Association between hormone replacement therapy and subsequent stroke: a meta-analysis

John Howard’s vigorous advocacy of dehydroepiandrosterone (DHEA) supplements does not seem to be impeded by actually testing for zinc deficiency. He chooses to ignore the evidence detailed in previous responses that hormonal contraceptives and HRT cause zinc deficiency and therefore more risk of headaches and strokes.

I have included biochemical studies co-authored by me during 35 years of analysing the mineral status in patients.1-3 In my experience, women with post-contraceptive (progestogen/oestrogen) amenorrheoa and anovulation usually regain normal ovarian function when zinc and magnesium and other essential nutrient deficiencies are repleted and become headaches-free.

Zinc deficiency has a direct action on steroidogenesis in gonads and in adrenal glands.4,5

In vitro acute stimulation by hCG on testicular tissue preparation obtained from marginal zinc deficient (MZD) rats resulted in much less androgen production (sum of androstenedione, testosterone, and androstanediol), 72.4%, p < .001, and a marked decrease in sperm counts (by 22.9%, p < .05) compared with controls compared with controls. Severe zinc deficient (SZD) showed the greatest decrease and were asospermic.6

In zinc-deficient rats, testosterone supplements inhibited endogenous synthesis of testosterone and caused further atrophy of testes.7

Dietary zinc restriction in normal young men significantly decreased serum testosterone concentrations after 20 weeks of zinc restriction (39.9 versus 10.6 nmol/L, p = 0.005). Zinc supplementation of marginally zinc- deficient normal elderly men for six months resulted in an increase in serum testosterone from 8.3 to 16.0 nmol/L (p = 0.02).8

It seems unethical to promote androgenic steroid DHEA supplements without ensuring that such use is not increasing zinc deficiency, an important cause of decreased endogenous steroid hormone production in the first place. I notice the massive internet advertising of DHEA supplements often includes exhortations to add unmonitored zinc supplements, which could cause copper deficiency.

1 Grant ECG. HRT causes thrombosis: HRT reduces DHEA by causing zinc deficiency.http://bmj.com/cgi/eletters/330/7487/342#96685, 13 Feb 20057

2 Grant ECG. Schizophrenics need zinc and not DHEA or testosterone supplements. http://bmj.com/cgi/eletters/330/7484/158#95066, 1 Feb 2005

3 Grant ECG. Does zinc deficiency in early foetal life cause schizophrenia? http://bmj.com/cgi/eletters/330/7484/158#95339, 3 Feb 2005

4 Flynn A, Pories WJ, Strain WH, Hill OA. Zinc deficiency with altered adrenocortical function and its relation to delayed healing. Lancet 1973; 1: 789-90.

5 Quarterman J. The effect of zinc deficiency on the activity of the adrenal glands. Proc Nutr Soc. 1972; 31: 74A-75A.

6 Hamdi SA, Nassif OI, Ardawi MS. Effect of marginal or severe dietary zinc deficiency on testicular development and functions of the rat. Arch Androl. 1997; 38(3):243-53.

7 Ai H, Chen J, He S. The effects of zinc deficiency and testosterone supplement on testosterone synthesis and skeletal muscle of rats. Wei Sheng Yan Jiu. 1997;26 (3):211-5.

8 Prasad AS, Mantzoros CS, Beck FW, Hess JW, Brewer GJ. Zinc status and serum testosterone levels of healthy adults. Nutrition 1996; 12: 344- 8.

Competing interests: None declared