Aging men and women today are faced with a dilemma. Television, magazines, and the Internet have ensured that the baby boomer generation and others are well aware of the consequences of menopause and the male equivalent labeled “andropause.” While women are warned of the risks of osteoporosis, which is a frequent consequence of postmenopausal estrogen deficiency, men are urged to seek testosterone replacement as a panacea for the depressing consequences of “Low T.” Yet when men and women take their concerns to their family practitioner and ask about being prescribed the needed hormones, their requests are often met with ignorance, skepticism or even open hostility.
The wide dissemination of information in our era has extended to peer-reviewed articles from medical journals that report the latest studies. The highly publicized outcome of the Women's Health Initiative in 2002, which associated non-bioidentical hormone replacement therapy with an increased risk of breast cancer, resulted in a knee-jerk reaction by millions of women and their practitioners that caused them to abandon any form of hormone replacement therapy. And now, more than a decade later when the interpretation of the WHI has been called into question, many practitioners are still afraid of the consequences of hormone replacement for menopausal women. For men, the situation may not be much better since testosterone is often associated with body building and athletic performance enhancement.
Despite the fact that bioidentical hormones (which, as the name implies, are chemically identical to those produced in abundance during our younger years) have been available by prescription from compounding pharmacies for years, many practitioners remain unaware of their existence or assert that they are the same as synthetic hormones such as Provera®. However, unlike Premarin® or synthetic hormones that are associated with significant risks, bioidentical hormones carry a much lower risk of adverse effects and actually may confer numerous benefits.
It is often the practitioner interested in preventive medicine who seeks to educate himself or herself in the field of bioidentical hormone replacement therapy (BHRT). Every year, numerous courses and seminars are offered worldwide to provide practitioners with the necessary training to evaluate their patients' hormone status and prescribe the appropriate bioidentical hormones. This requires ongoing monitoring of their patients' hormone status to confirm the correct treatment dose, which may require periodic adjustment to achieve the best effects. A BHRT specialist also needs to be aware of the often complex interaction between numerous hormones and the best way to achieve their ideal balance.
How do you know you've got the right doctor? While a practitioner's knowledge is paramount, willingness to listen and help are equally important. Your practitioner should obtain a detailed medical history, ask about current conditions and symptoms, and be made aware of any allergies you have or medications you are currently taking. He or she should also inquire about family history of disease, as some individuals at risk for hormonally driven cancers or other conditions might not benefit from hormone replacement therapy. A full explanation of any potential risks associated with the hormone or hormones prescribed should be disclosed to every patient prior to embarking on any hormone replacement regimen.
Your BHRT specialist should also advise you of the other elements involved in combating the adverse effects of hormone deficiencies. For example, while bioidentical estradiol or progesterone could aid in the prevention of osteoporosis, sufficient exercise, calcium, magnesium, and vitamins D and K are also important.
Your practitioner should be your partner on your journey to a longer and healthier life. Today's informed patients should not be seen as a threat to a practitioner's authority. Rather, they should be congratulated for their willingness to take an active role in their own health, so that they may remain independent and maintain a productive role in society. While BHRT may help many men and women extend the healthy portion of their lives, only a practitioner familiar with bioidentical hormones can confirm whether this therapy is right for you.
As with any healthcare service provider, a patient should conduct his or her own evaluation of a potential BHRT Practitioner and receive full disclosure on available services and fees in advance of treatment.