FAQ on hormone imbalance

Q. Are menopausal women the only people likely to have hormone imbalance problems?

A. Although hormone imbalance is the most pronounced in women entering menopause (related to sudden severe decline in ovarian hormone production), symptoms related to hormone imbalance can be seen in women of all ages, and men, most commonly as they age. In fact, Dr. Chen has treated patients as young as in their late teen years! Most women begin to experience signs and symptoms of ovarian hormone decline beginning in the late age 30s, and some even earlier. The chances of hormone imbalance are much greater especially if women notice symptoms with consistent correlation to their menstrual cycle. Men encounter andropause, which consists of a generally more gradual, slow decline in testicular production of testosterone. Many men simply attribute their symptoms and reduced vitality to aging, when they could very well be due to testosterone decline. Beyond the decline of sex hormones, there may also be hormonal imbalances of other glands, such as thyroid (which is much more common in women than in men), pancreas (leading to diabetes), adrenal glands (leading to excess production of or reduced reserves of adrenal hormones), pituitary gland, etc. Since all hormones are interconnected, coexisting imbalances of multiple hormones may be the case in some patients. In addition, proper gut function is required in order to reabsorb and/or activate several hormones; hence, gut dysfunction is often an overlooked factor in patients with seemingly “hormone imbalance” symptoms.

Q. Are saliva tests more accurate than traditional serum tests when evaluating hormone imbalance?

A. This is another area of great controversy in medicine, and currently, there is no agreement as to which is best, esp. when evaluating sex hormones. Reproductive endocrinologists have traditionally relied on serum testing for decades, and continue to do so, whereas proponents of saliva testing argue that only the free (unbound to protein) and therefore, biologically active fraction of a sex hormone is important and representative of what is actually in the tissues, which is what is measured in saliva testing. It appears that saliva testing may be superior when evaluating transdermal application of testosterone, due to more extensive metabolism by enzymes in the skin, which might not be picked up in the blood test. Saliva testing has been found to be an accurate way of measuring adrenal cortisol levels. In general, Dr. Chen favors serum testing on most hormones (with the exception of multiple saliva tests throughout the day to evaluate adrenal cortisol levels) as she has seen numerous inconsistencies with saliva testing based on multiple women who have come to her with obvious uncontrolled menopausal symptoms, and yet their saliva test results did not support the clinical symptoms.

Q. How extensive will my hormone testing be if I am evaluated by Dr. Chen and how much will it cost?

A. This will vary depending on each patient's level of complexity. In general, Dr. Chen will begin with blood testing for nutritional status, sex hormones, thyroid, and adrenal precursor hormones, if indicated. More detailed testing may be recommended, depending on each patient's medical situation. For local residents, Dr. Chen recommends testing be done at Labcorp or Quest Diagnostics. For patient who have an HMO, Dr. Chen will provide a listing of recommended labs, which the patient can request from his or her own in-network care provider. In this case, it will be the patient's responsibility to make certain that requested labs are done and results are sent to Dr. Chen for review. Patients with HMO insurances will have to consider paying cash if they are unable to find a doctor within their network who is supportive of the lab work-up.  Patients who have no insurance coverage for lab testing will need to investigate as to which reputable lab offers them the most affordable pricing. Reasonable discounts are often available to patients who are able to pay all charges at the time of service. The total cost varies from patient to patient, from a few hundred to several hundred dollars, depending on the insurance coverage, as well as how extensive a proposed lab work-up is felt to be needed by Dr. Chen after carefully evaluating each patient's medical status.

Q.  Does Dr. Chen also treat men with hormone imbalance issues?

A.  Yes, although the patient needs to understand that the great body of literature studying HRT applies mostly to women.  Andropause is a relatively new topic of focus, esp. by the anti-aging community and pharmaceutical industry.  It should also be noted that the majority of Dr. Chen's patients are women, indeed, since women seeking menopausal symptom relief have been much more likely to come to the attention of the medical community up until very recent times.  As with any possible advertised treatment aids, Dr. Chen cautions patients to be aware of misleading marketing for monetary gains, whether it is testosterone replacement or supplements, such as DHEA.  Currently, testosterone replacement is available in FDA-approved products of gel, patch, injections, and pellets, and can also be compounded by compounding pharmacies for those who are looking for alternatives.  Also available now is the Wiley Protocol for men, described in more detail at T. S. Wiley's official website: www.thewileyprotocol.com. Dr. Chen recommends mostly gel or cream, as injections provide wide fluctuation in blood levels, and she does not do office-based surgeries to place pellets.  The office evaluation of a patient requesting male HRT is also very specific to each patient, based on thorough review of the patient's history, and lab evaluations, much as Dr. Chen would approach the evaluation of a female patient.