Anti Aging Medicine


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Presentation on BioIdentical Hormone Therapy or Anti-Aging Medicine and how it can change your life like it has mine.

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  • Conventional medicine has always held the belief that aging is inevitable and that its progressive deterioration cannot be altered. Fortunately there is a new, exciting revolution in science and medicine that identifies aging as a disease. Age Management Medicine focuses on the prevention and delay of the aging process rather than simply the treatment of aging symptoms. Today, I’d like to start by giving you a brief description of what Age Management Medicine is and how it differs philosophically from the conventional medical approach to disease. Then, we’ll focus on a major facet of Age Management Medicine which is age related hormonal decline and its treatment, then at the end, I’d like to open up the discussion to your questions.
  • This slide shows 5 differences between the disease based conventional medical approach, and the preventative, health based approach of Age Management medical practitioners.
  • This is a graphical representation of what happens to us generally over the course of our lifetime. Explain graph
  • The conventional medical approach has been quite effective to provide an extension of the morbidity phase in life. Disease is recognized and managed. The result is prolonged life, but diminished functioning and disability during the life extension.
  • The preferred approach which is the preventative approach and what AMM is all about, is to intervene before reserve capacity and functioning have diminished to the point of conditions developing. The result is sustained vitality and compressed morbidity. And possibly longer life as well.
  • How is that done? The first difference is the emphasis on orthomolecular treatments vs. pharmaceutical
  • Allopathic (MD) Medical schools teach the pharmaceutical paradigm, and I spent well over 20 years practicing it. It does have its successes, but after years after seeing its shortcomings I favor the orthomolecular approach which seems more physiologic to me.
  • What are bio-identicals? These are hormones or enzymes that are made to be exact chemical copies of what your body normally produces for its normal functioning. (Read the slide)
  • Why doesn’t conventional medicine embrace the orthomolecular approach?
  • The AMM approach is to treat aging as a disease rather than a normal inevitable process.
  • This is the conventional view of hormones and aging:
  • This is the Age Management View:
  • Optimal range vs. “normal” range – what is meant by that? I’m referring here to laboratory tests and values, which both Age Management and conventional medicine often use to evaluate and guide therapy.
  • But here’s the problem with the conventional way of thinking about laboratory normal ranges: (Give TSH and thyroid as an example)
  • What do I mean by “class effect” ? Class effect refers to attributing the effects one particular drug or chemical to the whole “class” of substances. (Give example of Prempro vs. Provera and oral Premarin vs. transdermal estradiol)
  • Age Management is about taking personal responsibility for your health and making better choices to prolong your quality of life Age Management medicine looks at the whole picture, offering a comprehensive treatment plan that includes diet modification, exercise, stress reduction/lifestyle changes, conventional pharmaceutical treatments if necessary, supplements such as vitamins minerals and herbs, and hormone replacement therapy, which will be the focus of our remaining discussion today.
  • Here are some important basic principles of AMM. (Read slide) As you can see, there is a lot that could be said about the different aspects of these basic principles, but in the interest of time, today I’ll focus on age related hormonal decline, its symptoms, and treatment with bio-identical hormone replenishment.
  • One of the most important therapies in the new specialty of Age Management Medicine is hormone supplementation. Because most physicians have been taught, and accept that age related hormonal declines are natural, and should not be tampered with, the medical community as a whole has been very slow to offer hormone replacement therapy to the aging community. Research has shown, however, that hormone deficiencies associated with aging are no different than those of younger persons with hormonal imbalances, and should be treated as quickly as other hormonally related complications and diseases. What are hormones? (Read Slide)
  • What are the endocrine organs that produce various hormones that are involved in the regulation of body processes?
  • I alluded to the fact earlier that most hormone levels decline with aging.
  • Not only do levels of hormones decline, but the function of endocrine organs declines as well.
  • So what do physicians normally do for hormone deficient disease states?
  • Replenishment of hormonal levels to optimum physiologic levels has been shown to alleviate these age-related changes.
  • Let’s start by talking about menopause. This is a slide from on of Suzann Somer’s books.
  • The many symptoms associated with Menopause are typically characterized by varying deficiencies of estrogen, progesterone and testosterone.
  • Typically as a woman ages, she first experiences erratic ovulation which results in a relative progesterone deficiency and the following symptoms:
  • Later as she becomes menopausal, symptoms of estrogen deficiency due to ovarian failure become prominent:
  • These are the Principles for hormone replenishment in symptomatic women: This is typically done with a combination of pills, patches and creams which could be the topic of a whole other lecture.
  • Osteoporosis is an estrogen deficiency disease.
  • What about the thyroid?
  • I generally order 4 different thyroid tests when evaluating for hypothyroidism.
  • Why is it important beyond symptom relief to optimize your thyroid status?
  • Let’s turn our attention now to Men.
  • Andropause refers to “male menopause” which is typically caused by decline in testosterone levels.
  • Here are some quotes from the medical literature regarding testosterone supplementation and the prostate:
  • What are the typical positive effects that most andropausal men experience with testosterone supplementation?
  • Table 2. Potential Risks Associated with Testosterone-Replacement Therapy.
  • I’m going to speak very briefly about growth hormone. It is a very controversial area, and unlike other hormones, its replacement is under the scrutiny and restriction of the government.
  • Explain controversy.
  • In summary:
  • What I do with a patient is to look at the whole picture, offering a comprehensive and integrative treatment plan that includes diet modification, exercise guidance, stress reduction/lifestyle changes, conventional pharmaceutical treatments if necessary, supplements if needed such as vitamins, minerals and herbs, and hormone replacement therapy, when indicated.
  • In this way I work toward maximizing your reserve capacity, increasing your years of vitality and life enjoyment.
  • Aging is inevitable for everyone. However, increasing medical evidence suggests that many aspects of aging may be delayed, minimized or even avoided. Proper hormonal balance may offer significant benefits to men and women wishing to maintain or improve function, youthful vitality, and improve quality of life.
  • Anti Aging Medicine

    1. 1. Hormone Balance for Men and Women An Introduction to Age Management Medicine Paul Navar M.D.
    2. 2. Age Management Medicine: A New Paradigm <ul><li>Preventive/Health Based v. Disease Based </li></ul><ul><li>Orthomolecular vs. Pharmaceutical </li></ul><ul><li>Aging treated as a disease rather than a normal inevitable process </li></ul><ul><li>Optimal range v. “normal” range </li></ul><ul><li>Rejects the notion of “class effect” </li></ul>
    3. 3. Where are you on the Health span Curve? Optimum Health Sub-optimum Health Undiagnosed Conditions Development Vitality Degeneration Morbidity Reserve Capacity (% of Maximum Function)
    4. 4. Morbidity Extension keeps you alive… with your diseases Morbidity Extension Reserve Capacity (% of Maximum Function)
    5. 5. Morbidity Compression maximizes vitality & ‘health span’ Morbidity Compression Vitality Extension Reserve Capacity (% of Maximum Function)
    6. 6. Age Management Medicine: A New Paradigm <ul><li>Preventive/Health Based v. Disease Based </li></ul><ul><li>Orthomolecular vs. Pharmaceutical </li></ul><ul><li>Aging treated as a disease rather than a normal inevitable process </li></ul><ul><li>Optimal range v. “normal” range </li></ul><ul><li>Rejects the notion of “class effect” </li></ul>
    7. 7. Orthomolecular vs. Pharmaceutical Medicine <ul><li>Orthomolecular Paradigm —Find the biomolecular cause and correct it using bioidentical molecules </li></ul><ul><li>Pharmaceutical Paradigm —Find a non-natural, patentable substance (possibly toxic) that will improve the disorder in some way </li></ul><ul><li>Pharmaceutical should be secondary to Orthomolecular, not primary </li></ul>
    8. 8. The Problem with Pharmaceuticals <ul><li>Alien molecules: body does not recognize them or know how to eliminate them </li></ul><ul><li>Negative functions: disrupt physiology by blocking receptors, inhibiting enzymes, etc. </li></ul><ul><li>Toxic: All have side effects and both known and unknown deleterious long-term effects (not true of bioidenticals !!) </li></ul>
    9. 9. Bioidentical Hormones <ul><li>Are chemically converted from yams or soy and are identical in composition to human hormones </li></ul><ul><li>Are not patentable </li></ul><ul><li>Have been used in Europe over 40 years </li></ul><ul><li>Have been extensively researched </li></ul><ul><li>Estradiol, progesterone, and testosterone are FDA approved </li></ul><ul><li>In balance, the do NOT have the same risks as CHRT </li></ul>
    10. 10. Conventional Medicine <ul><li>Too much information, not enough time to do independent research, super-specialization, not taught that way </li></ul><ul><li>Info. controlled by pharmaceutical corps who promote pharmaceutical paradigm and ignore or suppress non-patentable natural vitanutrients and hormones </li></ul><ul><li>Result: Unfounded fear of hormone optimization ; unfounded confidence in toxic drugs </li></ul>
    11. 11. Age Management Medicine: A New Paradigm <ul><li>Preventive/Health Based v. Disease Based </li></ul><ul><li>Orthomolecular vs. Pharmaceutical </li></ul><ul><li>Aging treated as a disease rather than a normal inevitable process </li></ul><ul><li>Optimal range v. “normal” range </li></ul><ul><li>Rejects the notion of “class effect” </li></ul>
    12. 12. Conventional View of Hormones and Aging <ul><li>The loss of hormones is adaptive –helps us to live longer </li></ul><ul><li>Persistence of youthful levels of hormones would cause more heart attacks and cancers as we age </li></ul><ul><li>Losing our hormones is good for us </li></ul><ul><li>Pharmaceutical Agenda: Don’t replace hormones; take a drug for every problem. </li></ul>
    13. 13. Against the Conventional View <ul><li>All animals designed/evolved with a limited lifetime—a self-destruct program that kicks in at age 25 in humans </li></ul><ul><li>Aging is the degenerative disease that affects us all! </li></ul><ul><li>Cancers, heart attacks, autoimmune diseases, etc. occur years after hormone deficiencies begin and occur more often in people with lower hormone levels! </li></ul><ul><li>Studies of balanced BHRT show tremendous benefits with no proof of harm !! </li></ul>
    14. 14. Age Management Medicine: A New Paradigm <ul><li>Preventive/Health Based v. Disease Based </li></ul><ul><li>Orthomolecular vs. Pharmaceutical </li></ul><ul><li>Aging treated as a disease rather than a normal inevitable process </li></ul><ul><li>Optimal range v. “normal” range </li></ul><ul><li>Rejects the notion of “class effect” </li></ul>
    15. 15. Conventional Thinking: The Tyranny of the Lab Report <ul><li>Ranges are population stats , not optimals </li></ul><ul><li>Male free testosterone: 35-155 5x </li></ul><ul><li>Female free testosterone: 0.0-6.2  </li></ul><ul><li>Free T3: 1.8-4.2 2.5x </li></ul><ul><li>TSH: 0.3-5 17x </li></ul><ul><li>If test is “normal”—no diagnosis or Rx, pharmaceuticals for symptoms </li></ul><ul><li>If below “normal”, maybe  to “normal” </li></ul>
    16. 16. Age Management Medicine: A New Paradigm <ul><li>Preventive/Health Based v. Disease Based </li></ul><ul><li>Orthomolecular vs. Pharmaceutical </li></ul><ul><li>Aging treated as a disease rather than a normal inevitable process </li></ul><ul><li>Optimal range v. “normal” range </li></ul><ul><li>Rejects the notion of “class effect” </li></ul>
    17. 17. Common Sense Regarding “Class Effect” <ul><li>Problems caused by hormone substitutes should not be attributed to our natural human hormones until proven otherwise . </li></ul><ul><li>Bioidentical hormone replacement to restore youthful levels and balance should be considered safe until proven otherwise ! </li></ul>
    18. 18. Components of Age Management Diet Hormone Therapy Conventional Treatments Exercise Supplements Lifestyle
    19. 19. Age Management Medicine 5 Basic Principles: <ul><li>Education and Knowledge enables self determination </li></ul><ul><li>Lifelong attention to diet and normal weight maintenance enables the reduction of chronic inflammation </li></ul><ul><li>Exercise promotes Health and Weight Maintenance </li></ul><ul><li>Nutritional/Nutraceutical therapies preferred; pharmaceuticals when indicated </li></ul><ul><li>Hormone modulation and replenishment with bio-identical hormones </li></ul>
    20. 21. Hormones <ul><li>Intercellular communication devices </li></ul><ul><li>Travel via blood to cells’ receptors </li></ul><ul><li>Control cells’ proliferation, protein manufacture, metabolic rate, etc. </li></ul><ul><li>Most powerful molecules in biology </li></ul><ul><li>Optimal levels essential for health and quality of life </li></ul>
    21. 23. Hormonal Decline With Aging <ul><li>Hormones that build tissues and improve immunity decline with age by 50-80% (DHEA, Testosterone, HGH) </li></ul><ul><li>Progesterone starts to decline at age 30. </li></ul><ul><li>Estradiol disappears at  50—menopause. </li></ul><ul><li>Thyroid hormone production and sensitivity decline with age </li></ul><ul><li>Insulin output and sensitivity declines  Diabetes </li></ul><ul><li>By age 50— we’ve experienced 20 years of hormonal decline </li></ul>
    22. 24. Endocrine Deterioration of Aging <ul><li>Endocrine glands and their feedback control systems deteriorate with age </li></ul><ul><li>Our bodies cease to regulate our hormones for optimal health </li></ul><ul><li>Hormone losses speed our general deterioration: a vicious cycle . </li></ul><ul><li>The symptoms of hormone loss are warning signs of physical deterioration </li></ul><ul><li>Win-Win: Hormone levels that are better for your health also make you feel better! </li></ul>
    23. 25. Common Sense Hormone Replacement <ul><li>If a hormone is missing, replace it </li></ul><ul><li>If present but insufficient, optimize by supplementation if necessary </li></ul><ul><li>Type 1 Diabetes: give human insulin </li></ul><ul><li>Hypothyroidism: give thyroid hormone </li></ul><ul><li>Growth hormone deficiency: give HGH </li></ul><ul><li>Adrenal insufficiency: give Cortisol </li></ul><ul><li>What about hormone loss due to aging? </li></ul>
    24. 26. BHRT is Smart Medicine <ul><li>Restoring youthful hormone levels is essential preventative medicine </li></ul><ul><li>Restoring youthful hormone levels is essential to the treatment of all diseases! </li></ul><ul><li>Restoring youthful hormone levels is essential to Quality of Life! </li></ul>
    25. 27. Hormone Therapy <ul><li>Remember: We age because our hormones decline, our hormones don’t decline because we age. This is the Neuroendocrine Theory of Aging. </li></ul><ul><li>In this seminar, we will discuss the most important hormones: </li></ul><ul><ul><li>Estrogen: yes, you need it </li></ul></ul><ul><ul><li>Progesterone: the great balancer </li></ul></ul><ul><ul><li>Testosterone: the feel good hormone </li></ul></ul><ul><ul><li>Thyroid: the under-diagnosed deficiency </li></ul></ul><ul><ul><li>Growth Hormone: the Healing Hormone </li></ul></ul>
    26. 28. Hormonal Deficiency Symptoms <ul><li>Weight Gain </li></ul><ul><li>Loss of Muscle Mass </li></ul><ul><li>Degenerative Diseases (Diabetes, Cancer, Heart Disease, Osteoporosis) </li></ul><ul><li>A Compromised Immune System </li></ul><ul><li>Wrinkling and Thinning of the Skin </li></ul><ul><li>Depression and Anxiety </li></ul><ul><li>Cognitive Decline </li></ul><ul><li>Insulin Resistance </li></ul><ul><li>Loss of Sex Drive </li></ul><ul><li>Fatigue </li></ul><ul><li>Sleep Disorders </li></ul>
    27. 29. The Seven Dwarves of Menopause
    28. 30. Menopause <ul><li>Estrogen Deficiency </li></ul><ul><li>Progesterone Deficiency </li></ul><ul><li>Testosterone Deficiency </li></ul><ul><li>After menopause, women depend upon their adrenal glands for androgens and estrogens, so: </li></ul><ul><li>Menopause </li></ul><ul><li> + Adrenal Insufficiency </li></ul><ul><li> = BIG TROUBLE </li></ul>
    29. 31. Progesterone Deficiency/Estrogen Dominance Symptoms <ul><li>Mood Swings, PMS </li></ul><ul><li>Anxiety, Irritability, Depression, Fatigue </li></ul><ul><li>Fibrocystic breasts, breast tenderness, cysts </li></ul><ul><li>Uterine fibroids, heavy bleeding </li></ul><ul><li>Weight gain, water retention, bloating </li></ul><ul><li>Headaches, infertility </li></ul><ul><li>Symptoms of low thyroid </li></ul><ul><li>Increased risk of breast and uterine cancer </li></ul>
    30. 32. Estrogen Deficiency <ul><li>Hot flashes, night sweats </li></ul><ul><li>Vaginal dryness, urgency, incontinence </li></ul><ul><li>Foggy thinking, memory lapses </li></ul><ul><li>Tearful, depressed </li></ul><ul><li>Insomnia </li></ul><ul><li>Heart palpitations </li></ul><ul><li>Bone loss, aches, pains </li></ul><ul><li>Thinning skin, hair loss </li></ul>
    31. 33. Testosterone Deficiency in Women <ul><li>Decreased libido </li></ul><ul><li>Decreased energy, fatigue, lack of endurance </li></ul><ul><li>Decreased concentration, memory loss </li></ul><ul><li>Bone loss, muscle mass loss </li></ul><ul><li>Increased heart disease (CAD,CHF) & diabetes </li></ul><ul><li>Aches, pains, decreased coordination </li></ul><ul><li>Hot flashes, vaginal dryness, incontinence </li></ul><ul><li>Dry, thinning skin, wrinkles, hair loss </li></ul>
    32. 34. Long Term Effects of Combined Sex-Hormone Deficiency <ul><li>Irritability, insomnia, brain dysfunction </li></ul><ul><li>Possibly Alzheimer’s dementia </li></ul><ul><li>Fatigue, aches and pains. </li></ul><ul><li>Osteoporosis  fractures, loss of teeth </li></ul><ul><li>Genital atrophy , vaginal dryness </li></ul><ul><li>Atrophy of skin and connective tissue </li></ul><ul><li>Heart disease —higher risk than men after 65, higher mortality after 70! </li></ul>
    33. 35. Known Benefits of Estradiol Replenishment <ul><li>Eliminates hot flashes </li></ul><ul><li>Restores mood and mental function </li></ul><ul><li>Protects against Alzheimer’s disease </li></ul><ul><li>Maintains genital/vaginal skin and lubrication </li></ul><ul><li>Increases thickness, fullness of skin and hair </li></ul><ul><li>Prevents osteoporosis and osteoarthritis </li></ul><ul><li>Prevents heart disease </li></ul><ul><li>Prevents colon cancer and macular degeneration </li></ul><ul><li>Improves insulin sensitivity—helps diabetes </li></ul>
    34. 36. Benefits of Bio-identical Progesterone <ul><li>Helps balance estrogen </li></ul><ul><li>Protects against endometrial cancer, may protect against breast cancer </li></ul><ul><li>Helps you sleep, has a natural calming effect </li></ul><ul><li>Aids in use and elimination of fats </li></ul><ul><li>Helps normalize libido </li></ul><ul><li>Has an anti-proliferative effect (decreases the rate of cancer) on all progesterone receptors, not just the ones in the uterus) </li></ul><ul><li>Natural diuretic </li></ul><ul><li>Natural antidepressant </li></ul>
    35. 37. Testosterone for Women <ul><li>Improves energy, mood </li></ul><ul><li>Improves sexual desire and response </li></ul><ul><li>Increases muscle strength and reduces muscle and joint aches </li></ul><ul><li>With estradiol , increases bone density </li></ul><ul><li>J Reprod Med. 1999 Dec;44(12):1012-20. </li></ul><ul><li>Probably decreases risk of heart attack </li></ul><ul><li>J Womens Health. 1998 Sep;7(7):825-9. </li></ul><ul><li>Given with estradiol and progesterone , may reduce risk of breast cancer </li></ul><ul><li>Menopause. 2003 Jul-Aug;10(4):292-8., Endocr Rev. 2004 Jun;25(3):374-88. </li></ul>
    36. 38. Hormone Replenishment <ul><ul><li>Treatment of Peri-menopause and Menopause: </li></ul></ul><ul><ul><ul><li>Aimed at restoring levels to physiologic range for 25-35 year old </li></ul></ul></ul><ul><ul><ul><li>Replenish and balance low levels of </li></ul></ul></ul><ul><ul><ul><ul><li>Testosterone, Estrogens, Progesterone, DHEA, Thyroid </li></ul></ul></ul></ul><ul><ul><ul><li>Reduce high levels of </li></ul></ul></ul><ul><ul><ul><ul><li>Insulin, Cortisol </li></ul></ul></ul></ul><ul><ul><ul><li>Use Natural (Bio-identical) hormones </li></ul></ul></ul><ul><ul><ul><li>Monitor with regular serum levels </li></ul></ul></ul>
    37. 39. Other Hormone Replenishment <ul><ul><li>DHEA – precursor hormone </li></ul></ul><ul><ul><li>Pregnenolone – another precursor </li></ul></ul><ul><ul><li>May improve memory </li></ul></ul><ul><ul><li>May moderate Cortisol levels </li></ul></ul><ul><ul><li>Melatonin </li></ul></ul><ul><ul><li>Improves Stage III and IV sleep </li></ul></ul><ul><ul><li>Most significant antioxidant for the brain </li></ul></ul><ul><ul><li>Stimulates immune system </li></ul></ul><ul><ul><li>May reduce breast cancer risk </li></ul></ul><ul><ul><li>May prevent migraines </li></ul></ul>
    38. 41. Osteoporosis <ul><li>In menopause 5% bone loss each year for first 5 years=25%—all due to loss of estrogen ! </li></ul><ul><li>20 yrs. post menopause—50% reduction in trabecular bone, 30% in cortical bone </li></ul><ul><li>50% of women >65 yrs. old have spinal compression fractures </li></ul><ul><li>14% lifetime risk of hip fracture for 50 yr.old woman, 30% for 80 yr. old. </li></ul>Speroff L, Fritz M Clinical Gynecologic Endocrinology and Fertility, 7 th Ed.
    39. 42. Osteoporosis <ul><li>A hormone deficiency disease—the proper treatment is BHRT! </li></ul><ul><li>Estrogen prevents resorption of old bone while testosterone , progesterone , DHEA and GH build new bone </li></ul><ul><li>J Clin Endo Metab. 1996; 81:37-43. </li></ul><ul><li>J Reprod Med. 1999 Dec;44(12):1012-20. </li></ul><ul><li>Combined BHRT increases bone density far better than Fosamax  and preserves normal bone remodeling (no “rotting jaw”, eye inflammation,  Ca ++ ). </li></ul>
    40. 43. Speroff L, Fritz M Clinical Gynecologic Endocrinology and Fertility, 7 th Ed.
    41. 44. The Mighty Thyroid <ul><li>Regulates temperature, metabolism and cerebral function. </li></ul><ul><li>Increases fat breakdown, resulting in wt. loss & lowers cholesterol. </li></ul><ul><li>Symptoms of hypothyroid are more common in women & elderly: </li></ul><ul><ul><li>Fatigue </li></ul></ul><ul><ul><li>Lower than normal body temp. </li></ul></ul><ul><ul><li>Greater susceptibility to colds & viruses </li></ul></ul><ul><ul><li>Depression & mood swings </li></ul></ul><ul><ul><li>Weight gain and resistance to weight loss </li></ul></ul><ul><ul><li>Dry skin/brittle nails </li></ul></ul><ul><ul><li>High cholesterol </li></ul></ul>
    42. 45. Diagnosing Hypothyroidism <ul><ul><li>Must check T4, T3, and TSH. Most docs only measure TSH. But, a high T4 (which is inactive) will depress the TSH, even though the T3 might be low and the patient suffering all the symptoms of low thyroid functioning! </li></ul></ul><ul><ul><li>Also, autoimmune thyroiditis causing hypothyroidism (Hashimoto’s thyroiditis) is quite common, particularly in women. A test called TPO (thyroid antibodies) is necessary to diagnose this. </li></ul></ul>
    43. 46. Thyroid Optimization: Not Just for Quality of Life <ul><li>Incidence of severe atherosclerosis doubled with lower T 3 or higher TSH levels within the normal range </li></ul><ul><li> Clin Cardiol. 2003 Dec;26(12):569-73 </li></ul><ul><li>Lowers cardiac risk factors: cholesterol, triglycerides, C-reactive protein, homocysteine and lipoprotein(a) </li></ul><ul><li>Lowers blood pressure, dilates arteries </li></ul><ul><li>Reduces tendency to form blood clots </li></ul>
    44. 47. Age Management Approach to Thyroid Replacement <ul><li>Restore iodine sufficiency </li></ul><ul><li>If classic S/S present, give thyroid hormones in spite of “low normal” blood tests </li></ul><ul><li>Give T 3 in addition to T 4 (Armour, Cytomel) </li></ul><ul><li>Endocrinology 1996;137:2490-502. </li></ul><ul><li>Increase dose until symptoms are gone or S/S of excess appear </li></ul><ul><li>Often must suppress TSH to lower limit </li></ul><ul><li>No bone loss, cardiac abnormalities, or muscle wasting with moderate TSH suppression </li></ul>
    45. 48. Andropause
    46. 49. Andropause in Men <ul><li>Testosterone levels decline slowly in men—”Just getting old.” </li></ul><ul><li>Fatigue, reduced mental function </li></ul><ul><li>Passivity and moodiness—loss of drive and ambition </li></ul><ul><li>Loss of muscle mass, increased abdominal fat </li></ul><ul><li>Lastly: loss of libido, no morning erections </li></ul><ul><li>Low Testosterone levels are associated with a higher risk of depression, heart disease, osteoporosis, fracture rates, frailty and even dementia Salazar, J, Risks of testosterone replacement therapy in ageing men. Summary Expert Opinion on Drug Safety. November 2004, Vol. 3, No. 6, Pages 599-606 </li></ul>
    47. 50. Testosterone Levels and Age
    48. 51. Testosterone and the Heart <ul><li>Low testosterone levels, correlate with coronary artery disease and stroke </li></ul><ul><li>Phillips et al., Arterioscler Thromb. 1994; 14:701-706. </li></ul><ul><li>English et al., Eur Heart J 2000; 21; 890–4. </li></ul><ul><li>Zhao SP et al., Int J Cardiol. 1998 Jan 31;63(2):161-4. </li></ul><ul><li>Arterioscler Thromb Vasc Biol. 1996 Jun;16(6):749-54. </li></ul><ul><li>Treatment with Testosterone </li></ul><ul><li>Dilates coronary arteries—improves angina </li></ul><ul><li>Increases heart muscle size, strength </li></ul><ul><li>Decreases fibrinogen levels—prevents blood clots </li></ul><ul><li>Demirbag et al., Endocr Res. 2005;31(4):335-44. </li></ul>
    49. 52. Testosterone and the Prostate <ul><li>Higher testosterone levels do not increase risk of prostate cancer. </li></ul><ul><li>Studies of testosterone supplementation have shown no increase in prostate cancer </li></ul><ul><li>In fact, low testosterone correlated with more aggressive prostate cancers </li></ul><ul><li>Testosterone may promote the growth of an existing prostate cancer </li></ul><ul><li>Monitor with bi-yearly PSA tests </li></ul>
    50. 53. Testosterone and prostate cancer <ul><li>“ There is no clinical evidence that the risk of either prostate cancer or benign prostatic hypertrophy increases with testosterone replacement therapy.” (from the Mayo Clinic Proc. 2000) </li></ul><ul><li>“ These results argue against an increased risk of prostate cancer with testosterone replacement therapy.” </li></ul><ul><li>Testosterone replacement therapy and prostate risks: where's the beef? Can J Urol. 2006 Feb;13 Suppl 1:40-3. </li></ul>
    51. 54. Testosterone Replacement <ul><li>Improves mood and sociability </li></ul><ul><li>Restores energy and ambition </li></ul><ul><li>Improves cognition </li></ul><ul><li>Increases libido and sexual performance </li></ul><ul><li>Increases muscle and bone mass </li></ul><ul><li>Reduces abdominal fat, improves insulin sensitivity, lowers blood pressure--counteracts metabolic syndrome </li></ul>
    52. 55. Methods of Replacement <ul><li>Injections: Generally once per week. </li></ul><ul><li>Cream: Rubbed into the skin, alcohol based or cream based used once each day </li></ul><ul><li>Oral: Not good for the liver and is metabolized in only about 4 hrs. Doesn’t give good blood level. Not physiologic. </li></ul><ul><li>Patch: Some insurances will pay for these-good blood level, but some men don’t like the plastic patch. Cannot use sauna with the patch—get too high blood level. </li></ul><ul><li>Testosterone pellets: about the size of a grain of rice, pellets are injected under the skin every 6-8weeks </li></ul>
    53. 56. Rhoden, E. L. et al. N Engl J Med 2004;350:482-492
    54. 57. Growth Hormone
    55. 58. Growth Hormone <ul><li>Somatopause – decline of release of human growth hormone by pituitary with aging. </li></ul><ul><li>Proponents feel that Somatopause is responsible for the decline of </li></ul><ul><ul><li>Muscle to fat ratio </li></ul></ul><ul><ul><li>Immune function </li></ul></ul><ul><ul><li>Sense of well being </li></ul></ul><ul><ul><li>Bone and cartilage </li></ul></ul><ul><ul><li>YOUTH </li></ul></ul>
    56. 59. Growth Hormone vs. Age
    57. 60. Expected Benefits of HGH restored to 30 year old level <ul><li>Increased exercise capacity </li></ul><ul><ul><li>Increased skeletal muscle mass & strength </li></ul></ul><ul><ul><li>Increased cardiac output </li></ul></ul><ul><ul><li>Decreased fat mass (10%-14%) with first 6 mo. of therapy. </li></ul></ul><ul><ul><li>Improved bone density after 1 yr. </li></ul></ul><ul><li>Improved quality of life </li></ul><ul><ul><li>Less fatigue </li></ul></ul><ul><ul><li>Greater stamina </li></ul></ul><ul><ul><li>Increased physical performance </li></ul></ul><ul><ul><li>Improved mental acuity </li></ul></ul><ul><ul><li>Improved sexual function </li></ul></ul>
    58. 61. Conventional Endocrinology & Age Management Medicine agree up to a point! <ul><li>Pathological GH deficiency is a disease which should be treated </li></ul><ul><li>GH secretion declines with aging </li></ul><ul><li>GH decline is responsible for part of the clinical syndrome of aging </li></ul><ul><li>Aging and GH decline are normal, DON’T TREAT. </li></ul><ul><li>Pathological GH deficiency is a disease which should be treated. </li></ul><ul><li>GH secretion declines with aging </li></ul><ul><li>GH decline is responsible for part of the clinical syndrome of aging </li></ul><ul><li>Aging and GH decline is a deficiency disease which CAN and SHOULD BE TREATED </li></ul>
    59. 62. Methods of Replacement <ul><li>Given each day as an injection </li></ul><ul><ul><li>Oral growth hormone does not work-infomercials, radio ads-worthless! </li></ul></ul><ul><li>Side effects: edema & arthralgia related to high doses given 2-3x/wk. Best to take daily </li></ul><ul><li>Carpal tunnel syndrome, elevated glucose, abn. Growth of feet & other organs. </li></ul>NOTE:
    60. 63. BHRT—A New Science <ul><li>Unresolved issues—more investigation needed </li></ul><ul><li>Need more long-term randomized studies to study long-term effects. </li></ul><ul><li>Questions about delivery and monitoring </li></ul><ul><li>Medical profession should be studying bioidentical hormones instead of hormone substitutes! </li></ul><ul><li>We have the right to replace the hormones we lose to the disease of aging!! </li></ul>
    61. 64. What I do: Diet Hormone Therapy Conventional Treatments Exercise Supplements Lifestyle
    62. 65. Morbidity Compression maximizes vitality & ‘healthspan’ Morbidity Compression Vitality Extension Reserve Capacity (% of Maximum Function)
    63. 66. Maintaining Quality of Life
    64. 67. Thank you for attending The Center for Optimal Health Paul Navar MD 166 N. 300 W. Suite #3 St. George, Utah 84770 (435) 688-8582 Email:
    65. 70. DHEA-S levels vs. Age
    66. 71. Worst Side Effect?
    67. 72. .