is a term that is frequently used incorrectly, typically by being used interchangeably with BHRT. In actuality, NHRT uses molecules that have some effects similar to your body’s hormones, but do not have the exact same molecular structure as your body’s own hormones. One of the most highly prescribed estrogen hormones available is advertised as being “natural” – and it is, because it is derived from the urine of pregnant mares (part of nature, and hence “natural”); however it is not bioidentical because it isn’t structurally equivalent to human estrogen. This doesn’t mean that it doesn’t have an estrogenic effect in your body – it does; but this is due to its similarity to (rather than a structural duplication of) the estrogen your body produces. It is important to note, however, that cow/pig derived insulin prescribed to treat human diabetes is “natural” because it comes from the natural world, but is not bioidentical since it is still structurally different from human insulin. After decades of usage, it’s quite apparent that it does its job both effectively and safely. If you are going the route of using NHRT for treatment of menopausal symptoms, you can do this without even a prescription, simply by increasing the amounts of isoflavonoids (notably genistein and daidzien, both found in soybeans) and lignans (found in nuts, particularly walnuts, and flax seeds) in your diet. All these foods are rich in phytoestrogen, which is a nutrient derived from plants that, once ingested, has estrogen-mimicking properties in the human. Not to fear, there is a way to receive an HRT treatment that is both bioidentical (structural replicas of your body’s own hormones) and natural (derived from plants). You will need to see a physician that understands the differences between the two, and who also understands the role of a compounding pharmacy. A compounding pharmacy can prepare plant-derived bioidentical hormones from a prescription written by your physician following their full evaluation and analysis of your hormone levels.
New Testosterone Patch Demonstrates Libido Boost for SurgicallyMenopausal WomenExpected on Market Within Next One to Two Years Assistant Professor, Urology and Director, Female Sexual Medicine Center, UCLA Medical Center Since the FDA approved Viagra for treatment of erectile dysfunction in 1998, men have had the power to change their despondent sex lives by visiting their doctors. Today, 15 million women suffering from low sexual libido are one step closer to having that same power – a medically proven hormonal boost to restore loss of sex drive. In mid-June 2004, researchers from Procter & Gamble attending the Endocrine Society of America’s annual meeting presented results from their study of safety and efficacy for a transdermally-delivered testosterone (dispensed through a skin-patch) in women who had their ovaries removed (a characteristic frequently found in women who have undergone hysterectomy, and a trait that would ensure the treatment could be used effectively in postmenopausal women – women whose ovaries no longer function). The patch is called Intrinsa. Testosterone received FDA approval for use in men with hypogonadism and androgen insufficiency in 1953 (actually a non-bioidentical form which still does essentially the same thing as testosterone). Since testosterone is FDA approved for use in men, and is available in pharmacies, many physicians have been prescribing it “off-label” for women experiencing low libido, as well as other sexual and non-sexual complaints including difficulty reaching orgasm, loss of energy, memory changes, as well as changes in weight and metabolism. The problem has been that there were no standardized, well-studied dosing regimens for women. When testosterone therapy gains FDA approval for use in women, all healthcare professionals – not just specialists in the field of female sexuality or gynecology – will feel confident about appropriate dosing as well as efficacy and safety of testosterone supplementation for women. Testosterone is a major biologically active hormone in women. As a woman ages, testosterone levels gradually drop to points which cause her to lose sexual desire and interest, as well as instill fatigue and exhaustion. It is also responsible for mood and sense of well-being, as well as cognition and memory. Researchers have long demonstrated that women receiving testosterone supplementation regain their libido, sexual interest, and generally experience an increased level of energy and well-being. The goal of testosterone supplementation is to restore the patient’s level to that of a healthy and younger woman. The challenge is that not all women respond in the same way or require the same dose to achieve adequate improvement in symptoms. The new Intrinsa patch delivery system may be safer and more effective than other forms of testosterone replacement. Plus, the rate at which testosterone enters the blood stream is more tempered and gradual, exacting a favorably smoother effect and creating a treatment that needs to be “administered” only twice a week. The new patch is transparent, only the size of an egg, and may be discreetly worn on the abdomen. Women need to be aware that there are side-effects to testosterone if levels get too high – including weight gain, acne, oily skin, excess body hair and other masculine effects. But these are uncommon when testosterone (like any treatment) is used appropriately and given in the correct dosages under careful supervision of a doctor. Obstacles still remain in the way of a full approval for marketing testosterone to women with low libido; but in the meantime, it’s important to recognize that the field of sexual medicine has reached an important step, and women are much closer to their own FDA-approved treatment than ever before. Procter & Gamble hopes to have their product on the market sometime next year. (June, 2004)
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