How to Avoid a Hormone Replacement Disaster
Following what most people do will lead to the results most people get. Don't stay ignorant. Look "Beyond the Chart" with Dr. Bradley Campbell
Hormones can kill you, and they can save your life, too. It’s classic modern medicine: can’t live it, can’t live without it.
In truth, the answer is not simple, although most influencers, bloggers, doctors, and educators want to simplify things down these days. Our brains are designed to categorize, by default. We put people into political boxes, job boxes, financial boxes, etc. etc.
Whatever your knowledge/beliefs currently are about menopause and perimenopause and HRT, just know that the chart below is super validating when you see the extreme shifts in hormone levels around the transition.
I truly wish bio-identical hormone replacement therapy could be simplified into a binary system of either cancer-causing trickery or nurturing support. It would make things a whole lot easier.
My natural healing degrees lead me to prefer the philosophy that our bodies are innately intelligent, doing the best they can, with what they have been given, and that nothing synthetic or extraneous is necessary when we live in harmony with nature. This is true, but there is a lot more to how the body works. The body also does make mistakes, and does need intervention, especially considering how much our current society often poisons us. Our society basically lives in direct opposition to how we have lived for millennia, doing the exact opposite of living in harmony with nature.
One of my old friends used to say, in therapy, relationships, conversations, and most truths, the best, most healing phrase you can often use for your nervous system and interpersonal relationships is….
“Yes, and…”
This is critical. Many people will read part of this paid article, or just the first half of the free info, and move on. I do warn you though, that doing so could be deadly. Not just in this article, but in life in general. Cursory glances are not healing for our nervous system, as complexity, humility, curiosity, slowness, patience, pausing, and deep reflection are what actually heal.
Sort of like how we often listen to respond, rather than absorb the information, digest it, then ponder how to reply, we often read articles/posts and click “like” or “dislike” based and comment before even reading the entire article/post. This has ruined our cognitive complexity that makes us human. It is literally destroying our humanity.
The solution is to absorb what you read/see/hear, let it stew a little, and then take a pause to think about IF and HOW and WHAT and WHY to respond. Often, the most healing phrase is saying “Yes, and…”
For example, if someone posts something that is pro-Bill Clinton, you could say, “Yes, he did do those great things, and also, he did this other things.” This will often de-escalate conflict in seconds.
Most of social media and technology and news these days just has clickbait headlines that label HRT (hormone replacement therapy) as a miraculous life saving cure-all, (but of course!, now buy my specific branded test/lotion/potion/pill) OR, they find research showing elevated cancer risk; cue all the skeptics who then think, “Oh my god, I knew it!”.
The truth is that BHRT (bio-identical hormone replacement therapy) and regular HRT can save lives, and also end them. The body is innately intelligent, but we also have a sick society that is in desperate need of help. I am so grateful that there are many forms of help available, and HRT is just one form of that. (I will generally call BHRT and HRT just HRT for the rest of this article to simplify things)
This is what we call bio-individuality. It’s why your crazy uncle can pound a 30 pack case of Coors Light beer and seem normal, whereas you or I would probably end up in the Emergency Room.
Bio-individuality is why two identical twins, age 55, post-menopausal, with identical hormone lab test readings could take the exact same dose, form, and timing of HRT and end up with drastically different responses. There are an infinite number of reasons why bio-individuality occurs, but a few reasons could include:
Diet
Past trauma
Sexual History
Surgical History
Allergies/Sensitivities
Conscious/subconscious beliefs
Placebo/Nocebo
Other medications/supplements
Lifestyle
Wealth
Air quality
Other Environmental health factors
Spirituality/Religious convictions or lack thereof
Genetic variance
Toxic burden
Personal preference (example: some hate swallowing pills, others love it)
Only God Knows All the Variables
Some key takeaways that must not be missed:
Bio-identical HRT (BHRT) is not necessarily better than HRT. Inactive ingredients do matter, a little. The real key is in the dose and form, and the route it enters the body matters and which way is best can vary a lot person to person. BHRT is likely better than HRT, but even as a natural practitioner, sometimes you clinically have to say that practicality matters, and if someone is on regular HRT and all their labs come back normal and they feel amazing, the cost and expense of switching doctors and going to BHRT is rarely worth it for most of those people.
Goldilocks and Princess and the Pea are two useful stories to consider with HRT. Goldilocks is important because too low and too high of hormone levels can make people literally insane. Depression, anxiety, suicidal ideation, schizophrenia, hallucinations, insomnia, nightmares, the list goes on and on. Often, balancing someone’s hormones means using ideal functional lab ranges, not the mainstream lab ranges, and then tweaking them higher or lower depending on how that unique person feels/does at different levels.
Princess and the Pea: Many of my patients are healthier than normal, and therefore more aware of their bodies and reactivities than most people. Some like the princess in that fairy tale, can be aware of the most minuscule shifts in dosage, timing, form (oral, topical, injected, liquid, capsule, tablet), etc in their hormone regimen. Often it takes some experimentation and back-and-forth between a practitioner and a patient to find the ideal hormone stack that works for them, individually.
Cancer can be caused by taking HRT. BUT too low of hormone levels can also cause cancer. The summary is that overall, HRT when administered appropriately in women reduces risk of cancer more than it causes cancer, based on the current best research that exists. See this article that changed my mind for the research. Many practitioners disagree on whether people with a history of ANY cancer and/or hormone-receptor-positive cancers should take HRT. Most doctors agree that if someone has had a hormone-receptor-positive cancer history, that generally avoiding HRT is a wiser option, though of course, exceptions exist. In all truth, there are usually DOZENS of other factors (See list above of bio-individuality factors) that are more root causes of cancer. For example: estrogen is not the devil, even when people have estrogen-reactive cancers. I’ll discuss more in a bit.
HRT and BHRT for Men is generally a worse idea than for women. Testosterone is usually injected, and better options like oral DHEA or pregnenolone, herbal therapy, and other options I’ll share below behind the paywall are much safer. Testosterone and HRT for men can be a very healing crutch when someone is totally tanked and bottomed out on their labs, but it is never ever ever a root cause fix. Testosterone in excess causes heart attacks, strokes, liver problems, increases cancer risk, and more. Most injections create excess even when labs are normalized because of testosterone level spikes after injection and a non-natural entry route. Don’t believe me? Check out this Mayo expert. Excess testosterone is extremely inflammatory and aggravating to mental and physical health (hence the rage/violence many get). Often, clinical experience is not valued enough in medicine. Doctors for whatever reason trust double-blind placebo randomized controlled trials and meta-analyses more than the human experience. Research and science is often biased $cience, funded by industry these days, not legitimately open-minded, curious data scientists looking to learn the truth. What we really need is better research blended with clinical experience and medical logic. Without good science and research, we can stray into medieval medical practices like putting leeches on eyeballs, and with too much reliance on it, we limit the results we get in medical practice. I am actually going to host a one-time-only, online testosterone workshop (for men and women) just after Thanksgiving, so stay tuned for that!
Low progesterone is one of the most common causes of poor sleep in women over 25 years old. It’s not a root cause fix, but figuring out why progesterone is low and working on that often does help sleep.
Low estrogen can make bones weaker, the brain age faster, and skin wrinklier.
Not everyone needs to take hormones to normalize their levels. Many people who have been quite healthy for decades do worse with hormones, and should never be put on them. Test your levels to know for sure!
Ignore hormone imbalances at your own peril.
Estrogen and all forms of hormone therapy for women taken before perimenopause does increase cancer risk, and the risk is worse the longer a women has been on estrogen or estrogen & progesterone. Breast cancer and other cancers do become more likely. When taken for more than 15 years, prescription hormone therapy could cause a 0.1-0.2% total risk increase in breast cancer alone, or cause 1-2 in 1,000 women to get breast cancer. One glass of wine a day is a similar risk. Two glasses of wine a day is much higher risk. A lot of naturally-minded people know that daily alcohol is poisonous, carcinogenic, and are moving away from daily alcohol, wisely so. Yet we are still somewhat slow to condemn birth control, IUDs, and other hormone prescriptions. To me, birth control, IUDs, and hormones taken before menopause, alcohol, etc. should likely be avoided, but not feared with such intensity. Fear is not healing, but awareness and mindful living are the goal.
Medical decision making is quite complex, and includes an infinite number of variables, particularly including how the patient feels and responds to different suggestions. Some may know 10 people who had horrific side effects of birth control pills, and want to stay far clear, and others may have no such knowledge and need to take it to control severe PMS causing debilitating mental and physical illness. I rarely if ever try to change someone’s mind about a supplement or prescription, though it can be done and is often worthwhile if necessary. Similarly, if someone comes in and believes that a relatively worthless vitamin has helped cure all their ills, who am I to tell them it’s a placebo and to throw their miracle cure in the trash?
So in summary, the research for cancer risk for women, shows hormone therapy when younger is harmful, but that hormone therapy if started from perimenopause to 65 years old is helpful (but only if the right hormone levels are achieved)
Beginning HRT for women after 65 years old is a terrible, no good, very bad idea. Unless you like Russian roulette of stroke and heart disease. Continuing on HRT after 65 is ok, you just do not want to start it for the first time after 65.
Most hormones are not harmful because of the hormones themselves, but because of inflammation burdening the liver. The liver gets overwhelmed by other sources of inflammation, then can not detoxify estrogen as it is supposed to, and then we get harmful forms of estrogen which is the real problem.
Remember that we don’t want to blame cortisol, estrogen, testosterone, or progesterone for the root cause of why we feel bad. It’s not like you woke up and didn’t add enough estrogen in your protein smoothie today- it is a downstream impact from other problems, and just taking hormones is not a root cause fix. Perimenopause has other root causes (see my article on this). You wouldn’t blame your phone for sending a mean text to someone, just like you wouldn’t blame estrogen for developing an estrogen-positive cancer. Estrogen is not the villain. It is just a tool, a signaling molecule, a growth factor, not the root cause of an illness.
Only certain tests can help detect these differences. I will discuss them below after the paywall. I’ll also discuss my best tips on how to decide whether hormone therapy makes sense for you as you age. I’ll also share my favorite low dose hormone products you can get yourself without a practitioner, though having a practitioner guide you is extremely wise. Using lower dose options like topicals or low dose oral options are extremely safe and helpful.
