General principles:

What are Bioidentical Hormones?

Much confusion exists about the term “bioidentical” . Often the public equates this term with “natural” “herbal “ or “botanical” remedies such as red clover or black cohosh, but this is not the case .

Bioidentical hormones are synthesized in a laboratory , often from plant sources such as yams, but are CHEMICALLY IDENTICAL to human hormones; as opposed to conventional medications for menopause ,in which equine or horse estrogens are used instead of human estrogens (eg Premarin – derived from PREgnant MARe’s urINe); and progesterone-like compounds – progestagens -(eg Provera – medroxyprogesterone acetate) -which are similar, BUT NOT CHEMICALLY IDENTICAL to, human progesterone.

Why is it important to make this distinction?
Transdermal vs Oral Hormones
Measuring levels of Hormones and their Metabolites

The Hormonal Symphony: it’s all about Balance

Hormones secreted by different glands do not work in complete isolation from each other- there are  interactions and interdependent relationships between different systems – by competition for receptor sites, or competition for synthesis along common metabolic pathways.

e.g. A relative  excess of estrogen in the perimenopausal years may oppose the action of thyroid hormones leading to what is known as a functional hypothyroidism – i.e. symptoms of low thyroid activity, despite normal levels of thyroid hormones; or chronic psychological stress can suppress production of sex hormones – as both cortisol (the stress hormone) and testosterone share common precursor compounds.

Some hormones are at opposite ends of circadian rhythms- e.g. cortisol and melatonin are at opposite ends of the sleep-wake cycle; high cortisol secretion at night will suppress melatonin secretion which in turn , can have long term consequences on immune status and overall health (an important phenomenon in shift workers). Poor sleep will affect HGH (growth hormone) production, which in turn , will affect body composition; and weight gain around the middle can lead to insulin resistance etc.

These are only some illustrations of the complexity of the hormonal symphony; as Newton would have put it ..” For every action, there is an equal and opposite reaction..” hence the emphasis in metabolic medicine is  on detecting and correcting hormonal imbalances.

Let’s look at some common scenarios resulting from hormonal  imbalances