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Dr. Sarrel explains what a doctor evaluates during a hormone deficiency test before administering synthetic hormones.
Dr. Sarrel:
That’s a great question because, and it would be true for a thyroid evaluation or a diabetes evaluation, or in this case, the androgen evaluation. A woman should never, ever take something she doesn’t need. So part of the visit has to focus on why on earth would I even think of initiating treatment with this substance?
Well, she is distressed by the sexual dysfunction. The doctor has also picked up the fact that she has got a real problem with fatigue, so he or she is connecting in her mind. That’s two reasons to be responsive.
And then I would say to the doctor maybe you should get a bone density because you could easily find out that she is losing significant amounts of bone and you’ve got a baseline to begin with. For sure, the doctor should do a breast and a pelvic examination. Remember, the hormones circulate in the blood; they go to breast cells, and they have actions to stimulate breast cells. They go to the vagina, and they have actions in the vagina.
So a proper visit should include taking the blood pressure because too much testosterone can elevate the blood pressure. Certainly doing a breast examination and certainly doing an internal pelvic examination, and in that the doctor can determine how much effect there is of hormone deficiency.
The other issue will be the doctor can look to see, remember we mentioned the word atrophy before? A doctor can look at a woman’s external structures–the two small lips around the opening of the vagina and her clitoris and immediately see if there’s significant loss of tissue. That’s actually visible to the naked eye. You don’t need a microscope for that.
And then there’s a question of laboratory studies. Remember that taking any androgen, whether it be, we are going to talk about products in a moment, whether it be a DHEA product or a testosterone product, taking any of these products are going to have effects on cells throughout the body. So what would be the baseline measures to get in order to make sure that they are normal and then make sure there is no change?
Well, certainly you would want a measure of lipids. You want to know the total cholesterol, the HDL, the LDL, and another kind of fat type substance which is called triglycerides. All of these lipids go into the category of a cholesterol profile or a lipid profile; it’s a simple test. It’s a fasting blood specimen.
At the same time, the doctor should order liver function tests. Why? Because if you are going to take any hormone, whether it’s an estrogen or an androgen, the hormones are metabolized in the liver. They have to pass through the liver and be broken down into substances that the body can use. So you have to know you have a healthy liver, and then a year later you want to make sure it’s staying healthy.
So liver function studies are important. Lipid studies are important, and then there’s another simple test which is a simple blood count, and that’s to look at red blood cells. Occasionally someone, more in men an issue than women, there are too many red blood cells, and one of the 200 actions of testosterone is to induce a replication of red blood cells. You can actually get too many of them and have a stroke risk.
So we want to know a simple, what’s called the CBC. So that’s what should go into a visit. Number one, a good chance to give the historical information, “This is what I am experiencing; this is how often; and this is the severity; and this is how distressed I am.”
And then there should be a proper physical examination. And there should be some simple laboratory studies. We are not talking, you know, high science, expensive stuff; we are talking simple stuff. The doctor would probably also do a Pap smear.
And then finally, a summary of all of this and a chance to explain what products are available to meet her need. Would the testosterone be measured? Yes, it could be measured. It’s again, a fairly simple test; problem is a little bit of expense and getting the expense covered. But in the blood test the doctor could order what’s called a bioavailable testosterone. That’s the best screening test to actually pin down that there is a deficiency of it. I hope I haven’t said too many things, but it’s not a very long list.
About Dr. Sarrel, M.D.:
Philip M. Sarrel, M.D., completed his medical education at New York University School of Medicine, his internship at the Mount Sinai Hospital, and his residency at Yale New Haven Hospital. In addition to his many years on the faculty of the Departments of Obstetrics and Gynecology and Psychiatry at Yale University School of Medicine, Dr. Sarrel has also been a Faculty Scholar in the department of psychiatry at Oxford University, Visiting Senior Lecturer at King’s College Hospital Medical School at the University of London, Visiting Professor in Cardiac Medicine at the National Heart and Lung Institute in London, and Visiting Professor in the Department of Medicine at Columbia University College of Physicians and Surgeons in New York. He is currently Emeritus Professor of obstetrics, gynecology, and psychiatry at Yale University.