(Pete Hueseman, R.Ph, R.D.'s 9th visit to Power Surge) Dearest: Pete Hueseman, R.Ph., P.D., has been a registered Pharmacist for 27 years and works exclusively in the area of women's health and bio-identical, naturally compounded plant-derived hormones. Pete compounds natural prescription hormones, such as progesterone, estradial, estriol, estrone, tri-estrogen, DHEA, testosterone and pregnenolone, plus other compounds at Bellevue Pharmacy. His eagerness to answer our infinite questions about hormones, at a time when confusion seems to abound, has endeared Pete to the women of Power Surge. Pete Heuseman is professionally associated with NAMS, the Academy of Alternative Medicine, Alternative and Complementary Medicine Assc'n, and is registered with more than one professional Pharmacist's Association. Welcome back, Pete :) Pete Hueseman: Thanks for having me, it is always a pleasure. Dearest: Our pleasure, Pete :) Great, Dream, go ahead, please. Dream: I' m currently using endocreme900, when I went to the doctor she said for me to try Promensil. I was wondering if I can use both at the same time? Pete Hueseman: I am not familiar with endocreme 900, what is it? If it is progesterone cream (otc) then yes you can use them together with no problem. Dream: It a type of progesterone cream Dearest: She wants to know if she can use the progesterone cream and Promensil together. Dream: Thanks Pete Hueseman: Yes, use together. Theresa: What is pregnolone, and can it be used with natural progestrone? Pete Hueseman: Pregnenolone is the master hormone, precursor to progesterone and DHEA; it can be used in conjunction with progesterone, yes. Pregnenolone helps with memory and anti-aging. Dearest: And there's no problem taking these together, Pete? Can't we sometimes overdo it even if these products are OTC (over the counter)? Pete Hueseman: Not at all, we do it all day long, just adjust doses accordingly. Diannemarie: I am currently taking prometrium, 100mg, at hs.(am on my second cycle of it). I do not feel like it is helping at all with my anxiety symptoms or insomnia. Should I up the dose to 200mg? AND-- can prometrium be taken with Remifemin? Pete Hueseman: Yes, but we sell most of that on Rx from a patients doctor after testing is done, so as to not go overboard. Van: Had a total hysterectomy 2/14/2000 - presently on Estradiol patches .05mg, still experiencing severe hot flashes. I also have diabetes, and overweight I know does not help. Also found out recently Estrogen now considered a Carcinogenic? What proven natural way would replace Estradiol patches, would any pharmacy work with you on this. Pete Hueseman: Your anxiety is probably do to lack of estrogen, so yes try the Remifemin with it, or then call us for a natural estrogen Rx. We could get a Rx for a sublingual or capsule or a gel of Biest, progesterone & testosterone if necessary. We are the pharmacy, take insurance plans and ship everywhere. Pete Hueseman: Van, call me and we'll go over your history and I can give you an exact suggestion to discuss with your doctor. Dearest: Pete can be reached at 1-800-728-0288 or E.mailed at consultph@bpharmacysolutions.com. MsKitty's question is above, Pete. MsKitty: Since pregnenolone is an estrogen and progesterone precursor, instead of trying to figure out how much estrogen or progesterone to take, can I just use pregnenolone and let my body make what it needs? Does it work that way? Pete Hueseman: MsKitty: it is not that simple and that won't work very well for you. MsKitty: Why not? Pete Hueseman: You never know how much of any one thing the pregnenolone will turn into and it makes it very hard to just use alone. MsKitty: This sure gets complicated! Pete Hueseman: It can be complicated, let me help you figure it out. Dearest: Pete, can you elaborate a bit more about how pregnenolone works? Pete Hueseman: Well, without a chalk board and my diagram of how the hormones get metablolized down the tree it is hard, but basically pregnenolone comes from cholesterol and then it turns into either DHEA or progesterone and the hormones cascade down from there. Dearest: Thanks, Pete. Nancy, go ahead. Nancy: How important is it to keep an increased level of calcium intake when taking Evista? Pete Hueseman: DHEA originally used for arthiritis and pain in the early 50's, then dropped and now used for memory and anti-aging benefits most recently, along with the other hormone. I do believe calcium is very important, at least 1200mg per day. Dearest: And more for postmenopausal women, yes? Isn't it about 1250 for peri and 1500 for postmenopausal? Pete Hueseman: Yes, as high as 1500mg per day, or more if your doctor advises for more. Nancy: Also is it as important for protecting the breasts from cancer as I've heard? Donna: Do you have an opinion as to the risks of breast cancer with natural HRT vs. Synthetic- are the risks the same? younger sister diag..last month with breast cancer- estrogen fed type tumor, she was never on hrt- had partial hyster when she was 34-I am concerned about my history of breast cysts and using hrt, natural or synthetic. Pete Hueseman: You must do your self exams religiously, and even though it was estrogen positive doesn't mean that estrogen caused it. Donna: That is what I don't understand Pete Hueseman: The risk is less with natural than the synthetic for sure. 10% vs about 3%. Donna: Thanks, Pete. Dearest: Part of her question was how do you measure the risks of breast cancer from using naturally compounded hormones vs. synthetic hormones. Pete Hueseman: It is an estimated number and it is aproximately 10% for Synthetics and 3% for Natural. Ad3336: I'm 50 and was one year meno and had a hyst w/bso 6 mo ago. #1 Do I need tri-est 2xday? #2 What can you do about headaches caused by HRT? #3 Ears ring constantly since meno. What can you do for this? Pete Hueseman: Ad3336 call me, I don't believe the headaches are from the estrogen but possibly the lack of it. Ad3336: Pete, what about hips hurting? Pete Hueseman: I prefer to use Biest and balance it with a low dose natural progesterone and possibly add some Testosterone is necessary. We'll have to discuss your case at length, possibly arthritis or something else. That could also be lack of estrogen with no progesterone. Ad3336: Thank you, I'll call you tomorrow. Do you have a consult physician to help? Dearest: Yes, Ad, he does. Debbie, go ahead, please. DebbieK: What tests do you require to determine doses of estrogen replacement? Also, I have MediCaid right now and am not sure if they will cover natural estrogens. What would the cost be if I paid for it myself? Pete Hueseman: We order a saliva test, or your doctor can order a blood test, the price would be determined by the dose strenth how many and how you use it, possibly anywhere between $20.00 and 75.00 per month. DebbieK: Does the doctor prescribe the amount? Pete Hueseman: Your doctor would, yes. We're always glad to discuss it with your physician. DebbieK: So I would just need to give you my test results? Pete Hueseman: Yes, just call me or I'll give you my fax number so you can get me the test results. You can give them to your doctor and he can get in touch with us if he has any questions. Dearest: Pete, I was reading something by a doctor who said that Bi-est wasn't always estradiol and estriol. I thought that wa a standard combo for bi-est. She said bi-est can be anything the doctor prescribes. Your thoughts? Pete Hueseman: Never heard of anything in Biest except those two drugs, however the proportions can vary. Dearest: Can you explain to our guests the differences between estradiol, estriol and estrone, the three predominant estrogens? Thanks. Pete Hueseman: If they order something else (2 estrogens), then it is not a true BIEST. Estriol is the weakest and safest, and most abundant in the body when one is pregnant, estrone is strong and can turn into 16 hydroxy estrone which can be carcinogenic, but estrone is good for bones. Estradiol is the one that helps with all the menopausal symptoms, and your body metablolizes it into the amount of estrone that is needed. Estradiol is the best to solve bone disorders too. Dearest: Is that why they leave estrone out of bi-est, especially for postmenopausal women? Pete Hueseman: Yes, you have it exactly correct. Dearest: So, say a woman comes to you for natural hormones.. what would you say is the most recommended combo for her to use for her symptoms? Pete Hueseman: Biest in some form with progesterone either cycling or continuously and possibly some testosterone, and oftentimes some DHEA. Dearest: And one last question, why are only about 20% of peri and postmenopausal women using hormone therapy today? Pete Hueseman: Mostly they do not like the side effects from using hormones, the synthetics cause some breakthrough bleeding and breast tenderness and bloating to a much greater degree than the naturals. Dearest: I see. Thanks, Pete. Antisal, go ahead. Antisal: I started Estrace 10 days ago. How long before I feel any changes? I had allergic reaction to Premarin. I was taking "estro-logic" and it quit working. Pete Hueseman: Once we balance the naturals the sided effects are minimal. You should start getting some relief of symptoms by now with good improvement by 3 weeks. What is estro-logic? Is it OTC? Antisal: Hot flashes are still horrible. Yes, OTC soy and black cohosh. It stopped ALL symptoms for 8 months. Jeanne: I am 57 and never been on any hormones, now a nurse practitioner wants me to think about using them. Any reason to even consider hormones at my age? I have anxiety still and a few hot flashes, but no periods. Pete Hueseman: Yes, they can relieve your symptoms, so why not try a low dose of the natural and use progesterone with it continuously so you don't bleed. Black cohosh is not very good for bad hot flashes. Antisal: I had partial hysterectomy 6 years ago. one ovary left. Namaste: What would you suggest if I haven't had any work up and I am 52 with waking up at night hot, my last period lasted 15 days, lots of anxiety and memory lost is scary. Where would I begin. Can you outline in the beginning, first steps are? Pete Hueseman: First call me well get complete history, long process, but I'll probably recommend some biest, and cycle you with a fairly heavey dose of progesterone to control the bleeding to once a month for 4 to 5 days only. We can also order a saiva test. Dearest: Pete, your thoughts on OTC natural progesterone creams? Namaste: I will call. Is this a costly thing? Pete Hueseman: They can help some women in early stages of peri-menopause, but after tht they are usally too weak to do much good. Not too costly, we'll go over that too. Dearest: Thanks, Pete. Jeanne, reask your question, please. Pete Hueseman: If that doesn't give you a good enough asnwer for now then call me. Dearest: Bobbie, go ahead with your question. Thank you. Bobbie Can you tell me the difference in effect between DHEA and Testosterone - particularly Testosterone cream for Libido? Pete Hueseman: Testosterone will be much better for increased libido, you never know how much DHEA will turn into testosterone. May: I am using your compounded testosterone gel (2.5 mg/2 cc). I use 1 cc daily. Recently I was informed that the dose I am using (again, 1 cc daily) is a very, very high dose. I have been advised by my doctor to begin decreasing the dose to prevent any long term problems. Would you please respond to this, thanks! Bobbie: ok, thanks, I have been using the 3-estrogen cream for a week and 1/2. I have already stopped having hot flashes! Pete Hueseman: You are using only half the average daily dose for a woman, so I don't know what he is so worried about, have you had a lipid profile done and it is high or something? May: All levels are normal. Amazing: Hi, Pete! Do you work very much with Relaxin? Also, is there a test to check for it? Dearest: If anyone has any aditional questions, Pete can be reached at 1-800- 728-0288 or E.mailed at consultph@bpharmacysolutions.com Pete Hueseman: We do dispense a fair amount of Relaxin, I would call Mona EXT 119 at work and ask her if there is a test for it or not. I don't know. Amazing: Yes, it is a hormone that is secreted by the placenta and lining of uterus in pregnancy. Thanks, Pete! Ad3336: How long should you be on a dose of hormones before you can have your blood or salvia tests - which one is best and what do you have tested? Pete Hueseman: I would say you should be on your hormone for 2 to 3 months and then retest, after having a baseline done before you start if possible, either one is a good test, most insurances pay for blood, and saliva is good too, I can help to guide you using either one. You test usually estradiol, progesterone, testosterone, dhea, estriol, estrone, cortisol. Ad3336: Thank you. Dearest: Pete, what are the benefits of SERMS, selective estrogen receptor modulators, such as Raloxifene? Pete Hueseman: SERMS are especially good to solve osteoporosis problems in women with and being treated for breast cancer or other female cancer problems. Dearest: Thanks, Pete. RitaB, go ahead. RitaB: How do plant estrogens like soy compare to estradiol or any other estrogens? Pete Hueseman: Estradiol is derived from soy, estrone from soy and estriol from yams. Soy istself is a phytoestrogen. Soy peanuts etc have very little menopausal benefits alone. DebbieK: I had a bad reaction to progesterone cream, and to birth control pills that my doctor prescribed a few months ago (Estrastep). What do you suggest for women who can't tolerate progesterone? Pete Hueseman: We have to look at your whole history, call me, but for now I would say if you have a uterus, we would cycle only once every 3 months to avoid the progesterone reactions. Chris: I do not take HRT because of high risk for breast cancer. Can phytoestrogens in soy foods (150mg/day) cause me harm? Pete Hueseman: I do not believe so!!! Dearest: Chris, women in the Far East consume 150-200 mg. soy isoflavones every day and they have a low incidence of breast cancer and other western diseases. Chris: Do they act like a real estrogen on the body? Dearest: Yes, they have estrogenic effects, but do not effect your estrogen levels and do not pose a risk for cancer. Yuenlan, go ahead with your question. Chris: Ok, thanks. Yuenlan: I have been using progesterone cream-40mg/day, since 1998 but still having bad PMS and anxiety, am I using the right hormone? help! Pete Hueseman: You need some natural estrogen to go along with your progesterone cream, call me and let's figure out a proper dose for you. Anxiety is a lack of estrogen symptom. You probably need a little stronger progesterone too. Dearest: A perfect segue into my question, Pete. Is it advisable for women to use progesterone alone? Either peri or postmenopausal? So many women are using only NP creams and nothing else. Pete Hueseman: Yes, alone it helps in the early stages of perimenopause because it is the first hormone that is lacking and the ovaries begin to not work well, so it is replaced until other symptoms come about too, and then we add in the natural estrogens and/or testosterone. Dearest: Thanks. Connie, your turn. Connie: You may have answered the question....how much tofu, soy beans, etc. would one have to eat in order for soy product to have effect..particularly the tofu? and what about new soy non pres. pills available? Pete Hueseman: I don't have the exact answer to that. I believe maybe Dearest may know the mg amount of soy needed. The tablets are not very good to reduce symptoms as far as I have heard. Dearest: About a pound of tofu to get what the average Japanese woman consumes in isoflavones every day. True about the tablets not being very effective in reducing or eliminating symptoms, plus there's very little data on soy isoflavones in pill form, while there are hundreds of studies of it in powder/protein. Pete Hueseman: That's a lot of tofu. Connie: Of course, it is assumed that rest of diet is good, low carbs, no white flour, sugar, good mental. Dearest: Very true, Connie. Must be a holistic approach. Debbie go ahead, please Debbie Hi Pete, I take testosterone @ 1/4 tso daily, I have noticed some increase hair growth. Should I ask my doctor for tests to be conducted. I have been on this for 8 mos for libido since my hysterectomy. I can't take other hormones due to past estrogen/progesterone breast cancer. Pete Hueseman: Yes, I would get a test done, even if in the normal range, clinically you should lower the dose to get rid of the extra hair growth, call me and I can tell you about some of our other testosterone supplements that usually don't cause that problem. Dearest: If anyone has any aditional questions, Pete can be reached at 1-800-728-0288 or E.mailed at consultph@bpharmacysolutions.com Barb: When you talked about testing earlier, I had all those tested last July and all came back low except testosterone yet I couldn't get my dr's to take it seriously. I have suffered from migraines 4-6 days week since my hysterectomy Feb 2000. Currently using Vivelle Dot .10 and trying to attack Mig's from preventive mode even though suspect low estrogen cause - ob=gyn at loss what to try next. I'm 45. What do you recommend? Pete Hueseman: Call me we have an excellent sublingual tablet used twice a day every 12 hrs. and we can figure out a dose for your doctor to prescribe. and I bet we'll solve those problems in 1 month. Barb: I would love that. I will call you. Thanks Dearest: What is the benefit of using sublingual tablets as opposed to patches or ingesting pills? Pete Hueseman: Sublinguals bypass the liver and stomach just like a patch or cream, however it does get the best absorption, so good that it is second to only a shot. Dearest: Thanks, Pete. Lynnie, go ahead. Lynnie Hi Pete, How does it feel to be surrounded by so many beautiful women? How is it decided per women what is the right amount ot HRT or Holistic creams to use, with hormone headaches side effects etc. How is the right combination ever reached? Is there any one test? Dearest: That's the beauty of working with natural compouned hormones - all sorts of doses can be tried until you find the right one. One-size-fits-all doesn't work because all women are different. Pete Hueseman: the test is about 20% of the answer and clinical evaluation is about 80% of the answer, and even then it can take 2 or 3 months to fine tune the dose for any one woman. it takes a little time a patience. I work with many women closely to help them accomplish this. Dearest: So, Pete, it's important for women to keep in contact and tell you what they're experiencing on the different doses. Pete Hueseman: Yes, if they are not at least 85 to 90% improved, we can not always make it to 100%. Dearest: Pete will tell you all that I was the last one who would try any type of hormones until I found that nothing helped the internal shaking I have suffered from for years. Although Revival soy helped my hot flashes, lowered my cholesterol, and helped many other symptoms, the only thing that has helped the internal shaking PETE INSISTED was due to low estrogen was bi-est. Even the very small dose I use helps, so one doesn't have to take large doses of hormones. When I use the bi-est (now in gel form), I also have my Revival shake every morning because the two work synergistically. Pete Hueseman: You are correct, this was the biggest feather in my cap. Dearest: Haha!! And I thank you for it :) Yuenlan, please go ahead :) Yuenlan: Any suggestion what's for natural estrogen? Pete Hueseman: Please call me and we'll go over your case, and then I can give you an exact starting suggestion. Dearest: If anyone has any aditional questions, Pete can be reached at 1-800-728-0288 or E.mailed at consultph@bpharmacysolutions.com Froggy4: Thank you for talking with us, Pete. Two parts: first, does soy interfere with the efficacy of tamoxiphen (for post-breast cancer) and part 2, which helps regulate/bring on periods estrogen or progesterone or testosterone? (I need serious help, I know *wink*) Pete Hueseman: BTW: if I don't answer, please leave your name and area code and phone number. I return all calls. Leave a home and work number and best time to reach you and where. Soy will not interfere with tamoxifen, and progesterone is the main hormone to help regulate periods, but it may or may not work depending on how much estrogne is still in your system. Froggy4: Thank you Tracy: I have been on sublinguals and my FSH has gone down from 69 to 25.4. I am feeling human again but I seem to feel agitated alot. I am also using GH releasers. Do you think these are causing a problem? Pete Hueseman: Where do you get this sublingual from, what is in it, is the gh releaser the trans d tropin, might be best to call me and lets do a full evaluation and restructure your therapy possibly. Tracy: My sublinguals are progesterone 0.25 and estradiol 0.625 twice a day. Dearest: Pete can be reached at 1-800-728-0288, or E.mailed at consultph@bpharmacysolutions.com tracy: Yes the GH releasers are trans. Pete Hueseman: Looks like we need to talk about it and adjust the doses for you please call. I wouldn't stop the trans d tropin until you talk to me. Lynnie: So Pete, I call or email you and you will get me fixed up not my Dr.? Or does my Doc write a prescription? then I call you? Pete Hueseman: I'll work with you so you know what to have the doctor order for you as long as he does not get offended by my suggestion. This works well as long as you have a good relationship with your doctor. Dearest: Excellent, Barb, go ahead with your question. Barb: Pete, what time zone/state is Bellevue Pharmacy in? Pete Hueseman: I am located in Colorado (Mountain Time) but my hours are usually 7:30 A: to 4:00 P.M on Monday through Friday, but if that is not good for your work schedule, that is why I have you leave your phone number, area code and what time is good to call you at home, I sometimes do catch up after supper or on the weekends if we seem to be playing phone tag during the work week. I do try to avoid this daily, though. Barb: I most wanted to have my call be during your work day - the migs have been so bad that I actually quit working in November to try to get a handle on them. Pete Hueseman: Barb, call me and leave your number, I will be at conferencene tomorrow but I will get back to you. Dearest: Pete, thank you for another stimulating and informative chat about naturally compounded hormones in treating our menopausal symptoms. If anyone is interested in using naturally compounded hormones, you can call Pete at 1-800-728-0288 or E.mailed at consultph@bpharmacysolutions.com. Pete Hueseman: Thanks for inviting me, this was a very good chat session, one of the best. Dearest: Always a pleasure having you, Pete. For those who don't know, there are numerous transcripts of Pete's visits in the Library. Goodnight, everyone. Thanks, again, for all the excellent information and support, Pete. 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