Dr. Friedman discusses when a woman might see an endocrinologist as opposed to an OB/GYN.
Obviously when she has to consider herself having endocrine problem or hormonal problem and there’s many sort of overlaps between endocrine problems and other problems.
So if a woman is having menstrual problems that can often be a clue that she is having a hormonal problem. She could be having a pituitary problem or her pituitary is not functioning properly and therefore she is not making the hormones that stimulate the ovaries to make estradiol.
She could have a condition called polycystic ovarian syndrome where she is making too much testosterone or her ovaries are maybe overactive and that’s causing her not to have a period. Both of these maybe seen by an OB/GYN doctor or maybe seen by an endocrinologist.
If she has an OB/GYN doctor that’s thorough and very good and she has been seeing for years and she trusts, I think it’s reasonable to start with the OB/GYN doctor.
If she doesn’t have one or the OB/GYN doctor just wants to put her on birth control pills and doesn’t want to do any testing on why she is not having a period, I think it’s worthwhile seeing an endocrinologist.
Endocrinologists and OB/GYNs have a little bit different approach on treating things. Maybe an endocrinologist might want to try to get at the root of the problem a little bit more.
In terms of this polycystic ovarian syndrome the OB/GYN doctors often do an ultrasound of the ovaries. Endocrinologists usually don’t do that and they often do more blood testing. This might be their difference in training. I don’t know if one is better than the other.
Endocrinologists often treat the polycystic ovarian syndrome with medicines that improve the insulin and polycystic ovarian syndrome is associated with insulin resistance.
So an endocrinologist might give Metformin. An OB/GYN might give a birth control pill. Both of them are reasonable approaches, just a little different approach to it.
Endocrinologists usually see patients with thyroid problems, pituitary problems, adrenal problems, ovarian problems, diabetes, and if you consider and think you have one of those issues it’s probably worth seeing an endocrinologist.
Now there’s a lot of things for an endocrinologist to see, many endocrinologists specialize; many endocrinologists either because of their interest or that’s what makes up their practice, maybe see mainly diabetic patients.
And they are maybe quite good at treating diabetes but you are coming with something a little different – a pituitary or adrenal problem, they may not be that much better than an internal medicine doctor if they really don’t have that much experience in these other types of endocrine problems.
Other endocrinologists are generalists and they are great at seeing adrenal problems and thyroid problems and fatigue problems and ovarian problems and there be no problem with that.
Some doctors bill themselves as specialists in the thyroid. If you know you have a thyroid problem yeah, it might be reasonable to see a thyroidologist, but I don’t only see that’s needed because a general endocrinologist is very good in seeing the thyroid problem. And you may have a thyroid problem plus an adrenal problem and that thyroid doctor may not even look for the adrenal problem.
So I think often it’s better to see a general endocrinologist, maybe one that specializes in something you suspect. You know, if somebody is a general endocrinologist that has lot of experience in thyroid and you suspect a thyroid problem it might be worth seeing a doctor like that.
There are endocrinologists that are academic based and endocrinologists that are completely in private practice. The endocrinologists that are academic based would be affiliated with a hospital. They probably have a faculty appointment at a hospital. They might be doing research.
They might be doing some teaching. They might be training the next generation of endocrinologists, not always but those doctors that are sort of academic based they keep up with literature more. They are challenged by their students and the students say, “Why is it so Dr. X?”
And they have to read up all that night, they say, oh, I am going to go look that up so I am going to answer my student tomorrow. And that might make him even a little bit better doctor when they come to see you when you ask them some of the questions; they might be used to being sort of challenged.
While the doctor in private practice, maybe a little less so. Maybe that doctor also likes being challenged and he enjoys his patients challenging him. But often there is advantage of seeing academic endocrinologist.
About Dr. Theodore Friedman, M.D., Ph.D., M.Phil.:
Dr. Theodore Friedman, M.D., Ph.D., M.Phil., specializes in hard-to-diagnose-and- treat cases of adrenal, pituitary, thyroid, and fatigue disorders. He's been with the University of California Los Angeles School of Medicine since 2005 and serves as Chief of the Endocrinology, Metabolism and Molecular Medicine Division at Charles R. Drew University of Medicine and Science. He also served as Director of the Multi-Disciplinary Chronic Fatigue Clinic at Cedars-Sinai Medical Center from 1998-2000.
Dr. Friedman has a private practice near Beverly Hills, California as well as privileges at Cedars-Sinai Medical Center and Martin Luther King Medical Center.