Wednesday, September 30, 2009

Frequent Questions Asked By Doctors

Q. Why can't I start them on a 1/2 dose and titrate up?

A. The minimum dose used by the Basic Wiley Protocol may seem a bit high; but it is actually the least amount needed to show consistent improvement clinically and even approach the bottom of the reference range in the blood work for healthy young women. The only women eligible for less are women 60+, who have not had exogenous hormones ever and then only one month at a time for three months maximum. Estrasorb is the only FDA equivalent that is equal to baseline dose of the Wiley Protocol.

Q. What is wrong with giving Vaginal E3 (Estriol)

A. There's no need because if the Wiley Protocol is adjusted to a therapeutic optimum, within 3 months the vaginal tissues will have renewed and will retain moisture. After all, vaginal mucus is the hall mark of ovulation and normal hormonal peaks.

Q. Why do patients feel fine on static dosing?

A. Any hormone in any way is better (in terms of quality of life) than none at all. The dramatic improvement on the Wiley Protocol in all areas, in quality of life and clinical markers like bone density, hot flashes, far more pronounced. And, of course, Dr. Taguchi's work has shown a significant reduction in cancer risk compared to no hormone restoration at all.

Vaginal E3 is usually recommended when restoration of urogenital function is required. E3 is a metabolite of E2. If the urogenital system requires help, so do the rest of the hundreds of places in the body where estrogen is needed. Estradiol will convert to estriol and give the same benefits to the UG system as E3 alone, there is always metabolite to precursor ratio. Many physicians are afraid to give E2 due to fear of breast cancer, yet there is no data to support that giving E3 is safer than E2 anywhere.

This misconception is based on the widely publicized fact and conclusion by Dr. Jonathan Wright that E3 is the major estrogen in the third trimester pregnancy, and that pregnancy is linked to less breast cancer, therefore E3 might be breast tissue protective. The extremely high levels of E3 in third trimester pregnancy come from the fetal adrenal glands. There are studies that show if breast cancer occurs in pregnancy or very shortly after, it is more aggressive. The decreased risk of breast cancer is more closely associated with the number of pregnancies, age of first pregnancy, breastfeeding and other hormones, not E3 levels. With respect to the current data the WP does not see the benefit of supplementing with spent metabolite, again there would in nature never be more metabolite than precursor of E2. There is no substantial data to support that E3 is breast tissue protective.

Hormones are dose dependent. For example, when a woman approaches menopause the amount of estrogen produced by the ovaries steadily declines. Many internal changes take place without a perception of such...such as increased bone loss, loss of skin collagen and elastic tissue, decreased rate of nerve tissue repair, etc. However, when a critical point is reached many women experience hot flashes, psychological disturbances, sleep difficulty, which then brings them to their doctor. Many of these later symptoms can be relieved with small static doses of hormones, even synthetic ones. Many women with healthier adrenals can go through menopause without much difficulty. Logically to optimize mind and body function, hormones should be dosed and administered as close as possible to how nature did it, it is not scientific to ignore this. Remember, hormones are signals, they work in concert with one another and the environment, and they cannot be on all the time. Hormones have rhythms which we must respect.


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