Dr. Speroff Excerpts:
Taken from Speroff L, Glass R, Kase N
Clinical Gynecologic Endocrinology and Infertility
7th Edition
Lippincott, Williams and Wilkins
Baltimore, MD, 2005
Page numbers sited near statement

"In my opinion, in the absence of studies, in the absense of data, there is no right or wrong answer"
Dr. Speroff

Dr. Speroff has served as President of the American Fertility Society (now the American Society for Reproductive Medicine) and was the founding President of the Society of Reproductive Endocrinologists. Dr. Speroff's wide range of editorial activities has involved 14 specialty journals in obstetrics, gynecology, and reproductive medicine. He also served as the host of the Lifetime Cable Television program on obstetrics and gynecology. Dr. Speroff is the senior author of Clinical Gynecologic Endocrinology and Infertility, now in its sixth edition, and A Clinical Guide for Contraception, now in its third edition.

Hormone: substance that is produced in a special tissue where it is released into the bloodstream, and travels to distant responsive cells in which the hormone exerts it's characteristic effect.-Pg. 25

Once in the blood the hormone is either bound or free. The majority is bound to  avoid extreme sudden reactions, prevent rapid metabolism, and avoids peaks and valleys in levels -Pg. 26

Changes in the position on only one substituent can lead to inactive isomers -Pg. 28     

For Estradiol to have an effect it must be grasped by a receptor within the cell. Estradiol may produce its effect several times before metabolization -Pg. 26-27

Seretoin hormone cross the cell by simple diffusion. The concentration of FREE hormone in the bloodstream seems to be an influential determination of cellular function. Biological activity is maintained only while the nuclear site is occupied with the hormone receptor complex-Pg. 46

Sex Hormone Binding Globulin (SHBG) is increased by Estrogen, Pregnancy,   Thyroid Hormone, Fiber.-Pg. 38

SHBG is decreased by Androgens, Weight, IGF-1, Corticoids, Growth hormone, Insulin, Low Fiber -Pg. 38

Duration of exposure to the hormone is more important than the dose -Pg. 46

Duration of exposure to the hormone is more important than the dose -Pg. 46

Estrogen increases target tissue responsiveness to itself, progestins and androgens by increasing the concentrations the respective receptors (Replenishment). Progesterone blocks this -Pg. 46

Affinity The ultimate biologic response reflects the Balance of Actions of the different hormones with respect to their receptors -Pg. 61

In general progesterone antagonizes the estrogen stimulation of proliferation and metabolism This  antagonism can be explained by the effects of progestins on the estrogen receptor and on the enzymes that lead to excretion of estrogen oncogenes. -Pg. 130

Chronic Endogenous opiates and catecholamines alter release of GnRH
E and P alone increase opiates. E enhances the action of P. -Pg. 46 and 165

There is a link in most studies between early breast cancer (<40) and long term OC use. -Pg 896

Data indicates women <20 starting OC's increase risk of breast cancer 20% during current use and for 5 years after, independent of other risks-Pg. 896

The biologic plausibility and epidemiologic support for an estrogen link to breast cancer are impressive arguments. Whether the important factor in the total amount of E unopposed by progesterone, the amount of free (unbound) E, the duration of exposure to E, or some other combination, is not known-Pg. 599

Evidence indicates that with increasing duration of exposure, progesterone can limit the breast epithelial growth as it does with endometrial epithelium. Progesterone inhibits in vitro estradiol induced proliferation-Pg. 599

Breast cancer cells reach a mass detectable by mammography at a period of between 6.75 and 10 years. -Graph Pg. 610

OC's are effective for hirsutism and hyperandrogenemia, insulin resistance is unchanged-Pg. 487

FSH measurement is a clinical assessment of inhibin. The decrease in inhibin secretion by the ovarian follicles begins around age 35. FSH can not be used clinically to titer estrogen dosage in postmenopausal hormone therapy-Pg. 629

Throughout  perimenopause there is significant incidence of dysfunctional uterine bleeding. Although the greatest concern is endometrial neoplasm, the usual finding in non-neoplastic tissue displaying estrogen effects unopposed by progesterone. Unfortunately the hot flash is a relatively common psychosomatic symptom...Pg. 637

Prescribing Estrogen inappropriately (in the presence of normal levels of gonatotropins)  only temporarily postpones, by placebo response, dealing with the underlying issues-Pg. 641

Premenopausal women experiencing hot flashes should be screened for thyroid disease and other illnesses-Pg. 641

Conclusion: It is appropriate to inform a patient that when she uses preparations lacking in data regarding safety and efficacy, she is experimenting with her own body. Of course she has the right to do so, but we have the obligation to provide this admonishment. An impressive number of patients will appreciate this advise and conclude that they would rather not be the subject of experimentation.

There is only one medicine. Anything claiming to treat or prevent health problems must withstand the rigor of scientific studies of efficacy and safety. Anything with the potential to effect health must be subject to this requirement. Those treatment that pass this testing will become a part of our medical practice; those that fail will fall by the wayside. The simplicity and correctness of this argument are so overwhelming, this will be the future of alternative therapies. -Pg. 715

Epilogue: In late 2006 Dr Speroff concluded and announced that his previous conclusions were not appropriate and that the correct therapy was whether the patient wanted. (see front cover)
"with breast cancer and HRT, we have the opposite. We have a lack of agreement, lack of uniformity, lack of consistency. That tells me that if HRT has an effect on breast cancer, it has to be a small one. If it were a major effect, a large effect, we would have an agreement"

Misc notes: American Society of Reproductive Medicine states; All hormonal therapy should be individualized in symptomatic women. This involves prescribing the regimin and dosage according to individual effects. Posted 8/17/06