Dear Dr. Sandi,

I keep hearing about bio-identical hormones, but I am really confused.  Can you tell me what they are, where they come from and how they work?

F. P.

Dear FP:

Bio-identical hormones refer to estradiol, the estrogen made by our ovaries when we are younger, and progesterone, which is made by our ovaries after we ovulate.   The only natural source for these hormones are the ovaries of young women, and for obvious reasons they won't part with them. 

 Estradiol is made from the soybean.    Two molecules, genistein and dadzien, are extracted from the soybean  and then  manipulated until the resulting molecule is identical to the naturally occurring estradiol.  In reality it's "synthesized" but it matches what we "naturally" make and what we have receptors for. 

Bio-identical estradiol is commercially available at traditional pharmacies.  It is   available as patches, pills, creams, gels and vaginal rings.  There's nothing magic about having it made by a compounding pharmacy since they, like the pharmaceutical companies, get their raw ingredient estradiol from the same 3 or 4 suppliers. 

Progesterone is created from the Mexican yam root or Chinese cactus.  It's commercially available as Prometrium.  It's important to know that Prometrium contains peanut oil and  must be taken at bedtime because it will make you sleepy. I hope that clarifies things for you! 

Dr. Sandi

Dear Dr. Sandi,

I thought testosterone was a “guy thing”.  But lately I have been hearing that women have testosterone too.  I have to admit this is a scary thought to me!  If it’s true, can you tell me what testosterone does for me and why I need it?

E. V.

Dear EW,

It is true.  Women  have testosterone. We don’t have as much as males do, but we have some.  In fact, the first thing that happens in puberty for girls is the production of testosterone by the adrenal gland resulting in armpit hair, pubic hair, acne and attitude.  Several months later the ovary comes on line producing estrogen and testosterone. 

From that point on, half the testosterone in the female is produced by the adrenal gland and half by the ovary.  During our 40s, the adrenal gland stops producing testosterone, and only the ovaries continue to do so. .  So by the time we're in our 40s our testosterone level is down 50 percent .  According to my text books, the ovaries are supposed to continue producing testosterone for 10 years after they have  stopped making estrogen  Unfortunately, many ovaries never got  that particular email and they poop out during our  40s and early 50s.

The question is, what happens when we lose our small amount of testosterone? 

Some women experience many changes and others experience none.   The most common symptom  is that libido diminishes, but reduced libido is just one result of the loss of testosterone. Other symptoms include fatigue, lack of a sense of well being, lack of motivation, diminished muscle strength and  loss of mental sharpness.

The studies we have on giving women testosterone, all involve postmenopausal women already receiving estrogen.   For some of these women, adding the testosterone makes them feel like themselves again. 

Because current lab tests and available testosterone products are geared for males,  the existing studies and statistics aren't very accurate at our low range and the doses of the drugs are way too high for us.  Last year the testosterone patch for women was approved in Europe, but the U.S.  FDA asked for more safety data before granting approval. 

Keep in mind that any use of testosterone for women is "off label" and involves a compounding pharmacy or using small amounts of the gels and creams made for men.  Using testosterone can have side effects such as oily skin, acne, facial hair, feeling too assertive, increased appetite and male pattern hair loss.  When taken orally it can lower good cholesterol. 

In other words, this is a very individualized process and a woman needs to work with a doctor who has experience with this area of hormone management.

Dr. Sandi