Dear Editors of the Wellness Letter Special Report from UC Berkeley, ARE YOU KIDDING!!??

Dear Editors of the Wellness Letter Special Report from UC Berkeley,...ARE YOU KIDDING?!

I was so excited when I saw a link to the Berkeley Wellness Report about Hormone Therapy-Still An Option For Some Women, on my sponsored links for my Gmail account. University of California, Berkeley stands for advancements in medicine, thinking out of the box and demonstrating insightful thought processes. And was I ever disappointed. Whoever wrote this article appeared to base all their research on a combination of Ladies Home Journal and Newsweek. Instead of demonstrating provocative insight, the article only echoed the obsolete commentary of a Big Pharma supported program. George Washington died of epiglottis two years after his presidency, a tragedy for sure, as the only treatment used at the time was to bleed the President of his bad humors, instead of using antibiotics or airway management if required. Granted we now know this, and at the time the president’s physicians did not, so we cannot be too judgmental about their performance. But if there had been hundreds of articles published about the benefits of antibiotics, and the diagnosis of epiglottis was made properly, then I would have to say that the president’s physicians would have acted inappropriately. This is a parallel thought process to this SPECIAL REPORT by Berkeley University, as the benefits of proper bioidentical hormone therapies have been well described and I will provide a copy of an article that lists 196 articles supporting the benefits of bioidentical hormone therapy where the article states: Until there is evidence to the contrary, current evidence dictates that bioidentical hormones are the preferred method of HRT.

Now the first major error in this SPECIAL REPORT, it states that :” In 2002, it found that hormone replacement therapy(HRT, combining estrogen and progesterone) increases the risk of breast cancer and cardiovascular disease…” First the Women’s Health Initiative involved the use of neither estrogen and progesterone. Now if whoever wrote this article, made no attempt to discern between the two types , then they need to read the literature more before they write an article with the esteemed “ UC Berkeley” on it. The HRT described in that study was Conjugated Equine Estrogen ( Horse urine estrogen, estrogen from a mare’s urine that was starved and purposely dehydrated to concentrate the estrogen in the urine and led to 95 % of the foals born having birth defects, and they were immediately “discarded” so that the mare could be impregnated again) and Progestins which are synthetic progesterone, having nothing to do with the physiologic effects of progesterone and as stated in the Holtorf article: “.Bioidentical hormones have some distinctly different, potentially opposite, physiological effects compared with their synthetic counterparts, which have different chemical structures. Both physiological and clinical data have indicated that progesterone is associated with a diminished risk for breast cancer, compared with the increased risk associated with synthetic progestins. In addition the synthetic progestins cause a marked increase incidence of breast cancer and heart disease in women, which has been shown in numerous studies: In a meta-analysis of 61 studies, Lee et al found a consistently increased risk for breast cancer with synthetic HRT, with an average increase of 7.6% per year of use (95% CI: 1.070–1.082), and also found that higher doses of synthetic progestins conferred a significantly increased risk for breast cancer.75 Ewertz et al examined the risk for breast cancer for approximately 80 000 women aged 40 to 67 years from 1989 to 2002. For women older than 50 years, current use of synthetic HRT increased the risk for breast cancer by 61% (95% CI: 1.38–1.88). So the key is to stay away from synthetic progestins, and to USE natural progesterone as stated with the following notations: In 2007, Fournier et al reported an association between various forms of HRT and the incidence of breast cancer in more than 80 000 postmenopausal women who were followed for more than 8 postmenopausal years.59 Compared with women who had never used any HRT, women who used estrogen only (various preparations) had a nonsignificant
increase of 1.29 times the risk for breast cancer (P 0.73). If a synthetic progestin was used in combination with estrogen, the risk for breast cancer increased significantly to 1.69 times that for control subjects (P 0.01). However, for women who used progesterone in combination with estrogen, the increased risk for breast cancer was eliminated with a significant reduction in breast cancer risk compared with synthetic
progestin use (P 0.001).59 Bottom line, is that with progestins, or the synthetic ones, breast cancer is increased, and with the natural progesterone cancer is reduced and in fact less than patients never using any HRT. Don’t you think this may be an important point to bring out in your SPECIAL REPORT ?

The next amazingly obsolete approach is stated on page 2, where after a women has her uterus removed she only needs estrogen and not progesterone, because estrogen carries few risks. First of all I would also agree to stay away from using progestins as I have clearly outlined previously. But why not use natural progesterone which will balance the effects of estrogen reducing symptoms of estrogen dominance. Just because the uterus is removed, why does the body no longer need progesterone? Progesterone is an amazing hormone, and when you carefully read Holtorf’s article you will also agree. Natural Progesterone, not the killer progestins, reduces heart disease, coronary artery spasm, reduces LDL, reduces breast cancer and of course uterine cancer. But that is the only reason it is not recommended is because after a hysterectomy a women no longer has a uterus. She still has a heart, liver, kidneys, brain, and breast tissue, so why totally disregard this fact!? In addition natural progesterone is amazing to help a woman sleep, reduces headaches, anxiety, fatigue, fluid retention and abdominal fat distribution. So you recommend not to use it because a women no longer has a uterus? Now that is really archaic thought process, thinking that does not fit a University that is known for cutting edge ideas. In Cardiovascular medicine we have talked about the Berkeley labs and the ability to discern between particle size and the affect on cardiovascular disease, and even more important identifying Lipoprotein A which is 10 x more atherogenic than the small (really bad) LDL particle. (This took a while to catch on because the statin makers were mad that the most atherogenic of all cholesterol particles wasn’t even affected by their billion dollar drugs). But Berkeley pushed forward, because it was the right thing to do, and they were thinking way ahead of the rest of the country. By the way one of the few things that can reduce Lipoprotein A is transdermal or topical estrogens! Maybe your editorial board should look at that as well. What happened when your editors put together this worthless archaic and obsolete report about hormone therapy, when California has some of the best and the brightest minds in managing age related issues and hormone replacement therapies with bioidentical hormones? What Happened?

Your commentary on sexual desire is also so far off base. I would also strongly discourage the use of oral testosterone and estrogen (Estratest) as there has been repeated studies identifying an increase incidence of breast cancer by over 20% with those oral preparations. Now using topical
Estrogens ( biest-estriol and estradiol, never estrone), progesterone and testosterone, a marked improvement in energy, sense off well being, memory , and libido, as well as improvement in bone densities has been described. Vaginal preparations with Estriol (well described in 1994 NEJM article) not Premarin (again that horse urine stuff) has remarkable benefits when it comes to vaginal dryness, dyspareunia, urinary incontinence, and incidence of urinary tract infections.
I enjoy the same unresearched comments in the last section on the second page. You state: So-called “natural” estrogens, Estrace or Tri-Est and other hormones synthesized from soy and yams, appear to help with hot flashes,but their safety and long-term effects have never been tested. Are you kidding!! This sounds right out of the NAMS booklet, unfortunately those guys have never read past there plethora of studies only using synthetic progestins. Read Holtorf’s article closely, and also I will provide a 22 page paper I wrote about hormone therapy. There was a wonderful 24,000 women study in Europe that was over 10 years using bioidenticals with excellent long –term results and reduction in breast cancer by 24% , unfortunately it was in Europe and so none of the Gynecologic research in the states only looking at the progestins and horse urine estrogens or estradiol with the progestins is ever looked at. Please take a moment and look at the other studies and don’t base your opinions on these same old studies with cancer causing progestins, that by the way are being actively prescribed by Gynecologist all over the country despite the fact that there have been over 12 studies in the last five years that state that progestins cause breast cancer. The WHI showed that progestins increase the risk of breast cancer by 29% and the studies I cited early, stated that progestins increase breast cancer by 61 %. When are they going to listen? Hopefully a University program like yourself that stands for what is right and asks the tough questions will step forward and separate the control of our women’s care from the greedy Big Pharma who wants to now shove antidepressants, anti-anxieties and sleeping pills down women’s throats instead of balancing their hormones naturally. Your comments about the bioidentical estrogen /progesterone being “synthesized from Yams is accurate, but the process removes the side chains that make the molecule from a yam and create the IDENTICAL molecule that is present in Men and Women’s blood streams, not the synthetic abnormal progestins that can be patented to make money for big Pharma, but the natural progesterone , that is already present in our blood streams and therefore can not be patented with the associated big financial gains.
Finally your recommendation to not use any hormones to control symptoms and instead replace the hormones that we need, progesterone that results in calmness, estrogen that helps memory and fights depression, progesterone that helps women sleep, and testosterone that improves a women’s sense of well being and energy to live, with synthetic anti-depressants, synthetic sleeping pills, and synthetic anti-anxieties. ARE YOU KIDDING!? Now you want to take every women over 50 and turn her into a Stepford wife! Women don’t want anti depressants, they don’t want anti-anxieties, they don’t want sleeping pills. Of course they want to sleep, not be depressed or anxious and not irritable. They just want their hormones replaced so that these symptoms disappear! And of course the well documented reduction in heart disease, osteoporosis and cancer will become a reality. If a patient’s insulin levels are low and they are diabetic, I replace the insulin if required. I don’t put them on anti-depressants and anti-anxieties so that they live the rest of their lives in a stunned state. The same thing goes for thyroid disease. So why not restore these hormones to a more balanced state. I plead with you as a University that in my mind has always represented foresight, intelligence, and thinking out of the box, asking the questions that are difficult to ask despite all the answers being in front of you. Please step forward and re-examine your thoughts as described on the SPECIAL REPORT: Hormone Therapy-Still An Option For Some Women.


Robert G Carlson, MD, FACS