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.