Back in the 1960s, Robert Wilson, M.D., a gynecologist in
New York City, published a book called 
Feminine Forever, in
which he said that when women go through menopause, “theyenter a ‘vapid cow-like state’ and became very unpleasantcompanions for their husbands.” He evidently felt womenshould be treated for their husband’s benefit, not for their own.80 THE MIRACLE OF BIO-IDENTICAL HORMONES  He received tremendous financial backing from the makers of
Premarin, who helped publish his book and sent him on anation-wide tour so he could promote Premarin to otherphysicians around the country. THE CONTROVERSY OVER PREMARIN
Let me say a few words about Premarin. The name of this
manufactured estrogen compound actually delineates itssource: pregnant mares’ urine. There are about 100 moleculesof estrogen in this preparation, but only one of them is similarto a human estrogen. Although it is considered a “natural”hormone since it is derived from a natural substance, clearly itis natural only for horses. Premarin became the largest-selling drug in the world. However, eventually a darker side to hormone replacementtherapy emerged. It is estimated that in the first ten years afterthe manufacturer started the Premarin market campaign,somewhere between 200,000 and 2,000,000 women developedcancer of the uterus. However, instead of removing Premarinfrom the market, the drug company added Provera to it.Although this synthetic progesterone reduced the risk ofuterine cancer, it quadrupled a woman’s chances of gettingbreast cancer from the estrogen. Along the way, the drug company started ascribing certain
benefits to estrogen replacement therapy without the means toback up their claims. They claimed that estrogen was beneficial for women with
osteoporosis, and yet no study has shown estrogen to reverse thiscondition. We know that estrogen can help delay the onset ofosteoporosis, but only temporarily. In 1999, the FDA finally elim-inated osteoporosis as an indication for using estrogen.81 MENOP AUSE AND PERIMENOPAUSE  They also claimed that estrogen is good for the heart. However, every long-term study of estrogen has indicated thatit causes an increase in the incidence of heart attacks andstrokes. It is contra-indicated in coronary artery disease andcerebrovascular disease, so I fail to see the claimed benefit ofestrogen in these conditions. In order to determine once and for all the benefits of
long-term treatment with estrogen, the largest study ever ofhormone replacement therapy was conducted, beginning in1997. Called the Women’s Health Initiative, it involved track-ing the health of about 162,000 women. It was proposed asan eight-year study to monitor women on Premarin/Proveratherapy. There was a side study of Premarin by itself amongwomen who did not have a uterus. T wo years into the study they started getting some alarming
statistics, but they continued with the research. However, after5 
½years it was decided to stop the study for ethical reasons. The data was showing a significantly higher number of aggres-sive-type breast cancers along with a higher incidence ofcardiovascular complications in those women on thePremarin/Provera combination. When the Premarin/Provera arm of the study was halted in
the summer of 2002, it was front page news in every paper inAmerica; it was the cover story of all the news magazines andbecame fodder for TV news programs and talk shows. For thefirst time in history, women were made aware of a truth thathad been known in some circles for 30 years: that estrogenreplacement therapy might not be safe. The consistent recommendation put forth in the media
was: go talk to your health care practitioner. However, ifdoctors had been aware of the similar results found by priorstudies done in the 1990s, they might not have started theirpatients on these drugs in the first place or continued them.82 THE MIRACLE OF BIO-IDENTICAL HORMONES  Their responses to their patients’ concerns about the study’s
findings ran along the lines of: “Don’t worry about it” or “Thebenefits outweigh the risks” (they don’t) or “It’s your decision.”
The other arm of the study, Premarin by itself, was stopped
in March of 2004 because, once again, the risks proved tooutweigh the potential benefits. SUZANNE SOMERS—THE PROS AND CONS
Into this morass of contradictory information about hormones
walked celebrity/author Suzanne Somers. With her book
The Sexy Years, published in 2004, and a follow-up book
called Ageless, published in 2006, Ms. Somers propelled
herself into position as the new advocate for hormonereplacement therapy. Her books demonstrated some amazingly positive attrib-
utes. For the first time in history, women at large were madeaware of bio-identical hormones—natural hormones that areidentical to their own hormones and can be obtained fromcompounding pharmacies. No longer did they have to subjectthemselves to synthetic drugs that mimic hormones, nor didthey have to take hormones appropriate for horses ratherthan humans. Another tremendous benefit of Ms. Somers’ books was
their insistence that women have to become pro-active abouttheir health; they cannot rely on the traditional medical systemto keep them healthy. However, Ms. Somers makes some points in her books that
I feel require clarification. First off, just because a hormone is bio-identical does not
necessarily mean that it is safe. Hormones are extremely potentsubstances and must be used judiciously. Some of the doctorswho Ms. Somers interviewed are very strong proponents of83 MENOP AUSE AND PERIMENOPAUSE  estrogen. She quotes one doctor as stating that the only time a
woman is healthy is when she is having her periods. T o achievethis aim, this doctor provides her post-menopausal patientswith exceptionally high levels of estrogen in order to have themre-start menstruation. She has patients in their 80s and 90sbleeding every month and bent over with menstrual cramps.These women, needless to say, are intentionally put into thedangerous condition of estrogen dominance. /Wswashomen never stop making estrogen. /Wswashomen do stop making progesterone. In my own practice, the sickest women I have ever seen are
those who had been estrogen dominant, or were estrogendominant when I first met them. Let me remind you that anytime you utilize either a
hormone or a drug, you have to weigh the benefits versus therisks. I look at estrogen as primarily a toxic hormone. It isknown to cause six different cancers in women: breast, uterine,ovarian, cervical, vaginal, and colon cancers. It may causeAlzheimer’s disease, strokes, heart attacks, and phlebitis withfatal pulmonary emboli. It may cause fibroids, endometriosis,adhesions, fibrocystic disease, asthma, migraine headaches,and gallbladder disease. It can lead to auto-immune diseases,such as lupus, rheumatoid arthritis, Hashimoto’s thyroiditis,and others. Estrogen is the hormone that causes women to experience
menstrual cramps, PMS, breast tenderness, and nausea whenthey are pregnant. T o add insult to injury, estrogen is lipogenic.It creates fat around the hips, thighs, and buttocks, and it is thecause of cellulite. T ry telling women with a number of theseproblems that they are healthy because they are having periodsand you might find yourself in an argument.84 THE MIRACLE OF BIO-IDENTICAL HORMONES  It is surprising to me that Suzanne Somers, who already
had estrogen-induced breast cancer (she used to call estrogenher “happy pills”), is proposing that women take what Iconsider exceedingly high levels of estrogen. Not a week goesby when I do not see a patient who had an estrogen-inducedcancer while they were still having their periods. In otherwords, their own estrogen caused these cancers—it does notget more “bio-identical” than your own hormones. Interestingly, every problem, every complication, every
downside to estrogen is eliminated by progesterone (not to beconfused with Provera, or medroxyprogesterone, a syntheticchemical having no relationship to natural progesterone). Anytime high levels of estrogen, such as those proposed bySuzanne Somers’ books, are prescribed, a sufficient amount ofprogesterone must be prescribed to be protective. I believe thelevels of progesterone recommended in her books are woefullyinadequate and inappropriately administered. My advice on the proper dosing is available in chapter 11. T wo basic principles on which I base my approach are:
1. Women never stop making estrogen—it is prob-
ably the only hormone that hardly ever has to bereplaced. It continues to be made by fat cells,skin cells, and the adrenal glands. 2. Women do stop making progesterone. Because
of this, they are always at risk for developingbreast cancer, uterine cancer, ovarian cancer,colon cancer, and other cancers from estrogen. 85 MENOP AUSE AND PERIMENOPAUSE  MY APPROACH
When certain hormone levels decrease, for either natural or
surgical reasons, the pituitary responds by putting out certainhormones of its own to stimulate the ovaries to make morehormones. (The pituitary and hypothalamus glands are thestructures of the brain that control other glands throughoutthe body.) In this case, the pituitary puts out a hormone calledluteinizing hormone (LH) to stimulate the ovaries to makemore hormones. LH may be the primary cause of the vascularsymptoms women experience when they are going throughmenopause—the hot flashes and night sweats. It is my feeling that the pituitary’s primary reason for
trying to raise ovarian hormone levels is so the woman can getpregnant. Once the pituitary is convinced a woman no longerneeds to procreate, it stops sending out the signals and the hotflashes and related symptoms disappear. However, if thewoman is placed on high levels of replacement hormones, thepituitary gets confused. It becomes convinced again that thewoman is trying to get pregnant, and so whenever there is asignificant drop (e.g., from stopping Premarin), it puts outLH and the symptoms recur. The ovaries put out four different hormones—estrogen,
progesterone, testosterone, and DHEA. Replacement of anyor all of these hormones can alleviate perimenopausal andmenopausal symptoms. The primary aim of the replacementof hormones is to keep the woman healthy and to prevent thebody from deteriorating. Since I look at estrogen as a potentially toxic and fat-
creating hormone, and since the body never stops makingestrogen, I take a relatively sparing approach to its use. Iprimarily prescribe estrogen for several reasons—to help86 THE MIRACLE OF BIO-IDENTICAL HORMONES  alleviate hot flashes or night sweats, to help with “brain fog,”
and to relieve vaginal dryness. I will be discussing dosages,along with the various types of natural bio-identical estrogenavailable, in chapter 11. About two years prior to menopausewomen stop ovulating, which means they stop producingprogesterone. This causes them to experience an increase inPMS, breast tenderness, cramps, and related symptoms. Theremay be a development of fibroids or fibrocystic disease in thebreast, both being conditions caused by estrogen when thereis not enough progesterone. Progesterone is one of the most important hormones in a
woman’s body and, in my view, is probably the only hormonethat has to be replaced after menopause. T estosterone andDHEA are two other hormones I often prescribe for mypatients. I discuss the usual recommended dosages andapplications in chapter 11. THE BENEFITS OF PROGESTERONE
Looking over the stories of my patients presented in this book,
you can see that even though they had various medicalproblems, every one of them had conditions related to adeficiency of progesterone. Keep in mind that every problemrelated to estrogen is created by a progesterone deficiency.Giving women natural progesterone takes away menstrualcramps, PMS, breast tenderness, menstrual migraines, andasthma. It prevents fibroids, endometriosis, fibrocystic disease,and estrogen-induced cancers. The benefits of progesterone after menopause are as follows:
It can eliminate hot flashes and prevent and treat osteoporosis.It is a natural anti-depressant—it is the feel-good hormone forwomen. Progesterone is thermogenic—it helps fat to burn. It87 MENOP AUSE AND PERIMENOPAUSE  prevents Alzheimer’s disease, is great for the heart, and restores
the libido (estrogen does nothing for the libido). Throughout this book are numerous references to the
benefits of progesterone in terms of preventing estrogen-inducedcancer. It helps eliminate attention deficit disorder (ADD) andis the number one hormone for lowering insulin levels, therebyhelping to prevent obesity and adult-onset diabetes. WHAT ABOUT TESTOSTERONE ? The ovaries are the primary (but not the only) source of testos-
terone in women. My feeling is that testosterone is the secondmost important hormone to be replaced, after progesterone.Again, it certainly is a lot more important to replace thanestrogen. In women, testosterone is the main hormone thatprevents Alzheimer’s (progesterone is second). It is the numberone hormone for preventing and treating osteoporosis (proges-terone is second). It is the number one hormone for the heartbecause there are more testosterone receptor sites in heartmuscle than in any other tissue (250,000 people die ofcongestive heart failure every year, caused by weakening of theheart muscle). You cannot build muscle without testosterone,so it helps keep muscles toned; it gives women more energyand makes them feel more assertive. T estosterone is alsonecessary for an interest in sex; women often begin fantasizingabout sex around 6 weeks after starting on testosteroneand progesterone. Another benefit of testosterone is that it can, when used
correctly, that is, when used in tandem with certain exercises,eliminate urinary incontinence in about six days.88 THE MIRACLE OF BIO-IDENTICAL HORMONES  DHEA— THE ANTI-AGING HORMONE
Forty percent of the DHEA in a woman’s body is produced by
the ovaries; the other 60 percent comes mainly from the adren-als. However, as time passes, a woman’s DHEA levels go down. This hormone is an important part of the immune system
and helps to prevent cancer, heart disease, and arthritis. Womenwith the highest levels of DHEA have the lowest incidence ofbreast cancer. DHEA also helps to prevent the “bad” cholesterol(LDL) from oxidizing. It is a precursor to estrogen and testos-terone, so it can help to alleviate hot flashes. It is also considereda fat-burning hormone. Surprisingly, even though DHEA is a very powerful
hormone, it can be purchased over the counter as a foodsupplement in drug and health food stores. This by itself is atestament to the lack of information about hormones amongmedical practitioners. Like any other hormone, it should beused correctly, and only if there is a deficiency.89 MENOP AUSE AND PERIMENOPAUSE  HORMONES FOR WOMEN —
THE “HOW-TO” CHAPTER
chapter ELEVEN
The replacement of natural hormones is not an exact science. It
requires a team approach among the patient, the doctor, and thecompounding pharmacist. Over time, dosages may have to be adjusted, based not so
much on lab tests as on symptoms. For one thing, hormonelevels can vary through the course of the day. For another,every person’s hormone pattern is unique; there is no one-size-fits-all dosage. However, there are certain truisms. Forinstance, it’s fair to generalize that in postmenopausal women,the estrogen level is lower but estrogen is still being produced,testosterone levels are much lower, DHEA levels are at least 40to 50 percent lower, and progesterone levels are virtuallynon-existent. The dosages and protocols that I recommend in this book
are based on feedback from and experience with the thousandsof men and women I have treated. If you feel that a certainapproach might be appropriate for yourself, make notes anddiscuss it with your doctor. If he or she feels comfortable withthe suggestions, a prescription may be obtained, to be filled by acompounding pharmacy. These are regular pharmacies that also
91have pharmacists specially trained in compounding various
pharmaceuticals, including natural bio-identical hormones. If your doctor is reluctant to deal with natural hormones,
I suggest contacting a compounding pharmacy and askingthem to recommend a physician who is amenable to naturalbio-identical hormone replacement therapy. PROGESTERONE 
Progesterone is the number one hormone that has to be
replaced in most women as they approach and go throughmenopause. Doctors frequently say that if a woman doesn’thave a uterus, she doesn’t need progesterone. This is not correct.As we have seen, progesterone is an essential hormone forprotection against cancer and for addressing a wide spectrum ofmedical conditions. The level of progesterone drops as a personages. Replacing it as part of an HRT regimen can be a keystoneto good health. The benefits of natural bio-identical proges-terone have been stated repeatedly throughout this book. It isapplied as a transdermal cream that is absorbed through theskin fairly rapidly. Giving hormones as a cream allows them tobypass the liver initially. The problem with the oral form of bio-identical proges-
terone, as recommended in Suzanne Somers’ books, 
The Sexy
Years and Ageless, is that it goes directly to the liver and gets
converted to another hormone called pregnanediol. The samething happens with the oral progesterone called Prometrium.This too is bio-identical, but it converts to a different hormone. Progesterone cream has to be applied to areas where the
skin is thin so it is absorbed into the bloodstream, not intofatty tissue. The best place is the inside (not the outside) of thewrist area and lower forearm. Another site could be the upper92 THE MIRACLE OF BIO-IDENTICAL HORMONES  chest (but not the breast). It should never be applied to the
abdomen or thighs. The prescription should read: “Progesterone 100 mg/ ¼
tsp. Apply ¼tsp BID [twice a day].” I recommend using it
twice a day, every day, morning and evening. Some women experience tenderness of the nipples when
they first start progesterone, since there are many progesteronereceptor sites around the nipples. If this occurs, lower thedosage to 
⅛tsp, and later increase to a ¼tsp dose as the
tenderness diminishes. Some women experience menstrual bleeding after starting
progesterone. Progesterone does not cause bleeding, but it does“heal” the uterus, that is, it prepares the uterus for menstrualperiods or for pregnancy. The only hormone that causesmenstrual bleeding is estrogen, and if estrogen levels are highenough when a woman starts progesterone, bleeding mayoccur. But this too will pass after one or two months. THE TREATMENT OF ESTROGEN
DOMINANCE 
Prior to menopause, all symptoms related to an over-production
of estrogen, which include menstrual cramps, breast tenderness,PMS, migraine headaches, mood swings, and asthma, can beeliminated using natural progesterone. The dosage in this case isthe same as for menopause: 100 mg/
¼tsp twice a day. For those
patients who feel more comfortable mimicking how the bodynaturally produces hormones, they can skip the progesteronecream the first seven to ten days after their cycle starts. In fact,this is necessary for those women wishing to get pregnant.93 HORMONES FOR WOMEN  FERTILITY 
One of the areas, I believe, where modern medicine’s tragic
lack of hormonal knowledge is demonstrated is in the field offertility. Please note the following: 
1. The number one reason why women fail to get
pregnant or have trouble getting pregnant is alow progesterone level. 2. The number one reason why women have mis-
carriages is a low progesterone level. 3. The only reason women experience nausea when
they are pregnant is a low progesterone level (thenausea is actually caused by estrogen). 4. A frequent cause of premature birth is a low
progesterone level. 5. The only cause of postpartum depression, also
known as the “baby blues,” is a drop in proges-terone levels. For women who want to be pro-active about their
problems with fertility, conception. and maintaining theirpregnancies, natural progesterone is often the answer. Forthose who wish to avoid the expense and pain of in vitrofertilization, why not try natural progesterone? The uterus requires progesterone for the fertilized egg to
implant. It requires progesterone to sustain the pregnancy.Cramps, PMS, and breast tenderness with the monthly cycle—all are classic symptoms indicative of low progesterone levels.Taking natural progesterone not only eliminates these symp-toms but it “heals” the uterus, which allows pregnancy to occur.94 THE MIRACLE OF BIO-IDENTICAL HORMONES  In cases where conception is desired, I recommend the
same dosage of progesterone:100 mg/ ¼tsp twice a day, applied
topically to the inner forearm or wrist. Using this daily for twomonths gives the uterus a chance to fully “heal” and be wellprepared for a pregnancy. At the onset of the third cycle, theprogesterone can be stopped for ten days and then restarted. Ifthe woman becomes pregnant, she should increase the amountof progesterone (to support the pregnancy) as soon as she knowsconception has occurred. This is best done with a vaginalprogesterone suppository, in a dose of 400 mg twice a day,which must be maintained for at least four months. It shouldbe used frequently enough to prevent nausea. Around thefourth or fifth month, the placenta starts pouring out proges-terone, so the woman can discontinue the cream, but it may bewise to continue it through the whole pregnancy. /Eswashvery person’s hormone pattern is unique; 
there is no one-size-fits-all dosage. In my view, using high dosages of progesterone after
becoming pregnant offers three exceptional benefits:1) no feelings of nausea, 2) prevention of miscarriage, and3) a highly intelligent, usually very happy baby. Progesteroneis particularly important for brain function development.In this regard, it is my feeling that premature infants mightalso benefit from progesterone, since they are prematurelydeprived of the normally high levels of progesterone put outby the placenta in the final weeks of pregnancy.95 HORMONES FOR WOMEN  PERI/POSTMENOPAUSAL REPLACEMENT
OF ESTROGEN 
My approach to hormone replacement for women is admittedly
different from most others. My mother died of breast cancerand had been on estrogen therapy, so I have reason to doubtthe rationale for estrogen replacement. However, my recom-mendations are based soundly on medical logic, somewhat onintuition, and a lot on personal experience with thousands ofpatients. In the remainder of the chapter I discuss variousaspects of hormone replacement for women and explain myapproach to each one. EARLY TESTING FOR HORMONE LEVELS 
T esting hormone levels and starting a woman on bio-identical
hormones while she is in perimenopause helps ease her transi-tion into menopause, a time when her body’s chemistry isshifting. If a woman is still having periods, the ideal time todo a panel is about seven days prior to the onset of her cycle.If her menopausal symptoms are mild, I will have her startusing a progesterone cream, possibly testosterone cream, andpossibly DHEA. My preferred approach is to try to eliminatesymptoms like hot flashes or night sweats without using estro-gen. (As we saw earlier, a reduction in estrogen as well as otherhormones triggers the pituitary to release luteinizing hormone,which seems to be the cause of hot flashes.) If symptoms are severe, however, I will add BiEst cream
(a combination of 20% estradiol and 80% estriol) at a dosageof 1.25 mg/
¼tsp. This can be applied to the skin once or
twice a day. As soon as the symptoms abate, I recommendgradually decreasing the dosage. The eventual aim is to stopthe hormone if possible. Remember, that in my approach the96 THE MIRACLE OF BIO-IDENTICAL HORMONES  woman is also using progesterone cream, which protects her
against the negative effects of estradiol. Women never stop making estrogen. It continues to be
manufactured by their fat cells, skin cells, and the adrenalglands even after menopause. The majority of women I havetreated have not required it. However, there are women whofeel better with the replacement of estrogen. For women who do not have a major problem with hot
flashes but do have vaginal dryness, I also prescribe estriolcream, 2.5 mg/
¼tsp, along with a vaginal applicator. This is
applied intra-vaginally on a daily basis until the dryness isgone, then it is used perhaps once a week or once every otherweek, depending on dryness. FOR WOMEN ON ESTROGEN
As far as I can decipher, the primary clinical necessity for
replacing estrogen is to achieve levels of estrogen high enoughfor a woman to get pregnant. Such high estrogen levels offerno other benefits to the human body that I am aware of. When a woman takes high levels of replacement estrogen,
especially for a number of years, the pituitary is tricked intothinking she is still trying to get pregnant. Stopping estrogenat this point often results in severe hot flashes and night sweats.Very often, coming off Premarin is like detoxing from heroin.In these cases my approach is to maintain estrogen usage butchange to a natural bio-identical estrogen in the form of BiEstcream 1.25 mg/
¼tsp, used twice a day to start, then gradually
trying to wean off of it. The BiEst cream, of course, is taken in conjunction with the
natural bio-identical formulations of other hormones that mightbe needed, such as progesterone, DHEA, and testosterone.97 HORMONES FOR WOMEN Let me repeat: Women never stop making estrogen—
though admittedly, they do not continue making high enoughlevels to become pregnant. If getting pregnant is a woman’sgoal even though she is menopausal, then she should followthe advice of Suzanne Somers’ physician and take high levels ofestrogen. Of course, since there are no eggs left, gettingpregnant might be tough. It has been my observation that women who are thin are
more likely to benefit from or require estrogen replacement,because they have fewer fat cells to produce it. Women who areover-weight are generally loath to take it because, in most cases,giving them any type of estrogen, whether synthetic or bio-identical, creates fat and prevents them from losing weight. THE SECOND
MOST IMPORTANT HORMONE
As we have seen, progesterone, in my view, is the most impor-
tant hormone in a hormone replacement regimen during andafter menopause. T estosterone is the second most importanthormone. As with estrogen, women continue to make testos-terone as they age, but at reduced levels. The level of freetestosterone (the biologically active form of testosterone) in amenopausal woman is usually around 1.6. pg/nl Thiscompares to a level of 6.4 pg/nl during the teenage years. The benefits of testosterone are manifold. This is the
number one hormone needed by the bones for the preventionand treatment of osteoporosis. It is also the number onehormone for heart health. As I mentioned earlier, there aremore testosterone receptor sites in heart muscle than anywhereelse in the body. Some 250,000 deaths are attributed to conges-tive heart failure (weakening of the heart muscle) every year.98 THE MIRACLE OF BIO-IDENTICAL HORMONES  How many might be avoided with testosterone? In addition, testosterone is probably the most important
hormone for prevention of Alzheimer’s disease. Also, youcannot build muscle without the use of testosterone. The moremuscle one has, the better one is able to prevent fat from form-ing and skin from sagging. A woman requires two hormones for a good libido—
progesterone and testosterone. If her libido has been low, itmay take about six weeks after starting these hormones for herinterest in sex to kick in. TESTOSTERONE AND
URINARY INCONTINENCE
Urinary incontinence is a very common problem in many
women. Any time they cough, sneeze, laugh, or run on thetennis court, urine dribbles out. This forces many women toresort to mini-pads. Discussions with their doctors lead to pre-scriptions for Detrol or Ditropan, drugs that focus on bladderfunction. Sometimes they are referred to urologists for bladdersurgery. Quite often, perhaps more often than not, the medica-tion and the surgery do not help. The reason is that the incon-tinence they are experiencing is often not a bladder problem. Aswomen get older, the muscles around the urethra weaken andthey cannot keep urine from leaking out of the bladder. Natural testosterone cream is almost 100 percent effective
for this problem. A bio-identical testosterone cream can beobtained from a compounding pharmacy, along with a vaginalapplicator, and is inserted vaginally once a day in the morning.T wo exercises must be done along with using the cream toinsure effectiveness. The first exercise is stopping and startingthe urine stream while urinating, which helps you target the99 HORMONES FOR WOMEN  exact muscles you are trying to build up. The contraction of
these muscles is called the Kegel maneuver. The second is actu-ally the same exercise but done in other contexts. The samemuscles need to be compressed for about ten seconds, 20 to 30times per day, primarily in the morning. This can be donewhile you’re driving, sitting, watching television, or engaged inother activities. In about six to seven days, most women will experience a
complete resolution of the incontinence—if, besides using thecream, they do both sets of exercises. Once the incontinence isgone, the testosterone cream can be applied to the innerforearm. The dosages I usually prescribe are: First month: 2% cream
or gel, 
⅛tsp applied intra-vaginally (if necessary for inconti-
nence) or ⅛tsp to the forearm, daily. Second month and
thereafter: 1% cream or gel, ⅛tsp applied to the forearm on a
daily basis. The best way to gauge testosterone levels is by the libido. If you are experiencing a healthy libido, cut the dosage to twoor three times per week. T oo much testosterone can create sideeffects, such as acne, body hair growth, scalp hair loss, elevatedcholesterol, or aggressive behavior. DHEA—THE ANTI-AGING HORMONE
Forty percent of the DHEA produced in a woman’s body is
made by the ovaries. After menopause, the ovaries quit manu-facturing this hormone. DHEA is considered the mother of allsteroid hormones, since it is the precursor to other hormones,most notably estrogen and testosterone. Clearly, replacing thishormone alone can help to reduce hot flashes and night sweatsand restore libido.100 THE MIRACLE OF BIO-IDENTICAL HORMONES  The primary source of the remaining 60 percent of DHEA
is the adrenal glands, though DHEA production by the adrenalsalso declines over the years. People who have been exposed tohigh levels of stress during their life very often have low levelsof DHEA. As discussed earlier, DHEA is also known as an anti-aging
hormone. There appears to be a direct correlation betweenlevels of DHEA and longevity. People with the highest DHEAlevels seem to live longer lives. Perhaps this is related to the factthat DHEA stimulates the production of human growthhormone (HGH), sometimes referred to as the “fountain ofyouth” hormone. DHEA influences the immune system and helps prevent
cancer and arthritis. It’s also beneficial for the cardiovascularsystem. It has the same effect as the “good” cholesterol (HDL)on the “bad” cholesterol (LDL), in that it prevents its oxida-tion, which can cause damage to the coronary arteries. It is also known as a fat-burning hormone. The most likely
reason why it promotes weight loss is because it lowers insulinlevels, just as progesterone and testosterone do. DHEA tends to enhance one’s feeling of well-being. However, as with any hormone, replacement should be corre-lated carefully with need. Because DHEA can convert intoother hormones, it is absolutely necessary to check bloodlevels of this hormone prior to starting its use and to monitorthem during usage. When measuring DHEA, it is best to testDHEA-S levels rather than DHEA levels. Since DHEA levels change with age, so-called normal
levels are fairly low after menopause. My preference is toreplace DHEA to achieve levels consistent with those ofwomen about 40 years of age, which is in the neighborhood of250 mcg/dl. I start women whose levels are very low, around30 or less, with a dosage of 25 mg a day. Women with levels101 HORMONES FOR WOMEN  around 100 I start at 12.5 mg a day. I recommend obtaining
DHEA by prescription from a compounding pharmacy; thenyou are assured of receiving a pharmaceutical dosage in asustained-release form. Buying DHEA over the counter is lessreliable, since standards for regulating dosages are low ornon-existent. Hormones are potent chemicals, and one shouldbe careful when using them. The most common side effect of DHEA is acne—an
indication that most of the DHEA is being converted intotestosterone. The remedy here, of course, is to cut back on thedosage or the frequency of administration. Another approachmight be to switch to 7-keto DHEA, a form of DHEA thatdoes not convert into testosterone. It may be available at ahealth food store or possibly at a compounding pharmacy. Asuggested dosage is 100 mg/day. DHEA in any form is besttaken at bedtime.102 THE MIRACLE OF BIO-IDENTICAL HORMONES  ANDROPAUSE— THE
MALE MENOPAUSE
chapter TWEL VE
Although this fact is often overlooked, men and women produce
exactly the same hormones. And most hormone levels inmen, just as in women, become lower as men get older. Sincehormones affect every system of the body, profound changesoccur as one ages. This shift in men, which begins around age 50,is known as andropause. Its characteristics include a drop inenergy, libido, stamina, and joi de vivre, associated with weightgain around the middle. Moreover, it is just as important for men to receive
bio-identical hormone replacement as it is for women. Theconsequences of altered hormone levels in men may lead toconditions such as coronary artery disease, Alzheimer’s disease,prostate cancer, osteoporosis, and depression. TESTOSTERONE 
Unquestionably, the most important hormone to be consid-
ered for replacement in men is testosterone. It is most oftenthought of as a sex hormone, and it is, but it has otherfunctions that are probably more vital. 103T estosterone is the main hormone for the prevention of
Alzheimer’s disease. Studies done by the National Institutes ofHealth have confirmed this. It is the number one hormone affecting heart tissue,
including the coronary arteries, the conduction system, and,most important, the heart muscle itself. There are more testos-terone receptor sites in heart muscle than in any other musclein the body. T wo studies came out in 2003 demonstrating theuse of testosterone in men who had massive heart attacks, asituation that almost always results in congestive heart failure(CHF), a weakening of the heart muscle resulting in thebackup of fluid into the lungs and possibly the rest of the body.The men who received testosterone failed to develop CHF;those who did not went into heart failure. The development of osteoporosis, although not as com-
mon in men as women, actually has more dire consequences inmen. A fractured hip in a male, most commonly related toosteoporosis, is associated with a 25 percent mortality rate inthe first year of occurrence. T estosterone prevents and reversesosteoporosis. An extremely common consequence of low testosterone
levels in men is the onset of depression. They lose their interestin life, and their energy levels go down. Replacement of testos-terone brings back energy, restores lost strength and interest inlife, and leads to the buildup of muscle. Very often the libido returns too. I’ve seen male patients in
their 70s who hadn’t had sex in 25 years who, with testosteronereplacement, began having sex on a daily basis. Of course, theirpartners’ hormones had to be dealt with as well.104 THE MIRACLE OF BIO-IDENTICAL HORMONES  THE CORRECT USE OF TESTOSTERONE
As with any other hormone, testosterone must be used correctly,
especially since testosterone can convert into other hormonesthat may cause other problems. It is often beneficial to determine the blood levels of
testosterone. The test for free testosterone level is the mostimportant test in this regard, not the more frequently usedtest for total testosterone level. The free testosterone levelindicates the amount of biologically active testosterone thatis available. However, levels of testosterone go up and downduring the day. The highest levels occur early in the morning, before
testing is usually done. I have found that most men after theage of 50 have a level either below the normal range or else inthe lower range of normal. Yet many of these men still getmorning erections (an excellent indication of adequatetestosterone levels) and have no problems with performanceor libido. No matter how low the level, if a man has no sexual
problems I do not replace testosterone. Normal levels of freetestosterone range from 50 to 210. Normal levels of totaltestosterone range from 250 to 1,000. I find that checkinglevels of testosterone is more useful in determining correctreplacement dosages—too much or too little. When replacing testosterone, one should be aware that this
hormone can be converted into other hormones that may haveunpleasant consequences. One is the form of estrogen knownas estradiol, which can cause prostate cancer and possiblycolon cancer. The other is dihydrotestosterone (DHT), whichmay cause prostate enlargement and male pattern hair loss. Because of these possibilities, the levels of these two
hormones should be monitored. High levels of DHT can often105 ANDR OPAUSE—THE MALE MENOPAUSE  be avoided by correct placement of testosterone cream or gel
on the skin. It is always best to apply testosterone to areas ofthe body devoid of hair. Certain enzymes found around hairfollicles can convert testosterone into DHT (in other words,applying the cream to a shaved area will not help). Acceptableareas may include the upper and inner arms, shoulders, backof the knees, and around the ankles. Certain supplements canalso help in this regard, among them saw palmetto, beta-sitosterol, and pygeum. There are ways to keep estradiol levels lower. Discuss with
the compounding pharmacist or your medical doctor theaddition of 10 percent chrysin to the testosterone cream.Chrysin is an aromatase inhibitor. Aromatase is necessary toconvert testosterone into estradiol, so anything that lowers thisenzyme is beneficial. Arimidex can be used to lower estradiol.The recommended dose for men is 50 mcg per day, availablefrom a compounding pharmacy. Zinc is another important supplement to use while on
testosterone. The prostate gland absorbs more zinc than anyother area of the body. Zinc also acts as an aromatase inhibitor,thereby keeping estrogen levels low. As a side note: the eyes aresecond in the absorption of zinc, which helps prevent maculardegeneration, the most common cause of adult blindness. The dosage of testosterone should usually be about 
¼tsp
of a 10 percent transdermal cream twice a day. The prescrip-tion should read: “T estosterone 10%. Apply 
¼tsp BID [twice
a day] to hairless area” (upper or inner arms, shoulders, back ofknees, or ankles). When the libido returns, one dose a day maybe adequate. Blood tests that should be monitored include:
• T otal testosterone
• Free testosterone106 THE MIRACLE OF BIO-IDENTICAL HORMONES  • Estradiol
• DHT• PSA (prostate specific antigen) with free PSA
The benefits of testosterone far outweigh any potential
downside. But it should be used safely with attention toprostate health. In addition, too much testosterone can raisecholesterol levels, cause male pattern baldness, raise levels ofred blood cells, and possibly cause aggressive behavior. WHY PROGESTERONE
Many people, even some physicians, do not consider proges-
terone to be a male hormone (it is), and some are not awarethat men produce estrogen (they do). Once again, men andwomen produce exactly the same hormones, but in differentamounts. I prescribe progesterone for most of my malepatients over 50 for a number of reasons. As men get older,their levels of progesterone decrease, becoming almost non-existent around the age of 50. This is about the same age whenmen start putting on their “middle-aged paunch.” Could therebe a connection? The answer is a most definite yes. And the reason? Progesterone is the number one hormone for lowering insulinlevels, the hormone that creates fat right around the middle.This is also the time of life when men may experience fatiguebetween 3 and 4 in the afternoon or getting sleepy whiledriving or after eating—the classic times for tiredness relatedto over-production of insulin. When insulin levels go up,blood sugar goes down. A brain deprived of sugar gets sleepy. The number one
cause of people falling asleep while driving is hypoglycemia.The number one cause of hypoglycemia is too much insulin.107 ANDR OPAUSE—THE MALE MENOPAUSE  The number one cause of too much insulin is low proges-
terone. One of the first benefits people experience afterstarting progesterone is that they no longer get sleepy in theafternoon, after eating, or while driving. Another reason I believe men over 50 should take proges-
terone is that I suspect that it prevents prostate cancer. Icannot point to studies that show this, but it is logical. As menapproach andropause, their progesterone levels drop and theirestrogen levels start rising. This is also about the time thatprostate cancer becomes a risk. If estrogen causes six differentcancers in women, why wouldn’t it be up to no good in menas well? Not only cancer of the prostate but also cancer of thecolon could be caused by excess estrogen in men’s bodies. Other benefits from progesterone in men are as follows:
prevention of Alzheimer’s disease, prevention of osteoporosis,prevention of coronary artery spasm, reversal of depression,and elimination of asthma. JIM B. ’S STORY
The dramatic effects of progesterone in men are perhaps best
illustrated by the story of one of my patients, Jim B. When Ifirst met Jim, he was 54 years old. He came into my office, satdown, and with no other preamble stated, “Doc, if you don’thelp me, I’m going to commit suicide.” He added that I was hislast resort. He had four major complaints: 1) he was (obviously)
depressed, 2) he was severely hypoglycemic, 3) he had asthma,and 4) he had osteoporosis. I told him right off that his problems were easily resolved
and that he had a deficiency of progesterone. He looked at mequizzically and said that over the previous several years hehad been back and forth across the country, spent tens of108 THE MIRACLE OF BIO-IDENTICAL HORMONES  thousands of dollars, consulted with the best doctors in the
finest clinics and institutions, had hundreds of blood tests andprocedures done, and no one had ever mentioned the word“progesterone,” much less tested for it. And here, in the spaceof several minutes, I identified this as his problem. Although he strongly suspected I was a “quack,” he agreed
to a trial of progesterone. In only three days he was saying, “Inmy entire life I have never felt so good.”
This response was exactly the response I had expected. Progesterone affects every neurotransmitter in the brain andcan readily eliminate depression. It prevents the over-produc-tion of insulin and helps hypoglycemia. It is wonderful foreliminating asthma. This may possibly be related to its anti-estrogen effect. Estrogen is a common cause of asthma, andmen often have high levels of estrogen. Progesterone is alsobeneficial for preventing and treating osteoporosis. During their training, doctors receive an extremely limited
amount of information about hormones. Thus it is notsurprising that every medical specialist Jim had spoken to wasunable to diagnose his problem. I consider progesterone the second most important
hormone for replacement in men. There are actually no down-sides to using this hormone. It must be obtained from acompounding pharmacy. The cream is used in lieu of an oralform in order to bypass the liver. The prescription I usuallyrecommend is: progesterone 100 mg/
¼tsp twice a day for two
weeks, then ¼ tsp once a day. Progesterone is best applied to
the wrist area and lower forearm. However, men who greatlyover-produce insulin may require dosages three times a day. I have only had one complaint from a male patient whom
I placed on progesterone. He said it made him too compas-sionate. Wives, are you listening? In all fairness, I should mention that Jim B. had ADHD.109 ANDR OPAUSE—THE MALE MENOPAUSE  As I describe in chapter 15, the chapter on ADD and ADHD,
these patients have high levels of adrenaline to combat theirpersistent hypoglycemia induced by high insulin levels.Adrenaline is the “anger hormone.” Giving Jim progesteronelowered his insulin levels, so he no longer had hypoglycemia,and he stopped pouring out adrenaline (i.e., he became“compassionate”). Progesterone also eliminates restless leg syndrome (RLS),
another condition caused by too much adrenaline, althoughthis is not recognized by the medical community. Doctorsclaim there is no known cause for this condition and that it isincurable. They treat it with toxic anti-Parkinsonian drugs,once again treating the symptoms instead of the cause.However, using progesterone often eliminates RLS in aboutone week. Adults with ADHD, RLS, fibromyalgia—all conditions
associated with too much adrenaline—usually require proges-terone three times a day and must cut back on their carbohy-drate intake to reduce sugar and insulin levels. WHAT ABOUT DHEA ? The primary concern related to DHEA is that it can raise the
level of estradiol, the hormone associated with prostate cancerand possibly colon cancer. However, when DHEA is given incorrect dosages this rarely happens. The intent of hormonereplacement therapy is simply to replace what’s missing, not toadd more than is necessary. The number of receptor sitesavailable for each hormone is limited, so extremely high dosescan cause problems. The correct lab test for assessing blood levels of DHEA is
the test for DHEA-S (not plain DHEA). Most men in their50s have levels around 175 or less. My goal in replacing110 THE MIRACLE OF BIO-IDENTICAL HORMONES  DHEA is to achieve the levels that were present around the age
of 40. This means a DHEA-S level of around 400–500. Formen with levels of less than 100, I give a dosage of 50 mg aday. For levels higher than 100, I start with a 25 mg dosage.DHEA is best taken in the evening. THOUGHTS ABOUT PROSTATE CANCER
Allowed a long-enough life span, most men will develop
prostate cancer. Statistically, however, only 7 percent of prostatecancers will metastasize. In essence, this means that if a prostatecancer is left alone, most men would die with it and notfrom it. Based on this information, watchful waiting appears to be
a feasible and logical approach when it comes to prostatecancer. This disease is diagnosed by sticking twelve to eighteenneedles into the prostate, which means some blood capillarieswill be pierced and disturbed. If there are cancer cells present,is it possible, then, that the biopsy procedure itself may causethe cancer to metastasize by allowing cancer cells to get intothe blood? The traditional thinking in medicine is that testosterone is
the hormone that causes prostate cancer. Yet the men with thehighest levels of testosterone have the lowest incidence ofprostate cancer. And if it were true, why wouldn’t males haveprostate cancer at the age of 17, when the levels of testosteroneare at their highest? The level of testosterone in men starts dropping when they
are in their 20s, becoming very low by the age of 50. Whilethis is happening, the level of estradiol is rising. Men in their50s and beyond almost always have higher levels of estrogenthan women have. And they are no longer producing proges-terone to protect them from all of this estrogen.111 ANDR OPAUSE—THE MALE MENOPAUSE  Keep in mind that estrogen is the only known cause of
uterine cancer (other than the drug Tamoxifen). Since theprostate is derived embryologically from the exact tissue thatthe uterus comes from, why wouldn’t estrogen also be causingprostate cancer? Logically, it would appear to be so. Yet, insome cases, estrogen is used to treat prostate cancer. /Iswashn my view,
prostate cancer is probably a disease to be prevented,
rather than to be treated, by balancing a man’s hormones
and prescribing appropriate supplements. Right now, testosterone is thought to cause cancer of the
prostate, so most of the attention in treating prostate cancer ison eliminating testosterone. Often the drug Lupron is admin-istered, and many times it appears to be beneficial. However,besides lowering testosterone levels, it also eliminates estradiol.Perhaps this is its main benefit. Interestingly, in Europe testos-terone is now being used to treat prostate cancer. In my view, prostate cancer is probably a disease to be
prevented, rather than to be treated, by balancing a man’shormones and prescribing appropriate supplements. Here is alist of some of the supplements known to prevent and/or treatprostate cancer:
• Vitamin D3 – 5,000 I.U./day for prevention,        
20,000 I.U./day for treatment
• Vitamin E – 800 I.U./day in the form of                 
mixed tocopherols  
• Lycopene – 30 mg/day• Selenium – 200 mcg/day• Zinc – 25–50 mg/day112 THE MIRACLE OF BIO-IDENTICAL HORMONES  • Indole-3-carbinol – 300 mg/day
• Beta-sitosterol – 300 mg/day
Note that Vitamin D3 is known to prevent 26 different cancers;
it also kills cancer cells. It is more likely a prohormone, asubstance that converts into a hormone, rather than a vitamin.Dosages of up to 50,000 I.U./day are probably safe. For men whose lab tests show an elevated PSA (prostate
specific antigen) it is imperative to check the free PSA level aswell. A PSA level greater than 2.5 is now considered elevated(not 4.0, as previously thought). The free PSA test is animportant determinant of the possibility of cancer. However,keep in mind that the most common cause of an elevated PSAlevel is benign prostatic hypertrophy (BPH). Another frequentcause is prostatitis (infectious or inflammatory). A free PSA percentage greater than 20 percent suggests the
absence of cancer; a level less than 10 percent suggests itspresence. Levels from 11 to 20 percent are in the gray area. When my patients show any elevation of PSA, I start them
on progesterone, prescribe the supplements just listed, andcontinue to track their PSA and free-PSA levels. This approachis my own. Please discuss any prostate concerns you have withyour own physician.113 ANDR OPAUSE—THE MALE MENOPAUSE  ADULT-ONSET DIABETES
AND LOUIS R.
chapter THIRTEEN
Louis R. is a successful and contented 60-year-old who has
struggled with weight all his life. When I took his family history,it became clear that his weight problem was genetic. Everyone inhis family—mother, father, aunts, uncles, grandparents—was “heavyset.”
When we talked about his goals, Louis emphasized that he
was bound and determined not to “let himself go” at age 60,the way many of his family members had done. When his treatment is completed, Louis can be assured
he’ll be able to control his weight without dieting. He’ll also beable to manage his adult-onset diabetes without the use ofmedication. Here is his story:
I am a type II diabetic. My diabetes started in middle age, but
even before that I’d always experienced problems with my weight.At six different times in my life I’ve been 40 pounds over-weight,and I’ve dieted to lose those 40 pounds. Each time I was successfulin losing the weight, but over time those same 40 poundsreappeared. I have done Weight Watchers, I used Diet Center twice,and I’ve gone the Nutra System route and others. Each of these dietswas effective. The pounds just flew off but psychologically I was
115about four feet off of the ground at all times. Either that or I was
unbearably fatigued. My whole family is predisposed to beingheavy. My father was a little shorter than me and at one timeweighed about 240 pounds. My paternal grandmother was aboutsix feet tall and a very big woman who weighed about 230pounds. When my late sister was diagnosed with colon cancer, sheweighed 290 pounds. My maternal grandfather was large, as wasmy maternal grandmother. So I’m from sturdy big stock and I’m never going to be one of
those men who weigh 165 pounds. I know that. Once I dieted myway down to 168 pounds but I looked horrible. People wereasking me what disease I had, I was so gaunt. T oday my goal ismore realistic. I want to reach 185 pounds and stay there for therest of my life. My other goal is to control my diabetes with dietand exercise. When my mother turned 60, she told me she just wanted to
be a fat old lady. She just let everything go. When she died she was5’2” and weighed about 240 pounds. I turned 60 last year andI decided I did not want to be like my mother. I’m going in theopposite direction. I want to slim down and build some muscleand remain attractive. I have to say up front that when I first visited Dr. Platt, I
walked into his office with an attitude of skepticism. Not becauseof all the diets I’d gone on, but because I have an insider’sknowledge of medical scams. For 20 years my career consisted ofmarketing and selling pharmaceutical products. I know whatpharmaceutical companies will stoop to in order to turn a profit.I lost my innocence about medicine long ago, and I’m always onthe lookout for someone trying to turn an easy buck. But once I spoke to Dr. Platt I was relieved. From the way he
talked, I realized he wasn’t just promoting products. What he saidabout why people hang onto weight and why their bodies hate tolose fat made sense. There was none of the jargon and medical116 THE MIRACLE OF BIO-IDENTICAL HORMONES  babble that tends to cluster around trendy medical scams. Platt’s office staff have also been very supportive, and they
communicate a sense of being genuinely interested in everyone whocomes in there. The whole atmosphere is wonderful. They’re notpunitive when you don’t meet your goals as expected. As far as the process of losing weight is concerned, it’s been
virtually painless. The diet itself is easy to follow. I’m a fruit freakand that’s been the most difficult thing to give up, but I realizethat I will be able to go back to fruit later in the process; it’s notsomething I have to give up for the rest of my life. Once I’ve lostthe weight I want to lose, the fruit will be re-introduced. In theshort term, trust me, if that’s all I have to give up, that’s fine. There was a brief period when I was losing weight but not
feeling very energetic. I went in to see one of the nutritionalcounselors, who recommended a multi-mineral supplement. It wasmy thought, knowing just enough about medicine to be dangerous,that perhaps I should be taking potassium. I know diets can bepotassium-depleting. But the counselor said not only to do potas-sium but to take a multi-mineral as well. Sure enough, myenergy returned and I started feeling absolutely great. It made mewonder whether I’d been lacking in some mineral or other formany years. During my very first interview with Dr. Platt it came out
that my sister died of colon cancer and that now one of her daugh-ters has colon cancer. Also, my mother had a mastectomy when shewas 38. Dr. Platt was very interested in this. It’s one of the reasonswhy he placed me on progesterone, which is erroneously thought ofas a female hormone. But according to him, progesterone willprotect me from the excess estrogen I’m putting out. He knew thatwas true even before he did my blood work, just from my familymedical history. I was also started on testosterone, and the amounts were very
carefully monitored by Dr. Platt’s office. It certainly helped with117 ADUL T-ONSET DIABETES AND LOUIS R.  my libido (interest in sex). According to the blood work my DHEA
is that of a 30-year-old. Dr. Platt wanted to know if anyone inmy family had lived a long time. My grandfather lived to almost90, and my mother was almost 90 when she died. Dr. Platt also thought my thyroid was not putting out as
much hormone as it should, so he has me on a couple of thyroidmedications. This makes a difference. I’ve noticed since I’ve beenon this diet that I don’t get that late afternoon letdown I used toget. I think that’s due to the thyroid medications and the proges-terone, which Dr. Platt states is stabilizing my blood sugar. So far I’ve lost 32 pounds, and I’ve weaned myself off one of
my medications for diabetes. As we go along we’re fine-tuning mymedications. It seems to be a rather sensible approach. I’m verypleased with the results. DIABETES AND INSULIN
Louis has a strong family history of both obesity and adult-
onset diabetes. This means everyone in his family over-produces insulin, and insulin is the hormone that creates fat. A simple way of thinking about insulin is to understand
that insulin will take any sugar the body’s not using and store itprimarily in the fat cells. Once the sugar is absorbed into the fatcells, it is converted into fat. People have a limited number offat cells, which therefore can only contain a limited amount offat. As these cells fill up with fat, it gets harder for insulin to getthe sugar into them. This is what I refer to as “insulin resist-ance”; there are other types of insulin resistance that also play asignificant role in diabetes. Whichever type is in effect, thebody responds by producing even more insulin. This is called“hyperinsulinemia.” Insulin not only creates fat, it prevents fatfrom getting out of the fat cells—it is a fat-storing hormone.118 THE MIRACLE OF BIO-IDENTICAL HORMONES  One can easily see that if you have too much insulin, you
are going to have a weight problem. Eventually the fat cells get completely filled up and sugar
can no longer get into the fat cells—so it builds up in thebloodstream and the patient is told he or she has diabetes.While in fact diabetes is frequently a disease of too muchinsulin, doctors approach diabetes as if it is a disease of highblood sugar. So they give their patients medications tostimulate the pancreas to make even more insulin. This extrainsulin literally pushes the sugar into the fat cells, creating evenmore weight gain. The exception to this is the medication Glucophage, which
goes by the generic name metformin. Glucophage doesn’tactually lower blood sugar; it acts by increasing the sensitivityof tissues in the body to insulin, leading to a lowering ofinsulin levels. Needless to say, I do not necessarily wean peopleoff this particular diabetic medication. Many patients with type II (adult-onset) diabetes may
inappropriately wind up on insulin injections. Since probably90 percent of people with adult-onset diabetes already have toomuch insulin to begin with, placing them on insulin oftenexacerbates their weight problem
. HYPOGLYCEMIA AND INSULIN
If my patients are having hypoglycemic reactions, usually mani-
fested as afternoon fatigue, sleepiness after eating, sleepiness whilein a car either as the driver or as a passenger, this tells me that theyare over-producing insulin, irrespective of blood sugar levels. If I have a patient who has been diagnosed with diabetes
and has symptoms suggesting hypoglycemia, I can assume theyare producing an adequate amount of insulin. These patients119 ADUL T-ONSET DIABETES AND LOUIS R.  can often be cured of their diabetes by lowering their insulin
levels and changing the way they eat to a fat-burning mealplan. Once a certain amount of fat has been eliminated, thereis room in the fat cells for the sugar to be taken in, and thediabetes condition is gone. In my opinion, there is one major cause for hyperinsuline-
mia (too much insulin), namely, too little progesterone. Louis’family history is classic for this condition—which underscoresthe importance of spending time talking to patients. Muchinformation can be gleaned from a family history. In the firstplace, the prevalence of diabetes in the family was suggestive ofSyndrome X, the form of hyperinsulinemia associated withhigh triglyceride levels and low HDL cholesterol. The strongfamily history of estrogen-related cancers also suggested lowprogesterone levels. HORMONAL INFLUENCES
Louis had significant hormone problems. Besides indicating
low progesterone levels, his family history was consistent withevidence of estrogen dominance. The history of colon cancerand breast cancer among the women in his family would havebeen related to estrogen. The low progesterone led to problemswith hyperinsulinemia, with resultant obesity. Blood tests indicated that Louis also had low levels of
testosterone. This too is a hormone that lowers insulin levels,just like progesterone. T estosterone is probably the mostimportant hormone to replace in a male, for multiple reasons.It treats and prevents osteoporosis (as we have seen, fracturedhips are associated with a 25 percent mortality rate in men). Itappears to help prevent Alzheimer’s disease. And a man is notable to perform sexually with low levels of testosterone.120 THE MIRACLE OF BIO-IDENTICAL HORMONES  T estosterone also helps keep the heart healthy: The heart
muscle has more testosterone receptor sites than any othermuscle, which means the heart uses more testosterone thanany other organ. T estosterone is now being used to treatcongestive heart failure in men. A man cannot build musclewithout testosterone. It has been found that many men (andwomen) have very low levels of testosterone after a heartattack. Could it be a contributing factor? DIABETES AND WEIGHT MANAGEMENT
Louis will probably have to restrict the carbohydrates in his diet
for the rest of his life. Making Louis aware of how his metabo-lism works—how sugar and insulin throw his energy levels outof whack, and how he can use protein to stabilize his system—has made all the difference. With his hormones balanced andwith an informed approach to his diet, Louis is able to managehis weight and avoid the pitfalls of diabetes. We have a nationwide epidemic of obesity and type II
diabetes. Both of these conditions are strictly hormonalproblems. Understanding this connection, one can appreciateonce again the miraculous benefits of restoring hormonalbalance with bio-identical hormones.121 ADUL T-ONSET DIABETES AND LOUIS R.  PSYCHOGENIC MEDICATION
AND GREG C.
chapter FOURTEEN
When Greg C. walked into my office, I saw a handsome 32-
year-old whose body had become distorted by weight gain. Hetalked earnestly and honestly about a recent nervousbreakdown and the four powerful psychogenic drugs—almostall of them lipogenic (causing the body to store fat)—doctorssaid he needed for mental balance. I want him to tell his storyfor the benefit of the millions of people taking anti-depressantsand other psychogenic drugs who could live normal, happylives if their hormones were balanced. I’ve always been a high achiever. I set goals for myself and
then I pursue them with everything I’ve got. For a long time thisworked well for me. My achievements were pleasing to myparents, who gave me a lot of approval and made me want toachieve even more. My father was very successful financially ata young age and placed a lot of value on worldly status andpossessions. So did my mother, and, of course, so did I. By my mid-20s I was making a lot of money working in the
hospitality business in Las Vegas. I had a responsible job atCaesar’s Palace and I gave it everything I had, so much so thatI was losing my balance. I worked so much that I stopped doing
123very much of anything else. Las Vegas is a 24-hour-a-day, 365-
days-a-year place, a city that never sleeps, and demands aremade on you constantly to keep the machinery running. I wouldalways go the extra mile to troubleshoot an emergency, accommo-date unexpected guests … whatever came up. Somehow, amidst all this work I did manage to meet a
woman I wanted to spend my life with. Stephanie and Imarried when I was 30 and she got pregnant soon afterwards.This added even more responsibility, and although I didn’tunderstand it then I began showing signs of nervous exhaustion. I began to lose my appetite. I’m a wonderful cook—I went
to school to become a chef early in my life—and every day afterwork I’d come home and cook a healthy meal for my wife whileshe was pregnant, but I found I couldn’t eat. After the baby wasborn—he’s a boy—I cooked for each of them the kinds of nutri-tious meals I felt they should have, but again I couldn’t eat thefood I cooked. I’d have a piece of toast or something. Forsomeone going at breakneck speed the way I was, this wasn’tgood. I wasn’t taking care of myself. You see, I had this Superman complex where I felt I had to
take care of everyone and everything. I never told my wife howscared I was of failing because that wouldn’t be taking care ofher. I hid my insecurities and just pushed myself. Often I’d go back to work after dinner. If my wife protested,
I’d make up a story about some emergency that had come up. Thetruth was I felt I had to do more just to keep up. It’s a mindset. Ifelt things would fall apart if I didn’t hurry up and do more. At a certain point this became an issue for me and
Stephanie, and we saw a counselor who suggested I work in a lessstressful environment. I found a job at the Las Vegas Conventionand Visitors’ Authority, thinking it would allow me more timefor a normal life. But just the opposite happened. I became evenmore stressed and worked even longer hours.
The_Miracle_of_Bioidentical_Hormones_by_Platt.txt
Summarize the following text section accurately and concisely. Maintain specific details and numerical information, and use anti-repetition mechanisms:

        Back in the 1960s, Robert Wilson, M. D. , a gynecologist in
New York City, published a book called 
Feminine Forever, in
which he said that when women go through menopause, “theyenter a ‘vapid cow-like state’ and became very unpleasantcompanions for their husbands. ” He evidently felt womenshould be treated for their husband’s benefit, not for their own. 80 THE MIRACLE OF BIO-IDENTICAL HORMONES  He received tremendous financial backing from the makers of
Premarin, who helped publish his book and sent him on anation-wide tour so he could promote Premarin to otherphysicians around the country. THE CONTROVERSY OVER PREMARIN
Let me say a few words about Premarin. The name of this
manufactured estrogen compound actually delineates itssource: pregnant mares’ urine. There are about 100 moleculesof estrogen in this preparation, but only one of them is similarto a human estrogen. Although it is considered a “natural”hormone since it is derived from a natural substance, clearly itis natural only for horses. Premarin became the largest-selling drug in the world. However, eventually a darker side to hormone replacementtherapy emerged. It is estimated that in the first ten years afterthe manufacturer started the Premarin market campaign,somewhere between 200,000 and 2,000,000 women developedcancer of the uterus. However, instead of removing Premarinfrom the market, the drug company added Provera to it. Although this synthetic progesterone reduced the risk ofuterine cancer, it quadrupled a woman’s chances of gettingbreast cancer from the estrogen. Along the way, the drug company started ascribing certain
benefits to estrogen replacement therapy without the means toback up their claims. They claimed that estrogen was beneficial for women with
osteoporosis, and yet no study has shown estrogen to reverse thiscondition. We know that estrogen can help delay the onset ofosteoporosis, but only temporarily. In 1999, the FDA finally elim-inated osteoporosis as an indication for using estrogen. 81 MENOP AUSE AND PERIMENOPAUSE  They also claimed that estrogen is good for the heart. However, every long-term study of estrogen has indicated thatit causes an increase in the incidence of heart attacks andstrokes. It is contra-indicated in coronary artery disease andcerebrovascular disease, so I fail to see the claimed benefit ofestrogen in these conditions. In order to determine once and for all the benefits of
long-term treatment with estrogen, the largest study ever ofhormone replacement therapy was conducted, beginning in1997. Called the Women’s Health Initiative, it involved track-ing the health of about 162,000 women. It was proposed asan eight-year study to monitor women on Premarin/Proveratherapy. There was a side study of Premarin by itself amongwomen who did not have a uterus. T wo years into the study they started getting some alarming
statistics, but they continued with the research. However, after5 
½years it was decided to stop the study for ethical reasons. The data was showing a significantly higher number of aggres-sive-type breast cancers along with a higher incidence ofcardiovascular complications in those women on thePremarin/Provera combination. When the Premarin/Provera arm of the study was halted in
the summer of 2002, it was front page news in every paper inAmerica; it was the cover story of all the news magazines andbecame fodder for TV news programs and talk shows. For thefirst time in history, women were made aware of a truth thathad been known in some circles for 30 years: that estrogenreplacement therapy might not be safe. The consistent recommendation put forth in the media
was: go talk to your health care practitioner. However, ifdoctors had been aware of the similar results found by priorstudies done in the 1990s, they might not have started theirpatients on these drugs in the first place or continued them. 82 THE MIRACLE OF BIO-IDENTICAL HORMONES  Their responses to their patients’ concerns about the study’s
findings ran along the lines of: “Don’t worry about it” or “Thebenefits outweigh the risks” (they don’t) or “It’s your decision. ”
The other arm of the study, Premarin by itself, was stopped
in March of 2004 because, once again, the risks proved tooutweigh the potential benefits. SUZANNE SOMERS—THE PROS AND CONS
Into this morass of contradictory information about hormones
walked celebrity/author Suzanne Somers. With her book
The Sexy Years, published in 2004, and a follow-up book
called Ageless, published in 2006, Ms. Somers propelled
herself into position as the new advocate for hormonereplacement therapy. Her books demonstrated some amazingly positive attrib-
utes. For the first time in history, women at large were madeaware of bio-identical hormones—natural hormones that areidentical to their own hormones and can be obtained fromcompounding pharmacies. No longer did they have to subjectthemselves to synthetic drugs that mimic hormones, nor didthey have to take hormones appropriate for horses ratherthan humans. Another tremendous benefit of Ms. Somers’ books was
their insistence that women have to become pro-active abouttheir health; they cannot rely on the traditional medical systemto keep them healthy. However, Ms. Somers makes some points in her books that
I feel require clarification. First off, just because a hormone is bio-identical does not
necessarily mean that it is safe. Hormones are extremely potentsubstances and must be used judiciously. Some of the doctorswho Ms. Somers interviewed are very strong proponents of83 MENOP AUSE AND PERIMENOPAUSE  estrogen. She quotes one doctor as stating that the only time a
woman is healthy is when she is having her periods. T o achievethis aim, this doctor provides her post-menopausal patientswith exceptionally high levels of estrogen in order to have themre-start menstruation. She has patients in their 80s and 90sbleeding every month and bent over with menstrual cramps. These women, needless to say, are intentionally put into thedangerous condition of estrogen dominance. /Wswashomen never stop making estrogen. /Wswashomen do stop making progesterone. In my own practice, the sickest women I have ever seen are
those who had been estrogen dominant, or were estrogendominant when I first met them. Let me remind you that anytime you utilize either a
hormone or a drug, you have to weigh the benefits versus therisks. I look at estrogen as primarily a toxic hormone. It isknown to cause six different cancers in women: breast, uterine,ovarian, cervical, vaginal, and colon cancers. It may causeAlzheimer’s disease, strokes, heart attacks, and phlebitis withfatal pulmonary emboli. It may cause fibroids, endometriosis,adhesions, fibrocystic disease, asthma, migraine headaches,and gallbladder disease. It can lead to auto-immune diseases,such as lupus, rheumatoid arthritis, Hashimoto’s thyroiditis,and others. Estrogen is the hormone that causes women to experience
menstrual cramps, PMS, breast tenderness, and nausea whenthey are pregnant. T o add insult to injury, estrogen is lipogenic. It creates fat around the hips, thighs, and buttocks, and it is thecause of cellulite. T ry telling women with a number of theseproblems that they are healthy because they are having periodsand you might find yourself in an argument. 84 THE MIRACLE OF BIO-IDENTICAL HORMONES  It is surprising to me that Suzanne Somers, who already
had estrogen-induced breast cancer (she used to call estrogenher “happy pills”), is proposing that women take what Iconsider exceedingly high levels of estrogen. Not a week goesby when I do not see a patient who had an estrogen-inducedcancer while they were still having their periods. In otherwords, their own estrogen caused these cancers—it does notget more “bio-identical” than your own hormones. Interestingly, every problem, every complication, every
downside to estrogen is eliminated by progesterone (not to beconfused with Provera, or medroxyprogesterone, a syntheticchemical having no relationship to natural progesterone). Anytime high levels of estrogen, such as those proposed bySuzanne Somers’ books, are prescribed, a sufficient amount ofprogesterone must be prescribed to be protective. I believe thelevels of progesterone recommended in her books are woefullyinadequate and inappropriately administered. My advice on the proper dosing is available in chapter 11. T wo basic principles on which I base my approach are:
1. Women never stop making estrogen—it is prob-
ably the only hormone that hardly ever has to bereplaced. It continues to be made by fat cells,skin cells, and the adrenal glands. 2. Women do stop making progesterone. Because
of this, they are always at risk for developingbreast cancer, uterine cancer, ovarian cancer,colon cancer, and other cancers from estrogen. 85 MENOP AUSE AND PERIMENOPAUSE  MY APPROACH
When certain hormone levels decrease, for either natural or
surgical reasons, the pituitary responds by putting out certainhormones of its own to stimulate the ovaries to make morehormones. (The pituitary and hypothalamus glands are thestructures of the brain that control other glands throughoutthe body. ) In this case, the pituitary puts out a hormone calledluteinizing hormone (LH) to stimulate the ovaries to makemore hormones. LH may be the primary cause of the vascularsymptoms women experience when they are going throughmenopause—the hot flashes and night sweats. It is my feeling that the pituitary’s primary reason for
trying to raise ovarian hormone levels is so the woman can getpregnant. Once the pituitary is convinced a woman no longerneeds to procreate, it stops sending out the signals and the hotflashes and related symptoms disappear. However, if thewoman is placed on high levels of replacement hormones, thepituitary gets confused. It becomes convinced again that thewoman is trying to get pregnant, and so whenever there is asignificant drop (e. g. , from stopping Premarin), it puts outLH and the symptoms recur. The ovaries put out four different hormones—estrogen,
progesterone, testosterone, and DHEA. Replacement of anyor all of these hormones can alleviate perimenopausal andmenopausal symptoms. The primary aim of the replacementof hormones is to keep the woman healthy and to prevent thebody from deteriorating. Since I look at estrogen as a potentially toxic and fat-
creating hormone, and since the body never stops makingestrogen, I take a relatively sparing approach to its use. Iprimarily prescribe estrogen for several reasons—to help86 THE MIRACLE OF BIO-IDENTICAL HORMONES  alleviate hot flashes or night sweats, to help with “brain fog,”
and to relieve vaginal dryness. I will be discussing dosages,along with the various types of natural bio-identical estrogenavailable, in chapter 11. About two years prior to menopausewomen stop ovulating, which means they stop producingprogesterone. This causes them to experience an increase inPMS, breast tenderness, cramps, and related symptoms. Theremay be a development of fibroids or fibrocystic disease in thebreast, both being conditions caused by estrogen when thereis not enough progesterone. Progesterone is one of the most important hormones in a
woman’s body and, in my view, is probably the only hormonethat has to be replaced after menopause. T estosterone andDHEA are two other hormones I often prescribe for mypatients. I discuss the usual recommended dosages andapplications in chapter 11. THE BENEFITS OF PROGESTERONE
Looking over the stories of my patients presented in this book,
you can see that even though they had various medicalproblems, every one of them had conditions related to adeficiency of progesterone. Keep in mind that every problemrelated to estrogen is created by a progesterone deficiency. Giving women natural progesterone takes away menstrualcramps, PMS, breast tenderness, menstrual migraines, andasthma. It prevents fibroids, endometriosis, fibrocystic disease,and estrogen-induced cancers. The benefits of progesterone after menopause are as follows:
It can eliminate hot flashes and prevent and treat osteoporosis. It is a natural anti-depressant—it is the feel-good hormone forwomen. Progesterone is thermogenic—it helps fat to burn. It87 MENOP AUSE AND PERIMENOPAUSE  prevents Alzheimer’s disease, is great for the heart, and restores
the libido (estrogen does nothing for the libido). Throughout this book are numerous references to the
benefits of progesterone in terms of preventing estrogen-inducedcancer. It helps eliminate attention deficit disorder (ADD) andis the number one hormone for lowering insulin levels, therebyhelping to prevent obesity and adult-onset diabetes. WHAT ABOUT TESTOSTERONE. The ovaries are the primary (but not the only) source of testos-
terone in women. My feeling is that testosterone is the secondmost important hormone to be replaced, after progesterone. Again, it certainly is a lot more important to replace thanestrogen. In women, testosterone is the main hormone thatprevents Alzheimer’s (progesterone is second). It is the numberone hormone for preventing and treating osteoporosis (proges-terone is second). It is the number one hormone for the heartbecause there are more testosterone receptor sites in heartmuscle than in any other tissue (250,000 people die ofcongestive heart failure every year, caused by weakening of theheart muscle). You cannot build muscle without testosterone,so it helps keep muscles toned; it gives women more energyand makes them feel more assertive. T estosterone is alsonecessary for an interest in sex; women often begin fantasizingabout sex around 6 weeks after starting on testosteroneand progesterone. Another benefit of testosterone is that it can, when used
correctly, that is, when used in tandem with certain exercises,eliminate urinary incontinence in about six days. 88 THE MIRACLE OF BIO-IDENTICAL HORMONES  DHEA— THE ANTI-AGING HORMONE
Forty percent of the DHEA in a woman’s body is produced by
the ovaries; the other 60 percent comes mainly from the adren-als. However, as time passes, a woman’s DHEA levels go down. This hormone is an important part of the immune system
and helps to prevent cancer, heart disease, and arthritis. Womenwith the highest levels of DHEA have the lowest incidence ofbreast cancer. DHEA also helps to prevent the “bad” cholesterol(LDL) from oxidizing. It is a precursor to estrogen and testos-terone, so it can help to alleviate hot flashes. It is also considereda fat-burning hormone. Surprisingly, even though DHEA is a very powerful
hormone, it can be purchased over the counter as a foodsupplement in drug and health food stores. This by itself is atestament to the lack of information about hormones amongmedical practitioners. Like any other hormone, it should beused correctly, and only if there is a deficiency. 89 MENOP AUSE AND PERIMENOPAUSE  HORMONES FOR WOMEN —
THE “HOW-TO” CHAPTER
chapter ELEVEN
The replacement of natural hormones is not an exact science. It
requires a team approach among the patient, the doctor, and thecompounding pharmacist. Over time, dosages may have to be adjusted, based not so
much on lab tests as on symptoms. For one thing, hormonelevels can vary through the course of the day. For another,every person’s hormone pattern is unique; there is no one-size-fits-all dosage. However, there are certain truisms. Forinstance, it’s fair to generalize that in postmenopausal women,the estrogen level is lower but estrogen is still being produced,testosterone levels are much lower, DHEA levels are at least 40to 50 percent lower, and progesterone levels are virtuallynon-existent. The dosages and protocols that I recommend in this book
are based on feedback from and experience with the thousandsof men and women I have treated. If you feel that a certainapproach might be appropriate for yourself, make notes anddiscuss it with your doctor. If he or she feels comfortable withthe suggestions, a prescription may be obtained, to be filled by acompounding pharmacy. These are regular pharmacies that also
91have pharmacists specially trained in compounding various
pharmaceuticals, including natural bio-identical hormones. If your doctor is reluctant to deal with natural hormones,
I suggest contacting a compounding pharmacy and askingthem to recommend a physician who is amenable to naturalbio-identical hormone replacement therapy. PROGESTERONE 
Progesterone is the number one hormone that has to be
replaced in most women as they approach and go throughmenopause. Doctors frequently say that if a woman doesn’thave a uterus, she doesn’t need progesterone. This is not correct. As we have seen, progesterone is an essential hormone forprotection against cancer and for addressing a wide spectrum ofmedical conditions. The level of progesterone drops as a personages. Replacing it as part of an HRT regimen can be a keystoneto good health. The benefits of natural bio-identical proges-terone have been stated repeatedly throughout this book. It isapplied as a transdermal cream that is absorbed through theskin fairly rapidly. Giving hormones as a cream allows them tobypass the liver initially. The problem with the oral form of bio-identical proges-
terone, as recommended in Suzanne Somers’ books, 
The Sexy
Years and Ageless, is that it goes directly to the liver and gets
converted to another hormone called pregnanediol. The samething happens with the oral progesterone called Prometrium. This too is bio-identical, but it converts to a different hormone. Progesterone cream has to be applied to areas where the
skin is thin so it is absorbed into the bloodstream, not intofatty tissue. The best place is the inside (not the outside) of thewrist area and lower forearm. Another site could be the upper92 THE MIRACLE OF BIO-IDENTICAL HORMONES  chest (but not the breast). It should never be applied to the
abdomen or thighs. The prescription should read: “Progesterone 100 mg/ ¼
tsp. Apply ¼tsp BID [twice a day]. ” I recommend using it
twice a day, every day, morning and evening. Some women experience tenderness of the nipples when
they first start progesterone, since there are many progesteronereceptor sites around the nipples. If this occurs, lower thedosage to 
⅛tsp, and later increase to a ¼tsp dose as the
tenderness diminishes. Some women experience menstrual bleeding after starting
progesterone. Progesterone does not cause bleeding, but it does“heal” the uterus, that is, it prepares the uterus for menstrualperiods or for pregnancy. The only hormone that causesmenstrual bleeding is estrogen, and if estrogen levels are highenough when a woman starts progesterone, bleeding mayoccur. But this too will pass after one or two months. THE TREATMENT OF ESTROGEN
DOMINANCE 
Prior to menopause, all symptoms related to an over-production
of estrogen, which include menstrual cramps, breast tenderness,PMS, migraine headaches, mood swings, and asthma, can beeliminated using natural progesterone. The dosage in this case isthe same as for menopause: 100 mg/
¼tsp twice a day. For those
patients who feel more comfortable mimicking how the bodynaturally produces hormones, they can skip the progesteronecream the first seven to ten days after their cycle starts. In fact,this is necessary for those women wishing to get pregnant. 93 HORMONES FOR WOMEN  FERTILITY 
One of the areas, I believe, where modern medicine’s tragic
lack of hormonal knowledge is demonstrated is in the field offertility. Please note the following: 
1. The number one reason why women fail to get
pregnant or have trouble getting pregnant is alow progesterone level.
According to the author, the main purpose of estrogen replacement therapy is to achieve levels high enough for a woman to get pregnant.
What is the main purpose of estrogen replacement therapy?
The author believes that high levels of estrogen are not beneficial and can lead to various health issues, including breast, uterine, ovarian, cervical, and colon cancers.
What is the author's opinion on the use of high levels of estrogen?
The recommended dosage is 100 mg/¼ tsp, applied to the wrist area and lower forearm.
What is the recommended dosage of progesterone cream for a woman experiencing urinary incontinence?
The primary concern is that it can raise the level of estradiol, a hormone associated with prostate cancer and possibly colon cancer.
What is the primary concern related to the use of DHEA?
The author believes that insulin is a fat-storing hormone and that high levels of insulin are a major cause of obesity and diabetes.
What is the author's perspective on the use of insulin?