10 thoughts on "ASK DOCTOR BOLAND"

Frank Z. says:

Dr. Boland,
I am a 65 year old seasonal resident of Palm City, and I feel absolutely miserable. I have no energy, reduced sex drive, and sometimes lose my train of thought. I need an afternoon nap top get through the day. I can’t lift as much weight as I did 5 years ago at the gym and don’t have my old youthful vim and vigor anymore. Sometimes I just cant make important decisions and have reduced sexual stamina. My wife says I’m grumpy, moody, and irritable, but I think I’m fine. My cardiologist tested my thyroid and says I’m fine, and I don’t need my testosterone level checked. What do you suggest?

Neil Boland, MD says:

These are very typical symptoms of Low Testosterone or Andropausal Syndrome. An important question a lot of patients ask is “Am I aging because I lack hormones, or does lack of hormones cause aging?” The answer is BOTH.

You need an endocrine blood testing panel drawn, with special attention to your free and total testosterone levels, including a thyroid panel including free T3 level. Most physicians don’t check free T3, which is super important, because T3 is the real hormonal driver of cellular metabolism in our bodies. Subcutaneous pellet testosterone therapy and supplemental thyroid T4/T3 (non-synthetic, Bioidentical) will significantly improve not only the way you feel, but prolong your life.

Joanna Hunter says:

Dr. Boland,
Please help!
I am 55 years old, and started using Combipatches for my hot flashes and night sweats after I went through the change 3 years ago. The hormone patches initially worked ok, but lately they just don’t seem to be doing the job. My flashes have have returned with a vengeance! I don’t sleep. I can’t seem to focus at work anymore. I still have a very poor sex drive, and recently sex has even begun to hurt such that I hate sex. My husband says he wants to find out what’s wrong. My doctor says she doesn’t know what’s wrong because I’m not taking a generic medication, and it should work. What could be wrong? Am I just crazy?.

Neil Boland M.D. says:

Combipatches can work in some patients to help with menopausal symptoms. However, it’s not widely known that at least 45-50% of patients absorb almost nothing through their skin. Skin tissue varies in its absorptive capacities from individual to individual. It could be that at this point in your life, very little estrogen in getting through into your blood stream. I noticed this a lot when I formerly used the patches. The advantage of pellet therapy is that they are placed under the skin, and absorbed slowly over 3-4 months based on your own cardiac output (not time-released like injections). So the pellets may last longer than 3-4 months. There are no absorption issues with pellets, because your body forms small blood capillaries around them, and they go directly to target organs, such as your central nervous system, brain, heart, bones, and pelvic organs.

The poor sex drive you describe is because you are getting NO testosterone from your patches, which contain estrogen and progesterone only. Just like men, women require BOTH estrogen and testosterone to feel their best. Your ovaries manufactured both of these hormones in your 20s. A typical female patient receives both estrogen and testosterone pellets based on individualized computerized dosing, but you need endocrine testing first.

Rachael Squires says:

I am a healthy 58 year old female, and I feel fantastic on my my pellets.
I have heard conflicting info regarding how long I can continue my therapy.
How long is it safe to continue the pellets?

This is an excellent question which we get often. Unless there is a significant change in your health care status, the answer is to continue pellet therapy as long as you want to feel well. When the therapy is stopped, you will revert back to your old hormonal deficiency symptoms again.

Cheryl says:

I am 54 yrs old & feel like I am 94, I had a TAH w/ BSO when I was 27 through out the years I have tried many creams, patches, sprays only to stop because I could not stand the mood swings and weight gain. I absolutely have no pep in my step, intercourse is painful, Mood swings and NO ENERGY constantly dragging myself to do daily things. But at my age and length gone w/o hormones is it to late to start bio pellets and is it safe?

I apologize about my belated reply. At age 54, it is definitely not too late for you to acquire significant benefits from Bioidentical pellet therapy. It is safe for many patients, contingent upon Please call the office for more information 772-220-8766.

Janice Abrams says:

Last month my nurse practitioner ordered a lot of saliva hormone testing on me because she thought I might be in the menopause. When I opened the bill from the lab, it was $2,619.42, of which not a penny was covered by my insurance!!! I almost fell over. Then she gave me all of these estrogen and adrenal mixture creams which haven’t helped me yet, and I use them faithfully every day. I pay $722 a month for my health insurance. Do you know why insurance companies don’t want to cover saliva testing? I am very discouraged.

We at TCBI do not use saliva testing at all. I’m sorry your insurance did not cover salivary hormonal testing, but there is a good reason why it’s not covered. It’s not accurate or reliable. Blood hormonal testing is the gold standard. The following national professional organizations have published consensus opinions against salivary testing: ACOG, the U.S. FDA, NAMS, ICSI, AND AACE (see their published statements below).

I also DO NOT recommend seeing a healthcare professional who relies on unreliable testing to diagnose endocrine diseases, and then prescribes creams which are frequently poorly absorbed. Patients frequently receive suboptimal relief of symptoms, and certainly do not achieve maximum preventative long term benefits in increased quality of life, improved libido, weight control, osteoporosis prevention, and prevention of Alzheimer’s disease.

1- American College of OB/Gyn Committee Opinion #322: Salivary hormone testing is not meaningful because levels vary within each patient depending on diet, time of day, hormones being tested and other variables.
2- FDA: “There is no scientific basis for using salivary testing to adjust hormone levels”.
3- North American Menopause Society (NAMS): July 2008 Position Statement, Salivary hormone testing is a procedure that has not been proven accurate or reliable.
4- The Institute for Clinical Systems Improvement (ICSI): 2008 Assessment Statement: “Currently there is insufficient evidence in the published scientific literature to permit conclusions concerning the use of salivary hormone testing for the diagnosis, treatment, or monitoring for menopause or aging”.
5- American Association of Clinical Endocrinologists, Reproductive Medicine Committee, 2007 Position Statement on Bioidentical Hormones states “individualized dosing based on unproven testing methods, such as salivary testing, has not been validated.”

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