The FDA told him no in 1992. They said giving estrogen to breast cancer survivors would put women at "unacceptable risk." He did the study anyway.

Dr. Avrum Bluming is a medical oncologist, emeritus clinical professor of medicine at USC, former senior investigator for the National Cancer Institute, and co-author of Estrogen Matters. He's been fighting estrogen fear for over 30 years long before it was safe or popular to do so.

His origin story starts with his wife. At 45, she developed breast cancer. The chemotherapy he gave her threw her into premature menopause. She couldn't sleep. She had hot flashes, night sweats, painful urination, palpitations. She couldn't remember what she'd read two pages back. And he an oncologist who had induced menopause in countless breast cancer patients—had been sympathetic but didn't know how to help them until he saw what was happening with his wife.

So he started a study in 1992 to give estrogen to breast cancer survivors. The FDA denied him twice. He did it anyway. By 1997, he presented his data to 8,500 oncologists from around the world. The National Cancer Institute said it was "irresponsible" to study this. The audience challenged them. Dr. Bluming's data showed no increased risk of recurrence.

We talk about the Women's Health Initiative, how the media misinterpreted the data, why the estrogen alone actually decreased breast cancer by 23% and breast cancer death by 40%, and why the box warning that just came off in November 2025 never should have been there in the first place. There are now 26 studies in the English literature on giving estrogen to breast cancer survivors. Only one showed increased risk. Four showed decreased risk. Twenty-five showed no difference.

Highlights:

• The FDA denial story: "Don't shoot me, I'm just the messenger".
• Why tamoxifen works better in premenopausal women (even though it raises estrogen 4-5x).
• The DCIS patient whose oncologist changed their tune after the box warning came off.
• The FDA committee member who asked "most of your patients are going to die anyway, aren't they?"showing how little some understood about breast cancer survival.
• When he asked if the FDA actually read his research before denying it: "Don't shoot me, I'm just the messenger"—a quote that reveals everything.
• What actually causes breast cancer (spoiler: nobody knows).

If you've been denied estrogen or hormone therapy, share this episode with your provider. Share Estrogen Matters with its 555 references. Share the data. At this point, there's overwhelming evidence showing HRT is safe and beneficial for most women. But some clinicians are still using outdated information from 2002. You deserve care based on current science, not decades-old fear.

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of your time, but I do appreciate you finally getting you on my podcast. So thank you so much. Okay. Hi everyone. It's Dr. Samina Rahman, Gyno Girl. Welcome back to another episode of Gyno Girl Presents Sex, Drugs and Hormones. I'm Dr. Samina Rahman, board certified gynecologist, sexual medicine and menopause expert in downtown Chicago. Today, I'm super excited for this podcast. It's been in the making for a while.

We're gonna talk about estrogen fear and how the narrative of has really shaped the fear around estrogen has shaped women's health narrative for the last 20 plus years. And I'm super excited to have my guest on today, Dr. Avron Blooming. He's a medical oncologist. He's co-author of Estrogen Matters. And basically he's sort of the OG when it comes to a lot of breast cancer and everything that we know about it.

But he is an emeritus and clinical professor of medicine at the University of Southern California, a former senior investigator for the National Cancer Institute and master of the American College of Physicians, which is actually an honor that's really bestowed upon very few internists. I think less than 500, is that right, Dr. Blum?

That 500 out of 110,000.

That's amazing. Well, welcome, Dr. Blooming to my podcast. Thanks so much for coming on.

It's a pleasure to be here.

I was so happy to have met you last year at Ishwish when you came and you talked about estrogen and breast cancer. And so I really want to dive right into some of this because you're such a wealth of information. think that you've really, we always say that estrogen as a hormone has like really, has had really bad publicity for the last two decades. And so I feel like you were the new publicist that estrogen needed to defy some of the stuff that's been happening. But before I start, because you know, my

My Instagram handle is gyno girl, so I love comics and I love superheroes. I want to hear your backstory. What's your origin story for all the listeners today?

Well, the first important backstory is my wife at age 45 had breast cancer. And we treated it locally and I gave her chemotherapy to help prevent it coming back. Now she was 45, she's currently 82. So the story is going along very well.

Yes.

But the chemotherapy that I gave her precipitated a premature menopause in her with many of the symptoms that I'm sure many of the people listening are aware of.

She had hot flushes, she had night sweats, she had trouble sleeping, she had trouble falling asleep, trouble staying asleep. She had painful urination. She had palpitations and I took her to cardiologists and cardiologists I know and respect had no idea what was causing the palpitations. And because the workup was normal, they told her not to worry about it without explaining what was going on.

Wow.

Now menopause, premature menopause has been a fixture of my practice. 60 % of my oncology practice was based on patients with breast cancer and I induced many such situations. And when women would complain to me as they did about the symptoms of menopause, my...

reaction was, but it's very likely that we've cured your breast cancer. That breast cancer has now better than a 92 % cure rate, newly diagnosed breast cancer. And while I was sympathetic, there was really nothing I was offering. My wife didn't complain to me about any of her symptoms. I wasn't aware of many of them.

All right.

And then she found that she was unable to remember what she had read in a book two pages back. Or when we went to a symphony performance, she didn't recall the symphony that she had known very well. And those symptoms were intolerable. And that's what triggered.

my saying, wait a minute, is there something that can be done? I ought to listen more carefully to my patients complaints and see if I can help them. And what I found is that the negative feelings about estrogen and breast cancer, even back then, this is over 40 years ago, were not really based in hard data. And when I reviewed the hard data, I found that,

estrogen did not appear to cause breast cancer. And women who were diagnosed with breast cancer, even estrogen receptor positive breast cancer, did not have an absolute contraindication to starting hormone replacement therapy. And what I did rather than just give my wife estrogen is I started a study, which is now one of the 26 studies in the English literature.

of allowing women with a history of breast cancer to go on hormone replacement therapy.

And I had to get informed consent so that patients knew the data. And I wrote to the Food and Drug Administration, the FDA, and I asked them for consent, for approval. And what they said to me is, there are doctors who are already doing this. So if you call it treatment, you don't need our approval.

but if you're going to call it a study, you do need our approval. And I said, I'm calling it a study. And they said, well, send us information. And I sent them extensively referenced information about why I wanted to do the study. This was back in 1992. And they wrote me back about three weeks later.

saying we're putting a hold on your study because we believe that you are putting women at an unacceptable risk of recurrence. And so I said to the man who spoke to me over the phone, a doctor, did anybody read what I sent?

And he said to me, and I remember this so clearly because I've heard it many times since, he said, don't shoot me, I'm just the messenger. And so I said, well, please put me in touch with someone who can make a decision. And instead of doing that, I was invited to an FDA hearing in Maryland, which I went to. I was there.

Phil DeSaya was there, who was the head of OBGYN at the UC San Diego and is one of the leading pioneers in this movement. And so was Will Fudian, who at the time was the president of what was called the North American Manapar Society.

And so I flew home with one of the doctors who was with me and he said, you know, they didn't give us permission. And I said, it certainly sounded like permission. He said, just wait. And the way we had proposed it is that in my practice, I would do a pilot study, a single arm pilot study on 300 women to make sure that we weren't pouring kerosene on a fire.

And assuming that it passed that test, then UC Irvine would do a study of 5,000 women that would be prospectively double-blinded and randomized. And we thought that was reasonable. And about a month after the hearing, I started the study the night I returned from Maryland. But a month later,

Right.

Mm.

I got a letter from the FDA saying, even though we approved your study in principle, we don't agree to the single arm part of the study. We will only approve the prospective 5,000 person double blind randomized study. And I thought, well, that's irresponsible. Let's make sure we're not doing something harmful first.

technologies.

Yeah.

Right, right.

And this time I flew back to the FDA, the first trip they paid for, the second trip I paid for, and they reorganized the committee just to hear me, which I thought was very polite. And as I was sitting waiting for the meeting to start, these were all physicians. One female doctor, member of the commission, said to me, well,

most of your patients are going to die anyway, aren't they? So what's the difference? And I said, aren't you aware of the high curative breast cancer now? And she said, I guess I ought to read about that. Well, yes. And you should have read about it before this meeting. And a man on the committee, also a physician, said, why do you want to do this study? Why don't you do another study? And I said, I am doing other studies, but

I'm sorry.

This is an important study. And they convened the meeting. I spoke all morning. And at the end of the meeting, the doctors said to me, we don't vote to give you approval to do this. We think in spite of everything you've said to us, you're putting women at an unacceptable risk. Now this was based not on data. This was based on gut feeling or whatever.

That's my feeling, right? Right. Right.

And so I said to the committee, what would happen if I just went back and did the study anyway, which by the way, I've started a month and a half ago. And the chairman said to me, Dr. Blooming, we can't tell you how to practice medicine. Perfect. I went back home. I continued the study.

Well.

And what he said is we at the National Cancer Institute feel it is irresponsible to study administering hormone therapy to women with a history of breast cancer. And I figured being from Southern California.

I will be stoned before I even have a chance to present my data. But I wasn't stoned. In fact, what happened is the doctor giving the NCI point of view was challenged. What data are you basing this on? Why are you saying this? And this was 8,500 doctors from around the world. And his response was, wait for it. Don't shoot me. I'm just the messenger.

Yeah.

I could test that statement. And then I got up and presented my data and here were the leading oncologists from around the world. And every comment after my presentation was positive, everyone. And so when I returned to California,

Do you mind reviewing what the data showed just so the listeners know?

the other data showed that there was no increased risk of recurrence among women who got the cancer. This wasn't a double blind study, but when we compared stage by stage prognostic factor by prognostic factor, there was no increased risk of recurrence. Some women do recur, but there was no increased risk of recurrence and the women felt so much better. I don't have to tell you, you understand that.

You have our free-

That was 1997. So when in 2002, the Women's Health Initiative said we are stopping this study because of the increased risk of breast cancer, it was like a recurring nightmare. That's a long-winded answer, but that's the motivation.

Recurring nightmare. Yeah, totally.

Well, that brings us into the WGI, because I want to talk about that a little bit as well as the FDA removal of the boxed warning. But when the WGI came out, I actually just finished my first year internship in OB-GYN. And we had Journal Club with a GYN oncologist every week. so we had only heard the headline. So then we reviewed the study. And at the end of it, we're like, it's not that bad. I don't know why they made such a big deal out of

And she's like, that's why you have to know statistics. That's why you have to know what relative risk is. And then when I rotated with an REI, he was very much considered fringe because he kept his patients on hormones. He's like, my patients love their hormones. I just don't believe it's as big of a risk as they say. So I came from it from an angle of like, well, it looked like it was the progestin that was the real culprit here.

tell us how you handled it as an oncologist who was then treating women in, I'm assuming some of the women still with hormones at the time and what you did as a result. Or maybe you want to review, I mean, I think most of my listeners have heard me talk about the WHI a lot, but just a quick review of the summary of it.

Sure, but let me just go back a little. When you said, and so now we believe that it wasn't the estrogen, which by the way, the WHI found.

decreases, this is among women who never had breast cancer, but it decreases the risk of breast cancer by 23%. Most importantly, it decreases the risk of breast cancer death by 40%. That's from the WHI, which is the leading voice against hormone replacement therapy at the question time. And rather than say we were wrong,

Right.

What was said is, well, it's clearly not the estrogen, nevermind that the black label warning, black box warning that was just taken off all estrogen containing products was directed against estrogen based on no data, but thank goodness that's been removed. They said, well, it must be the progesterone.

when I...

And there are articles that go through the literature and say, you know, in this experimental study, in this clinical study, there might be this very small increase. And the words there might be is a very important thing to notice because there is no consistent data that say that it's progesterone. More than that,

Yeah.

The progesterone that was used in the Women's Health Initiative was Magestrol acetate, MGA. And people say, well, that's a progestin, it's a synthesized progesterone. That was to blame. Well, no. Two things. First, in the literature,

Yeah.

There are reviews of literature that show that when Magestral acetate is used against Tamoxifen in a randomized study among women who have measurable breast cancer, it is at least as effective as Tamoxifen. It doesn't cause the tumor to grow more. It actually shrinks the tumor more.

And the Women's Health Initiative, and I've written quite a few papers on this, that says, well, it's not the estrogen alone, it's only the estrogen progestin arm, that is simply incorrect based on their own data. It is incorrect because even if it were valid, and it's not valid,

us.

it would mean one extra case of breast cancer, not that there would be an increased risk of breast cancer death. They never found that. But there'd be one increased case of breast cancer per thousand women taking it per year. And even that is not valid because

What they did is they did a study for heart disease, not a study for breast cancer. That was the goal of the study. And if you're going to do a prospective double-blind study,

us and God bless.

you want to be sure that the risk factors are adjusted so that both arms of the study have the same risk of developing heart disease. And they did that. And what they found is for women who were within 10 years of their last menstrual period, they actually had up to a 50 % decreased risk of heart disease.

Washington, they said it made no difference. Well, it made a huge difference. The data that they report in that article went from being minimally statistically significant to not statistically significant. Yes.

Yeah, that's amazing. Yeah, I think that those nuances and interpretations oftentimes get missed. Can I ask you what some of the, know, obviously when you went to Ishwish, it was, we all loved your, what you had said. And there are a lot of people that there's obviously, you know, this is heated topic, right? People find estrogen and breast cancer very controversial still. And so, you know, there are always some of the

people that will disagree and look at the data differently. Do you think that because a lot of people contend that because the WHO used conjugated equine estrogens, so it wasn't a pure form of estradiol, that that cannot be extrapolated to all estrogens. Like you can't say that, now we're using more transdermal estradiol. And so a lot of clinicians will contend that we can't actually

extrapolate what conjugated equine estrogen does, because some people believe that that is the type of estrogens within that are the ones that actually have some sort of difference. They call them NEST. They're similar to the serums, and they act differently on different tissues. And so there are some doctors that contend that because the premarin is kind of more, some of the estrogens within it are like,

you know, a little selective and they might decrease receptivity at the breast that you can't actually extrapolate that with to estradiol, which is what's used nowadays.

Well, I think the reason that thinking came up was a marketing reason. What people said, misinterpreting the Women's Health Initiative, remember we said that the arm, which was only Premarin, that's what they used, which for those of your listeners, the one or two who don't know, is an acronym for Pregnant Mare Urine.

which sounds like a disgusting thing to take. In fact, had one doctor say to me, you know, it tastes like urine. So I put the pill in my mouth and bit it. didn't swallow it, but it doesn't taste like urine. It's a pill. Right. But that decreased the risk of breast cancer. Let's remember that. And there are at least, as you point out, 10 different forms of estrogen in premarin.

All right.

It's a pill, yeah. Right.

only one of which is estradiol, which is the estrogen that is the highest concentrated estrogen, as you know, in the circulation of premenopausal women. The public was informed that hormone replacement therapy increases the risk of breast cancer after the Women's Health Initiative.

First, it's an easy thing to accept even though it is wrong. And hormone replacement therapy, well, the first thing they replaced was estrogen. As you point out, even though the form of estrogen in the Women's Health Initiative was shown to be significantly beneficial, it was replaced by what was called bioidentical estrogen.

Well, that sounds very nice. Bioidentics, that's gotta be good. Well, as you pointed out, that isn't the estrogen that was administered in the Women's Health Initiative. It might not be as effective in preventing breast cancer. And the truth is, I don't know, but the studies that have been done,

Mm-hmm. Yeah. All right.

have not all been done with estrogen, with Premarin, they've been done with a variety of different estrogens. And I've reviewed the literature and published this in 2022. There are 26 studies in the English medical literature studying the administration of hormone replacement therapy to breast cancer survivors.

Yes.

And there are different forms of estrogen used in those studies. And there was only one of the 26 that showed an increased risk of breast cancer development, not an increased risk of breast cancer death, not an increased risk of metastatic breast cancer recurrence, an increased risk of breast cancer either in the same breast that was treated or in the contralateral breast.

and 25 studies showed no increased risk of recurrence without getting too technical. I've challenged and others have challenged that one studies that showed the increased risk in the local breast or the contralateral breast and it is challengeable and probably.

should not be taken as gospel. Four of the studies showed a decreased risk of breast cancer development, and that was using different forms of estrogen. So the data we have suggests that it's estrogen, and different forms don't seem to be different, but I don't have a specific answer to the different forms because I don't think that's exactly right.

We haven't done this. Great. Yeah, I'll put it in the link. Actually, it was a great article. Tis but a scratch, right? That was the one you're talking about. Or Tis but a bitch.

No, the Tis but a Scratch was published last year. The article, this was published in the Cancer Journal, it's called Hormone Replacement Therapy After Breast Cancer Colon, It Is Time. Which doesn't mean it should be given with abandon, but talk to the patient.

last year.

after.

It has time, that's the

Give it only if you are an informed physician and the patient is an informed patient, recognizing that we don't have absolute answers, but it's certainly not correct to simply forbid it based on ignorance.

Right. And I think that's kind of the point of what we all try to talk about in menopause, that it should really be precision medicine, right? We should really look at the person in front of you, their risks, what they're suffering with, and how we need to better their quality of life and potentially their health span. Yeah. The other thing I wanted to talk about with you is with regard to, hold on, let just make sure. When you actually decided to write this book,

Absolutely.

What, obviously you had done the research, you're an oncologist who has been treating breast cancer for decades. And so what actually pushed you into saying like, it's time for me to let the general public know that they deserve more nuanced care.

The book first was written both for the general public so that it's written in easy to understand language, but it was also written for the medical community so that everything we say in the book is referenced. There are 555 references through the eight chapters of the book. So when you talk to your doctor about it, the doctor can say,

That's right.

Are you going to take the word of a Southern California oncologist over me? The answer is no, but these are pretty convincing data that go back in history and up to the present time. And doctor, what I'd like you to do is read the book and give me your opinion on what this book is saying. The impetus for the book, this wasn't the book I was writing.

Yeah.

The book I started to write is a book about what is cancer and what causes cancer. And this was one chapter in the book. And I was writing the book with Dr. Carol Tavris. Dr. Tavris is a PhD social psychologist.

She is very smart, but not full of herself. She speaks in such an easy to understand and relate to language, and she has a sense of humor. And as we were working on that first book, she said when we came to this chapter, you know, this should be a book of its own. And it became a book of its own. And I still haven't finished that first book, but it's...

Yes.

That's how the book happened.

That's awesome. Well, I mean, speaking of your first book, obviously we don't have the answer to this, but you've been treating cancer and breast cancer specifically for decades at this point. When people ask you what causes breast cancer, what do you tell them?

I don't know.

and you're someone that's been treating it for decades and decades.

Well, when I say I don't know, there's clearly humility in saying that. I'm a reasonable expert acknowledged in this. But there's a certain arrogance too, because when I say I don't know, I know that nobody knows. I'm just willing to say I don't know, which is why I...

There's not one thing.

Nobody knows.

Right.

I look for data and try to make decisions based on the best of valuable data that I can amass and I read and study every day.

Do you, and so the follow-up question then is because, you know, people always assume that estrogen causes breast cancer, right? Which we've already obviously discussed. Why is so much of what we do then to treat cancers, I mean, I know, but I just want you to talk to them about like, is it, what is the mindset of like removing ovaries, you know, reducing your estrogen depletion to a point?

if it's not even potentially a cause of

That is the core question. And I will try to answer it as best I can with limited information, recognizing that I don't claim to have the final answer. Cancer cells appear to take advantage of a local environment that allows them to develop. And environment is very important. It's not the cell.

that we have to destroy. It's the environment that we have to change in order to allow the cell to either die off or mature into a normal cell. And by the way, there are many studies that show that you can take cancer cells of a variety of different types, including breast, and put them in a different environment.

and they don't die, the cancer cells mature into normal cells. And it's the environment we have to target. If the environment is conducive to the development of breast cancer, then what we try to do is change the environment.

If the environment is an environment that is rich in estrogen, then the simplest thing to do is to change the environment by removing estrogen. Tamoxifen was one of the first, the first actual hormonal manipulations that was introduced into the treatment of breast cancer.

And tamoxifen, which is a pill, how wonderful, it's not chemotherapy, was introduced and called an estrogen blocker. And people would say, well, wait, if I'm blocking estrogen, how come that's working and you're allowing me to take estrogen? Well, tamoxifen is not an estrogen blocker.

it works in at least 10 different ways. And we now know that it works largely independent of its effect taking up the place on an estrogen receptor and diminishing estrogen's ability to attach to the receptor. Let me mention first that before we had tamoxifen,

The first hormonal treatment for estrogen, for breast cancer was estrogen, high dose estrogen, which was associated with a 44 % decrease in the measurable breast cancer. Tamoxifen, which works in many different ways, we were told, cannot be given to premenopausal women because when tamoxifen is given to premenopausal women,

through.

the level of circulating estrogen can go up four or five fold. And so when tamoxifen first came out, and I was in practice at that time, we were told we can only treat postmenopausal women with tamoxifen. It turns out tamoxifen, even though it dramatically increases the risk of circulating estrogen,

yet it often controls breast cancer when it's measured. Tamoxifen is more effective when administered to premenopausal women than to postmenopausal women. And now we give it only to premenopausal women. Craig Jordan, Vernon Craig Jordan, who is the doctor responsible for introducing tamoxifen.

has given talks around the world saying, you know what happens is after a while, if measurable breast cancer has responded to tamoxifen, at some point it stops. And when it stops, do you know what works and causes the breast cancer to further shrink? Low dose estrogen.

It's the environment we have to focus on and we haven't been doing that enough.

Right. So that's so interesting because, and it probably has everything to do with the receptor status in the breast and how the estrogens and the tamoxifen sort of respond, right? Like in terms of if you saturate the receptors with tamoxifen, are you then like gonna be more...

I'd love to have a simple answer like that. And the problem is simple answers, at least so far, don't seem to work. know, the estrogen receptor alone, without estrogen.

Yeah.

Right.

Amazing.

So you think that's gonna be sort of the next wave of what people may, it already, okay, Yeah, okay, amazing. And so like what kind of, in terms of looking at patients that you've treated with breast cancer, are there, do you wanna talk about some of the lifestyle modifications that women can do that, you know, if there's so much fear around estrogen, which, you know, is a prescription that we have to give people.

But I always talk to patients about their risk assessment. Like, let's assess your risks and let's see what you're doing in your life that can decrease your risks if you're that sort of concerned about it based on family history or other things.

Thank you.

Alright.

That was it.

There's some.

That's true. Mm-hmm, for sure.

Absolutely. What about when people talk about alcohol and obviously serious smoking, but alcohol as a risk that is just as much as hormones for some people.

Sorry.

Sure.

Sure.

Absolutely. I think that's what's really important. I want to talk also about the FDA removing the boxed warning off of estrogen last month, which was a huge win. think that some people think that it just came out of nowhere, but this is decades in the making of trying to get it off because it shouldn't have been there in the first place. How do you think this is going to impact, you know, or do think it's going to impact access? you think that?

this is going to swing a lot of people like, it's going to swing the pendulum the other way. And, you know, everyone's going to get it and we're going to see all this increases and other things. What is your thoughts on that?

I thought you were gonna say a lot.

I know. I know.

Cool, right?

instead.

Yeah, it's so true.

Now.

It's insane, actually. And I think so much is amplified now because there's so much on social media and people are talking. patients get confused because different clinicians look like they're almost bickering online, where it's like everyone has sort of what they believe to be true based on their interpretation of the data. And so think it's very good. I'm glad that you said that because I feel like people listening sometimes even come to me very confused.

He was like, well, is that true? I heard so-and-so say this, but I heard so-and-so say this. And I was like, let's focus on your symptoms and let's talk about what we know and what we don't know and then how we can help you. Because I think at the end of the day, we all just want to do that, right? We want to be the best clinicians that we can.

to the misform ability, yeah. mean, you know, I don't practice obstetrics anymore, but you know, I do think that OB-GYNs get vilified a lot because we don't have control over every pregnancy outcome, but we are held accountable for every pregnancy outcome. And some things you just can't control, right? Things happen, they go wrong. We don't understand all the science and we can only do so much. And so I feel like, you know,

Again, very few of us go into this profession because we are villains, you know, where most of us really want to help people. I think, you know, saying that is very

us.

Right.

Yes.

to you.

printed out.

Bye.

Absolutely. Yeah, it's a wonderful informed consent form for both clinicians and patients. A patient can print it out and bring it to the office. The clinicians can tailor it to their own office. But I do think that's true. And I think especially because OBGYNs have traditionally been the ones that were thought to be the ones that should be prescribing hormones. And we are the most likely to get sued for obstetrics related things, right? Because we have such a high malpractice. I do think the fear of litigation

prevents and precludes a lot of them from really looking at this and trying to.

Absolutely, absolutely. So I think that's great reason. Dr. Blumey, I want to be cognizant of your time. I love your book. think it's made such a difference in not only the lives of probably the patients reading it, but truly in clinicians. Like I do think that there are some clinicians that, you know, there's so much I learned in it too, even though I had had an initial interpretation of the WHI, like getting into the nitty gritty, like really understanding from oncologist perspective. I feel like that's really important too, that you're someone that's

You put people into menopause year after year for so long. And then you realize you yourself didn't even realize what was happening for those patients. I think that you're doing so much great work. And I really appreciate that as another doctor that I've been able to really use this. I have patients coming in with this book every day like, I've read estrogen matters. And I'm like, yes, like high five, let's talk about it. Because I think that it really does empower people to.

you know, take the best care of their.

Mm.

Nice.

Amazing.

That was neat.

That's amazing. That's amazing. That's amazing. I have to tell you a story though. Like there was a patient recently, this is just to talk about what removal of the boxed warning meant for this clinician. I had a patient who had a history of DCIS and had was suffering horribly with all the worst because she was going through menopause herself after her treatment. And she went to her surgeon, she went to her clinicians, nobody wanted to give her any estrogen. So.

We spoke about it and we did treat her, and she was doing much better on her symptoms. And then she went back to her oncologist, and this was like two weeks after the boxed warning came off. And they were like, I'm so glad you're on estrogen. And the months before, they were like, hard stop, we will not give this to you. And she goes, well, what's changed? And she goes, well, now we know it's safer than it ever was, or something like that. Like, I don't think she had read the data. Most people don't have time.

maybe to get deep into it. But that person, that oncologist was finally like, I'm so glad you're on estrogen and your life is better. Isn't that amazing? mean, we'll accept it. The fact that the barrier was big enough for a lot of clinicians that they don't even go there. So one small step at a time.

Okay, so I always end my podcast with my husband jokes that like my listeners are vagilantes. So what's your hot take or your vagilante verdict that you listeners to remember or to take with.

going.

sure.

Wonder.

amazing, I'm gonna go read it myself. That's awesome. Well, thank you so much, Dr. Blooming. This has been great. I can't wait for it to go live. I'll let you know, I'll tag estrogen matters when it is. Thanks for listening, everyone. This is Dr. Smita Rahman, Gyno Girl. Thanks for listening to another episode of Gyno Girl Presents Sex, Drugs, and Hormones. I'm Dr. Smita Rahman. Remember, I'm here to educate so you can advocate for yourself. Please join me next week.