Hormones, Pseudoscience and Self-Deception

A few months ago I saw a letter in Time magazine from the actress Suzanne Somers. She roundly and quite unfairly criticized Andrew Weil for not talking about hormone replacement therapy using what are known as “bio-identical hormones.”

I didn’t say anything at the time. Andrew Weil is well able to take care of himself and treated the letter quite correctly: by not responding. Suzanne did not reveal in the letter that she has a commercial interest in the bio-identical hormones. I assume that she did tell the editors of Time magazine, to have not done so would obviously have been unethical.

Her comments were a bit silly. But why respond to her now? After all the world’s full of silly things, and most of the time we can just move on. But now she’s promoting a new book and I am afraid misleading people. It may be that these bio-identical hormones are the answer to a maiden’s prayer and maybe they are not. My worry is that she does not discuss the pros and cons of using these products. Just lots of pros, implying that almost every woman of a certain age should be taking them. She claims that there is some research to back her up. In fact there are some very big holes in the research.

Now we see the recommendation to measure sex hormone binding globulin (SHBG), because “if that number’s not right, it doesn’t matter how high your testosterone is.”

I am an endocrinologist, but this advice is so mind bogglingly absurd that I still thought that I might perhaps have missed something. SHBG is not a single entity carrying sex hormones like some molecular equivalent of the number 9 bus.

It is a complex of proteins and glycoproteins that has many jobs, only one of which is the transport of some sex hormones to tissues that need them. Measuring the SHBG is complex: there are many genetic variations in SHBG and each has a different capacity for carrying estrogen and testosterone. You, your brother, sister, and spouse may all have different types of SHBG, with varying numbers of recognition sites geared toward testosterone or estrogen transport. Some vary if you have inflammation or liver trouble, and the amount of abdominal fat impacts SHBG but subcutaneous fat does not. You see that is it quite a complex topic!

It is simply absurd to make pronouncements based on “Levels” of this group of proteins and glycoproteins. There is no such thing as a “normal” level: when we measure hormones or their carriers, we use “reference ranges,” because the levels “refer” to numbers obtained from large panels of apparently healthy people.

I’ve carefully examined all the papers that she cites in support of her line of bio-identical hormones, and they certainly do not say the things claimed. This worries me: pulling bits of half-understood studies does not help us to advance health care or quality of life. Suzanne can tell us about as many cases as she likes, but she is using pseudoscience to buttress her position.

Yes, it is possible that she is correct, but why oh why isn’t there some proper research to say so?

Hormones, whether naturally occurring or bio-identical, are powerful chemical mediators. Used judiciously they have a role in the care and treatment of some women, whose lives would otherwise be miserable. But you also need to remember that some tumors may be promoted by bioactive hormones, whether they are synthesized or derived from plants or animals. And there are other potential health risks.

Caveat emptor!