Podcast excerpt by Dr. Charles Mok discussing the history and shifting practice of hormone replacement therapy for menopausal/perimenopausal women. Covers early synthetic estrogen/progestin (premarin), the 2002 Women’s Health Initiative finding of increased breast cancer risk with combined synthetic hormones, and later evidence favoring testosterone-dominant therapy (reported ~70% lower breast cancer incidence and improved cardiovascular and quality-of-life outcomes), concluding that medicine has been slow to adopt testosterone-focused care.
Chapters
Foreign. Replacement therapy for women in menopause or entering menopause has been around for decades. And when it first came out, we chose to use estrogen and progesterone because we were able to get it very easily. In fact, the first form of estrogen was synthesized from pregnant mare urine or premarin. So they would get the urine from a five year old pregnant mare and dry it up. And the compound left behind was a type of estrogen to help treat menopause. In menopause or perimenopause, we traditionally used estrogen, particularly synthetic estrogen, and a progestin or synthetic progesterone to treat menopause. And back in 2002, there was a study called the Women's Health Initiative trial that showed that being on this combination of synthetic estrogen and progestin slightly increased a woman's risk of breast cancer. Now, it wasn't a major increased risk, it was 801%, but still an increased risk of breast cancer. Prior to that time, we've been using actual hormones that did not increase a woman's risk of breast cancer. But why that study came out is it, obviously you got a lot of women to rethink what they were doing in menopause, but about the same time in America and in Europe and Australia, we were using testosterone, which really is the mother hormone, it's the hormone that precedes estrogen to treat women in menopause and they'd actually add it to estrogen. What they found was that women who were taking testosterone as a dominant hormone, and estrogen is more minor hormone, had a remarkable decreased incidence in breast cancer, about 70% decreased incidence of breast cancer and still maintaining the cardiovascular protection, the improved quality of life, better energy, better sexuality, less mental fogginess. And this has led to a change in the way we're practicing medics in the United States. And it took a little while. You know, again, the Studies are about 17, 18 years old, but it's pretty overwhelming. 70% reduction in breast cancer, improvement of all symptoms associated with menopause, reduced heart disease rate. We learned this over the last 15 years. We should have been using testosterone in the first place. And the medical community has been a little slow to adopt this more modern understanding of how women age and how our hormones affect our body.
More from Dr.
PodcastEpisode 16: Can Rapamycin Reverse Skin Aging?