Rising Concern Over the Availability of Hormones

Dear patients and all friends of Optimal Wellness Medical Group,
 
I recently received this email (pictured below) from Medquest Pharmacy in Salt Lake City, and I’ve also had other physicians who utilize bio-identical hormones in their practices notify me about this very real threat to the availability of bio-identical hormones in this country. I would like to request your help in communicating your concerns about these two initiatives to your representatives in Congress (House and Senate) and to the FDA. I am convinced that it is vital for all of us who understand the importance of bio-identical hormones to make our voices heard at this time. 
 
Thank you so much.
 
Sincerely,
Steve R. Lasater MD
 
 
Links in email:
 
**Click here to follow the links in the below email.
 

Ask the Doctor: Weight Gain Post-Menopause

*Originally published in Women’s Lifestyle Magazine

 

A reader writes:

 

Dr. Lasater, may I ask your advice? I have been in menopause for about three years now, and because I was so bothered by hot flashes and night sweats, my doctor finally agreed to put me on an estradiol patch, after I had begged him to do so for over a year. I do feel better now, and my hot flashes and night sweats, while not totally gone, have become tolerable. But I keep struggling with weight gain, having put on over 15 pounds in the last three years. Also, I still feel a lot of fatigue, even though I generally get a good night’s sleep. My doctor has advised that I watch my calories and that I exercise regularly, both of which I really try to do, but it isn’t helping. What can I do? Please help!

Mary C.

 

Dear Mary,

I frequently hear this from new patients in my office, getting the impression, when voicing complaints of this sort, that they have in essence been told, “Welcome to the human race!” by friends, acquaintances, and on occasion even by their own physicians. But that is not a compassionate solution, and there are a number of steps that can be taken to help them.

Weight gain after menopause is extremely common, and has a number of possible causes. Certainly a woman whose lifestyle has changed as she ages, typically by having less physical activity and oftentimes by eating more calories than in the past, will almost certainly gain weight. It is so important to develop and maintain good habits of regular (preferably daily) exercise as well as to consistently eat healthy, both in the amounts of food as well as in the types of food that one consumes; these factors become even more important as a woman ages, both around the time of her menopause as well as in her post-menopausal years.

The type of diet with the most robust and convincing medical evidence supporting its health benefits is the Mediterranean Diet, which emphasizes whole grains, fruits and vegetables, fish rather than red meat, olive oil rather than dairy products, and, if one consumes alcohol, wine in moderation. Adherence to a Mediterranean Diet has been shown to reduce the incidence of cardiovascular disease, cancer, Alzheimer’s disease, as well as other diseases and problems. Note that the Mediterranean Diet is neither a weight-loss diet nor a diabetic-type diet per se, but it can be easily modified to achieve these ends by reducing the amount of carbohydrates, especially simple carbohydrates, that one chooses.

Another common factor that often contributes to weight gain after menopause is that a woman may be lacking in testosterone. (I discuss testosterone for women at length here.) Among the many benefits that testosterone provides is that adequate levels of testosterone in the body helps a woman maintain muscle mass and keep fat off!

(Does this get anyone’s attention?)

In combination with a healthy diet and a moderate exercise program, muscle mass can often be maintained or even increased, and belly fat in particular will often diminish.

Having adequate levels of testosterone can also help a woman feel more energy and avoid fatigue; having sufficient amounts of estradiol provided after menopause certainly is necessary in this regard, but adequate replacement of the woman’s missing testosterone can also help a lot.

One final word about a woman’s exercise plan: it’s very important to include both regular aerobic exercise, such as running, biking, swimming, rowing, etc., as well as regular resistance exercise, such as weight training or resistance bands. This does not mean that a woman needs to aggressively “pump iron” in an attempt to develop huge muscles, but that she should do some resistance training to maintain healthy muscles. This helps to reduce the risk of diabetes, of cardiovascular disease, and of osteoporosis, among others.



About the author:

Steve Lasater MD practices Bio-Identical Hormone Replacement and Age Management Medicine at Optimal Wellness Medical Group in Grand Rapids. He is committed to improving the overall health of men and women by using cutting-edge clinical principles that are both evidence-based as well as being customized for each individual. See more at http://www.OptimalWellnessMedical.com.

Ask the Doctor: Can Anything Be Done to Help a Woman with Diminished Libido?

*Originally published in Women’s Lifestyle Magazine

A reader writes:

Dr. Lasater, can you please offer some advice for a problem I have that’s quite embarrassing? I’m 50 years old and my husband and I have been happily married for 25 years. The first 23 or so of those years had been fantastic for us, as we had enjoyed a very healthy sexual relationship well into our 40’s. We were quite well-matched in this regard, with my own sexual needs and desires usually equaling – and sometimes even surpassing – his. Then, starting a couple of years ago, his libido started to decline somewhat. Although it was still considerably better than average for his age, judging by what my girlfriends have said regarding their husbands. But during these last two years, my periods have stopped, and my own libido has totally vanished, leaving me to feel like it retired to Florida without even saying goodbye! I still love my husband dearly, and he’s been quite understanding and patient with me in this area, but we both need something to be done to help me regain my sexual nature, for the sake of our marriage and for my own sense of personal well being. I asked my doctor about this recently, and she said that there is a prescription medication on the market designed to help women with this problem, but when she then explained that it could have some significant side effects, I decided not to try it. Is there anything at all that you can recommend to help me?

Gloria S.

Dear Gloria,

There is definitely something that can help in this situation. In fact, I’m sure you’ve heard of it before: it’s called TESTOSTERONE!

That’s right, the same hormone that many men are talking about, and that many are using, is also a hormone that every woman naturally has – or at least had! It’s not just a “male” hormone, although men of course have much higher levels of it than women. It’s the primary hormonal stimulus for libido – sexual desire – in both men and women.

The woman produces it in her ovaries as well as in her adrenal glands. By the time of menopause, which it sounds like you’ve just gone through, the ovaries have often been producing considerably less testosterone for several years; but this often worsens at menopause, as the ovaries also reduce their production of estrogen and progesterone. The relative lack of these latter two hormones accounts for most of the classic symptoms of menopause, including hot flushes, night sweats, vaginal dryness, moodiness, and fatigue, among others. But it’s the diminished level of testosterone in women that often contributes to this markedly diminished libido such as you’ve been suffering from, along with fatigue, mental fogginess, muscle loss, and weight gain – especially around the waist.

The medication that your doctor was referring to was probably flibanserin, which was approved in 2015 by the Food and Drug Administration for the treatment of pre-menopausal women with Hypoactive Sexual Desire Disorder (‘HSDD’), now re-named Female Sexual Interest/Arousal Disorder (‘FSIAD’). (Is it any wonder that women hesitate to admit having such a problem when it has a name like that?)

Flibanserin has also been shown to help improve sexual desire in post-menopausal women, although it is not FDA approved for those women. In addition, flibanserin can cause low blood pressure and even loss of consciousness, especially if taken with alcohol or with certain prescription medications.

A new medication for this problem has also just been approved by the FDA; it’s called bremelanotide, and is given via injection, is approved only for pre-menopausal women, and carries a significant risk of very bothersome nausea. 

There are numerous other possible causes of low sexual desire in women besides low testosterone levels, including depression, stress, fatigue, physical illness, the use of certain medications, alcohol or substance abuse, relationship issues, or any of several vaginal conditions that might lead to painful intercourse. So it’s a good idea to see your doctor to fully address the issue and to get a proper diagnosis.

Admittedly, testosterone has not been approved by the FDA for treatment of sexual desire issues in women, and research studies have not yet clearly defined an association between the blood levels of testosterone and sexual desire issues in women. There is some evidence that the blood level of testosterone is not what matters so much as the level of testosterone within the neurons in the brain. But there is clear evidence that giving testosterone to women with low sexual desire, both pre-menopausal as well as post-menopausal, can in many cases produce dramatic improvements in sexual desire, as well as helping with the woman’s energy level, memory, muscle tone, and weight control.

 

About the author:

Steve Lasater MD practices Bio-Identical Hormone Replacement and Age Management Medicine at Optimal Wellness Medical Group in Grand Rapids. He is committed to improving the overall health of men and women by using cutting-edge clinical principles that are both evidence-based as well as being customized for each individual. See more at http://www.OptimalWellnessMedical.com.

Ask the Doctor: Menopause, Hormones, and Life Choices

*Originally published in Women’s Lifestyle Magazine

 

A reader writes:

 

Dr. Lasater, may I ask your advice? One of my close friends, age 50, stopped having her monthly periods last year. She’s having awful hot flashes, night sweats, and moodiness. I’m not quite 50 yet and although I’m still having periods, they’re becoming much lighter and fairly irregular. I’m also starting to have some hot flashes myself on occasion. I’ve been reading that bio-identical hormones are the best way to treat the symptoms of menopause, but my friend says that her doctor told her that it’s safer for a woman NOT to take hormones after menopause, because they can cause major problems. What is your opinion?

Mary C.

 

Dear Mary,

You are correct – bio-identical hormones are the best way to treat the symptoms of menopause, including hot flashes, night sweats, moodiness, depression, and loss of interest in sex, among other symptoms. Just as importantly, bio-identical hormones help reduce a woman’s risk of some major health problems that become more likely after menopause, including osteoporosis, heart disease, colon cancer, diabetes, and Alzheimer’s disease!

Unfortunately, the advantages of bio-identical hormones are often misunderstood because many physicians have been misled into believing that all hormones used to treat the problems of menopause are the same – but they’re not the same!

For example, Premarin®, which contains estrogens from pregnant horses, is not the same as bio-identical estradiol, which is chemically identical to the type of estrogen that a woman’s own body has produced since puberty. Yet oftentimes a headline in a news story, or even in a medical journal article, will state something like “Study Shows Hormones Cause…” But not all hormones are the same! Imagine the confusion produced if a headline, in discussing a particular drug’s side effects, were to state “Pills Found to Cause Side Effect!” Which pills are supposed to cause this particular side effect? Does the author really mean all pills, including those used to treat high blood pressure, antibiotics used to treat infections, anti-inflammatories used for arthritis, etc.? Certainly not! That article would never be published unless it was much more specific.

But too many statements about hormones get lumped together in a headline or for a soundbite, thereby putting bio-identical hormones in with company they do not keep. When the medical literature is carefully examined, it becomes clear that the particular type of hormone in question matters greatly. For example, there is a dramatic difference between the effectiveness, as well as the safety of conjugated estrogen derived from horses (search the internet to learn how it’s collected – I just can’t say it here!) and that of bio-identical estradiol, which contains the exact same form of estrogen as the woman’s ovaries had been producing ever since she went through puberty.

In addition, there is also a huge difference in the route by which the hormone is administered. When conjugated estrogens (those derived from horses) are given by mouth, the hormone is absorbed through the small intestine and goes directly to the liver; this sudden hormone tsunami then causes the liver to respond by producing a number of inflammatory biochemical called cytokines and interleukins, which in turn produce several undesirable effects. They de-stabilize any plaque that the woman has in her coronary arteries and thus, for a time, increase her risk of having a heart attack. The cytokines and interleukins also increase the woman’s risk of developing a blood clot.

Fortunately, neither of these disastrous effects occurs when bio-identical estradiol is applied on or under the skin, rather then being taken orally. Clearly, this is a BIG DIFFERENCE – but one that is not at all apparent if the details have to be left out in order to fit the space allotted to a brief headline. Thus, in most cases, for a menopausal woman to take bio-identical hormones is truly a win-win situation: the woman feels much better, and she becomes much healthier because her risks are reduced. 

About the author:

Steve Lasater MD practices Bio-Identical Hormone Replacement and Age Management Medicine at Optimal Wellness Medical Group in Grand Rapids. He is committed to improving the overall health of men and women by using cutting-edge clinical principles that are both evidence-based as well as being customized for each individual.

5070 Cascade Road SE, Suite 210
Grand Rapids, Michigan 49546
(616) 301-7390