Consultations with Larry J. Frieders, RPh:
I no longer offer "formal" consultations at our pharmacy. Yes, there was a time when even I asked for saliva test results and a completed hormone evaluation questionnaire. I charged for the saliva test and for the consultation, as many still do today.
Why did I stop?
First, I'm a pharmacist and I'm not trained or certified to do personal health consultations. Yes, I know what I'm talking about through education, advanced training, and experience, but I have never been formally instructed on how to use that knowledge in a direct, personal consultation. While I have usually been comfortable explaining things, I found that I am awkward with some of the personal, intimate information people have been willing to share. At one time I actually considered installing audio and video recording equipment - first to record what was actually said (as a take-away reference for the person who received the consult), and second, to protect myself in the event of a claim that I acted improperly during a private session. I often felt that women shared things with me that I shouldn't have been privy to, especially in the realms of sex and intimacy.
After reviewing hundreds of test results and participating in many paid consultations, I came to the conclusion that all but a very small group could be directly associated with estrogen dominance, a set of circumstances where the estrogen activity in the body was more than could be kept in balance by other hormones, predominantly progesterone. It was and still is, sadly, very common to turn to combinations of hormones (particularly estrogens), to treat the "disease" associated with symptoms that are common at menopause.
I trace the ideas about menopause, disease, and sexuality back to a book written in 1966 by Dr. Robert A. Wilson titled Feminine Forever. Wilson's claim was that women could retain their femininity (aka their sexual activity) well into their later years if they only consumed a daily estrogen pill. This was written mainly as an advertisement for such a pill called Premarin, which contained hormones extracted from the urine of pregnant mares. The author was no more than a shill for the drug company that produced Premarin. Sadly, his book has influenced vast numbers of people - women, men, and even the majority of health workers. It is "common knowledge" that women lose their estrogen at menopause and need replacement.
It's untrue, but huge numbers of us believe it. As usual, beliefs are far more powerful than facts and women clamor for testing, consultations, and hormone replacement. Some claim that a hormone is a hormone, yet there are strong advocates for hormones that are chemically identical to those made in the human body - usually referred to as bioidentical. Given a choice between something derived from horse urine or an estrogen made to exactly duplicate human estrogen, I'd opt for the bioidentical. But, I stress that the need for estrogen is minimal, if at all, when other hormones are in balance.
Women - and men as well - are estrogen dominant. It is caused by real estrogen plus the accumulation of other substances that act like estrogens in the body, such as pesticides, plasticizers, and hormones used in livestock. A blood or saliva test will not detect increased levels of human estrogen, yet the person experiences symptoms that are directly associated with estrogen.
If this is the case - and it usually is - there is little if any reason to spend resources testing and endlessly talking about it. I am almost alone on this point, yet I hold fast to the evidence that regardless of the hormone levels reported, a person will feel much improved if he/she fixes a few dietary and behavioral issues and uses a progesterone supplement - a transdermal cream is my preference. Without the expense of testing, I can assure people that their symptoms can be controlled and they don't need to collect samples and answer lists of questions. It takes just a few minutes of discussion - and a container of progesterone.
I will go so far as to guarantee that a customer will be delighted with whatever they purchase from me. If they're not, we will gladly refund the purchase price.