The Importance of Hormone Testing

Interviewer:  With all the different factors and things that you've talked about, how important is hormone testing?

Dr. David Zava:  I think hormone testing is very important.  You know, I own a hormone testing laboratory so people will go, yeah of course he's going to say it's important.  But I see it on a daily basis.  One of the things different about our lab is that we not only generate numbers for people.  They say, OK I want to know what the hormone levels are.  We also have a questionnaire that asks people about the symptoms they have and the hormones they're taking.  So the test report...we call it a test report with meaning.  The test report is generated and it creates information about the patient.  So...and we've tested over two million people and I've seen what the symptoms are in people and I've seen what the hormones levels are and there's that relationship.  So we can say, OK there is this person is post-menopausal.  They have a low estradiol [sp], they have hot flashes and night sweats and sleep dis...these are the problems that bother people very day so you don't sleep.  You don't feel good.  You don't feel good.  You wake up in the morning you're like, oh OK I'm not right.  And you think about that.  How effective are you going to be in your job.  So it's...hormones are very important and when they begin to change or they are out of balance it creates a big problem.  So in that report we put together, I developed an artificial intelligence that actually looks at all that information, and it can generate very specific comments for the individual.  So it's an individualized comment field.  So we would say, for example, in that person had low estradiol.  So they had low estradiol, they had hot flashes, they had night sweats.  All the problems associated with low estradiol.  So it looks, the computer system looks t that, and it generates a report based on the information that we're given.  So that we can say, OK you've had your ovaries removed so the computer sees that.  Well maybe that person's had breast cancer.  So ordinarily that report would say, you have a low estradiol consistent with your symptoms.  Consider estrogen replacement therapy in combination with progesterone.  We can't say, take ten milligrams twice a day that's the physician and pharmacist to work out with the patient.  We lead them right to the door.  And we say, OK this is what we see.  However, if that patient put down that they had breast cancer the comment, that specific comment that's going to go with that is going to say, you've indicated that you have a history of breast cancer and estrogen replacement therapy is contraindicated.  You're not going to get that.  You could, if you've got a report from most other laboratories you're going to get a number.  And you're going to get a range.  And that's pretty much all you're going to get.  And it's left to you to figure it out. And the problem that I had when I first started developing these tests 25 years got is I got the tests all developed.  And they were good tests, they were developed in salvia and different body fluids and the physicians would call me on the phone and they'd say, can you help me out with this patient?  And I'd say, you know what?  I'm a lab guy.  I can help you, I know a lot about this. Tell me a little bit about the patient.  So they would go on and on and on.  I'd just always get calls they'd say, I don't know what to do with these numbers.  And pretty much people, that's how they feel.  I don't know what to do with these numbers.  This is a number that's high or low...what am I supposed to do?  And that's why people are here at these conferences because they're learning about what to do.  So they have great physicians who are working and know about this stuff and know what kind of dosing, what kind of response the patients are having to different combinations of therapies.  So the report basically...so what I figured out was, hey you know what?  I got to figure out how to create a report.  It's got to be in naked [?] fashion so I've got to collect symptoms.  And I have to know what hormones they're taking.  I have to know how they're taking, whether they're in topical.  Taking it oral.  How are they taking them?  Injecting them?  So how they're taking their hormones, when did they last take them?  If they took them 6 months ago it doesn't mean anything.  If they took them 3 days ago it doesn't mean anything relative to the numbers that you've got.  You've got to know that they just took it right then.  And how many hours has it been since they last took it because it's not relevant if it's more than two days out.  It's like, OK you're back to baseline again.  So we have to know all those parameters.  And I'm kind of a pack rat about information so developed computer systems to collect all this information and then I realized, OK I've got all this data I've got to create a report. So I've got to develop a software system that's going to...it's an algorithm that's going to dump all this information into it. It's going to take the numbers, it's going to take the expected ranges.  Is that high or low?  Is that number high or low?  What kind of symptom patterns are there?  The one I was talking about estrogen deficiency symptoms, they've got hot flashes, they've got night sweats, they have sleep disturbances, they're tearful, and blah, blah, blah, blah, blah.  How old are they?  Are they 45?  That's peri-menopausal.  Are the 70?  That's post-menopausal.  What kind of things?  It takes all that information into consideration and dumps it into sort of a think tank.  It's an algorithm and there are possibilities and comments that can be created because if that person's got breast cancer the comment that's going to come out of there is going to be very different from if that patient doesn't have breast cancer.   It's just going to be more of a warning.  But you're not going to get that in any other report.  So it's a unique specialized and that's what we call a test report with meaning.  Is it is a report that will tell you about the specific situation for that patient who's having their hormones tested.  And what that did for me is to solve the problem of having to spend all this time on the phone.  We still spend a lot of time on the phone but it helped a lot in physicians being able to take that...and they're very dependent on it.  They love it.  They like the test report with meaning.  It's kind of like a Wikipedia but it's a condensed...it's like here's all the relevant information.  You could look at, what is estrogen?  That's kind of what you get in a generalized report from most labs is it doesn't tell you specifically how's it relate to this person.  So I'd say that's what's unique.  And I call it a test report with meaning. It took about eight years to develop artificial intelligence around that.  So there are 20,000 different comments and that's always growing.  As we bring on new tests and they do things in different body fluids we have to create those specific comments for each one.  And once we've done it for a particular pattern then we don't have to do it again.  And we can add on to it.  We might add references.  New reference comes along we say we need to put that reference in for the physicians to be able to take a look at that paper.  So that's what I'd say is unique about the product that we have.

Interviewer:  Sure.