Healthcare reform and hypogonadism - Part 1

A little background first, then on to healthcare reform...

Treatment of profound hypogonadism uses hormone products to replace the hormones of the ovaries (female gonads) with the same hormones, in the same levels, just as if the ovaries were still working. The 'HRT' used in clinical trials like the Women's Health Initiative creates hormone levels that are never seen in healthy women during their entire lifetime and in no way even remotely resembles appropriate ovarian hormone levels as completely unnatural and unhealthy levels of hormones are created. It is inaccurate and misleading to label what was used in these trials as 'HRT'. Intentionally using misleading terminology is an abuse of the public's trust by the National Institutes of Health (NIH), the sponsor of the Women's Health Initiative.

Now on to the blog...

A few years ago I was asked to give a lecture on how much money the state of Washington would save if profound hypogonadism (name for the illness caused by menopause) was effectively treated in women. The answer was $330 million per year in the state of Washington alone. Multiply those savings for 50 states and you will begin to see the financial impact that appropriate treatment of profound hypogonadism in women can have.

The reason for the savings was quite clear. Osteoporosis would be virtually eradicated and as a bonus the occurrence of breast cancer would be lowered by at least 80%. The reduction in both osteoporosis and breast cancer was due to the effective treatment of the illness that causes both of these diseases, profound hypogonadism.

These savings were just for women. Preventing osteoporosis in men by treating hypogonadism would also add significant savings. The bonus for men would be a significant decrease in prostate disease. Yes, you guessed it. Chronic hypogonadism is the leading cause of prostate disease not aging.

So if the occurrence of expensive, devastating diseases can be significantly reduced and the treatment is at our fingertips why isn't it used?

That is a very good question with a straightforward answer.

Preventing disease means preventing income, status, and profits.

The healthcare industry knows only too well that when devastating diseases are prevented lots of money is saved. For instance, when diabetes or hypothyroidism are well controlled a person is much healthier. Healthier people translate into lower medical costs. Only when the cost of an illness exceeds the amount collected through premiums is a push toward prevention made. Once the premiums cover the cost of healthcare, the insurance industry has no incentive to prevent disease.

Also, the pharmaceutical industry has even less incentive to prevent disease. The pharmaceutical industry then has the opportunity to provide long term drug treatment for chronic illnesses that would not exist if the underlying illness were adequately treated. Osteoporosis is the best and most profitable example. Here is an illness that is 100% preventable and yet no one comes forward to point this out. Billions of dollars are spent on the treatment of a completely preventable illness. There are other illnesses like acid reflux or GERD, depression, high blood pressure, and breast cancer which are all a result of chronic profound hypogonadism. If these illnesses were to be significantly reduced what do you think would happen to the gravy train that the pharmaceutical companies are on now? There is absolutely no incentive for the drug companies to come up with replacement regimens that work, particularly for women. There is simply too much money to be made in keeping women sick for as long as possible. Does it make sense to you now why treatment for profound hypogonadism is not even acknowledged in women?

From a medical standpoint there is no reason not to prevent disease because the body does not change how it works. When something as devastating as organ failure occurs (i.e. ovarian failure), no matter the age of the person, it is completely understandable that disease ensues. Disease strikes because the body is not getting what it needs so it does the only thing it can do, it gets sick.

Many people think that Mother Nature provided ovarian failure and the loss of fertility as a way of protecting women as they age. There are abundant theories that are supposed to help us accept the physical and emotional harshness of profound hypogonadism.

To what end? When the average life span was 45 years ovarian function lasted until a woman's last day. From a dollars and cents point of view ovarian failure is not protective at all. Women outlive their supply of eggs and when they are exhausted the body, mind, and society suffers terribly. The medical community does nothing or worse by primarily only treating men and refusing to treat women for the identical illness. I don't think Mother Nature is trying to protect women. I think that human kind is failing to protect women when it fails to offer treatment for a treatable illness like profound hypogonadism.

Next time we will look at the numbers. The number of people who get sick and the number of doctors that are then required to treat them.
9/3/2009 8:27:12 AM
Beth Rosenshein
Written by Beth Rosenshein
Beth Rosenshein is an electrical/bio-medical engineer and is very familiar with medical research. She holds two United States patents, one for a unique design of a vaginal speculum, and one for a clever urinary collection device specifically designed for women. Beth discovered and documented an important drug interaction...
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Dear Sherri, The best thing you can do is to call menopause by its real name, profound hypogonadism. The loss of the gonadal hormones is a profound loss to a woman’s overall health and well-being. You can empower other women to seek and receive effective treatment for this very treatable illness. The more women know the better and healthier decisions they can make for themselves. You’ll not only be empowering women to be able to receive treatment but you’ll be giving doctors an opportunity to treat this very real illness. So tell your friends, your family, and your doctors that it should be an acceptable choice to not have to live with the ill effects of ovarian failure. The medications are available and there should be no stigma attached to using them. I thank you for wanting to empower women and their doctors. Beth
Posted by Beth Rosenshein
Dear CarolAnne11, You are absolutely right that ovarian hormones are essential to a woman’s continued well-being. Following the loss of so many hormones (menopause) the body can no longer maintain its health and many illnesses begin to appear, whether they are felt or not. Every organ and organ system in the body is adversely affected, the nervous system, the kidneys, liver, esophagus, bladder, genitals, etc. Women are denied the possibility of healthier aging when basic facts about hormone replacement therapy are manipulated into showing that it is not a healthy choice for the treatment of profound hypogonadism. Women and their doctors deserve the opportunity to know that profound hypogonadism is a real illness and that it is treatable. When this becomes a reality then the world will be a better place for women. Thanks, Beth
Posted by Beth Rosenshein
Thanks for the info about birth control pills. My experience: I was on a strong BCP for about 8 years due to endometriosis and ovarian cyst. I attribute this to developing fibromylagia [including awful TMJ] in my later 30s. this hit me like a brick wall -- debilitating TMJ and muscle soreness that wore me down for several years. I began going to a dr. [after many visits with chiros, physical therapists, and other drs] in my early 40s who treated with alternative therapies and medicines. I was put on strong vitamins [along with all the testing the dr. did, my minerals turned up chronically low, for 3-4 years -- very low magnesium and low calcium in particular] At one point I was taking 8 magnesium tablets a day in an attempt to raise these ---- however, I think I would have benefited from perhaps low doses of estrogen [perhaps also others such as testosterone] I have read that estrogen affects uptake of magnesium [and perhaps also calcium] Since I'm now apparently peri-men [irregular periods, at 47] I've been put on BHT [estrogen/progesterone]. For two years, only doing progesterone, now adding estrogen. The estrogen has done the trick -- my energy is back. I feel good, better than I've felt in a long time, and even went on an extended walk about a month after going on estrogen [right now I'm on .025, but think perhaps even the slightly higher .37 would be better -- I've done saliva testing/blood splatter test for estradiol and it's still somewhat under 100]-- My observation is, that there is no recognition that achiness, muscle conditions such as fibroymylagia which are predominantly found in women [as well, also chronic fatigue syndrome] are hormone-based, and that these diseases indicate body's response to the fluctuating/downshifting of hormones [in particular, estrogen, and in particular, estradiol]. Along with other issues I've had -- my eyes were very dry [one of the many symptoms they attribute to Fibromylagia, but which really align with estrogen deficiency] and that's gotten better also. I speculate on the role of estrogen [mainly estradiol] in women's health -- in such phenomena as 'depression' which I'd class right along with fibromylagia, as a disease the symptoms of which mimic, you guessed it, estrogen/estradiol deficiency--- I feel strongly that hormones such as estradiol are, rather than the demonized villains in breast cancer scenarios, are essential, vital and central to women's health.
Posted by CarolAnne11
Hi Beth and Dr. McGee, I am so excited as I read your exchange of ideas about spreading the word of the info on this site. This info is invaluable to millions of women who are, at the moment, completely unaware of it. I am not a medical profession, but I am a very well-read patient. I have grown more and more angry over the years at watching the pharmaceutical companies decide what patients "need", which is only compounds which can be patented and sold at very high prices for seven years or whatever it is. Something has got to be done. The FDA is a puppet for the drug companies. I know I sound very harsh, but I have had first-hand experience with FDA-approved medications which should have had clear warnings about side effects and risks of long-term use but did not. The FDA was a good idea when it was conceived but has some how lost its way and its original focus, protecting the American consumer. Any way, I'm not sure how a patient (albeit a well-informed patient) can help as you guys seek to spread the word of this site, but I would love to contribute to that process. Either way, and on behalf of all women with hormone imbalance that is not being treated properly by their regular drs, I thank you for caring enough to do what you do. Best, :) Sherri
Posted by sherri90036
Don, Labs are an essential part of any treatment plan. Labs help to know that not only have individual hormone levels been raised to eugonadal or normal levels, but are also essential in knowing that the hormones are in the proper ratios to each other. It is also important to know realistic reference levels, not the levels reported by most laboratories and to standardize how hormone levels are reported so it is easier to understand the results. For instance, currently, most labs combine hypogonadal and eugonadal levels into the same category and call it normal and also use a variety of units to report the results, ie pg/ml vs pmol/L. Here is a good example. The normal range for testosterone for men is typically shown as 300-1000 ng/dl. In reality, the normal range for testosterone is closer to 500 – 1000 ng/dl and hypogonadism would be below 500 ng/dl. What if your doctor is more familiar with nmol/L than ng/dl? That would mean that your doctor would have to take extra time from your appointment to convert units to something he understands. The same thing happens to women. Often labs will list the normal range for testosterone to be 14-86 ng/dl, which includes expected values for both healthy women and women with hypogonadism. The only way to have a level of 14 ng/dl would be if the ovaries are no longer producing testosterone, which means ovarian failure. How can the normal range include a disease state? How can testosterone levels be in the normal range without the primary source of testosterone in the body? The same problem with units also occurs and the time spent converting units could be better spent. So in answer to your question, yes, labs are an essential part of an effective treatment program. It is also essential to have realistic reference levels and standardized units for reporting those levels. What would be even better is if the ratios of all of the gonadal hormones to each other were calculated by the laboratory as well. Beth
Posted by Beth Rosenshein
Dear BYOURBEST, You are very perceptive. You probably know that oral contraceptives work by suppressing ovarian function, which means all of the ovarian hormones will need to be replaced. Unfortunately, oral contraceptives only contain non bio-identical estradiol and non bio-identical progesterone, with no added testosterone or dhea. Without full ovarian replacement every woman that takes oral contraceptives has hypogonadism or, as it is more commonly called, peri-menopause, which carries the risk of depression, sexual dysfunction, sleep disturbance, mood changes, and all of the problems normally associated with peri-menopause. To prevent this a woman would need to supplement her ovarian hormones to normal levels. The problems don’t stop after oral contraceptives are stopped. Studies have shown that prolonged use of birth control pills may change gene expression of liver enzymes so that the binding protein that escorts estrogens and androgens (ie testosterone) in the blood (called sex hormone binding protein) remains about 4 times higher than normal for a prolonged period. This is a problem. This means that a woman on birth control pills will have hypogonadism and even after stopping the pills she will continue to have hypogonadism because of the significantly elevated sex hormone binding protein and will continue to need to supplement her ovarian hormones. So what are the pros and cons? Knowing what I know about oral contraceptives and their short term and long term effects, I would still recommend Yaz and oral contraceptives in general. Yes, there is less than optimal health, but it is better than an unplanned pregnancy. Oral contraceptives are extremely effective at preventing unwanted pregnancy, which is more important than the health drawbacks of hypogonadism for a few years. My foundation, Diamond Research Foundation, recognizes that oral contraceptives can be made better and healthier and we are working to make that happen. However, until that day comes I still recommend using oral contraceptive for the woman who is not yet ready to be pregnant. Thanks, Beth
Posted by Beth Rosenshein
Beth; I like your outline. We can build in each zip code a community where consumers can know their resources in terms of practitioners and pharmacies. Do you see the need for labs on any assessment? Don.
Posted by Donald McGee
Hello Beth, Thanks for your information on hypogonadism and healthcare reform. I am particularly interested in oral contraceptive use in teenagers. Could this fall under the hypogonadism topic? I am particularly concern with the use of brands like YAZ as the hormones contained within it are synthetic. Any thoughts?
Beth: I see three sections to start off on: Your work, a section on medical nutrition, and a section on vascular (cardiovascular) health. I have Greta in New England who can anchor the business of health for a family. I will call as soon as I am awake in your window. Thanks. Donald
Posted by Donald McGee
Donald, These are all excellent ideas and I’ll be in touch with you offline to develop these ideas further. Beth
Posted by Beth Rosenshein
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