Bioidentical Hormones

Why is Hormonal Balance Important?

It is almos t impossible to turn on the TV these days or to open a newspaper and not hear or read something about the debate surrounding bio-identical hormones. Suzanne Somers has long been an advocate and has written several books about her wellness journey that tout the benefits of bio-identical hormones. Even Oprah has become a believer and has made the subject a frequent part of her show, inviting notable guest experts such as Dr. Christiane Northrup and Dr. Lauren Streicher.

Dr. Rashmi Gulati, MD and Suzanne Somers ( Author “Ageless”)

But why all the controversy? What exactly are hormones? And is replacing them safe? Is a synthetic hormone any different from a bio-identical one? Is hormonal balance really that important to wellness? And if it is, what is the best way to achieve it? If you are confused about any of these questions, you are not alone! Let’s take a closer look at hormones and how balancing them may hold the key to unlocking long-term health and wellness.

What are Hormones and How do Hormones Work?

Hormones are chemical messengers for our cells, carrying information and instructions from one group of cells to another. Because of this communication function, they influence almost every cell, organ and tissue function in our bodies. Hormones, derived from a Greek word meaning impetus, regulate growth and development, tissue and sexual function, the way we react to emergencies, the way we use food in our bodies, our mood and our overall feeling of well-being. That’s quite a lot of responsibility!

Endocrine Hormones are released into the bloodstream by glands. Hormones carry messages from the glands and circulate through the blood. They then wait to be recognized by a target cell that has a receptor that can only be activated by a certain hormone. Once a hormone finds its ultimate destination, the targeted cell receives the information and knows to begin the function that has been activated by that hormone, such as gene activation or energy production, for example.

There are two kinds of hormones, steroids and peptides.

Generally speaking, steroids are sex hormones made from cholesterol by the placenta when we are in the womb and then later by the adrenal gland or gonads (testes and ovaries). An example of a steroid hormone would be cortisol, whose function is to break down damaged tissue in order to allow healthy new tissue generation to occur.

Peptide hormones are made from long strings of amino acids. Because of this, they are sometimes referred to as protein hormones. Peptides regulate functions such as sleep and sugar concentration. An example of a peptide hormone is insulin, which begins the process of sugar conversion into energy.

Each hormone has a unique function and its own unique receptor cell sites in the body. Some hormones offset each other and therefore require a delicate balance between them for optimal functioning. Some hormones are precursors to other hormones or processes, which means their presence is necessary in order for that hormone to be produced. Generally speaking, a well-nourished, stress-free, and well-rested body can react to minor disruptions in hormone production by making adjustments based on the feedback it receives along the intricate cell communication cycle. But when that does not or cannot occur, it is easy to see how a shift in the delicate balance of hormones can lead to a chain reaction that can disrupt many cell, organ, and tissue functions within the body including diseases and conditions such as diabetes, PMS and thyroid dysfunction.

Traditional Hormone Replacement Therapy (HRT)

Hormone replacement therapy or HRT arose from this need to help the body make corrections to unbalanced hormone levels. Stress, poor nutrition, lack of exercise insufficient sleep and our generally busy lifestyles have led to an increase in hormonal imbalance. Pharmaceutical companies eager to take advantage of this booming opportunity developed synthetic hormone replacement drugs that they could patent such as Premarin, Prempro and Provera. But the chemical composition of these drugs is very different from the hormones produced by the human body, so they remain structurally foreign to the body and cause some undesirable side effects.

  • Premarin is a mixture of estrogens obtained from the urine of pregnant horses.
  • Provera is a synthetic progesterone (shown to cause bone loss or osteoporosis.
  • Prempro is a combination of the above, and contains both synthetic progesterone and horse estrogens.

These drugs were all the rage until the Women’s Health Initiative (WHI) revealed significant risks associated with them including both absolute and relative increases in breast cancer, blood clotting and stroke. Prempro now carries a black box warning for causing serious health risks.

The problem with these therapies is that they are not natural and while they can mimic the natural hormones to some extent and cause symptom relief, the body does not completely accept them as a substitute for that hormone within the body. It’s unfortunate that it took a huge medical study to reveal that the estrogen derived from a pregnant horse does not work the same way in our bodies as the estrogen we produce ourselves, but thankfully, the study results did shed light on the downsides of these drugs and encouraged women and their physicians to seek better solutions.

Bio-Identical Hormones

While bio-identical hormones have been around for a while, the results of the WHI study drew attention to finding alternative treatment options, resulting in bio-identical hormones beginning to get more of the attention they deserve. Bio-identical hormones mimic the natural structure and function of that hormone within the body. The body doesn’t need to change or alter the hormones in any way in order for them to work effectively. The goal of bio-identical hormone therapy is for hormone prescription at the same level and in the same ratio as would be found within the body naturally.

The most effective means of doing this is through a custom-compounding process. A custom-compounding lab will collect substances from natural sources and then artificially synthesize them in a laboratory to the specific levels and ratios your body requires. A comprehensive hormone panel is conducted by your physician in order to measure existing hormone levels. Then he or she will prescribe hormone supplementation for you based on those results, specifically targeting the hormones you need to replace at the dosages precisely right for your body.

The first greatest challenge associated with the use of the bio-identical hormones is not the hormones themselves, but the lack of knowledge about their usage. There are only a few companies producing and marketing the bio-identical hormones. The larger share of the market is occupied by the medicine companies, which produce and market non-bio-identical hormones and other conventional medicines.

In this suboptimal lock-in of the patients, doctors and medicine companies, the bio-identical hormones are struggling to gain a foothold, even though many people have already been convinced and benefitted by their applications.

The second problem with the bio-identical hormones is designing their optimal application. Diseases of individuals may have same names but their individual symptoms and details are seldom the same. Conventional medicines are available in pre-determined dosages. But in the case of bio-identical hormone therapy, samples of an individual’s hormone levels are taken and the required bio-identical hormone(s) is/are prescribed in the dosages required by the individual. To track the individual’s needs and the tolerance of externally administered hormones, an in-depth assessment of the patient’s medical history is required. along with several lab tests. During the administration of the hormones, the patient must be monitored very closely.

While very few physicians and practices are familiar with the testing or compounding process, let alone the ongoing follow up required to customize the hormone prescription levels to your unique body situation, Patients Medical has been recognized as being one of the few clinics in the country with the knowledge and experience to successfully prescribe, treat and monitor bio-identical hormone therapies. Suzanne Somers’ books also list Patients Medical as a bio-identical hormone resource.

The Patients Medical Bio-Identical Hormone Treatment Method

Patients Medical provides bio-identical hormone treatment based on five overarching principles of care:

  • Unique individual –Each patient is a unique individual and requires a separate and distinct focus of care. Treatment should be customized to each individual condition and situation in order to ensure a complete cure is realized and maintained.
  • Mind-Body-Spirit whole– Hormones affects all aspects of life. Therefore, the treatment prescribed must extend to — and coordinate with — the complete physiology and psychology of the person receiving it.
  • Empowerment and Partnership– A patient should be empowered with the confidence to heal him or herself. During the healing process, it is expected that he or she will become a partner with the practitioner.
  • Safety & Choice– Patients should be offered choice within the full spectrum of appropriate treatment options. Practitioners will monitor patient choices and progress and provide enhancements or modifications based on observations regarding the patient’s improvement on an ongoing basis.
  • Best practices and practitioners– Every patient deserves the best care available from a leading expert. The practitioners at Patients Medical are highly experienced and first-rate in their field.

On the basis of these five dimensions, Patients Medical provides integrative, holistic medical care for hormone replacement therapy. The following is a list of the hormone replacements Patients Medical will partner with patients to provide.

Progesterone (Bio-Identical)

While a lot is talked about regarding estrogen dominance in women, the truth is, it is not so much about too much – or too little – estrogen; rather, it is about the balance of estrogen with progesterone. Both estrogen and progesterone are required – at the right levels and in the right balance — for a normal female monthly cycle, as well as for several other body functions. Progesterone is made naturally in the body from cholesterol but what makes it unique from some other hormones is that through a process involving specific enzymes and co-factors, progesterone can be converted into estrogen and testosterone when needed. This allows the body to maintain the delicate hormone balance it requires even when things get off track by converting progesterone as needed to other hormones.

Progesterone helps sustain the endometrium to receive a fertilized egg for implantation during the second phase of the menstrual cycle. During pregnancy, progesterone also encourages the breast to grow the milk producing glands. Many PMS symptoms, including bloating, mood swings and breast tenderness are believed to derive, at least in part, from high progesterone levels. Natural progesterone enables women to feel much better than they would with any of the synthetic progestin’s and it is less likely to cause the side effects of synthetic products such as bloating, swelling, breast tenderness, bleeding, irritability and depression
Research indicates that micronized bio-identical progesterone may protect against:

  • − Uterine Cancer
  • − Breast Cancer
  • − Osteoporosis
  • − Fibrocystic disease
  • − Ovarian Cysts

Estrogen (Bio-Identical)

Arguably the most widely known of all hormones, estrogen actually refers to a group of hormones — estrone, estradiol, and estriol — found in both men and women. Estrogen not only regulates the uterine lining growth which occurs in the first half of the menstrual cycle, it drives changes in the breasts during pregnancy and adolescence, and also plays a role in many other metabolic processes, such as bone growth and cholesterol levels. In a healthy woman, estrogen circulates through the bloodstream and binds to estrogen receptors on cells, not just in the breast and the uterus, but also in the brain, the liver, the heart, in bones and many other tissues throughout the body.
Bio-identical Hormone Replacement is comprised of either two (Bi-est) Estradiol or Estriol or all three estrogens (Tri-est) using a bio-identical formula that your body recognizes as it would its own. Topical Estriol face cream (0.6% to 1.5%) is also used to treat Hirsutism, excess facial hair around lip, jaw and neck in women.

Research indicates that micronized bio-identical estrogens may protect against:

  • − Strokes
  • − Osteoporosis (increases osteoclasts)
  • − Alzheimer’s disease
  • − Urinary tract atrophy
  • − Vaginal dryness & atrophy
  • − Poor body fat distribution

Compounded Thyroid (Bio-Identical)

One of the most important glands in the body, your thyroid sits at the heart of the endocrine system and affects energy regulation in every cell, organ, and tissue in the body. The thyroid regulates body temperature, metabolism, and cerebral function. The thyroid also facilitates carbohydrate, lipid, and protein breakdown resulting in weight loss as well as lower cholesterol. When your thyroid doesn’t work properly, it can cause you to feel nervous or tired; make your muscles weak; cause weight gain or loss; impair your memory; and affect your menstrual flow. A thyroid disorder can also cause miscarriage and infertility. Compounded thyroid medication supplements T-3 as well as T-4 correct deficiencies of Thyroid hormone and return you to optimal levels.

Research indicates that thyroid hormone may protect against:

  • − Low body temperatures
  • − Colds and other viruses
  • − Weight gain
  • − Dry skin
  • − Headaches
  • − Depression and mood swings

Pregnenolone (Bio-Identical)

Pregnenolone, called the body’s “master hormone,” is a hormone that keeps our brains working at peak capacity. Pregnenolone is synthesized from cholesterol in a healthy body and serves as a precursor to estrogen, progesterone, testosterone, DHEA and cortisol. It is responsible for many functions within the body including but not limited to: memory, mental function, concentration, and overall well-being. Studies have estimated that by age 75, however, production of this important hormone may be decreased by as much as 60%, along with the levels of those hormones for which it is a precursor.

Pregnenolone should be prescribed in a sustained release micronized form to assure adequate absorptions and more importantly assures a pure grade supplementation devoid of any contaminants.

Pregnenolone is a precursor to other hormones which can:

  • Improve cellular repair
  • Enhance memory and learning
  • − Reduce PMS symptoms
  • − Boost immune function
  • − Decrease lipofusion deposition
  • − Protect cerebral function
  • − Protect against neuronal injury
  • − Treat inflammatory disorders

DHEA (Bio-Identical)

Dehydroepiandrosterone, or DHEA, the most common steroid hormone, is produced primarily by the adrenal glands but also in other parts of the body such as fat cells. DHEA is metabolized from Pregnenolone, which as discussed above, is metabolized from cholesterol. DHEA is somewhat of a multi-tasker in the body, as it can metabolize into other sex hormones such as estrogen and testosterone along with an estimated 150 other metabolites. The most tremendous effects seen from DHEA derive from its ability to stimulate protein synthesis in the cell, which in turn results in an increase in cell regeneration. This regeneration can forestall the disease process. DHEA is also known, however, to increase vitality, energy, and an overall feeling of youthfulness. DHEA should be prescribed in a sustained release, micronized form, which allows for complete absorption as well as a sustained level for a 24-hour period.

DHEA is known as a natural antioxidant that may:

  • − Restore Immunity
  • − Improve Memory
  • − Improve Energy
  • − Slow the aging process
  • − Positively affect depression and anxiety
  • − Improve psychological and physical aspects of sexuality

Testosterone for Men (Bio-Identical)

While testosterone is often considered the male hormone, women have small amounts as well. However, testosterone levels play a more influential role in the male hormone profile. As testosterone levels decline with age, there are health and appearance concerns that may accompany this loss. A “natural” form of testosterone is simply called micronized and may be prescribed in topical or oral formulation.

Research indicates men may experience:

  • – Increased bone density, formation, minerals
  • − Increased energy
  • − Improvement in sexual function
  • − Decreased body fat
  • − Increased muscle strength
  • − Decreased heart disease

Testosterone for Women (Bio-Identical)

Healthy women naturally produce small amounts of testosterone in the ovaries. It helps control a women’s libido and also may be known to enhance the functions of estrogen.

Research indicates women adding prescription ordered testosterone may experience:

  • – Enhancement of sexual drive
  • − Relief of menopausal symptoms
  • − Restoration of energy
  • − Strengthening of bone
  • − Prevention of osteoporosis
  • − An Improvement of an overall sense of well-being
  • Prevention of wrinkles and an increase in collagen and elastin

Melatonin (Bio-Identical)

This major hormone is produced in the Pineal Gland and helps to set your “bio-logical” clock for wake/sleep cycles. Melatonin is a natural hormone that helps regulate the rhythm of sleep as well as the deep stages. This regulation enables you to sleep more soundly and improve the function of your immune system.

Research indicates that prescription strength Melatonin is known to:

  • Improve your quality of sleep
  • Control body temperature
  • Improve kidney function
  • Boost immune function
  • Slow the aging process

Supplements Used in Treatment

As necessary, Patients Medical may also recommend supplements to be taken along with the bio-identical hormone treatment.

Such supplements to support healthy hormone function may include: Ayurvedic Botanical formulae, Herbal formulae, Homeopathic formulae, Men’s and Women’s Health formulae to Antioxidant and Phytonutrient formulae, Blood Sugar Support formulae, Stress Management formulae, Body Support formulae and cardiovascular formulae.


  • Estrone (E1), Estradiol (E2) and Estriol (E3) are the three Estrogenic hormones secreted by the ovary.
  • Progesterone is secreted by the adrenal glands, the gonads, the brain, and in time of pregnancy, in the placenta.
  • Testosterone is secreted mainly from the testes of males and ovaries of females.
  • Dehydroepiandrosterone (DHEA) is actually a natural steroid prohormone. It is produced from cholesterol by the adrenal glands, gonads etc.
  • Pregnenolone is another prohormone.
  • A Prohormone is a precursor to a hormone.
  • Thyroxine is actually a prohormone and a reservoir of triiodothyronine.
  • Triiodothyronine is the most powerful thyroid hormone affecting almost all bodily mechanisms.


Dr. Rashmi Gulati, MD, Medical Director of our Practice and most of our other physicians have been prescribing Bio-identical Hormones for many years.

Not sure which physician to select? When you call our new patient coordinator, we will be pleased to assist you.

Next Steps:

To schedule an appointment, plase send us an email to , complete and submit the form below or call our new patient coordinator at 1-212-661-7156.

We look forward to hearing from you.

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