Quote from: Kendra on September 27, 2018, 08:31:03 AM
I disagree.
Dr. Facebook didn't complete medical school for a decade or even a few days. Couldn't be bothered with a medical internship. Failed to qualify for a career in any clinic. And isn't qualified to guide any of my health care decisions.
By the same token, doctors and the pharmaceutical industry have a terrible track record when it comes to women's HRT. They quickly settled on bioidentical testosterone for men's hormone replacement (a comparatively small market), but when it came to women's hormone replacement (a much larger market), the pharmaceutical industry has been pushing synthetics for decades.
The pharmaceutical industry business model revolves around patents, and having a period of patent protection during which they can sell a drug for high prices without fear of being undercut by competitors. If a drug can't be patented, it's of no interest to them, even if it works much better than their patented products. Bioidentical hormones (bioidentical means chemically identical to the hormones that occur naturally in the human body) were already there in nature and weren't invented by man, so can't be patented. Although they've had the ability since at least the 1950s to produce hormones that are completely chemically indistinguishable to our own hormones, this issue of patentability meant that the pharmaceutical industry instead opted to promote "synthetic" hormones, which are manmade substances designed to target the same receptors as our naturally occurring hormones do, and produce similar effects.
As a result, most of the hormones used in medicine, and virtually all the hormone replacement given to women, has until very recently either been synthetics, or an extract of horse estrogens called Premarin. Although the estrogens in premarin are naturally occurring and therefore can't be patented, the means of production (extraction from the urine of pregnant mares) could be protected by patents, giving a single pharmaceutical company (Ayerst, later Wyeth, and now Pfizer) the monopoly on production. Even though it's an inferior estrogen, slick marketing means that premarin grew to become the main women's hormone replacement (a position I think it still holds in the US even now).
The way synthetics (and Premarin) have been marketed, is that their effects are essentially the same as the human body's own naturally occurring hormones. In fact, nothing could be further from the truth, and they all seem to have harmful side effects associated with them that aren't seen with bioidentical hormones. The orally active synthetic estrogens are particularly bad in that regard (e.g. DES and ethinylestradiol). They have a very high risk of causing DVTs, pulmonary embolisms, and cardiovascular events (strokes and heart attacks).
DES also turned out to be quite a potent carcinogen, and was eventually withdrawn (not until after millions of women and their unborn babies had been exposed though). Another side effect of DES, one the pharmaceutical industry have so far managed to keep quiet, is that, when administered during pregnancy, it crosses the placenta, and can trigger female brain development in male babies (see the DES thread on this site).
A synthetic progesterone mimic called medroxyprogesterone acetate (brand name Provera) has also seen extensive use in women's hormone replacement, and has since been shown to increase the risks (DVTs etc) associated with synthetic estrogens, as well as leading to an increased cancer risk in its own right.
All this has led to HRT gaining an undeserved reputation for being dangerous. In actual fact, it's not hormones per se that are the problem, but the type of hormone. All the hormones used for women's HRT that led to increased rates of disability and death are non-bioidentical, either synthetics (DES, ethinylestradiol and medroxyprogesterone) or premarin (whose main hormonally active ingredients are estrogens unique to horses, and for which we don't have the enzymes and other systems in place to deal with). There's no evidence of comparable harm associated with bioidentical hormones (other than estradiol taken by mouth increases clotting risk, a risk that can be avoided by using transdermal or injected forms).
Since hormones are prescription medicines, doctors have the legal monopoly on dispensing them. Even so, that doesn't alter the fact that they have a terrible track record in needlessly harming and killing women with bad HRT! IMO, if you're going to be taking hormones, it's important to understand at least the basics of what constitutes good and bad HRT, and not just blindly assume your doctor knows what they're doing. All too often they don't, and are just following stuff some pharma industry sales rep told them. That's why groups such as the trans HRT group on Facebook are important (and also so that trans women who don't have access to medical care, and are forced to use black market hormones, can at least minimise the risks to themselves).
