In this enlightening episode, Sue Moxley welcomes Dr. Fiona MacRae from the Marion Gluck Clinic to discuss bioidentical hormones and how they differ from conventional NHS hormone replacement therapy. Dr. MacRae shares her journey from NHS medicine and aesthetics practice to discovering bioidentical hormones, explaining how she witnessed countless women suffering from menopausal symptoms that weren’t being adequately treated by standard NHS options.
The conversation reveals a crucial distinction between bioidentical hormones and synthetic alternatives. Bioidentical hormones are naturally sourced and biochemically identical to the body’s own hormones, allowing for individualized dosing and combinations tailored to each patient’s needs. In contrast, NHS patches typically contain synthetic progestins rather than true progesterone, which can cause side effects like depression, bloating, and fluid retention while missing the protective benefits of natural progesterone for brain health, bone density, and mood regulation.
Dr. MacRae and Sue discuss the systemic barriers to bioidentical hormone availability, including Big Pharma’s influence on conventional medicine and lingering professional skepticism despite transformational patient results. The episode highlights how proper hormone replacement offers long-term benefits beyond symptom relief, including protection against osteoporosis, dementia, heart disease, and urogenital conditions—making the case for why women deserve access to individualized, natural hormone treatments.
Main Topics
Bioidentical hormones are naturally sourced and biochemically identical to human hormones, whereas synthetic progestins are manufactured compounds that don't provide the same protective benefits
NHS hormone patches typically contain synthetic progestins, not true progesterone, which can cause depression, bloating, and fluid retention while missing progesterone's benefits for brain, bone, and mood health
The Marion Gluck Clinic uses compounding pharmacies to create individualized hormone preparations based on measured hormone levels, rather than one-size-fits-all dosing
Bioidentical hormones protect against age-related diseases including osteoporosis, dementia, heart disease, and urogenital conditions when prescribed in appropriate doses long-term
Big Pharma drives conventional medicine's preference for patentable synthetic drugs over individualized natural hormone preparations, limiting women's access to optimal treatment
There is persistent professional skepticism and stigma around bioidentical hormones in the medical establishment despite strong patient outcomes and transformation
The Marion Gluck Training Academy is working to expand access by training doctors and nurses nationwide to offer bioidentical hormone services
Full TranscriptHi, I'm Sue Moxley. This is Women's Radio Station. This is The Menopause Show. Please follow us on Instagram, Women's Ra...▼
Hi, I'm Sue Moxley. This is Women's Radio Station. This is The Menopause Show. Please follow us on Instagram, Women's Radio Station, STN abbreviated, Facebook, Women's Radio Station, and YouTube. Really helps us to get the, the name out there and the word, um, for this wonderful station. So today I have a lovely guest. She's a doctor, Dr. Fiona MacRae, and she's going to talk to us about bioidentical hormones and the Marian Gluck Clinic. So, um, hi Fiona! Hi! Can you introduce yourself please? Yes, oh, hi everyone, my name is Dr. Fiona MacRae and I'm one of the doctors who works for the Marion Gluck Clinic, which is based in London. I've been an NHS doctor for far too many years, and I've recently retired from the NHS just to devote myself to the Marion Gluck Clinic. And I also have an aesthetics company up in the Northwest. So that keeps me busy. So do you actually do the aesthetics? Yeah, all sorts of facial aesthetic treatments. So I've been doing that for about 10 years whilst I was working in the NHS, just as, just as a bit of contrast really. And how is that going? Because I know that recently You're not allowed to treat anyone under the age of 18 now, I hear. No, I have never really treated patients under the age of 18. There have been very occasional exceptions to that, which, you know, quite individual circumstances, but as a rule Certainly for your, you know, your standard aesthetic treatments, 18 is the cutoff. Yeah. Where I live in Essex, so many young girls of like even 15 and 16 go and get aesthetics done, huge lips, etc. It's hard to regulate it, isn't it? Because there's so many people that that are kind of, you know, doing it illegally. They've not— they've not— they're not insured, all of that, you know. So, and the problem that the authorities have with regulating it is the, the ones that they can impose regulations on are all regulated anyway. There's, there's no way that they can influence, um, those who are doing it when they shouldn't really be doing it. Yeah, no, I've just noticed, I've noticed kind of around where I live and, you know, on social media, oh God, there's so many people doing aesthetics and I just think some of them only look about 18 or 19 themselves and I think, oh God, this could be a disaster. Yeah, but there you go, that's the world we live in, we just need to advise people to go to someone reputable like yourself and to just to do a bit of research first. I think that's the answer. Yes. Yeah. Yes. So tell us about the Bioidentical Hormone Clinic and what that is exactly and what it does. So I guess, well, how I got involved with it was was doing the aesthetics practice, and of course the age group I tend to treat were ladies who were also going through the perimenopause and menopause, and there was a lot of them complaining about the common symptoms. And I sort of thought, well, you know, there's hormones available on the NHS, why aren't they getting the hormone treatments there? But the conventional NHS treatments are very unsatisfactory. It's an area in medicine that we do not manage at all well. And somebody introduced me to the Marian Gluck Clinic and the idea of bioidentical hormones. And I have to admit, I was quite skeptical at first, because, you know, you can get hormones on the NHS. But I came down to London and did my training. And my eyes were completely opened. It's, it's a, it's a different mindset. And it's a very simple premise. It's, it's replacing hormones that you have lost because of age, replacing those with identical hormones, which are naturally sourced. And Marian has developed this, this setup where, where she measures hormone levels as a starting point and then uses a compounding pharmacy, which is a pharmacy who makes the preparations up from scratch, so that she can deliver individualized doses and individualized, um, combinations of hormones to suit each particular patient. And the results are fabulous. You know, they're really transformational results just by understanding, you know, what hormones are deficient, what's causing the symptoms, and targeting the, the treatment for that. And it's not just for, um, improving well-being in, in the present time, but it's also replacing hormones for a longer period of time to protect against diseases that we associate with old age. So things like softened bones, um, urogenital conditions, heart conditions, dementia. So hormones are very important for normal vital function. And if you deliver hormones in the lowest effective dose in a safe format, there's no reason why you can't stay on them for a long time, or even the rest of your life. Exactly. Well, I, I won't be coming off them. Um, but you see, with the conventional, you— the only hormone you get usually is oestrogen. You don't get progesterone except in one format, which is the tablet format, and it only comes in one dose. Otherwise, you have a synthetic progestin, which is a progesterone-like drug, but it does not do all the lovely things that progesterone does. Yeah, because progesterone— because I've obviously studied quite a lot. I had a really bad menopause myself, and I've been bioidentical hormones for 11 years, actually. So I know no one ever even used to know what they were when I said that. But progesterone is so important, isn't it, to counteract the estrogen? Absolutely. But, you know, the— just for example, like the patches that you get from the NHS, like, I don't know, I thought they— that some of them were estrogen and progesterone combined. No, no, they are not progesterone. They will be— a lot of them are proper bioidentical estrogen, if you like. The difference between body-identical estrogen and bioidentical, it's, it's an arbitrary difference, but it just refers to the fact that with bioidentical we can vary the dose. So you will get the same estrogen in, in many of these patches, and and in the gel, but you can only get the, you know, the 0.75 milligrams per pump of the gel, or, you know, the particular size patch. We, with the bioidentical, we can write a prescription for whatever dose of estrogen we want, and that is what will be put into the cream. But the 'Progesterone' in inverted commas in these patches is not progesterone. It's a synthetic progestin which works simply to protect you from endometrial thickening and therefore endometrial cancer. It doesn't have lovely effects on, on the brain or bones or anywhere else where we rely on progesterone, and it will also have side effects. So you get a double whammy there. You're not getting progesterone. You might get side effects from the synthetic compound. Like what? Well, depression is one thing. Fluid retention, bloating. Yeah. You know, progesterone is a natural diuretic. The synthetic can cause fluid retention and bloating. Progesterone is a natural anti-anxiety and a natural antidepressant, whereas the synthetic can cause depression or lead to depression. Why do you think that, you know, that— I'm not blaming the NHS because I know that they've got their own problems and they don't have lots of money, but I think that they haven't caught up with this. Do you know why? Why? Because it's not very good for women's health, is it? No. And the answer to that is, um, I think Big Pharma, because they drive this part of healthcare. What they're producing in the patch with the synthetic agent is, is a drug effectively. It's something that they can patent. It's something that they can earn a lot of money from, whereas what we are suggesting is individualized hormonal preparations and natural hormonal preparations. So there isn't the money to be made by the pharmaceutical companies in that. Yeah, so they don't want it to be out there, really? No. 'Cause it's quite hard to find. If you Google bioidentical hormones, you know, it's, it doesn't, there's not actually that many places. I mean, I know there's a few more now than when I used to very first started on it, but it's still not like massive, is it? It's different. It isn't. And, you know, I know Marian Gluck Training Academy is, is active, and we have quite a number of doctors and nurses coming through that and doing the training every year. And if they can set up businesses around the country then offering the service, then that's fabulous. But it isn't— I think there's There's, I guess, that there's a little bit of distrust still in this, and there's, because I think big pharma drive, because, you know, we sort of come up against convention, people are always a bit more suspicious, and, you know, there's the people have been quite, in the medical profession, quite disparaging about bioidentical hormones. And I think that sort of makes it more difficult to get a hold of. Yeah, because I'm— I actually— I mean, it's probably something you know about, but you know, the kind of laser machines that you can, you know, like the Mona Lisa Touch. I actually was treated with that probably about 7 years ago now. And it was wonderful. And together with my hormones, yes, my bioidentical hormones, I'm in quite a good place. But because it was so successful for me, I did go and do a chat for the company to a room full of doctors, and I told them my story and I said that I was on bioidentical hormones, and there was a lot of tittering in the room. Yeah. Couple of ladies at the front shaking their heads, doctors, you know, like, she's mad, what is this all about? Yes, well, it's not good. It isn't, and this is why, you know, Marion was so courageous, because she recognized that women were not being best served with what was available on the NHS. And she stuck to her guns and, you know, she's, she's pushed forward with this and the whole purpose is to get women feeling better. Yeah. And, you know, it's, it's, to me it's a no-brainer, you know, you've lost hormones. Yeah. So what are you going to do, have something synthetic or have the proper hormones? Okay, what's the actual difference then? So you, you talk about synthetic or the bioidentical. Where does it actually come from, and is it to do with the making of it that makes it either synthetic or bioidentical? So our bioidentical hormones are naturally sourced, so then they're tweaked in the lab so that they are then biochemically identical to our own human hormones. Right. So that means that, um, a molecule of this bioidentical hormone will sit exactly in the receptor on our cells and produce exactly the same effects as our hormones. Okay. The synthetic agents are not hormones. They are manufactured, manufactured products that, that will have some of the effects. So what convention is interested in is— because this is where the different mindset comes in— conventionally, your main menopausal symptom is hot flushes. So, um, general medical practitioners want to give you estrogen to get you through the hot flushes, and then you can go and be old. And estrogen is what you get. Now, because you can't give somebody who has a uterus estrogen alone, you have to give them something to keep the endometrium thin so that you don't you're not at risk of endometrial cancer. So you can either— for that purpose, you can either have a Mirena coil in, which will have a bit of this synthetic progestin in, or Big Pharma will make this synthetic compound which they can put with the oestrogen in a patch, for example, and then that will do the job of both. But they seem to have missed the point point that progesterone, the hormone, is also something that we miss during menopause. And, you know, so for example, you might get somebody who has a lot of anxiety or a lot of low mood going through the menopause. Well, conventional medicine will then give you antidepressants. Yeah, well, Why not give proper progesterone? But it all comes down to where the money is, because it's, as I say, it's driven by Big Pharma. So sad as well. I did notice that because I read about you, Fiona, and I noticed that you was a member of the Menopause Society. Yes. But they don't, they don't recognize bioidenticals. They don't like us. No, no, they're very, uh, discouraging about this. And their argument is that, um, we are not licensed, which we are not because we're delivering hormones rather than drugs. So, you know, it's difficult to get a drug license for something that isn't a drug. But also, each prescription, because it's individualized, again, it may— you know, you can't get that licensed. They also say that there isn't the evidence base to support safety as regards the bioidenticals. Yeah, these are the people who, um, not so long ago, and some practitioners, um, still do, um, they, they advocate the use of horse oestrogens, you know, Premarin. Yeah, that's derived from pregnant mare's urine. So these were equine estrogens that were packaged and delivered, and they're all licensed, and so everyone should trust them. Well, which would you rather take or use? Is it still out there then, Premarin? It is, it is. I couldn't believe it. I, I've had a couple of patients recently who horrendous estrogen-dominant symptoms, which is unsurprising. So, you know, the, the evidence base, because, you know, bioidenticals— again, this comes down to what drives it. And if Big Pharma are getting a drug license from something, for something, then they have to put in all these rigorous trials and And there is less evidence, admittedly, for bioidenticals, but the evidence is slowly growing and it has an excellent safety profile. Yeah, you just take breast cancer, for example, so that we know that estrogen on its own reduces your risk of breast cancer. Estrogen with progesterone brings your risk back to what it was, so it doesn't increase it. Estrogen with the synthetic increases the risk of breast cancer. Okay. And that is known, that's from the trials, from studies, it's replicated numerous times. Were they big trials? Oh yes, they've done massive trials into this. And there is a lot of evidence out there, and you will see that— I mean, the other problem is progesterone and progestin are often used interchangeably. So you will have conventional medicine talking about, um, the progesterone-only pill. Okay, it's not progesterone, it's a synthetic progestin. But they're used interchangeably, so I think in a lot of trials they're also used interchangeably. And we certainly do need more evidence from the bioidenticals, but it will come. You know, as more and more are used, the safety profile will become more evident. Yeah, so we just need to get it out there. Yes. And get more people offering it and, and take it. Or at least knowing about it so that you can ask, you know, proper questions. Because you can get, as I said, you can get proper natural progesterone on the NHS, but it's only available in a tablet at one dose. So it's called Utrogestan. Yeah. And that's proper progesterone. So you could have Estragel. Yes, a Utrogestan tablet, right? And that would be OK, and that would be OK. But again, it's— you don't have the ability to vary the dose. Yes, you know, one pump of Estragel, which is the lowest you can scientifically measure, is 0.75mg. But we prescribe, you know, much lower doses of oestrogen than that. So, so interesting. So how did— this is just a strange question— how did Marion come upon all this? Because how long ago did she, did she start the clinic? So the clinic, I think, has been well over 10 years. Yes. I want to say 2009, but I don't know whether I've just made that up. But, but certainly she's been practicing— she's been practicing in female medicine for virtually her whole life. So, so I think the clinic is sort of the, the end result of all of her life's work. And of course she's been running the training academies for a good while as well. I did my training, it was only in 2019, but I've been doing my own practice since then. And then I joined as a Marian Gluck doctor last summer. Okay, so but how did she find out about bioidentical? That's what I'm curious about. Sí, sí. Well, she did work, um, she did work, uh, abroad, um, and, and I think she came across it then. She came across, um, a researcher who had worked out how to, um, modify the plant hormone to be identical to the human hormone. Right, okay. And she came across a lot of women who, who were suffering because of what was available, um, and she then, um, went into, um, alliance is the wrong word, but you know what I mean. She, she went, she got together with, uh, people who could make these things up then in a compounding pharmacy. So these are the pharmacies that, you know, in the olden days pharmacies would make up their medicines in the back of the pharmacy shop, and most often now you do not have compounding pharmacies, you have, you know, everything's sort of off the shelf or whatever. But so Marion, a compounding pharmacy, so that these, these products could actually be made. So she's quite revolutionary, really, wasn't she? Oh, absolutely. Yeah. Oh, good for her. I'm just, um, she's, she has written a couple of books. Have you seen those? No, I haven't. What are they? It Must Be My Hormones. It Must Be My Hormones. Yeah, Dr. Marion Glocke and Vicki Edgson. Yeah, and the other one, It's Not My Head, It's My Hormones. It's Not My Head. Is that— that's great. I'm gonna read those. They're very easy reads. Um, I have scientific— a long time ago. But, but she tells you, um, she does a little bit about her story. Um, yeah, and I think it was about basically what I said. It was people coming to her who were unsatisfied with the, um, their experience with conventional, um, medicine. Yeah, I know, I will, you know, it's, um One of my really good friends, she's a bit younger than me, so she's just starting to go through it. And she has tried so many of them at different strengths and different brands, and she just can't cope with the side effects. And she's back to zero at the moment. But— Wow, she needs to come and see us. I know, we need to get her on bioidentical. That's what we need to do. So, okay, well, tell me a little bit about yourself, Fiona. You're Scottish. Was you born in Scotland? No, no, I was born in Billinge, near Wigan. Oh, okay. So I, my background in the NHS was in anaesthesia. Okay. Which is as far away as you can get your thinking from bioidentical hormones. However, now you're trying to wake people up before you was putting them to sleep. Yes, yes, exactly. Um, but I, I did have a lot of experience in anesthetizing patients with fibroids for hysterectomies and with endometriosis for either laparoscopic laparoscopic surgeries or hysterectomies. Yeah. And also a lot of patients with fractured hips. And it struck me that these were, you know, clearly they had soft bones because they'd fractured a hip, but they were nearly all suffering from dementia, heart disease. You know, having heart attacks under anesthetics was, was really quite common. And virtually all came to theater in a urine-soaked bed because they had no control over the bladder. Yes. And when I was doing the training with Marion Glock, this is the thing that struck me, was the prevention of disease in the future. And suddenly this, this picture that I was so used to seeing, usually of a weekend, wasn't necessarily what I had to look forward to. No. And that's when I became very interested— well, for other reasons as well, but that was key. And for me, that's That's the big thing, is, is preventing disease in the future, um, and living a longer, healthier life. Exactly. It's not just about the menopause, it's when we're in our 70s and our 80s. But you see, if you're giving somebody the synthetic and you know there's an increased risk of breast cancer, you're going to say to them, you have to limit the time that you're on this. Yes. What happens after that time? I know, you know, your thermostat might have reset, so you're no longer getting hot flushes. Yeah, but you've got all the rest of it then to look forward to. Oh, I never knew that. You know, maybe so it's possible for your thermostat to reset, what, after HCP, or it just It just naturally resets. Okay. You know, you— the, the estrogen that you'll be getting through HRT shouldn't be the same as your natural estrogen, um, level. So you, you will just get used to a different thermostat, and then the flushes will just fade. Your blood vessels will change, won't they? And you, you don't dilate your blood vessels as easily, because as you age, they will get a bit stiffer. You get changes in your lipids. So your flushes will subside. And this is where you have, you know, take oestrogens for so long and then see if your flush is gone. I mean, for a lot— for some women, they last for years and years and years. But for the vast majority, they will settle. And that's idea behind have this for a short time, wait until your flushes have settled, and the rest of it you just have to get on with. Because what— there's such a misconception. Even my husband, although now I've educated him, but he thought, he thought that a lady had menopause and then after a few years it ended. And you were then okay again. You just got to get through those, those few years. Well, mine has never ended, and that's been 11 years. But that's a lot of people still think that, especially lots of men. And that's not their fault. It's because they've not had an education. But yeah, people think, like men and ladies, that you're going to go through the menopause, you're going to have a couple of years where you you're not feeling good, and, and then after that it's gonna gradually settle and then you're going to be well again. Yeah, it doesn't work like that. No, it doesn't work like that. Carries on, doesn't it? And now you've mentioned men. Men have changes as well, because, you know, if— I don't know if you've noticed, um, increased anxiety with age. Yes, my husband used to be very, very laid back, and now he's sort of worrying about all sorts of things. And they need progesterone as well as an anti-anxiety. They lose progesterone, um, but also the big one is testosterone for men and maintaining, you know, normal function and healthy bones and healthy heart. So they are not to be ignored. So does that stop the cowboy boot and the sports car phase that they're going through? Maybe. I was just thinking I'll get my husband on progesterone really quickly in case he goes through that stage. Yeah, I've got mine on progesterone. But, um, but yes, so I, I did a lot of anesthesia, and then when, um, the pandemic hit, I went into microbiology because there was no call for general anesthetists. So I was seconded to microbiology because they were absolutely drowning in work, as you can imagine. Yeah. And I looked after the critical care patients from a microbiology perspective. You know, I wasn't a microbiologist, but I was the liaison between the critical care and the microbiology team. So that was really interesting. But what did it actually consist of, that job? What does— what did you do? I know you said you looked after— I had to check, so all the patients on ICU, I had to go through them every day. I would look for signs of deterioration, which could be due to an infection. I would check on the samples in the lab and make sure that correct samples have been sent. I would check on results. I would check on— it was a big part of it was spotting a deteriorating patient and alerting the microbiologist to that. Because during the, the first and even the second wave, um, the, the microbiology team didn't get to ICU to do the daily ward rounds that they, they used to do. So it needed somebody who could spot a deteriorating patient and then sort of marry that up with all the blood results or specimen results and spot an infection that was brewing. And then liaise in terms of antibiotics or further specimens or, you know, everything else. So that wasn't on people that had COVID, they were the other way around? No, no, this was, this was COVID. Oh, because we, you know, our ICUs were full of COVID patients. But the thing about COVID was we didn't know how it was going to behave in terms of other, you know, physiological hits. So for example, a lot of people succumbed to blood clots during the first wave of COVID We didn't know that that was part of how it would behave. We didn't know that the, the initial respiratory illness was then going to be followed from day 10 with a huge inflammatory response. We didn't know if there was going to be a lot of bacterial infections, associated with this particular virus as, you know, in other pandemics. So there was an awful lot of learning going on in the first wave, and then we knew a bit more of how to manage it in the second wave. But yes, it was just, you know, a sort of niche job that was just put together because of need, really. It was all hands on deck, and I wasn't intensivist. So I leapt at that opportunity. So, and it was, it was very, very tragic, awful, deathly interesting. Yeah. And then I packed in at the end of November last year, and here I am in the next phase of my career. Vaginas and hormones. Oh, so that's amazing. So, um, but what— so when did you train as a doctor then? Right. Oh my God, I can't say that on radio, it was so long ago. And where was Liverpool University? I went, um, yes, a long time ago. So, so that's all you ever wanted to do? Was your, was your family doctors or anything? Yes, my parents are both doctors, and out of 5 of us, 3 of us are doctors. I have 2 sisters who are general practitioners, um, in Rainford. Okay, so that— so all 5, though— so 3 of the 5 children are doctors? Yes. What do the other two do? I'm just curious. So one, both of those, one did physics at Imperial College and he now, both of them now do computing. So one is an IT consultant and the other actually works for my sister's practice and does all their computing. It's funny, isn't it? I think that, um, I do think we tend to sometimes follow our parents' careers. Um, yeah, yeah, either, either similar, um, personalities or no imagination, so you can't think of anything else to do. I haven't decided which one it was for me. I wouldn't admit to that if I was you. So, so take me through the procedure. So say, you know, one of our listeners wanted to, you know, go on bioidentical or, or try it, what would she have to do? What's the procedure from start to finish? She would contact the clinic, she would speak to one of the fabulous admin team and she would be booked in. She could either do it that way, she'd be booked in then for an initial consultation, or she could book online for an initial consultation so she can book herself. So all the doctors' bios are available, um, on the website and We all come from slightly different backgrounds, and, you know, she's— each patient can see who they think is going to be the best fit for them, or if they don't have a preference, they can go through the admin team, and then they will have an initial consultation, which can either be in person, via a video link, or via phone call. And that is down to patient preference. Okay. And the initial consultation time slot is 60 minutes, of which 45 minutes is earmarked for the actual consultation, and then 15 minutes is for us to do our notes. But very often the consultations will take up the full hour. And we just do our notes, you know, at a different time. Yeah. The initial consultation is very thorough. It goes through all current symptoms. It goes through past gynae history, obstetric history, medical history, medications, allergies, screening tests, treatments that have been tried so far. And then usually, I mean, I would say in the vast, vast majority of cases, we will require at that stage some sort of hormonal assay. And this can either be blood tests or it can be urine tests. Usually it's blood tests. Sometimes we like to do both at the start. And this is where one of the criticisms— sorry? Do you send out a kit for them or do they have to go to— No, well, if they're London-based, then we send them to the doctor's laboratory, which is on Wimpole Street. Yeah, but if they're elsewhere? If they're elsewhere, elsewhere, Marion has set up a number of contracts with Superdrugs across the country. Ah. And in that case, we can send the kit to the Superdrug, and then the patient will go there, and then the blood will be sent to the doctor's laboratory, who will process. Okay, and then what happens? And then we have a review appointment which can be 1 to 2 weeks later, to go through the results and then plan to commence some hormone replacement. And do the patients— I mean, because I order my— well, obviously I have a doctor that gives me a prescription, but then I send the prescription in to one of the compounding factory, well, pharmacist, but there only seems to be like 2 of those in the whole country. Have I got that wrong? Yes, well, there's definitely the one we use. There's another one I know of which I think is London-based, and there's a third which is more up this way, Cheshire-based, I think. I don't personally know of any others. I know, why? If this is becoming such, you know, it's going to become popular, why is there only, you know, like 2 to 3 compounding factories or laboratories? It's like so busy, and how do they cope with it? No, no, they are— well, certainly the specialist pharmacy can be very busy. That's where I find from, yeah. Yes, um, yes, no, they can be very busy. Um, I don't know is the answer to that, unless it's just that the, you know, the, the big drivers, as I've said, are the big pharmaceutical companies, and, you know, it might take a lot because presumably if, if as medics we get such criticism for what we're doing, maybe the pharmacies do as well. And you know, it takes somebody who either likes controversy or, um, yeah, has the guts because you know, some people just want And I totally get that. Yeah, that— yeah, because I— it surprised me. I thought there was literally only one because, um, they're very strict about their prescriptions, the specialist pharmacy, and sometimes to the point where, I don't know, they would say, oh no, this, this prescription, um, they've left out a little date or something or whatever. Yeah, I've, I've been going there for 11 years and I get— and I used to get a bit annoyed because then I'd have to go back to the doctor and say, can you rewrite my prescription? But because you've left a letter out or this or that, very, very strict. I think if, if you are doing something that isn't conventional, you have to be— you are more careful. I know through the clinic, even though we have the safety evidence, we still will put in additional tiers of, of investigation, additional tiers of safety. You know, for example, if we have patients who are on any sort of oestrogen supplementation, unless it's the very weak vaginal oestrogen, which doesn't count towards your systemic absorption. We will ask you to do a transvaginal ultrasound scan every 12 to 18 months, simply to measure endometrial thickness. Because— and you wouldn't be asked to do that on the NHS because their products are licensed. Yes. And so Big Pharma would take the flak. So therefore, there's not, you know, there isn't the financial interest for GPs. It's, it's licensed, there's the evidence. So that's that. Whereas, you know, we put that tier in to ensure patient safety. And I think you do extra things like that if you are against convention. Oh yeah, I understand now actually. I can understand why they're so thorough and strict, um, because I used to think, well, you know, surely you must have my records and know that I've been ordering this for, for so long. Um, but yeah, now I understand that that's because, um, they have to be, uh, they will be getting criticized that what you're producing is not licensed. And, you know, that's what they'll have in the back of their head. So if it's not licensed, is it illegal then? No, no, no, no, no, no. It just means it doesn't carry a drug license, right? Um, and because it's difficult to understand this bit, but it's because from my— the way I think about it is In order to get a drug on the market, yes, you need to say, I want to put this drug on the market and I want to treat this condition. And then you back that up with evidence that this drug will treat this condition, and then you pay a lot of money and you're given a license to market that drug for that indication. Now, a lot of the drugs we use, and especially a lot of the drugs we use in, in anaesthetics and pain medicine, we use for off-licence reasons. So we're not using the drug in accordance with the licence that was granted, we're using it because the drug was found to have a favourable side effect, and we're using it for that side effect. So we're using drugs in that situation that are not licensed for that indication. When you, you know, you are putting a hormone preparation on the market, how do you get a drug license for a hormone preparation? Because it's always been— it's, it's a hormone, it's a natural substance, isn't it? It's a natural molecule. Yeah. And then how do I— if you are on a particular combination of hormones, and I'm on a particular combination of hormones, do I then need to go and get a license for your combination and then another license for my combination? And, you know, it's just, um, it's just a minefield. So it's not possible to do. Now, it doesn't mean that we are illegal. It doesn't mean that we are not regulated. Um, it doesn't mean that we are not safe, you know, bioidentical hormones is a recognized legitimate form of HRT, but we're not licensed for that reason, and therefore we attract, um, controversy, a lot of snooty looks. When I spoke up about it at that convention, it was almost like, that's it, yeah, dirty word, you know. Yeah, it's almost like it's, it's a bit of a gimmick, and yeah, you know, you're a bit new age if you are trialing this. I remember when I first did the training and I told my sisters what I was doing, and the eyebrows raised and the eyes up to heaven. And then we had this debate about, but there's progesterone in what we prescribe. I said, there isn't. And we had this barney until I said to them, go to the drug book, look up what is in— what's in the Mirena coil. Oh, it's something called levonorgestrel, which is not progesterone. So, you know, and then they get it now. So they actually do bioidentical hormone replacement, but use the conventional drugs available conventionally. Yeah. Okay. So you even had to convince your sisters? I did. Because this is the whole misperception, misconception in, in, you know, a lot of conventional doctors think that what they are prescribing is progesterone. Or it's just a progesterone equivalent and will do the same things as progesterone, or that you don't need progesterone anyway. Yeah, as you age. Well, just look at all the poor women who suffer from PMS and PMDD and ask them, do they need progesterone? I know, yeah, it's crazy. Um, well, I do think that the menopause is being highlighted now in a way that it's never been before, um, don't you think? Absolutely. I think, um, that started with a certain program, didn't it? Davina. Oh, was it her? What do you think? That was what started it? I think that was what got people talking, I think. So she did a good thing there then, didn't she? Yes. Yeah, I mean, she didn't talk much about bioidentical hormones. She just highlighted the failing in the current NHS for helping women who have hormonal issues, and it is a woeful failing. And I don't think it's their fault. It's, you know, it's to do with where funds should be directed and also So again, you're coming up against Big Pharma who drive this part of the business. But controversially, do you think that if it had been a man's problem, it would have got dealt with quicker? Maybe. That's terrible. I shouldn't have been— No, no, that is very interesting. And I certainly I think it would have been. I remember, this is not to do with hormones, but as a young anaesthetist, I was almost dragged by the hair to theatre because of a patient who had a testicular torsion and was at risk of losing the testicle. And, you know, there was no urgency about other patients who might have had, you know, as emergent situations, but the threat of losing a testicle was— and it was a male surgeon, so I think there is something to be said for that. Yeah, because they're so precious to them, isn't it, their testicle, even if it isn't life-threatening or anything. Yes, very, very precious. Well, that was it. It wasn't it wasn't life-threatening, whereas they moved slower for life-threatening emergencies. That's not good. No. But yes, I think maybe, maybe it would have been different if it is a man's problem. Yes. And you know, men are affected clearly, but the they're less likely to come forward a lot of the time because they think, well, that's women's issues. And, you know, they feel uncomfortable coming and discussing their own hormone, potentially hormonal issues with, with what they see as a woman's doctor. So that's another conversation that needs to be had. And, you know, because Why should they be suffering? Yeah, well, the reason that this radio station was originally started up was because Russ Kane, the director, had a conversation about how the suicide rate in men is like 80% compared to 20% in women, realising that women do talk to their friends, or they will Yeah, they will go to see the doctor. And but men, they haven't got anyone to talk to because it's like not masculine to say that struggling and all that sort of thing. And that's originally why he started this, so that, you know, people could talk more openly about mental health and all types of health things. And yeah, because yeah, they have their own problems, the men, don't they? Because they're expected to. They're expected to be superhuman. And, you know, as you lose testosterone, then you become less superhuman. And then if you lose a bit of progesterone as well, you become a bit more anxious and a bit more low mood. And, you know, you can see things spiraling downwards. And the other thing, just talking about suicide, is, you know, that is hormonal reasons for suicide are pretty big. And, and it's so tragic when you think with a little bit of replacement and balancing of hormones, that could be solved. Yeah, I know, it's very sad. Um, but hopefully we're bringing awareness to that, and this radio station is That's the reason that, that it's— that we're here to, to get out, to get this, this out there more so that people— because when I very first had the menopause and I had some really horrific symptoms, no one really understood. My GP didn't understand what was going on, and it took me about 3 years of my own research, Fiona, to get to a stage where I actually feel okay now, you know. Um, but it's, um, yeah, it's hard. Need to get it out there. But it's very hard. Um, and it's unfortunate that it's only available, it seems, to, to people who can afford to pay for it, because you don't get it, you know, even the, the hormone specialists, um, in the NHS, they're still limited by the what's available on the NHS. Yes. And don't have access to the ability to vary and to offer a range of hormones. Yeah. You know, it's not just estrogen and progesterone. We, we have women on testosterone, we have women on DHEA, which is an adrenal androgen, which is your joie de vivre hormone, um, you know, and in different combinations, because it's not just about levels of hormones, it's about balancing the hormones. Yes. And with, you know, GPs might look at your, your— if they do blood results, they might look at your blood results and say, well, they're all normal, and you might be within the normal ranges, but if you're out of balance between your estrogen and your progesterone, you can feel absolutely dreadful. Yeah, for some reason we lost Dr. Fiona, and I don't know, just, just dropped out for some reason. So we're coming to the end of the show anyway, so I think I will tell you all of the details If you want to get in touch with the Marian Gluck Clinic, their phone number is 0207 191 2378, and it's Marian Gluck Clinic, so that's Marian and G-L-U-C-K clinic.com, and Yes, as, as the doctor said, as Dr. Fiona said, there's quite a few doctors on here. I think they're in different places in the country, so it'd be quite easy for you to probably find someone near you. Yes, that was a very interesting conversation today about bioidentical hormones and how much better they are for you, which I've always believed myself. Of course, there's going to be people out there that don't agree, and, you know, we're all entitled to our opinion, but I think that bioidentical hormones are the way forward. And so I'd like to thank Dr. Fiona McCrae for coming on the show today and telling us all about it. And, you know, thanks for listening to the show. Menopause Show, Sue Moxley on Women's Radio Station, um, and that is on Instagram, Women's Radio Station, with that abbreviated to STN, and also on YouTube and Facebook. Thanks for joining me today, and I'll see you all the week after next.
