Latest / The Dr Louise Newson Podcast / 55 – HRT, breast cancer and the real risks of not taking hormones

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55 – HRT, breast cancer and the real risks of not taking hormones · The Dr Louise Newson Podcast

• 0:00
  Doctor Jeffrey Dak is my guest today.
• 0:02
  He's AUS doctor and he talks a lot about the preventative roles
• 0:07
  of hormones, talks about how oestrogen can reduce future risk
• 0:12
  of breast cancer, but also other diseases such as osteoarthritis,
• 0:17
  osteoporosis and heart disease. We really explore about how we
• 0:22
  should be thinking differently about hormones and also about
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  how healthcare professionals should be less scared of
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  prescribing hormones to women. Jeff, I'm really excited to have
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  you on my podcast because I've listened to quite a few podcasts
• 0:38
  that you've been on on other people's your words of wisdom,
• 0:41
  your huge intellect is just incredible.
• 0:45
  And also your book, which I have lugged down to London on the
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  train last night, Bioidentical Hormones, 101, Menopausal
• 0:54
  Hormonal Replacement, second Edition.
• 0:57
  I'd just like to add, so just before we get started, just tell
• 1:01
  me a bit about you because you haven't always been a specialist
• 1:05
  in hormones. So can you just tell me a bit
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  about your story? Yes, of course.
• 1:10
  First of all, Louise, thank you so much for inviting me.
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  It's a great honor to be on your podcast.
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  And you know, my background, we, I started out as a diagnostic
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  interventional radiologist. I worked in the hospital for 25
• 1:21
  years doing that. And you know, I developed eye
• 1:25
  troubles. So I switched to a a outpatient
• 1:30
  clinic. I started my own outpatient
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  clinic here locally and doing bioidentical hormones at the
• 1:37
  beginning and, and then I later as, as I, we were chatting
• 1:41
  earlier, I mentioned that I became a reluctant
• 1:43
  thyroidologist and we have a second book on natural thyroid
• 1:48
  toolkit, which, you know, we can get into later.
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  But yeah, the, you know, I, I was prescribing bioidentical
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  hormones for, for 20 years. Their first edition of the
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  bioidentical hormone book came out in 2011 and we talked about
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  the, you know, the Women's Health Initiative study.
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  And at that time there was a, it was a different environment.
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  There was just a lot of negative newspaper articles on, on
• 2:15
  bioidentical hormone replacement.
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  So a lot of the chapters on the first book dealt with that.
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  The first edition is free on my website.
• 2:23
  You can download the free version We now have since 2011,
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  you know, another 14 years of research, a lot of new material,
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  a lot of new information, which is really changes the whole
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  landscape. And plus I put it on monthly
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  newsletter and must have tons and tons of material on
• 2:44
  bioidentical hormones from the newsletter.
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  So I, I had enough material for a book.
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  So I started putting it together and realized, you know what,
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  there's a lot of, there's a lot of medical research that needs
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  to go in the book, which I haven't looked at yet.
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  So as you know, writing a book like this, you get it sort of
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  takes mind a life of its own. And so, you know, that's what
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  goes into the book. You know, when you have these
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  little, these moments where the little light bulb turns on, you
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  know, the Eureka moment. So we do have a few of those in
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  the book. And I, you know, I think it's a
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  good book. I'm a little biased cause since
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  I wrote it and you know, we, we, one of one of the things that we
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  talk about is the Women's Health initiative, you know, 18 year,
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  20 year follow up data came out and showed this tremendous
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  protective effect of estrogen. You know, the, the estrogen
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  treated group had a 4045% reduction in mortality from
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  breast cancer. And I love the quote from Isaac
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  Mananda, who, who is there in London.
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  He's, I think he's at Saint George.
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  He's a professor at Saint George in London.
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  And he's been on, he, I'm, I'm he, I think he's one of your
• 4:07
  favorites. Also.
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  He comes out and says, you know what, looking at this new
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  evidence, you have to come to the, you're compelled to come to
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  the conclusion that estrogen, it does not 'cause breast cancer,
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  but it's actually preventive. And so the, you know, he's
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  quoted prominently in the book and the and then, you know, the
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  other thing that I didn't know, which I discovered writing the
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  book, is there is a difference between Premarin, which is the
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  hormone estrogen they used in the Women's Health.
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  They should do. It's the difference between
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  Premarin and estradiol, which is the human, you know, the strong,
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  the human hormone E2, which is the, you know, the, the major
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  strong hormone and the, and the difference is horses, you know,
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  primary comes from dragon horses, horse horses have these,
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  these estrogenic compounds that do not appear in humans.
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  It's very interesting because the biggest reason I think, or
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  the commonest reason that people are not taking hormones for
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  perimenopause and menopause and not prescribed hormones is this
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  unfounded fear of breast cancer. Because of the WHI like you say,
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  the Women's Health Initiative study.
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  Because the way it was misreported to the lay media and
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  the medical literature as well that HRT causes breast cancer.
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  And you know, when you unpick the literature and now we've got
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  the luxury of time where we can look at longer term data.
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  Like you say, this risk of breast cancer hasn't actually
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  ever been shown with estrogens, either estradiol, estradol or,
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  or the conjugated equine estrogens of pregnant horses
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  urine. But actually for you to say
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  there's a 45% reduction in mortality to death from breast
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  cancer. And, and it showed that there
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  was about a 23% reduction in incidents of breast cancer.
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  Like why wasn't that headline news?
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  I find that is so important when breast cancer is so common that
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  that's just been dismissed, hasn't it?
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  Well. You know, the the newspapers got
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  it wrong. And of course there was that in
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  2002 when the first arm of the study was published, which uses,
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  which used the, the primer along with the synthetic progestin,
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  the medroxy progesterone MPA for short, that, you know, that was
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  the one that showed increased risk of breast cancer.
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  The, the study was halted before it became statistically
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  significant. And then, you know, if you look
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  at the, the later follow up, 18, your follow up there was a, a,
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  you know, a, an increased number of deaths from breast cancer in
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  the synthetic progestin group. It was roughly, roughly you
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  know, the placebo group had about 40 deaths from breast
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  cancer in the 18 year follow up. The Premarin group had almost
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  half that 22 deaths compared to 40.
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  And then the Premarin, the Premarin plus
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  medroxyprogesterone MPA group had 60 deaths from breast
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  cancer. So if you compare the, the
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  formula that in the first arm that was followed in 2002, which
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  is the, the Premarin plus MPA to the, to the Premarin alone,
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  that's gonna be statistically significant in terms of, you
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  know, 60 deaths versus 20. So the statement that there is
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  no studies showing that MPA is, you know, increases mortality
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  from breast cancer with there's no that within with statistical
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  significance. That's, you know, I think that's
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  a little deceptive just to make that statement because #1 the
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  studies are halted early before they can reach significance.
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  And, and it's, it's, you know, to me, it's obvious that if you,
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  if you power a study and, and follow along enough, you're
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  going to see, you know, that type of significance in the
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  numbers, you know, in terms of synthetic progestins being
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  carcinogenic. You know, we know that, for
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  example, there there's a, you know, you go to the university
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  animal lab down this, you know, in the neighborhood and ask the,
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  the, the, the researchers in their little white coats and how
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  did, how do you give mice breast cancer?
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  And one of the, one of the techniques that's widely
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  available is the, they, they inject the mice with medroxy
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  progesterone. There's so many studies now
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  which show that adding a synthetic progestin to an
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  estrogen will increase the risk of breast cancer.
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  The, you know, the, the, the one that's quoted the most is
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  probably the the French cohort study by Agnes Fournier.
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  And she found that, you know, roughly 48% increase in breast
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  cancer when compared to placebo when the medroxyprogesterone is
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  added to estradiol and when estradiol is combined with
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  progesterone, natural progesterone, there is no
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  increased risk of, of breast cancer.
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  You know, the hazard ratio goes back down to 1.0.
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  And then, you know, you can look at the monkey studies.
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  We have an entire chapter in the book on, on entitled don't
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  monkey with my hormones and which is supposed to be cute.
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  And you know, we have these, these monkey labs, you know, the
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  Mac monkeys are very have menstrual cycles very similar to
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  humans. And they, the, they're
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  Physiology response is very similar in terms of response to
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  hormones and breast cancer Physiology.
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  And they, so, you know, Charles Wood compared the
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  doxyprogesterone to estradiol into Premarin and he did all
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  those monkey studies and he found that Premarin Premarin is
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  much less proliferative done this estradiol.
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  And then when you if you add medroxyprogesterone to
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  estradiol, it becomes even more massively proliferative.
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  And then, you know, there's studies done by the one that I,
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  I quote the most is it was done by Sebastian Giuliani in from
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  Argentina. He's a colleague of Claudia
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  Lanieri who did the MPA mouse studies.
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  And he found that that when you when you use medroxyprogesterone
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  added to estrogen, it up regulates ER alpha.
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  And then he found activation of oncogenes, these that are well,
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  very well known in the oncology literature.
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  Medroxyprogesterone activates breast cancer oncogenes.
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  Which is very, it's very interesting because you know,
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  people just think a hormone is a hormone.
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  And over here, and actually not just in UK and other countries
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  as well, doctors, nurses, pharmacists are quite happy to
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  prescribe these synthetic hormones in good faith.
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  They're using them as contraceptives.
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  But I remember going to a talk a menopause society meeting
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  several years ago when they were talking about the dangers of
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  bioidentical hormones, and I'd not really heard this phrase,
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  bioidentical, I didn't really know what it meant.
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  And they were talking about the compounding of how people have
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  hormones made, and they should all be regulated from
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  pharmaceutical companies. But certainly in some countries,
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  it's not possible to obtain estradiol or testosterone unless
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  it's compounded. And in my mind, bioidentical
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  doesn't really matter where it's made.
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  It just means it's the same chemical structure as the
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  hormone that we make ourselves, as in estradiol or estradiol or
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  testosterone or progesterone. But there's been so much
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  confusion on the words. And even when you talk about
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  MPA, magoxy, progesterone, acetate, it's not progesterone.
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  It shouldn't even have that word in its description.
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  So it causes no end of confusion.
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  But metabolically and biochemically, they work so
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  differently in the body, don't they, These synthetic chemical
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  hormones? They have very opposite actions
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  in terms of breast cancer and also in neuro steroid neuro, you
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  know the progesterone, natural progesterone is very
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  neuroprotective with all of those neuroprotective properties
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  are completely obliterated by by synthetic progestins.
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  You know, we do in here in the US we do have FDA approved
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  versions of of pretty much all of all of the bioidentical
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  hormones that in use in hormones in the human body.
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  There are versions of estrogen, you know, there are estradiol
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  patches that are FDA approved progesterone, micronized
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  progesterone oral was approved in 1998, FDA approved in 1998.
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  It was manufactured by Sullivan at the time and that that study
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  was showed that it prevented endometrial hyperplasia.
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  And so also Testosterone's FDA approved versions of that.
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  So estriol is more, yeah, I think approved in Europe, more
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  of an approval in Europe. So here in the US if we want to
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  use estriol, we have to get use that through a company pharmacy.
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  The you know, there there are FDA approved versions of SSG,
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  the estradiol patch and testosterone at the local
• 13:59
  pharmacy. The reality is FDA approval
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  doesn't necessarily mean you're dealing with a good drug. 10%,
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  yeah, 10% of FDA approved drugs are later with actually
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  withdrawn from the market because, you know, they're bad
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  drugs. And another 10% are given black,
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  the black box warning, which you know, is means this probably a
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  bad drug. When I think about compounded
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  compounding pharmacies, they, they do vary quite a bit in
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  quality. You know, they're little mom and
• 14:32
  pop compounding pharmacies, all, you know, on the street corner
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  down down the street. And then there we have these
• 14:39
  large compounding pharmacies that that specialize in women's
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  hormones. There's about half a dozen
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  around in the US and those are the ones that we use.
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  They have much higher quality, much more quality control.
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  And this is just another thing that we don't have to worry
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  about. You know, I look at compounded
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  hormone formulations as sort of a generic form of the F of FDA
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  approved version. You know, the and so you know,
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  it's an awful I can I look at it as as off label prescribing of a
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  generic version. The, you know, in 2020% of all
• 15:15
  prescriptions in the United States are prescribed off label.
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  There's no FDA approval for that indication 20.
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  You know, that's a big chunk of medical medical practice right
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  there. So, you know, and the other
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  thing to think about is here in the US, every hospital pharmacy
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  is a compounding pharmacy. So, you know, they try not to
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  use compounded formulas. I mean, if they can take
• 15:40
  something off the shelf, they'll prefer that.
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  But I'll, you know, in the hospital when they make up an IV
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  bag or, you know, you know, there's a significant chunk,
• 15:51
  significant percentage of the medications that they make up
• 15:54
  are compounded in every hospital in the United States.
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  So if you get rid of compounding, it's going to be a
• 15:59
  problem for, you know, the hospital system.
• 16:04
  I'm really excited to announce that I've written a new book.
• 16:07
  It's called Power of Hormones. It looks at how hormones
• 16:11
  actually work in our body and why so much of what we've been
• 16:14
  told and taught, especially as women, has actually been wrong.
• 16:19
  I explore the science, the history, and the uncomfortable
• 16:22
  truths about how hormones have been misunderstood, undertaught,
• 16:27
  and often dismissed within medicine.
• 16:30
  There are some stories that are actually quite shocking,
• 16:33
  frustrating, and I think essential for us all to know.
• 16:37
  This book is about understanding your body and hormones in a
• 16:40
  deeper way, about questioning symptoms that haven't always
• 16:44
  served women well. If you want to be among the
• 16:46
  first to read it, you can pre-order Power of Hormones now
• 16:50
  through the link in the show notes.
• 16:55
  It's all about words really, and understanding.
• 16:58
  But one of the things that worries me really is that
• 17:01
  globally, the majority of menopausal women are not
• 17:04
  prescribed any type of hormone at all.
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  Yet we know there are risks of not having hormones, don't we?
• 17:12
  That's the big problem, you know, especially in the in the
• 17:15
  early menopause, you know, the younger women either have
• 17:17
  hysterectomy or early menopause. You know, there's this
• 17:21
  tremendous increased risk of early mortality for those
• 17:25
  people. And you know, all the studies
• 17:29
  have been done showing that. And, you know, even the in the
• 17:35
  elderly, you know, there's a recent study called the 10
• 17:39
  million women studied by Co Bake looked at Medicare records and
• 17:44
  showed that in the elderly over the age of 65, there are
• 17:48
  tremendous advantages of hormone replacement.
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  Even, you know, in that in that age group, 20% reduction in
• 17:55
  mortality is what his data showed.
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  And then there was there was reduction in five different
• 18:02
  cancers. Why is it, do you think that
• 18:05
  like so many doctors are resistant to prescribing?
• 18:08
  Because in the UKHRT prescribing has plateaued over the last
• 18:12
  year. It's only about 14% of
• 18:14
  menopausal women. And you know, everyday I speak
• 18:17
  to women who are actively refused hormones, yet any other
• 18:23
  drug, if I was bringing a new drug to market and I said, oh,
• 18:26
  Jeff, I've got this new drug that will reduce mortality.
• 18:30
  So reduce death rate. It will reduce risk of cancers,
• 18:34
  it will reduce risk of heart attacks and strokes.
• 18:38
  Like you'd be going, well, what is it?
• 18:40
  This is amazing. This is too good to be true.
• 18:43
  And also then when I say what, it's just a natural hormone I'm
• 18:46
  just replicating in the body. It's not even a new formula drug
• 18:51
  that we don't know what's going to happen in the future.
• 18:54
  I really find it very confusing to understand why there's so
• 18:57
  much resistance. Here in the US and also
• 19:01
  probably, you know, the rest of the world, the, the use of
• 19:04
  hormone replacement plummeted. We, we had 30 million women
• 19:08
  using hormone replacement in 2002.
• 19:10
  Once the, that first armed of the Women's Health Initiative
• 19:13
  study was published, you know, use of hormone replacement
• 19:17
  plummeted down to 5% of instead of, you know, and the, and the
• 19:25
  other thing that happened, which which doctor Marty Makary
• 19:28
  mentioned when he was on the medical school stopped teaching
• 19:32
  it. And so we, this is 20 years now
• 19:35
  we the, we have a, you know, we have a doctors upset OB gyne
• 19:41
  doctors, primary care doctors, internists, none of them have
• 19:45
  had any training in hormone, in prescribing hormone replacement.
• 19:50
  And they don't just not comfortable with it and rather
• 19:52
  not do it. So that's, you know, it's
• 19:57
  causing misery and suffering, which is completely unnecessary
• 20:04
  because. In my opinion, hormone
• 20:08
  replacement, menopausal hormone replacement is the single most
• 20:10
  important medical intervention format for women of menopausal
• 20:15
  age. And we see tremendous
• 20:17
  improvements. Women are just so much, you
• 20:21
  know, improved quality of life and, and these are so much
• 20:25
  happier and, and they will, they come back to the office and they
• 20:28
  say thank you. And so it's, you know, you have
• 20:35
  to ask yourself when we touch on this in the book, who benefits
• 20:38
  from this fear of estrogen? You know, where's the benefit?
• 20:43
  Who benefits from it? And the greatest benefit I think
• 20:47
  is the Pharmaceutical industry because they women who have
• 20:53
  estrogen deficiency, you know, throughout their post menopausal
• 20:57
  years become very good customers of the drug industry.
• 21:02
  You know, for every menopausal symptom of chronic degenerative
• 21:07
  disease of estrogen deficiency, there's a there's a drug for,
• 21:10
  for osteoarthritis. The, the drugs for that joint
• 21:15
  replacements for insomnia, they have sleeping pills for
• 21:19
  depression, they have their SSRI antidepressants, which you've
• 21:25
  commented on many times. And, you know, goes on and on.
• 21:29
  They give statins for drugs for heart disease, which, you know,
• 21:34
  estrogen is a much better, much more effective and much safer
• 21:38
  and much more better approach to, to preventing heart disease.
• 21:43
  There's a rapid loss of bone density the first two years
• 21:45
  after menopause, roughly 5% a year less after that.
• 21:49
  You know, why should it be such a sudden rapid loss of in bone
• 21:52
  density? So the, the mechanism was
• 21:55
  suggested by a researcher from Harvard has suggested, you know,
• 22:01
  maybe there's this correlation between sudden decline in
• 22:05
  estrogen with what the sudden decline after after giving birth
• 22:11
  in pregnancy there there's calcium mobilized for the bones
• 22:16
  for breastfeeding. And perhaps that's the same, you
• 22:20
  know, it's an an analogy and that's why, you know, if there
• 22:25
  there's some mobilization of calcium from the bones causing
• 22:27
  osteoporosis as as a duplication.
• 22:31
  Of that, I mean, it's a big concern, osteoporosis, it's one
• 22:35
  of the main reasons I take HRT to prevent or reduce my risk of
• 22:40
  osteoporosis, especially of my spine.
• 22:42
  And the thoughts of this rapid bone loss that occurs even
• 22:45
  before menopause in the perimenopause years.
• 22:48
  I think people don't understand or don't want to understand or
• 22:52
  don't know what a serious condition osteoporosis is
• 22:57
  because it doesn't make front page of the newspapers, it
• 22:59
  doesn't sell the news. But it's so important that we
• 23:03
  think about osteoporosis. Isn't it you?
• 23:05
  Know, I have to tell you a story.
• 23:06
  When I was a medical student, my, my grandmother, you know,
• 23:11
  was in her 80s. And she, she asked me to look at
• 23:14
  her chest X-ray. So I, you know, I went to the
• 23:16
  hospital. I looked at her chest X-ray.
• 23:18
  She had this gigantic heart. She had more calcification in
• 23:21
  her aorta than she did in her ribs in her skeleton.
• 23:25
  And it was like I was struck by that.
• 23:28
  And, you know, that's what happens eventually to to many to
• 23:32
  many women. So, you know, yeah, you know,
• 23:35
  the the bonds have estrogen receptors and estrogen and also
• 23:41
  the the cartilage has estrogen receptors.
• 23:43
  So the estrogen is Rick is the is the best bond building and
• 23:50
  and together with testosterone you there are studies showing
• 23:52
  that when you add testosterone to estrogen, you get even a
• 23:56
  better bone building effect. You know the and the drugs that
• 23:59
  they use for the primary care docs are handing out the
• 24:03
  bisphosphonate drugs in that you now have newer drugs that are
• 24:10
  these antibody drugs that are even worse.
• 24:14
  I think the, the bisphosphonates are, I think, you know, all of
• 24:20
  these drugs are terrible drugs. You know, they cause
• 24:23
  osteonecrosis of the jaw. They cause spontaneous fractures
• 24:28
  of the mid femur. You know, the, the, the, the
• 24:34
  unfortunate woman is walking across the living room floor
• 24:39
  feel, feels a little pop in her and, and she has the spontaneous
• 24:43
  fracture of her femur. It's so the, these bones, the
• 24:46
  bisphosphonates make, they weaken the, they make the, the
• 24:51
  bones weaker, not stronger. And we actually have two, 2, two
• 24:56
  women in our neighborhood. They live down the street that
• 24:59
  we've known for years. Both husbands are doctors and
• 25:03
  they, their wives were on the bisphosphonates for five, 6-8
• 25:07
  years. They both develop spontaneous
• 25:09
  femur fractures just, you know, walking across the floor.
• 25:12
  So it they're bad, very bad drugs.
• 25:16
  So I don't recommend them for anyone.
• 25:18
  I mean, I people ask me, you know, what's your criteria for
• 25:21
  make recommending a drug? So I always say, look, if if you
• 25:26
  wouldn't give your dog this particular drug, then you
• 25:29
  probably shouldn't give it to people either.
• 25:31
  So, so I think that would fit that criteria.
• 25:33
  So, yeah, you know, the, the osteoporosis is very big.
• 25:37
  Women are concerned about that here in the US You know, we
• 25:40
  have, we have television advertising for drugs which you
• 25:43
  don't have in. And I think, you know, we need
• 25:45
  to be thinking very differently about how hormones can reduce
• 25:49
  future risk of diseases. So I'm very grateful for you to
• 25:53
  come on the podcast. I do want to cut you to come
• 25:55
  back to talk and in the future about thyroid because it's also
• 25:59
  another really important hormone.
• 26:01
  Before I end, I always ask for three take home tips.
• 26:04
  So I just want from you, if it's OK, three of the biggest reasons
• 26:11
  why women should consider taking hormones to reduce their risk of
• 26:14
  future diseases. We touched on the osteoporosis,
• 26:18
  you know, the bone density is a very good reason prevention of
• 26:20
  heart disease if you're in the 5059 age group, that's a very
• 26:24
  good reason. And then also, you know, we
• 26:28
  didn't mention another big one, which is the osteoarthritis.
• 26:31
  You know, cartilage has estrogen receptors and, and we've
• 26:34
  actually had a great experience using topical estrogen over the
• 26:39
  joints that are painful and the, and the joint pain does go away
• 26:43
  using estrogen as a topical application.
• 26:46
  And so I mean, those are three pigments that you know, and you
• 26:49
  mentioned many of your papers, the genital urinary syndrome.
• 26:54
  We have women who come to us, they've repeated urinary tract
• 26:56
  infections. So, you know, that's a terrible
• 27:00
  problem which they could get rid of entirely with hormone
• 27:03
  replacement. We use the, you know, estrogen,
• 27:05
  vaginal capsules, vaginal suppositories, which is very
• 27:11
  good for that. So that's three or 4.
• 27:14
  There's so many, I've been cruel asking for three, but it it's,
• 27:18
  it's important just to think differently.
• 27:19
  I think about hormones and I just really hope some of the
• 27:22
  conversations we're having will just change the direction for
• 27:25
  women and also for healthcare practitioners to prescribe them.
• 27:29
  People ask me, well, you know, they, they always, you know, the
• 27:33
  patients come into the office and say, they always, they ask
• 27:35
  me that all of the, they all ask the same question.
• 27:38
  My doctor is, is like this. They won't give me what I want.
• 27:42
  Why are my, why are all these doctors like that?
• 27:45
  And my answer is yes, they're all like that.
• 27:48
  They're never, ever going to change.
• 27:50
  And that's a good thing, because otherwise I'd have nothing to
• 27:53
  do. So, well, thank you so much for
• 27:56
  coming on the podcast today. Thank you.
• 27:58
  Thank you. Thanks so much for listening.
• 28:02
  It would be amazing if you could follow me or subscribe because
• 28:06
  it will really make a difference to grow numbers, enable this to
• 28:09
  reach even more people. Thanks so much.