Question: I have taken oral doses of bioidentical hormones for a couple of years. Should I ask my physician to change my prescription to transdermal (applied to the skin) or sublingual (taken under the tongue)?
Dr. Brownstein's Answer:
A bioidentical, natural hormone is a hormone that has been derived from a plant product and has the exact same chemical structure of a human’s hormone. Examples include natural progesterone and natural estrogen.
Because they have the same structure as our hormones, bioidentical, natural hormones are recognized to have specific receptors to bind to. By contrast, synthetic hormones, which are created by Big Pharma in order to be patentable products, have different chemical structures from our own hormones. This difference causes the synthetic hormones to cause adverse effects.
There are many delivery mechanisms for bioidentical hormones, including oral, transdermal, or sublingual dosing. Oral dosing of estrogens can be a problem because when estrogen is taken orally, it undergoes a “first-pass” effect in the liver. This means that the liver has to activate or de-activate the hormone depending on the body’s needs. The ability of the liver to adjust to the oral dosing of estrogen depends on the liver’s functional status.
Studies have also shown that oral dosing of estrogens (compared to transdermal doses) cause more adverse side effects, including gallstones, abnormal blood clotting, and weight gain.
Transdermal dosing bypasses this first-pass effect in the liver and is a much safer route. Sublingual dosing can also avoid the first-pass effect in the liver, but this type of dosing is dependent on not swallowing any of the hormone. I have found that transdermal dosing is the best route for estrogen-based hormones.