Hormone Therapy: It's Time for a Second Opinion

The opinion paper titled "Compounded Bioidentical Hormones," published by the American College of Obstetricians and Gynecologists in November 2005, appears to be aimed at influencing how some clinicians care for their patients. The paper may not accurately report the findings of authors listed in its own references in regard to safety and efficacy of bioidentical hormones, nor does it address the fact that a number of mass-produced preparations on the market include bioidentical estadiol, progesterone, and/or testosterone. The authors of the paper take the point of view that hormone therapy does not belong to a class of drugs with an indication for individualized dosing, but this position is not congruent with the fact that manufacturers of mass-produced hormones have U.S. Food and Drug Administration approval when they discuss flexible dosing of bioidentical hormones. The opinion paper openly opposes compounded bioidentical hormones, yet fails to mention the legal precedence and regulatory oversights that support the use of compounded prescriptions to dispense hormone replacement therapies, a practice that has since been upheld by a federal court. Also, the opinion paper fails to recogninze correlations between plasma and salivary hormone levels reported by reserachers listed in its own references. While it is always wise for clinicians to review the opinions of medical organizations, it is sometimes appropriate to ask for a second opinion.