Jennifer Gunter & Eric Topol: Discuss Women’s Health and Recent Changes by FDA for MHT
episodePreviously titled “Jennifer Gunter & Eric Topol - Discuss Women’s Health and Recent Changes by FDA for MHT” — renamed by the publisher on Aug 3, 2026
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So let me introduce the person who I have just a real pleasure, privilege to interview today. I have a conversation with Dr. Jen Gunter. She is a gynecologist, OB-GYN in Kaiser, Northern California. And she's been in the US for a few decades. She has two New York Times bestselling books. That's a big accomplishment on top of her career. She has a blog. Vagenda, which is phenomenal on Substance. And she's out there as one of the great truth tellers in medicine, in particular, and this topic. She's been my go-to source for years. So welcome, Jen.
Thank you. Thank you so much for having me.
Oh, this is really a delight. And so I thought we'd start because just two weeks ago was a big day in the world of MHT. Uh, and this was when there was a wall street journal editorial by Marty McCary, the FDA commissioner, and also simultaneously a JAMA paper, um, And so I just was gonna start by reading, obviously it was a big deal to have the black box from 2003 taken away, but there were a couple of statements I wanted to get your reaction to. The first was in the liberation editorial that Marty wrote. He said, in my professional opinion, The demonization of hormone replacement therapy for perimenopausal women and the undercreation of its health benefits ranks among the greatest mistakes of modern medicine.
And then the other one in JAMA, which is kind of in the same category, With the exception of antibiotics and vaccines, there may be no medication in the modern world that can improve the health outcomes of older women on a population level more than hormone therapy. What did you think about that?
Well, I would say that Marty McCary is an incredible cherry picker and really displays a lack of breadth of knowledge of women's health care in general, or I would say even like health care in general. Because, you know, if the data were that clear, if it was that thing, you know... Why do all the professional societies who have people who do the research and who have combed through everything and disclosed their biases, why do they have different conclusions? And so I think that, yeah, I mean, that was just propaganda. And primarily, it seemed like it was based on the book chapter he wrote, which was, again, cherry-picked with data from low-quality studies and in the press release and in the JAMA article.
I mean, they referenced... you know, pre-WHI data. A 1980 clinical, not even a clinical trial, a 1980 case control study, a 1996 case control study from a retirement community in Southern California, and then a review article from like 1991 of observational data. So I'm like, dude, if that's what you think is like the state of the art, like let me introduce you to a lot more stuff.
Yeah.
Yeah, so speaking of stuff, there were two trials in WHI. One, of course, was with the combination. And then the other, smaller but still, I think, important, 10,700 women randomized to estrogen alone versus placebo. And they had very different results. whereby you say, hmm, is this the estrogen? Is it the hit of the dual hormone? How did you interpret all that?
Yeah, well, so as somebody who was practicing menopause care before the WHI and after the WHI and whose care really has not changed at all, I would say that the Women's Health Initiative gave us a lot of information. It was, I would say, misconstrued by the press at the beginning based on a bad press release, which is really ironic because that's exactly what McCary did, right? So he is doing exactly what he accused the WHI researchers of doing. And I would say that the WHI has given us a lot of data about two hormone regimens. So one, estrogens. conjugated equine estrogens, which is an oral form, and about conjugated equine estrogens with medroxyprogesterone acetate, which are regimens that we don't use much now.
And we generally favor transdermal therapy. So it's very difficult for us to make kind of class-based decisions on one formulation, right? But I would say that the way I would summarize the WHIF or everybody, is this is really great evidence that hormones aren't going to hurt you.
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