New Hormone and Thyroid testing guidelines have added millions to the ranks of those who are thought to have hormone imbalances, although often these women and men are asymptomatic.
The latest studies show that thyroid and hormone testing lead to not only over-diagnosis of otherwise healthy adults, but often to over-treatment too.
Consider these things before making the decision to go on hormone replacement therapy (HRT) or get on thyroid medications.
Last week we talked about the danger of HRT—hormone replacement therapy. I received a lot of follow up emails and comment in the FREE online FB community for healing your hormone imbalances naturally.
There is a lot of confusion about the topic, and, unfortunately, a lot of pain that comes with making the decision on whether to use HRT, or to even get tested for it.
I even had a few emails from women, who seemed to have missed the part where I said that I am not against all hormone replacement therapies, who were outraged by my simple suggestion to look at the studies before making an informed decision.
While I do not back down from the truth, I thought that further exploration of this topic will be very helpful for those who are considering HRT.
So, today I want to talk about Hormone Testing, since it is one practice that will normally lead your MD or ND to put you on HRT.
A lot of women have had either saliva tests or blood tests showing that they have low levels of certain hormones and their doctors are telling them that they need supplemental hormones.
I won’t re-hash my recommendations for women in terms of how to regulate hormone production with diet, exercise and other lifestyle choices, which I discussed in the last episode, rather today I will focus on the testing methods and the meaning of those test results.
First, I have found no clear evidence that testing is effective for determining hormone levels and subsequently prescriptions for hormone replacement.
Saliva testing is not accurate, since very small levels of estrogen or progesterone are found in the saliva. It is almost a certainty that saliva testing will lead to a recommendation to supplement with hormones – great for compounding pharmacists, not so great for women.
Blood tests may be more accurate, but the problem with them is that hormone levels fluctuate from day to day and even from hour to hour, particularly in peri-menopausal women. This makes the results of these tests virtually meaningless.
Another issue is that I have been unable to locate any reliable information indicating how much supplemental hormone is needed in order to raise hormone levels. This makes prescribing hormone replacement a guessing game, and is often accompanied by trial and error.
Last but not least, women in their 40’s and 50’s are often tested and told that their levels of estrogen and progesterone are low.
Let me drop a bomb on you and on the medical industry… This is normal; these lower levels accompany menopause.
I have seen many reference charts in which the goal seems to “treat” women in order to restore their hormone levels to those of women much younger. This is not a good idea!
We know that there are serious risks in using pharmaceutical HRT to accomplish this objective – we don’t have safety data on bio-identical hormones.
I’ll stand by my recommendation to adopt a program of a low fat, whole food, plant based diet and optimal lifestyle habits in order to address unpleasant symptoms of menopause or hormone imbalances, and to avoid doctors and other practitioners who routinely use saliva and blood testing to determine hormone prescriptions for female patients.
Now, since a lot of you, who are listening to me, have thyroid related issues, I want to talk about thyroid screening. If you don’t have a thyroid disorder, listen anyway, since you have a thyroid and this will help you at your next doctor’s visit.
USPSTF Recommend Against Thyroid Screening for Asymptomatic Adults
The U.S. Preventive Services Task Force has concluded that there is insufficient evidence to warrant screening for thyroid dysfunction in adults who are not pregnant and have no symptoms. These type of screenings are done routinely. For no reason!
This is the third time the Task Force has published the same recommendations – the first time was eleven years ago.
Task force member Jessica Herzstein noted that screening asymptomatic adults has become a common practice but “there is very limited evidence that evaluates whether these practices lead to improved health outcomes.”
On the other hand, “indirect evidence points to the likelihood of important and frequent harms associated with screening in asymptomatic persons,” wrote Michael LeFevre, MD, MSPH, and colleagues on behalf of the U.S. Preventive Services Task Force.
Those harms include frequent false positive results, the stress associated with being diagnosed with a disease, when one might not be sick at all, and over-treatment for thyroid disease when patients do not have it.
The researchers also noted that there is no reliable set of consistent clinical symptoms that define thyroid dysfunction.
The researchers looked at randomized controlled trials and observational studies of screening and treatment. They could find none that evaluated the benefits and harms of screening by comparing screened and non-screened individuals.
In other words, screening has become a standard practice without studies showing that it benefits patients. They determined that screening asymptomatic people can identify abnormal thyroid stimulating hormone (TSH) levels, but that “…what constitutes an abnormal TSH level is uncertain.”
They also stated that normal levels vary among age groups; older adults tend to have higher levels than younger adults, but this does not necessarily mean that there is anything wrong.
Dr. Kenneth Burman, chief of the endocrinology section at MedStar Washington Hospital Center added that there is no proof that slightly abnormal TSH levels cause any significant medical issues.
Of course, those who make their living finding and treating thyroid dysfunction have a different point of view.
The American Thyroid Association and the American Association of Clinical Endocrinology both recommend that patients over 60 be screened, and “aggressively look for thyroid disease” in patients who are at high risk.
Mack Harrell, M.D. American Association of Clinical Endocrinology President, says “My fear is that the U.S. Preventive Services Task Force’s statement about a ‘lack of data’ to justify thyroid-disease screening will be incorrectly interpreted as a ‘lack of clinical need’ to find and treat thyroid disease.”
He added that he would not be changing his practice in response to the recommendations.
I’m sure he won’t – business will not be nearly as good if he no longer aggressively looks for “thyroid disease.”
Diagnosing thyroid dysfunction, particularly non-autoimmune hypothyroidism, has become a major disease mongering activity.
For many years, normal TSH levels were between 0.5 and 5.0 mIU/L.
In 2002 the American Association of Clinical Endocrinology revised the definition of normal to be between 0.3 and 3.0 mIU/L, which immediately qualified millions of people who were previously deemed “normal” for a diagnosis of hypothyroidism.
Some doctors claim that the upper limit should actually be lowered to 2.5, which would result in even more diagnoses.
Added to the insanity are numerous online sites promoting the idea that many if not most people have a condition called “subclinical hypothyroidism”, which cannot be detected with blood tests. These sites feature lists of symptoms that are so numerous and vague that almost all people qualify for treatment.
While patients used to request testing for thyroid disease in response to symptoms, many doctors now order tests as standard operating procedure for all patients. Studies show that more people are being diagnosed with minor abnormalities that are interpreted as thyroid disease, and over-treatment ensues.
This is aggravated by the expanded definition of hypothyroidism. Abnormal test results for markers for thyroid disease should be carefully considered before any action is taken, and considerations should include age, symptoms (or lack thereof), and the health status and medical history of the patient.
So, if you are asymptomatic, skip your treat to the doctor’s office.
If you are suffering with symptoms, on the other hand, get a real diagnosis, confirmed by at least 2-3 different practitioners, with your labs drawn at different time, and then use the principles that I teach you on this podcast and my website to heal your thyroid and your hormones naturally.
That’s it for today!
- If you have a hormone imbalance, and you missed last week’s webinar on PCOS and Endometriosis, and the one before that on Thyroid disorders and treating them naturally click on the links to view them, so you can learn how to heal your hormonal disorder naturally.
- And here is the link to the FREE Facebook group for those looking to heal their hormone imbalance naturally.
- LeFevre M on behalf of the U.S. Preventive Services Task Force “Screening for Thyroid Dysfunction: U.S. Preventive Services Task Force Recommendation Statement Screening for Thyroid Dysfunction.” Ann Intern Med. Published online 24 March 2015 doi:10.7326/M15-0483
- Pam Harrison “USPSTF: Thyroid Screens Not Supported in Asymptomatic Adults.” Medscape March 24, 2015 http://www.medscape.com/viewarticle/841932?src=wnl_edit_medn_wir&uac=5312MY&spon=34