Feeling Fat, Fuzzy, or Frazzled

Invitation to Medical Doctors

Author's Appeal to Medical Doctors

Dear Colleague:

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 it?

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 a person."

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.


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."

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