Ask Dr. Rosensweet – Which Hormonal Treatments are Best?

I’m Confused About The Many Hormonal Treatments That Are Promoted. What Are The Best?

Dr. Rosensweet: I’d like to begin by saying that when being thoughtfully treated by a healthcare professional who has special caring for this subject as well as special training in it, there are many approaches and forms of hormones that are beneficial. Since you asked my opinion, and I do have strong opinions, I recommend treatment with compounded bio-identical hormones, prescribed by licensed physicians, nurse practitioners and authorized P.A’s, and dispensed by compounding pharmacies. 

Why Recommend Compounded Bio-identical Hormones?

Dr. Rosensweet: There are several advantages, the most prominent of which is the ability to individualize treatment programs. Women vary significantly one to another as to how much of each of four ovarian hormones  they need, the balance of each hormone with the others, their sensitivity, their ability to absorb, preferences, and more. Dosages and dosage forms vary so much woman-to-woman. This is not an issue for a properly trained provider: there are methods to individualize dosages and balance, and be specific in the prescription. This is the “bread and butter” of compounding pharmacists: they have the tools and expertise to prepare and dispense with great specificity and individuality, the wide variety of dosages and balances called for.

How Are Compounding Pharmacies Regulated?

Dr. Rosensweet: A common retort regarding compounding pharmacies: they are not FDA approved. However they are so intensely regulated by state and federal government that it is challenging to do what they do. And, the bioidentical hormones they dispense are prepared in FDA approved facilities. 

For the vast majority of these pharmacists, (and there are at least 7,500 compounding pharmacies in the USA), they are the ones who love being pharmacists, and get to use the sophisticated and computerized tools now available. The physicians, and there are thousands of them, that go deepest into specializing in this hormonal work, the best of the best choose compounded bioidentical hormone replenishment treatments (cBHRT).

Why Is It Safer to Use Topical Estrogen and Testosterone Preparations?

Dr. Rosensweet: Also to note, it is safest  to use estrogen and testosterone in preparations that you apply to your skin. There are reasons for this. Compounding pharmacists have been preparing these topicals since the 1980’s.  (To be noted, progesterone can also be safely and effectively be taken orally). Estrogen for example, can be taken orally, and there are many oral preparations of it. Yet we learned from birth control pills that rarely, a woman can get a blood clot in her legs, and that blood clot, in rarer instances, can travel to the lungs and potentially cause big problems. This risk of enhanced blood clotting , and for reasons, does not occur with estrogens applied to the skin. Testosterone, sooner or later such an essential part of a treatment program for every menopausal woman, in oral form has risks to injure the liver, and should not be prescribed because of this. There is no need: transdermal testosterone absorbs beautifully.

 Another detail regarding compounding is that the optimal estrogen to be using is a combination of two of the estrogen’s a woman’s ovary produces, estradiol and estriol in a formulation called “Bi-Est.” Estriol is an estrogen that promotes de-proliferation, and thus can be protective in breast health.

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