Ignore health scares, HRT is safe, say scientists

Hormone Replacement Therapy is safe, scientists have concluded, and one million women may have been suffering debilitating symptoms of menopause needlessly because of flawed reports linking it to cancer.An entire generation of women stopped taking HRT following studies in the early 2000s which suggested that the treatment raised the risk of heart disease and breast, ovarian and womb cancers. But new research, which followed women for a decade has found no evidence that HRT is linked to any life-threatening condition. It means that for more than a decade, a million post-menopausal women have been enduring hot flushes, night sweats, depression and increased risk of osteoporosis for no reason. Dr Lila Nachtigall, a professor of obstetrics and gynaecology at New York University, said it was a "shame" that there had been a "huge drop" in the number of women taking HRT following health scares. "We found women taking HRT over a long period of time to be in very good health," she said.

"It's now clear that women on HRT over many years can enjoy benefits. The risks of HRT have definitely been overstated. The benefits outweigh the risks."

HRT, which boosts levels of the female hormones oestrogen and progesterone, was developed in the 1940s and was first made available to women in Britain in 1965. However by the mid 1990s concern was growing about the drugs and two large studies were launched, one in the US and one in Britain.

In 2003 the British Millennium Women Study published its findings claiming that HRT raised the risk of cancer. Many doctors immediately withdrew prescriptions while the Medical Healthcare and Regulatory Agency (MHRA) issued new guidance recommending all women be given the 'lowest effective dose should be used for the shortest time.'

Within four years the number of women taking the hormones had plummeted from two million to one million. Although later studies cast doubt on the original findings, and Danish research found HRT may even lower the risk of heart disease, the numbers of women taking the drugs never recovered.

The new study by New York University school of medicine tracked 80 women using hormone replacement for 10 years and compared them with a control group who were not using the medication. The HRT group suffered no more incidences of cancer, diabetes or heart disease than the control group.

Health experts in Britain said that many doctors were still confused by the research and were frightened to recommend HRT despite the wide benefits. Many women suffering symptoms are currently prescribed anti-depressants.

Professor John Studd, consultant gynaecologist at the London PMS and Menopause Clinic, said: "The problem is that most GPs are frightened of HRT – they will have learned as medical students that it is linked to health risks, and it sticks in their minds.

"But those studies that were replicated in the textbooks were worthless – they were completely rubbish. They collected the data all wrong.

"HRT has huge benefits in terms of relief of menopausal symptoms – there is less depression and women feel better."

A separate poll released today by HRT makers Mylan revealed that 85 per cent of women who could benefit from the treatment are not taking them, one in four because of health fears.

Dr Sarah Gray, a Cornwall GP and women’s health specialist, added: "Women are currently reluctant to seek help for their daily symptoms due to confusion over the role and safety of HRT. "This means that many women may be unnecessarily experiencing symptoms that are impairing their quality of life on a daily basis. "Women need to know about the available options, their risks and benefits and be empowered to become part of the decision-making process. "In the past, many menopausal women with low moods have turned to anti-depressants or anxiety medication, when an effective alternative might be HRT."

Nick Panay, consultant gynaecologist at Queen Charlotte's & Chelsea and Chelsea & Westminster Hospitals, said: "We believe that the tide is turning. "There were certain risks shown by the WHI (Women’s Health Initiative) study, but observational studies before that and other studies since have been much more reassuring. It seems that the problem with the WHI study was that the HRT doses used were too high and many women were well beyond the average age of menopause at 51.

"We believe that the right HRT preparation, in the right woman, has low overall risks and has significant benefits.

"Too many women are being denied hormone therapy that might benefit from it. Where there are risk factors, it is about properly risk assessing women on an individual basis."Menopause should be taken seriously and women should be given the opportunity to use hormone therapy when appropriate to do so."

Nice is planning to launch the first guidelines into the treatment of the menopause in November. The new research was published at the ASRM annual meeting in Baltimore.

Menopause Symptoms

As women enter their 40s and 50s, there are a number of changes going on within their bodies. Each woman will experience a different menopause, but becoming knowledgeable about the signs, symptoms, and treatment options is the first step to ensuring that you manage your menopause — rather than it managing you. Your “survival kit” is knowledge paired with action.

Knowledge: Some symptoms that may be a part of your menopause include: Hot flashes; rapid heartbeat; irritability, mood swings, sudden bouts of crying; trouble sleeping loss of libido; crashing fatigue; incontinence; breast tenderness; depression; weight gain; hair loss (or thinning); and increased facial hair.

Knowledge:

The phases of menopause include:

• Perimenopause: This is the time leading up to menopause when your body begins producing less of hormones like estrogen and progesterone. As a result, women begin to lose their ability to become pregnant. Symptoms may begin as early as 35, but often begin between 45 and 55.
• Menopause: Your period stops and perimenopause symptoms may increase. Menopause is defined as 12 consecutive months without a period (and there are no other causes).
• Post-menopause: Most of the menopausal changes have faded. Hot flashes may seem milder or less frequent; energy and emotional levels may seem to have stabilized. Bone loss and estrogen loss are areas of concern.

Action:

• Relieve the symptoms by keeping a journal to record changes and anticipate changes. Watch for food triggers like spicy foods or heavier meals.
• Dress in layers so you can easily cool down if a hot flash attacks.
• Focus on your health and improve where you can — stop smoking, start exercising.
• Some alternative therapies, such as acupuncture, may have results for some women.
• Counseling or support groups are an option for women struggling with the changes in their bodies and the associated lifestyle changes.
• Hormone replacement therapy (HRT) can be discussed with your physician if more moderate changes in diet, exercise, and supplements do not offer the level of treatment desired.

Contact us today to get your labwork completed!

Clomiphene Citrate (Clomid) - A Testosterone Therapy Alternative for Men with Low Testosterone Levels

Whether you are a 30, 50, 80 or even 110 year old man, having low testosterone levels (hypogonadism) is neither fun nor healthy. The symptoms of low testosterone in men range from lack of energy, depressed mood, loss of vitality, muscle atrophy (sarcopenia), muscles aches, low libido, erectile dysfunction, and weight gain...to bone loss (osteopenia), osteoporosis, mild anemia, increased risk of Alzheimer's, increased risk of high-grade prostate cancer, and increased risk of death due to all causes. As you may know, low testosterone in men may be caused by problems in the testes (or gonads). This is called primary hypogonadism and can be brought on by the mumps, testicular trauma, or testicular cancer, etc., and can only be treated with testosterone replacement therapy. However, the more common causes of low testosterone/hypogonadism result from problems in the pituitary gland and/or hypothalamus in a man's brain. Low testosterone levels caused by such "brain problems" are collectively described as secondary hypogonadism or hypogonadotropic hypogonadism and may result from depression/anxiety, head trauma, iron overload, anabolic steroid overdosing, diabetes, sleep deprivation, or some medications.

Traditionally, if low testosterone is diagnosed, testosterone replacement therapy is prescribed, and it most commonly comes in the form of a cream, gel, pellet, patch, and by injection. And although these types of therapy are effective, some methods are better than others, and there are side-effects with all of them. For example, testicular shrinkage, gynecomastia (breast enlargement), low sperm count/sterility, and polycythemia (overproduction of red blood cells) are common side-effects of testosterone replacement therapy (for many sufferers, these side-effects are mostly treatable or considered "worth it" by the patient).

However, specifically due to the sterility side-effect, such testosterone treatments aren't a good option for men who want to have children. In these (usually young) hypogonadal men, clomiphene citrate (CC pill, or Clomid) and/or human chorionic gonadotropin (HCG) have been used (by specialists) for decades to increase testosterone production, increase sperm production, and increase fertility. Both these therapies effectively help signal the testes to produce testosterone and thereby increase testosterone levels (assuming of course the cause of the initial problem is not in the testes' ability to make testosterone).

In a healthy male, the pituitary gland in the brain releases luteinizing hormone (LH) into the blood stream, which signals the testes to “GO” and produce testosterone. After testosterone has been produced it naturally converts to some estrogen (yes, there’s estrogen in men too) and this estrogen acts as a “STOP” signal to the pituitary to stop making LH. It is a delicate system of checks and balances which I have simplified here for our purposes.

Clomid (clomiphene citrate, or CC pill) works by blocking estrogen at the pituitary and hypothalamus. Thus, the usual estrogen message to "STOP" production of LH is essentially silenced, and therefore the pituitary makes more LH and there is an increased "GO" signal to produce testosterone in the testes. HCG works by mimicking LH, which also increases the "GO" signal to produce more testosterone in the testes. Prescribing testosterone for a man, however, does the opposite of what clomiphene and HCG do.

With traditional testosterone replacement therapy, the brain (hypothalamus and pituitary) gets the message that there is plenty of testosterone being made in the testes, so much so that it doesn't need to make anymore. Subsequently, the pituitary stops producing LH, and the natural production of testosterone (and sperm) in the testes ceases, which is why traditional testosterone replacement results in testicular shrinkage and low sperm count...a man's testosterone and sperm manufacturing plant is essentially shut off.

Clomiphene citrate (CC pill) and/or HCG do not turn off the testosterone manufacturing plant but rather turn it back on or reboot it. While some hypogonadal men require continuous use of clomiphene, for others it can be used for a 3-6 month time period and then discontinued. And, the checks and balances system is not interrupted, so there aren't the testosterone replacement side-effects which occur due to intentional or unintentional testosterone overdosing. Most interestingly, although it used to be thought that clomiphene and/or HCG only worked on young men, in the past decade or so it has been used effectively in older men too.

The 5 Main Reasons Clomiphene Citrate (CC pill, or Clomid) May be a Good Alternative to Testosterone Replacement Therapy in Men with Low Testosterone Due to Secondary Hypogonadism:

1. Clomiphene citrate (CC pill) stimulates the body's own production of testosterone
2. Clomiphene citrate (CC pill) doesn't interfere with the body's checks and balances of testosterone
3. Clomiphene citrate (CC pill) comes as a pill easily administered by mouth
4. Clomiphene citrate (CC pill) is generic and very cheap2
5. Clomiphene citrate (CC pill) has little side-effects and low risk of developing these side-effects

The 5 Main Reasons Clomiphene Citrate (CC pill, or Clomid) is Not Usually Prescribed to Men with Low Testosterone Due to Secondary Hypogonadism:

1. Most doctors aren't aware of the efficacy and safety of clomiphene use in men
2. Most doctors think of Clomid as a "women's drug" to increase fertility
3. Clomid is FDA approved only for use in women
4. Clomid use in men is considered "off label"
5. Clomiphene citrate (CC pill) is now generic and really inexpensive so it's not advertised very much

Note: HCG is more commonly known and prescribed for secondary hypogonadism in men but it involves injection and is expensive, so if clomiphene works alone I think that is preferred. The 4 Main Risks of Using Clomiphene Citrate (CC pill, or Clomid) in Men with Low Testosterone Due to Secondary Hypogonadism:

1. Very rarely, visual changes may occur which are reversible with discontinuation
2. In older men, there is a reported increased risk of pyospermia (a noninfectious increase in white blood cells in semen, with unseen detriment)
3. Clomiphene citrate (CC pill) is a drug which is not bioidentical.  This means it's molecular structure doesn't mimic a compound naturally found in the human body. And, correspondingly, clomiphene citrate (CC pill) doesn't have a known natural function in the human body and thus may at some point manifest a currently unknown side-effect in men. This latter, however, is a theoretical risk because for more than 40 years clomiphene use in men has only shown the risks above.
4. Clomiphene may not work...especially in older men who in addition to secondary hypogonadism may also have primary hypogonadism; or in men with an unresolved chronic disease

In conclusion, in the appropriate male patient, clomiphene citrate (CC pill, or Clomid) may be a good alternative to both short and long-term testosterone replacement therapy. Regardless, just like testosterone replacement, clomiphene citrate (CC pill) must be administered and monitored by a competent physician.