“Are you tired, run down, listless? Do you poop out at parties? Are you unpopular? The answer to ALL of your problems is in this little bottle.” Lucy Ricardo, for Vitameatavegamin
The advertisements aren’t for Lucy’s highly intoxicating elixir, but one can’t turn on the radio, or peruse a glossy, upscale magazine without being bombarded by them. The verbage is always some variation of this: “Are you tired, gaining some weight, feeling depressed? Love life not what it used to be? Not as much energy as you used to have? Not as much drive and vigor? The answer to all of your problems is having your hormones balanced! Call our office today! Our special, natural hormones are safe and effective! I got my life/marriage/career/happiness back, and so can you! You’ll feel twenty years younger in no time!”
Dubious hormone “Doctors” appear almost daily on one particular local daytime TV show, alongside some perky, thirtysomething host. With an earnest look, and a sense of urgency typically reserved for a television evangelist, the hormone “Guru” looks directly into the camera. He assures the viewers that though they are circling the drain, into the dark abyss of aging, his very special hormones will save them from midlife disaster. The first 20 callers will get 15% off, so dial in now.
Ever since the Baby Boom generation began to hit midlife, anti-aging hormone therapy has become wildly popular, for both women and men. Hormone “mills” are popping up on every corner, it seems, promising a midlife “tune-up” to anyone who comes in. Many of these places dispense hormones in an “assembly-line” approach: get people in, obtain cursory history and lab work, dispense/insert hormones, and most importantly, slide the credit card. It’s a very big, very profitable business, and rife with hucksters.
How to spot a Hormone Huckster
When considering hormone therapy, one should watch out for certain warning signs, and these should prompt particular caution. Let’s examine some of these.
Does the hormone clinic make promises that people will: lose weight, have great sex, be happy, or feel like they are twenty-five again? Some of these things may happen, but no promises should be made, and no guarantees of results.
What is the clinical background of the doctor/practitioner? For example, if they have been running a cosmetic clinic, or a “medical weight loss” center, chances are, the clinician went to a weekend-type hormone course. The hormones are being added to the clinic to make money, period. But how will that cosmetic/weight loss person manage uterine bleeding if it happens? Do they have any background or training in GYN? Can they tell if a uterine biopsy is warranted? Can they do it, and can they interpret the results? Bleeding is only one of a number of complications that may happen. Hormones have some serious risks, and should be taken seriously. Hormones, particularly hormones in pellet form, should only be administered by Clinicians who are extremely experienced and qualified to provide them safely.
Does the Clinician or office claim that the hormones she/he uses are made in a particular way, that makes them unique, special, or better than any other hormones? If so, then that Clinician is not being honest. No hormone is unique or special. Hormone medications do not possess mystical powers. Hormone dosages may be specially made, but the hormones themselves are not.
If people claim that their hormones are safe, or safer than other hormones, then they are not telling the truth. For many people, the careful use of hormone therapy is safe, for a season of life. Generally speaking, however, a hormone is a hormone. If there’s a reason a woman should not use estrogen, for example, based on her individual risk factors, then no estrogen is safe for her. It doesn’t matter if the estrogen is made by a pharmaceutical company, or compounded, or labeled “bioidentical.”
An exception to this is Progesterone. The use of synthetic/artificial Progestins in menopause has been clearly linked to increased rates of breast cancer, while natural Progesterone has no proven link. It must be noted, however, that some breast cancers are Progesterone-receptor positive, and women with these cancers should not use Progesterone at all.
Finally, how does the clinic respond if a patient has a complication or a problem with hormone therapy? Is the Clinician responsive to the patient’s concern, or is the patient just “blown off?” Can the patient actually get an appointment? Are they offered a clinical explanation for what is happening? Are any further tests or procedures warranted? There are some very common challenges that can happen with hormone therapy. Patients must have their concerns addressed, and they must be assured that any serious complication would be detected.
Hormone Therapy at Serenity Women’s Care
Hormone therapy is a very big part of my clinical practice, and I am convinced that hormones can improve the quality of our lives as we age. Hormone therapy is something we don’t need to be afraid of, but we do need to have a healthy respect for the possible risks, based on our individual health and family medical history.
It’s important to remember as well, that there is no guarantee that anyone who uses hormones, or anyone who doesn’t use hormones for that matter, will not have health problems or develop cancer in their lifetime. Over the years, I have seen women who used oral estrogen for thirty years, and never developed breast or uterine cancer. Conversely, I’ve seen women who never touched a hormone in their entire life develop cancer
My own clinical approach to hormone therapy starts with a very detailed review of the patient’s medical history and family history, and all of her/his medical conditions and medications. I order comprehensive, but not unnecessary, lab work. A pelvic ultrasound and/or mammogram is usually ordered, based on the patient’s age, and whether estrogen is being considered. At a follow up consultation, the patient and I review her/his lab work in great detail, the patient’s symptoms, individual risk factors for major diseases, risks and potential benefits of hormone therapy, and I present my recommendations. Every hormone decision belongs to the patient alone. There is never any pressure to use hormones.
Hope, not Hype
When making decisions about hormone therapy, it’s important to have realistic expectations and to avoid the hormone hucksters. As I often tell my patients: the hormones in the world aren’t going anywhere. There is time for each individual to weigh risks and benefits, and to make the decision that’s right for them. Though hormones can help people feel better as they age, they will never be, as Lucy Ricardo said, “The answer to ALL of your problems.”
I had an experience with the late Supreme Court Justice Antonin Scalia. A personal moment, as it were, just between the two of us. The year was 1991. I was in Washington D.C., and had decided well in advance to visit the Supreme Court. The late Justice Thurgood Marshall had retired from the Court in June of that year, and President George H.W. Bush had promptly, in keeping with his Constitutional responsibility, nominated Clarence Thomas to fill the vacancy. The very contentious hearings surrounding this nomination were ongoing, so only eight Justices were serving when I visited the Court.
Back then, security wasn’t like it is now. Visitors passed through a metal detector, left their cameras outside, and that was about it. Also, back in those days, visitors would be allowed to sit in the Court for a good ten minutes or so, before being quietly and politely ushered out, so that the next visitors could come in. On the day that I visited the Court, I was excited beyond belief. I waited outside for about an hour, ticket in hand. I then passed through the Check Room, Security, then at long last, I was ushered into the Chamber itself.
There I was, in the 7th or 8th row, looking up at the eight sitting Justices of the Supreme Court of the United States of America. I have no words to describe how I felt in that hallowed chamber, in which the most important constitutional questions in our nation’s history have ultimately been decided. I looked all around the room, at the art on the walls, at the beautiful woodwork, and at the teams of attorneys for both sides. I sat there, completely awestruck, studying everything I could see, and taking in the entirety of the experience. It was amazing. The case itself was a complete snoozefest: Hilton v. South Carolina Public Railway Commission. Justice Byron White was plainly nodding off, (I mean no disrespect). Justice Blackmun appeared to be trying to stay awake. Justice O’Connor was paying rapt attention. I don’t recall much about Chief Justice Rehnquist, or Justices Souter, Stevens, or Kennedy. As I kept looking all around, hoping that I could somehow remember every detail, I suddenly had that very funny feeling one gets, the feeling that someone is looking at them. I looked up, and ahead, and there he was, Supreme Court Justice Antonin Scalia. He was looking down, directly at me. Our eyes met in that moment of time. I, staring wide-eyed, (with my mouth hanging open I’m sure), and he, with a smile that widened, and then quickly turned into an obvious chuckle. I looked up at the Justice, blushing in embarrassment, and smiled back. In that moment, I realized exactly what the esteemed Justice must have seen.
I was a thirty year-old mother of three small children, soon to be four, then five. I was wearing my best denim skirt and a red blouse. Even though I was just a tourist, I wanted to dress appropriately to visit the Supreme Court. I was from Yuma, Arizona, a fine but forgettable town on the border of Mexico and California. I was nurse, who had dreams of Graduate School and making some kind of difference in the world. Most of my days, though, were consumed with laundry and loose teeth, spelling lists and nighttime prayers. But when I wasn’t wiping little noses, in the snatches of time that I could find, I read big books with big ideas. To Supreme Court Justice Antonin Scalia that day, however, as I was gawking around the room, I know that I looked like I had just fallen off of the proverbial turnip truck.
As the years went by, my season of exhaustion, of never-ending work, would pass. It always does. I raised those five children, who went on to become successful, well-educated adults. In the ten years after that visit to the Supreme Court, I did end up completing two rounds of Graduate School. I have now practiced for 34 years in the profession I love so dearly. I’ve worked in hospitals and community settings. I’ve taken care of individual patients, in times of joy and of sorrow. I’ve cared for families and for entire populations. I’ve written, given speeches, and mentored students. I’ve loved every minute of it.
I’m not sure if Justice Antonin Scalia looked down from that noble Bench and laughed at tourists very often, or if my conspicuous sense of wonder was particularly amusing to him on that day. One of the most powerful men in the country connected, for a moment, with a very tired Mom, who wanted to experience everything that day would bring, and then teach her young children all about it.
Justice Scalia was a brilliant man. I admired him greatly, while disagreeing with him mightily on matters of Constitutional interpretation. On that autumn day in 1991, though, I saw Justice Scalia as a man with kind eyes, and a ready laugh. May he be granted eternal rest. May perpetual light shine upon him. May he rest in peace.