First I want to shout out a huge hurray that we have finally refuted/retracted that study from decades ago that hormones were bad. Personally I ignored it anyway because I knew it was done wrong, in the wrong age group on women that already had preexisting risks of all the complications mentioned. I refused to let women suffer and kept on prescribing, in the right patient, with the right risk profile, and with the proper follow up. And, guess what? No one got cancer or got harmed or died. Sounds good right?

So, nowadays, well, actually this has been going on for awhile, everyone thinks that they can easily become hormone experts and prescribe whatever they want to anyone. They are literally handing them out like candy on Halloween. It sounds good, but here’s what they are missing. They are not examining anybody, which the patient incorrectly perceives as a bonus. They are not doing any ultrasounds on those with an intact uterus to see what is going on in the pelvis. And, most of them are relying on some outsourced lab to tell them what to prescribe in the first place and ending up putting patients on doses that are way above what is recommended. To top it off, they are not following up or screening them properly in any way and potential harm risks are missed.

I am going to say once again, how potentially egregious this approach is. Yes, I know I have said this many times, but it bears repeating. I keep seeing patients over and over again who have been going to these non-hormone experts and getting all kinds of hormones and then they finally end up seeing me, probably only because they are tired of paying cash not for an exchange in the quality of care. Then, I need to sit them down and explain how an exam and an ultrasound are necessary so that I can pre-evaluate for any risks or problems before we even start. I get it, I am not ready to provide the instant fix without any patient responsibility or any responsibility from me. Yes, that is true. I am determined not to intentionally cause harm. I also, tend to not rely on anyone else’s information and obtain my own before proceeding. This is sadly a problem for some because they perceive that a limited amount of time and investment and efficiency alone should be their own qualifying characteristics of good care.

I need to please ask all of you to reconsider before using these non-hormone expert alternative options. They are often expensive for one. Also, they are often actually dangerous. Just in these last three months alone, I have had a return of patients from the past who left to pursue these alternative options, only to return over ten years later to seek care from me again, and find out that they now actually have cancer that was missed while they were never getting examined or followed up properly. These are heartbreaking and preventable situations. I feel saddened as I need to tell them what is actually going on because they had been previously convinced that everything was good and paid a lot of money too. Nonetheless, despite these sad and potentially frightening situations, it is my job to protect and care for them properly. It makes me end up being what they see as the bad guy, when in reality I am the one trying to rescue them before it is too late.

I just need to say it one more time. Please reconsider before going to one of these places for hormones or women’s care. If it is a well-meaning primary care provider who doesn’t know better not to give estrogen alone to a patient with an intact uterus or a fancy beautiful place that requires no actual physical exam or ultrasound, please reconsider. By using these resources, you are, in fact, putting yourself in potential danger.

Dr. Katz