Bioidentical hormone replacement therapy

Bioidentical hormone replacement therapy (BHRT) is an alternative to conventional hormone therapies, which various crackpots promote like some sort of magic health fairy. 
BHRT prescribes hormones like progesterone, testosterone, estradiol, and estrogen for when the human body doesn't produce enough — just like normal hormone replacement therapy. The difference is that BHRT uses "natural" hormones which are extracted from plants (like yam and soy) via complex chemical processing in a laboratory — as opposed to "conventional" hormones, which are extracted from animals via complex chemical processing in a laboratory. —Conway. Bioidentical Hormones: An Evidence-Based Review for Primary Care Providers. Journal of the American Osteopathic Association. 2011 Mar;111(3):153-64. (Or indeed, "conventional" hormones may also be derived from plants.Julia Kollewe (September 24, 2022). "HRT: inside the complex global supply chain behind a $20bn market". The Guardian.)
"Bioidentical" supposedly refers to the hormones being "chemically identical" to those made by the human body itself. This is a bullshit claim, because no one has actually analyzed their chemical structure. —Rosenthal. Ethical problems with bioidentical hormone therapy (PDF). International Journal of Impotence Research (2008) 20, 45–52. —Bhavnani & Stanczyk. Misconception and Concerns about Bioidentical Hormones Used for Custom-Compounded Hormone Therapy. The Journal of Clinical Endocrinology & Metabolism. 2012, 97:3, 756-759. BHRT proponents pulled it straight out of their asses, and it's repeated over and over by its promotersThere isn't a references section large enough to contain all the sites claiming that bioidentical hormones are "chemically identical" to human hormones, but feel free to check out any of the 48,000+ results in Google. and, unfortunately, also by skeptics of BHRT. (Presumably "plant-derived" or "yam-based" just wasn't as marketable.)
==Health claims==
At first glance, BHRT's appeal is a simple "It's natural and therefore better!" argument. Advocates will probably mention that it's made from yams.
A second glance shows an incredible array of health claims being made about it. BHRT is claimed to prevent cardiovascular diseases,MyBioidenticalHormones.com claims BHRT solves cardiovascular, bone-related, mental health, and diabetes-related health problems. And of course, it does all that while making you look younger. —Blog post by a business selling BHRT. —Dr. Jonathan Wright. Bio-Identical Hormone Replacement ~ risks you should know and how to reduce them. VisceralSynergy.com. 2010 June 28. treat osteoporosis (better than proven treatments!), prevent Alzheimer's disease and eliminate depression, prevent diabetes, reverse aging, Bioidentical hormones: Help or hype?. Harvard Women's Health Watch. Harvard Medical School. 2011 September. and prevent breast cancer.Bioidentical Hormones: Why Are They Still Controversial? Life Extension Magazine. 2009 October.
In classic alternative-medicine-promoting fashion, BHRT advocates often mention how the therapy is tailored for each customer, while dismissing conventional therapy as "one-size-fits-all". According to one doctor's website.
BHRT proponents seem to target middle-aged people — the sort of people who might be looking to alleviate symptoms of menopause or adrenopause, and are wondering if hormone therapy might help. It's noteworthy how the health claims made by BHRT proponents — revolving around breast cancer, osteoporosis, Alzheimer's, heart disease, and general aging — line up perfectly with the sort of health problems that middle-aged people are most concerned about, despite there being zero evidence that BHRT helps with any of those things.
== The truth ==
None of the major claims about BHRT are true. There is no evidence demonstrating that BHRT is more effective than conventional treatments.Boothby & Doery. Bioidentical hormone therapy: a panacea that lacks supportive evidence. Current Opinion in Obstetrics & Gynecology. 20(4):400-7. 2008 August.May Clinic's answer to the question Are bioidentical hormones safer and more effective than hormones used in traditional hormone therapy for menopause symptoms? from the Expert Answers section at its website. The human body can't even tell the difference between the therapies, meaning BHRT has the same side-effects and risks as conventional therapy anyways. —The Endocrine Society Re-Issues Position Statement on Bioidentical Hormones. Endocrine Society. 2009. Fugh-Berman & Bythrow. Bioidentical Hormones for Menopausal Hormone Therapy: Variation on a Theme. Journal of General Internal Medicine. 22(7): 1030–1034. 2007 July. Harriet Hall. Bioidentical Hormones. Science-Based Medicine. 2010 June 29.
Furthermore, quality control and dosage are major concerns; because BHRT is unregulated, no one knows exactly what chemicals, and how much of them, are contained in a given treatment. —Investigative report on BHRT by More magazine. This is made worse by the fact that BHRT is prescribed based on saliva tests, which are completely useless. —ACOG Reiterates Stance on So-Called "Bioidentical" Hormones. American Congress of Obstetricians and Gynecologists. 2009 February 3.
Some BHRT businesses market their treatments in topical cream form. These are especially dubious; topical hormone creams do nothing and are basically placebos.Elshafie & Ewies. Transdermal natural progesterone cream for postmenopausal women: inconsistent data and complex pharmacokinetics. Journal of Obstetrics and Gynaecology. 2007 Oct;27(7):655-9.Benster, et al. A double-blind placebo-controlled study to evaluate the effect of progestelle progesterone cream on postmenopausal women. Menopause international. 2009 Jun;15(2):63-9. —What are bioidentical hormones?. Harvard Women's Health Watch. 2006 August. —One (admittedly pro-BHRT) doctor discussing hormone creams.Another pro-BHRT doctor admitting that topical hormone creams are goddamned useless.
In 2008, the FDA issued warnings to several pharmacies for making "false and misleading" health claims — the same health claims mentioned earlier on this page.FDA Takes Action Against Compounded Menopause Hormone Therapy Drugs. U.S. Food and Drug Administration. 2008 January 9. The FDA also notes that "bioidentical hormone replacement therapy" is a marketing term with no actual scientific or medical meaning. Bio-Identicals: Sorting Myths from Facts. U.S. Food and Drug Administration. 2008 April 8.
Even private health insurers disregard BHRT.Official Blue Cross Blue Shield web page bluntly noting that BHRT doesn't do any of the things it's claimed to do.
=== Cost of BHRT===
BHRT is expensive and, because it's an unproven treatment, rarely covered by health insurers. —Jennifer Jaynes. Journey with Bioidentical Hormone Replacement Therapy: Day 16. Project Jennifer. 2011 April 6. —As stated by this BHRT clinic. —Another clinic discussing its own BHRT. Various BHRT clinics offer price quotes with annual costs of $1660,See BioBalance Health's own price list. Not counting the initial consultation fee of $200 or more and using the cheapest possible options, their BHRT regimen has an annual cost of $1660. $2000,See this comment where someone claims they relied on BHRT, learned it wasn't covered by their insurance, and it ended up costing them $2000. $2400,BodyLogicMD, which heavily promotes BHRT, quotes its cost at $2400 a year. even way up at $4200 per year.Griffon Medical Group, which specializes in anti-aging and BHRT, flat-out states that it can cost up to $350 per month, and that insurance doesn't cover it. BHRT is hardly the cheap option.
==Notable proponents==
Unlike with other alternative medicines, many BHRT advocates are actual medical doctors. Far from being a positive thing, this is actually pretty shameful because so many of them sell their own branded hormone treatments to patients — this is a clear conflict of interest, which practicing medical doctors are supposed to avoid.
Dr. Prudence Hall, a California physician, is one such doctor.Dr. Hall's webpage. In 2011 she was interviewed by Dr. Oz on Oprah about BHRT.From the Oprah show archives: Dr. Oz talks with Dr. Prudence Hall, a proponent of bioidentical hormone replacement therapy. In addition to BHRT, her clinic also offers such services as the "Purity Cleanse" and the "Purity Cleanse Plus". And of course, she sells her own brand of supplements.Dr. Hall's store.
Suzanne Somers may not be a doctor but she is a full-blown snake-oil saleswoman and a huge proponent of BHRT.Deborah Kotz. Why Suzanne Somers Loves Bioidentical Hormones. U.S. News & World Report. 2009 March 25.Barron H. Herner. Suzanne Somers, Cancer Expert. New York Times. 2011 February 25. She wrote an entire book promoting BHRT as an anti-aging miracle, Ageless: The Naked Truth About Bioidentical Hormones.Suzanne Somers. Agless: The Naked Truth About Bioidentical Hormones. Crown Publishers, 2006. She's also a spokesperson for foreverhealth.com, a website that sells supplements and connects patients with doctors who offer BHRT,Forever Health page on Somers' website. in addition to being frequently promoted by fellow crackpot medical businesses like Life Extension.A search of Life Extension's website reveals 58 mentions of Somers in their magazine, across 11 years worth of issues.
== External links ==
*Good overview of BHRT by More magazine.
*Investigative report on BHRT by More magazine.
==References==
Category:Medicine
Category:Woo