Hormone replacement therapy (HRT) is a long-standing medical practice. Evidence over the past 20 years indicates that HRT, as practiced by conventional medicine, is not very effective and unnecessarily dangerous. This was confirmed by the recent Women's Health Initiative Study, published by the JAMA. There are several problems with conventional HRT that cause this debacle. Following are three steps that should be followed if one undertakes HRT. When these three steps are performed properly, HRT can be very beneficial without being dangerous. Until these steps are learned by conventional physicians, the unnecessary deaths and illnesses created by HRT will continue unabated.

1. Is the patient really deficient in the hormone? Is it really needed? No one would give insulin, for example, to somebody who didn't need it. In the case of the Women's Health Initiative Study, the participants were all healthy women and not tested in any way to see if they needed any hormones at all. The omission of this step is simply stupid and, as it turns out, quite dangerous to the women. All measurements of sex hormones over the past 30 years in women after menopause show that over 60% of them continue to make adequate amounts of estrogen until at least age 80, for example. Estrogen (particularly estradiol and estrone) are very potent hormones with a host of really undesirable side effects if not balanced with progesterone. Farmers, for instance, give estrogen to steers to make them retain fat and water so they get to market weight with less time and feed. No one in his right mind would give extra estrogen to women without somehow determining that they needed more of it. In this regard, good research shows that saliva testing is more relevant than blood serum testing.

2. Dosage. If you undertake to give extra hormone to anyone, the dose used should be the dose that raises the hormone level to that consistent with that of healthy people, and not in excess. This is referred to as physiologic dosing, rather than pharmacologic dosing. In the case of women found to be deficient in estradiol, for instance, the proper dose is just 0.25mg/day, or, if using estrone instead, the proper dose is just 0.3mg/day. The dosage used in the Women's Health Initiative Study was 2-4 times higher than that, despite the fact that participants were never tested to see if they needed any extra estrogen. This, too, is a grievous error of conventional HRT.

3. Bio-identical hormones. If you determine that a woman does, in fact, need extra sex hormones, replacement of that hormone is best done by using hormones identical to that made by humans, not some drug, foreign to humans, that is supposed to mimic the hormone's effect. This is true in giving insulin or thyroid hormone, also. It is especially true in the case of estrogen, since its potential side effects are so dangerous. Progesterone protects against these estrogen side effects such as endometrial cancer, ovarian cancer, breast cancer, strokes, heart attacks, gall bladder disease, etc. The Women's Health Initiative Study did not use progesterone - they used synthetic, non-bio-identical progestin (named Provera) instead. Provera is already known to cause many undesired side effects (see the Physicians' Desk Reference, PDR) and also to increase the risk of breast cancer beyond that due to estrogen alone.

Failure to follow these three rational and well established guidelines is a grevious error. It is the underlying cause for the failure of conventional HRT, as used in the Women's Health Initiative Study.

Many people, like so many doctors, are confused by the term natural. In the context of hormones, "natural" means merely that the hormone given is bio-identical to human hormones. It is natural to humans. Bio-identical hormones have been available since the late 1930's, being made from fats and oils in plants, a process discovered by Russell E Marker (then a young researcher from Pennsylvania State University) resulting in real (natural, bio-identical) progesterone. He gave his process to the world without getting a patent. Later, other researchers found chemical techniques to make other sex hormones from new chemical techniques of converting plant fats and oils into hormones, but they patented these processes. Pharmaceutical companies make their money from patented drugs. Since the process to make progesterone was not patented, pharmaceutical companies tend to ignore it. Instead, they convince doctors to use compounds that were foreign (i.e., not natural) to the body but could be patented. The driving force for this travesty is, of course, financial profit.

Thus arose the progestins - foreign compounds with some sort of progesterone effect but not the same as real progesterone, and all of them loaded with bad side effects. Instead of helping the fertilized egg implant and survive in the uterus, synthetic progestins block the implantation of the fertilized egg and/or the survival of the embryo. Thus, they become popular as birth control pills. Real progesterone, on the other hand, is the hormone that makes conception possible.

Over the years, doctors have come to think that these foreign compounds are somehow equivalent to bio-identical hormones. Unfortunately, this error became the conventional mode. Since malpractice risks are diminished by practicing in the conventional mode, doctors tend to follow the conventional way. In the process, women are being killed or suffer illnesses they didn't need to have.

This is the real story of the HRT debacle.

Best wishes John R Lee,
MD Sebastopol, California