Mary was a 44 year old woman with a history of both fibroids & endometriosis for which she had had a hysterectomy as well as the removal of one of her two ovaries.

Two months after the surgery she experienced a dramatic shift in her overall make-up, a system's wide shift. This broadly based change involved both physical & mental problems.

Systems' wide changes

Cognitive changes included glitches in memory, attention & processing while emotional shifts prominently included mood swings, agitation, anxiety, panic & a weepy style of depression.  There was a massive drop-off in sexual desire & orgasmic capacity, along with insomnia, generalized myalgic aches & pains, hot flashes & migraines.  These loud, intrusive symptoms were clearly being driven by hormonal flux rather than hormonal depletion, as confirmed by blood testing.  In other words Mary was still pre-menopausal rather than menopausal, her symptoms being fueled by estradiol & testosterone withdrawals rather than by hormonal deficiencies, although her testosterone level was more consistently low than was that of estradiol, possibly because of a chronic, stress-induced increase in the aromatase enzymes that serve to convert androgens into estrogens. 

Her primary physician had dismissed Mary as a headcase & treated her with antidepressants, which made her hot flashes far worse.  When a friend suggested a hormonal link to her widespread symptoms she came to see us & was treated with low dose testosterone implants with excellent results.  Everything was stable until three years later when she transitioned into the full menopausal state & her estrogen producing mechanism failed promptly. This second hormonal shift in Mary's life led to a  dramatic, more severe resurgence of her hormone-driven symptoms, whereupon estrogen therapy was added to the equation, being administered in pellet format along with her testosterone, which happens to be the most effective way of administering estradiol in a steady, invariant flow, devoid of significant flux.   Because Mary had already undergone a hysterectomy there was no need to expose her to any form of progesterone.  And the response to treatment was dramatic & gratifying. 

Consequences of erratic healthcare

Because the sexual hormones are so widespread in their influences, hormonal aberrations can account for a multitude of problems including behavioral ones, but fixing one's hormones does not make one into a different person.  This was certainly true of Mary, who was generally unreliable in gterms of follow up.  She tended to come in occasionally, when her hormonal implants had long been depleted, usually in crisis mode.  Thus on one occasion she arrived unannounced, some many months late for treatment.  Mary had been experiencing palpitations for about a month now, which were worse at night and tended to make her cough.  The palpitations seemed to be synchronous with symptoms of flushing, anxiety, mind-fog & insomnia.  So she visited her internist, who was located far closer to her home than we were.  An EKG in his office showed definite ST changes, a finding usually associated with ischemia, the condition where the heart muscle is being deprived of Oxygen, so he emergently referred her to a very smart cardiologist. 

Mary became alarmed & asked the cardiologist why she, a relatively young, female, non-diabetic non-smoker, should of all people fall victim to heart disease & whether she needed a coronary angiogram or perhaps even cardiac surgery.  He laughingly explained that there was nothing intrinsically wrong with her heart.  Instead the healthy, disease-free heart was acting as an innocent bystander being driven through hoops by her self-induced withdrawal from the sexual hormones, estradiol & testosterone.  In fact real concrete changes can occur in the cardiogram of the woman whose coronaries, far from being clogged or diseased in any way, suddenly go into spasm.  The process is called Printzmetal's angina. 

Mary promptly returned to us & was given both estradiol & testosterone pellets, & her problems resolved completely within some 24 hours.  Now, one would think that Mary might learn from this experience but she didn't return to us for another 5 months, already some 2 months late for her next hormonal treatment, and then only because of a recurrence of her estrogen withdrawal symptoms, including palpitations, flushes and migraines.  Once again Mary promptly responded to precision hormone therapy but she simply refused to get the message and continued with the same unreliable pattern until moving out of the area a few years later.