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12 Articles in Volume 17, Issue #2
Chronic Pain and Bipolar Disorders: A Bridge Between Depression and Schizophrenia Spectrum
Differences in Pain Management of Peripheral Vascular Disease and Peripheral Artery Disease
Duloxetine and Liver Function Tests
How Well Do You Know Your Patient?
Insurers End Policies Requiring Prior Authorization for Opioid Use Disorder
Letters to the Editor: Initiating Hormones
Managing Opioid Use Disorders and Chronic Pain
Opportunities and Challenges of Pain Management: The Family Physician’s Perspective
Pathways to Recovery From Co-Occurring Chronic Pain and Addiction
Strategies for Weaning Opioids in Patients With an Opioid Use Disorder and Chronic Pain
Treating Multiple Pain Syndromes: A Case Series Using a Functional Medicine Model
Treatment of Chronic Exhaustion and Chronic Fatigue Syndrome

Letters to the Editor: Initiating Hormones

March 2017

Initiating Hormones

I have read most of Dr. Tennant’s material and reviewed his talks on YouTube. I have a large pain practice and recognize the need to treat with hormones. The question is how to get started. It seems like there is so much information, and some of my patients have multiple hormone deficiencies. I have seen patients with decreased cortisol along with dehydroepiandrosterone (DHEA), and some have decreased progesterone as well. So where do I begin? How do I find the right pharmacy to work with me? Do you know of any training workshops? 

Thank you for responding to all these questions.

Steven Rupert, DO 
Evansville, Indiana

Dear Dr. Rupert,

Your questions are most appropriate, as hormone profiles recently have become available through every commercial laboratory. Physicians are increasingly testing serum hormone levels in chronic pain patients, as it is becoming abundantly clear that severe chronic pain has profound effects on the endocrine system. Also, it is becoming more evident that certain hormone deficiencies may aggravate and increase chronic pain, creating a demand for higher opioid dosages.

The best news is that modest—and even temporary—replenishment or subreplacement of specific hormones can be extremely therapeutic and may help curtail the need for higher opioid dosages.

Start simply. There are 6 hormones now available in serum profiles and for which commercial preparations are readily available for replenishment: cortisol, DHEA, estradiol, pregnenolone, progesterone, and testosterone. I recommend initiating a low dose of any deficient hormone, to be prescribed 3 to 5 days a week, to avoid any complications or sensitivities (Table 1).

I recommend retesting the patient’s serum profile in 4 to 8 weeks to see whether or not low-dose replenishment has raised the serum levels to normal. You can increase the daily dose and frequency of needed hormones, depending on the patient’s symptoms and serum tests.  

Keep in mind that pain patients, with rare exceptions, have normal, nondiseased glands and merely need replenishment dosages to keep the endocrine system functioning well enough to control pain and enhance healing. Low-dose hormone replenishment can be temporary or long lasting, depending upon the patient. Once you get a feel for low-dose replenishment, you may wish to consider exploring the effects of neurohormones, oxytocin, human chorionic gonadotropin (HCG), and human growth hormone (HGH).

—Forest Tennant, MD, DrPH

Last updated on: March 17, 2017
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Letters to the Editor: Central Sensitization, Microglia Modulators, Supplements
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