It has been two years since I launched Hormones Demystified. When it turned 1-year-old, I was excited and a little shocked that: one, I’d been cranking out lengthy posts roughly every 2 weeks for a full year; and two, reader expressions of gratitude and encouragement far outweighed the outraged voices of those offended by my irreverent writing style. Last year, I felt that reflecting on the blog’s first year of life would be a worthy endeavor, so I penned Hormones Demystified Turns One! I didn’t map out that post prior to writing, so I found its trajectory surprising; the end-product showed me that I accomplished all the goals initially set out in my mission statement. At the risk of appearing self-congratulatory, I thought that was pretty cool – I may have actually dislocated my shoulder patting myself on the back.
As Hormones Demystified approaches the end of its second year, I’d like to look back and see what – if anything – I’ve accomplished since its first blogiversary. Priding myself on being somewhat self-aware, I realize that asking casual readers to celebrate a second blogiversary is akin to inviting your adult friends to your kid’s second birthday. They may have been able to muster some forced enthusiasm for the first one, but by year two, the kid is old news. With that in mind, I’m going to stick to the major highlights, hopefully making this a short and painless read. For those who are still interested in a peek behind the curtain, please enjoy Hormones Demystified: Two-Year Update.
I’d like to begin where I left off at the end of my one-year update. At that time, I noted that I probably should have included a sixth goal in my original mission statement: connect more with kindred spirits/bloggers. I thought this would be important – not only for networking purposes to expand my reach – but because one leg of the “happiness” stool is strong relationships. As blogging is a mostly solitary activity, and I tend to prefer long stretches of quiet time in the wilderness to being surrounded by people, I’m quite selective about those with whom I associate. I can be “on” for short intervals, but then I require hours of alone time to recharge my social battery. That’s not exactly conducive to building bridges, is it?
With that in mind, the accomplishment – if I can call it that – about which I am happiest is connecting with M, the anonymous blogger behind Reflections of a Millennial Doctor. After binge-reading her burnout chronicle, I felt like I’d found a kindred spirit. But it was her dark humor that convinced me we should be besties. Like a mentally ill celebrity-stalker, I graduated from commenting on her blog to reaching out via email and suggesting we meet IRL (I had a rough idea of where she lives, and I happened to already have a trip planned to that region). After adequately reassuring herself that I was not likely to be dangerous, she agreed to meet, and thus our unlikely friendship was born. M and I “get” each other in a way that has allowed us to hop over all the circles of acquaintance and land squarely in the deep-connection bullseye.
So, although I couldn’t summon the effort this year to really “network” in the traditional sense, I’ll take quality over quantity any day. I feel like I’ve made a friend for life, which is simply awesome. M even called me a life coach at one point, which is both flattering to me and horrifying for her, at the same time. Of course, millennials are notoriously flaky, fickle, and capricious, so next year I may be telling you that M won’t return my calls anymore. 😉
Expanding Blog Reach
Along the lines of achieving greater reach for Hormones Demystified, a few intriguing opportunities have presented themselves. This tickles me, since I’ve been too consumed by other aspects of life and work to go about beating the bushes. I’ve declined most offers that have come my way, for various reasons. The bottom line for me is, if it’s not a “hell yes!” it’s a “no.” Out of respect to the folks to whom I’ve said no, I won’t go into detail about what I’ve declined. However, I will say that a major online medical resource reached out and asked me to create content for them. Although we could not come to a mutually acceptable agreement, I’d like to knock on that door again in the future to see if we can make it work.
I’ve also said no to every speaking engagement I’ve been offered, save one. I was asked to speak to an audience of physicians at the national level. My immediate reaction to the invitation was, “Hell yeah, I want to do that!” Then I proceeded to obsess over all the positives and negatives, polled my confidants, and then obsessed some more before agreeing to do it. I am an educator at my core, and I especially love teaching fellow doctors. So, I will be talking to a (hopefully large) group of physicians about how to approach patients who have one foot in the world of alternative medicine. What will be unique about my presentation – compared to others I’ve seen in this genre – is that I have access to a virtual treasure trove of insightful, poignant, and sometimes heartbreaking comments left by readers of this site. What better way to help my fellow docs empathize with our patients than to help them understand why people have sought care outside of mainstream medicine? To that end, I will share anonymized reader comments with the audience, which I expect will have a powerful impact. If I’m wrong, I’ll let you know next year. Regardless of how my talk goes, I’d like to thank my readers for generously sharing your experiences with me – I’ve learned a lot from you.
Favorite Content of the Year
I am still ridiculously proud of Everything You Never Needed to Know About Reverse T3. The construction of this post took me down so many rabbit holes that I wasn’t sure the finished piece would ever be coherent. The end result was a thorough debunking of everything I’ve ever seen alt med claim about the utility of rT3 testing. To the best of my knowledge, there is nothing like this post in the medical literature or elsewhere.
I also love You Can’t Eat for Your Thyroid. I had a lot of fun diving into the science behind how food can(not) affect the thyroid. Given the ubiquity of “eat this, not that” splattered across the internet, it felt great to call BS on all that nonsense…then prove it with science.
I had a love-hate relationship with my menopause trilogy (links below). It was painful to write, as my medical book knowledge in this arena outweighs my clinical experience. But, I suppose it’s good to put oneself in uncomfortable situations every now and then, as it forces one to hone a different skill set. Fortunately, I have an old friend who also happens to be an incredible OB/GYN, so I leaned on her heavily for fact-checking. The final posts did a great job debunking some of the absurd things alt med does in this realm; I hope they are a useful addition to the blogosphere:
- Why You Shouldn’t Care About Estrogen Dominance
- Are Bioidentical Hormones Safe?
- Salivary Testing for Bioidentical HRT: A Great Way to Waste Your Money
Of course, I would be remiss in not mentioning my three favorite posts about my favorite topic: Alternative Medicine. If you haven’t seen it already, check out Alternative Medicine is Kicking Our Ass. That post laid the groundwork for my next fave, Mainstream Medicine Needs to Play Offense, which was also published over at KevinMD. The third post sprung from a reader’s email, leading to my advice in Your Loved One is Alternative Medicine-Obsessed: Now What? I particularly liked this one because some of my advice applies to any disagreement between loved ones – now all I need to do is reread it every time I’m having an argument with my spouse.
Other standout posts from the last year include:
- Sexism and the Thyroid
- Life Lessons Learned at ENDO 2018
- How to Kill a Medical Practice
- Doing the Impossible: Fixing Healthcare
- Time-Restricted Feeding for the Pseudo-Athlete
- Should You Hate Your Doctor?
Where is Hormones Demystified Going?
At my day job, I have periodic performance reviews. My supervisors always ask, “What are your goals?” I despise that question. It’s not that I don’t think having goals is worthy – clearly it is – but in some circumstances, I think it’s acceptable to simply do great work until something fires you up. Then, shift gears and go after whatever lights that fire.
That said – at this very moment – I can’t rightly say what my goals are for the next year of Hormones Demystified, other than what I’ve already put forth in my mission statement. I do have some semi-formed, pie-in-the-sky ideas for where I’d like to take this enterprise. Because my brain still resides somewhere between pre-contemplative and contemplative on the action scale, I’m not yet ready to share these ideas. My primary focus right now is on continuing to refine my sustainable balance among work, play, family, self-improvement, and the blog.
Rest assured, I will strive to create content that educates and entertains, and I will continue to confront quackery. One thing I’ve learned over the last two years: there is no “defeating” bad medicine. The allure of quackery will always be powerful – too powerful to ever be completely suppressed by a simple presentation of sensible science. There are plenty of solid medical sites out there that offer evidence-based information. But, when smart people have trouble separating the wheat from the chaff, they will also need a reliable source that debunks the copious nonsense on the web.
I hope to be that source. Thanks for reading.
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Image Credit: Photo by Ian Schneider on Unsplash
28 Replies to “Hormones Demystified: Two-Year Update”
I’ve thoroughly enjoyed and appreciated your writing. You neatly summarize the difficulties of the “education” portion of clinical medicine.
Please continue to write. If nothing else, you’ve been a calming voice when I think that “Dr. Google” and the internet are going to overcome.
Thanks very much, planedoc.
Congratulations! I hope your blog will be around for many more years yet. I rarely comment here, but I do enjoy reading your writing.
I appreciate that, Lydia.
Happy Birthday! Keep up the good work, you’re answering important questions in your inimitable style!
Thank you, Michael.
Please continue to speak out about hormone quackery to your colleagues. As a patient I lived a hormone nightmare. An M.D internist put me on Armour thyroid supplementation for weight loss. I really had celiac disease.
I know your M.D and D.Os are jumping on the AM bandwagon. It is not based on anything they learned in medical school, it is not scientific, first do “no harm” has fell to the wayside, where are the clinical trials?
My elderly parents both put on Synthroid by veteran, female internist M.D., on the same day, she also sells hormone pellets. Their labs from specialty laboratory M.D uses said labs were optimal. My father had multiple myeloma cancer, researching I found article about subclinical thyroid levels beneficial to MM patients, something about cancer cell proliferation lessened. My father’s levels were perfect, negative TPO. He was experimented on. He died hypercalcemia, hyperparathyroidism, we took him home and watched him take his last breaths. The morning he died he was fighting to get out of bed and go to work, told me to “put the coffee on”. My mom was pushed to hyperthyroidism, ambulance to E.R, thought she had heart attack. Her doctor told her she needed to lower her thyroid meds. The cardiologist she had saw few months earlier had changed her to Armour and increased dosage. The public is in HARMS WAY. I have filed complaints that fell on deaf ears. Please get the word out.
You do such important and necessary work in this space, and I’m glad you continue to write despite your adamant non-use of self-imposed deadlines. Hopefully we can correct, ahem, I mean adjust, your abhorrence to social media and get your message to where your intended audience lives in the dark reaches of the internet.
Thanks for saying so many nice things about me, and know I feel the same.
But just so you know, I’ve only bought one canister of mace in my lifetime and that was intended just for you. Glad I didn’t have to use it!
And…that’s why we get along so well.
Happy Second Blog Birthday!
I appreciate your work here, the thyroid stuff is of personal relevance, but all of it is interesting and you are creating a useful resource to refer people to. Carry on!
Thank you, Jazzlet!
I will be taking an 81 year old elderly friend to see an endocrinologist. Friend had been ill with hemorrhoids, in hospital and was told to follow up with her doctor years ago. She never had a doctor bc she was never sick. The referred internist put her on thyroid supplementation bc of one tsh level of 7. Kept giving her more til she’s at tsh around 1. My friend feels sick, dizzy to take medication. She told internist she doesn’t take medicine if she going out. She also has problem with diarrhea, doesn’t go out bc of diarrhea urgency episodes after eating. Internist said it’s ok to not take thyroid meds couple of days and gave her diarrhea medication. WTH
Congratulations on your 2 year anniversary. I won’t go into details of my own history, but I’d say one reason patients seek out Alt-Med (I don’t, by the way) is when their own physician lacks empathy. I’ve had 3 endocrinologists, two had excellent interpersonal skills (sadly, both left my health care plan for various reasons). My current endo has a stellar reputation and is clinically gifted. She referred me to the UpToDate website for accurate information. So I have access to great care and state-of-the-art research and information on parathyroid and thyroid conditions. What led me to consider going outside of my network? My condition was pretty scary. I didn’t get the warmth and reassurance that I needed on an emotional level. So I gathered up my records and shopped around. I ultimately decided to stay with her and my health plan, mainly because my PCP possesses all the qualities I look for in a physician.
I appreciate that it’s difficult for endocrinologists to constantly balance science, clinical judgment and their patient’s emotional needs. And I agree that the health care delivery system is broken. I wish you luck in your journey.
Thanks for sharing, Kim. Your comment about a lack of empathy is a recurring thread with respect to why folks seek out Alt Med. This is something I remind myself of constantly while I’m seeing patients. It’s not good enough that I really care about my patients; they actually need to FEEL that I care. Sometimes that is hard to convey adequately, for various reasons.
I appreciate that. My husband was in the room and came away with an entirely different opinion. We both thought that she was trying to give me objective, factual information in a straightforward way so as not to over-or under-state my situation and options. But I was the one with the fear and fear can cloud one’s judgment. I think it would have gone better if she had just given me a hug. That said, I’m 16 months post-surgery and doing well. I’m glad I stuck with it.
I’m new to your blog (recommended by my endocrinologist) but I am hooked. I needed to read the “science” of thyroid and get away from the quackery out there. Thank you for your efforts to enhance science over desperation.
Thanks for reading, Shirley. And please thank your Endo for me, too!
Thanks so much for your blog, both in information and tone. I am an MD, Graves’ patient, and aspiring Master in Science health communicator. Your writing speaks to me in all those aspects of my life. I think any blog I may write would be similar in tone to yours, as I catch myself writing in that style to my classmates.
Thanks, Shannon. When you start your blog, I’d love to read it!
I just wanted to say that I greatly value your blog and its content. I have long read, but never commented.
As someone who is in remission from Cushing’s Disease (as my neurosurgeon and endo prefer that term to ‘cured’), I would selfishly love if you chose to tackle that issue (or even the asinine things that are spread about cortisol across the internet) during your third year of this blog.
In the patient circles I have been exposed to as a result of this disease, there is a population of individuals who I would class as disease seeking, for lack of a better term. And, often, many spend thousands of dollars to obtain a diagnosis (typically from a specific dr) and receive surgery, only to not have a positive outcome (likely because they didn’t have Cushing’s Disease in the first place). While not as prevalent as the AM nonsense that exists for the thyroid, there’s definitely a lot to work through that I’d appreciate your take on.
Really great comment, K. Cushing’s is one of the toughest endocrine diseases to diagnose as well as treat. I have seen exactly what you describe, with respect to inappropriate diagnosis and treatment.
This will go on my list of topics to consider, thanks.
I agree with the empathy bit.
It is hard to come by and I am guilty of not giving enough to my patients in my sometimes overstretched/pushed to the limits/busy day . I have also been on the receiving end of brisk, efficient and somewhat impersonal assessment while sick awhile ago .
It can also be the most important medicine we give to our patients. I find a good dose of empathy can do wonders for patients with chronic condition that needs to be managed ” rather than cured. Alternative medicine practitioners probably fill that gap by listening , taking time and being kind ? while prescribing expensive rubbish.
I’m a newbie to the thyroidectomy world and have bookmarked your blog. In a desperate attempt to learn, I belong to social media groups that prefer PAs and nurse practitioners (specializing in hormone balancing) that move around and practice in sleep studies centers over board certified MDs/DOs. I personally cant wrap my head around it. Give me evidence based science any day. I hope you continue educating us all. Thank you.
Thank you voice of reason!!! At 49 I’ve been on a hormonal rollercoaster. Have lost over 1 year of life and almost my career to the massive estrogen is evil / progesterone is good ‘noise’ on the internet. One progesterone web site (which has their own progesterone product to peddle. Sure sign of quackery in hindsight) encourages massively high doses of progesterone because ‘doesn’t pregnancy feel GREAT so how can it be harmful!’…which I followed, and felt GREAT, for a short period of time. Then my entire system – cortisol, adrenals, thyroid, etc. – went haywire and I’ve been chasing symptoms ever since. I ended up with anxiety, total loss of energy, depression, palpitations (could have been anxiety), HYPERthyroid, and was a mess. Spent $500 on saliva test with resultant ‘herbs’. Helped for a while then didn’t. Still have days where I feel like a mess. Stopped Progesterone, started 100mg prometrium, added Bi-Est, and it’s taken 6 months to start feeling better (not perfect, probably don’t need prometrium due to build up from cream but MD won’t allow Bi-Est without). Now dealing with HYPOthyroid issues. Ugh. We really need evidence-based menopause treatment guidelines AND an adjudicated singular if (symptom/then test x) – then (symptom/then test x) COVERED by insurance 100% as needed to tease out menopause vs. thyroid vs. diabetes vs. candida/SIBO (for kicks!), etc. I could on. Years of flawless emotions, etc. and all of a sudden I’m a mess following ‘blessed’ progesterone? Yep. Those web sites should be shut down. Thank heavens for finding your web site today. Sorely needed.
I stumbled across your blog while Googling “what to expect at your first endocrinolgist appointment.” I haven’t found if you have anything like that on here, but it’d be great to read from a non-medical abstract the meanings around the Ti-Rads classifications on an ultrasound. I had one done and was referred to an endocrinologist (2 nodules both Ti-rads 5; 1 1 cm and 1 < 1cm) but my PCP didn't explain really why or if there's much to be concerned about, so, as one does, I turned to the google.
I haven’t written anything about Ti-Rads. It’s a comparatively new risk-stratifying system, when compared to older ones like the ATA (American Thyroid Assn) system. It performs pretty well as a tool to help us biopsy fewer nodules, since most nodules are benign and therefore don’t truly need to be biopsied. However, there are multiple things I don’t like about it. One, in particular, is the verbiage they use like “moderately suspicious” or “highly suspicious” for certain TR scores. This needlessly worries patients, as many of these “highly suspicious” nodules aren’t really that suspicious when I review the images and will wind up being benign if we biopsy them.
This is very interesting. It is my first time visiting your blog and I found it really interesting. Oh by the way, congratulations!