Bio Identical Hormone Replacement

Before I get into this, let me take a few lines to work on nomenclature. There are three types of Estrogen in the body and there are shorthands for each. They are as follows:

Estrone------------------- E1

Estradiol------------------E2

Estriol---------------------E3

In general, Estriol is considered the Safe estrogen where the others are linked to the problems associated with too much estrogen such as blood clots, uterine cancer and possibly breast cancer.  Most women take hormones that contain Estradiol (E2) such as Premarin, Prepro (these are from Mares urine and the estrogen is not free but conjugated or combined with another substance). The pill and patch are the most common delivery systemss. When we use the Natural ratio estrogens we put them in the form of a troche a chicklet like lozenge that dissolves in the buccal mucosa (i.e. the inside of the cheek), where it gets directly absorbed into the blood. This allows us to bypass a medical condition known as First Pass Phenomenon which in medicine means that once any substance is eaten it leaves the intestines through the portal vein which only goes one place, the liver (i.e. The First Pass). The liver then essentially Checks all substances and tries to detoxify anything that passes though it (that is one of the main functions of the liver) and hormones are no exception. This reduces the effective amount of the Estrogen dose before it hits the rest of the body. Estrogen from troches, being at least partially directly absorbed, go directly into the bloodstream so the troches are one of the better delivery systems.

Now we need some more nomenclature. When prescribed, we use the names Triest and Biest which are what we write prescription for when we prescribe natural estrogens. We can also add 3 other hormones to the estrogen: Testosterone, DHEA and Pregnenolone so if you see one of the Doctors, mention that in your consultation. For men, this a convenient way of treating testosterone (male hormone) deficiency. There are two forms of Biest and one form of Triest that we prescribe:

Triest------------------80% E3; 10% E2; 10% E1

Biest-------------------80% E3; 20% E2

Biest-------------------90% E3; 10% E2

Suzanne Summers has written an excellent book on this subject. Perhaps this brief introduction will not only help you understand her book but will make you an informed patient and know what questions to ask the Doctors.




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