Tuesday, August 6, 2013

Jagged little pill--warning controversial topic ahead!!

Image From http://www.flickr.com/photos/hurricane_drunk/4536053722/
About a year ago, I was not feeling quite right and was looking for answers. Sound familiar? I was already supplementing with iron to boost my iron stores which I knew were low. I was taking vitamin D since I know that tends to be chronically low for me too. I suspected that I was also suffering from low estrogen levels. I wasn't showing signs of this in terms of my female cycle, but I had really low body fat and just assumed that my estrogen levels would be low. My doc and I discussed this and she okayed me to go on low dose BCPs. I actually started feeling better fairly quickly after that and pronounced myself cured by BCP. About 3 months later I started getting ocular migraines every other day. I normally get these 1-2 times per year. This was a huge red flag. I never once attributed the migraines to the hormonal supplements, but I was urged to stop taking the BCPs because of the fact that they, and all other estrogen-based hormone supplements, greatly increase your chance of having a stroke if you're a woman over 40 who also gets migraines with aura.

Now, I am pretty convinced that it was the BCPs that were causing my increased migraine frequency. I am eternally grateful to the doctors, including my sister-in-law, who urged me to stop taking the pills. Who knows how close I came to having a stroke. I will say that I am still fuming that my gynecologist told me it was totally safe to take these when my record clearly indicated that I had migraines with aura. This isn't the first time she missed something in my record and made a mistake. I finally switched doctors, but the new one isn't much better. Ah, the joys of having Kaiser as your HMO.

The reason I am so convinced that the BCPs caused my headaches is that I finally went in to get my estrogen levels tested. My ex-Kaiser doc refused to order tests for me, so I did it myself at HealthTestingCenters.com. I didn't know anything about this cool service until a month or so ago when I was looking for a place to get my serum ferritin tested. You simply order your test and they call it in to a lab close to your house. You go in, do the deed and *voila*, test results in 24-48 hours! It was almost as cheap as what I would co-pay at Kaiser. $39 for a ferritin test. The estrogen test was $99, but I didn't have a choice there.

The result? My estrogen levels were off the charts high and during a time of the month when they shouldn't have been maxed out. Who knows what they are when they're at the peak. The chart put me in a level commensurate with women undergoing IVF treatment to get pregnant. I did some research into high estrogen levels and found that this condition is actually more common than I thought in women. It can manifest itself with symptoms similar to low estrogen, but it just doesn't get as much attention. The problem is, there aren't a lot of simple things to be done for high estrogen. So, think about me having these high estrogen levels and then adding a continuous supplement of estrogen pills to that mix. Recipe for migraines? Uh, yes.

Can I rant for a minute? Wait, maybe I have been already. The reason I think that there is so little info out there about high estrogen levels is that doctors aren't testing for it. When I asked for these tests, my doctor refused on grounds that hormone levels change daily so why bother? That is a load of crap. While it is true that hormone levels do fluctuate a lot, that is not a legit reason to not test. Why not take readings at certain points in the cycle to establish a baseline for the patient in order to try to correlate these levels to better manage her symptoms? Wait, that would cost money and makes a lot of sense. Sorry, my bad.

What I found through my research is that having high estrogen alone isn't really the issue. It's typically an imbalance of the three big guys, estrogen, progesterone, and testosterone, that cause symptoms. There are clinics and whole centers designed around "women's health" that do good work along these lines. I just don't know the secret handshake to get in the door. I could, of course, pay out of pocket for these services, but I've decided not to pursue it.

This is where this post is going to be CONTROVERSIAL. When I probed more into managing hormone-related issues, I found a world that made me very nervous as a competitive athlete. I started hearing rumors of men and women taking testosterone boosting supplements to relieve legitimate symptoms associated with aging, however completely inappropriate for competitive athletes since the substances are banned. The rationale, as it is rumored, is that if it is a legitimate medical condition, then it's okay to take the banned substance. I even heard, second or third hand of course, this couched as something that would never show up on a drug test if the athlete's levels were low enough to start with. Still cheating.

So, when I thought about getting my testosterone and progesterone levels tested, I also had to think about what I would do if I found out they were low. The progesterone is easy, because it is not a banned substance. Add a dab of cream here and there, and I'm golden. Anything I took to raise my testosterone levels would almost certainly be a banned substance, and while it might make me feel better, I am not a cheater.

The issue of supplementation with substances that aren't banned, such as thyroid stimulating hormone (TSH), was recently a huge topic of controversy, and I found the discussion fascinating. There are those that say that if you can't handle the training load because your body breaks down (e.g. thyroid doesn't function), then that's just separating the men from the boys, so to speak, and you shouldn't be allowed to compete if you have to supplement. Take this a step further and you find those who say, if you can't get all your nutrition from food alone and have to supplement to train and compete, then you shouldn't be competing. That, I believe, is going too far. Should I not be allowed to take iron supplements because I happen to have a body that gets iron depleted easily with hard training?              

Where do you draw the line? Well, that's actually pretty easy. The line is drawn for us by WADA. If the substance is banned, and you are taking it. That is cheating.

Just. Say. No.

Where does this leave me? Well, my hormones are probably whacked out beyond belief, but, for once, I'm not sure I want to know the numbers right now. My body is aging but I can still train hard and compete well. I may end up going through periods where I feel super low energy, like I did the last 2-3 months, but this comes along with the role of playing the part of a woman in her 40s. The good news is, I don't have to worry about low body fat levels causing low hormone levels, which is actually quite a relief. Bring on the strength training and washboard abs!                


  1. This is interesting. Thanks for sharing.

    I, too, get driven up the wall when my doctors make mistakes, and I often find that if I ask even a simple question (e.g. is this contraindicated with my other medication?) the doc has to look up the info on the internet. Uh, hello!! You already wrote me the script... shouldn't you already know this info?

    But frustration with my docs is different from the battles with "the system"--I mean the battle to get the healthcare you need in an environment that is all about cost cutting, getting you to buy the meds that your insurer has a deal with, and pushing you out the door. I'm sorry this has an impact on you.

    Still, I think I would make the same decision as you. To choose to just not know, I mean. I think I would want that ignorance for awhile... until I felt like I couldn't compete anymore or like my health was really in jeopardy. It sounds like you are actually okay, though.

    Keep it up!

    1. Yum Runner,

      Thanks for commenting! It is a frustrating system to be sure. I take care of myself and as a result actually cost our health care system very little in the grand scheme. So, it is frustrating paying into a system where I am prejudged to not need care and actually have to fight so hard for just a little slice.

      I am a data loving girl, so not knowing is a special kind of torture. However, you are right. I am healthy and, certainly, being somewhat fatigued for a few months out of the year is something I can deal with!

  2. Hi Jaymee, I was diagnosed with hypothyroidism earlier this year and am taking the appropriate medication, which while not banned is probably used for performance enhancing reasons as evidenced by your link. I guess it enhances my performance in that it brings my levels back to normal so I can train. Actually, so I can just function. It's a slippery slope for sure, but I believe I'm on the right side of it. If it was a banned substance, I would consider my health first and would take the medication. I just couldn't compete.

    1. Hi! Thank you for posting and putting that issue into real-world context. I'm happy to hear that the treatment is working for you and allowing you to train. I also respect the fact that you would not compete if you were taking a banned substance, even if you needed it just to function.

  3. Hi Jaymee,
    I have always admired your accomplishments as a runner, especially as one who maintains a life (career, other interests, etc) outside of running... doesn't have an unjustifiably big ego... isn't catty about other females in your age group.. and doesn't break the rules to succeed.
    Let's just say that not everyone in your competitive set can say the same, which is unfortunate.
    However, it doesn't diminish the fact that you inspire a lot of people, including many recreational runners who learn a lot vicariously from your experiences.
    Keep up the good - and clean - work!

    1. Hi there,

      Thanks for your comment and kind words. I might disagree with you on the ego thing. It is actually quite large:) I have been told my head is so large it has its own weather system;)

      In all seriousness, it is a shame that we are competing against runners who don't play by the rules. What sucks even more is that It makes legitimately fantastic performances seem suspect. I guess there are cheaters everywhere: baseball, track, marathon running. For those who make a living from their sport, the money and fame are motivators. But masters runners? What is gained by cheating?

  4. Interesting post Jaymee. Totally agree with you about cheats. If you're taking anything on the WADA list you're cheating. I have hypothyroidism (it runs in the family) and have been taking thyroxine for a couple of years. It hasn't done any thing to enhance my performance! My a/g % is similar or worse than when it was as a young runner.

    If I were you I'd be getting those hormone levels checked. Agree that baseline levels (when healthy) would be a great thing to know. Are there other ways of managing them - lifestyle changes or diet? Maybe not. I think I'll be on thyroxine 'forever' - glad it's subsidised by the PBS!

  5. When you approach menopause, 5 or even more years before "the change" your hormones fluctuate a lot. Your body will start to fall off the normal "cycle" and you can have periods of high estrogen sometimes followed by low estrogen, non-ovulatory cycles followed by low progesterone among other oddities. Is this a possible reason for your hormone issues? I went through this relatively earlier than most women in the context of early infertility and the changes were startling and frustrating. Some hormone replacement therapies address these issues but they are not for everyone. The doctors are not necessarily wrong about the treatments but they often are not sensitive to the fact that you are a competitive athlete. I think the challenge is to see how much our aging bodies can do rather than trying to push the clock back artificially with drugs. Or at least this is what I believe should be the essence of our sport regardless of what WADA does nor not deem acceptable. Seeing that you still run at such a high level is inspiring to me and others.

    1. Thank you.

      I don't think I'm there yet, at least in full-on pre-meno mode, but I expect some shenanigans in the next few years given what my Mom went through. The trouble is that I haven't been able to get the hormone testing done to know what wild cycles I go through now in order to know when things change. With a doc who won't allow for tests when nothing is "wrong" with me, I don't see any resolution in the near future. To do this myself is more expensive than my interest in knowing the numbers.

      As one of my Facebook friends said, the real bummer about all of the masters runners partaking in the banned substance/hormone replacement free-for-all is that you start to question every fast performance you see a masters runner record, which sucks for those who are turning in legit performances.