253 ‒ Hormone replacement therapy and the Women’s Health Initiative: re-examining the results

This episode illustrates the power of persuasion and being a good orator. I have listened and re-listened to this podcast and if I were to exclude Dr. Attia’s commentary, I would believe that HRT is still dangerous and the only benefit is to reduce lost sleep and hot flashes due to menopause?!? Perhaps it’s her monotonous tone or fear of implicating herself by stressing the positives, though honestly this detracted from me looking into HRT unless absolutely necessary. I think you need a guest that stresses the positives backed by clinical data. If the intention was to get people to re-examine the controversial women’s health initiative and not fear HRT, it missed the mark. Please have a guest on that can speak honestly to the positives backed by clinical data to support HRT. Her responses were like a politician answering questions…though in the end left the female listener still weary.

Dear Dr Attia,
I would like to propose a (perhaps) new angle in approaching the topic of HRT in peri- and post-menopause. I would love it if you had a guest who can take us into estradiol’s role in ALL the organ systems of a woman’s body where this hormone has functions, and preferably into a level that goes beyond “estradiol is good for the bones, heart and brain”. I have heard that there are estrogen receptors in every organ system of a woman’s body, meaning estradiol serves many purposes beyond the reproductive functions …
I would really like a more detailed lecture on what estrogen does on a cellular level to keep a woman’s body functioning optimally. I would like to learn, what happens to those bodily functions when estrogen is no longer produced by a woman’s ovaries.
Once we understand all the important roles of estradiol (and progesterone, and testosterone) in the female body, we can ask why we are not viewing and treating it as a hormone deficiency like any other (thyroid hormone, insulin, vitamin D)? Dr Louise Newson in the UK, for instance, works tirelessly in this area, to have us understand menopause as a “long term female hormone deficiency with health risks”.
Ideally, it should be a woman’s choice whether to take hormone therapy for her quality of life and to help prevent important diseases.

I love these mega experienced drs speaking about their work. You should interview Professor Susan Davis on her work on testosterone for women.

Thankyou for discussing menopause, I only became educated after listening a few years ago to Prof Cassandra Szoeke (book-Secrets of Women’s Healthy Ageing). Thus a week go at age 55 asked my GP for HRT. I opted for gel(estrogen & progesterone), having osteopenia is a worry so I also do RT. Also not on PBS thus $83. Aud per 2 months👎

This whole thing makes me so angry, especially when the docs focus on hot flashes and night sweats. Yes, those are no fun, but my symptoms were much, much worse. I felt like I was falling apart mentally, physically and emotionally. I had almost all of the symptoms mentioned in the great book, Estrogen Matters. I would’ve given up 10 years of my life to feel better and be functional. I would’ve had a prophylactic mastectomy if that’s what it took. No doctor would prescribe estrogen for me because I had a stage 1 breast cancer in 2015. I’ve been cancer free since then and I understand the supposed increased risk in a recurrence (which I don’t necessarily buy.) In any case, it should be my choice – it’s my body and my life. I was lucky to find a friend who was willing to prescribe estradiol patches for me. My quality of life increased 10-fold in about a week. They can pry my estradiol patches out of my cold dead hands. I intend to stay on estrogen for the rest of my life. I believe that starting early will help prevent the conditions that are more prevalent in older age. I agree that it is sad that millions of women suffered unnecessarily since 2002. What about the millions of breast cancer survivors that are currently suffering? Dr Avrum Bluming has an article that goes over every study regarding estrogen after breast cancer and I am convinced that the current “contraindication” will someday be shown to be wrong. Even if there is an increased risk of recurrence, I am willingly taking that risk. Who wants to feel like hell for their later 20-30 years of their life? Not me.

Peter, I respect your diplomacy and professional focus throughout this interview. I love your podcasts which are so informative.
However, I think this leading expert "DOTH PROTEST TOO MUCH" AND REPEATEDLY DEFENDS BOTH DIRECTLY AND INDIRECTLY THE WOMENS INITIATIVE CONCLUSIONS which were highly misleading. She only backtracked a little and continued to emphasize that "IT CLEARLY PUT AN END TO AN UNNECESSARY PRACTICE as if that compensated for what I as layman regard as a great loss to the health and happiness of many women.
My mother lost her bone density and it was so bad she could not risk shaking hands with people because her fingers broke if squeezed and she had multiple other problems which she insisted were due to lack of hormones. I saw her rapid decline when she suddenly was refused HRT.
Pls let's continue to talk about this issue and create an even more nuanced picture. The subjective picture from my perspective is as follows. Aged 50 having suffered from hormone disturbances on and off all my life, I sadly also witnessed my mother's deterioration. I decided early in menopause to start on HRT "tresequence". and convinced my doctor by talking about the risk of osteoporosis, but in fact, it was much more the overall quality of life that changed positively from the first month. I am now 73 and have decided to never go off HRT until I die. My skin is excellent for my age despite living through no sun protection and as a young woman 60s 70s NS 80s being bombarded by cigarette smoke. My bone mass is great, I look much younger than my age and many people estimate I am in my mid-50s, my vagina is like when I was young. Breast density has reduced over the years, especially in the last 3 years when I have noticed a change as I have lost fat. By the way, my mother also developed severe dementia, which I think also had a lot to do with her hormones. So far I am ok with no signs of that yet either.
I run an NGO in Denmark and have more energy than when I was in my 40s. Many of my friends suffered for years with awful symptoms of menopause and also suffer now from a lack of bone destiny, hip fractures, etc. They think I was daring to continue on HRT after the 2022 rapport came out and they decided not to risk it, because they were told they risked a 25% possibility of getting breast cancer. My doctor for years has tried to convince me to stop. I am sure he means well.

Don't be fooled ladies, HRT is not safe or beneficial. Exercise, nutrition, sunshine and mental health will do so much for you during menopause rather than taking hormonal garbage. It is just ridiculous to see people still pushing and trying to convince women to take HRT 🙄

Bravo and thank you for addressing HRT. I had a complete and elective hysterectomy in my early 40's. I was placed on estrogen and ultimately testosterone. Prior to and after treatment I would participate in endurance sports (Ironman, swimming). At one point and new internist took me off testosterone. I went from running the Chicago marathon to not being able to run a mile (and taking several days to recover). I begged the doctor to put me back on. No body would and I reached the point of telling the doctor that I was a transgender male. I knew that endless amounts of testosterone would be given. I did not do this as I wanted a relationship with a doctor. Anyhow, I thought that i was going crazy. I went to a psychiatrist. He referred me to an oby/gyn and without I fnishing my sentence, she understood my problem and placed me back on testosterone (estro-test). My prior engergy never fully returned however, now I can run a 5k (before i over heat). I continue swimming(masters). I still struggle with mild fatigue and a decrease in motivation. I was off testosterone for two years and the experience was horrible.

I was not a fan of this guest. She was a tad defensive about the WHI and still projected fear about HRT. She brought up antidepressants as an effective alternative?? I guess if you’re clinically depressed, but why else would someone take a drug that alters brain chemistry and promotes weight gain. I think there are better experts out there: Susan Davis, Heather Hirsch, Barbara Taylor, to name a few. But Peter Attia is doing a wonderful job of highlighting overlooked women’s health issues.

I am a NAMS NCMP & saw Dr Mason speak at ASRM 2022. She continues to say we will never have a chance at another HRT RTC, but refuses to use any of the high quality ocservational data we DO have on E2+OMP. Please bring Drs Buming & Tavris back for an update!

Thanks Dr Attia for at least bringing up this issue, we never hear about. I have listened to several podcasts and also read sbout the failings of the Women's Health Initiative. Based on my own research, I feel this guest was a bit biased to the WHI considering she analyzed the data. Specifically there is a huge problem with the health of the sample. Most women in their 60's with significant health problems such as high blood pressure, smokers etc. How does this translate in any shape or form to healthy perimenopausal/menopausal women in their late 40's/early 50's with menopausal symptoms, considering most of the women had gone through menopause or had no symptoms?? I wish this podcast had gone more in depth in the protective benefits of estrogen against cognitive decline and bone health. The same number of women die of hip fracture as those who die of breast cancer. An excellent book, "Estrogen Matters", by Dr Avrum Bluming and Dr Carol Tavris highlights some of these research findings. Dr Barbara Taylor is another excellent source, here on You tube. Both that book and her findings have saved my life, with bio identical estradiol and progesterone for sleep and hot flashes. Please consider interviewing these clinicians in upcoming podcasts for women's health.

I had a hysterectomy/oophorectomy at age 23 and was profoundly symptomatic afterwards. I was initially prescribed Premarin, but after learning about liver cancer risks, transitioned to transdermal. I’ve been on ERT for 50 years, and at the age of 70 , had a hard fall from a road bike directly onto my hip, hitting so hard my hip turned black — but no bone damage… I have great bone density. Symptoms controlled by a little patch include migraine, PVCs, insomnia, soaking sweats, labile moods, formication, and insatiable appetite. Symptoms improved but not fully relieved are dry eyes and mouth memory issues, and anxiety. I’ll be on ERT till I die, even if that comes earlier than it might otherwise.

CATARACTS

Sorry wrong topic but

Just shows how all this superficial knowledge and lack of clear unerstanding makes the treatments sound good ,cataracts and eye physiology have studied now for 2 years protein aggregation is root cause ,that is misfolding and perhaps cacium build up of two types of heat shock proteins alpha and beta Alpha acts a a chaperone and is protective diet and certain nutrients or lack of them play a big part on oremature protein aggregation ,but what is amazing is the lack of enthusiasm fof preventative and cueative pharmacological interventions whilst many compounds have been successfully tried ,its a question of the gravy train old school lets perfect dhat is still potentially a damaging operation with many as yet un knodn longer term side efects ,laziness ,lack of incentive poor biochemical understanding of formation there ard many many possible different approaches syhetic lenses are a poof substitute etc ,a bit like slash and burn for cancer,it is thd height of stupidity to say this is a cure ,like Mercury amalgam for teeth etc my sense is there needs to be International collaboration to drive regenerative preventive and innovative less damaging more holistic interventions forward we are 50 -100 years bckwards instead w have stayed stuck with such remedies due in the msin the monetary factor ,ease and laziness of top medical proffessionals ,who are focussed on the end product ,catracg lense replacement isnt really ideal at all

Making extrapolations about biodentical hormones from studies with synthetic hormones is not appropriate. The results of the study she led apply to those chemicals administered only. It is disappointing to hear someone with so much research experience base any conclusion whatsoever about biodentical estrogen based on a study with congugated estrogen. Even more concerning to hear her make any assertions about bioidentical progesterone from this study using a synthetic progestin. 30 years ago making these extrapolations was questionable.

Today, its inexcusable to confabulate different chemicals to this extent. For instance, MPA is shown to increase breast cancer risk through the glucocorticoid receptor while progesterone has no such effect/mechanism. There are significant differences in how these two chemicals affect the nervous system as well. These are the things I was hoping she would address. Instead it was just, based on this 30 year old study, HRT is great for attentuating menopause symptoms, but thats it

THE SARAH PODCASTE I'SNT RIGHT , the QUESTION of CANCER , the spectre that looms over the modern world.

terrible yes but something is really put with the way she is portraying things.

Sorry Peter but again the podcast with Sarah something is definitley not right here my first thought Lynch syndrome but then thought she'll have had this test then this utterly crazy stuff at the end like fantasmagorical fantasy driven experiments with high dose chemo who allowed this ,the whole thing seems to be her in denial my only other intuitive feeling is was she was a secret drinker ,there must have been some underlying cause operating for some time sorry i just don't by out of thin air rubbish ,alcohol is a carcinogen bar non especially spirits women are prone to secret binge drinking seems to fir her skittish dramatic stuff . Something very odd going on ..

Again in addition there must have been some irritant enter her lungs at some stage , asbestos , chemical fumes even irradiated material , something as for glioblastoma , I hear of many incidents in children for gods sake often associated with umpteen houysr spent at consoles or people with an addiction to putting mobiles next to their heads , EMF pollution as well as other contaminants are a big factor , the unnecessary use of X rays for diagnhostics especially high power ones , DNA mutates in response to the conditions which go far beyond the norms and force mutation it is a syndrome not a diseases ie very tiny mutations are in some cases beneficial they allow the body to adjust ie epigenetically and even over many generations . But add an irritant like coal tar as in chimney sweeps one of the first breakthroughs in epidemiology of cancer , asbestos workers , people in other manufacturing jobs where noxious chemicals are involved , the increases in levels in background radiation our human DNA hasn't evolved to deal with this level of mutagenic substances and influences . Whatt I or we do know is that all levels are involved , Metaphysically it is a symptom of our greedy capitalism , our speudo -christian way of life which says f…y.., I'm out for what I can get , at best a small familial selfish mind set which ends in polarization or the so successful versus the not .

GOD 's WILL IS the opposite , his will pertains to all situations whether quantum mechanical , social etc , that is the Egyptians were infected with cancers for mocking God and enslaving the Israelites etc , all diseases have their roots in metaphysical distortion , in world quasi scientific paradigms which justify as Sarah pointed out an elitism , which treat people as objects , facism lurks in western capitalism as well as Russian leaders , the human race suffers because ignorance prevails , we must address all these levels not just the medical, healthy selfish men are an anthema to god or spirit again this video points to that blindness or scientific reductionist thinking is often spectacularly unsuccessfull, kind of neurosis , ill ignore all of this and concentrate almost in a self obessessive way because that is what modern life seems to say , a kinda curse descends on humanity , we need a more holistic , rgenerative , mmmulti layered approach to heltth care , certainly;y one which is geared to prevention and not spotting diseases when they happen , even one which encourages prayer , meditation , spiritual reading self insight which ultimmmately is about self transcendence and a Spirit focused way of living which sees the ego as a temporary if not aberrant way of living after all ego fixity and narcissism are pretty much the same thing , but the former is seen as normal even desirable ! It is truly a confusing time we live in and srahs death is a reminder that no matter how carefully we plan , no matter how much expert knowledge we have we only have this "now" and an ability to let go of this and trust in that , however you define it . Yes God grant us better understanding of this terrible syndrome disease and also a way to safeguard our health and recover form all that afflicts us ie functional medicine should be aour priority right now not longevity for the elite this is a terrible mistake . God grant us wisdom to discern what is important at the right time and the courage to actualize it and the discrimination not to act in ways which go against his will or the Spiritits inspiration , prayers (meditation) are need , Peter .
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I'm a 48 yo man. Got my blood work for the first time last week. My testosterone lvl was 878 (Free test came in at 100.9). My Dr. seemed a bit shocked (probably based on the symptoms I mentioned). But is this common for a man my age to come in at T 878?? So trt wasn't right for me. He did bring up CJC 1295 Ipamorelin. I reviewed info online and just ordered a 3 month cycle. Any opinions on CJC 1295 Ipamorelin?

Oh man i wish this podcast had been available 4 yrs ago when i was going thru the menopause and decided along with my gynecologist that it was relatively safe for me to start back up on low dose BCP as i was going through perimenopausal symptoms plus trying to prevent pregnancy. After only 2.5 yrs on it (and ironically at the very same time, had decided to stop) i was one of the unlucky ones who received an IDC diagnosis. What wasn’t discussed with me with my physician was the fact that, to begin with, I was already at high risk (high density, breast cancer history- mom & great aunt both diagnosed in their 70s, as well as being UNDERWEIGHT). After my diagnosis, I pulled studies off pubmed which were buried but mentioned how HRT and similar should NOT be used on women period if they are underweight. To put it in perspective, i have always weighed less than 100 lbs with a BMI well below 18. Had i known i was at such high risk to start off, and that being underweight was an important risk factor in itself, I would have avoided this as i transitioned. Because thin women naturally have far less circulating hormones in their body than the average weight or obese women the introduction of exogenous hormones that flood the body creates an ideal situation for breast cancer to develop— this is what happened in my case. It was the straw that broke the camel’s back so to speak. Whilst on the BCP i experienced a hard fall in the rain but did not even fracture my elbow falling straight onto concrete with a 30lb dog in my arms in the pouring rain… I am convinced it was the BCP that protected my bones, as I am convinced it was responsible for my cancer diagnosis… I applaud the doctors for stressing the importance that physicians be better educated in this area because my own gynecologist failed me (I have since switched drs after my diagnosis!) I also applaud Dr. Manson for stressing how critical it is that at the end of the day, doctors need to respect the personal decisions of the patient after presenting all the facts such as potential risk factors, etc. Making an educated choice and a personal one are two things that sit together on the shelf and not independent of themselves. On a final note, I find it ironic that the thing i was trying to prevent (hot flushing, sleepless nights) during the change, is now something i am made to suffer with daily for five years (or more) being on anti-endocrine therapy as a breast cancer survivor trying to live through my cancer treatment plan. Thank you so much for this podcast.

Started HRT at 58. DEXA scan prior to HRT showed osteoporosis and osteopenia. After a year on HRT osteoporosis now osteopenia and areas of osteopenia now normal bone. This along with other benefits of HRT have been amazing.

I am 71 and taking half strength PremPro, just two a week. I stopped it for two months and developed polymyalgia rheumatica. Hubby is a PCP, can prescribe for me, but I have to pay out of pocket for it on Medicare, over $400! What infuriates me is that trans identified men are freely given female hormones through Medicare, with a tiny copay, but actual women are not allowed to take it at all by regular doctors. I thought about declaring myself trans gender. Perhaps if I thought I was a man for a while, then changed my mind, I could qualify as trans and be allowed this drug. Double trans.

Thank you so much for this interview! I am now 56 years old. Menopause at 46. Bruh! Them hot flashes ain’t no joke! Also osteoarthritis! Have changed my diet! Weight training! And my Doc has tried 3 times to talk me into stopping my hrt! I did try twice, hot flashes were brutal! She 1:14:02 has since stopped thank goodness. And I have no desire to ever stop. Otherwise, I’m perfectly healthy, do all my yearly screenings. And I really would
Like for someone to help me with this arthritis! I don’t want to die of a hip fracture like my great grandmother!

Peter Attia's point that the hormone replacement estrogen what progesteron estrogen therapy continue to the seventies can reduce incidence of hip fractures is important. I would also like to know what kind of therapies if any can be use to reduce male hip fractures in their 70s and 80s.

Excellent article on this topic: The Estrogen Dilemna, by Cynthia Gorney, New York Times, 2010. Old article but still relevant.