Talk:Hormone replacement therapy (menopause)/Archive1

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Does this passage really belong to this article ?

HRT is also used by transsexuals to aid them in attaining the secondary sex characteristics of their desired gender.
For male-to-female transsexuals, HRT includes antiandrogens in addition to the estrogens and progestagens mentioned above. For female-to-male transsexuals, HRT consists only of androgens.

someone wrote the above Q, and I think I might agree. Shouldn't such info be at hormone therapy? Martin 17:17 4 Jun 2003 (UTC)

Actually, hormone therapy specifically refers to the use of hormones in the treatment of disease or cancer and also covers other types of hormones like growth hormone. Compare to chemotherapy. HRT does apply to TSs, not only because that is the term always used, but because one is literally replacing androgens with estrogens. Also, since HRT continues throughout a TSs life, including following SRS or castration, it doesn't really make sense to switch between terms. But no, hormone therapy is something completely different. Can we add this back in? Thanks, Paige 17:35 4 Jun 2003 (UTC)
Also, male-to-female transsexual HRT is very much like HRT for postmenopausal women (even more so if menopause was induced by hysterectomy). Transsexual HRT has benefited much from research into postmenopausal HRT. I specifically added the bit about TS HRT because, as Paige stated, it is used exclusively in that context. -- Kimiko 17:42 4 Jun 2003 (UTC)
I'd advise create a separate article Hormone Replacement Therapy in transsexuals then.
As I said, especially for male-to-female HRT there is very much overlap with postmenopausal HRT. After completion of a second puberty, it is even identical to HRT for non-transsexual women who have had hysterectomy. -- Kimiko 17:55 4 Jun 2003 (UTC)
Strange - I've always heard it referred to as "taking hormones" or "hormonal treatment" or "hormone therapy" - never as HRT. Still, I bow to your superior knowledge - please do re-add it. If you could fix the intro as well, that'd be good :) Martin 20:20 4 Jun 2003 (UTC)
HRT is the medical term. I've heard "hormone therapy" and the others, but not very often and only as a short or colloquial form of "HRT". Then again, I'm not (post)menopausal. -- Kimiko 21:13 4 Jun 2003 (UTC)

Following the frequently discussed, rarely understood WHI, the term "HRT" is no longer used in mainstream womens health. Rather, "ET" or Estrogen Therapy for Estrogen alone treatments, and "HT" or Hormone Therapy for combination E+P treatments are now standard.

I´m not sure about the terminology but IMO "hormone replacement" covers many more things such as corticoid replacement in Addison´s disease, Thyroxin in hypothyoidism, etc. etc. (perhaps even insulin in diabetes?) Are there other articles or should these matters be added here? Kosebamse 20:33 4 Jun 2003 (UTC)

All of those actually fall under hormone therapy, which is a VERY wide feild and growing rapidly. P.S. Many thanks to Martin and whomever else set up that page! Paige 20:56 4 Jun 2003 (UTC)
I think this may reflect usage in the transexual community, but may not reflect the way the terms are used by the medical community. Certainly the definition of "replacement" as meaning "replacing androgens with estrogens" is not the medical meaning. -- Someone else 21:08 4 Jun 2003 (UTC)
Yes, HRT is the medical term, also used among transsexuals. The 'replacement' in HRT refers to the replacement of hormones that are not produced by the body in sufficient quantities. -- Kimiko 21:13 4 Jun 2003 (UTC)

Oh I see. Didn´t note the subleties of "replacement". In medicine you would probably talk about "substitution", meaning replacing something that is deficient with something of similar effect (e.g. insulin in diabetes, cortisol in Addison´s). So if (or rather, iff) "replacement" does actually have that narrow meaning the other stuff should go somewhere else. Kosebamse 21:15 4 Jun 2003 (UTC)

HRT is the term generally used in medicine for substitution/replenishment of sex hormones. See for example a search of "HRT" on PubMed.
Yes, but "Hormone Replacement Therapy" is but a special instance of "hormone replacement therapy". The same phrase means different things in different contexts. -- Someone else 21:25 4 Jun 2003 (UTC)
Use of the term 'hormone replacement therapy' seems to be rare outside this context. Without further qualification, HRT almost always refers to replacement of sex hormones (usually of the female kinds, but try searching for "HRT testosterone male"). -- Kimiko 21:42 4 Jun 2003 (UTC)

Well but I think "hormone substitution treatment" or something like that would be more precise for the other examples, so I guess we could put these to "hormone therapy" or rather to a page to be linked from there. Kosebamse 21:30 4 Jun 2003 (UTC)

The phrase hormone substitution treatment is certainly not a widely used one. "Hormone replacement therapy" is an ambiguous phrase, referring popularly to "estrogen therapy" and referring medically to any hormone prescribed for a deficiency. I don't see any rationale to separating them, especially as it tends to obscure the fact that it's an ambiguous phrase. -- Someone else 21:39 4 Jun 2003 (UTC)
re latest edition of the article text. Neat solution to this talk page controversy. -- Kimiko 21:52 4 Jun 2003 (UTC)

Agree. So if get you right we should just leave things here? What then (if anything) should go to hormone therapy? Kosebamse 21:49 4 Jun 2003 (UTC)

Other hormone treatments, as indicated by SE's latest edit. For example, insulin, TSH and GH. -- Kimiko 21:52 4 Jun 2003 (UTC)
With the header as it stands now, explaining that the phrase has more than one meaning, it's a reasonable compromise to have this article focus on the more common meaning and have other stuff elsewhere. Though I'd be happier if the other were "hormone replacement therapy" and this were "Hormone Replacement Therapy" <G> (ah, the joys of case-sensitivity) -- Someone else 21:53 4 Jun 2003 (UTC)
Agreed. But having HRT (caps) and hrt (lower case) with different subjects would be way to confusing for casual readers. Heck, it would confuzzle me too. -- Kimiko 21:58 4 Jun 2003 (UTC)
Oh, I wasn't suggesting we do it, only saying I'd be happier if we did. ;) -- Someone else 22:01 4 Jun 2003 (UTC)
Case sensitive disambiguation is the work of the Devil! Martin

I'm somewhat distressed by the less-than-NPOV tone of this paragraph:

It has become increasingly clear that oral progestin and equine estrogen pills can increases a number of risks, including the risks of exacerbation of existing liver or gallbladder problems and of dangerous blood clots. Long term use of equine estrogens probably also increases the risk of breast cancer. In women with a uterus, therapy with equine estrogen, unopposed by progesterone, may also increase the risk of uterine cancers. This combination can also effect blood triglyceride levels and so may increase the risk of cardiovascular problems. Although HRT with progestins and equine estrogens was once widely thought to promote cadiovascular health in women, on February 4, 2004, the American Heart Association released guidelines stating that it should no longer be considered as an agent to increase heart health or to decrease the chances of cardiovascular disease.

Some of this content is correct (the AHA guidelines about not using estrogen or HRT for heart health reasons), but some of it is highly slanted against equine estrogens (to be fair, several studies have shown that plant estrogens such as Estrace have less of the inherent risks of Premarin, forming the basis for much of the over-the-counter "menopausal therapies") and the "It has become increasingly clear..." intro smacks of agenda-speak. Perhaps better editing would help ("A number of recent medical studies over the past ten years have found...")? Scarletsmith 18:41, 19 January 2006 (UTC)


Male HRT

Hormone Replacement Therapy (HRT) - Delighted that there is material on this subject. This text, however, reflects the old convention that HRT was strictly applicable to females. The endrocronologists and others working in this field have expanded it to cover the treatment of males and even refer to the age problem of males as "andropause". There are now "andrologists" and others treating "andropause" with HRT. Need an expert to redo this subject.

Aye. Men and women have hormones, and in both cases they decline with ageBoonukem 02:31, 2 January 2007 (UTC)

Celebrity Endorsements

There's no citation for Patti Labelle's endorsement of "natural" progesterone, and I can't find one. I did find this (her renouncement of her paid endorsement for HRT): http://www.yourlawyer.com/articles/read/5929

Moreover, I'm not sure celebrity endorsements are appropriate--borders on advertising. Suzanne Somers is troubling--she profits from books touting "natural" hormones. And she had breast cancer...she did not take her doctors' advice to stop taking the "natural" hormones once she was diagnosed. She did, however, get part of her breast removed and undergo radiation. She also took birth control pills for 20 years... Cindery 23:35, 28 July 2006 (UTC)

NPOV regarding "natural" hormones

HRT is commonly understood to refer to hormone replacement therapy for menopause, involving drugs approved by the FDA. (None of the so-called "natural" hormones were ever approved for use by the FDA for HRT.) This page reads like "HRT vs. "natural" hormones," not as an entry on HRT. (And with a pretty obvious bias in favor of "natural" hormones--the page seems designed to promote "natural" hormones.) "Natural" hormones could be a small subsection of this article, or provide link to page on "natural" hormones. But is is not NPOV re HRT to compare "natural" vs. synthetic all the way through as main thrust.Cindery 23:45, 28 July 2006 (UTC)

I agree with this assessment and think it should be changed to be more NPOV. QuizzicalBee 15:07, 16 April 2007 (UTC)


Bioidentical Hormones

I disagree with the above statements. First, this section header should use the term "bioidentical", rather than "natural" hormones.

The article would benefit from more information about bioidentical HRT, specifically the differences between human and equine hormones. The FDA hasn't approved bioidentical hormones because they are identical to the ones in your body. As I understand it, you can't patent the use of human hormones like that. This is in contrast to HRT drugs like Premarin, which comes from the urine of pregnant horses. Horse estrogens are different than our own.

Wyeth, the maker of Premarin (an HRT drug), has an employee editing this and related pages to disparage bioidentical HRT. The IP is 155.94.62.221 - http://whois.domaintools.com/155.94.62.0, check their edits. There seems to be an active campaign to discredit bioidentical hormones in this article.

The distinction between equine (horse) hormones and human/bioidentical ones needs to be solidified. It should be clearly spelled out that these are hormones from horses. I'd guess that less than half of Americans know the meaning of the term "equine".

Someone attempted to make that distinction clearly in the passage below, but it's not enough. It should be clearly stated that these are hormones from a horse, and are different than human ones. The word "horse" is not mentioned once in the entire article.

Studies finding adverse health effects of equine estrogens and progestins have often been reported, inaccurately, as revealing effects of "estrogen" and "progesterone." It is important to keep this habitual inaccurate generalization in mind in reviewing press reports. On the other hand, creams, gels, etc. containing "biodentical" hormones custom-prepared by compounding pharmacies are not subject to FDA monitoring or regulation, so that doses delivered and hormone blood levels produced are unpredictable and may be highly variable, and there are fewer large scale studies of these items.

Drake 18:05, 15 August 2007 (UTC)

Any problems you are running into with WP:COI or POV-pushing can be dealt with at WP:AIV, though make sure you run through the warning templates before reporting. Also, make sure any comments regards horse versus bioidentical hormones are sourced. The equine comment can be addressed through the use of a piped link. WLU 19:25, 15 August 2007 (UTC)

Testesterone Update

New data from the Nurse's study is now available re testerone and HRT. (It is linked to breast cancer, heart disease, etc.) This needs to be updated here, perhaps with a testerone subsection? Cindery 23:45, 28 July 2006 (UTC)

Should this article be for HRT in men and women?

Someone made a brief attempt to make this article about HRT in men and in women. I changed it back because the info as changed was vague and confusing, but a valid point is raised. While HRT is used almost exclusively to refer to hormone replacement for women, it is true that increasingly, men are being prescribed hormones. Should separate articles be created for both men and women, as well as having an HRT for Transexuals article? Or should these be a sub-heading for this article? Or should they be called something else entirely? When men are prescribed testosterone, is it called "Hormone Replacement Therapy" or "Testosterone Replacement Therapy"? My impression is that it's called "Testosterone Replacement Therapy," meaning that putting that information here would just be confusing, and a separate article for TRT should be created instead, to differentiate the different therapies. QuizzicalBee 15:54, 29 January 2007 (UTC)

water contanimation

like 'the pill', the is evidence HRT also causes water contamination, esp in large cities. Sorry, cannot provide sources. —The preceding unsigned comment was added by 195.27.20.35 (talk) 18:57, 5 February 2007 (UTC).

Category:Human reproduction

I propose removing this article from Category:Human reproduction. I have proposed narrowing the scope of that category at Category talk:Human reproduction. Please comment on the category talk page. Lyrl Talk C 15:01, 17 March 2007 (UTC)

Medline definition

Medline has the following definition[1]:

Hormone Replacement Therapy

Therapeutic use of hormones to alleviate the effects of hormone deficiency. Year introduced: 1999


Under that they have a subhead:


Estrogen Replacement Therapy

The use of hormonal agents with estrogen-like activity in postmenopausal or other estrogen-deficient women to alleviate effects of hormone deficiency, such as vasomotor symptoms, DYSPAREUNIA, and progressive development of OSTEOPOROSIS. This may also include the use of progestational agents in combination therapy. Year introduced: 1990


In Wikipedia, Estrogen Replacement Therapy simply redirects to Hormone Replacement Therapy. Do you think the difference between the 2 terms is a distinction worth keeping? Nbauman 19:21, 15 April 2007 (UTC)

I'm unclear about exactly why you are asking this question. I do not think the distinction should be kept in terms of ERT having its own entry. But explaining the distinction in a sentence in the HRT entry could be useful. My impression is that ERT is an antiquated term. When they first started giving menopausal women hormones, it was only estrogen, and therefore the term ERT was used. Later, it became standard to add progestin to the mix and then HRT became standard, but ERT lingered because some women do just take estrogen. But my opinion is that it's unnecessarily specific to say ERT rather than HRT. QuizzicalBee 15:13, 16 April 2007 (UTC)
HRT is a more general term, ERT is a more specific term. ERT is not antiquated; they still use it, as you can see if you search Pubmed for "Estrogen Replacement Therapy [mh]".
I think HRT (generally) and ERT (specifically) are two distinct entities and should be dealt with in separate entries. The main difference is the quality of evidence.
  1. ERT as defined above, in postmenopausal women, has many studies, some of them long-term prospective RCTs, with huge numbers of people, which have resulted in strong conclusions at Level I evidence.
  1. HRT, as defined above, includes replacement of other hormones, such as thyroxin. Each of those hormones has much less research. It's justified to treat patients without demanding Level I evidence in some cases.
The use of estrogen in XY men who have discordant embryonic development as a method of strengthening female sexual characteristics is significantly different from restoring estrogen to its original levels in post-menopausal women. One big difference is the numbers. Estrogen treatment of men isn't guided by Level I evidence. Another big difference is the purpose -- in women estrogen is supposed to "restore" a "healthy" state, whereas in men it's supposed to bring them into a state that never developed in the first place.
HRT can also refer to replacements of deficient adrenal hormones, thyroid hormones, growth hormones, etc. These treatments are simpler, the results are more obvious, and there's much less debate about them. Most people don't call for large RCTs (there aren't large numbers of patients); they're satisfied with the clinical observation that they seem to work.
However, restoration of testosterone to the levels at younger age, on the analogy of estrogen replacement for women, is a separate situation with much weaker evidence with issues that are different from the other applications, and has the weakest evidence of all.
These and other uses of hormone replacement therapy are so different that they each deserve their own Wikipedia entry. ERT is complicated enough that you could hardly discuss all the issues in a lengthy entry. Nbauman 16:57, 16 April 2007 (UTC)

Research Funding

I believe this statement is inaccurate - "Apart from a few studies funded by the U.S. National Institutes of Health, the overwhelming majority of research on hormone supplementation has been financed by manufacturers..." Wyeth, the maker of both Premarin and Prempro, which were the only hormone products studies, funded a significant part of the study. 72.205.193.253 03:54, 24 April 2007 (UTC)

I think that comment has either NPOV problems, or else it should have references. It's somewhat misleading, too, as it doesn't explain why the big Prempro/Premarin study was so important.QuizzicalBee 16:44, 24 April 2007 (UTC)
It isn't a NPOV if it's true, is it? Why was the Prempro/Premarin study so important? It is routinely referred to in the medical literature as the "gold standard" of hormone replacement research. It cost $750 million dollars and went on for 17 years.

72.205.193.253 17:59, 3 May 2007 (UTC)

No, it's not NPOV if it's true. That's why I said it was either NPOV or it needs references. If there are no references, then there's no proof it's true, and it could therefore very well be an NPOV violation. It might still be an NPOV violation because the comment isn't contextualized--most drug studies are funded by the manufacturers, unfortunately, but the way it's phrased makes it seem like this is an extraordinary circumstance. And the Prempro/Premarin study didn't go on for 17 years.QuizzicalBee 18:09, 3 May 2007 (UTC)


From http://www.nhlbi.nih.gov/whi/

"The WHI was launched in 1991 and consisted of a set of clinical trials and an observational study, which together involved 161,808 generally healthy postmenopausal women.

The clinical trials were designed to test the effects of postmenopausal hormone therapy, diet modification, and calcium and vitamin D supplements on heart disease, fractures, and breast and colorectal cancer.

The hormone trial had two studies: the estrogen-plus-progestin study of women with a uterus and the estrogen-alone study of women without a uterus. (Women with a uterus were given progestin in combination with estrogen, a practice known to prevent endometrial cancer.) In both hormone therapy studies, women were randomly assigned to either the hormone medication being studied or to placebo. Those studies have now ended. The women in these studies are now participating in a follow-up phase, which will last until 2010."

Wyeth provided medication to 161,808 women. At seventeen years, times 12 months, that's over 2 million prescription a year or 34 million in total. Even if they only cost $20 (which they didn't), that's over $600 million. So even a fraction of that is more than a minor grant. 72.205.193.253 23:32, 4 May 2007 (UTC)

You provide some valuable information, but some of your interpolation is not correct. The WHI study has lasted for 17 years, but the hormone study hasn't been going on for 17 years--the hormone study lasted an average of 7 years per woman, and not every woman of the 161,808 was in the study. The WHI is studying lots of different things. Plus, about half of the women who were in the study didn't even receive the hormones--they got placebos. If you look [link at the published results of the study], you'll see that 16,608 women were chosen to be in the Prempro study. 8506 got hormones. These hormones, provided at wholesale cost for 7 years, if we think of the wholesale cost as $5/month, would be $3,572,520. For the Premarin-only study, there were link 11,000 participants, about half of whom got Premarin, the others, placebo. So the cost would be less than 3.5million for them, too. But none of this is the point of my objection--my point was that we need references to support what is said, and an explanation of why the study was important.QuizzicalBee 02:31, 5 May 2007 (UTC)
I did say that "even a fraction of that" taking into account the reductions you cited. Placebo provided by Wyeth would still have the same cost. The cost of the hormone content in the pills is negligible. And I'm sure Wyeth would never agree that the wholesale cost was $5, but that's beside the point. Why was the study important? It is cited literally thousands of times in other peer-reviewed papers, not to mention the media. It is considered by many the gold-standard study on hormone replacement, despite its manifest flaws. I'm not sure how to answer that question. Why was the Warren Connission important? What measure of importance would convince you? The announcement of the stopping of the study was front page news in The New York Times, complete with a picture of Dr. Rowan Chlebowski MD/PhD, an endocrinologist/biostatistician who ran the statistical part of the study. Neil Raden 05:16, 6 May 2007 (UTC)

Wiley Protocol

This is inappropriate. There are hundreds of hormone replacement therapies, why single out one that is statistically insignificant, perhaps no more than 0.1% of the total HRT use? And the proper place to raise the issue about whether or not the Wiley Protocol is controversial is in the article about the Wiley Protocol. Neil Raden 05:21, 6 May 2007 (UTC)

Section from page

I removed the following section from the page - it's pretty much unreferenced (the links included don't link directly to the studies, just non-specific pages and a conference. The wording is off ('staggering'?), it discusses a specific type of HRT without citation, the explanations look like original research without a reference, and it appears to push bioidentical hormones, which violates WP:NPOV. At minimum, it needs sources, and probably a re-write. It can't go on the page as is. WLU 18:57, 1 August 2007 (UTC)

A study [2] by M.D. Anderson reported in a medical conference [3] in San Antonio Texas in December 2006 looked at new cancer diagnoses in the U.S. in 2003, the year following the initial reports of clotting in connection with use of PremPro. A staggering 7% drop in new diagnoses of breast cancer in the U.S. was noted in 2003, compared with 2002 levels. One third of the decrease could have been related to a reduced number of mammographies. But the balance appeared to be related to widespread cessation of PremPro use. Reductions were by far the sharpest in women over 50, the age group among whom prior PremPro use (and thus discontinuation) was most likely. This and other studies suggest that the shift away from the proprietary PremPro combination was a key factor. These studies are consistent with the possibility that replacing PremPro with bioidentical hormones could reduce cancer risks. Long-term use of hormone combinations other than PremPro has already been found to be associated with lowered incidence of cancer. For example a large 2004 population study of women who used birth control pills found a reduced risk of heart disease and stroke and an overall decreased risk of cancer. In this study, women who had used birth control pills at some point in their lives were noted to have an 8% lower risk of heart disease, no increased risk of breast cancer, and a 7% lower overall cancer risk including significant reductions in ovarian and colon cancer. This 2004 study of the contraceptive pill's protective effects followed smaller studies that had found a slight breast cancer promotion associated with use of certain oral contraceptives. The favorable picture of contraceptive benefits emerged from the 2004 study's analysis of the very large body data collected from the over 160,000 women who had participated in the Women's Health Initiative study.

Archive This is an archive of past discussions. Do not edit the contents of this page. If you wish to start a new discussion or revive an old one, please do so on the current talk page.