Estradiol has the most dramatic effects of any hormone. Its benefits include:✪ Helps the heart more than other hormones. ✪ Decreases the risks of cataracts, vaginal atrophy, and macular degeneration of the retina. ✪ Reduces the chances of stroke, diabetes, colon cancer, Alzheimer’s, memory problems, and osteoporosis.  ✪ Cures hot flashes and improves sexuality. From the Los Angeles Times, 1999: I could live without my husband, children, or cats. But I could never live without my beloved estrogen. Who should use estrogen and how much? Menopausal women and sometimes men transitioning to women are prescribed estrogen. Men with prostate cancer are also occasionally treated with it. Women in menopause should start at 1.5 milligrams in the morning, then increase to 2 to 2.5 milligrams. This brings blood levels up to about 70 pg/ml, which protects the heart and other organs. We believe this is safe because young, healthy women have estrogen levels in the hundreds during parts of their cycle. Premarin, the horse estrogen, was the first treatment for menopause. It has many beneficial effects, but it causes a slight increase in blood clotting. This makes it obsolete for long-term use. Estradiol, the primary bio-identical type, is safer. Every study on it—KEEPS, EPAT, WEST, CORA, DANISH, and ELITE (those academics love acronyms)—found no increase in blood clotting. Although the estradiol transdermal patch may provide the best relief of hot flashes and does not cause blood clots, it does not protect against heart disease. In contrast, both types of oral estrogen protect the heart. This was proven in many studies, including the CORA, ELITE, WEST, and DANISH. Since many medical authorities think that oral estradiol and oral Premarin are the same things with the same risks, they often recommend using the patch if there are concerns about blood clotting. Doctors should instead prescribe brand name, generic, or compounded oral estradiol. These are safe and protect against heart disease and stroke. Doctors are usually hesitant to prescribe oral estrogens for sick patients or those with heart risk factors such as smoking, obesity, or a family history. They use the patch for them if they recommend hormones at all. However, as I describe in the Be Careful Whom You Trust chapter, these are precisely the patients who need cardiac protection the most. In nearly every situation, their risk to reward ratio favors the oral type. We should accept the minor hazard of blood clotting to protect their hearts. Dr. Rouzier describes these issues in a well-referenced article.Surgeons and anesthesiologists have many responsibilities, and they rarely read the confusing estrogen studies closely. Since blood clots after surgery are such a hazard, most of them tell their patients to stop all replacement before surgery. Some gynecologists are adamant about this. Estradiol is available as generic, compounded, or patented varieties. Hormone doctors mostly recommend a compounding pharmacy's product because generics are less predictable and the patent type is too expensive if not paid for by insurance. Brand names from foreign sources made by major manufacturers are often affordable and of excellent quality. Estradiol patches such as Vivelle Dot (twice a week) or Climara (once a week) may relieve menopause symptoms better than the oral forms. The higher dose of .1 mg a day works best. To help the transdermal patch stick, patients scrub the area with alcohol before they apply it. The device sometimes causes skin irritation. SSupport the show