The "problem" of bioidentical HRTs

Medical news services are full, lately, of articles decrying recent surveys indicating the popularity of compounded HRTs (one, two). With figures showing use statistics varying from 28-68% of HRT users choosing compounded (so-called "bioidentical") HRTs, this represents a significant loss of income to physicians. Dismay over this loss is cloaked in a variety of concerns, typically that these HRTs are not FDA-approved and that they come without boxed warnings, but the subtext is very clearly "but they didn't get them from US" or even more blatantly "but they didn't do this OUR way." And the tactics suggested in the more instructional of these articles focus primarily upon creating fear and shame in these straying patients.

What seems to be substantially missing from the medical professionals' side of the discussion is any attentiveness to why women have made this decision and how medical practice could address those concerns better. "Personalized" is what a lot of the comments come down to, but that's not the full picture we see in our discussions with women.

Women talk about things like how they're seen as noncompliant when the stock HRT their doctor offers them doesn't suit their needs or even their lifestyle. Women talk about being rebuffed with "I can't help you" or "I don't do that" when they ask for a different HRT brand or route or dose as they struggle to find their way in an opaque and guideless wilderness of choices. Women take articles they've found from medical journals or medical specialty group consensus documents to appointments to discuss latest findings and guidelines and are waved off with "I know everything I need to about HRTs." Women who have had cancers find discussions of their hormone needs flatly dismissed with the notion that it is ungrateful, their lives having been saved from cancer, to want to enjoy those lives with some quality of comfort. Women disabled by symptoms are frightened when those symptoms are waved off with an "I gave you HRT so it can't be your hormones" and the blame turned back on them. Women in surgical menopause, who understand that this is a different entity to natural menopause, are unable to establish trust with health professionals who insist that their symptoms are simply self-indulgence and that "a few warms spells and it'll all be over." And women who have been taught that medicine is evidence-based are dumbfounded to find that there are no tests to guide their way and no objective standards that can be applied beyond "the FDA says this drug works" when a particular HRT manifestly doesn't for them.

There is a vast gulf between what doctors want—customers—and what women in menopause want—health—and everything in the current discussions seems to indicate that doctors are not willing to bridge that gap. Is it any wonder, then, that advertising claims of customization, personalized care, attentive adjustment of HRTs, "natural" treatments, and safety—no matter whether justified or not—are winning out with these customers in the face of the "do it our way or no way" approach they feel they are receiving from their medical caregivers?

It can be argued that menopause is really a poor fit for allopathic medicine in the first place, that being, by definition, the diagnosis and treatment of disease. What women in menopause want is not to be labeled with a disease requiring treatment but rather a way to maintain their health in the face of a lifestage change that alters their health, comfort, and risks profile. For all that is good and bad in the compounded HRTs industry (and we have many thoughts on that), that's what is, in the end, the perception of the product being sold. Women are no longer the dependent, easily-influenced, uninformed 50s-era housewives who hang upon their doctors' guidance: they're smart, educated, doing their research, and willing to shop for what they feel they need. And until doctors and other prescribing professionals can address this opportunity in a constructive manner that actually addresses these women's needs, this situation isn't likely to turn around.

In the end, it doesn't matter which HRTs are fully licensed or which of the compounders' claims are bogus. What matters is that those practitioners are saying to women: we hear you; we believe you; we'll work with you. And until medicine can do that, can meet menopausal women from a point of respect, it is likely to continue to hemorrhage patients to more receptive practices.