Newsletter # 5 August 2006
This newsletter is published
several times a year to provide women
Important: Please keep in mind that the purpose of the Hormone Center of New York and this newsletter is to provide general information. Anyone with a medical condition should be under the care of a physician and any changes in treatment must be discussed with him or her.
GEOFFREY REDMOND, MD TO DISCUSS FEMALE HAIR LOSS
On Saturday, August 19th, I’ll be on the Weekend Today show to discuss female hair loss (alopecia). A patient will also be on the segment to discuss how it feels for a woman to be losing her hair – and what a great difference effective treatment has made in her life. To the extent I have time, I’ll explain how treatment must be directed at the hormonal cause.
I’ll also be talking about my recent book, THE HORMONALLY VULNERABLE WOMAN (ReganBooks/Harper Collins 2005).
To be on national TV speaking about female hair loss is the culmination of years of trying to convince the media how important a health issue this is for women.
I feel that it is vital to inform the public that there are effective treatments available for female hair loss, especially since most doctors, including dermatologists, continue to tell their patients that nothing can be done.
Since there are treatments that work, I at last have the opportunity to get this optimistic message out to the public.
OTHER TOPICS IN THIS ISSUE OF THE NEWSLETTER:
Shortly after the scary findings of the Women’s Health Initiative (WHI) were released in 2002, an elderly friend of mine who had always refused to take estrogen said to me, “Well I guess it’s finally been proven that estrogen is no good.” Though this is how it seemed to many in 2002 when the preliminary results were reported, there turns out to be a lot more to the story.
The problem has always been that while some women breeze through menopause, others find it quite difficult to function. Those who have a hard time during the change want to feel better but are, understandably, worried. Adding to the uncertainty is the medias tendency to make light of menopausal symptoms. I talk to health reporters frequently and know the reason for this: most are in their twenties and thirties and are quite clueless about what menopause actually feels like.
What we’ve needed has been some clarity about how taking hormones can be made as safe as possible. Fortunately, new studies are helping us to better estimate what the risks really are. First, the increase in breast cancer reported in WHI was not due to the horse estrogen (Premarin) but to the synthetic progesterone-like hormone, Provera. Until recently, it was mistakenly assumed that women on more natural forms of these hormones would have the same risks.
That the progestin caused the breast cancer is apparent from the WHI data as well as a more recent report from the Nurses Health Study which showed that women on estrogen alone do not seem to have an increased risk of breast cancer unless they have been on it for 15 to 20 years.
Of greatest practical importance, the regimen I have been recommending and prescribing for more than a decade; transdermal estrogen (patch, gel or lotion) combined with oral natural progesterone (available by prescription as Prometrium) showed no increase in breast cancer risk according to a recent report. Data from France, where most estrogen used is transdermal rather than oral, also suggests that this form of estrogen does not increase breast cancer risk.
These studies are small. No one can say with certainty that taking hormones is entirely risk-free for all women. However if a woman makes the personal choice to go on hormones for menopause, transdermal estradiol plus oral natural progesterone is not only likely to be safer but also gives the best symptom relief. It is truly bioidentical, unlike some estrogen creams hyped by compounding pharmacies.
Another problem with WHI is that the average age of those entering the study was 63. More recent analysis of the data suggests that the widely publicized heart attack risk applies to women who start estrogen in their sixties or older. For women in their fifties, estrogen seems to be protective. Keep in mind, however, that there are many factors involved in heart disease prevention besides hormones so any decision you make in this area should be arrived at with a physician who knows your situation in detail.
Estrogen is not the only way to alleviate menopause – see the following section on soy. For a full discussion of everything that can be done for menopause, both medical and alternative, you might take a look at my recent book THE HORMONALLY VULNERABLE WOMAN.
As many of my readers know, I have been convinced that soy is one of the healthiest foods you can eat, despite rumors to the contrary. This is partly because I am vegetarian myself and my wife, being Chinese, eats tofu all the time. But more objectively, it is clear that the high soy intake in Japan is associated with much lower rates of breast and prostate cancer.
Studies of isoflavones, a group of active ingredients in soy have been inconsistent as to whether they help menopausal symptoms and maintain bones. A recently published study from China by Y. B. Ye and collaborators found that soy isoflavones improved bone mineral density in healthy Chinese women. This study is not definitive and given the very different nutrition of women in China, may not apply to women on Western-type diets. Nonetheless the results are encouraging. I do however think that actual soy foods such as tofu and soy milk are more beneficial than capsules containing isoflavones only.
An article I coauthored with Mark Messina of the Department of Nutrition of Loma Linda University regarding effects of soy on thyroid function was recently published in the journal Thyroid (2006; 16:249-58). We demonstrate that soy does not have adverse effects on the thyroid in healthy adults.
The irony to me is that negative rumors about soy proliferate, while the proven dangers of usual Western protein sources such as red meat and diary tend to be ignored. Soy is consumed in large amounts by some of the world’s healthiest populations. My goal here is not to push soy on those who dislike it but to reassure those who do want to give it a place in their diet.
Many of my patients have been frustrated when they have consulted physicians about their hormone problems, only to be told that they problems were psychological (read: all in their heads). A typical example is a woman being told she has “body dysmorphic disorder” because she is distressed by her acne or hair loss. Too many health professionals fail to recognize that when your face is broken out or your hair thinning, it is normal to be upset. In my experience treating thousands of women, when the acne clears or the hair fills back in, the supposedly psychological condition goes away.
Women are quite properly annoyed when real problems are dismissed as in their heads. Still, hormone problems often make life difficult and so considerable mental stress can be created by what is at root a biochemical problem. For some women, acne or hair loss are the final straw that makes other life stresses difficult to stand. In such cases, I do feel therapy can play a useful role in helping the person to gain perspective on her situation so as to be able to start helping herself more effectively.
One reason psychotherapy is seen as suspect is the old-fashioned approach derived from Freud in which all problems were assumed to be caused by childhood traumas. When I was growing up in New York City, psychoanalysis was in its heyday and I knew many who spent years on the couch remembering every detail of their childhood with the (expensive) aid of the psychoanalyst – and never seemed to benefit.
Fortunately things have changed for the better. The form of counseling that is termed “cognitive therapy” usually works the best, in my experience. The idea is to deal with the present rather than ignore it. It is less concerned with labeling people as abnormal and instead focuses on helping them break out of unproductive patterns and think in more constructive ways. Even when childhood traumas are involved, this sort of commonsense approach often gives considerable relief.
I recently gave a seminar on women’s hormone problems at the American Institute for Cognitive Therapy. Members of the group are all PhD clinical psychologists with varying specializations. I was very pleased at their interest in my presentation about the hormonal basis of such common women’s conditions as PMS, PCOS, and menopause, as well as the distressing skin and hair changes of acne, hirsutism and alopecia. They were all clearly open to an integrated approach in which both body and mind are considered.
The Director of the Institute, Dr. Robert Leahy has recently published a very helpful book, The Worry Cure (Harmony 2005), that I recommend to anyone with anxiety problems – which is most of us at one time or another. Their website is www.cognitivetherapynyc.com.
A CLOSING NOTE
Best wishes to all my readers,
Geoffrey Redmond, MD
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