The proponents of “natural hormones” or leaders in the field of BHRT –Bio-identical Hormone Replacement Therapy toss around the word “natural” or “bio-identical” in a very casual way.

 As a woman looking for the least harmful way of ameliorating the symptoms of menopause and aging, what these “experts” are offering, on the surface, seems much better than the Standard of Care Synthetics. 

However; upon closer inspection, what’s really being offered is the already proven dangerous The Standard of Care, the only twist is -  instead of prescribing the drug (synthetic) cocktail by Wyeth-Ayerst of Premarin or PremPro, a “bio-identical” look-alike molecule synthesized from plants is substituted for our own endogenously-produced hormone molecules.  The FDA has approved bio-identical estradiol and progesterone molecules in other drug company products (see Natural Hormones Sanctioned by the Government) like pills and patches.

T. S. Wiley conjectures that it may, in fact, not just be the molecule that matters. The way the hormone molecule is received at the receptor site and the way receptors are provoked may be at least as important, if not more. The WHI proved that dosing synthetic HRT in a static, low-dose regimen was harmful to woman over 65, particularly in regard to stroke and cardiac events.
What if the static, chronic, low-dose regimen was really to blame?

No group has ever tried to dose synthetic hormones in a way that would mimic normal levels in young women, in a way that would be more bio-identical. So, we don’t know the answer to the question. But the following group of doctors did advocate using bio-identical hormone molecules dosed in a way that mimics Premarin and PremPro….how good an idea could that be in light of the WHI’s findings?

John Lee was a Family Practice physician who worked at “hormone balancing” in the 1980’s. He and T.S. Wiley were colleagues, both searching for answers to natural progesterone’s positive potential in aging until Dr. Lee’s death. He acknowledged her work in molecular endocrinology in his book, What Your Doctor Won’t Tell You About Breast Cancer. Dr. Lee was in the vanguard of clinicians experimenting with natural hormone creams containing progesterone 20 or so years ago.

Dr. Lee was well aware of the deleterious effects of the “missing” second half (luteal phase, days 14- 28) of a woman’s cycle. John invented the phrase “estrogen dominance” to describe this peri-menopausal state of spotty ovulating or anovulation. * He prescribed weak (9% OTC) progesterone creams to address many of the symptoms of peri-menopause and menopause. He even pioneered, with Dr. David Zava, the saliva tests geared specifically to the amounts that he recommended. These are the saliva tests that many practioners continue to use today. They measure only the “free” hormones in the blood stream, so do not to give a complete picture.

Dr. Lee’s work never included replacing any of the missing estradiol that actually physiologically led to the loss of ovulation at peri-menopause. Dr. Lee often said that “Progesterone would do it all…,” meaning that progesterone would convert reliably to estradiol and testosterone once in the body. We now know that, in fact, the conversion of one hormone to the next is controlled by enzymes that are controlled by light, food and sleep, seasonally, so progesterone can’t do it all. Although, incomplete, Dr. Lee’s work was a platform for other clinicians to spring forth.

R. JOHN R. LEE'S THREE RULES FOR HORMONE REPLACEMENT THERAPY

• Rule 1. Give hormones only to those who are truly deficient in them.
• Rule 2. Use Bioidentical hormones rather than synthetic hormones.
• Rule 3. Use only in dosages that provide normal physiologic tissue levels.
  

The problem is Rule#3.  
Replacement to normal physiologic levels in a 40, 50 or 60 year-old woman is still an estrogen and progesterone deficient state, thanks to aging. That’s why heart disease, cancer, osteoporosis, memory loss and diabetes are all also normal at those ages. John Lee’s prescription for progesterone alone or with estriol (not FDA approved) in a static, chronic low dose is not “natural” or bio-identical.

Jonathan Wright is the next luminary to come along in the history of BHRT. Dr. Wright was also practicing in a small clinic in Tacoma, Washington on the West Coast in the 1980’s along with Dr. Lee in California. Jonathan’s contribution to the BHRT story was the recognition that women needed estrogen replacement from their Forties on, as well as progesterone supplementation. Dr. Wright’s approach was a static, chronic, very low dose regimen of estrogens, plural in a formulaic ratio for the whole month and 10 to 14 days of static, low dose progesterone to create a “faux luteal phase”.

Dr. Wright invented the ratio - what he called Triple Estrogen or “Tri-Est”, which eventually became Double Estrogen or “Bi-Est”. Triple Estrogen mimicked all three metabolites of estrogen - estrone (E1), estradiol (E2) and estriol (E3). Bi-est had only E2 and E3. The Tri-Est became Bi-Est when it was found that estrone (E1) is the most ubiquitous faction of estrogen found in frozen breast cancer slides. Both formulations of bio-identical hormone powders (available in creams or capsules) were designed to recreate the ratio of spent metabolites found in pregnant women in the third trimester of pregnancy.

Dr. Wright concluded from the work of Dr. Henry Lemon that it was a “safe” ratio because the third trimester of pregnancy is usually a healthy time for women. While it is a healthy time for women, the amount of E3 made in the third trimester is expanded by the production of the fetus (reference 1). Therefore, at no time in a woman’s life is it “normal” to have that specific ratio of estrogens, since the baby’s adrenals put out the copious amounts of sex steroids that convert to metabolites in mom (reference 2).
Since Dr. Wright’s model is pregnancy, he, too, feels that a period is optional.

Although Dr. Wright did attempt to address the faltering estrogen production of peri-menopausal and menopausal women, his model was not completely “natural” or bio-identical either. However, recently, Dr. Wright was quoted as saying in Smart Publications, Frontiers of Natural Medicine: An Interview with Jonathan Wright, MD, “We need to as closely as we can mimic the patterns of a young healthy woman with young healthy hormones.” So maybe he will agree with The Wiley Protocol® someday.

Uzzi Reiss has also discussed with T. S. Wiley her approach.  Dr. Reiss is a Beverly Hills, California Ob/Gyn. In his book, Natural Hormone Balance for Women, Dr. Reiss espouses Dr. Wright’s approach to estrogen; estriol in minute amounts, along with progesterone in minute amounts. Dr. Wright prefers creams and a stable, static low dosing regimen and Dr. Reiss uses gels.

The biggest difference, however, is that Dr. Reiss advises patients to do whatever feels right. On his website Dr. Reiss says that he believes in self-medication that, in fact, he teaches women to “self-adjust the intake” of the hormones that he prescribes. The problem with this approach is that every time you “self-adjust”, you destroy normal templates as well as derange your response to the last dose.

Endocrinology is a system of iterative functions, in other words - change the environment and the environment changes you and so on and so on and so on. Natural? Yes, but not with you at the wheel. He also says women don’t need to have periods and cites Wiley’s work in molecular oncology and endocrinology in Natural Hormone Balance for Women.

Christiane Northrup is an Ob/Gyn and, more importantly, a woman. She’s written four books, all with a “spiritual” bent, which is quite remarkable. There aren’t a lot of spiritual Ob/Gyns out there who talk about "emotional incision and draining".  She’s very clear in her books on peri-menopause and menopause that "many illnesses are the end result of emotions that have been stuffed, unacknowledged and unexperienced for years."

She does prescribe bio-identical hormones, and like all the others, usually estriol (not FDA approved) and natural progesterone creams in the template of the Standard of Care synthetics. However, she is very forward thinking in her views on post-diagnosis cancer patients and BHRT. She’s open. She firmly believes that menopause is an emotional and psychological rite of passage with a very bright light on the other side. Wiley would say that that light, for some of us, may very well be the light at the end of the tunnel on hormones with no rhythm or cycle not ending in a period. The way Dr. Northrup prescribes BHRT is really pretty traditional, but she speaks a very “new age” patois.

Her most famous patient, Oprah Winfrey had palpitations and was treated with thyroid medication, probably because Dr. Northup knew palpitations are a classic feature of a panic attack which is a symptom of hyperthyroidism in the presence of low estrogen feedback (reference 3 , reference 4 , reference 5 ).

But, when asked in an interview on the website Power Surge.com, “why do you suppose there's such a high incidence of panic attacks during menopause?” Dr. Northrup responded, “Because the kundalini energy rises in menopause and hits the heart chakra.  Any unfinished business related to grief, sorrow, rage, will make itself known at menopause.  That's why panic attacks are part of the body's wisdom - they cry out, "What about me and my life" (reference 6 ). She didn’t mention her extensive knowledge of endocrinology.

Dr. Northrup has said, “The female human body has various stages when you are more apt to be in touch with your spirit or your wisdom. One of those is just before your menstrual period is about to begin; one is during birth and postpartum and during breast feeding; and the last period is during menopause, including peri-menopause and the years leading up to menopause”.

She and Wiley agree on threshold-driven turning points in a woman’s life, but Wiley would tell you that they are endocrine, that hormone levels drive your emotional life and spiritual evolution. The quote opening her website, DrNorthrupMD.com says, “We’re meant to create and to grow and to change. In order to do that, we sometimes have to go through discomfort.” Of course as you age “discomfort” is natural (not so sure about character building), but getting wet when it rains is natural, too, but, some of us use umbrellas.

Elizabeth Vliet, too, is a woman and a doctor, which gives her a better vantage point for BHRT than having a Y chromosome. She manages to color inside the lines when it comes to the Standard of Care set by synthetics, too. Her recommended dose of natural progesterone for daily use is 100 mg daily (oral) – less than that if non-oral. Her BHRT of choice is the government sanctioned bio-identical estrogen (E2- estradiol) that comes in very, very small amounts in pills and patches. She vacillates on Bi-est usage, but no Tri-est, more importantly, no saliva testing. Wiley concurs.

She says in an interview on the Website PowerSurge.com, “I stopped using saliva tests about 5 years ago because they were so unreliable and didn't fit with what that women themselves were telling me.  The "gold standard" in reproductive endocrinology and the international menopause research field to test hormone levels is the serum assay in blood.  There are complicated reasons for this, but basically it has to do with the fact that more is involved in activating the hormone receptors than just the free fraction -- based on more recent research.  If you really want to have a better picture of where you stand, you would do well to have the serum levels done.  There are known minimum thresholds for the various target organ protective effects of E2, progesterone to prevent hyperplasia, testosterone for bone, libido effects etc. Cyclic progesterone or progestin does mean periods -- but also means less time on that part of an HRT regimen if you are having problems with it.”

By less Dr. Vliet means - as opposed to taking progesterone every day for 28 days with some form of estrogen, ala the PremPro template that made women so sick in the WHI. Dr. Vliet seems well-versed in endocrinology and as a clinician, very facile at symptom identification. It’s surprising that the frequency of rhythms, their pulsitility and amplitude in human female BHRT, escaped her astute scholarship. Without a beat, it’s not music.

Erika Swartz is known as DrErika.com in the Biz and she really is in the Biz of show business. She’s The National Inquirer Doctor, seriously. Her website is pink and dedicated to selling hormones over the internet, without a personal, face to face interview. Not a sound idea, since so much of endocrinology is tactile and visual. Her motto is “Feel Better Now!” on the internet order form.

She’s written 4 paperback books on hormones, relies on the Standard of Care Templates of static, low chronic dosing of E2 (estradiol) and natural progesterone in creams predominantly. She likes cocktails of hormone “mixtures”. Again, not a great idea to confuse variables, if you intend to do any scientific research at all.

Diana Schwartzbein is the only Endocrinologist in this list, Diabetologist, really. Her forté is insulin and blood sugar metabolism in Type II diabetes.  She only entered the field of HRT or BHRT when, at the request of one of her Montecito, California patients, she was made aware of “natural” hormone molecules about 15 years ago. The patient brought her John Lee’s book back in the early 1990’s.  Standing on the shoulders of giants, Dr. Lee and Dr. Atkins, she crafted her own “California” version of metabolic control and BHRT. Dr, Schwartzbein added whole grains and fruit (very Mediterranean – South Beach) to Atkins for her Type II patients and they got better. Using Dr. Lee’s premise and anecdotal clinical  information  Dr. Schwartzbein ordered her patients progesterone cream from Women’s International Pharmacy, eventually adding oral bio-identical estradiol in amounts ranging from 2- 6 mg. In her later days of prescribing, Dr. Schwartzbein switched to compounded estradiol lozenges (troches) in strengths between .5 and 3.25 mg. Progesterone became sublingual oil drops in 25, 50, 100 mgs.  Dr. Schwartzbein introduced Suzanne Somers to the benefits of BHRT, which changed the world of HRT forever, thanks to Suzanne’s 2003 book, The Sexy Years.

Doctor Swartzbein’s rules for prescribing are eerily similar to Dr. Lee’s…

• Do not take a hormone that is not low or missing
• Take only bio-identical hormones
• Mimic normal physiology as much as possible
• Track the hormone levels and their effects.
  

She broke her own rules (see italics) by never creating a rhythm or measuring hormones on “peak” days, not Natural.