Invitation to Medical Doctors
Author's Appeal to Medical Doctors
I don't know about you, but for me the practice of medicine
has become much more hectic and complex than I'd like. There
seems to be a constant shortage of time, but certainly no shortage
of new regulations and practice constraints.
Our patients appear to be experiencing acute frustration, as well.
While they are awash in increasing amounts of health information
from the media and Internet, the majority of the people I see in
my office feel more powerless and out of control than ever. In
addition to the major illnesses, it is as if there is an epidemic
of fatigue, depression, overweight, general anxiety, and decreased
ability to cope with the growing demands of daily life.
Could some of this increased distress be caused by mild, hard-to-diagnose
hormonal imbalances? We certainly see a large segment of the population struggling
with what should be a more normal menopause. Infertility has definitely shown
a dramatic increase in recent years. In my general practice, predominant
complaints can be traced to depression and anxiety, often secondary to thyroid
and adrenal dysfunction.
Many consumers are expressing dissatisfaction with the standard medical approach
to these concerns. Couldn't we, as a profession, be more responsive to the
issues that limit their enjoyment and successful pursuit of daily life? What
if many of these problems are actually symptoms of a hormonal imbalance that
we physicians could successfully treat if we were better able to diagnose
I've had some measure of success in recent years by listening closely to
what my patients are telling me, believing what they report, and consenting
to address what could be mild hormonal imbalance of thyroid gland, adrenals,
or gonads. I am finding it less
than useful to simply order a blood test and, based on that, tell someone "I'm
sorry, your test is normal, you don't have any imbalance" when my best
clinical judgment shows that they are an endocrine disaster.
The standard prescriptions for addressing these problems are often too strong,
and lately I have gotten into the habit of using simple mild interventions
as a first step. I've also searched for more sensitive tests than the local
labs provide, and have found promising results using saliva testing for the
free fraction of the hormones in question.
The first tenet of our profession is to do no harm. I believe we should attempt
to help people with these simple life intrusions, despite the fact that they
may not yet, if ever, be recognized as having serious named diseases. I believe
it is less harmful to treat gently at the stage of early symptoms, rather
than ignore the issue until the patients have lived twenty more years as "half
I was amazed to discover a wide and compelling literature on the veracity
of some of this new testing, and to witness the success of these mild interventions
in my own practice. Occasionally these maneuvers result in the diagnosis
of a severe abnormality that had not yet been tested for. Most often, however,
this is not the case.
Instead, the mild alteration of thyroid, adrenal, and other hormone levels
has been very helpful in allowing compromised people to feel better. At the
very least, the patients feel listened to and heard, resulting in greater
involvement in their own health care, and
more receptivity to our long-term recommendations for healthier habits.
Just as often, however, there is an almost unexpected improvement in their
general overall functioning. A person who is relieved of the hormonal cause
for her anxiety is now sleeping better, getting more exercise, maybe smoking
and drinking less. A person
who is less hormonally depressed feels better, allowing her to now care for
her ailing husband or her young children.
TO GENERAL DOCTORS
This new phase of my practice has also led to greater professional satisfaction.
Subtle endocrine balance is not something the endocrinologists generally
have time for. The widening epidemic of adult and childhood diabetes has
burdened their practices with very sick people who need detailed and multiple
interventions. Thus it might be quite appropriate for primary providers to
get more involved in endocrinology as an integral part of comprehensive care.
While some hormonal symptoms may seem minor to us, they could often be crucial
to our patients!
Let me say as a general practitioner that I believe many GPs would welcome
more collaboration with endocrinologists in working with this particular
group of patients. In confronting these complex hormonal interactions and
their effects on other aspects of metabolism, I am seeing what appears to
be the result of environmental xenoestrogen and thyrotoxic synthetic chemicals.
I hear from my patients that they would very much appreciate having more
of your open-minded attention to what they experience as major discomforts.
For some, living a decent life with energy and focus for their work and families
is as important to them as proper blood sugar is for one of your diabetics.
Also, many of your diabetic patients might have occult thyroid, adrenal,
and gonadal deficiencies that, when addressed more aggressively, might improve
the course of their diabetic involvement. In addition to the diabetes epidemic,
there is also a serious epidemic of hypothyroidism that I feel is not being
handled fully by simply giving 112 milligrams (mg) of Synthroid.
I know from many of my patients that some of your patients would likely be
ever so grateful if you would try harder to hear their real-Iife concerns.
Some endocrinologists would restore greater confidence to the endocrine specialty
as a whole if they would stop raising eyebrows when their patients bring
these issues up for discussion. It is possible that another subspecialty
is needed, so some can be "diabetologists," while
others treat "minimal" gland dysfunctions that feels anything but
minimal to the patients experiencing them. Those patients who feel diminished
by subtle glandular dysfunction and milder concerns could then work with practitioners
who provide "preventive endocrinology."