The search for a hormone replacement practitioner, or: From whom should I purchase my Ferrari?

I had a recent interesting experience in returning to my university for an anniversary event. The women and men that I knew from school are all now middle-aged. Some of them are still looking rather fit, and others. . . not so much.

Because I’m passionate about the field of medicine, and everything that it offers, a couple of conversations led to my assertion to my friends that they consider the benefits of “hormone balancing.”  With all the failures that we’ve had in medicine in demonstrating meaningful value for our patients, one of the biggest missteps has been in the area of preventative medicine. We have been driven by economics rather than science, and for women around the turn of the century we attempted to replace the wrong hormone at the wrong time in life. Then, we totally botched the analysis. “Botched” is such a strong word I have never used that word to describe another doctor’s result as the patient was consulting in my office. I would use another stronger word if it existed. As physicians we were as reckless in reversing our previous widespread recommendations as we had been when we originally recommended an unproven hormone replacement intervention strategy. The Women’s Health Initiative (WHI) showed us where we were right and where we were wrong, and we fumbled the ball.

For men it was different. We just extrapolated from women the idea that if hormones make you feel good, it’s very likely that they have bad effects. Men are probably just like women. There actually different enough that they need individual consideration.

For those who are interested, I’m always willing to share studies which in some cases show profound benefits with a favorable risk pattern. Most people just want to trust a doctor; they understand there might be risks, and if it’s going to make them feel better, they say “hit me, Doc.“ But, while economics has always driven poor analysis and an uninformed prescribing behavior, economic benefit has conflicted some practitioners who advocate current aggressive hormone intervention for apparent economic gain. These practitioners have flocked to this seemingly “easy win,“ and, upon examination, struggle to scientifically defend their prescribing habits. It is true that they see mosty very happy patients – “This is why I went into medicine,” they say. But the patient care might not rise to a level of thorough consideration that the profession of Medicine demands. HOWEVER, it is also demonstrated that some specialist physicians have become passionate about this hormone tool, distracting those practitioners from their established successful medical or surgical practice, and this passion has demonstrably cost them financially.

Because I care about this “golden nugget“ of symptom relief and preventative medicine, I demonstrated due diligence in researching the potential prescribers to whom I might refer. I relied upon terms that I used for a Google search as well as a list of names that I received from trusted colleagues and vendors. Wow! Even for me, a highly networked and experienced physician, I found it incredibly difficult to locate a “slam dunk“ practitioner who could be relied upon to take good care of my middle-aged friends. I searched two large metropolitan areas and the following is what I experienced:
1. Practices that had unprofessional appearing and non-functioning websites.
2. Offices that did not respond to a website request from a physician.
3. Websites that contained statements which were imprecise, inarticulate or inaccurate as it pertained to hormone replacement.
4. Practitioners who described themselves as being “all in“ on the natural hormone replacement revolution, but were using a turnkey marketing/pharmacy vendor to make all the prescribing dosing decisions.

The unfortunate thing is that most patients have come to expect a high level of inefficiency and inconvenience as they pursue healthcare services. Secondly, it is true that most practitioners prescribing hormone replacement find it very easy to demonstrate a favorable clinical response, so they don’t feel compelled to provide excellent access and a good patient experience.

All this above being true, the data continues to strongly suggest that the appropriate hormone replacement offers a new era in medical therapeutics. In many cases it may not matter from whom your get your Ferrari–take a test drive from a dealer near you.??
 

~ Gregory Laurence, MD