Medicine’s Blinders: How Flexner & Pharma Led Us Away from Bioidenticals—and What That Means for Your Hormones

If medicine were a horse, it's wearing blinders. That’s not dramatic—that’s by design.

Let’s unpick that: how education, patents, and synthetic hormones converged to narrow our doctors’ vision—and why you, hormonal woman, might still be paying the price. Then we’ll lift the blinders together, so you can choose what truly makes your body sing.

1. The Flexner Report: Medicine’s Origin Story—and Its Shackles

In 1910, Abraham Flexner—a non-doctor educator—visited 155 medical schools and declared most of them dangerously unserious. His remedy? Close half of them. Flood the survivors with science, labs, and clinical attachments. The goal: professionalize medicine.

And yes, educational quality soared. But so did conformity.

He shut down schools teaching anything outside the emerging biomedical mainstream: homeopathy, botanical medicine, eclectic therapies—they were gone. Alternative and minority-serving schools disappeared, too—only two Black medical schools survived.

Read more about the Flexner Report’s history and consequences here.

What hung in the balance wasn’t just curricula—it was curiosity. Flexner’s medicine demanded precision, yes—but also obedience. New ideas? Alternative frameworks? Now considered flaky, TV-doctor fodder. He got us a better-tested doctor, but he also gave us a doctor with blinders.

2. Patent Medicine + Pharma = Synthetic Hormone Nation

Fast-forward a few decades. Patents become power. Pill factories bloom. Estrogen therapy, once laboriously pulled from pregnant women’s urine, gave way to Premarin—cheap, mass-produced, profitable. That’s conjugated equine estrogen (CEE)—literally crafted from mare urine.
Here’s the history of Premarin’s rise and controversy.

Synthetic progestins like medroxyprogesterone acetate (Provera) got layered in. Until 2002’s Women’s Health Initiative (WHI) trial revealed they came with serious risks—breast cancer, clots, strokes. The trial halted early.

Remember when you read the link, that this is synthetic hormones. 
Details on the WHI findings here.

Cue growing suspicion of “natural” alternatives—bioidenticals. But don’t be fooled: not all "natural" is safe, not all “bioidentical” is better.

3. What Science Says: Bioidentical vs. Synthetic (Nerd Alert)

Let’s roll up with the nerdy receipts:

• Clinical reviews report that bioidentical hormones—progesterone and estradiol identical to what your body actually makes—often bring higher patient satisfaction and fewer side effects than synthetic versions.
  See this review here.

• A 2006 Moskowitz review found bioidentical progesterone didn’t negatively affect lipids or vascular markers—synthetic progestins did—and may carry lower risk of breast cancer.
  Read the abstract here.

• A 2009 Holtorf analysis found bioidentical hormones showed distinct physiological differences and lower risks, and concluded, “Until evidence is found to the contrary, bioidentical hormones remain the preferred method of HRT.”
  Access the Holtorf review here.

• Authoritative sources—like FDA, Harvard Health, and the Endocrine Society —emphasize that “bioidentical” isn’t automatically safer, especially when compounded without FDA oversight.

• Observational studies of compounded bioidentical therapies show some improvements—better sleep, drier skin, sexual symptom relief—but study quality is often low and controls are weak.

4. The Real Problem: Narrative Over Evidence

Medicine favors what fits the narrative—patentable, big-budget pharmaceuticals, one-size-fits-most protocols. Anything outside that gets shoved aside as fringe.

Your doctor likely trained in a system where the default is synthetic, regulated, “standardized.” Suggesting bioidentical therapy? You may get rolled eyes, being told it’s not evidence-based—even though that narrative was forged long before today's randomized trials could measure it.

That’s not doctors failing you—it’s a system that rewarded conformity over creativity, structure over nuance. And you? You become collateral.

5. Why This Matters to You: The Hormone Gap

Hormones aren’t one-size-fits-all. Estrogen, progesterone, testosterone—they decline differently, respond to food, stress, sleep differently, and influence your brain, bones, mood, skin differently.

Synthetic hormones mimic—but don’t mirror—your body’s chemistry. That can mean off-target effects. Bioidentical hormones, by nature, fit the receptors like they were made for them—because they are.

If you've tried HRT and it didn’t help—or made you feel worse—you may not be broken. You may just be using the wrong keys.

6. Evidence-Based, Heart-Based Approach (Dr. Tammy’s Way)

Here’s how I approach hormone therapy—the intersection of science, soul, and self-advocacy:

1. Use compounded bioidenticals
If you go that route, do so with labs, dose monitoring, and clinical feedback loops. Recognize the gap in standardization.

2. Track outcomes, not assumptions.
Patient-reported improvements matter: mood, sleep, libido, energy. Coupled with labs, they deliver what no narrative can—data that’s about you.

3. Advocate for nuance in your care.
Ask: “Why not bioidentical?” Ask: “What evidence supports this?” Then follow up: “Is there research for the alternative?” You’re not being combative—you’re being informed.

7. Resources to Explore

• The Flexner Report: Historical Impact on Medical Education

• Bioidentical Hormones Review (Holtorf 2009)

• Moskowitz Review (2006) on Bioidentical Progesterone

• FDA: Menopause Hormone Therapy Benefits & Risks

• Harvard Health: What You Need to Know

8. Your Blinders-Free Action Plan

1. Know the history. Systems shape thinking—but knowledge frees you from them.

2. Think structure first. Is the hormone molecule identical to your own? That matters.

3. Check the source. FDA-approved? Compounded? Know the difference.

4. Demand personalization. Hormone doses shouldn’t be off-the-shelf. Your protocol, your data.

5. Own your data. Track your symptoms, labs. Evidence beats conjecture.

6. Stay curious. Hormone science evolves. Ask for studies, ask for updates. Be your own advocate.

9. Final Word: Medicine Should Guide, Not Gatekeep

The Flexner Report made doctors better—but narrower. Pharma made synthetic hormones ubiquitous—but less nuanced.

You, dear reader, have everything the system didn't—but needs: your voice, your data, your story. Bioidentical therapy isn’t magic—but it can be more precise, more personalized, more aligned with being you.

So next time someone says “there’s no evidence,” you don’t panic—you ask, “Which evidence? And is it the evidence that speaks to me?”

Because medicine should be a conversation—not a set of blinders.

Ready to Take Control of Your Hormones?

At Hormone Bliss, we believe every woman deserves to be heard, tested, and treated with compassion and evidence-based care. No more guessing games. No more “it’s just your age.” We see you, and we believe you.

Step 1: Start with the Hormone Trio Test Kit
This simple at-home saliva test measures your estrogen, progesterone, and testosterone — the three power players that influence everything from mood and metabolism to sleep and sex drive. → Order Your Hormone Trio Test Kit

Step 2: Get Your Personalized BHRT Plan
Once your results are in, we create a customized bioidentical hormone therapy plan designed for your body, your goals, and your lifestyle — with safe, plant-based creams compounded just for you.

Step 3: Join the Hormone Bliss Program
Ready for ongoing support, advanced education, and direct access to our team? The Hormone Bliss Program includes coaching, progress tracking, supplement discounts, and a community of women just like you.

You don’t have to accept feeling “off” as your new normal. Let’s get you balanced, energized, and unapologetically YOU again.

Virtual hugs,
Dr. Tammy