Sunday, January 17, 2010

How to find a good hormone doctor

More and more people want to use “natural” or bio-identical hormones, and I’m one of them! Synthetic hormones just cause too many problems with too many strange side effects.  So, how do you find a good hormone doctor? I get asked this question a lot.

First of all, someone that can help you with balancing hormones doesn’t have to be a “doctor”. Hormone specialists come in all forms these days, from nurse practitioners to compounding pharmacists to naturopaths to health educators.

A couple things to keep in mind while you're looking. Your bio-identical hormones will likely be made by a compounding pharmacist (they're also available over-the-counter). They are also regular pharmacists but have additional training to make specialized “compounds” like hormones right in their pharmacy.

Bio-identical hormones may be available through regular pharmacies, but I haven’t pursued this yet. You can only get specialized doses through a compounding pharmacist, however – in creams, capsules, drops, whatever.  Some hormones (progesterone and estradiol) are available in creams over-the-counter and can be ordered online or purchased at good markets. 

Get your current hormone levels tested first. Then you know -- you’ve got a baseline. Good practitioners can estimate what dosages you need based on your symptoms. But...good practitioners can also be wrong. I’ve been really messed up (while being helped) using this approach (no testing first) and the fact is, you just don’t know until you know.

Saliva testing is best. Blood testing can be used in a pinch, but I repeat – saliva testing is best. You’ll be given a test kit, you fill the tubes, send them to the lab, and the results go to your dr. More on this in another blog. Ask me if you have questions.

Don’t see an endocrinologist. They mostly handle more severe, clinical hormonal issues. Asking an endocrinologist to help with hormone replacement, in my opinion, is like asking a gourmet chef to grill you a hot dog. That being said, there may be some that can help. But I would not pursue this route unless someone falls into your pathway.

Each person has a unique hormone profile so we all need unique dosing. Don’t let anyone give you a hormone cream (or capsule, or patch, whatever) with more than one hormone! This drives me crazy! Each hormone needs to be separate so each can be adjusted, separately. This is really important! It's true that relief of symptoms can happen quickly, but it takes a good 8 weeks for things to get adjusted. And then a few weeks or months later, doses may need adjusting again. This is true of any condition you're using hormones for, but especially if you're trying to get through the roughly 5-year process of menopause. Many women end up thinking their hormones "aren't working" simply because they can't adjust them properly.

So, here are some search tips I’d recommend:

Ask your regular doctor if they can help you. When I first needed to go on hormones, I mentioned it to my family practice doctor who said she knew a compounding pharmacist. She prescribed some capsules for me and that was a start. Unfortunately, she didn’t know much and I had to rely on the compounding pharmacist to guide me in adjusting dosages. I soon had to go out and find someone who knew more.

Ask your regular (PCP) doctor for a referral. Granted, it’s difficult for many drs. to admit they don’t know how to help with something. But a good one will, and can refer you to someone that may know more. It’s very possible they won’t know of someone who can help, but it’s worth asking. Even if the referral is to a compounding pharmacist.

Find a compounding pharmacist in your area (online search as in “google”, yellow pages, etc.). These pharmacists are the folks that actually make the bio-identical hormones, and they know all doctors and other practitioners in your area that can prescribe them. Many compounding pharmacists keep websites. Call the pharmacist and ask them for a recommendation.

Consult directly with a compounding pharmacist. Most of these pharmacists are extremely knowledgeable about the nuts and bolts of low-hormone symptoms and doses. They need to have a drs. prescription before they can make your hormones, however, because they cannot “prescribe”. Some of them are willing to consult with patients, come up with a recommendation, and then fax the recommend hormone/dosages to the patient’s regular dr. After the dr. signs, then the pharmacist is ready to go. This works well if you like your current dr. for most things, but that dr. doeson't know much about hormones. Compounding pharmacists also should have saliva test kits available for you too.

Ask your friends, family, and relatives. Especially if they’re over 45 (for menopausal issues). I like to let myself be guided to ask someone -- whoever -- and this usually works amazingly well. Answers can come from the most unlikely and unpredictable sources, if we're open.

Do an online search for any practitioner who does bio-identical hormones in your area. As I mentioned above, all kinds of health practitioners can help with this. And turn out to be quite knowledgeable. The second person I saw in my hormone journey was a nurse practitioner who had her own women’s health practice. She knew a lot and I was with her a year. Unfortunately, she used the “symptoms” approach without testing, and I suffered severe migraines because of it. So my search continued.

After several years of learning the ins and outs, and getting to know my symptoms, I now adjust my own hormones. And I see a functional neurologist for regular hormone testing, if you can believe that. He practices “functional” medicine (my favorite kind!) and integrative medicine. He simply evolved to help his women patients with their hormones because so many pain and ill-health issues involve the hormones. He also has a naturopathic dr. in his office who does hormones. Great combo.

Before my neurologist embraced hormones, however, I had found a different primary care physician (PCP) through my compounding pharmacist. Turned out, they went to hormone seminars together and the PCP knew almost as much as the compounding pharmacist. Almost, but not quite.

Good luck in your search! And as always, please let me know if I can be of help.  Feel free to contact me at:

Adele Sonora
Nutrition and Health Educator
B.S., Nutrition Science

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