"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
You can't turn on the radio or peruse a glossy, upscale magazine without being bombarded by advertisements like these, of some highly intoxicating elixir.
The wording 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 hormone therapy! Call our office today! Our special, natural hormones are safe and effective and cannot be given by any other provider! I got my life/marriage/career/happiness back, and so can you! You'll feel 20 years younger in no time!"
Dubious hormone "doctors" appear almost daily on one particular local daytime TV show, alongside some perky, 30-something 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 and make them look and feel 25. 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.
Hormone therapy is a very big part of my clinical practice, as I have been administering therapy for over 15 years, 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, as I like to say, "They aren't going anywhere."
When making decisions about hormone therapy, it’s important to have realistic expectations and to avoid the hormone hucksters. 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.”