(We recently asked Sangeeta Pati, FACOG to reflect on the impact of Oprah’s recent shows on HRT and give us her thoughts on bio-identical hormones. Dr. Patti will be presenting an important workshop addressing hormone therapy at the upcoming 17th World Congress on Anti-Aging Medicine in Orlando this spring. At the conference doctors can also commence their Anti-Aging Board Certification training.)
Logic dictates that human
identical, bio-identical products are the only acceptable products when we are
restoring hormones or nutrients. Why use a product that acts like the real thing when you can get the real thing? Oprah’s
show brings to the forefront of discussion the real need to help women (and I
should add men) who suffer from symptoms and the real need for people to
continue their quest for better health and options.
I would like to comment on three
issues that came up during Oprah’s recent show on hormone replacement therapy:
1. Risk in women? When women consider hormone replacement, the looming question is about the risks,
especially of breast cancer, strokes and heart attacks. On review, women are the most protected
during their 30’s when they have the highest (balanced) hormone levels. It is
only after menopause that women have increased risk of stroke, heart attack and
breast cancer. Data suggests that it is hormone
imbalances that contribute to breast cancer. We know that, most breast
cancers occur after menopause; precisely at the time when the ovaries stop
producing the normal balance of hormones.
Why? First, progesterone,
which prevents breast cell division, declines beginning in one’s late 30’s. Second,
approximately 10 years later comes an imbalance of the estrogens. Estriol (E3)
, which is breast and clot protective, decreases from 80% to 10%. Estrone (E1),
which is breast and clot stimulating, goes up from 10% to 80%. The increased E1
is undesirable as E1 is converted to forms of estrogen (i.e. 16-OH E1) which
are carcinogenic to the breast. So, restoration of protective hormone levels
needs to be considered a possible preventative step against breast cancer.
Large studies so far have used,
synthetic, hormones (not identical to human hormones) with a ratio of estrogen
weighted towards E1 like the large Women’s Health Initiative (WHI) study
published in 2002, which was followed by much confusion. Reanalysis of this
study and many others has eventually led to the following three solid
conclusions on hormone restoration in women.
- When started
within 10 years of menopause, hormones are
protective to the heart and brain. - “Progestins” (not
identical to bio-identical progesterone) have been shown to increase clots and
breast cancer in 5 trials compared with natural “progesterone” which is
associated with protection. - Bio-identical
Estradiol (E2) delivered through the skin has been shown to decrease clots and
risk of stroke and heart attacks, as opposed to E1, delivered through the mouth
(i.e. Oral PremarinTM used in WHI) which increases clot heart attack and stroke
risk because of the first pass through the liver which makes clotting factors.
So, when restoring hormones,
we aim to use protective forms (E2, E3) and protective delivery routes
(transdermal). We aim for protective levels for the heart, brain, bone, skin
and organs by measuring levels.
2. Not enough long term studies on
bio-identical hormones? This was stated a few times during Oprah’s
show. First, nature gave us these hormones and when they are balanced in our
20’s and 30’s we are most protected. Second, the FDA has over 20 bio-identical
hormone products approved and on the market such as Climara® patch, Vivelle® dot, Evamist® spray, and Prometrium® capsules (progesterone). Each one of these products
has been studied extensively, enough to get FDA approval. There is a very good reason why
pharmaceutical companies are currently busy developing new “bio-identical”
hormone products at an increasing pace. They can not patent the hormone, since
it is a natural product, however they patent the delivery systems ( i.e patch, dot, spray, gel). We should ask
ourselves why they are not patenting the “other” hormone products.
3. The compounding pharmacy. There is no need to be on one extreme end with the
position that there is no role for
compounding or on the other extreme end where there is no role for the pharmaceutical. At times one needs a 25 mg dose of
progesterone, which is only available at the compounding pharmacy. At times one
needs 100 mg of progesterone, which is available at CVS® and Walgreens®. At times
one needs Estradiol at .05 mcg available as Climara patch at CVS and Walgreens. At times one needs a lower dose available
compounded. I use both, depending on what suits the patient best.
When
choosing a compounding pharmacy check
credentials, certifications,
quality checks, sterility processes and membership in PCCA and other national
organizations that assess their quality standards and adherence to the principles
of compounding medicine.
In conclusion:
With the knowledge that we will live
longer than those before us, comes the quest to live better than
those before us. Will we be in a wheel chair with scarce
recollection of our past? Or will we be walking, talking,
energetic and happy?
To learn more about Dr. Pati’s upcoming workshop entitled, Putting It All Together: The Nuts and Bolts of Hormone Restoration in Men and Women, visit http://www.anti-agingevents.com/orlando.
About Dr. Pati:
Dr. Pati is a Georgetown University trained physician
who practiced traditional and holistic medicine for fifteen years in the
Washington D.C. area. She has practiced extensively in the U.S. and
internationally including serving as Medical director for a 350-employee non-profit
organization. Dr. Pati is multi-lingual and is renowned in her field having
authored numerous scientific articles and addressed audiences both nationally
and internationally. She is recognized by physicians internationally as a
foremost authority in the field of Hormone Replacement Therapy. Dr. Pati holds
board certifications from the American Board of Ob/Gyn and the American Board
of Anti-Aging and Bioregenerative Medicine. She is currently Medical Director
for SaJune Medical Center in Orlando, Florida, which specializes in restoring
optimal function through hormones, nutrients, detoxification and mind/body
balance.
