Hormone Replacement Therapy – A Frightening Proposition?


I want to thank my regular readers who noticed and commented on the paucity of my articles in the recent past. My endeavors to submit an article every other week have actually been affected by the government shutdown. Yes, it’s true! I usually write one-half of my articles while I am away from home on Air Force business and the shutdown temporarily suspended my travels. I won’t comment further on partisan politics other than to say that I don’t think our veterans and service members should be affected by an inability to come to an agreement.

Hormone replacement therapy (HRT) has been a recent buzzword and October ushered in an article discussing the safety and efficacy of the same. I’ll change formats to answer a few questions that my patients have raised.

Q: I’ve heard of some studies that show that HRT can increase the risk of heart attack, stroke, blood clots, and breast cancer. Is hormone replacement therapy dangerous?

A: Depends… HRT using conjugated equine estrogen (Premarin) and even oral bioidentical estradiol have been shown to increase the risk for heart attack, stroke, and blood clots. Oral estrogens/estradiol pass through the liver and cause an inflammatory response. Medroxyprogesterone (Provera) has been linked to an increased risk for breast cancer while bioidentical micronized progesterone hasn’t been shown to increase breast cancer risk. Bioidentical hormone replacement therapy (BHRT), as opposed to HRT, uses bioidentical hormones synthesized from natural plant sources. Europe and Australia have a better than 75 year safety history using bioidentical hormone replacement therapy. I am not aware of a single study that associates BHRT (using pellets, creams, gels, or patches) with increased risk for heart attack, stroke, blood clots, or any type of cancer in men or women.

Q: I know that bioidentical hormones come from compounding pharmacies. Isn’t it dangerous to use medications from compounding pharmacies considering the recent scare involving New England Compounding Center?

A: Depends… Compounding pharmacies are licensed by state pharmacy boards and are required to abide by both FDA and DEA regulations. NECC was cited for deficiencies for more than a decade by FDA and state inspectors but was never shut down despite well-documented cases of unsafe and dangerous practices. Laws were in place but never enforced. Does this mean that all compounded medications are dangerous? No! My practice uses compounded pellets coming from a licensed specialty compounding pharmacy that has a long safety history in addition to passing required sterility testing with flying colors. Non-sterile preparations? I trust Sierra Blanca Pharmacy to compound hormones and medications locally. Bottom line- know your pharmacist and compounding pharmacy!

Q: Are testosterone pellets FDA approved?

A: Depends… One commercial brand, Testopel, is FDA approved. By definition, compounded medications are not FDA approved as they use different doses. Testopel is approved only for a 75mg dose. The majority of the testosterone pellets I use are 100mg to 300mg doses and are much less expensive. Most of the medications I use are only FDA approved for one or two specific uses. Does that mean they don’t work for other things? No! All physicians use medications for off-label use, thus the four years of medical school prior to residency.

Trick or treat? I’ve looked at the evidence and am confident that bioidentical hormone replacement therapy is a safe choice for my wife, my patients, and myself. I never promise that BHRT will make you live longer (it might, based on some newer studies). I do promise that BHRT will make you feel better while you are living. You decide.

Disclaimer: Dr Stephen Rath, MD, DABA is a board certified anesthesiologist, Air Force flight surgeon, paramedic, and pilot as well as the owner and medical director of Fusion Medical Spa located in Ruidoso, NM. He firmly believes that BHRT has restored his zest for life. Comments or questions? His email address is: