There are thousands of articles in the medical literature related to the treating of midlife women and men with hormones. In this section we are featuring references that are more relevant to the need to protect access to cBHRT. Also, because there remains a dark cloud hanging over hormonal treatment of women based on the false initial report of the WHI, we are going to include references that support the eventual retraction of the WHI published in JAMA in 2017 by the original WHI study Committee, declaring that after 18 years of followup there is no increase in risk for breast cancer, heart attack and stroke.
In support of Compounded BHRT:
- A Review of the Safety and Efficacy of cBHRT 1
- The Importance of Estriol as it relates to lessened breast cancer risk. Also, the mechanism of estriol been a prime stimulant of estrogen receptor site β, the deproliferative step in breast glandular cell cycling. 2a, 2b, 2c, 2d, 2e, 2f, 2g
- Estriol is the most prevalent of estrogens produced by the ovary. (E3 >1.1 x (E2 + E1) 2a, 2c
- In a young fertile woman, the first phase of the menstrual cycle is proliferative, in preparation for possible fertilization. Included in this process is the initial preparation for breast feeding. Every month breast glandular cells proliferate, increase in number, breasts become fuller, cell replication via mitosis is occurring.2b If there is no implantation of a fertilized egg, the second half of the cycle is de-proliferative: apoptosis of the new cells. Proliferation is sourced via the estrogen receptor site alpha (ERα): de-proliferation via stimulation of ERβ. Estradiol is more the activator of ERα: Estriol of ERβ. We strongly favor hormonal treatment of women in menopause that leans rigorously towards non-proliferation of glandular cells, which is why Bi-est (E3 + E2) is a popular compounded bioidentical hormone replenishment treatment (cBHRT) topical. Estriol prevalence in healthy young women was discovered in the late 1960’s by oncologist Henry Lemon M.D., who uncovered that women with BCa did not have the same predominance of it. 2c The ERs α and β were discovered two decades later, in the 1990’s revealing Estriol’s proclivity for supporting deproliferation. 2d, 2e, 2f, 2g, 2h
- Estriol is available only through compounding pharmacists.
- The importance of individualizing programs for each individual woman and man: 3
- Women vary remarkably, one to the next, in hormonal needs, balance, sensitivity, absorption, preference and more. To obtain short and long term benefits for women in menopause, a professional health care provider needs to individualize each replenished ovarian hormone to each individual woman. In actual practice, let’s say for example with prescribing Bi-est, wide ranges of mg/ml as well as ratio of E3 to E2 are necessary to achieve excellence in individualization. This includes symptom alleviation and, for her ultimate hormone levels to test within optimal ranges (not to little and not too much). These individual dosage variations are easily achievable through precise hormone prescribing and compounding. This individualization results, practically speaking, in scores of possible Bi-est permutations. No pharmaceutical manufacturer could begin to practically produce and provide the multiple variations utilized in clinical practice. On the other hand, these precise prepartions are the “daily bread” of compounding pharmacists everywhere.
- There are also major variations woman to woman in the prescription of progesterone dosage, topical or oral, and of testosterone.
- This is a human hormone and very much needed by women. For women, it is available only through compounding pharmacies.
- Dosage variations woman to woman again are so different. It is impractical for a pharmaceutical manufacturer to produce all of the variations in dosage used in actual clinical practice.
- Testosterone is crucial to women. Loss of testosterone leads almost certainly and universally to sarcopenia of skeletal muscle so severe that the ultimate outcomes are canes, walkers, and wheel chairs. Sarcopenia of the levator ani coupled with vaginal atrophy is the perfect storm for loss of bladder control. Both can lead to so many women’s worst nightmare: loss of independence, need for extended care, and having to leave home and family fo assisted living and nursing home facilities.
- Ponder the consequence of lost ovarian hormones on our healthcare system in general!
1 The Bioidentical Hormone Debate: Are Bioidentical Hormones (Estradiol, Estriol, and Progesterone) Safer or More Efficacious than Commonly Used Synthetic Versions in Hormone Replacement Therapy? Kent Holtorf MD. Postgrad Med 2009;121(1):1-13.
2d The role of estrogen receptor beta (ERbeta) in malignant diseases–a new potential target for antiproliferative drugs in prevention and treatment of cancer. Warner M, Gustafsson Biochem Biophys Res Commun. 2010 May 21;396(1):63-6.
2e Quantitative Structure-Activity Relationship of Various Endogenous Estrogen Metabolites for Human Estrogen Receptor α and β Subtypes: ….Bao Ting Zhu, et al. Endocrinology Zhu et al. September 2006 147 (9): 4132
2f Differential Regulation of Estrogen Receptor (ER)α and ERβ in Primate Mammary Gland. Guojun Cheng, et al The Journal of Clinical Endocrinology & Metabolism, Volume 90, Issue 1, 1 January 2005, Pages 435–444
3 [Direct relationship to need for individualization]: Conference call with the NASEM Committee on the Clinical Utility of Treating Patients with Compounded Bioidentical Hormone Replacement Therapy and Daved Rosensweet M.D. Dr Rosensweet’s responses to questions from the NASEM Committee on 8/22/19: Questions 2 & 3: