If you follow my YouTube channel, you know education and saving lives is what Scala Precision Heath is about.  Bear with me as I recount these WTF moments in my life.  You’ll connect the dots in a minute.

When my extremely fit 35-year-old endurance athlete and training partner had a heart attack . . . WTF?

When we discovered antidepressant withdrawal is real . . . WTF?

When 6-time Mr. Olympia, Dorian Yates, called me after he had two DVTs (deep vein thromboses) and didn’t get answers . . . WTF?

When I was prescribed an estrogen blocker and my mood, energy, sleep and erections hit rock bottom . . . WTF?

At the time I knew estrogen increases serotonin levels and testosterone increases dopamine levels—both in the correct ratio for men and women make us feel good—and I still let the physicians block my estrogen . . . big mistake!

I’ve developed treatment plans and dosing for patients using hormonal replacement for over 20 years and trained hundreds of physicians on therapeutic hormone use.  I’ve seen the lifesaving benefits of hormone replacement in all age groups and witnessed the heart attacks and strokes in men and women on the wrong dosages.  It’s 2022 and conventional medicine still has not caught up with the critical importance of hormone replacement for brain chemistry and heart function.  And now they’re using hormones on children.

The Newest Uncharted Medical Territory

What keeps me awake at night now is this . . .

All the transgender boys and girls who are transitioning may also be damaging their hearts and brains by blocking hormones.  When I blocked my estrogen levels, I felt like I was going to die.  

Do I have all the answers?  Of course not, but I have a lot of questions.  If I can prevent one suicide with this information, then it was worth the stretch.

People who decide to transition are eager for hormonal changes to take place rapidly, understandably so.  But it’s very important to remember that the extent and rate at which changes take place depend on many factors.  These factors include genetics, the age at which a person starts taking hormones and the complicated puzzle of optimizing estrogen, testosterone, progesterone, thyroid hormones, cortisol and DHEA.  Pull one string on a spider web and the whole thing shakes.  That is how we need to see hormone replacement.

How Decades of “The Pill” Gives Us Clues

There are volumes of research on birth controls pills and how they affect the metabolism of women.  We have learned that “the pill” changes the brain; brain scans of women who are on the pill show structural and functional differences when compared with women who are not.

In many women, the estrogen in birth control lowers testosterone levels.  The testosterone to estradiol ratio is extremely important for maintaining the function of every artery going to the heart and brain—and both are high metabolically active.

One large meta-analysis found that total testosterone levels can decline by roughly 30% while free testosterone declines by nearly 60% with the use of hormonal contraceptives.  

One mind-blowing area that should make us all press pause is the fact that estrogen in women acts like fertilizer on multiple regions of the brain.  Research into brain injuries gave us this insight.  A woman’s brain is a very fluid and dynamic system that changes continuously.  Estrogen works like Miracle-Gro.  Testosterone and progesterone also play a role, causing brain cells to sprout new connections.  Will blocking estrogen during transition affect this process?  I’m not sure.  But someone needs to ask the questions out loud. 

The book, “This is your Brain on Birth Control,” by Sarah E. Hill, Ph.D. should be required reading for all physicians and transitioning folks.  A deeper understanding of biochemistry will save lives.

What Must We Do to Protect Transgender Health?

Do the physicians who help with transitioning understand how to order the correct lab tests to track not just the physical transformation but the metabolic transformation as well?

There are limited studies on the risks of transitioning, but we can get volumes of research from the bodybuilding community over the last 30 years.  I’ve researched this area for hundreds of hours.  The scary part is that the estrogen to testosterone ratio is critical for protecting the lining of arteries (the endothelial lining).  If estrogen, testosterone, progesterone or thyroid hormones are out if balance, the arteries can become blocked.

One study looked at the records of 5,000 transgender people and found a higher risk of blood clots, stroke and heart attack for transgender women.   (From NBC News: Study finds health risks for transgender women on hormone therapy)

After researching heart disease for 30 years, I understood that it’s not cholesterol but endothelial dysfunction that blocks the arteries.  I’ve shot a few videos on this topic.  The endothelial lining is part of the thousands of miles of arteries feeding oxygen and nutrients to every organ.  The endothelial lining releases nitric oxide (NO) to keep the arteries dilated so oxygen can get to the heart.  When estrogen or testosterone is blocked, this lining become damaged and starts the process of atherosclerosis (blocking of the arteries).  I wonder, if estrogen and testosterone are extremely important to protect the lining of every single artery, what happens when teens use puberty blockers?  How fast do these blockers affect the developing heart and brain?

Old Research Becomes New Again

My interest in hormone therapy started with the bodybuilding community, which I studied for years to better understand sarcopenia (muscle wasting) in the elderly.  If you look at bodybuilding in the 1960s compared to 2022 you can see the vast improvement in muscle size using anabolic steroids, IGF-1 and insulin.  Dorian Yates and I recorded a podcast recently on what’s killing bodybuilders and it got back to endothelial damage caused by blocking estrogen.  Will this same damage happen to females transitioning to males?

Now with over 60 transitioning centers in the US, I want to share research to educate how hormones affect mood, sleep, energy and quality of life.  Transitioning is a process that can take anywhere between several months to several years.  It’s critical that families have the knowledge of and access to the best lab tests to track multiple hormones, check for blood clot formation and assess nitric oxide levels (test for asymmetric dimethylarginine) to avoid serious medical conditions and complications.

Resource:

The effects of gender-affirming hormone therapy on cardiovascular and skeletal health: A literature review

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