Phoenix Medicine

07/07/2025

Something to be aware of with weight-loss drugs:

"Labeling for GLP-1 receptor agonists such as semaglutide and tirzepatide include warnings about the increased risk for diabetic retinopathy in patients with type 2 diabetes. The label for the combination of phentermine and topiramate (Qsymia) warns of a risk for acute myopia and secondary angle-closure glaucoma, and the label for the combination of naltrexone and bupropion (eg: Contrave) lists the risk for angle-closure glaucoma."

Although GLP-1 drugs make headlines for vision risks, other weight-loss medications carry their own eye-related side effects.

06/22/2025

An EXCELLENT, thorough review of studies on hormone replacement therapy by Dr. Barbara Levy, published in the American College of Obstetrics and Gynecology Journal in July, 2024.
She was encouraged to write this paper after expressing her concern over the continued mis-education of doctors and subsequent lack of optimal treatment for menopausal women.

"A thorough literature review affirms that, in postmenopausal women, estradiol (E2) effectively relieves vasomotor symptoms and symptoms associated with the genitourinary syndrome of menopause, that is, vulvovaginal atrophy symptoms, while maintaining bone mineral density. The evidence also supports that estrogen–E2 is associated with decreased breast cancer and cardiovascular mortality."

Dr. Barbara Levy is a prominent figure in women's health, known for her leadership roles and advocacy work. She is a clinical professor of obstetrics and gynecology at George Washington University and UCSD Health. She also serves as Chief Medical Officer for Visana Health, a company focused on women's telehealth.

nitiative initial results in 2002. Findings from that trial, which treated a population of older, asymptomatic patients, have been extrapolated over the past 21 years to all estrogen products, all menopausal women, and all delivery mechanisms. Our patients deserve a more nuanced, individualized appr...

06/22/2025

The antiquated, mis-representation of the Women's Health Initiative, which used Premarin ("CEE") and Provera ("MPA"), caused fear of blood clots and breast cancer with hormone replacement therapy. There were many problems with the WHI, including a patient population of older women (median age 63) who were ten years post-menopause, had not received any hormones during that time, and many had insulin resistance/obesity (which is independently linked to breast cancer).
Further, this study was not based on bio-identical hormones which are molecularly identical to those we make prior to menopause, but synthetic hormones (and we have long known that progestins, like those in birth control pills, are highly inflammatory and carry a risk of blood clots).
The accurate representation of the WHI only shows increased risk of breast cancer when adding the Provera ("progestin") to the Premarin ("estrogen").
Giving women the bio-identical form of hormones avoids the inflammatory effect of progestins and horse estrogens, and reduces risk of all-cause morbidity/mortality by 30%.

From the following article:
"Dr. Bosserman suggests that conflicting results from most United States-based research trials are due to not separating the trial results performed with synthetic hormone drugs—primarily CEE and MPA with those done with natural hormones, estradiol and micronized progesterone."

“What is now clear,” she says, “is that natural hormone replacement with oral estradiol (a form of estrogen taken by mouth), micronized progesterone (a form of progesterone broken down into very fine particles) alone or with testosterone is safe, effective and lifesaving.”

Many people wonder whether hormone replacement therapy is safe or whether HRT may be linked to cancer. Learn the pros and cons and what to consider.

06/16/2025

Another reason for hormone replacement therapy in women...

"Untreated genitourinary symptoms of menopause (GSM) can result in serious complications aside from vaginal symptoms, including urinary tract infections (UTIs) that increase the risk for sepsis and, in rare cases, vulvovaginal obliteration"

Recurrent urinary tract infections and potentially abnormal Pap smears are among the consequences of untreated GSM.

05/19/2025

More protein required during weight loss than what has been traditionally recommended:

"The recommended dietary allowance for protein is set at 0.8. This was established as the minimum amount of protein to preserve nitrogen balance, but as we'll see, it is far too low to provide optimal benefits."
"Overall, 1.2 grams of protein per kilogram of body weight per day may be enough to prevent loss of lean body mass during weight loss, but 1.6 or more may provide additional benefit, particularly for highly active individuals."

How to Educate Patients on Protein Needs During Weight Loss

01/19/2025

Daily aspirin is VERY rarely indicated for primary prevention (someone with no prior cardiovascular event), because the risk of a bleed (typically gastrointestinal or brain) is higher than the cardiovascular benefit.

Despite guideline recommendation changes, some patients are still taking a daily dose of aspirin for prevention of heart attack or stroke, according to a Jan. 13 The Washington Post report. 

01/19/2025

Bisphosphonates barely function to slow down (not prevent) osteoporosis and the absolute difference in fracture occurrence between them and placebo is only about 1%. Also, they should be prescribed for a limited time or run the risk of serious side effects. How to prevent osteoporosis? Estradiol replacement at menopause! (Along with vit D3, vit K2, Magnesium, and vit C.)

Should you take bone drugs like Fosamax for menopause osteoporosis? How bad are the side effects? Do they actually work? In this video, we’ll discuss the eff...

09/24/2024

"The federal agency took action against CVS Health's Caremark, Cigna's Express Scripts, and UnitedHealth Group's Optum and their respective group purchasing organizations — Zinc Health Services, Ascent Health Services, and Emisar Pharma Services. The three PBMs administer 80% of prescriptions in the United States, the FTC said in a statement announcing the action.
The three PBMs "have extracted millions of dollars off the backs of patients who need life-saving medications," said Rahul Rao, deputy director of the FTC's Bureau of Competition, in the statement."

Big Pharma, local pharmacies, prescription drug pricing, benefit managers, insurance restrictions of superior drugs...ALL of it comes down to greed and needs serious intervention.

The US Federal Trade Commission said that CVS Health's Caremark, Cigna's Express Scripts, and UnitedHealth Group's Optum illegally steered patients to higher-priced insulins.

09/12/2024

"The FDA warned that fezolinetant (Veozah), a hormone-free pill for moderate to severe hot flashes caused by menopause, could cause rare but serious liver injury." Symptoms of liver injury within 40 days of starting the drug.
Why is there a continued push to treat the symptoms with harmful drugs like this, rather than treating the cause with replacement hormones (which has the "side effect" of decreasing all-cause morbidity and mortality of aging)?

09/09/2024

I frequently hear from male patients that their primary care doctor is concerned about the testosterone causing an elevation in their blood count which could "make the blood thick and cause a blood clot." Polycythemia Vera (PV) is a disease where the hemoglobin/hematocrit is high, but SO IS the platelet count - these people are at a higher risk for blood clots, but that is due to the high platelet count.
I think there is confusion between the high blood count from testosterone and the high blood count with PV; they are not the same, and they should not be compared.
We know that people exposed to low oxygen (hypoxia), like those with COPD or living at altitude, adapt by making more oxygen-carrying blood cells (erythrocytosis), and have very high hemoglobin/hematocrit levels. We do NOT make them donate blood to lower the blood count - that would seriously endanger them. Nor do we worry about them being at an increased risk of blood clot.
There was a study published last year specifically looking at clotting differences at those living at sea level, and those with very very high blood counts living at altitude. And the group with the highest blood counts actually showed a HYPO-coagulable state compared with those at sea level. (Read the study for all the details.)
It is the high platelet count in PV that causes the clots.
It is not the high hemoglobin that causes the clots.

09/04/2024

Women experiencing depression during peri-menopause are typically given anti-depressants. However, if the depression is caused/exacerbated by the change in hormones, wouldn't it make more sense (and avoid manipulating neurotransmitters) to replace the hormones and thus treat the cause??

08/30/2024

Last year, a New York Times supplement featured hormone replacement in women...my only critique is that the focus remains on non-bioidentical hormones.

(I don't know if the "gift article" link will work here, but even without a subscription, you should be able to read a few articles as a guest.)

Hot flashes, sleeplessness, pain during s*x: For some of menopause’s worst symptoms, there’s an established treatment. Why aren’t more women offered it?