Fine, I'll Admit It: Sometimes Watching Hormones in Real Time Would Actually Help

But not to make a well woman “well-er.”

I’ve now delighted you with a number of articles outlining what is wrong with companies claiming to measure hormones “continuously” when they are doing no such thing, why taking all those data points to your next doctor’s appointment will bring you nothing but disappointment, and why monitoring “hormones” for wellness is not going to work in the way it does for glucose.

And now that I have spent all this time arguing against continuous hormone monitoring, it would be remiss not to flip that on its head. I wish we had continuous hormone monitoring! But with an important caveat. CHM for conditions where it actually matters. Which looks nothing like a wellness wearable.

The point of the prior articles was not to say I object to more hormone data. It was to say I object to passive, decontextualized “data” that is neither validated nor actionable. Marketing to the worried well, telling women they need this data in order to understand why today a bad hair day or whatever is the worst kind of gaslighting. It’s anxiety producing without justification.

BUT in the right clinical context, with the right question being asked, well, CHM is an entirely different proposition. That is this article.

Case 1: The Fertility Clinic

When I was going through IVF, I had frequent visits to the doctor but mostly for scans to check follicle progress and time the egg retrieval. I mean, so frequent I joked to my doctor about having a permanent ultrasound wand planted in my vagina. But what we didn’t do was endless blood sticks to check hormone levels. Today it’s different. Far more attention is paid to hormone levels prior to embryo transfer requiring frequent visits and pokey needles. Wouldn’t it be great if all that data was collected at home and relayed to the doctor to make adjustments in dosing of medication and better predicting timing for retrievals and transfers?

Gosh, a woman who co-founded a company that has developed a leak-free vaginal drug delivery platform for progesterone for IVF and miscarriage prevention would find that pretty nifty! Know anyone?

Case 2: PMOS

Formerly known as PCOS, PMOS is a highly variable condition that is, at its core, a metabolic and polyhormonal condition. One laboratory test that would be useful is the LH measurement. But not just once. In PMOS there is a change in pulse frequency. Being able to monitor that in real time over an extended period could not only clarify a diagnosis earlier but lead to better understanding and treatment.

Could you imagine a world where the PMOS patient who has been told five different things by five different clinicians has a piece of paper that says, “you are not crazy.” That would be amazing.

Case 3: Perimenopause

Now this one, I’m generally on the fence with. In my mind, if you are asking if you are in perimenopause, the answer is probably, “yes.” In my case, it was severe eczema and bleeding through my clothes for 6 months. I didn’t need CHM to tell me something was very off. In this case, what is causing all those symptoms is the erratic nature of hormones during the transition to menopause. A printout of that data is more likely to give you motion sickness than cause your doctor to change the therapeutic plan. The art of medicine still dominates when it comes to “is this perimenopause?”

That said, there are situations where CHM would be useful. For example, the 38-year-old new mom who can’t tell if her midnight sobbing is due to post-partum depression or perimenopause. In particular situations, knowing what is going on in a multi-dimensional way would be very useful. Even better, think of the research use cases. How many hot flashes are due to absolute estrogen levels, rates of change or the behavior of one’s spouse?

In this situation, however, I maintain that CHM is not a wellness product. A woman lying awake at 3am raging at the ceiling does not need a wristband to tell her something’s off.

Case 4: The Dose is the Drug

There are other conditions, though, where careful titration of medication is necessary to keep a patient healthy but without causing significant side effects. Congenital adrenal hyperplasia, for example, is a condition that requires steroids and salt replacement to avoid life-threatening consequences. Being able to monitor 17-OHP levels especially during medication adjustments is recommended but remains challenging. Again, an app feeding that information right to the endocrinologist would be fabulous.

Similarly, estrogen replacement in patients with conditions such as Turner syndrome or premature ovarian insufficiency would take the guesswork out of the prescription. In my case, an ambulance on the side of the freeway would have not been necessary to say I need an extra pump of the old Estrogel.

See, I can admit that there are situations where frequent or even continuous hormone data would be useful. However, none of this points to the utility or necessity of a wearable that claims to create “insight” without validated laboratory references.

In each of these cases, there is a common thread. The monitoring happens in the context of a clinical question, where a clinician will be making a decision based on the result.

The data points are actionable because the “so what” is defined. Adjust a dose. Trigger a cycle. Add more progesterone. Change the medication protocol.

NONE of this maps onto a consumer wellness device because there is no action loop to close. And marketing such a device to health women is not solving an unmet clinical need. It is manufacturing anxiety and selling an instrument to measure it.

Back to the beginning. Yes. CHM would be useful. For a woman trying to balance life and her IVF cycle. For the teenager with CAH who needs a medication adjustment. For a woman with irregular periods and thinning hair who is told to “just lose some weight.” The technology deserves to be developed and deployed for these women. I’m just not sure it needs to appear first as a rose-gold wearable with an app that encourages mindfulness.

That is the difference between medicine and wellness theatre.