(206) 812-9988

So if you use hormone replacement, USE HORMONES “APPROVED” BY NATURE

Front-page news! First story on the 11 o’clock report! “Officials” warn women that risks of long-term use of horse urine estrogen and “progestins” (“HRT”) are greater than benefits! Terminating five years of research, “officials” of the Women’s Health Initiative study announced that 1 woman in 100 had a health problem linked to taking horse urine estrogen and “progestin”.

According to the report, the risks per 10,000 women taking “HRT” included:

  • 7 more heart attacks
  • 18 more blood clots
  • 8 more strokes
  • 8 more cases of breast cancer

compared to women taking placebo.

By contrast, the benefits per 10,000 women taking “HRT” included:

  • 6 fewer cases of colorectal cancer
  • 5 fewer hip fractures

again, compared with women taking the placebo.

Given the risks in excess of benefits, should you take “HRT”? My answer is what it’s always been: NO! Especially when there’s a much safer alternative: bio-identical hormone replacement therapy, using hormones identical to those found in women’s bodies for at least the last 200,000 years, and probably longer. But first…..

Why is “HRT” Risky?

“HRT”, especially “long-term HRT”, is risky for the same reasons any patent medication treatment is risky: It uses molecules never before found in human bodies! Never, before patent medication companies synthesized and/or patented them, and then paid for FDA “approval”. Whenever you put molecules in your body that Nature didn’t intend to be there, you risk damaging a very precisely balanced bio-chemical system, sometimes temporarily, sometimes permanently. And the longer you ingest any unnatural molecules.…whether they’re patent medications (“pharmaceuticals”), chemical food additives, flavorings, colorings, preservatives, pesticides and herbicides in foods, whatever…the more likely it is that you’ll have bad effects.

The Women’s Health Initiative study used “Prempro”, a combination of Premarin and a “progestin”. Let’s take a closer look at what these are, a look which reporters and even experienced science writers seem unable to take.

Premarin is a combination of estrogens concentrated from horse urine. Although horses are certainly natural, there are some obvious differences between women and horses! There are equally obvious differences between horse estrogens and human estrogens. The principal horse estrogen is “equilin”, of which there is not a speck, not a nanogram, in any woman. Equilin is much, much “stronger” than any type of human estrogen. For example, equilin’s effects on the lining of the uterus are up to 1000 times stronger than the effects of human estrogen. (Could this be a “clue” about why Premarin greatly increases the risk of uterine cancer?)

Several years ago, researchers from the National Institutes of Health announced that they had identified a cancer-triggering metabolite of horse estrogen. This metabolite cannot be produced from women’s estrogens. The news was ignored, and “sank without a trace”.

For whatever reason, nearly all physicians, reporters, and even science writers appear to believe that estrogen and estrogen are identical, as shown by all the headlines about the “dangers of estrogen”. For women, PREMARIN IS NOT ESTROGEN!! Unless women are horses…

The “-pro” component of Prempro is “medroxyprogesterone” (Provera), a molecule invented and patented in the 1940s, since the profit margin on selling natural, identical-to-human progesterone wasn’t high enough. (I’m not being cynical. This is the motivation behind the entire patent medication industry!) Studies have shown Provera to be hazardous to heart health. (For details, see Natural Hormone Replacement for Women Over 45 by John Morgenthaler and me, available through the Tahoma Clinic Dispensary, 1-888-893-6878, www.tahomaclinic.com ) Since these studies have been available for some time, it should be no surprise that the women who took medroxyprogesterone had more heart attacks.

Obviously, the term “Hormone Replacement Therapy” (HRT) is entirely incorrect. A more accurate name might be “Horse Urine Estrogen and Medroxyprogesterone Therapy” (HUEMT), or maybe just “Prempro Therapy” (PT) to keep it short and simple.

Real Hormone Replacement Therapy

The “alternative” isn’t “alternative” at all! It’s actually the real thing, hormones present in women’s bodies for at least 200,000 years, and probably a lot longer. Premarin and Provera are actually 20th century substitutes for the real thing, introduced and sold for all the wrong reasons. If you’re going to use hormone replacement at all, it’s only logical to use hormones “approved by Nature” to be in women’s bodies.

Actually, this idea didn’t originate in the 20th century. Centuries ago, Imperial Chinese physicians appear to have been the first to use bio-identical hormone replacement therapy as an important part of over-all anti-aging therapy for the Emperor and his court. They evaporated urine from women in their late teens and early twenties, and combined the crystalline residue left behind with herbs and sweet gums to give to the Empress and women of the Imperial Court. They did the same thing for the Emperor and men of the Court using urine from young men. Those who took these preparations (all in older age groups) noted an anti-aging, rejuvenating effect on the skin, a return of energy and “well-being”, and of course improved sex drive.

As an aside…I have an idea for solving the chronic funding shortage at our nation’s public schools. It would involve a little re-plumbing of the high schools, and some purification equipment….you get the idea. But our schools would never lack for money again!

Before you get nauseated at this thought, or at the Emperor’s physicians, please remember that literally tens of millions of American women have been swallowing purified horse urine without a qualm for nearly forty years!

Since all of the hormones found in human bodies are excreted in the urine, a “recycling” program from those whose bodies produce the most hormones to those who produce the least is actually the best-balanced, closest to Nature, and safest way to go. But unless and until that day arrives, the best and safest hormone replacement is “bio-identical” hormone replacement, using estrogens, progesterone, and testosterone precisely identical to those found in human bodies, and “approved” by Nature.

So What’s My Alternative to “HRT”?

Progesterone and testosterone are each individual molecules. “Estrogen” is actually a collective term, used to refer to at least twenty to thirty distinct molecules all naturally present in human bodies. (To make it even more confusing, there are distinct “animal estrogens”, such as equilin, and a whole variety of “plant estrogens”, generally termed “phytoestrogens”). Although researchers have started to “sort out” the roles of all the various estrogens, the job is nowhere near complete.

The three human estrogens studied the longest (long enough that many textbooks group them as “classical estrogens”) are estrone, estradiol, and estriol. Estrone and estradiol are generally considered slightly pro-carcinogenic; estriol is generally considered anti-carcinogenic, or at worst, “neutral”.

In the early 1980s, at the insistence of a woman who insisted she wasn’t a horse (I’m not kidding!), I checked with several major clinical laboratories about the proportions of these three estrogens circulating naturally in a woman’s bloodstream. After considerable inquiry and calculation, the proportions turned out to be 10% estrone, 10% estradiol, and 80% estriol. I contacted Ed Thorpe, a compounding pharmacist at Kripps Pharmacy, Vancouver, British Columbia, who assembled these estrogens in these proportions into a compound which since then has been called “Triple Estrogen”. Since then, the use of Triple Estrogen and similar estrogen compounds (along with progesterone and testosterone) has spread from my patients at Tahoma Clinic and one compounding pharmacy to tens of thousands of women and over a thousand compounding pharmacies all around the USA.

Safety of Bio-Identical Estrogens

In the last 20 years, I have written several thousand triple estrogen prescriptions, along with prescriptions for progesterone, and testosterone. I’m very careful to explain that no treatment, not even natural treatment, is perfectly safe, but bio-identical (identical to human, “approved by Nature”) estrogens, progesterone, and testosterone are much safer than horse urine estrogen or medroxyprogesterone.

What about the “excess risk” found to accompany horse urine estrogen and medroxyprogesterone, the extra risk of heart attack, blood clotting, stroke, and cancer?

Heart Attacks

Let me tell you about Helen. A few years ago, after I’d been away from the clinic for two weeks, I was told that Helen didn’t have “that bad angina” any more. Since Helen hadn’t told me about any chest pain previously, I asked for details. It seems that Helen, who was 63 at the time, had started having “just a little” chest pain with exertion several months before. The pain gradually got worse, but she hadn’t done anything about it until two days before I left, when her husband “dragged” her to an emergency room because she couldn’t walk more than a hundred yards without chest pain. She’d been given nitroglycerin to relieve the symptoms, and referred to a local cardiologist, who had tests performed and then told her to check into a hospital for coronary by-pass surgery.

Instead, Mary persuaded her husband to drive her to Tahoma Clinic. Although I was gone, she was started on daily intravenous magnesium injections along with Triple Estrogen and progesterone. Ten days later, she could walk as far as she wanted with no chest pain at all; one month later her HDL cholesterol was considerably improved over the reading obtained by the cardiologist.

While this doesn’t prove that Triple Estrogen and progesterone prevented Helen’s heart attack (intravenous magnesium likely helped a lot) it does show they didn’t cause one, even in a “high risk” individual.

Next, some common sense. When do men start having a significant number of heart attacks? In their 40s. When do women start having a significant number. In their 50s, when menopause has deprived them of most of their naturally higher-than-men levels of estrogen and progesterone (not their horse estrogen and medroxyprogesterone.) What about women who have both their ovaries and uterus removed in their late 20s or early 30s, and then aren’t given any type of hormone replacement? These unfortunate women start having a significant number of heart attacks in their 40s….just like men!

All in all, enough of a picture to say that bio-identical, “approved by Nature” estrogens very likely reduce the risk heart attacks.

Blood Clots and Strokes

Bio-identical estrogens, particularly large quantities of them, do raise a woman’s risk of blood clots. Nature shows us this during pregnancies, when the risk of blood clots (“thrombophlebitis”) is significantly higher. Unfortunately, if blood clots form abnormally in the brain, a stroke follows.

Fortunately, estrogen-related blood clots are entirely preventable with omega-3 fatty acids and vitamin E. Although nearly all of the women who consult me about bio-identical hormone replacement are already taking these supplements, if they’re not I recommend one tablespoonful of cod liver oil and 400 IU vitamin E daily.

A complete discussion of stroke prevention can be found in last month’s Nutrition & Healing.


…is a well-documented risk of taking equilin, the principal estrogen in horse urine. (As noted above, at least one of the carcinogenic metabolites of equilin was identified a few years ago at the National Institutes of Health.)

Bio-identical estrogens carry considerably less cancer risk. In twenty years, and after thousands of prescriptions, only two women who’ve taken bio-identical estrogens have reported cancers. In one woman’s case, it’s very likely the cancer was present before the bio-identical hormones were started. It’s impossible to say about the other woman.

n the last few years, it’s become possible to do a simple urine test (FDA “approved”, no less) to estimate your risk of estrogen-related cancer. I insist that every woman who uses bio-identical hormones have this test done. It’s called the “2/16a hydroxyestrogen test”. It was first performed (at my request) by Meridian Valley Laboratories (1-253-859-8700, www.meridianvalleylabs.com ). If test results are abnormal, it’s possible to lower estrogen related cancer risk and “normalize” the test by eating “mustard-family” vegetables, including cabbage, broccoli, cauliflower, Brussels sprouts, bok choy, mustard greens, and many others. If eating these vegetables doesn’t lower estrogen-related cancer risk sufficiently, then supplements of indole-3-carbinol (I-3-C) or di-indolylmethane (DIM) have always done the trick. (For a comprehensive discussion, see Cabbages, Broccoli, et al. versus Sex Hormone Related Cancers, in the February 2000 Nutrition & Healing.)

Other foods and supplements which lower the risk of estrogen related cancers include soy (no more than two or three times weekly, please!) flaxseed, selenium, and folic acid.

Benefits of Bio-Identical Hormone Replacement

You may not need “long-term” bio-identical hormone replacement! Maybe just a little to “get you through” hot flashes, depression, sleeplessness, and irritability during menopause, but that’s all. If you’re healthy, and your older female relatives have been long-lived and free of heart attacks, osteoporosis, senility or Alzheimers’ disease, then excellent diet, exercise, positive attitude, and non-hormonal supplementation may be the “way to go”.

But if you have any of these risk factors in your family, you may still want to consult your doctor about bio-identical hormone replacement therapy. With it’s use, I’ve seen woman after woman improve her bone mass (even after age 70), lower her risk of heart attack by significantly improving her HDL (“good”) cholesterol, and improve her memory and general mental function. I’ve also worked with women who (after careful consideration) have decided to use bio-identical estrogens, progesterone, and testosterone as part of a carefully monitored “anti-aging” program. After 20 years, it’s obvious to me that skin aging and “aging in general” is less, strength and endurance is better, and mood and attitude are improved among women who use bio-identical hormone replacement. Many women have reported that their “sex drive” improves and stays improved.

It’s true that 20 years of observation isn’t the same as a placebo-controlled, double blind study. Perhaps the results of the “Women’s Health Initiative” study will finally start to eliminate the use of horse urine estrogen and medroxyprogesterone (“HRT” or more accurately “HUEMT”), and scientists will finally turn their attention to bio-identical hormone replacement. If they do, it’s very likely that formal studies will confirm my what clinical observation shows us: long-term bio-identical hormone replacement is effective for the very large majority of women, and while not perfectly safe, safe enough to use (with proper precautions) for years and decades.

-Jonathan V. Wright, MD