Bioidentical Hormone Restoration Best Medical Practice

1
Bioidentical Hormone RestorationBest Medical
Practice

• Relax this presentation is available online

2
Topics

• Introduction
• Why Doctors Dont Get It
• Hypometabolism Cortisol and Thyroid
• Hormone Loss with Age
• Estradiol and Progesterone for Menopause
• Progesterone prevents Breast Cancer
• Pharmaceutical Hormone Substitution
• Testosterone for Women and Men
• Compounding Pharmacies
• Practical Issues

3
Hormones

• Parts of our integrated neuro-endocrine-immune
  system
• Travel via blood to all cells
• Control cells proliferation, differentiation,
  protein synthesis, metabolic rate, etc.
• The most powerful molecules in biology
• Optimal levels and effects are essential for
  health and quality of life

4
Central Control
Master Gland
TSH
T3, T4
Cortisol, DHEA Aldosterone
ACTH
LH/FSH
Estradiol, Progesterone Testosterone
Testosterone
5
Human Steroid Hormones
Estradiol
Testosterone
DHEA
Progesterone
Aldosterone
Cortisol
Drug companies have patented 5 to 100 variations
of each molecule.
6
Bioidentical Hormones are not Drugs

• Correct molecular structuresame action at
  receptors, same metabolism and elimination
• Non-toxic
• No side effects, only effects
• No interactions with drugs
• No allergic reactions
• Safe in youthful physiological levels/balance
• Negative effects excessive dose, wrong delivery
  method, or imbalance with other hormones

7
Bioidentical Hormone Restoration is Good Medical
Practice

• If a hormone is missing, replace it! if present
  but deficient, optimize it!
• Type 1 Diabetes bioidentical insulin
• Hypothyroidism bioidentical T4
• Growth hormone def. bioidentical GH
• Adrenal insufficiency bioidentical cortisol
• The Controversies
• How do we diagnose deficiency?
• How do we decide which dose is right?
• What do we do about deficiencies due to aging?

8
Why Docs Dont Get It Reference Range
Endocrinology

• Normal ranges are misunderstood
• 95 of all persons tested (only 2.5 low)
• 95 of tested persons of same age
• Optimal values (glucose, cholesterol)
• Docs assume that all ranges are optimals!
• Male free testosterone 35-155 5x!
• Female free testosterone 0.0-2.2 ?!
• Thyroid - Free T4 0.6-1.8 3x!
• AM serum cortisol 5-25
  5x!
• Normal result?no hormonal dx/rx?drugs

May mean
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Reference Range Endocrinology
95/5 population range
Hormone Effect
Everything is Normal
Disease
Disease
No Disease
But hormone effects work on a continuumno
cut-offs in Nature
0
1
2
Hormone Level
FT4 ng/dL
10
Intelligent Endocrinology
Tighter range based on carefully screened young
healthy persons Individualized Diagnosis and
Treatment
Hormone Effect
Optimal??
0
1
2
FT4 ng/dL
Hormone Level
11
Hypometabolism Thyroid and Cortisol
Insufficiency

• Thyroid sets throttle, cortisol delivers the fuel
• Our health and quality of life require optimal
  levels of both hormones!
• Deficiency?reduced metabolic rate?fatigue, brain
  dysfunction, depression, pain
• Conventional tests are insensitive to most
  deficiencies
• Irrational fear of thyroid and cortisol
  supplementation
• Underdiagnosed, undertreatedDocs prescribe
  pharmaceuticals instead (SSRIs, amphetamines,
  anti-seizure drugs, anti-psychotics, sedatives,
  etc.)

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Glucocorticoids (Steroids)
Cortisol (hydrocortisone)
Methylprednisolone (5x) Medrol
Dexamethasone (70x) Decadron
Prednisone (4x)
13
Cortisol

• Made in the adrenal glands
• Maintains blood sugar (delivers the fuel)
• Modulates the immune system
• We need higher levels with stress, disease
• Too much?Diabetes, HTN, osteoporosis
• Too little?fatigue, depression, anxiety,
  autoimmune diseases, hypoglycemia, allergies,
  aches pains
• Women have lower cortisol levels/effects than
  men.

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Mild-to-ModerateCortisol Insufficiency

• Blood cortisol and ACTH stimulation tests are
  insensitive, need to do 24 hr. saliva testing
• Undiagnosed Docs only taught to recognize
  Addisons Disease (total adrenal gland failure)
• Common cause of chronic fatigue, pain
• Common cause of thyroid hormone intolerance
• Clues Feels better on prednisone, often needs
  steroids for allergies, illnesses, etc.

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Normal Saliva Cortisol Profile
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Cortisol Deficiency
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Cortisol Restoration

• Mild deficiency can resolve with ?stress, ?rest,
  adrenal supplements
• Moderate-to-severe deficiencyneeds cortisol
  restoration
• Physiological doses of 15-40mg daily do not cause
  hypertension, osteoporosis, diabetes
• Doctors fear of low-dose cortisol unfounded
• See 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
• 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

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Cortisol and DHEA

• Any Questions?

20
Hypothyroidism

• Mental fog, poor concentration
• Depression
• Fatigue, need for excessive sleep
• Cold extremities
• Aches and pains
• Thinning scalp hair
• Weight gain
• Constipation
• Ankle swelling, puffy face

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Thyroid Testing

• Doctors often order only a TSH test--Inadequate
• Thyroid stimulating hormone (TSH) is a pituitary
  hormone. It is NOT a thyroid hormone, it is not a
  measure of thyroid hormone levels.
• Must test free T4 and free T3 levels
• Hypothyroidism symptoms plus one or both hormone
  levels below middle of reference ranges
• Severe hypothyroidism signs and symptoms plus
  both hormones in lower third of ranges.

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We Need Optimal T3 Levels

• Incidence of severe atherosclerosis doubled with
  lower T3 levels within the reference 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

• Fatigue, fibromyalgia, and depression are due to
  low cortisol and/or low thyroid until proven
  otherwise
• Pre-1970s Treat the patients signs and
  symptoms with T4 and T3 (desiccated
  thyroid--Armour ?)
• Post-1970s Treat TSH test using T4 only!
• Doctors often lowered doses by 30-50!
• TSH-normalizing T4 dose often?lower free T3
  levels ?weight gain, persistence of symptoms
• Thyroid optimization helps most patients with
  symptoms and low-normal thyroid levels

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Rational Thyroid Restoration

• If sign/symptoms of hypothyroidism Restore!
• Do not rely on TSH test for diagnosis or
  treatment Fraser WD, Are biochemical tests of
  thyroid function of any value in monitoring
  patients receiving thyroxine replacement? Br Med
  J (Clin Res Ed). 1986 Sep 27293(6550)808-10
• Give T4 plus T3 (Armour?, Cytomel?T4)
• Adjust dose according to symptoms and free
  hormone levels
• Safe
• No bone loss if Vit. D and hormones are restored
• No cardiac abnormalities J Clin Endo Metab. 2000
  Jan85(1)159-64
• No muscle wasting Am J Phys Endol Metab. 2005
  Jun288(6)E1067-73

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Thyroid Restoration

• Any Questions?

26
What should we do about hormones that are lost to
normal aging?
27
DHEA ? DHEA-S
Adrenopause
J Clin Endocrinol Metab. 1997
Aug82(8)2396-402
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Thyropause
Endocr Rev. 1995 Dec16(6)686-715
TSH response to low T4 (2.7-3.2?g/dL)
Carle, Thyroid. 2007 Feb17(2)139-44
29
Growth Hormone (GH)
Somatopause
Clinical Chemistry 48, No. 12, 2002
30
Andropause Testosterone in Men
31
Steroid Loss in WomengtgtMen
Men Women
Progesterone average
Testosterone
90 Loss
50 loss
pg/ml
Less estrogen than old men!
?
?
?
?
DHEA-S 5,000,000pg/ml Cortisol 100,000 pg/ml
32
Common View

• 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
  (?)
• Fits the Pharmaceutical Agenda Take drugs for
  every symptom and disorder caused by hormone loss
  (!!)

33
Against the Common View

• Aging is a natural self-destruct program that
  kicks in around age 25 in humans
• Obesity, high blood pressure, heart attacks,
  autoimmune diseases, and many cancers increase
  years after hormone deficiencies set in and occur
  more often in those with lower hormone levels!
• Studies of balanced hormone restoration show the
  expected benefits and no proof of harm!!

34
New Paradigm Restorative Endocrinology

• Endocrine glands and their feedback control
  systems deteriorate with age.
• Our bodies cease to regulate our hormones for
  optimal health.
• Partial hormone deficiencies are harmful.
• The restoration of youthful/optimal nutrient and
  hormone levels is
• Essential to preventative medicine
• Essential to the treatment of disease
• Essential to our quality of Life!

35
Not Just Sex Hormones

• Estradiol, progesterone, testosterone and
  DHEA are required for the function, growth, and
  maintenance, of all tissues in both sexes!
• Maintain brain function and healthneurosteroids
  affect mood, cognition, memory, pain, etc.
• Maintain the immune systemprogesterone and
  testosterone are mild immunosuppressants
• Maintain connective tissue skin, hair, bone,
  muscle
• Improve insulin sensitivity prevent diabetes
• Reduce blood pressureimprove endothelial
  function
• Prevent atherosclerosis (plaques in arteries)

36
Women Killers and Hormones

• Cardiovascular disease (CVD), osteoporosis, and
  breast cancer are all rare before menopause.
• All three diseases are clearly related to hormone
  deficiency or imbalance.
• Youthful estradiol/progesterone/testosterone
  hormonal milieu protects women from these
  diseases.

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Coronary Heart Disease vs. Age
Female

• AIHW Heart, stroke and vascular diseases -
  Australian facts 2004.

38
Estrogen Replacement Prevents Alzheimers Disease
72 used Premarin? only
Zandi PP, et al., Cache County Study. JAMA. 2002
Nov 6288(17)2123-9. RR 0.46 in Kawas C, The
Baltimore Longitudinal Study of Aging. Neurology
1997481517-1521 RR 0.65 Paganini-Hill A, Arch
Intern Med 19961562213-2217. RR 0.4, Tang
M-X, Lancet 1996348429-432.
39
30
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
  years25due 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.
41
Osteoporosis Prevention and Treatment

• A hormone deficiency diseasethe proper
  prevention and treatment is hormone restoration.
• Estradiol prevents resorption of old bone while
  testosterone, progesterone, DHEA and GH build new
  bone. Raisz LG, J Clin
  Endo Metab. 1996 8137-43
• 
  Barrett-Connor E, J Reprod Med. 1999
  Dec44(12)1012-20
• Hormone restoration including Vit. D increases
  bone density better than bisphosphonates and
  preserves normal bone remodeling
• Bisphosphonate drugs cause ?Ca, esophageal
  inflammation and cancer, pain, and suppression of
  normal bone formation?poor fracture healing, late
  non-traumatic fractures, and rotting jaw.

42
Female Endocrinology

• Nature makes special demands on the female body
  for reproduction.
• Much more complex hormonal system than men
• 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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EstradiolProgesterone Complementarity

• Estradiol (human estrogen) promotes
  breast/uterine proliferation and growth.
• Progesterone stops proliferation and promotes
  maturation and differentiation.
• Differentiated cells cant become cancers.
• Progesterone withdrawal?sloughing and necrosis of
  uterine lining and breast duct epithelium.
  
  Longacre
  TA, Am J Surg Pathol. 1986 Jun10(6)382-93
• High progesterone/estradiol ratio suppresses
  proliferation and prevents cancers
• Estradiol is safe if opposed by progesterone.

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Progesterones Anti-Estrogenic Actions in Uterus
and Breast

• Decreases synthesis of estradiol receptors
• Increases conversion of estradiol to estrone
  (weak estrogen) by inducing 17ß-hydroxysteroid
  dehydrogenase Type 2
• Reduces conversion of estrone to estradiol by
  inhibiting 17ß-HSD Type 1
• Increases sulfation (inactivation) of estrogens

Williams Text. of Endocrinology, 10th Ed., p. 612
45
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
• Endometriosis

Progesterone restoration is the only effective
treatment for estrogen dominance
46
Aging Ovaries

• Females born with a fixed no. of oocytes which
  are continually lost
• With aging, fewer oocytes of lower quality are
  left?reduced estradiol and progesterone
  production beginning as early as age 30
• Lower progesterone?estrogen dominance
• No ovulationno progesterone

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Normal Progesterone Dominance
Ovulation
Ovulation
Menstrual Cycle
48
Perimenopause Luteal InsufficiencyEstrogen
Dominance
Inadequate Luteal Phase shorter periods, early
spotting ?d risk of breast cancer
Ovulation
Menstrual Cycle
49
AnovulationEstrogen Dominance
?d risk of breast and uterine cancers
Menstrual Cycle
50
Menopause
Estradiol and Progesterone Deficiency
51
Estradiol Deficiency

• Hot flashes
• Irritability, insomnia, depression
• Fatigue, aches and pains
• Poor memory, ?d risk of Alzheimers dementia
• Osteoporosis?spine and hip fractures, loss of
  teeth
• Genital atrophy, vaginal dryness
• Atrophy of skin and connective tissue
• Endothelial dysfunction, ?blood pressure
• Increased blood sugar
• Atherosclerosis, heart disease

52
Estradiol Restoration

• Eliminates hot flashes, restores sleep
• Protects cognitive function, improves mood
• Maintains thickness, fullness of skin and hair
• Protects against colon cancer and macular
  degeneration
• Protects against dementia
• Prevents atherosclerosis, hypertension
• Maintains genital/pelvic health
• Improves insulin sensitivityprevents diabetes
• Prevents osteoporosis and osteoarthritis
• Maintains gynecoid fat distribution

53
Q OK, estradiol restoration has many benefits,
but wont it increase the risk of breast
cancer? A Not if progesterone is also restored.
54
E3N-EPIC Study
Cohort study 55,000 women 8 years f/u c/w
WHI-- 16,000, 6 yr. f/u
TD-E2transdermal estradiol

No HRT
Int J Cancer. 2005 Apr 10114(3)448-54
E2 plus progesterone no increased risk of breast
cancer!
See also De Lignieres B, de Vathaire F, Fournier
S, et al. Combined hormone replacement therapy
and risk of breast cancer in a French cohort
study of 3175 women. Climacteric 2002533240.
55
Ordet Study Int. J. Cancer 112 (2004) (2), pp.
312318.
Progesterone vs. Breast Cancer in
menstruating women
6,000 women 5 yr. F/U
Risk of breast cancer
Higher progesteronelower risk of breast cancer
56
Progesterone vs. Breast Cancer

• Progesterone cream applied to the breast reduces
  proliferation. Chang
  KJ, Fertil Steril 1995 63785-91
  Barrat J, J Gynecol Obstet Biol Reprod
  (Paris). 199019(3)269-74 Foidart
  JM, Fertil Steril. 1998 May69(5)963-9
• Estradiol is carcinogenic in breast cell cultures
  unless progesterone is present.
• Russo J, J Steroid Biochem Mol
  Biol. 2003 Oct87(1)1-25
• Normal breast cells proliferate after E2
  treatment, but become quiescent when P is added.
  Malet C, J
  Steroid Biochem Mol Biol. 2000 Jun73(3-4)171-81
• Foidart JM, Fertil Steril.1998
  May69(5)963-9
• Estrogen upregulates cancer-promoting gene bcl-2,
  progesterone downregulates it.
• Formby B, Ann Clin Lab Sci.
  1998 Nov-Dec28(6)360-9

57
Progesterone vs. Breast Cancer

• Premenopausal women with low progesterone levels
  had 5.4x risk of early breast cancer
• Cowan LD, Am J Epidem
  1981114209-17
• Breast cancer victims have progesterone
  resistance
  Simpson HW, Br J Obstet Gynaecol. 1998
  Mar105(3)345-51
• Progesterone decreases proliferation and induces
  apoptosis in breast cancer cell lines.
• Ansquer Y, Anticancer Res.
  2005 Jan-Feb25(1A)243-8
  Groshong SD, Mol Endocrinol. 1997
  Oct11(11)1593-607
• Progesterone receptor positivity predicts better
  long-term survival with breast cancer
• Costa SD, Eur J
  Cancer. 2002 Jul38(10)1329-34
• Lamy PJ, Breast Cancer Res
  Treat. 2002 Nov76(1)65-71

58
Key Hormones within the Breasts

• Compared to the premenopausal breast,
  postmenopausal breast nipple aspirate fluid has
• Same estradiol concentration (youthful serum
  conc.)
• Much lower progesterone concentration
• Chatterton RT Clin Endocrinol
  Metab. 2005 Mar90(3)1686-91
• Breasts produce estradiol locally from adrenal
  androgens (DHEA, androstenedione)
• Breasts must get progesterone from blood, and
  they concentrate it by a factor of 3 to 4x.
• Gann PH, Cancer Epidemiol Biomarkers Prev.
  2006 Jan15(1)39-44
• In peri-menopause/menopause No progesterone?
  estrogen dominance in the breasts?breast cancer.

59
Breast Cancer Rate vs. Age
Loss of ovarian function?higher risk of breast
cancer
Menopause
Ovarian function
National Cancer Institute. SEER cancer statistics
review 1975-2002. Table IV-3.
60
Top European Researchers Agree!

• The hypothesis of progesterone decreasing the
  proliferative effect of estradiol in the
  postmenopausal breast remains highly plausible
  and should be, until the coming of new evidences,
  the first choice for symptomatic postmenopausal
  women.
• Modena MG, Sismondi P, Mueck AO, Kuttenn F,
  Lignieres B, Verhaeghe J, Foidart JM, Caufriez A,
  
  Genazzani AR The TREAT. Maturitas.
  2005 Sep 1652(1)1-10.

61

• So why are most doctors saying that hormone
  replacement for menopause is dangerous?

62
2002 WHI StudyHRT is Dangerous!

• Premarin? alone given to older postmenopausal
  women had adverse effects in the first year
  (strokes, blood clots) (as with all oral
  estrogens)
• Adding Provera? (Prempro?) caused more adverse
  effects (breast cancers, heart attacks)
• Prempro? caused a large increase in dementia,
  probably vascular.
• Thousands of lawsuits pending drug companies
  running a legal-protection propaganda campaign to
  paint all hormones as equally dangerous!

63
Pharmaceutical Hormone Replacement Therapy

• Horse-urine Premarin? approved in 1942
• Synthesis of first human steroid hormone,
  progesterone, in 1942. Poorly absorbed orally
• Progesterone altered to make progestinsamong
  the first drugs to be patented.
• HRT alien molecules with hormone effects
• Drug Co.s became dependent on HRT profits
• 1942 to presentPharm. Corps. pushed doctors to
  use hormone substitutes and to ignore or fear
  natural hormone restoration!

64
Conventional HRT is really HST Hormone
Substitution Therapy!

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

65
EE in Birth Control Pills
Ethinyl Estradiol
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
highly thrombogenic?DVTs, pulmonary emboli
66
Contraceptive Hormone Substitution is Dangerous

• EE with alien progestin, shuts down ovaries
• Lowers testosterone and DHEAS levels
• ?d risk of blood clots, stroke, heart attack
• 1-3x risk of breast cancer
• ?d blood sugar, blood pressure
• Liver tumors
• Diagnose and fix the hormonal disorder
• Use a copper IUD for contraception!!

UpToDate 2006
Instead of using BCPs
67
Premarin?Conjugated Equine Estrogens
Human Horse
Horse
Estrone Equilin Equilenin
CEE contains at least 10 estrogens, only 3 are
human also contains horse androgens and
progestins.

Klein R The Composition of Premarin. 1998 Int J
Fertil 43223
68
Oral Estrogen Replacement is Dangerous

• First-pass effect on the liver??IGF-1, ?SHBG,
  ?CRP, ?clotting factors? blood clots, strokes,
  heart attacks in the first year
• Transdermal estradiol has none of these effects!
• Oral but not transdermal estrogen is
  associated with an increased VTE risk.
• Canonico M, ESTHER study.
  Circulation. 2007 Feb 20115(7)840-5
• Transdermal estradiol improves insulin
  sensitivity, oral estrogens do not.

69
Progestins ? Progesterone
Progesterone Provera?
Drospirenone
?
Prempro?
Yasmin?
Progestins are often called progesterone, even
in scientific papers!
70
Progestin Zoo
progesterone
Kuhl, Climacteric 20058(Suppl 1)
Every progestin has a different spectrum of
androgenic, estrogenic, glucocorticoid, and
progestational effects!
71
Provera? ? Progesterone
Scientific studies show that

• Maintains pregnancy
• Improves mood
• Improves sleep
• Diuretic
• No effect on 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

72
As Women Choose Bioidenticals ACOG Caves In
to Pharma Pressure

• October 31, 2005, ACOG NEWS RELEASE No
  Scientific Evidence Supporting Effectiveness or
  Safety of Compounded Bioidentical Hormone Therapy
  
• Washington, DC hormone therapy does not
  belong to a class of drugs with an indication for
  individualized dosingACOG recommends that all of
  them should be considered to have the same safety
  issues as those hormone products that are
  approved by the FDA and may also have additional
  risks unique to the compounding process.
• (So.No differences exist between any
  women, estrogens, progestins, bioidentical and
  alien molecules, or oral vs. transdermal
  estrogens. All hormone therapies are the SAME!
  )
• ACOG is funded by Pharmaceutical Corporations
  that make hormone substitutes.
• ACOGs physicians individually receive money from
  these same Pharm. Corps.

73
Common Sense

• Substitutes are alien molecules!
• Problems caused by hormone substitutes cannot be
  attributed to human hormones until proven
  otherwise.
• Problems caused by oral estrogens dont apply to
  transdermal estradiol.
• Bioidentical hormone restoration to restore the
  youthful hormonal milieu must be considered safe
  until proven otherwise!

74
Menopausal Hormone Restoration

• Daily transdermal estradiol combined with
  progesterone (sublingual, transdermal). May stop
  for 5 days each month.
• No need to cycle and bleeduterine lining remains
  thin.
• No need to stop hormones, ever.
• Most women need testosterone and DHEA for optimal
  results.

75
Estradiol and Progesterone Restoration for
Menopause

• Any Questions?

76
Female Andropause

• Young womans free testosterone level is 2x her
  free estradiol
• DHEAS declines with agemain source of androgen
  effect in women
• Female testosterone levels decline 50 between
  age 20 and 45.
• Oral estrogens and birth control pills reduce
  free testosterone and DHEAS levels

77
Testosterone for Women

• Improves energy and mood
• Improves sexual desire and sensation
• Increases muscle and tissue strength
• 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
• Opposes estradiol-induced breast stimulation and
  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

78
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, increased abdominal fat
• Increased blood sugar and blood pressure
• Loss of libido, spontaneous erections, and
  eventually erectile function.

79
Testosterone Restoration for Men

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

80
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
• Testosterone dilates coronary arteriesimproves
  angina
• T increases heart muscle size, strength
• T decreases fibrinogen levelsprevents blood
  clots Endocr Res.
  200531(4)335-44

81
Testosterone and the Prostate

• Lower testosterone levels increase the risk of
  prostate cancer. Endogenous sex hormones and
  prostate cancer a collaborative analysis of 18
  prospective studies. J Natl Cancer Inst. 2008 Feb
  6100(3)170-83, also Morgenthaler A, Urology
  2006681263-7
• Testosterone supplementation does not increase
  the risk of prostate cancer. Morgentaler A,
  Testosterone replacement therapy and prostate
  risks where's the beef? Can J Urol. 2006 Feb13
  Suppl 140-3
• Low testosterone associated with more aggressive
  prostate cancers Slater S, Drugs Aging 2000
  Dec17(6)431-9
• Testosterone promotes prostate growth to a point,
  compared to no testosterone, but does not promote
  prostate cancer.

82
Testosterone for Women and Men

• Any Questions?

83
Growth Hormone

• Declines 14 per decade after age 25
• IGF-1 of many adults equal to hypopituitary
  patients (only 80-110 vs. 300 _at_25yrs.old)
• Deficiency ??heart disease, frailty, depression,
  body fat, bone loss
• GH restoration for GH-deficient adults
• reduces abdominal fat
• lowers blood sugar, cholesterol, and BP
• Improves cognition, mood, sleep, energy, stamina
• Increases muscle, decreases fat
• Improves bone density, skin thickness
• Downside at least 185/mo., daily injections

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What Else Can Hormone Restoration Help?

• Infertility, PMS, heavy bleeding, endometriosis
• Insomniaalmost always
• Heart failure, Angina
• Mood/Anxiety/Cognitive disorders
• Autoimmune diseases (Systemic Lupus
  Erythematosis, Rheumatoid Arthritis, Ulcerative
  Colitis, Crohns Disease, etc.)
• Allergies, skin diseases
• Every disease/disorder!!

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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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Compounding Pharmacies

• USP-certified bioidentical hormones mixed into
  creams, sublingual tablets, capsules.
• Convenient, low cost, locally made
• Winola PharmacyRt. 307 at Lake Winola,
  378-2885
• Harrolds PharmacyW-B, 822-5794
• Finos PharmacyDallas, 675-1141
• Hazle Drugs ApothecaryHazelton 1-800-439-2026

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Controversies

• Best delivery methods
• Ideal doses
• Variations between compounding pharmacies
• When/how to measure levels and effects
• To cycle or not to cycle estradiol and
  progesterone
• Estriol?
• Bioidenticals, especially compounded, not well
  studiedno money.

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Doing HR

• History, consent, contract forms online
• Get saliva and blood tests before visit, or Dr.
  Lindner can order tests at initial visit.
• Individualized adjustment, trial and error
• Follow-up office visits as needed at least every
  6 months initially, once/year when stable.
• Telephone follow-ups as needed. Brief e-mail
  responses are free.

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Costs

• Physician time only as required _at_ 4/min
• No Medicare or insurance billing may submit
  claim for recognized diagnoses
• Hormones10 to 80/month from compounding
  pharmacy, often covered by insurance
• Diurnal salivary cortisol test138, or insurance
• Blood testsinsurance usually covers, or pay for
  discount labs 50 to 300
• Out-of-pocket professional fees and prescription
  hormones are tax-deductible

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For More Information

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