Weighing In on BHRT

As you know, we offer practitioners and women the choice of compounded Bio-Identical Hormone Replacement Therapy (BHRT) at our pharmacies. We don’t go out of our way to market BHRT, but we certainly do not turn down the opportunity to help provide care for our clients.

The controversy over hormones will not be resolved any time soon. The discussion can be separated into two basic ideas: Should we treat or not treat menopause, and should we use synthetic or bio-identical preparations.

There are studies that show that some of the synthetic products cause cancer. Does estrogen (bio-identical) cause cancer? We will not have the definitive answer for decades.I would like to mention we all need hormones to exist. Whatever the hormone of discussion is (be it insulin, thyroid, testosterone, estrogen, progesterone, cortisol or any other choices), the body cannot function without them. We treat conditions that require these hormones with bio-identical preparations! We also know that each hormone can be dangerous if it is given in excess in any situation. Insulin overdose can be fatal quickly. Thyroid excess can kill over time. Testosterone and cortisol excess can cause a numerous range of problems. In order to treat patients using insulin or thyroid, lab values are taken and analyzed, and treatment adjusted. Treatment for BHRT should be monitored and adjusted in the same way.

The critics statements on BHRT often cite the lack of studies. This argument is at best naïve and at worst disingenuous. There is a wealth of data on BHRT. One just needs to look for it. It is just that simple. In addition, many of these critics have a direct relationship with entities that would benefit from fewer hormone therapy choices. Others will argue that there is no quality in compounding because the FDA is not involved in it. This implies that everything is perfect only if the governement has a hand in it. As we all know, there are drug recalls for a variety of reasons all of the time, illustrating that neither the manufacturing process or compounding is perfect.

In conclusion, I would say if BHRT by compounded pharmacies was not effective, or was of poor quality (a view which flies in the face of reams of data), thousands of women over the last decade would not have choosen (or continued) this therapy.


Richard B. Moon, PharmD, RPh, FIACP