Talk:Bioidentical hormone replacement therapy

Sources

Cirigliano quotes:

“ Pharmaceutical companies are bound to observe these restrictions in making claims concerning the efficacy or safety of their products, whereas compounding pharmacies are not even bound to disclose class warnings associated with estrogens (black box warnings). Responsible claims cannot be made about the superiority of any route or form of estrogen regarding either efficacy or safety. This is a clear problem, as unsubstantiated claims concerning BHT have been made in the past, including that BHT has few or no associated AEs, decreased risk of breast cancer ”

“ Estradiol, CE, and ethinyl estradiol (EE) (bioidentical, natural, and synthetic, respectively), all appear to offer similar benefits and harms, with none faring better or worse than the others.34 The one caveat is that head-to-head comparisons of different estrogens are lacking because most studies involved comparisons with different coadministered progestogens. This recognized need should serve as impetus for further clinical trials. Nevertheless, there appears to be little sound scientific rationale or support for the most common mixture of ratios of estrogens in biest and triest or for any other customized ratios based on sera levels, as there are no sensible means of monitoring or ensuring that they are maintained (from hour to hour and day to day), and, most importantly, there is no proven physiological benefit in doing so. Although estrogen levels decrease during menopause due to loss of ovarian function, estrogen clearance rates are not significantly changed.128 The simple use of either estradiol or estrone will cause elevated levels of estriol.124 The addition of further estrogen metabolites (estrone and estriol) in an ad hoc compounded mixture containing estradiol, based on saliva or sera estrogen levels, in an effort to provide a theoretical ideal ratio seems futile because the exogenous estradiol and estrone fractions are subject to metabolism at different rates.32,129 It would make more sense to provide sufficient amounts of estradiol alone and then allow the woman’s own metabolism to provide for the other estrogens. Therefore, the claim that no pharmaceutically manufactured product mimics the body’s production of estrogens other than such compounded products as triest and biest74 not only is unproven but also is highly unlikely to be the case. (Cirigliano) ”

• [1]
• [2] - single paragraph mention arguing against compounded products and for FDA-approved, but not for bioidentical hormones in general
• [3]
• [4]
• [5] - single paragraph, notes a lack of large clinical trials, argues for FDA approved versions
• [6] - single mention from 2005, stated no evidence for efficacy or adverse effects
• [7]
• [8]
• [9] Saskatchewan’s Academic Detailing Program
• [10]
• [11]
• [12]
• [13]
• [14]
• [15]
• [16]
• [17]
• [18]

I've requested the following from TimVickers. I've struck through the ones I got, and am trying to find the rest.

• Curcio JJ, Wollner DA, Schmidt JW, Kim LS. "Is Bio-Identical Hormone Replacement Therapy Safer than Traditional Hormone Replacement Therapy?: A Critical Appraisal of Cardiovascular Risks in Menopausal Women." Treat Endocrinol. 2006;5(6):367-374. PMID: 17107222 [19]
• Cicinelli E "Bioidentical estradiol gel for hormone therapy in menopause." Expert Review of Obstretrics and Gynecology, Volume 2, Number 4, July 2007 , pp. 423-430(8) [20], not pubmed indexed?
• M Lam Po, GWY Cheung, DT Shek, DTS Lee "Bioidentical hormone therapy: a review" Menopause, 2004 (need more details)

Slightly more dubious sources

• [21]
• [22]
• [23]
• [24] Public Citizen is also critical
• [25]
• [26]
• [27] Skeptic's magazine
• [28] Quackwatch's stance.
• [29] CTV news
• [30] CBC news article
• [31] Winnipeg Free Press

Neutrality tag

I removed the tag for numerous reasons. Some of those reasons are that the article seems to be indefinitely tagged for the past year or so. The principle editor who tagged the article does not seem interested in repeated suggestions to add their content on individual drugs to their respective drug article pages, nor was there any interest expressed in Doc James's helpful and sensible suggestion of using a popular culture/controversy or social type section for non-scientific or minority material. The same circular arguments have been going on for about a year and per the various policies such as WP:WEIGHT and WP:NPOV it is unresolvable.--Literaturegeek | T@1k? 17:04, 4 May 2010 (UTC)

Fine with me, the {{POV}} documentation does state that the tag is not a badge of shame or used to "warn" readers. No new sources or arguments have been provided for a while now. WLU (t) (c) Wikipedia's rules:^simple/_complex 12:52, 5 May 2010 (UTC)

Unencyclopedic tone

The tone of this article seems very out of place for Wikipedia. I don't think I've read another one like it. It comes across as very defensive—much more so than, say, Evolution, which I'd think would be under a much worse assault.

Roughly speaking, here's my background: I am a skeptical person with a family member who thinks bioidentical hormones are wonderful. I'm trying to learn more about them, mostly out of curiosity (I'm male anyway) so I can have an informed opinion. (My relative buys into a bunch of things that I don't agree with, but some other things she believes seem to have turned out to be correct.) I'm not invested in either side, and frankly not that invested in finding an answer, either.

As far as I can tell from other sources, the state of the debate is:

1. There is a small but vocal group of doctors and lay(wo)men who think this stuff is like the conventional therapy but doesn't have the side effects. This is a plausible but untested position.
2. There are blanket statements by medical organizations that their best prediction is that it's no better than the conventional therapy. This is also a plausible but untested position.
3. There are not really any large, solid studies supporting either of those positions. Since this is your health we're talking about, caution is probably prudent.
4. Oh, and there are doctors and laypeople who are making some really wild statements, too—you should be especially wary of those. Any claims beyond "they work the same as the conventional stuff but are safer" is utterly unsupported, as opposed to plausible but untested.

Is this correct? If so, why is the article so relentlessly negative, instead of describing the situation in a more nuanced way? And if not, what am I missing? —Brent Dax 00:14, 2 June 2010 (UTC)

Your summary of the debate is about right. The tone of the article could perhaps be improved. Do you have any suggestions? Any particular phrases that jump out at you as unencyclopedic for example? This article was under a prolonged content dispute for quite some time which may have influenced writing style.--Literaturegeek | T@1k? 00:21, 2 June 2010 (UTC)

You are mostly missing a long and acrimonious debate about BHRT. You are welcome to peruse the archives for the arguments themselves, but the heavily sourced page is, as far as I can tell based on reading a lot of sources, the way the actual medical "deabate" is. There are relentless cheerleaders for BHRT who claim it can make you youthful and improve health without risks, and there are a lot of doctors who are either confused (because they already know that bioidentical hormones exist, as FDA-approved drugs, and can't see what the fuss is about) or angry (because bioidentical hormones are marketed directly to consumers as a risk-free panacea that charges a whole lot of extra money for a whole lot of unnecessary "stuff"). There are plenty of sources, many are available as full-text versions (and chances are if you can't get it right off the web, I could e-mail you a pdf) so feel free to go directly to them to see what is available. Harvard Women's Health Watch is probably the easiest place to start with a professional perspective written at a layperson's level. You are welcome to improve the writing if you find it choppy or difficult to read, but much of the wording has been chosen pretty carefully to stay true to the sources, which often resist easy summary.

The reason the page doesn't read like evolution is because evolution is not a fringe theory - this one is. BHRT has a veneer of scientific respectability (unlike creationism, which is evolution's "opponent") but ultimately aside from a few sparsely-cited and even sparser-published proponents, there's not really much debate. Real scientists don't seem to use "bioidentical" as a term - they do research on estriol, estradiol, estrone, progesterone, testosterone, etc. Only bioidentical proponents seem to feel the need to gather all these into a "class" and proclaim them universally good and helpful. "Real scientists" would be those who actually research and publish on a regular basis, while proponents (like Erika Schwartz and Kent Holtorf) seem to spend more time in private practice, and writing books for popular audiences.

One thing I'll definitely sign-on to is that the page should be reviewed by someone who hasn't been involved in the debate at this point, to check for redundancy, choppiness, and general readability. Independent eyes would be very helpful. WLU (t) (c) Wikipedia's rules:^simple/_complex 00:29, 2 June 2010 (UTC)

I agree, the tone is all wrong. The main parts of the article are littered with citations, but the first two paragraphs don't have a single one. The tone of those first two paragraphs basically says "this is all bullshit." I'll admit that I haven't read the entire article yet, but the beginning is just a mess. Just the first (enormously long run-on) sentence has the words "exaggerated, unfounded claims" in it. A few (run-on) sentences later, it says "Bioidentical hormones may also present extra risks due to the process of compounding." Where's the citation for that? When I look up the article on Compounding, I see no mentions of risk. In fact, I see that "compounding pharmacies are licensed and regulated by their respective state like all other pharmacies."

In the second paragraph, it says "A major safety concern of bioidentical hormone replacement therapy is that there is no requirement to include package inserts despite the potential for serious adverse effects, including life threatening adverse effects, being associated with HRT. This can lead to consumers being deceived and even harmed as they are mislead into believing that BHRT is safe and has no side effects. Regulatory bodies require pharmacies to include important safety information with conventional hormone replacement therapy (CHRT) via package inserts." It sounds like this is more an indictment of compounding pharmacies than any issue with BHRT. Also, if compounding pharmacies are licensed and regulated, then aren't they also required to provide health warnings? My (non-compounding) pharmacy doesn't include packaging inserts, but they do include their own computer-printed summaries of the safety information and about possible drug interactions. Are we to believe that regulated compounding pharmacies have no such requirement? There are a whole lot of other things wrong with the first two paragraphs, but those are the biggest issues with the tone.

I'm looking into this because a blood test just told me that I have a low testosterone level, and I want to know as much as I can before I meet with the doctor this week. The tone of the first two paragraphs of this article would probably scare away many people in my position from seeking any further information about bioidentical HRT. That's something that no encyclopedia should ever do, in my opinion. If there are facts proving that it's all hype, then present them. If not, it should at best say something like it's "controversial" rather than saying it's exaggerated, unfounded, risky and misleading.

Something that wasn't pointed out is that, at least in the case of testosterone gel, getting these from compounding pharmacies will in many cases save you a lot of money. That's because big pharma has patents on testosterone gel. They can't patent testosterone, since it's a naturally occurring substance, but they can patent testosterone when they mix it into their gel. A compounding pharmacy can take the non-patented testosterone and mix it with a generic gel and save you about 90% of the cost of buying the patented gel (usually $150-$300 a month). If I had a guess as to who is behind this apparent attack on compounding pharmacies, I'd guess it's companies that stand to lose a lot of money if people start taking their business there.

Of course, that's just my opinion...I could be wrong. Who wants pie?

Uptick in interest

Anyone know why? Sciencebasedmedicine.org had a post yesterday that I was keen to read. WLU (t) (c) Wikipedia's rules:^simple/_complex 14:52, 30 June 2010 (UTC)

"the potency ranged from 67.5% to 268.4% of the amount specified on the label, and there were variations within the same samples. Contaminants have also been found, including bacteria." These factoids should be cited in this article. From memory, all this article says is additional risks from compounding, but this article does not say what those risks are.--Literaturegeek | T@1k? 18:51, 30 June 2010 (UTC)

That's alluded to in the criticisms>salivary testing and compounding section, but not the exact numbers. I don't have access to The Medical Letter and much as I LOVE SBM.org, I wouldn't recommend citing it. Certainly a very useful article to have.

There is continuously a grain of truth in the complaints made about how BHRT may be a better option than premarin or other molecules (there are a few citations pointing to an improved risk profile) but the research is very far from a blanket endorsement of any one hormone over any other hormone, or set of hormones, and certainly not on a priori grounds. One article made the point that artificial, non-human molecules might work better than human ones because they could modulate only one function of the hormone (i.e. bone mineralization or vasomotor symptoms) rather than all (i.e. endometrial or breast hyperplasia or hypertrophy). WLU (t) (c) Wikipedia's rules:^simple/_complex 19:58, 30 June 2010 (UTC)

Why do you need access to The Medical Letter? That reference on sciencebasedmedicine.org was freely available to me. Why do you feel that sciencebasedmedicine.org is not good for citing? Perhaps it is not a good source to build the bulk of articles but it may be ok to "fill in the gaps".--Literaturegeek | T@1k? 20:14, 30 June 2010 (UTC)

Struck my comment, I just checked and realised that it was a review of the letter. Perhaps still worth citing?--Literaturegeek | T@1k? 20:16, 30 June 2010 (UTC)

Naw, much as I like the source, it's still a blog (though one edited by doctors). It doesn't have its own wikipedia article, and neither do the individual contributors. Given the plentitude of MEDRS, I just can't justify including one that probably wouldn't qualify as a RS. I think the Medical Letter will give us much better, richer information than Harriet Hall's brief summary would, and it's undeniably reliable. I don't think there's any gaps that could be plugged with the SBM.org post that can't be better filled with a real source. The only ones I could see were the numbers given on just how off the compounding products were from what their labels said.

If we can get it, we certainly should integrate the ML article, considering it's a secondary source just shy of a Cochrane Review, Science, Nature, NEJM or JAMA. WLU (t) (c) Wikipedia's rules:^simple/_complex 20:39, 30 June 2010 (UTC)

Oh, I did not realised that it was a blog, even though I saw the comments below it. I didn't put two and two together! It is a shame but you are right it is not a reliable source especially for an article so well covered in other sources. Hopefully you will be able to find someone who can get the full text of the letter.--Literaturegeek | T@1k? 21:35, 30 June 2010 (UTC)

Protection request

I'll be requesting page protection. The blatant sockpuppeting is irritating me. WLU (t) (c) Wikipedia's rules:^simple/_complex 15:59, 30 June 2010 (UTC)

Done. WLU (t) (c) Wikipedia's rules:^simple/_complex 16:06, 30 June 2010 (UTC)

Protection UNDO Request

First I must apologize for the confusion concerning accounts. I am a new user, and opened an account witht he name thx1138robot, and was told by an administrator that the name was not suitable becasue iot contained the word fragment, "bot", so I was instructed to either change the name or opena new accoutn. I asked for the name change to thx1138robert, but I didnt see it approved, so I later opened a new account under name craigventersmonster. So that is the history of it. I am the reason why WLU placed a HOLD on the page. Rather than get into a discussion, WLU uses a technicality to place the page into protected mode. I don't think that is good for wikipedia. — Preceding unsigned comment added by Craigventersmonster (talk • contribs) 2010-06-30 17:38:38 (UTC)

You should tag your account with {{User Alternate Acct Name}}

I didn't use a technicality, I saw three new accounts editing towards a single, inappropriate POV version that gave undue weight to an unsupported set of assertions. And no matter what, edit warring was an issue, so page protection is legit.

I didn't protect the page, I'm not an admin. It'll expire in a week. WLU (t) (c) Wikipedia's rules:^simple/_complex 22:15, 30 June 2010 (UTC)

The Issue Simple, Whether "Bioidentical" defintion is Ill-defined or not

A perfectly good edit on the Bioidentical Hormone Therapy Page was undone (within minutes) by User talk:WLU who then made the page protected under a smokescreen of "sockpuppet" which is false. I was instructed to open a new account under a new name because my initial user name thx11138robot had the word fragment "bot". So I did so.

The issue is that User talk:WLU maintains a choke hold on the content of this page and will not allow any edits of the extremely biased information there. This is not what was intended by WIkipedia whose rules state that edits should be neutral.

The very first paragraph on the page state that the word bioidentical is ill-defined. This is incorrect and represents a biased viewpoint. Here is the edited text which was undone:

Definition of the Word Bioidentical

Firstly, the word, Bioidentical, is well-defined by the Miriam Webster Dictionary as "possessing identical molecular structure especially in relation to an endogenously produced substance <bioidentical estrogens>". Secondly, "bioidentical" is defined by Wiktionary as "identical to that which is naturally produced by the body." . The Endocrine Society Position Statement on Bioidentical Hormones definition is: “Bioidentical hormones” are defined as compounds that have exactly the same chemical and molecular structure as hormones that are produced in the human body. . This statement is also endorsed by the North Amerca Menopause Society. These sources are in agreement that the word, "bioidentical" has a well defined meaning.

Since I am a completely new user, I would ask any and all Wiki users and administrators to assist in having the page protection UNDONE, and allowing proper editing of the page. Craigventersmonster (talk) 21:38, 30 June 2010 (UTC)

Wiktionary isn't a reliable source. There are multiple sources that use many different definitions of "bioidentical", and further the page is about bioidentical hormone replacement therapy not simply the word "bioidentical". There are multiple sources in the body that verify many different things are meant when BHRT is discussed - that's part of the problem, it means many things to many people while simultaneously being misleading, meaningless and ultimately undefined. The lead section doesn't need citations provided it accurately summarizes the body - which it does, see the section on terminology. We don't pick the definition we like the best, we fairly represent the sources to the proportion they are found - WP:UNDUE, WP:NPOV, WP:FRINGE, WP:V. Though websters is an appropriate for a definition, it is rendered moot by the multiple reliable sources that state the term isn't as clear as it purports to be.

My page protection request, though based on sockpuppeting, would have been legitimate under a single account edit warring - which you were though given the two (three?) different accounts we could not tell. In fact, if we had known you were a single account, you probably would have been blocked instead. Anyway, the page is currently semiprotected which means in a couple days you'll be able to edit it irrespective. So, feel free to spend that time familiarizing yourself with the many policies that apply, as well as reading the critical sources - of which there are more than enough to justify a critical stance per WP:UNDUE. I would also suggest reviewing, if you have the chance, the latest paper from the highly esteemed publication The Medical Letter which I understand is quite startlingly negative.

Also note that the sources you so prominently point to may define bioidenticals in that way (molecularly identical to endogenous) but they also are highly critical of the promotion of them and claims made - you don't get to cite the parts you like and discard the parts you don't. A fair summary of both may verify that these agencies consider bioidenticals to be molecularly identical to endogenous, but they also state they aren't worth the money and are no safer than conventional HRT. Please consider this when planning your upcoming edits; they can not be towards the viewpoint of your previous edits, and you are now well aware of which policies to consider, so we all expect your behaviour and POV to adjust accordingly. WLU (t) (c) Wikipedia's rules:^simple/_complex 22:46, 30 June 2010 (UTC)

Is Bioidentical really "Strongly Associated" with pharmacy compounding?

Notice the first paragraph says: "but is also strongly associated with pharmacy compounding". This statement reveals an anti-bioidentical bias and should be edited to a more neutral viewpoint.

Is above this statement true? Where is the reference for this statement? None is provided. In fact this statement is false, since bioidentical hormones are widely available as FDA approved prescription drugs. The following FDA approved prescription drugs contain bioidentical hormones. These bioidentical hormones are NOT strongly associated with compounding pharmacies: Alora (estradiol) Climara (estradiol) Vivelle-Dot (estradiol) Estraderm Estrace (estradiol) Prometrium (progesterone) Androgel (testosterone). In fact, these bioidentical hormones are non-compounded, manufactured medications available by prescription from any standard pharmacy. So in fact there is no STRONG ASOCIATION with compounding pharmacies. The reality is that compounding pharmcacies can make up ANYTHING, bioidentical or synthetic, and they do depending on the prescription ordered.

In fact, it is just as credible and correct to make the statement that "bioidentical hormones " are strongly associated as FDA Approved Medications from local pharmacies. This is just as true. UGAcodon (talk) 23:24, 30 June 2010 (UTC)

Rather than the above, the appropriate response is to tag the unreferenced statement with {{cn}}. The above is just wasted effort. However, the references are in place for the statements, see PMID 17627398 and PMID 17549577, both of which are cited in the appropriate body section of the article. The lede section uses summary style, for which many articles omit citation. I'm not a fan of this approach. If you'd care to add the cites in the lede corresponding to the ones in the body, I wouldn't object. LeadSongDog come howl! 23:44, 30 June 2010 (UTC)

I'll echo that - see WP:LEAD, so long as the information is sourced in the body, no citations are necessary in the lead. Previous versions were much more citation-heavy. The last version to have a fully-cited lead can be found here, and I think most would agree that 21 citations in the lead is both distracting and unnecessary considering how much the sources converge. One thing the sources converge on is the conflation of BHRT and compounding, with all the associated accretions of unnecessary testing, wildly exaggerated claims, poor quality control and so on. Again, the fact that BHRT is heavily linked to compounding is well-supported - we are not concerned with the truth and we are not here to proclaim the wonder of bioidentical hormones, unjustly maligned. We are here to represent what the mainstream sources say about BHRT. The fact that compounding has little to do with molecular endogeny is known, as is the lack of support for bioidenticals being any better than nonbioidenticals. WLU (t) (c) Wikipedia's rules:^simple/_complex 00:48, 1 July 2010 (UTC)

Again there has been no real discussion of the point raised, which is that there has been no validation of the claim of the statement because the statement is confusing. The statement confuses two types of bioidentical hormones. The first type are the FDA approved versions sold in numerous Walgreens type pharmacies, and the second type is the compounded preparation sold through compounding pharmacies. Bioidentical Hormones are sold through both. In actuallity if one looks at the numbers, more bioidentical hormones are sold through compounding pharmacies compared to conventional pharmacies like Walgreens. In addition, there are many more Walgreens and CVS-type drug stores throughout the US which carry FDA approved bioidentical hormones than there are compounding pharmacies. This fact would then lead one to conclude that FDA approved Bioidentical Hormones are more strongly associated with conventional pharmacies like Walgreens. The statement "compounded hormone preparations are strongly associated with compounding pharmacies : is of course true,' So the above statment needs this type of clarification. FDA approved bioidentical are sold through conventional pharmacies which clearly outnumber ccompounded pharmacies. So in conclusion, the statement as written confuses FDA approved bioidentical with Compounded bioidenticals. And that is the problem. Bioidientical hormones are not compounding pharmacies, and the two ideas need to be kept separate. As written, the text clearly needs to be corrected. Any comment?

UGAcodon (talk) 05:20, 1 July 2010 (UTC)

Panacea for All Diseases? An Outlandish Opinion Intended to Discredit Bioidentical Hormones

In the first paragraph notice the statement : "Proponents have promoted BHRT as a panacea for nearly all disease rather than a means of relieving the symptoms of menopause and/or reducing the risk of osteoporosis (the goals of traditional hormone replacement therapy)"

Who are these proponents? What is the source or reference that says this? In fact, reputable proponents of bioidentical horomone therapy DO NOT HOLD this rather extreme and outlandish opinion. This statment is biased and is intended to discredit bioidentical hormones in the eyes of a lay reader. The reality is that bioidentical hormones are prescribed as FDA approved prescriptions from the drug store by physicians in much the same way as they also prescribe the synthetics like PremPro. The thing that is a panacea for all diseases isn't a medication, it's those Pods from Cocoon. People aren't idiots and they see right through this game.

UGAcodon (talk) 23:57, 30 June 2010 (UTC)

Your unsourced assertion is less convincing than the actual sources on the page. See Chervenak, 2009 and Fugh-Berman & Bythrow J, 2007 for a start, and Boothby & Doering (2008), with a title of "Bioidentical hormone therapy: a panacea that lacks supportive evidence", is probably also a candidate, and though it's not on the page yet, Hansen 2008 would probably also be a candidate ("Bioidentical hormones: panacea for menopausal hormonal therapy or bio-beware?"). As a matter of fact, there seems to be plenty of sources to verify bioidentical hormones being promoted as a panacea. Since wikipedia is about what is verifiable, not what is true (see WP:V), it is appropriate. You are right, bioidentical hormones (in the sense of molecularly identical to endogenous hormones) are prescribed as FDA-approved drugs, and accordingly have all the risks found in their inserts - and the opinion that they are expected to pose the same risks as other FDA-approved HRT should remain, prominently. WLU (t) (c) Wikipedia's rules:^simple/_complex 00:36, 1 July 2010 (UTC)

These aren't references, these are deceptions. You have not named a single reputable physician source claiming that "bioidentical homones are a panaces". Your referernces are non-references as anyone can see. This is nonsense. Yes, of course, there are attack articles sponsored by the hormone industry such as:Curr Opin Obstet Gynecol. 2008 Aug;20(4):400-7.

Bioidentical hormone therapy: a panacea that lacks supportive evidence. by Boothby LA, Doering. So yes, this is a catchy title, however, the title takes some artistic liberties and does not even name a single reputable physician who claims that bioidentical hormones are a panacea, and in fact if you do a Google search for the two words, "bioidentical panacea", there are no hits for physicans writing articles stating that "bioidentical hormones are a panacea". As anyone can see from the link, the physician proponents of bioidentical hromones are stating that it is NOT A PANACEA. Just because it makes a nice catch phrase in a title to an article in Obstetics and Gynecology, a magazine that serves the interests of the synthetic hormone industry, doesn't mean that this a valid reference, it's not. These aren't references, these are deceptions, just like the rest of the junk on the page. This is a biased anti-bioidentical page. People are educated and see right through it. By the way ACOG, which publishes Obstetrics and Gynecology has financial ties to the synthetic hormone industry, so the Boothby article is biased and not a neutral source.http://www.iacprx.org/site/DocServer/PharmasCampaignAgainstBHRT-_updated_1.14.08.pdf?docID=3321 Wyeth funds several annual awards for the American College of Obstetricians and Gynecologists(ACOG),] totaling approximately $29,000 per year. Wyeth is also a Friends of ACOG Participant, where Friends donate $3,000 per annum, and is a frequent exhibitor at ACOG’s Annual Clinical Meetings and sponsors ACOG’s annual “Resident Reporter” Program. --UGAcodon (talk) 01:07, 1 July 2010 (UTC)

That was unconvincing when Hillinpa (talk · contribs) repeatedly barfed it up, and it's still unconvincing. Keep in mind - for your comment to be true, every single critical source has to be part of your vast conspiracy. So do the peer reviewers that review the articles. And the FDA, which is also heavily critical. Also, there has to be an equally vast conspiracy to avoid publishing research showing bioidenticals are better. Because there isn't any. Plus, why do critical articles get smeared with "Big Pharma is evil and all the doctors are their pawns!!!" when the only people who actively make money on bioidentical hormones are those charging expensive consulting fees, private appointments and whole friggin' books on the topics? Why are these people, who apparently care so damned much for their patients, spend their time lucratively writing directly to a popular crowd rather than running the kinds of clinical trials that would actually help test their theories? Who makes more money from the bioidentical/CHRT battle, the doctors who recommend FDA-approved versions with extensive safety and effectiveness profiles, versus the people who sell their books to their clients directly?

All that's beside the point. WP:REDFLAG urges us to ignore sources that claim conspiracy, I've never seen a reliably sourced criticism that actually associates criticisms of BHRT with COI, and accordingly there's nothing here to adjust the page. Claiming conspiracy isn't a reason to either adjust the page based on preference or eliminate sources. Neither is a google search. Calling reliable sources deceptions is hardly as convincing, or in line with our policies, as actually finding, summarizing and citing a real source. WLU (t) (c) Wikipedia's rules:^simple/_complex 01:22, 1 July 2010 (UTC)

WLU: We are still waiting for the you to name the proponents of bioidentical hormones who claim it is a panacea. You have not named any because you cannot. There are no reputable physicians claiming bioidentical hormones are a panacea. A few minutes researching it with Google search shows that, rather, there are many proponents who actually state it is NOT a panacea. You are deceiving the readers and editors with this nonsense about panacea. This should be removed, undone, deleted. The reference you cite does not actually name any reputable physicians who claim this and is not a valid reference. You have not answered this. It should be deleted.

I have not mentioned the word conspiracy, and do not intend to mention it. Rather I have mentioned financial ties between ACOG and Wyeth. These are financial ties you have not denied. You can't deny it because this information is all public. This is a serious issue because financial ties and conflict of interest are serious matters which reduce the credibility of the source. Attack articles on bioidentical hormones are not the result of a conspiracy, however, they are definitely under the influence of financial ties to the synthetic drug industry. To hide this information from the readers is a disservice, and potentially harmful. This information should be on the bioidentical hormone page.

I agree there is no "vast conspiracy to avoid publishing research showing bioidenticals are better". Quite the contrary, this research has been done and it is published. And I would be more than happy to bring it to these pages. The problem is that it is deleted within seconds of its appearance. I would like some assurances from the multitude of editors here that this publicly available published research showing bioidenticals safer and more effecive than synthetics be allowed here on the bioidentical hromone page without being immediately deleted within seconds by an editor with a pro-synthetic agenda. Any comments here? UGAcodon (talk) 04:56, 1 July 2010 (UTC)

Wyeth manufactures transdermal 17b-estradiol, a bioidentical hormone, and Wyeth isn't the publisher or author of the multitude of articles that disparage the claims made about bioidenticals. In fact, the only people with a clear conflict of interest that would make me question their claims are the proponents - Kent Holtorf and Erika Schwartz. WLU (t) (c) Wikipedia's rules:^simple/_complex 17:37, 1 July 2010 (UTC)

Medical Letter article

I'd really love to see the recent Medical Letter article on bioidentical hormones. I believe it can be found on pubmed, PMID 20508582, but no preview or abstract. If anyone can get a copy, I'd appreciate a ping.

Short too, 2 pages. WLU (t) (c) Wikipedia's rules:^simple/_complex 01:09, 1 July 2010 (UTC)

Scratch that, I got a PDF now. It is indeed extremely short (ultimately one column spread across two pages, so really more like half a page) and it essentially reiterates the points already on the page - bioidentical hormones are oversold, already available, linked to blood and saliva testing (but shouldn't be), generally found in compounding pharmacies, not regulated, estriol is a bad idea, and concludes with "There is no acceptable evidence that “bioidentical” hormones are safe or effective. Patients should be discouraged from taking them." I'll be integrating it tomorrow or the next day, it's further evidence that due weight of the scholarly consensus should go to these drugs being essentially identical in risk and benefit to regular HRT. In fact, the article could essentially be the lead of this very page (it's almost short enough). WLU (t) (c) Wikipedia's rules:^simple/_complex 02:21, 3 July 2010 (UTC)

Sounds reasonable. Would support that wording with this ref. --Doc James (talk · contribs · email) 05:51, 3 July 2010 (UTC)

Integrated today. WLU (t) (c) Wikipedia's rules:^simple/_complex 05:27, 6 July 2010 (UTC)

April 2010 from a Previous Editor Who Gave UP

Apparently a previous editor has commented on the biases in the bioidentical hromone page: We are starting to understand what has been going on here.

"This article has evident bias--as seen in its misuse of definitions, its unjustified generalizations, and its exclusion of evidence and other points of view. Like other editors who argued extensively and in great detail against WLU in the past, I gave up in frustration. Neither I nor Riverinpa nor other persons had or have unlimited time to devote to fighting with such a determined propagandist over a Wiki page. WLU repeatedly, and without rational justification, removed every evidence, argument, or point of view that disagreed with his anti-bioidentical position. (Does it even make sense to be against human hormones?) I see now that WLU has gotten what he wanted--the page is fully owned by him and no one even bothers trying to change it anymore. There is no point is rehashing any arguments with WLU. All his violations of Wiki policies, all his pseudo-arguments against including evidence and points of view have been exposed in the talk pages. The reader can begin with Archive_5 and work backwards. Fortunately, WLU is a lousy writer, so the intelligent reader can see quite quickly that this is a hatchet job. BHRT is a dead page and will remain so as long as WLU owns it." editor above April 2010

All editors interested in reclaiming the bioidentical page and removing the pro-synthetic , anti-bioidentical bias, NOW IS YOUR TIME TO COME TOGETHER. Contact me and we can do this together, UGAcodon (talk) 05:27, 1 July 2010 (UTC)

Sources, not assertions. Also see WP:FORUM, WP:SOAP, WP:PARENT. WLU (t) (c) Wikipedia's rules:^simple/_complex 12:41, 1 July 2010 (UTC)

Bioidentical progesterone shown to be more efficacious than synthetic MPA medroxy progesterone in peer reviewed clinical study in mainstream literature.

"The effect of progesterone compared with MPA included a 30% reduction in sleep problems, a 50% reduction in anxiety, a 60% reduction in depression, a 30% reduction in somatic symptoms, a 25% reduction in menstrual bleeding, a 40% reduction in cognitive difficulties, and a 30% improvement in sexual function. Overall, 65% of women felt that HRT combined with progesterone was better than the HRT combined with MPA." Quoted from Holtorf

Reference: Fitzpatrick LA, Pace C, Witta B. Comparison of regimens containing oral micronized progesterone of medroxyprogesterone acetate on quality of life in postmenopausal women: a cross-sectional survey. J Womens Health Gend Based Med. 2000;9(4):381–387.

UGAcodon (talk) 03:55, 1 July 2010 (UTC)

WP:OR, WP:SYNTH. WLU (t) (c) Wikipedia's rules:^simple/_complex 12:42, 1 July 2010 (UTC)

This is relevant to the progesterone article as well as the medroxyprogesterone article. It is not unusual for one compound to show superiority or inferiority over another. Why not document this on their relevant articles?--Literaturegeek | T@1k? 17:53, 1 July 2010 (UTC)

Bioidenticals Safer than Synthetics in Clinical Study - Conclusive Evidence

Synthetic Progestin Increases Risk of Breast Cancer, While Bioidentical Progesterone Does NOT.

Fournier followed 80,377 postmenopausal women on various forms of HRT for 8.1 postmenopausal years. During the follow period,there were 2,354 cases of invasive breast cancer. Those women on estrogen and bioidentical progesterone had a relative risk of breast cancer of 1.00, same as the non-HRT control group. Those post menopausal women on estrogen and a synthetic progestin had an increased risk of breast cancer of 1.69 Hazard Ratio. The authors conclude" These findings suggest that the choice of the progestagen component in combined HRT is of importance regarding breast cancer risk; it could be preferable to use progesterone..." This study cleary shows that synthetic altered versions of progesterone, called progestins, increase the risk of breast cancer (HR 1.69). Alternatively, the use of bioidentical progesterone did NOT increase risk of breast cancer over that of control group. This information should be prominently posted on the Bioidentical Hormone Therapy Page. I would ask all editors reading this to weigh in on this topic and make a comment about it.

Fournier A, Berrino F, Clavel-Chapelon F. Unequal risks for breast cancer associated with different hormone replacement therapies: results from the E3N cohort study. Breast Cancer Res Treat. 2008;107(1):103–111.

UGAcodon (talk) 04:20, 1 July 2010 (UTC)

Interesting but it is not relevant to this article as it does not say that this difference is due to bioidentical versus synthetic. All this source is showing is the superiority of one compound over another. As stated above, this should be added to the progesterone article as well as the medroxyprogesterone article.--Literaturegeek | T@1k? 17:56, 1 July 2010 (UTC)

Synthetic Progestins are Dangerous for the Heart, Much worse compared to Bioidentical Progesterone

Evaluating Effect on Coronary Artery Disease

Bioidentical compared to Synthetic

The Rosamo study clearly shows that synthetic progestins are dangerous for post menopausal women with pre-existing heart disease, and that bioidentical progesterone is safer.

"In a blinded, randomized, crossover study, the effects of estrogen and progesterone were compared with estrogen and medroxyprogesterone (synthetic MPA) on exercise-induced myocardial ischemia in postmenopausal women with coronary artery disease. Women were treated with estradiol for 4 weeks and then randomized to receive either progesterone or MPA along with estradiol. After 10 days on the combined treatment, the patients underwent a treadmill test. Patients were then crossed over to the opposite treatment, and the treadmill exercise was repeated. Exercise time to myocardial ischemia was significantly increased in the progesterone group compared with the MPA group (P< 0.001)." Note: increased time is a good finding meaning the patients could walk on the treadmill longer. Shorter time means quicker onset of myocardial ischemia from known coronary artery disease. Quoted from Holtorf

reference: Rosano GM, Webb CM, Chierchia S, et al. Natural progesterone, but not medroxyprogesterone acetate, enhances the beneficial effect of estrogen on exercise-induced myocardial ischemia in postmenopausal women. J Am Coll Cardiol. 2000;36(7):2154–2159.

Abstract OBJECTIVES: We sought to compare the effects of estrogen/transvaginal progesterone gel with estrogen/medroxyprogesterone acetate (MPA) on exercise-induced myocardial ischemia in postmenopausal women with coronary artery disease or previous myocardial infarction, or both. BACKGROUND: Estrogen therapy beneficially affects exercise-induced myocardial ischemia in postmenopausal women; however, women with an intact uterus also take progestin to protect against uterine malignancies. The effects of combination estrogen/progestin therapy on myocardial ischemia are unknown. METHODS: Eighteen postmenopausal women (mean +/- SD age 59+/-7 years) were given 17-beta-estradiol in single-blinded manner for four weeks (1 mg/day for three weeks then 2 mg/day for one week). Estradiol (2 mg/day) was then continued, and the patients were randomized (double-blind) for 12 days to either transvaginal progesterone gel (90 mg on alternate days) and oral MPA placebo (10 mg/day), or vice versa. After another two weeks on estradiol alone, the patients crossed over to progestin treatment and repeated the protocol on the opposite treatment. Patients underwent treadmill exercise testing after each estradiol phase and at day 10 of each progestin phase. RESULTS: Exercise time to myocardial ischemia increased after the first estrogen phase as compared with baseline (mean difference with 95% confidence interval [CI]: 72 s [34 to 110], p = 0.001), and was increased by combination estradiol/progesterone therapy as compared with estradiol/MPA therapy (92 s [35 to 149], p = 0.001)). Two patients (11%) were withdrawn while taking estradiol/MPA owing to unstable angina. CONCLUSIONS: Combination estrogen/transvaginal progesterone gel increases exercise time to myocardial ischemia, as compared with estrogen/MPA. These results imply that the choice of progestin in women at higher cardiovascular risk requires careful consideration.

This information clearly belongs on the Bioidentical Hormone Page. Please comment. UGAcodon (talk) 04:39, 1 July 2010 (UTC)

It is not necessary to fill up the article talk page with abstracts that are available by PMID links. Please read WP:MEDRS in relation to primary sources and secondary reviews. SandyGeorgia (Talk) 09:22, 1 July 2010 (UTC)

(outdent) Same as above sections, this study is relevant to the progesterone article as well as the medroxyprogesterone article, not this article as the source does not say anything about bioidentical, all it is doing is showing a superiority of one chemical compound over another.--Literaturegeek | T@1k? 17:53, 1 July 2010 (UTC)

Various editors, nsuch as USER:WLU, have asked for medical literature sources which support the claim that bioidentical hormones are safer and more effective than synthetics. This article is one of many. What would you consider as a valid and usable source if this isn't it? And forgive my asking, since I am a fairly new user, please explain why this reference is not acceptable. And also please inform me would be acceptable. There are another 196 of these, so perhaps we need to establish some ground rules first. UGAcodon (talk) 20:50, 1 July 2010 (UTC)

WP:OR, WP:SYNTH, WP:SOAP, WP:ADVOCACY. WLU (t) (c) Wikipedia's rules:^simple/_complex 20:56, 1 July 2010 (UTC)

You need a recent secondary (review or meta analysis) peer reviewed source which specifically says that bioidentical compounds are superior to synthetic compounds. As I stated what this source and other sources say is that one compound is better in one aspect than another. They do NOT say that the reason for this is because it is bioidentical. To say that without a reference is a WP:SYNTH. You could look up synthetic drugs within the same drug class and see that one of them causes liver problems and another doesn't for example, so clearly different side effect profiles are not determined by whether a compound is "natural" or not.--Literaturegeek | T@1k? 21:38, 1 July 2010 (UTC)

Why do you not this content to progesterone article as well as the medroxyprogesterone articles?--Literaturegeek | T@1k? 21:38, 1 July 2010 (UTC)

Per WP:MEDRS, preference is for secondary sources - review articles. This is a primary source, detailing a single experiment, in addition to requiring synthesis to be used here. WLU (t) (c) Wikipedia's rules:^simple/_complex 10:47, 2 July 2010 (UTC)

Financial Disclosure - Conflict of Interest - Financial Ties to Drug Industry

ACOG, American College of Obstetrics and Gynecology

Financial Ties to the Synthetic Hormone Industry

By the way ACOG, American College of Obstetrics and Gynecology, and OB/Gyne Professors have financial ties to the synthetic hormone industry. Wyeth funds several annual awards for the American College of Obstetricians and Gynecologists(ACOG),] totaling approximately $29,000 per year. Wyeth is also a Friends of ACOG Participant, where Friends donate $3,000 per annum, and is a frequent exhibitor at ACOG’s Annual Clinical Meetings and sponsors ACOG’s annual “Resident Reporter” Program.Association of Professors of Obstetris and Gynecology Financial Disclosure Page

AACE

The following Pharmaceutical companies, some of which manufacture synthetic hormones, serve as members of the Corporate AACE Partnership. Their generous finanial support make possible many educational programs and activities that AACE provides for its members:

GlaxoSmithKline Member since 1996 www.gsk.com LifeScan, Inc.Member since 1994www.lifescan.com MannKind Corporation Member since 2010 www.mannkindcorp.com Medtronic MiniMed Member since 1995 www.minimed.com Merck & Co, Inc. Member since 1997 www.merck.com NeuroMetrix Member since 2007 www.neurometrix.com Novartis Pharmaceuticals Corporation Member since 1993 www.novartis.com Novo Nordisk Inc. Member since 1993 www.novomedlink.com Pfizer Inc. Member since 1993 www.pfizer.com PhRMA Member since 2006 www.phrma.org Procter & Gamble Pharmaceuticals Member since 1993 www.pgpharm.com Roche Diagnostics Corporation/Roche Insulin Delivery Systems Inc. Member since 1997 www.rocheusa.com sanofi aventis Member since 1994 www.sanofi-aventis.us Takeda Pharmaceuticals North America, Inc.

reference: (AACE Online).

Financial Disclosure - Conflict of Interest - Financial Ties to Drug Industry

This information is important and should appear on the Page. Your comments please? UGAcodon (talk) 12:14, 1 July 2010 (UTC)

Please read WP:OR, WP:TALK and stop filling the talk page with incorrectly formatted off-topic discussion. SandyGeorgia (Talk) 12:22, 1 July 2010 (UTC)

According to WP:TALK, the talk page intended for "Discussion of edits: The talk page is particularly useful to talk about edits. If one of your edits has been reverted, and you change it back again, it is good practice to leave an explanation on the talk page and a note in the edit summary that you have done so. The talk page is also the place to ask about another editor's changes. If someone queries one of your edits, make sure you reply with a full, helpful rationale. Make proposals: New proposals for the article can be put forward for discussion by other editors if you wish. Proposals might include changes to specific details, page moves, merges or making a section of a long article into a separate article. This exactly what my comments are accomplishing. I do not understand why you are saying this is off topic incorrectly formatted. This is exactly what the talk pages are for. To discuss edits and proposals. SandyGeorgia, please clarify your comment. Also I would ask you if your serve as a mediator.UGAcodon (talk) 14:24, 1 July 2010 (UTC)

No-one cares. Your assertion would require original research to draw any conclusions, and fails WP:REDFLAG. Wikipedia is not a forum to spin tales. If you have no explicit evidence from a reliable source stating BHRT is kept down because of conspiracy (and note, also, that drug companies make these drugs, thus failing on basic logic) then stop posting your opinions. WLU (t) (c) Wikipedia's rules:^simple/_complex 12:36, 1 July 2010 (UTC)

For WLU- People care about financial conflicts of interest by doctors and researchers, and failure to disclose this information has resulted in sever penalties for individuals and organizations. So yes, people do care about knowing conflicts of interst, and want researchers to follow a code medical ethics. That is what this is all about.

Let me ask you a question. Are you saying that the financial disclosure statements of a medical organization is not sufficient to serve as a source for a financial disclosure? If so, then what source would you accept as sufficent for this information? How would you go about including financial disclosure information?. This question is for all readers, and editors, I am requesting assistance. Any comments?

I do not believe there is any conspiracy, and have not used the word, and yet you continue to ascribe this reasoning to me. WHy? In order to falsely discredit my comment? Any editor can see that I am discussing financial disclosure which comes under the category of medical ethics.

Vendor relationships Studies show that doctors can be influenced by drug company inducements, including gifts and food.[22] Industry-sponsored Continuing Medical Education (CME) programs influence prescribing patterns.[23] Many patients surveyed in one study agreed that physician gifts from drug companies influence prescribing practices.[24] A growing movement among physicians is attempting to diminish the influence of pharmaceutical industry marketing upon medical practice, as evidenced by Stanford University's ban on drug company-sponsored lunches and gifts. Other academic institutions that have banned pharmaceutical industry-sponsored gifts and food include the University of Pennsylvania, and Yale University.[25] Quoted from Vendor relationships UGAcodon (talk) 14:35, 1 July 2010 (UTC)

Topic ban?

I'm all for calling for a topic ban if UGAcodon doesn't stop posting massive screeds and start reading policies. WLU (t) (c) Wikipedia's rules:^simple/_complex 12:45, 1 July 2010 (UTC)

== Requesting Dispute Resolution or Mediation ==

WLU has asked me for referenced material supporting the claim that bioidentical hormones are safer and more effectivbe than synthetics, and when I gave it to him, (see above), he then asks for a topic ban . Does this make sense? Rather than disuss the material I have posted, WLU has asked for a procerdural motion, a topic ban, to ban my comments. This is against Wiki tules and against the spirit and letter of what Wiki stands for. Wiki asks for consensus building, and it is obvious to any reader, that this is what I am trying to do. However, at this juncture, WLU refuses to participate in consensus building. I hope he changes his mind and starts to participate in the discussion process.

If not, then I am requesting a neutral third party to mediate this disoute.

I am requesting dispute resolution or mediation process. Apparently there is a dispute in terms of content here between UGAcodon and WLU. According to the rules, "Users may be banned as an outcome of the dispute resolution process, or by uninvolved administrators enforcing Arbitration Committee rulings."

My feeling is that WLU, an experienced user for years on WIkipedia is unjustly maintainng a choke hold on content on this page. Previous editors (see above) have made this very same observation and have asked for mediation. I agree with previous editors who have requestd that Mediation or Dispute Resulution with WLU. signed UGAcodon|UGAcodon]] (talk) 14:15, 1 July 2010 (UTC)

Has an SPI been filed yet? (the editor has admitted one accidental sock). I think WLUs edits are supported by WP:MEDRS while yours aren't. Verbal chat 14:24, 1 July 2010 (UTC)

I haven't filed one, and based on my history with previous POV-pushing editors I don't suspect sockpuppetry (but I could be wrong). I'm not bothering to waste further time on this - USAcodon obviously doesn't understand the P&G and shows little interest in learning, so I'm not bothering anymore. The page is edit protected, if the main BHRT is edited inappropriately, I may revisit but these talk page postings are obviously going nowhere. WLU (t) (c) Wikipedia's rules:^simple/_complex 14:32, 1 July 2010 (UTC)

To WLU- perhaps you, too, should re-read the page, P&G "editing a policy to support your own argument in an active discussion may be seen as gaming the system, especially if you do not disclose your involvement in the argument when making the edits." This is exactly what WLU is doing- "gaming the system". WLU is preventing editing of the medical literature references which support the claim of safety and efficay.

Again, I am requesting mediation and dispute resolution. Any help wopuld be greatly apreciated.UGAcodon (talk) 14:51, 1 July 2010 (UTC)

Mediation and/or Dispute Resolution Requested

I am requesting mediation and dispute resolution. Any help would be greatly apreciated.

UGAcodon (talk) 14:53, 1 July 2010 (UTC)

Presenting the Medical Evidence that Bioidentical Hormones are Safer and More Effective

If there are no further objections, I would like to continue presenting the peer reviewed medical literature which supports this claim. This is the intended purpose of the Talk Page , to discuss edits and proposals. UGAcodon (talk) 23:56, 1 July 2010 (UTC)

You are not permitted to synthesize a novel conclusion from tangential articles, and are doubly-prohibited from doing so in order to advocate for a specific viewpoint. If sources are missing, you can present them for review. If the article doesn't use the word "bioidentical", then please don't bother. Please just post a link or pubmed number, not a lengthy discussion. It is quite easy for an experienced editor to tell if a source is worthwhile or not, we don't need an explanation. WLU (t) (c) Wikipedia's rules:^simple/_complex 00:56, 2 July 2010 (UTC)

I would interpret your comment above means yes for Presenting the Medical Evidence that Bioidentical Hormones are Safer and More Effective. Is that correct? If so I will proceed with your permission of course. By the way, thanks for the links to the synthesize and [[WP:SOAP|. UGAcodon (talk) 01:56, 2 July 2010 (UTC)

non-working links

I noticed there are many non-working links in the reference area. This is one of them

37.^ a b c d Holtorf K (January 2009). "The bioidentical hormone debate: are bioidentical hormones (estradiol, estriol, and progesterone) safer or more efficacious than commonly used synthetic versions in hormone replacement therapy?" (pdf). Postgrad Med 121 (1): 73–85. doi:10.3810/pgm.2009.01.1949. PMID 19179815. http://www.holtorfmed.com/nss-folder/pdf/BHRT-PGM-2009.pdf.

Here is a working link to a pdf file: http://www.bobmehrpharmacies.com/images/_content/bio-identical/The%20Bioidentical%20Hormone%20Debate-%20Ken%20Holtorf%20MD.pdf

UGAcodon (talk) 10:22, 2 July 2010 (UTC)

Done. WLU (t) (c) Wikipedia's rules:^simple/_complex 10:45, 2 July 2010 (UTC)

Advocacy on medroxyprogesterone

The advocacy for BHRT has spread to a comparison of the benefits of progesterone on the medroxyprogesterone page. See talk:medroxyprogesterone for details, particularly the comparison section. WLU (t) (c) Wikipedia's rules:^simple/_complex 01:44, 6 July 2010 (UTC)

Reviewing talk:medroxyprogesterone, it appears that Progesterone (Prometrium) and Medroxyprogesterone are both FDA approved drugs, and not BHRT (defined as nonapproved compounded preparations). Statements appear to be neutral POV based on referenced medical studies. Needed are additional secondary sources coming to different conclusions that compare clinical profile of medroxyprogesterone with progesterone. Post them there on the talk page. UGAcodon (talk) 03:44, 6 July 2010 (UTC)