Bioidentical Hormone Replacement Therapy ( BHRT )

Position Statement

Dr. Kathryn Retzler

As a primary care physician who specializes in natural medicine, I think the most important role doctors can play is that of teacher – to provide complete, unbiased information so that patients can make their own informed decisions. Following is a list of facts I provide my patients when they seek help for   hormone imbalance symptoms:

• Many women and men have significant hormone imbalance symptoms as they age.   
• No two people are identical in terms of their hormone production or the symptoms they experience.    
• Eating a healthy diet, exercising regularly, minimizing stress, and avoiding environmental toxins are the natural   foundations for preventing and managing hormone imbalance symptoms.   
• If symptoms persist, bioidentical hormone replacement therapy is an option that contains benefits and risks.   
• People have different medication needs and drug detoxifying capacities. Testing baseline hormone levels and following up with repeat testing after treatment is a reasonable way to determine whether a patient is receiving too much hormone. Symptom improvement usually determines if a patient is receiving enough medication.    
• Synthetic hormones have been shown to have serious health consequences including increased risk of breast cancer, blood clots, heart disease, and stroke. Synthetic oral testosterone has been shown to increase the risk for liver inflammation and liver cancer.    
• When I refer to the term Bioidentical hormones I am referring to the molecular structure of the hormone, not the marketing term. That is, they are identical in structure to those hormones made by the body. There is a large body of research involving the effectiveness of bioidentical estradiol, progesterone, and testosterone. Bioidentical hormones do carry risks, especially when administered in excessive dosages, outside of physiological levels; overall, however, they have a lower risk profile than their synthetic counterparts (this is especially true for bioidentical progesterone vs. progestins, and bioidentical testosterone vs. methyltestosterone). More research about long-term effects of bioidentical hormone replacement therapy needs to be done.  
• "Bioidentical hormones" are found in pharmaceuticals (e.g., bioidentical estradiol patches such as Climara or Vivelle, bioidentical progesterone such as Prometrium, and bioidentical testosterone such as Androderm, Androgel, or Testopel) as well as in individual preparations made by compounding pharmacists.    
• Compounded medications have been available since the 1930s. Organizations such as the Professional Compounding Centers of America (PCCA) provide continuing education seminars for pharmacists and physicians, as well as a source of FDA-approved ingredients subjected to quality assurance standards.    
• Treating hormone imbalance symptoms requires a comprehensive understanding of endocrinology and gynecology, as well as significant clinical experience.   

I also share the following opinions with my patients:

• It makes sense to test baseline hormone production, and then if low levels and/or hormone imbalance symptoms deem necessary, to prescribe low dosages of bioidentical hormones that eliminate or minimize symptoms, or to bring a patient's hormone levels to within physiological range. There is no established protocol for such treatment and potential risks exist; therefore, a conservative approach to treatment is most prudent.    
• Choosing an doctor who listens, provides you with information, natural   and otherwise, and respects your treatment decisions is your right and responsibility. Expect your physician to provide you with available research, benefits, and risks of any treatment you choose. Do not be afraid to question any treatment or to make your own healthcare decisions  

Disclaimer:

We are a holistic longevity medical practice specializing in age management medicine.  We do not prescribe hormones to bodybuilders or anyone looking for isolated improvements in sports performance.

Dr. Retzler only prescribes hormones for established patients. Some hormone imbalance symptoms can be treated without hormone replacement. 

Dr. Retzler believes it is your choice whether or not to replace deficient hormones, and supports you in becoming informed about risks, benefits, and treatment options. As a patient, yearly lab tests and office visits are required to review your current health, BHRT prescription, and new research that may impact your treatment.

NO HORMONES WILL EVER BE PRESCRIBED BY DR. RETZLER WITHOUT AN IN OFFICE VISIT, MEDICAL EVALUATION, TESTING AND A PRESCRIPTION.