We have to admire Suzanne Somers's persistence. She doesn't give up—even when virtually the entire medical community is lined up against her. Three years ago, Somers wrote a best-selling book called "The Sexy Years" in which she promoted so-called bioidentical hormones as a more natural alternative to hormones produced by drug companies for menopausal women. Somers, now 60, claimed that these individually prepared doses of estrogen and other hormones, sold via the Internet or by compounding pharmacies, made her look and feel half her age. As the popularity of bioidenticals soared, major medical organizations like the American College of Obstetricians and Gynecologists grew so alarmed that they mounted publicity campaigns to convince Somers's readers that these alternative treatments, which are usually custom made for each patient, haven't been proven safe or more effective than traditional hormone therapy for symptoms like hot flashes.
This month Somers is at it again with her newest book, "Ageless." Subtitled "The Naked Truth About Bioidentical Hormones," the cover features a coquettish shot of the actress unclothed from the collarbone up. Inside, she calls bioidenticals "the juice of youth" and also promotes the questionable dosage advice of a former actress and "independent researcher" named T.S. Wiley (whose academic credentials are limited to a bachelor's degree in anthropology) who thinks menopausal women should have as much estrogen in their bodies as 20-year-olds. Now, even some of the pro-bioidentical doctors Somers quotes in her books are screaming foul. "Many of the claims throughout the book are scientifically unproven and dangerous," three of these doctors assert in a letter sent a few weeks ago to Somers's publisher, Crown. "By mixing quotes from qualified physicians ... with those of a person with no medical or scientific background, this book will further confuse women and we believe, may potentially put their health at risk."
Somers adamantly defends her book and bioidenticals. "From a woman's standpoint, this is the first time we've gotten some relief in a non-drug way," she says in an interview with NEWSWEEK. And the criticism from major medical groups? "Doctors are embarrassed that they don't know about this," Somers says. "When doctors don't have an answer, they like to pooh-pooh it." As for the letter to her publishers, she accuses those doctors of trying to get publicity for themselves. "Women at this point trust me more than someone they don't know," she says. She urges all doctors to study up on bioidenticals. "Learn more, go deeper," she says. "If I can learn it, they can learn it."
This newest controversy doesn't seem to have affected the popularity of Somers's book, which is a top seller on Amazon.com, or even bioidenticals themselves. Although there are no accurate numbers of annual sales for these products, many doctors we've interviewed say they are besieged by requests from their patients. Much of the demand can be traced to continuing confusion over the troubling conclusions of the federally funded Women's Health Initiative. In 2002 one arm of the study was halted early because researchers found that women taking the estrogen and progesterone in a widely used form of hormone therapy had more heart attacks, strokes, blood clots and breast cancer than women on a placebo. This was the opposite of what most doctors expected to hear. For decades, they had been recommending hormones to prevent future heart, bone and memory troubles. Their patients were equally stunned and many lost faith in their physicians and Big Pharma. Sales of FDA-approved hormones plummeted, inadvertently opening the door to bioidenticals.
Doctors who specialize in treating menopausal women feel they're fighting a tsunami of misinformation. "Highly sophisticated, unsubstantiated and downright dangerous marketing is leading women to go in and make demands for these bioidentical products, believing them to be effective and safe," says Dr. Wulf Utian, executive director of the North American Menopause Society. At their members' request, NAMS recently offered a three-hour tutorial on bioidentical hormones at its annual convention earlier this month. Although we did a lot of reporting on this subject for our book "Is It Hot in Here or Is It Me: The Complete Guide to Menopause" (Workman, 2007), the NAMS presentation was impressive and illuminating. Highlights:
The word bioidentical is a marketing term, not a scientific one, and it means different things to different people. To most doctors, bioidentical refers to a wide variety of FDA-approved drugs that are virtually identical to the hormones produced by women's ovaries. They come in many forms and doses, some of which have been used for years. Somers uses the term to refer to made-to-order treatments created by compounding pharmacies with dosages usually determined by the results of blood tests every two weeks (the method Somers herself uses), or regular saliva tests, a method most experts say is an unreliable way to measure a women's specific hormone needs. Somers claims that she is so "in touch" with her body's needs that she can "tweak" her hormones even without the benefit of these tests. "I know that a phone call this morning stressed me a bit," she says, "so I know my hormone requirement is going to be a little higher just to get me through the day." Does she worry about getting it wrong and overdosing? No, she says. "The thing about hormones is you won't take too much. If you take too much, you start bloating." Again, there is no scientific evidence for any of this. Proponents of Somers's program say only hormones prepared specifically for each woman can meet her unique needs. But since the Women's Health Initiative, the FDA has approved many new hormone products, including some in very low doses. While the FDA process isn't perfect, it's certainly better than what consumers get with compounding products: no black box warning about side effects, no package insert, no data on relative safety, no check on advertising claims and no manufacturing oversight. Somers says these custom-made treatments are natural and not really drugs. That's just not true. Bioidenticals may start out as wild yams or soybeans, but by the time this plant matter has been converted into hormone therapy, it is in fact a drug. All of these products—whether or not they're approved by the FDA—are chemicals synthesized in a lab. Another thing you should know: there are only a few labs in the world that synthesize these hormones. Everyone—from small compounding pharmacies to big pharmaceutical companies—gets their ingredients from the same places. Somers argues that bioidenticals are safer than FDA-approved hormones even though there are no high-quality studies to prove that assertion. In the absence of any reliable research to the contrary, most women's health experts say it's prudent to assume that all hormone products (FDA-approved or not) carry the same heart disease and cancer risks.
Since the health initiative, women have become much more skeptical about claims from pharmaceutical companies—and that's a good thing. Now we should apply that same skepticism to claims for alternative therapies. If you feel compelled to read Somers's book, do so carefully. You'll find lots to question. For example, she says bioidenticals kept her slim but then later complains about weight gain. She says she feels great but then later acknowledges that after years on bioidenticals, she was bleeding so heavily every day that she recently had to have a hysterectomy. That's the kind of success we can live without.
In our next column, we'll talk to a Harvard researcher about the latest scientific research on hormones and the safest ways to fight menopausal symptoms.