Your path to a new generation of patients
Your path to a new generation of patientsA landmark study from the Women’s Health Initiative (WHI) stunned the medical community and the public alike in 2002.1 The trial, which followed more than 160,000 postmenopausal women, was abruptly halted when researchers found synthetic hormone therapy—specifically, the combination of conjugated equine estrogens and medroxyprogesterone acetate—led to significantly higher risks of breast cancer, stroke and heart disease.
That moment marked a major turning point. Suddenly, hormone replacement therapy (HRT) was no longer the go-to solution for menopausal symptoms. Patients became wary, clinicians cautious. And into that void stepped bioidentical hormone therapy, heralded as a “natural” alternative with fewer risks and better outcomes. But is that true? And where do DCs fit into this conversation?
As a chiropractic physician with a specialty in nutrition, I encounter hormone-related issues almost daily from ue and mood swings to hot flashes, low libido and sleep disturbances. These symptoms signal more than inconvenience; they indicate physiological imbalances that affect long-term health. Although we cannot prescribe hormones, DCs are often among the first clinicians to hear about these challenges. That’s why understanding the difference between bioidentical and pharmaceutical hormones isn’t just helpful; it’s essential.
What are hormones, and why do they matter?
Hormones act as the body’s chemical messengers. They regulate metabolism, reproductive health, bone density, immune function and even brain chemistry. When they’re out of balance, patients experience a ripple effect of symptoms. Common culprits include estrogen, progesterone, testosterone, DHEA and thyroid hormones; each of which can be replaced using either synthetic or bioidentical therapies.
Defining the terms
Pharmaceutical (synthetic) hormones are chemically created in labs and often do not mirror the exact molecular structure of human hormones. Examples include Premarin (conjugated equine estrogens) and Provera (medroxyprogesterone acetate). These have been FDA-approved and widely used in conventional medicine for decades.
Bioidentical hormones, by contrast, are structurally identical to the hormones naturally produced by the human body. They are derived from plant sources, such as soy or yams, and can be custom-compounded or prescribed in standardized FDA-approved forms, like Estrace or Prometrium.
The safety debate: Bioidentical versus synthetic
A 2009 review in Postgraduate Medicine found patients using bioidentical hormones reported greater satisfaction and fewer side effects than those using synthetic hormones.2 Yet the evidence remains mixed. While bioidenticals offer promising results, compounded versions lack FDA oversight, making potency and purity harder to verify.
The WHI study’s findings on synthetic HRT remain sobering. Women using combined estrogen-progestin therapy had a 26% increased risk of breast cancer and a 41% increase in stroke risk. As DCs, we must understand these risks, even if we aren’t the prescribing provider, because our patients are using these therapies and trusting us to help them navigate their health choices.
What about men?
Though much of the hormone conversation focuses on women, men face hormone-related challenges as well—especially age-related testosterone decline. Known as andropause or late onset hypogonadism, this gradual reduction in testosterone can lead to fatigue, reduced muscle mass, low libido, depression and even cognitive changes.
Testosterone replacement therapy (TRT) is often prescribed to address these symptoms. But not all testosterone therapies are created equal. Traditional synthetic forms, such as methyltestosterone, have been linked to liver toxicity and cardiovascular complications.
According to Revitalize You MD, bioidentical testosterone offers a more natural, body-compatible alternative: “Bioidentical hormones are molecularly identical to those found in the human body, making them more easily metabolized and less likely to cause adverse effects” than synthetic options.
Men receiving synthetic testosterone may also experience suppression of the body’s natural testosterone production and disruption of other hormonal feedback loops. On the other hand, bioidentical therapy—especially when properly monitored—can help restore balance while minimizing risk.
The takeaway? Testosterone therapy, like estrogen and progesterone replacement, must be approached with caution, personalization and clinical oversight. DCs can support male patients by identifying symptoms of low testosterone, recommending appropriate testing and referring them to qualified providers for bioidentical options when necessary.
Why DCs should be in the know about pharmaceutical hormones
Here’s the bottom line: Our patients are already taking hormones, or they’re considering it. Whether prescribed by an OB/GYN, a urologist or purchased over-the-counter as supplements, these substances influence nearly every body system. That includes the musculoskeletal system we work so closely with.
Moreover, DCs trained in functional medicine or nutrition often recommend herbal or nutritional alternatives to support hormone health. Knowing the risks and benefits of all available options—pharmaceutical, bioidentical or herbal—makes us better advocates for our patients.
Clinical considerations: It’s not one-size-fits-all
- Hormone therapy is not without complexity. Key factors must be considered before anyone begins a hormone regimen:
Baseline testing is essential—through blood, urine or saliva—to understand current hormone levels. - Medical history should be evaluated, especially regarding cancers, clotting disorders and cardiovascular and liver disease.
- Route of administration matters. Transdermal estrogen or testosterone gels may carry fewer risks than oral options.
- Monitoring must be ongoing. Hormone therapy is not “set it and forget it.” Re-testing ensures safety and effectiveness over time.
- Individualized care is the gold standard. As noted in the 2020 North American Menopause Society guidelines, HRT should be used at the lowest effective dose for the shortest necessary time, and always with informed consent.
Natural alternatives within our scope
While DCs cannot prescribe hormones, we can offer support through:
- Herbal remedies, such as black cohosh, chasteberry, saw palmetto and ashwagandha, shown to support hormone balance in both men and women.
- Nutritional support using vitamins and minerals, such as zinc, magnesium and B-complex, that influence testosterone and estrogen metabolism.
- Lifestyle counseling focused on sleep, stress, alcohol intake and diet—all of which impact hormonal equilibrium.
Patient empowerment starts with education on pharmaceutical hormones
Many patients simply follow their doctor’s recommendation without fully understanding what they’re taking—or why. We can play an important role in bridging that knowledge gap. Here are three things I always emphasize with patients:
- Understand your options. Hormone therapy isn’t just one thing. There are FDA-approved bioidenticals, synthetic pharmaceuticals, herbal aids and nutritional supports.
- Know your numbers. Testing before and during therapy is crucial to ensure safe, effective treatment.
- Watch for signs. Symptoms like mood swings, fatigue, erectile dysfunction, breast tenderness or sleep disruption may point to hormonal imbalance—and they shouldn’t be ignored.
A quick reference guide
The comprehensive hormone therapy chart (Table 1) includes detailed comparisons of hormone and herbal therapies by type, use, dosage, contraindications and notes, and was created by compiling and summarizing clinical and alternative health references provided by The North American Menopause Society (NAMS), The Women’s Health Initiative (WHI), Mayo Clinic, NIH Office of Dietary Supplements and peer-reviewed medical literature (postgraduate medicine and The Journal of Clinical Endocrinology and Metabolism).
Final thoughts
As DCs, our strength lies in a holistic approach. While we may not prescribe hormones, we can support hormonal health through informed guidance, safe supplementation and collaborative care. Understanding the distinctions between synthetic and bioidentical hormones isn’t just an academic exercise—it’s a practical necessity for every provider working with real people in the real world of hormonal imbalance. By staying informed and curious, we empower our patients to take owner ship of their health—and that’s the kind of care that truly makes a difference.
Cindy M. Howard, DC, DABCI, DACBN, FIAMA, FICC, is a board-certified chiropractic internist and nutritionist specializing in finding the root cause of symptoms and diseases. She earned her Doctor of Chiropractic degree from the National University of Health Sciences and is in private practice in Orland Park, Illinois, where she focuses on individualized care. For more information, visit innovativehwc.com. If you’d like information about offering hormone therapy services, please call Howard at 708-479-0020 or email her at drcindymhoward@gmail.com.
