Bioidentical hormones have been shown to decrease and prevent the risk of Alzheimer’s, osteoporosis and heart disease, which parallels the increased risk that comes with aging. Should you be offering HRT to your patients?
Beverly Hills, Calif., dermatologist Ronald Moy, M.D., says that bioidentical hormones have been shown to decrease and prevent the risk of Alzheimer’s, osteoporosis and heart disease, which parallels the increased risk of heart disease that comes with aging.
In general, the treatment goal with bioidentical hormone treatment is to get patients to where they should be optimally - not to over or under treat, according to Dr. Moy.
Dr. Moy says he focuses on taking baseline blood tests for levels of all the hormones and then prescribing based on blood tests and symptoms.
“Many women are perimenopausal or postmenopausal and their levels will be low,” he says. “I try to get their levels to the high end of normal, or what we term ‘optimal.’ Their thyroid free T3 might be 2.4 and they need to get it up to 4.2. If they get it up, they feel better. Or the free testosterone is the low end of normal and if they get it up to the higher end of normal, they all of the sudden get in a better mood, have better skin, energy and libido. Obviously, you have to interpret everything within the context of the patient, as adjustment is made by many factors.”
Treating patients with bioidentical hormones is not conventional dermatology but is a part of dermatology practice, according to Dr. Moy. The addition of BHRT has been the most beneficial of all other treatments that Dr. Moy offers.
“It’s an area where most endocrinologists aren’t doing much, and most ob-gyns aren’t focused on all of the hormones nor do they understand the concept of optimizing levels. It’s sort of an unmet need, and I think that’s one reason it has become so common in my practice and so well embraced by so many patients,” Dr. Moy says.
Hormones are also beneficial to men. Dr. Moy recommends hormones for his male patients, too, and encourages women to refer their spouses for hormone replacement.
A Question of HRT Risk
Researchers of the Dermatology Online Journal review report bioidentical hormone replacement therapies are associated with dermatologic adverse effects. For example, testosterone is associated with acne, hirsutism and facial hair growth. DHEA might increase risk for skin pigmentation, increase skin oiliness, perspiration and more. And some treatments, including estrogen with or without progesterone, can cause localized allergic reactions if given in patch form. However, the side effects are rare and easily remedied by dosage adjustment, according to Dr. Moy.
Here is where the expertise of the practitioner is key. Dr. Moy adjusts the dose by monitoring therapy and serum levels.
Patients are often concerned that taking bioidentical hormones will increase their cancer risk, but that’s not what studies have shown, according to Dr. Moy.
“For estrogen, for example, there are some 40 articles to show there is no increased risk with bioidentical estradiol and progesterone in contrast to synthetic hormones that I do not recommend. I could show you that if there was an increased risk, it’s from the synthetic or non-bioidentical hormones, like Premarin (Pfizer) and Provera,” he says.
Premarin, a synthetic estrogen, carries a black box warning suggesting estrogen therapy alone can increase risk of endometrial cancer, stroke, deep vein thrombosis and possibly dementia in post-menopausal women and should not be used to prevent heart disease or dementia. There is no good evidence that the bioidentical hormones that are identical to the ones in humans carry increase cancer risk, according to Dr. Moy. That includes estradiol, progesterone, testosterone and DHEA.
Dr. Moy says he trained under Neal Rouzier, M.D., who offers bioidentical hormone treatment courses for physicians and wrote a book on the topic. Worldlink hormone training courses can be viewed at WorldlinkMedical.com.