If you have a question for your doctor that you’ve never had a chance to ask, or you’re just not getting a good answer, ask your question here – Scroll down and ask your question in the “Post Comment” section below. You may ask any question, and it will be answered by me personally, from an Integrative Medicine perspective.
– Dr. Shira Miller
P.S. To feel like you can really ask any question, without having to expose your identity, I recommend using a pen name.
68 yrs old with COPD (emphysema) for 27 yrs. On O2 for 5 years now. In last 3 yrs gaining weight in the abdomen area. Had Sperm production cut off 33 yrs ago after 2nd child born. Recent testosterone test came back “65”. Have been taking daily doses of DHEA tablets @ ~ 50mg/tablet for last two months, prior to that @ 25mg/day for over a year. Question 1.= just what does a reading of “65” mean in the blood test for testosteron? Question 2. Does DHEA orally taken help raise the testosterone level in older men? Quetion 3. Is there a danger in taking too much DHEA to try to improve the level of testosterone? Thank you, Morris Brinkman
All symptoms of the menopause, but had blood test results are 6.2
Bella,I have been to my doctor 2 times and gyno 2 times to dsuscis my symptoms of premature menopause they pretty much laughed me out the door. I have every single symptom I have ever read about, and they are getting worse. The worst one is anxiety, and panic over what seems like nothing, sometimes it’s so challenging to drive as I am anxious alot through the drive. I am only 34, but these symptoms started a few years after I had my tubes tied. It has been a very rough experience, but like you I am searching for relief and am still looking for a doctor who will listen. Good luck in your search.
Can estradiol be used to treat some of my menopause symptoms without restarting my menstrual cycle? What substance is in an Estring? Although I do SOMETIMES feel like I’m living a gray life, I don’t think of myself as being dead (flat lining), nor should you! What an awful prespective. Really, menopause isn’t THAT bad.
Can taking Metagenics Estrovera cause cloting issues as estrogen does?
Dear Ann,
Yes, there are lots natural alternatives to improve your blood pressure. If you stop smoking, that action will improve your health more than any other single thing you could do. My practice is located at: 562 S. San Vicente Blvd., Los Angeles, CA. Please call me at 310-734-8864 to schedule a consultation.
Dear Brian and Anne,
Your questions were answered in my blog/newsletter.
Dear Dr. Miller,
I am 30 years old and just got back blood tests indicating my cholesterol is off. LDL: 114, HDL: 49, cholesterol to HDL: 3.7. My whole family has had high cholesterol, high blood pressure, heart disease, heart attacks. My blood pressure was 100/80 and has tended to be on the lower side in the past. I am not physically active enough and do eat meat/dairy as part of my diet but no seafood (never liked the taste).
My concern is that this is a leading indicator to future heart problems as seen with my family. I feel a bit unsure as to how to proceed. Should I prioritize physical exercise and retest in 6 weeks? Cut out meat/dairy? Of course, I know there is no one single answer, but really would love some guidance about methods on how to approach this and know that the course that I am taking is proving effective.
Dear Happy Heart Nurse,
Assuming you are completely otherwise healthy, the fluid retention, high blood pressure, and palpitations may all be due to still not enough estrogen. Although oral estrogens may deliver higher estrogen to your body in comparison to the low dose estrogen you were on before, oral estrogens are associated with increased blood clotting and I don’t recommend them for most women. Rhythmic, high dose topical bioidentical estrogens are the way to go, balanced with progesterone for 2 weeks per cycle. Yes, even if you have had a hysterectomy. There are progesterone receptors everywhere in your body, not just your uterus. Look into the Wiley Protocol. I hope that helps.
Dear Mary,
Estradiol can be used to treat menopause symptoms without restarting a menstrual cycle, but I don’t recommend it for many reasons. Saying “Menopause, isn’t that bad” is like saying High Blood Pressure isn’t that bad. Just because you don’t feel the symptoms doesn’t mean there isn’t a problem.
Doctor is there any know harm that is done from producing so much FSH and LH hormone at menopause?
Dr Miller what are your thoughts for using HCG and/or HGH for weight loss? Can you provide any other useful supplements? My metabolism is shot. FYI … I have been diagnosed with PCOS, hypothyroidism, restless leg syndrome and fybromyalgia.
Dr Miller
I am 51 past menopause and I would like to know at what blood levels of estradiol pg/ml do you recommend for your patients that are replacing their hormones.
Dr Miller,
I am a 20 year old male with a low testosterone 330 and leutenizing hormone 2-5 and all of the symptoms low energy, low libido, brain fog etc. I eat clean, try to exercise routinely (but it’s getting tough due to the fatigue) and get enough sleep. After doing some research, I came to the conclusion that an hcg and clomid protocol would be a better option than TRT. Would you be able to help me out with this? What are your thoughts on using hcg and clomid as a restart for someone with secondary hypogonadism.
Thank You
Kev
Dr, Miller,
I am 58 and my Dr’ prescribe the bio treatment for menopause. She did blood test to see what i needed. The pharmacy that mixes exactly what i need. My problem is i am kinda scared to use it ( rub on skin ) because i could not take premarin,or any of those , i got severe headaches, that is why i am leary of starting this. It is more natural compond, is it safe ? I have hot flashes, feel depressed and so tired of feeling this way. Can this cuse cancer, or blood clots like ppremarin, and other meds like this ? Is the natural better ? Your opinion means alot. tthank u
Dr. Miller I’m 50yo American Veteran of 4 conflicts, Desert Storm, Kosovo, OIF, Haiti; I survived 3 ambushes, 7 IEDs, I was robbed at gun point during my R&R. and I have been diagnosed with PTSD. I have lost my sexual appetite…the Army doctors gave me magic pills, but I do not have any desire what so ever. I have hit my wife and fall off my bed due to nightmares. I have a beautiful wife of 30 years, and I have her support..Is my lack of sexual appetite due to PTSD?
Fibroid can be cured without any surgery, I was cure completely from it, and I was able to give birth to my lovely son. I suffered from the problem of Fibroid for years without any solution, then i found the solution from Dr Zack he helped me out, he sent me his medication which I used for a month, and it all went off,contact Dr Zack on his mail on mosthighsolutiontemple@gmail.com or call +2348077686213
Good job, Paula. It’s in the “About Dr. Miller” section on my homepage.
Hi Dr. Miller, In “Ten reasons to be happy about hormone replacement therapy: a guide for patients,” ends with “…less osteoporotic fractures in those who start HRT below the age of 60.” Is effectiveness decreased after 60?
Hi : ) I am FB friends with you but want to ask this anonymously. I have not had a period in over a year, am 51, active and fit and have been on HRT for almost a year. I am on an estrogen patch, testosterone cream, progesterone supplement, and Armour thyroid. I feel great and get my blood tested every 3-4 months. Problem: I bleed after intercourse. My doctor has ruled out any “problems” and prescribed Vagifem, which I insert twice a week. It’s not working. The bleeding starts toward the end of intercourse and is a combination of thin brownish blood and a truer, red blood that lasts for almost a week. Any ideas? I have a history of fibroids, which my doctor said may be shrinking and expelling after orgasm? This is very disturbing to me. : (
Hi A. Miller, I do see patients from out of town, here are the instructions: http://shiramillermd.com/custom_content/c_191324_out_of_town_patients.html. Or go to http://www.wileyprotocol.com and find a doctor in your area.
Hi Anonymous,
If there aren’t any problems with your uterus, cervix or vagina, then I would suggest switching to a program which aims to mimic reproductive hormone levels, rhythms, and cycles (the Wiley Protocol) and seeing if having a regular monthly bleed fixes the problem after intercourse. Sorry for the delayed reply.
I hope that helps.
Hi Anonymous,Yes menopause causes accelerated aging, due to estradiol and progesterone deficiencies that result.
Hi Catherine,
It’s not too late! Please email the office for pricing.
Hi Cathie,
Thank you!!! Go to http://www.wileyprotocol.com to find a provider near you.
Hi Cindy, I recommend the Wiley Protocol, which uses bioidentical estradiol and progesterone cream to bring your hormone levels and rhythms to approximately what you had in your 30s. The goal is to copy nature, as much as possible. I hope that helps.
Hi Doc.Miller,Went into a-fib for about 40hrs.returned to normal after iv of cardizem.Only risk factor is high BP.Now my Primary doc wants to stop bioidentical hrt.I DO NOT WANT TO!I have been using a low dose for about two years.No problems with the creams.Doc is afraid of the blood clot risk.How concerned should i be about the blood clot risk?I am 59 and in good health .
Hi Doctor
I wanted to know if menopause causes accelerated aging. And if so do you know why?
Thank you
Hi Doug, I’m so sorry you and your wife are suffering like this. Yes, your low libido could definitely be due to PTSD. That being said, both therapy and good nutrition/lifestyle are necessary to support with the healing process. Let me know if you would like to find help finding a specialist in your area.
Hi Dr. Miller
I have been on the WP for about 2 weeks and just added in the progesterone 5 days ago. I am finding no relief using the protocol, as I am having lots of anxiety, jitters and depression as I did before starting it. I also find that the progesterone cream is a very thick dense cream that when I try to rub it into my upper inner thigh, it sticks to my hand and fingers and congeals. I wake up every morning with anxiety and am finding I must take a half of valium just to get through which I don’t want to do as it is very addictive and I will reach tolerance soon. I am getting very crampy too. no one explained this to me very well. I don’t get the difference between the lunar calendar or the personal calendar and not even sure if I am using the cream right by counting out the correct lines.
I live in NY so to come see you would be a little impossible.
Thanks so much for your time.
There should be more doctors like you!!!
Regards,
Nanci
Hi Dr. Miller. I live in Marin County and am wondering if you see patients locally and where. I am 2 years into menopause, a melanoma survivor and am wondering if bio-identicals are safe for me considering my medical history? I am experiencing vaginal dryness, skin wrinkling and hot flashes as well as night sweats.
Thank you,
Jo
hi dr..i’m 56 and have had the menopause issue for about 10 yrs..my dr doesn’t want me to take anything because i’m high risk for cancer…i’m foggy , gained 30 lbs.irritable and the list goes on..i just can’t take this anymore..please help…thank you so much..
Hi Erika,
I’m sorry to hear about your acne. I would really need to know more about you. Finding the cause of your acne is the best way to look for a treatment. Sensitivities/allergies to sugar, gluten, dairy, or other foods, may worsen acne. Certain supplements such as zinc sometimes help acne patients too. Have you tried working with an integrative doctor? Go to http://www.acam.org to find a doctor you can work with, or feel free to contact me.
Hi Gracie, Bioidentical hormones are identical in structure to hormones your ovaries produced before menopause. They are completely different from Premarin, Provera, and Prempro. Go to my homepage for my presentation on the matter, it’s under “Understanding Natural Hormone Replacement.”
Hi Joan,
Thank you for sharing this intimate question. It could be a form of vasovagal ejaculation syncope. I would suggest seeing a cardiologist for a workup.
Hope that helps.
Hi Joanna, I do see patients from out of town. Here is how it works: http://shiramillermd.com/custom_content/c_191324_out_of_town_patients.html
If you would like a complimentary phone interview, please email me.
Hi Julie,
If there is a strong genetic predisposition for heart disease I recommend for patients to do blood work for cardiovascular disease risk factors and consult with a knowledgeable physician. http://www.bhlinc.com/ I hope that helps.
Hi Kathy, If you are still having problems then there may be an underlying gastrointestinal infection. I recommend a comprehensive evaluation first, before experimenting with treatments. I am still taking new patients if you are interested. Hope that helps.
Hi Lulu,
HGH is legal in California. What you would need is documentation of adult human growth hormone deficiency. If you doctor can show that and your doctor works with insurance companies, then your insurance may pay for it.
Hi Marcia, Yes, I do treat patients’ HPV, even after hysterectomy.
HI Mary, I agree that you do need to find an integrative doctor. The primary problem has not been determined, and some of your symptoms at this point may actually be side-effects of the medications you are taking. Estrogen deficiency, or a mineral deficiency may be causing your arrhythmias. http://www.ncbi.nlm.nih.gov/pubmed/20004189
You can look for a doctor at http://www.acam.org
Hi Menopauseat29,
Just like any hormones, bioidentical hormones can cause weight gain or other problems if they are not balanced or administered appropriately. You mentioned pills. I never recommend taking estrogen by mouth. This put strain on the liver, increases clotting and inflammation. For my menopausal women I prescribe a topical estradiol cream, balanced with progesterone cream, as per the Wiley Protocol. Blood levels need to be followed and other hormones tested as well.
Hi Mercedes,
Many doctors just never learned enough about hormones and so don’t feel comfortable prescribing them.
Hi Mike, I can’t give personal medical advice here. You should find an integrative urologist. I try not to use testosterone injections in my young male patients, even if these have 2 testicles…as fertility can be compromised. HCG is a good alternative, as well as Clomid. These are options to discuss with your physician. I hope that helps.
Hi Morris,
A testosterone of 65 is very low, even by conventional medicine standards. You need to be evaluated for hypogonadism. DHEA is not very helpful in elevating testosterone levels in men, so I wouldn’t recommend taking more for that purpose. I recommend finding an integrative doctor in your area to help you. Go to http://www.acam.org.
Hi Nanci,
Your Wiley Protocol doctor and pharmacy need to be managing your care. If not, there are other WP doctors in the Northeast. It can take a while for your hormones to balance, but you should be feeling better in general. I answered you on Facebook too. I hope this helps.
Hi Olivia, Hormone and vitamin deficiencies can definitely contribute to heart problems. Look for an integrative cardiologist to help you: http://www.acam.org
Hi Pam,
Yes, uterine bleeding can happen as a result of a hormone imbalance. Sometimes just balancing one’s hormones can stop the bleeding and prevent a hysterectomy. It depends on one’s specific situation.
Please let me know if I can help you further.
Hi Priscilla, I can only give personal medical advice to my patients. In general though, I do recommend cyclic therapy.
I hope that helps.
Hi Sara,
Low estrogen can definitely contribute to heart palpitations. Your creams may not have had enough estrogen in them. The increased blood clot risk is mostly associated with ORAL estrogens. That being said, if you have a rare genetic susceptibility and have hypercoagulable blood, topical estrogens can also cause blood clots. An integrative cardiologist in your area may be able to help you. Try http://www.acam.org to find a doctor near you. I hope that helps.
Hi Shawn,
You need a thorough evaluation to determine what is causing your low metabolism. The treatment depends on the cause. The fundamentals of good health always address nutrition, exercise, sunshine, and sleep. Go to http://www.acam.org to find an integrative physician who can help you.
Hi Sue,
I recommend the Wiley Protocol bioidentical hormone replacement therapy, which strives to mimic the hormone levels and rhythms found in reproductive women. So, the level depends on the day the blood is drawn. That being said, a woman’s symptoms are also used as a gauge to assess the dose. I don’t want to give you a random number because it would be out of context. One number that is very helpful is the FSH, and I try for that to be less than 20. FSH >20 means menopause. I hope this helps you.
Hi Sylvia,
Good question. According to studies which used non-bioidentical hormones on sick elderly women (WHI), if women start conventional HRT when they are older than 60, they have an increased risk of heart disease. This may be true of conventional HRT and is why women are encouraged to start before the age of 60, when estrogen is known to be protective against heart disease. In terms of osteoporosis, yes estrogen is effective after age 60 and is better than bisphosphonates. That being said, the earlier replacement starts the better. See this study: http://shiramillermd.com/custom_content/c_132223_hormones_better_than_bisphosphonates_for_osteoporo.html
Hi Vikki,
If you are considering HRT then please choose a doctor that prescribes bioidentical HRT, and preferably a doctor that knows the Wiley Protocol. Check for local doctors here: http://thewileyprotocol.com/wp-directory.html
Hi, Thanks for all of the amazing insights! You are wonderful!! I am a 57 yr. old woman and had very low testosterone levels and low t symptoms. I tried compounded creams and they did not elevate my levels. Now I am on pellets and love how I am feeling, but do not like the “insertion” process, being cut, not being able to work out for a few days, etc. What about injections? THanks again!
How can a woman in her late 40’s minimize the symptoms of hormonal changes such as fatigue, forgetfulness, lower ability to handle stress, hot flashes?
I am 35 years old. 4 month ago I stopped breastfeeding my twins after 13 months. I am still having extreme vaginal dryness, pain during sex and itching. I recently had my annual exam but my ob was unable to get enough cells because I am so dry. My doctor has prescribed Vagifem but I am afraid to use it. If I do use it would this be just a temporary fix? It seems as if there might be something causing this that needs to be addressed.
Dr Miller: Yes, Lori, breastfeeding does cause low estrogen levels systemically, not just in the vagina. Schedule to see an integrative gynecologist. Email me for referrals.
I am a 29 year old white male who has been tired and had a low sex drive for the past year. Testosterone levels came back between 250 & 500 depending on the time taken and I started shots of testosterone, hcg, and b12 biweekly about a month ago and have never felt better.
At a routine check up last week my urologist found a tumor in my left testicle, it was immediately removed, found to be cancer, and CT tests came back with no spread.
I am wondering if it would be wise to go back on the shots considering I only have one functioning testicle now, and what effect it would have on my fertility if I do continue to stay on. My urologist said not to, and my general doctor giving me the shots has told me it’s ok to. Thank you.
I am a 31 year old man and losing the hair at my temples. I have tried using Rogaine for the past 4 years and my hair loss seems to be continuing. I am considering using Propecia but I wonder if there are any natural options I should be considering. I should also mention my work invokes a high amount of stress and I don’t see that subsiding any time soon. Any advice would be appreciated.
I am a 57 yr old woman who has been menopausal for 12 years (no hysterectomy). I never took any hormones because of the bad press they were receiving during those years. My mother died from Alzheimer’s Disease a few years back and also never took hormones after she had a hysterectomy. I am concerned about my risks of Alzheimer’s and would like some advice about bioidendical hormone use at this stage of my life and if there would be any doctor in upstate NY who you could recommend. Thank you for your time. I loved your interview on The Future of Health Now.
I am a 61 year old woman who had a full hysterectomy due to HPV. I am not having any problems after my hysterectomy, but my first vaginal pap came back positive for HPV, which I expected would happen. Do you deal with women who have HPV? Thank you!
I am having a Hysterectomy in March. Due to hemmorraging and painful cramps this has been progressing for almost 2yrs now, I dont understand why this happening, but is this apart of premenopause?
I am just over 60 and interested in bioidentical hormones. I always feel depressed, low energy, on and on. Is it too late? And how much does it cost.
I had total laparoscopic hytetectomy February 21 of this year. Started Vivelle patch on March 16th, this caused fluid retention and was then switched to Bio-identical Hormone replacement pills Di-Estrace. Now having high blood pressure issues along with palpitation. Had thyroid hormones checked and all are normal. Any ideas as to why BP is high and pulse rate is high?
I have been considering HRT for a long time but have been concerned about safety and that the doctor is legitimate. I live in AR,near Hot Springs and wondered if you knew of any doctors in AR that you would recommend? I have no energy or interest in anything,Im 48 and have 3 kids, I cannot be the mom I need to be. I have had so many issues in the past an have gone several times over the years to doctors an have gotton no relief. I have started taking a supplement to balance my hormones they do help but not enough. Thank you for your time. Vikki
I have been on Ramipril for 8 years, am overweight and smoke. Recently, my blood test showed kidney irregularities. My insurance company alerted me to possible kidney problems from the use of Ramipril. The Ramipril is not working too good, either. I’m on 5 mg. Is there a natural alternative that you don’t have to take numerous times a day? Also, where is your office located? Thank you.
I have been visiting a holistic doctor and just had a female hormone health profile done. My Estradiol average is 6.2
Progesterone average level is 419
Testosterone average level is 85
Average progesterone to estradiol ratio is 67. He has me taking 3 Estro-Mend and 2 Metagenics Estrovera. I am still suffering with hot flashes in the night. They are somewhat better but, I was just wondering what your treatment would be. Thank you
I have never had digestive disorders or food allergies until I hit my early 50’s. I understand at this age we begin to lose digestive enzymes and need to replace them with supplement enzymes and probiotics. I have tried several probiotics but I seem to experience side effects with them. Do you know of a good probiotic and enzyme that works well with everyone? Thank you!
I have PVCs and short runs of SVT. I have had 2 EP studies and not able to induce arrhythmias. I take klonopin and toprol. I have had a cough and wheeziness for 2 years. This also occurred with a calcium channel. blocker. My vit D was at 13 now at 34. My dr. just prescribed Singulair which had no impact. I am 65 120 lbs 5’5″. I feel lousy most of the time but cant find a dr who will look at all the symptoms rather than try to mask each individual symptom. Any thoughts?
I was just wondering if being on bioidenticals cause weight gain. Even though I feel wonderful I am having a really hard time losing weigh. I study fitness and nutrition so I know what it takes, but for some reason since I started taking the pills (April 29/11) I have been really struggling with my weight loss even gained 2 pds. I just wanted to know with your experience if this is a normal thing or not. I did contact my dr. but just wanted to get a female opinion on this as well. Trying not to stress too much. Thank you for your time.
I’m 28 years old suffering from fatigue, brain fog, and ED since 20 years. Slow onset to the point where I couldn’t get out of bed. Testosterone was normal when I was tested around twenty even with these symptoms. Complete blood work over time indicated nothing else was wrong. At 26 years old went to endo who did complete blood work and found testoster was low. Axiron for one year and injections for several months. I didn’t like the results. Removed myself from treatment after taking zinc, vitamins, and minerals that took my recovery to a better level. Still not functioning normally. Had testosterone retested and it jumps between 355 and 600. Saw new endo who recommended clomid.
I’m so confused about my T levels. Its never consistent. How do I know what’s causing it? (1st or 2nd Hypo). I would like to address the cause but doing all I can right now. Perhaps cause is a little of both 1st and 2nd.
I would like to visit your office. I think you can track my situation well. Any upfront ideas I can look into until then?
I’m from Germany, 49 years and my gyno is sharing the common opinion that women on BHRT (I’m on VIvelle dot 0.1 patch) don’t need E levels higher then 80. But I feel good when I have E levels at least 100. The explanation of the majority of doctors here is that for women beyond 45 it’s unnatural and risky to have such high E levels.I’m using the patch plus additionally 2 pumps of Estrogel and the highest E levels I ever had were 210 and this was for my doc way too high. Any thoughts?
I’m in my early 20’s and have terrible acne. I was on hormonal birth control for several years, which helped somewhat. I’ve been off of hormonal bc for 8 months and now have a non-hormonal IUD. I’ve tried changing my diet, taking supplements, Lerosett, etc. Nothing works for me. Are you aware of any non-bc hormonal treatment for acne? Thank you.
is it hard to get prgnanet after i go off of Diane 35??i would like to try get prgnanet in a year or two and I’ve been on Diane 35 for just over a year (mostly for acne therapy). I’m wondering if it makes a difference when trying to conceive???
Is it possible for foods that are considered to be phytoestrogens to interfere with estradiol patches? Do the plant estrogen’s compete for the same estrogen receptor site? If so should those type of foods be avoided?
Is it possible to become pregnant on a BHRT regime? I am in menopause, in a new relationship and desire to have a baby. Would BHRT be a possible solution? I have had no trouble conceiving before menopause. Dr. Miller: If you are in menopause already, then BHRT alone will not help. However, it may help in the context of IVF with donor eggs.
Live in Wilmington, NC. Wish there was someone here like you. I am 56 years old, married for 37 years to a wonderful husband. Our sex life is null and void now. Wish there was something we could do. Need local help.
My significant other immediately after ejaculation experiences a pain in his upper left side of pectoral area followed by lightheadedness followed by pain in the right temple area followed sometimes by nausea. His general MD is stumped. Any ideas?
Or you could exercise?? Doesn’t ericxiseng increase the production of insulin and therefore reduces your risk of diabetes? Why would you tell someone to reduce your insulin levels and put them more at risk and then tell them to take growth hormone to lose weight when all you need to do is cardio for 30 mins a day and control your meal sizes?
Thank you for your response re: Estradiol to treat symptoms. Re your belief that menopause is a “problelm,” I’d be careful if I were you. It isn’t healthy to deny what is – like endings and beginnings. They’re part of the fabric of existence. Best regards.
What are your thoughts on taking medications for osteoporosis?
What dose and regimen do you recommend for a woman who wants to use an estrogen patch, such as climara, and prometrium? I understand that they are also biodentical and I cannot afford to use products that are not covered by my insurance. Do you recommend continuous or cyclic therapy, and at what dose for both? Thank you.
Yes JD,
That’s an excellent question. It has been shown that such FSH may be a key participant in the development of osteoporosis.
You don’t need to stop eating natural foods. The problem with estradiol patches is that they don’t mimic normal estradiol levels, rhythms, or cycles. Also they need to be balanced with cyclic progesterone, whether or not a woman still has her uterus.