Episode Transcript
[00:00:02] Speaker A: Welcome my outside the box thinkers to.
[00:00:04] Speaker B: The Anti Aging Unraveled podcast where I.
[00:00:07] Speaker A: Am your host, Dr. Lori Gerber. In this podcast we will explore the fascinating world of personalized anti aging medicine that considers the whole person inside and out and how all systems are interconnected to each other. In today's world of modern medicine, we often find ourselves like just another number in a system that prioritizes quick fixes over sustainable and more natural solutions.
Well, let's get ready for a paradigm shift in health and beauty. We look far beyond treating symptoms and aim to get to the root cause of our health and cosmetic issues. This podcast is your go to source for all things natural, outside the box and innovative in integrative medicine and cosmetic dermatology. So sit back, relax and get ready to dive deep into the world of functional medicine and aesthetics with me, Dr. Lori Gerber.
Let's take a trip down the real skin revolution pathway together.
[00:01:05] Speaker B: Hi guys. I am so excited to be back. This is a topic today on Anti Aging Unraveled that I love talking about. I'm really excited to talk about. And it's about time that I'm finally able to do a podcast and announce some good news on this topic.
So thank you for joining me. I hope that all of you guys share this podcast with anyone that you know that might be suffering the way that a lot of women are. And this is basically a podcast on estrogen and basically the Hormone Health Reborn, Debunking the WHI study and understanding the new Estrogen safety update. And I want to explain the WHI study, get into details about it, why it was wrong, what were the defects in it, the problems, the flaws, and why the FDA decided to remove the black box warning finally off of estrogen. That got a bad rap for a lot of years and in all honesty, a lot of women suffered because of it. So I'm really excited to bring this information to you and I hope that like I said, you guys share this with your friends, your family, anybody that you know that might be suffering because really the proof has been out there for a long time. I actually have another podcast on this topic that was very similar to this, going through the flaws of the WHI study, but I didn't have the positive news about the FDA actually removing the black box warning off of estrogen. So let's, let's start with saying that the WHI study did not study menopause. It studied older women using wrong hormones, delivered in the wrong way, over generalized the results to all women.
And today's bioidentical hormones are entirely different. They're physiologically safer and have been better studied than the synth synthetic hormones that were studied and used in 2002. So, so let's kind of dive right into what is different and where the flaws really lied in the Women's Health initiative study of 2002 and it really created a widespread fear. I mean most doctors that I knew almost instantaneously stopped prescribing estrogen to all of their patients, which if any of you out there are listening, you know what happens when you stop estrogen suddenly it becomes basically horrible. Experience hot flashes, you know, weight gain, dryness, you basically like shrivel up and your bones get brittle and, and you feel horrible. Everything hurts. It's a great anti inflammatory at its base. So but the study in general, really a layperson could have read this study and understood that it was poorly designed, misinterpreted and really was never applicable to the patient population that were actually receiving menopausal care then or today.
So I'm going to go through the biggest flaws. First, let's start with what was not a menopause study.
So the average age of participants, guys, and this is kind of interesting, was 63 years old.
So most of them or many of them were even 10 to 15 years past menopause already. So very late for treatment start. Right? So in that case, one, they already have pre existing conditions.
Two, we know they already have arterial plaque metabolic syndrome, higher baseline cardiovascular risk factors. So this study didn't reflect women seeking hormones at the onset or in the middle of menopause, which is usually ages anywhere. I don't know, they say 45 to 55, I'm going to say anywhere from probably early 40s to late 50s.
And this is all people past that point, all women past that point.
Two, another major point, they were not symptomatic. These are not people that again were coming asking for help. Meaning maybe they didn't have an estrogen to progesterone ratio that was off. Of course they didn't because their estrogen was already gone at 63. So they weren't having hot flashes, they weren't having sleep disruption, they were not having cognitive decline. And if they were, that wasn't the purpose of their, of this study. Right. It was really just to see what happened when you gave them the hormones.
And they were not having active menopausal symptoms. They were testing older women with no symptoms, not looking for women or women looking for symptomatic relief or prevention.
All right, three, the hormones they used were totally different than the hormones we use in current practice. And in all honesty, we were using these back then as well. But they were using synthetic hormones, not bioidentical hormones that mimic natural physiology. They were using Premarin, a horse derived estrogen that has multiple estrogens that are not made in the human body. Okay, so very strong estrogens and a progestin called Provera or medoxy progesterone.
And unfortunately, that's a synthetic progestin. It's not progesterone.
It actually shuts off natural progesterone production and which creates other problems which we'll talk about, but they're not bioidentical, they mimic pathophysiology. And that alone, if we took nothing else, that invalidates the relevance of the WHI study because modern bioidentical hormone replacement therapy is not the same hormones we are using physiologically, the same hormones in much lower doses, in different formulations and in a different mechanism we're delivering it.
So medroxyprogesterone acetate, which is progestin, and this is number four, guys, has known cardiovascular and breast cancer risks. We know that because it's in birth control. We know what happens when we give progestin to a female over a long period of time. It shuts off their progesterone, which we needed to do for birth control purposes. But it doesn't affect the brain the same way. It doesn't have the same anti cancer effect. So it doesn't balance out the estrogen. So we know that we get increased breast cell proliferation, increase increases in clotting risk, increases in the inside of the lining of the blood vessels, which is endothelial dysfunction and cardiovascular risk. And it blocks many of regular progesterone's proliferative or protective, sorry, protective effects because it shuts it down.
So by blocking progesterone, you're basically making estrogen take over.
When estrogen takes over, that's not a good biologic process. You need the balance of the progesterone, which stops those cells from growing, especially in the breast, ovarian, uterine and colon. So bioidentical progesterone does none of these things. It literally just supplements and gives you back some natural progesterone to go back towards what you're already producing. If you're not producing a lot, then it just gives you the beneficial protection effects. Okay, number five participants were allowed to have a high risk baseline status.
What does that mean? Well, the patient population that was picked, again, not asking for menopausal symptom help, they could have been smokers. And there were a lot of them. A lot of them had a BMI that was high and were obese. Many of them had hypertension, had subclinical or overt cardiovascular disease. They did not eliminate for these factors and had never even once been tested or evaluated for hormone deficiency prior to the start of the trial. How do you make a comparison on patients that you don't know if any of these other risk factors are contributing to cancer, which they will, and you don't know their baseline hormone status? You can assume they don't have a lot of hormones because they're 63, but maybe that's the point. We shouldn't have been checking the starting on the patients that were 63. We should have been starting it on patients that were 43, 45. So modern bioidentical hormone replacement includes risk stratification and picking the right patients, whereas the Women's Health Initiative did not that study.
So time the timing hypothesis was ignored. So this is point number six. We know now that starting estrogen early protects the arteries.
Starting it late after plaque forms may worsen the risk temporarily because it's already an unstable plaque.
So in timing of the treatment protocol, even a high risk estrogen, horse urine estrogen with synthetic progestin. Even if we take all that aside, we're starting in this, in this test way too late in this study.
So the hormones were already after the damage was done. Okay, seven, estrogen type matters.
Again, this I alluded to earlier, but when you give equine or horse urine estrogen, which has many more estrogens that are not in the human body, I want to say it's 14 more. We have three naturally occurring. I think there's 17 equine estrogen or in the Provera. It is insane to me that we thought it was okay to use Premarin on women and thought that that was the same thing as replacing estradiol RS trial. The receptors are different, the liver takes it in differently and metabolizes it differently. The whole vascular and endovascular system inflammation of the blood vessels process it differently. And it's much, much stronger at stimulating breast tissue because it has much stronger estrogens in it. So you can't generalize the effects of a horse urine derived estrogen to human estradiol or estriol. It's just they're not equivalent. All right, number eight, improper root. So they only used oral estrogen, the only type of estrogen they use they only studied oral estrogen. And we know that oral estrogen has a couple of things that are not going well for it. It increases clotting factors by itself, it raises triglycerides, it increases inflammatory pathways at higher doses and it raises CRP again, another inflammation marker. We do not see the same effect with sublingual transdermal. Yeah, sublingual or transdermal estrogens, estradiol specifically and estriol, or with oral or transdermal bioidentical progesterone. They were not tested by the Women's Health Initiative study, just oral estrogen. Okay, so oral horse conjugated estrogen, not exactly the same thing. And number nine, the results were massively misreported and overgeneralized. This is kind of the epidemic of our society right now anyway. But you know, early press releases implied hormones caused breast cancer and caused heart disease. Also the statistical significance data of the. Actually if you look at the percentage of people with breast cancer that actually got in the study, it wasn't even statistically significant data according to analysis. So not only was it not statistically significant, but the reports and the news massively misreported it and overgeneralized it.
So again, breast cancer increase was statistically insignificant. Heart disease risk increased only in older women with the pre existing disease.
Well, that doesn't, there's no, you can't prove causation at all there. And you used older women that already had it. So you can't again, you're using conjugated horse estrogen by itself an estrogen only arm later showed reduced breast cancer incidents.
Interesting. These findings were never presented to the public at the same volume as the initial fear based message, nor to physicians, mind you. So physicians really pulled it off the table for a really long time.
And number 10, interesting. Later WHI studies, follow up studies which I just alluded to contraindicated the 20 to 2002 headlines which showed later the estrogen only group, which is women without a uterus, had lower breast cancer incidents.
Younger hormone users 50 to 59 when they reanalyzed the data had significant cardiovascular protection.
Mortality was lower in hormone users aged 50 to 59 and quality of life improved significantly in symptomatic women.
None of this became the public narrative. This was never corrected until, you know, obviously in my line of work I corrected all the time, but it's very difficult to do that on a regular basis and to have that same argument with OB GYNs who unfortunately are also stuck with the confines of what the FDA say is approved. So now with this reversal of lockbox warning, I'm hoping this opens up the the world to more testing and more studies to show the benefits of progesterone, estrogen and testosterone for women specifically.
So I think that really what you guys need to understand and just a kind of brief summary overview. Equine estrogens, I.e. premarin, very strong horse estrogen, we don't have it. Why would we study that? They use medroxyprogesterone acetate or a progestin, not progesterone.
So in what we do, we use progesterone, bioidentical progesterone, which we know is GABA stimulation. It helps with anxiety and sleep, it reduces breast cancer risk in studies and it supports bone and metabolic health. That is the benefit of progesterone. We know that estrogen is an anti inflammatory and it also helps to prevent cardiovascular disease and improves bone density. So you know, just putting things in very basic terms, the hormones we use now are extremely beneficial. So let's talk about the benefits of bioidentical hormone replacement therapy in a little more detail and then I hope to show you why the FDA removed that black box warning. So breast cancer risk lower with bioidentical progesterone and balances out the cells that like to grow and differentiate in the breast tissue. And it stops it. Estrogen makes things grow. Progesterone makes it stop. We use estradiol and estriol, a very moderate to weak estrogen. We don't use any estrone, which was used in that old hormone replacement therapy with the horse urine estrogens.
So when we use those estrogens, they don't have the same stimulation effect. We also know that started early. We can improve the inside of the blood vessels, the endothelium, and make it less inflammatory and have less plaque.
We lower LDL cholesterol, increase good HDL cholesterol, prevents all our arteries from getting stiff and inelastic. And like I alluded to before, it actually reduces plaque formation in the arteries if started early enough, which was later confirmed when they relooked at the WHI studies, although I really don't like to look at that study at all anymore. But when they look back at the 50 to 59 year old users, the early users, they had lower heart disease risk.
This is a huge one. Bone density protection. Estradiol decreases the breakdown of bone. Let's say that again. Estradiol decreases breakdown of bone, so it reduces osteoporosis, guys. So we have this Whole generation of women that suffered from osteoporosis because we didn't treat them with any estrogen and we could have. It increases bone mineral density and reduces fracture. It's one of the strongest benefits of estradiol in addition to cognitive protection.
Neurotransmitter, all the brain synapses, right? Mitochondrial energy, so cellular energy, everyone's talking about that right now. And synaptic plasticity, so the ability for your brain to actually make new connections. This is all really important. Influences of estrogen and estradiol. Specifically, progesterone has the calming effect. I use a lot of progesterone in my practice, GABA stimulation. Highest percentage of those receptors are up here in the brain. So it chills it out, helps you fall asleep and helps with anxiety. Metabolism. Progesterone and estrogen both. But progesterone specifically helps with insulin sensitivity, abdominal fat distribution, our mitochondria again, and how we maintain muscle mass. It's huge. A really big one, I think goes unsung is the sexual and genital genitourinary health. When you lose estrogen, the lining of the uterus and the vagina and the skin all thin out. Without a little bit of estradiol, vaginal lubrication ceases to be and the PH of the tissues changes as well. So sex is a chore. UTIs and yeast infections are more recurrent. A little bit of vaginal estrogen or regular estradiol goes a long way towards that lubrication and having a good normal ph and it reduces pain in general with sex and actually in joints and improves pelvic blood flow. So progesterone is calming, but it also supports libido, so. And so does testosterone. So we need these in balance to have a normal sexual intercourse experience. Right. And when the bacteria are constantly there, it makes for chronic illness as well. So we don't want that either. And then let's take on the skin, hair and nail benefits, which you guys know I love to talk about at my practice.
But collagen regeneration with estradiol, where a lot of us are using estriol creams on the skin, estradiol creams on the skin, we can use it as a lozengeur as well. Really low dose or a cream just systemically. But it improves the skin elasticity and thickness. It's one of the most noticeable benefits that women have just from estradiol treatment. And it actually happens relatively quickly. So in light of all of this, the FDA decided finally, in their infinite wisdom, to remove the black Box warning off of estradiol. It is a historic shift in my world and in my practice, but honestly, for the world of women and in medicine because of this flawed data.
So I think it's a major opportunity for me to get out there and educate you guys, and that's why I'm doing this podcast. But to be honest, I mean, I think it finally might give some validation to the fact that that there really is medicine out there that might not be, quote, unquote, FDA approved or mainstream, but it works.
And just because it's not, it's whatever has a black box warning on it, or it's not FDA approved or maybe it's not mainstream, like a lot of the things that I do, doesn't mean it doesn't work.
And the historic shift finally acknowledges that the Women's Health Initiative study was flawed, that the mass media basically blew this out of proportion and created a huge disservice to women and the public, which happens a lot in our industry. So we tend to believe what comes across the news instead of really doing our own research and reading the study for ourselves. Because I will tell you, if anyone read this study on their own, even if they were not in science or in medicine, they would have asked very similar questions because it really, it was pretty straightforward, that this study was extremely flawed. I think even high school students that study the scientific method would have understood that this really wasn't a scientifically sound study. And the data never supported the panic and the hysteria that was created. Modern hormone therapy is totally different.
So it's not even apples to apples, even if we took that to be gospel. Progesterone is not medroxyprogestin or it's not synthetic. Progestin, estradiol and estriol are not equivalent to the oral strong horse urine, estrogen, other estrogens that were being used. We actually used to use estrone as well. None of that is being used anymore. And it's much more targeted in physiologic. We're using lower doses. We're giving it in formulations that are easily absorbed, maybe not as toxic on the liver as well, through the skin, under the tongue, and just a much more physiologic replacement. And bioidentical. Estradiol and progesterone are not the same drugs, period.
So this is, to me, a major opportunity for you guys to look at your own body, how you're feeling. Are you having night sweats, are you having hot flashes, are you having libido issues, anxiety and depression, and Mood swings and brain fog are probably the biggest stress symptoms I get asked to help every day. And libido, you do not have to live with those things. Yes, they are a normal part of aging, but you don't have to live with those things. Because really, part of what I do is creating a longevity and lifeevity so that you can age and live the way you want to live. And if you don't want to worry about sexual intercourse and how it feels and have it feel good and have it be enjoyable, or you don't want to have to chase UTIs and recurrent yeast infections, or you don't want to. You want to be able to train and lift and be lean and look the way you used to, I think that even the vanity parts of it make sense because the safety does support that it is. Okay. The safety data that we have and the efficacy data that we have on bioidentical hormones show that it's great for cosmetics, it's great for your overall health. Decreases inflammation, increases bone density, helps with mood, helps with sleep. All of those things are going to help your brain and your neurotransmitters as well and cardiovascularly and your lipid profile. So if we keep going down the line of metabolism and how all the different body systems interact, having these three hormones in balance makes a huge difference to the rest of the body. Obviously, we want to work on the rest of the body as well, but to me, they don't work in isolation. We have to kind of do the hormones with everything else.
But you shouldn't be done a disservice where you're told you cannot do estrogen. And to be honest, even patients that have had breast cancer, ovarian and uterine cancers, I challenge you, if you've been cancer free for more than five years, when's the last time someone looked at an estrogen level on you before they told you you couldn't have had, couldn't be replaced with estradiol or estriol, or when's the last time they checked your labs at all for any kind of hormones?
Because what we know is that the hormones that were given previously and the bioidentical hormones that are given now do not have the same carcinogenic stimulation effect.
So I encourage you just to look clinic critically at any news that comes out for anything, medical or otherwise, because this data has been out for what, 20, 23 years it took to get them to reverse the black box warning on estradiol.
And I'm very happy to be sitting here saying that it happened. But I'm also disappointed in basically our medical system because this was something that could have been avoided if they just had maybe unbiased parties looking at this data critically and understanding that what was being given and the patient population that was chosen is not the same thing. One, that's happening now in medicine, but two, that actually isn't menopause at all. And you're looking at a completely different patient population and a completely different medical medicine. Prescriptive. So that being said, guys, I hope this cleared it up for you. It gave you some clarity, gave you some understanding, and maybe you want to get started and start treating your own body and your own hormones and leaning out, I will say that I think maybe one day peptides will be in this conversation that they'll actually say, you know, peptides, wow, we're so sorry we gave a bad stigma to peptides for so long because they really never, they don't have any data to show that they're dangerous. There's no data out there to show dangerous studies with peptides. And I think the bigger thing is that pharma wants to make money off of peptides.
And being that they're a natural ingredient, they need to find a way to do that. And in order to do that, that means they have to pull them off the market, make them hard to get. Just like our GLP1s all of a sudden are now the biggest craze. Right? They've been around for a long time, guys. It just took time for the government or the FDA to get them to pharma so that pharma could do the testing and re release them. So again, use your brains, use your critical thinking skills and, and if anybody wants help with their own peptides or hormone balance, be sure to reach out to me and I hope that clears up the black box. Morning. And I'm going to hope this turns the tide on hormone replacement for women. And I encourage you to reach out to me if you have any questions. And stay tuned for our next podcast for Anti Aging Unraveled. I'm signing out, guys, thanks.
