Two Docs Talk:    Thyroid, Adrenals & Sex   Hormones - A Balancing ActLouis B. Cady, MD – CEO & Founder – Cady Wellness In...
Orientation to this talk• Sketch in the fundamental differences  between “wnl” and OPTIMAL• Quick review of hormones havin...
American Journal of Health Promotion;                 November/December, 2002                                    66%      ...
VISION: “We dramatically transform the lives of our patients and clients to levels of peak physical and mental health, sup...
Critical area of concern for men &    women. Things that will make them:•   Tired &/or depressed•   Unable to cope•   “Mea...
How would you take care of a classic?
“Age management”           “Conventional practice”There are fuel additives    No fuel additives shouldwe can use to keep o...
Toward an INTEGRATED approach:   Traditional     INTEGRATED                                                               ...
Interesting lab values – Cady – 3/11/03:Lab               Value       Cenegenics   Normala.m.glucose       87 mg/dl    65 ...
Modern Medicine’s Paradigm:Two Standard Deviations – “if you are not     sick, then you must be well.”                    ...
4
“But the doctor told me my thyroid                was fine.”• Can be “wnl” but suboptimal.• TSH frequently only thing chec...
“the foot soldier” “the evil twin”
“Thyrotropin (Thyroid-StimulatingHormone or TSH). Measuring TSH is themost sensitive indicator ofhypothyroidism.” (hunh?!)...
Rev T3   Se                        CORTISOL“the foot soldier” “the evil twin”
Yes, T-3 DOES get into the brain                  (Transthyretin = carrier protein)    Or: The idiocy of T4 only thyroid t...
“No duh” obvious thyroid teaching               points:• You must get ALL of your thyroid checked -  (not just “TSH.”)• St...
Fatigue from Adrenal FAILURE- The Worst  Case Scenario:            Addison’s Disease
Signs & Symptoms of Adrenal FATIGUE•   Difficulty getting up in a.m.•   Ongoing lethargy during the day.•   Continued fati...
“Hypoadrenia”: The Adrenal Problem that mostconventionally trained physicians don’t know about.•   Non-Addison’s hypoadren...
“Where did this new-fangleddiagnosis come from, anyway?”
Case report:• 55 year old male entrepreneur• Runs company with 200 employees – multi  hundred million dollar budget• Stres...
The state of adrenal exhaustion can           be determinedEarly-stage Chronic   Mid-stage Chronic   End-stage (exhausted)...
DHEA – the critical hormone most         doctors never check• Produced in the adrenal cortex    – Humans and primates are ...
334 citations on “DHEA with energy” – as of                07 29 2011
Other functions of DHEA• Boosts immune system• Sensitizes insulin receptors to work better• Neuroprotective• Has antidepre...
Why isn’t adrenal fatigue diagnosed?• Not a medical emergency.• Patient is blamed”  – “just neurotic”  – “avoidant”• “Func...
Modern Medicine’s Paradigm: 2 Standard Deviations – a model                            “NORMAL”                          O...
“Women’s issues”
One destigmatizing notion:            Estrogen as MAOI• Estrogen & Testosterone (!) decrease  MAO  – Luin, VN. Brain Res. ...
Estrogen-related mood disorders –  reproductive life cycle factors.    Douma SL et al. Adv. Nursing Sci. 2005. 28 (4):364-...
Symptoms of estrogen imbalances*: Hot flushes or flashes; night sweats Mood swings DEPRESSION, and/or anxiety, panic at...
Psychoactive Progesterone* Increases energy and libido Has a calming effect, acting like a  benzodiazepine to the brain ...
Testosterone: The “sexist” bias            against women• Fall in the circulating testosterone and the adrenal  preandroge...
Traditional vs.          Bio-identical “HRT”:• Synthetic means that the molecule is not natural to the human body.• Bio-id...
Women’s Health Initiative Study• Flawed study - it was designed as a  “Premarin & Provera” study, not a  bioidentical estr...
Women’s Health Initiative                 Study• The results presented did not justify  their overall broad conclusion:• “...
Women’s Health Initiative StudyTHE PARTICIPANTS:• 2/3 of the women in the study were older  than sixty• Of these women, mo...
Women’s Health Initiative Study    Facts You Should Know• In the first 1-3 years there was a higher  incidence of M.I.’s.•...
Women’s Health Initiative Study     Facts You Should Know• When the W.H.I. Study was  organized, the subjects were not  pr...
Hx of Baseline Health Characteristics   (total # of participants 16,608)Disease               HRT      PlaceboHypertension...
Traditional vs.             Bio-identical “HRT”:• Premarin raises C-reactive protein  significantly.• CRP is an inflammati...
Some of the “10 reasons” to be happy   [Studd J. Menopause Int. 2010 Mar;16(1):44-6• Trans-derm safer than          • HRT ...
50’ish year old female, post-     menopausal, on no hormones• On aggressive supplement regimen with  daily MVI and others•...
Treatment for this “normal” patient1. Armour thyroid – ¼ grain for 1 week, then ½ grain.   (Aiming for T3 in “high 3’s.”2....
What’s life like now?• “it’s like the colors of the rainbow have gotten more into the  pink.”• “My computer will survive –...
Special needs - Zinc• Low Zinc- associated with low testosterone  – Per USDA, 60% of US men between 20 – 49    years of ag...
Testosterone functions (Men ANDWomen)         • Enhances sex drive         • Builds muscle & decreases           fat      ...
“Hence, among older men reporting excellentasymptomatic health, age has no effect onserum T or E2 with a minor increase in...
Testosterone (Men)    • Decline in male sex steroids not as      abrupt as menopause, but equally      debilitating       ...
Andropause: Characteristics of              Change• Insidious & unpredictable onset• Slow progression• Subtle & variable m...
T vs Cognitive Function• 400 independently living men, 40-80yo  – 100 in each age decade  – MMSE 21-30, average 28  – TT: ...
T vs Mood in men• Study: 278 men, >45yo, followed 2 years• Compared to eugonadal patients,  hypogonadal men w/TT <200ng/dL...
Treatment options – not just       “the needle”
Testosterone and “Prostate Cancer risk”• Prostate CA found 2.15 & 2.26 times more  likely in lowest compared to highest te...
HOW OBVIOUS DOES IT HAVE TO BE?     The Challenge of Empathic Listening              & CREATIVE THINKING                  ...
Do you really want to try 100,000miles without changing the oil?
Definition of ‘normal’ – “where your  hormone levels are as lousy aseveryone else’s.” Neal Rouzier, MD                    ...
“For me, the practice of medicine hasopened the door to the greatest adventure inlife. Medicine is like a hallway lined wi...
Two Docs Talk: Drs. Cady & Gabhart Take it On the Road:
Two Docs Talk: Drs. Cady & Gabhart Take it On the Road:
Two Docs Talk: Drs. Cady & Gabhart Take it On the Road:
Two Docs Talk: Drs. Cady & Gabhart Take it On the Road:
Two Docs Talk: Drs. Cady & Gabhart Take it On the Road:
Two Docs Talk: Drs. Cady & Gabhart Take it On the Road:
Two Docs Talk: Drs. Cady & Gabhart Take it On the Road:
Two Docs Talk: Drs. Cady & Gabhart Take it On the Road:
Two Docs Talk: Drs. Cady & Gabhart Take it On the Road:
Two Docs Talk: Drs. Cady & Gabhart Take it On the Road:
Two Docs Talk: Drs. Cady & Gabhart Take it On the Road:
Two Docs Talk: Drs. Cady & Gabhart Take it On the Road:
Two Docs Talk: Drs. Cady & Gabhart Take it On the Road:
Two Docs Talk: Drs. Cady & Gabhart Take it On the Road:
Two Docs Talk: Drs. Cady & Gabhart Take it On the Road:
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Two Docs Talk: Drs. Cady & Gabhart Take it On the Road:

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Drs Cady and Gabhart of the Cady Wellness Institute deliver a "command performance" at the Kannise Hair Salon in Owensboro - apparently a hotbed interest site for information pertaining to thyroid dysfunction in women. (Hair stylists hear about it all the time!). This was a fun example of staff at CWI "taking it on the road" out to our communities to educate the lay public on topics of self-empowerment.

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  • Addison ’s disease, like so many medical conditions, has a history of being ignored, hidden, and misunderstood.  It is a rare disease that affects about one in every 100,000 Americans and is usually diagnosed around age forty. 
  • One goal is to rectangularize the health span curve. I.e. to improve vitality from middle age onward.
  • These symptoms correlate to decrease in bioavailable testosterone
  • RIA (in-house after diethylether extraction) Total testosterone - T (RIA) 208-1141ng/dL, average 536+/-153ng/dL Bioavailable testosterone - BT (calculated) 78-470ng/dL, average 236+/-63ng/dL
  • Hypogonadal if TT &lt; 200ng/dL or FT &lt; 0.9ng/dL
  • Two Docs Talk: Drs. Cady & Gabhart Take it On the Road:

    1. 1. Two Docs Talk: Thyroid, Adrenals & Sex Hormones - A Balancing ActLouis B. Cady, MD – CEO & Founder – Cady Wellness Institute Adjunct Professor – University of Southern Indiana Adjunct Professor – Indiana University School of Medicine Whitney W. Gabhart, ND Cady Wellness Institute Kennise Salon - Owensboro, KY April 30, 2012
    2. 2. Orientation to this talk• Sketch in the fundamental differences between “wnl” and OPTIMAL• Quick review of hormones having to do with FATIGUE and DEPRESSION: – Thyroid – DHEA – Testosterone/estradiol/progesterone – IGF-1 (“food soldier” of growth hormone)• Exposure to the literature/stimulation
    3. 3. American Journal of Health Promotion; November/December, 2002 66% 19% of those 18.8% “Incompletely healthy” surveyed were completely completely unhealthy, healthy with defined as high levels of having low both physical levels of health and mental with high Two-thirds of the adults health and a levels of reported some low level of illness. degree of mental illness. or physical illness that kept them from being completely healthy. OPTIMAL “Incompletely healthy.”DEAD HEALTH continuum
    4. 4. VISION: “We dramatically transform the lives of our patients and clients to levels of peak physical and mental health, supporting a lifetime of maximum performance and happiness.”
    5. 5. Critical area of concern for men & women. Things that will make them:• Tired &/or depressed• Unable to cope• “Mean”• Stressed• Demented• Deficient in libido or in the bedroom
    6. 6. How would you take care of a classic?
    7. 7. “Age management” “Conventional practice”There are fuel additives No fuel additives shouldwe can use to keep our be used. They arecars burning cleaner and unnatural. Gas is all thatpreserve engines. is required.We should use optimal The quality of the gas isquality of gas. Cheap gas irrelevant. Anything thatcauses “pinging” which is the motor will burn ishard on the engine. adequate.We should take our car in Preventive maintenance? Thisfor preventive is silly! Wait until something breaks, then have the carmaintenance before towed in so the mechanic cananything breaks. really tell what is wrong.
    8. 8. Toward an INTEGRATED approach: Traditional INTEGRATED Optimal Health No Disease = Health Medicine Medicine Forestall and Diagnose and PREVENT Disease – Treat Disease Optimize Mood &Death Function New Drugs Functional New Surgical & Informed Techniques Lab Testing Vitamins, HRT, Nutrition, Exercise
    9. 9. Interesting lab values – Cady – 3/11/03:Lab Value Cenegenics Normala.m.glucose 87 mg/dl 65 – 85 65 – 109Fasting insulin 3 u U/ml <5 <20HgB A1C 4.9 % <5.1% < 6.0 %Cholesterol 241 mg/dl <200 <200Triglycerides 42 mg/dl <120 <150Cor. Risk ratio 3.3 <4.0 Av = 5 – 6Homocysteine 7.9 <8.0 5.4-11.4DHEA-S 148 350 – 500 59 – 452
    10. 10. Modern Medicine’s Paradigm:Two Standard Deviations – “if you are not sick, then you must be well.” “NORMAL” OPTIMAL
    11. 11. 4
    12. 12. “But the doctor told me my thyroid was fine.”• Can be “wnl” but suboptimal.• TSH frequently only thing checked.• Nothing known about Free T4 or Free T3.• Free T4 can be converted to Reverse T3 under stress (cortisol)• Free T4 can be underconverted to T3.• Can have normal levels (or slightly elevated levels) of everything and have auto-immune thyroid disease.
    13. 13. “the foot soldier” “the evil twin”
    14. 14. “Thyrotropin (Thyroid-StimulatingHormone or TSH). Measuring TSH is themost sensitive indicator ofhypothyroidism.” (hunh?!) http://www.umm.edu/patiented/articles/how_serious_hypothyroidism Accessed: 9/5/2011
    15. 15. Rev T3 Se CORTISOL“the foot soldier” “the evil twin”
    16. 16. Yes, T-3 DOES get into the brain (Transthyretin = carrier protein) Or: The idiocy of T4 only thyroid treatment…• Terasaki, T. and Pardridge, W.M.: Stereospecificity of triiodothyronine transport into brain, liver, and salivary gland: role of carrier- and plasma protein-mediated transport. Endocrinology, 121(3):1185-1191, 1987.• http://www.kingpharm.com/uploads/pdf_inserts/Cytomel_PI.pdf.• Mooradian, A.D.: Blood-brain transport of triiodothyronine is reduced in aged rats. Mech. Ageing Dev., 52(2-3):141-147, 1990.• Cheng, L.Y., Outterbridge, L.V., Covatta, N.D., et al.: Film autoradiography identifies unique features of [125I]3,35-(reverse) triiodothyronine transport from blood to brain. J. Neurophysiol., 72(1):380-391, 1994.• Rudas, P. and Bartha, T.: Thyroxine and triiodothyronine uptake by the brain of chickens. Acta Vet. Hung, 41(3-4):395-408, 1993.
    17. 17. “No duh” obvious thyroid teaching points:• You must get ALL of your thyroid checked - (not just “TSH.”)• Stress and/or selenium deficiency can PROFOUNDLY alter it.• Do you want “normal” or “optimal”?
    18. 18. Fatigue from Adrenal FAILURE- The Worst Case Scenario: Addison’s Disease
    19. 19. Signs & Symptoms of Adrenal FATIGUE• Difficulty getting up in a.m.• Ongoing lethargy during the day.• Continued fatigue not relieved by sleep.• Craving for salt or salty foods.• Increased effort to do daily tasks• LESS PRODUCTIVE• Decreased sex drive• Decreased ability to handle stress.• Light-headed when standing up quickly• Increased recovery time for illness• Generally less happy about life.
    20. 20. “Hypoadrenia”: The Adrenal Problem that mostconventionally trained physicians don’t know about.• Non-Addison’s hypoadrenia• Subclinical hypoadrenia• Neurasthenia• Adrenal neurasthenia• Adrenal apathy• Adrenal fatigue• “Adrenal burnout”• “Chronic fatigue syndrome”?!!
    21. 21. “Where did this new-fangleddiagnosis come from, anyway?”
    22. 22. Case report:• 55 year old male entrepreneur• Runs company with 200 employees – multi hundred million dollar budget• Stressed with economy• Very tired in the a.m.• “Crashes” at night.• Still golfing, exercising.• Looks marvelous.
    23. 23. The state of adrenal exhaustion can be determinedEarly-stage Chronic Mid-stage Chronic End-stage (exhausted) Stress Response Stress Response Chronic Stress Response
    24. 24. DHEA – the critical hormone most doctors never check• Produced in the adrenal cortex – Humans and primates are unique in secreting large amounts• Immune system booster• Insulin regulator• Energy increase – remarkable• Boosts growth hormone – 20% in men; 30% in women in one study • [Yen, Morales Khorram – one year double-blind placebo controlled crossover experiment – with 100mg DHEA]
    25. 25. 334 citations on “DHEA with energy” – as of 07 29 2011
    26. 26. Other functions of DHEA• Boosts immune system• Sensitizes insulin receptors to work better• Neuroprotective• Has antidepressant effects – known to decrease suicide risk• Helps with bone retention in all ages of women
    27. 27. Why isn’t adrenal fatigue diagnosed?• Not a medical emergency.• Patient is blamed” – “just neurotic” – “avoidant”• “Functional medicine” testing not typically done (& rarely is DHEA-S checked)• Modern medicine focuses on NORMAL, rather than OPTIMAL. function.• “Bell Curve” paradigm
    28. 28. Modern Medicine’s Paradigm: 2 Standard Deviations – a model “NORMAL” OPTIMAL
    29. 29. “Women’s issues”
    30. 30. One destigmatizing notion: Estrogen as MAOI• Estrogen & Testosterone (!) decrease MAO – Luin, VN. Brain Res. 1975;86:273-306• Platelet MAO levels inversely correlated to estradiol levels – Klaiber EL et al. Psychoneuroendo- crinology. 1997 Oct;22(7):549-58.• Estrogen decreases MAO-A & MAO-B – Holschneider DP et al. Life Sci. 1998;63(3):155-60
    31. 31. Estrogen-related mood disorders – reproductive life cycle factors. Douma SL et al. Adv. Nursing Sci. 2005. 28 (4):364-375• “Clinical recovery from depression postpartum, perimenopause, and postmenopause through restoration of stable/optimal levels of estrogen has been noted.”
    32. 32. Symptoms of estrogen imbalances*: Hot flushes or flashes; night sweats Mood swings DEPRESSION, and/or anxiety, panic attacks “Concentration” issues: Memory, communication, and attention span loss, “brain fog.” (Think: “MORE MAO.”) Insomnia Weight gain – “appetite changes” SOMATIC symptoms : aches and pain General deterioration: Incontinence, digestive disturbances, sensory function loss, aging skin . . . thinning, wrinkles, sagging* Adapted from Whitney Gabhart, N.D.
    33. 33. Psychoactive Progesterone* Increases energy and libido Has a calming effect, acting like a benzodiazepine to the brain (HS dosing) Enhances mood Balances blood sugar (appetite) Regulates fluid balance, sodium mineral balance Necessary for fertility Helps relieve menopausal symptoms Decreases risk of endometrial cancer and may help protect against breast cancer, fibrocystic breasts, and osteoporosis * Adapted from Whitney Gabhart, N.D.
    34. 34. Testosterone: The “sexist” bias against women• Fall in the circulating testosterone and the adrenal preandrogens most closely parallel increasing age.• Accelerated decrease occurs in the years preceding menopause (like estrogen).• Their loss affects: libido, vasomotor symptoms (hot flashes), mood, well-being, bone structure, and muscle mass. – Burd, Bachmann. Androgen replacement in menopause. Curr Womens Health Rep. 2001 Dec; 1(3):202-5.
    35. 35. Traditional vs. Bio-identical “HRT”:• Synthetic means that the molecule is not natural to the human body.• Bio-identical hormone is one whose molecule is identical to that made by a human organ. SV2003- 41
    36. 36. Women’s Health Initiative Study• Flawed study - it was designed as a “Premarin & Provera” study, not a bioidentical estrogen study.• Premarin is a non-bio-identical substance• Provera is a non-bio-identical substance• Premarin is an equine derived array of 30+ female horse hormones. SV2003- 42
    37. 37. Women’s Health Initiative Study• The results presented did not justify their overall broad conclusion:• “Premarin & Provera yielded these findings; therefore, Hormone Replacement Therapy is not appropriate for women.”SV2003- 43
    38. 38. Women’s Health Initiative StudyTHE PARTICIPANTS:• 2/3 of the women in the study were older than sixty• Of these women, most were first-time users of HRT.• Had already experienced cessation of endogenous hormone production (for a DECADE!!!), therefore, at risk for: – Heart attacks, strokes, clots, cancer SV2003- 44
    39. 39. Women’s Health Initiative Study Facts You Should Know• In the first 1-3 years there was a higher incidence of M.I.’s.• Patients who stayed on that program beyond the 8th year started to actually outperform women on placebo.• WHY???? SV2003- 45
    40. 40. Women’s Health Initiative Study Facts You Should Know• When the W.H.I. Study was organized, the subjects were not prescreened for heart disease.• Without prescreening, a group of women was included with pre- existing heart disease.•SV2003- 46
    41. 41. Hx of Baseline Health Characteristics (total # of participants 16,608)Disease HRT PlaceboHypertension 37% 3039 2949High Cholesterol 11% 944 962Myocardial Infarction 2% 139 157Angina 288 234Stroke 61 77Embolism 79 62Family Breast Cancer 1286 1175Diabetes 374 360Fracture 1031 1029
    42. 42. Traditional vs. Bio-identical “HRT”:• Premarin raises C-reactive protein significantly.• CRP is an inflammation marker.• Inflammation is either the root cause (e.g., rupturing plaque), or a strongly contributing cause, of both Cancer & Heart Disease.SV2003- 48
    43. 43. Some of the “10 reasons” to be happy [Studd J. Menopause Int. 2010 Mar;16(1):44-6• Trans-derm safer than • HRT protects intervertebral oral discs – Coag factors not induced in • Est + T helps “reproductive liver depression”• Safe for tx of flushes, • Improves energy & libido sweats, vaginal dryness • Reduces incidence of heart• Estrogens prevent attakcs. osteoporotic fractures – • Beneficial effects on collagen should be FIRST CHOICE rather • Note 1 % increased lifetime bisphosphonates risk of breast cancer
    44. 44. 50’ish year old female, post- menopausal, on no hormones• On aggressive supplement regimen with daily MVI and others• Not ill• Top rated medical care with previous labs done• Nothing identified as seriously abnormal• “Just interested in having my hormones checked.”
    45. 45. Treatment for this “normal” patient1. Armour thyroid – ¼ grain for 1 week, then ½ grain. (Aiming for T3 in “high 3’s.”2. DHEA – 25 mg SR micronized, compounded – in a.m.3. Progesterone – 50 mg SR compounded – at night.4. Testosterone – 3mg topical per day x 1 wk, then 6 mg. “Decrease dosing as needed for side effects.”5. Vitamin D – 5,000 IU twice daily x 3 weeks, then decrease to one dose per day.6. Fish oil – 4.6 grams (c. 1660 mg EPA and 1,250 mg DHA by compound weight, plus misc. Omega 3)
    46. 46. What’s life like now?• “it’s like the colors of the rainbow have gotten more into the pink.”• “My computer will survive – I use to ‘lose it’ over my computer. I would swear obscenities.”• “I’ve gotten into a zen like mode. Handling everything that life can throw at me.”• “It’s almost as if I’ve taken a pill or drug that jus makes me handle everything that life is throwing at me. I can roll with it.”• “I’m not irritable any more. Time pressure has just one away.”
    47. 47. Special needs - Zinc• Low Zinc- associated with low testosterone – Per USDA, 60% of US men between 20 – 49 years of age do not get enough. – N.B.: Do not supplement with > 50 mg daily (can interfere with Cu+ metabolism) • Tsai, E.C., Boyko, E.J., Leonetti, D.L., & Fujimoto, W.Y. (2000). Low serum testosterone level as a predictor of increased visceral fat in Japanese- American men. International Journal of Obesity and Related Metabolic Dis 24, 485-491
    48. 48. Testosterone functions (Men ANDWomen) • Enhances sex drive • Builds muscle & decreases fat • Elevates mood • Prevents osteoporosis • Improves memory • Lowers cholesterol • Protects against heart disease
    49. 49. “Hence, among older men reporting excellentasymptomatic health, age has no effect onserum T or E2 with a minor increase in DHTwhile obesity decreases serum androgens…”
    50. 50. Testosterone (Men) • Decline in male sex steroids not as abrupt as menopause, but equally debilitating –Between 40 – 70, average male loses: • Nearly 2" of height • 15% of bone density • 10 – 20 pounds of muscle • At 70 yoa, 15% completely impotent
    51. 51. Andropause: Characteristics of Change• Insidious & unpredictable onset• Slow progression• Subtle & variable manifestations• Cannot be linked directly to a decrease in the hormone testosterone• Very different from menopause in women!• (Hubby reference: www.isitlowt.com) Charlton R. JMHG. 1(2004): 55-9 Kaufman JM. Endocrine Reviews. 26(2005):833-76
    52. 52. T vs Cognitive Function• 400 independently living men, 40-80yo – 100 in each age decade – MMSE 21-30, average 28 – TT: 208-1141ng/dL; Bio-avail T 78-470ng/dL• HIGHER T = better cognitive performance in OLDEST AGE category• Men with lowest 1/5 T = worse than men with highest 1/5 T• Highest Bio-available T more significant than TT, age, intelligence level, mood, smoking, and alcohol. Muller M. Neurology. 64(2005):866-71
    53. 53. T vs Mood in men• Study: 278 men, >45yo, followed 2 years• Compared to eugonadal patients, hypogonadal men w/TT <200ng/dL had – 4-fold increase risk of depression – Significantly shorter time to depression diagnosis• Depression risk inversely related to TT w/statistical significance <280ng/dL Shores MM, Arch Gen Psychiatry. 61(2004):162-7
    54. 54. Treatment options – not just “the needle”
    55. 55. Testosterone and “Prostate Cancer risk”• Prostate CA found 2.15 & 2.26 times more likely in lowest compared to highest tertile of total and free testosterone• “. . . there are several papers showing a relationship between LOW testosterone and prostate cancer. Specifically, low testosterone has been associated with high-grade tumors, advanced stage of presentation, and worse prognosis.” Morgentaler A. Eur Urol. 50(2006):935-9 Morgentaler A. Urology. 68(2006):1263-7
    56. 56. HOW OBVIOUS DOES IT HAVE TO BE? The Challenge of Empathic Listening & CREATIVE THINKING Ron Hunt lost an eye but suffered no brain damage after a freak accident with a large drill bit. (ABCNEWS.com)
    57. 57. Do you really want to try 100,000miles without changing the oil?
    58. 58. Definition of ‘normal’ – “where your hormone levels are as lousy aseveryone else’s.” Neal Rouzier, MD “NORMAL” OPTIMAL
    59. 59. “For me, the practice of medicine hasopened the door to the greatest adventure inlife. Medicine is like a hallway lined withdoors, each door opening into a differentroom, and each room openinginto another hallway,again lined with doors.Medicine is alwayswonderful and never willbe finished.”- Charles H. Mayo, M.D.

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