Let’s start by talking

about how to avoid being undertreated for hypogonadism (menopause). The health benefits of any hormone replacement regimen become more pronounced as the regimen gets closer and closer to how the body once produced the hormones. We see this very clearly in the treatment of diabetes and the improved delivery methods for insulin. For ovarian failure (menopause), ovarian hormone replacement can produce health benefits that can be felt, such as improved sexual function, and benefits that can’t be felt, like lowered blood pressure. Today, unfortunately, treatment of hypogonadism typically results in hormone levels far below those that occur before ovarian failure. How can you work with your doctor to avoid being under treated?

Understand that clinical trials provide guidance for doctors to know what regimens work best. Unfortunately, in the field of Ovarian Replacement Therapy or ORT (estradiol, testosterone, progesterone, dhea, etc.) there has never been a clinical trial on physiologic replacement. Clinical trials like the Women’s Health Initiative (WHI) say they used hormone replacement therapy, implying that hormones were used to replace the

hormones that the ovaries no longer produced. This is not what they tested. Instead, the WHI tested Premarin™, which produces levels of estrogen that are higher than normal, many times higher. Long term treatment with higher than normal levels of any hormone has never shown beneficial effects. It should have been no surprise that Premarin™ failed to improve health.  Without the guidance of a trial on appropriate replacement, healthcare practitioners are left on their own to design a protocol to treat ovarian failure.

Laboratory reference
levels are often used by healthcare practitioners as a guide because of the absence of a set of instructions or protocol. These reference levels typically combine levels for both functional ovaries and ovarian failure. Some labs will actually list zero as a normal level of free testosterone! Minimum levels are necessary for sexual function and these levels are not given. Using these reference levels as a treatment guideline for ovarian failure leads to under treatment.

Many healthcare practitioners also want to use only FDA approved products, which makes it even easier to under treat. Most of these

products were not developed for the treatment of hypogonadism, but rather to treat hot flashes, which only requires very low levels. To achieve appropriate levels for the treatment of hypogonadism a doctor would have to use multiple doses of FDA approved products or prescribe hand made, compounded, formulations from a special pharmacist for all of the ovarian hormones (estradiol, testosterone, progesterone, dhea, etc.).

To summarize:
There are three main reasons why women are typically under treated for hypogonadism

1) Lack of a well defined protocol or set of instructions

2) Doctors using inappropriate laboratory reference levels as a guide because there is no protocol

3) Lack of appropriate FDA products designed specifically for ovarian replacement therapy (ORT).

If you want to receive
ovarian replacement therapy and want to avoid being under treated then talk with your doctor about this. Discuss adjusting your regimen to get an even better response all the while keeping in mind that the closer you get to actual replacement the more health benefits you will achieve.