Hormone seminar (3 24 10).key,bio-identical hormone replacement,Professional Village Pharmacy,compounding pharmacy

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Hormones

Hormones  Powerful chemical messengers

Hormones  Powerful chemical messengers  Derived from cholesterol

Hormones  Powerful chemical messengers  Derived from cholesterol  Made in the brain, ovaries, testicles, adrenal glands and body fat

Hormones  Powerful chemical messengers  Derived from cholesterol  Made in the brain, ovaries, testicles, adrenal glands and body fat  Affect every tissue in the body

Hormones  Powerful chemical messengers  Derived from cholesterol  Made in the brain, ovaries, testicles, adrenal glands and body fat  Affect every tissue in the body  Overall effect depends on the balance between various hormones

Hormones  Powerful chemical messengers  Derived from cholesterol  Made in the brain, ovaries, testicles, adrenal glands and body fat  Affect every tissue in the body  Overall effect depends on the balance between various hormones  Duration of exposure is as important as dose

Bio-Identical Hormones

Bio-Identical Hormones  Bio-Identical Hormones are chemically identical to those in the human body  Derived from cholesterol-like molecules called saponins (extracted from soybeans and yams)  Plants do not make hormones (only precursors)  Some available without prescription (ProGest)  Others require prescription  a few manufactured products (eg: Vivelle, Estrace, Prometrium)  custom compounded medications

Estrogens Estriol, Estradiol, Estrone

Estrogens Estriol, Estradiol, Estrone  Exert a stimulating effect on breast, uterus and brain

Estrogens Estriol, Estradiol, Estrone  Exert a stimulating effect on breast, uterus and brain  Prevent bone loss by osteoclasts

Estrogens Estriol, Estradiol, Estrone  Exert a stimulating effect on breast, uterus and brain  Prevent bone loss by osteoclasts  Involved in vasodilation and improved blood ﬂow

Estrogens Estriol, Estradiol, Estrone  Exert a stimulating effect on breast, uterus and brain  Prevent bone loss by osteoclasts  Involved in vasodilation and improved blood ﬂow  Promote fat storage at hips

Estrogens Estriol, Estradiol, Estrone  Exert a stimulating effect on breast, uterus and brain  Prevent bone loss by osteoclasts  Involved in vasodilation and improved blood ﬂow  Promote fat storage at hips  Maintain integrity of urogenital tract

Progesterone

Progesterone  There is only ONE progesterone

Progesterone  There is only ONE progesterone  Works synergistically with estrogens  Balances effect of estrogens in many cases  slows cell growth  normalizes blood clotting  enhances estrogen’s cardiovascular beneﬁts  decreases ﬂuid retention (bloating)  improved fat metabolism

Progesterone  There is only ONE progesterone  Works synergistically with estrogens  Balances effect of estrogens in many cases  slows cell growth  normalizes blood clotting  enhances estrogen’s cardiovascular beneﬁts  decreases ﬂuid retention (bloating)  improved fat metabolism  Progesterone levels drop at peri-menopause

Testosterone

Testosterone  Anabolic hormone  builds and strengthens tissue, bone, urogenital tract, muscle

Testosterone  Anabolic hormone  builds and strengthens tissue, bone, urogenital tract, muscle  Declines with age

Testosterone  Anabolic hormone  builds and strengthens tissue, bone, urogenital tract, muscle  Declines with age  Vasodilator

Testosterone  Anabolic hormone  builds and strengthens tissue, bone, urogenital tract, muscle  Declines with age  Vasodilator  Balances effects of estrogen and cortisol

Testosterone  Anabolic hormone  builds and strengthens tissue, bone, urogenital tract, muscle  Declines with age  Vasodilator  Balances effects of estrogen and cortisol  Important for sex drive/sexual response

Dehydroepiandrosterone (DHEA)

Dehydroepiandrosterone (DHEA)  Made in the adrenal glands

Dehydroepiandrosterone (DHEA)  Made in the adrenal glands  Declines steadily with age

Dehydroepiandrosterone (DHEA)  Made in the adrenal glands  Declines steadily with age  Has important roles in immune function, ability to handle stress, and glucose disposal

Dehydroepiandrosterone (DHEA)  Made in the adrenal glands  Declines steadily with age  Has important roles in immune function, ability to handle stress, and glucose disposal  Balances cortisol

Dehydroepiandrosterone (DHEA)  Made in the adrenal glands  Declines steadily with age  Has important roles in immune function, ability to handle stress, and glucose disposal  Balances cortisol  Can convert into testosterone and estradiol

Cortisol

Cortisol  Made in the adrenal glands

Cortisol  Made in the adrenal glands  Catabolic hormone: breaks down tissue (part of the normal cycle of remodeling)

Cortisol  Made in the adrenal glands  Catabolic hormone: breaks down tissue (part of the normal cycle of remodeling)  Balances testosterone

Cortisol  Made in the adrenal glands  Catabolic hormone: breaks down tissue (part of the normal cycle of remodeling)  Balances testosterone  Stress hormone: modulates immune function, raises blood glucose, stores fat for energy

Cortisol  Made in the adrenal glands  Catabolic hormone: breaks down tissue (part of the normal cycle of remodeling)  Balances testosterone  Stress hormone: modulates immune function, raises blood glucose, stores fat for energy  In excess: osteoporosis, muscle wasting, obesity, brain neuron atrophy

Thyroid Hormone

Thyroid Hormone  Determines metabolic rate  nutrient utilization by tissue  fats, carbs, and protein)  affect protein synthesis  regulate bone growth  heat generation

Thyroid Hormone  Determines metabolic rate  nutrient utilization by tissue  fats, carbs, and protein)  affect protein synthesis  regulate bone growth  heat generation  Interacts with cortisol, progesterone, testosterone and estradiol

Female Hormone Patterns Menarche to Menopause

Female Hormone Patterns Menarche to Menopause  Teens  Anovulatory cycles are common  Low Progesterone  Estrogen Dominance

Female Hormone Patterns Menarche to Menopause  20 to 30 years old  May have regular monthly bleeding but may not be ovulating  if stressed: PMS  unbalanced hormone levels affect fertility and pregnancy

Female Hormone Patterns Menarche to Menopause  40 to 50 years old  Peak progesterone level declines  Total progesterone output throughout the luteal phase declines  Average estradiol level increases  may lead to estrogen dominance  Ovaries may secrete more testosterone instead of progesterone  Anovulatory cycles with irregular bleeding

Female Hormone Patterns Menarche to Menopause  40 to 50 years old  Estrogen dominance  Functional hypothyroidism  Normal TSH, but classic symptoms of under-active thyroid  Weight gain  Feeling cold  Dry skin, thinning scalp hair  Aching muscles  Fatigue  Low sex drive

Female Hormone Patterns Menarche to Menopause  50+ & Menopause  Estradiol level drops  Estrone level stays the same or rises  Ovary stops making progesterone and testosterone

Symptoms of Hormone Imbalance

Symptoms of Hormone Imbalance  Estrogen Excess  Tender, swelling, and/or ﬁbrocystic breasts  water retention  irritability  weight gain at hips  sometimes increased headaches or migraines  hypothyroid symptoms

Symptoms of Hormone Imbalance  Estrogen Deﬁciency  Hot ﬂashes & night sweats  vaginal dryness (also lips, skin, eyes...)  “brain fog” & memory problems  urinary incontinence (stress incontinence)  depression  bone loss

Symptoms of Hormone Imbalance  Estrogen Deﬁciency  Low percent of body fat = at risk for low estrogen  estrogen CAN be made in body fat...if you have enough!  women with enough body fat may not need estrogen supplementation for menopause  women with low body fat may need extra estrogen

Symptoms of Hormone Imbalance  Progesterone Deﬁciency  Irregular periods (teens and pre-menopause)  Tender and/or ﬁbrocystic breasts  water retention  irritability  anxiety/depression  weight gain at hips  migraines  hypothyroid symptoms

Symptoms of Hormone Imbalance  Androgen (Testosterone) Excess  Acne, oily skin  Facial hair growth  Weight gain at waist  High triglycerides  Seen in insulin resistance, polycystic ovary syndrome, obesity

Symptoms of Hormone Imbalance  Androgen (testosterone) Deﬁciency  Depression  fatigue  vaginal dryness  low sex drive  bone loss  decreased sense of well being

Symptoms of Hormone Imbalance  Cortisol (Stress Hormone) Excess  Irritability, anxiety, feel “burned out”  “brain fog” & memory problems  bone loss  insomnia & fatigue  low sex drive  weight gain at waist (“apple” proﬁle)

Symptoms of Hormone Imbalance  Cortisol Deﬁciency “Adrenal Fatigue”  Usually preceded by prolonged stress/ chronic illness  Fatigue, feel “ﬂat” or “burned out”  Allergies; immune function low  Feel cold all the time  Can’t get started in the morning  Low sex drive  Depression  Unstable blood sugar

Approach to Female Hormone Imbalances

Approach to Female Hormone Imbalances  The solution isn’t always HRT  Stress reduction (good diet, sleep, exercise, relaxation training)  Weight loss  Address insulin resistance  Nutrients  Herbs

Male Hormone Patterns

Male Hormone Patterns  Young Males  High testosterone  Low estradiol  Low progesterone

Male Hormone Patterns

Male Hormone Patterns  35 + years old

Male Hormone Patterns  35 + years old  Testosterone drops about 1% per year

Male Hormone Patterns  35 + years old  Testosterone drops about 1% per year  Estradiol and estrone may rise; Prog stays low

Male Hormone Patterns  35 + years old  Testosterone drops about 1% per year  Estradiol and estrone may rise; Prog stays low  Gain weight around middle

Male Hormone Patterns  35 + years old  Testosterone drops about 1% per year  Estradiol and estrone may rise; Prog stays low  Gain weight around middle  Sleep problems associated with excess weight may lead to increased cortisol

Male Hormone Patterns  35 + years old  Testosterone drops about 1% per year  Estradiol and estrone may rise; Prog stays low  Gain weight around middle  Sleep problems associated with excess weight may lead to increased cortisol  Abdominal fat converts testosterone to estradiol under the inﬂuence of cortisol

Male Hormone Patterns  35 + years old  Testosterone drops about 1% per year  Estradiol and estrone may rise; Prog stays low  Gain weight around middle  Sleep problems associated with excess weight may lead to increased cortisol  Abdominal fat converts testosterone to estradiol under the inﬂuence of cortisol  Cortisol and estradiol directly oppose the action of testosterone

Approach to Male Hormone Imbalances

Approach to Male Hormone Imbalances  Weight loss

Approach to Male Hormone Imbalances  Weight loss  Weight training

Approach to Male Hormone Imbalances  Weight loss  Weight training  Reduce dietary estrogen burden

Approach to Male Hormone Imbalances  Weight loss  Weight training  Reduce dietary estrogen burden  Testosterone supplementation

Approach to Male Hormone Imbalances  Weight loss  Weight training  Reduce dietary estrogen burden  Testosterone supplementation  Aromatase inhibitors

Solving Hormone Problems

Solving Hormone Problems  History 85%

Solving Hormone Problems  History 85%  Physical examination 10%

Solving Hormone Problems  History 85%  Physical examination 10%  Lab tests 5%

Solving Hormone Problems  History 85%  Physical examination 10%  Lab tests 5%  Respect individual differences

Solving Hormone Problems  History 85%  Physical examination 10%  Lab tests 5%  Respect individual differences  Endocrinology will always be somewhat of an art, not an exact science

Role of Testing

Role of Testing  Symptoms help us reach a tentative diagnosis

Role of Testing  Symptoms help us reach a tentative diagnosis  Lab testing conﬁrms or refutes the diagnosis

Role of Testing  Symptoms help us reach a tentative diagnosis  Lab testing conﬁrms or refutes the diagnosis  Need to do comprehensive testing

Thank You John C. Richards Pharm.D. Barbara Dace Pharm.D. Debby DeJager Pharm.D. P ro f es s i o n al Village Pharmacy 91 6 - 4 8 3 - 3 4 5 5 www.professionalvillagerx.com

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Hormone seminar (3 24 10).key,bio-identical hormone replacement,Professional Village Pharmacy,compounding pharmacy

by Professional Village Compounding Pharmacy & Medical Supplies on May 10, 2010

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Hormone seminar (3 24 10).key,bio-identical hormone replacement,Professional Village Pharmacy,compounding pharmacy — Presentation Transcript