Bioidentcal Hormones

Dr David Richardson


What are " Bioidentical Hormones".

Natural human hormones are made from  extracts of soybeans or  the Mexican wild yam dioscora , by adding carbon , oxygen, and hydrogen atoms to a base molecule called diosgenin. The resulting molecule is bio-identical to the human hormone. This means the hormones produced in this manner are exactly  the same hormones present in the human body.  Bio identical hormones that can be made this way are estrone (E1), estrodiol (E2), estriol (E3) , progesterone, the "male" hormone testosterone, and DHEA. The hormones are then mixed together according to the doctors prescription then made into an a troche which dissolves in the mouth, or a  cream.

 Bio Identical hormones can be superior to pharmaceutical hormone preparations, because they are able to be tailored for our own bodies and system, we are able to change their delivery form (oral lozenge or troche, transdermal cream),  & an individual mix is of up to six bioidentical hormones are prescribed for each patient.

I use a combination of the printable symptom chart that you fill in yourself, and initially blood tests to establish which of the 6 main hormones you may be lacking and tailor a troche for you to replace exactly these hormones. Then after 4 weeks and 12 weeks you redo your printable symptom chart to see how your symptoms have improved.

About 6-10 weeks after starting your troches we do a saliva or blood test  which measures all the main hormones to check we have got them in the right range. As hormones fall as we get older we usually aim for hormone levels about 10 - 15 years younger than your chronological age. Most 80 year old women would not enjoy having the hormones of a 19 year old!!!

One of the advantages of bio identical hormones is that they can be assayed, in this way. There is no simple way of measuring synthetic hormone levels like Provera, or the old horse oestrogens like Premarin.

 We can add or subtract any of these components that might not be working well, we can use saliva testing as a companion to therapy to confirm what may or may not be working, and we can change dosage amounts of particular hormones within our prescription. Hormone replacement is not one size fits all, we are all individuals with our own unique chemistry and physiological makeup.

Why every woman's menopause is different?

Female hormones peak at age 24. This corresponds to the time pregnancies have the least complications for both mum and  baby. After this hormone levels slowly decline, and some of the six important female sex hormones decline faster than others altering the all important balance between the hormones. Symptoms are caused not only by the falling level of each hormone, but also by this balance between them.

Menopausal symptoms often start years before periods actually cease. Which symptoms start first  depend on which hormones have declined most quickly in that person, and the relative balance between the remaining hormones.

For example if you become more tired, depressed, irritable and prone to panic  and  decreasing libido it may mean that the "male" hormones have declined first. If you develop PMT in your late thirties or thereafter it may mean that progesterone has declined faster than oestrogen. If hot flushes and dry skin eyes and vagina are the main problem it means oestrogen has declined first.

Every woman's menopause is different. This is why it is so important to individually tailor Natural hormone replacement to your symptoms, and why the "one size fits all" HRT of drug companies is less effective.

Why I Believe Natural HRT is Safer than HRT

Natural hormones are bio identical. This means they only do the things your own hormones do, and they do not do anything that your own hormones do not do. To say NHRT is not safe is to say that females hormones found in every female are not safe. We are replacing apples with apples. This is not the case with HRT.

To minimise symptoms I tailor the NHRT prescription for each woman. This helps maintain the best balance of hormones. This is not the case with HRT.

I use a mix of up to six hormones, all identical to the ones you have had since puberty. HRT uses no more than two often synthetic hormones.

I change the level and balance of the hormones as you get older, to maintain you feeling as good as possible with the smallest dose of natural hormones. This is not the case with HRT.

My philosophy is to use the least amount of the safest natural hormones available.  For women just past the menopause, this often starts with a combination of the two or three main oestrogens, (Biest or Triest) progesterone, testosterone, & DHEA; then as hot flushes and other oestrogen symptoms diminish switching  the Triest to Estriol (the safest oestrogen which is not linked to breast cancer), and the in time phasing out the oestrogen altogether and keeping up the progesterone, testosterone and eventually DHEA alone. This is not the case with HRT.

I believe this gives the best balance of  vitality  & wellbeing,  helps prevents of osteoporosis,  Alzheimers disease, breast, endometrial and ovarian cancer , improves skin, hair, libido and sexual enjoyment  while minimising heart disease and stroke risk. This is not the case with HRT.

Bioidentical HRT Controversy

In Australia for several years controversy has surrounded BHRT. This is led primarily by two or three Professors, who have published articles in many magazines, and have had airtime on radio and television, notably they had a wonderful run on ABC Catalyst. They use Australian Menopause Society  using  strong & emotive phraseology promoting the "perils of BHRT", and this is echoed by the AMA .

Their arguments generally make these points :

1.BHRT has not been tested and women who use it are "guinea pigs". Peer based reviews are lacking

Answer: BHRT has been used in USA since 1982 and possibly before. It has been used in Australia since the early 1990's. Hundreds of thousands of women have used BHRT and despite the best attempts of the above Professors aided by the enormous resources of major drug companies, very few cases of serious side effects or consequences have appeared. Women who use BHRT in my experience are well informed, have researched and read widely on the subject& I feel it is patronising to refer to them as "guinea pigs". Research on drugs is paid for by & large by the enormous multinational drug companies. There is no drug company pushing BHRT, and therefore no source of funds for huge studies, and so few peer based reviews - and those have results at odds with the experiences of the thousands of women who tell of the way BHRT has changed their lives.

2.BHRT is made by Compounding Pharmacists and not major drug companies. They may mix the dose wrongly.

Answer: You should choose a reputable Compounding Pharmacist. We can help you here. The beauty of BHRT is it is tailor made for each woman. By definition something which is tailor made cannot be mass produced. Again the Professors give no credit to the women who use BHRT - if ever a repeat script is mis compounded  changes in symptoms e.g. hot flushes returning, will occur. Women will notice this and very quickly be in contact with the prescribing doctor or the chemist, and the situation can quickly be remedied.

3. Three women have been identified by the professors who have developed endometrial cancer.(MJA article)

Answer: it has been known since the 1960's that using estrogen without progesterone (or adequate progesterone) increases the risk of endometrial cancer. This was discovered because early HRT with horse estrogens caused a minor epidemic in endometrial cancer. In other words all HRT not just BHRT if used without adequate progesterone may increase risk of endometrial cancer. It was the misuse of BHRT caused the endometrial cancer in three women. I repeat this treatment has been used in hundreds of thousands of women for more than 25 years. Again go to someone who knows what they are doing to get your BHRT script, and have regular testing to check your blood levels.

Ultimately each woman must weigh up the risks versus benefits of using any HRT including BHRT and make their own decision

For Reputable doctors opinions supporting BHRT see:

Dr Christiana Nothrop

Dr Seema Patel -Video link

What are "troches"?

Troches are lozenges made by the compounding pharmacist which contain the natural hormones in a special base. They are scored into quarters on the underside and are easily cut along the scores with a sharp kitchen knife. The usual dose is 1/4 or 1/2 troche twice daily.

Divide your dose into two and place it into the pouch of your cheek alongside the upper or lower gum, one piece on each side.

Troches take up to 35 minutes to dissolve. They dissolve more quickly if you have had a hot drink shortly before placing it in the mouth. The hormones are absorbed directly into the blood stream from the lining of the mouth

You can talk and carry on as normal while having the troche which are totally unobtrusive.

Don't eat with the troche in the mouth or it will be wasted. Do not go to sleep with the troche because it may not dissolve.