A little background first...
When it comes to HRT for women, insurance companies don't really want to reimburse for hormone medications. They don't because the feeling is that a woman is only trying to relieve her symptoms but will end up getting sicker because of it. It has been drummed into insurance companies, just like into doctors, that HRT is not healthy and should only be used for as short a period of time as possible.
The idea of HRT being unhealthy for hypogonadism (also called peri-menopause) and profound hypogonadism (also called menopause) has come primarily from one hormone formulation called Premarin, which is a pill made from horse urine. Premarin is supposed to contain estrogen and insurance companies and doctors readily accept that it is eugonadal (normal) estrogen replacement even though it is not. It is also readily accepted that Premarin, combined with Provera, a non bio-identical progesterone, is hormone replacement or HRT for profound hypogonadism even though it is not.
Because of the way these drugs are metabolized, when a woman takes Premarin, with or without Provera, the available levels of testosterone, progesterone, and dhea actually go down to below menopausal levels, and her estrogen levels go so high that it is predictable that it will make her sick. For decades these drugs have never worked, nor have they ever restored ovarian hormones to eugonadal (normal) levels, and yet these two drugs, individually and together, continue to be called HRT.
Why would an insurance company pay for drugs and the doctor visits to prescribe them, when it is known to create illness which would otherwise not exist and which costs the company more money in the long run? It makes no sense. To save healthcare dollars a different approach is necessary.
Now onto the blog...
Starting in medical school, doctors are not even given a basic vocabulary to address hypogonadism in either men or women. Very little time is spent discussing peri-menopause, menopause, or andropause. They are not discussed even though every woman and man over the age of 30 will have hypogonadism, which can advance to profound hypogonadism without treatment. There are no residency programs to teach anyone how to treat it with eugonadal (normal) hormone replacement. Because doctors aren't really sure of normal levels of hormones or even which products work and which don't, they don't realize that the 'HRT' that has been proven unhealthy for women is not the HRT that they expect.
Let's start at the beginning.
Here is what profound hypogonadism (also called menopause in women) looks like to the human (male and female) body.
- Hypoestrogenemia, below normal level of estradiol
- Hypotestosteronemia, below normal level of testosterone
- Hypoprogesteronemia, below normal level of progesterone
- Hypodehydroepiandrosteronemia, below normal level of dhea
When a doctor prescribes HRT there is the expectation that the result will be eugonadal (normal) levels.
Eugonadal (pronounced U-go-nay-dal) means bringing all of the ovarian hormones back up to normal levels.
Here is what your doctor EXPECTS when HRT is prescribed:
- Eugonadal level of estradiol, normal estradiol levels
- Eugonadal level of testosterone, normal testosterone levels
- Eugonadal level of progesterone, normal progesterone levels
- Eugonadal level of dhea, normal dhea levels
However, for women, instead of eugonadal levels of ovarian hormones, something very different happens.
The 'HRT' that your doctor has been told is bad for you is based on only one type of hormone pill which is commonly known as Premarin, Prempro, conjugated equine estrogens (CEE), conjugated estrogens (CE), estrogen replacement therapy or ERT, hormone therapy or HT, and menopausal hormone therapy or MHT. Premarin is made from the urine of pregnant horses and is the