Why you might see an endocrinologist
If you’re having heart issues, you may want to see a cardiologist. Serious digestive pain may warrant an appointment with a gastroenterologist.
But what kind of health issue would prompt you to see an endocrinologist?
While cardiologists and gastroenterologists specialize in one specific aspect of a patient’s health, endocrinologists treat issues of the endocrine system, which consists of glands that release hormones controlling a wide range of functions in the body, from respiratory and metabolism to sexual development. By extension, endocrinologists specialize in hormone-related conditions, such as diabetes, thyroid disease, osteoporosis, polycystic ovary syndrome and weight loss. For example, with diabetes, the body either doesn’t make enough insulin, a hormone produced by the pancreas, or it isn’t able to use that hormone to properly control blood sugar.
If you have any of these conditions, you might find yourself needing an appointment with an endocrinologist.
Before your appointment
One question many patients wonder is whether you need a referral to see an endocrinologist. This depends on your insurance. An endocrinologist is considered a specialist. If your insurance requires referrals for a specialist, then you will need to obtain this prior to your appointment.
Once you’ve set up an appointment, approach it as you might a well-run work meeting to get the most out of your visit with an endocrinologist, suggests Dr. David Lam, a New York City-based physician and associate professor of endocrinology, diabetes and bone diseases at the Icahn School of Medicine at Mount Sinai. Have an agenda of questions and topics you want to talk about — including preventing diabetes complications and reviewing medications you’re taking — to make sure you and your doctor are prepared.
“You and the doctor should be on the same page about your main concerns,” Lam says.
While your queries will vary by your medical needs, they may include some of the following:
Is my diabetes under control?
If you’re seeing an endocrinologist for other reasons, this isn’t pertinent. But for the many patients with diabetes who are visiting the specialist for the first time, this is absolutely the place to start the conversation.
If your blood sugar levels aren’t well-managed, that can be determined by an A1C test, which provides average blood sugar levels for three months. If your hemoglobin A1C measure is above 8%, the diabetes is technically uncontrolled, and you should discuss medications and lifestyle changes — like eating a healthier diet and getting more exercise — with your health care provider, says Dr. Caroline Messer, an endocrinologist at Lenox Hill Hospital in New York City.
Given the prevalence of diabetes and prediabetes, a precursor to diabetes, it’s worth it for other patients to ask an endocrinologist what their risk of diabetes is and how they can prevent it.
What do the test results mean, and what remains unknown?
Frequently, blood tests are ordered to better understand the role hormones may play in health, so it’s important to carefully discuss why you need certain tests, your results and any testing limitations.
Often, timing can influence test results.
“A woman may come in with a normal testosterone in the afternoon and could miss a diagnosis of polycystic ovary syndrome, where there’s high testosterone, because the test was checked at the wrong time,” Messer says. “Conversely, a man could come in with a diagnosis of low testosterone because it was checked too late in the day.”
Be sure to discuss what can be done to ensure testing accuracy to the greatest extent possible because hormones vary depending on many factors (time of day, age, foods, supplements, other medications, etc.).
Is my fatigue or any other issue actually hormone-related?
Low energy or fatigue can be a sign of a hormonal issues. It may be that the thyroid isn’t working properly, there’s an excess of progesterone or that there are other hormonal issues.
To determine the cause, your endocrinologist should know which test to order. If the issue isn’t hormone-related, they can help you find out what’s behind the issue and connect you with other specialists. For example, Messer notes, fatigue may be due to a sleep disorder, like sleep apnea, or it may be caused by anemia, a lack of red blood cells.
What are the side effects of the medications I need to take?
Whenever you see your endocrinologist or any other health care provider, it’s a good idea to bring your medications to your appointment or to provide an up-to-date list of your meds, says Dr. Shirisha Avadhanula, an endocrinologist at Cleveland Clinic in Ohio.
“It’s very important to review all of your medications during your doctor’s visit, including doses and medication changes that may have been done by your other providers,” Avadhanula says.
Some medications can have negative effects with certain medical conditions. For example, steroids and other medications can worsen your glycemic control, and you may need to make adjustments in your diabetes medications if a steroid dose is anticipated. Additionally, medications used commonly for diabetes, such as sulfonylureas, or medication used for depression can lead to unwanted weight gain.
“A thorough review with your care team and some small adjustments to your medications can lead to a big impact in your overall health,” Avadhanula says.
Any time drugs are prescribed, it’s important to talk with your doctor about possible medication risks. That’s especially true when it’s necessary to take them on an ongoing basis, such as with insulin or other drugs for diabetes, osteoporosis or hyperthyroidism.
Be sure to also talk about alternative treatments or drug options. For example, are there other medications that should be considered? What are the possible side effects of the medications?
“We talk about the benefits a lot, but we should also talk about the side effects,” Lam says.
Let your doctor know promptly if you think you experience any side effects, such as fatigue, with your medications.
Given my condition, are there any supplements I should avoid?
There’s no doubt that some supplements — such as vitamin D, vitamin B12 and folic acid — can boost your health if they are recommended by a member of your care team. Still, it’s a good idea to let your endocrinologist know what supplements you’re taking and to ask them if they can be harmful, considering your particular condition.
“For example, patients should avoid over-iodination, as it may lead to certain thyroid conditions,” Avadhandula says. “Additionally, many patients attest to using dietary supplements for weight loss, which may contain dangerous chemical/pharmaceutical agents that can potentially be harmful.”
It is always in your best interest to bring all supplements you may be taking to your doctor’s office for review.
What’s the role of lifestyle, including diet, in managing disease?
Certainly, medical treatment and medications play a significant role in your care. But endocrinologists are also well-versed in guiding patients to make everyday choices — such as eating healthier and getting regular physical activity — to help them improve their health and help with disease management.
“For an endocrinologist, specifically, lifestyle is almost always included in the discussion,” Lam says.
That can include talking about spreading carbs across the day to control blood glucose for people who are managing their diabetes. Or it could be about the role exercise plays in not only managing that chronic disease but also strengthening bones to prevent or help with the management of osteoporosis.
How can I prevent complications?
Prevention extends beyond avoiding the disease. There’s also secondary prevention, which focuses on avoiding complications from the condition, explains Dr. Dinamarie Garcia-Banigan, chair of endocrinology, diabetes and metabolism at Lahey Hospital & Medical Center in Burlington, Massachusetts. That includes preventing serious complications, like nerve damage or blindness from uncontrolled diabetes.
There’s also tertiary prevention, which includes rehab or taking other measures to reduce the impact of a disease that has progressed. If a person with osteoporosis sustains a fracture from a fall, Garcia-Banigan says it’s important to consider the following questions: How can we get that to heal? How can we keep you better balanced? How can we be even more proactive to maximize your physical function?
This type of prevention not only takes into account medical management but also the impact of lifestyle, like doing tai chi and other exercises for balance.
What’s the outlook, and will this require ongoing treatment?
Maybe you’re concerned about complications, or perhaps you just want to know what exactly the treatment will entail. For example, surgery may be performed to remove either one or both of the parathyroid glands for someone with hyperparathyroidism, or the condition requires ongoing care or medication.
While endocrinologists don’t have a crystal ball, it’s important to discuss expectations.
Is it something that I’m going to have to worry about for the rest of my life? Is it something that’s easily fixed with just medication? Do I have to take that medication for the rest of my life or will I only be taking it for a short time?
Experts say it’s important to discuss the big picture and the long-term outlook, so that you can prepare for what’s ahead and best manage a chronic disease.
Should I see anyone else?
While endocrinologists have a wide breadth of knowledge about hormone-related conditions, it’s important to remember that health care is a team sport.
Perhaps you’re developing a meal plan for better diabetes control with some advice from your endocrinologist but want to go further. Oftentimes, experts say, it’s necessary to see a registered dietitian for a deeper dive into what to eat with diabetes. That way, you’re able to take what you learn directly into your kitchen.
Similarly, a person may see an orthopedic doctor for treatment of a fracture related to osteoporosis, while also seeing an endocrinologist for the bone-thinning condition itself.
Many patients seek out an endocrinologist because they are concerned if their hormones are leading to fatigue, weight gain, hair loss, changes in sex drive, etc. These are very general symptoms that can be associated with many non-hormonal medical conditions as well. An endocrinologist will test you to ensure there is no true hormonal issue, and if there are none present, they will direct you to other specialists or your primary care doctor for further evaluation.
Ultimately, it’s important to make sure you ask if anyone else needs to be added to your team to optimize your care.
Questions to ask an endocrinologist
— Is my diabetes under control?
— What do the test results mean, and what remains unknown?
— Is my fatigue or any other issue actually hormone-related?
— What are the side effects of the medications I need to take?
— Given my condition, are there any supplements I should avoid?
— What’s the role of lifestyle, including diet, in managing disease?
— How can I prevent complications?
— What’s the outlook, and will this require ongoing treatment?
— Should I see anyone else?
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Questions to Ask an Endocrinologist originally appeared on usnews.com
Update 02/09/24: This story was previously published at an earlier date and has been updated with new information.
