Randi Hutter Epstein M.D. M.P.H.

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Hormones & Sexual Harassement

In the 1950s, Dr. Frank Beach fiddled with the testosterone levels of rats, the more testosterone the more they wanted to mate with female rats. He did the same for dogs, with less success. Some dogs were finicky and, regardless of the testosterone, injections, didn’t try to mount a bitch.

This led Beach to predict that the more complex the brain, the less direct control of testosterone and mating behavior. Beach, now considered a founder of the field in behavior and hormones, was onto something.

For the past five years, I’ve been interviewing experts, digging into archives, talking to patients who have had hormone ailments or have been treated with hormone supplements for my forthcoming book, AROUSED: The History of Hormones and How They Control Just about Everything.

It used to be that when I talked hormones, I got one of three responses: Women of my age want to know if I’m including menopause and whether I’m a pro or anti hormones for menopause. Men, around my age, want to know the deal with testosterone gel, will a little rub help rewind the clock? And the last responses are just a bunch of unfunny wisecracks or puns on the word hormone.

Lately, I’m asked about the role of sexual harassment and hormones.

One thing that often gets confused is that the animal studies of testosterone investigate mating behavior, which is different from libido (we can’t study that in animals) and it’s certainly different from bullying and humiliating. Most of the stories we are hearing lately do not have anything to do with mating or libido but have everything to do with the abuse of power.

Some studies have suggested that watching your sports team win leads to a fleeting uptick in testosterone. Perhaps bullying someone does the same. But bad behavior that bumps up a hormone level is far from an excuse or rationalization. That’s the tail wagging the dog explanation.

Nor can anyone claim “my hormones made me do that.”
That was tried that nearly one hundred years ago, during the 1924

murder trial of Nathan Leopold and Richard Loeb, two rich kids from Chicago who tried to get away with murder. They killed another rich younger kid from their neighborhood. Their trial became known as the Crime of the Century, turned into two feature films, one novel and at least three non-fiction books.

These were the days before testosterone was isolated or named. These were the days before we could measure hormones. Still, their parents hired a hormone expert who used a hormone defense. He claimed the boys lacked inhibition because of a stiff pineal gland. (We now know the pineal controls circadian rhythms but it was considered a seat of the soul then). The judge said (and I paraphrase): This burgeoning field of endocrinology sounds fascinating and I’m glad we are making advances, but it won’t get these kids off the hook for murder.

The thing is that we know that we can manipulate the mating behavior of rats quite simply by manipulating their testosterone; dogs not so much. It seems that most humans have higher cognitive functioning than rodents so with increased brain complexity, it’s hard to make one-to-one ties to upticks in hormone levels.

To be sure, the word “hormone” is not typically mentioned in articles about the recent cases of sexually harassment. But it is implied. When articles talk about people dismissing some behavior as “that’s just Charlie being Charlie,” or that’s just how some of the men here are. They are saying that it’s their chemistry. And if that’s the case, it’s something that colleagues should learn to deal with.

We’re learning a lot more about hormones and behavior and more about the impact of testosterone. We can measure fluctuations down to the billionth of a gram. But testosterone levels do not and should not provide men (or women) an excuse for harassing, bullying, or sexually assaulting other humans.

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What Hungry Dogs May Teach Us About Ourselves

New Insights Into Dog Hunger Hormones May Lead to Strategies for Humans

The other day I was walking my dog when I ran into Dr. Jeffrey Friedman. In 1994, his Rockefeller University team discovered leptin, the hormone that controls appetite. People with low leptin are voraciously hungry—and obese.

Friedman offered a treat to Ellie, my 11-pound Havanese dog, but she turned up her snout. I mentioned that Charlie, my late Golden Retriever was so food-obsessed we had to hold him back from scrambling under parked cars to nab chucked leftovers. Could it be hormones? I thought my question was rather facetious because I was talking to a dog-owning hunger-hormone expert.

Turns out, he said, some dogs are prone to the same hormone defect as humans. He referred me to a University of Cambridge study. I got home, fed my dog (she only likes one kind of dog food), found the dog-hormone scientific article and emailed the leading investigator, Dr. Eleanor Raffan.  A few days later, we SKYPEd.

Raffan told me the leptin defect was more common among Labradors and flat-coated retrievers compared to other breeds—no surprise to Lab owners. Here’s what may come as surprise: Among the Labradors, the mutation was much higher among guide dogs compared to the rest of them — 50 percent versus 25 percent. Raffan has a hunch that food-obsessed puppies might be easier to train, giving them a leg-up into the guide-dog program.

Oddly enough her studies did not find the mutation in golden retrievers. I have to believe that Charlie, my late golden, must have some other yet-discovered hormone defect; that his biological drive for food is somewhere on that spectrum between the picky-eating Havanese and the food-focused Labradors. To be sure, Raffan’s research provides insights into why some dogs may be hungrier than others, but in larger sense it’s providing more clues to the physiology of hunger—and may lead to new ways to staunch the obesity epidemic in dogs and humans. (Apparently dogs are getting fatter, too) Already there are a few experimental drugs that seem to be helping the rare people with leptin problems.

However, if you do not have the defect, the leptin shots and any touted leptin diets won’t do anything. That’s because for most of us, eating too much is not just about one mutation, but probably lots of hormones that control hunger, satiety, stress—not to mention all kinds of emotions that go into appetite. Sometimes we eat when we’re not hungry. Still, Studies like this one (that highlight the power of our hormones ) will likely lead to new ways to help those with the rare hormone defect, and certainly shed light on the basic biology of appetite. As Dr. Friedman told me,  “I don’t think on the whole that humans have come to grips entirely with how powerful our basic drives are, how difficult it is to use conscious means to control them.”

And yet.. and yet. When my kids were as young as my son was is in this photo, we spent a lot of time baking cupcakes and brownies. The stirring had a soothing effect on the kids. I gained weight. Friends (perhaps unaware of our daily cooking habit) kindly said it was just my hormones. (of pregnancy? of motherhood?) Nope, it was Duncan Hines Ready-to-Spread Icing. To be sure, understanding hormones will glean insight into our human urges, but sometimes the solution is not rewiring our brains, but rewriting the grocery list.

 

For further readings, this New York Times piece delves into the dog hunger hormone.

Check out this commentary by Harvard scientists that puts  leptin findings in perspective.

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Fake News, Silicon Valley and Our Health

In today’s New York Times, Emily Parker writes about something that we all sort of know but don’t want to face: When it comes to fake news going viral, Facebook, Twitter, and Google aren’t the entire problem. We are. As she writes, we are the ones spreading the information; we are the ones who find it much easier to digest news that’s fed to us in bite-sized, easy-to-digest portions. She calls complex debate the vegetables (good for you/not appealing) while fake stuff is candy (junk/super-tempting).

Funny that she went for the health side of it, because the whole time I was reading about fake news and politics, I was thinking that the same could be said for health news. We want a quick fix rather than a nuanced discussion of the pros and cons.

We complain that doctors keep changing their minds. Fifty years ago, hormone therapy for menopausal women was great, a few decades later it was dangerous, and now it’s good for some women, not others. Fifty years ago, natural growth hormone (from the brains of cadavers) was better than synthetic, then we were told the laboratory-made stuff was better.

Does that mean scientists were wrong? That we have to worry they are spreading fake news? No, it means we have to recognize that medicine is an uncertain art.

  • Don’t read every scientific study as the final word.
  • Be wary of people that tout quick fixes.
  • Appreciate that gleaning health information is often complex and takes more than a quick nod to understand. If you care about your health, care enough to read the whole story.
  • Understand that our knowledge of the human body is evolving.

“There is wisdom in the acceptance of uncertainty,” wrote Dr. Sherwin Nuland, my former medical school professor in an essay in the New York Times, six years before his death. Wisdom that isn’t easy to digest but it is good for you. That’s for sure.

For further reading on accepting uncertainty in medicine, I recommend this piece in the New England Journal of Medicine by Dr. David J. Hunter, professor emeritus of cancer prevention at Harvard T. H. Chan School of Public Health.

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Get Me Out: A History of Childbirth from the Garden of Eden is on sale!

Get Me Out: A History of Childbirth from the Garden of Eden to the Sperm Bank is on sale. For one week only, the e-book is only $1.99!! That’s cheaper than a  cappuccino. It lasts longer and doesnt spill.

Ever wonder how sperm banks choose their “donors”—Get Me Out has the inside scoop. Every wonder about what women were told in ancient times about getting pregnant? Okay maybe you didn’t, but Get Me Out tells about that too. 

Aug. 17-24 from BookBub — $1.99

https://www.bookbub.com/books/get-me-out-by-randi-hutter-epstein@BookBub

 

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Making Sense of Hormone Therapy

My mother is my news aggregator, better than any computerized algorithm. She culls stories for me that range from breaking news and general essays, to the arts, obituaries and every so often a wedding announcement. At 84, she’s sharper and more engaged than a lot of folks half her age. Last night, she shared with me an article posted on Facebook by one of her friends, an obstetrician-gynecologist.

I was enraged.

Her friend, who also lived around the corner from us growing up, promoted a piece about “optimizing your hormones optimal health and wellness.” It linked to a company that sells pills touted to be better than the ones your standard doctor prescribes. The article also said that she is part of group of doctors who have earned fellowships in Anti-aging Regenerative Medicine.

This whole thing infuriates me for so many reasons. Let’s start from the bottom:

To earn credentials from the American Association of Anti-Aging Medicine is about as worthy as having the Wizard of Oz place an award around your neck and tell you that you’re not longer cowardly or that you really do have a heart. It may boost your ego, but that’s about it. The anti-aging organization is not recognized by the American Medical Association nor do their board certifications count among the the American Board of Medical Specialities. If you want to read more, there’s a full account) in Arlene Weintraub’s Selling the Fountain of Youth. I went to one of their meetings and asked a doctor who was paying thousands of dollars to get board certified why he was doing it. He told me the piece of paper (you get a certificate) would impress his patients.

Bio-identicals, which my former doctor-neighbor is touting, means that the hormones mimic the exact chemistry of your body’s hormones. That may be a good thing. Some hormones have similar but not the exact chemistry and some studies show the ones that are “bio-identical” may have fewer side effects. I’m okay with that. What I’m not okay with is the insinuation that you have to go outside of the medical establishment to get them.

Bio-identicals are often confused with so-called “compounded” hormones. You’ll see advertisements, such as the one my mom forwarded to me, touting “bio-identical compounded hormones.”

Compounding is different. It means the hormones are tailor-made to fit the customer. That sounds all well and good. The point of compounding hormones is for the rare patient who is allergic to an ingredient in the mass produced pills, such as peanut oil; or the patient who can’t swallow a pill and may need a drinkable version. But in the last few decades, the compounding industry has skyrocketed. It’s not marketed to anyone, with the insinuation that it’s the organic version of drugs. It’s not. It’s the opposite. Compounded drugs are not within the FDA’s purview—that means that you may not be getting what you think you’re getting. There’s no quality control.

If you are thinking you want a hormone that is closer to the hormones in your body, there are standard drug companies that make them. Prometrium, a kind of progesterone that mimic’s the bodies hormone, is sold by pharmaceutical companies that are monitored by the FDA. For many women—who are taking hormones for menopause—this version may not have the same bloating, nauseating, moodiness impact that other forms of progesterone have. You don’t need to pay extra to see one of these anti-aging doctors, who are part of a multi-billion dollar industry.

My mother’s friend’s article (really an advertisement) gets worse. It tells patients that another mix of hormones also cures adrenal fatigue. Adrenal fatigue doesn’t exist! It’s a disease invented by folks who want to sell you a product for a fake ailment. You might as well sell me shampoo that claims to turbocharge by brain cells.

Doctors peddling cockamamie hormone treatments is nothing new. In the 1920s, a Kansas doctor became a mult-millionaire by selling goat testicles. Clients could shop at his farm, choose their own goat, and have the surgery done in the doctor’s kitchen. He wasn’t a surgeon. In the 1950s, a journalist published a book called, “Physical Attraction and Your Hormones, a Modern Guide to Beauty, Vitality, and Health.” It instructs women how to use hormones to find fulfillment, which was defined this way. “Woman,” Nina Katherine Lunn wrote, “is equipped by nature to be, first, a lure to man then, mother to the race.”

The Facebook message my mother forwarded to me was pretty much the same hogwash as this book written more than half a century ago, and not too different from the goat-gland doctor.

I am not against hormones to treat diseases. I’m not against hormones for menopause. I’m taking them, including prometrium (the bio-identical hormone) that my doctor prescribes and I get the old-fashioned way. (meaning a prescription that is covered by insurance.) What I am against is the insinuation that to get the safer versions of hormones you need to go outside of medicine and see doctors that have a silly credential and pay extra.

So buyer beware. To be clear, my mother—my news aggregator—did not send me this article to promote the wackiness of it all. She was curious about what her friend was up to. I detected a tone of skepticism in my mother’s voice. We’ll be talking about this as soon as she’s done with her morning water aerobics.

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