Bioidentical Hormones: What Are They and Where Do They Come From?

         Bioidentical hormones are exogenous compounds that are the same in chemical and molecular structure as endogenous hormones made by the human body.  Bioidentical hormones can be extracted from plants such as wild yams, cactus, or soy. The most common source is typically yams. The use of wild yams to treat menstrual cramps is thought to date back all the way to the 18th century. In the 1950s, scientists discovered a phytoestrogen, which is a hormone that is naturally occurring in plants, called diosgenin in the roots of wild yams. This compound can be extracted from the roots and chemically converted into the bioidentical hormones that we use regularly, such as progesterone, estrogen, testosterone, and DHEA (Dehydroepiandrosterone).

The endogenous hormones that our bodies make serve many purposes. They play a part in brain function, growth, metabolism, and sexual function. When the hormones in our bodies become imbalanced or depleted, it may manifest as physical symptoms that may be difficult to manage on our own. This is where Hormone Replacement Therapy, or HRT, comes in. Each patient is different, so there are many different options for HRT that may address each patient’s unique needs. There are some HRT preparations that are commercially available in retail pharmacies, such as bioidentical estradiol and progesterone. These may not be best for everyone, so other preparations can be customized for patients through compounding.

         When compounding HRT preparations using bioidentical hormones, there are so many more options than what is commercially available on the market in retail pharmacies. Other hormones not available in commercial preparations, such as estriol, DHEA, and pregnenolone may be included in some compounded formulations. Another benefit of getting bioidentical hormones in a compounded preparation is that there are many other formulations available than there are commercially. Patients could get a lozenge, sublingual tablet, oral solution or suspension, topical or vaginal cream, suppository, or custom strength capsules. In a retail pharmacy, a patient may only be able to get limited strengths of oral tablets or capsules.

References: Files, Julia A et al. “Bioidentical hormone therapy.” Mayo Clinic proceedings vol. 86,7 (2011): 673-80, quiz 680. doi:10.4065/mcp.2010.0714Woods, James. “Clarifying the Terms ‘Bioidentical Hormones’ And ‘Compounded Hormones.’” Obstetrics & Gynecology – University of Rochester Medical Center, University of Rochester Medical Center, 23 Apr. 2015, www.urmc.rochester.edu/ob-gyn/ur-medicine-menopause-and-womens-health/menopause-blog/april-2015/clarifying-terms-bioidentical-hormones-compounded.aspx.

This content was originally provided by Jen Calderone PharmD candidate 2021.