Tools for making correct decisions regarding hormone therapy. Part II. Organ response and clinical applications

OBJECTIVE: To review existing scientific knowledge of the complicated and variable behavior and response to hormone therapy (HT) of different organs during aging, and to summarize long-term consequences on human health. DESIGN: A MEDLINE computer search was performed to identify relevant articles. RESULT(S): Five body organs were evaluated. [1]. Physiologic aging of the bone has deleterious consequences on women's health and quality of life. Bone fractures could be attributed to the combination of estrogen depletion and osteoporosis, mechanisms of applied forces, and disturbed brain function, partially reversible by timely estrogen administration. [2]. Estrogen seems to have a profound neuroprotective effect. As physiologic aging of the brain is an unhealthy phenomenon, possible intervention is justified. The therapeutic time window seems crucial. [3]. The differentiation between response of a healthy or already damaged organ to sex hormones is the key factor to understanding the possible cardioprotective effects. [4]. Based on doubling time of tumor cells, intracrinology, epidemiological data on breast cancer, and behavior of breast cancer survivors in response to estrogen treatment, estrogen seems to be mainly a promoter and even a protector of breast cancer survivors. [5]. Colon cancer appears to be an estrogen-dependent tumor with a wide therapeutic window, as every report regardless of age and dose demonstrates protective effects. CONCLUSION(S): Knowledge of each organ's response to aging and sex hormone substitutions demonstrates that the organs could benefit from properly designed intervention. In the wake of the publication of the Women's Health Initiative study, which shocked the medical community, we suggest that the results be reevaluated according to the aforementioned principles, and that menopausal medicine could play an important role.