If tests indicate that you require hormone replacement as part of your treatment for adrenal fatigue, your healthcare practitioner will likely discuss prescribing bioidentical hormones. This treatment is called bioidentical hormone replacement therapy, or BHRT. Bioidentical hormones, which are derived from plant sources, are molecularly and chemically identical to the hormones your body makes.
Because bioidentical hormones are identical to your body's hormones, they're thought to be safer than synthetic hormones, which tend to have a worse side-effect profile.
If you've been prescribed bioidentical hormones, you need to obtain them at a specialized pharmacy called a compounding pharmacy. There, the pharmacists are experts in preparing natural products. (See the earlier sidebar “Using compounding pharmacies” for details.)
Bioidentical hormones can be dosed in different ways. Many practitioners prefer the topical forms (such as a patch or cream) to the oral form, despite the convenience of the oral form. Here's how the forms compare:
Oral formulation: All bioidentical hormones are available in oral form; however, many healthcare practitioners don't recommend oral dosing to their patients as first-line treatment, because a portion of such meds is broken down by stomach acid and the major part is metabolized by the liver. As a result, a patient is likely to absorb only 30 percent of the medication.
Hormone binding also plays a big role in hormone levels. When a protein in the blood binds to a hormone, the hormone level in the blood decreases, decreasing the hormone's efficacy.
For example, when you take an oral dose of estrogen, your body may produce more of the protein sex hormone binding globulin (SHBG), which may alter the levels of other sex hormones. That's why being under the care of a qualified practitioner and having your hormone levels followed is so important.
Transdermal patch: A patch produces a slow and continuous release of a hormone, bypassing the liver's processing. With the patch form, the levels of SHBG don't increase as much, making the treatment less likely to interfere with the levels of other hormones.
One disadvantage of a transdermal patch is that local skin irritation may occur. Often, you need to rotate the patch site with each application.
Creams: A cream is a very common form of hormonal preparation. Note that with estrogen (estradiol) and progesterone, vaginal creams are preferred. The vaginal mucosa (the mucus membrane) is a highly vascular area, and the hormone is able to reach effective levels in the bloodstream rather quickly. Many healthcare providers prefer creams.
A preparation may contain a combination of hormones — progesterone and estrogen, for example. A combination preparation (such as a combination transdermal patch) is convenient, but it can be troublesome if your provider needs to make adjustments to one part of the preparation. So despite the convenience, separate hormones are usually prescribed separately.