The 7 Things You Should Know About Hormones

The Health Journal section of the Wall Street Journal describes mainstream thinking on hormones and concerns with the recent “Oprah Winfrey Show” with Suzanne Somers. Melinda Beck, author of the article, recites the following mainstream thinking:

1) ‘Bio-identical’ hormones are available in FDA-approved forms.

2) Hormones from compounding pharmacies are not safer than conventional HRT.

3) Do not trust saliva tests.

4) There’s a critical window of time for starting HRT

5) The increased risk of breast cancer appears related to progesterone rather than estrogen.

6) Estrogen applied to the skin, in patch, cream or gel form, may have a lower risk of blood clots and strokes than in pill form.

7) Stay tuned (more theories are being tested right now).

My comments: The use of the term HRT (Hormone Replacement Therapy) has long been associated with the chemically altered progestin and chemically altered estrogens in the past. For example, progestin is chemically altered progesterone, with methyl and other chemical groups added to create the resultant synthetic hormone. With current labeling policies on HRT, it is still difficult to determine which products are ‘bio-identical’ and which are not, and still labeled HRT.

Regarding the comment of a “critical window of time for starting HRT”, there is a higher likelihood of the levels of FSH (follicular stimulating hormone) going up at the time of menopause. FSH stimulates the follicles (eggs) during the menstrual cycle years, so after menopause, the eggs are no longer needed, but the pituitary does not know that; it just knows the estrogen and progesterone levels have dropped. So it is trying to stimulate the ovaries. Unfortunately, when the FSH level gets above 80, it interferes with bone metabolism and contributes to osteoporosis. Some women’s FSH levels do not go up, so there’s no need for hormone replacement in those women, unless they have menopausal symptoms: hot flashes, night sweats, brain fog, etc. The “critical window” to which this article is referring is the first 1-5 years of menopause, which is the ideal time to start HRT. There are three reasons to be on estrogen and progesterone:

1) if the FSH levels are above 80, we want to bring that down because it will interfere with bone metabolism and contribute to osteoporosis.

2) if there are menopausal symptoms

3) the “Suzanne Somers” approach: someone wants to maintain the levels they had when they felt great in their thirties. This may mean that menstruation will continue on through the 50s and 60s. I am not aware of any science that shows that this approach is unhealthy.

Critics claim that bio-identical hormones are not sufficiently tested. Perhaps the bio-identical hormones aren’t ‘tested’ as well as we would like, but in making decisions about where to place your trust with hormonal adjustments, first look carefully at who decides where the money goes for testing. Current status of hormone approval is like the fox guarding the hen house. For example, science has proven that transdermal application of estrogen is more effective and lessens the risk of blood clots and strokes. If this is correct (and it is), why has conventional medicine used the pill form of treatment for so long? Until the jury is out, I will always favor bio-identical products over chemically altered substances—and if the jury is out in favor of substances the body does not naturally make, I would be very cautious of shifting my philosophy. Those who favor saliva testing make good points regarding their test results, and I have found saliva testing to be of help in determining hormone levels. I have also used blood testing. There is a great deal of deceit in the hormone industry. My patients and I have found the true bio-identical hormones to be far superior to the synthetic, chemically altered products.