42-year-old Caucasian male presented with a history of fatigue, hypertension, weight gain and low testosterone. He was prescribed testosterone cream by his primary care physician and initially felt better for a short period of time before having increasing fatigue and weight gain. His baseline testosterone was 225. Despite doubling the dose of testosterone, he continued to have a low level of 250 when he presented to my office. There was no additional testing done for any other hormones by the primary care physician.

Case discussion

After attending courses in bioidentical hormones and truly understanding the complexity of hormone metabolism, I obtained the knowledge and skills to help patients in the most appropriate way. Without this additional training, I would have fallen into the same predicament of inappropriate support and putting patients in harm’s way. In order to fully understand hormone physiology, we have to appreciate precursor hormones such as DHEA and pregnenalone. In addition, we must examine the aromatization of hormones, their breakdown, and utilize appropriate testing in blood, urine and saliva.

As physicians, we are trained to treat test results which show a low level of a particular hormone. Without understanding the true metabolic breakdown and the overall metabolism of the hormones, we run the risk of inappropriately treating the patient. For example, Age appropriate testosterone support is crucial, as testosterone supplementation has the potential to cause testicular atrophy and infertility in a younger patient.

For this patient, I ordered serum levels of DHEA , pregnenelone, total estrogen and estradiol , as well as salivary levels of cortisol and male hormones. The patient’s testosterone deficiency was treated by supplementing safe and effective precursors, nutritional support, and hormone support. The use of zinc ,indole 3 carbinol , calcium D glucarate , chrysin and aromatase enzyme inhibitors in low doses helped this patient lose weight and reach more appropriate testosterone levels.

If you or your loved ones are experiencing symptoms of weight gain, fatigue, decreased libido, and your physician recommends hormonal testing, there are several questions and tests that should be performed for a complete and thorough evaluation. The following list are some questions to ask your physician:

– What is my current hormonal status (testosterone, estrogen, estradiol, DHEA, pregnenalone, growth hormone, cortisol)
– What coexisting medical conditions do I have that may impact hormone regulation? (diabetes mellitus, fatty liver, obesity, etc)
– What is the status of my methylation pathways, which help regulate hormone breakdown.
– What disorders in my family history are important for my hormonal health?

While many books and articles have been written on hormonal replacement therapy and the appropriate use of bioidentical hormones, additional training is needed for physicians to support patients more appropriately. Hormonal replacement is both an art and a science, and it is imperative to address genetics, family history, and the body’s metabolism and excretion pathways prior to creating a treatment plan. With appropriate therapy, patients often experience a substantial improvement in their symptoms.