Natural Hormone Replacement Therapy

Part II

by Michael B. Schachter, M.D., C.N.S., F.A.C.A.M.

    There is a big difference between natural hormone replacement therapy, which consists of hormones that are identical to those produced in the body (bio-identical hormones), and synthetic hormones that are similar, but not identical.  

    Most conventional physicians do not distinguish between the two types and recommend synthetic hormones like medroxyprogesterone (Provera).  However the differences between them are seen clearly in a woman who is having miscarriages early in pregnancy.  Fertility specialists frequently recommend natural progesterone as soon as the woman becomes aware that she is pregnant.  Progesterone helps to protect the pregnancy and increases the chances of a normal child.  On the other hand, all of the synthetic progestins like Provera are absolutely forbidden during pregnancy because they cause birth defects.  This glaring difference between the two helps to underscore the many other differences between natural progesterone and synthetic progestins.  So, whenever I recommend hormone replacement therapy, I prescribe natural progesterone.

    When it comes to estrogens, the body produces three types, namely estrone, estradiol and estriol.  The first two tend to be stronger and also tend to be associated with a greater cancer risk.  Estriol tends to be weaker and seems to be less associated with cancer risk.  When prescribing estrogen replacement, I prescribe a preparation that is high in estriol and relatively lower in estradiol or estradiol and estrone.  Combining these natural estrogens with natural progesterone and titrating the dosage to the needs of the women may achieve excellent therapeutic effects with little to no side effects and with little apparent risk for cancer.

    A third hormone prescribed for women is natural testosterone (not the synthetic methyl testosterone).  This hormone is particularly helpful when a woman suffers form a low sexual drive, fatigue, weakness, and thin bones.  Testosterone can drastically improve quality of life and many physiologic functions.  Dosages used in women are much smaller than those used in men suffering from testosterone deficiency.

    Natural hormones may be administered either by applying them to the skin (as patches or creams) or in special capsules that can be taken by mouth.  Generally, the kinds that I prescribe are most available from compounding pharmacies that prepare or compound the prescription according to the doctor's instructions.  Dosage adjustments are made depending upon the clinical response and the results of laboratory testing.  I have found that measuring saliva levels of the natural hormones is more useful than measuring blood levels.

© 2001 Michael B. Schachter, M.D.