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THE NEW TESTOSTERONE TREATMENT
HOW YOU AND YOUR DOCTOR CAN FIGHT BREAST CANCER, PROSTATE CANCER, AND ALZHEIMER'S
By EDWARD FRIEDMAN, WILLIAM CANE
Prometheus BooksCopyright © 2013 Edward Friedman and William Cane
All rights reserved.
WHY HORMONES HAVE GOTTEN A BAD RAP: BUT WHY THEY SHOULDN'T FRIGHTEN YOU
The story you're about to read is so shocking you may not believe it. But that only goes to show that truth is indeed stranger than fiction.
It was 1991, the final year of the Cold War, and the Soviet Union had collapsed. Erwin Neher and Bert Sakmann won the Nobel Prize in Medicine for discoveries about the inner workings of the cell. And one of the world's foremost medical research centers, the National Institutes of Health (NIH), launched an unprecedented investigation aimed at helping women age gracefully. Optimism about humankind's ability to fix political and medical problems soared to an all-time high. In the wake of this near-universal confidence, no one—least of all the hundreds of scientists involved in the Women's Health Initiative, as the study was called—could have predicted that their well-meaning investigation would ultimately cause an enormous setback to medical science.
How had it happened? What had gone so terribly wrong? In those early days, when scientists had high hopes for the study, none of them could have guessed that their work would have a major adverse effect on the health of untold numbers of women. One of the most unfortunate results of this study was that hormones got a black eye and were painted in such a negative light that people—especially people who needed them most, the elderly and infirm—began to fear hormones and consider them the equivalent of poison.
Before I launch into the core of this book and the lifesaving information it offers to men and women of all ages, let me correct the common misperception about hormones promulgated by the Women's Health Initiative (WHI). Errors in thinking about hormones are so widespread in our society that hardly a day goes by without some news outlet foisting stories on us about the sinister dangers of hormones. So how did it happen that a study intending to help women turned out to harm them instead? The saddest part is that this study is still, to this day, continuing to spread misinformation about hormones, misinformation your doctor probably subscribes to right now.
Well, sometimes even umpires get it wrong. Everybody knows that. After all, they're only human and they, too, can make mistakes. The purpose of the initiative, of course, was to investigate how hormones impact women's health. More specifically, the scientists were hoping to see how progesterone and estrogen—two female hormones—impacted women's health and their susceptibility to disease. Chemical messengers produced by the human body, hormones serve a myriad of vital functions, such as regulating the development of secondary sexual characteristics, boosting cognition, and protecting the brain and heart from degenerative disease. So it made sense to study hormones and their role in eradicating disease.
What could possibly go wrong with a study that had such a humanitarian goal, investigating how these natural substances in the body affect women as they age? Well, for one thing, doctors conducting the WHI study did not use real hormones. As unbelievable, illogical, and dangerous as it may sound, the study instead used horse hormones. In fact, the substances they administered to unsuspecting women, equine hormones, are produced from the urine of female horses. In addition, scientists administered to these women a substance that had been created in a pharmaceutical laboratory and that never appears in the human body: synthetic progestin. Something totally foreign to human biology. But why, in heaven's name? Why did they use horse hormones and synthetic progestins instead of natural human hormones?
The answer disappoints everyone who understands the way our medical system works. Pharmaceutical companies usually can't make significant profits from selling natural human hormones. Why? Well, such hormones can't be patented. Only human-made substances, created in a laboratory, are afforded patent protection by our legal system. As a result, only these artificial drugs can be manufactured and sold for big bucks. So pharmaceutical companies, which had their fingers deep into the design of the WHI study, made sure that the chemicals administered to test women included horse estrogen, which they produced in the lab and patented, together with artificial hormone–like substances (synthetic progestins, which they had also patented in hopes of maximizing their profits).
Now, even a person with no knowledge of chemistry or biology might balk at such a study design. Wouldn't you? I sure would. But these scientists justified their actions and went forward, despite warnings from critics who believed that an unjustifiable risk existed because synthetic substances were being used. The study scientists assumed that horse estrogen worked the same as human estrogen and that synthetic progestins worked the same as human progesterone, but they did not do the due diligence to test these assumptions. After less than six years the WHI scientists had to stop the study prematurely, shamefaced, for they had found to their great dismay that the women taking these synthetic substances had a higher risk of developing various cancers and strokes than the control group of women who had not taken the drugs and who just had their own natural hormones circulating through their blood.
If you were to ask every doctor you know about the risk of women taking hormones, they would all claim that hormones increase the risk of women developing breast cancer. These doctors have the flawed WHI results fixed in their mind, which is why they share this common misconception.
As a result of the WHI study, if you were to ask every doctor you know about the risk of women taking hormones, they would all claim that hormones increase the risk of women developing breast cancer. These doctors have the flawed WHI results fixed in their mind, which is why they share this common misconception. We all remember the front-page headlines from 2002 announcing that hormone replacement therapy (HRT) causes cancer. At the time, HRT was used primarily by women who wished to alleviate the symptoms of menopause. Today, of course, HRT can be used safely by both men and women to restore youthful vitality, cognition, and health. But those ominous 2002 headlines sounded a death knell for the initial enthusiasm about hormones because something had gone terribly wrong with the Women's Health Initiative. More specifically, study administrators gave 16,608 women either HRT or a placebo. Originally, the study was to last for 8.5 years, but researchers terminated it after a mean of 5.2 years because those women receiving HRT demonstrated a 26 percent higher rate of invasive breast cancer than women taking the placebo. Other adverse health effects were also observed. In 2008 it was demonstrated that the negative effects from the WHI study were the result of using synthetic hormones, but we're getting ahead of ourselves and will come back to this important point shortly.
In 2003 the results of the Million Women Study seemed to verify the dangers uncovered by the 2002 WHI study. There were a total of 1,084,110 women in this new study. The protocol was different from the WHI study. Women who had already been taking various forms of HRT were compared with women who had never taken HRT. The rate of invasive breast cancer was again higher for those women taking the form of HRT used in the WHI study than for those in the control. Women who had taken HRT for less than five years experienced a 60 percent higher rate of invasive breast cancer, and women who had taken HRT for more than five years experienced a 142 percent higher rate.
Most people looking at the results of the above two studies wrongfully concluded that HRT caused breast cancer. However, there were a few doctors who criticized these studies because of the form of HRT that was being used. They argued that the results would be different if hormones that were chemically identical to the hormones found naturally in women, commonly known as bioidentical hormones, had been used. For most people, it is obvious what hormone replacement means. Replacing hormones means that you would take a woman of, say, sixty-five years of age and give her enough hormones to get her levels to that of a younger woman, perhaps a thirty-five-year-old. However, both of these studies on HRT used drugs commonly prescribed to women at that time; namely, a combination of horse estrogen and a synthetic progestin called medroxyprogesterone acetate (MPA). Horse estrogen contains significant amounts of certain components not found in humans and lacks other components that are found in significant amounts in humans. MPA is a compound never found in nature in any species. A number of doctors argued (incorrectly, as we found out in 2008) that it made no difference that hormones other than what are found normally in humans were used, since synthetic progestin binding to progesterone receptors should have the same results as human progesterone binding to progesterone receptors. Their argument was bolstered by the fact that the Million Women Study used two other forms of synthetic progestins (norethisterone and norgestrel/levonorgestrel) both of which exhibited results quite similar to MPA. But, oh, how wrong they were!
In looking at the above two studies, the question that has to be asked is, Do the results pass the smell test? Are hormones really dangerous to women? Do women actually experience their highest incidence of breast cancer and other diseases when their hormone levels are at their highest, generally in their late teens and early twenties? Obviously, the answer to this question is a resounding No! So the question becomes, Would using bioidentical hormone replacement therapy (BHRT) eliminate the increased risk observed with HRT (which uses synthetic chemicals)? Put more simply, is bioidentical hormone therapy safe? For many years, these were just hypothetical questions. However, in 2008 the E3N Cohort Study put these questions to rest. This study followed 80,377 women for 8.1 years. It verified that HRT using MPA was dangerous and resulted in a 48 percent increase in the rate of invasive breast cancer when compared to the control. However, its most important finding was that using bioidentical hormone replacement therapy results in no increase in the rate of invasive breast cancer. This astounding finding seems to have been totally ignored by the mainstream media. The New York Times, for instance, is still mistakenly using the flawed WHI results to claim that hormone replacement is dangerous for women:
It is, without question, risky for an older woman long past menopause to start hormone treatment to prevent chronic disease. Doing so dramatically increases the risk for heart attack, stroke, breast cancer and other complications.
This 2011 New York Times statement, based on the WHI study, is flat-out wrong. The WHI study can be used only to support the contention that synthetic hormones pose a risk. It says nothing about the safety of bioidentical hormones. In fact, research conducted after the WHI study demonstrates that the reason women suffered a slight increase in disease during the WHI study was not because they used hormones but because they used synthetic hormones. Unfortunately, you would be hard-pressed to find any doctor in this country who is aware of these findings, unless you are fortunate enough to happen across one who has training in anti-aging hormone therapy.
What does the above analysis mean for women? In plain English, it means wonderful news. It means women can now relieve the symptoms of menopause without worrying about increasing the risk of breast cancer. But it gets even better. Why not relieve the symptoms of menopause and at the same time reduce the risk of breast cancer to near zero—the same as it is for teenagers? In later chapters you'll learn exactly how to do that.
CORRECTING MYTHS ABOUT TESTOSTERONE
Now let's turn our attention to prostate cancer. If you were to ask every doctor you know about the effect of testosterone on prostate cancer, they would all say, "Testosterone causes and feeds prostate cancer. Taking away testosterone kills prostate cancer by starving it. Giving testosterone to a man with prostate cancer is like adding oil to a fire. I learned this in medical school, so it must be right." Unfortunately, what your doctor learned in medical school about testosterone is based largely on outdated research conducted in 1941 by Charles Huggins. Beginning his work with investigations of dog prostates and then turning his attention to humans, Huggins observed that removing testosterone killed most of the prostate cancer cells in his patients. His work convinced doctors that prostate cancer cells starved without testosterone. Huggins was later awarded a Nobel Prize for his work.
In 1977, Robert Noble developed a strain of rat now known as the Noble rat, which developed prostate cancer almost 20 percent of the time after prolonged exposure to very high dosages of testosterone. This experiment convinced doctors that testosterone caused prostate cancer.
In 1981, Dr. Jackson E. Fowler Jr. and Dr. Willet F. Whitmore Jr. published a landmark paper11 that seemed to support Huggins's findings and that is unfortunately still being relied on by medical schools throughout the world to illustrate the dangers of giving testosterone to men with prostate cancer. Fowler and Whitmore reported that for fifty-two men with prostate cancer, 73 percent of them experienced a noticeable worsening of their symptoms within thirty days of being given testosterone. This experiment convinced doctors that testosterone fueled prostate cancer. Putting all the above studies together seems to produce a straightforward argument for the relationship between testosterone and prostate cancer.
Testosterone causes and then feeds prostate cancer; increasing the level of testosterone results in prostate cancer growing faster; taking away testosterone starves prostate cancer, which is why so much of it dies when testosterone is taken away.
While this all seems to make sense, recent experiments have turned the medical profession's understanding of the relationship between testosterone and prostate cancer on its head. In 2006, Dr. Abraham Morgentaler, associate clinical professor at Harvard Medical School, published a groundbreaking study demonstrating that prostate cancer is actually present at a much higher rate in men with low testosterone. Morgentaler has published numerous papers over the years confirming and expanding on his original findings. A 2011 paper he coauthored is even more exciting since it actually shows a slight decrease in the prostate-specific antigen (PSA), indicating a reduction of cancer (about a one-third drop) after an average of 2.5 years for men with untreated prostate cancer who received testosterone replacement therapy. Researchers tend not to consider drops of less than 50 percent significant when treating prostate cancer. PSA is a protein made by prostate cells and prostate cancer cells. For patients who are known to have prostate cancer, a rise in PSA usually indicates an increase in prostate cancer growth. Morgentaler's paper is totally inexplicable by the model that claims testosterone fuels prostate cancer. Other findings also seriously challenge this model, in particular two studies involving the administration of testosterone to men with castration-resistant prostate cancer (CRPC) and the finding that none of the men experienced a rapid rise in PSA and that some experienced a drop in PSA. Finally, a new report seems to drive a stake through the heart of this flawed model. Researchers discovered in 2012 that alternating two weeks of ultra-high levels of testosterone with two weeks of near-castrate levels of testosterone reduced the PSA by over 50 percent for two out of four men treated. So today testosterone not only is not feeding prostate cancer but it is being used as an effective tool in its treatment!
Excerpted from THE NEW TESTOSTERONE TREATMENT by EDWARD FRIEDMAN. Copyright © 2013 by Edward Friedman and William Cane. Excerpted by permission of Prometheus Books.
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