Fun with Hormones
My Recent Experience
In June of 2020, I asked my nephrologist, Inder Patel—a brilliant and truly funny man who saved my life more than once—to check my thyroid hormone. He did and arranged for me to get treatment. Eventually, I wound up with an endocrinologist.
[After my first stay in the hospital (33 days) beginning in late 2019, I went home for 11 days only to return due to recurring fevers. My renewed incarceration caused a conflict with a scheduled appointment with Patel at his private office. Alerting him to this conflict, he responded with, “Phone my clinic and tell them you’re cancelling because Patel is a bad doctor.”]
The endocrinologist worked out of an office with about six doctors who focused on metabolic disorders, mostly diabetes. The office served a podiatrist, a nutritionist, an orthopedic shoe outlet, and an in-house lab.
His requirement to use their lab instead of Quest® or Labcorp® inconvenienced me, as for each consultation, I was obliged to travel to his office twice; however, I suppose this afforded him great control. One aspect of this control was that his patients were not allowed to view their lab results before consultation.
At the first of this year (2024), the office’s practices disintegrated. [Literally, they were no longer integrated.] The lab was shut down. About a third of the doctors and staff left for other pastures. Another third remained and partitioned off as a concierge practice. The final third remained with open practices. The building’s large reception room still served all. [My primary care physician alerted me to this change, but he knew none of the finer details that I would eventually discover.]
No notice was provided to the patients—at least not to the patients of my doctor.
In an effort to keep with my standing appointments—one being for the lab draw and the other for the doctor consultation—I phoned the general office number I had used for the past four years. No one answered, and the extensions to the various nurses and departments were inoperable. The voicemail was shut off. The website was down.
My only way into the system was to leave a message with a second phone number that was quickly mentioned in a voice announcement. I had to recall the first number several times to ensure that I had the correct second number.
After several days, no one returned my call, so I decided to drive to the office to physically face a receptionist. [This was on the day scheduled six months earlier for my lab draw.] She confirmed my appointment for the consultation, but did not thank me or acknowledge that I had fulfilled my responsibility to show for my lab-draw appointment—with a lab that no longer existed, but for which—in theory—I could have been charged for disregarding.
I then went to Quest for the lab draw and saw the endocrinologist (hereafter denoted Fool #1) the following week.
My consultation was extremely short as we had little to discuss. He said that my numbers were good and that my thyroid dose should remain unchanged. As I had expressed interest in my testosterone two years earlier, he mentioned that my testosterone was “in range” and that there was no reason to take action.
He left the exam room and his nurse entered. We requested a printout of the lab results from her. She agreed to print them but seemed annoyed at having to do so.
I later reviewed the results which revealed that five specific tests showed numbers out of range. Two of these were in regard to my kidneys. Why not, at least, mention these and, perhaps, refer me to other doctors?
My eye then went to Free Testosterone. The acceptable range was shown as: 250 - 1100 ng/dL. And my reading was 254. Fool #1 did not lie. I was definitely “in range.”
Of course, I would never place much confidence in a serum blood test for hormones. And I’m confident that Fool #1 knows nothing about the superiority of the saliva testing [He probably denigrates saliva testing.]. His forgiveness of a blood-test reading that is so close to the bottom of the range without further testing to validate is proof of his ignorance. However, there is a further point to me relating this story.
If you remember the virtual war I have had with my cardiologist (Fool #2) regarding the control of my cholesterol by way of the statins and the Repatha® family, you may now see the real possibility of exactly what I alluded to in The Scourge of the Bone Drugs. As my untreated low-density lipoproteins (LDL) are consistently very low, lowering them with a cholesterol abatement treatment might—if we have faith in the steroid hormone cascade—push my testosterone completely out of range. Then what?
As I posed before: Would Fool #2 be tracking my testosterone? (No.)
As I posed before: Would Fool #1 learn of any testosterone deficiency due to the cholesterol abatement treatment and know what to do about it? (No.)
I have a new question: Should I suspect a turf war between Fool# 1 and Fool #2?
Perhaps there is indeed an undeclared war going on here, but I doubt it. My favorite guess is that neither of these fools has any idea that they are working against each other at the expense of Medicare.
Nevertheless, I consider the potential confusion for a male—like what I have presented—to be relatively minor compared to what this potentiates for a female, especially a diabetic female, who is balancing her hormones between, not two fools, but three. It is likely that her gynecologist is messing her up with synthetic estrogens and progestins as her cardiologist is trying to kill her entire steroid cascade while as her endocrinologist is treating her diabetes with the ADA-approved carbohydrate-rich diet.
She gets fatter. She gets depressed. She becomes more insulin resistant. She gets cancers firing off. She gets kidney disease and heart disease and osteoporosis.
Bring in the clowns.