Related Topics: General, Opinion

Dr Tony Coope – An Introduction

My intention is that my fortnightly column gives us an arena to exchange information and ideas about anything and everything in the field of hormone health, and explore how to develop the discrimination necessary to arrive at the truth.

Dr Tony Coope

On my first day as a fully-fledged medical student, back in the mid-sixties, the Professor of Medicine gathered all of us students together for a welcoming talk to prepare us for the next three years of hard study that lay ahead. Thankfully there was not a vision or mission statement in sight, but he did talk about the Hippocratic Oath (first do no harm and all that) and what these three years would demand of us in terms of discipline and commitment.

Then he said, and it seems like yesterday, “But I want you to remember that, while we will be teaching you a very great body of knowledge, and half of it will be right, unfortunately half of it will turn out to be wrong. And there is one other problem. We have no idea which half is which! ”

How ‘the more things change, the more they stay the same’! There is so much information ‘out there’ and accessible now, much of it contradictory, or even misleading. I am very aware that as doctors we have plenty of scope for ‘sins of commission’, actually doing harm with the substances that we prescribe, often trading short term benefit for long term consequences.

But a greater area of concern for me is that because the body of information is now so enormous, and because of the division and specialisation in Medicine, it is very difficult to gain a truly coherent picture of how things actually are. We often fail to see the wood for the trees, and get lost in the ‘forest’ of knowledge. The consequence of this is that we often commit ‘sins of omission’, where, through unawareness, misunderstanding, misinterpretation or even wilful ignorance, we fail to provide help that IS already known and understood and ‘out there’ somewhere.

There are many areas in the field of health where these comments apply: in illnesses such as M.E./Chronic Fatigue Syndrome; the whole cholesterol debate; in obesity; and in what is known as functional medicine, to name but four. So the question is if it is so difficult for doctors to get it right, how then do you find a reliable understanding of, and answers to, today’s many and complex problems?

Fortunately, the area of hormone health provides a rewarding field for the study of these issues; from HRT to fertility problems; from premenstrual syndrome to post-natal depression; from fibroids to polycystic ovaries.

My intention is that my fortnightly column gives us an arena to exchange information and ideas about anything and everything in the field of hormone health, and explore how to develop the discrimination necessary to arrive at the truth.

I come to this from my own life experience; from a background of four years as a Doctor in hospital and twenty-five in general practice and from a career-long interest in psychology, philosophy and complementary medicine; and more recently in hormonal and metabolic medicine.  I have a great curiosity towards the WHY? of illness (which is not well answered by mainstream medicine), rather more than the HOW? of illness (which, of course, is).

The area of female health is fascinating as it demands a truly holistic approach to its problems, which may be physical, emotional, psychological or spiritual, and often all of these at the same time.

I hope that, as we continue, you will be sending me many questions and comments, as these will shape what I will talk about, and help make this column as relevant as possible to your own concerns.

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Dr Tony Coope | 8:54 pm, May 6th, 2013

Emah: that would be quite acceptable, the principle being to take the lowest dose which gives you satisfactory relief of symptoms. Even though you do not have a womb or ovaries, it is important to continue to use progesterone cream to balance the estrogen, to protect breast tissue. When you have finished the 20:1 cream you could switch to Serenity progesterone-only cream as long as you are taking the estrogen tablets.

emah | 12:18 pm, May 6th, 2013

Dr Coope
i am still waiting for your advice. Yu had advised me to use estrogen cream or patch in addition to 20 to 1 cream. i have natural estrogen tabs. can i take that since i dont want to take livial again.

Dr Tony Coope | 12:30 am, May 5th, 2013

Soph: I am very optimistic that you would benefit greatly from both. The ideal would be to do a simple saliva test for progesterone and estrogen, have a short consultation, and then we can see clearly what would be the best combination for you, and provide you with that. If you could e-mail me your contact details via, I’ll give you a call to arrange a consult.

soph | 7:04 pm, May 4th, 2013


I had a total hysterectomy when I was twenty six. I went on to HRT for six years, then came off it and took supplements. I am now 43 and feeling very ‘past it’ A friend of mine mentioned that received bio identicals from you. Having read about the risk of brain or heart disease I am at due to not having my ovaries. Please could you advise if I should be taking an oestrogen or progesterone or both. I have suffered severe head aches and weigh gain. I am through my menopause now though. Are we able to obtain these form you directly after a consultation.

Dr Tony Coope | 6:12 pm, April 28th, 2013

Emah: as you have only just come off Livial, it is possible that there may not be enough estrogen in the 20:1 combined cream to suppress your flushes, especially in these early stages. You could increase your dosage for a while (the balancing effect of the progesterone should negate any tendency to weight gain or breast enlargement), or you could continue on your present dose while adding a supplementary dose of estrogen via an estrogen gel or patch, which allows you to use the smallest dose that gives you relief of symptoms. Your GP may or may not wish to prescribe these for you, but if you experience any difficulties let me know.

emah | 6:20 pm, April 27th, 2013

Dr cooper i have been on livial- HRT estrogen since january 2012 after removal of my womb and ovaries. I still have hot flashes, weight gain, malaise,waist pain,leg pain, sleepless nights etc
i have stopped using livial for a week now and have been using 20 to 1 progesterone for 3weeks now. i still have hot flashes. pls advise bcos i dont want livial. will the 20 to 1 help in weght? i dont want my breasts to be enlarged.

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Denise | 6:01 pm, June 2nd, 2012

Hi Jo,
I used to have adult acne which I think was caused by stress. I also had bad PMT, dreadful menstural problems, migraine and a few more female problems.

All these problems got worse over the years. My GP suggested HRT but I declined. After a routine test my GP mentioned that my estrogen was high but didn’t seem to think it a problem. I did some research on the wonderful Internet and found a site called Health Science which is the original maker of natural progesterone cream called Serenity. I bought a pot and after a few weeks I could feel the benefit. I lost some weight, my migraines lessened and I felt a lot better all round.

There are many women who are ‘estrogen dominant’. This condition can start as early as 30. When GPs suggest HRT they are just giving some women more of what the do not need – estrogen. As well as the unwanted estrogen ther may be synthetic progesterone – called progestin. All this is taken orally and is not good for women.

I had my estrogen, progesterone and testosterone tested with an independent laboratory and I was indeed estrogen dominant.

After the menopause estrogen is still being made in a woman’s body but progesterone is practically zero. But this can happen at a younger age.

Would it be possible for you to have your hormones tested, if not via your GP, then by an independent laboratory?

I would recommend natural progesterone cream to most women – in this modern age there are an excess of estrogens in the food we eat and even in the plastics we use. It may be that there are a lot more women who are estrogen dominant than there were 50 years ago.

I would suggest you have a look at the Health Science website and also get your female hormones tested.


J | 10:30 am, June 2nd, 2012

I’m 35 and struggling with my hormones. Can you give any nutritional or herbal advice for the following symptoms that I have had for many years and have in the last fews months got suddenly worse. Acne that develops in 2nd half of my cycle and takes weeks to heal, melasma and midcycle bleeding (I’d had numerous investigations, all negative and my GP finally said it was just hormonal and I should go on the pill, I declined). I found that cutting out soya helped a lot with spots on chin, around nose and forehead, but not so much on jawline and cheeks. Any advice gratefully recieved. J

Dr Tony Coope | 8:38 pm, May 16th, 2012

Denise: thank you for your post, which is very pertinent to these times. Please don’t downplay your ‘lay’ qualifications to do your own research, – the ‘beginners mind’ you brought to this means that you avoided starting with all sorts of conditioned beliefs and perceptions that can be a major problem for those of us who have been through medical training.
My observation is that medical thinking has become more rigid, linear, compartmentalised and even closed since the early 90’s, when targets and fixed diagnostic and treatment protocols began to make their appearance. They have their place, in particular in acute and emergency medicine, but for problems like your own, the lack of a proper overview as to how these different systems influence each other, and the denial of psychological, emotional and spiritual factors in disease, makes a full understanding very difficult to reach.
Against that, however, my experience is that more and more of us, especially women, are following a similar path to yours; this must eventually have a significant effect, especially if in doing so they can nudge those doctors who are open to it towards a wider and more flexible perspective!
Your comment about the need for patients to take responsibility for themselves, while working with doctors to obtain optimum health, I think is ‘spot-on’.

Denise | 5:49 pm, May 14th, 2012

I was diagnosed as being hypothyroid by Dr Peatfield, a metabolic specialist, in 2007. He also diagnosed adrenal fatigue. I had been visiting my GP for many years beforehand with symptoms relating to the above. My GP said it was my age that was causing all my symptoms..

Dr Peatfield suggested adrenal support before going on to take thyroid medication. There was a lot of other visits to GP and endo – I could write a book – it was horrendous. But skip all that and today I am taking 1 grain of natural desiccated thyroid and 45 mcg of T3. I also use natural progesterone cream, take magnesium, high doses of vitamin D, A, C + other vitamins and minerals.

I have done a lot of research about thyroid and adrenal fatigue – as a lay person of course – progesterone, magnesium, fluoride, vitamins and minerals. I become a bit of a fanatic when I talk to others.

It may be that the RCP do not want GPs to think outside their box as most of the good things we can take are not regulated by the big pharmaceutical companies.

It is up to the patients to take their health into their own hands and work with doctors to obtain optimum health.

A colleague at work told me about this website. I hope my message is not too long.


Dr Tony Coope | 5:20 pm, January 10th, 2012

Lynda: you are very kind; as it so happens, I do remember you, and I’m so very sorry to hear of Simon’s misfortune.
Myrtazepine has a different mode of action to the majority of antidepressants such as the SSRIs. I have not had direct experience of it, but sometimes used the related drug mianserin which preceded it. In practice, I did find that some antidepressants did reduce pain perception in some patients even when clinical depression was not apparent, so they can be worth trying and persevering with if results and an absence of side-effects justify it.
Taking a more natural route, my inclination would be to try a product by the name of ‘Total Calm’, which contains taurine, GABA, and 5HT, precursors or building blocks of mood-enhancing and sleep-regulating neurotransmitters such as serotonin made in the brain. There are other things one could consider to lessen muscle spasticity and thereby pain, but there is not space to discuss those here, as the subject in this case is clearly a complicated one.
I would be very happy to explore some of these aspects with you, by phone if necessary, if that might be helpful to you, or at least have a initial discussion about it; (if you would like to do that, just forward your contact details directly to me at and I’ll come back to you.) Bon courage, Lynda.

LYNDA MEAD | 2:16 pm, January 10th, 2012

Hello Dr Coope, my name is Lynda Mead, I have just joyfully stumbled across your website. You probably will not remember me, but you were our family GP for 13 yrs whilst we were in Liphook…. and so sorely missed. I have three sons John, Matthew and Simon.
In 2006 Simon had a swimming accident which left him paralysed from the neck down C5 with twisted C3. I have been struggling to give him the appropriate care for many reasons, not least being due to NHS shortfalls. He left Salisbury district hospital in June 2007 without a wheelchair and has been waiting for one ever since. This has meant he has been on bed rest for 5 years.
We asked for a community physiotherapist to help us in November 2007, either with leg stretches or to give instruction on the appropriate way to move his legs after we found he had a dislocated right hip and nasty infection in the left leg. This never materialized and he now presents with acute knee constrictions which have effectively dislocated his left hip over Christmas this year. He suffers with autonomic dysreflexia at an alarming rate now, as he is in extreme pain and discomfort from his lower back and left hip.
We asked our GP to help advise on pain relief and he prescribed Simon Mirtazapine Tablets. Today he visited and forcibly insisted Simon should take these.
I was wondering your views on this. Would Mirtazapine help in neuropathic pain control?
Simon is optimistic and interested in many activities, my concern is that knowing these are anti-depressants and knowing that Simon is not even close to being depressed, could they be harmful to him by :- 1. lowering Simon’s awareness of the onset of AD and therefore lessening my chances to resolve it in time. 2. alter his brain chemistry?
I know this is far from hormonal problems in female terms but wonder if you could offer any assistance.
Kind regards
Lynda Mead

Dr Tony Coope | 4:04 pm, October 19th, 2011

Carol (part 2): due to a (rare!) ‘senior moment’ I have left out an important and relatively recent alternative to the above, which is a 20:1 progesterone/estrogen cream, giving you the progesterone but with about 5% estrogen added. This I am finding very useful and effective where a little estrogen is needed as well. You can obtain this directly from Wellsprings or through me, in which case you have access to guidance if you should need it.

Dr Tony Coope | 9:00 pm, October 18th, 2011

Carol: if you have already tried herbal preparations such as black cohosh or dong quai, or bioflavonoids, with no real improvement, it’s certainly a reasonable option to use an estrogen patch in conjunction with the progesterone, trimming it down to the lowest dose which is still effective for you. This reduces concerns about any risk from the estrogen, which is also balanced (‘opposed’) by the progesterone. In fact, if this combination was more widely used, it would be a significantly safer alternative to standard HRT incorporating synthetic progestins.

Carol | 6:10 pm, October 17th, 2011

Could you please advise me if it is ok to use half an evorelle25 patch with natural progesterone,I find the progesterone on its own isn’t enough,many thanks Carol

Dr Tony Coope | 5:17 pm, February 7th, 2011

Amorie: unfortunately I have no knowledge of practitioners in South Africa, let alone one qualified to do the right thing by you.
The information that you have given points to the possibility of two things: first, that you may have a low base-line level of progesterone (the marked drop in this hormone immediately after delivery can be a major factor in the development of ‘the baby blues’).
Secondly, excess estrogen is known to raise the risk of blood clotting events such as DVT.
Put these two things together and you have a possible diagnosis of estrogen dominance, which could explain your continuing state of poor health. Any of these following symptoms would tend to add support to such a diagnosis: heavy periods, fibroids, breast lumps or cysts, weight gain and fluid retention, anxiety and depression, PMS, cyclical migraines, reduced thyroid function, poor sleep patterns, low libido, infertility, recurrent miscarriages, impaired sugar control, and an increased tendency to auto-immune disorders.
If you have even a few of these, it’s vital you find a doctor who understands this area well. If this proves difficult for you, e-mail me direct with a more detailed history and I am sure we can work out a plan of action that will guide you back to health and well-being.

Amorie Joubert | 6:30 am, February 7th, 2011

Good day Doctor, I need help urgently. I am now 27 years old and have a son who is 3 years old. In 2007 after his birth I had depression, as well at DVT (Trombosis) In my right leg. Eversince all of that I have not been well. I can`t mention all the related issues, but need a specialist or professor. Do you know of anyone you can recommend for me in South Africa? I live in Johannesburg.

Kind Regards
Amorie Joubert

Dr Tony Coope | 12:58 pm, October 14th, 2010

Mary: Speedy alternatives are unfortunately in short supply in this situation; but if your present state of health is tolerable and you prefer to avoid surgery, then it would be worth starting on a course of bioidentical progesterone for 3-6 months in order to rectify the probable long-standing oestrogen/progesterone imbalance. This may well bring the menorrhagia under control and slow, stop, or even reduce the growth of the fibroids until the onset of menopause brings this about naturally; (progesterone would be also important post-hysterectomy should you take that option)
It is also important to replenish your iron stores, as deficiency tends to increase the blood loss, a negative and self-sustaining spiral.

On a metaphysical (emotional/spiritual) level heavy blood loss can be seen as the equivalent of a significant loss of ‘joie de vivre’, – joy and vitality, in your life, expressing physically what is too difficult or painful to be re-visited mentally or emotionally.
Is there a family fear that life is all downhill from here? Are there clues in your mother’s story, and her mother’s before her? Have you had traumatic events such as miscarriages, infertility, or in the sexual or relationship spheres of your life? Have you been unable to seek help or speak trustingly about such things to others? Often physical symptoms such as these are the end-product of a suppression or denial of emotions such as deep regret or sadness too painful to be expressed. They remain in the subconscious, quietly then not-so quietly trying to get your attention, so that they can be brought up into the light of awareness and healed.
If any of the above speaks of your story, it’s really important to contemplate it, and if necessary, find someone to help you with this. By healing the emotional, you may well find the physical symptoms resolve themselves, however unlikely this may seem to you at this present moment.

If you would find it helpful to talk this through in more detail, do please e-mail me (

Mary | 3:39 pm, October 13th, 2010

I have troublesome fibroids & due to menhorragia, have had a couple of blood transfusions. I am being persuaded to have surgery. What are speedy alternatives &/or support for my hormones in the case of hysterectomy?

Dr Tony Coope | 7:58 am, August 19th, 2010

Pina: no problem, but this is not the site for that! The office e-mail is

pina cumbers | 9:07 pm, August 18th, 2010

have tried to email you to confirm my order to dr tony coope as per phone call today 18th august regards Pina

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