Book Review: The Estrogen Alternative

Cheerful Rant and Book Announcement

Title: The Estrogen Alternative

Author: Steven R. Goldstein

Date: 1998

Publisher: Penguin Putnam

ISBN: 0-399-14453-6

Length: 184 pages with 5-page index

Quote: “[A] study in June 1997...reported that women who take hormone replacement therapy for ten years re­duce their risk of dying from all causes by 37 percent.”

Meh. This looks like a book, but it’s one big long infomercial. Summarized in a sentence: “I’m a doctor who’s been supplied with new patent medicines, specifically synthetic hormones made by the very generous Lilly Pharmaceutical Corporation, and here’s what my patients like about them.”

It’d have more credibility if Lilly hadn’t leaned on the newspapers to stop reporting that almost all people who “suddenly, senselessly” commit mass homicide followed by suicide, or who plot such things, have been using certain drugs, including Lilly’s well publicized product, Prozac.

If teenagers were making in their basement a drug that seems like a safe “high” for some users, has no effect on some, has mixed effects of pleasant mood swings and physical pain for most, and produces intense pain and violent insanity in three to ten percent of all users, by now those kids would have burned their supplies and begged to be locked up where the lynch mobs couldn’t get at them. Lilly, however, rolls on...and we have let it.

So when I read that Lilly’s synthetic hormone pills seem to be helping many of Goldstein’s patients, I am skeptical. What kind of results would Lilly be hiding for this study? With hormone replacement, the big risk is cancer: Estrogen is a growth hormone, and when bones and internal organs have stopped growing and there aren’t any babies to be nourished along, estrogen is fairly likely to encourage cancer cells to grow.

It’s one of the many difficult decisions we make in life. Personally, I inherited a tendency to hyperestrogenemia and haven’t noticed any symptoms of estrogen deficiency yet. I noticed midlife simply as life without the nuisance of cycling through lust, weariness, and mess. When I think about the Change of my Life, so far all that comes to mind is “Change for the better! Thank God!”

Y’know...there are good and bad things about the transition from child to teenager, and the bad things can include illness, but everything we tell children about adolescence is “Ooohhh, growing up is so wonderful! You get to do so many more things, you won’t even miss being expected to give up lots of things you now enjoy doing! Hurry up and be a teenager! Here, have a training bra to practice putting it on before you have anything to support with a real bra, an air rifle to practice annoying rabbits before you’re allowed to join the Army! You’ll be going to war and making babies before you know it! Oh goodygoodygoody!”

Yet nobody ever tells young adults about midlife in terms of “Ooohhh, growing up can be so wonderful! You get to think without all that carnal commotion and mood cycling! You can no longer be led through life by your private parts! You get to wear black all the time and never be asked who died (because it’s a rare middle-aged person who didn’t attend a friend’s funeral during the past year), and cover your mouth when you laugh (because if middle-aged people have pretty teeth they’re plastic), and write from the Truth Pedestal (because you’ve finally lived long enough to occupy it), and have intimate relationships only if you really want them rather than just craving to get close to any body of the right physical type, and just generally enjoy all the things that intense youthful sexuality interfered with doing! Hurry up and be middle-aged! You’ll be almost completely able to rise above all emotional moods before you know it! Oh yabbadabbadoo and yippiyippiyaaay!”

Well, here I stand to testify: Reaching postsexual maturity is, like reaching sexual maturity, not entirely a matter of pure undiluted fun. Concerns and responsibilities gradually change, and that has its sobering aspects. But when sexuality becomes a pure rational choice rather than a constant struggle with temptation, when you can trust your body not to gush personal “honey” even when you’re awake and fully clothed, when you can just get to work and get things done without the emotional distractions of which you may have been tired before you were even fifteen years old, and as a bonus your face hardly ever breaks out any more...I say yabbadabbadoo and yippiyippiyaaay, myself.

So, would I consider hormone replacement therapy? Yes...if I were, or were to become, one of those women whose bodies show that they’re badly undersupplied with estrogen (and don’t forget the progesterone): little wispy-looking skinny things with dry skin, thin brittle hair, no curves; they go from “cute little girl” at 25 to “Why can’t we have a baby?” at 30 to “She was born middle-aged” at 35. They never were passionate about sex and now, like their male counterparts, they can’t Do It, no matter how they try. This is sad, and bodies that are no longer cranking out any E or T at all are bodies that lose the ability to recover from injuries, which is even sadder. I might be tempted by an occasional hormone boost to prevent that.

What feminists find so objectionable about most discourse about hormone replacement is the tone in which it’s usually conducted—the idea that midlife is a disease process, that all reproductive parts that have stopped reproducing are “pre-cancerous” and need to be surgically removed right away, that even if you’re looking forward to lowered levels of hormones that’s not normal and you’re going to wake up feeling that your hormone levels have dropped right through the floors, all of them, penthouse to basement overnight if you don’t start “replacing” them now because those procreative parts need to be constantly ready to procreate, at any time, day or night, on demand, and there’s nothing romantic about slowing down and taking time to get each other into the mood, nosiree, so to be on the safe side what might need to be firm should be stiffened up so that it rubs painfully against your clothes for hours, and what might need to be moist should be hyper-moisturized so that it may drip onto the floor if you don’t wear padding...and that is just not true. Normal midlife, male or female, does not call for any kind of therapy. It’s actually pleasant!

And what Goldstein has wrought...I once received payment for doing a sort of parody of it. “I was dripping sweat onto the floor when the temperatures were freezing! I was catching myself bawling and howling and screaming for no reason! What blessed relief I found in Priceypilz!—wrote Mavis and Sally and Barbara and Doris, in documents discovered by their heirs, written shortly before they succumbed to metastasized cancer...”

No. That was the parody. Goldstein is a doctor whose patients were in fact ill. That was why they came to him for treatment, took the new pills Lilly provided him, and reported feeling less ill than they were before. They were by definition not normal. It is to be hoped that, beyond the point of “Jane Doe was fifty-five,” none of their experiences ever sounds much like yours.

If you’re ill, who am I to say that synthetic hormones may not work for you? Ask your own doctor. Let us hope that she’s not getting any kind of promotional benefits from Lilly and can discuss the success and failure rate, over the past twenty years, more impartially than Goldstein could.

If you’re healthy, or at least if your health problems are not age-specific even though you happen to be fifty or more years old, join me in giving thanks to God. All we did, in order naturally to enjoy middle-aged years in which we look and feel exactly the way we wanted to look and feel at twenty-five—strong muscles, solid bones, hair still describable as black/red/blond more than grey, but no mood swings and no acne, at last, at long-awaited last!—was to inherit a certain genetic type. That means we probably grew up among people for whom this was normal, and we think of “old” starting at eighty and see nothing unusual in the existence of Senior Games, sixty-plus or seventy-plus classes in marathons, and starting new relationships or business ventures at seventy. We still have plenty of hormones of our own, thanks just the same, Dr. Goldstein. And we still have sex when we want to, which will not be under any circumstances that could possibly include you.

I did not choose this book even at a dime-a-dozen sale; it was tucked into a basket. I don’t mind reselling it since it may be useful for someone Out There, but I will add one caveat: Lilly. Nufsed.