Monitoring Bioidentical Hormone Replacement (BHRT)

Shannon Bock Monitors BHRT Optimization

Shannon’s Credentials

• BS Kinesiology, CU Boulder
• Certified Massage Therapist, Boulder College of Massage Therapy
• Eleven years practice in neuromuscular therapy
• Physician Assistant-Certified at Red Rocks Community College
• Masters in medical science, St. Francis University
• Gunn Certified IMS Practitioner
• BHRT training by Dr Neal Rouzier via Worldlink Medical
• Works at Centeno-Schultz Clinic, Broomfield, CO

In the last two posts, Dr. Hanson told us about the study the Centeno-Schultz Clinic recently conducted. Would the optimization of hormone levels produce more stem cells for repair and regeneration? Shannon monitored the patients’ hormone levels and made recommendations to adjust the Rx.

Shannon, there is a plethora of conflicting information about hormone replacement therapy on the Internet. What is the difference between Hormone Replacement Thereapy (HRT) and Bioidentical Hormone Replacement Therapy (BHRT)? Are there more risks associated with one over the other?

Conventional HRT and BHRT are two different managements, with different attributes. Hormones used in HRT are synthetic drugs, chemically derived and synthesized in a laboratory, not found in nature, with hormone like effects, produced by the pharmaceutical industry. (Pharmaceutical companies cannot patent natural or bio-identical compounds.)

BHRT utilizes hormones that are molecularly identical in structure to the hormones naturally found in the body. These are typically either extracted from plants or otherwise created in a laboratory, or compounding pharmacy, to exactly match the hormones your body naturally produces. HRT is typically employed by the medical profession to avert or treat disease, while the primary goal of BHRT is to reach an optimal hormone balance that improves overall quality of life.

BHRT dosages can be individualized to a patient’s needs and come in many different routes of administration; HRT dosages are fixed, “one size fits all”, regardless of the patient’s specific needs, and routes of administration are limited. Finally, the vast majority of medical literature and clinical evidence supports beneficial effects of natural hormones of BHRT with no harmful effects, whereas synthetic hormones or HRT, have been shown to have many harmful effects.

Are all BHRT therapies “created equal”?

No. BHRT prescriptions do not necessarily have to be made by a compounding pharmacy. There are a handful of mass produced prescription drugs that are bio identical, available from the pharmaceutical industry. However, the bulk of BHRT prescriptions are custom made by compounding pharmacies.

Compounded bio identical hormones are not regulated by the FDA, but compounding pharmacies are regulated by the individual state agencies that regulate retail pharmacies. However, due to this, the quality and potency of compounded medications can vary greatly. For that reason, it is important to make sure you choose a compounding pharmacy that is using this equipment and has good quality assurance.

I personally recommend using pharmacies that are PCAB (Pharmacy Compounding Accreditation Board) accredited. This is a voluntary evaluation a pharmacy participates in to demonstrate that they comply with nationally accepted quality control, quality assurance and quality improvement standards. A compounding pharmacy that has the proper quality assurance procedures in place should consistently exceed any standards the FDA might have for the pharmaceutical industry’s mass produced medication, and assure that the patient receives a quality, customized medication.

On whose research did the Clinic base their study? Why?

To date, no one has shown that the most common BHRT regimen positively impacts human mesenchymal stem cells (MSCs).

There is certainly experimental animal data showing that hormones, especially testosterone, can impact MSCs. However, there were no human models in our literature review. Therefore, this was original research with the study design and protocol based solely on our desire to determine if this type of BHRT regimen positively impacts human MSCs,  as that could help partially correct some of the decreased proliferation seen in aged individuals. Our clinic is always looking for ways of improving our patients’ outcomes. We have already looked at the effects of various other factors such as drugs, supplements, and diet on MSCs, in respect to our Regenexx based procedures. Many of our providers, myself included, and patients already prescribed to the benefits of BHRT on their quality of life and overall well-being; so looking at BHRT effects on MSCs was just a natural progression.

What particular hormones were optimized, how was the need determined, and how often did the monitoring occur?

This study looked at males only. We optimized thyroid (free T3 in particular), testosterone, along with DHEA, and we wanted Vitamin D3 in the normal range. We opted to go with this regimen as it tends to be the most commonly prescribed one for middle aged males in the field of preventative and age management medicine, including our clinic. Monitoring included a baseline blood draw panel that included the hormone levels and Vitamin D, complete blood count, comprehensive metabolic panel, lipid panel, PSA and hemoglobin A1C.

This allowed us to determine if a participant fell within our inclusion/exclusion criteria as well as determining their individual hormone dosing needs to reach “optimal” levels that we defined as those equal to a 20-29 year old male’s normal reference range for those same hormones. After including those participants who met criteria and consented to the study, we began their individual BHRT regimen with the goal of reaching that optimal level, repeating the blood draw after their initial 6 weeks on their program, making dosage adjustments as necessary, and repeating labs at another 4-6 weeks if necessary. Once the participant achieved the optimal range for every hormone, we kept doses stable to keep them in that range for a 12 week period, with final labs drawn before their final bone marrow aspiration for their MSCs.

Based on your observations and test results, do you believe most older people can benefit from hormone optimization? Why would they consider doing this?

Yes, regardless of what our study outcomes may ultimately show in terms of impact on MSCs, BHRT is about improving and prolonging quality of life. Nothing reverses aging, but BHRT can slow down the process and help us maintain good health. Of course, this must come in combination with a healthy diet, regular exercise, and other supplements. While starting BHRT in midlife when hormones are first declining would be the best scenario in slowing those aging processes and the diseases that have become associated with normal aging, it is never too late to begin BHRT. It is still a case by case basis of evaluating the person, their medical conditions and health risks they may have, but if there are no significant contraindications to doing this, BHRT could certainly be initiated later in life.

Often, older individuals may feel that their progressive deterioration is inevitable and resign themselves to losing their physical and mental health. Replenishment or replacement of hormones to optimal, not excessive, physiological levels can help alter and control the aging process at any age and help in returning vigor and vitality. We do not have to accept that physical, mental, or emotional decline is just a normal part of aging when research demonstrates BHRT can alter this course and support healthy aging. Regardless of age, be it forty five or eighty five, BHRT gives one the choice of a healthy longevity to enjoy the remaining years of life!

Click to watch this clarifying YouTube video by Dr. Neal Rouzier, MD, as to why there is such a misunderstanding about hormone replacement.