Life Extension Magazine April 2005
Jonathan Wright, MD
By Dave Tuttle
A physician who pioneered the use of natural female hormone replacement therapy more than two decades ago, Jonathan V. Wright, MD, has obtained remarkable results for his patients while avoiding the dangerous prescription drugs that are so heavily promoted by pharmaceutical companies.
In this article, Life Extension examines Dr. Wright’s program to help aging women restore their youthful hormone balance safely without resorting to side effect-prone prescription drugs.
The mainstream news media seems to have a knack for skimming the surface of scientific studies and drawing erroneous conclusions.
One recent example involves negative reports about estrogen-progestin female hormone replacement therapy. Studies involving women who took chemically modified prescription hormones for extended periods showed that they had an increased incidence of breast cancer,1 along with a higher risk of heart attack, stroke, and pulmonary embolism.2 In reaction to these studies, the mainstream media generated headline news containing dire warnings that hormone therapy is dangerous.
The media ignored the fact that these results occurred in women taking synthetic hormones, which are patented chemical alterations of the body’s natural messengers. Television, radio, and newspaper reports made blanket assertions that the risks of hormone replacement therapy exceed the benefits. The result is that millions of women are now going “cold turkey” trying to cope with age-diminished hormone levels.
Achieving Natural Hormone Balance
According to Dr. Wright, the allegedly inevitable negative outcomes of hormone supplementation are avoidable. By using natural hormones and following a program of regular blood testing, women can develop an individualized hormone replacement regimen that is safe and effective.
“You need to use natural means to restore the body’s hormone balance,” says Dr. Wright, a member of the Life Extension Foundation’s Medical Advisory Board. “Bioidentical hormones are superior to patentable drugs because they are exact copies of what the body produces. They work better than the deformed, inexact copies that are required to get a patent.”
Dr. Wright pioneered the use of bioidentical estrogens and DHEA in the 1980s, and he has more clinical experience in hormone replacement therapy than any other practitioner. He and Ed Thorpe, an innovative compounding pharmacist, were the first to offer women an alternative to conventional synthetic drugs.
“By replacing the hormones that decline as time goes by, you can sustain your health and promote longevity,” explains Dr. Wright. “It’s never too late, either. I have had patients in their eighties who saw their health improve. For example, in cell cultures, gender-specific bioidentical estrogen or testosterone supplementation slows the accumulation of tau protein, neurofibrillary tangle, and amyloid in human neurons, reducing the potential for Alzheimer’s disease. The bioidentical versions of these two hormones reduce the risks of cardiovascular disease and osteoporosis as well. By returning to the physiological hormone levels you had earlier in your life, you can slow down the aging process and maximize your quality of life.”
Progesterone: First Hormone to Decline
While traditional medicine focuses on diminished estrogen levels, progesterone is the first hormone that declines during the aging process. Some women in their late twenties have progesterone deficiencies, while other women in their late forties and even early fifties are still producing youthful levels of progesterone. This is why hormone testing and individually designed treatments are so essential.
Progesterone is primarily manufactured in the adrenal glands and ovaries, though some is produced in the brain. This hormone is necessary for gestation to occur, and miscarriages are common when progesterone is deficient. Symptoms of a deficiency include premenstrual discomfort, night sweats, hot flashes, and a loss of well being, often including depression. Supplementation with natural progesterone reduces the prevalence of these negative events.
John Lee, MD, originated the clinical use of bioidentical progesterone. Reports by Dr. Lee and others have suggested that natural progesterone stimulates new bone formation by increasing osteoblast activity, which helps to prevent osteoporosis.3 While vitamin and mineral deficiencies, poor eating habits, and lack of exercise also contribute to osteoporosis, hormone imbalances—especially estrogen and progesterone deficiencies—play a significant role in the progression of osteoporosis in women.
Several studies have found that topical progesterone creams effectively combat aspects of the aging process. A one-year trial in postmenopausal women saw a significant reduction in vasomotor symptoms such as hot flashes in a group using a bioidentical transdermal progesterone cream.4 Researchers also noted reduced thickening of the uterine lining produced by an estrogen drug when postmenopausal women used a transdermal or vaginal progesterone cream for four weeks.5 This antiproliferative effect is one of the main reasons that traditional doctors prescribe medroxyprogesterone, a progestin (progesterone-like drug) known as Provera® that has numerous side effects. Synthetic progestin drugs do not function the same way as natural progesterone. Moreover, because progesterone enhances the sensitivity of estrogen receptors in cell membranes, the use of a natural progesterone cream may permit a reduction in estrogen supplementation.
Bioidentical progesterone has also been shown to reduce the incidence of breast cancer. Researchers at National Taiwan University Hospital found that progesterone reduces the proliferation rate of breast epithelial cells.6 Another study examined cancer incidence in women with progesterone deficiencies.7 The scientists discovered that hormone-deficient women were 5.4 times more likely to have premenopausal breast cancer and 10 times more likely to die from all malignant neoplasms than were women without a progesterone deficiency.
An even more intriguing study revealed that survival rates for breast cancer surgery are strongly correlated with the patient’s progesterone level on the day of surgery. Because it is involved in the menstrual cycle, progesterone concentrations vary dramatically at different times of the month. This study noted that 65% of women with a progesterone level of 4 nanograms (ng) per ml or more on the day of their surgery were alive 18 years later, while only 35% of women with low progesterone levels on that day were still living after 18 years. The researchers noted that progesterone lowers the expression of vascular endothelial growth factor, which promotes the increase in new blood vessels (angiogenesis) that is essential for tumor growth. This strongly suggests that women should time their surgery to match their monthly peak in progesterone.8
“The best results from progesterone supplementation are obtained when the natural monthly fluctuation in this hormone is followed as closely as possible,” notes Dr. Wright. “There should be a monthly pause in progesterone supplementation, because that’s what our bodies naturally do. Progesterone and estrogen are produced and received by their hormone receptors in cyclic fashion, with a brief lull every month. This ‘down time’ probably helps prevent long-term receptor down-regulation.
“As a general rule, I recommend using a progesterone cream from day 12 of the cycle until three to five days before the start of the next cycle. However, women with a family history of osteoporosis may need more days of progesterone exposure because this hormone positively influences bone formation.”
The Safest Estrogen: Estriol
Traditional medical doctors usually prescribe estrogen as the primary hormone for women going through menopause. In fact, unless a woman has had her ovaries removed, most physicians will prescribe only estrogen, and often the more toxic estrone and estradiol forms of the hormone at that. This is mainly the result of decades of drug company propaganda that has established the more harmful synthetic drugs made from these forms—such as Premarin®, Estrace®, and Estraderm®—as the standard of care for postmenopausal women.
Of course, recent disclosures about the dangers of these drugs, including the much-publicized halt to the Women’s Health Initiative study in 2002, have made clear that estrogen replacement therapy can have its risks.2 The unfortunate result of the media’s superficial reporting on this topic, however, is that millions of women have given up on estrogen therapy altogether, when the utilization of the more benign estriol, in conjunction with balanced levels of other hormones, can produce significant relief from menopausal symptoms without the dangers inherent in traditional “solutions” to the problem.
Estriol is used extensively in Europe by peri- and postmenopausal women for estrogen replacement therapy. Available in the US from a compounding pharmacy with a doctor’s prescription, it has been shown to provide many of the benefits of the traditional approaches without the harsh side effects of the trademarked synthetic drugs.9 Estriol is a weak estrogen, so higher doses are necessary for symptom relief. Nevertheless, this hormone provides a protective effect in the body. During pregnancy, estriol levels rise 1,000-fold, which guards against maternal breast cancer by antagonizing the effects of estradiol.
“Estriol is a fully detoxified estrogen,” explains Dr. Wright. “This was demonstrated in an unpublished 35- to 40-year prospective case-cohort study funded by the Department of Defense.10 This analysis compared 15,000 women who had pregnancies between 1959 and 1967. The women, who all belonged to the same health plan in California, had samples of their serum frozen for 30 years or more. In 1997, the researchers thawed the serum and analyzed steroid hormone levels in the women’s blood during their pregnancies. They then compared the results to the California Cancer Registry to determine the relationship between estriol levels during pregnancy and subsequent prevalence of cancer. The researchers found that breast cancer risk was reduced by 58% among women in the highest quartile of estriol production compared to those in the lowest quartile. The scientists also discovered that estriol levels were higher in Asian and Hispanic women, who are known to have a reduced risk of breast cancer. As a result, not only did estriol not increase the risk of this cancer—as estradiol and estrone do—but it actually reduced the risk.”