The Top 3 Answers to the Question “Why Should I Take Hormones?”

Recently during a patient’s visit, we were reviewing her most recent OB/GYN appointment. Her physician asked why she was taking hormones. Unable to offer a technical explanation, she simply stated that she felt much better than she did before she began her treatment program.

While the basic question of WHY is a good question by her physician, we actually need to answer three questions.

• What are my individual hormone levels?
• Are my hormones in appropriate balance?
• Is my body metabolizing those hormones in the right way?

The answers to these three questions will answer the one question: “Why should a patient take hormones?”

What are my individual hormone levels?

Contrary to what most think, hormones are not just about individual numbers. Instead, hormones work collectively as a means of communication within the body. I am amazed at the answers I get when I ask postmenopausal women, “Does your body still have or need hormones?”

The answer is a resounding YES, but most people seem to think otherwise. The body must have hormones to survive. For example, those who suffer from Addison’s Disease have a life-threatening deficiency of cortisol (one of the body’s many hormones).

Far too often I hear the comment, “I’ve had a hysterectomy, so I don’t need progesterone.” The truth is having a hysterectomy does not eliminate your body’s use or need for hormones. It just means you are missing your uterus. Hysterectomy or not, millions of cells throughout the body have progesterone receptors and those cells could care less if you’ve had a hysterectomy or what your OB/GYN thinks about progesterone. [Insert laugh here!] These organ systems throughout the body have receptors for progesterone because they need progesterone.

The aforementioned patient’s hormone therapy included progesterone cream and DHEA capsules. Testing results showed her to be deficient in both progesterone and DHEA (read about how we test hormones at Seasons), and thus replacement was needed. In addition to test results, the patient’s clinical symptom history warranted the replacement of these hormones.

So why was DHEA included in her treatment program? Two reasons. The first is that her DHEA levels were low in her testing results. The second reason? This patient had Type II Diabetes and, after some additional testing, was found to have chronic inflammation throughout her body. DHEA has been shown to reduce inflammation, improve insulin function, and reduce obesity, all of which are associated with diabetes. DHEA does this through a complex interaction with the hormones adiponectin and insulin. As insulin levels rise with insulin resistance, adiponectin falls. This hormone imbalance will result in Diabetes for many people.

Additionally, Type II Diabetes has been shown to be the result of chronic inflammation. What does that mean, you ask? Chronic, dysregulated inflammation causes insulin resistance. What is the source of this inflammation, you ask? Fat cells! The obesity epidemic is the root cause of our current healthcare crisis.

Let’s go back to the patient’s hormone therapy. Her test results showed her deficient in progesterone. Because progesterone is a natural anti-inflammatory, it is currently being used in traumatic brain injuries (TBI) to reduce inflammation and improve outcomes. In addition, women with low progesterone tend to have significantly more menstrual cramps, the result of inflammatory signals called prostaglandins. Progesterone therapy has been shown to reduce those prostaglandins and thus reduce menstrual cramps.

Are my hormones in appropriate balance?

Hormones don’t exist in a vacuum, as many seem to think. Hormones exist in a delicate balance. The most well publicized imbalance is that of the estrogens and progesterone.  Imbalance of estrogen and progesterone have been linked to many health problems: fatigue, weight gain, headaches, and increased risk of breast cancer to name a few.

I often tell patients that with every cause there is an effect. You can’t give one hormone without affecting many others. The addition of progesterone to the body when it has been chronically low will not only restore progesterone to an appropriate physiologic level, but will also allow estrogen signals to work better. The balance of hormones allows each hormone to work as it was intended. Mind you, we are NOT talking about using synthetic hormones which are simply not what the body is looking for and contain harmful additives. We only treat with bioidentical hormones (bioidentical hormone replacement therapy, also known as BHRT). 

Is my body metabolizing my hormones in the right way? 

The final key point is looking at how the body processes hormones (metabolism). Hormone metabolism is just as important as the individual hormone levels and the hormone balance. 

Let’s use estrogen metabolism, for example. Estrogens (there are actually three different types of estrogen) can be metabolized three ways: 2-hydroxy estrone, 4-hyroxy estrone, and 16-alpha-hydroxy estrone. Some of the risks associated with estrogen come from the body metabolizing estrogen utilizing the 4-hydoxy estrone pathway. This pathway results in many dangerous metabolites (break down products). Think of it as turning down the wrong road as you’re driving somewhere, and you end up in a briar patch!

Think about it. Many women with breast cancer and men with prostate cancer don’t take bioidentical estrogen nor do they take synthetic estrogen. Their problem, as it relates to hormones, comes from endogenous hormone production (the body’s own hormone overproduction or underproduction), hormone metabolization, and the often undiscussed environmental xenoestrogens (from environmental toxin exposure). In lay terms, the body is metabolizing estrogen using the 4-hydoxy estrone pathway resulting in higher risk of cancer.

It has only been in the last 50 to 60 years that major hormonal imbalances in industrialized countries seem to have come to our attention. Before that, people and their hormones seemed to do just fine for thousands of years. We can attribute much of that to diminishing nutritional value in our foods and continually increasing exposure to toxins. Nutrition and toxins both have profound effects on the body, hormones included.

In conclusion, why should a patient take hormones (BHRT)?

The answer is a summary of the three points we’ve looked at here. By determining current hormone levels, restoring balance, and evaluating the body’s metabolic processes, the body can once again function as God intended it. Should a patient be on hormones? Well, only if you need them. But the truth is few of us have perfectly balanced hormones due to nutrition, toxin exposure, and prescription medication side effects.

At Seasons Wellness Clinic, we use state-of-the-art testing that reveals your body’s biochemistry. With our years of advanced training, we can carefully customize a treatment plan to restore your body, offsetting the damage of poor nutrition, toxins, and prescription drugs. Our goal is to eliminate any need for prescription medication! We want you to be HEALTHY!

WELLNESS IS POSSIBLE! You don’t have to settle for a body that is not working as it should. You can make a conscientious choice towards good health and a longer, happier life.

Other related posts:

Evidence and Crazy Talk, Part 1 of 3

Evidence and Crazy Talk, Part 2 of 3

Evidence and Crazy Talk, Part 3 of 3

 

Why Doesn’t My Endocrinologist Know All Of This?

Historically, relying on a consensus statement to treat or not to treat a particular patient has been shown to result in poor care and, as such, society consensus statements and practice guidelines are considered to be worst level of evidence in support of a particular therapy or treatment. A number of organizations, including the World Health Organization and others, have ranked the strength and accuracy of various types of evidence used in the medical decision process. In all scoring systems, the highest strength of evidence is randomized control trials and meta-analyses, with lower scores for other types of evidence. All grading systems place consensus statements and expert opinion by respected authorities (societies) as the poorest level of evidence, because historically they have failed to adopt new concepts and treatments based on new knowledge or new-found understanding demonstrated in the medical literature (1-6).

For instance, a recent study published in the 2009 Journal of the American Medical Association studied the evidence supporting the practice guidelines and consensus statements published by the American College of Cardiology and the American Heart Association. It was found that only 11% of the recommendations, practice guidelines and consensus statements were based on quality evidence and over half were based on poor quality evidence that was little more than the panel’s opinion. The review also found that even the strongest (Class 1) recommendations, which are considered medical dogma, cited as a legal standards and often go unquestioned as medical fact, were only supported by high quality evidence 19% of the time and not revised based on new evidence (6).

Similarly, the Endocrine Society, the American Association of Clinical Endocrinologists and the American Thyroid Association also have a long history of guidelines and recommendations that are not supported by the medical literature and fail to adjust or abandon recommendations when new understanding and knowledge contradicts their recommendations. A case in point is the recommendation by these societies that a normal TSH adequately rules out thyroid dysfunction, despite massive amounts of literature that demonstrate this not to be the case (see Diagnosis of Hypothyroidism) or that T4 only replacement is adequate for most patients. A doctor who simply follows outdated society treatment guidelines that relies on a simple laboratory test and ignores the clinical aspects of a patient is not practicing evidence-based medicine. (1-7). Such doctors may be adequate as lab technicians, but as doctors and clinicians they fall short (1-7). This method of practice is consistently rebuked as improper and poor medicine, but has become the standard used by a large percentage of endocrinologists and physicians who feel medicine can be related to simply reading “normal” or “abnormal” in a laboratory column.

Discussing the lack of scientific basis of most medical society’s consensus statements and treatment guidelines in Internal Medicine News, Dr. Diana Petritti states, “Expert opinion and consensus statements can be quite misleading when used as the basis for a practice. Expert opinions imply that there is something that the experts know that clinician doesn’t know. I don’t think it’s always appreciated that it’s only opinion. There is a tendency to make guidelines and recommendations seem authoritative. I believe that physicians think that there is a great deal more behind authoritative recommendations than there might be when you lift the lid of the box and see what’s underneath(8).”

There has been significant concern by health care organizations and medical experts that physicians are placing too much reliance on consensus statements and failing to learn of new information presented in medical journals. Thus, they lack the ability to translate this new information into treatments for their patients. The concern is that doctors fail to practice evidence-based medicine, erroneously relying on what they have previously been taught and on “expert” societies instead of changing treatment philosophies based on new information as it becomes available. This is especially true for endocrinological conditions, where physicians are very resistant to changing old concepts of diagnosis and treatment — despite overwhelming evidence to the contrary — because it is not what they were taught in medical school and endocrinology residency.

This concern is particularly clear in an article published in the New England Journal of Medicine entitled “Clinical Research to Clinical Practice: Lost in Translation” (9). The article was written by Claude Lenfant, M.D., Director of National Heart, Lung and Blood Institute, and it is well supported. He states that there is great concern that doctors continue to rely on what they learned 20 years before and are uninformed about scientific findings. According to Dr. Lenfant, medical researchers, along with public officials and political leaders, are increasingly concerned about physicians’ inability to translate research findings in their medical practice to benefit their patients. He says that very few physicians learn about new discoveries from reading medical journals or by attending scientific conferences; thus, they lack the ability to translate new knowledge in the field into enhanced treatments for their patients. He states that a review of past medical discoveries reveals how excruciatingly slow the medical establishment is to adopt novel concepts, noting that even simple methods to improve medical quality are often met with fierce resistance. “Given the ever-growing sophistication of our scientific knowledge and the additional new discoveries that are likely in the future, many of us harbor an uneasy, but quite realistic suspicion that this gap between what we know about disease and what we do to prevent and treat them will become even wider. And it is not just recent research results that are not finding their way into clinical practice; there is plenty of evidence that ‘old’ research outcome have been lost in translation as well (1).”

Dr. Lenfant discusses the fact that the proper practice of medicine involves the combination of medical knowledge, intuition and judgment and that physicians’ knowledge is lacking because they don’t keep up with the medical literature. He states that there is often a difference of opinion among physicians and reviewing entities, but that judgment and knowledge of the research pertaining to the patient’s condition is central to the responsible practice of medicine. “Enormous amounts of new knowledge are barreling down the information highway, but they are not arriving at the doorsteps of our patients. (9).”

These thoughts are echoed by physicians who have researched this issue as well, such as William Shankle, M.D., Professor, University of California, Irvine. He states, “Most doctors are practicing 10 to 20 years behind the available medical literature and continue to practice what they learned in medical school….There is a breakdown in the transfer of information from the research to the overwhelming majority of practicing physicians. Doctors do not seek to implement new treatments that are supported in the literature or change treatments that are not (10).”

This view is echoed by the Dean of Stanford University School of Medicine who states that in the absence of translational medicine the delivery of medical care would remain stagnant and uninformed by the tremendous progress taking place in science and medicine (11).

This concern has also received significant publicity in the mainstream media. An example is an article by Sidney Smith, M.D., former president of the American Heart Association, published in 2003 in the Wall Street Journal entitled “Too Many Patients Never Reap the Benefits of Great Research.” Dr. Smith is very critical of physicians for not seeking out available information and applying that information to their patients, arguing that doctors feel the best medicine is what they’ve been doing and thinking for years. They discount new research, Dr. Smith says, because it is not what they have been taught or practiced, and they refuse to admit that what they have been doing or thinking for many years is not the best medicine. He states, “A large part of the problem is the real resistance of physicians…; many of these independent-minded souls don’t like being told that science knows best, and the way they’ve always done things is second-rate (12).” The National Center for Policy Analysis also expresses concern for the lack of ability of physicians to translate medical therapies into practice (13).

A review published in The Annals of Internal Medicine found that there is clearly a problem of physicians not seeking to advance their knowledge by reviewing the current literature, believing proper care is what they learned in medical school or residency and not basing their treatments on the most current research. The review found that the longer a physician is in practice, the more inappropriate and substandard the care (14). Thus, it is not a surprise that the scientific evidence as expressed in the literature is often opposite to what is continually repeated as dogma by most physicians and those considered to be “experts.”

Another example is a study published in the Journal of the American Medical Informatics Association (15). In reviewing the study, the National Institute of Medicine reports that there is an unacceptable lag between the discovery of new treatment modalities and their acceptance into routine care: “The lag between the discovery of more effective forms of treatment and their incorporation into routine patient care averages 17 years.” (16) In response to this unacceptable lag, the Business and Professions Code passed an amendment relating to the healing arts. This amendment — CA Assembly Bill 592; An Act to Amend Section 2234.1 of the Business and Professions Code — states: Since the National Institute of Medicine has reported that it can take up to 17 years for a new best practice to reach the average physician and surgeon, it is prudent to give attention to new developments not only in general medical care but in the actual treatment of specific diseases, particularly those that are not yet broadly recognized [such as the concept of tissue hypothyroidism, chronic fatigue syndrome and fibromyalgia] (17).

The Principals of Medical Ethics adopted by the American Medical Association in 1980 states that a physician shall continue to study, apply, and advance scientific knowledge, make relevant information available to patients, colleagues, and the public (18). This has, unfortunately, been replaced with a goal of providing merely “adequate” care. The current insurance reimbursement system in the United States fosters this thinking, as the worst physicians are financially rewarded by insurance companies. While it is true that the best physicians are continually fighting to provide cutting edge treatments and superior care that the insurance companies deem not medically necessary, even these physicians eventually get worn down and are forced to capitulate to the current system that promotes substandard care.

This was clearly demonstrated in a study published in the March 2006 edition of The New England Journal of Medicine entitled “Who is at Greater Risk for Receiving Poor-Quality Health Care.” The study found that the majority of individuals received substandard, poor-quality care, and that there was no significant difference among different income levels or whether or not the individual was covered by insurance. It used to be the case that only those in low socioeconomic classes without insurance received poor-quality care. But insurance company restrictions on treatments and diagnostic procedures have made the same poor care afforded to those of low socioeconomic status the new standard-of-care for society at large (19). An example of this is a physician’s failing to spend the time to adequately assess a potential hypothyroid patient and instead simply does a TSH test.

Most physicians will satisfy their required amount of continuing medical education (CME) by going to a conference a year, usually at a highly desirable location that has skiing, golf, boating, etc. Physicians are rarely monitored as to whether or not they actually showed up for the lectures or went skiing instead. One must also understand that the majority of conferences organized by medical societies are in fact sponsored by pharmaceutical companies. These payments by pharmaceutical companies are called unrestricted grants, so that the society has free reign to do what they want with the money and thus can claim there is no influence of lecture content by the companies. The problem, however, is that if the society wants to continue getting these “unrestricted” grants, they must think twice about providing content that the sponsoring pharmaceutical company might disapprove of. Consequently, ground breaking research that goes against the status quo and does not support the drug industry receives little attention.

Evidence-based medicine involves the synthesis of all available data when comparing therapeutic options for patients. Evidence-based medicine does not mean that data should be ignored until a randomized control trial of a particular size and duration is completed. A physician who tries to avoid the need of being a physician and is fine with just being a technician or health care provider will adamantly defend the “one-size fits all” method of diagnosis and treatment. But the best doctors who truly practice evidence-based medicine and not merely the perception of such will not rely on consensus statements to best provide their patients. Instead of relying on old dogma, the best physicians will seek out and translate both basic science results and clinical outcomes to decide on the safest, most efficacious treatment for their patients. Further, the best physicians will continually assess the current available data to decide which therapies are likely to carry the greatest benefits for patients and involve the lowest risks.

References

 

The Truth About Low T: Men, Middle-Age and More

I admit it. Those low T commercials are great marketing. The middle-aged man dancing with his testosterone shadow, all his strength, energy and vigor restored. His simple solution? Testosterone supplementation. It paints an oversimplified picture of men, as if we are nothing but testosterone sponges. When we get low, we just stop off at the local testosterone dispenser and we are good to go. However, the truth is not that simple about low T.

Low testosterone is a very common problem in men today. But it is much more complex than just adding testosterone to solve the problem. Men are complex. (And you thought only women were complex!) Looking at the specific causes of low T in an individual is a critical part of creating a plan to solve the low T problem.

What is testosterone? Testosterone is the predominate hormone in men. From the moment of conception, it is the key to male development. It is what makes a man a man. It is what gave us Tim “the tool man” Taylor.

What is low T? Quite simply, it is low testosterone. Symptoms include fatigue, reduced libido, estrogen dominance, weight gain, and loss of confidence and motivation. Low T is, in many ways, the middle-aged man suffering the dreaded “mid-life crisis.” Think about it. At the same time that women experience menopause, men are experiencing their own life change. Men are just as hormonal as women; however, the symptoms of change are different.

Low testosterone is a lot more common than you think. Approximately 40 million US men suffer from low testosterone. Only a fraction of these men are symptomatic, which means most men with low T don’t even know it.

Not only is low T a silent problem, it is a growing problem. Men are discovering low T at younger ages, too. I’ve seen men as young as their mid-20’s with low testosterone. Typically, however, most men living with low T are in their 40’s and beyond.

What is the cause of low T? It would be convenient if the answer was simply low testosterone production. But look at our bodies. We are complex creations. In most cases, low T results from a combination of issues.

Cause #1: Excess weight. Today, we eat so many items that suppress the body’s natural testosterone production. Just look at the American diet. Americans eat up to 200 pounds of refined sugar, 90 pounds of fats, 63 dozen donuts, 60 pounds of cakes and cookies, 23 gallons of ice cream, 22 pounds of candy, and 15 pounds of chips, popcorn, and pretzels annually. Obviously, this leads to excess weight.

Excess weight, especially around the mid-section, becomes a major estrogen-producing factory. Not only does the associated weight gain help produce more estrogen, but the enzyme that converts testosterone to estrogen increases as we age as well. We become estrogen dominant. Increased weight = increased estrogen and decreased testosterone.

Cause #2: The environment. The environment is full of hormone-like chemicals. Xenoestrogens are environmental estrogens. They range from pesticides and insecticides to plastics to hormone-laden meat and dairy products. Although not native to the body, the body views them as estrogens nonetheless. Xenoestrogens = increased estrogen and decreased testosterone.

Cause #3: Hormones. That’s right. Even giving testosterone to some men can be a problem. A 27-year male patient came to me after he was given testosterone for a suspected low T problem by another physician. The testosterone replacement made him feel worse. Why? He was already estrogen dominant, and the additional testosterone was like throwing gasoline on the fire. His proposed cure, testosterone supplementation, turned out to be the source of his problem: excess estrogen. Too much testosterone = increased estrogen.

What is the answer to low testosterone? There is no single answer. Answers are found through customized testing which determines exact hormone levels. From these results, we can create an individualized therapy plan. Because we are all created uniquely, causes can vary. Likewise, your therapy plan should be unique. Your symptoms are clues to the underlying problem. By uncovering the problem’s root cause, an effective treatment plan can be developed which will solve those health issues and eliminate your symptoms.

The truth about low T? Only a few men really need testosterone. The majority of men need weight loss, reduction of estrogen, and the elimination of environmental xenoestrogens. It is easier to simply supplement testosterone. But that will NOT treat the problem at the source and achieve true healing.

Now that you know the truth about low T, what will you do about it? If you have symptoms and need answers or more information, call our office at 318-255-3223.

 

From The Doctor’s Desk: Hormone Imbalance A Contributing Factor In Breast Cancer

Hormone Replacement Therapy (HRT) increases breast cancer. Have you read headlines like that? Or perhaps you were told that HRT caused someone’s breast cancer.

Do hormones really cause or lead to breast cancer? Think about this: every women continues to produce hormones, even after menopause. So, it cannot be that hormones in and of themselves cause cancer. Scientific evidence indicates that synthetic hormones and hormone imbalance do contribute to breast cancer.

The ABC’s of Estrogen.

Estrogen’s effects in the body are regulated through two different kinds of receptors: alpha and beta receptors. Estrogen-alpha receptors stimulate breast cell growth. Estrogen-beta receptors inhibit breast cell growth.

• Estradiol, the most potent estrogen, equally stimulates alpha and beta receptors = growth stable
• Estrone, the second most potent estrogen, stimulates alpha receptors 5:1 over beta receptors = pro growth
• Estriol, the weakest variety of estrogen, actually stimulates beta receptors 3:1 = growth inhibitory

The key element here is balance of hormones. Higher levels of estrone present in your body (produced by fat cells) result in more breast stimulation. Higher levels of estriol present in your body results in less breast cell stimulation and, therefore, breast protection. Estriol = Good. Estrone = Bad. If you have heard of someone developing breast cancer after starting Premarin, there’s a logical explanation for that. Guess what Premarin is loaded with? Premarin contains (48%) estrone (estrone = bad = breast cell stimulation).

Here are some more ugly facts about Premarin, also know as conjugated equine estrogen. Premarin actually decreases estrogen beta receptors. So, if you take Premarin, then you are taking high doses of estrone (estrone = bad) and decreasing your estrogen receptors that inhibit breast cell growth. In a nutshell: you are taking more of the bad estrogen and decreasing your amount of the good estrogen. This equates to a prime set up for breast cancer.  Don’t take my word for it. See the wonderful article by Kent Holtorf.

Progesterone: The Growth-Inhibitor Hormone

The confusion out there about estrogen and breast cancer is bad enough, but the confusion is even greater on the subject of progesterone.

Pregesterone is the key hormone in the second half of a woman’s cycle. Estrogen is the dominant hormone in the first half of your cycle (estrogen = growth = growth of the uterine lining to support implantation of an egg). The counteractive hormone to this growth phase is progesterone (progesterone = no growth = sloughing off of the uterine lining). It’s the amazing and fascinating way that woman was created.

Synthetic progestins, often prescribed, are NOT the same as the progesterone your body produces. Just look at the structure and you see that they are not. The one thing they do have in common is they both protect the lining of the uterus against excessive estrogen growth. But, that is where the similarities end.

While there are many differences between the two, our focus here will be on the difference in breast cancer potential. Simply stated, synthetic progestins are pro-breast cancer and bioidentical progesterone is breast protective. The Women’s Health Initiative (link) revealed a 26% increase in breast cancer as a result of taking synthetic progestin. The Nurse’s Health Study (link) found that synthetic progestins tripled breast cancer risk over that of estrogen only. The use of Provera, a synthetic progestin and component of Prempro, has been shown to increase the risk of breast cancer by 800%!

The statistics for bioidentical progesterone are the opposite. Bioidentical progesterone has many positive breast benefits:

• Progesterone decreases estrogen production
• Progesterone moves estradiol to weaker estrone
• Progesterone moves estrone to inactive (sulfated) form
• Progesterone moves estrone to weakest/safest estriol
• Progesterone down-regulates estrogen receptors all together
• Progesterone activates the cancer protection gene, p53

The idea that progesterone is a safer alternative to synthetic progestins is not new at all.  As early as the early 80’s, there has been a call for safer progesterone over synthetic progestin counterparts. In 1981, nearly 30 years ago, L.D. Cowan showed that just having low progesterone levels increases the risk of premenopausal breast cancer risk 5.4 times.

Unfortunately, progesterone-deficient states, (or estrogen dominance) are very common in women today as a result of many factors: being overweight, PCOS, environmental xenoestrogens, excessive estrogen therapy, and perimenopause. Another study, showed progesterone to have a 400% decreased breast growth rate.

The Scientific Evidence Is Clear.

The evidence in the scientific literature is clear with regards to estrogens, progesterone, and hormone balance.

Bioidentical and synthetic hormones should NOT be used interchangeably. They are not equal. They have very different physiologic effects on the breast:  synthetic progestins (Provera notably) increase breast cancer (800%) and bioidentical progesterone protects against breast cancer (400% decrease breast growth rate).

Estrogen therapy is not for everybody and is definitely not a panacea drug; in fact estrogen dominance is a major contributor to breast cancer risk. But if estrogen therapy is needed, then estriol (Estriol = good) is the best.

Hormone balance is the key. Without estrogen and progesterone balance, a women’s cycles are irregular, and infertility can be a big problem.

You know, once we understand hormones and the balancing cycle between estrogen and progesterone, it makes perfect sense that imbalance would cause breast problems. And the scientific evidence indicates just that. In honor of Breast Cancer Awareness Month, it’s time make sure your hormones are balanced and protect yourself from breast cancer.

Confession #6: Evidence and Crazy Talk. Part 3 of 3.

This is the third of three posts in response to a Newsweek headline, “Crazy Talk,” and the accompanying article, “Best Life or Risky Advice?” which blasted talk-show host Oprah Winfrey for many things, including her support and use of bioidentical hormones.

A quick recap. Read the Newsweek article for yourself. Second, make medical decisions based on medical research and evidence. Third, the right approach to bioidentical hormones is balance. Fourth, there is no blanket prescription for womanhood.

Individualized Treatment Results in Balanced Hormones.

In my last post, I talked about the blanket prescription for womanhood that seems to prevail in the medical world out there. But for me, the right answer was a treatment plan that balanced my hormones.

At Seasons, my hormones were tested and found to be terribly out of whack. Dr. Goodyear developed a therapy plan which included several varieties of bioidentical hormones according to my individual needs and life changes like proper nutrition and exercise. After a period of time, they retested my hormones and adjusted my prescriptions. This cycle continues until the body returns to normal hormone levels with no bioidentical hormone support.

My course of treatment will soon come to an end. It has been nearly a two year journey marked by gradual and noticeable improvement. I feel so much better now. And girl has it been interesting! I am so much more educated about my body and how it works.

I also have more courage. I stood up to “hearsay” with scientific evidence. I feel comfortable researching medical issues. I am aware that there are multiple sides to any story. I am confident I made the right choice for me.

Give Kudos To Courageous Women.

Right or wrong, Oprah and Suzanne Somers said, “Hey…traditional medicine isn’t working for us! Is somebody listening?” Many of us echo that sentiment. I’ve had multiple conversations with multiple doctors in different states about my health problems. No one seemed to have an answer other than those treatments du jour I mentioned in Confession #5.

The fact is, Mr. Kosova and Mr. Wingert (authors of the Newsweek article), women listen to Oprah because they identify with her. She listened to us. She is one of us. She came from nothing, worked hard, made her dreams come true, and now helps her viewers and listeners accomplish their goals. She has challenged us to run marathons, read books, and ask questions. We listen when she asks questions! And we listen when she offers solutions.

And this time, she found the same health solution that I did.

Confession #5: Evidence and Crazy Talk. Part 2 of 3.

This is the second of three posts in response to a Newsweek headline, “Crazy Talk,” and the accompanying article “Best Life or Risky Advice?” which blasted talk-show host Oprah Winfrey for many things, including her support and use of bioidentical hormones.

A quick recap. First, read the Newsweek article for yourself. Second, make medical decisions based on medical research and evidence.

Bioidentical hormones are not the “solution of the week.” They are not a trend. Many out there are claiming bioidentical hormones are the cure for all that ails you. Seasons doesn’t make that claim. They are, however, a great solution for many women.

The Seasons Approach to Bioidentical Hormones is Balance.

The key to weathering the hormonal storms of womanhood is balance: balance between what we eat and how much exercise we get; balance between work and play; balance between rest and activity.

We also need balance on the inside. Balance between estrogen, progesterone, testosterone, DHEA, cortisol, thyroid, and melatonin. When these hormones became imbalanced (as mine did), we develop symptoms: hot flashes, fatigue, mood swings, irritability, mental fog, weight gain, just to name a few. This may or may not have anything at all to do with menopause (mine was stress and pregnancy related). But once these hormones are back in balance, the symptoms diminish or disappear.

And, oh, the bliss when the symptoms disappear! Don’t underestimate the value of just plain old “feeling good.” (Ladies, feel free to chime in with an Amen here!)

There Is No Blanket Prescription for Womanhood.

We can’t just take three pills and feel better (and if that doesn’t work, just do a hysterectomy). But that seems to be how modern medicine treats us. Think about it. We all have different bodies, different levels of hormones. These hormones are affected by environment, genetics, stress, pregnancy, etc. There’s no way my hormones and yours could be the same. Our lives are different. Our genetics are different. It just doesn’t make sense that our solutions should be the same.

So why is it that many physicians want to prescribe the same treatment for all of us? Birth control pills and anti-depressants are the prescription du jour for women between 30 and menopause. And for the those approaching/in/completing the BIG change of seasons (menopause), the prescription du jour is synthetic hormones and (yes) anti-depressants. Don’t get me wrong, here. There are some who need an anti-depressant for true symptoms of depression. But as a blanket prescription for womanhood, anti-depressants are a bad idea.

In fact, my husband told me a few years ago that I was the only wife he knew who wasn’t taking an anti-depressant – he and his friends actually had this conversation. That’s not to say I wasn’t having mood-swings. I just flat-out refused to take an anti-depressant even though my physician at the time offered it as an option. I knew depression was not my issue. It was something else. I just couldn’t quite put my finger on it.

You know, when the solutions you are offered in life just don’t work, you have to keep searching, especially when you just don’t feel good and you want your life back. I did keep searching. And I found a solution that worked. In my next post, I’ll complete my comments and share with you my solution.

See you there.

Confession #4: Evidence and Crazy Talk. Part 1 of 3.

Crazy Talk.

I’ve heard that expression before. But when I heard the Newsweek headline about Oprah was entitled “Crazy Talk,” I was scared to read the article.

Why was I scared? You see my own personal experience with bioidentical hormones has made me a huge advocate. When Oprah revealed on national TV that bioidentical hormone therapy had worked for her, I was thrilled! “Maybe Oprah’s support will encourage her viewers to learn more about them,” I thought. “Maybe her media power will help open the closed minds of many traditional doctors…give them a reason to listen when their patients ask questions…”

A week after it was published, I finally mustered up enough courage to read the article. It wasn’t as bad as I anticipated. The article certainly had a negative tone, but it was more about Oprah’s power than bioidentical hormones.

Read the Newsweek Article For Yourself.

The most important thing we can do is think for ourselves. To read the article at Newsweek’s website (“Best Life or Risky Advice?”, Newsweek, published 6/30/09), click here.

The authors, Weston Kosova and Pat Wingert, point a finger at one major issue: Oprah has an unopposed platform to air her views and give credibility to whatever she chooses. That’s true. Oprah’s greatest accomplishment is her media power, through television, radio, print and her website. With that great power comes great responsibility. Mr. Kosova and Mr. Wingert work on the assumption here that Oprah has missed the boat on the responsibility part. And while I might agree with some (or even much) of what they said, I think they “threw the (bioidentical hormone) baby out with the bath water.”

Make Medical Decisions Based On Medical Research and Evidence.

There is definitely controversy on the topic of bioidentical hormones, and plenty of it: controversy between traditional medicine and a more progressive approach to medicine; controversy between drug companies and compounding pharmacists; even controversy between doctors and their patients.

But there is also plenty of research and evidence that supports the use of bioidentical hormones. Loads of it, actually. Spend a little time exploring the Seasons website and you will find numerous links to research articles. I encourage you to read for yourself!

In my next post, I’ll continue with more thoughts on the “Crazy Talk” article.

See you there.

What Is Seasons?

At Seasons, our focus is wellness, not just treatment of disease. In this video, Dr. Nathan Goodyear talks about his vision for Seasons and our revolutionary approach to women’s health care.

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Bioidentical Hormones: What Does The Scientific And Medical Evidence Say?

A young lady came into my office the other day to discuss hormones. She was a breast cancer survivor. Her concern, and rightly so, was her risk of getting breast cancer again. Since she lived in the south (our main office is in Ruston, Louisiana), she had experienced the women’s ritely passage of menopause: “the hysterectomy ceremony.”

Her question to me was: can she take hormones? Years ago, her cancer doctor had placed her on premarin, telling her that it was safe. She also was told that because she had a hysterectomy, progesterone was not necessary. Her gynecologist, in contrast, told her she couldn’t take premarin. Different doctors, different opinions.

I’m not trying to offer a third opinion here. I just want to stay focused on the evidence. That is what evidence-based medicine is all about. Unfortunately, market forces are clouding evidence-based medicine today.

In earlier posts, I’ve talked about progesterone, synthetic progestins and their polar opposite effects on a woman’s breasts. Progesterone lowers risks. Progestin increases risks. I want to get a little more specific today with some information from an outstanding review of the evidence. In Dr. Kent Holtorf January 2009 article, the Bioidentical Hormone Debate, he exhaustively reviewed 196 research articles. (If you aren’t up to reading the full article, you can read an abstract of the review.)

Here is my summary of the risks associated with synthetic progestins:

• increased breast cell growth
• increased conversion of weaker estrogens into more potent estrogens
• promoted the formation of toxic estrogen metabolites (16-hydroxyestrone)
• stimulated the conversion of inactive estrogen to active estrogen (estrone sulfate to estrone)
• had anti-apoptotic effects. (Apoptosis is programmed cell death: which is a way to control cancer growth. Anti-apoptosis means your body lacks this method of controlling cancer growth.).

Contrast this with the benefits of the natural bioidentical hormone progesterone.

• reduced breast cell growth by 400%
• downregulated estrogen receptors in the breast
• induced cancer cell apoptosis (programmed cell death that helps control cancer growth)
• reduced breast cell division and growth
• and in some studies, progesterone actually arrested human breast cancer cells.

After looking at nearly 200 independent studies, Dr. Kent Holtorf concluded that “Both physiological and clinical data have indicated that progesterone is associated with a diminished risk for breast cancer, compared with the increased risk associated with synthetic progestins.” Studies have shown that synthetic progestins increase the risk of breast cancer:

1. by approximately by 25% for each 5 years of use
2. by triple the risk (67%) of breast cancer when added to estrogen therapy
3. double the risk to 4% per year when compared to estrogen therapy alone.

This is in stark contrast to bio-identical progesterone, which reduces the risk of breast cancer by 10%.

“As far as the east is from the west”—that is how different the effects of progesterone and synthetic progestins are on the breast. Holtorf concludes his article in Postgraduate Medicine with statements like this: “With respect to the risk for breast cancer, heart disease, heart attack, and stroke, substantial scientific and medical evidence demonstrates that bioidentical hormones are safer.”

In my next post, I’ll look at synthetic premarin versus bioidentical hormone estrogen.

Related articles by Zemanta

• The Bioidentical Hormone Debate (www.postgradmed.com)
• Abstract: Are Bioidentical Hormones (Estradiol, Estriol, and Progesterone) Safer or More Efficacious than Commonly Used Synthetic Versions in Hormone Replacement Therapy? (holtorfmed.com)
• Study: Hormone therapy caused breast cancer for thousands (cnn.com)

Bioidentical Progesterone Helps Your Heart

President Eisenhower said, “Men occasionally stumble over the truth, but most of them pick themselves up and hurry off as if nothing ever happened”

In my last post, we looked at some new discoveries in science about the truth of bioidentical hormone therapy. Specifically, we looked at the different ways bioidentical progesterone and synthetic progestins affect the breasts. This week I want to look at the different ways they affect the cardiovascular system.

I can hear what you’re probably thinking. “You mean some hormones might have beneficial effects on the heart? That is not what my doctor told me.”

I don’t know your doctor or your specific situation, but I do know about the latest scientific research.

Synthetic hormones increase cardiovascular risks.

One study, the Women’s Health Initiative saw a large increase in the risk of heart attacks and stroke in women who used Provera. This is not at all surprising since synthetic progestins have previously been shown (in the PEPI study) to negate the positive cardiovascular benefits of estrogen.

These results stand in stark contrast to studies using bioidentical progesterone, which has been shown to provide additional cardiovascular benefits.

Here’s some more down and dirty science. First, you need to understand that blood vessel constriction and plaque formation both increase your risk of stroke and heart attack. Bioidentical progesterone reduced blood vessel constriction and plaque formation by 50%, but synthetic progestins actually increased blood vessel constriction and plaque formation.

Wow. I wish President Eisenhower’s words weren’t so appropriate. The truth is easy when everyone believes it; but the truth is hard to follow when so many people seem blind to it.

Here’s the truth: Bioidentical progesterone provides cardiovascular benefits to women.

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