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. Dr. Chen has treated patients as young as in their
late teen years for hormone imbalance. 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 may 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. 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. 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 pellets are not sterile and difficult to regulate in terms of absorption. 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.