Hormone replacement info

[PG]

I have taken the bio-identical hormones for a month now. This includes testosterone and DHEA. My eyes feel normal. I don't wake up in the middle of the night needing eye drops. I use drops 0-3 times per day (used to be 25). I don't wear moisture chamber glasses at work anymore. I am down to one warm compress per day (used to be 3). My eyes are not red anymore. My eyes do not feel dry anymore. I went to my dry eye specialist this month. This is a doctor that I had to search and search for, and travel many miles to see. My oil consistency is now normal (used to be like toothpaste), and only one gland was clogged. I have lost 20% of my glands.

Just to put this in perspective, in June 2014 I went to a "dry eye specialist" and was told that I had severe MGD 3+ and that it was a progressive chronic condition which was going to get worse. I had all of the auto-immune testing done by my family doctor. This testing was all negative. Other than this, she had no suggestions but was willing to refer me to any eye doctor that I could find. I went to my gynecologist (of 25 years) for hormone testing. She refused to do this testing and was not aware that dry eye can be a menopause symptom. She would not prescribe testosterone. She did not refer me to anyone who could address a condition that was affecting my quality of life. My conclusion: Question any doctor who says he/she cannot help you or says that you have a condition that cannot be treated, and you just have to live with it. What they are really saying is "I don't know what to do with you," and you need to find a doctor who can.

It makes no sense for someone with double-insurance coverage and financial means, living in the US near a major city to have to spend two years finding a solution, suffering every day, with this forum being the main resource of information. I find that to be absurd.

I would like to extend a HUGE THANK YOU to those who keep this forum going and all members for providing resources and initiating so many conversations regarding the cause of this condition.

[MGD1701]

Cong. PG and thanks so much for sharing.
Your huge effort finally paid off.

[PG]

https://www.womensinternational.com/dry-eyes/

[hopeful_hiker]

PG, great to hear about your experience! What kind of specialist prescribed you the hormones? Can eye specialists do that?

Also, I am curious about MGD causing issues at night. Why does MDG cause discomfort at night? I understand how aqueous deficiency would cause discomfort but why does lack of oil cause problems when the eyes are closed? What did you feel? My dry eye symptoms began at night, actually. My eyes felt "rough" as if friction of eyes and eyelids became more apparent.

TFOS DEWS II report has a whole section on sex, gender, and hormones but hormonal testing does not seem to be a standard practice at all. I suppose hormones fall through the cracks since the medical specialists each occupy a specific niche. A regular eye specialist treating the patient probably does not feel comfortable fiddling with hormones (or does not even know about the connection), whereas a gynecologist or an endocrinologist are unlikely to be part of a dry eye patient medical team.

Some excerpts from the report

Topical or systemic androgen administration significantly decreases DED signs and symptoms, and stimulates tear flow, in patients with Sjögren syndrome [394,396,397,461]. These findings support the hypothesis that androgen deficiency is a significant risk factor in the pathogenesis of lacrimal gland dysfunction, inflammation and aqueous-deficient DED in Sjögren syndrome.

The meibomian gland, a large sebaceous gland, is an androgen target organ. Androgens stimulate this tissue's function and appear to suppress its keratinization [2,10,462,540–544]. Androgen deficiency, in turn, is a risk factor for meibomian gland dysfunction and a corresponding evaporative DED [2,10,35,391,392,540–542].

[PG]

That is a great report hopeful_hiker, probably the most comprehensive I have seen. Thank you for sharing.

A gynecologist prescribed my bio-identical hormones. To my knowledge, eye specialists do not do this. An integrative medicine doctor or naturopath would, however.

I believe that MGD is symptomatic at night because you do not blink.The blink spreads oil from the meibomian glands across the eye surface and keeps the water from evaporating. And maybe the eye is open just a tad, making it all that much worse. My eyes felt very, very dry at night, and this would wake me up to put in drops. I did not have friction. My symptoms first emerged in air conditioned environments.

[PG]

Thought I'd provide an update.

After using the bio-identical hormones for about 2.5 months my lid margins became bright pink and inflamed again and would not subside.

I went to the doctor hoping that she would modify my prescription. However I she stated that estrogen would increase the moisture of the eyes and did not want to modify the prescription. I am focused on the connection between hormones and inflammation, not hormones and moisture. My problem is inflammation of the lid margin and the meibomian glands which in turn affects the oil distribution which leads to reduced moisture. Loss of moisture is just a symptom, not the cause. So I reached an impasse with this particular doctor.

I discontinued the bio-identical hormones and resumed the DHEA micronized tablets. I discovered that I now need a higher dose, which I assume is due to messing with my hormones. I am using 7 mg per day. My eyes improved in two weeks. I take 5 mg in the morning and 2 mg at night. Life is good again.

[PG]

I also want to add that per my opthamologist, the state of my lid margins very likely has a multifaceted cause: Loss of testosterone plus ocular rosacea. Something tipped the scales causing me to become symptomatic--probably the hormone loss.
It seems to me that MGD itself is a symptom and is used to describe of the state of my lid margins, but is not the root cause of my dry eye.

[Guest]

@PG

What brand DHEA do you use?

[PG]

Douglas Laboratories, micronized DHEA