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Hormone replacement therapy is intended to improve and/or maintain quality
of life and increase life expectancy. There are many regimens that are available to the postmenopausal woman and
which she chooses may depend on her individual goals of therapy, her attitude about HRT, and any existing medical
conditions. If her physician's knowledge of HRT is limited to only a few basic regimens it will influence which
HRT program will be offered If she feels an alternate program is more suited to her needs she should consider finding
a physician who is more knowledgeable about HRT.
In my private practice most of my patients came to see me either because they continued to experience significant
symptoms in spite of being on an HRT (i.e.; lack of libido, persistent hot flashes, insomnia, heavy vaginal bleeding),
and were told, " Nothing else can be done" or "You just can't take HRT" or "How are things
with you and your husband", or "Maybe you need to see a therapist". This is an all too persistent
theme in new patient interviews.
It is unfortunate for a number of reasons. First, this is a very unhappy woman, desperate to feel better and afraid
she never will. She has been told nothing else exists to make her feel better, and worse, that she's part of the
problem. The physician, who has limited skills in the treatment and care of menopausal women, is sincere and actually
believes this to be true. The physician's rational works something like this; "I gave her the treatment the
book and conventional wisdom says works, so the problem can't be me or the treatment...it must be her". If
she stops looking for an answer she never will feel any better.
The "gold standard" for determining if a problem is due to your menopause is simple. If you didn't have
it before before your natural/surgical menopause and there is no other rational cause for your symptoms, it's menopausal
until proven otherwise. In fact, there is a very good chance it can be improved by appropriate HRT.
That being said, HRT regimens consist of first the administration of estrogen and if indicated progesterone(progestins)
and/or testosterone. Progesterone is given to prevent overstimulation and/or abnormal changes of the lining of
the uterus and so is not usually a part of an HRT program after a hysterectomy. Testosterone is the sex hormone
most closely associated with sex drive and is also a factor in energy levels and the preservation of muscle mass.
There is a great deal of hysteria among some physicians and laypersons about testosterone. Shouts of "you'll
grow a beard" are interspersed with plaintiff wails of " women are too aggressive if they take testosterone".
It's normal for women to have testosterone levels, the ovary produces testosterone prior to menopause and continues
to do so following menopause for several years in most women. If the ovaries have been removed or are not functioning
appropriately testosterone levels may be very low. Replacement is done with the idea of approximating normal levels
in women and significant growth of male-like facial hair at these levels would be rare and I have not seen it in
my practice except in women who have a preexisting problem with excess hair growth and this can usually be helped
by taking Aldactone, a medication that prevents the skin receptors for hair growth from being stimulated by testosterone.
As for women being too aggressive on appropriate doses of testosterone I have not found that to be true and have
a concern that women who are testosterone deficient may be too passive.
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Dr Nosanchuk is currently in practice in Southeastern Michigan
and is accepting new patients. His office is located in Bingham Farms, a suburb of the Detroit Metropolitan Area.
Dr N specializes in the care and treatment of menopausal women and has a special interest providing treatment to
women whose lives have been altered by their menopause, hysterectomy, or both. This includes strategies to restore
quality of life, by resolving problems, such as persistent symptoms, loss of libido and disturbances of sexual
function.
Appointments with Dr Nosanchuk can be scheduled by calling (248) 644-7200
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