About Laura Strommen

This author has not yet filled in any details.
So far Laura Strommen has created 112 blog entries.

Virility Drugs for Erectile Dysfunction…What about Sex Hormones?

Virility Drugs for Erectile Dysfunction…What about Sex Hormones?

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

Virility drugs such as Viagra, Cialis and Levitra work by inhibiting the breakdown of cyclic guanosine monophosphate (cGMP), a molecule which enables the penis to fill with blood and become erect for intercourse. However, these treatments are not always a “magic bullet.” They may not work for many men who try them and they may not enable the same quality of erections men experience in their teenage years.  Also, they do not increase sexual desire and using these drugs does not address any of the underlying medical conditions that may be the cause of erectile dysfunction (ED).

The linchpin in the series of reactions needed for healthy erections is cGMP. The enzyme PDE5 acts to break down cGMP. Virility drugs block the PDE5 enzyme which prolongs cGMP activity in the penis allowing it to fill with blood and become erect. Although these drugs can restore erectile function by slowing the enzymatic breakdown of cGMP, hormones, such as estrogens, progesterone, androgens (e.g., DHEA, testosterone and dihydrotestosterone (DHT)), insulin, and growth hormone can actually increase cGMP production by modulating nitric oxide (NO) production.

NO is an extremely important signaling molecule generated in the body and lasting just a few seconds before it is broken down. It is a potent smooth muscle relaxant and mediates the transformation of guanosine triphosphate (GTP) into cGMP. Hormones are important modulators of NO production and stimulate the production of NO and cGMP. By contrast, glucocorticoids (for instance, cortisol) and prolactin can reduce the bioavailability of NO, possibly reducing the amount of available cGMP as well.

Documentation submitted for a US Patent by Steven Ferguson reveals interesting observations and data about ED. The patent application centers on a clinical trial of 20 men with ED, ranging in age from 21 to 88 years old.

When measuring their hormone status, Ferguson found that these men were low in testosterone, low in progesterone, and normal to high in estradiol. All had some health issue(s) such as hypertension, diabetes, heart disorders, prostatic hyperplasia, renal insufficiency, depression, high cholesterol, chronic obstructive pulmonary disease (COPD), or cerebral palsy. Many of these health issues or the drug treatments for them are known as risk factors for the development of ED. Ferguson’s treatment was to supply progesterone and testosterone together in topical creams which were applied to non-hairy skin areas daily.

Ferguson’s group was reflective of the general health status of men who experience erectile dysfunction. In one to three months, the majority of men treated with his progesterone with testosterone cream were able to achieve full erections. These results were stunning in that no attempt was made to address any underlying disease states.

Although virility drugs are widely used, they do not address the underlying cause of ED. Diminished hormone production with aging or from other causes may be the root of the problem. Ferguson’s successes illustrate just how important hormone balance can be in reversing ED.

  • Duckles S, Miller V. Hormonal Modulation of endothelial NO production. Pflugers Arch. 2010 May; 459(6): 841–851
  • Ferguson SW. Progesterone/testosterone cream for erectile dysfunction. Google Patents. https://www.google.com/patents/US20070167418. September 7, 2004. Accessed July 2018.
  • Huang SA, Lie J. Phosphodiesterase-5 (PDE5) Inhibitors In the Management of Erectile Dysfunction. P T. 2013 Jul; 38(7): 407, 414-419. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3776492/. Accessed July 2018.

© 2018 Women’s International Pharmacy

Edited by Michelle Violi, PharmD; Women’s International Pharmacy

For any questions about this article, please e-mail

Carol Petersen at carol@womensinternational.com

Virility Drugs for Erectile Dysfunction…What about Sex Hormones?2018-09-11T14:42:30+00:00

Metallo-estrogens

Metalloestrogens

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

gears with rustThe world abounds with substances that affect hormone balance. It is widely accepted that that there are many organic substances that affect hormone activity in the body. For example, soy has estrogen-like qualities and ginseng acts as an adrenal adaptogen. We can use these organic substances in ways that are beneficial to the body. On the other hand, organic substances like phthalates, PCBs and BPA mimic estrogens in a negative way. They create a burden of too much estrogen activity in the body.

Researchers are now turning to inorganic sources of hormone disruption. In 2006, Dr. Philippa Darbre published a paper that identified many metals that have an effect on estrogen receptors. These effects include: altering gene expression, estrogenic activity, and displacing estrogens from estrogen receptors. Metals that have been identified to exert an influence on estrogen receptors include aluminum, antimony, arsenite, barium, cadmium, chromium, cobalt, copper, lead, mercury, nickel, selenite, tin, and vanadate. These metals are referred to as metalloestrogens. The paper also identified metalloestrogen activity at progesterone, testosterone and glucocorticoid (hydrocortisone-like) receptors. For example, cadmium has been shown to produce testosterone activity, displace testosterone from testosterone receptors and affect gene changes. Dr. Darbre concludes that all steroid hormone receptors may be affected.

Some metalloestrogens are essential minerals. Cobalt, chromium, copper, and nickel are all needed in trace amounts for normal human body function. When the amounts of these minerals exceed the amount needed by the body, they begin to interfere with the hormone receptors.

Other metalloestrogens, such as cadmium, aluminum, and lead, are not needed by the body in any amount. Cadmium is problematic because the human body doesn’t have an enzyme system to eliminate it once we are exposed. Making matters worse, the kidneys reabsorb cadmium rather than eliminate it. The amount of cadmium in our bodies continues to increase as we age. Common sources of cadmium, outside of industrial uses, include cigarette smoke and certain foods due to cadmium pollution in our environment. Cadmium may be a trigger for endometriosis. Several studies point to an association between the presence of cadmium in the body and endometrial tissue proliferation. One especially interesting study found melatonin was able to block the estrogenic effect of cadmium in endometrial tissue.

Lead acts as a metalloestrogen by occupying hormone receptors. Unsurprisingly, lead contributes to a number of health conditions. The Environmental Protection Agency (EPA) recognizes lead can cause a number of problems for women. After menopause, increased levels of lead in the body increase one’s risk for hypertension, atherosclerosis, reduced kidney function, and decreased cognitive functioning with symptoms similar to dementia. Osteoporosis, another condition common in menopause, can cause lead to be released into the body as bone breaks down. Those of us who have been exposed to lead paints and leaded gasoline have higher levels of lead in our bones, causing higher levels of lead in our bodies as lead is released from our bones. (For more information, read our article Lead Toxicity and Disease.)

As research expands and we dig deeper into hormone balance issues, more information emerges to help us solve the riddle of hormone imbalance. The effects of metalloestrogens are not always considered by busy practitioners. Furthermore, many are not trained to help reduce the body’s load of metalloestrogens. Three medical groups that focus on reducing metalloestrogens in the body are the International College of Integrated Medicine (www.icimed.com), the American College for Advancement in Medicine (www.acam.org), and the American Association of Naturopathic Physicians (www.naturopathic.org).

  • Darbre PD. Metalloestrogens: An Emerging Class of Inorganic Xenoestrogens With Potential to Add to the Oestrogenic Burden of the Human Breast. J Appl Toxicol. 2006 May-Jun;26(3):191-7. DOI:10.1002/jat.1135.
  • U.S. Environmental Protection Agency Aging and Sustainability List Serve
  • Silva N, et al.  Metalloestrogen cadmium stimulates proliferation of stromal cells derived from the eutopic endometrium of women with endometriosis.Taiwan J Obstet Gynecol. 2013 Dec;52(4):540-5.
  • Jackson LW, Zullo MD, Goldberg JM. The association between heavy metals, endometriosis and uterine myomas among premenopausal women: National Health and Nutrition Examination Survey 1999 – 2002. Hum Reprod. 2008 Mar;23(3):679-87. DOI: 10.1093/humrep/dem394. Epub 2008 Jan 12.
  • Chemical of the Day. Metalloestrogens. https://chemicaloftheday.squarespace.com/most-controversial/2014/9/4/metalloestrogens.html. September 2014. Accessed August 2018.
  • Martínez-Campa C, et al. Melatonin inhibits both ER alpha activation and breast cancer cell proliferation induced by a metalloestrogen, cadmium. J Pineal Res. 2006 May;40(4):291-6.
Metallo-estrogens2018-09-12T10:29:02+00:00

Premature Balding in Men

Premature Balding in Men

A Symptom of Metabolic Syndrome and Benign Prostatic Hyperplasia

Written by Women’s International Pharmacy Staff

premature balding in menAccording to Statistic Brain, 35 million men in the US experience hair loss, 40% of which have hair loss by the age of 35.(i) The same hormonal imbalances that contribute to early onset balding may also cause more serious conditions. Because of its strong association with hormone imbalances, prostate enlargement, and metabolic syndrome, premature hair loss could be indicator for men of deeper health concerns.

A Male Version of PCOS?

Polycystic Ovary Syndrome (PCOS) is a hormonal disorder common among women of reproductive age. At the Progressive Medical Education meeting in Irvine, CA in August 2017,(ii) Dr. Matthew Cavaiola presented a hypothesis published by Kurzrock et al.(iii) He stated because the primary defect underlying PCOS may not be a defect in the ovaries themselves, it is possible that this condition can also occur in men.

Symptoms of PCOS in women include:

  • High androgen hormones (like DHEA and testosterone) in the blood
  • Obesity focused on the waistline
  • High insulin levels
  • Development of diabetes
  • Infertility

Dr. Cavaiola stated that young men can suffer from similar symptoms:

  • Insulin resistance
  • Obesity
  • Increased risk for diabetes and cardiovascular disease
  • Early onset of male pattern baldness
  • Excessive body hair
  • High levels of testosterone and dihydrotestosterone (DHT, the active form of testosterone)

In addition to the symptoms listed above, sex hormone binding globulin (SHBG) levels may be low which further increases the amount of available testosterone and DHT in the body. Dr. Cavaiola also pointed out that when SHBG levels are low, insulin levels are abnormally high. Persistently high levels of insulin may lead to metabolic syndrome, prediabetes, and diabetes.

Prostate Enlargement and Insulin Resistance

Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH) is the enlargement of the prostate gland and is a common condition as men age. Common signs and symptoms of BPH include a frequent or urgent need to urinate, increased frequency of urination at night (nocturia), difficulty starting urination, a weak urine stream or a stream that stops and starts, dribbling at the end of urination and an inability to completely empty the bladder. There appears to be a strong correlation with early onset balding and BPH, as men with BPH tend to have more inherited baldness and an increased severity of baldness. Some studies also point to an increased risk of prostate cancer.(iv, v)

Insulin Resistance

Insulin is a hormone made by the pancreas. It allows cells in the body to use glucose (sugar) for energy. Insulin resistance (also called metabolic syndrome or prediabetes) is a condition where cells throughout the body don’t recognize insulin as they should. This causes the cells to have trouble absorbing glucose, which causes a buildup of sugar in the blood. It also causes the body to produce more insulin leading to high insulin levels in the body. These high levels of insulin may be a major contributor to BPH and early onset balding as postulated by Ajit Vikram et al.(vi)

Insulin resistance may also be associated with, high blood pressure, high triglycerides and acanthosis nigricans (dark patches of skin usually on the back of the neck, groin, and armpits).

Treatment Options

Addressing Baldness and Prostate Enlargement with Finasteride

Drug companies have come up with a possible solution for hair loss and prostate hyperplasia with a synthetic molecule, finasteride. Finasteride is the generic name for two prescription drugs: Propecia and Proscar. Propecia has been approved by the FDA to treat male pattern baldness at a dose of 1 mg per day. Proscar is the same drug in a 5 mg dose, and has been approved to treat BPH. Finasteride inhibits the 5 alpha reductase enzyme, which is the enzyme responsible for converting testosterone into its more active form, (DHT). Studies suggest high levels of DHT may be responsible both for male pattern baldness and BPH.

Negative Side Effects of Finasteride

There are a number of negative side effects that have been associated with finasteride. The Post Finasteride Syndrome Foundation studies these persistent adverse effects,(vii) which include:

  • Loss of penis sensitivity
  • Decreased ejaculatory force and volume
  • Loss of libido and low penile temperature
  • Reduced feeling of pleasure or emotions
  • Lack of mental concentration
  • Loss of muscle tone/mass
  • Severe depression, suicidal ideation, and suicide
Why Not Progesterone?

Progesterone, a hormone that naturally occurs in the human body, also acts as a 5 alpha reductase inhibitor,(viii) as well as having a great number of other important functions in the body. The drug, finasteride, structurally resembles progesterone. The prostate has receptors for progesterone in addition to receptors for androgens (testosterone and derivatives) and estrogens. While many studies have explored the relationship of prostate enlargement and prostate cancer to androgen and estrogen receptors, little research exists for the relationship to progesterone.

Progesterone is produced in men by the testes and the adrenal glands. Men have progesterone levels similar to a woman’s progesterone levels during the follicular phase of the menstrual cycle. RuiQi Chen et al. present a case for inhibition of prostate enlargement—and possibly prostate cancer—using progesterone.(ix)

Conclusion

Some men may consult a practitioner when confronting hair loss and may be prescribed Propecia in an attempt to grow hair back, but why use a synthetic drug when rebalancing hormone levels with progesterone, a hormone natural to the body, may help? Hair loss may be the first sign of hormone imbalances that could lead to metabolic syndrome and prostate hyperplasia. Other potential risks may include high blood pressure, high cholesterol, obesity, diabetes, and heart disease. By proactively considering hormone balancing solutions, men may forestall the loss of their hair and prevent more drastic declines in their health.

  • (i) Statistic Brain. Hair Loss Statistics. https://www.statisticbrain.com/hair-loss-statistics/. August 2016.
  • (ii) Cavaiola M. Environmental Medicine: Focus on Men’s Health & Longevity. A presentation at the Progressive Medical Education Meeting. August 2017.
  • (iii) Kurzrock R, Cohen PR. Polycystic ovary syndrome in men: Stein-Leventhal syndrome revisited. Med Hypotheses. 2007;68(3):480-3. Epub 2006 Nov 28. (3)
  • (iv) Oh BR, et al. Association of benign prostatic hyperplasia with male pattern baldness. Urology. 1998 May;51(5):744-8.
  • (v) Papa NP, et al. Early onset baldness and the risk of aggressive prostate cancer: findings from a case-control study. Cancer Causes Control. 2018 Jan;29(1):93-102. doi: 10.1007/s10552-017-0981-0. Epub 2017 Nov 14.
  • (vi) Vikram A, et al. “Insulin-resistance and benign prostatic hyperplasia: The Connection” Eur J Pharmacol. 2010 Sep 1;641(2-3):75-81. doi: 10.1016/j.ejphar.2010.05.042. Epub 2010 Jun 9.
  • (vii) Post-Finasteride Syndrome Foundation. https://www.pfsfoundation.org. Last accessed: April 2018.
  • (viii) Ling YZ, et al. Synthesis and in vitro activity of some epimeric 20 alpha-hydroxy, 20-oxime and aziridine, pregnene derivatives as inhibitors of human 17 alpha-hydroxylase/C17,20-lyase and 5 alpha-reductase. Bioorg Med Chem 1998;6:1683-1693. https://www.ncbi.nlm.nih.gov/pubmed/9839000
  • (ix) Chen R, et al. Progesterone receptor in the prostate: A potential suppressor for benign prostatic hyperplasia and prostate cancer. J Steroid Biochem Mol Biol. 2017 Feb;166:91-96. doi: 10.1016/j.jsbmb.2016.04.008. Epub 2016 Apr 25.
  • Fung J. The Obesity Code: Unlocking the Secrets of Weight Loss. Greystone Books; Vancouver, BC, Canada: 2016.
Premature Balding in Men2018-07-17T16:31:21+00:00

Book Review – Estrogen’s Storm Season

Book Review – Estrogen’s Storm Season: Stories of Perimenopause by Dr. Jerilynn Prior

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

stormDr. Jerilynn Prior is a Professor of Endocrinology and Metabolism at the University of British Columbia in Vancouver. She is also the Scientific Director of the Centre for Menstrual Cycle and Ovulation Research (CeMCOR).  Not only is Dr. Prior a dedicated scientist and medical writer, she has now turned to fiction to share her knowledge about women’s health. She knows from experience that it can take decades to disseminate information to those who would benefit the most. In Estrogen’s Storm Season she uses storytelling to carry her message by personifying the main challenges of perimenopause.

Perimenopause begins when the first symptoms appear and lasts until one year after the last menstrual cycle. In her book, Dr. Prior carefully documents the stages of perimenopause. Through fictional encounters with women going through perimenopause, she weaves useful information and helpful hints and concepts into her writing so that readers may be able to identify what is happening in their own lives. Here are the main symptoms she brings into focus:

  • Night sweats and hot flashes
  • Menorrhagia or heavy bleeding
  • Nausea
  • Infertility
  • Migraine headaches
  • Moodiness
  • Weight gain
  • Breast tenderness, pain, and swelling

While touching on these issues with broad strokes, she illustrates that life can be messy, as many other issues are entwined in her characters’ lives. Their concerns include high blood pressure, diabetes, heart disease, osteoporosis, and cancer. She also addresses the stress of work situations, relationships, financial concerns, and diet. Like real women, her characters discover that their discomforts and health concerns may be part of a bigger picture, and that solutions should be comprehensive, addressing health concerns and lifestyle modifications in addition to perimenopausal symptoms.

Many individuals may be unaware of an underlying theme of perimenopause, which Dr. Prior reveals in this book. Perimenopause has long been characterized as the time of life when women experience a decline in estrogen production. Dr. Prior claims this is not so; in fact, she has found in her studies that women experience the highest estrogen levels in their entire lifetime during perimenopause. In her opinion, too many women are prescribed estrogens (or birth control pills containing estrogens) when they are already suffering from too much estrogen. According to Dr. Prior, the hormone that is in decline is actually progesterone, which is needed to offset the effects of high estrogen levels. Dr. Prior has found success in progesterone treatments in tandem with employing a whole spectrum of life enhancements.

As her fictional characters come alive, Dr. Prior teaches women how to document their initial symptoms and their interventions with any subsequent symptom changes so that they can see for themselves what works and what doesn’t. These tools are available on the CeMCOR website, which overflows with practical information about the menstrual cycle as well as addressing questions and concerns a woman may have throughout her lifetime. Through Estrogen’s Storm Season, Dr. Prior’s guidance and understanding empowers women to take charge of their health.

Updates as of August 8, 2018:

The electronic version of the second edition of Estrogen’s Storm Season is available to download at the following additional sites:

Recent revisions to the print version of Estrogen Storm Season are posted to the Cemcor.ca site:

Additional Resources:

Book Review – Estrogen’s Storm Season2018-08-08T15:09:01+00:00

Vaginal Use of Estriol

Vaginal Use of Estriol

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

Estriol is one of the three main estrogens made in a woman’s body. The other estrogens are estrone and estradiol. Estriol levels are highest in a woman’s body during pregnancy. Normal ranges for non-pregnant, non-menopausal and menopausal women are not usually noted, making it difficult to determine what would be considered “normal levels” in the body. Estriol may be used alone or in combination with the other estrogens in a number of different dosage forms, and has been shown in studies to have good activity in the vaginal area. In 1993, a landmark study published by Raul Raz et al. in the New England Journal of Medicine sparked great interest in using estriol vaginally, not only for improving the condition of the urinary tract, but vaginal tissue as well.[i]

In 2016, Salvatore Caruso et al. published a study in Menopause reaffirming the effectiveness of vaginally-used estriol.[ii] This study included monitoring the acidity of the vaginal tissue. Healthy vaginal tissue is in the slightly acidic range and favors the growth of friendly lactobacillus acidophilus bacteria. When this tissue becomes thinner and more alkaline as estrogen declines in menopause, the protection of the friendly bacteria declines, which may lead to infections by other less desirable organisms. Even the small amount of estriol used in this study, 50 microgram doses, caused an improvement in cell structure, acidity of the vaginal tissue, better urine control, and increases in sexual function and in quality of life. The study concluded that estriol should be a first choice in managing menopausal symptoms in the genital and urinary tracts in menopausal women.

Also in 2016, Filippo Murina et al. studied the application of a 25 microgram dose of estriol (applied daily with a finger or cotton swab) to the vulvar vestibule. After the study period of 12 weeks over 80% of the participants experienced relief from pain on intercourse. The authors maintain that direct application of estriol to the vestibule, rather than applying it vaginally, is necessary for pain relief.[iii]

Estrogen receptors

Although in reality, the process is much more complex, a simplified description of estrogen’s interaction with its receptors begins with an estrogen hormone binding to an estrogen receptor protein. When bound, the estrogen hormone-estrogen receptor complex is shuttled to the cell nucleus, where it gives specific DNA instructions and produces proteins to create an estrogen effect. This description is complicated by discoveries that there is more than one type of estrogen receptor (alpha and beta). The beta type tends to predominate in the mucosal areas, such as the vagina. The higher affinity of estriol to beta receptors over other estrogens such as estradiol predicts that estriol might be more effective in those tissues. (For more on this topic, see our article, How Hormones Interact With Receptor Sites.)

Labial Adhesions

Estrogens are sometimes used to treat labial adhesions in babies and young girls. Estriol may be the preferred choice because of its strong affinity to mucosal estrogen receptors. A study published in 2016 by Stefanie Bussen et al. demonstrated a favorable outcome in comparison to manual or surgical separation. A 1 milligram estriol dose was applied in this study nightly for four weeks at the fusion site. In most of the cases, further treatment was not needed.[iv]

Commercially Available Abroad

Estriol has been in use both as an oral and a topical estrogen supplement for many years in other countries. A product named Ovestrin, which contains a half milligram of estriol per dose, is government-approved for use in many countries.[v] The recommended dosing of estriol for the genital tract and urinary tract atrophy is one dose nightly for some weeks, then decreasing to a maintenance dose of twice weekly applications as symptoms improve. As the cells normalize and normal bacteria and acidity is re-established, issues such as infection, inflammation, pain on intercourse, dryness, itching, urinary complaints, and mild incontinence may resolve.

Estriol in the United States

Estriol has had a tumultuous time in the United States. Since there was no commercial product available, compounding pharmacists came to the rescue by preparing estriol containing creams or other dosage forms in varying strengths for individual use. The drug company Wyeth (the makers of Premarin and Prempro until purchased by Pfizer in 2009) sought to have the FDA ban its use in the United States, even while selling a commercial product containing estriol in Europe.[vi] To this date, there is no human drug product containing estriol in the United States which has been approved by the FDA. At this time, it is solely available through compounding pharmacies.

Ironically, there is an estriol product for animals approved by the FDA for use in spayed (the surgical removal of the ovaries and uterus) female dogs with estrogen-responsive urinary incontinence. Urinary incontinence is a common problem in spayed female dogs because the removal of the ovaries depletes hormones, including estrogens. This drug, Incurin, contains 1 mg of estriol in tablets.[vii]

Conclusion

The use of estriol vaginally is a clear illustration that our current medical system, based on government approvals and a one-size-fits-all model, leaves large therapy gaps. As of the time of this writing, no drug company in the United States has succeeded in bringing an estriol-containing product to market for human use. In the meantime, compounding pharmacists have made estriol available in a wide array of dosage forms and doses to address each woman’s individual needs.

  • [i] Raz R, et al. A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections. N Engl J Med. 1993 Sep 9;329(11):753-6.
  • [ii] Caruso S, et al. Quality of life and sexual function of naturally postmenopausal women on an ultralow-concentration estriol vaginal gel. 2016 Jan;23(1):47-54. doi: 10.1097/GME.0000000000000485.
  • [iii] Murina F, et al. Coital Pain in the elderly: could a low dose estriol gel thrill the vulva vestibule? Eur J Obstet Gynecol Reprod Bio 2016 Dec;207:121-124. doi: 10.1016/j.ejogrb.2016.10.016. Epub 2016 Nov 2.
  • [iv] Bussen, S et al, Comparison of Conservation and Surgical Therapy Concepts for Synechia of the Labia in Pre-Pubertal Girls. Geburtshilfe Frauenheilkd. 2016 Apr; 76(4): 390–395. doi:1055/s-0035-1558101.
  • [v] Ovestin cream (estriol). https://www.netdoctor.co.uk/medicines/a7950/ovestin-cream-estriol/. Accessed February 9, 2018.
  • [vi] Alliance for Natural Health USA. Access to Estriol. https://www.anh-usa.org/access-to-estriol-2/. Accessed February 9, 2018.
  • [vii] MSD Animal Health. Incurin product details. https://www.msd-animal-health.co.nz/Products/Incurin_/020_Product_Details.aspx. Last accessed: April 2018.

© 2018 Women’s International Pharmacy

Reviewed by Michelle Violi, PharmD; Women’s International Pharmacy

For any questions about this article, please e-mail

Carol Petersen at cpetersen@womensinternational.com

Vaginal Use of Estriol2018-09-12T11:18:05+00:00

Book Review – The LDN Book edited by Linda Elsegood

Book Review – The LDN Book, edited by Linda Elsegood

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

Linda Elsegood’s personal success story tells how using low-dose naltrexone (LDN) to treat her multiple sclerosis restored her quality of life and gave her hope for the future. Now she is a woman on a mission to help others learn about LDN and to promote further research into how it may be used to treat a variety of diseases. In The LDN Book: How a Little-Known Generic Drug—Low Dose Naltrexone—Could Revolutionize Treatment for Autoimmune Diseases, Cancer, Autism, Depression, and More, Elsegood has compiled chapters written by practitioners who have become experts in the use of LDN.

History

Pharmacist Stephen Dickson provides a comprehensive history of the opium poppy and the subsequent creation of synthetic drug compounds called opiates, which are all active at the opioid receptor sites. Opioid receptors are meant to be activated by hormones produced in the body called endorphins and enkephalins, which can relieve pain and contribute to wellbeing. However, these receptors can also be stimulated by opiates. Naltrexone was originally developed to block these receptor sites in order to assist people addicted to opiates. The developers of naltrexone reasoned that when opioid receptors were blocked, there would be no need to use or abuse opiate drugs. While a logical theory, in actual practice they had little success.

However, in low doses, naltrexone acts to temporarily block opioid receptors. The body responds by producing increased amounts of endorphins and enkephalins. The opioid receptors also increase in sensitivity and number.

Multiple Sclerosis and Lupus

Dr. Deanna Windham begins with a thorough explanation of multiple sclerosis and lupus. While she recognizes that we do not currently have drugs that treat the complexity of these diseases, LDN has been shown in a number of studies to stabilize and stop their progression. The use of LDN is a pillar in Dr. Windham’s treatment plans, though she maintains that each patient must be treated individually for their toxic load, hormone imbalances, nutrient deficiencies, and sleep issues.

Inflammatory Bowel Diseases

Dr. Jill Smith was the first to publish a study on LDN and inflammatory bowel diseases. There are opioid receptors in the gut and on immune system cells. There are a number of different types of opioid receptors and naltrexone may target different opioid receptors depending on the dose.

Dr. Smith provides case studies of remissions of inflammatory bowel diseases, Crohn’s disease and ulcerative colitis with the use of LDN, both alone and with other commonly-used drugs. LDN blocks opioid receptors for about six hours, during which the body increases its endorphin and encephalin production. After about six hours, the LDN is removed from the opioid receptors by the body and the elevated endorphins and enkephalins can act at the receptor to block cell proliferation or reverse inflammation. LDN also sensitizes and increases the number of receptors. Remission may be confirmed with radiology showing healing of the intestinal tract.

Few of Dr. Smith’s patients have experienced side effects, however, one possible side effect is sleep disturbances, which can be alleviated by changing to a morning dose or using a lower strength.

Thyroid

Dr. Kent Holtorf, president of the National Academy of Hypothyroidism, explores LDN treatment with thyroid disorders. He explains how LDN can be used effectively in both Grave’s Disease (hyperthyroidism) and Hashimoto’s Disease (hypothyroidism). He believes LDN can potentially improve abnormal inflammation and immune dysfunction seen with thyroid disorders, and thus, improve the reduced tissue T3 (active thyroid hormone) levels inside the cells that these conditions can cause. Normal thyroid tests cannot predict the activity of thyroid inside the cell, and so this can go unidentified and untreated.

Chronic Fatigue and Fibromyalgia

Dr. Holtorf also addresses chronic fatigue and fibromyalgia.  He writes about phases of treatment with LDN:

  1. Stabilize the patient. This stage is where pain and sleep disturbances are addressed.
  2. Enhance mitochondrial energy production with nutrients.
  3. Balance hormones as these patients typically have deficiencies.
  4. Enhance the immune system function and treat the infectious components. LDN is often part of this stage of treatment.
  5. Address issues like heavy metals, leaky gut, mold toxicity, and coagulation problems.
  6. Maintain health and balance.

An integrative approach has shown success, with treatment plans adjusted to the individual needs of each patient.

Restless Leg Syndrome

Dr. Leonard Weinstock is a gastroenterologist and internist, with a special interest in restless legs syndrome (RLS) and has identified an association between RLS and small intestine bacterial overgrowth (SIBO) and other inflammatory conditions in the gut. He used LDN to treat patients with and without antibiotics for infection. In each case he found some positive results, and has used LDN for long-term remission.

Depression

Endorphins are very psychoactive, and account for the warm feelings of falling in love, coping with stress, and bringing joy and contentment. Dr. Mark Shukhman describes the symptoms of endorphin deficiency as including:

  • Discomfort with disturbances such as changes in sound, light, temperature, or touch
  • Immune system problems such as frequent infections, allergies, and autoimmune disease
  • Crying easily, and have difficulty with painful situations
  • Craving chocolate, wine, marijuana, and alcohol

LDN helps in these conditions by increasing the levels of endorphins. Many people who have turned to opiates describe that it is the first time that they have felt normal. Although his chapter focuses on depression, psychiatrist Dr. Shukhman has also used LDN in his practice for treatment of autism, post-traumatic stress disorder, multiple personality disorder, anxiety, obsessive compulsive disorder, psychosis, and even sexual dysfunctions.

Autism

Dr. Brian Udell has a special needs pediatric practice and has found a common theme with autism to be inflammation and gut disturbances. He cites Dr. Jacquelyn McCandless’ work with children using LDN as a cream, rather than tablets, because of its bitter taste. He has seen LDN increase speech and communication, decrease aggression, and improve social development. Beta endorphin levels can be measured to confirm LDN activity.

Cancer

Dr. Angus Dalgleish, an oncology practitioner in the UK, writes that, while there is very little in the published literature, LDN seems to be universally useful across all tumor types. He writes of his personal experience treating patients with metastases, achieving stability and long–term, disease-free status. He finds that LDN affects more receptor sites than just the opioid receptors. Naltrexone in large doses actually promotes tumor growth in the laboratory, so the best effects occur when it is used in low doses and used intermittently rather than continuously. Its anti-inflammatory action can be helpful in cancer. Dr. Dalgleish reports that the use of LDN also increases the production of natural killer cells. Finally, LDN can produce positive effects on mood that help in combatting the disease. He writes that failure with LDN may be linked to low vitamin D levels.

Conclusion

The LDN Book is just a part of Linda Elsegood’s work. Under her direction, the LDN Research Trust has an incredible number of accomplishments, including organized conferences, LDN radio, and crowdfunded documentaries. This outreach has stimulated investigation into endocrine and immune system activity that was hardly known before. This book is a window into the large body of knowledge we have gained in the last ten years.

Book Review – The LDN Book edited by Linda Elsegood2018-02-26T12:09:00+00:00

MS, Lupus, LDN, and the Hormone Connection

Multiple Sclerosis, Lupus, Low-Dose Naltrexone, and the Hormone Connection

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

Nerve cells are affected by autoimmune diseases such as MS.

According to the American Autoimmune Related Diseases Association (AARDA) about 50 million Americans have an autoimmune disease and 75% of Americans with autoimmune disease are women. Multiple sclerosis (MS) and lupus are the most common of the more than 100 different autoimmune diseases.[i] Research suggests that low-dose naltrexone (LDN)—and its potential effects on hormone imbalance—may prove a positive treatment option for these diseases.

Multiple Sclerosis and Lupus

Multiple sclerosis is an autoimmune disease that affects the central nervous system. The immune system attacks the myelin sheath, the insulating layer of cells that surround and protect the nerve cells. A healthy myelin sheath allows electrical impulses to transmit quickly and efficiently along the nerve cells. When the myelin sheath is damaged, the nerve cells are left exposed and inflamed and plaques begin to form along the central nervous system. The inflammation and plaques can slow or disrupt the electrical impulses moving between the brain and the rest of the body which may cause symptoms such as numbness, weakness, tingling, dizziness, fatigue, pain, vision disturbances, difficulty walking, slurred speech and difficulties with bladder and bowel function.[ii]

Lupus is an autoimmune disease that targets the body’s tissues and organ systems including the skin, joints, cardiovascular system, brain, and kidneys. There are several types of lupus and one type may be induced by medications such as blood pressure medications, antibiotics and anticonvulsants.[iii] Because tissue damage can occur anywhere in the body, lupus can be difficult to diagnose.

While the causes for MS and lupus are unknown, environmental factors may be an instigator in susceptible people. Environmental factors that may instigate MS or lupus include:

  • Nutritional deficiencies (possibly caused by poor food quality)
  • Pathogens and distortion of the gut microbiome
  • Disturbed sleep or sleep deprivation
  • Chemical exposures
  • Hormone imbalances
  • Gluten sensitivity
  • Emotional or physical stress.
  • Vitamin D deficiency (MS)
  • Smoking (MS)
  • Epstein Barr infection (MS)

 

Low-Dose Naltrexone

Low-dose naltrexone (LDN) has emerged as particularly effective in treating autoimmune diseases that involve impaired gastrointestinal function. Crohn’s disease, irritable bowel syndrome, and ulcerative colitis have responded, sometimes dramatically, to LDN treatment.[iv] Autoimmune disorders such as MS and lupus may also be associated with gut disturbances. Recent research on MS has found a connection with the gut microbiome, providing a reason to consider low-dose naltrexone as part of a treatment plan.[v]

Naltrexone was originally developed as a drug to block opioid receptors. These receptors are meant to be activated by hormones produced by the body called endorphins and enkephalins, which can relieve pain and contribute to wellbeing. However, these receptors can also be stimulated by opium-derived drugs called opioids. The developers of naltrexone reasoned that when opioid receptors were blocked, there would be no need to use or abuse opioid drugs. While a logical theory, in actual practice they had little success.

Low doses of naltrexone act by temporarily blocking opioid receptors. The body responds by producing increased amounts of endorphins and enkephalins. The opioid receptors also increase in sensitivity and in number.

Naltrexone is commercially available in a 380mg injection and 50mg tablets to be used as part of a treatment program for alcohol or opioid dependence. It is also added as an abuse deterrent to opioid medications and available in combination with an antidepressant for weight loss. LDN, however, is currently only available from compounding pharmacies.

The use of very small doses of naltrexone was pioneered by Dr. Bernard Bihari. He first demonstrated the effectiveness of LDN in the treatment of patients with AIDS. He established that endorphin levels were low in patients with AIDS and LDN treatment provided substantial increases in these levels. LDN treatment not only improved these patients’ quality of life, but also reduced the rate at which they died.

LDN has since been shown in studies to have multiple health benefits. LDN appears to improve the body’s response to infection with an immunomodulatory effect, resulting in patients having fewer and less frequent infections. LDN also can help the body eliminate and manage toxic exposures by improving glutathione levels, which aids in detoxification and decreases oxidative damage, making it easier to clear the body of toxins. Oxidative stress has been implicated as a triggering factor of both MS and lupus due to loss of antioxidant/oxidant balance.[iv] LDN may help to repair the linings of the gut and brain barriers that prevent absorption of foreign substances, thus healing issues caused by a damaged microbiome. Additionally, LDN may balance stress hormones and also relieve anxiety and depression by improving brain neurotransmitter function.

Treatment

Dr. Deanna Windham, a contributor to The LDN Book,[iv] explored treating patients with MS and lupus with LDN. While it is not the only treatment option she uses for MS and lupus, Dr. Windham does not hesitate to use LDN because of the many benefits she has seen it provide. She cautions that full benefit may not be achieved for 12 to 18 months, so patience and commitment is essential. Dr. Windham individualizes treatment to each patient’s needs by taking a holistic approach.

  • Address diet by eliminating gluten, sugar, saturated fats, and non-foods, and add nutrient supplements
  • Help patients with detoxification of metals and solvents
  • Assist patients in smoking cessation
  • Help patients with sleep problems
  • Test hormone levels, and treat deficiencies with bioidentical hormones
The Hormone Connection

So, how are MS, lupus, and LDN connected to hormones?

High levels of estrogen relative to progesterone, or exposures to estrogen-like chemicals, may be linked to the development of autoimmune disease. In addition, high estrogen levels in men with MS correlate with more brain damage.iv However, research has shown that one specific estrogen, estriol, can have an anti-inflammatory effect in MS. Women’s International Pharmacy provided the estriol capsules used in this landmark study.[v]

Adrenal and thyroid function may also play a role in autoimmune disease. Individuals with autoimmune disease commonly experience low levels of adrenal hormones, specifically cortisol and DHEA. In fact, DHEA has reached clinical trials for FDA-approval for the treatment of lupus. Treating even subclinical thyroid deficiencies can help fatigue, brain fog, memory and sleep. Additionally, increased endorphins stimulated by LDN may even help with hormone balance.[iv]

Conclusion

Seeing the benefits of using LDN has directed research into studying previously unknown connections between the immune and endocrine systems. According to Dr. Windham’s experience, the key to treating MS and lupus may be using LDN in conjunction with diet, addressing other health concerns, and a healthy balance of hormones.

MS, Lupus, LDN, and the Hormone Connection2018-04-09T13:55:26+00:00

Progesterone for Mental Health

Progesterone for Mental Health

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

The Diagnostic and Statistical Manual of Mental Disorders (DSM) outlines the symptoms of schizophrenia and bipolar disorders to include scattered thinking, memory problems, confusion, behavioral changes, depression, anxiety disorders, unstable emotions, uncontrollable anger, low motivation, and changes in appetite. Many psychiatrists rely on the DSM’s description of symptoms as a way to diagnose mental disorders. They attempt to describe and categorize aberrant behaviors before applying an assortment of treatments that may include antipsychotic drugs, behavior modifications, counseling, or institutionalization. Often, the goals of treatment are to return patients to society, but may not include a “cure.”

Recent studies suggest hormones–specifically, progesterone—may offer some solutions not found in standard treatments. According to Doris King, each of the DSM’s symptoms for schizophrenia and bipolar disorder can be traced back to a deficiency of progesterone. In her book, Curing Bipolar Disorder and Schizophrenia, King claims that she was able to turn around her diagnoses of both these disorders.[i] She bases many of her arguments on writings by the late Dr. John Lee, which stress the importance of maintaining normal progesterone levels.

Could Progesterone Be the Key?

Dr. Lee recommended supplementing progesterone in doses that reflect the amount of hormone the body should normally produce.[ii] However, King maintains that people who have a long history of progesterone depletion—as in the case of patients with schizophrenia or bipolar disorder—need much more progesterone, stating simply, “When you have bipolar disorder or schizophrenia, your brain doesn’t have the progesterone it needs to function properly.” She introduces the idea of a loading dose, using progesterone in doses 3-4 times higher than Dr. Lee’s recommendation, until the body’s deficit is restored. During King’s recovery from bipolar disorder she used high doses of progesterone for four months.

Niacin and Schizophrenia

Another progesterone-related angle to schizophrenia is through treatment with niacin. Niacin aids in the synthesis of the sex hormones estrogen, testosterone, and progesterone. Dr. Abram Hoffer spent his career successfully treating patients with schizophrenia with high doses of niacin, a B vitamin.[iii] Niacin taken in high doses may normalize adrenaline metabolism. Dr. Hoffer identified an oxidized metabolite of adrenaline, which he named adrenalchrome, as being responsible for the hallucinogenic effects present in schizophrenia.

Progesterone and Adrenaline Imbalance

In his book, Adrenaline Dominance, Dr. Michael Platt writes that the medical field often ignores the effects of excessive production of adrenaline by the adrenal glands.[iv] Adrenaline is part of our “fight or flight” response, which may make us shaky, hyperactive, superhumanly strong, and intensely aware. A problem occurs when adrenaline is consistently overproduced, leading to symptoms associated with ADHD, anger, depression, PTSD, bipolar disease, addictions, and more. According to Dr. Platt, progesterone, produced in both the adrenal glands and sex organs, is the natural balancing hormone for excess adrenaline.

Nerve Damage Research and Other Breakthroughs

The myelin sheath wraps itself around nervous system tissue as a protective shield. If the myelin sheath is damaged, nerve conductivity is lost. Led by Natalya Uranova, Russian scientists have published research linking damaged myelin sheaths to both schizophrenia and bipolar disorder.[v] They examined the nervous system tissue of deceased patients who had these disorders, identifying myelin damage in these patients. In another study, Michael Schumaker et al. concluded that progesterone can be independently produced by myelin tissue and can be used in myelin repair strategies.[vi]

Conclusion

Mental health has become a large focus of today’s healthcare, as researchers strive to identify the genetic and environmental influences on mental health. While sex hormones have long been associated with changes in mood—such as anxiety and depression found in PMS or menopause—we can now turn our attention to the hormonal influences on other psychiatric disorders such as schizophrenia, bipolar disorders, and more. As research continues, progesterone may emerge as a key factor in developing treatments to recover and optimize mental health.

Additional Resources:

For more information on mental health and hormones visit our Mental Health Resources page.

Progesterone for Mental Health2018-04-09T13:58:51+00:00

Book Review – The 6-Week Cure for the Middle-Aged Middle by Mary Dan Eades, MD, & Michael R. Eades, MD

Book Review – The 6-Week Cure for the Middle-Aged Middle by Mary Dan Eades, MD, & Michael R. Eades, MD

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

 

scale and measuring tapeHow many middle-aged adults experience weight gain in their midsection?  Even with no changes in diet or exercise, weight gain is commonplace, particularly around the middle. Worse, this area of weight gain is the very abdominal obesity associated with heart disease. Drs. Michael and Mary Dan Eades address ways to eliminate unhealthy fat that accumulates around the organs in their book, The 6-Week Cure for the Middle-Aged Middle.

Drs. Michael Eades and Mary Dan Eades gained fame in the 70s for their weight loss success and their bestselling book, Protein Power. Both physicians lost a considerable amount of weight by incorporating principles they learned as they researched their weight problem. In turn, they successfully helped many others lose weight.

After decades of success, however, a problem arose. As the Eadeses prepared for a televised show, although they continued to follow their own prescription for success, the cameras zeroed in on a problem: a middle-aged spread around the middle. They wondered how they could promote the success of their program with this weight concern.

The Eadeses went back to what had worked for them the first time: research. They set out to find what had sabotaged their program for successful weight loss.

The answer? Hormones.

 

Cortisol and Estrogen

During middle age, the adrenal glands may increase their production of cortisol. This may be provoked by a number of factors including stress or sleep disturbances. The increased cortisol levels send signals to store fat, particularly in the abdominal area.

Weight can be affected by both high and low estrogen levels. With aging, estrogen (the hormone associated with curviness in women) decreases, and may contribute to midlife weight gain. The Eadeses recommend using only bioidentical estrogens, estradiol or estradiol with some estriol, as non-bioidentical therapies may not help with weight and may even worsen it.

The Liver and Hormone Deficiencies

6 week cure for the middle aged middle bookIn middle age, the pancreatic hormone insulin rises, signaling the liver to store more fat. Additionally, as we age, the liver creates more sex hormone binding globulin (SHBG), a protein carrier for hormones. When the hormones are bound to this protein, they are not available for use by the body.  While SHBG levels increase with age, the sex hormones carried by SHBG such as testosterone, DHEA, and estrogens decline with age. Hormone deficiencies can occur as lower levels of hormones are produced overall and more SHBG binds the hormones that are produced, making them unavailable for use by the body. These hormone deficiencies can lead to loss of muscle and bone mass and an increase in body fat percentage.

According to the Eadeses, what happens in middle age is a combination of a number of factors: loss of sleep, increased stress, a diet lacking in fat (due to concerns with cholesterol levels), hormones imbalances, introduction of new medications, and difficulties with nutritional intake. Their book is not a weight loss plan, but a path to “body-rehabilitation,” as fat stores leave the middle and the body becomes leaner and stronger.

A dietary plan to address abdominal weight gain is spelled out in The 6-Week Cure for the Middle-Aged Middle. The Eadeses report great success for themselves and their patients. For those that are struggling with middle aged weight gain, this book may hold the resources needed to help combat it.

Book Review – The 6-Week Cure for the Middle-Aged Middle by Mary Dan Eades, MD, & Michael R. Eades, MD2018-01-22T10:50:12+00:00

Green Tea for Oral Health

Green Tea for Oral Health

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

green teaTea is one of the most popular beverages consumed worldwide, second only to water.[i] A review by Sabu Chacko et al. discusses the studies and observations of green tea in particular as an antibacterial, antiviral, anti-inflammatory, anti-carcinogenic, and antioxidant.[ii] Here we will explore the role of green tea in promoting oral health.

 

Green Tea and HPV

In 2006 the FDA approved a green tea ointment called Veregen.  As the first botanical ever approved by the FDA, this product demonstrates evidence of green tea’s antiviral properties. Veregen is indicated for the treatment of genital and perianal warts caused by human papilloma virus (HPV).[iii] HPV can also cause lesions to form in the mouth.

Evidence suggests such HPV lesions could be precursors to oral cancers.[iv] In the Journal of Natural Science, Biology and Medicine, Vijayalakshimi Ramshankir et al. explored the use of green tea to prevent oral cancers, identifying many biomarkers that indicate cancer development. Drinking green tea or using green tea extracts may positively impact these biomarkers.[v]

 

Whole Green Tea Extracts

Whole plant extracts, or preparations containing all parts of the plant as opposed to one isolated compound, may have an additional benefit of synergy between multiple complex substances enhancing the effectiveness of each other. One of the most useful substances found in green tea is epigallocatechin-3-gallate (EGCG), a very potent antioxidant. EGCG is not typically extracted from green tea to use alone as it not a stable single molecule. When whole green tea extracts are used in supplements, the percentage of ECGC is often specified on the label. Green tea extracts are available as supplements in various strengths of ECGC.

Compounded Green Tea Lozenges

Some might find a drawback to green tea consumption to be its caffeine content.  Larger amounts of green tea or green tea extract that might achieve the best results may be too stimulating for regular use. Compounded lozenges of decaffeinated green tea extract could be a solution for oral health issues without the stimulatory effects of caffeinated green tea or green tea extract. Lozenges are designed to slowly dissolve in the mouth. The tissue in the mouth may benefit by prolonged exposure to the green tea before swallowing. Because green tea, black tea, and coffee are known for staining the teeth, rinse your mouth with water to minimize staining after drinking these beverages or using lozenges.

Like many plants, green tea contains a wealth of substances that scientists are discovering to be beneficial to our health. While drinking tea is an ancient practice, modern science confirms that green tea is a powerful supplement and oral health is just one of its benefits.

  • [i] Tea Association of the U.S.A. Inc. Tea Fact Sheet. https://www.teausa.com/14655/tea-fact-sheet. Last accessed: April 2018.
  • [ii] Chacko S, et al. Beneficial effects of green tea: A literature review. Chinese Medicine. 2010;5:13.
  • [iii] Fougera Pharmaceuticals Inc. Veregen information. PharmaDerm. www.veregen.com.
  • [iv] National Institute of Dental and Craniofacial Research. Oral Cancer. https://www.nidcr.nih.gov/OralHealth/Topics/OralCancer/DetectingOralCancer.htm. Reviewed February 2018. Last accessed: April 2018.
  • [v] Ramshankar V, et al. Chemoprevention of oral cancer: Green tea experience. J Nat Sci Biol Med. 2014;5(1):3-7.
  • [vi] American Academy of Periodontology. Go Green for Healthy Teeth and Gums. https://www.perio.org/consumer/green-tea. Last accessed: April 2018.
  • [vii] Deshpande N, et al. Evaluation of intake of green tea on gingival and periodontal status: An experimental study. J Interdiscip Dentistry. 2012;2(2):108-112.
Green Tea for Oral Health2018-04-09T13:11:48+00:00