Healthcare reform and hypogonadism - Part 1 Comments

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

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

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.

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

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

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

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.

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

Donald, These are all excellent ideas and I’ll be in touch with you offline to develop these ideas further. Beth