hormone seminar

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hormone seminar

  1. 1.   “ The compounding specialists” Welcome
  2. 2. Hormones <ul><ul><li>Powerful chemical messengers </li></ul></ul><ul><ul><li>Derived from cholesterol </li></ul></ul><ul><ul><li>Made in the brain, ovaries, testicles, adrenal glands and body fat </li></ul></ul><ul><ul><li>Affect every tissue in the body </li></ul></ul><ul><ul><li>Overall effect depends on the balance between various hormones </li></ul></ul><ul><ul><li>Duration of exposure is as important as dose </li></ul></ul>
  3. 3. Bio-Identical Hormones <ul><ul><li>Bio-Identical Hormones are chemically identical to those in the human body </li></ul></ul><ul><ul><ul><li>Derived from cholesterol-like molecules called saponins (extracted from soybeans and yams) </li></ul></ul></ul><ul><ul><ul><ul><li>Plants do not make hormones (only precursors) </li></ul></ul></ul></ul><ul><ul><ul><li>Some available without prescription (ProGest) </li></ul></ul></ul><ul><ul><ul><li>Others require prescription </li></ul></ul></ul><ul><ul><ul><ul><li>a few manufactured products (eg: Vivelle, Estrace, Prometrium) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>custom compounded medications </li></ul></ul></ul></ul>
  4. 4. Estrogens Estriol, Estradiol, Estrone <ul><ul><li>Exert a stimulating effect on breast, uterus and brain </li></ul></ul><ul><ul><li>Prevent bone loss by osteoclasts </li></ul></ul><ul><ul><li>Involved in vasodilation and improved blood flow </li></ul></ul><ul><ul><li>Promote fat storage at hips </li></ul></ul><ul><ul><li>Maintain integrity of urogenital tract </li></ul></ul>
  5. 5. Progesterone <ul><ul><li>There is only ONE progesterone </li></ul></ul><ul><ul><li>Works synergistically with estrogens </li></ul></ul><ul><ul><ul><li>Balances effect of estrogens in many cases </li></ul></ul></ul><ul><ul><ul><ul><li>slows cell growth </li></ul></ul></ul></ul><ul><ul><ul><ul><li>normalizes blood clotting </li></ul></ul></ul></ul><ul><ul><ul><ul><li>enhances estrogen’s cardiovascular benefits </li></ul></ul></ul></ul><ul><ul><ul><ul><li>decreases fluid retention (bloating) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>improved fat metabolism </li></ul></ul></ul></ul><ul><ul><li>Progesterone levels drop at peri-menopause </li></ul></ul>
  6. 6. Testosterone <ul><ul><li>Anabolic hormone </li></ul></ul><ul><ul><ul><li>builds and strengthens tissue, bone, urogenital tract, muscle </li></ul></ul></ul><ul><ul><li>Declines with age </li></ul></ul><ul><ul><li>Vasodilator </li></ul></ul><ul><ul><li>Balances effects of estrogen and cortisol </li></ul></ul><ul><ul><li>Important for sex drive/sexual response </li></ul></ul>
  7. 7. Dehydroepiandrosterone (DHEA) <ul><ul><li>Made in the adrenal glands </li></ul></ul><ul><ul><li>Declines steadily with age </li></ul></ul><ul><ul><li>Has important roles in immune function, ability to handle stress, and glucose disposal </li></ul></ul><ul><ul><li>Balances cortisol </li></ul></ul><ul><ul><li>Can convert into testosterone and estradiol </li></ul></ul>
  8. 8. Cortisol <ul><ul><li>Made in the adrenal glands </li></ul></ul><ul><ul><li>Catabolic hormone: breaks down tissue (part of the normal cycle of remodeling) </li></ul></ul><ul><ul><li>Balances testosterone </li></ul></ul><ul><ul><li>Stress hormone: modulates immune function, raises blood glucose, stores fat for energy </li></ul></ul><ul><ul><li>In excess: osteoporosis, muscle wasting, obesity, brain neuron atrophy </li></ul></ul>
  9. 9. Thyroid Hormone <ul><ul><li>Determines metabolic rate </li></ul></ul><ul><ul><ul><li>Nutrient utilization by tissue </li></ul></ul></ul><ul><ul><ul><ul><li>(fats, carbs, and protein) </li></ul></ul></ul></ul><ul><ul><ul><li>Effect protein synthesis </li></ul></ul></ul><ul><ul><ul><li>Regulate bone growth </li></ul></ul></ul><ul><ul><ul><li>Heat generation </li></ul></ul></ul><ul><ul><li>Interacts with cortisol, progesterone, testosterone and estradiol </li></ul></ul>
  10. 10. Female Hormone Patterns Menarche to Menopause <ul><ul><li>Teens </li></ul></ul><ul><ul><ul><li>Anovulatory cycles are common </li></ul></ul></ul><ul><ul><ul><li>Low Progesterone </li></ul></ul></ul><ul><ul><ul><li>Estrogen Dominance </li></ul></ul></ul>
  11. 11. Female Hormone Patterns Menarche to Menopause <ul><ul><li>20 to 30 years old </li></ul></ul><ul><ul><ul><li>May have regular monthly bleeding but may not be ovulating </li></ul></ul></ul><ul><ul><ul><li>If stressed: PMS </li></ul></ul></ul><ul><ul><ul><li>Unbalanced hormone levels affect fertility and pregnancy </li></ul></ul></ul>
  12. 12. Female Hormone Patterns Menarche to Menopause <ul><ul><li>40 to 50 years old </li></ul></ul><ul><ul><ul><li>Peak progesterone level declines </li></ul></ul></ul><ul><ul><ul><li>Total progesterone output throughout the luteal phase declines </li></ul></ul></ul><ul><ul><ul><li>Average estradiol level increases </li></ul></ul></ul><ul><ul><ul><ul><li>May lead to estrogen dominance </li></ul></ul></ul></ul><ul><ul><ul><li>Ovaries may secrete more testosterone instead of progesterone </li></ul></ul></ul><ul><ul><ul><li>Anovulatory cycles with irregular bleeding </li></ul></ul></ul>
  13. 13. Female Hormone Patterns Menarche to Menopause <ul><ul><li>40 to 50 years old </li></ul></ul><ul><ul><ul><li>Estrogen dominance </li></ul></ul></ul><ul><ul><ul><li>Functional hypothyroidism </li></ul></ul></ul><ul><ul><ul><li>Normal TSH, but classic symptoms of under-active thyroid </li></ul></ul></ul><ul><ul><ul><li>Weight gain </li></ul></ul></ul><ul><ul><ul><li>Feeling cold </li></ul></ul></ul><ul><ul><ul><li>Dry skin, thinning scalp hair </li></ul></ul></ul><ul><ul><ul><li>Aching muscles </li></ul></ul></ul><ul><ul><ul><li>Fatigue </li></ul></ul></ul><ul><ul><ul><li>Low sex drive </li></ul></ul></ul>
  14. 14. Female Hormone Patterns Menarche to Menopause <ul><ul><li>50+ & Menopause </li></ul></ul><ul><ul><ul><li>Estradiol level drops </li></ul></ul></ul><ul><ul><ul><li>Estrone level stays the same or rises </li></ul></ul></ul><ul><ul><ul><li>Ovary stops making progesterone and testosterone </li></ul></ul></ul>
  15. 15. Symptoms of Hormone Imbalance <ul><ul><li>Estrogen Excess </li></ul></ul><ul><ul><ul><li>Tender, swelling, and/or fibrocystic breasts </li></ul></ul></ul><ul><ul><ul><li>Water retention </li></ul></ul></ul><ul><ul><ul><li>Irritability </li></ul></ul></ul><ul><ul><ul><li>Weight gain at hips </li></ul></ul></ul><ul><ul><ul><li>Sometimes increased headaches or migraines </li></ul></ul></ul><ul><ul><ul><li>Hypothyroid symptoms </li></ul></ul></ul>
  16. 16. Symptoms of Hormone Imbalance <ul><ul><li>Estrogen Deficiency </li></ul></ul><ul><ul><ul><li>Hot flashes & night sweats </li></ul></ul></ul><ul><ul><ul><li>Vaginal dryness (also lips, skin, eyes...) </li></ul></ul></ul><ul><ul><ul><li>“ Brain fog” & memory problems </li></ul></ul></ul><ul><ul><ul><li>Urinary incontinence (stress incontinence) </li></ul></ul></ul><ul><ul><ul><li>Depression </li></ul></ul></ul><ul><ul><ul><li>Bone loss </li></ul></ul></ul>
  17. 17. Symptoms of Hormone Imbalance <ul><ul><li>Estrogen Deficiency </li></ul></ul><ul><ul><ul><li>Low percent of body fat = at risk for low estrogen </li></ul></ul></ul><ul><ul><ul><ul><li>Estrogen CAN be made in body fat...if you have enough! </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Women with enough body fat may not need estrogen supplementation for menopause </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Women with low body fat may need extra estrogen </li></ul></ul></ul></ul>
  18. 18. Symptoms of Hormone Imbalance <ul><ul><li>Progesterone Deficiency </li></ul></ul><ul><ul><ul><li>Irregular periods (teens and pre-menopause) </li></ul></ul></ul><ul><ul><ul><li>Tender and/or fibrocystic breasts </li></ul></ul></ul><ul><ul><ul><li>Water retention </li></ul></ul></ul><ul><ul><ul><li>Irritability </li></ul></ul></ul><ul><ul><ul><li>Anxiety/depression </li></ul></ul></ul><ul><ul><ul><li>Weight gain at hips </li></ul></ul></ul><ul><ul><ul><li>Migraines </li></ul></ul></ul><ul><ul><ul><li>Hypothyroid symptoms </li></ul></ul></ul>
  19. 19. Symptoms of Hormone Imbalance <ul><ul><li>Androgen (Testosterone) Excess </li></ul></ul><ul><ul><ul><li>Acne, oily skin </li></ul></ul></ul><ul><ul><ul><li>Facial hair growth </li></ul></ul></ul><ul><ul><ul><li>Weight gain at waist </li></ul></ul></ul><ul><ul><ul><li>High triglycerides </li></ul></ul></ul><ul><ul><ul><li>Seen in insulin resistance, polycystic ovary syndrome, obesity </li></ul></ul></ul>
  20. 20. Symptoms of Hormone Imbalance <ul><ul><li>Androgen (testosterone) Deficiency </li></ul></ul><ul><ul><ul><li>Depression </li></ul></ul></ul><ul><ul><ul><li>Fatigue </li></ul></ul></ul><ul><ul><ul><li>Vaginal dryness </li></ul></ul></ul><ul><ul><ul><li>Low sex drive </li></ul></ul></ul><ul><ul><ul><li>Bone loss </li></ul></ul></ul><ul><ul><ul><li>Decreased sense of well being </li></ul></ul></ul>
  21. 21. Symptoms of Hormone Imbalance <ul><ul><li>Cortisol (Stress Hormone) Excess </li></ul></ul><ul><ul><ul><li>Irritability, anxiety, feel “burned out” </li></ul></ul></ul><ul><ul><ul><li>“ Brain fog” & memory problems </li></ul></ul></ul><ul><ul><ul><li>Bone loss </li></ul></ul></ul><ul><ul><ul><li>Insomnia & fatigue </li></ul></ul></ul><ul><ul><ul><li>Low sex drive </li></ul></ul></ul><ul><ul><ul><li>Weight gain at waist (“apple” profile) </li></ul></ul></ul>
  22. 22. Symptoms of Hormone Imbalance <ul><ul><li>Cortisol Deficiency “Adrenal Fatigue” </li></ul></ul><ul><ul><ul><li>Usually preceded by prolonged stress/chronic illness </li></ul></ul></ul><ul><ul><ul><li>Fatigue, feel “flat” or “burned out” </li></ul></ul></ul><ul><ul><ul><li>Allergies; immune function low </li></ul></ul></ul><ul><ul><ul><li>Feel cold all the time </li></ul></ul></ul><ul><ul><ul><li>Can’t get started in the morning </li></ul></ul></ul><ul><ul><ul><li>Low sex drive </li></ul></ul></ul><ul><ul><ul><li>Depression </li></ul></ul></ul><ul><ul><ul><li>Unstable blood sugar </li></ul></ul></ul>
  23. 23. Approach to Female Hormone Imbalances <ul><ul><li>The solution isn’t always HRT </li></ul></ul><ul><ul><ul><li>Stress reduction (good diet, sleep, exercise, relaxation training) </li></ul></ul></ul><ul><ul><ul><li>Weight loss </li></ul></ul></ul><ul><ul><ul><li>Address insulin resistance </li></ul></ul></ul><ul><ul><ul><li>Nutrients </li></ul></ul></ul><ul><ul><ul><li>Herbs </li></ul></ul></ul>
  24. 24. Male Hormone Patterns <ul><ul><li>Young Males </li></ul></ul><ul><ul><ul><li>High testosterone </li></ul></ul></ul><ul><ul><ul><li>Low estradiol </li></ul></ul></ul><ul><ul><ul><li>Low progesterone </li></ul></ul></ul>
  25. 25. Male Hormone Patterns <ul><ul><li>35 + years old </li></ul></ul><ul><ul><li>Testosterone drops about 1% per year </li></ul></ul><ul><ul><li>Estradiol and estrone may rise; Prog stays low </li></ul></ul><ul><ul><li>Gain weight around middle </li></ul></ul><ul><ul><li>Sleep problems associated with excess weight may lead to increased cortisol </li></ul></ul><ul><ul><li>Abdominal fat converts testosterone to estradiol under the influence of cortisol </li></ul></ul><ul><ul><li>Cortisol and estradiol directly oppose the action of testosterone </li></ul></ul><ul><ul><li>High estradiol is sensed by the brain and may shut down testosterone production </li></ul></ul>
  26. 26. Approach to Male Hormone Imbalances <ul><ul><li>Weight loss </li></ul></ul><ul><ul><li>Weight training </li></ul></ul><ul><ul><li>Reduce dietary estrogen burden </li></ul></ul><ul><ul><li>Testosterone supplementation </li></ul></ul><ul><ul><li>Aromatase inhibitors </li></ul></ul>
  27. 27. Solving Hormone Problems <ul><ul><li>History 85% </li></ul></ul><ul><ul><li>Physical examination 10% </li></ul></ul><ul><ul><li>Lab tests 5% </li></ul></ul><ul><ul><li>Respect individual differences </li></ul></ul><ul><ul><li>Endocrinology will always be somewhat of an art, not an exact science </li></ul></ul>
  28. 28. Role of Testing <ul><ul><li>Symptoms help us reach a tentative diagnosis </li></ul></ul><ul><ul><li>Lab testing confirms or refutes the diagnosis </li></ul></ul><ul><ul><li>Need to do comprehensive testing </li></ul></ul>
  29. 29. Thank You John C. Richards Pharm.D. Barbara Dace Pharm.D. Professional Village Pharmacy 916-483-3455 www.ProfessionalVillageRx.com

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