A practitioner and a pharmacist working in the same building in the Spokane medical district claim that bioidentical hormones are becoming the hormones of choice for women. 

Hormone replacement therapy has become more refined, they say, in the years following the 2002 Women’s Health Initiative study that scared many patients and practitioners off HRT.

Debbie Judd, advanced registered nurse practitioner at The Metabolic Institute, a holistic functional medical practice located at 508 W. Sixth, on the lower South Hill, advocates for balanced hormone replacement therapy.

“There’s no reason for women to suffer with hormonal imbalance,” says Judd, who co-founded The Metabolic Institute with her husband, Dr. Michael Judd, a cardiovascular surgeon who’s now retired.

Judd says she only prescribes bioidentical hormones derived from plants such as soy and yams for hormone replacement therapy. Bioidenticals are more identical to human hormones than hormones synthesized from animal sources, she says.

Pharmacist Erik Nelson, owner of Sixth Avenue Medical Pharmacy, also located in the Sixth Avenue Medical Center building, at 508 W. Sixth, says he’s seen a dramatic increase in orders for compounded bioidentical hormones just since he bought the pharmacy two years ago.

“More and more women are seeking out personalized medicine with compounding and hormones,” Nelson says.

Sixth Avenue Medical Pharmacy is one of a few Spokane pharmacies that specializes in compounding services. Compounding is the preparation of medications customized to meet the needs of individual patients. Medications can be mixed into creams, liquids, or chewable forms rather than conventional pill form.

Medications also can be measured in custom doses and set up in delayed or quick-release forms.

Commercial options for bioidentical hormone therapy replacement are limited, and standard doses often are higher than women need, Nelson asserts.

“Any woman will tell you her body is different,” he says. “They just need to replace hormones with their normal physiological dose.”

Customers are reporting better results anecdotally with custom compounded bioidentical hormone prescriptions than with commercial pharmaceuticals, he claims.

A number of women’s health and medical organizations, including the North American Menopause Society and the Endocrine Society, however, say more study into bioidentical hormones is needed before they can accept such claims.

Despite the growing popularity of bioidentical hormone therapy treatment, the U.S. Food and Drug Administration says that so far, there’s no scientific or medical evidence to show that bioidenticals are safer or more effective than synthetic hormones.

Commercially available bioidentical hormones are approved by the FDA, but compounded medications aren’t subject to oversight by the federal agency, and such individualized formulations aren’t required to have warning labels that come with standardized commercial medicines.

“They’re still drugs,” Nelson says of compounded bioidentical hormones. “Patients have to have a prescription, and we have to follow strict rules and regulations.”

He says some more providers and patients are revisiting hormone replacement therapy, as new data and interpretations of the WHI study are published.

The 2002 study included a set of clinical trials that tracked the effects of hormone therapy on postmenopausal women.

One trial examined the effects of women with a uterus taking estrogen, and another trial included women without a uterus taking a combination of estrogen and progestin.

The estrogen-plus-progestin study found an increased risk of heart attack, stroke, blood clots, and breast cancer.

The estrogen-only study found an increased risk of stroke and blood clots and an unclear effect on breast cancer.

Looking into the WHI data in the years following the study, a common observation is that the average age of participants was beyond menopause age.

Menopause is the point in a woman’s life at which she hasn’t had a menstrual cycle for a year.

Judd says symptoms that women seek relief from, however, can begin a decade or more before menopause. Such perimenopausal symptoms include hot flashes, night sweats, mood swings, depression, insomnia, lack of sexual interest, and migraine headaches.

“The 45- to 55-year-old women I treat tend to be the most symptomatic,” Judd says. “Most women want to get to the root cause of the symptoms. They don’t want to be given a pill to numb them.”

Some women can be on hormone replacement therapy for the rest of their lives.

“In my experience, as patients age, they tend to need lower doses,” she says. “Balance is important. That’s where testing comes in.”

Another common assessment of the WHI study was that the only hormones used by participants were synthetically derived.

Judd asserts synthetic estrogen, progesterone (progestin), and testosterone don’t fit in human receptors the same as bioidenticals.

Synthetics also can be much more potent, and the body metabolizes them slower, potentially allowing a harmful buildup of synthetic hormones, she says.

Bioidenticals match the patient’s own hormone receptors, Judd contends.

It’s important to strike a balance of doses of estrogen with progesterone to counter potential harmful effects of estrogen, even if the patient doesn’t have a uterus, she says.

“Hormone therapy may have some breast cancer risk, especially if they’re out of balance,” she says. 

Judd also looks at a patient’s metabolic pathways, which are series of biochemical reactions that enable cells to convert and absorb certain molecules.

If treatment goes down healthy pathways, it can reduce cancer risk, she asserts.

Also, genetics and lifestyle factors, such as diet, exercise, environment, attitude, and sleep, can have roles in cancer risk.

“It isn’t just about hormones,” she says, although she adds that lifestyle adjustments often can help a patient’s hormone levels improve naturally.

Hormone replacement therapy should regulate rather than boost normal hormone levels, Judd says.

“We always test and monitor, and we never overdose,” she says.

For most patients, Judd prefers to prescribe topically administered hormones rather than oral doses. Oral estrogen, for example, can contribute to elevated liver enzymes, blood pressure, triglycerides, and incidents of gall stones, she asserts.

Even for topical applications, Judd says she often advises patients to take regular hormone holidays to prevent buildup of hormones in certain tissues.

Nelson says he attends a few conferences a year that focus on hormones.

“It’s amazing to see the results and hear stories women have from replacing hormones with bioidenticals at the right compounded levels,” he says. “I wish we could see more doctors and practitioners at these meetings.”

Nelson says the pharmacy can assist physicians if they’re uncomfortable or don’t have much experience prescribing bioidentical hormones.

“We can help read lab levels if adjustments need to be made,” he says.

He says almost all hormone replacement prescriptions that Sixth Avenue Medical Pharmacy prepares are for compounded bioidenticals, which can be less expensive than their standardized commercial counterparts.

“We often can save women (costs) going the compounded route,” he says. 

For example, Nelson says that the standard prescription for the name brand Premarin (synthetic estrogen) vaginal cream costs $250.

“We can compound something in the range of $45 to $50,” he says.

Judd asserts bioidentical hormone treatment will withstand further evidence-based examination.

“I think this is the trend,” she says. “There’s no reason for it not to spread. It makes sense.”