Letters to the Editor: Hormone Therapies
Dear Dr. Tennant,
Thank you for your continued articles on hormone changes and therapies for patients with chronic pain! I wondered if you had noted better absorption for subcutaneous human chorionic gonadotropin (HCG) when given in the abdominal tissue versus the anterior thigh or forearm.1 Also, does one need to take a special course to prescribe HCG? I read mention of this in Dr. Uzzi Reiss’ book, Natural Hormone Balance for Women. Are you planning an article on this hormone in a later issue of Practical Pain Management?
—Manya Helman, MD
Dear Dr. Helman,
I personally like to use the abdominal tissue for subcutaneous HCG injections. Patients seem to report more effectiveness, but I can’t prove this scientifically.
You certainly don’t need any special training for HCG or any other hormone. I recommend that you familiarize yourself with each hormone you want to prescribe. Also, talk with any physicians who use the hormone to glean their tips and experience. Due to the need to test pain patients for hormonal abnormalities (high or low) as well as to administer some specific hormones, some national pain conferences are starting to offer sessions on pain and the endocrine system. Given the high cost of the injectable form and the low cost and convenience of sublingual HCG, I’ve been primarily prescribing it. Compounding pharmacies can easily make it. I start pain patients at 125 to 250 units per day or every other day. I then have the patient titrate upward until his or her pain is reduced and need for opioids and other medication is lowered.
Editor’s Note: For more on HCG and the FDA’s recent decision to remove over-the-counter homeopathic HCG products promoted for weight loss, please read the Editor’s Memo.