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Rumors that my new book really is coming out at last are true. The title is The Hormonally Vulnerable Woman and it is published by ReganBooks/HarperCollins. As the many of you who are my friends know, I have been planning this for a long time. My earlier book, The Good News About Women’s Hormones came out in 1995 and there have been many developments in women’s health in the intervening ten years. Also, I have seen several thousand more women in my practice and as always, I have learned much from them. Indeed, I dedicated this latest book to my patients who have been my greatest teachers. I have also acknowledged my wife, Mingmei Yip, for keeping me cheerful, almost, during the arduous process of writing this new book. The title and theme of hormonal vulnerability reflects my growing awareness of how pervasive the effects of hormones are on a women’s well-being. Often tests are normal, but appearance, physical well-being and emotions are adversely affected. The problem, I have come to realize, is that many women’s bodies over-react to normal levels of their own hormones. This is certainly the case with hirsutism. I remember when I first became interested in this problem I saw a woman who had to shave twice a day. I am sure all electrologists have seen other unlucky women with this problem. In her case, as in many others, testosterone levels were normal. Other doctors had told her she was normal, based on her tests, but as she put it to me, “For a woman to have to shave is not normal.” She was right, of course. In an earlier column I explained some of the reasons a testosterone result can be normal in such situations. What I emphasize in The Hormonally Vulnerable Woman is that most often, the problem is not the hormones themselves but how an individual woman’s body reacts to them. This is what I term hormonal vulnerability. Of course, sometimes hormone levels are abnormal, making matters even worse. When I wrote The Good News About Women’s Hormones, I was upfront about the problems women have getting help for almost any sort of hormonal condition. Electrologists are well aware of this with regard to hirsutism. I’d hoped that things would quickly improve but am sorry to say that in the ten years since that book, things are only slightly better. There is, for example, much greater awareness of polycystic ovary syndrome (PCOS) but full understanding is not yet easily found. My purpose in writing The Hormonally Vulnerable Woman was to give women the information they need to understand their hormones and get help. I cover not only the skin and hair problems caused by testosterone – acne, hirsutism and alopecia – but also other common conditions such as PMS, mood swings, metabolic effects of PCOS, and menopause. As always, I do my best to show how hormone problems can be overcome with treatments available today. The treatment of PCOS has been transformed by the introduction of metformin (Glucophage). Yet metformin is not, as some doctors assume, a cure-all for PCOS. Antiandrogens are still necessary for control of acne, hirsutism and alopecia. In the new book, I’ve tried to bring out these subtleties in the treatment of PCOS. Menopause and hormone replacement, always fraught subjects, have only gotten more so. In the new book, I’ve explained that hormone therapy with estrogen is not in itself good or bad but rather good for some women and bad for others. I offer a series of guidelines to help women make a decision which will be comfortable for them. An area I cover much more extensively in The Hormonally Vulnerable Woman than in my previous book is sexual difficulties, particularly loss of interest. Recent studies show that about a third of women feel their libido is lower than they would like. When I’ve lectured to electrologists I’m always asked about this, so they are no more immune than any other group of women. The use of testosterone has been widely publicized as a way for women to enhance their desire. In the past I have been very critical of this trend because I see so many women who have been given excessive doses that put their levels in the male range. The result, not surprisingly, is hair loss, hirsutism and acne. I’ve even seen a few women whose doctors told them that testosterone would help their alopecia. I’ve spoken out against this sort of endocrine abuse, at times annoying those who perpetuate it. Recently however, results of the testosterone patch studies have been published and indicate that problems are infrequent, providing that only enough testosterone is used to give blood levels that are appropriate for a woman. I’ve even devised a method for doing so, which I describe in detail in The Hormonally Vulnerable Woman. I feel the future of testosterone therapy for women lies in teaching doctors how to correctly dose and monitor it. The women’s testosterone patch, Intrinsa, will be a great step forward when it is finally approved. In the meantime, safe use is possible with the method described in my book. Nonetheless, women with hirsutism or other testosterone-related problems should be very hesitant about taking testosterone in any form. I strive to give a message of hope. So many women with hormonal vulnerability end up demoralized, their lives on hold, because no one seems able to help. As medicine becomes more complex, better treatments are available but become harder to find. By using the information I provide in The Hormonally Vulnerable Woman, readers will be empowered to seek the treatments that can solve their problems. |
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