Hormones According to the LA Times
An article on bioidentical hormones appeared in the
Los Angeles Times.(1) The author was a
medical journalist with a master's degree in biology. Sadly, this article contained a number of
omissions, errors and falsehoods that require correction:
The article says: "Over the decades, millions of women
have taken some form of hormone therapy to relieve symptoms of menopause... The
treatment typically included Premarin, estrogen isolated from the urine of
pregnant mares, combined with Provera, a synthetic version of the hormone
The article correctly states that millions of women
have taken hormone preparations to relieve symptoms of menopause. However it then presents the biased and
narrow viewpoint that all of these women took "synthetic" chemically
altered hormones in the form of Provera and Premarin. These are chemically altered hormones sold by
the major drug companies. The reality is
that millions of women have taken and continue to take human bioidentical
hormones, rather than Premarin and Provera for relief of menopausal symptoms.
Women's Health Initiative Study
The LA Times article then discussed the Women's
Health Initiative Study, halted early because the study showed that synthetic,
chemically altered hormones (Premarin and Provera) cause cancer and heart
disease. In this, they are quite
when a six-year study of more than 16,600 postmenopausal women that was part of
the Women's Health Initiative found that the combination of Premarin and
Provera seemed to increase the risk of breast cancer, stroke and heart disease,
doctors and patients suddenly had to consider other options."
Although this is correct, I would remove the word,
"seemed" from the text. The
synthetic hormones, Premarin and Provera didn't "seem" to cause
cancer and heart disease. They DID cause
cancer and heart disease in the WHI study.
That's why the study was terminated early, a small fact conveniently
left out of the story.
after the WHI made headlines, some pharmacies, alternative health clinics and a
few outspoken doctors started heavily promoting so-called "bioidentical
hormones" for the treatment of menopausal symptoms. Unlike Premarin or
Provera, bioidentical hormones — which are produced in laboratories using yam
and soy phytoestrogens as a starting point — exactly match the hormone made by
After the revelations of the WHI study were made
public in 2002, millions of smart women abandoned synthetic hormones and
switched to bioidentical hormones. This
switch was not a product of a massive advertising campaign of the type we see
on television for drugs like Lipitor and SSRI antidepressants. As a matter of fact, there was no TV
advertising for bioidentical hormones, so I would disagree that bioidentical
hormones were "heavily promoted".
They weren't. The massive switch
was more a product of the rank and file Physicians who stopped writing
prescriptions for Medroxyprogesterone (MPA), also called Provera™, the
synthetic hormone used in the WHI study. What was conveniently left out of the
story is that this sudden drop in the number of synthetic hormone prescriptions
in 2003 was accompanied by a nine per cent drop in breast cancer rates as
reported in the New England Journal of Medicine by Dr. Ravdin. (22) The author
is quite correct in the statement that bioidentical hormones are exactly the
same as the hormones made by the ovaries.
Approved Bioidentical Hormones
Food and Drug Administration has approved several prescription-only drugs that
contain bioidentical hormones, including Estrace pills, Estrasorb topical cream
and the Alora patch. But many health clinics and pharmacies also sell
non-approved creams that contain bioidentical estrogen and/or progesterone.
These creams are often custom-made — or "compounded" — for each
patient, sometimes based on the results of a saliva test that measures a
woman's hormone levels."
FDA approved bioidentical hormone preparations are
available at the corner drugstore. However, the author omits the fact that
compounding pharmacies are regulated at the state level, not by the federal
government, so FDA approval is not required or even desired for compounded
hormone preparations. Insisting on FDA
approval for compounded hormone preparations is similar to insisting that your
state driver's license is invalidated because it was not issued by the federal
FDA approval is sometimes waved about like a
majestic frond, as if it grants magical qualities to a drug. In reality, FDA
approval does not automatically mean the drug is effective or desirable. Ten percent of all FDA approved drugs are
later recalled or banned and designated as "Bad Drugs". Another ten
per cent of FDA approved drugs later receive black box warnings. FDA approval means a major drug company has
paid a lot of money for studies showing efficacy over placebo. Sometimes, these studies are fudged.
22 for Natural Substances
Another important omitted fact is that the FDA
approval process is so expensive that it makes financial sense only for
patented drugs with prospects for large returns. It is unlikely that any drug company will
invest the millions for FDA approval studies when the drug in question is a
natural substance such as a bioidentical hormone that cannot be protected by a
patent. The publicly financed Women's
Health Initiative study sponsored by the NIH was done with patented hormones,
Premarin and Provera, not the natural non-patentable bioidentical
hormones. This no doubt reflects drug
company control over NIH research dollars.
The NIH should be studying natural substances like bioidentical
hormones, but they rarely do.
One Corner, We Have: Dr Kent Holtorf
The LA article goes on:
"Dr. Kent Holtorf, a physician and
proponent of bioidentical hormones ...The website for Holtorf's clinic says
that women using bioidentical hormones "feel great" without suffering
any of the side effects of "synthetic hormones," said to include
fatigue, depression and weight gain, along with the increased risk of breast
cancer and heart disease. In a phone
interview, Holtorf said that bioidentical hormones are more effective and safer
than traditional treatments. "Over and over, women have told me that they
feel much better" after taking the bioidentical hormones, he says."
the Other Corner, We have Dr. Nanette Santoro Representing Mainstream Medicine
and Synthetic Hormones
hormones have an obvious appeal to women seeking relief for menopausal
symptoms, says Dr. Nanette Santoro, chair of the department of obstetrics and
gynecology at the University of Colorado Health Sciences Center in Denver and
vice president of clinical science for the Endocrine Society. After all, it
just seems to make sense that anything that exactly mimics a woman's own
hormones must be better than mare's urine or a man-made compound that doesn't
exist in nature."
Santoro says there is no proof that bioidentical hormones are any safer or more
effective than traditional treatments. "All of the evidence that we have
suggests that all of these hormones should be painted with the same
brush," she says."
Dr Santoro represents mainstream medicine and
synthetic hormones sold by the major drug companies, and as such uses coded
language which requires translation.
means synthetic chemically altered hormones sold by the drug companies. “Painted
with the same brush” is the usual attempt to confuse the difference between
chemically altered hormones and bioidentical hormones, claiming they are all
the same thing. They are not the same
thing. Chemically altered hormones are
"Monster Hormones" that
cause cancer and heart disease.
Bioidentical hormones have the same chemical structure as the hormones
in the human body and are safe and effective.
Kent Holtorf Review Article Shows Bioidenticals Are Safer and More Effective
Dr Kent Holtorf's
review article, “The Bioidentical
Hormone Debate”, cites 196 medical studies showing bioidentical hormones are
safer and more effective than synthetic altered hormones. (2) In my opinion,
chemically altered hormones are MONSTERS
that should never have been approved for human use. Lehninger's textbook of biochemistry uses the
word hormone which means a "bioidentical" hormone. Synthetic
chemically altered hormones do not exist in the human body. The sole purpose of chemically altering a
hormone chemical structure is to obtain a patent to protect profits of the drug
industry. These chemically altered monster hormones are a recent invention in
the history of medicine and are MONSTERS that should never have been approved
for human use. Alternatively,
bioidentical hormones and other natural substances by definition cannot be
patented and therefore not profitable for the drug industry.
Nanette Santoro Has Concerns
has many concerns about bioidentical hormones that don't have FDA approval. For
one thing, she says, it's impossible to know if unapproved creams have the
promised amounts of hormones. "I've seen patients on these compounds
actually losing bone mass because they were getting an insufficient dosage,"
she says. "Why take that chance?"
We already discussed the FDA approval issue
above. Compounding pharmacies are
regulated by the states, not the federal government, so FDA approval is neither
required nor desired for compounded preparations. The issue of quality control and proper
dosage is a real consideration that applies to ALL TYPES of medications whether
FDA approved or not. To get the best
quality, I recommend working with a knowledgeable physician familiar with the
best compounding pharmacies with the highest reputation for quality and
service. Perhaps Dr Santoro’s statement
is referring here to over-the-counter progesterone creams which are regulated
by the cosmetics act. I agree with her
point. These are not recommended because
the amount of active hormone is not listed on the label, nor is there any
assurance of the amount of active hormone inside the product.
take a chance?"
says Santoro. This is typical
drug company propaganda and fear mongering that is usually seen with drug company
television advertising. This plants
doubt about compounded preparations. The
problem with this logic is that the same doubt can be raised about hospital
pharmacies which are all compounding pharmacies. For example, the intravenous medications prepared
in the hospital pharmacy are, in fact, compounded medications. The reality is that synthetic hormones are
the monsters, and the bioidentical hormones are the safe and effective choice.
Cynthia Stuenkel, clinical professor of medicine at UC San Diego
Stuenkel, clinical professor of medicine at UC San Diego and president of the
North American Menopause Society, shares this concern. "Some progesterone
creams may contain little or no progesterone, while others contain so much that
they definitely should be available only with a prescription," she
says. “Taking hormones without the
careful guidance of a doctor is risky business,” Stuenkel says, ” Among other things, too many hormones can
potentially cause blood clots and endometrial hyperplasia, a precursor to
Dr Stuenkel is correct in that progesterone creams
are relatively safe, and available OTC (over the counter) without a
prescription. These are regulated by the
cosmetics act. She is also correct in
that the OTC progesterone creams may vary in potency. The highest quality and most reliable progesterone
creams are made by prescription at a compounding pharmacy. These are freshly prepared according to the
prescribed dosage written by the physician.
This is all OK.
Clots and Endometrial Hyperplasia and Uterine Cancer - Omitting History
Dr. Stuenkel is right that certain types of hormones
cause blood clots and uterine cancer.
However, blood clots are caused by oral estrogen, not progesterone. Uterine cancer is caused by oral estrogen,
specifically Premarin. Progesterone is not on this list. Jumping from progesterone to blood clots and
endometrial hyperplasia is somewhat misleading and reveals a lack of
understanding of the history of medicine.
Progesterone does not cause blood clots, endometrial hyperplasia, or
uterine cancer. Progesterone is protective. This is taught to first year
medical students. Blood clots,
endometrial hyperplasia and uterine cancer are all caused by oral estrogen
tablets, called Premarin, given without progesterone, which historically was
the usual practice from 1950 to 1975.
This medical practice was halted with the publication of a NEJM report
revealing that Premarin causes uterine cancer . To prevent uterine cancer, a synthetic progesterone
called Provera was added to the regimen, hence Prempro (a combo drug of
Premarin plus Provera), the drug used in the WHI (women’s health initiative) study. This is a little history omitted from the LA
Also omitted was that oral estrogen tablets cause
increased coagulability and increased risk of blood clots. For example, oral
estrogen in birth control pills is the cause of blood clots, deep venous
thrombosis, pulmonary emboli and stroke in young women. On the other hand, Bioidentical Estrogen in
topical cream form is safe, and not associated with increased risk of blood
the Payroll of Wyeth
Also omitted from the LA Times article was that the
two hormone experts, Stuenkel and Santoro both disclosed financial ties to
Wyeth and other drug companies that make synthetic chemically altered
"Monster'" hormones. These
financial ties were publicly disclosed elsewhere as required by medical ethics
rules. In addition, The North American
Menopause society has financial ties to Wyeth and other synthetic hormone
makers. This is publicly disclosed on the NAMS position statement in which many
members of the NAMS advisory panel have financial ties to the drug industry.(15-17)
Using Modern Science to Create
The Los Angeles Times also conveniently omits
important historical information about the first synthetic hormone invented in
1938, DES, Diethylstilbestrol. This
monster hormone drug was used from the 1940s until the late 1980s, as an
FDA-approved estrogen-replacement therapy.
In 1972, the first reports of cervical
cancer in the daughters of DES treated women was published in the New England
Journal, and the drug was banned in 1975 after millions of women had been
exposed. Another early synthetic hormone
was Bisphenol A, originally invented in 1936, and now, six billion pounds per
year is used for baby bottles, water bottles, and children’s toys. These early "monster" hormones
gave us a preview of coming attractions with the pharmaceutical industry
continuing to sell chemically altered hormones to the public. It's all about money, not health. The take home message is that smart women
are avoiding the "monster hormones".
Left Image: Boris Karloff from The
Bride of Frankenstein,1931, courtesy of Universal Studios and Wikimedia
to Go For Trusted Information
Rather than rely on newspapers like the LA Times for
your medical information, I suggest you go to a more reliable source. Heroic doctors like David Brownstein, Kent
Holtorf, Sangeeta Pati, C.W. Randolph, Erika Schwartz, Bruice Kenton, and Jonathan
Wright provide their patients with the safer and more effective bioidentical
hormones. They also provide the public
with trusted and reliable information in their books, web sites and blogs.
For references and links, see my web site: www.bioidenticalhormones101.com
Articles with Related Interest:
BioIdentical Hormones Trashed by AP News
Bioidentical Hormones According to the LA Times
Ten Bioidentical Hormone Fallacies
References for Chapter 18. Bioidentical Hormones According to the LA Times
LA Times, Bioidentical hormones for menopausal symptoms. Proponents boast
improvement over older treatments; others say there isn't enough evidence yet.
The Healthy Skeptic June 07, 2010,|By Chris Woolston, Special to the Los
Angeles Times, Chris Woolston, M.S
http://www.postgradmed.com/index.php?article=1949 Postgraduate Medicine: Volume 121: No.1 by
Kent Holtorf , The Bioidentical Hormone Debate: Are Bioidentical Hormones
(Estradiol, Estriol, and Progesterone) Safer or More Efficacious than Commonly
Used Synthetic Versions in Hormone Replacement Therapy?
(3) http://jeffreydach.com/2009/11/01/bioidentical-hormones-trashed-by-marilynn-marchione-ap-news.aspx BioIdentical Hormone
Disinformation From AP Medical Writer, Marilynn Marchione
(4) http://www.usatoday.com/news/health/2009-10-29-menopause-herbal_N.htm Bioidenticals: Estrogen without
FDA approval for menopause? By Marilynn Marchione, The Associated Press
http://www.nejm.org/doi/full/10.1056/NEJM197108122850707 Vaginal Cancer after Maternal Treatment with
Synthetic Estrogens, Peter Greenwald, M.D., Joseph J. Barlow, M.D., Philip C.
Nasca, M.S., and William S. Burnett, M.D. N Engl J Med 1971; 285:390-392August
DES Exposure: Questions and Answers- What is DES? Amer Cancer Society
(7) http://www.medscape.com/viewarticle/450670_2 Diethylstilbestrol (DES) Update:
History of DES
Bisphenol A from Our Stolen Future: Are
We Threatening Our Fertility, Intelligence, and Survival?--A Scientific
Detective Story, Theo Colborn, Dianne Dumanoski, John Peter Meyers, Plume,
(9) http://www.environmentcalifornia.org/environmental-health/stop-toxic-toys/bisphenol-a-overview Bisphenol A Overview
(10) http://www.kentonbruicemd.com/blog/Tag/synthetic-hormones Kenton Bruice MD, Why Synthetic Hormones Can Be
Dangerous to the Body
(11) http://www.wsu.edu/~delahoyd/frank.comment3.html Frankenstein: The Man and the
Monster- Suzanna Storment October 2002 - The future of science, if
uncontrolled, could be disastrous.
(12) http://www.medpagetoday.com/pdf/IndiciaME03/ Cynthia A. Stuenkel,
MD, NCMP Dr. Stuenkel is a consultant for Eli Lilly, Upsher-Smith,
(13) http://www.clinicianschannel.com/pik/1833/index.cfm Cynthia A. Stuenkel, MD, has received
honorarium from Wyeth Pharmaceuticals, Upsher-Smith Laboratories, Inc,
and Ally Pharma Options Pvt. Ltd.
(14) http://cme.medscape.com/viewarticle/709447 Cynthia A. Stuenkel, MD,
(15) http://www.drugs.com/news/american-association-clinical-endocrinologists-north-american-menopause-society-fail-disclose-7750.html American Association of Clinical
Endocrinologists and North American Menopause Society Fail to Disclose
Financial Ties to Wyeth Pharmaceuticals - Half of NAMS's Board of Trustees for
2007-2008 receives consulting fees or research support from Wyeth, including
(16) http://www.iacprx.org/site/PageServer?pagename=Press_Releases_2007 Wyeth funds research,
awards, annual meetings, lectureship funds, educational programs and other
activities of NAMS.
(17) http://www.menopause.org/donorlist.pdf Corporate Supporters of NAMS
Nanette Santoro, M.D., Grants/Research Support: Ferring Pharmaceuticals Inc.,
Serono SA. Consultant/Advisory Board: Ferring Pharmaceuticals Inc., Serono SA, Wyeth, Pfizer Inc. Speakers’ Bureau: Wyeth, Pfizer Inc., Berlex Inc.
(19) http://www.uchsc.edu/obgyn/ Nanette F. Santoro, M.D.
(20) http://www.clinicianschannel.com/pik/1833/index.cfm Nanette F. Santoro, MD, has
received grants, support , consulting
fees honorarium from Wyeth.
(21) http://www.ncbi.nlm.nih.gov/pubmed/171569 N Engl J Med. 1975 Dec
Increased risk of endometrial carcinoma among users of conjugated
estrogens.Ziel HK, Finkle WD.
(22) http://www.nejm.org/doi/full/10.1056/NEJMsr070105 The Decrease in Breast-Cancer Incidence in 2003
in the United States, Peter M. Ravdin, Ph.D., M.D et al. N Engl J Med 2007;
356:1670-1674April 19, 2007