Healthcare reform and hypogonadism - Part 2

Before we get started, a little background. The gonads of women (ovaries) and of men (testicles) produce all of the same hormones, estradiol, testosterone, progesterone, dhea and more. When 1 or 2 gonadal hormones fall below normal levels the resulting illness is called hypogonadism. When 3 or more gonadal hormones fall below normal levels the resulting illness is called profound hypogonadism. Hypogonadism and profound hypogonadism occur in both men and women and progress in a similar way. Testosterone and progesterone decline first, followed by dhea and estradiol.

There is more than one name for hypogonadism in women. When testosterone and progesterone levels begin to decline it is also called peri-menopause. When testosterone, progesterone, dhea and estradiol levels are all below normal it is called profound hypogonadism or menopause. Hypogonadism, hypothyroidism, and diabetes are all examples of endocrinopathies, or illnesses in which 1 or more hormones are below normal. Endocrinology is the specialty that is supposed to study and treat hormonal deficiencies of the endocrine organs, which include the gonads of men and women.

The endocrinology medical groups and societies are supposed to identify and promote medical research to improve treatment options. To date, no endocrine group or society has ever stepped forward to promote progress for the treatment of hypogonadism in women. As a result, it is rare to find an endocrinologist willing to acknowledge and treat hypogonadism in women.

Now on to the blog...

Let's look at the number of people that are denied the possibility of better health and the staggering amount of income that is generated by treating preventable illnesses. It is equally important to look at how we can transition the medical community from a "fix it as we go" model to a preventative medicine model at the same time.

Let's start with breast cancer, then we'll move on to prostate cancer.

Half of all oncology visits are for breast cancer and are primarily for women.

Breast cancer in men is one of the rarest forms of breast cancer, less than 1% of all breast cancers. For every man with breast cancer there are at least 100 women with it.

It is not hypogonadism (1 or 2 low hormone levels) but profound hypogonadism (3 or more low hormone levels) that causes such an increase in breast cancer. Men and women have the same risk of breast cancer, about 1-2%, when each has hypogonadism. However, as hypogonadism progresses to profound hypogonadism the risk of breast cancer increases to about 1 in 9. It appears that women have a higher risk because more women live with untreated profound hypogonadism, but if you look at the few men that live with untreated profound hypogonadism, their risk of breast cancer is the same as women's, 1 in 9. Breast cancer is treated the same way in women and men and the cost of medical treatment is between $50-150,000 which includes the cost of surgery, chemotherapy and hospitalization. There are about 200,000 new cases of breast cancer each year in the US. At an average of $100,000 in treatment costs, that works out to $20,000,000,000 a year.

Most of the other half of an oncologist's day is filled with treating prostate cancer, the most prevalent cancer in men. In fact, more men get prostate cancer than there are women who get breast cancer, about 1 in 6. The reason for the significant increase in prostate cancer is the same reason for the increase in breast cancer, abnormal gonadal hormone ratios. Once a man reaches age 30 his progesterone and testosterone levels begin to drop. Decreasing progesterone and testosterone levels changes the ratios of gonadal hormones from healthy to unhealthy. Long term unhealthy gonadal hormone ratios allow the prostate to enlarge which, left unchecked, often leads to prostate cancer. Treatment for each of those cases is about $42,000. There are about 200,000 new cases of prostate cancer each year in the US. Total treatment cost is $8,400,000,000 a year.

The costs don't stop there.

As testosterone and progesterone levels continue to fall in both women and men and gonadal hormone ratios become more and more unhealthy, other illnesses like depression, infertility, sexual dysfunction, sleep disorders, heartburn, constipation, malodorous (foul smelling) flatulence and the list goes on begin to emerge.

What happens with all of these ills? First, a doctor needs to evaluate and diagnose them. Then the pharmaceutical company provides either a non-hormonal drug or an ineffective hormonal drug to put a big enough band-aid on the problem so it doesn't hurt as much. Why don't endocrinologists come forward to acknowledge and demand that the underlying problem, hypogonadism, be treated? For if that happened the fabric of healthcare and drug delivery would change dramatically for the better.

What would it cost to treat the underlying hormonal imbalance and prevent these illnesses? Between lab tests and gonadal hormone replacement therapy, costs would be in the hundreds of dollars per patient, which represents tens of thousands of dollars in savings per person. Changing the healthcare model from treatment of symptoms to illness prevention would save all of that money and more. In addition, and just as importantly, all of these patients would have a much higher quality of life.

A key way to transition the medical community from a "fix it as we go" model to a preventative medicine model is for the endocrinology community to end their silence. Silence not only to the unnecessary suffering of so many, but to the bizarre clinical trials which women are subjected to. As a group, endocrinologists have abandoned their scientific roots in favor of silence and indifference. To date, not one endocrinology group has challenged the NIH's assertion that hypogonadism is only treatable in men and not in women, a scientifically impossible assertion.

A transition to a preventative model would be faster with the help of endocrinologists. However, it can still be done without their support. It will just take much longer as internists and family practice doctors continue to do what endocrinologists refuse to do, treat hypogonadism and prevent devastating diseases like breast cancer and prostate cancer.

Next time we'll examine the few products available to treat hypogonadism in women and men and why there aren't more.
10/17/2009 11:52:50 PM
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 Inge, I am glad that you enjoyed my book. I am an electrical/bio-medical engineer and would be happy to talk to you about getting treatment for profound hypogonadism. Unfortunately, I do not know of a doctor in NY but I would be happy to work with you so that you will be able to convey your wishes to your doctor and receive the treatment that you are seeking. You can reach me at 303-665-5215, MST. Looking forward to hearing from you, Beth
Posted by Beth Rosenshein
Dear Beth, I just finished reading your book and I am thanking you for addressing this health issue. It sounds promising and I am wondering if you take patients. If not, will you be able to recommend a doctor in NYC? I am 47 yrs., and I was diagnosed with menopause in 2007 after unsuccessfully trying to get pregnant for 2 years. I was totally overwhelmed by the news of my infertility combined with the onset of strong menopausal symptons. My GYN put me on "preempro" after 3 months and like a miracle drug, it took away the symptons within 2 weeks and I was able to enjoy life again. However, I never felt comfortable taking this drug and have used it only off and on for the past two years. I stopped taking it two weeks ago and now slowly my symptons moving in again. I am afraid of what's laying ahead but I do not want to get back on HRT pills as I am aware of the risks. I found the information in your book encouraging and would love to work with a doctor to get back my hormonal balance with bioidentical hormones and be able to live a "normal" life. Thank you again for writing this book. I will make sure that all my girlfriends will read it!! I wish I would have read it much earlier.... With best regards, Inge
Posted by Inge
Dear Sherri, I do not know of a doctor in the Southern California area that can help you. You are right to want a doctor who understands that opiods have an impact on gonadal function. Endocrinologists and other doctors are not typically taught to recognize and treat hypogonadism in women, but that does not mean that they can’t learn how. Unfortunately, most do not look for this information and leave their patients under treated or untreated. Every endocrinologist should know about thyroid antibodies and how to evaluate your thyroid function. This is very important as both low and high thyroid function can adversely affect a baby’s development. Feel free to ask any questions as you seek treatment. Thanks, Beth
Posted by Beth Rosenshein
Hi Beth, Thank you so much for your prompt reply! I am so thrilled to have found your site! One more question for you. The endocrinologist at UCLA that I saw is a very nice man and has been practicing endocrinology for a long time and seems very knowledgeable. But I'm not sure if his understanding of how opioids affect the endocrine system is as extensive as I would like. Basically, I was wondering if you could recommend any endocrinologists in the southern California area? Discontinuing Subutex is proving to be much more difficult than I had anticipated. It is wreaking even more havoc on my endocrine system. (I've read that Subutex is about 50 times stronger than morphine. So maybe I should get off it at all costs, even if that means just switching back to Ultram or even Vicodin) Besides going from ovulating to being post-menopausal in one month, I also tested positive for Thyroid Peroxidase Antibodies, so not sure what that's about. So as you can see, finding a great endocrinologist is crucial for me. I had a reproductive endocrinologist for a while who was just an IVF factory. Didn't know the first thing about hypogonadism. Not sure how he can even call himself an RE w/o an adequate understand of HH. But any way... Thanks again so much! If you know of any physician, even if not specifically an endocrinologist, in the southern California area who could help with my situation, I would be forever indebted. I have looked high and wide and am not really finding anyone who blows me away. Maybe the one I have started to see will be able to help me. He did mention wanting to put me on hormone replacement therapy, but it worried me that he might mean the synthetic stuff that doesn't work as well and has side effects. But I guess I ought to wait and hear what he says before I judge. Just hoping that maybe you might know of someone good! Thanks in advance either way! Very best regards, :-) Sherri
Posted by sherri90036
Dear Sherri, You are correct that opioids will induce hypogonadism. This happens because opioids suppress the hormones from the brain which stimulate the ovaries to produce hormones. Less ovarian stimulation means less ovarian hormones are produced. In medical terms this is called hypogonadotropic hypogonadism. It is good that you are taking dhea and that you began ovulating again. That alone demonstrates that you still have ovarian function and may be able to conceive with the help of an endocrinologist. To improve your chances you will want to further improve your ovarian function by also using a small amount of testosterone cream. Testosterone is an important hormone that helps to normalize recruitment of eggs within the ovary. Yes, there is hope however there is no way to really know what your chances are until your doctor can assess your ovarian status better. If you have any other questions after you speak with your endocrinologist please let me know. Thanks, Beth
Posted by Beth Rosenshein
I am a 41-year old female and am virtually certain that I have opioid-induced hypogonadism. After a long exhaustive search, I think I have found an endocrinologist at UCLA who might be able to help me. I am also close to completing an at-home detox program to get off the opioids. Lately I have been having worsening menopausal symptoms since the addiction specialist switched me to Subutex to help with opioid withdrawal. My question to you is - Is there any hope that, once I am completely off of the opioids, my hormone levels might eventually return to normal? I noticed improvement in the past at times when I decreased the opioid dosage, and also for a few months, while I was taking a DHEA supplement, I felt better and started ovulating again. I am desperate to have at least one child with my own eggs. I am praying that the endocrinologist at UCLA will be able to help me. My appt is in two weeks. I am taking a low dose of DHEA each day now, which I plan to continue since it seems to help. I know you can't say for sure, but assuming I am correct about having hypogonadism at my age, is there hope for me or are these menopausal symptoms signifying that I am actually starting menopause (albeit early due to opioids). Thank you in advance! :) Sherri
Posted by sherri90036
Don, Hypogonadism and profound hypogonadism can start long before symptoms set in. That is why it is very important to know when to start testing and to begin supplementing whether you have symptoms or not. Any type of testing you do will give you a snapshot of when you took your tests. I like serum blood testing because I have found it to be the most accurate however saliva and blood spot testing can provide good information as well, and are particularly useful for following trends. The most important factor when choosing your testing method is to use one that your doctor is familiar with. Like it or not, time is money and your doctor is unlikely to want to spend time learning about new reference ranges or spending time converting units, so using the test your doctor is familiar with is usually best. Thanks, Beth
Posted by Beth Rosenshein
Beth. Do you use quantitative lab tests to access such conditions? What is most reliable: blood, saliva, etc. thanks
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