Dry eye, menopause and testosterone

Dry eye syndrome is absolutely awful. What's more, it is preventable when it is a result of untreated profound hypogonadism (menopause). Your doctor may tell you that it is not curable but that is because the studies on HRT have shown that it is made worse by taking post-menopausal hormones. Dry eye is made worse because the hormones that were used in these studies are nothing like the hormones that the gonads (ovaries) made before they failed. Instead, oral estrogens like Premarin were used. Because of the way the body digests estrogens in a pill the result is a lower testosterone level. So oral estrogens are also anti-testosterone pills. So from now on I am going to write oral E/anti-T when referring to any oral estrogen pills. A good example of how estrogen pills reduce testosterone levels is birth control pills. Birth control pills reduce acne and libido by reducing testosterone levels which is a direct result of the estrogen in the pills and how they are digested.

Dry eye has many causes and for menopausal women it is a result of reduced testosterone levels. As levels of testosterone fall, like for women with ovarian failure (the ovaries are a major source of testosterone) less tears are made and those tears are evaporated more rapidly than usual leaving the women with dry, gritty, red, painful eyes. It can be a debilitating condition that affects every aspect of a woman's life and career. So it makes sense that taking an oral E/anti T pill or standard HRT will only make it worse.

This is a perfect example of the vast difference between oral E/anti-T pills and transdermal estrogens (those you rub on your skin). One will make a terrible illness worse and the other will cure it. This is precisely the reason why the term HRT should no longer be used. The term HRT has become a term to manipulate the public into thinking every hormone combination provides the same benefit and that all hormones are alike and have the same effect if they have estrogen in the name.

Not all is lost, as progress is being made. Typically, artificial tears are used to treat dry eye syndrome but a better way is in clinical testing. A company is making eye drops with testosterone and progesterone, bio-identical, of course. Testosterone so the tears won't evaporate as quickly and progesterone to reduce the inflammation in the eye.

Progress should not stop there. All of your body should benefit from treatment. Ovarian failure may be something that we know will happen but that doesn't mean we should abandon our health when we are faced with an illness like profound hypogonadism.

Dry eye syndrome is a topic that makes me angry and sad. Years ago, before I started to receive treatment for profound hypogonadism I had the feeling of sand in my eyes, I couldn't walk past a fan without sharp pain in my eyes and my optometrist told me it was perfectly normal, not curable but something I would get used to. My doctor said this to me because of the studies he read in his journals. He was very surprised to see my dry eye syndrome resolve after I began taking appropriate gonadal (ovarian) replacement. I, like many other women on appropriate treatment, soon found this incurable illness completely resolved.

Hormones are important components of who we are as human beings. I work with women who are struggling to get appropriate treatment and they are met with the same answer, no. HRT will give you breast cancer, HRT will make dry eye worse, HRT is not a good option for menopause.

All of this is completely untrue. The gold standard in medicine is just that because it works. When an organ fails, the goal is to restore function in as similar a manner as possible. This standard is not applied to women and that is why standard HRT, which uses oral E/anti-T pills, doesn't work.

Here's to a better and healthier future for all women!