Hillary D. White, Ph.D., is an associate professor of microbiology and immunology at Dartmouth Medical School. Dr. White has fibromyalgia and is currently researching testosterone replacement therapy (which she uses herself) to successfully treat fibromyalgia.
ImmuneSupport.com: As a medical researcher, when did you first become aware of fibromyalgia?
Hillary White, Ph.D.: I had heard about fibromyalgia a long time ago, but like most people, I didn’t really understand it. I first became more acutely aware of fibromyalgia as I struggled to understand my own initial symptoms of this syndrome – chronic fatigue and (initially) pain in selected muscles — within a few months the pain had spread to all my muscles. I found the internet, particularly government sources such as www.nlm.nih.gov/medlineplus/ and some of the sites devoted to fibromyalgia (such as this site), to be enormously helpful in beginning to understanding this syndrome.
ImmuneSupport.com: As an FM patient yourself, what circumstances – both physiological and environmental, do you believe triggered your individual symptoms and disease onset?
Hillary White, Ph.D.: It is clear to me that my fibromyalgia was triggered by the long hours and lack of exercise and sleep involved in writing a grant on T cell immunology in the human female reproductive tract – this occurred over a number of weeks, about 7 years ago. The regulation of the immune system by hormones has been utterly fascinating to me, but I suppose some unhealthy habits crept in at this particular time in my career.
ImmuneSupport.com: What do you think is the cause of FM in most patients?
Hillary White, Ph.D.: We think fibromyalgia is due to a physiological state in which there are low levels of certain hormones such as testosterone that are involved in building up or maintaining muscle, metabolic processes, cognitive function and control of pain pathways. Further, we think this physiological state must coincide with (it may also be induced by) some stressor, such as surgery, chronic or acute disease, accident, emotional stress, etc. Others have demonstrated dysfunctional stress responses in patients with fibromyalgia, and this makes a lot of sense.
ImmuneSupport.com: What treatment(s) do you find to be most effective in managing your FM?
Hillary White, Ph.D.: I manage my own fibromyalgia with testosterone replacement therapy, a serious exercise routine (I built up strength slowly to avoid injury), good diet and getting sufficient sleep. Exercise is most helpful, but that is often difficult in fibromyalgia patients in the absence of testosterone replacement therapy.
ImmuneSupport.com: You are researching testosterone as a treatment for FM. Could you talk about that research in some detail, where you are with it and so forth, and what your goals and hopes are for making that treatment available to FM patients around the world?
Hillary White, Ph.D.: Since the research is not yet published, I cannot give details, except to say that we are very excited about our results with testosterone replacement therapy in our initial phase I/phase II study of individuals with fibromyalgia.
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ImmuneSupport.com: Do you use any complementary or alternative therapies to manage your symptoms? If so, what are they and how do they help you?
Hillary White, Ph.D.: I personally do not use any alternative therapies for fibromyalgia. Because of my experience in reproductive immunology, I was more aware of how the sex steroid hormones work than most people, and so I was receptive to how they may be important in disease states. As an immunologist, I am aware that women in particular, as they age, can develop hypersensitivity to medicines. In fact, the reason we have used the same testosterone molecule as is found naturally in your body, and not some analog like methyl-testosterone, is to minimize possible adverse side effects.
While it is true that modern western medicine has not done justice to women’s health issues, I think this is due in part to a lack of testable model systems and a lack of focus in the research arena. There is also an inability on the part of some clinicians to understand fibromyalgia symptoms (and other female complaints), and so women feel abandoned by the western medical establishment and are searching for cures, taking matters into their own hands. I should note that the 5% of fibromyalgia patients who are men also acutely understand how western medicine has failed to provide answers.
I must say, however, that my colleagues have been very supportive in this research – in fact the clinical research we have done so far wouldn’t have been possible without the great team here at Dartmouth Hitchcock Medical Center. I must also say that there are a number of other research groups that are working hard at understanding fibromyalgia, and I am confident that the research community will eventually solve this problem. Incidentally, it is noteworthy that the National Institutes of Health now has a National Institute of Alternative Medicine, which recognizes the power of alternative medicines and seeks to study them.
ImmuneSupport.com: What is your advice for FM patients seeking to manage their chronic pain?
Hillary White, Ph.D.: Since our research was initially noted on the ImmuneSupport.com web site, I have gotten many inquiries from individuals who have asked for help. I have developed a response that answers many of the most common questions, and I include it here:
If you are interested in testosterone therapy I would suggest you find a doctor who is willing to test you for testosterone deficiency (off-trial), and if you are deficient (hallmark is fatigue and low serum levels), then your physician can call me about our experience with our initial trial (I’m a Ph.D., reproductive immunologist and/or I can refer you to our MD who is a reproductive endocrinologist and part of our team). Capsules are available through Madison Pharmacy (800-558-7046) by prescription — that’s what I take. The correct dose may need to be lowered with time (or raised initially if blood levels aren’t raised in response to therapy).
It is important to be monitored periodically to ensure you don’t raise your testosterone serum levels out of the reference range. Gels are starting to be available for women, but development lags behind the gels developed for men. The Princeton consensus statement (Bachmann et al., Fertility and Sterility 77:660, 2002) suggests it is important to have balanced estradiol and progesterone hormone concentrations when considering treating women for androgen deficiency. You should discuss with your doctor any increased risks vs. benefits that you may have when considering any hormone replacement therapy.
Please be aware that it is also important to eat well (balanced diet using the new Harvard food pyramid [http://www.hsph.harvard.edu/nutritionsource/pyramids.html] with whole grains, nuts, oils, fresh vegetables and fruits, fish, poultry and eggs, and minimize or delete white sugar from your diet), consider talking with a nutritionist about correct doses of vitamins, exercise (stretching, weight lifting and some type of exercise that increases your heart rate for extended periods of time), and be mindful of stress reduction techniques (of interest is Jon Kabat-Zin’s book on “Full Catastrophe Living” – he’s director of the stress reduction clinic at U. Mass Medical School).
With respect to exercise, stretching is important because it will reduce the increased risk of exercise-related injury in FMS patients, weight lifting is important for FMS patients to build muscle (with FMS it is difficult to maintain muscle), and cardiovascular training helps FMS patients induce endorphin-like molecules (pain relief). Testosterone therapy is likely to help you improve your ability to exercise.
ImmuneSupport.com: What else interests you about fibromyalgia?
Hillary White, Ph.D.: I am curious whether there are women who have had fibromyalgia during their child-bearing years, and whether pregnancy seems to lessen the symptoms. Conversely, I understand that women who have had both their ovaries removed develop symptoms similar to those for fibromyalgia. I would be interested in hearing from women who have had experiences that confirm or refute these concepts. This is interesting to me because the ovaries are a significant source of testosterone in women.
Hillary D. White, Ph.D.
Department of Microbiology and Immunology HB7556
Dartmouth Medical School
Lebanon, NH 03756-0001
603-650-8262 (office, voice mail)