Bio Identical or Natural Hormone Replacement Therapy


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Bio Identical or Natural Hormone Replacement Therapy

  1. 1. Bioidentical Hormone Restoration Best Medical Practice
  2. 2. Hormones <ul><li>Neuro-endocrine-immune system </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 our bodies </li></ul><ul><li>Optimal levels essential for health and quality of life </li></ul>
  3. 4. Hormones and Aging Why Doctors Don’t Get It
  4. 5. Bioidentical Hormone Restoration is Common Sense <ul><li>If a hormone is missing, replace it ! </li></ul><ul><li>If present but insufficient, optimize it ! </li></ul><ul><li>Type 1 Diabetes: bioidentical insulin </li></ul><ul><li>Hypothyroidism: bioidentical T 4 </li></ul><ul><li>Growth hormone def.: bioidentical GH </li></ul><ul><li>Adrenal insufficiency: bioidentical cortisol </li></ul><ul><li>But what about hormones lost to aging? </li></ul>
  5. 6. Pregnenolone—Mother Steroid J Clin Endocrinol Metab. 1997 Aug;82(8):2396-402.
  6. 7. DHEA  DHEA-S J Clin Endocrinol Metab. 1997 Aug;82(8):2396-402.
  7. 8. Growth Hormone (GH) Somatopause J Clin Endocrinol Metab. 1999 Jun;84(6):2013-9. Normal Adults Pituitary Disease fatigue Sufficiency Log scale
  8. 9. Testosterone Progesterone Estradiol pg/ml DHEA–10,000 pg/ml, DHEA-S 5,000,000 pg/ml ! ♀ ♀ ♂ ♂ Andropause Menopause
  9. 10. Hormonal Changes With Aging <ul><li>Hormones that build tissues and improve immunity decline with age by 50-80% ( DHEA, Testosterone, GH ) </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 </li></ul><ul><li>Insulin output declines  Diabetes </li></ul><ul><li>By age 50— 20 years of hormonal deficiency </li></ul>
  10. 11. 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>Fits the Pharmaceutical Agenda : Take drugs for every symptom and disorder caused by hormone loss! </li></ul>
  11. 12. Against the Conventional View <ul><li>Aging is a self-destruct program that kicks in at age 25 in humans </li></ul><ul><li>Aging is natural degeneration! </li></ul><ul><li>Weight gain, high blood pressure, high cholesterol, 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 hormone restoration show the expected benefits and no proof of harm !! </li></ul>
  12. 13. Example: Growth Hormone <ul><li>Declines 14% per decade after age 25 </li></ul><ul><li>IGF-1 of many adults equal to hypopituitary patients (only 80-110 vs. 350 @25yrs.old) </li></ul><ul><li>Deficiency  heart disease, frailty, depression, body fat, bone loss </li></ul><ul><li>GH restoration reduces abdominal fat, lowers blood sugar and blood pressure </li></ul><ul><li>Improves cognition, mood, sleep, energy </li></ul><ul><li>Increases muscle, decreases fat & cholesterol </li></ul><ul><li>Improves bone density, skin thickness </li></ul><ul><li>Downside: high cost, nightly injections </li></ul>
  13. 14. The Endocrinology 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 restoration makes you feel better and improves your health! </li></ul>
  14. 15. Since the Loss of Hormones is Harmful,THEN… <ul><li>Restoring youthful hormone levels is: </li></ul><ul><li>essential preventative medicine </li></ul><ul><li>essential to the treatment of disease </li></ul><ul><li>essential to Quality of Life! </li></ul><ul><li>We have the need and the right to restore hormones lost to aging ! </li></ul>
  15. 16. Hormones and Aging Any Questions?
  16. 17. Human Steroid Hormones Testosterone Estradiol Progesterone Cortisol DHEA
  17. 18. Where Do They Come From? <ul><li>All steroid hormones (including substitutes) are chemically synthesized from diosgenin (wild Mexican yams, soy, and other plants). </li></ul>
  18. 19. Not Just “Sex Hormones” <ul><li>Estrogen, progesterone, testosterone and DHEA essential to cellular growth and function in all tissues in both sexes ! </li></ul><ul><li>Maintain brain function —modulators of mood, cognition, pain, etc. </li></ul><ul><li>Maintain the immune system — progesterone and testosterone are immunosuppressants </li></ul><ul><li>Maintain connective tissue : skin, hair, bone, muscle, and blood vessels </li></ul>
  19. 20. Female Endocrinology <ul><li>Nature makes special demands on the female body for reproduction </li></ul><ul><li>Breast, uterine and ovarian tissues undergo a monthly cycle of proliferation, differentiation, and breakdown </li></ul><ul><li>Defects in this cycle can lead to cancers in female organs and to many medical disorders. </li></ul>
  20. 21. Estrogen—Progesterone Complementarity <ul><li>Estrogen promotes breast/uterine tissue proliferation and growth </li></ul><ul><li>Progesterone stops proliferation and promotes maturation and differentiation </li></ul><ul><li>Differentiated cells can’t become cancer cells </li></ul><ul><li>High average progesterone/estrogen ratio suppresses proliferation and prevents cancers of female organs </li></ul>
  21. 22. Progesterone Deficiency  Estrogen Dominance <ul><li>Allergies </li></ul><ul><li>Autoimmune diseases </li></ul><ul><li>Anxiety, irritability </li></ul><ul><li>Insomnia </li></ul><ul><li>Decreased sex drive </li></ul><ul><li>Depression </li></ul><ul><li>Bloating and edema </li></ul><ul><li>Fibrocystic breasts </li></ul><ul><li>Uterine fibroids </li></ul><ul><li>Breast cancer </li></ul><ul><li>Ovarian cancer </li></ul><ul><li>Uterine cancer </li></ul><ul><li>Thyroid dysfunction </li></ul><ul><li>Gallbladder disease </li></ul><ul><li>Heavy periods </li></ul><ul><li>Migraines </li></ul><ul><li>Seizures </li></ul>Progesterone and Iodine/Kelp reduce estrogen dominance
  22. 23. Historical Perspective <ul><li>Throughout most of human history, women were usually: </li></ul><ul><ul><li>Pregnant— high progesterone </li></ul></ul><ul><ul><li>Breastfeeding— low estrogen </li></ul></ul><ul><li> (both protect against breast cancer ) </li></ul><ul><li>Women cycled for 4 years avg.; today many cycle for 35 years </li></ul><ul><li>Cycling=  risk of estrogen dominance and other hormonal disorders </li></ul>
  23. 24. Perimenopause <ul><li>Females born with a fixed no. of oocytes which are continually lost to age and ovulation </li></ul><ul><li>With aging, fewer oocytes of lower quality are left  reduced progesterone production beginning around age 30  estrogen dominance </li></ul><ul><li>No ovulation= no progesterone </li></ul><ul><li>Estrogen swings from very high to very low—often for several years. </li></ul>
  24. 25. Normal Progesterone Dominance Ovulation Menstrual Cycle
  25. 26. Perimenopause Luteal Insufficiency=Estrogen Dominance Ovulation Menstrual Cycle Inadequate Luteal Phase shorter periods, early spotting
  26. 27. Perimenopause Anovulation=Estrogen Dominance Menstrual Cycle
  27. 28. Menopause Estrogen and Progesterone Deficiency
  28. 29. Also Uterine and Ovarian Cancer
  29. 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>
  30. 31. Effects of Combined Sex-Hormone Deficiency <ul><li>Irritability, insomnia, brain dysfunction </li></ul><ul><li>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>
  31. 32. Estradiol Restoration <ul><li>Eliminates hot flashes </li></ul><ul><li>Restores mood and mental function </li></ul><ul><li>Probably 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 heart disease </li></ul><ul><li>Prevents colon cancer and macular degeneration </li></ul><ul><li>Improves insulin sensitivity—helps diabetes </li></ul><ul><li>Prevents osteoporosis and osteoarthritis </li></ul>
  32. 33. Speroff L, Fritz M Clinical Gynecologic Endocrinology and Fertility, 7 th Ed.
  33. 34. 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.
  34. 35. Osteoporosis <ul><li>A hormone deficiency disease—the proper treatment is hormone restoration ! </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 BHR increases bone density far better than Fosamax  and preserves normal bone remodeling (no “rotting jaw”, eye inflammation,  Ca ++ ). </li></ul>
  35. 36. Estrogen, Progesterone, and Osteoporosis Any Questions?
  36. 37. Total and Free Testosterone in Men Baltimore Longitudinal Study of Aging (BLSA). Harman et al., 2001
  37. 38. 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>Increased risk of heart and prostate disease </li></ul><ul><li>Increased risk of Alzheimer’s dementia </li></ul><ul><li>Increased risk of autoimmune diseases </li></ul>
  38. 39. Testosterone Restoration <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>
  39. 40. Testosterone and the Heart <ul><li>Low testosterone levels, correlate with coronary artery disease and stroke </li></ul><ul><li>Arterioscler Thromb. 1994; 14:701-706 </li></ul><ul><li>Eur Heart J 2000; 21; 890–4 </li></ul><ul><li>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>T dilates coronary arteries—improves angina </li></ul><ul><li>T increases heart muscle size, strength </li></ul><ul><li>T decreases fibrinogen levels—prevents blood clots </li></ul><ul><li> Endocr Res. 2005;31(4):335-44. </li></ul>
  40. 41. Testosterone and the Prostate <ul><li>Higher testosterone levels do not increase the risk of prostate cancer. </li></ul><ul><li>Studies of testosterone supplementation have shown no increase in prostate cancer—even though so many men have it! </li></ul><ul><li>Low testosterone correlated with more aggressive prostate cancers </li></ul><ul><li>Testosterone promotes prostate growth to a point, but not prostate cancer </li></ul>
  41. 42. Where’s the Beef? <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>
  42. 43. Estrogen Dominance Theory of Prostate Disease <ul><li>In many men, free testosterone declines > estradiol </li></ul><ul><li>Estrogen dominance is a probable cause of prostrate enlargement and a possible cause of prostate cancer </li></ul><ul><li>Elevated estrogen/Test. ratios in BPH Scandinavian Journal of Urology and Nephrology, 1995; 29: 65-68. </li></ul><ul><li>High levels of estradiol and estrone found in BPH tissues </li></ul><ul><li>Estradiol upregulates oncogenes </li></ul>
  43. 44. Female Andropause <ul><li>Young woman’s free testosterone level in serum is 2x her free estradiol </li></ul><ul><li>Female testosterone levels decline 50% between age 20 and 45 </li></ul><ul><li>Birth control pills   testosterone and DHEA levels </li></ul><ul><li>DHEA declines with age —main source of androgens in women </li></ul>
  44. 45. 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 , reduces 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><ul><li>Menopause. 2004 Sep-Oct;11(5):531-5, FASEB J. 2000 Sep;14(12):1725-30. </li></ul>
  45. 46. Testosterone Any Questions?
  46. 47. “ My doctor says that hormone replacement is dangerous and there’s no evidence that bioidentical hormones are safer!”
  47. 48. Two Approaches to Medicine <ul><li>Natural-Scientific —Identify the deficiency/excess at the molecular level and correct it with bioidentical molecules </li></ul><ul><li>Pharmaceutical —Create non-natural, patentable substances that will produce some improvement </li></ul><ul><li>Natural Science should be primary ; Pharmaceutical Science secondary . </li></ul>
  48. 49. Problems with Pharmaceuticals <ul><li>Alien molecules: not recognized, not easily eliminated </li></ul><ul><li>Negative functions: disrupt normal physiology by blocking receptors, inhibiting enzymes, etc. </li></ul><ul><li>Toxic: </li></ul><ul><ul><li>Side effects even at low doses </li></ul></ul><ul><ul><li>Allergic reactions </li></ul></ul><ul><ul><li>Long-term damage </li></ul></ul>
  49. 50. Pharmaceutical Billions <ul><li>Mission: Sell pharmaceuticals </li></ul><ul><li>Information control —journals, CME, med. schools, professional org.s, etc. </li></ul><ul><li>Strategy: Suppress competition ( natural vitanutrients and hormones—human physiology!! ) </li></ul><ul><li>Conventional Docs: Unaware </li></ul><ul><li>Result: Unfounded fear of hormone optimization ; unfounded confidence in toxic drugs </li></ul>
  50. 51. History of “Hormone Replacement Therapy” <ul><li>Horse-derived Premarin  approved in 1942 </li></ul><ul><li>Progesterone synthesized in 1942. Poorly absorbed orally </li></ul><ul><li>Chemically altered to make “ progestins ”—among the first drugs to be patented. </li></ul><ul><li>“ HRT” came to mean the use of alien molecules that had hormone-like effects </li></ul><ul><li>Drug co.s became dependent on HRT profits </li></ul><ul><li>Drug co.s push doctors to use hormone substitutes and to ignore or fear natural hormones!! </li></ul>
  51. 52. Dirty Secret: Conventional “HRT” is really H S T! <ul><li>Progesterone substitutes : </li></ul><ul><li>medroxyprogesterone acetate ( MPA-Provera  ) and 30+ other “ progestins ” </li></ul><ul><li>Estradiol substitutes : conjugated equine estrogens ( CEE-Premarin  ) and ethinyl estradiol (birth control pills) </li></ul><ul><li>Testosterone substitute : oral methyltestosterone </li></ul><ul><li>Patented drugs —not hormones ! </li></ul><ul><li>Most docs don’t know the difference! </li></ul>
  52. 53. Premarin  Conjugated Equine Estrogens (CEE) Estradiol-17 β Dihydroequilin-17β CEE contains at least 10 estrogens, only 3 are human . CEE contains 3x more Dihydroequilin than Estradiol . DHE has 10% higher binding affinity for est. receptors. DHE binds far less to SHBG and has a slower metabolic clearance The most abundant estrogen in CEE is Equilin sulfate . Kuhl H, Climacteric 2005;8(Suppl 1):3–63 Human Horse
  53. 54. Estradiol Ethinyl estradiol EE cannot be inactivated by normal oxidation! EE does not interact with estrogen receptor  ! EE is 12,000-60,000 times more potent by weight! EE is much more thrombogenic than estradiol EE in Birth Control Pills Acetylene
  54. 55. Progesterone vs. Progestins Progesterone MPA (Provera  ) Megestrol  Every progestin has a different spectrum of androgenic, estrogenic, glucocorticoid , and progestational effects!
  55. 56. Progestin Zoo Kuhl, Climacteric 2005;8(Suppl 1) Progesterone NAMS-”Call ‘em all Progestogens”
  56. 57. Testosterone Substitution Testosterone Methyltestosterone Methyltestosterone ( in Estratest  ) aromatizes to an alien estrogen and increases risk of breast cancer , also causes liver damage and breast enlargement in bodybuilders Headlines: “Testosterone therapies increase risk of breast cancer.”
  57. 58. Sex Bias <ul><li>If a Man’s testes are removed or non-functional, bioidentical testosterone replacement is started immediately </li></ul><ul><li>If a woman’s ovaries are removed or non-functional, she is offered horse hormones or hormone-like drugs; or is told to “ Live with it ”. </li></ul><ul><li>It IS a Man’s World! </li></ul>
  58. 59. Birth Control Hormone Substitution is Dangerous <ul><li>2x risk of stroke, heart attack </li></ul><ul><li>2-30x risk of blood clots </li></ul><ul><li>1-3x risk of breast cancer </li></ul><ul><li>Increased blood sugar, blood pressure </li></ul><ul><li>1.5x risk systemic lupus erythematosis </li></ul><ul><li>Liver tumors </li></ul><ul><li>Diagnose and fix the hormonal disorder </li></ul><ul><li>Use a copper IUD for contraception!! </li></ul>UpToDate 2006 Instead: :
  59. 60. 2002 WHI Study—Menopausal Prempro  HST is Dangerous! <ul><li>Oral CEE (Premarin  ) alone had adverse effects in the first year (strokes, blood clots) </li></ul><ul><li>Adding MPA (Provera  , PremPro  ) caused more adverse effects (breast cancers, heart attacks) </li></ul><ul><li>CEE/MPA caused a large increase in dementia </li></ul>And we know why these forms of hormone substitution are dangerous !
  60. 61. Dangers of Oral Estrogen Replacement <ul><li>First-pass effect on the liver  IGF-1,  SHBG,  CRP,  clotting factors  blood clots, strokes, heart attacks in the first year </li></ul><ul><li>Smokers have greater risk of clots </li></ul><ul><li>EE increases clotting much more than estradiol , Premarin ® </li></ul><ul><li>Transdermal estradiol has none of these effects! </li></ul>
  61. 62. Dangers of Estrogen-only HRT <ul><li>Estrogen alone, estrogen-progestin H S T and BCPs all reduce DHEAS and testosterone levels 25-60% </li></ul><ul><li>Estrogen without progesterone and testosterone  estrogen dominance and  risk of breast cancer and other medical disorders </li></ul>
  62. 63. Provera   Progesterone <ul><li>Maintains pregnancy </li></ul><ul><li>Improves mood </li></ul><ul><li>Improves sleep </li></ul><ul><li>Diuretic </li></ul><ul><li>Lowers blood sugar </li></ul><ul><li>Maintains estrogen-induced arterial dilation </li></ul><ul><li>Improves lipid profile </li></ul><ul><li>No evidence of  CVD </li></ul><ul><li>Reduces estrogenic stimulation of breasts </li></ul><ul><li>Prevents breast cancer </li></ul><ul><li>Causes birth defects </li></ul><ul><li>Can cause depression </li></ul><ul><li>Insomnia, irritability </li></ul><ul><li>Fluid retention </li></ul><ul><li>Raises blood sugar </li></ul><ul><li>Counteracts estrogen-induced arterial dilation </li></ul><ul><li>Worsens lipid profile </li></ul><ul><li>Causes heart attacks </li></ul><ul><li>Increases estrogenic stimulation of breasts </li></ul><ul><li>Causes breast cancer </li></ul>Progestins are Dangerous Scientific studies show that:
  63. 64. Atherosclerosis and Clotting <ul><li>“ In both peripheral and cerebral vasculature (of live animals), synthetic progestins caused endothelial disruption, accumulation of monocytes in the vessel wall, platelet activation and clot formation, which are early events in atherosclerosis, inflammation and thrombosis. Natural progesterone or estrogens did not show such toxicity .” </li></ul><ul><li>Climacteric. 2003 Dec;6(4):293-301 </li></ul>
  64. 65. Progesterone and Breast Cancer —the Evidence <ul><li>Premenopausal women with low P levels had 5.4 times greater risk of early breast cancer , 10x greater risk for all cancers </li></ul><ul><li> Am J Epidem 1981;114:209-17. </li></ul><ul><li>Breast cancer victims have signs of progesterone resistance </li></ul><ul><li>Br J Obstet Gynaecol. 1998 Mar;105(3):345-51. </li></ul><ul><li>P downregulates BRCA1 and induces apoptosis in breast cancer cell lines. </li></ul><ul><li> Anticancer Res. 2005 Jan-Feb;25(1A):243-8. </li></ul><ul><li> </li></ul>
  65. 66. Progesterone and Breast Cancer —the Evidence cont. <ul><li>Estrogen cream applied to the breast induces proliferation , adding progesterone cream reduces proliferation to baseline </li></ul><ul><li> Fertil Steril 1995; 63:785-91 </li></ul><ul><li>Estrogen is carcinogenic in breast cell cultures unless progesterone is present </li></ul><ul><li> J Steroid Biochem Mol Biol. 2003 Oct;87(1):1-25. </li></ul><ul><li>Estrogen upregulates cancer-promoting gene bcl-2, progesterone downregulates it. </li></ul><ul><li> Ann Clin Lab Sci. 1998 Nov-Dec;28(6):360-9. </li></ul>
  66. 67. E3N-EPIC Study Bioidentical estradiol plus progesterone decreased the risk of breast cancer ! Int J Cancer. 2005 Apr 10;114(3):448-54. Cohort study 54,000 women 5.8 years f/u c/w WHI-- 16,000, 6 yr. f/u No Evidence that BHRT is safer?
  67. 68. ORDET Study Int. J. Cancer 112 (2004) (2), pp. 312–318. Higher progesterone= lower risk of breast cancer 6,000 women 5 yr. F/U
  68. 69. Progesterone and Breast Cancer —Conclusion <ul><li>“ The balance of the in vivo evidence is that progesterone does not have a cancer-promoting effect on breast tissue.” </li></ul><ul><li>J Steroid Biochem Mol Biol. 2005 Jul;96(2):95-108 </li></ul><ul><li>In fact, the balance of the evidence indicates that progesterone protects against breast cancer ! </li></ul><ul><li>So… women can be given estradiol as long as it’s balanced by progesterone and testosterone ! </li></ul>
  69. 70. Pharmaceutical Corps’ Dilemma <ul><li>They need to control the HRT market </li></ul><ul><li>Their progesterone and estradiol substitutes are dangerous </li></ul><ul><li>They can’t patent natural hormones </li></ul><ul><li>Pharm. Corps. have to get FDA-approval for every natural hormone preparation $$$ </li></ul><ul><li>Compounding pharmacies can dispense natural hormones cheaply </li></ul>
  70. 71. Pharm. Corps’ Choices <ul><li>Stop compounding pharmacies so they can control of the BHR market  Wyeth’s appeal to the FDA, media propaganda blitz </li></ul><ul><li>Suppress BHR in favor of their substitutes </li></ul><ul><li>Keep looking for substitutes that will provide benefits without risks </li></ul><ul><li>Result: Your doctors will never learn the truth about hormones unless he/she goes looking for it </li></ul>
  71. 72. Common Sense <ul><li>Substitutes are alien molecules! </li></ul><ul><li>Problems caused by hormone substitutes cannot be attributed to human hormones until proven otherwise . </li></ul><ul><li>Bioidentical hormone restoration should be considered safe until proven otherwise ! </li></ul>
  72. 73. Hormone Substitution Any Questions?
  73. 74. Metabolic Regulators: Thyroid and Cortisol <ul><li>Thyroid sets throttle, cortisol delivers fuel </li></ul><ul><li>Deficiency  reduced metabolic rate  fatigue, brain dysfunction, depression, pain </li></ul><ul><li>Subtle deficiency  symptoms and disease </li></ul><ul><li>Usual blood tests are insensitive </li></ul><ul><li>Irrational fear of supplementation </li></ul><ul><li>Underdiagnosed , undertreated —Docs prescribe pharmaceuticals (SSRIs) instead </li></ul>
  74. 75. Hormone Ignorance : the Tyranny of the Lab Report <ul><li>Reference Range=95% of “normal people”  optimum </li></ul><ul><li>Male free testosterone: 35-155 5x </li></ul><ul><li>Female free testosterone: 0.0 -2.2  </li></ul><ul><li>Free T3: 1.8-3.2 2x </li></ul><ul><li>TSH: 0.3-5 17x </li></ul><ul><li>If “within normal limits” no diagnosis; pharmaceuticals for symptoms </li></ul><ul><li>If below normal, just replace to “WNL” </li></ul>
  75. 76. Hypothyroidism—Symptoms <ul><li>Mental fog, depression, anxiety </li></ul><ul><li>Fatigue </li></ul><ul><li>Cold extremities </li></ul><ul><li>Aches and pains </li></ul><ul><li>Hair falling out </li></ul><ul><li>Weight gain </li></ul><ul><li>Constipation </li></ul><ul><li>Self-Test: Basal body temperature <97.8 °F axillary in bed in AM </li></ul>
  76. 77. Thyroid Hormone—T 3 <ul><li>Maintains metabolism, mood, and energy </li></ul><ul><li>Controlled partly by thyroid stimulating hormone (TSH) from the pituitary gland </li></ul><ul><li>TSH test is indirect: does not measure T 3 levels or effects in various tissues </li></ul><ul><li>Docs prescribe T 4 only (Synthroid  and Levoxyl  )— pro hormone that must be converted to T 3 </li></ul><ul><li>Docs rarely measure free T 3 levels! </li></ul>
  77. 78. We Need Optimal T 3 Levels <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><ul><li>Prevents weight gain </li></ul>
  78. 79. Fatigue, Fibromyalgia and Depression Epidemic <ul><li>Pre-TSH: Treat the patient’s symptoms </li></ul><ul><li>Post-TSH: Treat the test (?) </li></ul><ul><li>1970s—Doctors lowered doses by 30% </li></ul><ul><li>TSH-normalizing T 4 dose  low T 3 levels! </li></ul><ul><li> Williams’ Textbook of Endocrinology. Saunders, Philadelphia, pp 357-488) </li></ul><ul><li>T 3 alone often effective in fibromyalgia </li></ul><ul><li>T 3 alone relieves depression even if tests “normal”! J Affect Disord. 2006 Feb </li></ul>
  79. 80. Rational Approach to Thyroid Restoration <ul><li>If S/S of hypothyroidism: Treat! </li></ul><ul><li>Give T 4 plus T 3 (Armour, Cytomel) </li></ul><ul><li> Endocrinology 1996;137:2490-2502 </li></ul><ul><li>Increase dose until symptoms gone or S/S of excess appear </li></ul><ul><li>Safe--even moderate TSH suppression does not cause: </li></ul><ul><ul><li>bone loss Horm Res. 2005;64(6):293-8. Epub 2005 Nov 1. </li></ul></ul><ul><ul><li>cardiac abnormalities J Clin Endo Metab. 2000 Jan;85(1):159-64. </li></ul></ul><ul><ul><li>muscle wasting Am J Phys Endol Metab. 2005 Jun;288(6):E1067-73. </li></ul></ul>
  80. 81. Pharmaceuticals, Labs, and Thyroid Any Questions?
  81. 82. Cortisol <ul><li>Made in the adrenal glands </li></ul><ul><li>Maintains blood sugar (delivers the fuel) </li></ul><ul><li>Modulates immune system </li></ul><ul><li>Need high amounts when stressed </li></ul><ul><li>Too much  Diabetes, HTN, osteoporosis </li></ul><ul><li>Too little  hypoglycemia, fatigue, autoimmune diseases, aches and pains </li></ul>
  82. 83. Cortisol Deficiency <ul><li>Fatigue, depression </li></ul><ul><li>Aches and pains </li></ul><ul><li>Can’t stay asleep </li></ul><ul><li>Can’t deal with exercise, stress, or illness </li></ul><ul><li>2 nd wind late at night </li></ul><ul><li>Hypoglycemia, feels better after eating </li></ul><ul><li>Nausea, abdominal discomfort, diarrhea </li></ul><ul><li>Allergies, autoimmune diseases </li></ul><ul><li>Hard to gain, hard to lose weight </li></ul><ul><li>Low blood pressure, salt and sugar cravings </li></ul>
  83. 84. Mild-to-Moderate Cortisol Deficiency <ul><li>Blood tests are insensitive , need diurnal salivary cortisol profile </li></ul><ul><li>Underdiagnosed: Docs taught only about severe “adrenal insufficiency” due to physical destruction of the adrenal glands (Addison’s Disease) or pituitary </li></ul><ul><li>Common cause of chronic fatigue, pain </li></ul><ul><li>Clue: Felt great when taking prednisone </li></ul>
  84. 85. Normal Saliva Cortisol Profile
  85. 86. Cortisol Deficiency
  86. 87. Cortisol Deficiency —Normal Waking Cortisol
  87. 88. Depression —Elevated PM Cortisol
  88. 89. Cortisol Restoration <ul><li>Mild deficiency can resolve with  stress,  rest, nutrient restoration </li></ul><ul><li>Moderate-to-severe—need cortisol , not cortisol substitutes like prednisone </li></ul><ul><li>Physiological doses (5 to 20mg=<1-4mg prednisone )—NOT excessive doses that cause hypertension, diabetes, osteoporosis, etc. </li></ul><ul><li>Fears of low-dose cortisol unfounded </li></ul><ul><li>Dr. William Jeffries’ Safe Uses of Cortisol </li></ul>
  89. 90. DHEA—The Other Adrenal Hormone <ul><li>Most abundant steroid hormone yet ignored </li></ul><ul><li>Cells make testosterone and estradiol with it </li></ul><ul><li>Levels decline with age, stress and disease </li></ul><ul><li>Anabolic —builds tissues, improves immunity </li></ul><ul><li>Reduces abdominal fat </li></ul><ul><li>Reduces pain —restores natural endorphins </li></ul><ul><li>Reduces inflammation (  IL-6, TNF-  ,  IL-2) </li></ul><ul><li>Anti-cancer effect in animal, in vitro studies </li></ul><ul><li>Lower levels assoc. with  disease,  mortality </li></ul>
  90. 91. Fatigue, Depression, and Pain <ul><li>Should be considered as due to a nutrient, thyroid, cortisol, or DHEA deficiency until proven otherwise by testing and by trials of nutrient and hormone restoration. </li></ul>
  91. 92. Cortisol and DHEA Any Questions?
  92. 93. What Else Can Hormone Replacement Help? <ul><li>Infertility, PMS, heavy bleeding </li></ul><ul><li>Insomnia—almost always helps </li></ul><ul><li>Heart failure </li></ul><ul><li>Mental disorders </li></ul><ul><li>Autoimmune diseases (systemic lupus erythematosis, rheumatoid arthritis, ulcerative colitis, Crohn’s disease, etc.) </li></ul><ul><li>Allergies, skin diseases </li></ul>
  93. 94. Hormone Restoration <ul><li>Unresolved issues—more investigation needed </li></ul><ul><li>Need more long-term randomized studies to study long-term results </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>
  94. 95. Local Compounding Pharmacies <ul><li>Winola Pharmacy —Rt. 307 at Lake Winola, 378-2885 </li></ul><ul><li>Harrold’s Pharmacy —Wilkes-Barre, 822-5794 </li></ul><ul><li>Fino’s Pharmacy —Dallas, 675-1141 </li></ul><ul><li>Hazle Drugs Apothecary —Hazelton phone 1-800-439-2026 </li></ul>
  95. 96. Doing BHRT <ul><li>History, consent, fees online </li></ul><ul><li>Initial visit: order tests </li></ul><ul><li>F/U visit: Results—prescribe—retest </li></ul><ul><li>Repeat until stabilized at proper dose </li></ul><ul><li>Follow-up office visit once every 6 months, test only as needed. </li></ul><ul><li>Telephone and e-mail contact—charges for clinical decisions, refills, etc. </li></ul>
  96. 97. Costs <ul><li>Physician time only as required-- first year ~$200-$400; then <$200/yr. </li></ul><ul><li>No insurance billing; may submit claim for recognized diagnosis </li></ul><ul><li>Hormones—$10 to $70/month , some covered by insurance (GH adds $130/mo.) </li></ul><ul><li>Diurnal salivary cortisol test—$120 </li></ul><ul><li>Blood tests—insurance may pay, lab kits $170-$220, Saliva/blood kit—$299 </li></ul><ul><li>Out-of-pocket expenses tax-deductible </li></ul>
  97. 98. For More Information <ul><li>The Miracle of Natural Hormones David Brownstein, MD </li></ul><ul><li>How to Achieve Healthy Aging—Look, Live, and Feel Fantastic After 40 Neal Rouzier, MD </li></ul><ul><li>The Hormone Solution—Stay Younger Longer Thierry Hertoghe, MD </li></ul><ul><li>Life Extension Foundation ( </li></ul><ul><li>BHRT info. and hundreds of abstracts at . </li></ul><ul><li>Contact me: [email_address] </li></ul>