What to look for when Testosterone and Estradiol pellets are not working as planned.
It is not often that I have trouble determining a successful treatment plan for menopausal women based on hormone pellet therapy, however I have been struggling with trying to make one of my patients better for the past ten months. Because this has been such a challenge I thought that this clinical case might help some patients and their doctors to solve similar situations. Case studies are vital to the education of doctors and the successful treatment of complicated patients, and this case centers around a patient who continued catabolic loss of muscle despite treatment with testosterone pellets.
She is a 5-1 62-year-old woman who weighed 105 lbs. at the beginning of treatment 10 months ago. Her symptoms were muscle weakness and atrophy, lax skin, fatigue, hot flashes, insomnia, poor coordination, “looking old”, “belly fat”, anxiety and depression (she had tried 4 different drugs without success) and no libido at all which was unusual for her.
These are typical symptoms of low testosterone, so she was accepted for her first treatment and consultation 10 months ago. I was confident that she could be “cured” with testosterone and estradiol pellets.
Her Quest lab showed abnormal free-testosterone of 0.2 (normal >7.0), estradiol < 25, estrone of 40 (should be half of estradiol), normal thyroid, low growth hormone (90 with young healthy level being 150-350), Slightly elevated Cortisol, High FSH (112, with nl <23) and high LH (85 with normal < 10). Her prolactin was normal.
Other lab that was abnormal included her blood count which showed anemia and large red blood cells. Her lipids were abnormal with an LDL of 190, and a normal HDL. Inflammatory marker was slightly elevated. Her metabolic profile included one abnormal liver enzyme, but the rest of liver and kidney studies were normal.
At our consultation I noted that she looked more than fatigued—exhausted would be a better word. Her nails were covered with gel nail polish so I could not observe that. Her hair was abundant, but straw-like and her gait was slow wit obvious hanging muscles of her upper arm, creepy skin, and uneven skin coloring. She had a tremble of her lower lip that I chalked up to anxiety.
We discussed lifestyle and it seemed typical—3 meals a day, she loves to cook, and had a glass of wine nightly. She did not smoke or take drugs except for two antidepressants, blood pressure medicine, and Xanax.
Her first treatment included just testosterone because she was “afraid of estrogen”, B12 sublingual tablets for her pernicious anemia, Endo Dren for her elevated cortisol and Iodoral because we live in the “goiter belt”.
Second visit she told me “nothing worked” ….she was no better and she did not look better! Her lab showed a slight improvement in growth hormone, testosterone level was great, but none of her symptoms were better.
I reviewed her lifestyle and she told me that she worked out aerobically 2 hours every day! She described her diet as normal and her alcohol intake as a glass of wine every night. I changed her dosage to increase the T, added estradiol and told her that she was working out too much and that she needed to work out on the elliptical every other day and add light weights on the other days for 30 minutes.
Third visit, she had hair shedding from the higher dose of T, and the hot flashed went away but her lower extremities were weaker and now she had pain in them! She had had her back x-rayed, her pelvis evaluated and except for a few minor bulging disks she was normal.
I reviewed her blood work and she had not responded to her vitamins for pernicious anemia, her liver enzyme was still high, and she looked….worse!
OVER EXERCISE—with obsession!
My aha moment began when I asked her to assure me she had decreased her aerobic work out to every other day. NO! she couldn’t because it was the only thing that made her better! I told her to stop exercise…then she told me that 3 other doctors told her to do the same but she didn’t……
ALCOHOLISM—and BODY DYSMORPHIA
Then I asked her to recite everything she ate and drank in a day. She drank a BOTTLE OF WINE EVERY NIGHT and limited her calories to 220 per meal! She was actually her own worst enemy….No amount of T or GH can combat these issues.
I told her she must stop drinking, double her methyl B 12 and stop counting calories, but to eat 6 times a day and add meat, cheese or eggs to every meal…she was primarily eating fruit and veggies only!
I continued to treat her with a lower dose of pellets, and she continued to find a doctor who would not require that she stop drinking and allowed her to fade away by starving herself! We can be our worse enemies, and I believe that her lifestyle plus the other drugs she was on prevented her from succeeding with her hormone pellet replacement!
This Health cast was written and presented by Dr. Kathy Maupin, M.D., Bio-identical Hormone Replacement Expert and Author, with Brett Newcomb, MA., LPC., Family Counselor, Presenter and Author. www.BioBalanceHealth.com.