Episode 8: Maintaining a Balanced Level of Hormones With HRT

What does it take to cure diseases, not just manage their symptoms? This is Inside the Cure from Allure Medical and its founder, Dr. Charles Moak. He explores world renowned healthcare that benefits patients and the economy. Hi, I'm Cam CARMAN and today Dr. Moak and I are discussing HRT or hormone replacement therapy. And what can you tell us about the Latest advances with HRT? Dr.

So the really awesome thing is they ain't that late. So these got Approved in the 50s and what happened is that hormone replacement therapy was first FDA approved back decades ago and it started turning into more drug therapy and then we found problems with the drugs and now we're back on to hormones. So what's new is what's really old. So it's been around a long time. So we look at it, we can divide this up in men or women. So we'll talk about women first. So when women would go into menopause, which is typically defined as having your ovage removed or not having a period for a year, your ovaries are in failure and are not producing hormones that made you feel better in the past. And that's why women know symptoms of menopause because they're no longer producing as much estrogen, progesterone, testosterone. What's interesting is when we started doing hormone replacement, women, we started using ground up sheep ovaries. And then they found that the urine from a pregnant mare, from a horse, five year old pregnant mare, had hormones, enough estrogen in it that would actually relieve menopausal symptoms. And that's where Premarin came from. Pregnant mare urine came from pregnant horse urine. Now, now they actually make it from synthetic soybean sources, but it represents the composition of a five year old pregnant horse. And we've always had estrogen available, which is this human estrogen, estradiol. But the drugs were more popular to use these other synthetic drugs and they got wildly popular as number one drug prescribed in the 80s and 90s. And then in 2002 and 2004 came out the Women's Health Initiative trial, which was a study of thousands of women over a period of time. And they found that these synthetic drugs, the synthetic estrogen and what's called a progestin, which is a synthetic progesterone, increased women's risk of breast cancer, heart attacks, blood clots and stroke. Not a substantial increase, but 8,101% enough that had a public health effect. And doctors were routinely prescribing these drugs for prevention with that happened well prior to the women's Health Initiative trial, we were primarily using any kind of estrogen along with actual progesterone, which is a women's hormone. And we found in studies such as the PEPE trial that they had less cardiac events, less heart attacks. They really studied breast cancer. It wasn't clear if there was a risk of breast cancer or not. And so they became widely used because clearly women would live longer, be healthier. So then we turned our tides towards, if we can use a synthetic estrogen, can we use a synthetic progestin? There's one available. And so they mix them together called Prempro, and then this wound up having problems. Now, what's interesting is, although they saw that women who were on this Prempro had an increased risk of heart attack, 8.1percent, there is what's called a timing bias. In the study. It was done different than the practice of medicine. The practice of medicine. A woman goes into menopause and she's symptomatic. We might put her on Prempro. Now, again, we don't use that. We use actual hormones, but that's what was done. And they saw in the studies that they actually live longer, had less heart attacks. But why they have more heart attacks in this study? Well, this study they did differently. They took women that were not on hormones and were not necessarily in menopause, they were well into menopause, and they put them on these synthetic drugs. It turns out if you eliminate the women that were started on the synthetic drugs more than 10 years after menopause, they actually had a 40% reduction in heart attacks. It was actually saving lives. But the women that were started on much later with these strong synthetic drugs that increased risk of heart attacks and strokes. So it took about five years to figure this out, because when we first reported, doctors stopped using it got a bad name. And then here we are, fast forward 2020, and things are totally different. So since that time, we've been studying the fact that first off, the primary hormone in a woman is. Is testosterone. She has about 20 times more testosterone than estrogen. Even when your doctor gets a blood work back, there's so much more testosterone than estrogen that they change the units of measure. So the numbers are about equal. Okay, so if it says 90 of this and 50 of this, it's actually like 900 to 50. But they change the unit so they look similar. Because doctors like looking at things that have like maybe two or three. That's how we know it as physicians, that there's different units for everything. Like you have way more, say, red blood cells or white blood cells. So Instead of saying 10,000 of this and a million of this, they say 10,000 of this and 5,000 of this. So testosterone is much more abundant. And they've been using testosterone in women for years. In Europe, put a little pellet in your skin and you make your own estrogen out of it. And they found that women on testosterone appear to have less cardiovascular events, but notably they had substantially less breast cancer. Well then In America, about 15 years ago, one of my favorite series of studies done In Dayton, Ohio, Dr. Glaser, she looked at women for 10 years on testosterone with no estrogen. And we saw a 72% reduction in breast cancer over a mass group of women who were not on testosterone, which is pretty profound and also improves all symptoms of menopause as you make your own estrogen out of it. And that's the biggest paradigm shift is we picked the wrong hormone. In the 60s, we picked estrogen. When the hormone of a woman is testosterone, that makes into estrogen and it reduces symptoms. Now for men, we have a lot more testosterone than women do, about 10 times as much and very low estrogen. And back in the 50s, they found that men that were missing their testicles or had brain damage that caused them not to make testosterone, or they had an extra female chromosome, they would develop these gynecoloid or female features, they would start putting low fat on too, and they would get health problems. They made testosterone replace it and got FDA approved for men that had testosterone because of the brain damage, testable damage, or extra female chromosome. And it's been on the books for years. Well, it got really popular because we found that not only men that had low testosterone because of damage to their brain or testicles. What about men that just got low testosterone as they aged, like a menopause for men? And it got become very popular in the 90s and 2000s. In fact, one of the drug companies had the low T campaign, a big commercial campaign, and the FDA actually sued them and said, you know, we approved this for, in the 50s for men that had damage to their brain or testicles. And you're just saying for any reason at all, it's not proof of that. And they don't really approve stuff. So once they've approved, it doesn't, it's called off label. Doctors can prescribe it for anything, but the manufacturer can't talk about other stuff. And that's what they're doing. So it kind of went away. It actually spooked some doctors into thinking that they shouldn't be using it, which is actually false. The other thing that happened is a study in 2013 in the journal American Medical association that showed that testosterone possibly increased heart attack risks. Now, that study was subsequently withdrawn because it was an error. But the FDA issued a bulletin that we don't know that testosterone doesn't cause heart attacks. You should warn men. Well, study done in 2016 with 83,000 men. So just to put in perspective, 83,000 men in the study is enormous. For six years, men that have low testosterone, the ones that did not get treated with testosterone replacement were twice as likely to have a heart attack, stroke, or die. There's been over 120, 130 medical journals showing that testosterone reduced heart attacks. Most medical studies came out against the FDA's stance because they kind of spooked doctors that weren't going to read the literature. But for men, where I'm interested in saving health care. So men at low testosterone, we don't want to have a heart attack. But flip side is helps with symptoms. Just like women have symptoms of menopause, men might have weight gain, tiredness, sleepiness, grumpy old man, less sex drive, less energy. A lot of times guys line up testosterone with sex drive. This is one of the things. It may or may not be diminished, but it's like everything else, a lot of fatigue. Any man that's got delta onset diabetes almost always has low testosterone. We actually reverse that to some degree with testosterone replacement. So testosterone is the mother hormone for sex hormone. They go through like little palates, like pieces of rice. And your skin lasts two to six months and it restores. It's like having your stuff back.

Right. It's not painful, the procedure. Right?

Yeah. You're numbed up for it. You get a shot and you're numbed up and it gets inserted in your skin and you can feel them for a couple of days and then they can't really feel them.

It seems so much easier to do that rather than take a bunch of pills, do a whole other regimen. This seems very easy and patients seem very satisfied with it.

Yeah. So for women, they have the option of pills or patches or creams or pellets. We're finding pros and cons of each in our practice. We're thinking the pellets are the best option right now. But I would say in general, they're all pretty safe of using bioidentical hormones. They're all beneficial. So you shouldn't change what you're on. If it's working for you, they're pretty similar for men. They should not be taking testosterone pills that causes liver damage. That's out there. Shots, creams or pellets. And I would tell you that the creams have least science behind them. They have that most, which we call peaks and valleys. Your lab fluctuates the most, probably the most unwanted side effects, which is almost nonexistent with shots or pellets. Unwanted side effects would be like some breast issues or hair issues. So if you're on cream, I'm not a fan of that. I think that's the improper way to treat. But shots or pellets are probably ideal. Shots would be like every three to five days or every week and then pellets be every three to seven months.

When you say bioidentical, can you explain what that is?

Yeah, I'm glad you brought that. So bioidentical just means a hormone. It is synthesized. So they make them out of, let's say soy cholesterol or something like that, because all our hormones come from a cholesterol molecule. But it means that it's identical to the stuff that a human would normally make. Not identical to a five year old pregnant horse, which would be premarit.

And talk one more time about the family practices adding HRT to their.

So a lot of family practices are treating things like diabetes and there are a lot of weight gain issues and people are tired and what they're doing, they're putting on diabetic medicines, antidepressant medications, anti anxiety medications. And they're realizing, you know, a lot of this is tied into their hormones. But the drug reps come to their offices, are selling drugs, right? And that's the big thing is pushing the drugs. And we're realizing as a medical society that we have too much of an addicted side of some of these drugs. And really if we prevent diabetes, we're probably better off than treating it. So I think they're really kind of tuning into the fact that if the problem is, I mean, when do we get diabetes? It's when we're in menopause or menopause. You know, male, female menopause. When do we get sleep disturbance? When do we get hot flash? It occurs with hormone deficiency and the treatment's been with a drug because that's where there's, you know, it's a multibillion dollar industry to make drugs for conditions that happen to everybody. So imagine like you're a drug company and everybody would benefit from anti anxiety and antidepressant if you want to push it. But what about treating the underlying cause?

Well, great information as usual, Dr. Moak. Appreciate it. Thank you.

Thanks.

Thanks for listening to Inside the Cure with Dr. Charles Moak. See you next time.