The reason I am explaining this story is because of an alarming fact: 90% of the compounding pharmacies in this country dispense creams and they have no idea what harm they are doing to their patients. The majority of these patients will eventually stop taking bio-identical hormones and will walk-away with the impression that BHRT is not effective — when in fact, these patients are just not receiving the proper method of dosing.

When I first started with bio-identical hormone replacement therapy (BHRT) over 20 years ago, I originally invented a transdermal cream base called Viaderm FMG (Patented & Trademarked 2003). At the time, this was the best transdermal cream I had ever come across, so I started dispensing bio-identical hormones within this cream base.  But after two to four years of my patients being on the cream, I noticed a phenomenon occur:  The majority of my patients came back to me complaining they were experiencing the same hormonal imbalance symptoms that brought them to me in the first place. So, I had to reason out why this was occurring after so many years of success with BHRT. It was obvious the symptoms were returning because the endocrine system was out of balance once again:  but why?

Coincidentally, at the same time this was happening, I had a patient that came to me and who’s saliva test yielded these results:

It is key to note the progesterone levels of this patient, indicated by the flat line at the top of the graph.

So, I decided to re-test all of the patients who were having sudden problems with the BHRT cream. All of the saliva tests came back identical to this patients chart, with the progesterone clearly elevated and not cycling the way it should. I have approximately 500 charts that look the exact same way. At last, I had figured out the imbalance. I deduced that the creams were getting into the muscle and fat cells of these patients; thereby releasing the hormones slowly into the body. At the same time, the women were increasing their own dosage to try to alleviate their symptoms.

You will notice the same elevated progesterone level in this patient's chart. The reason that this patient's progesterone is elevated is due to the way in which the body absorbs BHRT creams. This is why I am an advocate of sublingual dosing.

After much more deliberation on what would make a better way to dose my patients, the idea of using sublingual lozenges came to me. Sublingual delivery is the most superior dosing method, because it is the most immediate method of absorption into the human body and once the sublinguals are absorbed, they go directly to the cells where they are needed. Sublingual delivery allows the practitioner to control the dosage per day, making it easier for the practitioner to alleviate the symptoms of all women, at any age in which hormones play a major part of their life, even in cases of fertility problems and puberty.

-Dr. Robert Fishman