About Me

My photo
Scottsdale, Arizona, United States
Angela M. DeRosa DO, MBA, CPE graduated from the Chicago College of Osteopathic Medicine in 1995. She went on to do an Internal Medicine Residency with a fast track emphasis in Women’s Health at Lutheran General Hospital. After her residency, she became the Director of Women’s Health Services and Education at Lutheran General Hospital. After two years of practice she started a full time career as the West Coast Senior Medical Director with Procter and Gamble Pharmaceuticals. There she worked on women's health product development, research and marketing. Seven years after starting this position, Dr. DeRosa decided to pursue other clinical endeavors. Dr. DeRosa is a nationally recognized internist and women’s health expert. Her clinical focus is on revitalizing the physician-patient relationship; striving to provide the highest quality of care to her patients in a warm compassionate environment.

Sunday, October 24, 2010

Sensational Media At It Again....Truth or Fiction?

Just because a family has one creepy drunk uncle, doesn’t mean the whole family is awful.


So goes it with Estrogens. The media is at it again…..scaring women about hormones and doing it in a fashion that I would consider negligent. Just this last week, there is yet again, another article in the New York Times about the negative effects of hormones and even Nancy Snyderman, MD from the Today show jumped on the bandwagon. While it appears from the headlines that “new” studies are being released, many people do not realize that these “new” publications are actually more data from the same Women’s Health Initiative study of women using Prempro (combination therapy with the synthetic hormones conjugated equine estrogen and medroxyprogesterone acetate, MPA, progestin) that was first reported in 2002. They are trying to make it sound like it is “hot off the presses”.

Since the Prempro part of the study was stopped, researchers are publishing only the data analysis from this group, not data from the women taking estrogen (Premarin) alone. Consumers do not realize is that it is common in academic medicine for the same study population data to be “mined” (or analyzed) for multiple publications on different topics. Rather than put all of the data analyses into one publication, a series of publications based on the same study group may be published over several years as the researchers consider different variables.

For women and physicians, it is confusing, because it seems another concern hits the news every other week. Unfortunately, the media headlines make it sound like this is yet another, different, study adding more fuel to the fire. In fact, it is simply more data from the same study, and the same combination of horse-derived estrogen and synthetic progestin (Prempro) being given to elderly women.

Most women’s health and hormonal experts would agree that Premarin and Prempro are poor choices for hormonal therapy. The estrogen is a synthetic estrogen made from horse’s urine (not the bio-identical estrogen made by a women’s ovary) and it is an oral delivery of estrogen which can increase a women’s risk for cardiovascular effects. Oral hormones have to process through the liver; called first pass liver metabolism. This type of processing allows for blood clotting factors to be released with can increase a person’s risk for blood clots, heart attack and stroke.

In addition, many physicians and researchers think that many of the adverse outcomes found in the PremPro arm of the study are more likely due to the particular progestin being used (Provera or medroxyprogesterone acetate), since earlier studies have shown that this progestin negates the beneficial effects of estrogen.

It is very important to ensure that women who have had a hysterectomy avoid taking progestin or progesterone unless there is a clear medical reason to do so. If a woman requires Progesterone they should only take one which is bio-identical such as Prometrium or compounded Progesterone like the one our body’s ovaries make.

These characteristics make Premarin and Prempro dangerous medications, but to say that all hormones are bad is just not true and is not based on scientific data.

Premarin and Prempro used in the WHI are not the same hormones made by our body, and the WHI study is not looking at the difference in the types and routes of delivery for the many other forms of hormone replacement therapy available. This study should not blanket over all estrogens. Non oral, bio-identical hormones have decades of data to support the positive effects especially when delivered via a subcutaneous method such as with bio-identical pellets. (I will be loading the site with many reference articles to support this claim)

Recent News also covers up the fact that the risk increases reported from the WHI were seen only with the Prempro group (combined daily progestin and estrogen). The Premarin (conjugated equine estrogen alone) group of women did not have these risks, and the women in that group who had had a hysterectomy and could take estrogen alone, ARE continuing the study. And early data suggests that the Premarin treatment group are deriving multiple benefits from a cardiovascular standpoint, decrease in breast cancer and osteoporosis etc. Even with the worst possible estrogen preparation on the market for women is showing benefit for women.. The media just doesn’t talk about this, because it “does not bleed so it can’t lead”.

To make matters worse, most physicians are as confused by this data as their patients. This is because they do not have the time to sort through all the data, and they often say “there is no data to support other forms of hormonal delivery”. If your health care provide say’s this……he or she is wrong. There is a big difference between “no data” and not having read the data. Lastly, there is a great fear of lawsuit in this country and many providers do not want to put themselves at risk and it is easier to not prescribe proper hormones than spend the time and energy to educate themselves and their patients on the “true data, risks and benefits and possible short and long term effects”. Lastly, time has become short in physician practices and they do not have the luxury to take the much needed time to have these discussions.

So before, “you throw the baby out with the bath water”……..educate yourself on the real data, talk to experts like myself and others who have dedicated their careers to understanding the data and effects on health, and question everything the media says about health and hormones in particular. You won’t be sorry.

Sunday, October 3, 2010

My doctor tells me my labs are normal........

So doctors don't always "get it".  Now that is not to say, they don't know what they are doing, but most physicians are not taught anything but the basics about women's health and especially the roles of hormones.  And most certainly nothing about the role of ttestosterone in women.  The United States, in particular, is light years behind when it comes to this. 

The advent of the Internet and more "baby boomers" getting to menopause is creating a higher demand for understanding and desire to feel better.  This is forcing more and more physicians to take notice.  With that said, there are only a handful of doctors who truly "get it" when it comes to hormones and know how to properly treat hormonal imbalances.

So what are the problems in getting diagnoses properly......

1) Doctors don't know all the signs and symptoms of testosterone deficiency.  The big ones are: mood swings, irritability, lack of patience, anxiety, depression, fatigue, loss of stamina, impaired memory and concentration, loss of libido, sleep disturbances, muscle weakness, inability to loss weight despite diet and exercise, increasing blood pressure, worsening cholesterol, impaired sugar metabolism and plain ole apathy.  You may ask yourself, "why do I hate my life or feel nothing, when I have everything I want".     Most doctors try to put you on an antidepressant, because this is easier than actually trying to figure out that you have a hormonal imbalance.

2) The  lab reference ranges are only reflecting true endogenous hormone production of testosterone....meaning what the ovaries and adrenals make every day.  This causes a perplexity to treatment and the ability to truly know what is "normal" for a particular women/patient.  Most lab reference ranges suggest that levels between 6-82 ng/.dl are normal.  However the labs are often inaccurate, not properly calibrated from women, do not capture the day to day variations in hormones and in peri-menopausal and menopausal women do not reflect the proper levels for treatment dosing.  There is no data to support that proper dosing for exogenous (or the testosterone we give you to take) should be based on establish ranges from endogenous production.  In fact, often good proper treatment levels can be 2-3time the "normal reference" range.  You MUST base treatment on the unique needs of each women to find the optimum dose to provide good effect without adverse side effects.  This take time and listening to each patient.

3) The media has scared the heck out of women when it comes to hormones.  There is so much misinformation out there and it takes time and scientific knowledge about studies to understand and sift through all the information.  This is not easy and a challenge even for the best of us.


More later......and I promise we will get to estrogen as well.  Just starting with this topic for now. We will address the perimenopause and what this transition means.. Sounds like fun huh!