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Endocrinologist or GYN for hormone regulation?? Endocrinologist or GYN for hormone regulation??

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  #1  
Unread 02-29-2012, 10:17 AM
Question - Endocrinologist or GYN for hormone regulation?? Endocrinologist or GYN for hormone regulation??

I am 35 years old and scheduled to have a TVH on June 1st. I had my right ovary removed 11 years ago due to multiple dermoid cysts. Now my left ovary is engulfed in dermoid cysts as well and needs to be removed. I also suffer from cystocele and rectocele. Therefore, my surgery will include removal of my ovary, uterus, repair of bladder and rectum as well as a bladder sling to prevent leakage. At the age of 35 it has been recommended that I go on estrogen therapy until my natural menopause age of 50+. I have a lot of concerns about the correct balance of hormones. I want to take estrogen, however, I also want to take testosterone. I am a moderate weight lifter and also do moderate/intense cardio 2/3x a week. I want to be sure my levels are correct for my lifestyle and symptoms post surgery. Reading posts on estrogen I already believe I am producing low levels of estrogen... with only 1 ovary which is severely compromised due to the cysts. I have several symptoms people list when they feel/know they are low. I am contemplating going to an endocrinologist even prior to my surgery to have my hormone levels checked so that I have a pre-surgery baseline and will know where I should be post-surgery, however, I also feel I am low now, so that would confirm that as well.

I am not sure this is something my GYN would be specialized enough to do. In searching for endocrinologists in my area I see a lot of them specialize in diabetes or peds. Are there endocrinologists who specialize in menopause?

Any feedback would be greatly appreciated!!
  #2  
Unread 02-29-2012, 12:26 PM
Re: Endocrinologist or GYN for hormone regulation??

I think it really depends on your doctor. Find one that is familiar with bioidenticals. I am actually working with my primary care physician on my hormones.
  #3  
Unread 02-29-2012, 12:31 PM
Re: Endocrinologist or GYN for hormone regulation??

Thanks Molly. I have a co-worker who also sees my GYN and she is on Vivelle Dot and in looking into it I believe it is what I will request as well. I do have a call into my GYN to address some specific hormone concerns I have pre/post surgery. I am just not sure that their office can handle my requests because when I had my pap/pelvic back in January I had requested to have my estrogen/testosterone levels checked because I suspect balance issues and the PA didn't seem interested and actually said it isn't something they can easily do. That is why I am wondering if I shouldn't seek out a reproductive endocrinologist to help me along this hormone journey.
  #4  
Unread 02-29-2012, 12:50 PM
Re: Endocrinologist or GYN for hormone regulation??

  Quote:
Originally Posted by lmk2d View Post
I am just not sure that their office can handle my requests because when I had my pap/pelvic back in January I had requested to have my estrogen/testosterone levels checked because I suspect balance issues and the PA didn't seem interested and actually said it isn't something they can easily do.
It actually isn't easily done for any office/doctor if you have functioning ovaries and are not menopausal. Hormone levels change constantly depending on where you are in your cycle and even your activity level for a given space of time. Thus, you would need multiple tests over several weeks to find out any kind of accurate information for specific hormones. Having issues that are leading to a hysterectomy and oophorectomy could also give you numbers that are not ideal for you anyway as many of those issues can affect hormone levels in some way.

The only hormone numbers any of my doctors have ever checked is my FSH as anything else with working ovaries would only be a number for that given time on that given day rather than an accurate overall picture.

As far as managing HRT after a hysterectomy, it definitely depends on the doctor. There are physicians in many areas of study who are knowledgeable about hormones. It can depend on their interest and if they have chosen to take a special interest in HRT.

  #5  
Unread 02-29-2012, 12:58 PM
Re: Endocrinologist or GYN for hormone regulation??

Wow... that is great to know. So obviously getting a "base line" for before my ovary is removed isn't going to be an option. So.. then my question is.. how do they know what level of estrogen and progesterone to put you on after ovary removal? With the patch/pill you are given a steady dose.. not a varying does due to cycle/activity level, etc. I've been doing a lot of reading and it sounds like people can tell when they are too high, too low, etc. I saw someone comment that they could tell they needed more estrogen after working out. I am at the gym weight lifting or doing cardio 5+ days a week. I am very nervous about my hormones getting figured out after surgery. Hopefully my GYN will have some insight or at least be able to point me in the direction of a specialist. Thanks Weiser!
  #6  
Unread 02-29-2012, 01:08 PM
Re: Endocrinologist or GYN for hormone regulation??

  Quote:
Originally Posted by lmk2d View Post
So obviously getting a "base line" for before my ovary is removed isn't going to be an option.
Not really at all.

  Quote:
So.. then my question is.. how do they know what level of estrogen and progesterone to put you on after ovary removal?
Unfortunately, it is a lot of guess work. Plan to have a lot of patients and keep a detailed symptom diary. In general, your doctor is going to use your age and typical activity level to make an educated start. From there, it will take time to see how your body does on each dose before it is changed and/or another hormone is added. In general, women are started on estrogen only first. When that dose and type is figured out, progesterone may be added. Keep in mind, progesterone can change the dose of estrogen you need. Testosterone is often added last unless there is a specific reason it is needed sooner.

  Quote:
With the patch/pill you are given a steady dose.. not a varying does due to cycle/activity level, etc. I've been doing a lot of reading and it sounds like people can tell when they are too high, too low, etc. I saw someone comment that they could tell they needed more estrogen after working out. I am at the gym weight lifting or doing cardio 5+ days a week.
Yep, it can sound ideal to have a steady dose of hormones. The problem can be that our lives aren't steady so we may need more or less hormones on a given day. That is one reason why HRT is not a perfect solution for everyone and some ladies really want to trying to find the right regime for them.

Definitely keep a list of all of your questions and concerns and share them with your doctor. If you and your doctor don't connect on this topic, it won't necessarily mean your doctor is a bad doctor. You will just need to find one with the knowledge you need for you.

S
  #7  
Unread 02-29-2012, 01:19 PM
Re: Endocrinologist or GYN for hormone regulation??

Thank you for all of your help!! I really appreciate it. You sound super informed about all of this hormone stuff. I'll be sure to discuss all of my concerns with my GYN and hopefully we'll be on the same page, however, if not I will search for a reproductive endocrinologist. I am not sure if I will need progesterone though as I won't have my uterus. I have read that it isn't needed without one. I still need to research what else would be needed besides estrogen and testosterone. I am going to request testosterone as I weight lift and it is an essential element in building/maintaining muscle mass. Without adequate muscle your body's metabolic rate will slow thus causing weight gain..... I want to avoid that at all cost.
  #8  
Unread 02-29-2012, 01:25 PM
Re: Endocrinologist or GYN for hormone regulation??

Some women do need progesterone added into the mix and some need testosterone as well as estrogen. I just saw my primary doc who is an internist and seems to be pretty educated about HRT. She said if the estrogen alone doesn't cut it she will add some progesterone in for me. She just wrote me a prescription for Estrace pill 1mg since after 3 months the Vivelle dot doesn't seem to be giving me enough consistancy. I seem to "run low" on E by the 2nd day on the patch. Hopefully the pill will work better for me, otherwise we try something else.
  #9  
Unread 02-29-2012, 01:35 PM
Re: Endocrinologist or GYN for hormone regulation??

How can you tell you don't have enough estrogen.. what are your symptoms? I worry about that too.. since I already think I run low. I'm not sure I even know what normal is.....
  #10  
Unread 02-29-2012, 01:35 PM
Re: Endocrinologist or GYN for hormone regulation??

  Quote:
Originally Posted by lmk2d View Post
Thank you for all of your help!! I really appreciate it.


  Quote:
You sound super informed about all of this hormone stuff.
Actually, this topic is so complex that what I know is a drop in the bucket!

  Quote:
I am not sure if I will need progesterone though as I won't have my uterus. I have read that it isn't needed without one.
This can be a controversial topic with strong opinions by medical professionals on both sides. So this is something you and your doctor will have to work through together to see what is right for you. Keeping the symptom diary will be helpful.

  Quote:
I am going to request testosterone as I weight lift and it is an essential element in building/maintaining muscle mass. Without adequate muscle your body's metabolic rate will slow thus causing weight gain..... I want to avoid that at all cost.
Definitely talk to your doctor because being a weightlifter could affect your needs. But also know that not all doctors will prescribe testosterone so you will need one who is open on this topic.

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