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A4 m 5 19-12 comprehensive hormone replacement therapy v 1.1
- 1. Professional Education Series David S. Klein, MD, FACA, FACPM Stages of Life Medical Institute Longwood, Florida
- 2. Comprehensive Hormone Replacement Therapy In the Traditional Medical Setting
- 3. Hormone Replacement Therapy? Where do you start? What are your goals? What tools do you have at your disposal? (c) 2012 Stages of Life Medical Institute
- 4. What is Hormone Replacement Therapy • More importantly, – What hormones do we address? – What hormones are most critical to assess? – How do you plan your assessment? – In what order, and in what manner do you initiate corrective/therapeutic action? (c) 2012 Stages of Life Medical Institute
- 5. Natural Hormone Therapy or Xenohormone Therapy? (c) 2012 Stages of Life Medical Institute
- 6. The first responsibility of the clinician is to determine the most precise diagnosis possible. This is accomplished first with a detailed history, physical, and only then, laboratory measurement. (c) 2012 Stages of Life Medical Institute
- 7. Why are we concerned with hormone balance, anyway? • What are hormones? • Why are they important? • What happens when the system breaks? • What options are available to correct and restore balance? (c) 2012 Stages of Life Medical Institute
- 8. Command and Control Hard wired mechanisms – Nerve Wireless mechanisms – Hormonal – Humoral – Chemical (c) 2012 Stages of Life Medical Institute
- 9. Physiological Command and Control Mechanisms • Neuronal • Hormonal – Motor • Regional, organs & tissues? • Distinct & precise • Global – Sensory • Regional, predictable , broader areas – Autonomic • Global (c) 2012 Stages of Life Medical Institute
- 10. Common Endocrine Concerns • Common – Thyroid Axis – Adrenal Axis – Pancreatic Axis – Gondal Axis – Parathyroid (c) 2012 Stages of Life Medical Institute
- 11. Populations at risk • Thyroid Disease affects 1/3 of the American Adult population. • Diabetes, pre-diabetes and „metabolic syndrome X‟ affect 1/3 or more of the American population. • Adrenal Dysfunction affects 15% of the American population. • Gonadal Hormone dysfunction will affect nearly 100% of the adult population, at some time. “Do you feel lucky…., punk..” Clint Eastwood (c) 2012 Stages of Life Medical Institute
- 12. Bodily Fluid Analysis • Serum – Traditional – Influenced by diurnal variation & timing • Urine – Gives indication of cellular function from the „back end.‟ • Saliva – Assumes neutrality of salivary tissues relative to metabolism. – Assumes lack of concentration issues (c) 2012 Stages of Life Medical Institute
- 13. Advantages & Disadvantages • Each testing tells a part of the story • No single part tells it all • Each piece adds to an understanding of the whole picture. (c) 2012 Stages of Life Medical Institute
- 14. Estrogen Dominance Definition: Elevated ratio of measured estrogen level, relative to progesterone level.
- 15. Second only to Thyroid Dysfunction, Estrogen Dominance is the Most Common Dysfunction in Females (c) 2012 Stages of Life Medical Institute
- 16. Causes of Imbalance • 1. Gonadal Dysfunction – Ovarian Dysfunction • 2. Pain – Narcotic • 3. Medication side-effect • 4. Stress • 5. Dietary Imbalance, over time (c) 2012 Stages of Life Medical Institute
- 17. Libido Decreases with Estrogen Dominance • Progesterone imbalance leads to vaginal dryness. • Relative estrogen elevation leads to emotionality, lability and irrationality. • Sexuality is a sign of health. (c) 2012 Stages of Life Medical Institute
- 18. A Decrease in Libido is a Sign of Illness (c) 2012 Stages of Life Medical Institute
- 19. Medical Evaluation • Detailed medical/social history. – An ongoing process. – Many factors & facts are noted over time. • Assume that the depression is secondary to the problem. • Begin with hormonal evaluation. (c) 2012 Stages of Life Medical Institute
- 20. Saliva Testing • Estrogen – Estradiol – Estriol • Testosterone • Progesterone • Cortisol • DHEA (c) 2012 Stages of Life Medical Institute
- 21. Hormonal Blood Testing • Estrogens, Total – Estradiol & Estrone • Progesterone • Testosterone, total • DHEAs • Androstendione • Insulin • Thyroid – T3, T4, TSH, TPA, Anti-thyroglobulin (c) 2012 Stages of Life Medical Institute
- 22. Cellular Testing • Micronutrients • Anti-oxidants • Trace Minerals (c) 2012 Stages of Life Medical Institute
- 23. Testosterone, Estrogen & Progesterone Balance (c) 2012 Stages of Life Medical Institute
- 24. HRT is all about Balance (c) 2012 Stages of Life Medical Institute
- 25. Medical Treatment • Restore normal sleep cycle. • Restore normal hormone levels. • Eliminate or reduce medications that may result in dysfunctional States. (c) 2012 Stages of Life Medical Institute
- 26. Hormone Replacement Priorities • Always start with the Thyroid • Next, address the Adrenals • Then, deal with the Gonadals. (c) 2012 Stages of Life Medical Institute
- 27. Administration Techniques Transdermal Route – Creams – Patches – Sub Lingual, trans-clitoral Oral Route Parenteral Approach (c) 2012 Stages of Life Medical Institute
- 28. Success Results From a Team Effort. (c) 2012 Stages of Life Medical Institute
- 29. Questions? (c) 2012 Stages of Life Medical Institute