Many people turn to bioidentical hormone replacement therapy because they want to be able to fully understand what ingredients are being used, and they like the assurance that what is being used to replace hormones that are too low is as natural as the original hormones were. One door that the BHRT path opens is to formulas that are uniquely created for each person – as opposed to synthetics that are mass-produced in pre-made formulas, bioidentical hormones can be custom compounded. THis may seem like an obvious positive, but things are a little more complicated than that.
Bioidentical hormones that are custom compounded present a unique quandary for those interested in BHRT. On the one hand, it makes complete sense that if your bioidentical hormone replacement therapy is using ingredients that are not only picked very uniquely for you and your symptoms, and then combined in doses that seem to be a good fit, you may respond even better to this course of treatment. However, one would think that the research would back this fully, and would be very clear. Unfortunately this is not the case, but that is not at all surprising: Research into custom compounded natural hormones is merely looking at the whole universe of custom compounding and everyone who has tried it without being able to look at the specific formulas that people were on because by definition they are all different. In other words, any study is not looking at your custom compounded BHRT ingredients, but rather a compilation of everyone’s. Yours may be quite effective, even if in general the world of custom compounding brings mixed results.
So let’s say that your bioidentical hormone doctor wants to prescribe your natural hormones in a combination of doses that she or he thinks are perfect for you, or maybe he or she wants to take a formula that is usually taken by mouth and make it into a gel. Even if the same ingredients that are in FDA approved bioidentical hormones are to be used, they will perhaps be used in different quantities or different forms so the approval does not hold up. You will not be able to find a study that says that that formula definitely works, or that method of delivery is optimal.
All of this does not mean that you should not pursue custom compounded bioidentical hormone replacement therapy, but rather that you should be careful in your choice of a BHRT doctor and compounding pharmacy. You should ask questions about why custom compounding is the option that is being chosen, and how much more effective this choice may be vs. the more traditional approach. You might also want to ask whether the formula you will be on closely resembles a formula that your bioidentical hormones doctor has used before, and what the science is behind the choices as far as ingredients. In short, when considering custom compounding three additional steps are warranted:
1. Make sure that your doctor generally has a lot of experience with this approach, and more specifically has treated people like you with your symptoms and the likely custom compounding formula that will be used.
2. Make sure that the doctor is using a trusted and well-established pharmacy that will be doing the compounding. Ask questions about that pharmacy such as how long they’ve been in business and why the doctor chooses to use them.
3. Be even more involved during treatment, letting your doctor know how you are doing so that changes can be made as necessary – this not only takes advantage of the flexibility of custom compounding, but also makes sure that the approach works.
Custom compounding of bioidentical hormones opens up doors of possibility, but also must be approached with care and caution.