Happy blogiversary to ME…happy blogiversary to MEEEEE…hap – I bet you guys didn’t take me for a singing, party-throwing kind-of-person, did you? Well, I admit that you pegged me correctly. As I’ve said before, I tend to have more of a glass half-empty and leaking mentality…but I’m working on that (the combination of practicing meditation, mindfulness, and Stoicism seems to be helping, for anyone who’s interested).
Today, I’m embracing positivity and throwing a virtual celebration to commemorate the one year mark of Hormones Demystified’s birth. I don’t mean to arrogantly assume that you should be as interested in my reflections as I am. But, since I always enjoy year-end round-ups from my favorite bloggers, I thought at least some of my readers would appreciate insight into how I feel about how things have been going this past year.
To provide context for how I gauge the blog’s progress, it’s essential to review the goals from my mission statement:
- Help people separate Endocrinology from quackery
- Reach at least one order of magnitude more people than I see in a day at the office, to maximize my impact on society
- Have patients come to my office quoting me, as opposed to quoting quacky blogs
- Scratch my creative itch
- Provide a place where both patients and medical practitioners can come for education and a few laughs
When it comes to my first goal of helping readers separate good medicine from voodoo, I think I can check that box. In case you missed them, some of my favorites in this category include:
- Adrenal Fatigue – A Fraud Perpetrated on Unsuspecting Patients
- How Men’s Clinics Create Drug Addicts
- It’s Not Your Thyroid
- T3 or Not T3 – Exploring the Controversy
- Low-dose Naltrexone – Hashimoto’s Cure or Powerful Placebo?
- The Ultimate Guide to Thyroid Function Testing – Hypothyroidism Edition
- Selenium and the Thyroid – Secrets Your Naturopath Doesn’t Want You to Know
- Endocrinology vs. Naturopathy – Steel Cage Death Match
- Dear Alternative Medicine – Stop Testing!
- Ketogenic Diet – Diabetes Cure?
- Hyperinsulinemia: Should You Be Tested?
- The Anti Osteoporosis-Drug Conspiracy
An acquaintance of mine is an entrepreneur in the health and fitness realm. His business partner wrote a book a couple of decades ago, which has sold millions of copies around the world. Some years ago, these two guys took a meeting with the president of a large, nationally-respected medical group. After they gave their pitch, the president began to explain all the reasons why their business plan was crap and wouldn’t work. The prez pointed to a book he had written as a reference for the way things should be done. The guy who wrote the best-seller responded, “That’s great, but you have the best book nobody has ever read. Mine has sold millions of copies and changed lives around the world.”
My point: I’m putting all this great content (conceited, much?) out there, but if nobody reads it, does it matter? While I would still be proud of the material, I admit if I thought it wasn’t having an impact, my blog-writing libido would be greatly diminished and this venture would wither. Happily, I have hard (no pun intended) data demonstrating this blog is reaching at least one order of magnitude more people than I see in the office, thereby fulfilling goal #2.
As of February 28, 2018, the total number of page views (the currency for gauging blog traffic) on this site is 85,464. That’s not bad for a niche-within-a-niche-blog. If we drill down further, what were the top 10 posts/pages you guys read?
It’s clear that the internet loves pissed-off breakup-posts, à la Alanis Morissette, as evidenced by the semi-viral performance of Top 5 Reasons Why Your Doctor is Quitting. Yes, I know it didn’t exactly go “viral,” but by Endocrinology blog standards, it was akin to the widely-viewed Janet Jackson wardrobe malfunction.
Astute readers will notice that the Quitting post has been viewed an entire order of magnitude more times than each of my other posts in the top 10. Does it bum me out that my more educational efforts aren’t matching up to my top performer? Not at all. Remember that I write about whatever fires me up, and I honestly enjoy the process, from wordsmithing all the way to finding a featured image that captures the essence of a post. While I would love for all my pieces to be read tens of thousands of times, I find it fascinating to observe the will of the internet. Instead of wishing that my less-viewed posts were more popular, I prefer to focus more on the fact that 30,000+ medical providers and laypeople felt that my Quitting post resonated deeply and/or made them laugh, thereby helping me fulfill goal #5.
I also remind myself that this endeavor is still in its infancy; it takes time to build readership. There appears to be no end to the number of things that get my creative juices flowing, so I plan to keep doing this for the foreseeable future. Eventually, I may reach a point at which I have nothing else to say, but I can’t yet visualize that day.
As for the effort involved in building readership, I recognize that I am extraordinarily lazy in this regard. For one, I just can’t seem to get into social media. It takes time and interest, two things in which I am deficient. Some of you follow me on Facebook (thank you); I don’t even know if anyone follows me on Twitter (I have an account but never log in). From the beginning, my mindset has been to focus on what I enjoy, which is writing and being interviewed on podcasts. Otherwise, this morphs from fun hobby into painful obligation.
Because of this lack of dedication to promotion, I’ve focused my efforts on where I can get the most bang for my buck. To this end, I reached out early on to Britt Marie Hermes, the creator of Naturopathic Diaries. As many of you know, she is a former naturopath who became disillusioned with the rampant quackery in her field, and she now crusades against said quackery on her blog, as well as at major conferences for science-based skeptics. I had stumbled across her blog a couple of years before I launched mine, so I was already a fan. More importantly, I noted that many of her posts had hundreds of comments, which suggested a wide reach.
I offered to write a guest post for her site and, despite the fact that she perused my blog and found some of my writing a bit offensive, she agreed to consider my submission. The result was the publication of Endocrinology vs. Naturopathy – Steel Cage Death Match. Here is what happened to my blog traffic after this post went live in May 2017:
The bars for March and April look like they’ve been jumped on and squashed by a Super Mario Brother, but part of that is due to the y-axis being skewed by my Quitting post hitting it out of the park in August. The point is that Britt helped lift my blog out of obscurity, and for that I will be eternally grateful. By the way, for those who haven’t heard, she is being sued by a naturopath who objects to Britt’s characterization of the naturopath’s cancer treatments. Simply defending this lawsuit had the potential to bankrupt Britt and her husband, so an international legal defense fund was organized by Australian Skeptics, Inc. on her behalf; they raised over €50,000 in one week (yes, I donated)! If you would like to donate, know this from Britt: “Any legal fees not used in my lawsuit will either be donated to Sense about Science, a charity that played an active role in reforming U.K.’s libel laws, or the extra funds will be parlayed into a generalized skeptic defense fund.”
After being featured on Naturopathic Diaries, I realized that guest posting is definitely the way to go, if I want to gain a broader audience. Since then, I’ve gotten some additional mileage from posting Why I Wish All My Patients Were Transgender to T-central, with some good feedback from the transgender community. I received a bump from posting Dear Alternative Medicine – Stop Testing! to KevinMD. Additionally, Physician on FIRE was kind enough to include a couple of my posts in his Sunday Best. Unfortunately, my desire for anonymity comes with a price tag – Science Based Medicine will not publish pseudonymous pieces. Too bad, because The Anti Osteoporosis-Drug Conspiracy would have been perfect for that site. One of my goals for the next year is to get connected with more people in this anti-quackery space and build some bridges.
Scratching the Itch
So far, I’ve described how I’ve successfully met goals 1 (help people recognize quackery), 2 (reach more people than I can see in the office), and 5 (educate and entertain both colleagues and laypeople). I’ve touched on 4 (scratch my creative itch) a bit, but I’d like to explore that one further.
When I was younger, I was pretty good at creative writing. I remember writing some goofy skits and poems for end of summer shows at the day camp where I used to work. I would write one version for the camp-wide performance and another one that was significantly less politically correct to entertain my bosses and fellow counselors. In high school, I wrote a particularly disturbing short story and, upon finishing reading it to the class, looked up to see a bunch of horrified emojis staring back at me. If this had been in the era of school shootings, I probably would have been paid a visit by the FBI, just to make sure I wasn’t totally unhinged.
I have acted in plays, spoken to large crowds, edited a journal of poetry, and written some amusing accounts (for friends and family) of a few of my far-flung travel adventures. For the last couple of decades, though, medicine has taken over my life. That’s not unusual for a doctor, as it takes an incredible amount of time and energy just to keep up with the field and practice at a high level. But it does mean that the muscles we’re not using tend to atrophy, and sometimes we start to miss feeling fulfilled by endeavors outside of the career.
Writing the posts for this blog has definitely reinvigorated me on a creative level, which has been immensely satisfying. Even the process of constructing the blog itself, on a technical level, delivered an overwhelming sense of accomplishment. I’m not a total neophyte when it comes to computers, but I certainly wouldn’t portray myself as a savvy power-user. It took me a good 4 months to get this thing up and running, from registering the domain name and finding a host, to tweaking the format just the way I wanted it. What I’m trying to say is, my itch has been scratched.
The Jar of Awesome
Lifestyle-design guru, podcaster-extraordinaire, author, investor, blogger, and all-around Renaissance man Tim Ferriss often refers to something called “the jar of awesome.” The story goes something like this (I’m paraphrasing from memory, but I promise the broad strokes here are accurate): an old girlfriend of his noticed that he usually obsessed over the negative – where he was failing, what wasn’t working, etc – without devoting adequate energy to celebrating the wins in life, both big and small. Basically, he would take all the positives for granted, as if to say, “Of course that should have gone well, but look at all this other stuff that’s going to pot.”
Tim’s girlfriend created a literal “jar of awesome,” a labeled mason jar in which she had him toss slips of paper, each with a “win” written on it. Any time he had any kind of win, he would write it down and throw it in the jar. Then on bad days, when nothing seemed to go right, he would open up the jar and read a few of the slips. Although this may sound a little corny or contrived, it helped him avoid spiraling down into completely negative self-talk.
To follow Tim’s example, I’d like to share a few things from my [virtual] jar of awesome. In my original mission statement on the Start Here page, I asked:
What if, ultimately, this site becomes so trusted that people come into my office quoting…me? Then I could finally feel like I’ve done the job I was meant to do.
Well, it happened. Granted, it has only happened once thus far, but it was amazing and certainly unexpected. A patient who did not know that I am the author of this blog sought me out for a consultation. He proceeded to explain how his naturopath was treating him and why he was losing faith in that treatment plan. He went on to tell me that he’d been doing some research on the web, and he came across this “really informative and funny blog by an Endocrinologist.” He then proceeded to quote a bunch of stuff I had written, nearly word-for-word, and asked my opinion about the veracity of the information. Yeah, I could barely suppress my huge grin as I attempted solemn nodding to indicate that, indeed, the information was good.
Another awesome thing that happened was in Denby Royal’s post (on her self-titled blog), I Used To Be a Holistic Nutritionist. She eloquently explains the cascade of events and self-discovery that led her to leave the “Church of Woo.” Denby then closes with this:
I am here to say good-bye and to leave you with a list of resources that I hope can provide insight and knowledge to those looking for additional answers. These links are all articles, podcasts and resources that I have found paramount in pulling me out of the heap of raw, paleo, organic bullshit I was buried in for so long.
Below that, she links to Hormones Demystified, alongside giants in the skeptic-world like Science-Based Medicine, Naturopathic Diaries, Neurologica, and Dr. Jen Gunter, among others. She also specifically linked to my post, Top 10 Reasons Why Smart People Are Stupid About Their Health, as an example of one of the most impactful articles she’s read.
In the comments section after her post, I told her that I was honored and humbled to be called out for having that kind of impact on her life. She responded:
I’m speechless! If your blog was a book it would be dog-eared and full of highlights. I can’t stress enough how in debt I am to your services, and to others, who are doing [the] work to get this information out there. You’ve been an integral part that has set my current life in motion. Many thanks.
Here’s another interaction you might enjoy. I received this email from an Emergency Medicine physician:
I am an ER doctor in a busy clinical practice in [redacted]. I relocated after my residency in the straight-laced [redacted] to naturopathic obsessed [redacted]. I had never met or even heard of a naturopathic doctor until I started my first day as an attending. I came across your blog after a particularly frustrating few weeks of cases at work and conversations with well educated friends steered into dangerous medical territory by naturopathic guidance (iatrogenic hyperthyroidism, cellulitis from “testosterone replacement” s/p failed treatment with naturopathic remedies (not antibiotics), bizarre and expensive diets to treat invented abdominal conditions that are actually constipation, home birth at 36 weeks gone wrong, and the list goes on . . . Your writing is the perfect synthesis of refreshing science and dark humor.
About 6 weeks later, I get paged by – you guessed it – said ER doctor for some advice. I already knew – based on her practice location – that there was a chance our paths would cross one day; but given how infrequently I get paged by the ER, I didn’t think it would be so soon. This was a rare instance in which I just couldn’t help myself. Once we finished talking about her clinical question, I casually said, “So, you like my blog.” After a beat, she realized who she was talking to, we had a good laugh, and I swore her to secrecy.
I’ve received numerous emails like this one, which are a nice counterweight to some of the comments I get on my posts telling me what an a*hole I am. Overall, though, the positive comments and emails outnumber the negative ones, or at least that is how I am choosing to perceive it.
What this all has taught me is that there should be a 6th goal in my mission statement: connect more with other people, because one of the pillars of happiness is building relationships. Although I spend plenty of time with my amazing family and some with a small circle of good friends, blogging has been a relatively solitary activity for me. I write slowly, for the most part, so I can easily spend several hours staring at my computer screen before looking up to see what else is going on in the world.
In furtherance of the mission to build more bridges, I hope to continue doing podcasts over the next year. Being a recurring guest (3 times now!) on Dr. Bret Scher’s Boundless Health podcast has not only been lots of fun, but it has helped Bret (an old friend) and I reconnect on a personal level. This has been enriching for me, at least. I don’t know about Bret – he seems to have a larger social circle than I – but hopefully he’s also enjoying rekindling our friendship.
I also loved doing the two-parter podcast with The Gender Rebels. As many of you know, I am happy to support the transgender community in whatever way I can, and this show provided me an avenue to do just that.
The final unique podcast opportunity of this past year sprang out of an email exchange I had with reader Amy Peikoff, of Don’t Let It Go…Unheard fame. Thus, our marathon session podcast was borne, and I can honestly say that my life has been enriched by having gotten to know Amy and her work.
Spreading the Word
I’ve had readers ask me, “what can I do to support you?” You can share my posts with friends, family, colleagues, and strangers you meet on the plane. Please do not underestimate the power of sharing. I know that, realistically, we tend to read something on the web, say “that’s interesting,” and move on. But if you truly want to help in the crusade against quackery, it’s all about providing sensible voices to counter the cacophony of crazy out there. So my “ask” is: tell everyone you know about Hormones Demystified. It’s already spread this far around the world, but we need more red and less yellow*:
*If Physician on FIRE is reading this, I got Greenland!
What do you think about how we can best counter the quackery out there? Have you tried to bring relatives or friends back into the realm of legitimate medicine, only to be met with extreme resistance, or do the people you know tend to be receptive to logic and reason? Do you have any big-picture (or small-picture) suggestions for me, with respect to new directions for the blog? Is there something you’d like to see more of? Less of? Comment below!
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Image credit: Photo by Thanh Tran on Unsplash
11 Replies to “Hormones Demystified Turns One!”
Congrats on a successful first year! Love the blog and your writing style. Looking forward to what the next year brings. I’d love to see an article on hormonal issues during peri-menopause and beyond and your take on the value (or lack thereof) of topical progesterone creams.
As for convincing firends and relatives to abandon quackery, I have given up. Now, I just smile and nod when they tell me about the whatever miraculous, holistic, naturopathic woo they’re into currently. Logic is powerless when dealing with most of these true-believers.
Thanks, JoDi. Yes, the whole “bioidentical” women’s hormone replacement issue is on my list of topics to tackle; I’ll get there. I agree with you that “Logic is powerless when dealing with most of these true-believers.”
Incredible job! It must be very satisfying creating something. Love the story of a patient quoting you to you, you have the makings of a good spy if the medical career burns out!
Aw shucks, HD. I can’t believe I missed this! The honour is still all mine. Thanks again for everything you do.
I just wanted to thank you for your well-written, humorous, thoughtful blog. I am working my way through your posts and enjoying them and learning as well. I’m sincerely grateful!
Thanks, Michael! That motivates me to continue putting fingers to keyboard.
first, congratulations for your successful blog!! I truly enjoyed reading all of them. Not only due to the informational aspect, but also your style of writing is pretty entertaining 🙂
Unfortunately there is no blog about Vit D out yet but a question is bothering me and since Vit D is considered a hormone i might just ask it here…
Are there reason why someones 25(OH)D level wont rise above “low reference range levels” even when being outdoors -full body exposed- the whole day for weeks in summertime?
Maybe impaired production / conversion? Increased usage?
Thanks, Maria. It could just be that different bodies have different set points for where they like to keep the vit D level. So a low-normal level could be perfectly normal. I vaguely recall a study done on Hawaiian surfers/lifeguards, where they measured their vit D levels before and after their peak surfing season. The surfers were out all day in the sun, without sunscreen, and their levels never got higher than the 50’s ng/ml. Most labs still report that the upper limit of normal is 100 ng/ml, but it seems like the body self-regulates to not get anywhere near that upper limit.
While possible to have enzymatic defects in the vit D metabolic pathway, I suspect that most otherwise healthy people are fine. If there was concern about a low-normal vit D, they could always just take a supplemental D pill. There is still plenty of debate about whether 20 ng/ml is fine for the average person, or if the lower limit really should be 30. In my opinion, it doesn’t hurt to push it to 30-40, so that’s where I aim to keep mine.
Ive have noticed a similar thing. Relatively low levels despite extremely high UVB exposure with a set point as you have called it at around 70ng/ml (seen in previous measurements).
I came across the theory that inflammation in the body causes the 25(OH)D to be low.
Either because is somehow directly impairs production or because it will get used up at a high rate (Vit D has an important role in the immune system and inflammation simply displays high immune system activity).
Whats your thoughts on this?
PS.: in my case i attributed it to spring allergy season which hit me hard this year with eosinophils increased as well.
Might this be the explaination for the surprisingly low Vit D levels?
Interesting theory, but I really couldn’t say.