What's the Word? Part 1: BHRT Terminology

When is natural really natural?

Terms used to describe the use of bioidentical hormone therapies can be misleading and misunderstood when the words have different meanings to different parties. The most common problem area lies with the use of the word "natural." Natural to the majority of lay people means that the substance exists in or comes from nature. The usual perception is that if a substance is natural, it is generally safer for consumption than the alternative, something synthetic, or made in a laboratory. While it is true that most natural herbs and botanicals have less adverse side effects than counterpart pharmaceutical drugs, just because it comes from nature doesn’t make it totally safe. Natural substances can have side effects, and some substances from nature are poisonous to humans.

To me, natural should refer to the system that the substance is used in, not where it came from. To be considered natural to the human body, the substance needs to be something we would consume in our normal diet, or it matches what the body normally produces.

Just because something originates from nature, it doesn’t make it natural for human beings. For marketing purposes, Conjugated Equine Estrogen has been described in some publications as natural because the source is found in nature. But it’s not natural for a horse to consume its own urine, much less to put it into a human. What makes a hormone natural for us is that the chemical or molecular structure is exactly identical to that which the body has produced itself for years. That is why I much prefer the term bio-identical, meaning identical to the structure produced by our own biological system.

Bioidentical hormones are natural in the sense that they do originate in nature. A precursor chemical found in soy and yam plants is extracted, and then converted in a lab to the exact structure of the hormones produced by our body. In a sense, since the precursors are converted in a laboratory, they could be considered semi-synthetic and not totally natural. However, since they match the hormones that our bodies produce, they are in fact 100% bio-identical. In matching the molecules produced by our bodies with bioidentical hormones, we are attempting to match the same functions of the hormones that they have preformed for years in our bodies, which is the key to safer, effective hormone therapy.

Phytoestrogens are natural substances that are often used to treat the symptoms of menopause. While they may help to relieve bothersome symptoms such as hot flashes and insomnia, they do not duplicate all the actions of the hormones in our bodies. Phytoestrogens have not been shown to provide the same cardiovascular, bone, or brain protection that our own hormones do. While useful as an adjunctive therapy to help with symptom management, phytoestrogens should not be relied on to replace deficient estrogen in providing protection to multiple critical systems.

Many times I hear the word “conventional” used to describe hormone therapy. There are conventional therapies that use bio-identical hormones and conventional therapies that use synthetics – agents which differ in structure from human hormones. Even when conventional therapies use products that contain bioidentical hormones, in almost all cases the manufactured products deliver much more hormone than body needs or ever produced on its own. I try to avoid the use of the terms conventional and natural, and identify the therapy I use as physiological bioidentical. Physiological refers to restoring the hormone to the level of a younger individual and no more, so it separates the individualization of compounded bioidentical therapy from the one-size-fits-all overdosing mentality of manufactured bioidentical products.