Menopause and Low Testosterone: Jan’s Story

This is the story of my patient who I will call Jan. When she came to see me she was 56 years old and had been experiencing menopause symptoms for about 6 years. She was having 5-6 hot flashes every day and 2-3 hot flashes every night with sweating that soaked her from head to toe. Needless to say this was more than annoying. 
She was fatigued, irritable, had lost all her sex drive and no longer felt her usual zest for life. She had gained 15 lbs over the past year without changing her diet or usual routine. She was also experiencing joint pains and memory loss. At first she just looked at menopause as an annoyance, but now it was destroying her life. She just didn’t feel like  herself anymore.
Patient: Jan    Age: 56
First Office Visit
Chief Complaints:
1)     Hot Flashes w/sleep disturbance 2-3 times/night with night sweats head to toe;
hot flashes 5-6 times per day ( due to low Estriol)
2)    Vaginal Dryness (due to low Estriol)
3)     Low Sex Drive (due to Low Testosterone)
4)     Moodiness, Fatigue (due to low Testosterone)
5)     Memory Loss (due to low Pregnenolone)
6)     Weight gain in the Abdomen ( due to low Testosterone)
7)     Joint pains (due to low Testosterone and low Growth Hormone)
Medications: Estrace (Estradiol) associated with significant increased risk of invasive breast cancer, uterine cancer, heart attacks and strokes
Female Symptoms: Vaginal Dryness (due to low Estriol); Painful Intercourse (due to low Estriol); Low Sex drive – None (due to low Testosterone)
Mental: Poor Memory; Forgetful (due to low Pregnenolone); lack of usual spark – no sense of joy (due to low Estriol, low Testosterone, and low Serotonin)
Skin: Getting thinner; Bruises easily and has Varicose Veins (due to deficiency of Estriol, Growth Hormone and bioflavonoids that strengthen collagen and elastin, which line the veins and arteries)
Sleep: disrupted 2-3 times/ night with hot flashes (due to low Estriol)
Musculoskeletal: Arthritis, back pain (due to deficiency of Testosterone, Growth Hormone and bioflavonoids that strengthen collagen and elastin that make up ligaments, tendons and cartilage)
Physical Exam: BP 140/90 (elevated Blood Pressure due to hardening of the collagen and elastin in the arteries from a deficiency of Testosterone, Growth Hormone and bioflavonoids); overweight: 134 lbs (due to low DHEA and Testosterone that decline with age. DHEA is made by the adrenal glands and is converted into Testosterone; both are needed to maintain muscles where fat is burned; with muscle atrophy that occurs with age, the ability to burn fat decreases and it accumulates, especially in the abdomen); height: 5’4″ (Fran can’t change her height, but she should only way about 120lbs for her height)
Note: Jan is a typical example of hormone imbalance. The good news is that we can now test her hormone levels individually and create a specific and individualized plan just for her unique biochemistry – a plan that will restore hormone balance, vitality and a tremendous sense of well being. For a more detailed description of each hormone and hormone testing, see my article entitled “Balance Your Hormones, Balance Your life.”
Initial RX: Estriol 2mg per day at bedtime; Peak Advantage: 2 capsules 3 times per day; GSE Ultra 110: 1 cap twice daily (provides nature’s most potent source of OPC bioflavonoids that stimulate and protect collagen and elastin needed for healthy skin, joints and blood vessels).
2 Weeks later
Jan came back to review the result of her lab tests and to get a comprehensive and updated prescription based on her specific individual lab test results and her response to my initial prescription.
Since starting the Estriol Jan is now sleeping through the night!
Still getting hot flashes during the day, but less intense
Follow-up RX: Estriol 2mg twice per day(Estriol has a short duration of action in the body, so if hot flashes occur both night and day, it is necessary to take a dose twice daily);  Add Progesterone 25mg once daily at bedtime; DHEA 10mg once daily; Cognition (containing Pregnenolone) 2 Caps twice daily (for memory, brain health); Testosterone shots 0.1cc (20mg)  1x/wk for 4 weeks (Jan’s Testosterone level was so low I decided to give her Testosterone injections once per week for 4 weeks to jump start her energy, mood and sense of well-being); after 4 wks of Testosterone shots I will change the Rx to sublingual Testosterone.
1 month after 1^st visit
Feeling Great!  No longer having any hot flashes day or night!
Emotionally, feeling normal again.
Physical Exam: BP: 134/80
Rx: 2nd Testosterone injection (0.1cc)
Feeling really great!
Rx: 3rd Testosterone injection (0.1cc)
6 Week Follow-up Visit
“Sex drive is back. Mentally and physically I’m finally feeling alive. I feel like a 16 year old again. It feels good to feel this way.”
Rx: 4th Testosterone injection (0.1cc)
 7 weeks from 1^st visit
“I’m feeling GREAT! Energetic. I’m not feeling that terrible blah feeling anymore. I’m Happier.  Jan reported that she realized she had been kind of living in a fog mentally.
Rx: Stopped Testosterone injections; Re-test serum Testosterone level.
4 Month follow-up since 1st Visit
Feeling awesome; Energy better; mood better; head clear – no longer feel like in a fog; overall very happy;
No more vaginal dryness; sex drive feels great!
Sleeping great; Sleeping soundly all night long without waking;
Physical Exam: BP: 110/80 (down from 140/90); Heart Rate: 68; Weight: 131lbs. (lost 3 lbs without changing diet or exercise; ready to start my “Vital Life-time Diet”)
 
Rx: ReTest labs to determine if hormones are now appropriately balanced.
 

4 Month Report of Lab Test and Treatment Plan Re-evaluation

Jan is now feeling great! She has absolutely no hot flashes any more during the day or night (Estriol). She is happier than she has been in years (Estriol, Progesterone, Testosterone). She is no longer moody or irritable (Progesterone). Her energy is great (Testosterone). Her sex drive is fantastic (Testosterone). She has fewer aches and pains (Testosterone). She feels stronger both physically and emotionally (Testosterone, Progesterone, Estriol). And she has lost some belly fat and regained some muscle tone (DHEA and Testosterone)
Jan’s only remaining complaint is that her memory is still lacking (Pregnenolone). This is reflected in the only lab test result that did not come up to within the Optimal Level. Her Pregnenolone level rose 10x, but still is half where it needs to go. She will need to double her dose of this one hormone. She will continue to take all the other hormones and nutritional supplements as directed for the next 8 months, until her one year follow-up visit.