Dearest:  Tonight's guest, Theodore Friedman, M.D., Ph.D., is in private 
practice specializing in adrenal, pituitary, thyroid and fatigue disorders. 
His practice includes detecting and treating hormone imbalances, including 
hormone replacement therapy.

Dr. Friedman is also an expert in diagnosing and treating pituitary disorders. 
His career reflects his ongoing quest to better understand and treat endocrine 
problems. With both medical and research doctoral degrees, he has conducted 
studies and cared for patients at some of the country's most prestigious 
institutions.

Welcome to Power Surge, Dr. Friedman. When I first started this community in 
1993, 20% of women of menopausal age were using hormone replacement therapy. 
Eight years later, those figures haven't changed. To what do you attribute no 
increase in the percentage of women using HRT? 

Please remember, everyone, that the information you're receiving here is for that 
purpose alone, information. It's not intended as a substitute for a visit to your 
own doctor.


Theodore Friedman, M.D., Ph.D.:   Some of the reasons is a lack of good hormonal 
replacement products, some of it is lack of clear cut benefit for patients to 
take the products, some of it is concern about side effects and some may be that 
doctors aren't tailoring the correct products to the correct patients. 


Dearest:  Thanks, Dr. Friedman. With so many brands of estrogen and progesterone 
available today, many plant-derived, naturally compounded, bio-identical 
hormones, why is it so many doctors are still prescribing Premarin and Provera? 


Theodore Friedman, M.D., Ph.D.:   Heavy marketing by drug companies, ignorance on 
the part of many doctors and patients and for many patients, it works well 
(although maybe not optimal).


Smitty:   I have been followed for a year and a half for hyperthyroid, no 
medication given yet.  My recent test showed hypothyroid.  I am wondering if 
there could be a correlation between these readings and the rapidly descending 
hormone levels I am experiencing as menopause approaches.  Age: 49


Theodore Friedman, M.D., Ph.D.:   Both hyperthyroidism and hypothyroidism are 
laboratory diagnosis not true diagnosis.  It would be important to figure out 
what type of hyperthyroidism you had.


Smitty:   Dr told me I probably had an infection at some point. How would we do 
that - I had lots of tests.


Theodore Friedman, M.D., Ph.D.:   Some types naturally evolve to hypothyroidism 
and may not require any treatment. 


Margaret:   I had a hysterectomy June 98, then was put on ERT (estrogen 
replacement therapy), Premarin, in July 99, had lots of side effects won't go 
into that to long.  I stopped ERT on my own April, 2000, then my hair fell out 
dramatically, so my doctor suggested going back on ERT.  I tried the patch.  It 
was working very well but my hair continues to fall out and no regrowth. Is there 
a connection between hormones and hair?  I see a dermatologist July 13. I have 
seen him before.  


Theodore Friedman, M.D., Ph.D.:   Margaret, hormones and hormonal changes do play 
a role in hair loss.  The recovery from changes may take time.  In general, 
estrogen is beneficial for hair and androgens and progesterone are detrimental.  
You probably should have your thyroid tested also.


Margaret:   I am thinking of coming off ERT again.  Should I?  I did already, was 
told it's fine.


Theodore Friedman, M.D., Ph.D.:   I would probably stay on the patch as that is 
working well. 


TrishEileen:   What do you feel is the best way to test for hormone/menopause, 
blood or saliva?  And how often should it be done? 


Theodore Friedman, M.D., Ph.D.:   Blood tests (FSH) and also your menstrual 
patterns. 


TrishEileen:   Patterns are fine but estrogen is around 50.  On Climara 75mg.


Theodore Friedman, M.D., Ph.D.:   Probably you should get a serum FSH.  If its 
starting to rise, you are perimenopausal. 


Dearest:   Dr. Friedman, women's bodies naturally produce testosterone. As they 
go through menopause and lose estrogen and progesterone, so, too, do they lose 
testosterone. If testosterone is such an important hormone for women, why isn't 
it supplemented in most brands of HRT? 


Theodore Friedman, M.D., Ph.D.:   Although there are very few 
good studies on the effects of testosterone in menopausal women, I think it is 
likely to be beneficial for some patients.  For those patients, they probably 
should take the testosterone separately from other hormonal pills so that each 
hormone can be regulated individually.


Dearest:   Dr. Susan Rako has been a guest in Power Surge a few times and says 
that Estratest has too high a dose of testosterone. What is the proper dose for a 
perimenopausal woman? 


Theodore Friedman, M.D., Ph.D.:   I'm also concerned about possible liver 
toxicity in oral testosterone preparations such as estratest.  New preparations 
have appeared for men such as creams and patches and will likely come out for 
women. 


Dearest:   Thank you, Dr. Friedman. 


Boost:   What herbs can we take?  Like soy?


Dearest:   Be sure to check out the recommendations page on Power Surge at 
http://www.power-surge.com/recommend.htm


Theodore Friedman, M.D., Ph.D.:   I don't know. 


Dearest:   Dr. Friedman specializes in hormone therapy, not herbs. Email me if 
you have any questions about alternative medicine, you'll want to check out the 
message boards, specifically the althernative medicine board, 
the newsletters, transcripts with guest experts in the area of 
alternative medicine and the recommendations 
page.  Deboc, go ahead, please.


Deboc98:   What are your thoughts on overgrowth of yeast (candida) and how it 
affects hormones and the endocrine system or does the imbalance cause the 
overgrowth in some individuals with overuse of antibiotics for frequent 
infections?  My system is out of whack since my hysterectomy and trying to get 
balance back, but need these hormones for severe hot flashes. Ovaries removed 
also.


Theodore Friedman, M.D., Ph.D.:   I don't know of any connection between candida 
and hormones.  You should probably take some form of estrogen.


Ieboc98:   I am on a patch but candida is rampant.


Dearest:   Dr. Friedman, Deboc says she's on the patch.


Theodore Friedman, M.D., Ph.D.:   You should discuss with your doctor about anti-
candida drugs. 



KathieFran:   I read that if you don't have any risk factors for heart desease 
that you don't need HRT is this true?


Theodore Friedman, M.D., Ph.D.:   No, estrogen has a lot of benefit besides 
related to heart disease. Osteoporosis prevention, vaginal lubrication, cognition 
and a general sense of well being.  Also many women get heart disease even 
without classic risk factors. 


Mattie:   I am 41 and was told I am perimenopause as of the beginning of this 
year.  Had a baby in Nov. 99 and stopped breastfeeding her in Sept. 2000.  
Periods were getting shorter and PMS symptoms extreme beginning this year.  Dr. 
put me on Loestrin 1/20 to regulate cylce.  Now period comes every two weeks AND 
this week my breasts are leaking milk.  This is my concern. I am having a period 
now and breasts are ready to nurse again! Is this perimenopause or a pituitary 
issue?


Theodore Friedman, M.D., Ph.D.:   You should have your prolactin measured.


Mattie:   What other tests would you recommend? 


Theodore Friedman, M.D., Ph.D.:   Thyroid tests. 


Lori:   I was on Birth Control pills for perimenopause and came off then tested 
for menopause.  Estrogen was less than 10 and FSH was 68.  Is that an accurate 
reading only 1 week off of pill?  I recently tested and estrogen was 35.  I am on 
Vivelle dot 1mg and Prometrium 200mg.  I am 43.  Thank you. 


Theodore Friedman, M.D., Ph.D.:   That looks like you are in menopause, how are 
you doing on the Vivelle? 


Lori:   OK, but I still don't feel great.  Anxiety, spotting, heart racing, very 
sensitive to adrenaline


Theodore Friedman, M.D., Ph.D.:   If the spotting continues you probably should 
go to your gynecologist to evaluate it.  Lorie, you should also be checked for 
hyperthyroid. 


Lori:   They did TSH and everything was fine.  


Dearest:   But also remember that heart racing, palpitations, skipped beats 
aren't uncommon during perimenopause.  KAREN, go ahead.  


Karen:   I am taking FemHrt 1 mg/5mcg and it seems to be working as far as mood 
swings, etc. but I've noticed that no matter how much sleep I get at night I can 
still fall asleep pretty easily during the day (i.e. cat naps) should I be 
concerned-- I'll be 45 in July and this is my 2nd year of menopause?


Theodore Friedman, M.D., Ph.D.:   Karen-probably not but you can get your thyroid 
checked.  Hypothyroidism happens frequently at the time of menopause. 


MaryO:   I had a pituitary disease several years ago.  With the combination of 
that and menopause - is there any way I'll ever get rid of the hirsuitism?  Does 
Vanqua really work?  I get tired of shaving every day. 


Theodore Friedman, M.D., Ph.D.:   What kind of pituitary tumor-was it treated? 


MaryO:   Cushing's - pituitary adenoma.  It was removed (just the tumor, not the 
gland)


Theodore Friedman, M.D., Ph.D.:   Mary, I presume you don't have any signs of 
Cushing's returning.  Then you should have your DHEA and testosterone levels 
checked. 


MaryO:   Not returning.  I have some symptoms, like the hirsuitism, that never 
left.  Thanks :)  I get my growth hormone checked, too.


Theodore Friedman, M.D., Ph.D.:   You should probably have a urinary free 
cortisol to make sure your Cushing's hasn't returned. 


MaryO:   I have everything like that repeated annually :)


Theodore Friedman, M.D., Ph.D.:   For all guests:  Cushing's disease is a 
pituitary tumor leading the body to make excess cortisol. 


Sally:   I am 38, infertile, gaining weight, depressed, missed 3 periods. I was 
put on provera and had a D&C afterwards due to vaginal hemorrhaging.  Then I 
missed another period.  What is going on? 


Dearest:   Part of what is going on is that you're taking Provera :(


Theodore Friedman, M.D., Ph.D.:   Have you had your thyroid checked?


Sally:   I only took it for ten days.


Theodore Friedman, M.D., Ph.D.:   You could be going throught menopause. Was your 
FSH checked?


Sally:   My thyroid has not been checked or my FSH.


Theodore Friedman, M.D., Ph.D.:   Also, you may have insulin resistance (also 
called syndrome X).  This is an important, relatively new disease that can give 
infertility, excess hair growth and irregular periods and weight gain. 


Margaret:   I have yellow skin around my eyes (above eyelids) should I be 
concerned?  What is a normal level for testosterone for women, and finally can 
you have too much estrogen in your system when taking ERT?  If so, what happens 
to it?  Thanks for your time.  

Theodore Friedman, M.D., Ph.D.:   1) Get your cholesterol and triglycerides 
checked
2) Total testosterone should be between 30 and 60 but estrogens affect the 
measurement so if you are on estrogens it may be higher.
3) excess bleeding, maybe irritability and it increases your risk of breast cancer. 


Margaret:   What if its low, like 2?  What side effects? 


Theodore Friedman, M.D., Ph.D.:   Your doctor should try to figure out why its so 
low, how old are you?   Side effects from what? I would have your doctor test your pituitary, 
adrenal and ovaries to see why its so low. 


Margaret: 43, I am the one experiencing hairloss.


Sally:   Thank you Dr. Ted, although I am frustrated because I am only 38 years 
old.


Dearest:   Dr. Friedman, is there an E.mail address you can be reached at?  
Sally, you may want to E.mail Dr. Ted.


Theodore Friedman, M.D., Ph.D.:   hormonedoctor@hotmail.com.


TrishEileen:   Had one blood test, estrogen was 50.  I am now on Clmara 75 mg 
patch, still have symptoms, extreme premenstrual irritability, memory loss, 
weight gain, hair loss, bloating and no libido.  What else can I do?  My doctor 
doesn't want to up Climara, progest/thyroid fine. I'm 36. 


Theodore Friedman, M.D., Ph.D.:   Trish, tough call.  Maybe try a different form 
of estrogen.


Dearest:   Great. Remember you can write Dr. Ted at hormonedoctor@hotmail.com.  



Theodore Friedman, M.D., Ph.D.:   Information about consults is on my website-
www.goodhormonehealth.com


LibraDoll:   My thyroid test came back t3 low and antibodies high. What does this 
mean, do I need thyroid medications? My mom had a goiter and had surgery. I'm 50, 
total hysterectomy September 2000. 


Theodore Friedman, M.D., Ph.D.:   Probably.  What was your tsh?


LibraDoll:   .096.


Theodore Friedman, M.D., Ph.D.:   LibraDoll, your tests are quite confusing.  You 
can email me for a consult.


Carole: I had a pituitary adenoma 8 years ago which was treated with Parlodel for 
2 years and it went away. What are the chances of it returning? I am having 
difficulty with perimenopause and had to be put on Trazodone to help with 
sleeping and depression, anxiety. How related is the pituitary gland to menopause 
issues? I am on birth control pills all 4 weeks with no "off' week per my 
gynecologist for the perimenopause. Yet I still have some troubling symptoms and 
spot continually on the 4 week pill regimen.


Theodore Friedman, M.D., Ph.D.:   Carole, pituitary is extremely important for 
menopause and symptoms.  What is your prolactin?  You probably need your other 
pituitary hormones checked.


Carole:   My prolactin was about 15 last year.


Theodore Friedman, M.D., Ph.D.:   Thyroid and growth hormone (by an IGF1) would 
be a start. 


Carol:   There is so much confusing info out there.  What do you prefer, natural 
alternatives such as soy, biest, vitamins, etc. or HRT?  Also, what would help a 
post-meno woman still experiencing symptoms of perimenopause?


Dearest:   Carol, Bi-est really is a form of HRT although naturally compounded 
hormones.  Bi-est being bi-estrogen (estriol and estradiol).


Theodore Friedman, M.D., Ph.D.:   I usually go for an estrogen patch, but it 
needs to be individualized for each patient. 


MsMolly:   Good evening.  I was diagnosed with endometriosis...later had a 
hysterectomy and kept ovaries.  By age 30 I was having some menopausal symptoms 
and by 32 was told I was perimenopausal.  Can endometriosis have an effect on 
perimenopause coming earlier then normal?  I was told by keeping the ovaries I 
should not go through it early. Also my thyroid was checked and fine.


Theodore Friedman, M.D., Ph.D.:   Endometriosis can effect your ovaries, so it 
might. You should have your FSH checked. 


Fejdoc: Dear Dr. I'm 45 yrs old and having irregular menstrual cycle since 6-7 
years. It started after insertion of multiloaded coil which was removed after 6 
months but I'm still having irregular periods, like I have periods after a period 
of 2-3 months, sometimes it is 4 months or 1 1/2 month, flow is normal, no 
Dysmenorrhoea, I had hormonal profile which was normal. I know its a 
premenopausal age but why it has started so early, nowadays I'm having hot 
flushes, mood changes.


Theodore Friedman, M.D., Ph.D.:   Fejdoc, you sound perimenopausal-I'd start on 
some estrogen.


Dearest:   Again, if you have any additional questions, Email Dr. Friedman at 
hormonedoctor@hotmail.com.  


Mutyi:   A year ago, I went right from birth control pills to PremPro when my FSH 
indicated perimenopause. A week ago, I stopped taking the PremPro just to see 
what would happen. Absolutely nothing! Previously only symptom was irregular 
bleeding.  Next week I see the GYN MD. Will hormone tests taken at that time be 
more accurate due no supplemental hormones being taken? Saliva tests versus blood 
test? 


Theodore Friedman, M.D., Ph.D.:   Blood tests, but they will be hard to interpret 
since you were on PremPro. 


Mutyi:   That's how I felt about the bc pills too. How long to be off PremPro 
before tests? 


Theodore Friedman, M.D., Ph.D.:   Maybe 3 months.


Dearest:   Fejdoc, 45 is not early to start perimenopause.  You're at the exact 
age when women go into perimenopause.


Theodore Friedman, M.D., Ph.D.:   Thanks 


Dearest:   Dr. Friedman, thank you for joining us tonight in Power Surge. This 
has been a very informative and stimulating chat. Do visit Dr. Friedman's Web 
site at www.GoodHormoneHealth.com and if you're interested in consulting with Dr. 
Friedman, you can E.mail him at hormonedoctor@hotmail.com 



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