FREQUENTLY ASKED QUESTIONS

Bio-identical (Natural) Hormones: Frequently Asked Questions

Q.  What are bio-identical or natural hormones?
A.   They are hormones identical to those the body produces-and in their physiologic amounts. When we "replace" deficient levels of hormones in the body it makes the best sense to replace the exact hormone that is deficient, not a synthetic, altered version of that hormone. The hormones we most commonly use are Estradiol, Estriol, Progesterone, Testosterone, and DHEA.

Q.   How do I get natural hormones?
A.  Besides low potency progesterone creams that are available over the counter, Bio-Identical hormones must be prescribed by a physician.

Q.   Once I get my prescription where do I get it filled?
A.  Bio-identical hormones are not available at any pharmacy. They are only available at a compounding pharmacy. This is because the ingredients are naturally derived and it is impossible for a manufacturer to obtain a patent on these substances. Without a patent it is unlikely that a manufacturer will go to the expense of obtaining these products for marketing and sales. Therefore, bio-identical hormones must be individually prepared for you by a compounding pharmacist.

Q.  What is a compounding pharmacy?
A.  It is actually one of the oldest types of pharmacies in the world, basically an apothecary with a pharmacist trained in these formulations. They prepare the hormones from pure ingredients on the order of a physician. The pharmacist and physician work closely together to create just the right dosage and strength for you, the patient.

Q.   How do I take bio-identical hormones?
A.  There are many different formulations and methods in which compounded hormones can be made. Each method has advantages for different uses. Most commonly they are prepared as transdermal creams, but can also be formulation in oral forms, suppositories or troches (a type of lozenge).

Q.   Where do bio-identical hormones come from?
A.   The hormones are termed "bio-identical" or "natural" because they are identical to the hormones in the body. They are often derived from natural sources-like soybeans or yams, but this is not universal. They still have to be converted chemically in a lab to create the hormones that are identical and indistinguishable from the body's own.

Q.   Aren't they also "synthetic" if they are made in a lab?
A.   No, bio-identical hormones are natural in the sense that they are biologically identical to the structure and function of the hormones in your body. Other manufactured hormones are considered "synthetic" because they are chemically altered forms of the body's own hormones.

Q.   Will my insurance cover the cost of bio-identical hormones?
A.   These bio-identical hormones are compounded by the pharmacist for each individual patient and are not, therefore, mass-produced like many pharmaceuticals. However, most insurance companies will reimburse a portion of the cost to the patient. It is best to call your insurance company in advance to confirm your specific benefits. Additionally, you may use your flexible spending account to reimburse you for your prescriptions.

Q.  Are bio-identical hormones FDA approved?
A.   The Food and Drug Act of 1938 contains specific information about the approval process, with the expressed intention of not interfering with a doctor's ability to treat his or her patient. "The FDA cannot approve or disprove of how a legally marketed drug is used by a physician in practice. The agency approves of what the manufacturer may recommend about uses in its labeling (package insert) and advertising." (JAMA 1984;252:1054-5). Therefore, the physician has the ultimate responsibility for judging the appropriateness of a medication for his or her patients.

Q.  How will the doctor know what dose to prescribe for me?
A.   Every patient is an individual and therefore treated differently. Every patient undergoes salivary testing to determine their baseline hormone levels. Based on these lab studies (and the patient's medical history and symptoms) an initial dose is prescribed. Doses are then slowly adjusted until the patient's symptoms are under control and their lab studies show them to be at an optimal level. Performing lab tests takes the guesswork out of prescribing hormones and also allows for routine monitoring.