Bioidentical Hormone Restoration Best Medical Practice

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Bioidentical Hormone RestorationBest Medical
Practice

• Henry_at_hormonerestoration.com

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Hormones

• Neuro-endocrine-immune system
• Travel via blood to cells receptors
• Control cells proliferation, protein
  manufacture, metabolic rate, etc.
• Most powerful molecules in our bodies
• Optimal levels essential for health and quality
  of life

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Hormones and Aging

• Why Doctors Dont Get It

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Bioidentical Hormone Restoration is Common Sense

• If a hormone is missing, replace it!
• If present but insufficient, optimize it!
• Type 1 Diabetes bioidentical insulin
• Hypothyroidism bioidentical T4
• Growth hormone def. bioidentical GH
• Adrenal insufficiency bioidentical cortisol
• But what about hormones lost to aging?

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PregnenoloneMother Steroid
J Clin Endocrinol Metab. 1997 Aug82(8)2396-402.
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DHEA ? DHEA-S
J Clin Endocrinol Metab. 1997 Aug82(8)2396-402.

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Growth Hormone (GH)
Somatopause
Normal Adults Pituitary Disease

Sufficiency
fatigue
Log scale
J Clin Endocrinol Metab. 1999 Jun84(6)2013-9.
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Testosterone Progesterone Estradiol
Andropause Menopause
pg/ml
?
?
?
?
DHEA10,000 pg/ml, DHEA-S 5,000,000 pg/ml !
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Hormonal Changes With Aging

• Hormones that build tissues and improve immunity
  decline with age by 50-80 (DHEA, Testosterone,
  GH)
• Progesterone starts to decline at age 30.
• Estradiol disappears at ?50menopause
• Thyroid hormone production and sensitivity
  decline
• Insulin output declines?Diabetes
• By age 5020 years of hormonal deficiency

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Conventional View of Hormones and Aging

• The loss of hormones is adaptivehelps us to live
  longer
• Persistence of youthful levels of hormones would
  cause more heart attacks and cancers as we age
• Losing our hormones is good for us(?!)
• Fits the Pharmaceutical Agenda Take drugs for
  every symptom and disorder caused by hormone loss!

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Against the Conventional View

• Aging is a self-destruct program that kicks in at
  age 25 in humans
• Aging is natural degeneration!
• Weight gain, high blood pressure, high
  cholesterol, cancers, heart attacks, autoimmune
  diseases, etc. occur years after hormone
  deficiencies begin and occur more often in people
  with lower hormone levels!
• Studies of balanced hormone restoration show the
  expected benefits and no proof of harm!!

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Example Growth Hormone

• Declines 14 per decade after age 25
• IGF-1 of many adults equal to hypopituitary
  patients (only 80-110 vs. 350 _at_25yrs.old)
• Deficiency ??heart disease, frailty, depression,
  body fat, bone loss
• GH restoration reduces abdominal fat, lowers
  blood sugar and blood pressure
• Improves cognition, mood, sleep, energy
• Increases muscle, decreases fat cholesterol
• Improves bone density, skin thickness
• Downside high cost, nightly injections

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The Endocrinology of Aging

• Endocrine glands and their feedback control
  systems deteriorate with age
• Our bodies cease to regulate our hormones for
  optimal health
• Hormone losses speed our general deterioration
  a vicious cycle.
• The symptoms of hormone loss are warning signs of
  physical deterioration
• Win-Win Hormone restoration makes you feel
  better and improves your health!

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Since the Loss of Hormones is Harmful,THEN

• Restoring youthful hormone levels is
• essential preventative medicine
• essential to the treatment of disease
• essential to Quality of Life!
• We have the need and the right to
  restore hormones lost to aging!

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Hormones and Aging

• Any Questions?

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Human Steroid Hormones
Estradiol
Testosterone
DHEA
Progesterone
Cortisol
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Where Do They Come From?

• All steroid hormones (including substitutes) are
  chemically synthesized from diosgenin (wild
  Mexican yams, soy, and other plants).

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Not Just Sex Hormones

• Estrogen, progesterone, testosterone and DHEA
  essential to cellular growth and function in all
  tissues in both sexes!
• Maintain brain functionmodulators of mood,
  cognition, pain, etc.
• Maintain the immune systemprogesterone and
  testosterone are immunosuppressants
• Maintain connective tissue skin, hair, bone,
  muscle, and blood vessels

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Female Endocrinology

• Nature makes special demands on the female body
  for reproduction
• Breast, uterine and ovarian tissues undergo a
  monthly cycle of proliferation, differentiation,
  and breakdown
• Defects in this cycle can lead to cancers in
  female organs and to many medical disorders.

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EstrogenProgesterone Complementarity

• Estrogen promotes breast/uterine tissue
  proliferation and growth
• Progesterone stops proliferation and promotes
  maturation and differentiation
• Differentiated cells cant become cancer cells
• High average progesterone/estrogen ratio
  suppresses proliferation and prevents cancers of
  female organs

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Progesterone Deficiency? Estrogen Dominance

• Allergies
• Autoimmune diseases
• Anxiety, irritability
• Insomnia
• Decreased sex drive
• Depression
• Bloating and edema
• Fibrocystic breasts
• Uterine fibroids

• Breast cancer
• Ovarian cancer
• Uterine cancer
• Thyroid dysfunction
• Gallbladder disease
• Heavy periods
• Migraines
• Seizures

Progesterone and Iodine/Kelp reduce estrogen
dominance
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Historical Perspective

• Throughout most of human history, women were
  usually
• Pregnanthigh progesterone
• Breastfeedinglow estrogen
• (both protect against breast cancer)
• Women cycled for 4 years avg. today many cycle
  for 35 years
• Cycling?risk of estrogen dominance and other
  hormonal disorders

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Perimenopause

• Females born with a fixed no. of oocytes which
  are continually lost to age and ovulation
• With aging, fewer oocytes of lower quality are
  left?reduced progesterone production beginning
  around age 30?estrogen dominance
• No ovulationno progesterone
• Estrogen swings from very high to very lowoften
  for several years.

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Normal Progesterone Dominance
Ovulation
Menstrual Cycle
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Perimenopause Luteal InsufficiencyEstrogen
Dominance
Inadequate Luteal Phase shorter periods, early
spotting
Ovulation
Menstrual Cycle
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Perimenopause AnovulationEstrogen
Dominance
Menstrual Cycle
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Menopause
Estrogen and Progesterone Deficiency
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Also Uterine and Ovarian Cancer
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Menopause

• Estrogen Deficiency
• Progesterone Deficiency
• Testosterone Deficiency
• After menopause, women depend upon their
  adrenal glands for androgens and estrogens, so
• Menopause
• Adrenal Insufficiency
• BIG TROUBLE

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Effects of Combined Sex-Hormone Deficiency

• Irritability, insomnia, brain dysfunction
• Alzheimers dementia
• Fatigue, aches and pains.
• Osteoporosis?fractures, loss of teeth
• Genital atrophy, vaginal dryness
• Atrophy of skin and connective tissue
• Heart diseasehigher risk than men after 65,
  higher mortality after 70!

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Estradiol Restoration

• Eliminates hot flashes
• Restores mood and mental function
• Probably protects against Alzheimers disease
• Maintains genital/vaginal skin and lubrication
• Increases thickness, fullness of skin and hair
• Prevents heart disease
• Prevents colon cancer and macular degeneration
• Improves insulin sensitivityhelps diabetes
• Prevents osteoporosis and osteoarthritis

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Speroff L, Fritz M Clinical Gynecologic
Endocrinology and Fertility, 7th Ed.
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Osteoporosis

• In menopause 5 bone loss each year for first 5
  years25all due to loss of estrogen!
• 20 yrs. post menopause50 reduction in
  trabecular bone, 30 in cortical bone
• 50 of women gt65 yrs. old have spinal compression
  fractures
• 14 lifetime risk of hip fracture for 50 yr.old
  woman, 30 for 80 yr. old.

Speroff L, Fritz M Clinical Gynecologic
Endocrinology and Fertility, 7th Ed.
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Osteoporosis

• A hormone deficiency diseasethe proper treatment
  is hormone restoration!
• Estrogen prevents resorption of old bone while
  testosterone, progesterone, DHEA and GH build new
  bone
• J Clin Endo Metab. 1996 8137-43.
• J Reprod Med. 1999 Dec44(12)1012-20.
• Combined BHR increases bone density far better
  than Fosamax? and preserves normal bone
  remodeling (no rotting jaw, eye inflammation,
  ?Ca).

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Estrogen, Progesterone, and Osteoporosis

• Any Questions?

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Total and Free Testosterone in Men
Baltimore Longitudinal Study of Aging (BLSA).
Harman et al., 2001
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Andropause in Men

• Testosterone levels decline slowly in menJust
  getting old.
• Fatigue, reduced mental function
• Passivity and moodinessloss of drive and
  ambition
• Loss of muscle mass, increased abdominal fat
• Lastly loss of libido, no morning erections
• Increased risk of heart and prostate disease
• Increased risk of Alzheimers dementia
• Increased risk of autoimmune diseases

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Testosterone Restoration

• Improves mood and sociability
• Restores energy and ambition
• Improves cognition
• Increases libido and sexual performance
• Increases muscle and bone mass
• Reduces abdominal fat, improves insulin
  sensitivity, lowers blood pressure--counteracts
  metabolic syndrome

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Testosterone and the Heart

• Low testosterone levels, correlate with coronary
  artery disease and stroke
• Arterioscler Thromb. 1994 14701-706
• Eur Heart J 2000 21 8904
• Int J Cardiol. 1998 Jan 3163(2)161-4
• Arterioscler Thromb Vasc Biol. 1996
  Jun16(6)749-54
• T dilates coronary arteriesimproves angina
• T increases heart muscle size, strength
• T decreases fibrinogen levelsprevents blood
  clots
• Endocr Res. 200531(4)335-44.

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Testosterone and the Prostate

• Higher testosterone levels do not increase the
  risk of prostate cancer.
• Studies of testosterone supplementation have
  shown no increase in prostate cancereven though
  so many men have it!
• Low testosterone correlated with more aggressive
  prostate cancers
• Testosterone promotes prostate growth to a point,
  but not prostate cancer

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Wheres the Beef?

• These results argue against an increased risk of
  prostate cancer with testosterone replacement
  therapy.
• Testosterone replacement therapy and prostate
  risks where's the beef? Can J Urol. 2006 Feb13
  Suppl 140-3.

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Estrogen Dominance Theory of Prostate Disease

• In many men, free testosterone declines gt
  estradiol
• Estrogen dominance is a probable cause of
  prostrate enlargement and a possible cause of
  prostate cancer
• Elevated estrogen/Test. ratios in BPH
  Scandinavian Journal of Urology and Nephrology,
  1995 29 65-68.
• High levels of estradiol and estrone found in BPH
  tissues
• Estradiol upregulates oncogenes

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Female Andropause

• Young womans free testosterone level in serum is
  2x her free estradiol
• Female testosterone levels decline 50 between
  age 20 and 45
• Birth control pills??testosterone and DHEA levels
• DHEA declines with agemain source of androgens
  in women

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Testosterone for Women

• Improves energy, mood
• Improves sexual desire and response
• Increases muscle strength and reduces muscle and
  joint aches
• With estradiol, increases bone density
• J Reprod Med. 1999 Dec44(12)1012-20.
• Probably decreases risk of heart attack
• J Womens Health. 1998 Sep7(7)825-9.
• Given with estradiol and progesterone, reduces
  risk of breast cancer
• Menopause. 2003 Jul-Aug10(4)292-8, Endocr Rev.
  2004 Jun25(3)374-88.
• Menopause. 2004 Sep-Oct11(5)531-5, FASEB J.
  2000 Sep14(12)1725-30.

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Testosterone

• Any Questions?

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My doctor says that hormone replacement is
dangerous and theres no evidence that
bioidentical hormones are safer!
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Two Approaches to Medicine

• Natural-ScientificIdentify the deficiency/excess
  at the molecular level and correct it with
  bioidentical molecules
• PharmaceuticalCreate non-natural, patentable
  substances that will produce some improvement
• Natural Science should be primary
  Pharmaceutical Science secondary.

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Problems with Pharmaceuticals

• Alien molecules not recognized, not easily
  eliminated
• Negative functions disrupt normal physiology by
  blocking receptors, inhibiting enzymes, etc.
• Toxic
• Side effects even at low doses
• Allergic reactions
• Long-term damage

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Pharmaceutical Billions

• Mission Sell pharmaceuticals
• Information controljournals, CME, med. schools,
  professional org.s, etc.
• Strategy Suppress competition (natural
  vitanutrients and hormoneshuman physiology!!)
• Conventional Docs Unaware
• Result Unfounded fear of hormone optimization
  unfounded confidence in toxic drugs

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History of Hormone Replacement Therapy

• Horse-derived Premarin? approved in 1942
• Progesterone synthesized in 1942. Poorly
  absorbed orally
• Chemically altered to make progestinsamong the
  first drugs to be patented.
• HRT came to mean the use of alien molecules
  that had hormone-like effects
• Drug co.s became dependent on HRT profits
• Drug co.s push doctors to use hormone substitutes
  and to ignore or fear natural hormones!!

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Dirty Secret Conventional HRT is really HST!

• Progesterone substitutes
• medroxyprogesterone acetate (MPA-Provera?) and
  30 other progestins
• Estradiol substitutes conjugated equine
  estrogens (CEE-Premarin?) and ethinyl estradiol
  (birth control pills)
• Testosterone substitute oral methyltestosterone
• Patented drugsnot hormones!
• Most docs dont know the difference!

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Premarin?Conjugated Equine Estrogens (CEE)
Human Horse
Estradiol-17ß
Dihydroequilin-17ß
CEE contains at least 10 estrogens, only 3 are
human. CEE contains 3x more Dihydroequilin than
Estradiol. DHE has 10 higher binding affinity
for est. receptors. DHE binds far less to SHBG
and has a slower metabolic clearance The most
abundant estrogen in CEE is Equilin sulfate.
Kuhl H, Climacteric 20058(Suppl 1)363
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EE in Birth Control Pills
Estradiol
Ethinyl estradiol
Acetylene
EE cannot be inactivated by normal oxidation! EE
does not interact with estrogen receptor ?! EE is
12,000-60,000 times more potent by weight! EE is
much more thrombogenic than estradiol
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Progesterone vs. Progestins
Progesterone MPA (Provera?)
Megestrol
?
Every progestin has a different spectrum of
androgenic, estrogenic, glucocorticoid, and
progestational effects!
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Progestin Zoo
Progesterone
Kuhl, Climacteric 20058(Suppl 1)
NAMS-Call em all Progestogens
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Testosterone Substitution
Headlines Testosterone therapies increase risk
of breast cancer.
Methyltestosterone
Testosterone
Methyltestosterone (in Estratest?) aromatizes to
an alien estrogen and increases risk of breast
cancer, also causes liver damage and breast
enlargement in bodybuilders
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Sex Bias

• If a Mans testes are removed or non-functional,
  bioidentical testosterone replacement is started
  immediately
• If a womans ovaries are removed or
  non-functional, she is offered horse hormones or
  hormone-like drugs or is told to Live with it
  .
• It IS a Mans World!

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Birth Control Hormone Substitution is Dangerous

• 2x risk of stroke, heart attack
• 2-30x risk of blood clots
• 1-3x risk of breast cancer
• Increased blood sugar, blood pressure
• 1.5x risk systemic lupus erythematosis
• Liver tumors
• Diagnose and fix the hormonal disorder
• Use a copper IUD for contraception!!

UpToDate 2006
Instead
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2002 WHI StudyMenopausal Prempro? HST is
Dangerous!

• Oral CEE (Premarin?) alone had adverse effects in
  the first year (strokes, blood clots)
• Adding MPA (Provera?, PremPro?) caused more
  adverse effects (breast cancers, heart attacks)
• CEE/MPA caused a large increase in dementia

And we know why these forms of hormone
substitution are dangerous!
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Dangers of Oral Estrogen Replacement

• First-pass effect on the liver??IGF-1, ?SHBG,
  ?CRP, ?clotting factors ? blood clots, strokes,
  heart attacks in the first year
• Smokers have greater risk of clots
• EE increases clotting much more than estradiol,
  Premarin
• Transdermal estradiol has none of these effects!

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Dangers of Estrogen-only HRT

• Estrogen alone, estrogen-progestin HST and BCPs
  all reduce DHEAS and testosterone levels 25-60
• Estrogen without progesterone and
  testosterone?estrogen dominance and ? risk of
  breast cancer and other medical disorders

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Provera? ? Progesterone
Scientific studies show that
Progestins are Dangerous

• Maintains pregnancy
• Improves mood
• Improves sleep
• Diuretic
• Lowers blood sugar
• Maintains estrogen-induced arterial dilation
• Improves lipid profile
• No evidence of ? CVD
• Reduces estrogenic stimulation of breasts
• Prevents breast cancer

• Causes birth defects
• Can cause depression
• Insomnia, irritability
• Fluid retention
• Raises blood sugar
• Counteracts estrogen-induced arterial dilation
• Worsens lipid profile
• Causes heart attacks
• Increases estrogenic stimulation of breasts
• Causes breast cancer

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Atherosclerosis and Clotting

• In both peripheral and cerebral vasculature (of
  live animals), synthetic progestins caused
  endothelial disruption, accumulation of monocytes
  in the vessel wall, platelet activation and clot
  formation, which are early events in
  atherosclerosis, inflammation and thrombosis.
  Natural progesterone or estrogens did not show
  such toxicity.
• Climacteric. 2003 Dec6(4)293-301

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Progesterone and Breast Cancerthe Evidence

• Premenopausal women with low P levels had 5.4
  times greater risk of early breast cancer, 10x
  greater risk for all cancers
• Am J Epidem 1981114209-17.
• Breast cancer victims have signs of progesterone
  resistance
• Br J Obstet Gynaecol. 1998
  Mar105(3)345-51.
• P downregulates BRCA1 and induces apoptosis in
  breast cancer cell lines.
• Anticancer Res. 2005 Jan-Feb25(1A)243-8
  .

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Progesterone and Breast Cancerthe Evidence cont.

• Estrogen cream applied to the breast induces
  proliferation, adding progesterone cream reduces
  proliferation to baseline
• Fertil Steril 1995 63785-91
• Estrogen is carcinogenic in breast cell cultures
  unless progesterone is present
• J Steroid Biochem Mol Biol. 2003
  Oct87(1)1-25.
• Estrogen upregulates cancer-promoting gene bcl-2,
  progesterone downregulates it.
• Ann Clin Lab Sci. 1998 Nov-Dec28(6)360-9.
  

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E3N-EPIC Study
Cohort study 54,000 women 5.8 years f/u c/w
WHI-- 16,000, 6 yr. f/u
No Evidence that BHRT is safer?
Int J Cancer. 2005 Apr 10114(3)448-54.
Bioidentical estradiol plus progesterone
decreased the risk of breast cancer!
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ORDET Study
Int. J. Cancer 112 (2004) (2), pp. 312318.
6,000 women 5 yr. F/U
Higher progesteronelower risk of breast cancer
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Progesterone and Breast CancerConclusion

• The balance of the in vivo evidence is that
  progesterone does not have a cancer-promoting
  effect on breast tissue.
• J Steroid Biochem Mol Biol. 2005
  Jul96(2)95-108
• In fact, the balance of the evidence indicates
  that progesterone protects against breast cancer!
• Sowomen can be given estradiol as long as its
  balanced by progesterone and testosterone!

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Pharmaceutical Corps Dilemma

• They need to control the HRT market
• Their progesterone and estradiol substitutes are
  dangerous
• They cant patent natural hormones
• Pharm. Corps. have to get FDA-approval for every
  natural hormone preparation
• Compounding pharmacies can dispense natural
  hormones cheaply

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Pharm. Corps Choices

• Stop compounding pharmacies so they can control
  of the BHR market?Wyeths appeal to the FDA,
  media propaganda blitz
• Suppress BHR in favor of their substitutes
• Keep looking for substitutes that will provide
  benefits without risks
• Result Your doctors will never learn the truth
  about hormones unless he/she goes looking for it

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Common Sense

• Substitutes are alien molecules!
• Problems caused by hormone substitutes cannot be
  attributed to human hormones until proven
  otherwise.
• Bioidentical hormone restoration should be
  considered safe until proven otherwise!

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Hormone Substitution

• Any Questions?

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Metabolic Regulators Thyroid and Cortisol

• Thyroid sets throttle, cortisol delivers fuel
• Deficiency?reduced metabolic rate?fatigue, brain
  dysfunction, depression, pain
• Subtle deficiency?symptoms and disease
• Usual blood tests are insensitive
• Irrational fear of supplementation
• Underdiagnosed, undertreatedDocs prescribe
  pharmaceuticals (SSRIs) instead

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Hormone Ignorance the Tyranny of the Lab Report

• Reference Range95 of normal people ? optimum
• Male free testosterone 35-155 5x
• Female free testosterone 0.0-2.2 ?
• Free T3 1.8-3.2 2x
• TSH 0.3-5 17x
• If within normal limits no diagnosis
  pharmaceuticals for symptoms
• If below normal, just replace to WNL

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HypothyroidismSymptoms

• Mental fog, depression, anxiety
• Fatigue
• Cold extremities
• Aches and pains
• Hair falling out
• Weight gain
• Constipation
• Self-Test Basal body temperature lt97.8F
  axillary in bed in AM

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Thyroid HormoneT3

• Maintains metabolism, mood, and energy
• Controlled partly by thyroid stimulating hormone
  (TSH) from the pituitary gland
• TSH test is indirect does not measure T3 levels
  or effects in various tissues
• Docs prescribe T4 only (Synthroid? and
  Levoxyl?)prohormone that must be converted to T3
• Docs rarely measure free T3 levels!

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We Need Optimal T3 Levels

• Incidence of severe atherosclerosis doubled with
  lower T3 or higher TSH levels within the normal
  range
• Clin Cardiol. 2003 Dec26(12)569-73
• Lowers cardiac risk factors cholesterol,
  triglycerides, C-reactive protein, homocysteine
  and lipoprotein(a)
• Lowers blood pressure, dilates arteries
• Reduces tendency to form blood clots
• Prevents weight gain

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Fatigue, Fibromyalgia and Depression Epidemic

• Pre-TSH Treat the patients symptoms
• Post-TSH Treat the test (?)
• 1970sDoctors lowered doses by 30
• TSH-normalizing T4 dose?low T3 levels!
• Williams Textbook of Endocrinology.
  Saunders, Philadelphia, pp 357-488)
• T3 alone often effective in fibromyalgia
• T3 alone relieves depression even if tests
  normal!
  J Affect Disord. 2006 Feb

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Rational Approach to Thyroid Restoration

• If S/S of hypothyroidism Treat!
• Give T4 plus T3 (Armour, Cytomel)
• Endocrinology 19961372490-2502
• Increase dose until symptoms gone or S/S of
  excess appear
• Safe--even moderate TSH suppression does not
  cause
• bone loss Horm Res. 200564(6)293-8. Epub 2005
  Nov 1.
• cardiac abnormalities J Clin Endo Metab. 2000
  Jan85(1)159-64.
• muscle wasting Am J Phys Endol Metab. 2005
  Jun288(6)E1067-73.

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Pharmaceuticals, Labs, and Thyroid

• Any Questions?

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Cortisol

• Made in the adrenal glands
• Maintains blood sugar (delivers the fuel)
• Modulates immune system
• Need high amounts when stressed
• Too much?Diabetes, HTN, osteoporosis
• Too little?hypoglycemia, fatigue, autoimmune
  diseases, aches and pains

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Cortisol Deficiency
www.adrenalfatigue.org

• Fatigue, depression
• Aches and pains
• Cant stay asleep
• Cant deal with exercise, stress, or illness
• 2nd wind late at night
• Hypoglycemia, feels better after eating
• Nausea, abdominal discomfort, diarrhea
• Allergies, autoimmune diseases
• Hard to gain, hard to lose weight
• Low blood pressure, salt and sugar cravings

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Mild-to-ModerateCortisol Deficiency

• Blood tests are insensitive, need diurnal
  salivary cortisol profile
• Underdiagnosed Docs taught only about severe
  adrenal insufficiency due to physical
  destruction of the adrenal glands (Addisons
  Disease) or pituitary
• Common cause of chronic fatigue, pain
• Clue Felt great when taking prednisone

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Normal Saliva Cortisol Profile
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Cortisol Deficiency
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Cortisol DeficiencyNormal Waking Cortisol
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DepressionElevated PM Cortisol
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Cortisol Restoration

• Mild deficiency can resolve with ?stress, ?rest,
  nutrient restoration
• Moderate-to-severeneed cortisol, not cortisol
  substitutes like prednisone
• Physiological doses (5 to 20mglt1-4mg
  prednisone)NOT excessive doses that cause
  hypertension, diabetes, osteoporosis, etc.
• Fears of low-dose cortisol unfounded
• Dr. William Jeffries Safe Uses of Cortisol

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DHEAThe Other Adrenal Hormone

• Most abundant steroid hormone yet ignored
• Cells make testosterone and estradiol with it
• Levels decline with age, stress and disease
• Anabolicbuilds tissues, improves immunity
• Reduces abdominal fat
• Reduces painrestores natural endorphins
• Reduces inflammation (?IL-6, TNF-?, ?IL-2)
• Anti-cancer effect in animal, in vitro studies
• Lower levels assoc. with ?disease, ?mortality

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Fatigue, Depression, and Pain

• Should be considered as due to a nutrient,
  thyroid, cortisol, or DHEA deficiency until
  proven otherwise by testing and by trials of
  nutrient and hormone restoration.

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Cortisol and DHEA

• Any Questions?

93
What Else Can Hormone Replacement Help?

• Infertility, PMS, heavy bleeding
• Insomniaalmost always helps
• Heart failure
• Mental disorders
• Autoimmune diseases (systemic lupus
  erythematosis, rheumatoid arthritis, ulcerative
  colitis, Crohns disease, etc.)
• Allergies, skin diseases

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Hormone Restoration

• Unresolved issuesmore investigation needed
• Need more long-term randomized studies to study
  long-term results
• Questions about delivery and monitoring
• Medical profession should be studying
  bioidentical hormones instead of hormone
  substitutes!

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Local Compounding Pharmacies

• Winola PharmacyRt. 307 at Lake Winola, 378-2885
• Harrolds PharmacyWilkes-Barre, 822-5794
• Finos PharmacyDallas, 675-1141
• Hazle Drugs ApothecaryHazelton phone
  1-800-439-2026

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Doing BHRT

• History, consent, fees online
• Initial visit order tests
• F/U visit Resultsprescriberetest
• Repeat until stabilized at proper dose
• Follow-up office visit once every 6 months, test
  only as needed.
• Telephone and e-mail contactcharges for clinical
  decisions, refills, etc.

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Costs

• Physician time only as required--first year
  200-400 then lt200/yr.
• No insurance billing may submit claim for
  recognized diagnosis
• Hormones10 to 70/month, some covered by
  insurance (GH adds 130/mo.)
• Diurnal salivary cortisol test120
• Blood testsinsurance may pay, lab kits
  170-220, Saliva/blood kit299
• Out-of-pocket expenses tax-deductible

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For More Information

• The Miracle of Natural Hormones David
  Brownstein, MD
• How to Achieve Healthy AgingLook, Live, and Feel
  Fantastic After 40 Neal Rouzier, MD
• The Hormone SolutionStay Younger Longer Thierry
  Hertoghe, MD
• Life Extension Foundation (www.lef.org)
• BHRT info. and hundreds of abstracts at
  www.hormonerestoration.com.
• Contact me Henry_at_hormonerestoration.com