The Hormone Hoax Thousands Fall For

Lab tests conducted for More show that hormones custom-made to boost your well-being may do more harm than good

by Cathryn Jakobson Ramin
hormone hoax illustration
Photograph: Mark Allen Miller

The misconception that compounded bioidentical hormone therapy is safer than commercial hormone therapy has potentially serious consequences. While most MDs are cautious about prescribing estrogen to women at risk for breast cancer, More had no trouble finding women with a family history of the disease who said they’d been assured by hormone-clinic physicians that the BHT drugs were perfectly safe.

After Julie Johnston turned 50 in 2005, she went to a hormone clinic near her home in Kingston, Tennessee, where a doctor prescribed estrogen, testosterone and progesterone even though Johnston’s mother had developed breast cancer in her sixties. Johnston, who does double duty as an intelligence analyst for the National Nuclear Security Administration and as a strategic intelligence officer for the Army Reserve, had read one of Somers’s books, and it spoke to her issues. She was having hot flashes. She was also involved with a new guy and hoped that hormone therapy would add some oomph to the relationship.

It was important to Johnston that she take a “natural” medication. “I fell for the premise that the hormones are safe because they are exactly what your body makes,” says Johnston. No one at the hormone center, she says, brought up risk factors. “When you’re seeing a medical doctor, you think everything’s all safe and sanctioned.” In late 2010, Johnston was diagnosed with a common form of breast cancer that is fueled by estrogen. It is impossible to prove that the very high doses of estrogen she’d received were a contributing factor, but the normal range of estradiol (a kind of estrogen) for a postmenopausal woman who hasn’t taken hormones is 0 to 30 picograms per milliliter, and in June 2010, according to medical charts that Johnston collected from the hormone clinic, her level reached 523.8 picograms per milliliter. In January 2011, Johnston had a double mastectomy. Last winter the clinic she visited was shut down by the state of Tennessee.

The dangers of poor quality control
It would take a major study to fully examine the effectiveness and safety of compounded BHT. The testing More commissioned is not that study—but it does address a basic, essential question about the quality of BHT products made under unregulated circumstances: Do those pills contain what they are supposed to?

To answer that question, we analyzed the ingredients, potency and weights of a common 30-day BHT prescription we’d sent to 12 compounding pharmacies. The prescription called for three forms of bioidentical estrogen (estradiol, estrone and estriol; the combination is known as Tri-Est) as well as progesterone. The estrogens differ mainly in terms of potency. Estradiol, the dominant estrogen in premenopausal women’s bodies, is 12 times as potent as estrone, which takes over in the body once menopause has occurred, and 80 times as potent as estriol, which is the primary estrogen produced in the placenta during pregnancy. Although estradiol and estrone are approved ingredients, estriol is not FDA approved, because it has never undergone clinical tests in the United States. The FDA has issued official Warning Letters to seven compounding pharmacies that include estriol in medications, telling them to stop. Yet none of the places we contacted declined to include this hormone in the capsules we ordered. Flora Research’s analysis confirmed that estriol was present in each filled prescription.

One important question is whether compounded bioidenticals contain the precise doses of medicine specified by the prescribing doctor. More’s testing shows cause for concern. “The results are astounding and terrifying,” says Wulf H. Utian, MD, PhD, DSc, founder of the North American Menopause Society, who reviewed our findings.

Consider this: Among the 12 prescriptions we filled, estriol was sub-potent in all samples, meaning that the hormone was present in lower quantities than the prescription label indicated. In all but two cases, the other two estrogens in Tri-Est, estrone and estradiol, were superpotent—they delivered a higher dose than prescribed.

First published in the October 2013 issue

Share Your Thoughts!


Karen 02.28.2015

It's perfectly reasonable to be skeptical of "alternatives," but I would've preferred to see just as much skepticism of the "traditional" approaches, which have, in large part, gotten plenty wrong. It's not like the FDA, the pharmaceutical industry, and their audience-doctors are exactly without flaws. It's not like it is only the alternative doctors who are in it "for the money" as this article implies. In fact, many of the theories and approaches of the bioidentical hormone movement that were heavily criticized years ago, are now being adopted by the pharmaceutical industry, who have more of the money to prove their worth through convenient testing. Now, thanks in large part to the alternative movement, hormone replacement therapy, once deemed "dangerous" is now considered "beneficial," even for BRCA patients. I also would've preferred that More quoted not just Somers' books, but more of the BHT doctors. I would've loved to hear their defense. This article was chock-full of quotes and interviews from, basically, just the opponents.

Arros 12.18.2013

Working for Wyeth are we?
You write as if you took only the worse-case scenarios, stretch the "fear factor" and sensationalize anything about compounding and put an article together to sell advertisements. Good for you for putting your bottom dollar first and not explore more into what BHRT has done for hundreds of thousands of women who get tens of thousands of different customized medications.
Also, the Estriol fiasco was debunked a long time ago when Wyeth themselves marketed Estriol in Europe as a "wonder drug". I guess I'll be looking at MORE LESS!!!!


As a woman who has tried both bioidentical and FDA approved HRT I am shocked by the misleading and quite frankly, slanderous spin of this article. I could write a novel about the years I tried to help my body get through menopause with chemical "equivalents". I could write another novel about how a Naturopathic physician who prescribed compounded BHRT (in cream form, which is better absorbed than pill form) helped me feel like a vibrant woman again, not some nut job bouncing off walls, growing facial hair and a penis from the one-size-fits-all FDA approved horse urine therapy. But I will simply say this, your story is blatantly irresponsible and will only serve to get more women interested in drugs, which will help the FDA to achieve its goal of tapping into that $2.5 billion dollar biodentical "industry". The government needs to get its hands off of my body and moreover, my constitutional right to choose what I put into it. Thank you very much, I'll pick yams over pregnant horse urine every time.

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