Bioidentical hormone replacement therapy

{{bronze}}{{altmed}}
'''Bioidentical hormone replacement therapy''' ('''BHRT''') is an alternative to [[Hormone replacement therapy|conventional hormone therapies]], which various [[crackpot]]s 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 [[Appeal to nature|"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.<ref>{{refquote|...the standard in HRT for many years, are derived from animal sources, not chemically synthesized, and thus they are arguably no less natural than those used in BHT.}} —Conway. [https://web.archive.org/web/20141114203756/http://www.jaoa.osteopathic.org/content/111/3/153.long Bioidentical Hormones: An Evidence-Based Review for Primary Care Providers]. ''Journal of the American Osteopathic Association''. 2011 Mar;111(3):153-64.</ref> (Or indeed, "conventional" hormones may ''also'' be derived from plants.<ref>Julia Kollewe (September 24, 2022). [https://www.theguardian.com/business/2022/sep/24/hrt-inside-the-complex-global-supply-chain-behind-a-20bn-market "HRT: inside the complex global supply chain behind a $20bn market"]. ''The Guardian''.</ref><ref name=SBM/>)

"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''.<ref name=ethics>{{refquote|...no one has put forth structural crystallographic data demonstrating structural identity with circulating human hormones... BHRT is sold by the practitioner who prescribes it, this constitutes a serious conflict of interest and violates professional ethical conduct.}} —Rosenthal. [http://www.nature.com/ijir/journal/v20/n1/pdf/3901622a.pdf Ethical problems with bioidentical hormone therapy] (PDF). ''International Journal of Impotence Research'' (2008) 20, 45–52.</ref><ref>{{refquote|...so-called bioidentical hormones may not be identical to the natural hormones produced in vivo by the human body.}} —Bhavnani & Stanczyk. [https://academic.oup.com/jcem/article/97/3/756/2536306 Misconception and Concerns about Bioidentical Hormones Used for Custom-Compounded Hormone Therapy]. ''The Journal of Clinical Endocrinology & Metabolism''. 2012, 97:3, 756-759.</ref> BHRT proponents [[PIDOOMA|pulled it straight out of their asses]], and it's repeated over and over by its promoters<ref>There 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 [https://www.google.com/search?q=bhrt+%22chemically+identical%22 48,000+ results in Google].</ref> 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 "[[appeal to nature|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,<ref name=MegaCrackpot>MyBioidenticalHormones.com claims BHRT solves [http://www.mybioidenticalhormones.com/Bioidentical_Hormones.html#Cardiovascular_Health,_Heart_Health_and_Bioidentical_Hormones cardiovascular], [http://www.mybioidenticalhormones.com/Bioidentical_Hormones.html#Bone_Density,_Bone_Health_and_Bioidentical_Hormones bone-related], [http://www.mybioidenticalhormones.com/Bioidentical_Hormones.html#Memory_Problems,_Brain_Health_and_Bioidentical_Hormones mental health], and [http://www.mybioidenticalhormones.com/Bioidentical_Hormones.html#Type_2_Diabetes_and_Bioidentical_Hormones diabetes]-related health problems. And of course, it does all that while [http://www.mybioidenticalhormones.com/Bioidentical_Hormones.html#Skin_Health,_Skin_Rejuvenation_and_Bioidentical_Hormones making you look younger].</ref><ref name=HHWL>{{refquote|Those undergoing BHRT can expect to experience an increased sense of well-being and improved energy, along with better concentration and focus skills. If you have been feeling depressed as a result of abnormal low levels of hormones, you may find the depression has lifted. ...Those undergoing therapy may also notice an increase in muscle mass, along with a reduction in body fat. If your blood pressure and cholesterol levels reached unhealthy levels, they may once again be within healthy limits. Lastly, BHRT can also reverse osteoporosis.}} —[https://web.archive.org/web/20130314013251/http://blog.hormonehealthandweightloss.com/learning_center/bid/232574/The-Benefits-of-BHRT Blog post] by a business selling BHRT.</ref><ref name=synergy>{{refquote|BHRT will substantially reduce your risk of Alzheimer’s disease and other cognitive decline. Other research has proven that BHRT significantly lessens risk of heart and blood vessel disease, osteoporosis, and (in non-smoking women) chronic obstructive pulmonary disease (COPD). It has also been proven to significantly reduce deaths from all causes in men (it’s very likely it will reduce all-cause mortality for women, too...<br> Another 'perk' of BHRT is that it slows the progression of aging, including age-related changes in appearance. Women using BHRT for five to 10 years appear significantly younger than women of the same age who haven’t used BHRT.}} —Dr. Jonathan Wright. [https://web.archive.org/web/20131014015715/http://visceralsynergy.com/Visceral_Synergy/Bio-Identical_HRT.html Bio-Identical Hormone Replacement ~ risks you should know and how to reduce them]. VisceralSynergy.com. 2010 June 28.</ref> treat osteoporosis (better than proven treatments!),<ref name=MegaCrackpot/><ref name=HHWL/><ref name=synergy/> prevent Alzheimer's disease and eliminate depression,<ref name=MegaCrackpot/><ref name=HHWL/> prevent diabetes,<ref name=MegaCrackpot/> reverse aging,<ref name=MegaCrackpot/><ref name=HHWL/><ref name=synergy/><ref>{{refquote|Somers endorses the use of bioidentical hormones not just for the relief of menopausal symptoms but as a veritable fountain of youth.}} [https://web.archive.org/web/20111005162508/http://www.health.harvard.edu/newsletters/Harvard_Womens_Health_Watch/2011/September/bioidentical-hormones-help-or-hype Bioidentical hormones: Help or hype?]. ''Harvard Women's Health Watch''. Harvard Medical School. 2011 September.</ref> and prevent breast [[cancer]].<ref name=MegaCrackpot/><ref>[http://www.lef.org/magazine/2009/10/Bioidentical-Hormones/Page-01 Bioidentical Hormones: Why Are They Still Controversial?] ''Life Extension Magazine''. 2009 October.</ref>

In classic [[alternative medicine|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".<ref>{{refquote|The other difference between CHR and BHRT is that BHRT treatment regimens are custom tailored to the individual based on results of saliva or blood testing, medical history, physical exam and symptoms. CHT is a "one-size-fits-all" approach.}} According to [https://web.archive.org/web/20120513023306/http://dramybrenner.com/services-bioidenticals.htm one doctor's website].</ref>

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.<ref>Boothby & Doery. [http://www.ncbi.nlm.nih.gov/pubmed/18660693 Bioidentical hormone therapy: a panacea that lacks supportive evidence.] ''Current Opinion in Obstetrics & Gynecology''. 20(4):400-7. 2008 August.</ref><ref name=Mayo>May Clinic's answer to the question [http://www.mayoclinic.org/diseases-conditions/menopause/expert-answers/bioidentical-hormones/faq-20058460 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.</ref> 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.<ref name=Endocrine>{{refquote|Risk accompanies therapy regardless of the chemical structure of the hormone. However, medications from compounding pharmacies—including bioidentical hormones—are not always subject to FDA monitoring for dose, purity, safety or efficacy. Inconsistency of dose and purity presents additional risk to patients.}} —[https://www.endocrine.org/news-room/press-release-archives/2009/societyreissuespositionstatementonbioidenticalhormones The Endocrine Society Re-Issues Position Statement on Bioidentical Hormones]. Endocrine Society. 2009.</ref><ref name=B&B>{{refquote|...natural or bioidentical compounded estrogen preparations are being promoted to consumers as safe alternatives to conventional menopausal hormone therapy and as health-promoting tonics. No reliable data support these claims. <br>...Salivary tests may be used to persuade asymptomatic consumers to use hormones (or symptomatic patients to use higher doses than those needed to mitigate symptoms), a practice that can be expected to result in adverse events.}} Fugh-Berman & Bythrow. [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2219716/?report=classic Bioidentical Hormones for Menopausal Hormone Therapy: Variation on a Theme]. ''Journal of General Internal Medicine''. 22(7): 1030–1034. 2007 July.</ref><ref name=SBM>{{refquote|Advocates claim that bioidenticals are safer than pharmaceuticals, but since they are essentially the same compounds, there is every reason to think they would have the same side effects.<br>...dosage is usually guided by salivary hormone levels, which are unreliable. Suzanne Somers even advocates that the patient adjust her own dosage from day to day just depending on how she feels.}} Harriet Hall. [http://www.sciencebasedmedicine.org/bioidentical-hormones/ Bioidentical Hormones]. Science-Based Medicine. 2010 June 29.</ref>

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.<ref name=Mayo/><ref>{{refquote|Among the 12 prescriptions we filled, estriol was sub-potent in all samples, meaning that the hormone was present in lower quantities than the prescription label indicated. In all but two cases, the other two estrogens in Tri-Est, estrone and estradiol, were superpotent—they delivered a higher dose than prescribed.}} —[https://web.archive.org/web/20140312135241/http://www.more.com/health/wellness/hormone-hoax-thousands-fall-0?page=4 Investigative report on BHRT] by ''More'' magazine.</ref> This is made worse by the fact that BHRT is prescribed based on saliva tests, which are completely useless.<ref name=Mayo/><ref name=B&B/><ref name=SBM/><ref>{{refquote|salivary testing of a woman's hormone levels is not useful because they vary within each woman depending on her diet, time of day, the specific hormone being tested, and other variables. Although monitoring salivary hormone levels is promoted by some as a means of 'tailoring' a hormone treatment to an individual, hormone therapy does not require customized dosing.}} —[https://web.archive.org/web/20150105042916/http://www.acog.org/About-ACOG/News-Room/News-Releases/2009/ACOG-Reiterates-Stance-on-So-Called-Bioidentical-Hormones ACOG Reiterates Stance on So-Called "Bioidentical" Hormones]. American Congress of Obstetricians and Gynecologists. 2009 February 3.</ref>

Some BHRT businesses market their treatments in topical cream form. These are especially dubious; topical hormone creams do nothing and are basically [[placebo]]s.<ref>Elshafie & Ewies. [http://www.ncbi.nlm.nih.gov/pubmed/17999287 Transdermal natural progesterone cream for postmenopausal women: inconsistent data and complex pharmacokinetics.] ''Journal of Obstetrics and Gynaecology''. 2007 Oct;27(7):655-9.</ref><ref>Benster, et al. [http://www.ncbi.nlm.nih.gov/pubmed/19465671/ 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.</ref><ref>{{refquote|So-called natural, plant-derived progesterone creams sold over the counter contain too little of the hormone to be effective. And yam extract creams don’t help because your body cannot convert them into progesterone.}} —[https://web.archive.org/web/20071217072428/http://www.health.harvard.edu/newsweek/What-are-bioidentical-hormones.htm What are bioidentical hormones?]. ''Harvard Women's Health Watch''. 2006 August.</ref><ref>{{refquote|...about the use of progesterone creams, particularly regarding the efficacy of yam-based or other plant-based creams. ...wild yam (Dioscorea barbasco) cannot be converted into progesterone in the body.}} —[https://web.archive.org/web/20080408084104/http://www.drnorthrup.com/womenshealth/healthcenter/topic_details.php?topic_id=129 One (admittedly pro-BHRT) doctor] discussing hormone creams.</ref><ref>Another pro-BHRT doctor admitting that [http://naturalmedicinejournal.com/journal/2010-03/bioidentical-hormone-replacement-guiding-principles-practice topical hormone creams are goddamned useless].</ref>

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.<ref>[https://web.archive.org/web/20090614045007/http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2008/ucm116832.htm FDA Takes Action Against Compounded Menopause Hormone Therapy Drugs]. U.S. Food and Drug Administration. 2008 January 9.</ref> The FDA also notes that "bioidentical hormone replacement therapy" is a marketing term with no actual scientific or medical meaning.<ref>{{refquote|'BHRT' is a marketing term not recognized by FDA.}} [https://web.archive.org/web/20090607024734/http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm049311.htm Bio-Identicals: Sorting Myths from Facts]. U.S. Food and Drug Administration. 2008 April 8.</ref>

Even private health insurers disregard BHRT.<ref>[https://web.archive.org/web/20110930114530/http://www.bcbst.com/learn/treatment-options/BHRT.shtm Official Blue Cross Blue Shield] web page bluntly noting that BHRT doesn't do any of the things it's claimed to do.</ref>

=== Cost of BHRT===
BHRT is expensive and, because it's an [[alternative medicine|unproven treatment]], rarely covered by health insurers.<ref>{{refquote|The trouble was that BHRT usually isn’t covered by insurance. It’s definitely not covered by mine and it’s quite costly. Especially the lab work that you have to get before the therapy even begins.}} —Jennifer Jaynes. [http://projectjennifer.com/2011/04/my-journey-with-bioidentical-hormone-replacement-therapy-day-16/My Journey with Bioidentical Hormone Replacement Therapy: Day 16]. Project Jennifer. 2011 April 6.</ref><ref>{{refquote|Typically, BHRT (implants and insertions) is not covered by insurance companies.}} —As stated by [https://web.archive.org/web/20131020113150/http://www.milligansurgicalclinic.com/hormone_therapy_16.html this BHRT clinic].</ref><ref>{{refquote|since BHRT is considered 'alternative therapy', it is usually not covered.}} —[http://sunriseclinics.com/bioidentical-hormones.html Another clinic discussing its own BHRT].</ref> Various BHRT clinics offer price quotes with annual costs of $1660,<ref>See [http://www.biobalancehealth.com/faq/bioidenticalpellet-price-list/ 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.</ref> $2000,<ref>See [http://health.costhelper.com/hormone-replacement-therapy.html#comments this comment] where someone claims they relied on BHRT, learned it wasn't covered by their insurance, and it ended up costing them $2000.</ref> $2400,<ref>BodyLogicMD, which heavily promotes BHRT, [https://www.bodylogicmd.com/faq/if-i-decide-to-start-on-a-bioidentical-hormone-therapy-program-how-much-will-it-cost quotes its cost] at $2400 a year.</ref> even way up at $4200 per year.<ref>Griffon Medical Group, which [https://web.archive.org/web/20051103111731/http://www.griffinmedical.com/index.html specializes in anti-aging and BHRT], flat-out states that it can cost [https://web.archive.org/web/20070218043524/http://www.griffinmedical.com/bhrtcosts.htm up to $350 per month], and that insurance doesn't cover it.</ref> 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,<ref name=ethics/> which practicing medical doctors are supposed to avoid.

Dr. Prudence Hall, a California physician, is one such doctor.<ref>[https://web.archive.org/web/20141012224841/http://store.hallcentervenice.com/dr-prudence-hall Dr. Hall's webpage].</ref> In 2011 she was interviewed by [[Dr. Oz]] on ''[[Oprah Winfrey|Oprah]]'' about BHRT.<ref>From the ''Oprah'' show archives: [http://www.oprah.com/health/Dr-Oz-Talks-with-Dr-Prudence-Hall-About-Bioidenticals Dr. Oz talks with Dr. Prudence Hall, a proponent of bioidentical hormone replacement therapy].</ref> 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.<ref>[https://web.archive.org/web/20141019062949/http://store.hallcentervenice.com/shop/all-products-a-z.html?hcv_gender=5 Dr. Hall's store].</ref>

[[Suzanne Somers]] may not be a doctor but she is a full-blown snake-oil saleswoman and a huge proponent of BHRT.<ref>Deborah Kotz. [http://health.usnews.com/health-news/blogs/on-women/2009/03/25/why-suzanne-somers-loves-bioidentical-hormones Why Suzanne Somers Loves Bioidentical Hormones]. ''U.S. News & World Report''. 2009 March 25.</ref><ref>Barron H. Herner. [http://well.blogs.nytimes.com/2011/02/25/suzanne-somers-cancer-expert/?_r=0 Suzanne Somers, Cancer Expert]. ''New York Times''. 2011 February 25.</ref> She wrote an entire book promoting BHRT as an anti-aging miracle, ''Ageless: The Naked Truth About Bioidentical Hormones''.<ref>Suzanne Somers. ''[https://web.archive.org/web/20150413094032/http://lccn.loc.gov/2006020962 Agless: The Naked Truth About Bioidentical Hormones]''. Crown Publishers, 2006.</ref> She's also a spokesperson for foreverhealth.com, a website that sells supplements and connects patients with doctors who offer BHRT,<ref>[http://www.suzannesomers.com/pages/forever-health Forever Health page] on Somers' website.</ref> in addition to being frequently promoted by fellow crackpot medical businesses like Life Extension.<ref>A [http://search.lef.org/?q=somers search of Life Extension's website] reveals 58 mentions of Somers in their magazine, across 11 years worth of issues.</ref>

== External links ==

*[http://www.more.com/health/perimenopause-menopause/are-natural-hormones-safer Good overview of BHRT] by ''More'' magazine.
*[http://www.more.com/health/wellness/hormone-hoax-thousands-fall-0 Investigative report on BHRT] by ''More'' magazine.

==References==

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