First, do no harm – this is what we are taught as doctors.
Yet every day women are being harmed by doctors who refuse to learn about hormones. This is unacceptable and urgently needs to change.
As a medical student in Manchester University in the 1980s, I was taught that we should do no harm to our patients. Yet every day in my clinical practice, I am speaking to women who have been harmed by doctors, and I am so saddened and frustrated about this.
All doctors have to act responsibly and work in the best interests of their patients. But this is not the case for so many women.
Every day, millions of women are being harmed by doctors who are not listening to their patients, are not believing them and are refusing to prescribed them hormone treatments that their patients both want and need.
As medical doctors, we are responsible for doing the best for our patients yet for these women who are being refused hormone treatments, the best is not being done for them.
Not prescribing hormone treatments is harming women as this is resulting in these women experiencing unnecessary symptoms and also being at risk of health conditions including heart disease, diabetes, osteoporosis, inflammatory bowel disease, cancers, auto-immune diseases, multiple sclerosis, Parkinson’s disease, non-alcoholic fatty liver disease, chronic kidney disease, depression, bipolar disorder, schizophrenia and dementia.
Most of this harm is coming from ignorance of doctors rather than stupidity. Ignorance due to a lack of knowledge, information, education, and understanding about three important hormones – progesterone, estradiol (a form of estrogen) and testosterone. Numerous doctors are failing to understand the important roles these hormones have on every cell, tissue and organ in the body. They have never been taught how to prescribe these hormones as bioidentical hormone treatments to women.
As doctors, we are clinical scientists who should be applying our medical knowledge to prevent, diagnose and treat illnesses, while promoting health. We are uniquely responsible for complex decisions in uncertain situations and must maintain a commitment to evidence-based practice, reflective learning and professional development.
The Medical Schools Council represents medical schools. Its Role of the doctor consensus statement [1] sets out a shared understanding of the role of the doctor in the UK. I will use some of this content (in bold) throughout this article.
This document is very clear that doctors must combine scientific knowledge with clinical judgement to act in the best interests of patients and the wider population.
Ignoring the important roles of hormones in the body is actually not acting in the best interest of their female patients. Doctors who are refusing to acknowledge that the myriad of symptoms that can occur in women with changing or low hormone levels are not combining scientific knowledge with clinical judgement.
Symptoms of low mood, brain fog, anxiety, memory problems, joint pains, migraines, muscle aches, palpitations, urinary urgency and frequency, abdominal bloating, dry eyes and irritability are commonly being misdiagnosed with conditions including chronic fatigue syndrome, fibromyalgia, depression, personality disorders, functional neurological disorder, irritable bowel syndrome, early onset dementia and overactive bladder.
This is resulting in too many women being medicalised with drugs for these conditions which often have far more risks and side effects than bioidentical hormone treatments.
The statement is clear that doctors are expected to support patients in understanding their conditions and making informed decisions about care.
Far too often, this is not happening – I am constantly hearing stories from women who are not believed, not listened to, not understood and actually commonly dismissed by doctors. They are frequently requesting hormone treatments but are wrongly being refused so these women are not involved in shared decision making about their care and treatment.
The role of a doctor requires strong communication, empathy, teamwork and integrity, alongside advanced diagnostic and decision-making skills.
These are real quotes from GPs speaking to different women about their symptoms:
‘I will only prescribe you antidepressants’
‘HRT is a waste of time so just get on with it’
'At 57 years old, you are too old to go on HRT’
‘HRT is a vanity drug, you don’t need it’
‘You do not need testosterone as you are recently divorced and do not need a libido'
'Are you stupid to want to talk to me about HRT?’
‘PMDD is not a condition, women make this up’
‘You should do more exercise or get pregnant to improve your symptoms’
‘You should get drunk before having sex to reduce the discomfort’
Each of these doctors are not showing empathy nor communicating well with their patients.
Even if these doctors are nor confident enough to prescribe hormone treatments, they should be knowledgeable and experienced enough to diagnose a hormonal condition and signpost or refer their patients to the appropriate clinical specialist for them to receive hormone treatments. This does not happen for so many women.
As doctors, we should stay curious and continue to learn after we qualify as medical doctors.
RELATED: Fixing doctors' fear of hormone treatments including testosterone
The Role of the doctor consensus statement is clear that:
Medical education should foster intellectual rigour, adaptability and a commitment to research and lifelong learning.
It is not acceptable to be a medical doctor - whether that is a GP or psychiatrist, a cardiologist or a urologist, a dermatologist or a neurologist – and simply state ‘I do not know about hormones.’
If I decided, as a GP, to ‘not know about diabetes’ it would be completely unacceptable. Even if a doctor did not know all the different treatments for diabetes, he or she should refer that patient for treatment but they should know the common symptoms of diabetes (thirst and passing urine more frequently) so they can make the right diagnosis. It would be unacceptable not to believe their patient with possible diabetes and send them away without either doing some tests or referring them for a diagnosis.
So why is it acceptable that for women with hormone conditions including PMS, PMDD, PMOS, postnatal depression, postnatal psychosis, testosterone deficiency, perimenopause and menopause are often dismissed and turned away by so many doctors without any investigations, referral or treatment?
This statement about doctors also is clear that:
They must be able to manage risk, work beyond protocols when needed and use resources responsibly.
Many doctors are still not aware that the risks of hormone treatments (HRT) are with synthetic hormones that are in older types of HRT and also with synthetic testosterone. These are different chemical structures than hormones in the body and are associated with risks such as clot, heart attack, stroke and cancer. The bioidentical hormone treatments that are most commonly prescribed now are the same chemical structure as our own hormones so are not associated with these risks.
So many guidelines, including the NICE menopause guidelines, do not distinguish between synthetic and bioidentical hormone treatments which causes confusion and unfounded fears about hormone treatments. Many guidelines are written by menopause societies who have no regulatory status and are simply membership societies. The law is clear that menopause societies are unable to dictate what is and what is not appropriate practice in menopause care and treatment, so their guidelines do not have to be adhered to.
Doctors should understand this so they can work out of the best evidence for their patients with respect to hormone treatments rather be constrained by guidelines and protocols which are not legally binding nor based on solid evidence.
Medicine is an art as well as a science and the art is individualising care and treatment for patients.
RELATED: Beyond the label: rethinking hormone health
The role of a doctor is evolving in response to changing patient expectations, advances in healthcare and the development of other professional roles.
This is really true – when I qualified as a doctor 31 years ago, I knew very little about hormones and different types of hormone treatments, including testosterone. If I have not evolved properly then I would never have learnt so much about hormones which I put into my clinical practice every day. I know that my clinical practice has improved the health and lives of tens of thousands of women by prescribing them the right dose and type of hormone treatments. This would not have happened if I had not progressed my knowledge and changed my clinical practice, especially over the past decade.
RELATED: Hormone health: why language matters
This is very important from the statement:
Doctors must have the capacity to work out solutions from first principles when the pattern does not fit.
So why is this ignored so frequently when addressing hormonal changes? We have known about the hormones progesterone, estradiol and testosterone for over 80 years and it has been known about the many beneficial effects they have throughout the brain and body for many decades.
Even in the 1970s, doctors understood that women taking hormone treatments had a lower risk of diseases including heart disease, osteoporosis and dementia so why has this been disregarded for so long?
I have written extensively about the roles thes three hormones have at reducing inflammation, improving mitochondrial function, working as neurotransmitters and modifying our genes in my book The Power of Hormones. Once people, including doctors, understand the basics of hormones then it is disgraceful and actually immoral to ignore the science and then harm patients by refusing to prescribe them hormone treatments to improve their future health.
All doctors need to know that there are more risks of *not* prescribing bioidentical hormone treatments to women than prescribing them. They need to remind themselves this in every consultation they have with women.
Doctors and medical students should all be adequately trained and educated about hormone treatments. The current standard of hormone care globally is unacceptable and urgently needs to improve. And that starts with accessible, evidence-based education for clinicians, which is exactly what we're striving to provide through Newson Education's Confidence in Hormones programme.
Change has to happen: too many women are being failed and harmed.
