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Menopausal Symptoms

I waited to announce the emerging research regarding the safety of post-menopausal hormone replacement therapy for breast cancer patients suffering from severe menopausal symptoms until the research finally supported my belief that women have the right to receive the treatment that they need if they accept the risks of that treatment.

The past year of research (2024-2025) has produced a significant amount of research demonstrating the health risks associated from not taking hormone replacement therapy, as well as the safety of using testosterone after breast cancer and the limited risks of hormone replacement therapy following breast cancer.

I have practiced women’s medicine for over 40 years, and I believe that female patients should have the right to receive post-menopausal hormone therapy if they understand and accept the associated risks and benefits, as long as it is administered safely.

Let me pause here to discuss how doctors ethically make decisions about treatment. First, the aim of medical treatment is to improve health and longevity while alleviating symptoms. It is a doctor’s responsibility to evaluate, treat, and advise patients on the best course of therapy based on their medical training, practical experience, and the latest research. However, the third factor is often overlooked when advising patients about hormone replacement therapy after breast cancer. Doctors determine the best course of treatment by using this information and weighing the benefits of a treatment against its risks. We are trained to provide this information to patients to facilitate informed decision-making with the patient, not for the patient. This process requires time that doctors no longer have. Ah, and therein lies the problem.

Doctors are trained to follow research related to the diseases and conditions they treat and to integrate that research into their practice. The basic decision-making process involves weighing the benefits of treatment (or no treatment) against the associated risks. When the benefits of a treatment outweigh its risks, it is recommended to the patient. “Recommended” means the doctor, based on current knowledge, believes it to be safer and more effective for the patient’s health to pursue a specific treatment. However, this does not imply that the patient must follow the doctor’s advice. A patient is autonomous and can assess the risks and benefits once informed, allowing them to refuse a treatment or request one that falls outside current medical guidelines. Doctors do not have to embark on a treatment they do not believe is beneficial or safe. Doctors have autonomy as well!

Doctors in mainstream medicine adhere to “medical guidelines” established by our specialties, which represent the minimum level of care expected from a physician. However, these guidelines are often decades behind current research, meaning that the risks and benefits communicated to a patient may be outdated. A legal requirement known as informed consent mandates that a doctor inform the patient or include this information in a consent form that the patient reads and signs, detailing the procedure or treatment. If the treatment is newer than the guidelines, it is categorized as “off-label.” It is essential for the doctor to inform the patient that the treatment does not conform to current guidelines, and the patient must acknowledge the known risks associated with the treatment.

At BioBalance Health®, we often find ourselves ahead of the guidelines, and my experience indicates it may take up to 20 years for the guidelines to catch up with us. Much of our treatment is considered off-label because it is current and ahead of the guidelines. It is superior to other treatments and remains safe, but risks are inherent in every treatment!

Now, let’s return to breast cancer and the roles of estradiol, testosterone, and progesterone replacement. Here are the facts about breast cancer:

• Most breast cancer patients are post-menopausal, and have symptoms of menopause
• Not all types of breast cancer are stimulated by estradiol or progesterone, and therefore for these cancers hormone replacement therapy is safe.
• Breast Cancer patients with negative nodes who have had a bilateral mastectomy are candidates for hormone replacement therapy after their treatment.
• The risks of estrogen replacement for ER+ breast cancer patients may promote the growth of cancer cells, while testosterone replacement lowers the risk of recurrence and alleviates certain menopausal symptoms.
• When testosterone is combined with estradiol, the risk of developing breast cancer in all women is reduced.
• Testosterone enhances the quantity and activity of cancer-fighting T-killer and T-helper white blood cells.
• All breast cancer patients can manage menopause symptoms using testosterone pellet therapy and vaginal estrogen without an increased risk of recurrence.

Do you remember when I mentioned that the risks of treatment should be balanced with the benefits of that same treatment?

Recently, numerous research articles have outlined the benefits of estradiol treatment, which I included in my 2017 book, “The Secret Female Hormone: How Testosterone Replacement Can Change Your Life.” In early 2025, the safety of taking estradiol for menopausal women confirmed the less publicized research that had come before. The Journal of Endocrinology and Metabolism reported that women who underwent estradiol replacement after the age of 60 live 20% longer than those who do not take hormone replacement therapy. This challenges the guideline that advises OB-GYNs to discontinue hormone replacement therapy before the age of 60.

The Benefits of Estrogen replacement after menopause, based on multiple research studies over the last 20 years is as follows:

• ERT alleviates symptoms such as dry vagina, painful intercourse, insomnia, hot flashes, and night sweats.
• Estrogen replacement prevents and treats osteoporosis in women.
• Testosterone replacement in women with osteoporosis can reverse the process of bone loss, bringing bone back to normal strength and decreasing fracture risk.
• Non-oral Testosterone and Estradiol can prevent arteriosclerotic heart disease.
• ERT and HRT decreases the risk of diabetes with aging.
• Estradiol replacement during the first decade after menopause can delay the onset of Alzheimer’s disease and dementia by ten years. If you are genetically predisposed to developing Alzheimer’s or dementia by age 80, E2 replacement may postpone this onset until you turn 90.
• Testosterone replacement in the first 10 years after menopause postpones the onset of Alzheimer’s disease and dementia for an additional ten years.
• Testosterone boosts immune function in both sexes and diminishes the onset and severity of infectious diseases.
• Aging causes cognitive decline, marked by challenges in memory and thinking, and menopause speeds up this process. Testosterone and estradiol replacement therapies may aid in reversing this decline.
• Muscle mass decreases after menopause due to a decline in testosterone but replacing testosterone with bio-identical pellets restores muscle mass to premenopausal levels.

The latest medical article that inspired me to create this podcast was published in the journal Menopause, which discussed the challenges many women face after breast cancer treatment without hormone replacement for their severe menopausal symptoms. Here are the quotes I think you should hear: (MHT = Menopause Hormone Therapy)

“Among 226 breast cancer survivors.. the menopause symptom burden was high and

women’s experience of menopause-related breast cancer after-care was poor. Few women felt actively involved in menopause treatment decisions.

 The NICE breast cancer guideline (NG101) states that women with a history of

breast cancer can be offered MHT in “exceptional” circumstances if other treatments have failed (off-label use). However, NICE does not define what “exceptional” circumstances are or who gets to decide.

Up to 50% of breast cancer survivors, especially those with debilitating menopausal symptoms, may choose to accept a small increase in risk in exchange for an

improved quality of life and/or to mitigate future health risks associated with chronic estrogen deficiency.  “Allowing”. women to have MHT only in “exceptional” circumstance undermines patient autonomy and limits a clinician’s ability to integrate clinical knowledge and judgment with the best currently available evidence (which is decades behind clinical guidelines). Clinicians have a legal and ethical responsibility to patients to make informed treatment choices.

If you have had breast cancer and are experiencing symptoms you no longer want to endure, my advice is to find a doctor with whom you can make an informed decision based on the latest research. It’s important to understand and accept the risks and to sign a High-Risk Consent for HRT. 

If you aren’t that brave, then seek a physician who will prescribe testosterone pellets along with vaginal estradiol to alleviate some of your post-menopausal symptoms. Life is too short to follow guidelines that are 20 years out of date when you are suffering.

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Last time we reviewed why interpreting your lab may lead you to the wrong diagnosis and treatment.  Today we continue our review of each lab panel and why the reference ranges on your lab results may not be the “Healthy Normal Range” that you should compare your results to.

Lab reference ranges are established with a one-size-fits-all mentality, ignoring the numerous variables that influence blood results.

Have you ever tried on a “one-size-fits-all “ANYTHING? Those clothes may fit 20% of the population but for the rest of us, the garment doesn’t fit our width, weight or height! All one-size-fits-all lab reference ranges are much the same. 

For example, the standardized “reference ranges” in the US serve as a one-size-fits-all “ideal range” applied to everyone, despite genetic differences, varying latitudes, and the diverse diets that characterize the American multiethnic population. This presents the first problem with using a single range for all people: variations among individuals based on differing genetic needs.  The second issue is that the ranges on the lab report indicate the minimum levels necessary for survival, not necessarily the healthiest blood levels for most individuals. Another example of one size doesn’t fit all is the reference range for women’s hormones. A range is displayed for cycling women, but there is no healthy range for menopausal women.  Does the range displayed refer to menopausal women with HRT, or menopausal women without HRT to treat their menopausal symptoms? Is the range based on what is healthy, or what is average? We aren’t sure.

Labs don’t ask patients questions that could help interpret lab values. Therefore, they cannot provide a truly diagnostic reference range for any illness. They only consider gender and age, as reference ranges are solely adjusted for these two factors.  A doctor must interpret individual lab results alongside a patient’s medical and surgical history, including established diseases, medications, supplements, hormonal treatments, and past lab values. For instance, laboratory companies should offer reference ranges based on whether a patient is menopausal, a woman is undergoing ERT, a man is receiving testosterone, a patient is on thyroid medication, a person is being treated for diabetes, or the diabetic tests are performed to diagnose diabetes.

Some Reference Ranges are Based on comparing results to Misleading formulas

The best example of this issue is the Lipid Panel. Doctors use this panel to determine a person’s risk for heart attacks caused by atherosclerosis. Most doctors don’t know the formula for determining Total Cholesterol. This test doesn’t predict heart disease in most patients, as the formula used to arrive at that number is not indicative of the disease. However, doctors have been advised that when   total cholesterol levels are high, a patient should start taking a statin, a drug that reduces blood cholesterol and sometimes lowers the rate of heart attacks in certain individuals, though it is rarely predictive in 50% of the population.

The problem with the lipid panel is twofold: the LDL level indicates future atherosclerosis in only about 50% of the population and is not a specific test for future heart disease risk.

Total cholesterol is even less predictive of heart disease because it stems from a flawed formula.

Doctors interpret a high Total Cholesterol level as an indication that a patient may be at increased risk for heart disease in the future. When I test patients with elevated Total Cholesterol or high levels of LDL using a Cardiac Calcium Scan to measure plaque, only half of them actually produce plaque, and consequently, are not at risk for atherosclerotic heart disease. I believe that the Total Cholesterol number is derived from an inaccurate formula for determining a person’s risk of future heart disease. The Total Cholesterol number is calculated using a flawed equation. The equation is as follows:

        LDL + 1/5 Triglycerides+ HDL = Total Cholesterol

Total Cholesterol = LDL (bad cholesterol) + 1/5 Triglycerides (high risk factor) + HDL (good cholesterol)

Let’s examine this formula simply like this:   Bad + Bad + Good does not equal Bad. Due to this incorrect formula, thousands, if not millions, of patients have been prescribed statin drugs for a lifetime without justification!  Statins carry risks. The list of side effects is extensive and includes muscle deterioration and statin-associated dementia. Unfortunately, most people who experience statin side effects are women. Women tend to have higher HDL levels than men. Additionally, they typically do not have atherosclerotic plaque until menopause and usually do not develop it after menopause if they undergo estrogen replacement therapy!

This gender issue is just one of the problems with laboratory reference ranges that are not adjusted for sex. The total cholesterol values were developed solely from the blood levels of men, who typically have lower HDL levels. Women were excluded from the tests conducted to create this blood panel. For women, I dispel the myth that high total cholesterol predicts heart disease by recommending a Cardiac Calcium Scan to check for plaque. If a woman has no plaque by the age of 50 and is taking estrogen, she is unlikely to develop plaque in the future.  I still test them every 2-3 years to ensure that no metabolic changes have altered their risk, but I don’t put much faith in the unreliable cholesterol blood panel.

There is another blood test that has deceptive reference ranges: IGF-1

How about the GH-IGF-1 test, the test for Growth Hormone?  IGF-1 is a metabolite of GH that we can measure to determine how much the patient produces.  This hormone aids in healing and replenishing aging cells in patients after their growth is complete.  The healthy normal range with which I was trained, (150-350 MIU), has been changed to an age-adjusted normal that compares a person to others in her age category who had their blood drawn the previous year.  What is wrong with this?

• Growth hormone (GH) decreases with age and contributes to the declining health people experience as they grow older. Similarly, IGF-1 diminishes with age and illness, which means that the “reference range” essentially reflects that you are “average for the sick individuals who visit Quest to have their IGF-1 levels checked. ” IGF-1 levels can be enhanced through weight loss, testosterone replacement, and an increase in muscle mass.
• The current reference range does not indicate health or illness; it merely shows whether you fall within the average for your age group.
• This non-scientific method of determining “health” is widespread in contemporary medicine. By comparing aging individuals to others within the same age group, for hormones that decline with age, based on samples from sick patients who visit a specific lab in the past year, these labs label patients as “healthy” even when they are as ill as other individuals their age who go to that lab! This practice constitutes age discrimination! Regarding hormones, the levels we maintained during our fertile and youthful years correspond to the blood levels indicative of health in all individuals ages.

For example:

People who check their IGF-1 (Growth Hormone) levels and see a low “52 ng/ml” might feel satisfied that they are within the standard range (50-280 ng/ml). However, they may not realize that this range applies to older, unhealthy individuals, not to healthy young ones (150-350 ng/ml).  This is just one example of the issues that arise when non-medical individuals, who do not monitor these tests regularly, draw conclusions from the numbers.

Some illnesses require more than one blood test for diagnosis

If you consider only one of the three tests for diabetes or prediabetes (Fasting Blood Sugar, HbA1c, and Insulin), you cannot self-diagnose as diabetic, prediabetic, insulin resistance or healthy.  Diabetes is a disease that has coincided with the rising number of obese individuals.  Both conditions affect nearly 50% of the American population. Blood tests cannot be interpreted accurately unless a patient has fasted for 12 hours; all three tests should be evaluated. When diagnosing diabetes and insulin resistance, we perform three tests to assess whether a patient has insulin resistance, prediabetes, or diabetes. These tests guide our diagnosis and inform the treatment we provide based on their results.

Fasting insulin is a highly misleading test. Over 15 years ago, a significant study was conducted that was believed to change the reference ranges for fasting insulin.  The new range set for normal fasting insulin was less than 10 mIU/ml. By publishing the reference range less than 18 mIU/ml, they miss diagnosing many patients with insulin resistance

HBA1C is a test that gives a value of average blood sugar over three months.

The results are often used alone to determine prediabetes and diabetes; however, considering all three aspects makes the diagnosis and treatment plan more specific for the patient.

FBS (fasting blood sugar) is the third diabetes test. It is generally used as a screening test that prompts the ordering of the other two blood tests; however, some patients exhibit symptoms of diabetes and insulin resistance without having elevated fasting insulin levels.

Many medications can raise diabetic test values, causing a patient to seem diabetic when they are actually experiencing a side effect of the drug.  One such medication is Atorvastatin.  The solution is not treating diabetes but rather adjusting the medication. 

Hormone tests are especially challenging to interpret, Especially when testing free Testosterone in women

Here are the problems with the free Testosterone test itself:

1. Women have extremely low levels of free testosterone and testosterone compared to men. I have been informed by Quest that women’s free testosterone levels are not reliable with current methods because they are not always reproducible when a test is conducted twice on the same day. This leads me to believe that hormone levels do not always reflect the actual blood levels of free testosterone and estradiol.
2. The levels of testosterone in women are based on menopausal levels of T. Women have long been thought to not produce testosterone, so the “normal” levels are quite low, and 0 used to be considered normal- until one day I managed to persuade a medical director at Quest to increase it to 0.2!
3. Women’s testosterone is influenced by their production of E2 and E1, which inactivate free T. Women vary in how their cells respond to testosterone and estradiol.
4. Receptor sites and their genetic acceptance of hormones can mean that the same blood level of testosterone in both sexes does not produce the same effects in all patients. Some women (and men) are resistant to E2 and T, or to one of the two. This indicates that the hormone-free T level may be optimal for one woman while being ineffective in alleviating any low T symptoms for another. The latter individual is T resistant, and we currently have no means outside of research labs to determine which women are sensitive and which are resistant. This requires that doctors and NPs look beyond typical reference ranges to effectively manage E2 and T replacement for women.
5. Lastly some labs use the total testosterone level through a formula determine the free T. This carries inherent risks of reporting the wrong active level of testosterone.

Total and free testosterone blood levels for men, are derived from results of older men, rather than from the blood levels that indicate health and the levels at which men experience no symptoms. This leads men to believe they are normal, even though they are symptomatic, and they can’t get treatment.

There is no time to discuss the reference ranges for LH, FSH, Estradiol, and Estrone; these topics will be addressed in a future blog. I hope I have encouraged you to review your blood work with your doctor or Nurse Practitioner, and not to act as your own doctor by interpreting your blood tests.

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There is a new federal rule for lab companies that requires them to report your blood tests to you as soon as they are finished, often even before your doctor has seen them.  This rule, deemed unreasonable, was established by individuals without medical expertise (politicians), who know little about interpreting lab data or the workings of doctor’s offices. Sending your lab results to you before doctors can assess them is not a decision rooted in sound medical practice but rather in the notion of individual freedom. While this is important, it does not compare to having an expert interpret your results with you.

The law requiring that your lab results be sent to you as soon as they are completed does not consider the fact that these results are not designed for laymen to interpret. Additionally, lab results are meant to be analyzed alongside a patient’s medical history, age, gender, and medications.  The results are not tailored to report information specific to your situation, which is how a doctor would interpret them.

• Lab results often lack layperson-friendly explanations. This new protocol can cause anxiety, as patients may panic over results that appear abnormal, even if they are normal for their specific medical condition and treatment. Furthermore, lab companies only request your age and gender. The factors that doctors evaluate when interpreting your results are diverse and numerous, each influencing the overall interpretation.

What are the considerations that doctors add to their interpretation?

• Menopausal status
• Medical conditions
• Healthy normal for young and healthy adults
• The newest recommended ranges for health
• Body weight
• Other lab values seen on the same report

The problem with you getting your own lab and interpreting it as written is multifactorial:

1. The lab is sent to you digitally with very little explanation except for reference ranges.

There is no information about who you are being compared to. Other women, both men and women? Old women? Young women? Women with symptoms or women who are well without symptoms.  The reporting of the lab results to a patient directly may hide problems that need action or create fears that are unnecessary.

1. Anxiety over your results will continue until your doctor’s appointment to discuss … so you may experience unnecessary worry in many circumstances.
2. Reference ranges make many assumptions, but labs don’t input vital information about you into their computer.
   1. your age of menopause,
   2. your weight
   3. your height (or BMI)
   4. previous illnesses and your medications.
   5. if you are on hormones or testosterone

Here is a good example. The test for pituitary hormones FSH and LH.

When a woman aged 45 is menopausal, and has a very high FSH and LH, the lab says it is “normal” (in the reference range), yet the woman is having severe hot flashes, night sweats, anxiety, and insomnia.  That is not healthy or “normal”.

The same two tests can be used to determine if a person is menopausal.

Let’s say a 42-year-old woman has elevated FSH and LH, but her estradiol is very high (200-300). To the layperson, this looks like menopause, but in reality, it is the picture of ovulation, not menopause. One has to look at another test, estradiol, to determine whether she is premenopausal and ovulating or menopausal (her estradiol would be very low, and FSH and LH would be high). See the problem?

1. Reference Ranges don’t tell you what the doctor is looking for.

The same two tests, FSH and LH, are used to diagnose polycystic ovaries (PCO) too.  In women without PCO, the FSH is higher than the LH, but if the LH is greater than the FSH, the diagnosis of PCO should be considered! There is no information about this interpretation in the lab report.

1. Falling within the reference range doesn’t guarantee health or absence of symptoms. If patients are to interpret their own lab results, reference ranges should reflect health in every possible scenario.

FSH and LH are influenced by BCPs and menopausal HRT. Lab results should be interpreted considering the information regarding BCPs or ERT that the patient is taking. When women are on BCPs and HRT or ERT, their FSH and LH levels are suppressed to an extremely low point. If you are unaware that the patient is taking these hormones, it may appear that the diagnosis is pituitary failure affecting estrogen levels and ovulation. Only doctors can interpret this test. There should truly be a “normal” range for those undergoing hormone replacement therapy, along with a reference range that reflects overall health, rather than merely the average for your geographical area in the US or your age group.

1. Please make an appointment with your doctor to review your lab results so you can understand how they are interpreted. If you have questions about your lab results that are concerning you, schedule a time to discuss them with your doctor. Doctors don’t have the time to explain results over the phone or through email—that is what appointments are meant for. Phone calls to doctors’ offices are not intended for lab result interpretation. You or your insurance will not compensate the doctor or NP for this service over the phone.

1. The reference ranges for many tests and medical situations are actually wrong. If you aren’t trained as a doctor or Nurse practitioner who interprets metabolic lab results every day, you could get the wrong diagnosis!!!
   1. For example, when evaluating a patient for insulin resistance, the reference range was officially changed almost two decades ago. Still, the lab companies have left the normal range very high (insulin> 18). In the revised range, fasting insulin diagnoses insulin resistance if the value is > 10. The resulting outcome is that many people are not diagnosed at a time when they can be easily treated without drugs and are told that they are “normal” when they are really experiencing insulin resistance. This is misleading and just wrong!

1. Lab values are not adjusted to your individual situation.

1. Many tests are adjusted for gender; however, some are specifically adjusted for women who are menstruating regarding H/H. In other words, men and women have different “normal” H/H levels in the reference range. Women who do not menstruate or who are menopausal should be compared to the same reference range as men, but that does not happen.
2. This leads to menopausal women, who are normal, often being told they have too many red blood cells when that is not the case. Conversely, menopausal women who are truly anemic are told they are normal, which means it takes longer to diagnose their anemia from colon cancer! The H/H should have a reference range that is considered “normal” for a woman’s stage in life, depending on whether she is experiencing menstrual periods or not.

1. Many reference ranges are averages for regions of the US and vary between lab companies; therefore, they are not reliable values for comparing patients.

1. For instance, the Homocysteine test has a normal range that is relatively high, and each lab has different reference ranges. This test serves as a screening tool for MTHFR genetic risk related to embolic stroke and heart disease.   The suggested treatment involves methylated B vitamins; however, the interpretation on the lab printout advises taking B12 and folic acid, which, in my experience, tends to increase the number rather than decrease it.

• Reference ranges for nutrients, vitamins, and minerals reflect the minimum levels needed for survival, not optimal health.

1. For example, B12 reference range levels for B12 blood levels are listed as 200-1100 pg/ml, yet I was trained to try to achieve 400 -1500 pg/ml. The lower range of the written reference range (200-400) is not healthy.
2. The desired blood levels for vitamins are often controversial, and various medical colleges issue new recommendations on Vitamin D levels each month. Consequently, doctors must determine which level of Vitamin D to recommend for their patients. These institutions not only provide changing reference ranges but also offer differing advice on how frequently to test Vitamin D. This inconsistency arises primarily from the ongoing debate about the minimum acceptable level of Vitamin D.

I have more information about your lab results next week that your doctor may not share with you. There is a lot of controversy surrounding the reference ranges on the lab sheet, and you should know the truth in case your doctor doesn’t.

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog

The newest miracle drug for weight loss is changing the lives of thousands of people who have battled obesity for extended periods of time….These GLP-1 medications are also treating or preventing the diseases that go with long term obesity: Diabetes, Heart Disease, Joint replacements, Arthritis, Sleep Apnea, and Alzheimer’s Disease. Researchers are finding more indications every day for patients to take these weight loss medications.

But like anything else there is no perfect answer to any problem.  Among the few side effects of this drug, the most frequent side effect is reflux, also called acid indigestion, or GERD (gastroesophageal reflux disease).  Often my patients don’t even know what their diagnosis is, they just tell me about their symptoms.

The symptoms of GERD include:

• Asthma symptoms
• A bad taste in the mouth
• Difficulty swallowing
• Dry, hacking, cough
• Chest pain after meals

These symptoms are worse after a big meal, at bedtime, after spicy food, or dose related.  Most of my patients don’t want to discontinue the GLP-1 inhibitors because they are finally losing weight!  We manage the GLP-1 side effect of GERD by decreasing dose of the medication and slowly increase the dose back to an effective level. We also offer lifestyle and dietary treatments before we offer prescription medication.

Therefore, if reflux is not constant, and is not causing any lasting damage to the patient’s esophagus, we can treat it with lifestyle changes and over the counter medication, to lower the stomach acid that is refluxing into the esophagus.

The lifestyle changes patients can employ on their own are described below.

Lifestyle changes needed to avoid or treat Gastric Reflux caused by GLP-1 agonists. What can you do to prevent and treat this side effect:

• Eat smaller meals: Large meals expand your stomach and put pressure on your lower esophageal sphincter (LES).
• Don’t go to bed less than 2 hours after eating
• Avoid trigger foods see below
• Sleep on your left side
• Elevate the head of your bed
• Avoid tight clothing:
• Chew your food well– chew each bite for 20 seconds.
• Quit smoking: Smoking weakens your LES and makes your stomach more acidic.
• Stop drinking alcohol
• Chew (non-mint) sugar-free–gum

 In addition to changing your active lifestyle, changing your diet is necessary as well.

There are trigger foods to avoid minimizing your reflux symptoms.

 tomato sauce and other tomato-based products

• high fat foods, such as fast food and greasy foods
• fried foods
• citrus fruit juices
• soda-diet and regular
• Caffeine
• Garlic
• onions
• mint of any kind
• milk based products

My patients ask me, “So what can I eat?” …I admit I did take away some of the most exciting foods, however my patients ask me what they can eat so the list of foods that help avoid and treat GERD are listed below.

• High-fiber foods: vegetables, fruit, and whole grain bread.
• Alkaline foods. Foods fall somewhere along the pH scale (turns litmus paper blue).
• Drink alkalinized water (PH > 8)
• Ginger—fresh sushi Ginger from Asian food stores.
• Apple cider vinegar on salads and a Tablespoon in water every morning
• Lemon water—just squeeze a slice of lemon in your water.
• Coconut water
• Honey.
• Lean Protein including meat
• Low-Fat and Nonfat Dairy Products.
• Non-Citrus Fruits like apples, pears, bananas, and melons
• Vegetables like broccoli, Carrots, Corn, Cucumbers, Green Beans, Green peppers, Potatoes and Sweet potatoes

For my patients who take herbal and other supplements, the following is a list of the supplements that may decrease your symptoms of GERD.

• Chamomile Tea
• Licorice
• Marshmallow
• Slippery Elm Tablets
• Probiotics-Mega Brand
• Prebiotics-Mega
• Digestive Enzymes
• Aloe Vera Juice
• Baking Soda
• Magnesium glycinate

What happens when you have made all the lifestyle changes you can and have lowered your GLP-1 dose or changed to a different type of GLP-1 Agonist, and you still have GERD?

As a physician I prescribe medications to help my patients treat their GERD, however most of the medications have been placed over the counter so I can recommend them to my patients, and they can buy the medication without a script.

The class of medication that treats GERD include Antacids, H2 Blocker, and Proton Pump Inhibitor.

 Antacids neutralize stomach acid, but they typically only work for short periods. They are generally made of calcium. This type of medication is best used prn for symptom relief.  Side effects of antacids may include constipation and diarrhea.

The second option for treatment of GERD is an H2 blocker. These drugs reduce the amount of acid the stomach releases. Eg. Pepcid, Tagamet, Gaviscon.

Proton pump inhibitors (PPIs): These drugs are available by prescription from a healthcare provider, and now some doses are over the counter. PPIs help reduce the amount of acid the stomach makes.  They should be used for a two-week period only for severe attacks and then you should change to an H2 blocker or antacid.

WHY stop a PPI after 2 weeks?   Omeprazole is an example of a PPI.  Theses medication kill the good bacteria in your intestines, change your breath and can affect how you absorb your nutrients. If you must take them chronically to treat and prevent the progression of damage to the esophagus.

What if I did everything and GERD is still a problem:

If your condition is severe, your doctor may recommend a consultation with a GI doctor for an endoscope or other diagnostic procedure.  In addition, you may have to hold your GLP-1 Agonist for a period of time while you treat your esophageal inflammation.

Just as in all medical issues there are many ways to treat side effects of drugs. Your provider will prescribe the medication that she or he is most comfortable with.

What next?

So if you have reflux and are on a GLP-1 inhibitor, you may be advised to decrease your dose or switch to Tirzepatide medication (Mounjaro, Zepbound).

There are many steps you can take before you need prescribed medication. Your doctor may even change your GLP-1 agonist prescription or refer you to a GI doctor, but before this is necessary you should try the lifestyle and dietary changes that I recommend in this Blog first.

This side effect of GLP-1 agonists doesn’t affect every patient and can be managed as you see above, however the lifestyle changes and dietary changes can only be done by you, so the ball is in your court!

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog

Almost every week I hear from my male patients that their PCP doctor has scared them by telling them to stop taking testosterone pellets because their Hematocrit is too high.  Alternatively, their doctor recommended a lower dose of T. These two recommendations are those doctors who don’t understand all the good that the testosterone is doing for these men.

My male patients come to me for Testosterone pellets to treat their ED, lack of libido, loss of muscle, inability to think, weight gain, lack of motivation, anxiety attacks, poor stamina, arthritis, loss of balance, and basically everything that makes a man a man!  The most amazing thing is that I can treat them with ONE hormone, Testosterone in pellet form, and cure all these problems! If a man stops taking Testosterone, they get these symptoms again and have to take a multitude of drugs to feel just a fraction better! The treatment for a high H/H is simple…it is a routine removal of blood, either a blood donation or a phlebotomy (removal of 500 cc of blood) in the office, every 2-6 months to keep their H/H under control.

The advice their doctors give them is going to cause them great pain and actually shorten their lives and there is little risk if any to removing blood every few months! In the event that a man demands that I lower their dose…..and I do it…the next inevitable phone call is to complain that their symptoms are coming back!  They literally blame me for the advice of their PCP!

I would like to tell these men that the same doctors who could not help them with their low T are the same ones who are giving them the advice to lower or stop their testosterone therapy with T pellets.  It is human nature and especially that of doctors to try to criticize the advice of the doctor who got better results with a patient than they did! So, if you develop a condition called erythrocytosis secondary to your testosterone replacement, then you can keep your T therapy, if you are compliant and follow your testosterone doctor’s directions and get your blood removed when it is scheduled.  This should prevent any severe reaction from your doctor.

This is a typical response to my patient who has concerns.  However, I have given my patients many sources of written and video information about every aspect of testosterone replacement, the risks and benefits including erythrocytosis.  These include my book, Got Testosterone? was given to them on the first visit.  We also have over 650 informational blogs and videos on You Tube, FAQs and a very extensive handout given to each of them on the first visit. They just have to read!

I have read your concern about erythrocytosis and testosterone replacement that was brought up by your PCP.  It is true that T replacement increases the H/H in both sexes.  It is useful if you are anemic, but if you have a genetic response to testosterone that elevates your H/H above what is considered normal, then we advise blood donation or phlebotomy every 2-6 months. It is true that the dose of T can affect the H/H, but men often need a high dose of T to feel normal. The removal of blood is low risk and effective.

I am a Specialist in   Hormone Replacement Medical care with a 38-year history of replacing bioidentical hormones and 23 years of experience replacing bioidentical hormones with T and E2 pellets.  You came to me because your doctors were not helping you with the symptoms of testosterone deficiency and because I have the most experience in the Midwest.

#1.    The first issue that we must always consider while we treat anyone is the primary goals for treatment, the relief of low testosterone which is why you came to me. You made an appointment with me because you had un-addressed issues that your PCP (Primary Care Doctor) didn’t treat satisfactorily

Your symptoms were treated with testosterone pellets successfully at a dose that is individual to you. Your health as you get older is also dependent on your blood level of free Testosterone (the total T is not significant) by delaying the diseases of aging. The level that is required to treat your symptoms is the young healthy Free T blood level of a young and healthy man.

Most labs give a reference range for older men which reflects the fact that free testosterone levels drop with age. Old men don’t feel well BECAUSE they have low free T.  The low free T level is why you don’t feel well. Our practice has found that everyone has an ideal free T level that we try to maintain, and these are young-healthy level but not old-man level.  That is what we have been trying to achieve for our patients.

#2. The second issue is a side-effect that you, as an individual, have experienced with pellets and will experience with any T replacement that you receive that is a high enough dose to treat your symptoms. 

Erythrocytosis is a side effect that some men experience on any form of testosterone, however its occurrence doesn’t mean you are on too much testosterone, it means you have a side effect of having a normal free T level.  Erythrocytosis is genetic, and your free T blood level stimulates the production of too many red blood cells.  We don’t stop the treatment that is making you better, to treat the side effects of it.  We treat the side effects.

We treat this side effect with phlebotomies to keep your H/H within the safe range.  Did your medical doctor/cardiologist tell you why this is important?  We tell you: too many red blood cells can increase the work of the heart, however the Hematologists that we consult with give us the HCT% number we should stay below is 58%.  We like to keep your HCT% below 52% but that requires you to be compliant with your regular blood donated or phlebotomized in our office (that takes an appointment). You must be compliant to keep your H/H normal.

These 2 issues are at odds with one another. I cannot give a man enough testosterone to treat his symptoms, without stimulating some production of RBCs.  I have no other low T treatment that doesn’t stimulate your bone marrow to make red cells BUT I do have a simple treatment to remove your extra blood cells routinely to keep you from having too many blood cells circulating.

Only you can make the decision to choose health with T pellets and do phlebotomies regularly as recommended, or to stop T and allow your blood count to decrease., and your symptoms will come back.

I want you to read your post-pellet instructions, locate my book Got Testosterone? and read it especially the section on Erythrocytosis, and look at FAQs (frequently asked questions) on the www.biobalanacehealth website, read related episodes of my 677 blogs and or listen to my health casts for your answers.  You can imagine how I feel when my patients don’t read what I provide to them in multiple forms to answer their questions.

In the future you should read the information I have given you or come in for an appointment to discuss these matters.

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog

I am not sure if you play THE “WHAT’S THE DISEASE THAT I DON’T WANT TO HAVE GAME with yourself, but since I am a doctor I have spent a lot of time thinking about what diseases I do not want! I started my list in medical school when I witnessed what certain diseases can do to your life.  Medicine has many cures and treatments, yet some diseases that are treated still can negatively change your life forever.

Even though losing a limb and amputation were at the top of my list there is one disease that tops my list.  Of course, I also have under stroke the usual scary situations like paralysis, or having an incapacitating heart attack that prevents an individual from taking care of himself or herself. However, my most feared diagnosis is having a STROKE!

You may not fully comprehend how a stroke can change your life, but it can affect your speech, your ability to move, to think, to go places, to have a sense of humor, to write and communicate, even to have a sexual relationship with your loved one. A stroke essentially can take away your ability to be the person you have always been, AND it requires that someone must become your caretaker.  That helplessness is something I am most afraid of….We all have our personal fears, but whether you fear having a stroke or not, you should  try your hardest to avoid having one!

DEFINITION: a stoke is a medical emergency that occurs when blood flow to the brain is  blocked or a blood vessel bursts. This can damage or kill parts of the brain, which can lead to long-term disability, brain damage, or even death.  This can cause s a loss of function, physical, mental, and  emotional, and loss of one or more of the senses like sensation, speech, sight, hearing and  taste and smell!

In my practice at BioBalance Health we always work with our patients to prevent them having a stroke and or heart attack. These two conditions are the biggest villains that steal the joy of our “golden years” from us.  From the start of my BioBalance Health practice, I have incorporated  healthy diet training, exercise options and encouragement, how and what to take to supplement my patients’ diet and how to outsmart their genetic makeup so they can be healthier than their parents. All of these lifestyle changes can decrease the risk of stroke and heart attack in a person.

So what is it like to have a stroke?

First let’s go over what symptoms are typical of someone having a stroke.

The symptoms of a stroke are multiple, and a person might not have all of them.

• Weakness on one side of the body
• Facial drooping on one side of the face
• Dizziness
• Numbness
• Loss of balance
• Sudden loss of vision.
• Trouble making sense when speaking
• Trouble talking, reading or understanding
• Sudden nausea and vomiting
• Brief loss of consciousness such as fainting, seizures, confusion, or coma.

When someone has one or more of these symptoms it is an emergency, and you should call 911, then start asking the patient to open their eyes, smile, raise both arms and hold them up. Ask them to talk to see if their speech is impaired. Your findings will be helpful to the EMTs who come to the scene.

An event is called a stroke, when there is a deficit in physical or mental function and that deficit continues and doesn’t go away.  If it the symptoms completely resolve, it is called a TIA- a transient Ischemic attack. It is a warning to see a doctor and make sure you don’t have a stroke in the future and it is a wakeup call to stop all poor lifestyle choices.

PREVENTING A STROKE:

This last month, the American Heart and Stroke prevention Association released new Guidelines on how to prevent a stroke.

 I think talking about the risk factors for stroke and discussing how to prevent having one, is worthy of discussion. Recently the medical guidelines for stroke prevention have been revised, and even though I think a few more things should have been included, the fact that they made the first change in the guidelines in 10 years is a first step. Here is what they advise all people who are aging should do.

#1 See your internal medicine or Family physician regularly, at least yearly

#2. Stop sedentary behavior—walk/exercise/ do Yoga, just get out of the chair for the majority of your day!

#3. If you are diabetic, they advocate going on Ozempic/Mounjaro to lose weight—that will lower your risk of a stroke, and heart attack..

#4 If you are hypertensive, take your BP medicine every day

#5 Follow these lifestyle changes called Life’s Essential 8: Your behavior and lifestyle put you at risk for having a stroke:

 Healthy diet, low carb Mediterranean diet, no junk food!

 Physical activity every day

 Achieve a healthy weight,

 Make sure your sleep is restful

 Stop use of tobacco products, No smoking or vaping

 Achieve healthy levels of blood glucose, and blood pressure.

 Don’t drink more than one 4 oz glass of wine a day

 I add these recommendations to theirs for the care of my patients:

• Drink ½ your weight in water every day
• Wat at least half your weight in grams of protein a day
• Get a Cardiac calcium scan to see if you have arterial plaque. If you do have plaque (arteriosclerosis) then you are at risk for stroke as well. See a cardiologist to be treated preventatively and tested.
• Option other than a cardiac calcium scan, get a carotid ultrasound to make sure you don’t have plaque in the neck vessels that lead to your brain..
• Make sure your Homocysteine level is normal (

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog

If you are receiving testosterone or estradiol hormone pellet therapy, BioBalance Health wants to know if you have any of the following medical conditions that may require you to take antibiotics before any medical or dental procedure that breaks the skin, including pellet insertions and dental cleanings. BioBalance Health is dedicated to providing safe and effective hormone replacement with pellets for both men and women, and we want to ensure your health and safety throughout the process. We use sterile procedure guidelines, but certain conditions still require antibiotics to prevent local infections.

Conditions That May Require Pre-Procedure Antibiotics:

1. If You Have Had a Joint Replacement.Some orthopedic surgeons recommend that patients take antibiotics before dental procedures to prevent infection in the joint that was replaced, while others may not. It is important that you follow the advice of YOUR orthopedic surgeon regarding antibiotics before any procedure. If your orthopedic surgeon has advised you to take antibiotics, please let us know. We can provide you with an antibiotic injection or a prescription to take the day of your pellet insertion that will prevent infection.

1. If You Have Uncontrolled Type 1 or Type 2 Diabetes. If your blood sugar is not well-controlled, you may need antibiotics before your pellet insertion to prevent infection of the pellet insertion area. If you are treated and keep your sugars in good control you may not need antibiotics, however if your diabetes is in poor control, you are more likely to get an infection. It is important that you take antibiotics before your pellet insertion.

The following blood sugar levels are considered indicators of poor diabetes control:

• HbA1c > 9.0
• Fasting blood sugar > 150 mg/dL

If your blood sugar exceeds these levels, or if your primary care doctor has recommended that you take antibiotics before dental cleanings or procedures, you should also take antibiotics before your pellet insertion to reduce the risk of infection. 

1. If You Have an Autoimmune Disease and are on Immunosuppressive Treatment. If you are receiving treatment for an autoimmune condition that suppresses your immune system, you may be at higher risk for infection at the insertion site. In this case, you will need to take antibiotics before each pellet insertion. If your Rheumatologist does not believe antibiotics are necessary for you, you may proceed without them. 

1. If You Are Receiving Cancer Treatment. Certain cancer treatments, especially those that suppress white blood cell production, can compromise your immune system. If you are undergoing such treatment, you should take antibiotics before or with your pellet insertion to prevent infection.

In Summary: If a doctor has advised you to take antibiotics for procedures, such as dental cleanings, you should also take antibiotics before your pellet insertion. Please inform us of any conditions or treatments that may require this precaution, and we will ensure you are properly prepared for your procedure.

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog

If you feel ignored and unheard by your doctor or nurse practitioner, your feelings are correct!  As a group women are not listened to and often dismissed as emotional and not smart enough to understand “complicated” medical information, by the Misogynistic American medical community, the US governmental agencies who make the rules for what women need.  If you feel unheard and dismissed by your doctor, your impression is probably right, and you need to vote with your feet and leave that doctor for someone who listens to you and treats your symptoms and conditions that undermine you and your productivity.

The Myths that the majority of people believe are created by men and broadcast by premenopausal women and the media who have no first-hand knowledge of the problems that women contend with when they become pre-menopausal. Here are just a few of the lies and Myths that we must contend with.

• Women love the freedom of being in menopause! No worry about pregnancy or bleeding.  LIE
• Women can’t become president’s companies or the President of the United States because we are going to hit the red button to destroy the world because we experience PMS before menopause, and after we just can’t think or make educated decisions. LIE
• Symptomatic Menopausal Women are Over-reacting to a “normal” Phenomenon that “strong” women take in their stride. LIE
• Women complain about menopausal symptoms to get attention. LIE
• Women’s menopausal symptoms are really from psychiatric disease. LIE
• Women who complain of bleeding all the time don’t need a hysterectomy! Just use medication (that doesn’t work). LIE
• Women’s menopause symptoms are from behavior problems. They need counselling! LIE
• Menopause should be a wonderful time of your life! Right!  LIE

All these LIES are damaging to the women who need medical treatment.  We don’t need name-calling, subtle dismissal of our symptoms by our doctors, one size fits all non-medical treatment like vitamins and herbs, or basically categorizing our physical symptoms as imaginary or mental which allows doctors to be excused from treating our hormone deficiencies.

No sex drive, painful sex, insomnia, fatigue, brain fog, weight gain, fatigue, hot flashes and sleep disturbances, migraines, loss of muscle weight gain and fatigue, depression and anxiety are physical symptoms of menopause and pre-menopause, that can all be treated with estradiol, testosterone and in some cases progesterone replacement.  Menopause and the years leading up to it CAN BE TREATED safely and effectively but we aren’t offered treatment by the doctors who work for our insurance companies! Refusing to provide the hormones you need at menopause is denying you the treatment for literally losing the hormones that made you, YOU is not only disturbing but scary!

Medical care includes the replacement of waning hormones The only differences between menopause and testosterone loss and hypothyroidism,  Cortisol deficiency (Addison’s disease), Parathyroid deficiency, Growth hormone deficiency in children are all paid for by insurance and doctors willingly treat these illnesses because they are not only paid to do so but they have taken a Hippocratic oath to treat the symptoms and diseases of the patients who come to them.  However, in my office I hear the struggles that women have had getting treatment for their symptoms.  Their doctors generally use the excuse, “I don’t believe in hormones.” So, they get out of treating half of their patients over 50.  Hormonal treatment isn’t a religion, it is a condition that 50% of the population will have in their lifetimes. If your doctor is a PCP Primary Care Physician or OBGYN, then they have the training and the duty to treat you.

Sadly, these lies have sculpted how women are looked at in the American and English-speaking countries.  Misogynistic beliefs are meant to keep women in a second-class status. The result is ignoring the simplest and the most affordable menopausal treatment -Estrogen and testosterone- and profit from our menopausal pain by serving up very expensive treatments for each of the many complaints secondary to menopause that no women can afford.  eg: one drug for dry vagina, another for just hot flashes, a third for4 the mood changes that occur with menopause, and another for osteoporosis.  All these symptoms can be treated with a combination of testosterone and estradiol, and you can get your sex drive back too! If you think that your government is going to help you , remember the leaders  in US government are mostly men who buy-in to the destructive misogynist group think!

Lie #1: Women love the freedom of being in menopause!  No worry about pregnancy or bleeding anymore.

Menopause might have been a relief from bleeding every month however, we no longer worry about childbearing before menopause since the birth control pill was created in the 1960s.  In contrast the women of the first half of the 1900’s before Birth control, because menopause stopped women from having unwanted or unaffordable numbers of children. In reality, women living 100 years ago rarely lived past age 45 for women so most women didn’t live to experience menopause!  Women suffered then but they were gagged by societal rules, and no one cared how they felt after childbearing years.  Now we are very integral to society at any age, not just for childbearing, and menopause is not freedom or enjoyable! We need one all encompassing answer.  The answer is long-acting estradiol and testosterone pellets that can resolve all these symptoms and make the years of a woman’s life after menopause like any other era.

Lie #2. Women can’t become presidents of companies or the President of the United States because we are too emotionally unstable.  Women are portrayed as unreasonable, hysterical and unreliable. LIE!

The belief that women can’t be a CEO or president of an organization, or of the US, because we are too emotional before menopause, and after menopause we are not competent to make decisions, is based on uneducated beliefs and old wives tales (really old husband’s tales).  We are more competent than men before menopause because we can think of more than one thing at a time, and act on the information, and because we have outstripped men in high school and college class status for decades. As for after menopause, we are at least as competent to lead if we have our menopause treated as men who are aging and becoming addled.

If we had the information that has been kept from us about the treatment for menopause, and if we were encouraged to get treatment instead of disparaged by our doctors of both sex in the US, and the US government, then we could hold any position we are qualified for, probably better than men.  Even the “Societies” that say they are for women don’t seem to be when they publish articles like the one, I read last week from the Medical Journal called “Menopause” women need counselling not medical treatment for the symptoms that we “imagine”.

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog

During our interview I reviewed her path through recovering from years of no hormones and discussed how dramatic her recovery was.  Her symptoms included no libido and no orgasms, Painful intercourse from a dry vagina, fatigue, depression, troubles with memory, Insomnia, lack of motivation, dry wrinkled skin, alopecia, osteopenia, weight gain, loss of muscle mass and weakness, fibromyalgia, migraines, hot flashes, insomnia and poor of quality of life.  Her symptoms impaired her ability to have a quality life.  During the years after her hysterectomy, she developed hypertension and Rheumatoid Arthritis. After she was treated with Estradiol and Testosterone pellets, her recovery was dramatic and fast!  It amazed both of us, and she has continued to improve her health and now she is very healthy, without hypertension and she had almost a decade free of Rheumatoid Arthritis.

It turns out that the recovery of her energy, confidence and strength was well timed. She needed all the health and strength she could get to take care of her husband who finally succumbed to brain cancer in 2019.  The same year she had the strength to become VP of Paramount bank as her employment.  It seemed that the more life-disasters that she overcame, the stronger she got! As generally happens when people are overly stressed, even hormone replacement is overwhelmed.  In 2018 had a recurrence of rheumatoid arthritis, and she developed Hypothyroidism and Insulin resistance.  Grace, my NP at BioBalance Health, helped her treat her thyroid and weight gain and guide her to overcome these medical problems including losing the weight she gained with insulin resistance.

In 2022 she met, and married Mark Behlmann, who she served on the same charity boards with, but she had never met before.  She got her second chance with Mark at finding love and fulfillment in her partnership with him.  He encouraged her to compete in the. Ms. Missouri Senior, and she employed her energy, talent for singing, her own passion for success and service to become the 2024 Ms. Missouri Senior. In her role she encourages women to use their gifts to achieve everything that they can in life and to find a doctor to help them survive loss of hormones after menopause, so they can continue their service to family and society throughout their lives…she is the best example I can think of living your life to the fullest every day, no matter how old you are!

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog

Do you ache all over? Are you weaker every year? Shorter and more bent over?   Are your clothes hanging off your shoulders? Do you walk slower and hold on to things as you walk? If you notice these signs in yourself or someone you love it means you, or they are becoming frail.

As a physician I had to become a people watcher…. or more accurately an observer of the people around me.  Even if you aren’t medical people, I am sure many of you are as well…. but being very observant is a requirement for a physician because there are many signs of illness that can be observed just from observing a patient who we I am treating.  I always pay attention to how the patient I am consulting with walks, shakes my hand (their strength), and how well they care for themselves, the quality of their speech, whether they look well nourished, over-nourished or frail.  All of these individual observations and more, become automatic to me as a doctor. They help me diagnose and treat my patients without a stethoscope or even an x-ray… Today I want to talk about frailty, what it is, and what it means to your doctor and you as a patient.

Frailty can be defined as the visible qualities of loss of muscle mass, bone mass, energy, as and strength, as well as thinning of the skin, kyphosis of the spine (standing with your head looking down and your shoulders rounded), slow movements, weakness of strength and voice.  Frailty is the visible sign of aging.

The opposite of Frailty is the Quality of being robust. When we are young we are strong, energetic, our muscles are visible, our skin is clear and taught, our posture is straight and we appear healthy and strong….when we are young we are Robust!   Frailty is the quality of being old and weak, in a catabolic state (or a state of tissue breakdown and “shrinking”).  You can equate Frailty with aging, or physically being old.

What does frailty mean to a doctor?

When we take care of a patient who comes to us for the first time in a frail state we rule in or out a list of diseases of aging and physical problems. These include:

• Arthritis
• Osteoporosis
• Sarcopenia or severe loss of muscle mass and strength
• Inflammatory diseases like arthritis
• Heart disease
• Diabetes
• Dementia
• Inability to be independent

Doctors must look for illness and decide on a treatment to remedy a disease, but frailty is not considered a disease that has a treatment.  It is a sign that a patient is going through the last stage of life.  Many studies have been done that equate frailty to a limited life span and a loss of quality of life, but no treatment has been employed by mainstream medicine to delay, avoid or treat frailty.

Up to now this is all very depressing, however it is my well founded belief that the loss of testosterone  after age 45 in women and 55 in men is the first step toward frailty, however if  adequate testosterone is replaced soon after the symptoms of T deficiency starts, then frailty can be avoided as we age, and the eventuality of loss of quality of life will be delayed or avoided all together. 

It is a fact that nothing other than the hormone testosterone can reverse frailty and stop it from progressing. With T treatment my patients increase their muscle mass, create stronger muscles, and improved their mental and physical stamina.

To me this is such an easy one-hormone-answer to actually improve my patients lives, at any stage in the aging process, however the pharmaceutical companies that control American medicine much prefer to treat each symptom with a different drug.  There are millions of aging folks in nursing homes who could have maintained their independence, and avoided the use of many drugs if they were treated with testosterone before their frailty reduced their mobility so they need help to perform daily activities of living independently.

Sadly, medicine in the US basically gives up on frail and aging patients and we doctors are taught to make frail patients “comfortable”, just treating their symptoms without hope of reversing frailty and the outcomes of that condition.  Of course, it is much healthier to prevent frailty by replacing the essential hormone testosterone early on, however your doctor will have to think out of the box to arrive at the Testosterone treatment, rather than follow the medical protocols that involve just keeping aging patients “comfortable”.

Research studies and articles to be read by doctors like the recent one in the New England Journal of Medicine that draws a direct line between aging and frailty, but only concentrates on the fact that frailty portends early death and discussed the best ways to make patients comfortable dictated by the severity of frailty.  There is no treatment other than high protein diet and vitamins with physical therapy which will not “treat” this disease.

I want to tell you about two very different patients in my practice.  The first is a very successful man in his late 70s who came to me seeking weight loss because he had been an athlete and still enjoyed playing golf, but he was complaining of weakness and other symptoms of frailty, in addition to looking borderline frail when he first came to me.  We did a body composition test, and he had a higher fat mass and a lower that ideal muscle mass which is the way frailty begins.

We discussed the fact that weight loss (fat loss) obtained by more exercise and less carbohydrate in his diet might improve his Pre-diabetes and inflammation, but would not make him stronger, or increase his physical and mental stamina, in other words reverse his beginning frailty.  He chose to embark on an exercise-based weight loss program combined with a high protein low carb diet.

In the end he did not take my advice about the best way to lose weight without losing muscle which would have been to add Testosterone and Metformin to his treatment plan, however he wanted to be the one directing his own care (he was a business man and not a doctor) without a basic knowledge of physiology, or  nutrition, or any training about aging and frailty. Let me note that if he was younger than 55, and he tried this weight loss program while he was making adequate Testosterone, he might have had a successful fat loss program and gained muscle density and strength while he lost fat, however, this gentleman is 78.

You can guess the end of the story.  He did lose weight, however he lost as much muscle as fat and was even weaker after 6 months.  This is sometimes what happens when very successful people in one area of life think that makes them brilliant in all disciplines.

Now, the flipside of the coin.  I will tell you about an 82-year-old doctor who came to me almost too late.  His much younger wife was already my patient, and she encouraged him to have a consult with me to see what I could do for him.  He had the right attitude, but was already frail, and I could feel the humorous bone of his arm, when I ushered his into my office for his consultation.  I explained what observing him and his lab told me more while he told me that he had almost every symptom of aging, and frailty.  He told me that he was an athlete in college and that he always had a lot of muscle, and he watched every day as his muscles “melted away”, despite his exercise daily.  He was frustrated and had trouble with his memory as well because he had lost his testosterone long ago and he had done well for as long as he had because he had eaten a nutritious diet, taken supplements and worked out daily. We discussed his other medical problems, and some treatments for them, additional supplements to assist in building muscle and bone strength.

He came back 5 months later after he had his T pellets inserted and he walked in with confidence, and the difference in his muscle mass was visible!  He was no longer “frail looking”.  He told me he was thinking better, not completely yet, but his mind was getting progressively better.  He had lost fat and gained muscle. He had turned the clock back 15 or more years.  Testosterone in the right dose and delivery system can erase frailty and give a quality of life back to my patients who had no help from other doctors.

Look around you if you aren’t yet at the age that carries with it frailty  or if you are without Testosterone and are experiencing frailty…look at those around you in the doctor’s office or when you are waiting to board a plane…look at the pre-borders who can’t walk the length of the ramp to the airplane and see if they have the visible characteristics I am talking about.   If you are over 45 and female or 55 and male and not on Testosterone maybe you should consider having your testosterone replaced so you can keep your muscle mass and independence as long as you live.