Conventional hormone replacement
therapy (HRT) - NOT
necessary / causes harm
women, while Some physicians are prescribing
estrogens to treat a presumed hormone deficiency in postmenopausal women. others are prescribing
drugs that block estrogen production
Studies have found that conventional HRT, using
increase risk of breast
cancer >30%, heart attack, blot clots, stroke. Dr. Lee, the
break-through pioneer in bioidentical hormone therapy suggests 3 rules for HRT.
Rule 1. Give
hormones only to those who are truly deficient in them.
Rule 2. Use
bioidentical hormones rather than synthetic hormones. Rule 3. Use only in
dosages that provide normal physiologic tissue levels.
DR. JOHN R. LEE'S THREE RULES FOR HORMONE REPLACEMENT THERAPY
The estrogen replacement regime assumes that
women are estrogen
deficient after menopause
Drs. John Lee and Ray Peat say this assumption is false
production naturally tapers off as a woman's egg
supply is exhausted. It ceases to be delivered to the uterus each month, however:
"Even with ovaries removed, women make
primarily via aromatase enzyme in body fat
and breasts that converts the adrenal hormone,
androstenedione, into ESTRONE .
Women with plenty of body fat can make more .
Breast cancer specialists are so concerned about all the
estrogen after menopause than skinny women make before menopause estrogen women make after menopause that they
now use drugs to block the
- Dr. John
After careful review, Dr. Lee determined, along
with other authorities, that over 2/3 of women up to age 80 continue to make all
the estrogen they need in their
tissues. And the evidence continues to build . . .
• Blood hormone levels do NOT directly represent
abundant, and conversely, in the absence of PROGESTERONE ,
tissues retain estrogen
even with little circulating
levels decrease when estrogen
increases. This occurs sharply at puberty and again at menopause.
(stimulated by estrogen) increases around puberty, and often increases at menopause
▲. Its increase is associated with osteoporosis and other age-related symptoms.
(required to produce estrogen ) increases with aging - present in many
tissues including breast and endometrium;
Women who have
had their ovaries removed are usually told
that they need to take but animal experiments consistently show that
removal of the gonads causes the tissue estrogen,
aromatases to increase - The loss of
PROGESTERONE and ovarian
probably responsible for this generalized increase in the formation of
estrogen . In
the brain, aromatase increases
under the influence of
DR. JOHN R. LEE'S THREE RULES FOR HORMONE REPLACEMENT THERAPY
From Dr. John
Lee's official web-site:
Use a sprinkle of common sense and a dash of logic.
by John R. Lee, M.D.
Lancet publication of the Million Women Study (MWS) removes any lingering
doubt that there's something wrong with conventional HRT (see Million Woman
Study in the UK,
Published in The Lancet, Gives
New Insight into HRT and Breast Cancer for details). Why would supplemental
estrogen and a progestin (e.g. not real PROGESTERONE ) increase a woman's risk of
breast cancer by 30 percent or more? Other studies found that these same
synthetic HRT hormones increase one's risk of heart disease and blood clots
(strokes), and do nothing to prevent Alzheimer's disease. When you pass through
puberty and your sex hormones surge, they don't make you sickâ€”they cause your
body to mature into adulthood and be healthy. But, the hormones used in
conventional HRT are somehow not rightâ€”they are killing women by the tens of
isâ€”where do we go from here? My answer isâ€”we go back to the basics and find out
where our mistake is. I have some ideas on that.
Over the years I
have adopted a simple set of three rules covering hormone supplementation. When
these rules are followed, women have a decreased risk of breast cancer, heart
attacks, or strokes. They are much less likely to get fat, or have poor sleep,
or short term memory loss, fibrocystic breasts, mood disorders or libido
problems. And the rules are not complicated.
1. Give hormones only to those who are truly deficient in them.
The first rule is
common sense. We don't give insulin to someone unless we have good evidence that
they need it. The same is true of thyroid, cortisol and all our hormones. Yet,
conventional physicians routinely prescribe estrogen or other sex hormones
without ever testing for hormone deficiency. Conventional medicine assumes that
women after menopause are estrogen-deficient. This assumption is false.
Twenty-five years ago I reviewed the literature on hormone levels before and
after menopause, and all authorities agreed that
over two-thirds (66 percent) of women up to
age 80 continue to make all the estrogen they need. Since then, the
evidence has become stronger. Even with ovaries removed, women make estrogen,
primarily by an aromatase enzyme in body fat and breasts that converts an
adrenal hormone, androstenedione, into estrone. Women with plenty of body fat
may make more estrogen after menopause than skinny women make before menopause.
Breast cancer specialists are so concerned about all the estrogen women make
after menopause that they now use drugs to block the aromatase enzyme . Consider the
irony: some conventional physicians are prescribing estrogens to treat a
presumed hormone deficiency in postmenopausal women, while others are
prescribing drugs that block estrogen production in postmenopausal women.
How does one
determine if estrogen deficiency exists? Any woman still having monthly periods
has plenty of estrogen. Vaginal dryness and vaginal mucosal atrophy, on the
other hand, are clear signs of estrogen deficiency. Lacking these signs, the
best test is the saliva hormone assay. With new and better technology, saliva
hormone testing has become accurate and reliable. As might be expected, we have
learned that hormone levels differ between individuals; what is normal for one
person is not necessarily normal for another. Further, one must be aware that
hormones work within a complex network of other hormones and metabolic
mediators, something like different musicians in an orchestra. To interpret a
hormone's level, one must consider not only its absolute level but also its
relative ratios with other hormones that include not only ESTRADIOL,
PROGESTERONE and TESTOSTERONE, but cortisol and thyroid as well.
For example, in healthy women without breast cancer, we find that the saliva
PROGESTERONE level routinely is 200 to 300 times greater than the saliva
ESTRADIOL level. In women with breast cancer, the saliva PROGESTERONE /ESTRADIOL
ratio is considerably less than 200 to 1. As more investigators become more
familiar with saliva hormone tests, I believe these various ratios will become
more and more useful in monitoring hormone supplements.
Serum or plasma
blood tests for steroid hormones should be abandonedâ€”the results so obtained are
essentially irrelevant. Steroid hormones are extremely lipophilic (fat-loving)
and are not soluble in serum. Steroid hormones carry their message to cells by
leaving the blood flow at capillaries to enter cells where they bond with
specific hormone receptors in order to convey their message to the cells. These
are called "free"hormones. When eventually they circulate through the liver,
they become protein-bound (enveloped by specific globulins or albumin), a
process that not only seriously impedes their bioavailability but also makes
them water soluble, thus facilitating their excretion in urine. Measuring the
concentration of these non-bioavailable forms in urine or serum is irrelevant
since it provides no clue as to the concentration of the more clinically
significant "free"(bioavailable) hormone in the blood stream.
through saliva glands, the "free"non-protein-bound steroid hormone diffuses
easily from blood capillaries into the saliva gland and then into saliva.
Protein-bound, non-bioavailable hormones do not pass into or through the saliva
gland. Thus, saliva testing is far superior to serum or urine testing in
measuring bioavailable hormone levels.
Serum testing is
fine for glucose and proteins but not for measuring "free"steroid hormones.
Fifty years of "blood"tests have led to the great confusion that now befuddles
conventional medicine in regard to steroid hormone supplementation.
2. Use bioidentical hormones rather than synthetic hormones.
The second rule is
also just common sense. The message of steroid hormones to target tissue cells
requires bonding of the hormone with specific unique receptors in the cells. The
bonding of a hormone to its receptor is determined by its molecular
configuration, like a key is for a lock. Synthetic hormone molecules and
molecules from different species (e.g. Premarin, which is from horses) differ in
molecular configuration from endogenous (made in the body) hormones. From
studies of petrochemical xenohormones, we learn that substitute synthetic
hormones differ in their activity at the receptor level. In some cases, they
will activate the receptor in a manner similar to the natural hormone, but in
other cases the synthetic hormone will have no effect or will block the receptor
completely. Thus, hormones that are not bioidentical do not provide the same
total physiologic activity as the hormones they are intended to replace, and all
will provoke undesirable side effects not found with the human hormone. Human
insulin, for example, is preferable to pig insulin. Sex hormones identical to
human (bioidentical) hormones have been available for over 50 years.
companies, however, prefer synthetic hormones. Synthetic hormones (not found in
nature) can be patented, whereas real (natural, bioidentical) hormones can not.
Patented drugs are more profitable than non-patented drugs. Sex hormone
prescription sales have made billions of dollars for pharmaceutical companies
Thus is women's health sacrificed for commercial profit.
3. Use only in dosages that provide normal physiologic tissue levels.
The third rule is
a bit more complicated. Everyone would agree, I think, that dosages of hormone
supplements should restore normal physiologic levels. The question isâ€”how do you
define normal physiologic levels? Hormones do not work by just floating around
in circulating blood; they work by slipping out of blood capillaries to enter
cells that have the proper receptors in them. As explained above, protein-bound
hormones are unable to leave blood vessels and bond with intracellular
receptors. They are non-bioavailable. But they are water-soluble, and thus found
in serum, whereas the "free"bioavailable hormone is lipophilic and not water
soluble, thus not likely to be found in serum. Serum tests do not help you
measure the "free,"bioavailable form of the hormone. The answer is saliva
It is quite simple
to measure the change in saliva hormone levels when hormone supplementation is
given. If more physicians did that, they would find that their usual estrogen
dosages create estrogen levels 8 to 10 times greater than found in normal
healthy people, and that PROGESTERONE levels are not raised by giving
supplements of synthetic progestin such as medroxyPROGESTERONE acetate (MPA).
levels (and not serum levels) of PROGESTERONE will clearly demonstrate excellent
absorption of PROGESTERONE from transdermal creams. Transdermal PROGESTERONE enters the bloodstream fully bioavailable (i.e., without being protein-bound).
The PROGESTERONE increase is readily apparent in saliva testing, whereas serum
will show little or no change. In fact, any rise of serum PROGESTERONE after
transdermal PROGESTERONE dosing is most often a sign of excessive PROGESTERONE dosage. Saliva testing helps determine optimal dosages of supplemented steroid
hormones, something that serum testing cannot do.
It is important to
note that conventional HRT violates all three of these rules for rational use of
supplemental steroid hormones.
A 10-year French
study of HRT using a low-dose ESTRADIOL patch plus oral PROGESTERONE shows no
increased risk of breast cancer, strokes or heart attacks. Hormone replacement
therapy is a laudable goal, but it must be done correctly. HRT based on
correcting hormone deficiency and restoring proper physiologic balanced tissue
levels, is proposed as a more sane, successful and safe technique.
is not the only cause of breast cancer, strokes, and heart attacks. Other risk
factors of importance include the following:
Poor diet (excess sugar and
refined starches, trans fatty acids, lack of needed nutrients such as
omega-3 fats, full range of essential amino acids, vitamins, minerals, etc.)
Environmental xenoestrogens and
hormones not removed by water treatment. (Be sure that your home water
filter will remove hormones.).
Lifestyle problems such as excess
light at night (poor sleep, melatonin deficiency), alcohol, cadmium
(cigarette smoking), and birth control pills during early teens.
Men share these
risks equally with women. Hormone imbalance and exposure to these risk factors
in men leads to earlier heart attacks, lower sperm counts and higher prostate
hormone replacement therapy (HRT) composed of either estrone or ESTRADIOL, with
or without progestins (excluding PROGESTERONE ) carries an unacceptable risk of
breast cancer, heart attacks and strokes. I propose a more rational HRT using
bioidentical hormones in dosages based on true needs as determined by saliva
testing. In addition to proper hormone balancing, other important risk factors
are described, all of which are potentially correctable. Combining hormone
balancing with correction of other environmental and lifestyle factors is our
best hope for reducing the present risks of breast cancer, strokes and heart
A much broader
discussion of all these factors can be found in the updated and revised edition
of What Your Doctor May Not Tell You About Menopause and What Your
Doctor May Not Tell You About Breast Cancer.