Controversy and Lack of Consensus: Hormone Therapy for Primary Prevention

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Dr. Roger Lobo true vet here!





In this episode of the You Are Not Broken podcast, Dr. Kelly Casperson and Dr. Roger Lobo discuss the use of hormone therapy for primary prevention in women. They address the controversy surrounding hormone therapy and the lack of consensus among healthcare providers. Dr. Lobo emphasizes the importance of education and the need for providers to be knowledgeable about hormone therapy. They also discuss the role of estrogen in preventing chronic diseases such as cardiovascular disease and osteoporosis. Dr. Lobo mentions advancements in the field, including the use of estriol and selective estrogen receptor modulators.




Takeaways

  • Misdiagnosis and lack of understanding are common in areas such as PCOS and menopause.
  • The WHI study led to a generation of women being undertreated due to misconceptions about hormone therapy.
  • Hormone therapy should be individualized based on factors such as age, risk assessment, and transdermal delivery.
  • Progesterone is important for protecting the uterine lining in hormone therapy.
  • Bioidentical hormones may still carry risks and should be monitored.
  • There is controversy and lack of consensus among healthcare providers regarding the use of hormone therapy for primary prevention in women.
  • Education is crucial to ensure that healthcare providers are knowledgeable about hormone therapy and can provide accurate information to patients.
  • Estrogen has a role in preventing chronic diseases such as cardiovascular disease and osteoporosis.
  • Advancements in the field include the use of estriol and selective estrogen receptor modulators.



Chapters

00:00 Introduction and Background
02:46 Misconceptions in PCOS and Menopause
09:28 Understanding Hormone Therapy
15:16 Navigating Hormone Therapy for Older Women
19:33 Individualized Treatment and Informed Consent
26:05 The Role of Progesterone in Hormone Therapy
28:27 The USPSTF and Hormone Therapy for Primary Prevention
35:41 The Importance of Education: Ensuring Providers are Knowledgeable about Hormone Therapy
39:05 Estrogen's Role in Preventing Chronic Diseases
42:46 Advancements in Hormone Therapy: Estetrol and Selective Estrogen Receptor Modulators
 

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TRT Hormone Predictor

Predict estradiol, DHT, and free testosterone levels based on total testosterone

⚠️ Medical Disclaimer

This tool provides predictions based on statistical models and should NOT replace professional medical advice. Always consult with your healthcare provider before making any changes to your TRT protocol.

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Understanding Your Hormones

Estradiol (E2)

A form of estrogen produced from testosterone. Important for bone health, mood, and libido. Too high can cause side effects; too low can affect well-being.

DHT

Dihydrotestosterone is a potent androgen derived from testosterone. Affects hair growth, prostate health, and masculinization effects.

Free Testosterone

The biologically active form of testosterone not bound to proteins. Directly available for cellular uptake and biological effects.

Scientific Reference

Lakshman KM, Kaplan B, Travison TG, Basaria S, Knapp PE, Singh AB, LaValley MP, Mazer NA, Bhasin S. The effects of injected testosterone dose and age on the conversion of testosterone to estradiol and dihydrotestosterone in young and older men. J Clin Endocrinol Metab. 2010 Aug;95(8):3955-64.

DOI: 10.1210/jc.2010-0102 | PMID: 20534765 | PMCID: PMC2913038

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