Aaron Hartman and Christian Jensky argue that doctors still misunderstand the 25-year-old Women's Health Initiative trial, which scared women away from hormones. The study used oral synthetic hormones in older women and smokers, not the bioidentical estradiol and micronized progesterone that doctors now prescribe. They explain why personalized hormone optimization, not just replacement, matters.
Chapters
Welcome back once again, everybody. I'm super excited to be here with my friend, colleague and partner in crime, Dr. Christian Jensky. And we are going to talk about all things hormones over the next three episodes. I feel like this has become a really important topic because even in the integrative and functional medicine world, what I'm seeing is not hormone optimization, but hormone replacement. And it's kind of like the integrated version of green allopathy, where if you're deficient in this, you take that and not actually getting to the root of what's going on. So we're going to talk about that and hopefully you'll learn a lot about this. If this information is helpful, please, like, share, subscribe. That's how we get this information out there. As always, this information, we cannot diagnose or treat any medical condition. This is for educational purposes only. As always, talk with your personal healthcare provider. And with that, let's begin. You know, we were, we actually just started talking going into this.
I know we should have recorded what we were just talking about. I, I feel like we'll cycle back to what we were just touching on because this is not a rare conversation. Right. This is something we're having often. And this is a conversation that I imagine you have with your patients daily. It is absolutely probably one of the most confusing things out there with regards to information, I think. I mean, how would you define optimization? What separates that out from what's being done?
Okay, let's talk about hormone replacement therapy first. What's going on? You know, we just, in the last year, I feel like, have had a window to open in the last 25 years that it's now becoming acceptable to do bioidentical hormones, to do a hormone replacement, do a lab, test, the low, Give back what's lacking, you know, and let's talk about that briefly before we talk about optimization, because since the Women's health initiative in 2000, when we were misled to think that, um, bioidentical hormones would cause cancer. Cancer and things like that. Well, maybe we should start the conversation there.
Yeah, that's, that's a great.
That's where we get off track.
Yeah.
So maybe I'll fill in historical gaps for you, but tell us about the, the National Health nhs. Tell us what that was.
Yeah.
And then maybe we can together talk about what was so bad about it.
Tear it down. Because that's where, that's where it belongs. So the Women's Health Health Initiative was actually run. It was a study run by a cardiologist and, and the cardiologist's goal was to determine if hormone replacement therapy decreased cardiovascular risk in women. And the average age of the woman in that study was 65 years old. So just by that demographic alone, you knew the study results were gonna be skewed. So during the study, one of the arms of the study, it was the synthetic progestin arm, which is a drug still used today, by the way, showed a slight uptick in breast cancer. And so this person came out and said, all hormones cause cancer. And everybody believed them. And generations of women were, had had their hormones taken away or were not offered hormones. And really since I think 2019, it's been walked back. So six years ago. And they basically said, just kidding, we were wrong, we revisited the study, are bad, so sorry for all of the damage that you all have suffered. Um, it was just the progestin arm, and that still stands, yet still prescribed. And hormones may be useful and helpful in certain situations, but it's patient dependent. And that's about the extent and specific nature of which they would say, like they didn't come out and say they're beneficial. They didn't come out and say they will absolutely help you with your heart or your brain or your bones. They didn't specify. But at least they weren't saying they're going to kill you. Don't use them.
It's more sinister than that. Yeah. So maybe sinister is the wrong word. I need to be more. Show more grace.
Politically correct.
Yeah. But there was a significant number of the females who were smokers, which we know hormones and smoking do not mix. And the strange thing about it was, you know, during the pandemic we saw a lot of pre publication releases. And what happened was there was kind of one of those pre publication releases that happened where the media kind of took it and put it out there that, oh my gosh, this is horrible. Before it's published. So the media had a two week lead time on the publication of the actual study. So all of a sudden, for two weeks, death, dying, mayhem kind of stuff, and it actually came out and people like myself, like you, like a bunch of other people read it and we're like, wait a second. We started noticing that the primpro, it was oral estrogen equine hormone, plus the medoxyprogesterone, which causes tumors in rats, which is pro thrombotic. Why was it oral? Why were these doses. The estradiol arm was actually preventative. We started actually seeing that at week three, but the damage was done and because it was so widespread and this is where, you know, was social media even a thing back then? I forget. I don't think it was, but just the way media and the way things work, the scare factor was so severe. It was just. And it's literally taking 19, maybe 25 years for us to finally. I feel like now I'm finally in a place where people are like. I think I've heard that bioidentical hormones actually might be good for me. It's really interesting. There's a book, Blind spots by Martin McCary. He wrote, talking about, and he mentioned this very topic in his book. And he actually quotes a study around the same time, 2019, that showed that if a female was on bioidentical hormones and they were diagnosed with breast cancer, it was less aggressive. Yeah. So wait a second. These are maybe, maybe breast protective. The exact opposite, yeah. And this, this blind spot, this mischaracterization, I wish it was less common in medicine. I wish I could say, oh my gosh, I had no idea this happened in medicine. Happens all the time, sadly. And so that has changed for going to say for a quarter of a century, how we deal with women's hormones to the detriment of over half of a population.
It's, it's horrible. It's literally. We were just talking about this. I feel like we both become medical feminists, like, in the process of treating predominantly women in, in my practice. And I think yours is the same. It's like you hear these horror stories over and over again and, and still like it's, it's better, but it's not good. And there's still misinformation, there's still misguiding. I feel like my patients often feel sadly like they're stuck between a rock and a hard place because they have me telling them what I believe to be the truth. And this is the truth and data driven about the safety and risk stratification of using hormones appropriately, how to monitor them and things that we're going to talk about. And then their other provider, whether that's an endocrinologist or an OB GYN or the primary care doctor who's telling them something different and what they're being told by this other person is usually in the context of fear mongering and not informed consent, in my opinion. And so it's really, really hard. I mean, I have a conversation about the Women's Health Initiative all the time. We talk about. Because there's a lot of misinformation also about just how you're supposed to do these hormones because there's no standardization at this point in time. Right. There's no. This is the true right way. We think we know that. We think we have good idea. And I think being more thorough is always the right way in the way of testing. But I think we're going to kind of get into that.
And the one thing, if you're going to personalize hormones, it can never be standardized.
Yeah.
I have female patients who are on 0.025 milligrams of topical estradiol and they still have high levels and have women on 0.5, not quite 1 milligram and their numbers are off the charts. And, and so how does your skin absorb it? How do you metabolize it? Is your skin dry? What's your hydration status? Percent body fat. These things are stored in body fat. If you're an older female who's very slender, has no fat, stuff's gonna go right into your tissues. There's no place for it to sit. If you're an overweight female, you've got lots of storage place, so you're gonna need higher doses. You cannot individualize and personalize in a random, by definition, in a randomized placebo controlled trial. Hormone therapy. So too many moving parts.
Yeah. I think standardization would come with what formularies and, and, and what the testing should be. That, that's what I think. If there was uniformity there, there'd be so much clarity.
Yeah.
You should check if using this, check serum and saliva. If using this, check just saliva. And for all of them, check metabolites to make sure they're detoxing well. Oh, by the way, here are the formularies of estrogen that are safe. Here are the formulary. Here is the formulary of progesterone. That is safe. Right. And that way there's not all this confusion because I see an attempt, I see a desire by conventional medicine to want to do this right. They don't test right. They don't test enough or at all. But at least they're using estradiol a little bit and micronized progesterone instead of progestin. So I'm seeing this trend and I'm a little hopeful. But I'm also like, eh, you got a lot of work to do.
It took us 25 years to figure out that that was wrong. It took us 30 years to figure out hand washing was a good thing. Yeah, it took.
Smoking was mad.
It took us 50 years. Right now we're in the midst of this vaping thing. I'm not gonna go down the pathway because we might get canceled because.
