Questions to Ask an Endocrinologist

Michael O. Schroeder

Why you might see an endocrinologist

The endocrine system consists of glands that release hormones controlling a wide range of functions in the body, from respiratory and metabolism to sexual development. By extension, endocrinologists specialize in hormone-related diseases. For example, with diabetes, the body doesn't make enough of a hormone produced by the pancreas called insulin, or it isn't able to use that hormone to properly control blood sugar.

"I would say about 75 to 80% of my referrals are for diabetes management," says Dr. Chirag Boradia, an endocrinologist at Saint Barnabas Medical Center in Livingston, New Jersey. That said, according to Boradia and others who specialize in the field, the reasons people might see an endocrinologist -- like the functions of hormones themselves -- vary widely. Those range from osteoporosis due to bone loss to issues related to the hormone-producing thyroid gland in the neck, including cancer.

Before your appointment

To get the most from your visit with an endocrinologist, approach it as you might a well-run work meeting, suggests Dr. David Lam, medical director of the Clinical Diabetes Institute for the Mount Sinai Health System. Have an agenda when you arrive for what you want to talk about -- including items such as preventing diabetes complications and a review of the medications you're taking -- and make sure you and your doctor are prepared. "You and the doctor should be on the same page about your main concerns," Lam says.

Medical records should be shared by your primary care doctor with the endocrinologist or provided to the specialist directly well in advance of your appointment. And have your questions handy, too. While these will vary by your medical needs, they may include some of the following:

Is my diabetes under control?

Certainly for those seeing an endocrinologist for other reasons, this isn't pertinent. But for the many patients with diabetes who are visiting the specialist for the first time, this is absolutely ground zero to start the conversation.

Maybe your blood sugar levels aren't well-managed. That can be determined, for example, by an A1c test, or hemoglobin A1c, which provides average blood sugar levels for the past two to three months. So if your diabetes isn't under control, the next natural question is: "How far am I from that goal, and how can that be better achieved?" Boradia says.

Given the prevalence of diabetes and prediabetes -- a precursor to diabetes -- it's worth it for other patients to ask an endocrinologist what their risk of diabetes is and how they can prevent it, as well.

What do the test results mean -- and what remains unknown?

Frequently, blood tests are ordered to better understand the role hormones may play in health. So it's important to carefully discuss the reasons tests might be suggested, your results and any testing limitations.

Often, timing can influence test results. "A woman may come in with a normal testosterone in the afternoon and could miss a diagnosis of polycystic ovary syndrome, where there's high testosterone, because the test was checked at the wrong time," says Dr. Caroline Messer, an endocrinologist at Lenox Hill Hospital in New York City. "Or conversely, a man could come in with a diagnosis of low testosterone because it was checked too late in the day" -- when it would be normal if rechecked first thing in the morning.

So be very aware of timing with tests, she says. Make sure you also talk with the specialist about the reasons, risks and, ultimately, results for any test that's ordered. Discuss what can be done to ensure testing accuracy to the greatest extent possible.

Is my fatigue -- or any other issue -- actually hormone-related?

Low energy or fatigue can be a sign of a hormone imbalance. It may be that the thyroid isn't working properly, an excess of progesterone or other hormonal issues. Or health concerns like fatigue that are suspected to be hormone-related might not be at all.

Given that, having an open mind can make all the difference. Your endocrinologist should know which test to order, and then if this issue you're having isn't hormone-related, help direct you to the real cause. For example, Messer notes, fatigue may be due to a sleep disorder like sleep apnea, or it may be caused by anemia, a lack of red blood cells.

What are the side effects of the medications I need to take?

It's important to talk with your doctor about possible medication risks any time drugs are prescribed. And that's especially true when it's necessary to take them on an ongoing basis, such as with insulin or other drugs for diabetes, osteoporosis or hyperthyroidism (overactive thyroid).

Talk, too, about alternative treatments or drug options. "Are there other medications that should be considered?" says Lam, who is an assistant professor in the division of endocrinology, diabetes and bone diseases at Icahn School of Medicine at Mount Sinai in New York City. "What are the possible side effects of the medications? Because we talk about the benefits a lot, but we should also talk about the side effects."

Let your doctor know promptly as well if you think you experience any medication side effects.

What's the role of lifestyle, including diet, in managing disease?

Certainly, medical treatment and medications may play a significant role in your care. But from helping with weight management to giving dietary advice, endocrinologists are well-versed in guiding patients to make everyday choices that can improve their health and help with managing disease.

"For an endocrinologist specifically, lifestyle is almost always included in the discussion," Lam says.

That can include talking about spreading carbs across the day to control blood glucose for people who have diabetes. Or it could be about the role exercise plays in not only managing that chronic disease but also strengthening bones to prevent or help with the management of osteoporosis.

How can I prevent complications?

Prevention extends beyond trying not to get the disease. There's also secondary prevention focused on avoiding complications from the condition, explains Dr. Dinamarie Garcia-Banigan, an endocrinologist at Lahey Hospital and Medical Center, who practices in Burlington and Peabody, Massachusetts. That includes preventing serious complications like nerve damage or blindness from uncontrolled diabetes.

There's also tertiary prevention, such as rehab or taking other measures to reduce the impact of a disease that has progressed. So, for example, if a person with osteoporosis sustains a fracture from a fall, it's important to consider, "How can we get that to heal? How can we keep you better balanced? How can we be even more proactive to maximize your physical function?" Garcia-Banigan says. This type of prevention also takes into account not only medical management but also the impact of lifestyle, like doing exercise such as tai chi for balance.

What's the outlook -- and will this require ongoing treatment?

Maybe you're concerned about complications. Perhaps you just want to know if treatment involves a single procedure. For example, surgery may be performed to remove the parathyroid glands for someone with hyperparathyroidism, in which one or both of the parathyroid glands (behind the thyroid in the neck) become overactive. Or instead, maybe the condition you have requires ongoing care or medication.

While endocrinologists don't have a crystal ball, it's important to discuss expectations. "Is it something that I'm going to have to worry about for the rest of my life? Is it something that's easily fixed with just a medication?" Lam says. "That medication -- do I have to take it for the rest of my life?" Or will you only be taking it for a short time? Experts say it's important to discuss the big picture -- and the long-term outlook -- so that you can prepare for what's ahead and best manage a chronic disease.

Should I see anyone else?

Perhaps you're developing a meal plan for better diabetes control, and you get some advice from your endocrinologist but want to go further. Oftentimes, experts say, it's necessary to see a registered dietitian nutritionist for a deeper dive into what to eat with diabetes. That way you're able to take what you learn directly into your kitchen.

Similarly, a person may see an orthopedic doctor for treatment of a fracture related to osteoporosis, while also seeing an endocrinologist for the bone-thinning condition itself. While endocrinologists have a wide breadth of knowledge about hormone-related conditions, it's important to remember that health care is a team sport, experts say. So make sure to ask if anyone else needs to be added to your team to optimize your care.

Questions to ask an endocrinologist

-- Is my diabetes under control?

-- What do the test results mean -- and what remains unknown?

-- Is my fatigue -- or any other issue -- actually hormone-related?

-- What are the side effects of the medications I need to take?

-- What's the role of lifestyle, including diet, in managing disease?

-- How can I prevent complications?

-- What's the outlook -- and will this require ongoing treatment?

-- Should I see anyone else?