Updated: Jun 8, 2021
Have you ever been to your primary care, endocrinologist or gynecologist’s doctor office for hormonal symptoms? Were you able to get a solution for your symptoms? One of the most troubling things I come across with new patients who seek hormonal treatment is their frustration with having gone to multiple clinicians with no adequate hormonal evaluation. As a clinician that has post residency training in bio-identical hormones, I can confidently attest that bio-identical or natural hormones are not a topic that are thoroughly taught in medical school or residency. More often than not, going to a doctor with no training in BHRT places the patient at a significant disadvantage, as it is commonly thought in traditional medicine that hormonal imbalance during perimenopause or postmenopause is “normal.” Research indicates, however, this may not be true and that women do not need to suffer. The simple answer to why traditional doctors may not be well versed in hormones comes down to two reasons: the economics and politics of medicine.
Take progesterone, as an example. Natural or bio-identical progesterone (meaning the exact chemical structure that your body produces) cannot be patented, as it is considered a natural substance. Synthetic progesterone, however, such as progestins, are chemically altered and bind to the receptors differently, producing an altered effect. Synthetic hormones can be patented. This is a primary reason why pharmaceutical companies do not promote natural hormones. They cannot profit from natural hormones They can, however, profit from synthetic hormones.
Furthermore, many pharmaceutical companies play a significant role in forming medical guidelines. These companies finance the research that develop the guidelines, which are commonly taught throughout medical school and residency. Future doctors are evaluated and tested on their knowledge of these guidelines. Therefore, when a physician graduates residency training, they enter the world of medicine predominantly carrying knowledge that is promoted by pharmaceutical companies. Indeed, much of this knowledge can be incredibly valuable in caring for patients safely and appropriately. However, when it comes to the topic of hormones, specifically natural hormones, there is limited information taught during a clinician’s academic career.
In March of 2019, the FDA approved the medication, Brexanolone. This medication is considered to be a treatment for postpartum depression. Brexanolone is also known as allopregnanolone, which is a metabolite of progesterone. It is a well known fact that following the delivery of the placenta, there is a significant drop in a woman’s progesterone level. This sudden decrease in progesterone may contribute or exacerbate clinical symptoms of postpartum depression. A doctor may prescribe FDA approved Brexanolone to balance the progesterone deficiency at the cost of $34,000 for one infusion. A doctor, however, may unlikely know to prescribe natural or bio-identical progesterone, at the estimated cost of $40-50 per month, which produces the same metabolite that is in Brexanolone.
To further complicate matters, many clinicians who have no formal training in BHRT claim that natural hormones are harmful. Some may claim there is no difference between synthetic and natural hormones. However, countless studies provide evidence regarding the difference between synthetic and natural progesterone. In this study involving 86,881 postmenopausal women, natural progesterone was associated with lower breast cancer risk compared to synthetic progestins. This is a meta-analysis study of postmenopausal women that used progesterone vs. synthetic progestins in combination with oestrogen. The study found that progesterone-oestrogen was associated with a lower risk of breast cancer compared with synthetic progestins. In this study, the use of synthetic progestin had adverse effects on the cardiovascular system by attenuating the benefit of estrogen. Estrogen, playing over 400 functions in the human body, has a significant impact on our cardiovascular health. The study further stated that “natural progesterone seems to be the progestational agent of choice as it avoids the unwanted detrimental effect of synthetic progestins.”
There are countless contributions that traditional doctors and traditional medicine has made with regards to overall patient care. There are advanced screening tools for certain cancers, vaccinations that have eradicated illnesses and medications that aid our body in getting rid of infections. Many traditional clinicians, however, lack sufficient knowledge of hormones and how they play a major role in the well being of a patient as well as prevention of chronic disease. The greatest struggle many patients face is finding a clinician that has post-residency training in BHRT. My hope is that all doctors will eventually become well-versed in the hundreds of studies from around the world that indicate hormones, when given naturally and correctly, can make a remarkable impact on our patients’ lives.
Asi N, Gionfriddo M, Prokop L, et al. “Progesterone vs. synthetic progestins and the risk of breast cancer: a systemic review and meta-analysis.” Systemic Reviews. 2016, Jul.
Rymer, J. “HRT and breast cancer risk.” British Medical Journal. 2019;367:l5928
G M Rosano, C Sarais, S Zoncu, et al. “”The relative effects of progesterone and progestins in hormone replacement therapy.” Human Reproduction. 2000, Jun.