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“The compounding specialists”



W elc o me
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
...
Hormones
   Powerful chemical messengers
   Derived from cholesterol
   Made in the brain, ovaries, testicles, adrenal
...
Hormones
   Powerful chemical messengers
   Derived from cholesterol
   Made in the brain, ovaries, testicles, adrenal
...
Hormones
   Powerful chemical messengers
   Derived from cholesterol
   Made in the brain, ovaries, testicles, adrenal
...
Bio-Identical Hormones
Bio-Identical Hormones
   Bio-Identical Hormones are chemically identical
    to those in the human body
      Derived f...
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...
Estrogens
          Estriol, Estradiol, Estrone
   Exert a stimulating effect on breast, uterus
    and brain
   Prevent...
Estrogens
          Estriol, Estradiol, Estrone
   Exert a stimulating effect on breast, uterus
    and brain
   Prevent...
Estrogens
          Estriol, Estradiol, Estrone
   Exert a stimulating effect on breast, uterus
    and brain
   Prevent...
Progesterone
Progesterone
   There is only ONE progesterone
Progesterone
   There is only ONE progesterone
   Works synergistically with estrogens
       Balances effect of estrog...
Progesterone
   There is only ONE progesterone
   Works synergistically with estrogens
       Balances effect of estrog...
Testosterone
Testosterone
   Anabolic hormone
       builds and strengthens tissue, bone,
        urogenital tract, muscle
Testosterone
   Anabolic hormone
       builds and strengthens tissue, bone,
        urogenital tract, muscle
   Declin...
Testosterone
   Anabolic hormone
       builds and strengthens tissue, bone,
        urogenital tract, muscle
   Declin...
Testosterone
   Anabolic hormone
       builds and strengthens tissue, bone,
        urogenital tract, muscle
   Declin...
Testosterone
   Anabolic hormone
       builds and strengthens tissue, bone,
        urogenital tract, muscle
   Declin...
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...
Dehydroepiandrosterone
             (DHEA)
   Made in the adrenal glands
   Declines steadily with age
   Has important...
Dehydroepiandrosterone
             (DHEA)
   Made in the adrenal glands
   Declines steadily with age
   Has important...
Cortisol
Cortisol
   Made in the adrenal glands
Cortisol
   Made in the adrenal glands
   Catabolic hormone: breaks down tissue
    (part of the normal cycle of remodel...
Cortisol
   Made in the adrenal glands
   Catabolic hormone: breaks down tissue
    (part of the normal cycle of remodel...
Cortisol
   Made in the adrenal glands
   Catabolic hormone: breaks down tissue
    (part of the normal cycle of remodel...
Cortisol
   Made in the adrenal glands
   Catabolic hormone: breaks down tissue
    (part of the normal cycle of remodel...
Thyroid Hormone
Thyroid Hormone

   Determines metabolic rate
       nutrient utilization by tissue
            fats, carbs, and protei...
Thyroid Hormone

   Determines metabolic rate
       nutrient utilization by tissue
            fats, carbs, and protei...
Female Hormone Patterns
 Menarche to Menopause
Female Hormone Patterns
         Menarche to Menopause

   Teens
       Anovulatory cycles are common
       Low Proges...
Female Hormone Patterns
 Menarche to Menopause
Female Hormone Patterns
         Menarche to Menopause

   20 to 30 years old
       May have regular monthly bleeding b...
Female Hormone Patterns
 Menarche to Menopause
Female Hormone Patterns
         Menarche to Menopause
   40 to 50 years old
       Peak progesterone level declines
   ...
Female Hormone Patterns
 Menarche to Menopause
Female Hormone Patterns
         Menarche to Menopause
   40 to 50 years old
       Estrogen dominance
       Functiona...
Female Hormone Patterns
 Menarche to Menopause
Female Hormone Patterns
         Menarche to Menopause
   50+ & Menopause
       Estradiol level drops
   
     
     
 ...
Symptoms of Hormone
     Imbalance
Symptoms of Hormone
               Imbalance
   Estrogen Excess
 
         
     
       Tender, swelling, and/or fibrocy...
Symptoms of Hormone
     Imbalance
Symptoms of Hormone
               Imbalance
   Estrogen Deficiency
           
     
     
       Hot flashes & night swe...
Symptoms of Hormone
     Imbalance
Symptoms of Hormone
              Imbalance
   Estrogen Deficiency 
       Low percent of body fat = at risk for low
    ...
Symptoms of Hormone
     Imbalance
Symptoms of Hormone
                Imbalance
   Progesterone Deficiency
          
     
    
       Irregular periods (...
Symptoms of Hormone
     Imbalance
Symptoms of Hormone
                 Imbalance
   Androgen (Testosterone) Excess
 
       Acne, oily skin
       Facial...
Symptoms of Hormone
     Imbalance
Symptoms of Hormone
              Imbalance

   Androgen (testosterone)
    Deficiency
 
       Depression
       fatigu...
Symptoms of Hormone
     Imbalance
Symptoms of Hormone
               Imbalance
   Cortisol (Stress Hormone) Excess
       Irritability, anxiety, feel “bur...
Symptoms of Hormone
     Imbalance
Symptoms of Hormone
             Imbalance
   Cortisol Deficiency “Adrenal Fatigue”
     Usually preceded by prolonged st...
Approach to Female Hormone
        Imbalances
Approach to Female Hormone
        Imbalances
   The solution isn’t always HRT
       Stress reduction (good diet, sleep...
Male Hormone Patterns
Male Hormone Patterns

   Young Males
       High testosterone

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

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

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

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

   Estradiol ...
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
   ...
Approach to Male Hormone
           Imbalances
   Weight loss
   Weight training
   Reduce dietary estrogen burden
   ...
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
...
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
    diagnosi...
Thank You
       John C. Richards Pharm.D.
         Barbara Dace Pharm.D.
        Debby DeJager Pharm.D.


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

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

  1. 1. “The compounding specialists” W elc o me
  2. 2. Hormones
  3. 3. Hormones  Powerful chemical messengers
  4. 4. Hormones  Powerful chemical messengers  Derived from cholesterol
  5. 5. Hormones  Powerful chemical messengers  Derived from cholesterol  Made in the brain, ovaries, testicles, adrenal glands and body fat
  6. 6. Hormones  Powerful chemical messengers  Derived from cholesterol  Made in the brain, ovaries, testicles, adrenal glands and body fat  Affect every tissue in the body
  7. 7. 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
  8. 8. 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
  9. 9. Bio-Identical Hormones
  10. 10. 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
  11. 11. Estrogens Estriol, Estradiol, Estrone
  12. 12. Estrogens Estriol, Estradiol, Estrone  Exert a stimulating effect on breast, uterus and brain
  13. 13. Estrogens Estriol, Estradiol, Estrone  Exert a stimulating effect on breast, uterus and brain  Prevent bone loss by osteoclasts
  14. 14. 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
  15. 15. 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
  16. 16. 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
  17. 17. Progesterone
  18. 18. Progesterone  There is only ONE progesterone
  19. 19. 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
  20. 20. 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
  21. 21. Testosterone
  22. 22. Testosterone  Anabolic hormone  builds and strengthens tissue, bone, urogenital tract, muscle
  23. 23. Testosterone  Anabolic hormone  builds and strengthens tissue, bone, urogenital tract, muscle  Declines with age
  24. 24. Testosterone  Anabolic hormone  builds and strengthens tissue, bone, urogenital tract, muscle  Declines with age  Vasodilator
  25. 25. Testosterone  Anabolic hormone  builds and strengthens tissue, bone, urogenital tract, muscle  Declines with age  Vasodilator  Balances effects of estrogen and cortisol
  26. 26. 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
  27. 27. Dehydroepiandrosterone (DHEA)
  28. 28. Dehydroepiandrosterone (DHEA)  Made in the adrenal glands
  29. 29. Dehydroepiandrosterone (DHEA)  Made in the adrenal glands  Declines steadily with age
  30. 30. Dehydroepiandrosterone (DHEA)  Made in the adrenal glands  Declines steadily with age  Has important roles in immune function, ability to handle stress, and glucose disposal
  31. 31. 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
  32. 32. 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
  33. 33. Cortisol
  34. 34. Cortisol  Made in the adrenal glands
  35. 35. Cortisol  Made in the adrenal glands  Catabolic hormone: breaks down tissue (part of the normal cycle of remodeling)
  36. 36. Cortisol  Made in the adrenal glands  Catabolic hormone: breaks down tissue (part of the normal cycle of remodeling)  Balances testosterone
  37. 37. 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
  38. 38. 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
  39. 39. Thyroid Hormone
  40. 40. Thyroid Hormone  Determines metabolic rate  nutrient utilization by tissue  fats, carbs, and protein)  affect protein synthesis  regulate bone growth  heat generation
  41. 41. 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
  42. 42. Female Hormone Patterns Menarche to Menopause
  43. 43. Female Hormone Patterns Menarche to Menopause  Teens  Anovulatory cycles are common  Low Progesterone  Estrogen Dominance
  44. 44. Female Hormone Patterns Menarche to Menopause
  45. 45. 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
  46. 46. Female Hormone Patterns Menarche to Menopause
  47. 47. 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
  48. 48. Female Hormone Patterns Menarche to Menopause
  49. 49. 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
  50. 50. Female Hormone Patterns Menarche to Menopause
  51. 51. Female Hormone Patterns Menarche to Menopause  50+ & Menopause  Estradiol level drops  Estrone level stays the same or rises  Ovary stops making progesterone and testosterone
  52. 52. Symptoms of Hormone Imbalance
  53. 53. 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
  54. 54. Symptoms of Hormone Imbalance
  55. 55. 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
  56. 56. Symptoms of Hormone Imbalance
  57. 57. 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
  58. 58. Symptoms of Hormone Imbalance
  59. 59. 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
  60. 60. Symptoms of Hormone Imbalance
  61. 61. 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
  62. 62. Symptoms of Hormone Imbalance
  63. 63. Symptoms of Hormone Imbalance  Androgen (testosterone) Deficiency  Depression  fatigue  vaginal dryness  low sex drive  bone loss  decreased sense of well being
  64. 64. Symptoms of Hormone Imbalance
  65. 65. 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)
  66. 66. Symptoms of Hormone Imbalance
  67. 67. 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
  68. 68. Approach to Female Hormone Imbalances
  69. 69. 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
  70. 70. Male Hormone Patterns
  71. 71. Male Hormone Patterns  Young Males  High testosterone  Low estradiol  Low progesterone
  72. 72. Male Hormone Patterns
  73. 73. Male Hormone Patterns  35 + years old
  74. 74. Male Hormone Patterns  35 + years old  Testosterone drops about 1% per year
  75. 75. Male Hormone Patterns  35 + years old  Testosterone drops about 1% per year  Estradiol and estrone may rise; Prog stays low
  76. 76. Male Hormone Patterns  35 + years old  Testosterone drops about 1% per year  Estradiol and estrone may rise; Prog stays low  Gain weight around middle
  77. 77. 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
  78. 78. 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
  79. 79. 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
  80. 80. Approach to Male Hormone Imbalances
  81. 81. Approach to Male Hormone Imbalances  Weight loss
  82. 82. Approach to Male Hormone Imbalances  Weight loss  Weight training
  83. 83. Approach to Male Hormone Imbalances  Weight loss  Weight training  Reduce dietary estrogen burden
  84. 84. Approach to Male Hormone Imbalances  Weight loss  Weight training  Reduce dietary estrogen burden  Testosterone supplementation
  85. 85. Approach to Male Hormone Imbalances  Weight loss  Weight training  Reduce dietary estrogen burden  Testosterone supplementation  Aromatase inhibitors
  86. 86. Solving Hormone Problems
  87. 87. Solving Hormone Problems  History 85%
  88. 88. Solving Hormone Problems  History 85%  Physical examination 10%
  89. 89. Solving Hormone Problems  History 85%  Physical examination 10%  Lab tests 5%
  90. 90. Solving Hormone Problems  History 85%  Physical examination 10%  Lab tests 5%  Respect individual differences
  91. 91. 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
  92. 92. Role of Testing
  93. 93. Role of Testing  Symptoms help us reach a tentative diagnosis
  94. 94. Role of Testing  Symptoms help us reach a tentative diagnosis  Lab testing confirms or refutes the diagnosis
  95. 95. Role of Testing  Symptoms help us reach a tentative diagnosis  Lab testing confirms or refutes the diagnosis  Need to do comprehensive testing
  96. 96. 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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