FAQ on homone 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 menopauase (related to sudden severe
decline in ovarian hormone production), symtpoms related to hormone
imbalance can be seen in women of all ages, and men, most commonly as
they age. 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 much 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.
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 metablism 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 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 sex hormones, thyroid, and adrenal precursor hormones, if
indicated. More detailed testing may be recommended, depending on each
patient's situation. For local residents, Dr. Chen recommends testing
be done at Labcorp (formerly Stanford satellite labs) or Quest
Diagnostics (which is also available nation-wide). 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 primary 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 are
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 price. Reasonable discounts are
often available to patients who are able to pay all charges up front in
cash.
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. 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.