Natural Hormones: Why are doctors clueless?

If you've never been exposed to this seemingly simple issue of how to maintain the hormonal balance and health, you are probably wondering why the controversy? In this day and age--with all the technologies to measure even the tiniest trace amount of hormones anywhere in the body, and drugs to block any hormone almost at will, plus manufacturing capabilities to produce hormones of any shape or form whether they exist in nature or not--you might think that all the experts would agree on the basic facts. But with billions of dollars for drug companies at stake, the quality of life (if not life and death) of billions of women and men get caught up in confusion.
When I was told "You should be using natural progesterone." by a nutritional supplement dealer, my response was "But, I don't have uterus and my doctor told me…". Before I could finish my sentence, she told me "You need to read this." and pulled out a printout of some summary information on the subject. I took it home, and as I started to read it, I realized what I was reading, if true, was a major medical blunder in modern medicine. You might even say it has a smell of conspiracy that makes "the Vast Right-Wing Conspiracy" on Bill and Hilary Clinton pale in comparison (see what PremproCounsel Legal Team has uncovered). That was 1998, many years before the Women's Health Initiative (WHI) clinical trial was terminated with shocking results in 2002.
In case you are not familiar, the clinical trial found that women treated with combined Premarin (estrogen from horse urine) and Provera (a fake progesterone) therapy experienced higher rates of breast cancer, stroke, heart attack, pulmonary embolism, and blood clots. (In 2003, Premarin-only arm of the same study was also stopped early with increased risks of stroke and dementia. Another study done by National Cancer Institute (NCI) found that long-term estrogen-only use significantly increased the risk of ovarian cancer.)
Actually it wasn't shocking to those in the know, including the drug companies. Most of those side effects have been known and listed on the warning labels, albeit not adequate. So, after spending millions of dollars of tax-payer's money and exposing tens of thousands of women to the hazardous substances, there was an eerie silence instead of a swift action to ban the dangerous fake hormones along with the so called "standard HRT". Then the damage control began. They went back and "reanalyzed" the WHI clinical trial data and stepped up their campaign to tell doctors that it's OK to continue the "standard HRT". Their claim was that if you just look at the younger, healthier subjects, they were OK, and besides, there is nothing better anyway. Of course women aren't buying it (neither the French[1], nor the Brazilians), but it's what the US doctors are told in their medical journals, in their professional society's position statement[2], and fellow physician speakers, most of whom are paid by drug companies.


It all began when it became clear that real (natural bio-identical) hormones are not easily absorbed when taken orally because most of it gets "digested" (converted or metabolized to some other forms of hormones), and the drug companies opted to tinker with the hormones to make indigestible fake hormones rather than figuring out effective delivery methods of the real hormones. For one thing, there is more money in selling patentable artificial (fake) substances than in selling naturally occurring substances that are not patentable.
Of course, there are always ingenious people who see a need and figure out a way. If you need to avoid digestion, you use other routes--such as skin. Skin can absorb lots of things. Luckily, progesterone has been one of the safe hormones available without prescription in the US. So, progesterone skin cream and oil became available as over the counter supplements. It did not require any large scale studies to convince the consumers. All you need to do is to try it out yourself to see it work for you. It is inexpensive, easy to use, and safe. By the time late Dr. John R. Lee published his first book of the "What Your Doctor may Not Tell You About …." series in 1996, there were more than 30 companies manufacturing and selling progesterone cream he found suitable for supplementation.
Then, there surfaced a group of people--a propaganda machine, if you will--who started to publish articles in medical journals to discredit everything related to natural bio-identical hormones, especially the progesterone cream available over the counter or from compounding pharmacies[3][4][5]. First they thought they were on firm ground when progesterone cream failed to raise plasma progesterone level to a luteal (after ovulation) level and failed to induce bleeding with cyclic regimen. They were confident that was pretty good evidence to convince doctors that progesterone cream was no good. Then they found out that the world of menopause hormone therapy had shifted to continuous regimen and that low level progesterone had been demonstrated to be enough to protect uterine lining from hyper proliferating (the cause of uterine cancer) without inducing monthly bleeding (D L Moyer et al. 1993[6]).
They also found out that saliva or capillary blood hormone test will show a strong evidence of absorption. But, they were not deterred. They are still pushing the propaganda by discrediting saliva test itself by saying that saliva hormone levels do not correlate with plasma hormone levels[7]. No logic or data is presented in support. It is just an inconvenient fact that they want to ignore.
First, saliva test was used simply to show that a plenty of progesterone gets absorbed[8]. The timeline and the amount of hormones that show up in saliva after application is a separate issue. Besides, since when did the plasma hormone test become a reliable indicator of progesterone action in women's body? There are plenty of evidences to prove it is not (Trévoux, et al. 1986[9], Sojo-Aranda et al. 1988[10], Friedler et al. 1999[11], Tavaniotou et al. 2000[12], C Ficicioglu et al. 2004[13]). Yet they argue the lack of correlation with the plasma progesterone level discredit the saliva test (I can argue the exact opposite; The lack of correlation discredits the plasma hormone tests). By making these disingenuous baseless arguments, they are discrediting themselves.
Evidently, some of them became so disparate as to make up lies[14] about late Dr.John R. Lee who dedicated his retirement years to educate the world the importance of progesterone in women's health and how safe and easy it is to maintain hormonal balance and health using over the counter natural progesterone cream, while pointing out the danger of fake hormones used in birth control pills and conventional HRT. It is not hard to imagine, that very fact --easy, safe, inexpensive, and effective-- could be the exact reason why some in the drug industry and medical establishment try so hard to discredit its use. Over the counter natural progesterone cream can be a serious competition that can affect their bottom lines.
Transdermal application of steroid-sex hormones are not limited to natural progesterone cream and all steroid-sex hormones are of similar size and structure. Transdermal applications such as Cortisone cream, estrogen and testosterone (both fake and real) in patch/cream/gel/oil/spray form, fake progesterone/estrogen patch for contraceptives, vaginal rings/gel/cream containing natural progesterone and estradiol have been FDA approved, and known well absorbed. So if they want to claim natural progesterone in cream form some how can not be absorbed and ineffective, they need to demonstrate the biological mechanism of why natural progesterone alone behaves differently. Anything short of that should be rejected.
When they realized there is no scientific basis to argue that progesterone cream cannot be absorbed, instead of calling to ban the fake hormones that have been proven dangerous, they started to argue there is no evidence that natural bio-identical hormones are safer than fake hormones that have been proven dangerous, and until some large scale experiments are conducted, you need to assume they are equally dangerous[15] and need to control them the same way (meaning no over the counter products should be allowed). They are trying to convince doctors as well as FDA that access to nature hormones should be restricted. FDA's move to restrict doctors' access to natural hormones through compounding pharmacy was defeated thanks to those who staid vigilant[16] [17].
Let's get it straight. We already have decades worth of research data on natural hormones. After all, they are exact bio-identical substances to what our body makes. That means every research that looked at endogenous hormone status of women from menarche to menopause and beyond is part of natural hormone research. It is disingenuous to pretend those research have no bearing on natural hormone supplementation.
The North American Menopause Society 2008 Position Statement[18] speaks louder than anything else about who is controlling the information with whose interest in mind by their failure to differentiate the proven dangerous fake progesterone (progestins such as medroxyprogesterone acetate used in Provera and Prempro, norethindrone acetate, etc.) from natural progesterone (in 2004 Position Statement, they did not even bother to mention natural progesterone). Their bias becomes even clearer when you put it next to the 2004 position statement of Brazilian Society of Endocrinology and Metabolism that concluded "Whenever possible, one should use 17-beta estradiol, associated to natural progesterone" (both 17-beta estradiol and natural progesterone are the main hormones produced in ovaries).
The fact is the train has already left the station while doctors are all confused, misinformed, and disoriented by those disingenuous propaganda articles in the aftermath of the Prem-Pro WHI clinical trial fiasco. Millions of people have been using over the counter progesterone cream all over the world. If you are given a choice between a drug that is proven dangerous and a hormone your body used to make and thrived on, is there any doubt about which you chose? Unlike the fake hormone Prempro that some doctors are still routinely prescribing despite the fact it's been proven dangerous and notorious for its compliance problem (it makes you feel miserable and many will stop using it), the over the counter natural progesterone cream has many satisfied customers who continue to use it. By keeping doctors ignorant and misinformed, the medical community will further lose credibility they have already lost by the Prem-Pro clinical trial fiasco.

[1] Fournier, Franco Berrino, Françoise Clavel-Chapelon. Unequal risks for breast cancer associated with different hormone replacement therapies: results from the E3N cohort study. Breast Cancer Res Treat. 2007 Feb 27
This study compared different progestogens (natural progesterone and fake ones) in combination with transdermal estradiol) in long term post menopause hormone replacement therapy. Natural progesterone was the clear winner. Estrogen only (either oral Premarin or transdermal estradiol) turned our not safe against breast cancer either.

[2] Menopause. 2008 Jun 20; Estrogen and progestogen use in postmenopausal women: July 2008 position statement of The North American Menopause Society.
They are making all sorts of excuses to encourage doctors to continue using HRT regimens the WHI studies proved dangerous. At the same time they discourage the use of other alternatives, especially natural bio identical hormonesclaiming you need to assume they are just as dangerous as the fake ones.
[3] J Gen Intern Med. 2007 Jul ;22 (7):1030-1034 Bioidentical Hormones for Menopausal Hormone Therapy: Variation on a Theme. Adriane Fugh-Berman, Jenna Bythrow
A propaganda article to scare doctors away from natural bio-identical hormones. In one breath they say fake hormones are OK to use although they are proven dangerous. In another breath they attack natural hormones because the studies that proved its safety and efficacy is not perfect. Basically they are disregarding any and all evidences that does not agree with their desire to continue the status quo of using dangerous fake hormones.

[4] J Obstet Gynaecol. 2007 Oct ;27 (7):655-9 Transdermal natural progesterone cream for postmenopausal women: Inconsistent data and complex pharmacokinetics. M A A Elshafie, A A A Ewies
Another one of those propaganda articles to scare doctors away from natural progesterone cream. Which do you choose? Drugs proven dangerous or over the counter supplement products that have been used by millions of satisfied customers and plenty of studies to prove it is safe and effective? They are counting on doctors ignorance about hormone tests other than those using venous blood. They are telling the doctors it's too complex for them to understand and does not bother to explain. Or, they don't have any explanation?
[5]Med J Aust. 2005 Mar 7;182:237-239 Transdermal progesterone creams for postmenopausal women: more hype than hope? Barry Wren
Another one of those propaganda articles. He runs progesterone cream studies that fail to show positive results and claims that his failure to show positive result can discredit studies showing positive results. In the world of science, you cannot prove something does not exists. One demonstration of positive result is enough to prove it exist. When he found saliva test can detect progesterone at high level, he simply pushed it aside by saying "The level of progesterone detected in saliva was up to several hundred times greater than that measured in blood. This suggests that progesterone is probably concentrated and excreted by the salivary glands instead of filtering passively down a diffusion gradient from red blood cells to saliva." Here, he feels no need to dig deep into the underlining biological mechanism to solve the puzzles. He simply discredit the saliva test by disingenuous argument and baseless speculation, clinging on to his earlier argument that "slight/no increase in plasma progesterone" is proof enough that progesterone cream does not work.
The disingenuous nature of his arguments gets totally exposed when he makes up lies about late Dr. John Lee designed to give impression that everything he said about progesterone cream was to promote the progesterone cream he developed and sold. A total lie. Dr. Lee did not develop nor sell progesterone cream.
[6] D L Moyer, B de Lignieres, P Driguez, J P Pez. Prevention of endometrial hyperplasia by progesterone during long-term estradiol replacement: influence of bleeding pattern and secretory changes.
Fertil Steril 1993 May ;59 (5):992-7
[7] John G Lewis. Steroid Analysis in Saliva: An overview. Clin Biochem Rev. 2006 Aug ;27 (3):139-46
Another one of those propaganda articles. He discredit saliva test by noting a lack of correlation between blood and saliva progesterone levels. He obviously believes that venous blood hormone level is the true indicator of how much hormone is available to various tissues in the body. This is another area doctors are not adequately trained and he thinks he can get away with his disingenuous baseless speculation.
[8] O'leary P.; Feddema P.; Chan K.; Taranto M.; Smith M.; Evans S. Salivary, but not serum or urinary levels of progesterone are elevated after topical application of progesterone cream to pre-and postmenopausal women. Clinical Endocrinology, Volume 53, Number 5, November 2000 , pp. 615-620(6)
[9] R Trévoux, J De Brux, M Castanier, K Nahoul, J P Soule, R Scholler. Endometrium and plasma hormone profile in the peri-menopause and post-menopause. Maturitas. 1986 Dec ;8 (4):309-26
[10] I Sojo-Aranda, R Alonso-Uriarte, M González-Diddi, V Cortés-Gallegos. The biological expression of natural progesterone. J Steroid Biochem. 1988 Aug ;31 (2):219-22
[13] C Ficicioglu, B Gurbuz, S Tasdemir, S Yalti, H Canova. High local endometrial effect of vaginal progesterone gel. Gynecol Endocrinol. 2004 May ;18 (5):240-3
[14] Barry Wren Transdermal progesterone creams for postmenopausal women: more hype than hope? Med J Aust. 2005 Mar 7;182:237-239
[15] Adriane Fugh-Berman and Jenna Bythrow, Bioidentical Hormones for Menopausal Hormone Therapy: Variation on a Theme. JGIM 2007
[18] Menopause. 2008 Jun 20; Estrogen and progestogen use in postmenopausal women: July 2008 position statement of The North American Menopause Society.

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Before you post your HRT questions, please try what I think safe and effective for at least 3 months: estradiol 0.025~0.050mg/day patch, with 20~40mg/day progesterone cream (about 1000mg progesterone in 2oz cream). You can also add DHEA 5~10mg /day.
That is the only recommendation you will get from me.