For Physicians of Patients Being Treated by Dr. Lindner

If Dr. Lindner is treating one of your patients, please read his letter concerning his practice and how it will interact with the
medical care you provide. On this website, you can read his arguments for why it is safe to restore estradiol and progesterone
in postmenopausal women. You may be concerned by your patient's thyroid or cortisol replacement therapy. Dr. Lindner
diagnoses thyroid and cortisol insufficiency in many patients who are not diagnosed by the usual criteria. He is able to help
many people who were not helped by other doctors
precisely because he does not adhere to their insensitive and ineffective
endocrine practices. He has read many textbooks and hundreds of papers and thereby gained a very well-informed view of
hormone deficiencies and their treatment. For more explanation of how he has diagnosed your patient as deficient, and
determined how much hormone they need, see the following documents:  

Information for Physicians of Patients on Thyroid Hormones
Information for Physicians of Patients on Hydrocortisone

Many of your patients with hypothyroid symptoms are being inappropriately denied life-giving thyroid optimization because their
TSH and free T4 are normal. Did you know that the
free T4 range found in 95% of relatively healthy persons in actual
studies is 1.0 to 1.6ng/dL
? Yet most labs report FT4s as "normal" down to 0.6 ng/dL!  Why? Labs are taking doctor-ordered
thyroid panels from symptomatic patients with "normal" TSH levels and including their free T4 and free T3 values in their
ranges. They are therefore including all patients with
partial central thyroid insufficiency, which is much more common than
believed.

Did you know that top experts have said that
merely "normalizing" the patients' TSH level with T4 therapy is not
sufficient
? They realize that patients on T4 therapy often require free T4 levels near or above the top of the laboratory's
reference range. Some recommend that the TSH should be reduced to around 1. However, the TSH is the wrong test. It is not a
measure of thyroid hormone levels or effects--either in the untreated or treated state. Many, if not most of your patients on
levothyroxine, dosed to "normalize" the TSH, are being undertreated. That is why they have persistent fatigue, weight gain, cold
extremities, constipation, headaches, depression, etc.

Physician Consultations
Using the same fee schedule as for patient consultations ($7/min), Dr. Lindner will respond to clinical questions about specific
patients from other health care providers, either by mail, e-mail, or telephone. He will provide not only relevant scientific data,
but also concrete recommendations to follow with your patients. If there are a large number of labs to be discussed, please
e-mail or fax the results with the reference ranges. Remove any identifying patient information.
E-mail Dr. Lindner to set up the
consultation, or call his office.

Dr. Lindner has concentrated on nothing but hormone restoration and optimization for the last 10 years. He has
seen a large number of patients with varied hormonal and other issues. He has gained a great deal of clinical experiencewith
both routine replacement and more difficult hormonal problems. He is conversant with much of the relevant medical literature.
Much of what he has learned is completely unknown to conventionally- trained physicians--of which he was once a typical
example. Conventional medical training and current guidelines do not equip physicians, including endocrinologists, to diagnose
mild-moderate hormone deficiencies or to optimize hormone replacement. (See
Why Docs Don't Get It.)

Do you want to help a specific patient with hormone replacement? Have you run into a problem with a patient's hormone
therapy that you cannot resolve? Do you have a female patient who cannot tolerate estrogen replacement, or a hypothyroid
patient who cannot tolerate thyroid replacement? Do you have patients on thyroid replacement with a normal TSH who still
complain of hypothyroid symptoms? Do you still think that menopausal female hormone in dangerous? See
Sex-Steroid
Restoration for Women to learn why it's dangerous NOT to replace a woman's lost estradiol and progesterone.

Patients are learning about hormone replacement via the Internet. They are increasingly asking their doctors for testing and for
treatment. You can either remain ignorant and have them seek care elsewhere, or you can avail yourself of the ideas and
information available at this site and from other sources. Physicians who try to replace hormones often run into a number of
problems for which they are not prepared to cope. They have to learn to think about hormones in a way that is very different
from pharmaceutical medical practice. For instance, patients sometimes have negative response to replacement of a hormone
in which they are deficiency. SInce hormones have no side effects, this means that either the dose is too low or too high, or
they are missing some other hormone or nutrient that they need to balance the higher hormone levels.
Many
peri-menopausal and postmenopausal women seeking hormone replacement have significant thyroid and/or
cortisol insufficiencies.
Their pain, fatigue, depression, insomnia, and irritability may not improve much with sex hormone
restoration, and in some cases it can make them feel worse. Even rather straightforward and uncomplicated tasks like
restoring  testosterone levels in men require a knowledge of how the different routes of administration, how to monitor dosing,
and how to achieve optimal effects. Many men have come to Dr. Lindner after having been diagnosed and treated for
hypogonadism, but never given adequate doses for optimal effect. Dr. Lindner prefers testosterone
injections--self-administered subcutaneously each week--to the use of creams or gels. The latter produce a highly abnormal
DHT/testosterone ratio.
For Health and Quality of Life