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The Peter Attia Drive

Feb 25, 2019

In this episode, Avrum Bluming, hematologist, medical oncologist, and emeritus clinical professor at USC and Carol Tavris, social psychologist and author of Mistakes Were Made (But Not By Me), discuss their collaboration on their recent book, Estrogen Matters. Their book takes on the very polarizing and confusing topic of hormone replacement therapy for women suffering with symptoms of menopause. In many ways, the story and history of HRT is in striking parallel to the bad science that led up to the dietary guidelines being set forth in 1980. Carol and Avrum make a compelling case that most women benefit greatly from being on postmenopausal hormone replacement therapy, and can do so without increasing their risk of breast cancer. We also cover the history of HRT, the impact of the Women's Health Initiative, and take a deep dive into each of the clinical conditions for which HRT should be considered, such as cardiovascular disease, neurodegenerative disease, and osteoporosis, to name a few.

We discuss:

  • The background of Carol and Avrum, and the impetus for writing Estrogen Matters [8:45];
  • The sad early history of hormone replacement therapy, treatments for prostate and breast cancer, and the difference between the treatment of women vs. men [14:00];
  • What hormones do, and why they drop off rapidly in women compared to gradually in men [20:15];
  • Mistreatment of women leading to great skepticism [23:45];
  • Breast cancer vs heart disease: Comparing the incidence and mortality in women [27:00];
  • Case studies of women suffering symptoms of menopause [30:00];
  • What are Carol and Avrum’s true motivations in this endeavor? [32:45];
  • The changing perceptions of HRT, the impact of the Women’s Health Initiative (WHI), and the problems with the WHI [37:45];
  • Is this one big conspiracy? The uncanny resemblance of the story of HRT and how the dietary guidelines were created [46:00];
  • Why people (falsely) think estrogen causes a 25% increase in breast cancer, and a lesson in absolute vs. relative risk [57:15];
  • The truth about progesterone and cancer risk, and the best types of estrogen and progesterone to be taking [1:09:00];
  • The Women’s Health Initiative: the reported findings, walking back their bold claims, and their hesitance to admit they were wrong [1:17:45];
  • Brain benefits of HRT, Alzheimer’s disease in women, and estrogen as a preventative treatment for AD [1:22:45];
  • The impact of HRT on heart disease, the ideal time to start HRT, and the risks associated with HRT [1:26:45];
  • The benefits of estrogen on bone health, and the incidence and mortality of hip fractures [1:33:15];
  • Colon cancer: Can HRT reduce the risk of colon cancer? [1:38:15];
  • Diabetes: Can HRT reduce the risk of developing diabetes? [1:40:30];
  • The downsides of hormone replacement therapy (HRT) [1:41:30];
  • How to approach your doctor who may already have a very strong point of view about HRT [1:42:15];
  • What kind of research needs to be done to answer the remaining questions about the benefits and risks of HRT? [1:48:30];
  • Cancer: Our evolving understanding and the future of treatment [1:59:15];
  • Welcoming the critics: Avrum and Carol want to start a conversation [2:02:00];
  • Are there racial differences in benefits and risks with HRT? [2:04:15];
  • The reactions to Estrogen Matters, and why it is a must read [2:09:15];
  • HRT after a diagnosis of breast cancer [2:13:45]; and
  • More.

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