I am a physician, a husband, a father, and a grandfather. Many years ago, at the age of 43, my former wife was diagnosed with triple negative breast cancer and died at age 47. Our journey began the day before Valentine’s Day when her mammogram was scheduled. I had ordered flowers to be delivered the next day. What should have been a perfect Valentine’s Day instead was filled with phone calls to a surgeon and an oncologist regarding how to manage breast cancer. While outsiders might have felt sympathy, sadness, even pity, could they really understand the significance of those next four years? The path my wife and I took can truly be appreciated only by those who have traveled it.

Throughout our lifetime, our body continually is engaged in renewing itself. Every minute, somewhere in our bodies our aging cells pass on their “personality” by creating “daughter cells” that will replace them in location and function. Old cardiac cells produce identical but younger heart cells. Old muscle cells generate newer muscle cells and so on. These amazing events occur through a process called deoxyribonucleic acid (DNA) replication.

Our bodies efficiently make our natural hormones. Cholesterol from our diet is converted into a family of progesterones, which then become our androgens, such as testosterone, androstenedione, and dehydroepiandrosterone (DHEA). Androgens are important since they are the substrate for all of the estrogens in our body. The ovaries alone convert testosterone to estradiol (E2), the most powerful of the estrogens. Fat cells can convert androstenedione to other weaker estrogens, including estrone (E1), only 40% as active as estradiol, and estriol (E3), only 10% as active as estradiol. Since menopausal symptoms seem to arise with falling estrogen levels, estrogen has been sought as treatment of these symptoms.