The Dr Louise Newson Podcast - 55 – HRT, breast cancer and the real risks of not taking hormones

Episode Date: April 7, 2026

In this episode, Dr Louise Newson is joined by physician and author Dr Jeffrey Dach, who is the founder and Medical Director of the TrueMedMD Clinic in Florida and author of numerous books including Bioidentical Hormones 101.Together, Louise and Jeffrey challenge some of the biggest myths surrounding hormone treatments, including the long-standing fear around breast cancer and the lasting damage caused by the Women’s Health Initiative study.They discuss the important differences between body identical and synthetic hormones, and why hormones should be recognised not just for symptom relief, but also for their roles in improving long-term health.It’s a powerful conversation about fear, misinformation and why so many women are still being denied the hormone treatments they both need and want.LET'S CONNECT  Subscribe here 👉 https://www.youtube.com/@menopause_doctor Website 👉 https://www.drlouisenewson.co.uk/Instagram 👉   / @drlouisenewsonpodcast  LinkedIn 👉     / https://www.linkedin.com/in/drlouisenewson/ TikTok 👉   / https://www.tiktok.com/@drlouisenewson Spotify 👉 https://open.spotify.com/show/7dCctfyI9bODGDaFnjfKhg LEARN MORE Download my balance app 👉 https://www.balance-menopause.com/balance-app/Get tickets for my new theatre tour, Breaking the Cycle 👉 https://www.nlp-ltd.com/dr-louise-newson-breaking-the-cycle/ Pre order my new book 👉 https://bio.to/ThePowerofHormones 

Dr. Jeffrey Dack is my guest today. He's a US doctor and he talks a lot about the preventative roles of hormones. Talks about how estrogen can reduce future risk of breast cancer, but also other diseases such as osteoarthritis, osteoporosis and heart disease. We really explore about how we should be thinking differently about hormones and also about how healthcare professionals should be less scared of prescribing hormones. to women. Jeff, I'm really excited to have you on my podcast because I've listened to quite a few podcasts that you've been on on other people's. Your words of wisdom, your huge intellect is just incredible. And also your book, which I have lugged down to London on the train last night,

bioidentical hormones 101, menopausal hormonal replacement second edition, I'd just like to add. So just before we get started, just tell me a bit about you because you haven't always been a specialist in hormones. So can you just tell me a bit about your story? Yes, of course. First of all, Louise, thank you so much for inviting me. It's a great honor to be on your podcast. And, you know, my background, I started out as a diagnostic interventional radiologist. I worked in the hospital for 25 years doing that.

And, you know, I developed eye trouble. So I switched to a outpatient clinic. I started my own outpatient clinic here locally and doing biocinical hormones at the beginning. And then I later, as we were chatting earlier, I mentioned that I became a reluctant thyroidologist. And we have a second book on Natural Thyroid Toolkit, which we can get into later.

But yeah, you know, I was prescribed being bioidentical hormones for 20 years. Their first edition of the bioidentical hormone book came out in 2011, and we talked about the women's health initiative study. And at that time, it was a different environment. There was just a lot of negative newspaper articles on biodendical hormone replacement. So a lot of the chapters on the first book dealt with that. The first edition is free on my website. You can download the free version. We now, have since 2011 you know another 14 years of research a lot of new material a lot of new information which is that really changes the whole landscape and plus I put on a monthly

newsletter and uh might have tons and tons of material on bioidentical hormones from the newsletter so I had enough material for a book so I started putting it together and realized you know what there's a lot of there's a lot of medical research that needs to to go on the book, which I haven't looked at yet. So, as you know, writing a book like this, you get, it sort of takes mind a life of its own. And so, you know, that's what goes into the book. You know, and you have these little, these moments where the little light bulb turns on, you know, the eureka moment. So we do have a few of those in the book. And, you know, I think it's a good book. I'm a little biased because since I wrote it.

And, you know, one of the things we talk about is the Women's Health Initiative, you know, 18-year, 20-year follow-up data came out and showed this tremendous protective effect of estrogen. You know, the estrogen-treated group had a 45% reduction in mortality from breast cancer, And I love the quote from Isaac Mannianda, who is there in London. He's, I think he's at St. George. She's a professor at St. George in London. And he's been on, I think he's one of your favorites also. Indeed.

He comes out and says, you know what? Looking at this new evidence, you have to come to the, you're compelled to come to the conclusion that estrogen does not cause breast cancer, but it's actually preventive. And so, you know, he's quoted prominently in the book. And the, and then, you know, the other thing that I didn't know, which I discovered writing the book is there is a difference between peremorin, which is the hormone, the estrogen they used in the Women's Health Initiative. So the difference between peremorin and estradiol, which is the human, you know, the strong, the human hormone, which is the, you know, the major strong hormone. And the difference is horses, you know, permanent comes from pregnant horses. Horses have these estrogenic compounds that do not appear in humans.

It's very interesting because the biggest reason I think, or the commonest reason that people are not taking hormones for perimenopause and menopause and not prescribed hormones is this unfounded fear of breast cancer because of the WHO, like you say, the Women's Health Initiative study because the way it was misreported to the lay media and the medical literature as well that HRT causes breast cancer. And, you know, when you unpick the literature, and now we've got the luxury of time

where we can look at longer-term data, like you say, this risk of breast cancer hasn't actually, ever been shown with estrogens, either estradiol, eustriol or the conjugated equine estrogens of pregnant horses urine. But actually for you to say there's a 45% reduction in mortalities of death from breast cancer and it showed that there was about a 23% reduction in incidents of breast cancer. Like, why wasn't that headline news? I find that is so important when breast cancer is so common that that's just been dismissed, hasn't it?

Well, you know, the newspapers got it wrong. And, of course, there was that in 2002 when the first arm of the study was published, which used the, which used the Cremont along with the synthetic progestion, the midroxyprogesterone, MPA for short. That, you know, that was the one that showed increased risk of breast cancer. The study was halted before it became statistically significant. And then, you know, if you look at the later follow-up, 18-year follow-up, There was an increased number of deaths from breast cancer in the synthetic progestin group. It was roughly, you know, the placebo group had about 40 deaths from breast cancer in the 18-year follow-up.

The Permanent group had almost half that. 22 deaths compared to 40. And then the Permanent plus Medioxy progesterone MPA group had 60 deaths from breast cancer. So if you compare the formula in the first arm that was published in 2002, which is the Perman Plus MPA, to the Perman alone, that's going to be statistically significant in terms of 60 deaths versus 20. Yeah. So the statement that, oh, there is no studies showing that MPA, you know, increases mortality from breast cancer with, there's no statistical significance. That's, you know, I think that's a little deceptive just to make that statement because, number one, the studies are

halted early before they can reach significance. And it's, you know, to me, it's obvious that if you, if you power a study and follow it long enough, you're going to see, you know, that type of significance in the numbers. You know, in terms of synthetic progestins being carcinogenic, you know, we know that, for example, there's a, you know, you go to the university animal lab down this, you know, in the neighborhood and ask the people, the researchers in their little white coats, you know, how do you give mice dress cancer? And one of the techniques that's widely available is they inject the mice with madroxy progesterone.

There's so many studies now which show that adding a synthetic progestin to estrogen will increase the risk of breast cancer. The one that's quoted the most is probably the French cohort study by Agnes Fornier, and she found that roughly 48% increase in breast cancer. compared to placebo, when the midoxy progesterone is added to estradiol. And when estradial is combined with progesterone, natural progesterone, there is no increased risk of breast cancer. You know, the hazard ratio goes down to 1.0.

And then, you know, you can look at the monkey studies. We have an entire chapter in the book on entitled, Don't Monkey with My Hormones, which is supposed to be cute. And, you know, we have these monkey labs. You know, the Mac monkeys have menstrual cycles very similar to humans. And their physiology response is very similar in terms of response to hormones and breast cancer physiology. And they, so, you know, Charles Wood compared the progesterone to estradiol and to pomerin. He did all those monkey studies, and he found that pomerate is much less proliferative than this estradiol.

And then if you add madroxy progesterone to esterial, it becomes even more massively proliferative. And then, you know, there's studies done by, the one that I quote the most is, it was done by Sebastian Giuliani from Argentina. He's a colleague of Claudia Lennary, who did the MP. P.A. M.A. M.S. studies. And he found that when you use medroxyprogesterone added to estrogen, it upregulates ER alpha. And then he found activation of oncogenes that are very well known in the oncology literature. Medroxyprogesterone activates breast cancer oncogenes. Which is very, it's very interesting because, you know, people just think a hormone is a hormone.

And over here, and actually not just in UK in other countries as well, doctors, nurses, pharmacists are quite happy to prescribe these synthetic hormones. In good faith, they're using them as contraceptives. But I remember going to a talk at a Manipal Society meeting several years ago when they were talking about the dangers of bioidentical hormones. And I had not really heard this phrase bioidentical. I didn't really know what it meant. And they were talking about the compounding of how people have hormones made and they should all be regulated from pharmaceutical companies. But certainly in some countries it's not possible to obtain estradiol or testosterone unless it's compounded.

And in my mind, bioidentical doesn't really matter where it's made. It just means it's the same chemical structure. as the hormone that we make ourselves, as in estradiol or estradiol or testosterone or progesterone. But there's been so much confusion on the words. And even when you talk about MPA, mojoxy progesterone acetate, it's not progesterone. It shouldn't even have that word in its description. So it causes no end of confusion. But metabolically and biochemically, they work so differently in the body, don't they? These synthetic chemical hormones.

They have very opposite actions in terms of breast cancer and also in neurosteroid, you know, the progesterant, natural progestions, very neuroprotective. All of those neuroprotective properties are completely obliterated by synthetic progestins. You know, here in the US, we do have FDA-approved versions of pretty much, all of the bioidentical hormones in use,

hormones in the human body, there are versions of estrogen, you know, there are estradiol patches that are FDA approved. Progesterone, micronized progesterone, oral, was approved in 1998. FDA approved in 1998. It was a manufacturer by Solve at the time.

And that study showed that it prevented endometrial hyperplasia. And so it also testosterone's FDA-approved versions of that. So estriol is more, I think, approved in Europe, more of an approval in Europe. So here in the U.S., if we want to use estradiol, we have to use it through a company pharmacy. The, you know, there are FDA-approved versions of the estradiol patch and testosterone at the local pharmacy. The reality is FDA approval doesn't necessarily mean you're dealing with a good drug. Absolutely.

10 percent of FDA-approved drugs are later actually withdrawn from the market because, you know, they're bad drugs. And another 10 percent are given the black box warning, which, you know, means this is probably a bad drug. When I think about compounding pharmacies, they do vary quite a bit in quality. you know, their little mom and pop compounding pharmacies, you know, on the street corner down the street. And then we have these large compounding pharmacies that specialize in women's hormones. There's about half a dozen in the U.S. And those are the ones that we use. They have much higher quality, much more quality control.

And it's just another thing that we don't have to worry about. You know, I look at compounded hormone formulations as sort of a generic form of the, FDA-approved version, you know, the, and, so, you know, it's an awful, I can, I look at it as as off-label prescribing of a generic version. The, you know, 20% of all prescriptions in the United States are prescribed off-label. There's no FDA approval for that indication. 20, you know, that's a big chunk of medical practice right there. So, you know, and the other thing to think about is, Here in the U.S., every hospital pharmacy is a compounding pharmacy. So, you know, they try not to use compounded formulas.

I mean, if they can take something off the shelf, they'll prefer that. But, you know, in the hospital, when they make up an IV bag or, you know, there's a significant chunk, a significant percentage of the medications that they make up are compounded in every hospital in the United States. So if you get rid of compounding, it's going to be a problem. for, you know, the hospital system. I'm really excited to announce that I've written a new book. It's called Power of Hormones. It looks at how hormones actually work in our body

and why so much of what we've been told and taught, especially as women, has actually been wrong. I explore the science, the history, and the uncomfortable truths about how hormones have been misunderstood, undertought and often dismissed within medicine. There are some stories that are actually, actually quite shocking, frustrating, and I think essential for us all to know. This book is about understanding your body and hormones in a deeper way,

about questioning symptoms that haven't always served women well. If you want to be among the first to read it, you can pre-order power of hormones now through the link in the show notes. It's all about words really and understanding, but one of the things that worries me really is that globally, the majority of menopause or women are not prescribed any type of hormone at all. Yet we know there are risks of not having hormones, don't we? That's the big problem, you know, especially in the early menopause, the younger women, either have hysterectomy or early menopause, you know,

there's this tremendous increased risk of early mortality for those people. And, you know, all the studies have been done showing that. And, you know, even in the elderly, you know, there's a recent study called the 10 million women's study by C.O. Bake looked at Medicare records and showed that in the elderly, over the age of 65, there are tremendous advantages of hormone replacement. Even, you know, in that age group, 20% reduction in mortality is what his data showed. And then there was there was reduction in five different cancers. Why is it? Do you think that like so many doctors are resistant to prescribing? Because in the UK, HLT prescribing has plateaued over the last year. It's only about

14% of menopause or women. And, you know, every day I speak to women who are actively refused hormones. Yet any other drug, if I I was bringing a new drug to market and I said, oh, Jeff, I've got this new drug that will reduce mortality. So reduce death rate. It will reduce risk of cancers. It will reduce risk of heart attacks and strokes. Like, you'd be going, well, what is it? This is amazing.

This is too good to be true. And also then when I say, well, it's just a natural hormone. I'm just replicating in the body. It's not even a new formula drug that we don't know what's going to happen in the future. I really find it very confusing to understand why there's so much resistance. Here in the US, also, you know, in the rest of the world, the use of hormone replacement plummeted. We had 30 million women using hormone replacement in 2002. Once the first arm of the women's health initiative study was published, you know, use of hormone replacement plummeted down to 5% of instead of, you know.

And the other thing that happened, which Dr. Martin McCarray mentioned when he was on, the medical school stopped teaching it. And so this is 20 years now. We have a, you know, we have doctors upset, Obie Guiny doctors, primary care doctors, internists. None of them have had any training in hormone, in prescribing hormone replacement. and they're just not comfortable with it and rather not do it. So that's, you know, it's causing misery and suffering, which is completely unnecessary because, in my opinion, hormone replacement, menopausal hormone replacement is the single most important

medical intervention for women of metapausal age. And we see tremendous improvements. women are just so much, you know, improve quality of life. And these are so much happier. And they come back to the office and they say, thank you. And so it's, you know, you have to ask yourself, when we touch on this in the book, who benefits from this fear of estrogen? You know, where's the benefit?

Who benefits from it? And the greatest benefit, I think, is the pharmaceutical industry, because women who have estrogen deficiency, throughout their post-menopausal years, become very good customers of the drug industry. You know, for every menopausal symptom, a chronic degenerative disease of estrogen deficiency, there's a drug for osteoarthritis,

the drugs for that, joint replacements. For insomnia, they have sleep. keeping kills for depression. They have their SSRI antidepressants, which you've commented on many times. And, you know, goes on and on. They give statins for heart disease, which, you know, estrogen is a much better, much more effective and much safer and much more, a better approach to preventing heart disease. There's a rapid loss of bone density the first two years after Manipa is a roughly 5% a year, less after that. You know, why should it be such a sudden rapid loss in bone density?

So the mechanism was suggested by a researcher from Harvard who suggested, you know, maybe there's this correlation between sudden decline in estrogen with what the sudden decline after giving birth in pregnancy, there's calcium mobilized for the bone. for breastfeeding, and perhaps that's the same, you know, it's an analogy. And that's why, you know, if there's mobilization of calcium from the bonds causing osteoporosis as a duplication of that. I mean, it's a big concern, osteoporosis. It's one of the main reasons I take H.R.T to prevent or reduce my risk of osteoporosis, especially of my spine. And the thought of this rapid bone loss that occurs even before menopause in the perimenopause years, I think people don't

understand or don't want to understand or don't know what a serious condition osteoporosis is because it doesn't make front page of the newspapers, it doesn't sell the news. But it's so important that we think about osteoporosis, isn't it? You know, I have to tell you a story. When I was a medical student, my grandmother, you know, was in her 80s and she asked me to look at her chest x-ray. So, you know, I went to the hospital. I looked at her chest x-ray. She had this gigantic heart. She had more calcification in her aorta than she did in her ribs in her skeleton. And it was like, I was struck by that. And, you know, that's what happens eventually to many, to many women. So, you know, yeah, you know, the bonds have estrogen receptors and estrogen,

and also the cartilage has estrogen receptors. So the estrogen is the best bond building, and together with testosterone, there are studies showing that when you add testosterone to estrogen, you get even a better bone building effect. You know, and the drugs that they use for the primary care docs are handing out the bisphosphonate drugs. And you now have newer drugs that are these antibody drugs that are even worse, I think. The bisphosphonates are, I think, you know, all of these drugs are terrible drugs. You know, they cause osteinecrosis of the jaw. They cause spontaneous fractures of the midfemar.

You know, the unfortunate woman is walking across the living room floor feels a little pop in her, and she has a spontaneous fracture over a femur. So these bones, the bisphosphonates, make, they weaken the, they make the bones weaker, not stronger. And we actually have two women in our neighborhood. They lived down the street that we've known for years. Both husbands are doctors, and their wives run the bisphosphonates for five, six, eight years. They both develop spontaneous femur fractures, just walking across the floor. They're bad, very bad drugs. So I don't recommend that for anyone.

I mean, people ask me, you know, what's your criteria for recommending a drug? So I always say, look, if you wouldn't give your dog this particular drug, then you probably shouldn't give it to people either. So I think that will fit that criteria. So, yeah, you know, the osteoporosis is very big. Women are concerned about that. Here in the U.S., you know, we have television advertising for drugs, which you don't have in the UK. And I think, you know, we need to be thinking very differently about how hormones can reduce future risk of diseases. So I'm very grateful for you to come on the podcast.

I do want to count you to come back to talk in the future about thyroid because it's also another really important hormone. Before I end, I always ask for three take-home tips. So I just want from you, if it's okay, three of the biggest reasons why women should consider taking hormones to reduce their risk of future diseases. We touched on the osteoporosis. You know, the bone density is a very good reason,

prevention of heart disease if you're in the 59 age group, that's a very good reason. And then also, you know, we didn't mention another big one, which is the osteoarthritis, cartilage has estrogen receptors. And we've actually had a great experience using topical estrogen over the joints that are painful, and the joint pain does go away using estrogen as a topical application. And so, I mean, those are three pigments that, you know, and you mentioned many of your papers, the gender to urinary syndrome. We have women who come to us, they've repeated urinary tract infections. So, you know, that's a terrible problem, which they can get rid of entirely with hormone replacement. We use the, you know, estrogen vaginal capsules, vaginal

suppositories, which is very good for that. So that's three or four. There's so many. I've been cruel asking for three, but it's important just to think, differently, I think about hormones, and I just really hope some of the conversations we're having will just change the direction for women and also for healthcare practitioners to prescribe them. People ask me, well, you know, they're always, you know, the patients come into the office and say, they always ask me to all of the same, they all ask the same question. My doctor is like this. They won't give me what I want. Why are my, why are all these doctors like that? And my answer is, yes, they're all like that. They're never, ever.

going to change. And that's a good thing because otherwise, I'd have nothing to do. So, well, thank you so much for coming on the podcast today. Thank you. Dr. Nusser. Thanks so much for listening. It would be amazing if you could follow me or subscribe because it will really make a difference to grow numbers, enable this to reach even more people. Thanks so much.