Questions & Answers Your questions answered every 2 weeks. If you have a question for Dr Elstein, click here. DISCLAIMER: Answers given here are based upon the information given by you. We recommend that you personally see either Dr Elstein at his clinic or a qualified medical practitioner.  I am a 46 year-old female and I would like to know what steps I can take naturally for preparing my body for menopause.  I take vitamins daily including E, C, coenzymeQ10, Omega3/6/9, vitamin B12 and the herb Rhodiola as I am starting to feel fatigued.  I eat healthily, run 20min and power walk 40min everyday and lift light weights but I am starting to see my skin loosing its elasticity.  Can you please help me.   Answer: That you are looking after your health in a preventive fashion is highly commendable.  As you are noticing fatigue this would be a good time to assess your dietary and digestive function. You might not be on a diet with which you are compatible which would limit your ability to benefit from the supplements you are taking. This would also compromise your capacity to digest and assimilate the nutrients you need from your food that would energise you.  Equally if your digestive function is sub-optimal your capacity to break down the food you consume into smaller particles which can be absorbed would be impeded.  You need nutrients to make hormones and a lack of skin elasticity suggests that your hormones might not be present in adequate amounts or if present might not be functioning to their full capacity.  Despite the fact that you are taking these supplements a lack of skin elasticity also suggests vitamin E and fatty acid deficiency together with dehydration.  This would be an ideal time to have the kind of assessment which evaluates your diet and digestive function together with your hormone function.  Not all practitioners are sensitive to the kinds of tests which would encompass this sort of assessment so you might need to shop around before you find the kind of specialist who is qualified for the job. I am a 52 year-old with a good sex drive, however whenever I have sex only a small amount of fluid is ejaculated (about less than half a tea spoon).  Could you assist?     Answer: The normal male ejaculate is 1.5-5mls which is 1/2tsp to a 2 teaspoons.  There is some evidence that zinc deficiency and low testosterone levels can reduce ejaculate quality and quantity.  Animal studies show that zinc, vitamin C and vitamin E and optimal levels of testosterone and thyroid hormones impact semen production and function in a positive fashion.  This might be a good time to have your hormone levels evaluated together with an assessment of your vitamin and mineral status. You would need to find a practitioner who can assess these in a proper and adequate fashion and this is the kind of practitioner whose practice focuses on health and vitality medicine. Two years I ago started noticing sagging skin, loss of energy and nodule on my right thyroid.  Had the right side removed and was given the diagnosis of papillary carcinoma and Hashimoto’s. I'm on replacement therapy of 50MCG.  My doctor wants to shut down my thyroid completely but higher doses make my skin even worse.  My doctor thinks since my levels are good she ignores my skin problem. Is there anything I can do or take to help my skin's elasticity?   It just doesn't look healthy.  Answer:  Unfortunately oestrogen treatment can make papillary cancer grow so you are in a difficult predicament.  Make sure that you are getting adequate supplies of essential fatty and amino acids which are necessary for maintenance of healthy skin along with adequate hydration.  My book ‘You have the power’ has a chapter on managing skin aging with some useful suggestions. I have had lupus for quite some time along with other secondary diseases. I was hospitalized with immune thrombocytopenic purpura. I was given huge amounts of prednisone by IV's and then got a staph infection and was too ill to walk much less to get out of bed for a long time.  Being on prednisone for years and gaining and losing weight has caused big tears in my skin, and sagging skin. I am on many other med but no longer on prednisone. Will I ever get to look normal again or near normal and if so, what do I have to do? Answer: There are hormones that can positively impact lupus and these include melatonin, vitamin D and DHEA.  Unfortunately estrogen which looks after your skin can impact negatively on this disease.  To build healthy skin and healthy tissue you need good supplies of protein, fats and minerals like zinc and the nutrient sulphur.  You need to find a health practitioner who can assess the presence of these nutrients as there are blood tests which can measure amino acid and fatty acid levels as well as 24-hour urine tests which can evaluate minerals like zinc.   I have mitral valve prolapse, Hashimoto's and gluten intolerance.  I am also perimenopausal.  For the Hashimoto's, I take 75 mcg. 1x/day & 5 mcg. Cytomel 2x/day.  For the female hormones, I take 25 mg. Bi-Est sublingual (0.1-0.2 mL in a.m. & p.m.) and apply 10% progesterone cream on days 12-28.  I have no problem with eating gluten-free and exercise aerobically 5 days a week for 45 minutes, and do weight-training 3 days a week.  I have had some stressors that exhausted my adrenals, lost 10 pounds (have since gained it back) and have learned how to treat that through the book "Adrenal Fatigue" and have learned all I can about what I can do to treat my thyroid well by reading Dr. Shames' books.  However, I have noticed that my skin has gotten very thin (you can see the bones and veins on the tops of my hands very easily) and I'm gaining fat on my abdomen and the fat is more visible on my thighs because of the thin skin.  Is there anything I can do for the thinning s!  kin?  Would it be safe for me to start growth hormone injections?  I eat a good diet with adequate amounts of protein, lots of veggies, and good fats.  I am 5'5" and weigh 125 lbs.   Answer: You seem to have a reasonable handle on your health.  What you now need to do is assess whether your body is catabolic or anabolic and if your skin is thinning and you are losing condition then certain imbalances are prevailing.  My suggestion is to have a glucose tolerance test over two hours also assessing cortisol and insulin at the one and two hourly mark.  Elevated blood glucose or sugar levels is associated with fat gain around the abdomen and with what is known as inflammation which compromises hormonal function.  Losing skin also suggests a catabolic state and imperfect anabolic status and so you need to assess your protein status and this can be done by dividing urea by creatinine and the number should be greater by a factor of seven which means that if you multiply creatinine by seven this amount should be less than the number for urea.  Your physician will know what this means.  Then you also need to assess your thyroid treatment by measuring T3, T4, and reverse T3 together with your zinc status.  I have often found that yeast and gluten intolerance go hand in hand and this can be evaluated by means of a candida antibody test.  Have your estrogen and progesterone status assessed by means of saliva or 24-hour urine assays.  Before embarking on growth hormone treatment have your levels measured by means of either a 24-hour urine assay or IGF-1/IGFBP3 levels. 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