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practice that is recognised and guided by the medical, nursing and pharmaceutical professional bodies.7 cBHRT allows different medicines to be combined in a formula that is unique to the patient’s individual prescription. The same approved hormones used in licensed rBHRT are combined in a UK pharmacy registered with and regulated by the General Pharmaceutical Council (GPhC).8 The resulting hormone combination is a namedpatient, prescription-specific, qualityassured extemporaneous medicine which can no longer be termed as ‘licensed’ as the ingredients have been combined.
Incorporating BHRT into Practice Dr David Eccleston provides his tips for successfully incorporating customised bio-identical hormone replacement therapy into an aesthetic practice Bio-identical hormone replacement therapy (BHRT) is a field that is fast gaining worldwide traction within the medical and aesthetic industry. According to market research company IMARC Group, the global BHRT market is projected to reach US $6.3 billion by 2024.1 Patients are educating themselves on the options available to them and seeking this treatment from private hormone specialists. However, it has become a natural fit for medical practitioners within aesthetics to offer this service as their existing patient base is generally already interested in ageing treatments and within the appropriate age group, making them the ideal target market. In my experience, BHRT has demonstrated a great way for aesthetic clinics to add more value to existing patients, as well as attracting new patients with this service offering.
About BHRT Bio-identical or ‘body identical’ hormones have been around since the early 1930s2 and are an important option for women in balancing their hormones. Bio-identical hormones are produced from the chemical diosgenin, which is extracted from plant sources such as Mexican wild yam and soy, and manufactured into micronised
form.3 Many prescribers do not realise that synthetic hormones have a different arrangement of carbon, oxygen and hydrogen atoms compared to naturallyoccurring hormones in the body; therefore, hormone replacement therapy (HRT) does not behave in the same way as the hormones made by our body. Conversely, BHRT has the same chemical and molecular structure as the hormones produced in the body. As a result, they fit our hormone receptor sites wholly and their effects can be more consistent with the normal biochemistry of the body.4,5 cBHRT vs. rBHRT There are two types of BHRT: registered bio-identical hormone replacement therapy (rBHRT) and customised bio-identical hormone replacement therapy (cBHRT). Customisation (or the compounding) of hormones offers personalised solutions for treating hormone imbalances and follows a prescription that is based on the individual patient’s diagnosis, symptoms and blood hormone levels that are measured at specific time points.6 cBHRT is classed as ‘off-licence’ prescribing (also known as ‘unlicensed’), which is common across many healthcare sectors. Prescribing unlicensed medicines is a regulated
With more demand for a personalised treatment approach, cBHRT made in a regulated compounding pharmacy is becoming more commonly prescribed to patients. The benefit of this personalised approach is that the patient is less likely to experience side effects,5 as they are given the lowest required dose needed to manage their symptoms. It also offers them the opportunity to access a wider range of routes of intake compared to rBHRT, which are typically taken via capsule form for progesterone and gel/patch form for oestrogen, so patients can choose their preferred method. Combining different hormones into a cream, for example, can simplify a regimen and therefore encourage compliance. Personalised treatments also allow the patient a much longer consultation than available on the NHS, meaning that they have time to fully discuss their symptoms and a fully comprehensive medical assessment can be conducted.
My experience with cBHRT From personal experience as an aesthetic practitioner, and with a strong medical background, including in obstetrics and gynaecology, I could not ignore this treatment. Whilst working both in aesthetics and general practice, I was seeing an increased demand for cBHRT, which led me to seek training. I worked with my team to ensure we were set up to do this to the highest standard and we soon had regular patients. We have now expanded to train our in-house practice nurse to support this popular service and I personally support and oversee every case with her. The most frequent line I hear from patients after the start of treatment is, “I have got my life back” and, for me, professionally, this
Reproduced from Aesthetics | Volume 7/Issue 5 - April 2020
