Feel Good Hormones – Thyroid and Testosterone

Feel Good Hormones – Thyroid and Testosterone

Treatment Scenario 

Your 58 y/o hormone patient requests consultation with you over concerns of her HRT program. The patient notes her desire to stop the HRT program as her best friend was just diagnosed with breast cancer. Although the breast cancer patient is not your patient, she is on a similar HRT program as your patient. Your patient’s family and PMD have advised her to stop her HRT program out of concern for developing breast cancer. She desires your advice and expertise on the matter and questions whether the HRT program is safe. 

You empathetically express that you share the same concern as her doctors and family. However, you advise her that you would not prescribe any HRT that would be harmful nor would you prescribe any hormones that you would not prescribe for you or yours. On the other hand, studies have demonstrated that the BHRT prescribed does not increase the risk of breast cancer.  More importantly, studies prove/demonstrate that each hormone prescribed has been proven to decrease the risk/incidence of breast cancer. Lastly, progesterone and testosterone are used in treatment of active breast cancer. And estrogen has been proven to decrease breast cancer and mortality, an important outcome that has not been shown with tamoxifen or AIs. You provide the patient with studies demonstrating the above as you need to be your patient’s advocate. On the other hand, you respect her decision to stop the HRT and assure her that she may resume her HRT program at any time in the future if she so desires. 

However, we must advise the patient that taking BHRT does NOT guarantee that a patient will not develop breast cancer. If a patient does develop breast cancer, everyone is quick to blame the hormones (and you). Stopping the HRT program will put her mind to rest as well as her family. If the patient chooses to stop the HRT program, she should be given a negative informed consent. This is an explanation of what potential harms the patient will encounter upon stopping the hormones: increased CVD, Alzheimer’s and dementia, osteoporosis and fracture related mortality, memory loss, vision loss, tooth loss, uro-genital atrophy, increase in diabetes and associated complications, and cancer. It should be a shared decision-making process with the patient having all the data, research, discussion, and your expertise to guide her in her decision-making process. Probably everyone but you will advise the patient to stop the HRT program, including her PMDs. This is as would be expected, but no one understands better than you that SHRT is not BHRT. Perhaps the patient is only interested in stopping the E2 and may wish to continue P4 and testosterone based on the studies that you have provided. 

Ultimately, the patient decides to stop the E2 based on input from friends and family. However, she decides to continue the P4 and testosterone due to all the literature that you had provided. So, who is the practitioner that is best suited, best prepared, most knowledgeable, and has better command of the medical literature to address this complex topic? It’s you.

Haven’t taken training with us yet, but interested in learning more about the value and efficacy of BHRT as an alternative to medication-based therapies? Please consider our four part Hormone Optimization Workshop Series, and start training with us at Part I: Discover the Power of BHRT.

Feel Good Hormones – Thyroid and Testosterone

All hormones have health benefits and feel-good benefits. As I mention in the BHRT Workshop Series, estradiol and progesterone are important for prevention of CVD, diabetes, Alzheimer’s disease, osteoporosis related fractures, cancer, as well as an overall decrease in morbidity and mortality. However, other than relieving symptoms of menopause, there are no significant improvements in how we feel and function. Many women go through the menopausal transition unscathed as they do not experience any hot flashes, night sweats or temperature dysregulation. Since they don’t have any menopausal symptoms, they will not perceive any benefit in taking menopausal HRT. In other words, the menopausal symptoms that they don’t have don’t get better with HRT (just as reported in the WHI). However, we all experience patients that relate to us that the hormones made them feel tremendously better. “Wow! What a difference. Thank you for giving me my life back,” they often profess. Well, if E2/P4 do not make women feel better (other than relieving HF/NS), then what is it that makes menopausal women feel so much better? There are only 2 feel-good hormones in women, thyroid and testosterone.

Studies Show Health Benefits of Testosterone for Women

In the first several webinars, I discussed the current AACE guidelines on the use of testosterone in women. I also reviewed the “expert” opinions published in JAMA, both guidelines recommending against the use of testosterone in women. These opinions and guidelines did not site any harm of testosterone use in women; however, they claim (as they always do with hormones) that there are no long-term studies on the use of testosterone in women. Well, there will never be any long-term FDA studies as there is no FDA-approved testosterone for use in women. On the other hand, there are many long-term studies on the use of testosterone in women, but somehow the experts that write testosterone guidelines for women fail to read/acknowledge/grasp/appreciate all the studies that DO SHOW long-term safety and efficacy of testosterone use in women. It is so unfortunate that the plethora of studies that prove safety and efficacy and health benefits of testosterone go unrecognized. Thus, it has been my purpose in providing these webinars so that we clinicians review and have access to all of the pertinent studies demonstrating the health benefits of testosterone as well as the quality of life benefits.

Higher Dosing and Symptom Improvement

Similar to men, testosterone deficiency has adverse effects on our cardiovascular system, musculo-skeletal system, brain and neurologic system, immune system, and sexual function. The absence of ovarian testosterone production in postmenopausal women was associated with deleterious effects on endothelial function. Testosterone administration reverses this and prevents plaque deposition and CVD which causes mortality in over 90% of women. Multiple studies prove benefit to testosterone; however, the question remains as to what dose or level Is best. Fortunately, many studies demonstrate that supraphysiologic levels of testosterone are necessary to improve symptoms and that should guide our therapy, and not serum levels. Nevertheless, our peers and guideline experts don’t grasp or acknowledge these studies or concepts.  Therefore, I have tried to search the literature to provide the most important and pertinent studies to have in your library.

Defending a Case as an Expert Witness

In a recent case that I had to defend involved a non-WLM trained physician that was being sued by a 63 y/o patient that developed breast cancer after being on BHRT for 9 months. Plaintiff’s expert testified that testosterone should never have been prescribed because the baseline testosterone level was normal (TT was 15ng/dL). As with many cases that I have defended in the past, plaintiff’s expert claimed that the hormones prescribed “caused” the breast cancer. The experts also claimed that the serum TT level was way too high (TT level on treatment was 220) and that also led to the breast cancer. Obviously, nothing could be further from the truth. Under oath, the hired gun academician stated that progesterone causes cancer. He was asked to provide medical literature to support his statements. His response was that he did not need to waste his time providing studies because everyone knows that hormones cause cancer. He provided no literature support for his testimony, only his expert opinion. He testified that each of the hormones individually, as well as all together, increased the risk of breast cancer. Furthermore, the excessive doses and dangerously high hormone levels achieved were responsible for the breast cancer. I was chomping at the bit to testify against plaintiff’s expert.

I presented > 50 papers demonstrating that estrogen does not cause cancer. In fact, every study proves that estrogen (either CEE or E2) decreases the risk of cancer. The expert claimed that estrogen increases breast cancer mortality. I presented all the recent data proving that the only treatment that decreases breast cancer mortality is estrogen. The expert was adamant that P4 causes cancer. I presented > 50 studies demonstrating that P4 protects against cancer, whereas it is MPA that increases the risk of cancer 4-fold. The expert claimed that there was no difference between P4 and MPA. We provided the literature proving that P4 is apoptotic to breast cancer cells and has been used as a very successful adjunctive treatment for active breast cancer. Finally, I presented > 50 papers proving that testosterone protects against breast cancer and has been used as a very successful adjunctive treatment for active breast cancer for over 50 years. Multiple studies prove that TT levels of at least 300-500 ng/dL prove safety and efficacy, with levels less than 300 being less efficacious. In fact, a TT level of 220 ng/dl was probably subtherapeutic and certainly not harmful. Our literature proved that both P4 and testosterone are apoptotic to breast cancer cells, both in-vivo and in-vitro. Almost every statement made by plaintiff’s expert I proved wrong and incorrect. We also demonstrated that breast cancer is present at least 5 years before diagnosis, thereby proving that the hormones did NOT cause this breast cancer, nor did the BHRT increase the growth of the breast cancer. If anything, it probably slowed it down.

The defense attorney for the physician confided in me that plaintiff’s attorney did not like my testimony. Imagine that. Therefore, the plaintiffs made a motion to settle as they tried to recoup some of their cost. Their slam-dunk case backfired. I advised the defense attorney to not settle as I was eager to testify in court. In fact, I could not wait. After much stalling and negotiation, plaintiffs dropped the case. (That’s a 100% ARR). Juries have no expertise in deciding malpractice cases, as the experts for both sides appear impressive. However, it is a battle of experts as to who can convince the jury. A lay jury should not have to decide cases as they don’t understand or have any experience with medicine. In the end, it was all about the medical literature providing overwhelming support against plaintiff’s expert testimony thereby leading the plaintiff’s attorney to drop the case.

Haven’t taken training with us yet, but interested in learning more about the value and efficacy of BHRT as an alternative to medication-based therapies? Please consider our four part Hormone Optimization Workshop Series, and start training with us at Part I: Discover the Power of BHRT.