Journal of American Physicians and Surgeons Volume 13 Number 2 Summer 2008
This very academic article (with 66 academic references) makes interesting reading for anyone looking for “evidence” regarding the benefits of compounded bioidentical hormone replacement therapy.
The key issue is the use of human hormones at the appropriate dose—not the type of pharmacy. Most physicians using bioidentical hormones have a significant percentage of prescriptions filled at compounding pharmacies rather than non-compounding retail pharmacies. This is because compounding affords advantages such as customized dosing, so that the lowest effective dose can be used, and allows the prescribing of hormones such as estriol that are not available at non-compounding retail pharmacies.
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Wyeth, the maker of Prempro, has been a leader in opposing the use of compounding pharmacies and has effectively petitioned the FDA to assist in eliminating competition. Could this be related to the fact that Wyeth made more than $1 billion annually from the sale of Premarin and Prempro before theWHI study? These drugs are still on the market although they are known to increase cancer risk.
The Importance of the Identical Structure
Molecular structure determines activity. The smallest of changes can completely change the physiologic effect. Consider testosterone and estrone, whose structures are shown side by side in Figure 1. The mere existence of an effect similar to that produced by a hormone does not make a compound a hormone. If it did, plastic would be a hormone. For example, bisphenol A (BPA) is an estrogen receptor agonist. When BPA binds with the estrogen receptor, the complex so formed interacts with DNAand can lower sperm counts and increase the risk of developmental problems, cancer, schizophrenia, neurologic disorders, and weight gain. The interaction with the hormone receptor does not make BPA a hormone—but rather the hormone mimicry interferes with normal physiologic processes, causing a wide variety of adverse effects.
The use of exogenous chemicals as hormone substitutes has been shown to be unsafe and should be stopped. Hormone supplementation should be done with compounds identical to the natural molecules. Although more research is needed, there is already evidence of the benefits of hormone supplementation in the proper doses and in proper balance. The future of medicine is in physiology rather than pharmacology.
Read the whole article at http://www.jpands.org/vol13no2/hotze.pdf