Reply to FDA removed black box warning for HRT

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[quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous]To the people who think hormone replacement therapy is just a grift from the wellness industry why aren’t you looking at the other side of the grift? It’s not as if women who don’t choose hormone replacement theory are aging naturally, lol

I’m a healthcare policy walk who can answer any question on Medicare spend and is deep on the data of what happens to aging women in America. Anyone who says women are aging naturally are either deeply delusional or deeply denial and throw in a dose of deeply ignorant.

Do you have any idea of the number of postmenopausal women who are on antidepressants, anti-anxiety meds, prescriptions sleep aids, hypertension drugs, statins, osteoporosis medications, treatments for UTI, treatments for sexual dysfunction, and the list goes on. Not to mention the care that we spend on frailty from hip fractures, chronic pain meds from bone breaks, hospitalizations caused from UTIs in older women and again the list goes on.

Do you know a lot of dentists will not treat women who are on osteoporosis meds beyond basic cleanings because the mortality rate for any kind of dental surgery for women on these meds is so high? Have you thought about what might happen if you need to go on osteoporosis meds, and something happens to your dental health. You probably should.

While I agree that the evidence does not seem to be there to just put every woman on HRT for primary prevention - if women are having symptoms there does seem to be good evidence that it does help prevent the need for some of these other medical conditions.

I’d be very wary of anyone trying to stop any kind of discourse on HRT. It’s just a grift on the other side and frankly, the spend is a lot higher than what we would spend on HRT. Again, I will stress that I do not think every woman should be on HRT, but to not even entertain the need for research and do not even question The bad advice women got 25 years ago from a deeply flawed that has been retracted, there’s something really disturbing going on there. [/quote]

There’s zero evidence that HRT’s “prevent” all the things you listed. HRTs are very effective for one thing - hot flashes. There is good evidence for osteoporosis. But women are still going to need statins, SSRIs, therapy, blood pressure meds, even when HRT. [/quote]

It's important to pause here to distinguish between indication (what offical approval does the therapy have) and effectiveness, as well as the standards of evidence for treatment vs. prevention.

HRT is indicated for the *treatment* of hot flashes and other vasomotor symptoms, genitourinary symptoms, osteoporosis, and other issues related to estrogen deficiency. It is also indicated for the *prevention* of osteoporosis in at-risk postmenopausal women. It has both treatment and prevention indication for osteoporosis, because the biological mechanism is direct and clear (and has been confirmed in every major study).

But it's much harder to get preventive indications when biological mechanisms aren't direct, and/or don't apply equally to all populations-- for example, cardiovascular disease and type 2 diabetes. These diseases are complex, and they involve multiple pathways. So it's much, much harder to meet a blanket indication standard. That said, multiple randomized trials and meta analyses do suggest quite strongly that HRT helps prevent type 2 diabetes. And newer trials and re-analysis of the women's health initiative (removing women who had already developed heart disease, for example) offer evidence that women who begin HRT before 60 have lower rates of heart-disease and all-cause mortality. But because the data are more complex and more nuanced, the FDA can’t write a blanket approval for prevention the way it can for treating hot flashes or preserving bone.

TLDR: Evidence is not the same thing as approval. I think that's partly what makes this discussion so challenging. [/quote]

I don’t disagree with what you wrote. I was responding to the PP who seemed to be trying to claim that HRT can replace the medications/therapies/lifestyle interventions for basically all chronic diseases. No. Even if HRT has some protective effect on heart disease, depression, diabetes, joint pain, etc, women will still need to take statins, GLPs, SSRIs, get therapy, etc.  it doesn’t cure any of those things, even in the most positive of trials.

[/quote]

But no one wrote that. You’ve misinterpreted that post, per your apparent usual.

Are you a [b]researcher[/b] or a physician? [/quote]

Lol, "researcher".  :lol:  :lol: 
[/quote]

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