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Compounded Preparations of Bioidentical Hormone Therapy (BHT)

Bioidentical hormone therapy (BHT) uses bioidentical hormones (BHs), which are derivatives of plant extracts chemically modified to be structurally indistinguishable from human endogenous hormones. Typically, compounded preparations of BHs may include estriol, estrone, estradiol, testosterone, micronized progesterone, and occasionally dehydroepiandrosterone (DHEA).

Dosage Forms. Currently there are several ways to administer bioidentical hormones: patches, oral capsules, sublingual lozenges, pellets, and transdermal creams and injections. In relation to testosterone, synthetic versions are not recommended because of a link to liver damage. Additionally, by oral route, they become inactive.

Subcutaneous pellet therapy or pellet implantation is a method many physicians and patients find effective. Inserting the pellet is a relatively simple office procedure. The use of implants was introduced in the late 1930s and was applied as an alternative treatment for climacteric symptoms 10 years later. The popularity of this approach peaked in the 1970s.

The most common implants used in the treatment of menopausal symptoms are biodegradable crystalline pellets containing estradiol, progesterone and testosterone. For andropausal symptoms, pellets contain testosterone. Pellets are inserted into the subcutaneous fat through a quick procedure and have the advantage of providing very consistent blood levels without having to remember to take pills. They also avoid the possible skin irritation associated with some patches, unpredictable absorption of vaginal creams, or marked variability of levels associated with injections.

Hormone replacement therapy by pellet implantation has been used with great success in the United States and other countries since 1938: It is NOT AN EXPERIMENTAL METHOD. Pellets deliver consistent, physiologic levels of hormones and avoid the fluctuations of hormone levels seen with other methods of delivery.

Hormones delivered by the subcutaneous implants bypass the liver, do not affect clotting, and do not increase the risk of thrombosis. Testosterone and estradiol delivery by pellet implantation does not adversely affect blood pressure, lipid levels, glucose, or liver functions. Pellets are superior to oral and topical hormone therapy with respect to relief of menopausal symptoms and do not have the same risk of breast cancer as synthetic hormones.

In conclusion, the use of bioidentical hormone therapy is well tolerated, provides symptom relief, and can address many of the health needs as well as the individual preferences of menopausal and perimenopausal women.