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Bio-Identical Hormones: An Alternatve Choice for Hormone Replacement Therapy
(By Gaye Sandler)

Cindy Sinclair, president of the ICU of Texas (now PURE HOPE), suggested I contact gynecologist Randy Birken for an interview.  Dr. Birken is on the ICU medical advisory board and has spoken at Cindy’s group about the significant improvements he’s seen in patients who are taking bio-identical hormone replacement therapy (BHRT).

Several years ago I tried a compounded estrogen cream from a woman’s pharmacy, but an inactive ingredient, or the type of estrogen, or the prescribed dosage flared my bladder symptoms.  When I called the pharmacy to figure out the problem, they were of little help and absolutely did not want to hear about IC.  What impresses me most about Dr. Birken is how closely and individually he works with his patients, including his IC patients.  In my experience there’s nothing worse than a health care practitioner who only fits you into his or her regime. With that said I’m eager to begin the interview so you and I can learn about BHRT.

Q. What are BHRT?

A.  Bio-identical hormones (BHRT) are molecularly identical to human hormones and are extracted from yams and soy, and are processed by specialized compounding pharmacies.  These substances are protected by federal regulation and may not be patented.

Q. Why are they better for the body than synthetic hormones?

A. Since BHRT are the same as human hormones, they are accepted and metabolized as if our bodies made them, producing effects that are more physiologic rather than therapeutic.  In other words…. the body recognizes these hormones as natural instead of foreign.  Instead of treating a condition with a drug, BHRT are preventative and boost immune responses, as well.  Many researchers believe that BHRT are essential for age management and do not carry conventional synthetic hormones risks.

Q. Are BHRT considered designer hormones?

A. In a way, yes, since I can change the formulation of each hormone dependent on a patient’s needs and blood levels.  This includes prescribing them as micronized tablets, creams, or lozenges to meet each individual’s unique metabolism.

Q. How are BHRT prescribed?

A. With the use of specific blood testing for adrenal, thyroid, as well as reproductive hormones.  Low levels can be restored to normal values leading to more energy and endurance as well as improvement in an overall sense of well-being. 

Q. How do patients feel on BHRT?

A. Patients sleep better, have less moodiness, anxiety, and depression, and experience increased muscle strength and libido.  Since metabolism is checked through blood tests, restoration of thyroid and adrenal hormone aid in weight loss, increase muscle mass, and improve skin texture.

Q. What bio-hormones do you prescribe, other than estrogen and progesterone, to get these good results?

A. Testosterone is an essential hormone for both men and women, producing better skin tone, more energy, as well as improved libido.  Most patients don’t realize that testosterone has a profound effect on mood.  Low levels of testosterone can cause depression.  Many of my patients can stop their anti-depressants/anti-anxiety medication once their levels become normal.*

 *Taking an antidepressant for depression is different than taking a small dose of an antidepressant to control IC symptoms.

 Q. So, do you believe that all post-menopausal women need these three hormones, estrogen, progesterone and testosterone? 

 A. Just about 100% need all three.  Synergistically, they protect against heart disease as well as improve bone and muscle mass.  If a patient has a normal level, I may not prescribe a particular hormone, but women age, and estrogen, progesterone, and testosterone decrease, leading to aging.

Q. I don’t know how IC patients respond to testosterone, but I understand that progesterone thins the bladder lining, and can cause frequency in some women. I have never wanted to try any form of progesterone because of this.  Do you have IC patients who can tolerate bio-identical progesterone?

A. That’s with synthetic progestin, not natural progesterone.  They are two different animals.  All patients prescribed progesterone benefit.

Q. I take a little estrogen and it absolutely helps my bladder, but if I take too much I feel like I’ve had some red wine – the histamines flare-up my bladder symptoms.  I know of IC patients who say they cannot tolerate estrogen, but I think it really depends on so many factors:  the type of estrogen, the inactive ingredients, and the strength.  What do you think?

A. Again, it depends if you’re taking synthetic estrogen or natural estrogen.  Too much synthetic estrogen can upgrade cell receptors and cause a paradoxical effect.  This does not occur with biological estrogen.     

Q. Is it possible to explain what happens when estrogen cell receptors are upgraded and cause a paradoxical effect?

A. Molecular biology is very complex, but in simple terms, each cell has receptors or “ports” on its surface (membrane), or within (cytoplasm), where hormones attach to regulate the cell’s process or processes.  Synthetic hormones are not quite chemically the same as bio-identical ones, therefore sometimes attaching differently to the cell with less effect or creating more sensitive receptors that upgrade them.  Additionally, synthetic hormones stimulate the liver to produce more sex hormone binding globulin (SHBG) which attaches to other hormones, reducing available (free) hormones in the body.

Q. In your article, The Medical Management of Aging: One Physician’s Experience with Bio-identical Hormones, you write about the benefits of bio-identical thyroid.  Many IC patients, as well as fibromyalgia patients, suffer with hypothyroidism and can’t tolerate synthetic thyroid replacement.  I am one.  Many of us must take Armour thyroid which is made from pig’s thyroid.  (I’ve heard of a few patients who cannot tolerate Armour thyroid.)  Doctors, however, usually want their patients to take synthetic thyroid because it’s easier to regulate.

A. Most physicians are taught to use synthetic thyroid based on the principle that the T4 thyroid will convert to T3.   Standard thyroid screening includes a Thyroid Stimulating Hormone (TSH), T4, and T3uptake.  However, to really look at one’s thyroid status, a free T4 and free T3 blood test allows the clinician to check both thyroid levels and determine if someone is low on T3 that can lead to a slower metabolism, fatigue, and sometimes foggy memory.   Looking at the recommended standard thyroid function tests will miss those who don’t have thyroid disease, but who need a “boost” with bio-identical thyroid.  Additionally, while Armour thyroid is inexpensive, a good compounding pharmacy can make bio-identical thyroid from plants and will even change the ratio of T4 to T3 as requested by the physician, further customizing the dosage.  Also, for those who are not allowed to ingest pork products, the bio-identical thyroid is an excellent choice.   While synthetic thyroid is easier to regulate, most patients have no problem adjusting to bio-identical thyroid, especially if taken in the morning as well as early afternoon.

Q. What exactly is bio-identical thyroid made from?

A. BHRT comes from plants, such as soy and yam, and is molecularly engineered into a natural human hormone.   To get a clear picture of one’s hormone levels, estradiol, progesterone, free testosterone, DHEA-sulfate, and TSH, free T4 and free T3 blood  levels are reviewed.  While checking the levels after one month can help “tweak” the  dosage, it’s how the patient feels that is most important. 

 Q. What is DHEA?  Why do you recommend patients take estrogen, progesterone, and testosterone along with thyroid and DHEA?

A. DHEA is short for dehydroepiandrosterone acetate, a real tongue twister.  DHEA is made in the adrenal glands and is the precursor for all hormones.  Patients who take DHEA see improvement in their metabolism, and lower cholesterol levels due to the breakdown of fat.  DHEA can be a mood enhancer as well.

Q. When I began to experience perimenopause I got psoriasis and it has never gone into  remission even with estrogen replacement.  When my mother was told to cut back on her estrogen she broke out with psoriasis.  How might bio-identical hormones help the skin?

A. The first thing I notice when I see a BHRT patient back for her one month follow up is the condition of her skin – radiant and healthy.  While estrogen improves skin collagen, it’s the testosterone that gives the skin its youthful appearance.   Many patients are afraid that taking testosterone will cause hair growth or acne, but that can be a side effect of synthetic, not bio-identical testosterone.

Q. Is it difficult for patients to find a Dr. to do the blood work if they cannot deal with you in person?

A. Unfortunately, most doctors know little about BHRT and what type of blood tests to order, or even how to interpret them.  It is possible to find physicians who know about BHRT by going to the American Academy for Anti-Aging Medicine website (A4M).  I would be happy to do phone consultations with patients if they live too far away.

Q. In your article you mentioned that BHRT is not covered by insurance.  About how much do the hormones and blood work cost?

A. Depends how the lab is coded.  There are some compounding pharmacies that will file with insurance.  An excellent one is Richie’s Pharmacy in Montgomery, TX

Q. My last question may be the most important question for IC patients.  With the realization that there may be no therapeutic benefit, are you willing to let IC patients try a very small amount of one bio-identical hormone at a time?  This is the only way we can determine if there will be an adverse reaction in our bladders.  Even if you don’t think this is necessary, it brings us peace of mind because we are usually so bladder sensitive to traditional hormone replacement, as well as medicines and supplements, etc.   

A. Yes, any way can be customized according to the patients feelings and/or medical condition(s).

Dr. Randy Birken is Clinal Assistant Professor Baylor College of Medicine Fellow, American College of Obstetricians and Gynecologist Fellow, American College of Surgeons.  Dr. Berkin has a practice in Houston, Texas and can be reached at 281-893-1246.

About The Authors:
Gaye is an author and IC patient & support group leader who has been involved in IC work for years. In 1990 she published "Stretch Into a Better Shape" and produced a stretching and exercise video for IC patients in 1993. She is a specialist in Aston-Patterning movement and muscle re-education.

Andrew has over ten years of clinical and health care management position. Andrew holds a Ph.D. in Special Education, a M.A. of Health Adminstration, M.A. of Clinical Psychology.

They welcome your comments and feedback on their articles at: The Sandlers

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