The injectable Depo-Provera earned itself an FDA black-box warning because it significantly increases the risk of osteoporosis, probably by blocking the action of real progesterone, which plays a role in building bone.
Women who smoke absolutely should not use oral contraceptives—it is a deadly combination, especially in women over the age of 35. Oral contraceptives also increase the risk of arterial disease and vision loss, and controversial studies suggest they increase the risk of breast cancer, cervical cancer, and osteoporosis, especially when taken long term. Oral contraceptives can cause candida overgrowth (yeast infections), breast tenderness and lumpiness, and nausea.
Women going off them may be infertile, usually for a few months, but it can be permanent in older women.
CAUTION!
Please avoid these drugs altogether, and use an alternative form of birth control. If the only other choice is an unwanted pregnancy, then perhaps birth control pills should be an option, but they cannot be considered a safe drug.
What Nutrients Do They Throw out of Balance or Interact With? Primarily vitamins B6 and folic acid. See the section on synthetic estrogens for details.
What Else to Take If You Take These Drugs. Vitamin B6 (50 mg daily), folic acid (400 mcg daily), and vitamin C (2,000 mg daily).
Examples of Synthetic Testosterone
Fluoxymesterone (Halotestin)
Methyltestosterone (Android, Testred, Virilon)
Testosterone cypionate, injection
Examples of Natural Testosterone
Androderm, patch
Androgel
Striant, buccal or in the cheek
Testoderm, patch
What Do They Do in the Body? Testosterone is the male hormone that develops the male genitals, increases metabolism and muscle, encourages the growth of hair, and deepens the voice.
What Are They Prescribed For? In men, a deficiency of testosterone, which may be caused by genetics, environment, or disease. They are used in women to treat metastatic breast cancer and postpartum breast pain and as hormone replacement when testosterone levels are low, as in hysterectomy.
What Are the Possible Side Effects? Although the effects of the synthetic testosterones are hard to separate out from the effects of real testosterone, you can probably safely assume that most of the side effects are caused by the synthetic testosterones or by excessive doses of real testosterone. Side effects can include hypercalcemia (too much calcium in the blood), liver damage, reduced ejaculatory volume, fluid retention, abnormal swelling of the breast in men, masculinization and menstrual irregularities in women, worsening of prostate enlargement and prostate cancer, acne, baldness, nausea, headache, aggressiveness, anxiety, and increased or decreased libido. They may also raise the risk of some types of cancer in women.
CAUTION!
Please don’t use synthetic testosterone. If you need testosterone, use the real thing. See the discussion on testosterone in “Using Natural Hormones” later in this chapter.
Examples of Synthetic Glucocorticoids (Adrenal Hormones)
Beclomethasone, asthma inhaler, cream (Becotide, Qvar, Beconase, Vancenase)
Betamethasone, various creams, gels, and so on
Cortisone acetate
Deoxycorticosterone acetate
Dexamethasone (Decadron, Dexameth, Dexon)
Methylprednisolone (Medrol)
Prednisolone (Delta-Cortef, Orapred, Prelone)
Prednisone (Deltasone, Orasone, Panasol, Meticorten)
Triamcinolone (Aristocort, Atolone, Kenacort, Kenalog)
Examples of Natural Glucocorticoids
Hydrocortisone (Cortisol, Cortef)
What Do They Do in the Body? They are potent anti-inflammatory drugs that also play a role in regulating the immune system, appetite, and sodium balance in the cells. They play dozens of roles in the body having to do with metabolism and inflammation. See the section “Using Natural Hormones” for more information.
What Are They Prescribed For? Adrenal insufficiency, arthritis, lupus, psoriasis, allergies, eye inflammations, respiratory diseases such as bronchial asthma, Crohn’s disease, multiple sclerosis, and other diseases that involve severe, chronic inflammation or overactive immune response.
What Are the Possible Side Effects? The glucocorticoids have many very dangerous and destructive side effects, but many are due to the use of the synthetic versions of the drug and excessively high doses. Side effects and adverse reactions can include weight gain, osteoporosis, increased blood pressure, peptic ulcers, adrenal suppression, immunosuppression, increased susceptibility to bacterial and fungal infections, masking of bacterial and fungal infections, water retention, increased appetite, cataracts, glaucoma, steroid psychosis, muscle weakness, blood clots, pancreatitis, heartburn, thin and fragile skin, scaly lesions, headaches, dizziness, menstrual irregularities, increased sweating, and blood sugar imbalances.
People who take these drugs over a long period of time should never stop taking them abruptly. See your health care provider.
CAUTION!
Think Twice About Taking These Drugs If . . .
• You have high blood pressure.
• You have osteoporosis.
• You have ulcers, eye disease, or kidney or liver disease.
• You have a fungal infection.
• You are obese, elderly, or pregnant.
Examples of Thyroid Hormone Drugs
Levothyroxine, T4 (Synthroid, Levothroid, Levo-T, Levoxyl, Unithroid)
Liothyronine, T3 (Cytomel, Triostat)
Liotrix, T3 and T4, synthetic (Euthroid, Thyrolar)
Examples of Natural Thyroid Drugs
USP thyroid, dessicated beef or pork, T3 and T4 (Armour, Nature-Throid, Thyrar, Westhroid)
What Do They Do in the Body? Thyroid hormones regulate many types of metabolism in the body, including heart rate and strength of heartbeat, respiratory rate, oxygen consumption, body temperature, metabolism of food, growth, maturation, and enzyme activity.
What Are They Prescribed For? Thyroid hormone deficiency. (See the section “Using Natural Hormones” for more details on thyroid.)
What Are the Possible Side Effects? Side effects of a physiologic dose of USP thyroid in someone who is thyroid deficient are rare. Excessive thyroid can cause heart palpitations, rapid heartbeat, irregular heartbeat, angina, heart attack, tremors, headache, nervousness, insomnia, diarrhea, weight loss, menstrual irregularities, sweating, and intolerance to heat.
CAUTION!
Think Twice About Taking These Drugs If . . .
• You have diabetes. Work very carefully with your doctor.
• You have Addison’s disease. Work very carefully with your doctor.
What Else to Take If You Take These Drugs. If you have hypothyroidism, it’s a good idea to eat iodine-rich foods regularly, such as dried seaweeds (dulse, kelp).
Using Natural Hormones
Pregnenolone
Pregnenolone is a steroid hormone made from cholesterol. All the other steroid hormones, including progesterone, DHEA, the cortisols, the estrogens, and testosterone, are made from pregnenolone. Like progesterone, pregnenolone is not a sex steroid, meaning it doesn’t have masculinizing or feminizing effects on the body, and it seems to be safe even in higher doses.
A flurry of research was done on pregnenolone in the 1940s, but the only clear effect it had was in relieving symptoms of rheumatoid arthritis. You can try 10 to 200 mg divided into three doses daily for arthritis and see if it helps. Give it at least three weeks to work. It is available as a supplement, over-the-counter.
More recent studies show that pregnenolone improves memory after learning, which makes sense because it has an excitatory effect on the brain and blocks GABA receptors, which play a role in blocking memory. Studies in rats and humans suggest that giving pregnenolone enhances the ability to learn and enhances memory. Other studies suggest that it improves sleep and reduces anxiety.
Even though pregnenolone is a precursor
to all of the other steroid hormones, taking a pregnenolone supplement will not necessarily raise the levels of other hormones in the body. It might, but so far the evidence isn’t in to indicate that this happens reliably.
Pregnenolone needs to be studied much more closely, but it is clearly of benefit for people who complain that they aren’t retaining information when they learn something new. You can take up to 100 mg daily between meals for improving memory.
Progesterone
Progesterone is a steroid hormone with important effects nearly everywhere in the body. It is a precursor to all of the other steroid hormones except pregnenolone and DHEA, and it is made by the adrenal glands in both sexes and in a woman’s ovaries. Progesterone is also made in the peripheral nervous system. It is an essential part of the Schwann cells that form the myelin sheath that protects nerves. Studies done with progesterone and brain injuries show that progesterone is effective in reducing the effects of a brain injury when given after an accident.
One of progesterone’s biggest roles in a woman’s biochemistry is opposing or balancing estrogen in the uterus and probably elsewhere. While estrogen stimulates cell growth, progesterone signals cells to mature and differentiate.
Women produce progesterone in their ovaries only when they ovulate. During months when they don’t ovulate but still have a menstrual period, they may be estrogen dominant, a condition where estrogen levels aren’t necessarily high, but there is no progesterone to balance its effects. This can cause PMS, and over time, according to Dr. John Lee, it can also cause fibroids, fibrocystic breasts, cervical dysplasia, and reproductive cancers. In his book What Your Doctor May Not Tell You About Breast Cancer (Warner Books, 2002), written with David Zava, Ph.D., and Virginia Hopkins, Dr. Lee makes a convincing argument in favor of estrogen dominance as an important risk factor for breast cancer. In women going through menopause, it can cause symptoms such as weight gain, irritability, mood swings, and headaches.
A woman’s ovaries normally produce 20 to 30 mg of progesterone daily during the middle part of the menstrual cycle. Progesterone is made by the placenta in pregnant women in relatively huge quantities (as much as 300 mg daily in the last trimester). Much of postpartum depression may be caused by the plunge in progesterone levels.
At menopause, progesterone production in a woman drops even more than estrogen does, and women can often relieve menopausal symptoms using only a natural progesterone cream. In a bizarre twist of conventional medicine working hand in hand with drug company marketing and advertising, progesterone has been all but forgotten in the rush to prescribe estrogen, and yet it is equally if not more important than estrogen in HRT.
Many premenopausal and menopausal women who use progesterone cream report that their hair becomes thicker, their libido comes back, and their vaginal dryness disappears.
Progesterone should never be confused with its synthetic cousins the progestins, such as Provera, which have many negative side effects. Natural progesterone is made in a laboratory, but it is the exact same molecule found in your body. The progestins have been altered to produce not-found-in-nature molecules that can be patented and sold at high prices. Women who take them generally report feeling awful, and their risk of dangerous side effects is very real. In contrast, women who use natural progesterone tend to be very healthy, and there are no known negative side effects at recommended doses.
If you are using HRT or contemplating it, please use natural progesterone and natural estrogens. The books What Your Doctor May Not Tell You About Menopause (Hatchette, 2004) and What Your Doctor May Not Tell You About Premenopause (Hatchette, 2005), by John R. Lee, M.D., and Virginia Hopkins, and Dr. John Lee’s Hormone Balance Made Simple, by John R. Lee, M.D., and Virginia Hopkins (Hatchette, 2006) are classics that are recommended for all premenopausal and menopausal women. They will give you a very good sense of how your hormones work and how to balance them in a safe, natural way.
Progesterone cream works wonders for the majority of postmenopausal women; most feel dramatically better physically, mentally, and emotionally. It also works well for women of any age suffering from premenopause symptoms such as PMS, weight gain, mood swings, fibroids, and fibrocystic breasts.
In general, the best way to use progesterone is as a cream in a dose of 15 to 20 mg daily. We know that physicians prefer to give pills, but in this case the cream probably gives a more accurate dose. When taken orally, as much as 80 percent of the progesterone is processed by the liver and excreted, so you have to take 100 mg or more to get the dose you need. Depending on how your liver is working, you may get far more or far less than you need.
In a 2-ounce jar containing 800 mg of progesterone, a physiologic dose would work out to ¼ to ½ teaspoon per day. Only progesterone USP is natural progesterone.
Please be aware that some “wild yam” products may not contain any progesterone. They may contain diosgenin or dioscorea, but these will not convert to progesterone in the body.
It does not matter whether the progesterone cream is made from wild yam or soy—when they come out of the lab, they’re both progesterone.
Don’t think that more is better when it comes to dosing with hormones. If the recommended dose doesn’t help your symptoms, then you need to do more detective work to find out what’s causing the problem. Dr. John Lee’s Hormone Balance Made Simple is a great book for tracking down the causes of hormonal imbalances.
You can buy a variety of progesterone creams over-the-counter, but if you don’t understand how to use them, work with a health care professional. Please check the “Resources and Recommended Reading” section at the back of the book for sources of more detailed information on natural hormones and hormone balancing.
Dehydroepiandrosterone (DHEA)
Dehydroepiandrosterone (DHEA) is a steroid hormone manufactured in the adrenal glands. These prune-sized glands sit on top of the kidneys and are responsible for the secretion of over 150 hormones. The adrenal hormones are our major stress buffers, allowing us to adapt to whatever stresses our environment brings.
DHEA is the most abundant steroid hormone in the body. It acts as a precursor from which several other steroid hormones are made, including estrogens and testosterone, but not progesterone or the cortisols. It is an androgenic or male hormone. Only 5 percent of the body’s circulating DHEA is in the active form; the remainder is joined to sulfur molecules (DHEAS) and serves as a reserve of the hormone that can be easily converted back to the active form.
DHEA production peaks between the ages of 20 and 25, with men having a higher peak than women. There is about a 2 percent decrease in blood levels for each year of life that follows. A large body of research, particularly on men, shows a clear relationship between this progressive drop in DHEA levels and diseases of aging, such as cardiovascular disease, diabetes, and some cancers. In other words, sick people have less DHEA in their bodies than well people do. Elderly people have less than young people, and elderly people with higher DHEA levels are healthier than those with low levels.
Several studies have shown that when DHEA is given to elderly subjects who started out with low levels, there is a sizable improvement in their sense of well-being. Both men and women with depression, some types of cancer, allergies, type 2 diabetes, or autoimmune diseases (such as rheumatoid arthritis) have low blood levels of DHEA. Researchers guess that raising DHEA levels can help prevent or treat these diseases. Some clinicians have reported success in treating patients who have lupus with DHEA.
DHEA may help prevent heart disease in men, but its effect on heart disease risk in women is much less promising. Most studies on this topic indicate that risk may even increase somewhat in women if it is supplemented in too high a dose. Here again, it’s important to use a physiologic dose, or one close to what the body would produce naturally. In a woman, that would be less than in a man.
DHEA aids in the body’s immune defenses against unwelcome invaders. One mechanism for this may involve DHEA’s opposing actions to corti
sol, a fight-or-flight hormone secreted by the adrenal glands when we are under stress. Cortisol suppresses some parts of the immune system. This makes sense if you’re a caveman. If your body thinks you are in some kind of immediate danger, it wouldn’t waste energy on building up the immune system during the crisis. This would be like deciding to cook dinner for the family in the kitchen of a house that’s burning down. Modern life resembles the house that could catch fire at any moment; too dangerous to relax and cook a nourishing meal in, but not such an emergency that you have to escape immediately. Chronic stress (an almost inescapable part of life these days) leads to chronically elevated cortisol levels, which lessen our immunity against illness. The result of many years of constantly high cortisol levels can exhaust your adrenal glands, causing output of cortisol and DHEA to drop to unhealthy lows. This seems to be particularly true of women.
DHEA supplementation appears to enhance the youth-preserving effects of growth hormone, which will be addressed in detail later in this chapter. This may be one reason for DHEA’s remarkable effect on well-being. In one study, a large dose of DHEA given before sleep to 10 healthy young men increased the amount of REM (rapid eye movement) sleep. REM sleep is the most restorative kind of sleep, and it is reduced in the elderly.
In a study of pregnant women, intravenous DHEAS (the sulfate form, the same form as the body’s reservoir of DHEA) dilated a major eye artery, increasing blood flow. This points to a possible use of DHEAS as a blood vessel dilator that can improve circulation to the eyes.
It follows that raising DHEA levels could have powerful health-enhancing and youth-preserving effects. However, straightforward assumptions rarely work with hormones, and we can’t assume that DHEA levels appropriate for a 25-year-old will be safe for a 75-year-old. That might be like putting a jet engine on an old biplane; it might fly really fast for a little while, but a crash is inevitable. We do recommend DHEA, especially for older men, but again, in moderate doses and with regular measurement of hormone levels. It’s best to work with an alternative physician if you would like to use DHEA on a regular basis.
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