Bioidentical Hormones are under attack again from Medscape, an online medical information site funded by the major drug companies. In spite of all the “Guidelines” created by medical organizations advising women to use their “FDA approved” synthetic hormone products, women and their physicians have rejected these “Guidelines” and have switched to bioidentical hormones. Could it be possible that a few “rebellious” physicians refuse to cooperate with “Big Pharma”, revealing a callous disregard for authority ? No, this couldn’t be possible. It must be the doctor’s lack of training on using the proper phrases and arguments in a conversation with the patient on hormone replacement. This Medscape article then goes on to instruct us doctors exactly what to say to you when asked about hormone replacement. What follows is a comedy of errors of monumental proportions. I almost fell off my chair laughing (1)
Pennies From Heaven – Turn Your Umbrellas Upside Down
Turn Your Umbrellas Upside DownThis time, the lies about bioidentical hormones come from an appropriately named author, Dr. Lie, a recipient of sizable funds from Merck, maker of women’s hormone products Nuvaring and Nexplanon. (4-10) Both products contain etonogestrel, a chemically altered version of progesterone which does not occur anywhere in nature or in the human body.(2,3) Altering the chemical structure of the ovarian hormone progesterone, creates a “Monster Hormone”, causing cancer and heart disease. This is not a good idea. For example, a cousin of etonogestrel, medroxy-progesterone was found to cause breast cancer and heart disease in the ill-fated Womens Health Initiative Study published in 2002 in JAMA.(11). Left image Hormone Therapy Courtesy of ANH.
No Studies on Etonorgestrel and Breast Cancer
You might therefore ask the question:
“Does etonorgestrel cause breast cancer? “
Since the drug is “FDA approved”, one might mistakenly think this has been thoroughly studied. The FDA approved patient label will set you straight. It has never been studied. Here is a quote from the product label for Nexplanon, the implantable etonorgestrol product by Merck:
“It is not known whether NEXPLANON use changes a woman’s risk for breast cancer.” quote from FDA approved label (13)
People Who Live in Glass Houses…
Merck Drug CompanyAs we see above, Merck’s two synthetic hormone products have not been thoroughly studied as to whether or not they cause cancer or heart disease?
One of the main criticisms of bio-identical hormones by Dr Lie, and her colleagues who represent the major drug companies, is Bioidentical Hormones have not been studied in a double blind placebo controlled trial, the type of study needed to obtain FDA drug approval. Well, if I lived in a glass house, I wouldn’t be throwing stones. The truth is that synthetic hormones like these two Merck monsters should never have been approved for human use.
The truth is that Biodientical Hormones have been studied and found safe, and are the preferred choice. See my previous article on this. Left Image of Merck courtesy of Reuters.
Rebellious Physicians Refuse to Cooperate
Jeffrey Dach MD Bioidentical Hormones
Jeffrey Dach MD Bioidentical Hormones
Getting back to our Medscape “Medical Education” article: Firstly, the author laments that women and their physicians have rejected the “Medical Guidelines” and have switched to bioidentical hormones, identical to those made by the human ovary.
Could it be possible that some rebellious physicians refuse to cooperate with “Big Pharma”, revealing a callous disregard for authority ? No, this couldn’t be possible. It must be the doctor’s lack of training on using the proper phrases and arguments in a conversation with the patient on hormone replacement. The author’s job is to provide this missing information. The artile then goes on to instruct us exactly what to say when asked about hormone replacement.
“how should clinicians approach the conversation with their peri- or postmenopausal patients about the use of bioidentical hormones for their symptoms?”(1)
Understanding a Few Myths
The Medscape author then explains that your doctor should first understand a few myths about bioidentical hormones so these can be clarified in a conversation with you, the patient. What are these myths? Well, here they are:
Myth (1): “Bioidentical hormone therapy is natural and therefore superior to CHT.” (Note:CHT means Conventional Hormone Therapy, chemically altered synthetic hormones like Merck’s etonorgestrel)
This is not a myth. This is actually a true statement. Hormones made by the human ovary are superior and safer than chemically altered synthetic hormones offered by the drug companies. The drug companies must alter the chemical structure of the hormone in order to qualify for patent protection which makes the drug profitable.
Horse Estrogen is NOT Bioidentical Unless You are a Horse
PregnantHorseUrine1PremarinThe author, Dr. Lie, in spite of her Oxford and Cambridge pedigree, missed the mark on the meaning of “bioidentical”, a word indicating the chemical structure of the hormone is “identical” to those made by the ovary. Dr Lie goes on to make another error in the statement “bioidentical products that may be derived from equine or other sources.“. Here, Dr. Lie is referring to Premarin, estrogen from horses (equine). Yes, Premarin is bioidentical if you happen to be a horse. Horse estrogen (Equilin) is a different chemical structure and is not the human estrogen, estradiol, made in the ovary. Premarin is by definition NOT bioidentical, as any high school kid could understand.
Myth (2): Compounded bioidentical hormones are better than CHT.
This is actually a true statement, and not a myth. There are many reasons why individualized compounded formulation are better than mass produced pre-packaged hormone products. The main reason is obvious. Compounding allows more versatility and choice by the doctor in making up a specific formulation. Three or four hormones can be mixed in proper ratio to make an individualized topical hormone cream. This cannot be done with the prepackaged hormone products from the major drug companies like Merck and Pfizer.
Myth (3): Custom compounding individualized to the patient using salivary hormone assessment is superior to CHT because it mimics the patient’s own natural hormone levels.
Astronaut NAsaContrary to what the author, Dr Lie says, most patients expect a competent physician to perform testing for either salivary or serum hormone levels. Dr Lie says:
“Hormone therapy should be individualized by symptom relief and side-effect profile and not laboratory test results.”
I actually agree with this statement, and we do not routinely use salivary hormone testing. Rather hormone dosages are titrated for menopausal symptom relief. Even so, we routinely include hormone testing on our routine blood testing panels. Unlike Dr Lie, I wouldn’t belittle the salivary hormone testing technique, as I have found clinically useful results can be obtained with salivary testing. Not only that, there is an extensive body of medical literature on salivary hormone testing in athletes, and in astronauts on the space shuttle (12), etc. Left image astronaut courtesy of NASA.
Falling Out of My Chair in Laughter
car_sales_techniques_hormonesThe next section of Dr Lie’s Medscape article is so hilarious, I almost fell out of my chair in laughter. In this section, Dr Lie explains how the doctor (that’s me) should use “beneficial persuasion” techniques to convince the patient that bioidentical hormones are “bad” and synthetic chemically altered monster hormones are “good” for you. These are techniques you might see in a training manual for closing auto sales : 1) vivid depictions, 2) framing, 3) regret, 4) refocusing. This might be OK if you are buying a new car. It is not OK in your doctor’s office. Let me put it very simply. If your doctor is learning how to have a conversation in the office with you about hormone replacement from a Medscape article like this one, then you need a new doctor. Left upper image : used car salesman courtesy of Kurt Russell Escape from New york.
This article is merely another one in a long string of false and deceptive drug marketing propaganda masquerading as medical education. Why do we even have to put up with this nonsense? I am really tired of it. Unfortunately, we can expect even more misguided articles in the future like this Medscape comedy of errors, as the public rejects synthetic hormones for the monsters they really are.
Many doctors, and consultants, regularly confuse synthetic progestins with the natural hormones and are not aware of their effectiveness or worldwide use. If you are not sure how bioidentical hormones could help with a range of conditions from PMS to Osteoporosis as well as menopausal symptoms such as hot flushes, then these articles will be helpful.