However, mainstream doctors believe all estrogen is dangerous, regardless of its source, and has the same risks as the standard menopause hormones like Premarin and Prempro, which the Women's Health Initiative showed to raise the risk of breast cancer and stroke.
Q. Why are patients so eagerly embracing unproven treatments that could actually harm them?
A. They're very popular among the baby boomer generation. They want to keep working or have an active retirement, and don't want to get frail. So they're very eager to try substances even if they might be risky.
Q. It's hard to argue that someone wouldn't want more sex or sleep.
Q. Would you consider wrinkle creams and Botox as risky as bioidentical hormones?
A. Botox is one of the only FDA-approved antiaging products. Its label contains a lot of warnings, so patients know what they're getting into. The compounded hormones being prescribed for antiaging generally don't offer as much cautionary information.
Q. Why don't they have to carry warning labels?
A. There's a web of regulations and rulings in this country, including the Dietary Supplement Health and Education Act of 1994, that dictate what compounding pharmacists can and cannot do. But the bottom line is that compounding pharmacists have a lot of freedom. For example, they don't have to include warning labels on their products. That's tragic. They should have to include the same warning labels as pharmaceutical companies when they're using the same chemicals.
Q. So drug companies and compounding pharmacies are offering essentially the same products?
A. Exactly. They're all hormones, just derived from different sources. So women are really confused. They don't know they can get bioidentical hormones that are approved by the FDA and maybe paid for by insurance, because the antiaging industry does such a good job telling them only their compounding pharmacy can make these products.
Q. Are there any real differences?
A. Well, the other controversy is that the antiaging industry says you have to have a form of estrogen called estriol, because that's what your body makes naturally. Estriol is not actually in any FDA-approved drugs, so technically, under FDA guidelines, compounding pharmacies are not supposed to be using it in any products. There are some studies showing it to be dangerous. The FDA told me they've had adverse reports of people taking estriol.
Q. If both mainstream medicine and antiaging practitioners are offering virtually the same products, why is there more concern about the antiaging industry's programs?
A. Antiaging doctors will often tell people it's safe to be on these regimens indefinitely. But the mainstream medical world believes the safest route is to take the smallest dose possible for the shortest amount of time possible. Also, many critics believe antiaging products should carry labels saying things like, "This product contains estrogen and progesterone, which have been tied to breast cancer," or "This product also contains estriol, which is not contained in any FDA-approved product."
Q. Why aren't antiaging doctors telling their patients there are FDA-approved alternatives?
A. I did meet some ethical doctors who give their patients a choice. But they say, "You can get such-and-such product made by a pharmaceutical company, or you can go to our compounding pharmacy and get something that's tailored just for you."