Tag Archives: women

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Hormones and rabbit holes

Medicine is confusing right now. Ok, it is always confusing because we try to base it on science and science is always changing. There are always special areas that are currently a mess. Hormones!

I speak to a patient recently who is female, premenopausal, and is getting hormone replacement therapy for hot flushes and not sleeping well from an outside source. The person wants me to order hormone tests. I do order hormone tests but not the ones she has in mind. I test a TSH, thyroid stimulating hormone, to see if she is low or high in thyroid.

She is thinking of me testing estrogen and progesterone and other related hormone levels. The party line from gynecology MDs and DOs is that these are not useful tests because women’s hormone levels are so varible. However, there are lots of naturopaths out there and functional medicine MDs and DOs who will test levels. Why is the patient asking ME to test them? Most of those naturopaths and functional medicine providers do not take insurance and charge cash. Also, insurance may not pay for them anyhow because the party line is that they aren’t useful. Why would the cash providers check levels? One reason is CASH. Another is to prescribe “bioequivalent hormone replacement”. Sounds natural, right? Well, the natural thing was for the hormones to stop at menopause and all of the hormones are either made in a laboratory from plant pre-estrogens or from pregnant mare urine, so bioequivalent seems to imply natural but it really isn’t. Pills do not grow on trees, they are made by humans in laboratories.

However, I question party lines, and off I go down the hormone rabbit hole. The current guidelines are that female hormone replacement, after menopause, should be lowest dose possible and only for a maximum of three years because of the increased risk of breast cancer. This doesn’t address my question: does premenopausal hormone replacement count as part of those three years? I may need to ask gynecology. I don’t think it counts. A woman is postmenopausal when she has had no periods for a year. Or had her ovaries removed. Or if she’s had a hysterectomy and still has her ovaries, a yearly follicle stimulating hormone and lutienizing hormone test. Both tests rise when the ovaries stop making hormones and eggs.

Also, there is another caveat. We know that when men are on opioids, the opioids can suppress their hormones and lower testosterone. Here is a paper: https://pubmed.ncbi.nlm.nih.gov/31511863/. Half the men studied in multiple studies had low testosterone when on chronic opioid therapy. 18429 subjects (patients) in 52 studies. That is a lot. Women studied? NONE. What? Yeah, none. Why? Here is part of the answer: about a decade ago I worked with the UW Telepain group and asked the head of the UW Pain clinic a question. “If opioids lower hormones in men, do they in women too?”

His reply, “I don’t know.”

“Have you ever tested a woman?”

“No.”

“Isn’t that sort of sexist?”

“Yes.”

So here I am, rechecking a decade later, and we still don’t know if giving women chronic opioids messes up their hormone levels. It would be more complicated and difficult to check women. We might have to do individual hormone baselines or something in premenopausal ones, say, 2 weeks after menses. Remember that for most of the history of medicine, clinical drug trials were only done in men, because, well, sexism. They said women could get pregnant. Yes, but then we gave the drugs to women who could get pregnant. Also, postmenopausal women can’t get pregnant. The whole thing seems stupid to me.

There is an interesting new finding here: https://neurosciencenews.com/estrogen-t-cells-pain-28548/ . Apparently in women, estrogen and progesterone work on receptors at the base of the spine to reduce pain signals using T cells, part of the immune system. The article says this doesn’t happen in men, but they were studying mice. The male mice didn’t seem to have worse pain after estrogen and progesterone were blocked. The female mice were in more pain. But wait, estrogen and progesterone are produced in men as a by product of making testosterone. Less than women, until menopause. Then the 70 year old man has more estrogen and progesterone than his postmenopausal wife. The article says that they don’t know why the receptors are in women and female mice (um, my intuitive guess would be childbirth and micebirth, right? Men don’t do that and women giving birth to a child after the first one sometimes say, “WHY did I want to do THIS again?” I think those receptors are so that women and mice can get through more than one pregnancy.) Now I need to read the article again because maybe men and male mice don’t have the receptors, even though they do have some estrogen and progesterone. Maybe they just don’t have enough estrogen and progesterone.

Maybe we can’t figure out women’s hormone because men aren’t smart enough, heh, heh. Yes, that is sexist right back at all those historical figures who didn’t study women.

At any rate, that still doesn’t answer my two questions: does premenopausal hormone replacement count towards the three year total beyond which hormone replacement increases the risk of breast cancer? And does chronic opioid treatment lower women’s hormone levels?

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For the Ragtag Daily Prompt: hormone.

I took the photograph of a Port Townsend rabbit in 2011.

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Cauldron

2 Ways to Manage the Emotional Cauldron of Anger
Freud’s Theory of the Unconscious Mind

So, the iceberg graphic is wrong, wrong, wrong. Am I right? Icebergs are about 90% below the surface, which is NOT what the picture shows. Regarding the first article, preset timeouts? I think when two people are losing it, that may go by the wayside. My strategy is, “I have to use the bathroom.” It might take a while if I am really upset and want to rip the sink off the wall. But, it lets me cool down, cool off and not say terrible things. Let them stay inside my head until I am calmer and realize how stupid and nasty I wanted to be.

But let’s think about cauldrons, yes? A stew of emotions? Our culture still has little respect for emotions. Just think if we were all nice on the surface all the time and never showed any other emotion. Bunch of AI robots, I think.

Cauldron

It’s not so surprising to look up the emotional cauldron
and have it be about anger. Anger in couples, but the cauldron itself
brings up witches and therefore women. Women in black
women with cauldrons, women boiling angry.

I vacillate between thinking that black men are treated the worst and then, no,
women are treated the worst. Assumptions, useless, toys, pretty, be nice,
true that women don’t get shot as much, but our country found a black man acceptable
in the white house, but not a woman, black or white.

Anger is not nice, I am told. But anger is appropriate at injustice, when people
are discriminated against, treated badly, pushed from homes, jailed, hung and shot.
Much of our country reveres guns to protect homes, a man’s home is his castle,
and what is left for women? Not the workplace, the public, the home.

How dare they take the cauldron as a symbol of anger stewing?
The truth is that men fear women’s anger and rightly. They fear the people
who are enslaved, discriminated against, shot and dismissed, rising up.
Rising angry, anger not in a cauldron, but hot as lava and righteous.

A sermon about fear and abuse and the minister says, this is where anger can be understood
and is right. Anger at the abuse and at the fear, letting people break free.
Energizing a person to leave abuse, to leave an intolerable situation
and no reconciliation without the abuser taking responsibility.

What the cauldron really holds is greed, the people who think they deserve
more than others, more money, more women, more adulation, more more more.
Greed, gossip, lust, and all the other sins. Anger at mistreatment is not wrong
though it may not be safe to show it. Let it be conscious even if not expressed

and fight on.

For the Ragtag Daily Prompt: emotional cauldron.

The photograph is my mother, Helen Burling Ottaway, in 1945. She was seven. I have photographs of my daughter and me with the same expression. Not anger, thought. I cannot credit the photograph because I don’t know who took it.

And to lighten the mood, both sexes are profiled.

Not all anger is right, though, and it’s often because of different interpretations, different frames of reference or misunderstanding.

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not really, right?

I ask a male friend of mine, older and perhaps wiser. “Um, the guys I have dated or even just hung out with are only interested in their interests. They are not interested in me or what I am doing. For example, I mention that I have a blog twice to two different males recently and they completely ignore it. I mention that I just did a poetry reading and one whips out his phone and shows me a family member’s poem. What is it with that?”

“Well,” he says, “Men are only interested in what a woman is doing, if they are in love with her.”

“Really?” I say. “Holy crap.”

“Absolutely.”

I am still chewing on this. I have dated various “gentlemen” for a couple of years each since I got divorced. One of them is still a friend. Last month he said, “I think you like writing better than I do.” Um. He has known me since 2008. Powers of observation, like a hawk in flight, heh.

I can think of seven guys since 2007, when my divorce was final, who really showed very little interest in what I was doing. Ok, one of them did read my blog and another admitted to reading at least one post, but refused to EVER comment. What the hell? Meanwhile they want to talk about their collections, their jobs, their lives, their interests.

And so I reexamine my ex-husband. He actually DID listen and WAS interested. Mostly he laughed at me, but medical school and residency were off the scale dysfunctional and ridiculous. And in turn I listened to his golf shots and watched Payne Stewart dress in NFL colors and plus fours.

But I don’t get it. Maybe the younger generations are a lot smarter and I think they are darn smart to say who cares about the XX or XY or XO or XYY chromosomes! There are lots of other chromosomes! Let’s get over race and gender! That stuff is shallow unless you are interested in someone in the pants zone.

And then men complain to me that they do not understand women. Really? I ask if they have ever read a romance novel. One said, “Those are for women. I wouldn’t do that.” So one romance would take away your man credentials? I say, well, you might understand what our culture indoctrinates women with if you did read a romance. Not to mention notice that Disney animation glorifies virginal princesses, but gosh, queens are either dead or evil. Doesn’t seem like a good career choice, breeder for the ruler. Especially if you’ll die in childbirth or turn evil.

I hope my male friend is wrong, but I am paying attention. And noticing if a man is not.


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National Museum of Women in the Arts

I took these photographs at Christmas 2017. My daughter and I visited my son and my daughter-in-law in Maryland. We went to the National Museum of Women in the Arts. It is fabulous. They have been closed for renovations, but I hope they’ll be open next time I visit my son and daughter-in-law.

The Smithsonian is also working on a museum about women and about time, too.

For the Ragtag Daily Prompt: museum.

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On The Edge of Humanity Magazine

Huge thanks to The Edge of Humanity Magazine, for publishing two essays.

The first one on May 9, 2022, that abortion must remain legal for women’s health:

An Abortion Story

The second today, about behavioral health in a pandemic and war. As caring humans, how could we NOT respond with distress to the suffering and deaths from both Covid-19 and disasters and wars?

Current Events And Mental Health

I am so delighted to be featured on this platform. I enjoy so many of the artists and writers and poets who are featured there and I am very happy to contribute!

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Playlist: Stages of Grief 3

Stages of Grief Playlist 3

All women all the time today. Grieving for their men or our culture. Fighting back.

Denial

Dolly Parton: The Grass is Blue

Bargaining

Ann Peebles: I can’t stand the rain

Anger

Lily Allen: Not Fair

Acting Out/Fighting Back

Sweet Honey in the Rock: Give Your Hands to Struggle

Revenge

Dolly Parton: Silver Dagger

Grief

Tricia Walker: The Heart of Dixie

Acceptance

Bessie Smith: You been a good old wagon

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speaking up 3

Here are speaking up and speaking up 2.

More events in my life:

I am on the metro in Washington, DC. It is not rush hour. I am reading my book.

I suddenly realizeΒ  as the metro stops, my car is empty. I am the only one in the car. One man gets on. I am hyperalert. He walks down the car and sits next to me.

The car starts up. I stare at my book.

“Hi.” he says, “What’s your name?”

I don’t answer.

“C’mon. What’s your name?”

“I am reading my book. I don’t want to talk.”

“C’mon, baby, be nice.”

I stand up, purse and book. “Excuse me.” I step by him and stand at the metro car door. I get off that car at the next stop and move to the next one with people on it. Shaking with both the threat and anger, that I have to deal with this.

2. I take a dance class in Washington, DC. I work at the National Institute of Health. I leave my car at NIH and ride the metro.

One night I get off the metro at NIH and I am riding up the escalator, with my backpack.

A man, clearly drunk, steps up on the escalator beside me, and says “Hi, baby, what’s your name?”

“LEAVE ME ALONE!” I snarl and stomp up the escalator. It is dark and there are very few people at the stop and in the lot. I am in danger from this drunk.

I am walking fast at the top, away from the escalator, when I hear running steps behind me. WHACK! He takes a swing at me and runs off. He hits my backpack and not me. I am screaming at him.

He is gone. I run to my car, get in, and sit there, hands on the wheel. Shaking. There is a part of me that wonders what I would do if he crossed the road in front of my car.

My next class is not dance. I take tae kwon do.

3. I have used my tae kwon do once so far. Where? In first year medical school.

No way, you say.

Yes, way.

We have lecture after lecture in the same hall. We usually sit in the same places. I am newly married. The guy behind me starts tickling my neck during a lecture, with a pen. I twitch a couple times and then hear muffled giggles and realize that it’s the person behind me.

I stiffen and wait until I am really ready. Breathe. The tickle comes. I snap a basic block back and forward: and have his pen.

He SCREAMS!

The whole class turns towards us. The lecturer stops, staring. I am facing forward, holding the pen down low, not moving. He has the entire room staring at him, everyone but me. He doesn’t say a word. You could hear a …. pen…. drop.

The lecturer shakes his head and continues.

I keep the pen.

Just think, he’s a doctor.

I took the photograph when we were in Wisconsin. I went to UW Madison. I like being a badger.

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fall

For the Ragtag Daily Prompt: fall.

Trigger warning: speaking up 2, to follow speaking up.

So: why do the WOMEN have to speak up?

Why don’t MEN speak up? Ok, gentlemen: every man who participated in a “train” or a gang rape or who had sex with a woman who they now are not sure consented or who has made more money than a woman in the office and knows it or who has sexually abused a child: how about YOU speak up. FALL ON YOUR KNEES AND SPEAK UP.

Confess. Pay reparation. We know you are out there. Are you waiting for ALL of the women to speak up? How about you step forward, bust yourself, bust the other men? When are you going to be MEN? When are you going to take responsibility?

Why do WOMEN have to speak up? Let’s see the MEN speak.

Our tears have been falling for years. It’s time for men to speak, to bust each other, to break the silence, to confess: speak up.

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Women’s March 2018

My guesstimate is around 2000 people in Port Townsend yesterday, huge range of age, race and gender. Stand up, speak up, march and vote!

And my guess is LOW! The PDN estimates 4000: http://www.peninsuladailynews.com/news/thousands-turn-out-for-peninsula-womens-march-in-port-townsend/.

And more women to run for office. Bravo!