Talk:Bioidentical hormone replacement therapy/Archive 6

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Neutrality tag

I removed the tag for numerous reasons. Some of those reasons are that the article seems to be indefinitely tagged for the past year or so. The principle editor who tagged the article does not seem interested in repeated suggestions to add their content on individual drugs to their respective drug article pages, nor was there any interest expressed in Doc James's helpful and sensible suggestion of using a popular culture/controversy or social type section for non-scientific or minority material. The same circular arguments have been going on for about a year and per the various policies such as WP:WEIGHT and WP:NPOV it is unresolvable.--Literaturegeek | T@1k? 17:04, 4 May 2010 (UTC)

Fine with me, the {{POV}} documentation does state that the tag is not a badge of shame or used to "warn" readers. No new sources or arguments have been provided for a while now. WLU (t) (c) Wikipedia's rules:^simple/_complex 12:52, 5 May 2010 (UTC)

Unencyclopedic tone

The tone of this article seems very out of place for Wikipedia. I don't think I've read another one like it. It comes across as very defensive—much more so than, say, Evolution, which I'd think would be under a much worse assault.

Roughly speaking, here's my background: I am a skeptical person with a family member who thinks bioidentical hormones are wonderful. I'm trying to learn more about them, mostly out of curiosity (I'm male anyway) so I can have an informed opinion. (My relative buys into a bunch of things that I don't agree with, but some other things she believes seem to have turned out to be correct.) I'm not invested in either side, and frankly not that invested in finding an answer, either.

As far as I can tell from other sources, the state of the debate is:

1. There is a small but vocal group of doctors and lay(wo)men who think this stuff is like the conventional therapy but doesn't have the side effects. This is a plausible but untested position.
2. There are blanket statements by medical organizations that their best prediction is that it's no better than the conventional therapy. This is also a plausible but untested position.
3. There are not really any large, solid studies supporting either of those positions. Since this is your health we're talking about, caution is probably prudent.
4. Oh, and there are doctors and laypeople who are making some really wild statements, too—you should be especially wary of those. Any claims beyond "they work the same as the conventional stuff but are safer" is utterly unsupported, as opposed to plausible but untested.

Is this correct? If so, why is the article so relentlessly negative, instead of describing the situation in a more nuanced way? And if not, what am I missing? —Brent Dax 00:14, 2 June 2010 (UTC)

Your summary of the debate is about right. The tone of the article could perhaps be improved. Do you have any suggestions? Any particular phrases that jump out at you as unencyclopedic for example? This article was under a prolonged content dispute for quite some time which may have influenced writing style.--Literaturegeek | T@1k? 00:21, 2 June 2010 (UTC)

You are mostly missing a long and acrimonious debate about BHRT. You are welcome to peruse the archives for the arguments themselves, but the heavily sourced page is, as far as I can tell based on reading a lot of sources, the way the actual medical "deabate" is. There are relentless cheerleaders for BHRT who claim it can make you youthful and improve health without risks, and there are a lot of doctors who are either confused (because they already know that bioidentical hormones exist, as FDA-approved drugs, and can't see what the fuss is about) or angry (because bioidentical hormones are marketed directly to consumers as a risk-free panacea that charges a whole lot of extra money for a whole lot of unnecessary "stuff"). There are plenty of sources, many are available as full-text versions (and chances are if you can't get it right off the web, I could e-mail you a pdf) so feel free to go directly to them to see what is available. Harvard Women's Health Watch is probably the easiest place to start with a professional perspective written at a layperson's level. You are welcome to improve the writing if you find it choppy or difficult to read, but much of the wording has been chosen pretty carefully to stay true to the sources, which often resist easy summary.

The reason the page doesn't read like evolution is because evolution is not a fringe theory - this one is. BHRT has a veneer of scientific respectability (unlike creationism, which is evolution's "opponent") but ultimately aside from a few sparsely-cited and even sparser-published proponents, there's not really much debate. Real scientists don't seem to use "bioidentical" as a term - they do research on estriol, estradiol, estrone, progesterone, testosterone, etc. Only bioidentical proponents seem to feel the need to gather all these into a "class" and proclaim them universally good and helpful. "Real scientists" would be those who actually research and publish on a regular basis, while proponents (like Erika Schwartz and Kent Holtorf) seem to spend more time in private practice, and writing books for popular audiences.

One thing I'll definitely sign-on to is that the page should be reviewed by someone who hasn't been involved in the debate at this point, to check for redundancy, choppiness, and general readability. Independent eyes would be very helpful. WLU (t) (c) Wikipedia's rules:^simple/_complex 00:29, 2 June 2010 (UTC)

I agree, the tone is all wrong. The main parts of the article are littered with citations, but the first two paragraphs don't have a single one. The tone of those first two paragraphs basically says "this is all bullshit." I'll admit that I haven't read the entire article yet, but the beginning is just a mess. Just the first (enormously long run-on) sentence has the words "exaggerated, unfounded claims" in it. A few (run-on) sentences later, it says "Bioidentical hormones may also present extra risks due to the process of compounding." Where's the citation for that? When I look up the article on Compounding, I see no mentions of risk. In fact, I see that "compounding pharmacies are licensed and regulated by their respective state like all other pharmacies."

In the second paragraph, it says "A major safety concern of bioidentical hormone replacement therapy is that there is no requirement to include package inserts despite the potential for serious adverse effects, including life threatening adverse effects, being associated with HRT. This can lead to consumers being deceived and even harmed as they are mislead into believing that BHRT is safe and has no side effects. Regulatory bodies require pharmacies to include important safety information with conventional hormone replacement therapy (CHRT) via package inserts." It sounds like this is more an indictment of compounding pharmacies than any issue with BHRT. Also, if compounding pharmacies are licensed and regulated, then aren't they also required to provide health warnings? My (non-compounding) pharmacy doesn't include packaging inserts, but they do include their own computer-printed summaries of the safety information and about possible drug interactions. Are we to believe that regulated compounding pharmacies have no such requirement? There are a whole lot of other things wrong with the first two paragraphs, but those are the biggest issues with the tone.

I'm looking into this because a blood test just told me that I have a low testosterone level, and I want to know as much as I can before I meet with the doctor this week. The tone of the first two paragraphs of this article would probably scare away many people in my position from seeking any further information about bioidentical HRT. That's something that no encyclopedia should ever do, in my opinion. If there are facts proving that it's all hype, then present them. If not, it should at best say something like it's "controversial" rather than saying it's exaggerated, unfounded, risky and misleading.

Something that wasn't pointed out is that, at least in the case of testosterone gel, getting these from compounding pharmacies will in many cases save you a lot of money. That's because big pharma has patents on testosterone gel. They can't patent testosterone, since it's a naturally occurring substance, but they can patent testosterone when they mix it into their gel. A compounding pharmacy can take the non-patented testosterone and mix it with a generic gel and save you about 90% of the cost of buying the patented gel (usually $150-$300 a month). If I had a guess as to who is behind this apparent attack on compounding pharmacies, I'd guess it's companies that stand to lose a lot of money if people start taking their business there.

Of course, that's just my opinion...I could be wrong. Who wants pie? —Preceding unsigned comment added by 76.105.237.221 (talk) 03:24, 2 August 2010 (UTC)

Per WP:LEAD, the lead section needs to summarize the article, but doesn't need citations so long as the body text is appropriately sourced. Compounding pharmacies do tend to make quite a profit on the absolutely unnecessary compounding of FDA-approved drugs. The page, in my opinion, adequately summarizes the scholarly, skeptical opinion on BHRT - most bodies think they are overhyped bunk that offers little besides poor quality control. You may want to read the section on Other hormones. If someone is trying to sell you bioidentical hormones, chances are they are a quack. "Bioidentical hormones" aren't leading edge science, they are unproven science. You know what we call science that has been tested and proven? Medicine.

Also, you know who makes a lot of money on compounding testosterone gel with generic gel? Compounding pharmacies. WLU (t) (c) Wikipedia's rules:^simple/_complex 14:44, 4 August 2010 (UTC)

"doesn't need citations so long as the body text is appropriately sourced" and as long as the claims are not controversial or contested. If editors believe the claims in the lead are controversial or should be cited, then they SHOULD be cited. Active Banana (talk) 15:13, 4 August 2010 (UTC)

The same editors would contest nearly everything in the body. The last version with full citations can be found here. I consider it ugly and unnecessary. All the citations are in the body. The actual comment from WP:LEADCITE is that it should be determined case-by-case, using consensus. I don't think there is any info in the lead not in the body, and don't think they are necessary. Most of the disputes have been about the basic information, not whether the lead should be cited. Adding citations to the lead tends to invite people to expand the lead with citations, without actually adding any in the body, when the lead should follow the body. If this is a serious topic for discussion, then it should be started in a new section. WLU (t) (c) Wikipedia's rules:^simple/_complex 15:55, 4 August 2010 (UTC)

Uptick in interest

Anyone know why? Sciencebasedmedicine.org had a post yesterday that I was keen to read. WLU (t) (c) Wikipedia's rules:^simple/_complex 14:52, 30 June 2010 (UTC)

"the potency ranged from 67.5% to 268.4% of the amount specified on the label, and there were variations within the same samples. Contaminants have also been found, including bacteria." These factoids should be cited in this article. From memory, all this article says is additional risks from compounding, but this article does not say what those risks are.--Literaturegeek | T@1k? 18:51, 30 June 2010 (UTC)

That's alluded to in the criticisms>salivary testing and compounding section, but not the exact numbers. I don't have access to The Medical Letter and much as I LOVE SBM.org, I wouldn't recommend citing it. Certainly a very useful article to have.

There is continuously a grain of truth in the complaints made about how BHRT may be a better option than premarin or other molecules (there are a few citations pointing to an improved risk profile) but the research is very far from a blanket endorsement of any one hormone over any other hormone, or set of hormones, and certainly not on a priori grounds. One article made the point that artificial, non-human molecules might work better than human ones because they could modulate only one function of the hormone (i.e. bone mineralization or vasomotor symptoms) rather than all (i.e. endometrial or breast hyperplasia or hypertrophy). WLU (t) (c) Wikipedia's rules:^simple/_complex 19:58, 30 June 2010 (UTC)

Why do you need access to The Medical Letter? That reference on sciencebasedmedicine.org was freely available to me. Why do you feel that sciencebasedmedicine.org is not good for citing? Perhaps it is not a good source to build the bulk of articles but it may be ok to "fill in the gaps".--Literaturegeek | T@1k? 20:14, 30 June 2010 (UTC)

Struck my comment, I just checked and realised that it was a review of the letter. Perhaps still worth citing?--Literaturegeek | T@1k? 20:16, 30 June 2010 (UTC)

Naw, much as I like the source, it's still a blog (though one edited by doctors). It doesn't have its own wikipedia article, and neither do the individual contributors. Given the plentitude of MEDRS, I just can't justify including one that probably wouldn't qualify as a RS. I think the Medical Letter will give us much better, richer information than Harriet Hall's brief summary would, and it's undeniably reliable. I don't think there's any gaps that could be plugged with the SBM.org post that can't be better filled with a real source. The only ones I could see were the numbers given on just how off the compounding products were from what their labels said.

If we can get it, we certainly should integrate the ML article, considering it's a secondary source just shy of a Cochrane Review, Science, Nature, NEJM or JAMA. WLU (t) (c) Wikipedia's rules:^simple/_complex 20:39, 30 June 2010 (UTC)

Oh, I did not realised that it was a blog, even though I saw the comments below it. I didn't put two and two together! It is a shame but you are right it is not a reliable source especially for an article so well covered in other sources. Hopefully you will be able to find someone who can get the full text of the letter.--Literaturegeek | T@1k? 21:35, 30 June 2010 (UTC)

Protection request

I'll be requesting page protection. The blatant sockpuppeting is irritating me. WLU (t) (c) Wikipedia's rules:^simple/_complex 15:59, 30 June 2010 (UTC)

Done. WLU (t) (c) Wikipedia's rules:^simple/_complex 16:06, 30 June 2010 (UTC)

Protection UNDO Request

First I must apologize for the confusion concerning accounts. I am a new user, and opened an account witht he name thx1138robot, and was told by an administrator that the name was not suitable becasue iot contained the word fragment, "bot", so I was instructed to either change the name or opena new accoutn. I asked for the name change to thx1138robert, but I didnt see it approved, so I later opened a new account under name craigventersmonster. So that is the history of it. I am the reason why WLU placed a HOLD on the page. Rather than get into a discussion, WLU uses a technicality to place the page into protected mode. I don't think that is good for wikipedia. —Preceding unsigned comment added by Craigventersmonster (talk • contribs) 2010-06-30 17:38:38

You should tag your account with {{User Alternate Acct Name}}

I didn't use a technicality, I saw three new accounts editing towards a single, inappropriate POV version that gave undue weight to an unsupported set of assertions. And no matter what, edit warring was an issue, so page protection is legit.

I didn't protect the page, I'm not an admin. It'll expire in a week. WLU (t) (c) Wikipedia's rules:^simple/_complex 22:15, 30 June 2010 (UTC)

The Issue Simple, Whether "Bioidentical" defintion is Ill-defined or not

A perfectly good edit on the Bioidentical Hormone Therapy Page was undone (within minutes) by User talk:WLU who then made the page protected under a smokescreen of "sockpuppet" which is false. I was instructed to open a new account under a new name because my initial user name thx11138robot had the word fragment "bot". So I did so.

The issue is that User talk:WLU maintains a choke hold on the content of this page and will not allow any edits of the extremely biased information there. This is not what was intended by WIkipedia whose rules state that edits should be neutral.

The very first paragraph on the page state that the word bioidentical is ill-defined. This is incorrect and represents a biased viewpoint. Here is the edited text which was undone:

Definition of the Word Bioidentical

Firstly, the word, Bioidentical, is well-defined by the Miriam Webster Dictionary as "possessing identical molecular structure especially in relation to an endogenously produced substance <bioidentical estrogens>". Secondly, "bioidentical" is defined by Wiktionary as "identical to that which is naturally produced by the body." . The Endocrine Society Position Statement on Bioidentical Hormones definition is: “Bioidentical hormones” are defined as compounds that have exactly the same chemical and molecular structure as hormones that are produced in the human body. . This statement is also endorsed by the North Amerca Menopause Society. These sources are in agreement that the word, "bioidentical" has a well defined meaning.

Since I am a completely new user, I would ask any and all Wiki users and administrators to assist in having the page protection UNDONE, and allowing proper editing of the page. Craigventersmonster (talk) 21:38, 30 June 2010 (UTC)

Wiktionary isn't a reliable source. There are multiple sources that use many different definitions of "bioidentical", and further the page is about bioidentical hormone replacement therapy not simply the word "bioidentical". There are multiple sources in the body that verify many different things are meant when BHRT is discussed - that's part of the problem, it means many things to many people while simultaneously being misleading, meaningless and ultimately undefined. The lead section doesn't need citations provided it accurately summarizes the body - which it does, see the section on terminology. We don't pick the definition we like the best, we fairly represent the sources to the proportion they are found - WP:UNDUE, WP:NPOV, WP:FRINGE, WP:V. Though websters is an appropriate for a definition, it is rendered moot by the multiple reliable sources that state the term isn't as clear as it purports to be.

My page protection request, though based on sockpuppeting, would have been legitimate under a single account edit warring - which you were though given the two (three?) different accounts we could not tell. In fact, if we had known you were a single account, you probably would have been blocked instead. Anyway, the page is currently semiprotected which means in a couple days you'll be able to edit it irrespective. So, feel free to spend that time familiarizing yourself with the many policies that apply, as well as reading the critical sources - of which there are more than enough to justify a critical stance per WP:UNDUE. I would also suggest reviewing, if you have the chance, the latest paper from the highly esteemed publication The Medical Letter which I understand is quite startlingly negative.

Also note that the sources you so prominently point to may define bioidenticals in that way (molecularly identical to endogenous) but they also are highly critical of the promotion of them and claims made - you don't get to cite the parts you like and discard the parts you don't. A fair summary of both may verify that these agencies consider bioidenticals to be molecularly identical to endogenous, but they also state they aren't worth the money and are no safer than conventional HRT. Please consider this when planning your upcoming edits; they can not be towards the viewpoint of your previous edits, and you are now well aware of which policies to consider, so we all expect your behaviour and POV to adjust accordingly. WLU (t) (c) Wikipedia's rules:^simple/_complex 22:46, 30 June 2010 (UTC)

Is Bioidentical really "Strongly Associated" with pharmacy compounding?

Notice the first paragraph says: "but is also strongly associated with pharmacy compounding". This statement reveals an anti-bioidentical bias and should be edited to a more neutral viewpoint.

Is above this statement true? Where is the reference for this statement? None is provided. In fact this statement is false, since bioidentical hormones are widely available as FDA approved prescription drugs. The following FDA approved prescription drugs contain bioidentical hormones. These bioidentical hormones are NOT strongly associated with compounding pharmacies: Alora (estradiol) Climara (estradiol) Vivelle-Dot (estradiol) Estraderm Estrace (estradiol) Prometrium (progesterone) Androgel (testosterone). In fact, these bioidentical hormones are non-compounded, manufactured medications available by prescription from any standard pharmacy. So in fact there is no STRONG ASOCIATION with compounding pharmacies. The reality is that compounding pharmcacies can make up ANYTHING, bioidentical or synthetic, and they do depending on the prescription ordered.

In fact, it is just as credible and correct to make the statement that "bioidentical hormones " are strongly associated as FDA Approved Medications from local pharmacies. This is just as true. UGAcodon (talk) 23:24, 30 June 2010 (UTC)

Rather than the above, the appropriate response is to tag the unreferenced statement with {{cn}}. The above is just wasted effort. However, the references are in place for the statements, see PMID 17627398 and PMID 17549577, both of which are cited in the appropriate body section of the article. The lede section uses summary style, for which many articles omit citation. I'm not a fan of this approach. If you'd care to add the cites in the lede corresponding to the ones in the body, I wouldn't object. LeadSongDog come howl! 23:44, 30 June 2010 (UTC)

I'll echo that - see WP:LEAD, so long as the information is sourced in the body, no citations are necessary in the lead. Previous versions were much more citation-heavy. The last version to have a fully-cited lead can be found here, and I think most would agree that 21 citations in the lead is both distracting and unnecessary considering how much the sources converge. One thing the sources converge on is the conflation of BHRT and compounding, with all the associated accretions of unnecessary testing, wildly exaggerated claims, poor quality control and so on. Again, the fact that BHRT is heavily linked to compounding is well-supported - we are not concerned with the truth and we are not here to proclaim the wonder of bioidentical hormones, unjustly maligned. We are here to represent what the mainstream sources say about BHRT. The fact that compounding has little to do with molecular endogeny is known, as is the lack of support for bioidenticals being any better than nonbioidenticals. WLU (t) (c) Wikipedia's rules:^simple/_complex 00:48, 1 July 2010 (UTC)

Again there has been no real discussion of the point raised, which is that there has been no validation of the claim of the statement because the statement is confusing. The statement confuses two types of bioidentical hormones. The first type are the FDA approved versions sold in numerous Walgreens type pharmacies, and the second type is the compounded preparation sold through compounding pharmacies. Bioidentical Hormones are sold through both. In actuallity if one looks at the numbers, more bioidentical hormones are sold through compounding pharmacies compared to conventional pharmacies like Walgreens. In addition, there are many more Walgreens and CVS-type drug stores throughout the US which carry FDA approved bioidentical hormones than there are compounding pharmacies. This fact would then lead one to conclude that FDA approved Bioidentical Hormones are more strongly associated with conventional pharmacies like Walgreens. The statement "compounded hormone preparations are strongly associated with compounding pharmacies : is of course true,' So the above statment needs this type of clarification. FDA approved bioidentical are sold through conventional pharmacies which clearly outnumber ccompounded pharmacies. So in conclusion, the statement as written confuses FDA approved bioidentical with Compounded bioidenticals. And that is the problem. Bioidientical hormones are not compounding pharmacies, and the two ideas need to be kept separate. As written, the text clearly needs to be corrected. Any comment?

UGAcodon (talk) 05:20, 1 July 2010 (UTC)

Panacea for All Diseases? An Outlandish Opinion Intended to Discredit Bioidentical Hormones

In the first paragraph notice the statement : "Proponents have promoted BHRT as a panacea for nearly all disease rather than a means of relieving the symptoms of menopause and/or reducing the risk of osteoporosis (the goals of traditional hormone replacement therapy)"

Who are these proponents? What is the source or reference that says this? In fact, reputable proponents of bioidentical horomone therapy DO NOT HOLD this rather extreme and outlandish opinion. This statment is biased and is intended to discredit bioidentical hormones in the eyes of a lay reader. The reality is that bioidentical hormones are prescribed as FDA approved prescriptions from the drug store by physicians in much the same way as they also prescribe the synthetics like PremPro. The thing that is a panacea for all diseases isn't a medication, it's those Pods from Cocoon. People aren't idiots and they see right through this game.

UGAcodon (talk) 23:57, 30 June 2010 (UTC)

Your unsourced assertion is less convincing than the actual sources on the page. See Chervenak, 2009 and Fugh-Berman & Bythrow J, 2007 for a start, and Boothby & Doering (2008), with a title of "Bioidentical hormone therapy: a panacea that lacks supportive evidence", is probably also a candidate, and though it's not on the page yet, Hansen 2008 would probably also be a candidate ("Bioidentical hormones: panacea for menopausal hormonal therapy or bio-beware?"). As a matter of fact, there seems to be plenty of sources to verify bioidentical hormones being promoted as a panacea. Since wikipedia is about what is verifiable, not what is true (see WP:V), it is appropriate. You are right, bioidentical hormones (in the sense of molecularly identical to endogenous hormones) are prescribed as FDA-approved drugs, and accordingly have all the risks found in their inserts - and the opinion that they are expected to pose the same risks as other FDA-approved HRT should remain, prominently. WLU (t) (c) Wikipedia's rules:^simple/_complex 00:36, 1 July 2010 (UTC)

These aren't references, these are deceptions. You have not named a single reputable physician source claiming that "bioidentical homones are a panaces". Your referernces are non-references as anyone can see. This is nonsense. Yes, of course, there are attack articles sponsored by the hormone industry such as:Curr Opin Obstet Gynecol. 2008 Aug;20(4):400-7.

Bioidentical hormone therapy: a panacea that lacks supportive evidence. by Boothby LA, Doering. So yes, this is a catchy title, however, the title takes some artistic liberties and does not even name a single reputable physician who claims that bioidentical hormones are a panacea, and in fact if you do a Google search for the two words, "bioidentical panacea", there are no hits for physicans writing articles stating that "bioidentical hormones are a panacea". As anyone can see from the link, the physician proponents of bioidentical hromones are stating that it is NOT A PANACEA. Just because it makes a nice catch phrase in a title to an article in Obstetics and Gynecology, a magazine that serves the interests of the synthetic hormone industry, doesn't mean that this a valid reference, it's not. These aren't references, these are deceptions, just like the rest of the junk on the page. This is a biased anti-bioidentical page. People are educated and see right through it. By the way ACOG, which publishes Obstetrics and Gynecology has financial ties to the synthetic hormone industry, so the Boothby article is biased and not a neutral source.http://www.iacprx.org/site/DocServer/PharmasCampaignAgainstBHRT-_updated_1.14.08.pdf?docID=3321 Wyeth funds several annual awards for the American College of Obstetricians and Gynecologists(ACOG),] totaling approximately $29,000 per year. Wyeth is also a Friends of ACOG Participant, where Friends donate $3,000 per annum, and is a frequent exhibitor at ACOG’s Annual Clinical Meetings and sponsors ACOG’s annual “Resident Reporter” Program. --UGAcodon (talk) 01:07, 1 July 2010 (UTC)

That was unconvincing when Hillinpa (talk · contribs) repeatedly barfed it up, and it's still unconvincing. Keep in mind - for your comment to be true, every single critical source has to be part of your vast conspiracy. So do the peer reviewers that review the articles. And the FDA, which is also heavily critical. Also, there has to be an equally vast conspiracy to avoid publishing research showing bioidenticals are better. Because there isn't any. Plus, why do critical articles get smeared with "Big Pharma is evil and all the doctors are their pawns!!!" when the only people who actively make money on bioidentical hormones are those charging expensive consulting fees, private appointments and whole friggin' books on the topics? Why are these people, who apparently care so damned much for their patients, spend their time lucratively writing directly to a popular crowd rather than running the kinds of clinical trials that would actually help test their theories? Who makes more money from the bioidentical/CHRT battle, the doctors who recommend FDA-approved versions with extensive safety and effectiveness profiles, versus the people who sell their books to their clients directly?

All that's beside the point. WP:REDFLAG urges us to ignore sources that claim conspiracy, I've never seen a reliably sourced criticism that actually associates criticisms of BHRT with COI, and accordingly there's nothing here to adjust the page. Claiming conspiracy isn't a reason to either adjust the page based on preference or eliminate sources. Neither is a google search. Calling reliable sources deceptions is hardly as convincing, or in line with our policies, as actually finding, summarizing and citing a real source. WLU (t) (c) Wikipedia's rules:^simple/_complex 01:22, 1 July 2010 (UTC)

WLU: We are still waiting for the you to name the proponents of bioidentical hormones who claim it is a panacea. You have not named any because you cannot. There are no reputable physicians claiming bioidentical hormones are a panacea. A few minutes researching it with Google search shows that, rather, there are many proponents who actually state it is NOT a panacea. You are deceiving the readers and editors with this nonsense about panacea. This should be removed, undone, deleted. The reference you cite does not actually name any reputable physicians who claim this and is not a valid reference. You have not answered this. It should be deleted.

I have not mentioned the word conspiracy, and do not intend to mention it. Rather I have mentioned financial ties between ACOG and Wyeth. These are financial ties you have not denied. You can't deny it because this information is all public. This is a serious issue because financial ties and conflict of interest are serious matters which reduce the credibility of the source. Attack articles on bioidentical hormones are not the result of a conspiracy, however, they are definitely under the influence of financial ties to the synthetic drug industry. To hide this information from the readers is a disservice, and potentially harmful. This information should be on the bioidentical hormone page.

I agree there is no "vast conspiracy to avoid publishing research showing bioidenticals are better". Quite the contrary, this research has been done and it is published. And I would be more than happy to bring it to these pages. The problem is that it is deleted within seconds of its appearance. I would like some assurances from the multitude of editors here that this publicly available published research showing bioidenticals safer and more effecive than synthetics be allowed here on the bioidentical hromone page without being immediately deleted within seconds by an editor with a pro-synthetic agenda. Any comments here? UGAcodon (talk) 04:56, 1 July 2010 (UTC)

Wyeth manufactures transdermal 17b-estradiol, a bioidentical hormone, and Wyeth isn't the publisher or author of the multitude of articles that disparage the claims made about bioidenticals. In fact, the only people with a clear conflict of interest that would make me question their claims are the proponents - Kent Holtorf and Erika Schwartz. WLU (t) (c) Wikipedia's rules:^simple/_complex 17:37, 1 July 2010 (UTC)

Medical Letter article

I'd really love to see the recent Medical Letter article on bioidentical hormones. I believe it can be found on pubmed, PMID 20508582, but no preview or abstract. If anyone can get a copy, I'd appreciate a ping.

Short too, 2 pages. WLU (t) (c) Wikipedia's rules:^simple/_complex 01:09, 1 July 2010 (UTC)

Scratch that, I got a PDF now. It is indeed extremely short (ultimately one column spread across two pages, so really more like half a page) and it essentially reiterates the points already on the page - bioidentical hormones are oversold, already available, linked to blood and saliva testing (but shouldn't be), generally found in compounding pharmacies, not regulated, estriol is a bad idea, and concludes with "There is no acceptable evidence that “bioidentical” hormones are safe or effective. Patients should be discouraged from taking them." I'll be integrating it tomorrow or the next day, it's further evidence that due weight of the scholarly consensus should go to these drugs being essentially identical in risk and benefit to regular HRT. In fact, the article could essentially be the lead of this very page (it's almost short enough). WLU (t) (c) Wikipedia's rules:^simple/_complex 02:21, 3 July 2010 (UTC)

Sounds reasonable. Would support that wording with this ref. --Doc James (talk · contribs · email) 05:51, 3 July 2010 (UTC)

Integrated today. WLU (t) (c) Wikipedia's rules:^simple/_complex 05:27, 6 July 2010 (UTC)

April 2010 from a Previous Editor Who Gave UP

Apparently a previous editor has commented on the biases in the bioidentical hromone page: We are starting to understand what has been going on here.

"This article has evident bias--as seen in its misuse of definitions, its unjustified generalizations, and its exclusion of evidence and other points of view. Like other editors who argued extensively and in great detail against WLU in the past, I gave up in frustration. Neither I nor Riverinpa nor other persons had or have unlimited time to devote to fighting with such a determined propagandist over a Wiki page. WLU repeatedly, and without rational justification, removed every evidence, argument, or point of view that disagreed with his anti-bioidentical position. (Does it even make sense to be against human hormones?) I see now that WLU has gotten what he wanted--the page is fully owned by him and no one even bothers trying to change it anymore. There is no point is rehashing any arguments with WLU. All his violations of Wiki policies, all his pseudo-arguments against including evidence and points of view have been exposed in the talk pages. The reader can begin with Archive_5 and work backwards. Fortunately, WLU is a lousy writer, so the intelligent reader can see quite quickly that this is a hatchet job. BHRT is a dead page and will remain so as long as WLU owns it." editor above April 2010

All editors interested in reclaiming the bioidentical page and removing the pro-synthetic , anti-bioidentical bias, NOW IS YOUR TIME TO COME TOGETHER. Contact me and we can do this together, UGAcodon (talk) 05:27, 1 July 2010 (UTC)

Sources, not assertions. Also see WP:FORUM, WP:SOAP, WP:PARENT. WLU (t) (c) Wikipedia's rules:^simple/_complex 12:41, 1 July 2010 (UTC)

Bioidentical progesterone shown to be more efficacious than synthetic MPA medroxy progesterone in peer reviewed clinical study in mainstream literature.

"The effect of progesterone compared with MPA included a 30% reduction in sleep problems, a 50% reduction in anxiety, a 60% reduction in depression, a 30% reduction in somatic symptoms, a 25% reduction in menstrual bleeding, a 40% reduction in cognitive difficulties, and a 30% improvement in sexual function. Overall, 65% of women felt that HRT combined with progesterone was better than the HRT combined with MPA." Quoted from Holtorf

Reference: Fitzpatrick LA, Pace C, Witta B. Comparison of regimens containing oral micronized progesterone of medroxyprogesterone acetate on quality of life in postmenopausal women: a cross-sectional survey. J Womens Health Gend Based Med. 2000;9(4):381–387.

UGAcodon (talk) 03:55, 1 July 2010 (UTC)

WP:OR, WP:SYNTH. WLU (t) (c) Wikipedia's rules:^simple/_complex 12:42, 1 July 2010 (UTC)

This is relevant to the progesterone article as well as the medroxyprogesterone article. It is not unusual for one compound to show superiority or inferiority over another. Why not document this on their relevant articles?--Literaturegeek | T@1k? 17:53, 1 July 2010 (UTC)

Bioidenticals Safer than Synthetics in Clinical Study - Conclusive Evidence

Synthetic Progestin Increases Risk of Breast Cancer, While Bioidentical Progesterone Does NOT.

Fournier followed 80,377 postmenopausal women on various forms of HRT for 8.1 postmenopausal years. During the follow period,there were 2,354 cases of invasive breast cancer. Those women on estrogen and bioidentical progesterone had a relative risk of breast cancer of 1.00, same as the non-HRT control group. Those post menopausal women on estrogen and a synthetic progestin had an increased risk of breast cancer of 1.69 Hazard Ratio. The authors conclude" These findings suggest that the choice of the progestagen component in combined HRT is of importance regarding breast cancer risk; it could be preferable to use progesterone..." This study cleary shows that synthetic altered versions of progesterone, called progestins, increase the risk of breast cancer (HR 1.69). Alternatively, the use of bioidentical progesterone did NOT increase risk of breast cancer over that of control group. This information should be prominently posted on the Bioidentical Hormone Therapy Page. I would ask all editors reading this to weigh in on this topic and make a comment about it.

Fournier A, Berrino F, Clavel-Chapelon F. Unequal risks for breast cancer associated with different hormone replacement therapies: results from the E3N cohort study. Breast Cancer Res Treat. 2008;107(1):103–111.

UGAcodon (talk) 04:20, 1 July 2010 (UTC)

Interesting but it is not relevant to this article as it does not say that this difference is due to bioidentical versus synthetic. All this source is showing is the superiority of one compound over another. As stated above, this should be added to the progesterone article as well as the medroxyprogesterone article.--Literaturegeek | T@1k? 17:56, 1 July 2010 (UTC)

Synthetic Progestins are Dangerous for the Heart, Much worse compared to Bioidentical Progesterone

Evaluating Effect on Coronary Artery Disease

Bioidentical compared to Synthetic

The Rosamo study clearly shows that synthetic progestins are dangerous for post menopausal women with pre-existing heart disease, and that bioidentical progesterone is safer.

"In a blinded, randomized, crossover study, the effects of estrogen and progesterone were compared with estrogen and medroxyprogesterone (synthetic MPA) on exercise-induced myocardial ischemia in postmenopausal women with coronary artery disease. Women were treated with estradiol for 4 weeks and then randomized to receive either progesterone or MPA along with estradiol. After 10 days on the combined treatment, the patients underwent a treadmill test. Patients were then crossed over to the opposite treatment, and the treadmill exercise was repeated. Exercise time to myocardial ischemia was significantly increased in the progesterone group compared with the MPA group (P< 0.001)." Note: increased time is a good finding meaning the patients could walk on the treadmill longer. Shorter time means quicker onset of myocardial ischemia from known coronary artery disease. Quoted from Holtorf

reference: Rosano GM, Webb CM, Chierchia S, et al. Natural progesterone, but not medroxyprogesterone acetate, enhances the beneficial effect of estrogen on exercise-induced myocardial ischemia in postmenopausal women. J Am Coll Cardiol. 2000;36(7):2154–2159.

Abstract OBJECTIVES: We sought to compare the effects of estrogen/transvaginal progesterone gel with estrogen/medroxyprogesterone acetate (MPA) on exercise-induced myocardial ischemia in postmenopausal women with coronary artery disease or previous myocardial infarction, or both. BACKGROUND: Estrogen therapy beneficially affects exercise-induced myocardial ischemia in postmenopausal women; however, women with an intact uterus also take progestin to protect against uterine malignancies. The effects of combination estrogen/progestin therapy on myocardial ischemia are unknown. METHODS: Eighteen postmenopausal women (mean +/- SD age 59+/-7 years) were given 17-beta-estradiol in single-blinded manner for four weeks (1 mg/day for three weeks then 2 mg/day for one week). Estradiol (2 mg/day) was then continued, and the patients were randomized (double-blind) for 12 days to either transvaginal progesterone gel (90 mg on alternate days) and oral MPA placebo (10 mg/day), or vice versa. After another two weeks on estradiol alone, the patients crossed over to progestin treatment and repeated the protocol on the opposite treatment. Patients underwent treadmill exercise testing after each estradiol phase and at day 10 of each progestin phase. RESULTS: Exercise time to myocardial ischemia increased after the first estrogen phase as compared with baseline (mean difference with 95% confidence interval [CI]: 72 s [34 to 110], p = 0.001), and was increased by combination estradiol/progesterone therapy as compared with estradiol/MPA therapy (92 s [35 to 149], p = 0.001)). Two patients (11%) were withdrawn while taking estradiol/MPA owing to unstable angina. CONCLUSIONS: Combination estrogen/transvaginal progesterone gel increases exercise time to myocardial ischemia, as compared with estrogen/MPA. These results imply that the choice of progestin in women at higher cardiovascular risk requires careful consideration.

This information clearly belongs on the Bioidentical Hormone Page. Please comment. UGAcodon (talk) 04:39, 1 July 2010 (UTC)

It is not necessary to fill up the article talk page with abstracts that are available by PMID links. Please read WP:MEDRS in relation to primary sources and secondary reviews. SandyGeorgia (Talk) 09:22, 1 July 2010 (UTC)

(outdent) Same as above sections, this study is relevant to the progesterone article as well as the medroxyprogesterone article, not this article as the source does not say anything about bioidentical, all it is doing is showing a superiority of one chemical compound over another.--Literaturegeek | T@1k? 17:53, 1 July 2010 (UTC)

Various editors, nsuch as USER:WLU, have asked for medical literature sources which support the claim that bioidentical hormones are safer and more effective than synthetics. This article is one of many. What would you consider as a valid and usable source if this isn't it? And forgive my asking, since I am a fairly new user, please explain why this reference is not acceptable. And also please inform me would be acceptable. There are another 196 of these, so perhaps we need to establish some ground rules first. UGAcodon (talk) 20:50, 1 July 2010 (UTC)

WP:OR, WP:SYNTH, WP:SOAP, WP:ADVOCACY. WLU (t) (c) Wikipedia's rules:^simple/_complex 20:56, 1 July 2010 (UTC)

You need a recent secondary (review or meta analysis) peer reviewed source which specifically says that bioidentical compounds are superior to synthetic compounds. As I stated what this source and other sources say is that one compound is better in one aspect than another. They do NOT say that the reason for this is because it is bioidentical. To say that without a reference is a WP:SYNTH. You could look up synthetic drugs within the same drug class and see that one of them causes liver problems and another doesn't for example, so clearly different side effect profiles are not determined by whether a compound is "natural" or not.--Literaturegeek | T@1k? 21:38, 1 July 2010 (UTC)

Why do you not this content to progesterone article as well as the medroxyprogesterone articles?--Literaturegeek | T@1k? 21:38, 1 July 2010 (UTC)

Per WP:MEDRS, preference is for secondary sources - review articles. This is a primary source, detailing a single experiment, in addition to requiring synthesis to be used here. WLU (t) (c) Wikipedia's rules:^simple/_complex 10:47, 2 July 2010 (UTC)

Financial Disclosure - Conflict of Interest - Financial Ties to Drug Industry

ACOG, American College of Obstetrics and Gynecology

Financial Ties to the Synthetic Hormone Industry

By the way ACOG, American College of Obstetrics and Gynecology, and OB/Gyne Professors have financial ties to the synthetic hormone industry. Wyeth funds several annual awards for the American College of Obstetricians and Gynecologists(ACOG),] totaling approximately $29,000 per year. Wyeth is also a Friends of ACOG Participant, where Friends donate $3,000 per annum, and is a frequent exhibitor at ACOG’s Annual Clinical Meetings and sponsors ACOG’s annual “Resident Reporter” Program.Association of Professors of Obstetris and Gynecology Financial Disclosure Page

AACE

The following Pharmaceutical companies, some of which manufacture synthetic hormones, serve as members of the Corporate AACE Partnership. Their generous finanial support make possible many educational programs and activities that AACE provides for its members:

GlaxoSmithKline Member since 1996 www.gsk.com LifeScan, Inc.Member since 1994www.lifescan.com MannKind Corporation Member since 2010 www.mannkindcorp.com Medtronic MiniMed Member since 1995 www.minimed.com Merck & Co, Inc. Member since 1997 www.merck.com NeuroMetrix Member since 2007 www.neurometrix.com Novartis Pharmaceuticals Corporation Member since 1993 www.novartis.com Novo Nordisk Inc. Member since 1993 www.novomedlink.com Pfizer Inc. Member since 1993 www.pfizer.com PhRMA Member since 2006 www.phrma.org Procter & Gamble Pharmaceuticals Member since 1993 www.pgpharm.com Roche Diagnostics Corporation/Roche Insulin Delivery Systems Inc. Member since 1997 www.rocheusa.com sanofi aventis Member since 1994 www.sanofi-aventis.us Takeda Pharmaceuticals North America, Inc.

reference: (AACE Online).

Financial Disclosure - Conflict of Interest - Financial Ties to Drug Industry

This information is important and should appear on the Page. Your comments please? UGAcodon (talk) 12:14, 1 July 2010 (UTC)

Please read WP:OR, WP:TALK and stop filling the talk page with incorrectly formatted off-topic discussion. SandyGeorgia (Talk) 12:22, 1 July 2010 (UTC)

According to WP:TALK, the talk page intended for "Discussion of edits: The talk page is particularly useful to talk about edits. If one of your edits has been reverted, and you change it back again, it is good practice to leave an explanation on the talk page and a note in the edit summary that you have done so. The talk page is also the place to ask about another editor's changes. If someone queries one of your edits, make sure you reply with a full, helpful rationale. Make proposals: New proposals for the article can be put forward for discussion by other editors if you wish. Proposals might include changes to specific details, page moves, merges or making a section of a long article into a separate article. This exactly what my comments are accomplishing. I do not understand why you are saying this is off topic incorrectly formatted. This is exactly what the talk pages are for. To discuss edits and proposals. SandyGeorgia, please clarify your comment. Also I would ask you if your serve as a mediator.UGAcodon (talk) 14:24, 1 July 2010 (UTC)

No-one cares. Your assertion would require original research to draw any conclusions, and fails WP:REDFLAG. Wikipedia is not a forum to spin tales. If you have no explicit evidence from a reliable source stating BHRT is kept down because of conspiracy (and note, also, that drug companies make these drugs, thus failing on basic logic) then stop posting your opinions. WLU (t) (c) Wikipedia's rules:^simple/_complex 12:36, 1 July 2010 (UTC)

For WLU- People care about financial conflicts of interest by doctors and researchers, and failure to disclose this information has resulted in sever penalties for individuals and organizations. So yes, people do care about knowing conflicts of interst, and want researchers to follow a code medical ethics. That is what this is all about.

Let me ask you a question. Are you saying that the financial disclosure statements of a medical organization is not sufficient to serve as a source for a financial disclosure? If so, then what source would you accept as sufficent for this information? How would you go about including financial disclosure information?. This question is for all readers, and editors, I am requesting assistance. Any comments?

I do not believe there is any conspiracy, and have not used the word, and yet you continue to ascribe this reasoning to me. WHy? In order to falsely discredit my comment? Any editor can see that I am discussing financial disclosure which comes under the category of medical ethics.

Vendor relationships Studies show that doctors can be influenced by drug company inducements, including gifts and food.[22] Industry-sponsored Continuing Medical Education (CME) programs influence prescribing patterns.[23] Many patients surveyed in one study agreed that physician gifts from drug companies influence prescribing practices.[24] A growing movement among physicians is attempting to diminish the influence of pharmaceutical industry marketing upon medical practice, as evidenced by Stanford University's ban on drug company-sponsored lunches and gifts. Other academic institutions that have banned pharmaceutical industry-sponsored gifts and food include the University of Pennsylvania, and Yale University.[25] Quoted from Vendor relationships UGAcodon (talk) 14:35, 1 July 2010 (UTC)

Topic ban?

I'm all for calling for a topic ban if UGAcodon doesn't stop posting massive screeds and start reading policies. WLU (t) (c) Wikipedia's rules:^simple/_complex 12:45, 1 July 2010 (UTC)

== Requesting Dispute Resolution or Mediation ==

WLU has asked me for referenced material supporting the claim that bioidentical hormones are safer and more effectivbe than synthetics, and when I gave it to him, (see above), he then asks for a topic ban . Does this make sense? Rather than disuss the material I have posted, WLU has asked for a procerdural motion, a topic ban, to ban my comments. This is against Wiki tules and against the spirit and letter of what Wiki stands for. Wiki asks for consensus building, and it is obvious to any reader, that this is what I am trying to do. However, at this juncture, WLU refuses to participate in consensus building. I hope he changes his mind and starts to participate in the discussion process.

If not, then I am requesting a neutral third party to mediate this disoute.

I am requesting dispute resolution or mediation process. Apparently there is a dispute in terms of content here between UGAcodon and WLU. According to the rules, "Users may be banned as an outcome of the dispute resolution process, or by uninvolved administrators enforcing Arbitration Committee rulings."

My feeling is that WLU, an experienced user for years on WIkipedia is unjustly maintainng a choke hold on content on this page. Previous editors (see above) have made this very same observation and have asked for mediation. I agree with previous editors who have requestd that Mediation or Dispute Resulution with WLU. signed UGAcodon|UGAcodon]] (talk) 14:15, 1 July 2010 (UTC)

Has an SPI been filed yet? (the editor has admitted one accidental sock). I think WLUs edits are supported by WP:MEDRS while yours aren't. Verbal chat 14:24, 1 July 2010 (UTC)

I haven't filed one, and based on my history with previous POV-pushing editors I don't suspect sockpuppetry (but I could be wrong). I'm not bothering to waste further time on this - USAcodon obviously doesn't understand the P&G and shows little interest in learning, so I'm not bothering anymore. The page is edit protected, if the main BHRT is edited inappropriately, I may revisit but these talk page postings are obviously going nowhere. WLU (t) (c) Wikipedia's rules:^simple/_complex 14:32, 1 July 2010 (UTC)

To WLU- perhaps you, too, should re-read the page, P&G "editing a policy to support your own argument in an active discussion may be seen as gaming the system, especially if you do not disclose your involvement in the argument when making the edits." This is exactly what WLU is doing- "gaming the system". WLU is preventing editing of the medical literature references which support the claim of safety and efficay.

Again, I am requesting mediation and dispute resolution. Any help wopuld be greatly apreciated.UGAcodon (talk) 14:51, 1 July 2010 (UTC)

Mediation and/or Dispute Resolution Requested

I am requesting mediation and dispute resolution. Any help would be greatly apreciated.

UGAcodon (talk) 14:53, 1 July 2010 (UTC)

Presenting the Medical Evidence that Bioidentical Hormones are Safer and More Effective

If there are no further objections, I would like to continue presenting the peer reviewed medical literature which supports this claim. This is the intended purpose of the Talk Page , to discuss edits and proposals. UGAcodon (talk) 23:56, 1 July 2010 (UTC)

You are not permitted to synthesize a novel conclusion from tangential articles, and are doubly-prohibited from doing so in order to advocate for a specific viewpoint. If sources are missing, you can present them for review. If the article doesn't use the word "bioidentical", then please don't bother. Please just post a link or pubmed number, not a lengthy discussion. It is quite easy for an experienced editor to tell if a source is worthwhile or not, we don't need an explanation. WLU (t) (c) Wikipedia's rules:^simple/_complex 00:56, 2 July 2010 (UTC)

I would interpret your comment above means yes for Presenting the Medical Evidence that Bioidentical Hormones are Safer and More Effective. Is that correct? If so I will proceed with your permission of course. By the way, thanks for the links to the synthesize and [[WP:SOAP|. UGAcodon (talk) 01:56, 2 July 2010 (UTC)

Are you saying that this article is doubly improper as it stands in that it advocates for a corporate pharmaceutical company POV?(EnochBethany (talk) 08:10, 30 December 2010 (UTC))

non-working links

I noticed there are many non-working links in the reference area. This is one of them

37.^ a b c d Holtorf K (January 2009). "The bioidentical hormone debate: are bioidentical hormones (estradiol, estriol, and progesterone) safer or more efficacious than commonly used synthetic versions in hormone replacement therapy?" (pdf). Postgrad Med 121 (1): 73–85. doi:10.3810/pgm.2009.01.1949. PMID 19179815. http://www.holtorfmed.com/nss-folder/pdf/BHRT-PGM-2009.pdf.

Here is a working link to a pdf file: http://www.bobmehrpharmacies.com/images/_content/bio-identical/The%20Bioidentical%20Hormone%20Debate-%20Ken%20Holtorf%20MD.pdf

UGAcodon (talk) 10:22, 2 July 2010 (UTC)

Done. WLU (t) (c) Wikipedia's rules:^simple/_complex 10:45, 2 July 2010 (UTC)

Advocacy on medroxyprogesterone

The advocacy for BHRT has spread to a comparison of the benefits of progesterone on the medroxyprogesterone page. See talk:medroxyprogesterone for details, particularly the comparison section. WLU (t) (c) Wikipedia's rules:^simple/_complex 01:44, 6 July 2010 (UTC)

Reviewing talk:medroxyprogesterone, it appears that Progesterone (Prometrium) and Medroxyprogesterone are both FDA approved drugs, and not BHRT (defined as nonapproved compounded preparations). Statements appear to be neutral POV based on referenced medical studies. Needed are additional secondary sources coming to different conclusions that compare clinical profile of medroxyprogesterone with progesterone. Post them there on the talk page. UGAcodon (talk) 03:44, 6 July 2010 (UTC)

Lede

Just a comment, but this was the first time I looked at this article and I have to say that lede is intimidating. Huge wall of block text. A suggestion would be to cut that thing in half, or maybe a third. I would be bold about this, but just seeing as how huge the lede was I can tell there must have been quite a few edit wars here and I have no interest in fighting either side of this. Just, for my sanity, please make that shorter! Rmosler | ● 18:44, 27 September 2010 (UTC)

Hi Rmosler. I split the first big paragraph into two paragraphs to improve readability. Per WP:LEDE#Length, for an article this size 3 or 4 paragraphs are recommended.--Literaturegeek | T@1k? 23:18, 27 September 2010 (UTC)

Thanks, I do appreciate that, I didn't get to read through the rest of the article until today and I didn't realize how incredibly long it was for this topic. 19 print pages, 14 of which are "main body" prose consisting of 39kb or 5936 words. I changed the formatting of the reflist into two columns. I don't know if there is a consensus to make this more user friendly/readable maybe by seeing if there is any redundancy that could be removed, or perhaps adding some pictures to break up the text. I'll look through it a bit more tomorrow and see what I can suggest. Rmosler | ● 20:47, 28 September 2010 (UTC)

Copyedits

Comments regarding recent copyedits:

• Per WP:LEAD, citations are optional in the lead. Having a single citation in the lead looks odd, I'd rather remove it.
• "Custom compounded BHRT is a practice almost wholly restricted to the United States" sourced to Cirigliano should be replaced in the body, which will also mean the citation should be removed from the lead.
• "The publication of a book by Suzanne Sommers in 2006 popularized the term "bioidentical" and it became "a poorly understood new adjective in the field" should also be replaced, the first half at least, and I would like the intent of the second half (the quote) replaced as well if an appropriate wording can be found. It could be used to source the first sentence, or a modified version of it, in Terminology. WLU (t) (c) Wikipedia's rules:^simple/_complex 12:19, 12 January 2011 (UTC)

I'm just copyediting for syntax, grammar and spelling (and, I admit, removing some redundancies; the section on estrogens is especially unclear). Since this is a contentious article and I'm maintaining NPOV—and, come to think of it, the copyedit tag has been removed anyway—I'm just going to give the rest of the article a once-over and call it quits. Wi2g 14:42, 12 January 2011 (UTC)

The copyedit is appreciated, the three comments above were my only objections to an otherwise fine set of improvements. If you have no objections to my suggested changes then I'll wait a bit for you to do your once-over and replace them. Thanks for helping out. WLU (t) (c) Wikipedia's rules:^simple/_complex 15:13, 12 January 2011 (UTC)

Glad to help; your points are well taken! Wi2g 19:19, 12 January 2011 (UTC)

• Just a clarification - nowhere does WP:LEAD say citations are optional, and WP:LEADCITE makes it clear that they are not optional. They may be necessary depending upon whether information is contested. II | (t - c) 02:14, 18 February 2011 (UTC)

Revert

I've reverted the most recent set of changes. It was a POV-pushing effort that removed citations, added shoddy ones to justify dubious claims, removed critical information, and added a lot of unnecessary {{fact}} tags. WLU (t) (c) Wikipedia's rules:^simple/_complex 11:08, 24 March 2011 (UTC)

While looking at the diff I noticed that it claims that testosterone and estriol is "not approved" in the US. That might be suprising not only for me and the {{fact}} tag belongs there. Or maybe the statement was about some specific formulation then it needs a clarification. Richiez (talk) 19:37, 24 March 2011 (UTC)

See Bioidentical hormone replacement therapy#Other hormones for testosterone. A testosterone patch is approved in Europe but not in Canada and the US, sourced to Derzko and this monograph. The section needs work, I'll try to get to it tomorrow. For estriol, see Bioidentical hormone replacement therapy#Criticisms and Bioidentical hormone replacement therapy#Estrogens. I'll revisit the testosterone information to make sure it's accurate, estriol certainly isn't approved in the US. I continue to believe that the lead does not need citations since the body is replete with them, but if enough people insist I can replace them. WLU (t) (c) Wikipedia's rules:^simple/_complex 00:41, 25 March 2011 (UTC)

Ok, was only a slightly misleading formulation. In the leading paragraph it says "—and testosterone, dehydroepiandrosterone (DHEA) and estriol, which have not been approved for use in Canada and the United States." Which almost certainly is overbroadly formulated and should be related to some specific use and formulation. Richiez (talk) 12:26, 26 March 2011 (UTC)

I've made some changes, though long I think it's accurate. WLU (t) (c) Wikipedia's rules:^simple/_complex 16:58, 3 April 2011 (UTC)

New source

Sood, R.; Shuster, L.; Smith, R.; Vincent, A.; Jatoi, A. (2011). "Counseling Postmenopausal Women about Bioidentical Hormones: Ten Discussion Points for Practicing Physicians" (pdf). The Journal of the American Board of Family Medicine. 24 (2): 202–210. doi:10.3122/jabfm.2011.02.100194. PMID 21383221., I'm going to try to track it down I've got it and I'm going to try and integrate it soon. WLU (t) (c) Wikipedia's rules:^simple/_complex 16:45, 9 March 2011 (UTC)

[1] Doc James (talk · contribs · email) 21:25, 5 April 2011 (UTC)

I knew it read familiar. Already integrated once, but certainly could use more. WLU (t) (c) Wikipedia's rules:^simple/_complex 22:55, 5 April 2011 (UTC)

Factual errors, disorganization

The section Components and compounding > Estrogens begins with the undocumented erroneous assertion "In premenopausal women the majority of estrogen produced by the body is estradiol ..." I replaced it with documented evidence. This error has a long history and features prominently in articles designed to obscure the dramatic contrast between CHRT ingredients and human hormones.

A related point: this article needs better structure. Titles like "Components and compounding" mix science and practice. This section, indeed this article, needs to be split and reorganized into conceptual topic sections such as the following:

• BHRT science - ingredients and pharmacology

• BHRT products - development, testing, marketing, usage, product safety, etc.

Page Notes (talk) 23:46, 22 August 2011 (UTC)

It is documented in the review Chervenak. We do not use primary studies (and especially ones published in biased publications like Alt Med Review) to rebut secondary reviews per WP:MEDRS. Yobol (talk) 01:51, 23 August 2011 (UTC)

Thanks for the pointer to WP:MEDRS, my apologies. I believe there a couple of places where this Wikipedia article misquotes Cirigliano.

1. Cirigliano does not claim that "In premenopausal women the majority of estrogen produced by the body is estradiol", but instead claims "Estradiol ... is the primary source of total estrogen in women during their reproductive years". The discrepancy stems from the fact that estriol is produced primarily as a metabolite of estrone and thus estradiol.

2. Cirigliano does not claim that the composition of triest was based on unpublished research. He quotes Wepfer as having made a similar claim and then gives a lengthy critique of a supporting publication of Wright et al. (his reference 123). A correct short summary of Cirigliano might be as follows: The composition of triest was originally based on two beliefs, that (1) estriol is the primary circulating estrogen in normal premenopausal women, and (2) estriol is less carcinogenic than estradial. The first assertion has been supported by data from a small uncontrolled short-term study. Small-scale studies regarding the second assertion have provided mixed results, and relevant large-scale studies are needed. Page Notes (talk) 15:19, 24 August 2011 (UTC)

I have no problem with your first suggested edit. Your second suggested edit probably works too, the relevant information can be found on page 615 of Cirigliano; it's obviously complicated so if you can manage a short but accurate summary, I say have-at thee. My only caveats are that you are editorializing in your "large scale studies are needed" (even if Cirigliano himself says this, it would need to be attributed and is probably better just left out). Otherwise, they seem like good changes. I'd have to re-familiarize myself with the literature to give a solid opinion. WLU (t) (c) Wikipedia's rules:^simple/_complex 17:29, 26 August 2011 (UTC)

Citations for saliva and compounding

The citations for the lack of efficacy of saliva testing and extra risks of compounding can be found here. Per WP:LEAD I've preferred to avoid citations in the lead due to the number required, but they can be added if others feel strongly about it. WLU (t) (c) Wikipedia's rules:^simple/_complex 10:49, 29 August 2011 (UTC)

Is This a Pharmaceutical Company Attack Ad?

This article reads like it was written by a polemicistic advertising firm hired by a Pharmaceutical company. It contained red herring issues, like stuffers in prescription boxes and salvia tests, which have nothing to do with the validity of BHRT. The article seems to fail to recognize that biest and triest are commonly used BHRT. It neglects the face validity of taking hormones that are biologically and chemically identical with human hormones instead of derived from horse urine and different in molecular structure. It bad-mouths state licensed compounding pharmacies, as if they were incompetent jackasses. I don't know why we would trust large corporations (who could well subcontract to a sweat shop) more than a compounding pharmacist.

And it contained arrogant, dogmatic, unprovable negative statements, which are by nature impossible to verify or prove. A statement like, "There is no scientific research about X," is an unscientific statement in its own right. How do you know? Have you read every journal in every civilized country, including China and Japan? And how do you know at the time of writing that "there is no research on X"? It could have been done last week, and you haven't yet read it. Now an honest statement would be, "I don't know of any research about X," but then the author would have to admit ignorance!

An important point would be not that one assumes that if horse urine hormones have negative effects in humans, then human hormones in humans would probably also have negative effects. The important consideration is that human hormones are likely to be safe in humans. Proof is neede to the contrary. The common sense hypothesis is that a restoration of the body's chemistry to what it was when a person was in his 20's should be beneficial. It is obvious that our bodies decay over time. It is not certain ipso facto that putting the hormones back at age 25 concentrations would be beneficial, but such a hypothesis has more face validity than assuming that youthful body chemistry would be bad for older persons. I think this article well-deserves a NPOV (EnochBethany (talk) 08:06, 30 December 2010 (UTC))

All of the text is well referenced and the concerns are legitimate concerns in the medical community. It is what sources say, rather than what editors say as wikipedia is a reference work. It is the source that is saying that no scientific research has been done in that area; if you have a more recent source which discusses new research done, then updating the article would be worth doing but until then we must say no research has been done. The claim of restoring hormone levels back to levels when aged in 20's is a popular selling point for bioidentical advocates, but it is flawed, the body lowers production of hormones because it no longer needs them, thus taking hormones creates a biological abnormality, and we know that taking hormones has a range of serious adverse effects up to and including cancer and effects on the heart. It would be very inappropriate and potentially harmful to promote bioidentical theories without strong medical research supporting the claims and would go against WP:NOR and WP:MEDRS. Ironically this type of promotion is similar to things drug companies have gotten into trouble for doing in the past, promoting drugs for unapproved uses, which might indicate that bioidentical companies or people selling books are involved in underhanded activities with profit in mind. Can you see the hypocrisy? The question could be asked, is this a bioidentical hormone industry attack post on the article you made? :-P--Literaturegeek | T@1k? 09:55, 30 December 2010 (UTC)

How do you know that the body no longer needs hormones? Does a woman's vagina no longer require healthy epithelial tissue? Does she no longer need to be comfortable during intercourse? It is obvioius that the body deteriorates. You may as well say that persons don't need to live. How can you claim that a person's body would not benefit by being restored to its condition at age 25? All of this text is not well-referenced. For example, negative statements cannot be proved. "There is no evidence" statements cannot be verified because the author has no way of knowing all of the research or even what has very recently been done. Indeed, this article looks like a propaganda piece for a pharmaceutical company. So far as I know, there is no bioidentical hormone industry comparable to the pharmacuetical corporations, only individual compounding pharmacists here and there, duly licensed by their states & duly trained. (EnochBethany (talk) 14:48, 31 December 2010 (UTC))

Sometimes a woman does benefit from hormones, which is why they are prescribed for example if the symptoms of menopause become severe or distressing but due to potentially serious adverse reactions and contraindications they should only be given under the supervision of a doctor who in conjunction with the woman can determine the risk/benefit ratio for the individual patient as with any other prescribed therapeutic intervention. If a review of the medical literature determines that there is no evidence to support a claim, then that is good enough for us to say that in the articles. Wikipedia is about verifiability, not an individual editor's version of the truth. Compounding pharmacists don't manufacture the hormones, so there must be an industry that manufactures them.--Literaturegeek | T@1k? 22:51, 2 January 2011 (UTC)

We can discuss further in the new year if you like. I shall end on a positive note if I may; no hard feelings, have a happy new year. :)--Literaturegeek | T@1k? 09:55, 30 December 2010 (UTC)

The statement "human hormones are likely to be safe in humans" is not correct. Epinephrine is a human hormone and in large quantities is not good for you. Biology is about balance. Anytime you change this balance one needs evidence to verify it is safe.Doc James (talk · contribs · email) 16:02, 30 December 2010 (UTC)

The illustration proves nothing. "Human hormones are LIKELY to be safe in humans" is quite correct. That statement does not say that in every case and in every quantity human hormones are safe in humans.(EnochBethany (talk) 14:45, 31 December 2010 (UTC))

No sources means this really isn't worth discussing. WLU (t) (c) Wikipedia's rules:^simple/_complex 11:52, 6 January 2011 (UTC)

This subject and therefore this entry is important to me. I am very knowledgeable on this topic. I am willing to put in more work to try and make it better. Each of my attempts have been reversed. When I cited my information, it was called conspiracy theory. There are literally hundreds of studies and thousands of books that refute just about everything this entry tries to impart.. The medical community is heavily divided on this. If no other thing comes to pass, that fact needs to be illustrated. That the number of physicians who believe in BHRT has doubled over the past two years from 11,000 to over 22,000 needs to be illustrated. The sources of the various information need to be better explained. When the studies saying it is harmful, dubious or in anyway negative, are being run from a medical school, it is important to explain that medical schools get their funding for studies from pharmaceutical companies. My wife is a professor at a medical school and I know this to be a fact. Second, when sources are quoted as saying that there are no studies refuting their information, it is important to not that, actually there are plenty. They have been conducted in other countries where there is not such a strangle hold on alternative medicine and therapies. If anyone else cares that this entry be treated fairly, please let me know and we can work on it together. Nutritiondr (talk) 01:51, 29 August 2011 (UTC)

WP:MEDRS outlines what are appropriate sources for Wikipedia.Doc James (talk · contribs · email) 01:55, 29 August 2011 (UTC)

If the medical community is genuinely divided, it should be easy to find peer-reviewed journals to substantiate your point. You also must refer to journals that explicitly discuss hormones within the context of bioidentical hormones - taking papers not on that topic then claiming they apply would be original research and forbidden.

As usual, the claim that Big Pharma (who manufacture most of the hormones, bioidentical or not) is behind the opposition to BHRT because of money is laughable. It particularly misses the fact that the practitioners who offer consulting fees and pharmacists that custom compound them are making significant amounts of money, direct to their pocket. There are financial conflicts of interest nearly everywhere, not just from "Big Pharma". WLU (t) (c) Wikipedia's rules:^simple/_complex 11:04, 29 August 2011 (UTC)

• If you take a look at the conflict resolution I set up for this topic, you will see that there are plenty of cited references including the New England Medical Journal and other scholarly medical journals. Nutritiondr (talk) 17:08, 29 August 2011 (UTC)

If you want to discuss specific sources, please at least start by presenting them here rather than the DRN. Also, please start a new section by clicking on the blue "+" at the top of the page. Please note that I have looked at those sources and provided comments - they are old, and there are much newer, much more prestigious sources used on this page that clearly and authoritatively discredit bioidentical hormones specifically. WLU (t) (c) Wikipedia's rules:^simple/_complex 17:30, 29 August 2011 (UTC)

Sources added in recent edit

Nutritiondr (talk · contribs) recently added sources to the page, diff. The sources are not adequate, and here is why:

• Langer, Stephen (1984). Solved: The Riddle of Illness. New Caanan, CT: Keats Publishing. pp. 1064–68. ISBN 0071470573.

This book is from 1984, at which point I don't believe there was such a thing as "bioidentical hormones". It's about thyroid dysfunction. There is a 2006 edition which does not use the word "bioidentical" (and "identical" only twice, neither of which is relevant). It appears that the book is being used to justify thyroid hormone as a bioidentical hormone. This requires an explicit reference, it is original research to claim that it applies to the page without a specific reference. WLU (t) (c) Wikipedia's rules:^simple/_complex

• "American Academy of Anti-Aging Medicine".

This is the American Academy of Anti-Aging Medicine. The page doesn't mention bioidentical hormones (or hormones in general). This is a citation that verifies the A4M exists, not that it trains and accredits individuals in the field of bioidentical hormone replacement therapy or does not promote the use of estrogen (overall this citation seems like a total non sequitur). In addition, the A4M is a fairly quack-tastic group, I wouldn't really trust their position on anything and don't believe they represent areliable source on the scientific mainstream. WLU (t) (c) Wikipedia's rules:^simple/_complex

• Opera, Winfrey. "The Bio Identical Debate".

This is a slide show presentation from the Oprah Winfrey show. It's mis-attributed (I doubt Oprah actually wrote it) and further, it's not a reliable source. Neither is Suzanne Somers' popular book on the topic. This illustrates the fact that the "positive" citations for BHRT are in popular, non-medical and non-scholarly press, thus illustrating the parity of sources is extremely uneven. Wikipedia gives weight to scholarly sources above all else. WLU (t) (c) Wikipedia's rules:^simple/_complex

• Klatz, Ronald, M.D. (1996). Advances in anti-aging medicine, Volume 1. New York: Mary Ann Liebert. pp. 50–60. ISBN 0913113719.{{cite book}}: CS1 maint: multiple names: authors list (link)

This book was missing a title parameter, based on the ISBN I added one (here is a google books link). Like Langer above, search inside reveals no mention of the words bioidentical or identical and thus it is unacceptable for the same reasons. WLU (t) (c) Wikipedia's rules:^simple/_complex

• Andrew, Weil. "M.D."

This is a link to Andrew Weil's website. Weil is a noted partisan pushing CAM therapies, he's the most scientific of a nonscientific, data-over-reaching bunch, but his website still isn't a reliable source. But the greatest flaw is that it discusses the Women's Health Initiative but simply doesn't mention BHRT. Though it could theoretically be used to source the WHI being shut down (though there are far, far better sources), it says nothing relevant about the BHRT, and it's summary was inappropriately editorial to a grotesque degree in addition to being an unacceptable amount of original research.

• Commenting on content, "Much of the controversy over bio-identical hormones come from the aspect that they are compounded. Compounding is the way in which drugs were originally dispensed, before chain drug stores and huge pharmaceutical companies came about. They are independent laboratories which customize the mixtures of medications for every ailment imaginable when the pharmaceutically produced alternative will not suffice. Bio-identical hormones are produced by the large pharmaceutical companies, and are available at mainstream drug stores. They are FDA approved and sold under the names: Androgel, Vivelle patch, Climera, Estraderm, Estrace, and Prometrium. However, they are only sold in set dosages. This is where a compounding pharmacy can dispense the same bio-identical hormones that are FDA approved, sold by major pharmaceutical companies, and distributed by your local drug store, simply making the dosage appropriate to an individual's specific needs.Schwartz" is also inappropriate. First, there are several sources that discuss, explicitly, the dangers of custom compounding. Second, there's way to much pharmanoia here. Third, on a personal note I would love to find these custom compounding pharmacies that presumably make and dispense drugs for free; if the criticism is Big Pharma makes money, then surely these kind, gentle, generous souls must give out all their drugs at no cost, otherwise the person making the argument is either ideologically blinded or a hypocrite. It's also inappropriately giving advice. Plus, there are several sources stating there are no advantages of custom-dosing. BHRT practitioners, like doctors, tailor medications to patients' symptoms despite their lip service to "unique blends customized to your specific needs". WLU (t) (c) Wikipedia's rules:^simple/_complex
• Some more content, "However, it is important to point out that a lack of evidence simply means that there have not been any studies, of which they approve, showing results that refute their comparison. Since there have been no studies for which these bodies approve, it is also important to point out that any statement containing negative information about the safety or efficacy of bio-identical hormone replacement therapy is an opinion.Oprah" Inappropriately editorial again, shoddy source and a blatant, inappropriate opinion. WLU (t) (c) Wikipedia's rules:^simple/_complex
• "One common claim from patients that use bio-identicl hormones are the number of pharmaceutical medications they no longer need as a result of their program." Completely unsourced testimonial. WLU (t) (c) Wikipedia's rules:^simple/_complex
• "The controversy concerning bio-identical hormones would not be fairly or evenly discussed without bringing up the point that IF bio-identical hormones are completely safe, and IF they do exactly what people say they do, THEN major pharmaceutical companies stand to lose a lot of money as people become healthier and stop taking their drugs." Sourced to the reference below, and inaccurate. Big Pharma already sells bioidentical hormones. Further, they are the manufacturers who provide these hormones to custom compounded pharmacies in the first place. And IF bioidentical hormones are safe, it needs to be DEMONSTRATED, not merely ASSERTED. If this is sourced to Erika Schwartz, it's solely her opinion and completely unjustified for the lead, and probably for the body. It certainly doesn't compare anywhere near the many medical sources that rebut this point. WLU (t) (c) Wikipedia's rules:^simple/_complex
• Schwartz, M.D., Erika. "The Politics of Bioidentical Hormones".

Presumably this is linked to this url. This is a blog, it's not a MEDRS. Dr. Schwartz doesn't get to have the same amount of play or content as the NAMA or other medical organizations that are highly critical of the rhetoric and shoddy evidence base of BHRT practitioners.

:: oh you are such an irretrievably biased and hypocritical editor on this subject. Pick a foot and stand on it. Here you dismiss Erika Schwarz (one thing we do agree on), but cite her as a reliable source for the Wiley Protocol page to make your point. You've exposed yourself as not fit to edit these pages. Others looking at this page or Wiley Protocol or T S Wiley join me in getting WLU banned. Send him back to his parents basement watching Star Trek and eating pizza. He's not an editor for encyclopedic content, he's a bully who uses Wikipedia policy to taint every page he touches. This is not a sudden argument, I've been battling him for 5+ years. I've had it. Neil Raden (talk) 19:47, 29 April 2012 (UTC)

And before anyone shouts "BIG PHARMA SHILL", I don't care. A conspiracy theory is not a reason to adjust any page. Not to mention, unless Dr. Schwartz is giving free consultations, books and talks (and she's not, it's apparently $275 for a phone consultation; oh, and it doesn't matter how you fill in the online form, you always get the same recommendation), criticizing Big Pharma for making a profit is, as I said above, hypocritical. WLU (t) (c) Wikipedia's rules:^simple/_complex 13:52, 29 August 2011 (UTC)

I've added another source to the sources section above. It is yet another one critical of BHRT. WLU (t) (c) Wikipedia's rules:^simple/_complex 23:22, 29 August 2011 (UTC)

Unprovable Negative Statements

All the unprovable negative statements saying "there is no evidence" needed deletion, except where the claim is that somebody said it (which is verifiable). You cannot prove a negative. You can rightly say, "I don't know of any evidence." But an author cannot know that he has read all the research, nor that while he is writing, new research has just been published. Here is an example of a legitimate way to make a negative statement taken from the FDA, "FDA is not aware of credible scientific evidence to support these claims." (EnochBethany (talk) 14:58, 31 December 2010 (UTC))

That's sourced to Cirigliano, so it passes WP:V. Not to mention the "evidence" in question would be peer-reviewed scientific evidence, and though the peer reviewed literature is voluminous, it is not infinite. There has been to direct experimental comparison of BHRT with conventional that I am aware of, not to mention they're just regular hormones. It's possible new evidence has been provided, but that would require the citation of new peer reviewed, secondary sources to demonstrate this. WLU (t) (c) Wikipedia's rules:^simple/_complex 11:50, 6 January 2011 (UTC)

By your statement, "It's possible new evidence has been provided," you establish the point that such statements as "there is no evidence" are intrinsically invalid. The scientific thing to say is, "The author cited is unaware of evidence." (EnochBethany (talk) 19:55, 7 November 2012 (UTC))

Obfuscation & Polemics

The tone of much of this article is obfuscating and polemical. A sober consideration of the real issue needs to be presented with a dismounting from the hobby horse. The basic question needing addressing in considering prescribing hormones, is whether or not prescribing hormones that are molecularly identical to human hormones, has any advantage over prescribing synthetic hormones, or over non-human animal hormones. There is an immediate common-sense appeal to the notion that exact copies of human hormones might be superior to non-exact analogs where a human body has a deficit of human hormone. The issues of who makes the hormones (compounding pharmacies vs. corporate giants), saliva testing, popularity in the USA vs. other countries, and unsubstantiated claims on one side or the other, is ultimately irrelevant and obfuscating to the basic issue: Do genuine exact copies of human hormones have advantages over synthetic analogs and animal hormones, for human use? The POV that exact copy human hormones should be assumed to have the same problems as synthetic analogs is unfounded. (EnochBethany (talk) 19:18, 31 December 2010 (UTC))

Research needs to be done, to determine that, it is not up to wikipedians to decide what the outcome of research might be as that would be a severe violation of the no original research policy.--Literaturegeek | T@1k? 22:53, 2 January 2011 (UTC)

What does that reply have to do with my commenT??? If you are going to reply, kindly address the issues raised. Where did I advocate posting original research? Actually this article is a serious violation of NPOV.(EnochBethany (talk) 06:40, 4 January 2011 (UTC))

Appealing to conspiracy theories is not research, nor is it a reference. It also ignores the profits made by people who promote BHRT, which is far more lucrative for doctors doing the prescribing, and compounding pharmacists doing the mixing. It also ignores safety issues, since the dosing of a compounded product is incredibly variable, unlike the standardized potencies produced by drug company factories. Horse urine is modified during its passage through the GI tract to become identical to human hormones. It's still dangerous. BHRT doesn't correct a deficiency, it unnaturally raises the naturally low levels of hormones in menopausal women. Saliva testing is an inaccurate representation of the level of hormones in the blood and active tissues, and is also irrelevant since there is no known standard or ideal hormone level for the saliva that can be dosed towards. Practitioners are actually doing exactly what doctors do - giving hormones then adjusting the dose based on symptoms. There are a large number of full-text sources available in the references section; if you have an issue with the critical statements, I suggest reading the accompanying reference. Please don't continue to reference "Big Pharma" unless you have a source that demonstrates explicitly that a pharmaceutical company has unethically interfered in this case. It's also a bit of a stupid argument, since the "bioidentical" hormones are made by pharmaceutical companies in the first place (and the mint made by proponents). We've seen this before, and it's still not convincing. WLU (t) (c) Wikipedia's rules:^simple/_complex 12:00, 6 January 2011 (UTC)

Making straw man arguments is not research, nor is it a reference, nor is it valid. Note that most of what you say has nothing to do with my post. Your claim about horse urine requires proof. You need proof that ingesting horse urine results in the same chemical additions to the blood stream that ingesting molecular identical hormones results in. (You also need proof for other routes on delivery; e.g., topical.) I said nothing about saliva testing, and this is a red herring to the discussion. What practitioners are doing requires a lot of observation and proof, instead of supposition. My issue is with NPOV. Are you actually reading what I write? I said absolutely nothing about "Big Pharma." This is a straw man. What do you mean, "Please don't continue blah blah"? I won't use the insult word "stupid" with you, but kindly refrain from charging me with a stupid argument I NEVER MADE. (EnochBethany (talk) 20:14, 7 November 2012 (UTC))

Guilt by Association

The opening line of the article is seriously lacking in clarification. "Bioidentical hormone replacement therapy (BHRT), also known as bioidentical hormone therapy or natural hormone therapy is a generally ill-defined term that frequently refers to the use of hormones that are molecularly identical to endogenous hormones in hormone replacement therapy, but is also strongly associated with." I suggest that after observing that BHRT is imperfectly defined, then the author give a definition of what he is going to talk about: "For the purposes of this article, BHRT will be defined as . . . blah, blah." Then the author should stick to the topic & not bring in polemical red herrings. The safety of Pharmacists compounding is another issue altogether. Should one write that synthetic hormones from horse urine are strongly associated with Pharmacological Corporations and then list all the alleged faults of that industry?(EnochBethany (talk) 06:49, 4 January 2011 (UTC))

Source(s)? The lead is based on the body. See WP:LEAD. Also note that most "regular" hormones are not produced from mare urine, they're made using the same plant sources and manufacturing processes as supposed "bioidentical" ones. BHRT is considered a scam, that's well documented. Please substantiate your statements with sources rather than opinion. The archives contains years of discussions on this topic, we're retreading old ground. WLU (t) (c) Wikipedia's rules:^simple/_complex 12:00, 6 January 2011 (UTC)

You say "Please substantiate your statement with sources rather than opinion." Where did I make a statement that requires substantiating? I am criticizing the approach of the article and how it brings in red-herrings and obfuscates the issues. The article shows that itself, as I point out. Please cease from erecting straw man arguments. (EnochBethany (talk) 20:25, 7 November 2012 (UTC))

I agree with Enochbethany. This page does not have NPOV. The editor, WLU is guilty of being a pharma shill and sits on this page for the pharma industry. This is obvious. BHRT is a scam? This is preposterous proposal by WLU, a pharma shill. Why does the FDA continue to approve bioidentical hormone preparations? Is the FDA a scam as well? --UGAcodon (talk) 02:05, 14 February 2011 (UTC)

Accusing others of being "shills" is a clear violation of WP:NPA, WP:AGF, WP:TPG, and probably several others. You would do well to avoid such talk. Discuss content, not the editor. Yobol (talk) 04:07, 14 February 2011 (UTC)

I've made something like a couple hundred edits to this page over the course of several years. With nearly 44,000 edits to my name, I'm clearly investing a lot of time in an extremely elaborate beard of edit to totally unrelated articles. Frankly, even if I knew another editor with my editing history was genuinely a pharma shill and paid to edit, I'd support that editor because the net benefit to wikipedia is remarkable.

Codon, you don't know what WP:NPOV is. This page is neutral, you just disagree with the large number of conclusions made by the multiple reliable sources cited on the page. You've been consistently unable to substantiate your edits through reference to reliable sources or the appropriate policies and guidelines. That's the problem, but until you can find sources to support your point, unfortunately you'll have to live with it. WLU (t) (c) Wikipedia's rules:^simple/_complex 01:50, 18 February 2011 (UTC)

The main purpose of this article appears to be to say that bio-identical hormone treatments are untested and therefore suspect.

And yet it then states in a number of places that they are presumed to have the same risks as synthetic hormones.

Why would any scientist presume that one compound would have the same effects in the human body as a different compound without testing it?

This is a very unscientific approach for a medical topic, which make the entire article self-contradictory.

I quote:

"Bioidentical hormones are expected to carry the same risks and benefits as their non-bioidentical counterparts, but there have been no studies that directly compare compounded bioidentical hormones with their non-bioidentical counterparts.[1][19] Hormones—as used in CHRT—have been studied for years and their risk, benefit, and effectiveness profiles are known and demonstrated through years of research.[11]" CHRT are NOT bioidenticla hormones. This is illogical.

Mariposa pesada (talk) 16:15, 26 October 2011 (UTC)

Yep, the main thrust of the commentary in WP:MEDRS on BHRT is that these treatments are either untested, or present exactly the same as CHRT (plus any risks due to custom compounding). Because BHRT normally involves a mix of tested (estrogens, progesterone and estradiol) and untested (pretty much estriol) mixtures, BHRT combines the risks. Whether synthetic hormones present the same risks as bioidentical is an unanswered question (and ultimately comes down to a comparison of different already-FDA-approved hormones for risks and benefits). It's a confusing topic, and the polemics and unabashed promotion that most BHRT proponents engage in certainly do not help. BHRT really isn't a separate "thing", it's a whole bunch of new rhetoric for a pre-existing set of compounds. WLU (t) (c) Wikipedia's rules:^simple/_complex 17:19, 26 October 2011 (UTC)

The Natural State of Aging Humans

I suggest that some thought be given to the argument which indicates that it is natural for post-menopausal women (and aging men) to lack the hormone levels that they had when young, thus to attempt to restore hormone levels is "unnatural." Also, thought could be given to whether or not the term "natural" confuses the issues. It should be self-evident that persons in general start out with good health and that their health declines with age. They lose strength, ability to run, ability to see well. Decline takes place step-by-step until one goes to the grave. The idea that a person would want to impede the deterioration and even recover lost youth, has intuitive appeal. Thus it is doubtful that one should depreciate attempts to impede the natural decline of the organism as "unnatural." It may be natural for the barn to slough off its paint, but who would say a new coat of paint is bad? And who is to say that the decline is in fact natural? Could it be that the human was created in an excellent and undeclining state and that its decline is actually an unnatural fact of life? (EnochBethany (talk) 20:42, 7 November 2012 (UTC))

Need a reliable source for these claims. Editor opinion is original research and not sufficient to adjust the page. WLU (t) (c) Wikipedia's rules:^simple/_complex 17:20, 29 November 2012 (UTC)

Is This a Pharmaceutical Company Attack Ad? Of Course It Is

I would agree with the above comments that this page on Bioidentical Hormones is a biased pro-industry attack ad. This is obvious. Bioidentical hormones compete with synthetic hormones for market share. Indeed, since the 2002 WHI revelations that combination of premarin and medroxyprogesterone called Prempro causes cancer and heart disease, synthetic hormone drug maker Wyeth has lost billions in market share to bioidentical hormones. It seems that the drug industry has paid a few key people to sit on this page and prevent any corrections of its many errors. The page plays down bioidentical hormones, and plays up synthetic hormones. As an obvious pharmaceutical attack ad, this is a very successful page. Mark up a win for the drug industry. --UGAcodon (talk) 16:38, 11 February 2011 (UTC)

Interesting idea, except it doesn't hold water. Why would the companies attack their own products? Do you think that the bioidenticals are not drugs that they could make as much profit on as the non-bioidenticals (whatever that term really means)? Still, if you really think you can show that there are such editors socking here, you are free to build a case at wp:SPI. Don't forget to show wp:DIFFs supporting your accusations. Not that I recommend that course of action. Instead, I suggest you actually find high quality (e.g. Cochrane) reviews of the science and understand those, and discount what the bloggers assert, especially when their statements support your preconceptions. LeadSongDog come howl! 18:29, 11 February 2011 (UTC)

Conspiracy theories are not sources. How about I spin one too - bioidentical practitioners make much more direct money from the sales of consultations and specially-compounded products. It is an industry, with pharmacists, natural products practitioners, and the manufacturers in on the unjustified promotion of unproven remedies while hiding the potentially deadly side-effects of these unregulated products, products proven to have such varying levels of active ingredient, you don't know if you'll get an overdose or ineffective dose. All because Big Bioidentical is so greedy to make money, they're willing to promote direct to consumers and completely bypass doing proper scientific research in order to increase their market share! Talk about a win for Big Bio!!!!

Convinced? I'm not. WLU (t) (c) Wikipedia's rules:^simple/_complex 01:43, 18 February 2011 (UTC)

This is totally unproductive. We need to get a mediator or something in here.QuizzicalBee (talk) 01:58, 18 February 2011 (UTC)

To what end? No editor has been able to demonstrate that there are missing, high-quality sources that support bioidentical hormones. There are many editors who seem to personally believe bioidentical hormones are some sort of risk-free miracles, but none who have been able to defend that perspective through actual references. WLU (t) (c) Wikipedia's rules:^simple/_complex 12:13, 18 February 2011 (UTC)

The subject is not what various editors do (ad hominem, personal attack). The subject is the objectivity of this article. If you have proof that arguing about saliva tests and greed is relevant, kindly bring it forth. Until you do so, I shall remain convinced that the article should address the comparison, validity, and efficacy of hormones. (EnochBethany (talk) 20:30, 7 November 2012 (UTC))

The standard is the use of reliable sources to verify information. An article is never "objective", it is neutral when it adequately expresses the opinions of relevant experts. People who advocate for BHRT don't tend to be experts and don't tend to publish in MEDRS. Those who do are in the distinct minority, while expert bodies are essentially uniform in condemning BHRT as useless, harmful and/or unsupported.

Also note that you're replying to a section that is nearly two years old. WLU (t) (c) Wikipedia's rules:^simple/_complex 17:24, 29 November 2012 (UTC)

NPOV

The history of this talk page illustrates well how this article does not have a neutral point of view. (EnochBethany (talk) 15:10, 31 December 2010 (UTC))

Statements like that need to be substantiated by reference to sources, not bare assertion. "Neutral" does not mean uncritical, and it's pretty clear that the mainstream opinion of BHRT is that it's marketing rather than science. WLU (t) (c) Wikipedia's rules:^simple/_complex 11:47, 6 January 2011 (UTC)

What is your proof that "it's pretty clear"? Is it not clear that if chemicals are identical between two different entities that identity is something different from the relationship between two entities that are merely similar? (EnochBethany (talk) 20:04, 7 November 2012 (UTC))

The large number of peer reviewed sources, consensus statements and criticisms by expert bodies that BHRT is not based on good science and the claims made by promoters are not substantiated, combined with the lack of comparable peer-reviewed sources supporting BHRT. Everything on wikipedia is based on reliable sources - most of which are critical. That is what "neutral" on wikiepdia means. Quoting from the policy:

“ Editing from a neutral point of view (NPOV) means representing fairly, proportionately, and as far as possible without bias, all significant views that have been published by reliable sources...Wikipedia aims to present competing views in proportion to their representation in reliable sources on the subject. ”

That is what "neutral" means, and by that definition this page is neutral because it cites a large number of peer-reviewed sources and consensus statements which converge on a common theme - BHRT isn't a miracle and there is no reason to expect it will deliver on the promises made by proponents. WLU (t) (c) Wikipedia's rules:^simple/_complex 17:30, 29 November 2012 (UTC)