Talk:Bioidentical hormone replacement therapy

Sources

Cirigliano quotes:

“ Pharmaceutical companies are bound to observe these restrictions in making claims concerning the efficacy or safety of their products, whereas compounding pharmacies are not even bound to disclose class warnings associated with estrogens (black box warnings). Responsible claims cannot be made about the superiority of any route or form of estrogen regarding either efficacy or safety. This is a clear problem, as unsubstantiated claims concerning BHT have been made in the past, including that BHT has few or no associated AEs, decreased risk of breast cancer ”

“ Estradiol, CE, and ethinyl estradiol (EE) (bioidentical, natural, and synthetic, respectively), all appear to offer similar benefits and harms, with none faring better or worse than the others.34 The one caveat is that head-to-head comparisons of different estrogens are lacking because most studies involved comparisons with different coadministered progestogens. This recognized need should serve as impetus for further clinical trials. Nevertheless, there appears to be little sound scientific rationale or support for the most common mixture of ratios of estrogens in biest and triest or for any other customized ratios based on sera levels, as there are no sensible means of monitoring or ensuring that they are maintained (from hour to hour and day to day), and, most importantly, there is no proven physiological benefit in doing so. Although estrogen levels decrease during menopause due to loss of ovarian function, estrogen clearance rates are not significantly changed.128 The simple use of either estradiol or estrone will cause elevated levels of estriol.124 The addition of further estrogen metabolites (estrone and estriol) in an ad hoc compounded mixture containing estradiol, based on saliva or sera estrogen levels, in an effort to provide a theoretical ideal ratio seems futile because the exogenous estradiol and estrone fractions are subject to metabolism at different rates.32,129 It would make more sense to provide sufficient amounts of estradiol alone and then allow the woman’s own metabolism to provide for the other estrogens. Therefore, the claim that no pharmaceutically manufactured product mimics the body’s production of estrogens other than such compounded products as triest and biest74 not only is unproven but also is highly unlikely to be the case. (Cirigliano) ”

• [1]
• [2] - single paragraph mention arguing against compounded products and for FDA-approved, but not for bioidentical hormones in general
• [3]
• [4]
• [5] - single paragraph, notes a lack of large clinical trials, argues for FDA approved versions
• [6] - single mention from 2005, stated no evidence for efficacy or adverse effects
• [7]
• [8]
• [9] Saskatchewan’s Academic Detailing Program
• [10] (membership required)
• [11] (membership required)
• [12] (membership required)
• [13] (membership required)
• [14] (membership required)
• [15] (membership required)
• [16] (membership required)
• [17] (membership required)
• [18]

I've requested the following from TimVickers. I've struck through the ones I got, and am trying to find the rest.

• Curcio JJ, Wollner DA, Schmidt JW, Kim LS. "Is Bio-Identical Hormone Replacement Therapy Safer than Traditional Hormone Replacement Therapy?: A Critical Appraisal of Cardiovascular Risks in Menopausal Women." Treat Endocrinol. 2006;5(6):367-374. PMID 17107222
• Cicinelli E "Bioidentical estradiol gel for hormone therapy in menopause." Expert Review of Obstretrics and Gynecology, Volume 2, Number 4, July 2007 , pp. 423-430(8) PMID 17107222
• Lam Po M, Cheung GWY, Shek DT, Lee DTS, et al. "Bioidentical hormone therapy: a review." Menopause 2004;11(3):356-67.(erroneous citation number 15 seen in this paper intended to cite Boothby et al?
• Boothby LA, Doering PL, Kipersztok S. "Bioidentical hormone therapy: a review" Menopause, 2004;11(3):356-67. PMID 15167316

or possibly intended as another paper from the same issue,

• Lam PM, Cheung GW, Shek DT, Lee DT, Haines CJ, Chung TK. "A randomized, placebocontrolled, crossover study of tibolone (Livial) on menopause symptoms, psychological wellbeing, and dyadic relationship of postmenopausal Chinese women and their spouses." Menopause. 2004;11(4):416–422. PMID 15243279
• Roush, K "Menopausal Hormone Therapy: What We Know Now" American Journal of Nursing. 2011, 111 (6), p. 38-47. PMID 21613919, doi: 10.1097/01.NAJ.0000398539.52283.55, link
• Pharmacology for Women's Health. Jones & Bartlett Learning. 2009. pp. 377. ISBN 0763753297. {{cite book}}: Unknown parameter |authors= ignored (help)
• Osteoporosis: clinical guidelines for prevention, diagnosis, and management. Springer Publishing Company. 2008. pp. 115. ISBN 082610276X. {{cite book}}: Unknown parameter |authors= ignored (help)
• One hundred questions and answers about breast cancer sensuality, sexuality, and intimacy. Jones & Bartlett Learning. 2010. pp. 72. ISBN 0763779091. {{cite book}}: Unknown parameter |authors= ignored (help)
• Karen Roush (2010). What Nurses Know ... Menopause. Demos Medical Publishing. pp. 141. ISBN 1932603867.

Slightly more dubious sources

• [19]
• [20]
• [21] ABC News
• [22] Public Citizen is also critical
• [23] WorstPills.org
• [24] EssentialDrugs.org
• [25] Skeptic's magazine
• [26] Quackwatch's stance.
• [27] CTV news
• [28] CBC news viewpoint article
• [29] Winnipeg Free Press

Fun article on Oprah and BHRT [30]. Not sure where to use it. WLU (t) (c) Wikipedia's rules:^simple/_complex

More recent ones

• PMID 21486160
• [31]
• [32]
• [33]

Bioidentical Hormones vs. Synthetic Hormones

Kent Holtorf, M.D., review of the medical literature demonstrating how natural hormones are superior to their synthetic counterparts. The conclusion is clear that bio-identical hormones are a safe alternative to Premarin and medroxyprogesterone acelate (MPA), marketed as Provera. The natural bio-identical hormones are very different from their synthetic versions, often having completely opposite physical and cellular effects. It is critical that women be given the information that these natural hormones do not have the negative side effects of the synthetic hormones and in no way pertain to the conclusions reached by the Women's Health Initiative (WHI) study. Natural hormones are a safe and more conservative approach to hormone replacement therapy that does not carry the risks associated with Premarin and Provera. Premarin is made from pregnant horses' urine, hence it's name Pre (pregnant)-mar (horse)- in (urine). It consists of a combination of conjugated equine (horse) estrogens that are more potent and more carcinogenic than other natural estrogens such as estradiol and especially estriol. Postgraduate Medical Journal, a leading peer-reviewed publication for practicing clinicians, showed that non-synthetic or bioidentical HRT are associated with reduced health risks and are more efficacious than their synthetic counterparts. Conducted by a leading expert in hormone replacement, Kent Holtorf, M.D., medical director of Holtorf Medical Group Center for Hormone Imbalance, Hypothyroidism and Fatigue, in Torrance, California, the paper reviewed and evaluated results from more than 200 physiological and clinical studies. The review also showed that patients taking bioidentical HRT were less likely to experience sleep problems, anxiety, depression and cognitive effects - common side effects of synthetic HRT. — Preceding unsigned comment added by 2602:306:BD3A:5AF0:E97F:5010:A55B:505E (talk) 22:09, 29 June 2015 (UTC)

Sure, but there are lots of other sources and consensus statements showing that Holtorf's claims are spurious. We don't give undue weight to one practitioner whose practice is centered around prescribing bioidentical hormones. WLU (t) (c) Wikipedia's rules:^simple/_complex 23:17, 16 November 2015 (UTC)

Neither of you actually cite any article. If Holtorf's purported review exists, that would potentially be very strong, certainly far above "one practitioner's findings". I visited https://holtorfmed.com/what-we-treat and you could hardly call that "centered around prescribing ... hormones", though I get bad vibes from the glitzy site in any case and would not trust my body to any of their services. The present wikipedia article is in a dreadful state, dominated by voices opposed to the therapy in question, but as a quick check I looked at one citation, "The American Cancer Society also stated that "natural" and "bioidentical" hormones present the same risks as synthetic hormone replacement therapy such as heart disease, blood clots, strokes and an increased risk of breast cancer with long-term use.[52]" The reference is not to a PDF, but the (unscholarly) PDF linked from the referenced page (https://www.cancer.org/content/dam/CRC/PDF/Public/8579.00.pdf) makes no mention of "bioidentical" anywhere, and the only occurrences of "natural" are in the phrase "natural environment". I'm not surprised by the crap citation. I bet most of the citations are bogus or off-topic. Some unbiased, competent editor with a real interest in this subject needs to start from scratch. Also concerning the (potentially valuable) table comparing claims from the pro/con side, not a single entry on either side has a corresponding citation. Pathetic! At the end of the day, I hope anyone will begin with the sensible belief that (human) bioidentical hormones will be as safe or safer than foreign hormones from other species, or than synthetics, barring actual verifiable proofs to the contrary. Saegeas (talk) 03:14, 8 May 2021 (UTC)

External links modified

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• Added archive https://web.archive.org/web/20110106211914/http://www.solaltech.com/doctors/3/HOT%20OFF%20THE%20PRESS%20Premarin-The_Intriguing_History_of_a_Controversial_Drug.pdf to http://www.solaltech.com/doctors/3/HOT%20OFF%20THE%20PRESS%20Premarin-The_Intriguing_History_of_a_Controversial_Drug.pdf
• Added archive https://web.archive.org/web/20091126113646/http://www.fda.gov/Drugs/GuidanceComplianceRegulatoryInformation/PharmacyCompounding/ucm183088.htm to http://www.fda.gov/Drugs/GuidanceComplianceRegulatoryInformation/PharmacyCompounding/ucm183088.htm
• Added archive https://web.archive.org/web/20091128035645/http://www.endo-society.org/advocacy/policy/upload/BH_Position_Statement_final_10_25_06_w_Header.pdf to http://www.endo-society.org/advocacy/policy/upload/BH_Position_Statement_final_10_25_06_w_Header.pdf
• Added archive https://web.archive.org/web/20110716070523/http://www.sigmamenopause.com/pdf/Derzko_BHT-Oct09.pdf to http://www.sigmamenopause.com/pdf/Derzko_BHT-Oct09.pdf
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Semi-protected edit request on 24 November 2021

Change "A number of claims by some proponents of bioidentical hormone replacement therapy have not been definitively established through scientific testing." to "A number of claims by some proponents of bioidentical hormone replacement therapy have not been confirmed through scientific testing." Simonemcgill (talk) 21:39, 24 November 2021 (UTC)

 Done - agree that this is clearer. PianoDan (talk) 22:23, 24 November 2021 (UTC)

Semi-protected edit request on 16 January 2022

Hello there. I am Deborah Moskowitz and I did not use the word "superior" in my review article on Bio-Identical Hormones. That is an extrapolation I did not make. Will you please correct. 2603:7081:7000:CAF3:78E0:D0F:173D:EA97 (talk) 16:59, 16 January 2022 (UTC)

 Partly done: Skimming through the article it does seem to be the case that it only suggests that some forms of bioidentical HRT might be safer, and I've edited the article to reflect this. However, as I mentioned in my edit log, I am not a pharmacologist, so I would appreciate if another editor could look this over for me. Uberlyuber (talk) 20:35, 17 January 2022 (UTC)