Aug 252009

Recently, I was asked the following question:

I am using bio-identical hormones for my hot flashes and night sweats. How long do I have to keep using them?

Hormone balance in addition to proper nutrition and exercise is essential to optimum health. Most disease states exhibit themselves after many years of asymptomatic progression. Often people feeling well and seemingly in good health are told much to their surprise that they have a serious illness as revealed by some test.

In my view the necessity of using bio-identical hormones is not only for symptom relief but also for good health. Just like taking calcium and vitamin D to prevent osteoporosis, proper hormone balance is essential to perpetuate the many biochemical tasks of good health that are prevalent at a younger age.

To illustrate this point, I recently came across an article written by Sergey A. Dzugan, Ph.D. and R. Arnold Smith, M.D. with regards to cholesterol. Cholesterol is the precursor to steroidal hormones such as estrogen, progesterone, dhea, testosterone, etc.

Dzugan and Smith conducted a clinical study for 6 years between 1997 and 2003 on 41 patients with high cholesterol. Their hypothesis was that a deficiency of hormones is the underlying cause of many disorders associated with normal aging including hypercholesterolemia. They treated these patients with hormone restorative therapy using human identical hormones such as oral pregnenolone and dhea capsules as well as topical triestrogen, progesterone and testosterone gels. All patients responded positively with mean serum total cholesterol dropping by 25.6%.

Their reasoning for these results is that many of the body’s biochemical mechanisms work by means of a biofeedback mechanism. Human aging lowers hormone levels. This in turn will trigger the body to make more cholesterol. The cholesterol acts as a feedback mechanism to provide more substrate with which to make more of these below-optimal-level-hormones.

Therefore providing bio-identical hormones to make up for the deficiency offers a feedback mechanism to lower the high cholesterol levels correcting the possible reason for the rise in the first place.

This is only one of many reasons why hormone balance is important for optimum health regardless of hormone deficiency symptoms such as hot flashes and night sweats.

I therefore think it incumbent to keep balancing your hormones as long as you want to optimize your health. This means that you may want to supplement with bio-identical hormones for the rest of your life, but it also means that you should adjust your dosage from time to time to properly balance your levels

Marvin Malamed,B.Sc.Phm.,C.C.N., has owned Haber’s Compounding Pharmacy for over 17 years. He is an award winning pharmacist and a certified clinical nutritionist. He can be contacted at
© 2008 Haber’s Compounding Pharmacy. All Rights Reserved.

Aug 242009

Recently, I was asked the following question:

My doctor said I was hypothyroid and put me on Synthroid. I have been on Synthroid for 6 month, but I don’t feel any better. Why don’t I feel better and what can I do about it?

Synthroid contains T4 (levothyroxin) the main hormone produced by the thyroid gland, however T4 is not very active. The major active hormone is T3 (triiodothyronine). T4 has to be converted by the body to T3 to exhibit benefits as only T3 stimulates activity at the receptor sites.

There are many reasons why supplementation with just T4 may not be effective. If for any number of many reasons, the T4 (even with sufficient dosage) is not being converted to the active T3 form, you will not see the benefits of the thyroid supplementation.

There are many reasons why you might be hypothyroid. The most prevalent factor might simply be a lack of iodine. We all need some form of iodine. If we don’t get it in our diet, it is essential to take it in the form of supplements. The need for and lack of iodine is the reason why salt was iodized. However, with the current emphasis on decreasing salt intake, salt has lost its importance as an iodine source.

There are also many cofactors that are necessary for T4 to be converted to T3 such as zinc, copper, vitamins A, B2, B3, B6, and C. If any of these are missing in sufficient amounts, your supplemental T4 (Synthroid) will not be converted to T3 and you will still exhibit the symptoms of a low thyroid.

There are many factors that influence the enzyme which converts T4 to T3 such as: selenium deficiency, stress, heavy metal toxicity, dieting, inadequate protein intake, high carbohydrate diet, elevated cortisol, chronic illness, and decreased kidney or liver function.

In addition there are many medications that block this conversion such as beta blockers,   birth control pills, estrogen, lithium, phenytoin, theophylline, chemotherapy, glucocorticoids and clomipramine. There are also environmental toxins to consider such as dioxins, PCB, phtalates (chemicals added to plastics).

As you can see hypothyroidism can be very complicated and may need further investigation. Paying attention to your diet, supplementing with the appropriate supplements as previously mentioned, and dealing with stress issues are important first steps.

A better scenario than synthroid might be the use of dessicated thyroid. Dessicated thyroid derives from pig thyroid which is very close in composition to human thyroid i.e. a mix of T4 and T3. Adding supplemental sustained release T3 made by compounding pharmacists, along with adjustment to your synthroid dosage might also be helpful.

Treatment of thyroid dysfunction should be individualized and customized to each patient. It is therefore very important to work with your physician to solve your thyroid issues, keeping some of these options in mind.

Marvin Malamed,B.Sc.Phm.,C.C.N., has owned Haber’s Compounding Pharmacy for over 17 years. He is an award winning pharmacist and a certified clinical nutritionist. He can be contacted at
© 2008 Haber’s Compounding Pharmacy. All Rights Reserved.

Aug 212009

For those who are not familiar with the acronym, BHRT stands for Bio-Identical Hormone Replacement Therapy. Bio-identical hormones are hormones that are biologically identical to those produced by your body, and therefore the most appropriate hormones for replacement. For approximately forty years, the gold standard in hormone replacement therapy was a concoction of horse estrogen and a synthetic foreign-to-the-planet progestin like medroxyprogesterone (MPA). The most recent studies showed this combination not only to be unhelpful but in fact detrimental to a woman’s health.  The subsequent fall-out from these studies led to a lot of confusion and possibly poor decision choices. So let’s dispel some of the confusion and put some logic into the topic.

When women are pre-menopausal i.e. all the years of their adult life before peri-menopause, they have a much healthier scenario than their male counterparts. Only when they start to lose their hormonal balance do the risks to their health start to increase to those of men. This fluctuation in hormones causes symptoms in many women, which is the primary reason why they seek HRT help.

So, why give estrogen extracted from the urine of a pregnant mare? Historically an easily obtainable resource produced an inexpensive by-product (the estrogen) that would have otherwise been wasted. It resolved the issue of uncomfortable symptoms for which women sought help and it was patentable.

So, why develop a synthetic alien progestin like medroxyprogesterone (MPA)? After several years of supplementation with horse estrogens many women were falling ill to uterine cancer. MPA was designed to act like progesterone (a bio-identical hormone) and protect the uterus from the proliferative effects of the estrogens. MPA does accomplish this task, however, it does NOT perform many of the other positive functions of progesterone. The production of progesterone was not feasible at that time as it was very expensive and not well absorbed. This is no longer the case as progesterone can be readily made from a precursor molecule in yam and soy and the micronization process has solved the issues with absorbability.

Women produce three main estrogens: estradiol, estone, and estriol. Estrogen has approximately 400 hundred functions in the body. Some of those functions are: helping with the absorption of calcium, magnesium & zinc, maintaining proper cholesterol levels, bones and memory, improving sleep, and decreasing fatigue.

Bio-identical estrogen can now also be made from yam and soy precursor molecules. This allows us to maintain these four hundred functions in the body by supplementing with exactly the same hormones that are diminishing, rather than substituting with many different estrogens belonging to horses.

You need the proper amount of estrogen for optimum health. A horse has many estrogens which are indigenious only to the horse and foreign to the human. We now have the alternative of giving women bio-identical human estrogens. Does it make sense to continue giving women horse estrogen? Where’s the logic? Why should the prescribing of bio-identical hormones be dictated by the negative studies done with horse estrogen and synthetic progestins?  There are no scientific grounds for this approach.

Much attention is given nowadays to the damaging effects on our health caused by trans fats. There is even talk of banning trans fats from our prepared foods. The  difference between a trans fat and otherwise healthy fat is just a twist in the chemical structure of the fat. No molecules added or taken away, just a twist! Natural Vitamin E is four times as potent as synthetic Vitamin E for the simple reason that the process in making the synthetic produces equal amounts of a mirror image molecule. Nothing has been added or taken away! The only difference is the mere positioning of the molecule! The difference between a free radical and an anti-oxidant can be that of one electron (a minute part of an atom). So how can we equate the effect of MPA to progesterone where the difference in chemical structure is the addition of many atoms? How can we paint progesterone with the same brush as MPA? Where is the logic? To give just one example of the difference (of which there are many), MPA is contraindicated to be given during pregnancy because of its damaging effects, whereas progesterone is readily prescribed in fertility clinics to help conceive and prevent miscarriage during pregnancy.  Some of the other functions of progesterone are: helping balance estrogen and sleep, lowering blood pressure and cholesterol, increasing scalp hair and metabolic rate as well as acting as a natural antidepressant. MPA is foreign to the human body and does not provide many of the positive effects of progesterone. It has many side effects not seen with progesterone yet the reason for not prescribing progesterone are often based on studies that are done with MPA.

Where is the logic? This is compounded by the fact that many in the medical community and often medical literature refer to progestins as progesterone. No wonder the confusion!

As I mentioned earlier in this article, women’s health scenarios are much better when they are younger and their hormone levels are higher and balanced. When they start to age their hormones start to drop and lose their balance. Some of these health risks are: breast cancer, osteoporosis, cardiovascular and alzheimer’s disease. The prescribing of the combination pregnant mare’s urine estrogens and the MPA has dropped considerably over the past few years due to the negative results from both the WHI and the HERS 11 studies. During the same period the prescribing and use of bio-identical hormones has risen tremendously. It is interesting that over this very same period the incidence of breast cancer has declined.

It is important for optimum health to look at the whole picture. It is just as crucial for thyroid and adrenal hormones, testosterone, dhea and insulin to be balanced as they affect estrogen and progesterone levels and visa versa.

To be highly effective the proper administration of bio-identical hormones is vital.
Although symptoms are the driving force and a viable reason to use hormones, many diseases do not have symptoms until they are well entrenched. Hormones are an important part of one’s well-being and should be extensively assessed and responsibly administered in our striving for optimum health.

Marvin Malamed,B.Sc.Phm.,C.C.N., has owned Haber’s Compounding Pharmacy for over 17 years. He is an award winning pharmacist and a certified clinical nutritionist. He can be contacted at
© 2008 Haber’s Compounding Pharmacy. All Rights Reserved.