Hormone Therapy In A Medi-SpaHormone Therapy In A Medi-Spa
Rex Moulton-Barrett, MD
Plastic & Reconstructive Surgery
Alamed...
55 Components of Hormone TherapyComponents of Hormone Therapy
Optima (4)Optima (4)
• Skinny Shot 40 day Weight Loss Progra...
Skinny Shot 40 Pound Weight LossSkinny Shot 40 Pound Weight Loss
• Beta Chorionic Gonadotrophin: Glyco - 244 polypeptide
HCG:HCG: PlacentaPlacenta < 1 week gestation< 1 week gestation
mIU/mlmIU/ml
• Non-pregnant: < 5.0Non-pregnant: < 5.0
• 3 w...
Skinny Shot 40 Pound Weight LossSkinny Shot 40 Pound Weight Loss
• Contraindications:
1. Diabetic: oral agents & or insuli...
Skinny Shot 40 Pound Weight LossSkinny Shot 40 Pound Weight Loss
• Kit sent to office: 40 syringe/needles, alcohol,
sharps...
Skinny Shot 40 Pound Weight LossSkinny Shot 40 Pound Weight Loss
• Pregnyl: chorionic gonadotropin for injection FDAchorio...
Skinny Shot 40 Pound Weight LossSkinny Shot 40 Pound Weight Loss
• Pregnyl® may causePregnyl® may cause OvarianOvarian
Hyp...
Skinny Shot 40 Pound Weight LossSkinny Shot 40 Pound Weight Loss
• Pregnyl® may also cause rupture of ovarian cystsPregnyl...
Skinny Shot 40 Pound Weight LossSkinny Shot 40 Pound Weight Loss
• Novarel:hCG : 10,000U 1 day after menotrophinsNovarel:h...
Skinny Shot 40 Pound Weight LossSkinny Shot 40 Pound Weight Loss
• 8x8x5 box arrived Fed Ex Ground 3 Business days $ 7.56
...
Skinny Shot 40 Days: 1 lb. Weight/daySkinny Shot 40 Days: 1 lb. Weight/day
• 500 K Cal diet after first 2 days until 3 day...
Skinny Shot 40 Pound Weight LossSkinny Shot 40 Pound Weight Loss
• Claimed weight loss 30 pounds 26- 40 days
• Suggested t...
Skinny Shot 40 Pound Weight LossSkinny Shot 40 Pound Weight Loss
EVIDENCE BASED MEDICINE
• FDA: no evidence it causes weig...
Am Soceity of Bariatric Medicine Statement 1997
Bioidentical Hormones for Women
Choices of Compounded Optima Gel:
• Topical Testosterone and DHEA,
• Thyroid hormone (Armo...
Bioidentical Hormones for Women
Purpurted Responses to daily topical hormones:
• Energy increase
• Sexual drive increase
•...
Bioidentical Hormones for Women
Labs ordered from Quest
( Call Optima for preselected panel to fax to us:
1 877-216-8004 o...
Bioidentical Hormones for Women
Method of application
• Topical
• Apply to clean moisturizer free surface
• Apply to Insid...
Bioidentical Hormones for Men
Purported Effects
• Increased energy
• Increased sexual drive
• Increased muscle mass
• Incr...
Bioidentical Hormones for Men
Specific hormones measured in men:
• Testosterone
• DHEA
Testosterone
Bioidentical Hormones for Men
Specific hormones compounded
Optimus Gel:
• Botanical Aromatase inhibitors
• Reduce conversi...
Bioidentical Hormones for Men
Risks of testosterone supplementation for normal ageing:
Risks include: sleep apnea
polycyth...
Hormone Therapy for GynecomastiaHormone Therapy for Gynecomastia
Khan, HN, Rampaul, R, Blamey, RW, 2004. Breast 13(1), 61-...
Growth Hormone Stimulation
• Meditrophan amino acid complex: oral sachet
• Purported to “Improve quality of life”
• For un...
Growth Hormone Stimulation
Purported Improvements ( < 40 yrs of age)
•< 6 weeks: skin improvement and energy increase
•< 3...
Growth Hormone Stimulation & or Injection
Contraindications:
• Active cancer < 5 yrs
• DM is not a contraindication
• Side...
Is there really a visible evidence based support for the use
hormone therapy?
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  • H &amp; P form &amp; consent provided by optima Risks: Head-aches, low BP, hair loss, rupture polycycytic ovaries ( unlikely if s/c vrs sublingual/nasal)   contraindications: diabetic requiring long acting oral agents or long acting insulin no base line labs are required Optima may requst email to send Quest requisition slip for lab Kit shipped to office, includes 40 syringe/needles, alcohol, sharps, documentation sheets, reconstitute from powder with sterile H2O and add cyanocobalamin, custom nutriant supplement, first injection in office.   
  • H &amp; P form &amp; consent provided by optima Risks: Head-aches, low BP, hair loss, rupture polycycytic ovaries ( unlikely if s/c vrs sublingual/nasal)   contraindications: diabetic requiring long acting oral agents or long acting insulin no base line labs are required Optima may requst email to send Quest requisition slip for lab Kit shipped to office, includes 40 syringe/needles, alcohol, sharps, documentation sheets, reconstitute from powder with sterile H2O and add cyanocobalamin, custom nutriant supplement, first injection in office.   
  • H &amp; P form &amp; consent provided by optima Risks: Head-aches, low BP, hair loss, rupture polycycytic ovaries ( unlikely if s/c vrs sublingual/nasal)   contraindications: diabetic requiring long acting oral agents or long acting insulin no base line labs are required Optima may requst email to send Quest requisition slip for lab Kit shipped to office, includes 40 syringe/needles, alcohol, sharps, documentation sheets, reconstitute from powder with sterile H2O and add cyanocobalamin, custom nutriant supplement, first injection in office.   
  • H &amp; P form &amp; consent provided by optima Risks: Head-aches, low BP, hair loss, rupture polycycytic ovaries ( unlikely if s/c vrs sublingual/nasal)   contraindications: diabetic requiring long acting oral agents or long acting insulin no base line labs are required Optima may requst email to send Quest requisition slip for lab Kit shipped to office, includes 40 syringe/needles, alcohol, sharps, documentation sheets, reconstitute from powder with sterile H2O and add cyanocobalamin, custom nutriant supplement, first injection in office.   
  • H &amp; P form &amp; consent provided by optima Risks: Head-aches, low BP, hair loss, rupture polycycytic ovaries ( unlikely if s/c vrs sublingual/nasal)   contraindications: diabetic requiring long acting oral agents or long acting insulin no base line labs are required Optima may requst email to send Quest requisition slip for lab Kit shipped to office, includes 40 syringe/needles, alcohol, sharps, documentation sheets, reconstitute from powder with sterile H2O and add cyanocobalamin, custom nutriant supplement, first injection in office.   
  • H &amp; P form &amp; consent provided by optima Risks: Head-aches, low BP, hair loss, rupture polycycytic ovaries ( unlikely if s/c vrs sublingual/nasal)   contraindications: diabetic requiring long acting oral agents or long acting insulin no base line labs are required Optima may requst email to send Quest requisition slip for lab Kit shipped to office, includes 40 syringe/needles, alcohol, sharps, documentation sheets, reconstitute from powder with sterile H2O and add cyanocobalamin, custom nutriant supplement, first injection in office.   
  • H &amp; P form &amp; consent provided by optima Risks: Head-aches, low BP, hair loss, rupture polycycytic ovaries ( unlikely if s/c vrs sublingual/nasal)   contraindications: diabetic requiring long acting oral agents or long acting insulin no base line labs are required Optima may requst email to send Quest requisition slip for lab Kit shipped to office, includes 40 syringe/needles, alcohol, sharps, documentation sheets, reconstitute from powder with sterile H2O and add cyanocobalamin, custom nutriant supplement, first injection in office.   
  • H &amp; P form &amp; consent provided by optima Risks: Head-aches, low BP, hair loss, rupture polycycytic ovaries ( unlikely if s/c vrs sublingual/nasal)   contraindications: diabetic requiring long acting oral agents or long acting insulin no base line labs are required Optima may requst email to send Quest requisition slip for lab Kit shipped to office, includes 40 syringe/needles, alcohol, sharps, documentation sheets, reconstitute from powder with sterile H2O and add cyanocobalamin, custom nutriant supplement, first injection in office.   
  • H &amp; P form &amp; consent provided by optima Risks: Head-aches, low BP, hair loss, rupture polycycytic ovaries ( unlikely if s/c vrs sublingual/nasal)   contraindications: diabetic requiring long acting oral agents or long acting insulin no base line labs are required Optima may requst email to send Quest requisition slip for lab Kit shipped to office, includes 40 syringe/needles, alcohol, sharps, documentation sheets, reconstitute from powder with sterile H2O and add cyanocobalamin, custom nutriant supplement, first injection in office.   
  • H &amp; P form &amp; consent provided by optima Risks: Head-aches, low BP, hair loss, rupture polycycytic ovaries ( unlikely if s/c vrs sublingual/nasal)   contraindications: diabetic requiring long acting oral agents or long acting insulin no base line labs are required Optima may requst email to send Quest requisition slip for lab Kit shipped to office, includes 40 syringe/needles, alcohol, sharps, documentation sheets, reconstitute from powder with sterile H2O and add cyanocobalamin, custom nutriant supplement, first injection in office.   
  • H &amp; P form &amp; consent provided by optima Risks: Head-aches, low BP, hair loss, rupture polycycytic ovaries ( unlikely if s/c vrs sublingual/nasal)   contraindications: diabetic requiring long acting oral agents or long acting insulin no base line labs are required Optima may requst email to send Quest requisition slip for lab Kit shipped to office, includes 40 syringe/needles, alcohol, sharps, documentation sheets, reconstitute from powder with sterile H2O and add cyanocobalamin, custom nutriant supplement, first injection in office.   
  • Optima hormone therapy slideshare

    1. 1. Hormone Therapy In A Medi-SpaHormone Therapy In A Medi-Spa Rex Moulton-Barrett, MD Plastic & Reconstructive Surgery Alameda & Brentwood Ca Is there a safe and evidence based: angle to support the value of therapy ?
    2. 2. 55 Components of Hormone TherapyComponents of Hormone Therapy Optima (4)Optima (4) • Skinny Shot 40 day Weight Loss Program * • Bioidentical Hormones for Women: topical * • Bioidentical Hormones for Men: topical * • Hormone therapy for Gynecomastia: oral * • Growth Hormone Stimulation: oral * • Growth Hormone Supplementation: sub-lingual / subcutaneous
    3. 3. Skinny Shot 40 Pound Weight LossSkinny Shot 40 Pound Weight Loss • Beta Chorionic Gonadotrophin: Glyco - 244 polypeptide
    4. 4. HCG:HCG: PlacentaPlacenta < 1 week gestation< 1 week gestation mIU/mlmIU/ml • Non-pregnant: < 5.0Non-pregnant: < 5.0 • 3 weeks LMP:3 weeks LMP: 5 - 505 - 50 • 4 weeks LMP:4 weeks LMP: 5 - 4265 - 426 • 5 weeks LMP:5 weeks LMP: 18 - 7,34018 - 7,340 • 6 weeks LMP:6 weeks LMP: 1,080 - 56,5001,080 - 56,500 • 7 - 8 weeks LMP:7 - 8 weeks LMP: 7, 650 - 229,0007, 650 - 229,000 • 17 - 24 weeks LMP: 4,060 - 165,40017 - 24 weeks LMP: 4,060 - 165,400 • 25 - 40 weeks LMP: 3,640 - 117,00025 - 40 weeks LMP: 3,640 - 117,000 Postmenopausal females: < 9.5 mIU/mlPostmenopausal females: < 9.5 mIU/ml
    5. 5. Skinny Shot 40 Pound Weight LossSkinny Shot 40 Pound Weight Loss • Contraindications: 1. Diabetic: oral agents & or insulin-hypoglycaemia 2. Pregnancy: check urine pregnancy, teratogenic? 3. Labile hypertension: may lower BP3. Labile hypertension: may lower BP 4. Polycystic ovaries; may rupture, rare: IM > subcut4. Polycystic ovaries; may rupture, rare: IM > subcut 5. Alopecia: may lead to hair loss5. Alopecia: may lead to hair loss 6. Breast & Testicular cancer: hormone dependency?6. Breast & Testicular cancer: hormone dependency? 7. Precocious puberty7. Precocious puberty 8. Labile migraines especially hormone related: menstrual8. Labile migraines especially hormone related: menstrual
    6. 6. Skinny Shot 40 Pound Weight LossSkinny Shot 40 Pound Weight Loss • Kit sent to office: 40 syringe/needles, alcohol, sharps, documentation sheets, reconstitute from powder with sterile H2O and add cyanocobalamin( B12 ), custom nutrient supplement, first injection in office.    •  10,000 IU FDA approved human b HCG: Novarel or Pregnyl, ‘human urine extraction’ derived, versus considering a new Ovidrel derived by DNA technology- sub-cutaneous      
    7. 7. Skinny Shot 40 Pound Weight LossSkinny Shot 40 Pound Weight Loss • Pregnyl: chorionic gonadotropin for injection FDAchorionic gonadotropin for injection FDA approvedapproved to: a. induce ovulation &to: a. induce ovulation & b. induce pregnancy in women with anovulation,b. induce pregnancy in women with anovulation, following pretreatment with human gonadotropinsfollowing pretreatment with human gonadotropins ( FSH and LH )( FSH and LH ) • Will not help women with primary ovarian failureWill not help women with primary ovarian failure • OFF LABEL USE FOR WEIGHT REDUCTIONOFF LABEL USE FOR WEIGHT REDUCTION •• Patients to sign off label use consent formPatients to sign off label use consent form
    8. 8. Skinny Shot 40 Pound Weight LossSkinny Shot 40 Pound Weight Loss • Pregnyl® may causePregnyl® may cause OvarianOvarian Hyperstimulation Syndrome (OHSS):Hyperstimulation Syndrome (OHSS): rarerare cause of death.cause of death. • OHSS causes fluid build up within theOHSS causes fluid build up within the abdomen and chestabdomen and chest • S/S: severe pelvic pain (lower abdomen),S/S: severe pelvic pain (lower abdomen), nausea, vomiting, sudden weight gain, ornausea, vomiting, sudden weight gain, or reduced urine output.reduced urine output.
    9. 9. Skinny Shot 40 Pound Weight LossSkinny Shot 40 Pound Weight Loss • Pregnyl® may also cause rupture of ovarian cystsPregnyl® may also cause rupture of ovarian cysts resulting in internal bleeding (hemoperitoneum),resulting in internal bleeding (hemoperitoneum), multiple births, and artery blockage by a bloodmultiple births, and artery blockage by a blood clot (arterial thromboembolism).clot (arterial thromboembolism). • Other side effects with Pregnyl® includeOther side effects with Pregnyl® include headache, irritability, restlessness, depression,headache, irritability, restlessness, depression, fatigue, edema, and pain at the site of injection.fatigue, edema, and pain at the site of injection.
    10. 10. Skinny Shot 40 Pound Weight LossSkinny Shot 40 Pound Weight Loss • Novarel:hCG : 10,000U 1 day after menotrophinsNovarel:hCG : 10,000U 1 day after menotrophins for anovulationfor anovulation • Patients usually received previous treatment withPatients usually received previous treatment with gonadotropins: BRAVELLE® (urofollitropin),gonadotropins: BRAVELLE® (urofollitropin), MENOPUR® REPRONEX® (menotropins)MENOPUR® REPRONEX® (menotropins) • In males: non - anatomic cryptorchism,In males: non - anatomic cryptorchism, hypogonadotrophic hypogonadism:hypogonadotrophic hypogonadism: 4,000U/3xwk4,000U/3xwk
    11. 11. Skinny Shot 40 Pound Weight LossSkinny Shot 40 Pound Weight Loss • 8x8x5 box arrived Fed Ex Ground 3 Business days $ 7.56 • Vial in powder vial store at room temperature • Reconstitute: 4mls of water & 6mls of vit B12 = 1,000 U/ml ( 10ml total ), store in refrigerator up to 35 days • inject subcutaneous: 125-250U/day ie. 0.125-.25mls • Subcutaneous anterior thigh/abdo, test H20 inj in office • If menstruating wait until complete before starting • High calorie diet first 2 days then a 500K cal diet/day • No topical hormones or GH supplements doing HCG
    12. 12. Skinny Shot 40 Days: 1 lb. Weight/daySkinny Shot 40 Days: 1 lb. Weight/day • 500 K Cal diet after first 2 days until 3 days after HCG • Diet : 3 meals, 1 snack, 10 glasses of water • Strict adherence to diet is critical • Breakfast: one fruit • Lunch & Dinner: 100g cooked meat, no fat, one vegetable, one fruit, one melba toast or breadstick • Snack: can substitute fruit from lunch • 30 minutes mild exercise: walking • Gentle laxative for constipation • Full 40 day program • Then resume 2,200-3,000K cal diet
    13. 13. Skinny Shot 40 Pound Weight LossSkinny Shot 40 Pound Weight Loss • Claimed weight loss 30 pounds 26- 40 days • Suggested to incorporate self additional nutritional consult • WE DO NOT PROMISE WEIGHT LOSS • We weigh them each visit: no shoes, belt coat, jacket • Flip video success stories, consent for U Tube success-videos and before & afters
    14. 14. Skinny Shot 40 Pound Weight LossSkinny Shot 40 Pound Weight Loss EVIDENCE BASED MEDICINE • FDA: no evidence it causes weight loss • 500K Cal diet may be harmful long term • 125 Units HCG s/c versus placebo: ineffective • Sicia, et al, 1976: Am J Clin Nut 29, 940-948. • Greenway, et al, 1977: West J Med 127, 461-463. • Bosch B, et al, 1990. Human chorionic gonadotrophin and weight loss. A double-blind, placebo-controlled trial. S Afr Med J 77:185- 189. • Lijesen, etal, 1995. Brit J Clin Pharm 40: 237-243
    15. 15. Am Soceity of Bariatric Medicine Statement 1997
    16. 16. Bioidentical Hormones for Women Choices of Compounded Optima Gel: • Topical Testosterone and DHEA, • Thyroid hormone (Armour Thyroid), • Growth Hormone secretagogue (MediTropin), • Antioxidants • Multi-vitamins • Vitamin D:Replesta botanical aromatase inhibitors: • Estradiol and Progesterone creams
    17. 17. Bioidentical Hormones for Women Purpurted Responses to daily topical hormones: • Energy increase • Sexual drive increase • Reduction in peri-menapausal flushing • Improved skin quality
    18. 18. Bioidentical Hormones for Women Labs ordered from Quest ( Call Optima for preselected panel to fax to us: 1 877-216-8004 option: 0 ) • Progesterone • Estrogen • Testosterone • GH: IgF4 • Thyroxine Repeat labs $130 6 and 12 months later
    19. 19. Bioidentical Hormones for Women Method of application • Topical • Apply to clean moisturizer free surface • Apply to Inside forearm or thigh • Rub in until no longer visible 1/2 to 1 minute
    20. 20. Bioidentical Hormones for Men Purported Effects • Increased energy • Increased sexual drive • Increased muscle mass • Increased hair thickness
    21. 21. Bioidentical Hormones for Men Specific hormones measured in men: • Testosterone • DHEA Testosterone
    22. 22. Bioidentical Hormones for Men Specific hormones compounded Optimus Gel: • Botanical Aromatase inhibitors • Reduce conversion testoterone to Estridiol • may elevate testosterone • without elevating estradiol
    23. 23. Bioidentical Hormones for Men Risks of testosterone supplementation for normal ageing: Risks include: sleep apnea polycythemia acne prostate hyperplasia gynacomastia * limit sperm production * ( * Secondary to conversion to estrdiol )
    24. 24. Hormone Therapy for GynecomastiaHormone Therapy for Gynecomastia Khan, HN, Rampaul, R, Blamey, RW, 2004. Breast 13(1), 61-5 Tamoxifen 20mg daily for 6-12 weeks 100% resolution lump type versus 62% fatty, non blinded, non placebo study • In a double blind study vrs placebo: p < 0.005, long term results • Can use up to 30mg/day • Side effects: nausea, vomiting, flushes, liver, blood clots, boney pain • Other druges effective: Danazol 200mg/day for 3 months 8/42 failures: best for adults Chomiphene 50mg/day for 3 months 5/12 failures
    25. 25. Growth Hormone Stimulation • Meditrophan amino acid complex: oral sachet • Purported to “Improve quality of life” • For under 40 yr patients: causes elevation of GH • No H and P and no baseline labs required • However best to check IGF-1 prior tot starting • Significant increase in IGF-1 level after 12 weeks • =/- Follow-up labs every 3 months • Unclear mechanism of action
    26. 26. Growth Hormone Stimulation Purported Improvements ( < 40 yrs of age) •< 6 weeks: skin improvement and energy increase •< 3 months: increased exercise capacity •< 6 months: decrease body fat, increase muscle mass, increase bone density, reduced cholesterol profile, lower diastolic BP
    27. 27. Growth Hormone Stimulation & or Injection Contraindications: • Active cancer < 5 yrs • DM is not a contraindication • Side effects: edema carpel tunnnel syndrome acne excessive muscle development excessive sweating difficulty with sleep ( check thyroid )
    28. 28. Is there really a visible evidence based support for the use hormone therapy?

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