Healthcare reform and hypogonadism-part 3

A little background first...

The only way to save money is to prevent major diseases that cost a lot of money to treat and cure. The length of our lifespan makes every one of us vulnerable to major diseases, not because of our age, but because of untreated chronic illness.

Every one of us, woman and man, will suffer from hypogonadism (also called peri-menopause in women and andropause in men) from age 30 on. For every woman and many men hypogonadism will progress to profound hypogonadism (also called menopause in women). Both hypogonadism and profound hypogonadism are treatable illnesses. Yet the vast majority of us will not receive treatment either because of cultural taboos that tell us that aging comes with chronic disease and there is nothing that we can do about it or because of the lack of availability of products and doctors who know how to treat this illness.

Either way, treatment can be elusive.

Now, onto the blog...

You have made the decision to seek treatment for hypogonadism (andropause and peri-menopause) and profound hypogonadism (menopause) because you want a better quality of life and want to avoid devastating diseases like prostate cancer, breast cancer, uterine cancer, metabolic syndrome, osteoporosis, abnormal sleep patterns, and the list goes on and on.

You also want to make your healthcare more affordable by keeping yourself healthier.

Unfortunately, the pharmaceutical companies do not make it easy for you and neither does the Food and Drug Administration (FDA). When it comes to treatment for hypogonadism, obstacles are what you will find. As a result of lack of treatment, millions of men and women suffer needlessly from preventable illnesses which cost billions of dollars to treat. Don't let this stop you.

For men and women, what can you expect to happen when you attempt to treat hypogonadism and profound hypogonadism? First of all, treatment of hypogonadism in men and women is very similar. It requires monitoring and supplementation of the same gonadal hormones. It is similar because the gonads of women, the ovaries, and of men, the testicles, provide all of the same hormones. The only difference is in the amount of each hormone that is made.

The proper way of describing normal levels of a gonadal hormone is to use the word eugonadal. Eugonadal is pronounced U-go-nay-dol. You can use the similar term, euthyroid (pronounced U-thyroid), for normal levels of thyroid hormones.

For women and men side effects of eugonadal replacement would be minimal. Side effects are felt when the levels of any one of testosterone, estradiol, progesterone, or dhea are outside of the normal or eugonadal range. You are always healthier with eugonadal levels of all of these hormones after puberty and continuing for your entire adult life. The way your body works does not change and hormone needs don't change. Your bones stay strong, your breasts stay healthy, and your prostate stays healthy with the same hormones in the same levels in your old age as in your youth. Your hormones are needed for your body to work and you need the right amount of them for your body to stay strong and healthy. This is a cornerstone of preventative medicine.

For men, attaining eugonadal hormone levels is easier than it is for women but more difficult than it should be. Available products are relatively modern, measured, and monitored. Unlike those for women, products for men are almost always transdermal, meaning they are rubbed on the skin, or taken by shot, or as pellets that are inserted under the skin. Men are rarely offered oral supplementation because it doesn't create eugonadal levels as well as the creams, gels, pellets, and shots do.

Most men and their doctors believe that treatment for hypogonadism only includes testosterone replacement and that an enlarged prostate is the price you pay for replacement. This is untrue. Think about this. How is it that when an older man restores his testosterone levels to normal he will experience an enlarged prostate and a younger man with the exact same testosterone level will have a small, healthy prostate?

The answer is because the younger man has eugonadal levels of not only testosterone, but estradiol, progesterone, and dhea as well. An older man has only replaced one of them, testosterone, but still has non-eugonadal levels of estradiol, progesterone, and dhea. If a man were to add progesterone and dhea to his testosterone then he would have eugonadal levels of all of his gonadal hormones. With eugonadal levels his prostate is protected from enlarging and he can more fully enjoy the health benefits of gonadal replacement.

HRT for men is only HRT when it creates eugonadal (normal) levels of all of the gonadal hormones, not just one.

Women run into the same problem. Women and their doctors believe that only estrogen needs to be replaced and use any estrogen in any dosage. Is that how their ovaries functioned, with random levels of estradiol, estrone, or estriol? No. The ovaries provide very specific hormones in very specific levels to create very specific ratios to keep a woman healthy and cancer at bay. Just like for men, replacement is very specific and important to overall health and well being.

Replacement products for women are not user friendly at all. Estradiol creams and gels are gooey and sticky, patches can be very itchy, and the vaginal rings can be annoying. Almost all of these products are in such low doses that even after estradiol treatment a woman still has below normal estradiol levels!

Progesterone products are even worse. There are only two ways to get progesterone, with a pill that is perfectly round so it can very easily get stuck in your throat, or with a vaginal cream that can cause vaginal irritation. What is inexplicable is that the oral progesterone contains peanut oil which can cause a life threatening allergic reaction. In this day and age couldn't a different oil be found that would be less life threatening to a woman with a nut allergy? It's almost as if the pharmaceutical companies really don't want their products to be widely used.

I would talk about testosterone products but there aren't any. The FDA has shot down every application for a replacement product for testosterone for women. Once testosterone is made available and it is combined with estradiol, progesterone, and dhea and eugonadal levels are restored there will be no need for osteoporosis drugs because women won't get it. Once testosterone is available breast cancer rates will go down, depression will go down, better sleep will be possible, urinary incontinence will occur less, and women will enjoy better overall health.

The only way to truly reduce healthcare costs is to reduce disease. You will need to work with your doctor and recognize that you are not powerless to treat hypogonadism and profound hypogonadism and will reap the health benefits.

But how can you reap the benefits of treatment if your doctor tells you that hypogonadism is better left untreated. How can your doctor not understand what you understand about your health and quality of life? You need your doctor's help to prevent major disease so why aren't you able to get it?

In my next blog we will explore how doctors are manipulated into thinking that hypogonadism and profound hypogonadism is better left untreated.