Bioidentical Hormone Replacement Therapy (BHRT)

Town & Country Compounding Resources

What is BHRT?

BHRT
Risks

Who Benefits?

Common Hormones

BHRT
Dosage

BHRT Side Effects

What is BHRT? Bioidentical vs Synthetic Hormone?

Bioidentical hormones can be derived from plant substances such as soy or yam, and are natural in the sense that they are formulated in the lab to be biologically identical in molecular and chemical structure and function to hormones produced by the human body. Our body recognizes these bioidentical hormones as its own.
Synthetic hormones are synthesized to mimic innate hormones, but with slightly different chemical structures for convenience of pharmaceutical dosing and patentability by the pharmaceutical manufacturer. Synthetic hormones are not the same as the naturally-produced human hormones and often have unintended side effects.

The pharmacists at Town and Country Compounding are available to discuss with you or your physician your options for bioidentical hormone replacement therapy.

Women’s Hormone Therapy

Men’s Testosterone Replacement

Hormone Production Naturally Declines with Age (Left: Women, Right: Women & Men)

Is Hormone Therapy Risky?

In 1991, Women’s Health Initiative (WHI) study was done to research how common diseases such as cardiovascular disease, breast cancer, colorectal cancer, and osteoporosis affect women after menopause.
In 2002, results showed that post-menopausal women taking combination estrogen and progestin (progestin is not progesterone) hormone therapy for menopause symptoms had an increased risk for breast cancer, heart disease, stroke, blood clots, and urinary incontinence.
This study has raised concerns about hormone therapy. However, it focused on commercially available synthetic estrogen and progestin therapy. It failed to consider the inherent weaknesses of synthetic estrogens and that the age of the subjects predisposed them to such risks.

In 2004, this part of the study was closed down. The press release announced that: “After careful consideration of the data, NIH has concluded that with an average of nearly 7 years of follow-up completed, estrogen alone does not appear to affect (either increase or decrease) heart disease, a key question of the study. It has not increased the risk of breast cancer during the period of the study.”
The misconception that “hormone therapy causes cancer” was caused by this particular study and this does not apply to bioidentical hormones. In fact, it does the opposite. Some studies show that bioidentical hormones may protect the human body from cancers, prevent osteoporosis, and prevent/improve cardiovascular diseases.

Who Can Benefit from BHRT?

Menopausal or perimenopausal (time during which human body makes natural transition to menopause) women
Premenopausal women with hormone imbalance or conditions such as premenstrual syndrome (PMS), polycystic ovary syndrome (PCOS), infertility, migraines, premenstrual dysphoric disorder (PMDD) and more
Men with hormone imbalance

Potential Benefits of BHRT as Shown in Studies

Prevent osteoporosis and restore bone strength
Reduce incidents of hot flashes
Reduce vaginal dryness/thinning
Better maintenance of muscle mass and strength
Prevent heart disease and stroke
Improve cholesterol levels
Reduce the risk of endometrial cancer and breast cancer

Reduce the risk of depression
Improve sleep quality and mood
Improve concentration, memory, mental acuity
Prevent Alzheimer’s disease
Improve energy levels
Improve sex drive

Common Hormones

ESTROGEN

Simply, anyone who has signs of estrogen deficiency may start estrogen replacement.
3 main types of estrogens produced in our bodies:
- Estrone (E1)
- Estradiol (E2): used topically, vaginally, or orally
- Estriol (E3): often in vaginal creams alone & commonly in combination with estradiol topically or orally
- Bi-est: a combination of estriol and estradiol
- Tri-est: a combination of estriol, estradiol, and estrone

Potential positive effects of estrogen:
- Improve cognition/insomnia and prevent Alzheimer’s disease
- Improve vaginal dryness/atrophy
- Prevent heart disease/stroke
- Prevent osteoporosis
- Improve skin

PROGESTERONE

NOTE: Balancing levels of estrogen and progesterone are important, therefore commonly taken together
In menopause, women’s bodies barely make any progesterone as opposed to estrogen that does still get produced although less.
Recommended to take at bedtime
Potential positive effects of progesterone:
- Prevent osteoporosis
- Reduce the risk of heart disease
- Reduce the risk of uterus and breast cancer
- Reduce migraine/swelling especially from PMS
- Reduce the percentage of body fat
- Improve sexual desire
- Improve insomnia

TESTOSTERONE

Used for men AND women
- Men’s testicles primarily make testosterone, therefore it’s a major male hormone.
- Women’s ovaries also make testosterone, though in much smaller amounts.
- Postmenopausal, premenopausal, and perimenopausal women can benefit from testosterone therapy.

Potential positive effects of testosterone in men and women:
- Improve menopausal symptoms
- Improve sexual desire
- Improve cognition/memory
- Improve stamina
- Reduce the risk of heart disease
- Reduce the risk of Alzheimer’s disease
- Reduce the percentage of body fat
- Improve muscle strength and bone density

DHEA (DEHYDROEPIANDROSTERONE)

Most abundant steroid hormone in the body produced by the brain and adrenal cortex
Converts to estrogen, progesterone, and testosterone
Declines with age starting in the late twenties and stress may change levels at any age
Potential positive effects of DHEA:
- Improve energy levels
- Reduce the risk of heart disease
- Reduce cholesterol and percentage of body fat
- Improve memory/cognition
- Improve immune system
- Improve sexual desire

PREGNENOLONE

Synergistic effect in combination with DHEA
Converts to DHEA, estrogen, progesterone, and testosterone
Low level is a possible indicator of stress as it inhibits the production of cortisol.
Potential positive effects of pregnenolone:
- Improve cognition/memory
- Improve mood/anxiety/depression
- Improve sleep
- Reduce the percentage of body fat
- Improve energy level
- Improve skin

OTHER HORMONES

Human growth hormone
Melatonin

Do You Need a Private Consultation?

Schedule a Consultation Today

Available Dosage Forms are Available? Tips for Administration?

Usage of specific dosage forms depends on compliance, type of response desired, and medications involved

ORAL CAPSULES/SUSPENSIONS

Immediate-release capsules
- Compounded to dissolve without delaying or prolonging absorption, therefore the onset of effect is faster. However, it may require multiple doses throughout the day.
Slow-release capsules
- Compounded to dissolve over time in order to be released slower into the bloodstream while having the advantage of being taken at less frequent intervals
Oil-filled capsules
Oral Liquid suspensions
May take with food or right after a meal to prevent stomach upset

TOPICAL CREAMS/GELS

Apply on clean skin, ideally after shower
Apply on slightly fatty skin (not too much and not too little fat). Ideal sites will vary with body types. Common locations are the inside of the upper arm or the inside of the upper thighs (if the thighs are not too heavy).
Rotate application sites
Apply about an area the size of a small plate for topical dose prescribed can cover as much skin as possible
Rub in well for at least one minute
Wash hands after application to prevent possible transfer of hormone to other people or pets

VAGINAL SUPPOSITORIES/CAPSULES/CREAMS/GELS

Commonly used for women with vaginal and lower urinary tract symptoms such as vaginal dryness, painful sexual intercourse, urgency/frequency, and urinary tract infections
Creams/gels:
- Apply on the outside and/or inside genitals
Suppositories/capsules:
- Insert inside genitals

Vaginal suppositories and creams may leak, so recommended to use at bedtime when you are moving less
Vaginal applicators are recommended for intravaginal use
- NOTE: Town and Country does provide patients with vaginal applicators
- Wash your vaginal area and hands with soap and warm water, and dry well with a clean towel
- Best positions to apply are to either lie on your back with your knees bent, or you can stand with your knees bent and your feet a few inches apart
- Gently insert the applicator into vagina as far as it will comfortably go and press the plunger as far as it goes. Then, remove the applicator.
- Applicators are reusable. May wash with soap and warm water.
- Make sure to wash hands right away

SUBLINGUAL/BUCCAL

Sublingual (under the tongue) and buccal (between the gums and the linings of inner cheek pocket) are quickly absorbed into bloodstream and results are felt more immediately
Sublingual liquid drops:
- Use an oral syringe to measure out prescribed liquid amount and instill medication under the tongue and let absorb for a few minutes or as long as possible
Troches:
- Small lozenges designed to dissolve in mouth, not swallowed
- Place in mouth and gently push the troche as deep as it will go between the gum and cheek or under the tongue. Do not swallow or chew. It usually takes between 15-30 minutes for the troche to dissolve.
Rapid dissolve tablets (RDT):
- Designed to dissolve quickly on or under the tongue without water
- Ideal for patients who have difficulty swallowing
For all sublingual/buccal formulations, do not eat or drink for at least 30 minutes after taking medication to allow maximal absorption

INJECTABLES

Usually used for infertility treatments or male hormone replacement
Lasts for a long period of time, therefore less hassle to apply daily or weekly
The cons are pain from injection and difficulty manipulating dosing due to long lasting effect

How are Hormones Dosed?

Generally, your physician will start on low doses and adjust slowly
BHRT is not one-size-fits-all. Every patient is different.
Efficacy can be improved by changing timing of application and/or route of administration

Hormone testing is critical because symptoms of different imbalances overlap. Too much of a hormone can create the same symptoms as too little. Therefore, validating each hormone independently is very important. Regular hormone testing is necessary to review and adjust doses accordingly
Compliance is most important. Do not adjust the dosage without supervision.

Find a Prescriber

T&C Compounding Experts work with providers to educate and inform them of new advancements in treatment options being developed and what might fit their patients’ needs. Submit your info to get a referral to a prescriber in your area.
See if we ship to your state >>

Possible Side Effects/Precautions to Watch Out For?

May occur with improper dosing or imbalance of hormones, however can be resolved with dosage adjustment. Please let your physician or our pharmacists know if you experience any.

Itching/redness at the site of injection or topical application of hormones
Increased facial hair
Tiredness
Spotting
Acne
Cramping
Bloating

Mood swings
Headaches
Breast tenderness
Weight gain
Blurred vision
Indigestion

What to Expect Once Starting the Therapy?

Give at least a month to see how your body adjusts. Don’t give up even if you don’t feel perfect!
It may take multiple dosage adjustments to find the perfect dose. Listen carefully to what your body says!
The symptoms of hormone imbalances can overlap. An above-normal level of one hormone can present the same symptoms as a below-normal level of another. It is important to evaluate all of the hormones to determine which may need adjustment.
If you are premenopausal or perimenopausal, you still have your hormones in addition to the hormone replacement. Your hormones are still constantly changing from month to month and this can also affect how you feel.
Our gut makes hormones and it is responsive to hormones. Hormones help digestion, immune function, metabolism, growth, prevention of disease, and healing. Therefore, what you eat, nutrition and vitamins are very important.

Do you need a private consultation?

Please reach out to us to schedule a consultation!
Call 201-447-2020 or email pharmacist@tccompound.com

DO YOU HAVE A QUESTION FOR A PHARMACIST?