Best practice for ERT?

Before leaving that day, Ashley asked, “Did you check out the Internet? Did you read about the horses?” I did know about the horses, and I understood why she, the animal loving vegetarian, had insisted on nonequine estrogen. Anyone wishing to know about the fate of the horses and their foals should search pregnant mare’s urine on the Internet.There is ample precedent for a movement away from animal sources for hormone replacement. Recombinant human technology has been used to make thyroxine and insulin rather than relying on older hormones extracted from beef and pork. After reviewing the scientific and ethical issues, we decided that in most cases, it was best practice to prescribe estrogens identical to that found in the human body rather than those derived from animals.

Our experience with Ashley changed our prescribing practice. Today we wonder why anyone, in pediatric or adult practice, would prescribe animal-derived hormones when those identical to that produced by the human female body are available?19

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Eileen Durham, C-PNP, CNS, MSN, is a pediatric nurse practitioner in the Division of Pediatric Endocrinology & Diabetes at Lucile Packard Children’s Hospital at Stanford in Palo Alto, California.


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