The decision to treat a patient with bioidentical (natural) hormone therapy (BHRT) is like any other decision to treat a patient or not treat a patient with medication. It does not matter whether the patient is young or elderly, diseased or healthy. It does not matter if a drug used is intravenous or oral tablets, and it does not matter if it is synthetic or natural. The only real consideration is that the doctor and patient understand the risks, benefits, and alternatives to this intervention.
Consider that an antidepressant medication can be shown in five consecutive studies to NOT have demonstrated safety and efficacy compared to placebo. A sixth study that shows efficacy and safety is all that may be required for the drug to become FDA-approved for clinical treatment of depression. So, historically there has been a lot of latitude given to physicians to determine whether treatment is appropriate. The important matter is that the physician uses all the data currently available to guide this decision process. Historically, there have been antidepressant medications deemed “safe and effective” whose use has been curtailed dramatically when further studies have indicated increased risk of suicide. In this case physicians have not discontinued the use altogether, they have just considered this new data in the analysis of risk, benefits, and alternatives.
The consideration for treatment with bioidentical hormones is exactly the same as any other medical treatment. There have been a multitude of studies which associate normal or optimal levels of particular hormones with a lower risk for cancer, cardiovascular and other disease. As with any other interventions, there are risks that also must be considered. It is well recognized that patients who undergo hormone replacement (synthetic or bioidentical) often times feel much better. Although this is an important consideration, the improvement of overall long-term health is the primary focus. Some patients report a restoration of a quality-of-life that was unimaginable, while others simply report maintenance of normal functionality. Some physicians look at the available data and, while they acknowledge improved symptoms, do not believe that certain health risks are outweighed by the benefits. Other physicians look at the same data and conclude that for many individuals the health benefits clearly outweigh the risks.
Not all of our patients are candidates for full BHRT treatment. Our experience reveals that for those that are, about a third do not see a big difference in how they feel. For these patients half continue BHRT, even though they know they might be giving up the benefit of disease risk reductions. One third of our patients have significant improvement in their sense of well being, and the majority of these patients plan to continue BHRT for a lifetime. The final third of our patients are restored to a level of function that they previously had only hoped for and not thought possible. This group is elated to have found a diagnosis and treatment that restores quality of life. Physicians across all specialties are beginning to acknowledge many of these treatment successes. It reminds us of why we entered medicine to begin with: to prevent disease and to make an impact on the lives of our patients.