I have just completed a letter to a friend's physician discussing the issue of hormone levels and what constitutes "normal." Sigh... I keep fighting the same battle over and over again.

As I explained to my friend's doctor, nobody in their right minds would tell us it's normal for a car's oil to run dangerously low after 20,000 miles, so you shouldn't replace it, or if you do replace it, just add a tiny fraction of what the engine needs to run properly. Yet that's exactly what the medical establishment tells us about our sex hormones...which, by the way, are about a whole lot more than sex. They keep our brains, hearts, bones and muscles (among other sexy bits) healthy and vibrant.

If we're talking about dull, boring hormones like cortisol, thyroid, or insulin, the answer to deficiencies is almost always to supplement the hormone until it reaches an ideal or optimal level and your body once again is operating the way it's supposed to. But when it comes to the sex hormones, the medical community behaves as if we were talking about recreational drugs, rather than substances our bodies were designed to run on.

The first place we get into trouble is with the definition of "normal." We typically get some kind of test, perhaps a blood test or a saliva test. The results come back and the lab flags any values that were either above or below their "reference values" as being abnormal. So that implies that anything within the reference range is normal.

But how do they determine the reference range? They test a bunch of presumed healthy people and set the highest and lowest scores as the top and bottom of the reference range. 

This seems like a reasonable thing to do, until you get into the touchy subject of sex hormones. And then the labs add a little twist: they set their reference ranges according to a bunch of "healthy" people in your age group. What that does is reset the numbers to show what's normal for people your age. But what if "at your age" most people are deficient in that hormone? Now the lab test is telling you that it's normal to be deficient. 

That's exactly what happens with hormones like estrogen, testosterone and progesterone. 

But even if they include all age ranges, they are still going to show that it's "normal" for some otherwise healthy folks to be at the bottom of the tank sucking fumes.

So when my friend's doctor told him his testosterone levels were good, he was comparing them to the reference values for men over 65...which are virtually always deficient! Instead he should be comparing them to the optimal values for the healthiest men in their prime.

What's equally important is the question of what's normal for you...or rather what's optimal for you.  In a perfect world, we should all have our hormones tested at various times in our lives, especially when we are at our healthiest, so we know what our body's chemistry looks like when we feel our best. Then as we get older, we can use those levels as benchmarks to know what we need to get back to.

But even that may be misleading, because, for example, research shows that the average testosterone levels in men of all ages have declined over the past few decades, presumably because of all the estrogen-like substances in our food supply and environment. So even at your youthful best your hormones may have been low or imbalanced.

Which brings us back to defining optimal ranges, and that may take a certain amount of art as well as skill to determine.  

The bottom line is that if you want to restore your body's chemistry to optimal levels, seek out a doctor who understands what that means and is willing to deviate from standard practice...in a responsible way...to get you back to where you need to be, both objectively and subjectively. And if you already have a doctor you really like and trust, encourage him/her to think outside the box. Perhaps print out this article for your next office visit. 

Life is too short to do things half way.  

First, let me say there is no clinical definition of this "needy" state. But I suspect every woman knows what it feels like and nobody likes it. It takes away our independence and self-confidence and reduces us to babies...clingy, sometimes desperate, sometimes crying and inconsolable babies. To make matters worse, we may get angry when the need is not met.

For me, the neediness feels like a kind of ravenous emotional hunger. A hunger for validation, for love, for a sense of wholeness and value as a person, maybe even more specifically as a woman. The first time it happened to me (in my "Life 2.0" after 10 years of feeling dead), the sweet man who was with me had that deer-in-the-headlights look in his eyes. "I don't know what to do," he said. He wanted desperately to help but felt completely incapable of doing so.

What I've learned now, over several recurrences of this mood, is that when the neediness happens there IS NO satisfying the hunger. It is bottomless.  

And it seems that the very best those who love us can do when this happens is simply to be there, to actively show and express their love, their concern and caring, until it passes. 

For those who are lucky enough to have romantic partners who love them and are willing and able to help them through these moods, maybe continuous lovemaking would suffice to fill the need or at least quiet the craving temporarily. But for some of us, even that wouldn't be enough. Even given the most tender and passionate affection, we would still need to hear different words, we'd need different actions, we'd need "something other" than what we have, something more...we would still be drowning, grasping for the life preserver because this crazy sense of need cannot be quenched.

The good news is that if it is hormonally fueled, we can at least wait for the particular combination of hormone levels to pass. And if we are manipulating our hormones through birth control methods or hormone replacement therapy, we may be able to adjust our regimens or switch to other forms or dosages that minimize the neediness. 

In tracking my hormones, I have found that my needy days typically come when I do not have enough estrogen in my system to properly process my progesterone. (Our bodies need a spike of estrogen in order to ensure that our cells can take in progesterone.) In the case of my first psycho-needy day, I had accidentally used 1/3rd less estrogen than usual, then I used the normal dose of progesterone. My other, milder, needy days seem to come around the same general "time of the month" when progesterone levels are highest and when I may not have gotten enough estrogen. 

If you are still getting periods, that time would probably coincide with the middle of the luteal phase of your cycle, or about a week before your period. Whenever it occurs, if you see that it comes and goes with certain phases of your cycle, all you have to do it wait and it will pass. 

If you are on birth control hormones (whether the pill or a product like the NuvaRing or hormonal IUD), the challenge is a lot more complicated. You may be feeling needy because the combination of hormones that is keeping you from conceiving is also keeping your hormones in an unnatural balance. If you struggle with a lot of needy days and they are ruining your life, you may want to consider a different kind of birth control.

If you are post-menopausal and are using HRT, you may have a little more control. Like me (and with your doctor's supervision), you may be able to calm these needy periods by ensuring you get that initial surge of estrogen before you add your progesterone.

Be aware, however, that many doctors may say you don't need the progesterone at all if you've had a hysterectomy. That's not true. You still need progesterone for your brain, bones, muscles and heart, and to calm or prevent autoimmune conditions. But perhaps most important, you need progesterone to balance the effects of estrogen in your body. For example, estrogen promotes the clotting of blood; progesterone thins the blood. Estrogen build cells that bring fluid into the breast; progesterone builds cells that drain fluid away. Estrogen promotes rapid cell division; progesterone slows it down.

In any case--whether or not you happen to be in a position to alter the underlying conditions, whether or not you can "out-last" the mood--I think it helps to at least know this "need" you feel is chemically/hormonally induced. You are not crazy. You are not psychotic, though you may feel that way as you grab and grasp looking for that one last thing that will make you feel full, satisfied, safe, or whole.

And in the meantime, you can try to manage your moods through natural means like diet and exercise, meditation, self-talk or even acupuncture, or by directly altering your hormones.

Just remember that this extreme neediness seems to be related to an overexpression of progesterone, the primary hormone of pregnancy. And in evolutionary terms, this neediness may have served to make females cling to their mates during pregnancy to ensure a provider would be there for the baby.

I know, it doesn't help evolved creatures like ourselves, especially when the neediness is likely to drive away all but the most devoted and patient of males. But if you can expose your own patterns, discover what times of the month are most likely to send you into those needy moods, and figure out how long they last, you may be better able to prepare for them and to help you and those who care about you to cope with them.

Following a battery of psychological tests and an EEG, my 27-year-old daughter, M, was recently diagnosed as having attention deficit disorder (ADD). When I heard that her therapist--whom I respect and trust--had raised the possibility, I admit I worried a bit.  Would M latch onto this and see it as a "magic bullet" that could solve all her issues...only to be ultimately disappointed?

More important, I worried that the drug treatment for ADD might end up being a minus rather than a plus overall.

Drugs that affect the mind can work miracles. But their miracles can also carry a high price tag.  When a spirited but unpredictable individual becomes predictable and passionless, has a real improvement been achieved? Some would argue that predictability is not worth the surrender of a person's essential spark, their aliveness.

And who really benefits most from the drugs? The person with ADD? Or those around him or her?

I have a friend, a nurse, who has ADD. My friend, B, has tried the drugs. She found that they turned her into a zombie, so she quit taking them. B explained that we all have something we have to deal with, whether it's a bad temper, or overeating or laziness. We can let these things run wild and ruin our lives or we can do something about them. Maybe drugs will work for some people. But if they don't work or if the side effects are unaccepable, you do what people have always done: you find ways to cope. You figure out tricks that work for you, and you apply self-discipline to keep your natural tendencies from getting out of control.

So M called me yesterday, having taken her first dose of Adderall. She had been terrified that maybe the diagnosis was wrong and the drug (an amphetemine) would act directly as a stimulant on her system, rather exert the kind paradoxical calming effect it promises people with ADD. When I answered the phone M said, "I think I'm high" and giggled delightedly.

She actually sounded normal to me, except for a faint sense of unusual "lightness" about her. She described the feeling as being "more present" in the moment. And to me--someone only a few months into Life 2.0, someone whose mantra is "live in the moment, seize the now"--this declaration of hers was indeed a good sign. If she could be here in the moment, fully and patiently, rather than buzzing around worrying, and sampling, and processing madly, then maybe this could be a turning point for her.

It's way too soon to tell, of course. The drug's effects are cumulative. Which means its side effects are liable to add up as well. The good news is that she treasures her ability to feel things and to experience life intensely, so she is not likely to give up those essential aspects of herself in exchange for the centeredness a drug like this offers...not without a fight anyway. And she has a wonderful husband who will be watching to makes sure the M that he loves never fades too far from sight. 

So I will keep you posted as the experiment progresses.

Carpe modo!

My idea of what an ADD sufferer's brainwaves look like on an EEG:

Today is July 4, and all around me friends and neighbors are celebrating the independence of our great nation. 

But this day is meaningful to me in another way...because this is the first year in over 12 that I have been free of a crazy affliction that started when my hormones went south at the time of menopause. It is also the first year in over 12 that I have felt truly alive.

This affliction is something I call the broken record syndrome, or auditory memory loops (AMLs). You may know it as simply having songs stuck in your head, or "ear worms." And for most of us, it's nothing but an occasional nuisance. However, for others of us (and I have learned that I'm not alone) it is a maddening and destructive phenomenon that can literally ruin your life.

For one solid year I had multiple songs stuck in my head 24 hours a day 7 days a week. They were so "loud" I couldn't hear my own thoughts. I couldn't get rid of the music...ever. I could only "change the channel" and get a different song stuck when one had become so painfully familiar I thought I might jump off a bridge. They played throughout my waking hours and then filled my dreams with insideous torture.

For one solid year, I never had one minute of quiet anywhere in my world. And I now know that many others have suffered even longer than I did. I honestly don't know how they have remained sane.

I have since hypothesized that this phenomenon may be associated with the stress hormone cortisol. However, my efforts to reduce cortisol with supplements have only provided moderate success.

What worked most effectively for me was to keep my progesterone levels fairly low...lower than I really wanted to. After all, like all women, I needed progesterone to balance the estrogen I was taking (and still making in my adrenal glands and fat cells, even after my hysterectomy). But progesterone can break down along either of two paths: (a) toward the sex hormones like estrogen and testosterone, or (b) toward the adrenal hormones like cortisol and adrenalin/epinephrine. For whatever reason, my progesterone seemed to prefer to break down into cortisol. And the high cortisol seemed to feed the broken record syndrome.

The real breakthrough came late last year when I experimented with a new hormone replacement therapy (HRT) regimen. The hypothesis behind this regimen exploited the fact that during a woman's normal 28-day cycle she experiences a surge of estrogen in the middle of the month. This helps her body prepare for and trigger ovulation. But this surge of estrogen also helps prime her body's cells to accept the progesterone that will be coming along right after ovulation.

Rather than attempt to mimic a full 28-day cycle I tried to do half of that...a 14 day cycle. I have not yet found documentation that tells me just how much E your body needs in order to prepare those progesterone receptors to take in the progesterone. Neither do I yet know exactly what the E surge does. One source says it "creates" progesterone receptors. Another says it "opens up" progesterone receptors.

In any case, my hypothesis has been that perhaps I had plenty of progesterone floating through my system but without the E surge the doors wouldn't open and I couldn't get the P inside the cells. So instead, the P converted to cortisol which powered the crazy jukebox in my head.

Once I started the new regimen, the broken record syndrome went away! Curiously enough, the new regimen also has reduced my allergies, taken away the headaches I'd had, and eliminated a certain pain in my right side that I suspect may have been caused by a bit of endometriosis missed during my hysterectomy.

What's most profoundly important about this new regimen is that along with my ability to enjoy music again, it has given back my aliveness, my passions and creativity. You see, for 12 years I had felt dead inside, sometimes "knowing" a moment or a thing was special but being completely unable to FEEL it. The touch of a dear man's hand on mine a year ago tormented me as I studied it and begged the universe, "Why can't I feel this?"

Now I feel everything again, experience everything in rich detail, and am learning all over again (perhaps with a whole new appreciation I never had before) to savor every moment, to explore every facet of that moment and to be fully present in it. 

So I feel free and today I am celebrating my independence...from lifelessness, from the two-dimensional world that some insisted was to be expected at my age.  I never gave up on that hope of finding myself again, of reawakening the passions in me. And neither should any of you.  

Happy independence day!

For more information about the broken record syndrome, see my other blog at http://brokenrecordsyndrome.wordpress.com/