Guest guest Posted April 25, 2007 Report Share Posted April 25, 2007 Yes, I have seen this letter. I have not read her new book "Ageless..." but it did get her in a lot of trouble with people she cited and especially ACOG. I am not suggesting she is a good scientific expert by any means. However, she has been a strong voice for alternatives for women, and a "fountain of youth" perspective which I do not like. However, mainstream medicine has been overly influenced by big "Pharma" in this area. She, and many more like us, should challenge that. Joe ph E. Scherger, MD, MPHClinical ProfessorUniversity of California, San DiegoMedical Director, AmeriChoice8840 Complex Dr. Suite 300San Diego, CA 92123Phone: Fax: JScherger@...>>> Seto 4/25/2007 12:49 AM >>>I know very little about bioidentical hormones but I found this "Letter to Suzanne Somers" on a website by Dr. Schwartz and one of the co-signers is the very Dr. Schwarzbein whom you mention below. Basically, it is very critical of Ms. Somers newest book, "Ageless: The Naked Truth about Bioidentical Hormones":http://drerika.typepad.com/notepad/2006/10/letter_to_suzan.html"While some of us were interviewed for the book, a significant portion of the material in the book relies on information and opinion from T.S. Wiley, an actress with a B.A. in anthropology. Wiley has no medical or clinical qualifications. To our dismay, Wiley dispenses gratuitous advice on significant medical issues including the use of bioidentical hormone therapies, areas that are legally and ethically the domain of licensed medical practitioners.Many of the claims throughout the book are scientifically unproven and dangerous. By mixing quotes from qualified physicians who are experts in their fields and bioidentical hormone treatments, with those of a person with no medical or scientific background, this book will further confuse women and we believe, may potentially put their health at risk.We believe Ageless is detrimental and dangerous to the thousands of women who read it because the book freely and repeatedly blurs the line of medical ethics and science with hearsay. The so-called "protocols" endorsed and promulgated throughout the book may expose women to serious health dangers. They offer a "one size fits all" approach, endorsing dangerously high levels of estrogen."So while Ms. Somers may have some medical background, her opinions appear to be in conflict with those of her own personal physician. Or perhaps T.S. Wiley is her new personal "physician". Then I found this website which seems to open up a whole new can of worms: http://www.wileywatch.com/. Dueling bioidentical hormone protocols. It's confusing. SetoSouth Pasadena, CAFYI, Suzanne Somers is a registered nurse, and worked as a nurse in San Francisco before she was "discovered" by Lucas as an actress. For you movie buffs, she was the "blonde in the window" of the car in American Graffiti. Her autobiographical play of the same title is quite good. As many of you know, she has also had breast cancer, and has gone out on a limb with taking human identical hormones. Her personal physician, Swartzbein, an endocrinologist in Santa Barbara, is featured in her book, The Sexy Years, which is a fascinating read. There is a chapter on women over 80 (for the person who said their patients are too old) and a chapter on men. Swartzbein is a controversial physician who has written several books of her own. Joe ph E. Scherger, MD, MPHClinical ProfessorUniversity of California, San DiegoMedical Director, AmeriChoice8840 Complex Dr. Suite 300San Diego, CA 92123Phone: Fax: JSchergerucsd (DOT) edu>>> <vargasca1verizon (DOT) net> 4/24/2007 7:32 PM >>>I had a conversation with one of the specialists in ne Somers's second book who said that she is funding, and finding funding for, research in BHRT, since there is little interest among established HRT manufacturers in finding out that something else is better than their product.I am watching this area closely, and I will solicit the input of a colleague of mine who is a board member of the American College for the Advancement of Medicine (ACAM) and post it here.Ms. Somers could probably deserve a degree after the efforts and knowledge she has compiled in this area. Only time will tell, though, as it does for other drugs. She will soon be heralded as the actress/infomercial icon-turned guru, or just actress/infomercial icon.Charlie Vargaslin, NCFrom: ph Scherger <jschergerucsd (DOT) edu>Date: 2007/04/24 Tue PM 12:01:54 CDTTo: Subject: Re: Re: Bioidentical hormonesThe compounding processed allows for customized dosing, which is often adjusted based on how the patient feels, which of course is very subjective. Some do compounding to achieve and maintain certain hormone blood levels, again difficult to interpret. Estradiol is the dominant estrogen in the human body. I have limited my practice to estradiol from .5 to 2 mg daily and prometrium 100 mg daily (or every other day). Prometrium is not just to protect the uterus, it has a role in perimenopausal hormone balance, especially with the androgen issue. So I use it even in some women without a uterus.There is little good evidence based medicine here. One tragedy in our health system is that once a drug does generic (estradiol), only NIH is left to fund controlled trials, and this has not been a priority area.Joeph E. Scherger, MD, MPHClinical ProfessorUniversity of California, San DiegoMedical Director, AmeriChoice8840 Complex Dr. Suite 300San Diego, CA 92123Phone: Fax: JSchergerucsd (DOT) edu>>> Kathy Broman <kbroman1mac> 04/24/07 5:47 AM >>>When patients in my area come in to talk about bioidentical hormones, they are usually talking about the compounded hormones that mix estradiol with estrone and estriol. So, if estradiol and micronized progesterone-prometrium are just as "bioidentical", I guess the marketing is a bit misleading. Some pharmacists compound to use it topically and some orally. They can compound to combine with DHEA and or testosterone. Often pharmacies that do this compounding would also be doing the salivary hormone testing which would then advise women, what they needed to treat their symptoms. Now, I believe that even salivary testing needs a doctor's order, which it hadn't previously. I was never convinced that salivary testing was that accurate, although proponents feel it is more accurate than serum testing. Progesterone is either given as a troche or orally or topically when it is compounded. Those that market compounding, rave about the effects of the estrone over the estradiol as being more "natural". There are books, about the wonders of the compounded bioidentical hormones, but I have not read them as of yet. Some written by physicians, not just Suzanne Sommers. I believe, without reading them, that they rely on patient history rather than research, but as I said, I haven't read them. The proponents also rave about it being much more safe, but I haven't seen much research on this yet, although I am hoping some studies on the way some where. I have seen some studies that document fewer episodes of DVT etc with transdermal estrogen, but I am not well versed enough in epidemiology to judge whether they are adequate studies or not. Some women that seem to prefer the compounded bi estrogen and tri estrogen for their menopausal symptoms, over the other types of pharmaceutical forms of estrogen. I don't know if most had been on premarin previously or not. It seems that the women that are most symptomatic with hot flashes, memory and mood changes, are often the ones that are most happy with compounding, as they have tried most of the other types of estrogen, but once again, I am assuming this and don't have studies to prove it. For me the osteoporosis was more worrisome than the hot flashes.Kathy BromanOn Monday, April 23, 2007, at 02:37PM, <magnetdoctorcomcast (DOT) net> wrote:>I actually use both. I rarely use Prempro, unless a patient stopped it, and then asks to get back on, after problems with other estradiol or prometrium agents. Here's some of what I tell patients. >The largest study to date only looked at Prempro, and used women average age 60, time past menopause 2-10 yr. No one would argue against the idea, that a 60 yo who hasn't had any estrogen/progestero<wbr>ne naturally for 10 yr has different arteries, than someone 49, who is currently in the perimenopause. We have no 6 y, 50,000 person study on estradiol, or any of the transdermal forms of estrogen+/- progesterone. We believe based on the idea that you can give less, and bypass the first pass effect, that transdermal anything is likely to be safer. Until we have a 50,000 person study on estradiol transdermal, cream, lotion or patch, we won't know. We believe based on smaller studies of estradiol and prometrium, and experience in other countries that these are safer, horse mare urine, has 3 estrogens, but in reverse ratio of what we produce. That is the safest estrogen is the least available in the horse urine, and the most clot inducing, cancer inducing is the highest in horse mare u>rine. I tell people it is a very hot area of research, to make a decision yrly based on their symptoms, family hx, and any new studies. >I bow to the vast research mining skills of Dr Joe Scherger, on what may be latest/greatest. >Dr Scherger, nice to see you on list, even though I no longer do obstetrics, you vastly influenced my life, for the better for several yrs, by your example. > Cote' MD>Four Corners Family Medicine>No fianancial ties to Suzane Sommers ( I hate that book, get a degree already), Prempro or any of the various forms of Estradiol now on the market. >>Original message ---------------------->From: " Brand" <laura.j.brandgmail>>> >> >>> > Hi gang!>> > >> > It's me and my goofball questions again! >> > >> > Does anyone prescribe bioidentical hormones? I'm curious to hear the>> > experience of others >> > >> > Hugs,>> > >> > Britney>> >>> I use them myself and I think they work well for my post-menopausal>> symptoms. My patients also like them. They are quite popular with a>> number of gynecologists in our area.>> >> Brand>> >> >>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 22, 2007 Report Share Posted May 22, 2007 I have a patient who is using ‘arbonne” “prolief” cream daily for 10 days of mid-cycle to reduce moodiness and has had some relief. I asked her to get more information and she was able to learn that the product is plant based but “tweaked” in lab to become bio-identical. It is delivered in a metered-dose pump with “20 mg” to each dose. Anyone on the list serve have any advice with regards to this product or as how to advise this patient? I would love to attend some CME on the issue of “bio-identicals” so if anyone spots such a seminar, please pass info to me. Thanks Ramona It seems a low dose (?) and perhaps holds little harm and may even be helping the patient (even if placebo effect)? Ramona G. Seidel, M.D. www.baycrossingfamilymedicine.com Your Bridge to Health I know very little about bioidentical hormones but I found this " Letter to Suzanne Somers " on a website by Dr. Schwartz and one of the co-signers is the very Dr. Schwarzbein whom you mention below. Basically, it is very critical of Ms. Somers newest book, " Ageless: The Naked Truth about Bioidentical Hormones " : http://drerika.typepad.com/notepad/2006/10/letter_to_suzan.html " While some of us were interviewed for the book, a significant portion of the material in the book relies on information and opinion from T.S. Wiley, an actress with a B.A. in anthropology. Wiley has no medical or clinical qualifications. To our dismay, Wiley dispenses gratuitous advice on significant medical issues including the use of bioidentical hormone therapies, areas that are legally and ethically the domain of licensed medical practitioners. Many of the claims throughout the book are scientifically unproven and dangerous. By mixing quotes from qualified physicians who are experts in their fields and bioidentical hormone treatments, with those of a person with no medical or scientific background, this book will further confuse women and we believe, may potentially put their health at risk. We believe Ageless is detrimental and dangerous to the thousands of women who read it because the book freely and repeatedly blurs the line of medical ethics and science with hearsay. The so-called " protocols " endorsed and promulgated throughout the book may expose women to serious health dangers. They offer a " one size fits all " approach, endorsing dangerously high levels of estrogen. " So while Ms. Somers may have some medical background, her opinions appear to be in conflict with those of her own personal physician. Or perhaps T.S. Wiley is her new personal " physician " . Then I found this website which seems to open up a whole new can of worms: http://www.wileywatch.com/. Dueling bioidentical hormone protocols. It's confusing. Seto South Pasadena, CA FYI, Suzanne Somers is a registered nurse, and worked as a nurse in San Francisco before she was " discovered " by Lucas as an actress. For you movie buffs, she was the " blonde in the window " of the car in American Graffiti. Her autobiographical play of the same title is quite good. As many of you know, she has also had breast cancer, and has gone out on a limb with taking human identical hormones. Her personal physician, Swartzbein, an endocrinologist in Santa Barbara, is featured in her book, The Sexy Years, which is a fascinating read. There is a chapter on women over 80 (for the person who said their patients are too old) and a chapter on men. Swartzbein is a controversial physician who has written several books of her own. Joe ph E. Scherger, MD, MPH Clinical Professor University of California, San Diego Medical Director, AmeriChoice 8840 Complex Dr. Suite 300 San Diego, CA 92123 Phone: Fax: JSchergerucsd (DOT) edu >>> <vargasca1verizon (DOT) net> 4/24/2007 7:32 PM >>> I had a conversation with one of the specialists in ne Somers's second book who said that she is funding, and finding funding for, research in BHRT, since there is little interest among established HRT manufacturers in finding out that something else is better than their product. I am watching this area closely, and I will solicit the input of a colleague of mine who is a board member of the American College for the Advancement of Medicine (ACAM) and post it here. Ms. Somers could probably deserve a degree after the efforts and knowledge she has compiled in this area. Only time will tell, though, as it does for other drugs. She will soon be heralded as the actress/infomercial icon-turned guru, or just actress/infomercial icon. Charlie Vargas lin, NC From: ph Scherger <jschergerucsd (DOT) edu> Date: 2007/04/24 Tue PM 12:01:54 CDT To: Subject: Re: Re: Bioidentical hormones The compounding processed allows for customized dosing, which is often adjusted based on how the patient feels, which of course is very subjective. Some do compounding to achieve and maintain certain hormone blood levels, again difficult to interpret. Estradiol is the dominant estrogen in the human body. I have limited my practice to estradiol from .5 to 2 mg daily and prometrium 100 mg daily (or every other day). Prometrium is not just to protect the uterus, it has a role in perimenopausal hormone balance, especially with the androgen issue. So I use it even in some women without a uterus. There is little good evidence based medicine here. One tragedy in our health system is that once a drug does generic (estradiol), only NIH is left to fund controlled trials, and this has not been a priority area. Joe ph E. Scherger, MD, MPH Clinical Professor University of California, San Diego Medical Director, AmeriChoice 8840 Complex Dr. Suite 300 San Diego, CA 92123 Phone: Fax: JSchergerucsd (DOT) edu >>> Kathy Broman <kbroman1mac> 04/24/07 5:47 AM >>> When patients in my area come in to talk about bioidentical hormones, they are usually talking about the compounded hormones that mix estradiol with estrone and estriol. So, if estradiol and micronized progesterone-prometrium are just as " bioidentical " , I guess the marketing is a bit misleading. Some pharmacists compound to use it topically and some orally. They can compound to combine with DHEA and or testosterone. Often pharmacies that do this compounding would also be doing the salivary hormone testing which would then advise women, what they needed to treat their symptoms. Now, I believe that even salivary testing needs a doctor's order, which it hadn't previously. I was never convinced that salivary testing was that accurate, although proponents feel it is more accurate than serum testing. Progesterone is either given as a troche or orally or topically when it is compounded. Those that market compounding, rave about the effects of the estrone over the estradiol as being more " natural " . There are books, about the wonders of the compounded bioidentical hormones, but I have not read them as of yet. Some written by physicians, not just Suzanne Sommers. I believe, without reading them, that they rely on patient history rather than research, but as I said, I haven't read them. The proponents also rave about it being much more safe, but I haven't seen much research on this yet, although I am hoping some studies on the way some where. I have seen some studies that document fewer episodes of DVT etc with transdermal estrogen, but I am not well versed enough in epidemiology to judge whether they are adequate studies or not. Some women that seem to prefer the compounded bi estrogen and tri estrogen for their menopausal symptoms, over the other types of pharmaceutical forms of estrogen. I don't know if most had been on premarin previously or not. It seems that the women that are most symptomatic with hot flashes, memory and mood changes, are often the ones that are most happy with compounding, as they have tried most of the other types of estrogen, but once again, I am assuming this and don't have studies to prove it. For me the osteoporosis was more worrisome than the hot flashes. Kathy Broman On Monday, April 23, 2007, at 02:37PM, <magnetdoctorcomcast (DOT) net> wrote: >I actually use both. I rarely use Prempro, unless a patient stopped it, and then asks to get back on, after problems with other estradiol or prometrium agents. Here's some of what I tell patients. >The largest study to date only looked at Prempro, and used women average age 60, time past menopause 2-10 yr. No one would argue against the idea, that a 60 yo who hasn't had any estrogen/progestero<wbr>ne naturally for 10 yr has different arteries, than someone 49, who is currently in the perimenopause. We have no 6 y, 50,000 person study on estradiol, or any of the transdermal forms of estrogen+/- progesterone. We believe based on the idea that you can give less, and bypass the first pass effect, that transdermal anything is likely to be safer. Until we have a 50,000 person study on estradiol transdermal, cream, lotion or patch, we won't know. We believe based on smaller studies of estradiol and prometrium, and experience in other countries that these are safer, horse mare urine, has 3 estrogens, but in reverse ratio of what we produce. That is the safest estrogen is the least available in the horse urine, and the most clot inducing, cancer inducing is the highest in horse mare u >rine. I tell people it is a very hot area of research, to make a decision yrly based on their symptoms, family hx, and any new studies. >I bow to the vast research mining skills of Dr Joe Scherger, on what may be latest/greatest. >Dr Scherger, nice to see you on list, even though I no longer do obstetrics, you vastly influenced my life, for the better for several yrs, by your example. > Cote' MD >Four Corners Family Medicine >No fianancial ties to Suzane Sommers ( I hate that book, get a degree already), Prempro or any of the various forms of Estradiol now on the market. > >Original message ---------------------- >From: " Brand " <laura.j.brandgmail> >> >> > >> > Hi gang! >> > >> > It's me and my goofball questions again! >> > >> > Does anyone prescribe bioidentical hormones? I'm curious to hear the >> > experience of others >> > >> > Hugs, >> > >> > Britney >> > >> I use them myself and I think they work well for my post-menopausal >> symptoms. My patients also like them. They are quite popular with a >> number of gynecologists in our area. >> >> Brand >> >> > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 25, 2007 Report Share Posted May 25, 2007 There is a world anti-aging medicine and regenerative biomedical technoogies seminar in Chicago from Aug 2-4. You can go to www.worldhealth.net for more info. Bio-identical hormones is one of the topics discussed.See what's free at AOL.com. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 25, 2007 Report Share Posted May 25, 2007 See what's free at AOL.com. There is a world anti-aging medicine and regenerative biomedical technoogies seminar in Chicago from Aug 2-4. You can go to www.worldhealth.net for more info. Bio-identical hormones is one of the topics discussed.See what's free at AOL.com. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 25, 2007 Report Share Posted May 25, 2007 I recently ordered 18 audio CD's on Nutritional Therapy in Medical Practice by ALan Gaby, MD and , MD from their conference in late Jan in Las Vegas for $395. (It would have cost a lot more to go to the conference) There are 2 CDs on endocrine therapy and Dr. has written a book on Bioidentical Hormones several years ago. While these two doctors are somewhat controversial and no CME is available, these guys have scoured the scientific literature as well as amassed years of experience. I am finding the CDs very informative. You also get a book of references and a book of common diseases and the supplements recommended. This is the 17th year they have run this seminar. Janice Pegels, MD > >> > > >> > Hi gang! > >> > > >> > It's me and my goofball questions again! > >> > > >> > Does anyone prescribe bioidentical hormones? I'm curious to hear the > >> > experience of others > >> > > >> > Hugs, > >> > > >> > Britney > >> > > >> I use them myself and I think they work well for my post-menopausal > >> symptoms. My patients also like them. They are quite popular with a > >> number of gynecologists in our area. > >> > >> Brand > >> > >> > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 25, 2007 Report Share Posted May 25, 2007 Website for Nutrition Therapy in Medical Practice is www.wrightgabynutrition.com Janice > >> > > >> > Hi gang! > >> > > >> > It's me and my goofball questions again! > >> > > >> > Does anyone prescribe bioidentical hormones? I'm curious to hear the > >> > experience of others > >> > > >> > Hugs, > >> > > >> > Britney > >> > > >> I use them myself and I think they work well for my post-menopausal > >> symptoms. My patients also like them. They are quite popular with a > >> number of gynecologists in our area. > >> > >> Brand > >> > >> > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 26, 2007 Report Share Posted May 26, 2007 I had a pt using that before, too. I think it is their progesterone cream? I’m not aware of them having an estradiol cream, but I may not be up to date. She brought in the product and the info on it. It supposedly is air tight, so the decay is minimal. It is supposed to have a metered delivery so you get a standard dose per pump. It worked well for her. A. Eads, M.D. Pinnacle Family Medicine, PLLC phone fax P.O. Box 7275 Woodland Park, CO 80863 www.PinnacleFamilyMedicine.com From: [mailto: ] On Behalf Of RGMS Sent: Tuesday, May 22, 2007 12:46 PM To: Subject: RE: Re: Bioidentical hormones I have a patient who is using ‘arbonne” “prolief” cream daily for 10 days of mid-cycle to reduce moodiness and has had some relief. I asked her to get more information and she was able to learn that the product is plant based but “tweaked” in lab to become bio-identical. It is delivered in a metered-dose pump with “20 mg” to each dose. Anyone on the list serve have any advice with regards to this product or as how to advise this patient? I would love to attend some CME on the issue of “bio-identicals” so if anyone spots such a seminar, please pass info to me. Thanks Ramona It seems a low dose (?) and perhaps holds little harm and may even be helping the patient (even if placebo effect)? Ramona G. Seidel, M.D. www.baycrossingfamilymedicine.com Your Bridge to Health I know very little about bioidentical hormones but I found this " Letter to Suzanne Somers " on a website by Dr. Schwartz and one of the co-signers is the very Dr. Schwarzbein whom you mention below. Basically, it is very critical of Ms. Somers newest book, " Ageless: The Naked Truth about Bioidentical Hormones " : http://drerika.typepad.com/notepad/2006/10/letter_to_suzan.html " While some of us were interviewed for the book, a significant portion of the material in the book relies on information and opinion from T.S. Wiley, an actress with a B.A. in anthropology. Wiley has no medical or clinical qualifications. To our dismay, Wiley dispenses gratuitous advice on significant medical issues including the use of bioidentical hormone therapies, areas that are legally and ethically the domain of licensed medical practitioners. Many of the claims throughout the book are scientifically unproven and dangerous. By mixing quotes from qualified physicians who are experts in their fields and bioidentical hormone treatments, with those of a person with no medical or scientific background, this book will further confuse women and we believe, may potentially put their health at risk. We believe Ageless is detrimental and dangerous to the thousands of women who read it because the book freely and repeatedly blurs the line of medical ethics and science with hearsay. The so-called " protocols " endorsed and promulgated throughout the book may expose women to serious health dangers. They offer a " one size fits all " approach, endorsing dangerously high levels of estrogen. " So while Ms. Somers may have some medical background, her opinions appear to be in conflict with those of her own personal physician. Or perhaps T.S. Wiley is her new personal " physician " . Then I found this website which seems to open up a whole new can of worms: http://www.wileywatch.com/. Dueling bioidentical hormone protocols. It's confusing. Seto South Pasadena, CA FYI, Suzanne Somers is a registered nurse, and worked as a nurse in San Francisco before she was " discovered " by Lucas as an actress. For you movie buffs, she was the " blonde in the window " of the car in American Graffiti. Her autobiographical play of the same title is quite good. As many of you know, she has also had breast cancer, and has gone out on a limb with taking human identical hormones. Her personal physician, Swartzbein, an endocrinologist in Santa Barbara, is featured in her book, The Sexy Years, which is a fascinating read. There is a chapter on women over 80 (for the person who said their patients are too old) and a chapter on men. Swartzbein is a controversial physician who has written several books of her own. Joe ph E. Scherger, MD, MPH Clinical Professor University of California, San Diego Medical Director, AmeriChoice 8840 Complex Dr. Suite 300 San Diego, CA 92123 Phone: Fax: JSchergerucsd (DOT) edu >>> <vargasca1verizon (DOT) net> 4/24/2007 7:32 PM >>> I had a conversation with one of the specialists in ne Somers's second book who said that she is funding, and finding funding for, research in BHRT, since there is little interest among established HRT manufacturers in finding out that something else is better than their product. I am watching this area closely, and I will solicit the input of a colleague of mine who is a board member of the American College for the Advancement of Medicine (ACAM) and post it here. Ms. Somers could probably deserve a degree after the efforts and knowledge she has compiled in this area. Only time will tell, though, as it does for other drugs. She will soon be heralded as the actress/infomercial icon-turned guru, or just actress/infomercial icon. Charlie Vargas lin, NC From: ph Scherger <jschergerucsd (DOT) edu> Date: 2007/04/24 Tue PM 12:01:54 CDT To: Subject: Re: Re: Bioidentical hormones The compounding processed allows for customized dosing, which is often adjusted based on how the patient feels, which of course is very subjective. Some do compounding to achieve and maintain certain hormone blood levels, again difficult to interpret. Estradiol is the dominant estrogen in the human body. I have limited my practice to estradiol from .5 to 2 mg daily and prometrium 100 mg daily (or every other day). Prometrium is not just to protect the uterus, it has a role in perimenopausal hormone balance, especially with the androgen issue. So I use it even in some women without a uterus. There is little good evidence based medicine here. One tragedy in our health system is that once a drug does generic (estradiol), only NIH is left to fund controlled trials, and this has not been a priority area. Joe ph E. Scherger, MD, MPH Clinical Professor University of California, San Diego Medical Director, AmeriChoice 8840 Complex Dr. Suite 300 San Diego, CA 92123 Phone: Fax: JSchergerucsd (DOT) edu >>> Kathy Broman <kbroman1mac> 04/24/07 5:47 AM >>> When patients in my area come in to talk about bioidentical hormones, they are usually talking about the compounded hormones that mix estradiol with estrone and estriol. So, if estradiol and micronized progesterone-prometrium are just as " bioidentical " , I guess the marketing is a bit misleading. Some pharmacists compound to use it topically and some orally. They can compound to combine with DHEA and or testosterone. Often pharmacies that do this compounding would also be doing the salivary hormone testing which would then advise women, what they needed to treat their symptoms. Now, I believe that even salivary testing needs a doctor's order, which it hadn't previously. I was never convinced that salivary testing was that accurate, although proponents feel it is more accurate than serum testing. Progesterone is either given as a troche or orally or topically when it is compounded. Those that market compounding, rave about the effects of the estrone over the estradiol as being more " natural " . There are books, about the wonders of the compounded bioidentical hormones, but I have not read them as of yet. Some written by physicians, not just Suzanne Sommers. I believe, without reading them, that they rely on patient history rather than research, but as I said, I haven't read them. The proponents also rave about it being much more safe, but I haven't seen much research on this yet, although I am hoping some studies on the way some where. I have seen some studies that document fewer episodes of DVT etc with transdermal estrogen, but I am not well versed enough in epidemiology to judge whether they are adequate studies or not. Some women that seem to prefer the compounded bi estrogen and tri estrogen for their menopausal symptoms, over the other types of pharmaceutical forms of estrogen. I don't know if most had been on premarin previously or not. It seems that the women that are most symptomatic with hot flashes, memory and mood changes, are often the ones that are most happy with compounding, as they have tried most of the other types of estrogen, but once again, I am assuming this and don't have studies to prove it. For me the osteoporosis was more worrisome than the hot flashes. Kathy Broman On Monday, April 23, 2007, at 02:37PM, <magnetdoctorcomcast (DOT) net> wrote: >I actually use both. I rarely use Prempro, unless a patient stopped it, and then asks to get back on, after problems with other estradiol or prometrium agents. Here's some of what I tell patients. >The largest study to date only looked at Prempro, and used women average age 60, time past menopause 2-10 yr. No one would argue against the idea, that a 60 yo who hasn't had any estrogen/progestero<wbr>ne naturally for 10 yr has different arteries, than someone 49, who is currently in the perimenopause. We have no 6 y, 50,000 person study on estradiol, or any of the transdermal forms of estrogen+/- progesterone. We believe based on the idea that you can give less, and bypass the first pass effect, that transdermal anything is likely to be safer. Until we have a 50,000 person study on estradiol transdermal, cream, lotion or patch, we won't know. We believe based on smaller studies of estradiol and prometrium, and experience in other countries that these are safer, horse mare urine, has 3 estrogens, but in reverse ratio of what we produce. That is the safest estrogen is the least available in the horse urine, and the most clot inducing, cancer inducing is the highest in horse mare u >rine. I tell people it is a very hot area of research, to make a decision yrly based on their symptoms, family hx, and any new studies. >I bow to the vast research mining skills of Dr Joe Scherger, on what may be latest/greatest. >Dr Scherger, nice to see you on list, even though I no longer do obstetrics, you vastly influenced my life, for the better for several yrs, by your example. > Cote' MD >Four Corners Family Medicine >No fianancial ties to Suzane Sommers ( I hate that book, get a degree already), Prempro or any of the various forms of Estradiol now on the market. > >Original message ---------------------- >From: " Brand " <laura.j.brandgmail> >> >> > >> > Hi gang! >> > >> > It's me and my goofball questions again! >> > >> > Does anyone prescribe bioidentical hormones? I'm curious to hear the >> > experience of others >> > >> > Hugs, >> > >> > Britney >> > >> I use them myself and I think they work well for my post-menopausal >> symptoms. My patients also like them. They are quite popular with a >> number of gynecologists in our area. >> >> Brand >> >> > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 26, 2007 Report Share Posted May 26, 2007 I had a pt using that before, too. I think it is their progesterone cream? I’m not aware of them having an estradiol cream, but I may not be up to date. She brought in the product and the info on it. It supposedly is air tight, so the decay is minimal. It is supposed to have a metered delivery so you get a standard dose per pump. It worked well for her. A. Eads, M.D. Pinnacle Family Medicine, PLLC phone fax P.O. Box 7275 Woodland Park, CO 80863 www.PinnacleFamilyMedicine.com From: [mailto: ] On Behalf Of RGMS Sent: Tuesday, May 22, 2007 12:46 PM To: Subject: RE: Re: Bioidentical hormones I have a patient who is using ‘arbonne” “prolief” cream daily for 10 days of mid-cycle to reduce moodiness and has had some relief. I asked her to get more information and she was able to learn that the product is plant based but “tweaked” in lab to become bio-identical. It is delivered in a metered-dose pump with “20 mg” to each dose. Anyone on the list serve have any advice with regards to this product or as how to advise this patient? I would love to attend some CME on the issue of “bio-identicals” so if anyone spots such a seminar, please pass info to me. Thanks Ramona It seems a low dose (?) and perhaps holds little harm and may even be helping the patient (even if placebo effect)? Ramona G. Seidel, M.D. www.baycrossingfamilymedicine.com Your Bridge to Health I know very little about bioidentical hormones but I found this " Letter to Suzanne Somers " on a website by Dr. Schwartz and one of the co-signers is the very Dr. Schwarzbein whom you mention below. Basically, it is very critical of Ms. Somers newest book, " Ageless: The Naked Truth about Bioidentical Hormones " : http://drerika.typepad.com/notepad/2006/10/letter_to_suzan.html " While some of us were interviewed for the book, a significant portion of the material in the book relies on information and opinion from T.S. Wiley, an actress with a B.A. in anthropology. Wiley has no medical or clinical qualifications. To our dismay, Wiley dispenses gratuitous advice on significant medical issues including the use of bioidentical hormone therapies, areas that are legally and ethically the domain of licensed medical practitioners. Many of the claims throughout the book are scientifically unproven and dangerous. By mixing quotes from qualified physicians who are experts in their fields and bioidentical hormone treatments, with those of a person with no medical or scientific background, this book will further confuse women and we believe, may potentially put their health at risk. We believe Ageless is detrimental and dangerous to the thousands of women who read it because the book freely and repeatedly blurs the line of medical ethics and science with hearsay. The so-called " protocols " endorsed and promulgated throughout the book may expose women to serious health dangers. They offer a " one size fits all " approach, endorsing dangerously high levels of estrogen. " So while Ms. Somers may have some medical background, her opinions appear to be in conflict with those of her own personal physician. Or perhaps T.S. Wiley is her new personal " physician " . Then I found this website which seems to open up a whole new can of worms: http://www.wileywatch.com/. Dueling bioidentical hormone protocols. It's confusing. Seto South Pasadena, CA FYI, Suzanne Somers is a registered nurse, and worked as a nurse in San Francisco before she was " discovered " by Lucas as an actress. For you movie buffs, she was the " blonde in the window " of the car in American Graffiti. Her autobiographical play of the same title is quite good. As many of you know, she has also had breast cancer, and has gone out on a limb with taking human identical hormones. Her personal physician, Swartzbein, an endocrinologist in Santa Barbara, is featured in her book, The Sexy Years, which is a fascinating read. There is a chapter on women over 80 (for the person who said their patients are too old) and a chapter on men. Swartzbein is a controversial physician who has written several books of her own. Joe ph E. Scherger, MD, MPH Clinical Professor University of California, San Diego Medical Director, AmeriChoice 8840 Complex Dr. Suite 300 San Diego, CA 92123 Phone: Fax: JSchergerucsd (DOT) edu >>> <vargasca1verizon (DOT) net> 4/24/2007 7:32 PM >>> I had a conversation with one of the specialists in ne Somers's second book who said that she is funding, and finding funding for, research in BHRT, since there is little interest among established HRT manufacturers in finding out that something else is better than their product. I am watching this area closely, and I will solicit the input of a colleague of mine who is a board member of the American College for the Advancement of Medicine (ACAM) and post it here. Ms. Somers could probably deserve a degree after the efforts and knowledge she has compiled in this area. Only time will tell, though, as it does for other drugs. She will soon be heralded as the actress/infomercial icon-turned guru, or just actress/infomercial icon. Charlie Vargas lin, NC From: ph Scherger <jschergerucsd (DOT) edu> Date: 2007/04/24 Tue PM 12:01:54 CDT To: Subject: Re: Re: Bioidentical hormones The compounding processed allows for customized dosing, which is often adjusted based on how the patient feels, which of course is very subjective. Some do compounding to achieve and maintain certain hormone blood levels, again difficult to interpret. Estradiol is the dominant estrogen in the human body. I have limited my practice to estradiol from .5 to 2 mg daily and prometrium 100 mg daily (or every other day). Prometrium is not just to protect the uterus, it has a role in perimenopausal hormone balance, especially with the androgen issue. So I use it even in some women without a uterus. There is little good evidence based medicine here. One tragedy in our health system is that once a drug does generic (estradiol), only NIH is left to fund controlled trials, and this has not been a priority area. Joe ph E. Scherger, MD, MPH Clinical Professor University of California, San Diego Medical Director, AmeriChoice 8840 Complex Dr. Suite 300 San Diego, CA 92123 Phone: Fax: JSchergerucsd (DOT) edu >>> Kathy Broman <kbroman1mac> 04/24/07 5:47 AM >>> When patients in my area come in to talk about bioidentical hormones, they are usually talking about the compounded hormones that mix estradiol with estrone and estriol. So, if estradiol and micronized progesterone-prometrium are just as " bioidentical " , I guess the marketing is a bit misleading. Some pharmacists compound to use it topically and some orally. They can compound to combine with DHEA and or testosterone. Often pharmacies that do this compounding would also be doing the salivary hormone testing which would then advise women, what they needed to treat their symptoms. Now, I believe that even salivary testing needs a doctor's order, which it hadn't previously. I was never convinced that salivary testing was that accurate, although proponents feel it is more accurate than serum testing. Progesterone is either given as a troche or orally or topically when it is compounded. Those that market compounding, rave about the effects of the estrone over the estradiol as being more " natural " . There are books, about the wonders of the compounded bioidentical hormones, but I have not read them as of yet. Some written by physicians, not just Suzanne Sommers. I believe, without reading them, that they rely on patient history rather than research, but as I said, I haven't read them. The proponents also rave about it being much more safe, but I haven't seen much research on this yet, although I am hoping some studies on the way some where. I have seen some studies that document fewer episodes of DVT etc with transdermal estrogen, but I am not well versed enough in epidemiology to judge whether they are adequate studies or not. Some women that seem to prefer the compounded bi estrogen and tri estrogen for their menopausal symptoms, over the other types of pharmaceutical forms of estrogen. I don't know if most had been on premarin previously or not. It seems that the women that are most symptomatic with hot flashes, memory and mood changes, are often the ones that are most happy with compounding, as they have tried most of the other types of estrogen, but once again, I am assuming this and don't have studies to prove it. For me the osteoporosis was more worrisome than the hot flashes. Kathy Broman On Monday, April 23, 2007, at 02:37PM, <magnetdoctorcomcast (DOT) net> wrote: >I actually use both. I rarely use Prempro, unless a patient stopped it, and then asks to get back on, after problems with other estradiol or prometrium agents. Here's some of what I tell patients. >The largest study to date only looked at Prempro, and used women average age 60, time past menopause 2-10 yr. No one would argue against the idea, that a 60 yo who hasn't had any estrogen/progestero<wbr>ne naturally for 10 yr has different arteries, than someone 49, who is currently in the perimenopause. We have no 6 y, 50,000 person study on estradiol, or any of the transdermal forms of estrogen+/- progesterone. We believe based on the idea that you can give less, and bypass the first pass effect, that transdermal anything is likely to be safer. Until we have a 50,000 person study on estradiol transdermal, cream, lotion or patch, we won't know. We believe based on smaller studies of estradiol and prometrium, and experience in other countries that these are safer, horse mare urine, has 3 estrogens, but in reverse ratio of what we produce. That is the safest estrogen is the least available in the horse urine, and the most clot inducing, cancer inducing is the highest in horse mare u >rine. I tell people it is a very hot area of research, to make a decision yrly based on their symptoms, family hx, and any new studies. >I bow to the vast research mining skills of Dr Joe Scherger, on what may be latest/greatest. >Dr Scherger, nice to see you on list, even though I no longer do obstetrics, you vastly influenced my life, for the better for several yrs, by your example. > Cote' MD >Four Corners Family Medicine >No fianancial ties to Suzane Sommers ( I hate that book, get a degree already), Prempro or any of the various forms of Estradiol now on the market. > >Original message ---------------------- >From: " Brand " <laura.j.brandgmail> >> >> > >> > Hi gang! >> > >> > It's me and my goofball questions again! >> > >> > Does anyone prescribe bioidentical hormones? I'm curious to hear the >> > experience of others >> > >> > Hugs, >> > >> > Britney >> > >> I use them myself and I think they work well for my post-menopausal >> symptoms. My patients also like them. They are quite popular with a >> number of gynecologists in our area. >> >> Brand >> >> > > > Quote Link to comment Share on other sites More sharing options...
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