My Encounter With The New Doctor
As I mentioned in my most recent podcast , I saw a new doctor yesterday. His name is Dr. Andry. I found him by googling "Bioidentical hormones Bloomington IN." I'm 52, and I was concerned about my estrogen levels. About 18 months ago, my primary care physician and I had hormone tests run. They showed I was estrogen deficient, and yet estrogen dominant -- ie, not enough estrogen, but considerably more estrogen than progesterone. They also showed that my testosterone levels were remarkably high. That didn't surprise me. I've long suspected I had high testosterone for a woman. Those of you who have listened to the podcast or my interviews know that I have a very deep voice. I've also always been aggressive -- not mean, just aggressive, willing to to start conversations, willing to take the initiative, willing to speak my mind.
Anyway, I was thinking maybe I needed estrogen, too, and my primary care physician simply felt she wasn't well-versed enough in bioidentical hormone therapy to advise me and prescribe. Hence, my googling.
So I saw Dr. Andry, and was exceedingly impressed. Super-smart guy, very nice. Runs an insurance-free practice, so I had to pay out of pocket for my consultation, but he spent more than an hour with me, really going into my history and current health status in depth. He was very pleased to learn I'm a low carber -- he's been low carbing since 1999, and recommends the diet unreservedly, especially for patients who need to lose weight or have blood sugar problems. He knows a number of the members of what I call The Low Carb Mafia -- Dr. Eric Westman, Dr. Mary Vernon, etc; even knew Dr. Atkins. (I need to take Dr. Andry a cookbook!)
Anyway, he doesn't think my problem is estrogen per se. He thinks it's insulin, and the effects of insulin on estrogen utilization. Indeed, he thinks I have a form of PCOS -- polycystic ovarian syndrome. I have long suspected that I was an undiagosed diabetic, or at least pre-diabetic, by the time I went low carb. I know that I have to keep my carbs very low to keep my weight off; I rarely go above 25 or 30 grams a day these days. I've also had slightly elevated fasting glucose on arising; I've seen it as high as 112. That last worried me, but since my A1C -- the "snapshot" of blood glucose over time -- was healthy, I didn't dwell on it. It had never occurred to me, however, that I might have PCOS. My periods had always been regular, I hadn't had the thinning hair or acne that can accompany PCOS, none of that. But Dr. Andry says that the name is misleading, and it really ought to be called something like "insulin-driven sex hormone derangement syndrome."
Dr. Andry is convinced that my liver is over-producing glucose -- you know, that gluconeogenesis thing that means we don't need to eat carbohydrates to have enough glucose in our blood -- and that glucose is driving elevated insulin levels. I know I'm insulin resistant; that's a given. All of this is skewing my testosterone high, and my estrogen low. It would also explain why I have only been able to get my weight down so far, and no further, you know?
Anyway, Dr. Andry has put me on a modest dose of metformin, an old-school diabetes medication that both improves insulin sensitivity and slows glucose production in the liver. (Interestingly, metformin is the only diabetes medication that Dr. Mary Vernon and Jackie Eberstein recommend in The Atkins Diabetes Revolution.) This should drop my insulin levels, and help straighten out my other hormones. That it may also let me drop a few more pounds is a not-unwelcome possibility.
I will, of course, keep you posted.
