Patches, Pills or Pellets – What’s the Best Method for Bioidentical Hormone Therapy?
[music]>>KATHY: Welcome to episode 49 of BioBalance
Healthcast. I’m Dr. Kathy Maupin.>>BRETT: And I’m Brett Newcomb and we are
continuing our conversation about items in the news. Today we’re going to talk about
the news that has broken that says HRT patches may be better for people than pills.
>>KATHY: Yes.>>BRETT: I stop to think about pills because
in the information that Kathy puts out on her website, in these podcasts, and in the
book that she’s writing, she talks about all the multiple delivery systems for hormone
replacement therapy. And she has been arguing that there is a hierarchy of effectiveness
and safety that has evolved through the development of different delivery methodologies and she’s
been a voice in the wilderness. Then this news comes out that says ‘well there’s
a point to be made here’ and it’s not as advanced as the point that she typically
makes. But it’s something that I thought we would discuss. You are familiar with this
particular article which came out on ABC world news, but it was first published in the Journal
of the AMA and the Journal of Endocrinology. What happens is that news media constantly
surf those kinds of things, looking for key words, looking for little tidbits that they
can put in the news, news of the day, those kinds of things. And they don’t necessarily
give expansive coverage that provides a lot of detail.
>>KATHY: But they do summarize for us. And sometimes the summary to doctors is like ‘wait
a minute, that’s not what that study said’.>>BRETT: It’s jarring.
>>KATHY: But in this case their estimation of what this study said is right. That the
delivery system of a patch that you put, (women use patches that have both estrodial and then
estrodial and progesten), on their abdomen or on their hip and it does transdermal, meaning
through the skin, absorption. So it doesn’t go through the stomach. And I’m going to
talk about that. Why it is important that hormones don’t go through your stomach.
But let me go through the progression of all the types of delivery systems. Delivery system
really refers to how you get it into your body. We’re delivering it to your body.
So the oldest delivery system that is currently known is oral pills. You put the hormone in
the pill, you swallow it with water or something, and then it supposedly goes to work. Then
we have vaginal delivery systems. Generally that has never been for delivery to your whole
body. It’s just been to get a little bit of estrogen to the vaginal wall. But in recent
years they’ve developed a ring that you can put into the vagina for 1-3 months and
it delivers estrodial, not pure estrodial, but a type of estrogen to your body for three
months. You take it out, you put a new one in. And that’s how you do it. Every delivery
system that is not oral is better than oral for hormones. That doesn’t go for every
drug it only goes for hormones, because, here’s the reason, hormones that are swallowed immediately
go to your liver and your liver breaks it down into components. And these components
aren’t very good for you and they’re not pure estrogen anymore or pure progesten.
>>BRETT: They’re metabolites.>>KATHY: Right, they’re metabolites. And
they never get to your body as a pure hormone, they get to your body as metabolites. One
of those metabolites in oral estrodial or oral estrogen and oral progesterone is estrone,
old lady estrogen that gives you belly fat and breast cancer and all those other things.
So I’ve told people for years that if I can get them off oral and on to anything else
then they’ll be safer to prevent any breast cancer, especially if they have a family history.
So that is my almost as good as pellets delivery system, the transdermal patches. If we could
put bioidentical hormone in that it would still not be as good as pellets because when
it goes through your skin it changes a little bit and makes more estrone than when you take
a pellet. Pellet goes under the skin, it goes to your body as pure testosterone and pure
estrodial. Delivery system is important but what’s in the delivery system is also important.
And the hierarchy there goes synthetic is never as good as pure estrodial and pure testosterone
and pure progesterone. So if you’re choosing the safest method . . .
>>BRETT: So pills are synthetic.>>KATHY: Pills are synthetic. There are few
that aren’t synthetic but because they go through your stomach they’re destroyed.
>>BRETT: They become metabolite and they’re not pure again.
LK: And then you don’t get the good effects and you get some of the bad. So a lot of the
studies on all estrogens that kind of damned all estrogens were done on oral pills.
>>BRETT: Which weren’t pure, they were synthetic. And which were converted to metabolites
because they were oral. What about sublingual?>>KATHY: Sublingual is a very nice way to
take estrodial. It lasts a day.>>BRETT: And sublingual means?
>>KATHY: Under the tongue, or in the cheek. They have troques that go through your cheek
or under the tongue. That is a way to get a bioidentical hormone. Because they don’t
have synthetics made that way yet. It goes directly into your system and is mostly estrodial
but it makes more estrone then pellets or patches.
>>BRETT: So were talking about delivery systems and there are a couple of issues, 3 that I’m
hearing you articulate. One is the content of what is delivered. Whether it’s synthetic
or whether it’s bioidentical. One is the method of delivery. And the third is what
happens, the changes or transitions. The breakdown of the chemicals as the body starts to process
the hormone replacement and distribute it to the locations where it’s supposed to
be. So you’ve got three different things you need to consider when you evaluate these
methodologies and say which one is best for me. And some of that depends on what you are
trying to accomplish. Like you were talking about the vaginal ring or the vaginal delivery.
>>KATHY: They have vaginal tablets. Generally what is approved by the FDA and the American
College of the OBGYN is such a low dose, it’s not very good. At a higher dose it would be
better, you’d have to use three of them to get your vagina wetter and not so dry.
Dryness causes bladder infections, it causes difficult and painful intercourse, it causes
shrinking of the vagina so that it really can’t accommodate you for intercourse even
with lubricants. So it has several different functions. But that’s all those do, they
don’t go to the rest of your body.>>BRETT: So they’re very narrowly focused
for a specific outcome. They’re also time referenced. If you use one of those you have
a window of time where you receive that benefit. But typically through the day or the week
you don’t have that benefit.>>KATHY: That’s right it’s usually a
couple days, it depends on the type or the company. But it’s usually a couple days
and we call it the half life. Any drug is viewed by pharmacist and by doctors as how
long is the half life? You can tell how long the half life is easily because it’s how
often we dose it. If the half life of a pill is every day, it’s every day because half
of it is gone in one day. So then you re-dose. That’s how we dose drugs. Now the patch,
some of the patches for estrodial and progesterone, my favorite is combi-patch because it lasts
three and half days so you change it twice a week. It never really drops. The half life
is probably four days. So you never really get this drop before you change the patch.
Other patches are once a week and often times my patients say “I run out, and get hot
flashes, and feel miserable the day before I should change it”. So in that way the
half life is really 5 days, and not 6 or 7 days. The patient’s getting her symptoms
back. That’s not good for women, it’s not good for how we act. It’s not good for
our health to go up and down in estrogen. The only reason that was good and everybody’s
out there saying, well we did that when we had babies, and that’s because we were made
to have babies. And that’s the only reason we go up and down. If you look at ideal hormone
dosing, men have the same hormones every day when they’re young. Every day they make
the same testosterone level for that man. There are no moods, that’s why they don’t
have moods. There’s no fluctuation.>>BRETT: I have moods.
>>KATHY: I know that. But you know I don’t think it’s from that. And you’re not like
19 anymore.>>BRETT: I have a 16 year old that has moods.
>>KATHY: Yeah, okay, as they start getting their testosterone they get moods too, but
once you’re established and you’re through puberty, then generally you have the same
thing every day. That’s pretty much the pattern of what we should have. So after menopause
we don’t need to have babies. We don’t need to create an atmosphere of constantly
making an egg and getting rid of an egg, if the egg just passes out and dissolves if it’s
not fertilized. So we don’t have to do that anymore so we can be more like you guys.
>>BRETT: Great.>>KATHY: We get our hormones, we should have
our hormones for health and psychological happiness every day the same way. So you need
to have a half life that you can live with. If I can tell you like Suzanne Sommers says,
and I love Suzanne Sommers because she broke this into the eyes of patients and mainstream
news. She has someone that gives her drops under her tongue 6 times a day, maybe 5 times
a day. 5 or 6 times a day. I don’t go to the bathroom that often because I’m too
busy, and my patients are too busy. Unless you have somebody walking around, and putting
the drops under your tongue, or if you’re obsessive compulsive and do nothing else than
watch your hormones, you can’t do that, so I have to think about what can you do.
That’s why, that’s one of the great reasons pellets work.
>>BRETT: I’m smiling because that’s such an atypical life style. I mean you talk about
people eating.>>KATHY: You mean I have an atypical lifestyle
or what Suzanne Sommers did?>>BRETT: No, what Suzanne Sommers is talking
about. I mean for most people, even in a more common domain they talk about dieting and
eating healthy, they talk about eating a little bit every two hours. And most people can’t
schedule their day to do that.>>KATHY: I’d have to brush my teeth every
two hours then.>>BRETT: Yea, I mean you’d have to do all
those things. So 6 times a day is just not acceptable for the lifestyle of most women.
>>KATHY: I can’t walk out into the waiting room and say I’m eating and brushing my
teeth and putting my drops under my tongue.>>BRETT: You people all just wait for me.
>>KATHY: Yeah, you all just wait for me. I mean that’s not going to work in most
people’s lives. So a doctor should always think, I’m not sure we always do that, about
how often you have to do something. Often they give pills because it’s once a day
in the morning and then it’s over. Well that seems good but it’s a much inferior
kind of replacement. Pellets are every four months. I mean you can do that. You can show
up at my office, fill up your tank and then leave. And you know, you’ve wasted an hour
every four months. Not 10 minutes, six time a day.
>>BRETT: Let’s talk a little bit about the way you do those pellets though. When
you talk about delivery systems you have talked about taking an oral tablet or pill that you
swallow, you have talked about sublingual, you have talked about a vaginal insertion,
you have talked about a skin patch. And for all of those things there are absorption modifiers
that break it down or change it as it gets into the interior of the body and begins to
disperse and go to its functionality. The pellets that you use, you put directly into
the interior of the body. And there’s a procedure for doing that.
>>KATHY: Yes, in the fat.>>BRETT: And it’s put into the body fat
of the hip or the abdomen, the hip. There’s no pre-metabolizing process. So what happens
then is that it’s already in the body and the body then begins to utilize this natural
hormone.>>KATHY: Not a synthetic.
>>BRETT: Not a synthetic hormone in a delivery system that’s maximized for optimal efficiency
and delivery.>>KATHY: And to actually adjust itself to
you. Not like an insulin pump adjusts itself with a computer. But your own little control.
When you’re working out you need a lot of estrogen and testosterone, when you’re having
sex you need a lot of estrogen and testosterone. You’re moving fast your blood flow is going.
But when you’re sleeping, you don’t need as much. You’re not using it up. So it’s
a reservoir. You go pick it up.>>BRETT: It’s an on-demand system that’s
keyed to your individual body.>>KATHY: And it’s somewhat time-released
because of that. It’s not like contact pills that have little balls that are time released
in your stomach. It’s time released because it’s surrounded by little blood vessels
that pick up a certain amount all the time.>>BRETT: So it’s kind of an osmosis process;
it just flows through the cell structure.>>KATHY: It flows through the fat. It has
to be in fat, if you have no fat, then I can’t put pellets in.
>>BRETT: I have some fat.>>KATHY: So we put them in an area of fat.
So you can’t lipo-suction yourself to death because I don’t know where I’d go. That’s
how it dissolves. They’re all, all hormones, are lipid soluble. They dissolve through the
fat right into the blood stream. There is no change in that hormone when it does that.
It is a lot like your ovary used to do, make estrogen and testosterone and send it out.
It’s probably better because it’s not up and down every month. But it sends it out
directly into the blood. We want to be like we used to feel. It’s healthier, it feels
better. I really believe that the next best is vaginal, and we do have bioidentical tablets
for sublingual. That would be my next choice for delivery systems. But the kind of vaginal
tablets we use are bioidentical, little tablets or suppositories. They are delivered once
a day. Generally at night before you go to bed. And they are put into the vagina and
in the old days we used to put them into the rectum because we didn’t know the vagina
would work like that. And you can also have them in your cheek. They don’t change as
much as the other delivery systems. Next to pellets that’s my next favorite. And the
other thing is don’t take testosterone through the cheek or under the tongue. Because 90%
of the people that take that get nothing. I do their blood tests. They absorb their
estrodial, they absorb their progesterone. They cannot absorb testosterone that way.
So you’re just wasting your money. So they say “oh testosterone doesn’t work for
me” because they tried it that way. I say “well just give me a chance.”
>>BRETT: What about IM shots?>>KATHY: The IM shots are not bioidentical.
And in women, testosterone shots are placed into the muscle and they have a peak. They
do this. Pellets are more like slowly active, stay up and then slowly come down. So a shot
is every two weeks or every month. They go up and down.They feel terrible in these two
areas until it’s up here. They feel good for a few days and then it comes down. In
that delivery system it’s too variable and it’s testosterone siprianate or it’s testosterone
ethanate and it may last a month but it’s not the same thing every day.
>>BRETT: So the half life will cause things to fluctuate.
>>KATHY: And it makes women really greasy and hairy so I’m not really fond of that
one.>>BRETT: What we’ve been talking about
today involves various different methodologies for delivering hormones and two different
types of hormones; the synthetic hormones that you would take in a pill or a tablet
that you would swallow into your stomach, and the natural hormones that can be delivered
sublingually, though a patch, a vaginal insertion or through the method that you use is to insert
it, you make a small slice in the skin.>>KATHY: A small slice. A 2mm slice. It’s
not like this. Like my little finger, it’s like that.
>>BRETT: A small slice, and put a little metal tube in and put the pellets in through
the tube.>>KATHY: Like a straw.
>>BRETT: Like the size of soda straw. And then seal that back up.
>>KATHY: Take the straw out, leave the pellets in, put a steri-strip over it, no stitches.
>>BRETT: Over four months for women, 6 months typically for men, that chemical is in your
body it is an on-demand system, it is a natural system, you don’t have the mood swings,
you don’t have the functionality swing that you have with the other delivery systems.
>>KATHY: It’s not really a chemical but that’s okay. It’s a pure hormone. It’s
made from soy and yams.>>BRETT: Pure hormone. The scientist and
the lay man. So I guess the end message is, think about these things and talk to your
physician about what you are trying to achieve, what your health concerns are and have this
information about the delivery system so that you can discuss that with your doctor.
>>KATHY: And in the news today is Patches Are Healthier Than Pills. They’ve made one
step toward really what we’ve always known – that anything that’s not oral is safer
for women to take, in terms of hormones.>>BRETT: So if you have any questions or
comments about this program you can e-mail us at [email protected], you can
contact me at my blog at brettnewcomb.com.>>KATHY: And if you want more information
about bioidentical hormone pellets, visit our website at BioBalanceHealth.com or call
us at 314-993-0963. [music] Copyright © 2011 BioBalance Health | St.
Louis, MO 63141 • 314.993.0963 Produced by Davis Interactive.