Proper Use of Bioidentical Hormone Replacement Therapy by Joseph J Collins, RN, ND 

Conclusions:

This is the concluding article in the series of short articles on Bioidentical Hormone Replacement Therapy. It is appropriately titled “Proper Use of Bioidentical Hormones Replacement Therapy” to make one final point: We must actively avoid any inclination for “one-size-fits-all” healthcare. 

One of the greatest advantages of bioidentical hormone replacement therapy is that is allows for – or rather requires - significant personalization and customization based on dosage and delivery system. That is something that everyone using compounded BHRT appears to agree upon. 

And this focus on personalized healthcare needs to be the predominant effort of BHRT. We need to recognize that statements such as “everyone needs progesterone supplementation” are as inappropriate as “everyone needs estrogen replacement”. And this need for personalization must extend beyond BHRT. Because if we truly realize that BHRT Should be Done Last, then we will encourage men and women to first address the Foundations of Hormone Health and other Hormone Health Guidelines. The inspiration to write the mainstream medicine error of one-size-fits-all-hormone-combinations (such as prempro) and the alternative medicine error of one-size-fits-all-herbal-combinations (what I call “herbal prempro”) as well as the alternative medicine error of “everyone needs progesterone cream”. 

So, what is the “Proper” use of BHRT? It is using BHRT as part of a program that includes lifestyle, diet, the judicious use of nutritional, herbal support, and precursors as appropriate, and then the proper dosage and form of BHRT. 

It is good to always be mindful of this point:

• If we prescribe BHRT to a patient who is dehydrated, constipated, sleep deprived, dysbiotic, poorly detoxified and nutritionally imbalanced – then all we have is a dehydrated, constipated, sleep deprived, dysbiotic, poorly detoxified and nutritionally imbalanced patient on hormones. 

Thankfully, more and more clinicians agree on personalization of healthcare. However, it appears we will continue to see some subtle variations on how BHRT is prescribed. We need to be honest about the fact that some of the variations are market driven; such as the aggressive marketing of single day sex hormone saliva tests or the aggressive marketing of over the counter progesterone creams. Other variations are based on misguided tradition; such as measuring TSH to assess the function of thyroid hormones (T3 & T4), or the rotation of topical BHRT application, or the application of topical BHRT close to breast tissue.

I am sure we all wish that someone had questioned the validity (and sanity) of giving women hormones concentrated from horse urine before we saw the deaths and suffering that resulted. If we give serious thought to the points and questions raised in this series of short articles on bioidentical hormone replacement therapy, we  may avoid some troubling revelations in years to come.