It’s your choice

Approximately 50% of women who are treated with estrogen (especially the estradiol implant) will experience uterine bleeding. If a menopausal patient has bleeding, she must notify her gynecologist or family physician and have an evaluation, which may include a vaginal ultrasound and endometrial biopsy. The primary cause of bleeding is stimulation of the uterus by estrogen. Estrogen also stimulates the breast tissue can cause breast pain and cysts. It also increases the risk of breast cancer. Higher levels of estrogen (in the second half of the menstrual cycle) are needed for pregnancy. Most women feel better with lower levels of estrogen.
 Most women choose a testosterone pellet alone. Almost all symptoms, including hot flashes, are
relieved with testosterone pellets alone. A study by Sherwin in 1985 looked at testosterone,
testosterone with estradiol, estradiol alone and placebo. The group of women who responded best
(somatic, psychological and total score)…testosterone alone! The groups that did the
worst…estrogen alone and placebo. Higher levels of testosterone were associated with a better
response. These results are expected. Testosterone, not circulating estradiol, is the major
‘substrate’ for estrogen production in the brain, bones, vascular system, breast and adipose tissue.
Some physicians do not understand this and may insist that estrogen therapy is needed.

 In both men and women, excess estrogen can cause anxiety, weight gain, belly fat, tender
breasts, emotional instability, symptoms of PMS, and mood swings. Long-term exposure to stronger estrogens like estradiol and Premarin can increase the risk of breast cancer. In addition, there is exposure to many estrogen-like chemicals.  Some women (and men) ‘aromatize’ or convert too much testosterone to estradiol, which can interfere with the beneficial effects of testosterone. An ‘aromatase inhibitor’ (i.e. anastrozole) may
be prescribed to prevent this. Patients, including breast cancer survivors, may be treated with the
combination testosterone-anastrozole implants.
 If needed, one of the most effective and safest ways to deliver estrogen is vaginally as a cream or
tablet (Vagifem®) twice weekly. This treats vaginal symptoms like dryness and discomfort, along
with urinary symptoms like urgency, frequency, hesitancy, nocturia (waking at night to urinate) and
incontinence. Estriol (E3) is less stimulatory to the breast tissue and uterus than estradiol and may
be compounded with progesterone in a single cream. Once tissue has healed and symptoms are
no longer present, the vaginal cream or tablet may be discontinued. Unlike Vagifem®, which is
considered ‘low dose’ estrogen, higher dose Estrace® and Premarin® creams deliver systemic
levels of strong estrogens.
 Thin women with a low bmi and little body fat may benefit from systemic estrogen therapy.  Testosterone increases muscle mass and bone density while decreasing fatty tissue. However, a diet of refined carbohydrates/sugars will prevent weight loss and other benefits of testosterone
implant therapy. Diet and lifestyle (exercise) are extremely important for health and well-being.
Prescription medications can also interfere with the effect of the testosterone implant. For additional
information, see the ‘Trouble Shooting’ handout.

Progesterone may be used in addition to testosterone to help women who have difficulty with
sleep, hot flashes, tension or anxiety. Testosterone and progesterone have beneficial effects on the brain and nervous system.


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Common Superficial Oral Lesions TABLE 1 From: Common Oral Lesions: Part I. Superficial Mucosal Lesions . Am Fam Physician. 2007 Feb 15;75(4):501-506.WANDA C. GONSALVES, M.D., ANGELA C. CHI, D.M.D., and BRAD W. NEVILLE, D.D.S., Medical University of South Carolina, Charleston, South Carolina Condition Clinical presentation Treatment Comments Candidiasis4– Pseud

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from 1995 The Demon-Haunted World: Carl Sagan’s “Baloney Detection Kit” What’s in the kit? Tools for skeptical thinking. What skeptical thinking boils down to is the means to construct and to understand, a reasoned argument and—especially important—to recognize a fallacious or fraudulent argument. The question is not whether we like the conclusion that emerges out of a train of

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