Why aren't All Doctors Restoring Hormones to Optimal Levels and/or Effects?
When a patient is suffering from symptoms that could be due to a hormone deficiency, and their levels of one or more hormones
are low compared to other persons (one's levels can be 1/2 or even 1/5th those of others and still be "normal"), one would think
that a physician would try to see if they can help the person by optimizing his/her hormone levels. These are, after all, the most
powerful and beneficial molecules in the human body. One would think that hormone optimization would be an accepted part of
medical practice. Instead, doctors diagnose a hormone deficiency only if the level is "low"--in the lowest 2.5% of the general
population. Then they provide enough hormone is provided to get the level into the population range. Worse, hormones are
misunderstood and feared, and the practice of optimizing hormones villified. WHY? Physicians hold many false beliefs about
hormones and hormone restoration, many dating back to the early to mid-20th century. (See below.) Much of the ignorance and
fear is caused by corruption of medicine by patent and corporate law and the pharmaceutical industry.
Natural molecules, vital to our body's normal function, cannot be patented. Pharmaceutical corporations, therefore, have
little interest in the restoration of health through the correction of hormonal, vitanutrient, toxic or other biochemical disorders.
They instead teach physicians that every symptom and disorder as an indication for a patented drug. Doctors therefore fail
to understand the body as a complex biomolecular system. They fail to seek or correct the cause, which is, in most cases, a
hormone, vitanutrient, toxic, genetic, or other biomolecular deficiency/disorder. The use of patented drugs for every symptom is
encouraged, while the optimization of nutrients and hormones is discouraged as ineffective or dangerous. So among
physicians, including endocrinologists, there is:
1. Ignorance of the importance of optimal levels of vitanutrients and hormones in human biochemistry and physiology,
which is tantamount to ignorance of human biochemistry and physiology in general.
2. Ignorance of the complexity of the hormonal system and the many interactions between the various hormones.
3. Failure to see aging as a destructive process/disease, and therefore failure to see the loss of hormones with aging as
deleterious. Since they think that the loss of hormones with age has no negative effects, they think that low hormone levels
must not be a problem in general, and perhaps are better for us!
4. Adherence to an outdated glandular disease-model of endocrinology instead of a functional model. Docs think that the
endocrine system functions perfectly unless it's damaged by trauma or disease. In fact, nothing functions perfectly, especially as
we age and are subject to malnutrition, toxins, illness, and stress. Most persons with symptomatic hormone deficiencies
have no identifiable disease. Usually the cause is partial dysfunction of the hypothalamic-pituitary system (insufficient,
not zero production of TSH, ACTH, LH, GH, etc.), and/or partial peripheral hormone resistance.
5. Failure to grasp the difference between bioidentical human hormone replacement and the use of alien hormone-like
drugs that have created so many problems (anabolic steroids, cortisol-like "steroids", and "estrogens" and
progestins/progestagens like those in Prempro and birth control pills).
6. Thinking of hormones as drugs, with "side effects". Hormones are not drugs; they are original parts in a very delicate
and complex system. Higher hormone levels don't make a person feel better unless they are deficient to start with. Hormones
do not have "side effects" as drugs do. They only have "effects". Hormone replacement is not "unproven". Hormones are the most-
studied molecules in Nature. They can cause problems only if introduced into the body by the wrong route, or given in too high a
dose or if there is a lack of balance with other hormones. Examples: women can't develop virilization when given testosterone
unless the dose is too high. Adults given growth hormone don't develop fluid retention, joint aches, and diabetes, unless the dose
is excessive! Hormones are not drugs and the FDA (Federal Drug Administration) should not lump hormones together with
hormone-like drugs, nor should it apply the same warnings to them..
7. Relying on indirect and insensitive tests to diagnose hormone deficiencies or determine the dose. (e.g. the TSH, an
AM serum total cortisol, the ACTH stimulation test, etc.). These tests cannot diagnose the more common partial hormone
deficiencies caused by hypothalamic-pituitary dysfunction. The TSH test cannot be relied upon to diagnose hypothyroidism
or to adjust thyroid replacement therapy, any more than LH can be used to diagnose testosterone deficiency or determine
the dose, or ACTH be used to diagnose or treat cortisol deficiency.
8. Misunderstanding and Misuse of the broad laboratory reference ranges (misleadingly called "normal ranges"). These
are not optimal ranges--not even close. They are 95%-inclusive population ranges--they include almost all of a group of
"apparently healthy" adults who were not screened for symptoms of deficiency. So the ranges include persons with
symptoms of hormone deficiency. Only the bottom and top 2.5% are "low" or "high". So if a person's hormone level is near the
bottom of the range, he/she is in the lowest 5% of all adults! How can a physician say that's "good enough"? Even when someone
is below a population range, in the lowest 2.5%, the doctor will typically repeat the test to see if he can get a "normal" result. Only
If the level is repeatedly low will he give them some hormone replacement to "normalize" their levels! This is a game of
population statistics. It is not clinical medicine. In fact, much more than 2.5% of the population has suboptimal levels due to
aging, endocrine dysfunction, and disease. Dr. Lindner calls this unthinking practice "Reference Range Endocrinology". The
doctor glances at the lab report and if there is no bold "H" or "L" for "high" or "low" next to the hormone level, declares that there is
no hormonal problem--even if the patient has symptoms and the hormone level is near the bottom of the range! There are no cut-
offs in Nature. Hormones work on a continuum from the lowest to the highest levels. One cannot draw a line and say
everything above this line is "normal", and everything below this line is "disease". There is no substitute for medical judgment in
deciding who will benefit from hormone restoration. This question ultimately must be settled by a clinical trial--supplementing the
hormone to higher levels/effects to see if it helps the patient.
9. Belief in many HORMONE MYTHS, such as:
- The hypothalamic-pituitary (H-P) system that controls our other glands always functions perfectly unless destroyed
by some disease. (Of course nothing in the body always functions perfectly, and partial H-P dysfunction is the most common
cause of hormone deficiency. Almost all these patients are currently undiagnosed.)
- Almost all hypothyroidism is caused by disease of the thyroid gland. (Actually, hypothyroidism means inadequate T3
effect in the tissues. The vast majority of persons with hypothyroid symptoms do not have thyroid gland disease. The most
common causes of hypothyroidism are inadequate TSH production, poor conversion of inactive T4 to T3, and peripheral
resistance to T3.)
- A Free T4 anywhere within the reference range is good enough. (In fact, the free T4 range is not even a population
reference range. Laboratories include physician-ordered thyroid hormone tests in their FT4 and FT3 ranges--if the TSH is
normal. So reported free T4 ranges go as low as 0.6 to 0.8ng/dl, when studies of non-patients produce 95% ranges of 1.0
to 1.6ng/dl.) Persons on levothyroxine usually need to have free T4 levels near or above the top of the reference range!
- TSH production is immaculate--the TSH test always indicates the overall thyroid hormone status of the person
whether taking or not-taking oral thyroid hormones. (Nonsense, the TSH production is just as likely to be inadequate as the
thyroid gland's production, or as any other hormone or neurotransmitter in the human body. Inadequate TSH production is a
- Simply normalizing an elevated TSH level using levothyroxine (Synthroid) is adequate treatment. (Multiple studies
show that it is not, "authorities" have admitted that it is not; yet this nonsensical, non-clinical practice is nearly universal!)
- A low or undetectable TSH in a person on thyroid replacement therapy means that he/she is overtreated and will
suffer all the consequences of hyperthyroidism. (Nonsense. The TSH is not a measure of thyroid levels or effects. TSH
hyposecretion is often the cause of the hypothyroidism. Also, the TSH is over-suppressed by the thyroid level peaks that
occur with once-daily oral thyroid replacement. Treatment cannot be adjusted by the TSH levels. It must be adjusted
according to signs and symptoms first, and the free T3 and free T4 levels second. It is absurd to claim that a thyroid-
treated patient is hyperthyroid just because the TSH is low--when the patient has no symptoms and the free T3 and free T4
are within the pop. ranges 24 hrs after the daily dose.)
- The body always converts just enough T4 to T3, therefore physicians don't need to prescribe T3 or test for T3 or reverse
T3 levels. (False, many persons on levothyroxine therapy have low-in-range or even low free T3 levels, and are quite
hypothyroid as a result. Reverse T3 actively counteracts T3 and its level must be checked when therapy is not effective.)
- T3, the active thyroid hormone, is irrelevant to diagnosing or treating thyroid insufficiency. (In fact, studies show that in
persons on TSH-normalizing levothyroxine doses, the free T3 remains lower than in normal controls, and its levels
correspond to symptoms better than any other test.)
- There is no benefit in prescribing T3 or Armour thyroid (which contains T3 and T4), because the body always converts
just enough T4 to T3. (When a doctor says "always", you know he/she is just blowing smoke.)
- Armour thyroid, Nature-Throid, and all dessicated thyroid gland products are outdated treatments and are
inconsistent in hormone content from batch to batch. (This is 1970s propaganda from the maker of Synthroid. In fact they are
USP-certified because they pass the same tests for hormone content as Synthroid and other T4 preparations. They are more
efficacious than levothyroxine because they contain the active thyroid hormone, T3. Their higher T3 content is needed
because the reduction in TSH with therapy reduces T4-to-T3 conversion throughout the body.)
- Higher thyroid levels will cause bone loss. (Wrong. Higher thyroid levels simply increase the rate of all processes in the
body, so if a person is losing bone they will lose it faster, if gaining bone they'll gain it faster! The solution is not to keep post-
menopausal women hypothyroid, but to restore their bone-building hormones:estradiol, progesterone, testosterone and
- Testosterone is bad for a man's heart. (actually low testosterone is a risk factor for heart attacks in men.)
- Testosterone causes prostate cancer. (On the contrary, low testosterone is a risk factor for cancer. Read Dr.
Morgentaler's "Testosterone for Life".)
- Testosterone causes liver toxicity. (Another false belief related to the use of hormone substitutes. Certain testosterone-
like drugs created for oral therapy did cause liver toxicity. They are no longer prescribed. Transdermal and injected
testosterone have no negative effects on the liver, yet you can still hear this myth from "authorities".)
- Men do not need optimal testosterone levels, whatever is "normal" for age is OK. (The top of the ref. range is 5 times
greater than the bottom! Many studies show that higher, youthful levels improve important health parameters (insulin
sensitivity, blood pressure) and quality of life.)
- Estradiol levels must be kept low in men on testosterone therapy. (Actually male estradiol levels decline with age due
to falling testosterone levels. Estradiol has the same health benefits for men as for women--preventing atherosclerosis,
osteoporosis, and dementia.)
- All female estrogen replacement is alike and will cause blood clots, strokes, and heart attacks as does oral
Premarin® and birth control pills. (In fact transdermal estradiol avoids the first-pass effect on the liver and does not
increase blood clotting at all!)
- Human progesterone is no different from any drug-company-invented progestins. (Nonsense. They are different
molecules, and studies show marked differences in favor of progesterone.)
- Progesterone causes breast cancer. (In fact there is overwhelming evidence that progesterone protects against breast
cancer growth by reducing estradiol's stimulation of breast tissue. Provera® and other progestins lack this anti-estrogen
effect and thereby increase the risk of breast cancer diagnosis.)
- Restoring a woman's estradiol and progesterone increases the risk of breast cancer. (No it doesn't. See the E3N-
EPIC study in the powerpoint presentations.)
- Women do not need estradiol after menopause--menopause is good for women. (Nonsense, estradiol is essential for
the prevention of many serious diseases (atherosclerosis, dementia, osteoporosis, etc.) not to mention quality of life (mood,
sleep, hot flashes, etc.). Estradiol replacement must be accompanied with sufficient progesterone to reduce its
proliferative effects in the breasts and uterus.)
- Women on estrogen replacement don't need progesterone if they don't have a uterus (But they still have breasts.
Progesterone has other known beneficial effects--on mood, sleep, and bone mass.)
- Women do not need any testosterone, after all the free testosterone lab range is 0 to 2.2pg/ml! (In fact, testosterone
improves women's mental function, muscle strength, and sexual function!)
- Female hormone replacement doses do not have to be individualized. (Well, no doctor actually believes this but the
American College of Obstetrics and Gynecology made this ridiculous statement under pressure from its supporters, the drug
- Adults do not need any growth hormone in their bodies. (In fact adult growth hormone deficiency is well-known to
reduce health and quality of life, elderly adults often make practically no growth hormone, and studies have shown that
replacement is safe and beneficial.)
- Adults have all the cortisol they need unless they have a disease that destroys their adrenal or pituitary glands.
Dysfunctional cortisol insufficiency (a.k.a. "adrenal fatigue") does not exist. (In fact hypocortisolism of various
degrees is common, especially in women, but is misdiagnosed as depression, fibromyalgia, chronic fatigue, hypoglycemia,
insomnia, rheumatic disease, etc., Unable to diagnose the hormone deficiency, physicians treat these patients with anti-
depressants and amphetamines that, unknown to them, work at least in part by raising cortisol levels!)
- Cortisol is no different from any of the artificial patented steroids (prednisone, Medrol, etc.) except in dose.
(Nonsense. Only the correct, bioidentical cortisol-hydrocortisone molecule works properly in the human body.)
- Taking any dose of cortisol long-term will cause all the problems of Cushing's syndrome. (Nonsense of course.
Only overdosing can cause these problems. In addition, taking cortisol or an artificial steroid completely suppresses
DHEA production--producing a severe hormone deficiency and many of the "side effects" of steroid therapy!)
- Adults do not need any DHEA in their bodies. (Consider the odds that we don't need the most abundant steroid in our
bodies! DHEA is ignored by doctors because it is available over-the-counter; they can't write a prescription for it! It must be
worthless! In fact, DHEA is lost in aging and should be restored. Also, any person on cortisol or invented steroids must
supplement DHEA to restore youthful DHEAS levels. (See "The Evidence"' for abstracts of DHEA studies.)
As the result of the many hormone myths there is among doctors:
10. Unwarranted Fear of prescribing natural hormones; yet no fear of prescribing any of the thousands of toxic
chemicals blessed by the FDA ( "I'm covered!")
11. Ignorance of the How-Tos of hormone restoration: preparations, delivery methods, doses, monitoring, interactions,
troubleshooting, etc. Most doctors know little-to-nothing about hormone replacement.
12. Fear of legal liability or professional censure for straying outside of ignorant, officially-sanctioned, glandular disease-
oriented, reference-range-based practice guidelines--which are promulgated by pharmaceutically-funded research, "experts",
medical organizations and journals.
13. Over-prescription of patented drugs to treat symptoms and disorders that are caused by inadequate hormone and
vitanutrient levels or effects (e.g. overuse of antidepressants, psychostimulants like Ritalin® and Provigil®, anti-anxiety drugs,
cholesterol-lowering drugs, painkillers, birth-control pills, anti-clotting drugs, osteoporosis drugs like Fosamax®, etc.).
Almost all physicians believe that the pharmaceutical "drug for every symptom" model taught in schools, conferences, and
journals is the only true medical practice. They believe that the ideas and practices advocated in textbooks and journals are
uncontaminated medical science as determined by objective experts. If they were to doubt this, then each of them would have to
begin researching every issue on his/her own--a daunting and time-consuming task. It's so much easier to just go with the
system. In addition, the doctor will not even question "authority" unless he/she is somehow confronted with the fact that the
system is wrong. Even then, he/she will need to have the time, the desire, and the ability to do independent study and to re-learn
many aspects of medicine. Very few doctors are therefore able to learn the truth about hormonal disorders and how to correct
them, and those who do, do so only late in their careers. No physicians are being trained with this knowledge in medical
school or residency. The bottom line is that those who control medical information control medical practice. Follow the money.
You might think that board-certified endocrinologists should be experts in diagnosing hormone deficiencies of all degrees
andoptimizing hormone levels for best health and quality of life. Unfortunately this is not what they are trained to do. They are
trained in internal medicine (disease-drug medicine), then briefly introduced to reference range endocrinology in a fellowship.
They are taught all the false ideas mentioned here. They adhere to the nonsensical TSH-based thyroidology. They are
incapable of diagnosing partial central hypothyroidism and partial central adrenal insufficiency--and therefore incapable of
understanding the endocrine system and its role in so many symptoms, conditions and diseases. In addition, they don't know much
about testosterone because they leave that to the urologists. They don't know much about female hormones because they
leave estradiol and progesterone to the gynecologists. Since all hormones affect each other, this fragmentation guarantees that
endocrinologists cannot understand the hormonal system as a whole, nor be adept at restoring optimal/youthful hormone levels
and balance. Perhaps one day "Restorative Endocrinology" as introduced in these pages will be a universally-recognized
specialty and the population will have easy access to knowledgeable hormone restoration specialists.
Hormone and vitanutrient restoration to optimal levels for health and well-being is not alternative, complementary,
or anti-aging medicine. It is the foundation of sound medical practice.
For Health and Quality of Life