Womens Health Associates Blog

Empowering Women Through Health


Filed under: Hormones — womenshealthassociatesblog @ 9:43 pm

At menopause (around age 55) estrogen production declines by 40-60% depending on your body fat content.  However, Progesterone levels drop to zero at menopause.  Thus most menopausal women are even more estrogen dominant than perimenopausal women.  This is one of the reasons that women’s risk of breast cancer goes up with each year of life.  It does not decline after menopause.  So why do some women have sufficient estrogen levels after menopause, but have estrogen deficiency symptoms?  In order to respond to estrogen you must have adequate estrogen receptors on your cells (sort of like satellite dishes on your roof).  You do not make adequate estrogen receptors without progesterone.  Thus, many menopausal women are estrogen-dominant, but relatively estrogen-resistant.  The medical establishment, not realizing this, often treat menopausal symptoms with high doses of synthetic estrogen (such as Premarin) which override the defective receptors.  Now these women become REALLY estrogen-dominant.  While on the subject of synthetic estrogens such as Premarin, it is worth mention that the dominant estrogen in this product is Equilin (obviously of horse origin).  One dose of Equilin takes almost two weeks for your body to eliminate.  It is easy to see how daily oral administration could lead to very high tissue levels over time.                   

 There are three human estrogens:  Estradiol, Estrone, and Estriol.  Estradiol is the strongest and some of it converts into Estrone.  Estrone has a mid-range strength, but is felt by some authorities to have more cancer causing attributes than Estradiol.  Estriol is the weakest estrogen and is more water soluble than the others.  It has the least propensity for cancer stimulation and some experts feel that it decreases breast cancer risk.  It used to be thought that Estriol was produced only during pregnancy but recent studies show it is produced at high levels throughout the menstrual cycle. 

Testosterone is produced in women and men.  Men produce ten times more than women and thus it is usually called a male hormone.  Testosterone is anti-inflammatory and vital for men and women.  I do not believe that Testosterone is the cause of prostate cancer.  Prostate cancer is related to elevated systemic inflammatory change and the increased conversion of  Testosterone into Estradiol by the aromatase enzymes found in excess visceral fat (especially beer/wheat belly).  Testosterone is responsible for muscle mass, ambition, sex drive, and positive outlook, for example.  

Following childbirth some women lose some of their Testosterone production from the interstitial cells of the ovary.  Most hormonal contraception causes suppression of Testosterone.  This can lead to fatigue, depression, and decreased sex drive.  The usual explanation for these symptoms is stress and depression related to child rearing, marriage, work etc.  The most common treatment suggested is counseling or antidepressant therapy with meds that can often cause more sexual dysfunction, weight gain, and fatigue.  While stress issues are very real in our society, testosterone deficiency (and hypothyroidism) is very real and should be evaluated before blaming stress.  

In my next blog, I will discuss how I use these “Tres Amigos” to treat perimenopausal and menopausal  women who suffer from symptoms of hormonal imbalance.


THE HORMONE DIARIES-VOLUME 2-LOS TRES AMIGOS by William Trumbower, M.D. November 9, 2011

Filed under: Hormones — womenshealthassociatesblog @ 6:59 pm
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Bioidentical HRT usually involves three hormones:  Estrogens (estradiol & estriol), Progesterone, and Testosterone.   Estrogens are wonderful hormones.  They are responsible for development of feminine traits and are thus essential for sexual attraction and reproduction.   Estrogens  are necessary for brain function and involved in mood control.  The down-side to estrogens is that they are pro-inflammatory growth hormones.  Their message to the cells in your body is to “grow baby grow”!  Thus they tend to be associated with weight gain, blood clots, and cancer.  Estrogens are balanced by Progesterone.  Progesterone is an anti-inflammatory, anti-growth hormone.  So while estrogens are telling your cells to grow (especially breast cells), progesterone is telling your cells to grow up and be mature (sounds like me talking to my kids when they were teens).  Mature cells are much less likely to spin out of control and become cancerous.  Mature cells die when they are supposed to (a process called apoptosis).  Remember, cancer cells are immortal.  They are like vampires that can out live you and kill you too!  I like to think of Progesterone as the wooden stake in the heart of the vampire breast cancer cell.             

As women enter the perimenopause (around the age of 35), their Progesterone production begins to decline.  This is due to anovulatory cycles and inadequate luteal phase progesterone production causing an increase in fertility problems as women age.  Perimenopausal women become Progesterone deficient ( Estrogen dominant).  Estrogen production in the perimenopause becomes erratic with both higher and lower levels during the cycle.  These changes cause the common perimenopausal symptoms such as weight gain, fatigue, decreased sex drive, abnormal bleeding, and cyclic moods (PMS).  Estrogen dominance is also an issue in uterine fibroids and endometriosis.   Remember, Dr. Katharina Dalton, the inventor of the term PMS, recommended progesterone suppositories for the treatment of PMS.  I spent a week with Dr. Dalton inLondon in 1985 learning about her theories.  She came to Columbia and presented two talks.  One was a private talk for physicians only.  Two doctors attended; myself and a family physician no longer in private practice.  The other presentation was for the general public and was at the Ramada Inn.  Well over 500 attended and many were turned away for lack of room. 

Check back for the continuation of Volume 2 of Dr Trumbower’s Hormone Diaries where he discusses more about the “Tres Amigos” and what happens to estrogen production at menopause.



THE HORMONE DIARIES: Volume I – An Introduction by William Trumbower, M.D. August 11, 2011

Filed under: Hormones — womenshealthassociatesblog @ 6:19 pm

I am William Trumbower MD, a senior member of Women’s Health Associates.  When I found that we had a blog, I thought it would be fun and educational if I could write some of my opinions formed after 40 years of medical practice. 

There is a lot of talk about bioidentical hormone therapy.  Bioidentical hormones (BH) are hormones that are molecularly identical to the ones produced by the human body.  BH differ from synthetic hormones which have different structures than the ones made in your body.  Most hormone products made by pharmaceutical companies are at least partially synthetic so that they can be patented to increase profits.   BH have advantages over synthetics in that they fit your cell receptors perfectly, and thus cause the same effects as your own hormones. As a result, they are also much easier for your body to eliminate after their effect is completed.  Based on these characteristics, in my opinion, BH is a safer product than synthetic hormones.

An example of a synthetic product is Prempro, a combination of horse-derived estrogens, Premarin (pregnant mare’s urine) and Provera a synthetic progestin.  The Women’s Health Initiative (WHI) study in 2001 showed that Prempro increased heart attacks, strokes, blood clots and cancer. 

Examples of BH include Estradiol, Estriol, Testosterone and Progesterone.  These hormones are all made naturally by women (men also make their own bioidentical hormones—more in a later blog) and are the ones that are usually used in Bioidentical Hormone Therapy (BHT).  

There has been little hormone research in this country since the WHI study.  Most research is funded by government grants or by pharmaceutical companies.  It is possible that the drug companies do not want to test their synthetic products as the results may mirror the WHI study findings.  However, the French have done large studies on BHT.  The French Cohort study was published in Maturitas, an international medical journal.  It reported a 10year study looking at BHT (the French rarely used synthetic HT).  The results showed no increase in heart attacks, strokes, or blood clots and a slight decrease in breast cancer rates compared with the national averages.  

Not all menopausal women need hormone therapy, but many women suffer from incapacitating hot flashes, mood swings, vaginal dryness, and decreased sex drive symptoms that are not relieved by over the counter or herbal remedies.  BHT may be a reasonable option for many such women.   BHT requires a prescription and is often compounded by a pharmacy.   Routes of administration can be oral, transdermal, sublingual, injectable, or subcutaneous pellets.  The dosage level can be monitored by saliva or blood tests as well as by clinical symptoms.

Volume 2 of The Hormone Diaries will cover more about bioidentical hormones, including a brief history of how I became interested in BHT.  For those persons who want to learn more, the best starting books are those written by Dr. John Lee:  What Your Doctor May Not Tell You About Premenopause, What Your Doctor May Not Tell You About Menopause, and What Your Doctor May Not Tell You About Breast Cancer.