Advocates of personalised BHRT (bioidentical hormone replacement therapy), however, claim that this approach – which is available privately and is currently unregulated in the UK – offers greater benefits and fewer side effects. The treatment was popularised in America more than a decade ago, but in the last couple of years there has been a boom in the number of prescribers and clinics opening up in the UK, particularly in the capital.
Dr Kishan Raichura, a former maxillofacial surgeon offering BHRT at London’s Lovely Clinic, says that from the age of 12-13 to about 35-36 years, all women’s hormones fluctuate “in a rhythm, in the main” unless there is an underlying health issue causing an imbalance.
The top layer of the skin – the epidermis – begins to thin around the age of 25, due to a drop in progesterone and oestrogen. Hormone fluctuations also cause a “flattening” of the skin, a drop in collagen levels, changes in facial-bone density and increased pigmentation. “The skin loses glow too” he says. “This cannot be fully replaced, even with injectables.”
His patients most commonly come to him in their early 40s, seeking remedies for the visible signs of ageing – not only on the face. “Many patients come in for vaginal rejuvenation or for a solution to thinning hair,” he says. ‘Hair is also a reflection of inner health, and it’s something men are concerned with too… Prescribing hormones is holistic; the aim is to make you look and feel better. Unbalanced hormones can cause tiredness, difficulty losing weight, depression and anxiety, poor sexual function, acne. Hormone levels also affect our neurological and cardiovascular systems, our cholesterol, and bone health.
‘Women who have a low-fat diet, who have had tubal ligation [female sterilisation] or those who do aggressive exercise or shift work will likely notice this depletion of hormones earlier. Maintaining oestrogen levels is really important to protect against osteoporosis, but it also supports the bones in the face – the cheekbones, chin and angle of the jaw and temporal bone, which can lose density. These literally underpin how we look.’
Dr Raichura does not treat anyone who’s had a hormone-sensitive cancer (such as breast or gynaecological cancers or prostate cancer) in the past five years. Each BHRT prescription is administered via a carrier – a capsule, a lotion rubbed on the inside of the forearms or groin, a dissolvable lozenge placed in the mouth, or a vaginal pessary. Dr Raichura uses a specialist “compounding” pharmacy (the first of which only opened in London 10 years ago) to create bespoke hormonal prescriptions if necessary. Anti-ageing face creams containing hormones for topical use can be made here too. “My aim isn’t just to bring people up to a hormonally ‘normal’ range, but to the optimal,” he says.
“When I reached my late 30s, I started to notice my skin looked grey and a bit slack,” says one fashion-industryinsider, who wishes not to be named. “My pores were more noticeable. I never wanted to be one of those people with a face full of filler, but I didn’t want to look drawn or saggy either.
A friend – who looks incredible and also works in the fashion industry – recommended the Marion Gluck Clinic [in Marylebone], so I made an appointment. That was seven years ago. I’m now 45 and BHRT is really my secret weapon. I not only look youthful and well, but I have so much more energy and appear to have completely escaped the effects of the perimenopause now dogging my friends.”
BHRT can help men too. In February, Joe Craig, 33, who works in marketing, sought the advice of Dr Raichura about a variety of what appear to be unrelated symptoms. “I was suffering a lack of energy. I had trouble sleeping, knee pain, hair loss, weight gain. I felt foggy all the time and had no real motivation or drive,” Craig says. “A lot of men don’t really talk about things like this.”
After undergoing blood, urine and saliva tests, Craig was prescribed a mixture of 20 vitamins and medications: “about 30 or 40 pills a day, some in the morning, some at night – something for my thyroid, hydrocortisone, DHEA, pregnenolone and a testosterone injection at the very start”, at a cost of around £250 each month.
Craig says he felt a huge difference immediately after the testosterone shot: “increased libido, higher motivation and energy, and, over the coming weeks, less hair loss – which I had been noticing since I was a teenager in one particular area”. In a little over a month, the knee pain he had been experiencing went away.
But for Craig, the biggest difference was losing 33lb over the next six months, an achievement he puts down to a renewed sense of motivation and drive. “Suddenly, I regained the impetus to lose weight and exercise. I started a wholefood/paleo diet. I had been very fit about five years previously, but let things slide when I focused on my career. At my two-month check-up, Dr Raichura changed the dose of melatonin, which was leaving me groggy for an hour or two in the morning after waking up. I now feel great. I can imagine continuing this for the rest of my life.”
Before he retired this spring, having been in medical practice since 1978, consultant gynaecologist Yehudi Gordon helped popularise the prescription of bioidentical hormones in the UK for women ranging from their late teens through to after the menopause. “Dr Katharina Dalton was one of the pioneers of the bioidentical-hormone movement,” says Dr Gordon. ‘She started the very first premenstrual-tension clinic in the world in London in the 1940s, and advocated giving patients pure bioidentical progesterone via a vaginal pessary – these are still in use today in the infertility world.
“A woman in her late teens or early 20s may suffer from an imbalance between oestrogen and progesterone, which can be helped by prescribing a small amount of progesterone. Around the time of the menopause, the oestrogen levels from the ovaries drop and a woman starts needing more oestrogen. Later still in life, she may need more testosterone.”
“Hormones are also responsible for maintaining collagen production, so they make the skin appear younger. Taking bioidentical hormones plumps up fine lines. And there is an oestriol cream that can be rubbed on to the exposed areas of the skin, which can help.”
Perhaps unsurprisingly, a process this elaborate is costly. At The Lovely Clinic, which is in Chelsea, initial consultations start at £1,450-£2,050. Costs for prescriptions vary from just a few pounds to £500 a month for more complex and precision-personalised treatment plans, including custom-blended anti-ageing face creams or hair-regeneration tonics.
Dr Mica Engel of Cosmetica London is not sure it’s a price worth paying. Despite being thought of by many devotees as little more than “the second generation of vitamins”, hormones of any kind could expose users to danger, she says. “Some cancers, such as breast cancer, are hormone-sensitive, which means they can have their development stimulated by hormones (oestrogen in this case). While it is not known if they are able to generate a tumour, they can certainly contribute to the development of pre-cancerous lesions. Testosterone use is also linked to cardiovascular problems. People must be aware of the risks.”
Hollywood dermatologist Dr Harold Lancer goes even further. He says BHRT “is really a marketing tool. In my opinion, pharmaceutical-grade HRT is the same as, if not better than, compounded bioidenticals because these are not always precise,” he says. “People perceive bioidenticals to be “better” for them, but BHRT may not have significant benefits over pharmaceutical-grade hormones. There are also unanswered questions around the issues of heart disease, breast cancers and cervical tumours occurring from unnecessary hormone manipulation.”
Dr Gordon, however, remains unswerving in his praise. “In all the years I practised obstetrics and gynaecology, I never came across a treatment that has such a massive benefit to women as BHRT, and the cost-benefit ratio is massive too.” He believes the benefits far outweigh the side effects. “Of course, BHRT doesn’t prevent ageing, but it slows it down. The most important thing is that people’s quality of life improves. How you look in the mirror when you go out in the morning is one thing, but how you feel is a whole other ball game.”
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