A note from Dr. Longo:

Hormone therapy has had a rocky road over the last 20 years. The good news is that we are all becoming more aware of the benefits and real risks (which are fewer than you think).

Let’s start there. Why did we all think hormone therapy was risky, and why did women lose access to hormone replacement in the early 2000s?

In 2002, a study by the Women’s Health Initiative was investigating the benefits and risks of hormone replacement for post-menopausal women. This study was stopped early when it was suggested that taking Prempro—a combination of conjugated equine estrogen and medroxyprogesterone acetate—increased the risk of breast cancer. This study had many faults, and many follow-up studies did not show this risk. In fact, the follow-up studies showed many benefits. The problem was that the media only focused on inflammatory headlines that proclaimed "HRT BAD!!" When studies came out showing low risks and increased benefits, there were no big announcements or “sorry about that other headline” moments. A whole generation of post-menopausal women missed out on a very beneficial treatment. Worse, many practitioners continue to treat patients under the assumption that HRT is not safe and should only be used for a short duration. This is changing slowly, but it remains a problem that impacts patients daily.

For the majority of my 22 years of practice, I have been aware that the WHI study was flawed and have done my best to educate patients about the real benefits of hormone replacement and the limited risks. This meant daily discussions with patients who were scared to utilize this treatment for their health. It is sad to think that so many patients who “succumbed” to hormone replacement therapy when their symptoms became too severe did so believing they were taking on significant risks to obtain a better quality of life. In reality, they were improving their quality of life with very few risks and even more benefits.

Now is the time I would like to apologize to every patient, and there have been thousands, who came to me complaining of fatigue, low libido, irritability, weight gain, brain fog, chronic pain, and a collection of other complaints for whom I said things like “drink more water,” “eat clean,” and “it’s normal” (THE WORST). I am sorry. In reality, other than the “it’s normal” comment, starting with a healthy diet is still something I would recommend, but now I know that I not only need to provide the tools to help you achieve this, but there is so much more that can be done. Even when every fiber of my being knew I needed to be talking about nutrition, sleep, stress, and symptoms, I didn’t. I can blame my formal medical education, which left out nutrition and prevention. I can blame my hectic schedule that gave me only 15 minutes to see patients. (I mean, surely that’s enough time to listen to patients, do an assessment, develop a plan, and educate a patient about how to implement that plan.) And lastly, I can blame being too attached to the dogmas of the traditional medical model.

I no longer want to treat diseases and symptoms. I want to stop them at their source. I want to help you optimize your health. The most important part of that last statement is “YOU.” I want to help YOU optimize your health. The best part of all of this? You want that too. I hear it from patients every day. And I was hearing it before; I just wasn’t “hearing” it. I was interpreting what I thought was a request for a band-aid for a symptom, so if I did not have a prescription that could fix the complaint, I would call it normal or blame it on the patient’s weight, habits, etc. I didn’t take the time to listen to them as they repeatedly asked me to help them feel better and give them the tools to do so. Once again, I am sorry.

How does all this lead us to a note about hormones? I am glad you asked! Hormone replacement is much more than treating hot flashes and vaginal dryness. Last year, if you had asked me, this would have been what I used hormones to treat. It turns out you can teach an old dog new tricks. Hormone replacement isn’t just about treating symptoms; it’s about effectively protecting us from chronic disease. The added benefit of improved quality of life makes it a win/win. This will be a new concept for many of us, which is odd considering the mountain of evidence that hormone replacement is crucial in preventing most of the diseases we associate with loss of function and death: Alzheimer’s, dementia, cardiovascular disease, stroke, and cancers, to name a few.

Where do we start? Well, GUT HEALTH is the beginning. A healthy microbiome is essential to our hormone function. I know most of your eyes just glazed over because “gut health” and “leaky gut” seem like a cop-out, right? Go to a physician about a symptom, and instead of a prescription, you get a lecture about diet and gut health. Well, what if your prescription was a probiotic and recommendations for supplements that replace essential minerals and vitamins so your cells could carry out their functions? How did we get away from believing that we could effectively prevent and treat disease with diet, exercise, and supplements? What if it really is a simple solution in a complex world?

The next step is optimizing the levels of hormones (estrogen, progesterone, testosterone, thyroid, and vitamin D3) that regulate EVERY cell in our body in one way or another. Let’s look at that again. The function of hormones is to turn on cellular functions. If we don’t have the amount of hormone we need, some functions do not get done. How do we determine the amount we need? A little bit of magic. Well, not really. But a whole lot of looking at labs, listening to patients, and assessing responses to treatment. Most importantly, we need to critically evaluate long-held beliefs about “normal” levels and treatments. You don’t need a $1,500 lab panel to feel better, but you do need some baseline labs and a skilled provider who can help you achieve optimal health. Again, it really should be simple and effective.

I am excited to move into a space where I can help you optimize your health. It feels like I have had a little bug whispering in my ear for the last 22 years that there was more to be done; I just didn’t have the tools until now!

Thank you to all my past, present, and future patients who have trusted me with their healthcare. I am grateful for your trust and excited to walk this new health journey with you.