A Few Questions

Dr. Seibel,

First of all, I want to thank you for your time. In the past, I had asked you a few questions and as well, have read your responses to others. You struck me as level headed and an emotionally even keeled person. A breath of fresh air, to those of us who suffer "white coat syndrome" ;-) and nice to find in an individual, period.
That said, I thought you were a woman...until the forum changed and revealed pictures of the doctors here. lol I hope you take no offense. Quite frankly...I think it's a good thing, especially considering your field. Wink. lol

One of your replies to mine: http://www.medhelp.org/forums/menopause/messages/130.html

You were right. Sadly, I could not get my doctor to run any sex hormone testing. Too young for perimenopause, he thought and hormones were too difficult to test (reliability issues?) So, I had to take care of this on my own. While on vacation down south (Alaskan resident here), I utilized healthcheck.usa and had labs drawn at a lab nearby my stay in California.

My results (8 days after menses ceased) are as follows:

-Testosterone, Serum    79      14-76   ng/dL
-% Free Testosterone   1.42      0.50-2.80   %  
-Testosterone,Free    1.12      0.10-0.85   ng/dL

-DHEA-Sulfate    324      45-270   ug/dL

Continued...

[Machelle Seibel, MD]

Hi,
First of all thanks for the kind words.It is always nice to know that a response is helpful.

It is good that you followed through and sought more information. Unfortunately, your question was cut off at the end and there is no more content after the DHEA-S levels. But it does seem your Testosterone is upper normal and your DHEA-S is elevated.

It is best to talk with your doctor about these findings. Some things that are often used as treatment are the birth control pill and sometimes medications such as prednisone or dexamethasone which help turn off adrenal hormones. Usually this isn't a serious problem because your levels are not very elevated, but it is best to have a talk with your doctor or see a reproductive endocrinologist or an endocrinologist. Either should be able to help you.
Machelle M. Seibel, MD

[borninquisitive]

-Progesterone   1.3         ng/mL  
Female:
Follicular 0.2 - 1.4
Luteal 3.3 - 25.6
Mid-luteal 4.4 - 28.0

-Estradiol   79      19-528   pg/mL  
Menstruating Female
(Day of cycle relative to LH Peak)
Follicular (-12) 19 - 83
(- 4) 64 - 183
Midcycle (- 1) 150 - 528
Luteal (+ 2) 58 - 157
(+ 6) 60 - 211
(+12) 55 - 150

To note, my bad cholesterol is elevated but so is my good. My Triglycerides  are looking good.

Thyroid labs:
-TSH   1.302      0.350-5.500   uIU/mL
-Thyroid Peroxidase (TPO) Ab   <10      0-34   IU/mL (dropped 7 points)
-Antithyroglobulin Ab    43      0-40   IU/mL (which also revealed elevated in April, however dropped a few points)
-Triiodothyronine,Free,Serum   2.8      2.3-4.2   pg/mL
-T4,Free(Direct)   0.97      0.61-1.76   ng/dL

If I were your patient, what you do? If further testing, any time that is better in correlation to menses?

I don't know why my Dr. is so stodgy. It seems to me, that he thinks anti anxiety/depressants are the answer for so many complaints. While I see them as having their place, I think they are too "cheerfully" prescribed. I'd rather work on the root of the problem and if that fails (or isn't enough), then consider additional treatment.

That said, I have taken measures to better my life.

To note, I have decided to pay for saliva testing, for cortisol (x 4) and it also tests for sex and thyroid hormones. What are your thoughts regarding saliva testing?

I am not too sure about sex/thyroid testing via saliva but thought the Cortisol may be better in that it measures it separately 4 times (taken at different hours), as apposed to testing an average (urine).

Thank you so much. I appreciate your time and responses.

Sincerely,
~Kate

[borninquisitive]

Sorry about the amount of posts. I thought I should add that in '06 my pap test came back abnormal.
My Dr. (at the time) said it was fine and I was rather taken aback when waiting for this years pap test, in having looked at the lab sheet: stated my '06 pap test was abnormal. This year, it came back fine. That is good but thought it odd and worth mentioning.

It has been 3 years since I delivered my last child, a son. If that matters.

Thanks again,
~Kate