Home Recreation: A Way of Life Modern society tends to fragmentize life Sports Films History Baseball: The Components of Profit Estrogen and Antagonists Diet and Nutrition The Vitamins Vitamin B Vitamin C Vitamin D Vitamin E Let the stars size up your shopping style Astrology: Magic or Science? Jamaica For Cyclists Maine: Earliest Inhabitants The passion for football Changes in Body Weight The Metabolism and Energy Transformations of Healthy Man Normal Activity Restricted by the Conditions of Experiments Metabolism During Specific Activities and Movements Public Colleges M to N N to Z What Is It We Want? Directed Thinking On Being Oneself Economics Is a Branch of Biology Life Is Also Frustration How Goods are Bought and Sold Leisure and work The Pecuniary Standard of Living The Uses of Time Teaching People to Want Things Art as leisure The Loss of Privacy The Great Emptiness	Estrogen and Antagonists The whole concept underlying this work derived from the many pathological conditions that accompany hyperestrogenism and their correction by reducing the estrogen level to normal. At first, it was menorrhagia and dysmenorrhea that were successfully treated by my father and older brother and later by myself and younger brother. Then it was found that the alpha fraction of vitamin E could control the antiproteolytic factor found in the serum of aborting women and that it could prevent abruptia placentae, this between the years 1935 and 1937. Gradually, it became apparent that there were at least four estrogen antagonists, namely progesterone, thyroid extract, alpha tocopherol, and testosterone and that these could be used singly or in combination. The result was a simple and effective method of treating the many conditions associated with the overproduction of estrogen by the body. Most of these concepts have now been accepted. Paul Starr for example, states without the need for reference that "in women during the reproductive years, hypothyroidism should be considered in any case of amenorrhea, infertility, habitual abortion, menorrhagia, or other menstrual disorders. it must be remembered that some of these cases are characterized by hyperestrogenism. . . ." No references are really necessary since most of the information was published between 1935 and 1942 over Dr. Evan Shute's name. Since menorrhagia and dysmenorrhea respond so well to thyroid extract, that is if there is no other cause, such as fibroids or polyps or pelvic inflammatory disease, it follows that such patients must be hypothyroid. However, there really has been no accurate measure of low thyroid activity available until the advent of the Protein Bound lodine and lodine Uptake Tests. When these tests did become available, random samplings of the American population, especially one· in the Chicago area, confirmed our long-standing and often-stated impression that there was a great deal of subclinical hypothyroidism. The Chicago study produced the figure of 55 per cent of females and 45 per cent of males in this category. Before the days of the P.B.I. and the lodine Uptake Test we relied entirely on a careful history and the physical examination of the patient. We long ago abandoned the Basal Metabolic Rate Test as inaccurate and misleading, in fact, useless. In this view, we have not been alone. Hamolsky and Freedberg (LLS) point out that the B.M.R. has been largely abandoned in many clinics and is being replaced by a therapeutic trial. The patient with subacute hypothyroidism will have some but not necessarily all of the following symptoms: dry hair; dry skin, which if dry enough will of ten crack around the ends of the fingers or around the nails in winter; a tendency to gain weight easily, to have cold feet in bed (a very typical symptom ), and to have one other symptom hard to describe in a few words. Many subclinical hypothyroids are slow starters, find it hard to get going in the morning, are usually doing at II o'clock what they ought to have done by nine o'clock and doing at four p.m. what they ought to have done by two p.m. However, as the day goes on they become more efficient, and by nine o'clock at night have "caught up" and are now full of life and ambition. They may be hard to get to bed at night and just as hard to get up in the morning. A woman who regularly irons at nine o'clock at night and sings as she irons, is a hypothyroid. This symptom has nothing to do with intelligence or ambition. In fact, an overly energetic, highly educated young woman who became my patient was far from fat, served on several Y.W.C.A. boards, was engaged in several civic activities, played badminton and bridge, and was obviously a typical hyperthyroid until her history was taken in detail, when she became just as obviously a hypothyroid. If the patient is a woman in her reproductive years, the diagnosis is much easier. She may have the typical symptoms associated with her menstrual cycle, the symptoms of overproduction of estrogen, namely, premenstrually sore, tender, and swollen breasts with a gain of weight due to water retention, irritability, and a heavy sensation in her abdomen. Her periods will usually be heavy, with clots, accompanied by dysmenorrhea and unduly prolonged. She may have pelvic pain at the time of ovulation. On examination, she may obviously have the typical dry hair and skin, a poor outer third of the eyebrows, sideburns, beard, and mustache, and quite frequently hairs around the areola or between her breasts. Occasionally there will be a typical masculine distribution of pelvic hair with hair growing upwards to or toward the umbilicus. She is apt to have hairy legs. These signs and symptoms are much more dependable than most tests. They make the diagnosis fairly certain, although a slow pulse is a necessary accompaniment, and in some forms of heart disease the pulse may not be slow until the he art condition comes under control. It has become very obvious that the majority of cardiac and peripheral vascular disease patients that I see daily, are frankly hypothyroid and this condition must be corrected if possible, if complete treatment is to be attained. Chrome hypothyroidism results in the following disorders: "1. Arteriosclerosis - especially of the brain. "2. Myocarditis - sufficient to produce heart failure. "3. Slow mentation, delayed comprehension, poor memory, loss of initiative. "4. Atherosclerosis of the coronary arteries, with resulting angina pectoris. "5. Anemia, resembling either the primary or secondary form. "6. Somatic muscle weakness, leading to orthopedic disability. ''7. Anorexia and constipation, even to the point of obstruction. "8. Fibrositis, with body-wide pains resembling gout. "9. Phlebothrombosis, with resulting embolism." Subsequently, he emphasizes the point, that "the citizen being damaged by hypothyroidism does not know it." In other words, it requires careful history taking and a knowledge of the physical signs and peculiar symptomatology to establish the diagnosis. The patient correctly treated may well feel like a normal human being for the first time in his or her life, and the effect on the family that comes with the discovery of a different and more happy and efficient housewife is also a joy and a wonder. One can always safely give the patient a clinical trial, starting at a safe level of crude or not too refined thyroid product and increasing until the desired effect is achieved, remembering that one out of ten who need thyroid can't take it, but that an overdosage is easy to detect and completely harmless as long as the drug is discontinued or reduced relatively promptly. The hypothyroid female produces too much estrogen. This can nearly always be controlled by thyroid medication. if not detected and controlled she may well in later life develop the cardiovascular and other damage enumerated by Paul Starr and then need the full treatment with alpha tocopherol and thyroid.