Ellen: Hormones and cholesterol

Ellen was a fairly healthy woman in her late 50's who established care with me over two years ago. Her only remarkable history was high blood cholesterol (over 250). When asked, she stated that she had been told this was likely genetic, since she has carried this diagnosis for years. After initial testing, I diagnosed Ellen with Hashimoto's thyroid disease (an autoimmune thyroid disease usually leading to low functioning thyroid). I started her on thyroid hormone replacement, and at the same time, talked her into starting bio-identical hormone replacement therapy for her minor menopausal symptoms, as I suspected that the lack of female hormones was also related to her high cholesterol problem. I knew that female hormones were necessary to regulate cholesterol synthesis, and that studies done even with Premarin (derived from pregnant mare's urine), the most prescribed conventional HRT, usually showed positive effects on cholesterol of close to 15-30%. Four to five months later, after absolutely no change in her diet whatsoever, we re-tested her cholesterol and to our surprise, her total cholesterol (and especially LDL--the more harmful fraction) dropped nearly 100 points from 301 to 228. Ellen felt that her dramatic drop in cholesterol was likely related to the thyroid hormone rather than her HRT. Close to a year later, she electively stopped her HRT, but remained on her thyroid hormone, not because she was experiencing any negative effects, but simply because she was tired of going to the pharmacy monthly. Four to six months later we re-tested her cholesterol, and it was right back to its original high number, once again, without a change in diet, nor an interruption in her thyroid hormone.

This case demonstrates that not all problems are genetic, and that drugs such as Lipitor or other "statin drugs" are not necessarily the answer to a high cholesterol concern. Being aware that sex hormones have a direct impact on the regulation of cholesterol synthesis in Ellen and documenting that she was, indeed, deficient in sex hormones, led to the use of HRT in her situation which resulted in dramatic reduction in cholesterol, even though she did not have any major "menopausal symptoms" such as hot flashes or night sweats.