Sitting in a corner office of a gleaming Beverly Hills high-rise, Uzzi Reiss, M.D., a gynecologist whose name is on the speed dials and well-plumped lips of Hollywood housewives, starlets, and power brokers alike these days, catalogs the miseries of premenstrual syndrome. “You feel foggy, fatigued, a little bit depressed, your skin is more oily….,” he says, his nose wrinkling in distaste. I’d always thought these things were fairly normal, but when I tell that to Reiss—an indefatigable 58-year old who wears small Sigmund Freud glasses—he looks stricken. “No, they’re not normal. I don’t believe we should suffer anything,” he declares in his stentorian Israeli accent. “Do you think your husband would be able to go through this every month? For one week to be a little depressed, a little uninspired, with an inability to make decisions? No! He wouldn’t take it.”
How my husband (or any guy) would take PMS is one of those cosmic questions to which I’ll never know the answer. But Reiss, whose fans include blockbuster producers Paula Wagner and Lynda Obst, plus a number of the women on staff at the William Morris Agency, built his bustling practice by thinking about health and well-being cosmically—or at least well outside the mainstream medical box. A charter member of the controversial American Academy of Anti-Aging Medicine, which has mushroomed from a dozen members to more than 10,000 worldwide since it was founded a decade ago, Reiss, like other academy physicians, ministers various combinations of estrogen, progesterone, testosterone, human growth hormone, DHEA, and the hormone precursor pregnenolone to ward off disease and disability as hormone levels naturally decline with age. For patients who haven’t yet reached menopause, Reiss also provides individualized regimens that he says can help reduce the “hormonal chaos” created by the menstrual cycle—fewer mood swings, better sleep, greater confidence, deeper concentration, stronger sex drive, thicker hair, harder nails, and perkier breasts are just some of the benefits he says he can offer women in their child-bearing years and beyond. And he’s not alone here, either. Ron Livesey, MD, a cofounder of Anti-Aging Medicine Associates of Manhattan, has more than 500 patients, some of whom pay him and his partner close to $1,000 a month for individually mixed hormone cocktails. Most of Livesey’s patients are in their forties—but he says he regularly treats women in their late twenties with DHEA and women in their thirties and forties with many of the same hormones Reiss uses. Women who come to him saying “they just don’t have the energy they had before, that they’re fatigued, not as optimistic,” get improvement “in all those areas,” he says, after they start treatment. “It’s amazing how differently your brain works when you restore these hormones.”
Estrogen’s ability to reduce hot flashes is incontrovertible, and many gynecologists and internists administer hormonal supplements in various forms to tweak sex drive and mood (to postpartum patients, for instance). But since a large controlled study known as Women’s Health Initiative (WHI) showed in 2002 that a widely prescribed estrogen and progesterone replacement therapy known as Prempro increased the risks of heart disease and breast cancer in postmenopausal women, many doctors have become understandably gun-shy about prescribing hormones. And yet true believers like Reiss claim the regimens they provide not only are safe (he and his colleagues say theirs are different from the likes of Prempro and are “bioidentical” to the hormones women naturally produce) but also satisfy critical needs of his patients. Reiss won’t provide a head count, but he says his practice has continued to thrive in the wake of the WHI, with more and more women beating a path to his door.
“After he put me on estrogen and progesterone, I felt like I was finally in my skin,” says a 40-year-old William Morris agent who also takes testosterone and growth hormone. “My moods were completely stabilized, and I was sleeping through the night. I have a really high-pressure job, and it just made everything so much easier to deal with.” (Reiss has also done “amazing things” for friends, she adds.) Suffering from fatigue, anxiety, irregular periods, and low sex drive when she first went to see Reiss at 27, a 30-year-old psychotherapist says the estrogen, progesterone, and vitamins the doctor has her taking have not only helped her “maintain a better state of mind” but regulated her periods “like clockwork.” A 26-year-old TV-marketing manager who had severe menstrual cramps after endometrial surgery and who has been applying progesterone cream daily for over a year on Reiss’s advice says she hasn’t “had a cramp since I started seeing Uzzi. It’s changed my life.”
THE “OPTIMAL” DOSE
Hormones are chemical messengers that move through the bloodstream, regulating growth, metabolism, immune function, and sexual production. After puberty, the sex hormones—estrogen, progesterone, and testosterone—along with growth hormone and DHEA ( a steroid produced in the adrenal glands that’s metabolized into estrogen or testosterone), remain consistently high for a decade or so, helping young bodies and brains reach full maturity. Beginning in the twenties, DHEA and growth hormone levels gradually begin to decline. And although there’s debate about exactly when women begin to produce less estrogen and progesterone—some say it’s in the thirties, others say after 40—most gynecologists agree that the critical, permanent dip takes place during menopause, when the ovaries reduce their hormone secretion.
To illustrate why he thinks premenopausal women can benefit from supplementation, Reiss sketches a graph showing how, over the course of a typical 28-day menstrual cycle, estrogen steadily rises as ovulation approaches, then drops during the week prior to menstruation. Because women tend to feel best when estrogen is high, he says that during a low-estrogen week, women with “signs of estrogen deficiency”—feeling “down, depressed, foggy, uninspired”—can benefit from putting the hormone back into their system. Or, really, whenever they’d like a lift: Reiss prescribes his patients estrogens synthesized from soy and wild yams in cream and gel forms that can be rubbed on arms, legs, even the face at any point, just like Jergens. “I don’t know what day you want more or want less. I want you to have control,” he says. “If you wake up one day and didn’t sleep well, you’re uninspired, your breasts droopy, you may need more estrogen.”
Because progesterone also falls during the week leading up to menstruation, he says, women with “signs of progesterone deficiency”—water retention, breast tenderness, “feeling a bit antsy, uptight”—can likewise benefit from taking more of the hormone. And as with estrogen, he says that the “natural sedative effect” of progesterone can help a woman soothe herself any time anxiety spikes. As for the other drugs he prescribes, testosterone, which is manufactured in the ovaries and adrenal glands of women, delivers greater confidence, sexual energy, and physical endurance, Reiss says. DHEA, which is available as a dietary supplement at health food stores, purportedly restores pep and improves mood, while growth hormone—genetically engineered from E. coli—not only helps his patients who inject it several times a week to improve skin tone, it also, he claims, “restores every other tissue in the body.” When I ask him to explain more about growth hormone, Reiss thumps himself on the chest and tells me that he’s been taking it for 12 years. “It gives me this wonderful ability as a grown-up to teach, to share, to learn. And if it’s a little good to the skin,” he says, grinning now, “great!”
Before he calibrates a hormonal regimen for his patients, Reiss says he runs extensive tests to assess their individual hormone levels, along with immune and thyroid function, cardiovascular health, and mineral and antioxidant levels. He then encourages his patients to experiment with their dosages within set limits, increasing the amounts until they achieve maximum benefit. Once Reiss’s patients experience certain side effects, which he tells them to look out for—such as sore breasts from too much estrogen, grogginess from too much progesterone, acne and facial hair from too much testosterone—they know it’s time to dial down their dosages. Reiss talks a lot about striving for “optimal” levels of hormones, and when I ask what he means by this (because it sounds like turning up the volume to 11), he leans back in his chair and adopts an unusually philosophical tone. Because women are living longer than ever before, often putting off having children as they pursue high-pressure careers, he believes we need to try to restore our hormones to where they were when we were still in the ascendant phase of life. “My dear, when you were 16, your kidneys reached optimal development, your brain reached optimal development,” he says, gently reminding me of every one of my 36 years, “and every year it’s decreased since then.”
HORMONAL HIGH JINKS
As often happens when there’s a new medical craze promising a roster of rewards, there’s no shortage of skepticism in the scientific community, in this case about Reiss’s hypothesis. It’s true that younger women with dramatic hormonal deficiencies such as hypothyroidism are commonly given supplements and that those who’ve had their ovaries removed or have had premature ovarian failure frequently take estrogen because it’s known to protect against bone loss. It’s also not uncommon for women with PMDD—premenstrual dysphoric disorder—to be treated with such antidepressants as Prozac or birth control pills.
Yet it’s a leap of logic, many say, to think that a drug can be used to tweak a typical woman’s normally fluctuating menstrual cycle into a more pleasing rhythm.
“You manipulate nature when you really need to,” says Lorraine Fitzpatrick, MD, a professor of endocrinology at the Mayo Clinic. “But for people who really are healthy, it’s hard to imagine why you’d want to provide them with something that is expensive and that hasn’t been proven to work.”(The types of estrogen Reiss uses, as well as the progesterone and testosterone he prescribes, are all available from “compounding pharmacies” that specialize in mixing custom prescriptions medications. He and other proponents of bioidentical hormones say they match the exact chemical structure of those that women naturally produce and therefore are safer than synthetic. But even though these preparations may be structurally closer to the urine of pregnant horses, the products turned out by compounding pharmacies are unregulated by the FDA, and it has never been established that bioidenticals are safer than Prempro or more effective than placebos.)
Moreover, taking estrogen and progesterone in sporadic, do-it-yourself doses to try to block these symptoms could create worse problems, suggests Fitzpatrick. (Many doctors dispute the ability of blood tests to accurately measure individual hormone levels, since hormonal action takes place in cells, not in the bloodstream.) The monthly decline in progesterone is what signals the blood-enriched endometrium to finally slough off, so adding progesterone at exactly the moment it’s supposed to drop could potentially interfere with normal menstruation, she says. Carolyn Shaak, MD, a gynecologist in Needham, Massachusetts, shares Reiss’s view that plant-based estrogens can be a helpful form of therapy for postmenopausal women. But she disagrees that you can favorably alter a menstruating woman’s mood and energy with estrogen. If you take it “in the low-estrogen phase…inadvertently, you may be shutting down the rest of the cycle,” including ovulation, she says.
The lack of double-blind, controlled studies on the long-term safety of boosting estrogen and progesterone of any type in women who are still producing hormones themselves is another concern. Molly Carnes, MD, the director of the University of Wisconsin Center for Women’s Health Research in Madison, emphasizes that hormones are not M&M’s but powerful drugs. “Let’s not forget that estrogen is a steroid hormone that actually goes into the nucleus of a cell and affects its DNA. We’re only now starting to realize that treating people with steroid hormones can have effects years later.”
Like cancer, Postmenopausal estrogen therapy is known to be associated with an increased risk of endometrial cancer and breast cancer. Reiss says there’s been absolutely no evidence among his patients of cancer caused by his treatments, but Francis Bellino, PhD, the deputy associate director of the biology of aging at the National Institute of Aging, likens the complexly intertwined operation of hormones in our bodies to an orchestra, “where the instruments have to come in at the right volume at the right time.” If you start “messing with that,” he says, “it goes from a beautiful piece of music to a horrible-sounding one.” Giving a woman “who’s already making adequate levels” of estrogen more estrogen, he adds, could be a recipe for a pathological discord. “It’s pretty scary from a cancer point of view.”
However, I spoke to several who, like Reiss, find testosterone helpful to women with unusually low libido. “I do think it’s an essential hormone for women, even though when levels decline—and what causes them to decline—is still under research,” says Jennifer Berman, MD, the director of the Female Sexual Medicine Center at UCLA. Right now, Berman is conducting a study of women with low libido who are on birth control pills. (Women who take the Pill miss out on the midcycle squirt of testosterone that precedes the release of an egg.) By taking some women off the Pill, Berman says, she often sees their testosterone, and sex drive, return. If not, she prescribes testosterone replacement therapy. But because testosterone supplementation has been found to lower HDL (the “good” cholesterol), Berman says it is always important for women taking testosterone to be carefully monitored.
When it comes to using DHEA or growth hormone for energy enhancement, I couldn’t find anyone not running an antiaging clinic who’s in favor of them. Growth hormone, which is used in the treatment of underdeveloped children, was found in a 2002 National Institute of Aging study to help men and women over 65 lose weight and gain muscle, but researchers concluded that its side effects—diabetes, swollen legs, and joint pain—made it, the agency said, “not ready for prime time.” DHEA does begin declining in women in their twenties, but Carnes says there’s no evidence that the decline has any direct effect on women in their thirties. And she adds, tongue slightly in cheek, it’s even possible that the decline “is the font of wisdom.” DHEA may play a role in helping younger brains sprout thousands of new synapses, she says, but after hormones stop “jumping in a hundred different directions” in adolescence, perhaps a handful of older synapses are reinforced through regular use, making us smarter. “That’s very speculative,” she says, chuckling, “but no more so than saying that if we treat people with DHEA they’re going to feel better.”
THE MOST POTENT MEDICINE
If there’s one humbling lesson we’ve learned—or should have learned—about hormones lately, it’s that they’re actually a lot wilier and more mysterious than previously thought. Scientists are just beginning to unravel the disappointing results of the Women’s Health Initiative and explore whether different forms of estrogen and progesterone can safely bring about long-term health benefits. Forward-thinking investigators are optimistic that one day doctors will be able to look deeply into a woman’s cells, weigh her relative predispositions to various diseases, and determine if any prophylactic medication—including hormones—might help her live a longer, healthier life. “Not in my lifetime, but certainly in yours,” says Morris Notelovitz, MD, a retired gynecologist from Boca Raton, Florida, who now works as a research consultant in women’s health, “a woman will have a blood test that can give her genetic profile telling her if she’s at risk for certain conditions and how to respond.”
In one of his passionate outbursts, Reiss tells me it defies common sense “that something that ignites the body when you’re 18 is suddenly bad for the body when you’re 80!” Soon after, he admits that there are no long-term controlled studies on the safety or efficacy of his treatments. So how to account for the dramatic benefits some of his patients report? A former patient who saw Reiss in her late thirties offers some piquant insight. For a while, she tells me, she faithfully ran upstairs to dab progesterone drops under her tongue whenever she felt her three children starting to increase her stress level and dutifully rubbed testosterone cream on herself before planning to have sex with her husband, since Reiss promised her this would help her get in the mood. She enjoyed her hormone regimen because it made her feel like she was spending time on herself, she says, “and being hypersensitive to what I was feeling every second.” But then, when she eventually grew tired of the time-consuming regimen and its cost, she realized that maybe the psychological influence of paying attention to herself was a lot more powerful than the treatments that were depleting her bank account. After applying testosterone cream, “of course you feel sexy,” she says, laughing, “because you’ve been rubbing your inner thighs and vagina!”
Reiss tries to sell his message to young women as one of empowerment (he calls efforts to discredit estrogen “the biggest insult to feminism, on womanhood, in this era!), but Cynthia Krause, MD, a gynecologist who has examined a former patient of Reiss’s, sees it as a subtle form of sexism. “There are real effects of hormones on mood, but in a way, it can be used against women in an almost patronizing way. ‘If you control your hormones, you’ll be all set, dear.’ I think hormone therapy has a place, but it’s a little grandiose for doctors to think that if they prescribe hormones to women that it will be a panacea for all their problems.”
Each of Reiss’s fans effused over his patience and sympathetic ear for the “female” problems other doctors don’t have time for, and he is indeed a genial guy. After our interview—during which Reiss barely let me get a word in edgewise—the doctor rightly detects that my own stress level has climbed pretty high. He then graciously drives me to my car, and when we get there, reaches up to pat me on my shoulder. “Madam, from now on, you don’t get stress,” he says in his soothing tone. “Breathe, relax.” It’s the kindest—and most empowering—message I’ve heard from him yet.
This article was taken from Elle magazine.
*Recent studies have shown the use of DHEA sublingual may increase bone mass 20% to 40%, in postmenopausal women.(Supplement to Menopause Management, 2002) We, at Sherry's Drug, have started our own study, and have seen the same results. Appointments for bone density scans are available, on site at Sherry's Drug, 405-341-1683.