Six errors underlying the conventional HRT paradigm

[Guest guest]

Yet Another Spin On The Conventional Medicine Point of ViewSix errors underlying the conventional HRT paradigm. By John R. Lee, M.D.http://www.johnleemd.net/breaking_news/hrt_paradigm.htmlParadigms are based on underlying assumptions. Paradigm shift occurs when the underlying assumptions are changed. I believe that the conventional HRT is not only wrong but also is dangerous. Following are six errors of underlying assumptions.Conventional physicians believe that the fall in estrogen levels at menopause is responsible for menopausal symptoms and the increased risks of osteoporosis, heart disease, and cancer that is experienced by postmenopausal women. The facts are that estrone falls only about 40% and estradiol falls about 60%. The majority of postmenopausal women continue to make estrogen from conversion of androstenedione into estrone in body fat in sufficient quantity for all known estrogen benefits short of pregnancy. The problem of apparent estrogen deficiency is inhibition of estrogen receptors by excessive binding protein (sex hormone binding protein, SHBG). In most cases this is corrected by restoring physiological levels of progesterone. Estrogen supplementation should be reserved for those women who are truly estrogen deficient. And estrogen should never be given without progesterone.Conventional physicians believe the gold standard of steroid hormone testing is the so-called "blood" test using serum or plasma. The fact is that serum or plasma tests are irrelevant since they measure both protein-bound (non-bioavailable) hormone and "free" (non-protein bound bioavailable) hormone rather than the total "free" hormone (Reference: Cummings, et al. NEJM 10 Sept 1998). Most of the "free" hormone is carried by red blood cells, not the serum or plasma. The "free’ hormone is, however, readily soluble in saliva; it filters directly through the saliva gland into saliva regardless of whether it is in serum or in red blood cells. Only the saliva test directly measures free, bioavailable hormone.Conventional physicians regard any particular hormone level to be "normal" when it fits within the bounds of some presumed "normal" range. The fact is that the ratio of estradiol to progesterone is far more important than any given absolute value of either one. It is therefore important to measure both hormones to determine the ratio between them. A healthy ratio of progesterone to estradiol in saliva concentrations is 200-300 to 1. The goal is to maintain that ratio. Since conventional physicians rarely measure saliva levels of both estradiol and progesterone, they rarely are aware that progesterone supplementation is needed.Conventional physicians erroneously believe that various illnesses such as osteoporosis, heart disease, and loss of libido are due to estrogen deficiency simply because they tend to occur in postmenopausal women. The fact is that progesterone deficiency plays a larger role in these illnesses than estrogen. Osteoporosis, for instance, often starts at age 35 when estrogen levels are high, but progesterone levels have fallen. Even after menopause, most women are estrogen dominant because they still make estrogen and their progesterone has fallen to near zero. Without properly measuring both hormones, this factor remains hidden and unknown.Conventional physicians erroneously believe that estrogen levels decline during the pre-menopausal years. This is not true. During the premenopausal years, estrogen levels fluctuate more but do not decline. It is an error to give estrogen to women who are still menstruating. Progesterone levels often do decline 10 years or so before menopause. We now know, for example, that hormone dependent cancer is more likely to be related to estrogen dominance (progesterone deficiency) than to estrogen deficiency. This is the likely reason why breast cancer, which takes 8-10 years to become apparent, is diagnosed so commonly at about age 48-50. If any sex hormone is given to menstruating women for symptoms of hot flushes, bloating, or lack of libido, it should be progesterone.Conventional physicians erroneously believe that synthetic progestins are an adequate substitute for progesterone. The fact is that progesterone is a unique hormone with a full spectrum of benefits throughout the body and provides protection against all undesirable estrogen side effects, whereas none of the synthetic progestins do. Provera, for instance, increases the risk of coronary artery spasm whereas progesterone prevents it. Synthetic progestins occupy progesterone receptors (and often androgen receptors, also). Thus they convey different messages than progesterone and actually block progesterone from its receptors.The common theme through all of these examples is that conventional medicine has greatly ignored progesterone and focused solely on estrogen in arriving at their HRT paradigm. The new paradigm must include the important roles of progesterone.TOPJohn R. Lee, M.D.info