BHRT Safety First by Joseph J. Collins, RN, ND
One of the fundamental precepts of healthcare is “primum non nocere” (first do no harm), which is why so many clinicians feel more comfortable using bioidentical hormone replacement instead of hormones that do not exist in nature or are concentrated from horse urine. But switching to bioidentical hormone replacement therapy (BHRT) is not enough. In order to maintain that goal, a very thorough patient history, family history must be done to assess for risk of cancer. In addition appropriate physical evaluations must be performed.

For women this means PAP exam, and breast exam and/or mammography. For men, a prostate exam is required.

Don’t underestimate the importance of family history – by which I of course mean genetically related family. 

Diabetes in the family is associated with increased risk of PCOS in women; and there is a correlation between prostate diseases in men of the family with breast cancer in women of the family. 

Baseline lab should of course include CBC, lipids and chemistry panel. Anemia still occurs in this society, and must be ruled out before investigating adrenal or thyroid problems as a cause of fatigue. Out of range lipid profiles may indicate that diet and liver function need more attention. Adding magnesium and amylase to the basic metabolic panel keeps a closer eye on the mineral profile, as well as the pancreas. More detail is given on hormone testing in another section of this series. 

Beyond the baseline lab test, physical exams, and family histories, there are specific practices that that can be done to ensure that BHRT stays safe and effective. 

These practice include; addressing foundational health before BHRT, using the lowest possible dosages, and the proper administration and monitoring of BHRT. 

Next: BHRT Should Be Done Last