As Sophia on ‘The Golden Girls’ would preface her famous stories, picture it, you are at your PCP office for your yearly physical. Your doctor asks you how you are doing. Instead of saying the inevitable, “fine,” you decide to disclose the truth. You feel awful, and something seems off. You have found yourself snapping at your spouse and coworkers over nothing. One moment you think life is sustainable the next moment you feel like the walls are caving in and nothing is going right. You get hot for no reason, and you have gained weight that you can’t blame on the holidays. Your friends suggest cautiously, “could it be your hormones?” How offensive is that? The thought of the people you thought cared most about you making you feel like you are old or even worse menopausal. Wait. Maybe they are right. So you ask your doctor to check your hormones to consider the possibility. And in a flash, you receive a quick, “Nope, we don’t do that.” Or worse, you get the old, “here is a prescription for an antidepressant, you’re probably just depressed.” Nothing feels worse than feeling discounted or that you are overreacting. Any time you feel like your body is telling you something, you have a right to ask. An empathetic doctor will at least hear you out. If your doctor does agree to order a hormone panel, likely when the results come back, you will get very little explanation as to what the levels mean or told that your levels are all within a normal range. Why?
Doctors are trained to read the lab’s suggestions on what ‘normal range’ is. The interesting thing is that different labs have different ‘normals.’ There’s a fun fact for you! The labs determine the normal ranges. Now, most of the ranges across the board of different labs are similar but not identical. The problem is that what is normal for you may not be normal for the next person. The normal range also does not mean that your hormones are balanced across the board, either. Hormones work together, and if one level is on the high end of normal and the other is on the low end of normal, that is not going to create a balance.
The other issue with normal ranges is that your hormones change a lot, so checking your hormone levels just once only gives you one piece to a much larger puzzle. If you are peri-menopausal, ovulating or menopausal will all play a part in where the lab values fall as well, without considering where your cycle may be (if at all). The lab results don’t mean much, if anything at all. Have you had a hysterectomy? Do you still have any periods? When was the last time? Have you had an ablation? Do you have an IUD? These are all factors that need to be considered alongside your actual lab values. If your PCP doesn’t specialize in hormones, he may not consider these factors.
Another huge factor in evaluating lab results are the symptoms. Your body is responding to changes, and that can look like many different things. You may have extreme changes in body temperature with little to no warning. You may notice that you are easily agitated, and things that bother you now aren’t things that used to bother you. Your sex drive could be down or gone and follow that with vaginal dryness, just to name a few.
The takeaway from all of this is not to encourage you to disregard your PCP. Just consider that if you had a heart condition, you would want to be seen by a heart doctor. If you break a bone, you probably won’t call a kidney doctor. Hormone replacement is no different. Hormone replacement is a specialty, just like other practices of medicine. Find a hormone specialist that can discuss with you safe options like bio-identical hormone replacement therapy. You have one life to live, don’t settle for being told you are ‘normal’ when you know your body better than anybody else could. Meet with the experts, and what you find may surprise you.