Conquer DIABETES
     with Gender-Specific
Bio-Identical TESTOSTERONE

     Edward Lichten, M.D.
      FACS, FACOG, FABAAM...
If you were faced with

           The Worst Diabetic Male
      50 years old, dark skinned man on insulin
      No regu...
What Would You Do?
 Send him to the hospital?
 Refer him to an endocrinologist, who
  handle 75% of all diabetics?
 Tre...
Hemoglobin A1c= 18:
 Uncontrolled Diabetic
             18
             16
                               HgB-A1c
        ...
There is
 a new way of
thinking about
    staying
   healthy..
  And it is
   called        “Ageless” 75 year old Mary
   ...
Ten Years Ago the Future of
     Anti-Aging Medicine was
   Using Bio-Identical Hormones that
    identically match the h...
Ten Years Ago the Future of
     Anti-Aging Medicine was
   Using Gender-Specific Hormones
    –   Estradiol and Estriol ...
Because of the Ground Breaking Exposure to       B-HRT from
    the A4M and the Life Extension Foundation
     There is a ...
The problem with
   Anti-Aging Medicine

Is that our Antidotal Reports
         do not have a
   Scientific Methodology:
T...
And why not?
Our products—vs– their products
 Compounded thyroid         Armour thyroid
 Estradiol topical cream    Es...
Scientifically,
 Hypothalamus
    Pineal

    Pituitary
                        There are 6
  Thyroid            Endocrine...
Calciferol

           Growth
           Hormone
                          When in Balance
      Thyroxin
       & T3     ...
In Suzanne Somer‟s book it is


    Suggested that proper
     replacement of bio-identical
     hormones holds great
   ...
When you have a Disease
     like Diabetes

          You have
         no Balance,
         No Energy,
   And Inadequate ...
When you have Diabetes
           This imbalance



  may shorten life expectancy
  10 years and be the cause of
  multipl...
21st Century
            Diabetic Epidemic
60

50

40
                                        Millions of
30
             ...
The Future of
Anti-Aging Medicine
      is here!

   Treating Diabetes
          With
     Bio-identical
  Testosterone In...
Diabetes Mellitus
   Today, we will re-teach the physiology of
    diabetes. Diabetes Mellitus is the leading cause of
  ...
Diabetes Mellitus

What do we really know about
1. The cause of diabetes?
2. The diagnostic tests for diabetes?
3. Best me...
The
                  Definition
             of Diabetes Mellitus
The Webster‟s Deluxe Unabridged Dictionary Second Editi...
The
                     Cause
              of Diabetes Mellitus:
   The ancient Egyptians, Chinese, Macedonians
    (Hi...
The
                  Cause
           of Diabetes Mellitus:
    Type I: Insulin Deficiency
        characterized by
    ...
What are the
                Diagnostic Tests
             for Diabetes Mellitus?
   Screening tests
    – Urine: presenc...
Fact- 1:    GTT-I needed to classify type of diabetes

             Glucose Tolerance Test
               with Insulin Lev...
The Glucose Tolerance Test
          with Insulin Levels
 The GTT-I shows the                                   60
  dyna...
Fact-2: Type I and Type II late have inadequate, flat insulins < 70
 Type-I and Type-II late AODM lack
    an insulin dyna...
Based on the hospital approved Evidence Based Protocols

    The Standard of Care protocol
    for treating diabetes melli...
But since Type I and Type II
     late are practically identical!
 Type I diabetes             GTT-I: no Insulin changes...
Fact-3: Hypoglycemic agents are not indicated for Type I or late Type II
         Scientific Method:
   Lab Tests must dic...
The Failure of
      Evidence Based
         Medicine
 American physicians have been taught to treat
  by protocol the dis...
But You Already Know the
Cause and Treatments? Right?!
  Type I is an autoimmune disease that
   destroys the Beta islet ...
NORMAL PHYSIOLOGY is
       Facilitated Transport
              Promotes glucose storage
      CELL
                      ...
Is the Cause of Poor Type I
diabetic control unavailability of
 physician supervised Insulin?


               No
Type I Diabetes Mellitus
         Treatment: Injectable Insulin
      FACT: Ideal control of Diabetes, “lowest
       pos...
Insulin Therapy is
      Not Enough for
     Type I Diabetics!
     UNDERSTANDING
        the Role of
Testosterone Therapy...
Oral Therapy is
    Not Enough for
   Type II Diabetics!
UNDERSTANDING the Role of
 Testosterone Therapy for Men
   with N...
Fact-4: A4M attendees heard it first!
              ―All Diabetic Men are
             Testosterone Deficient!‖
  A4M: 19...
Fact-5: Need energy                    Why Testosterone?
      Physiology of Diabetes-
 Cells Need Energy as well as Insul...
Fact-6: Two keys to cell wall dynamics: insulin and testosterone in men


    There are two keys to opening
   the cell wa...
Understanding SHBG
   Sex Hormone Binding Globulin (SHBG) when bound to the sex
    hormone of TESTOSTERONE or ESTRADIOL ...
Examples of better glycemic
 control in Type I diabetics
―Since Harvard now agrees with the A4M‘s lecturer Dr. Lichten
   ...
Insulin Dependent
                  Diabetes Mellitus
    Testosterone IM Reduces Insulin Requirements
   72 yo. White ma...
Insulin Dependent
                  Diabetes Mellitus
    Testosterone IM Improved Glycemic Control
   A.M. 50 year old B...
Fact-7: Testosterone improves glycemic control in IDDM men


    Insulin Dependent Diabetic Men
 12 IDDM patients have   ...
The Key to Tight Glycemic Control is
  that men on Testosterone rarely
experience HYPOGLYCEMIC Crash!

  Hypoglycemia and...
Fact-8: Testosterone prevents hypoglycemia

         The Key to IDDM Control                          is that
       Testo...
Protecting Men Diabetics
        from Hypoglycemia
 Is Unique to Testosterone
 Makes addition of Testosterone
    MANDAT...
Fact-9: Only Injectables are Effective

     How Do We Now Treat Insulin
       Requiring Diabetic Men?

      Insulin and...
How Do We Now Treat Insulin
  Requiring Diabetic Men?
                        Testosterone Enanthate     $ 25/mo
         ...
Conclusion: Type I and II-late need testosterone and insulin




                 Insulin Requiring Diabetic Men
         ...
Adult Onset Diabetes Mellitus:
has the same complications as Type I
   Hyperglycemia and
    Hyperinsulinemia precede
  ...
Adult Onset Diabetic Men
  need Testosterone!!
        Before and 1-year
        after testosterone
          replacement:...
Fact-4: All Diabetic Men are Testosterone Deficient
Fact-10: All NIDDM, Diabetic men may benefit from Testosterone
    Non...
Fact-11: Testosterone improves glycemic control with/out weight loss

             Testosterone improves
                H...
Fact-12: Screen everyone for diabetes with fasting glucose, HgB-A1c, lipids--
and for men, bio-available testosterone

Scr...
Perform the GTT-Insulin Test:
                   with hourly insulin levels
                                      400
   ...
Add-Back Testosterone
and follow the improved HgB-A1c
                            Hemoglobin A1c
                         ...
U.K. Treats Diabetic Men with
             IM Testosterone
   D. Kapoor in 2006 published  Statistical findings
    doub...
Adult Onset Diabetes Mellitus:
When treating a 35+ years old
 male, with sexual complaints
                               ...
Measurement of Bio-Available
       Testosterone
   Serum Testosterone Levels
    – Total Testosterone
                  ...
Diabetic Men are
         Testosterone Deficient!
    (also Obese, Heart, Lipid, Hypertensive)
 The Europeans measure „un...
Avoid treating Type II-early
 diabetes with oral agents
(sulfonylureas, insulin sensitizers)


 It is bad practice to trea...
FACTS to REMEMBER
   1: GTT-I needed to classify type of          7: Testosterone improves glycemia for
    diabetes    ...
Putting it all together
 INSULIN is still involved in facilitated (glucose)
  transport but transport takes ENERGY!
 TES...
Hippocratic Oath:
                     Above all,
                     physician,
                    Do No Harm!
Practici...
Health Care is in Flux
   Paradigm Shift from „prescription Pharma‟ to
    prevention is being fueled by 50 million payin...
We have learned today that
Gender-Specific hormones
 are the key to living well
          “I don‟t buy the Pharma story”
...
Pharma is flooding U.S. with
      more useless Diabetic Drugs
   FDA approving drugs of questionable value
    – Byetta©...
So we are offering our patients FDA approved injected testosterone at
a cost of $15 per month and, an „entirely new concep...
Are you an Evidence Based
    ‗protocol‘ puppet of Big Pharma?
   Writing for oral agents for           Incretin mimics
...
Or a U.S. DOCTOR
    who puts his patients‘ first?
    Endocrine Today: October 2006
    American Association of Diabetic ...
You need to decide


 Testosterone Injections and Pellets can be
  dispensed in your office practice
 Along with better ...
TESTOSTERONE is the key
  to life for men…period.

Testosterone has been studied and used
since 1939; before there was an ...
If you learn only one thing today, remember

       You, Doctors,
are the Masters of Medicine
           For you and your ...
The purpose of science is not to cure
  us of our sense of mystery...
  but to constantly reinvent
        and reinvigorat...
So Become the Anti-Aging
   Doctor of the future
Be the doctor that knows the science behind the
                causes of...
The Future of Medicine




     Is in your hands
I hope I have done that for you today.

         Edward M. Lichten, M.D.,
             FACS, FACOG
         WEBSITE: www.U...
Insulin Resistance predicts
      Age- Related Disease including Cancer
 Metabolic Syndrome (Increased Fasting Insulin,
 ...
Hypothesis:
    Add Back Testosterone is Anti-Aging
 Men who are testosterone deficient by FAI will
  live longer and bet...
Personal and Medical Experience

                My own andropause at 45
                trigger my interest and I knew
  ...
American Academy of Anti-Aging Medicine on the internet
American Academy of Anti-Aging Medicine on the internet
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American Academy of Anti-Aging Medicine on the internet

  1. 1. Conquer DIABETES with Gender-Specific Bio-Identical TESTOSTERONE Edward Lichten, M.D. FACS, FACOG, FABAAM American Academy of Anti-Aging Medicine December 14-15, 2007
  2. 2. If you were faced with The Worst Diabetic Male  50 years old, dark skinned man on insulin  No regular source of work, food, healthcare  Junk food and history of homelessness  Confused and disoriented What Would You Do?
  3. 3. What Would You Do?  Send him to the hospital?  Refer him to an endocrinologist, who handle 75% of all diabetics?  Treat him? Even if you were a Board Certified Gynecologist?
  4. 4. Hemoglobin A1c= 18: Uncontrolled Diabetic 18 16 HgB-A1c 14 12 10 8 6 4 2 0 Anthony 2006 2006 2006 2006 2007 July Aug Sep Oct Jan
  5. 5. There is a new way of thinking about staying healthy.. And it is called “Ageless” 75 year old Mary won the Alcatraz swim by ―Anti-Aging‖ going directly across San Francisco Bay Medicine
  6. 6. Ten Years Ago the Future of Anti-Aging Medicine was  Using Bio-Identical Hormones that identically match the hormones produced in the body – Sustained release  T4 and T3 thyroid – DHEA – Pregnenolone
  7. 7. Ten Years Ago the Future of Anti-Aging Medicine was  Using Gender-Specific Hormones – Estradiol and Estriol for women – Progesterone for women – Testosterone for women – Testosterone for men  Because a man and a woman are different, their body respond differently. Medical therapy must be based on matching their innate ratio of natural sex hormones. And that was good and the A4M increased in members
  8. 8. Because of the Ground Breaking Exposure to B-HRT from the A4M and the Life Extension Foundation There is a Greater Awareness that Staying Healthy can be assisted by Replacing and Maintaining, these Natural, Bio-Identical Hormones But we must remember 1991: A4M LOFTY GOALS: “Anti-Aging medicine seeks to identify the root cause of one‟s symptoms...We age because our hormones decline, our hormones don‟t decline because we age.” Michael Galitzer, M.D.
  9. 9. The problem with Anti-Aging Medicine Is that our Antidotal Reports do not have a Scientific Methodology: Therefore, our detractors say we are „snake-oil‟ salesmen
  10. 10. And why not? Our products—vs– their products  Compounded thyroid  Armour thyroid  Estradiol topical cream  Estrasorb©  Progesterone micronized  Prometrium© capsule  Testosterone cream  Androgel© Not much different!
  11. 11. Scientifically, Hypothalamus Pineal Pituitary There are 6 Thyroid Endocrine Glands in the human body Adrenal Pancreas that release Ovaries-Testes biologic hormones
  12. 12. Calciferol Growth Hormone When in Balance Thyroxin & T3 12 MAJOR HORMONES Released by these six DHEA & Insulin & endocrine glands Cortisol Glucagon work together, Testosterone Estradiol & „Exciting‟ your body to Progesterone Energy and Health
  13. 13. In Suzanne Somer‟s book it is  Suggested that proper replacement of bio-identical hormones holds great promise in the future in slowing the aging process, Treatment and as a for age-related diseases
  14. 14. When you have a Disease like Diabetes You have no Balance, No Energy, And Inadequate levels of Bio-identical Hormones
  15. 15. When you have Diabetes This imbalance may shorten life expectancy 10 years and be the cause of multiple end-organ failures
  16. 16. 21st Century Diabetic Epidemic 60 50 40 Millions of 30 Americans with Diabetes 20 10 0 1950 1970 1990 2010 2030 With twice as many MORE still to be diagnosed!
  17. 17. The Future of Anti-Aging Medicine is here! Treating Diabetes With Bio-identical Testosterone In Men
  18. 18. Diabetes Mellitus  Today, we will re-teach the physiology of diabetes. Diabetes Mellitus is the leading cause of morbidity, mortality and 80% of non-cancer medical office visits: it is the primary cause of  heart disease  high blood pressure  Cholesterol elevation  cerebral vascular stokes and  obesity.
  19. 19. Diabetes Mellitus What do we really know about 1. The cause of diabetes? 2. The diagnostic tests for diabetes? 3. Best medication to control diabetes? 4. The mechanism of action of the medications available for diabetes? 5. The future for treating diabetes?
  20. 20. The Definition of Diabetes Mellitus The Webster‟s Deluxe Unabridged Dictionary Second Edition defines diabetes mellitus as:  Diabetes mellitus is a chronic form of disease characterized by excess of sugar in the blood and urine, hunger, thirst, and gradual loss of weight: also called sugar diabetes. Wikipedia incorporates a more scientific description  Diabetes mellitus is a disorder of carbohydrate metabolism. It is a disease characterized by persistent hyperglycemia (high blood sugar levels). It is a metabolic disease that requires medical diagnosis, treatment and lifestyle changes. Medical Practice  The presence of abnormally elevated glycogenated hemoglobin is diagnostic of diabetes mellitus The World Publishing Company- William Collins Publishers, Inc. 1979
  21. 21. The Cause of Diabetes Mellitus:  The ancient Egyptians, Chinese, Macedonians (Hippocrates) and Romans (Aretaeus of Cappadocian) recognized this disease to be one of excessive urine (polyuria), leading to wasting and death. Today, we scientifically characterize this disease by its specific anomaly of carbohydrate metabolism  Type I: Inability to make insulin  Type II: Resistance to the insulin made
  22. 22. The Cause of Diabetes Mellitus:  Type I: Insulin Deficiency characterized by – Destruction of the pancreatic islet cells by some infection or autoimmune reaction – Typically occurring in a child or adolescent  Type II: Resistance to the Action of Insulin characterized by – Resistance to insulin at the cellular level with the initial excessive insulin production being unable to clear glucose from the blood stream Pre-Diabetes: Metabolic Syndrome is a pre-diabetic condition with excessive insulin production effectively keeping the glycogenated hemoglobin in normal range.
  23. 23. What are the Diagnostic Tests for Diabetes Mellitus?  Screening tests – Urine: presence of glucose – Blood: elevated glucose level  Diagnostic tests – Blood: elevated fasting serum glucose – Insulin: elevated fasting insulin level – Red Cell: elevated glycogenated hemoglobin measured directly or as Hemoglobin A1c  Comprehensive testing – Glucose Tolerance Test with Insulin levels
  24. 24. Fact- 1: GTT-I needed to classify type of diabetes Glucose Tolerance Test with Insulin Levels  The GTT shows the dynamic 350 response of glucose being 300 cleared from the blood after the 250 stress of a glucose load. 200 Type I  GTT-I was described by Kraft 150 Normal in 1976; any glucose >145 or 100 Type II 50 insulin >50 is strongly Glucose suggestive of obesity and/or the 0 0 2 Levels metabolic syndrome. hour hour RL Kraft, M.D. Chairman, Dept. Of Pathology, St. Joseph‟s Hospital, Chicago, Ill. In Radio-assay: Clinical Concepts. Proceedings from a Symposium On Radioimmunoassay Held in Washington, DC January 28-29, 1974;91-106.
  25. 25. The Glucose Tolerance Test with Insulin Levels  The GTT-I shows the 60 dynamic response of insulin 50 in presence of the stress of a 40 Type I glucose load. 30  Normal 4 fold increase at first Normal hour; 50% drop at 2hr 20 Type II  Type II diabetes is a 10 early progressive disease 0 characterized by increasing 0 1 2 Normal hour hour hour demands for insulin. Insulin Hollenbeck C, Reaven GM. Variations in Insulin-Stimulated Glucose Levels Uptake in Healthy Individuals with Normal Glucose Tolerance. JCEM 1987;64: 1169-73
  26. 26. Fact-2: Type I and Type II late have inadequate, flat insulins < 70 Type-I and Type-II late AODM lack an insulin dynamic response 60 50 40 Type I 30 Normal Type II early 20 Type II late 10 0 0 hour 1 hour 2 hour Type I: SumI <70 Normal: SumI 70-130 Type II-late SumI <70 Type II-early SumI >130
  27. 27. Based on the hospital approved Evidence Based Protocols The Standard of Care protocol for treating diabetes mellitus is  Type I: add subcutaneous insulin  Type II: add oral hypoglycemic agents, insulin- sensitizers and newer oral and injectable agents  Type II-late: add insulin injections if all else fails With the goal is to control hyperglycemia
  28. 28. But since Type I and Type II late are practically identical!  Type I diabetes  GTT-I: no Insulin changes  Normal screened group  GTT-I: normal or metabolic – Obese, aging population syndrome based on normal  Type II diabetes  GTT-I: hyperglycemia and – Early higher insulin release  Type II diabetes  GTT-I: No or poor insulin – Late response Why would you treat Type-I or Type-II late differently?!
  29. 29. Fact-3: Hypoglycemic agents are not indicated for Type I or late Type II Scientific Method: Lab Tests must dictate treatment Scientific Methodology 1. Cannot treat NIDDM without a GTT-I 2. Type I and Type II-late are virtually identical 3. Stop oral hypoglycemic agents Type I & II late. 4. Ask “why would a U.S. Doctor start oral agents to temporarily treat hyperglycemia while accelerating the transition from Type II early to Type II late?” Especially when we now know that better bio-identical treatments exist?
  30. 30. The Failure of Evidence Based Medicine American physicians have been taught to treat by protocol the diseases like heart, diabetes, obesity and high blood pressure. DIABETES MELLITUS GIVES US A CHANCE TO THROW AWAY THE PROTOCOLS AND TREAT THE „CAUSE‟.
  31. 31. But You Already Know the Cause and Treatments? Right?!  Type I is an autoimmune disease that destroys the Beta islet cells that produce insulin. Treat with insulin.  Type II is caused by insulin resistance. Treat with oral hypoglycemic agents.
  32. 32. NORMAL PHYSIOLOGY is Facilitated Transport Promotes glucose storage CELL Only in the presence of INSULIN is GLUCOSE taken into the cell. GLUCOSE INSULIN (Sugar Bag) (Big Cheese)
  33. 33. Is the Cause of Poor Type I diabetic control unavailability of physician supervised Insulin? No
  34. 34. Type I Diabetes Mellitus Treatment: Injectable Insulin  FACT: Ideal control of Diabetes, “lowest possible Hemoglobin-A1c” is the single, most important predictor of a long-life and freedom from complications. M Rizzo, ADA  FACT: Adding insulin alone brought less than 40% of volunteers to HgB-A1c of 8.1-2 1. Mathew Riddle, M.D. Letter to the Editor: JAMA. 1997; 297(19): 1523. 2. Hayward RA. Maning WG, Kaplan SH, Wagner EH. Greenfield S. Starting insulin therapy in patients with type 2 diabetes: effectiveness, complications and resource utilization. JAMA 1997; 278:1663-69. 3. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. New England J Medicine 11993; 329977-986.
  35. 35. Insulin Therapy is Not Enough for Type I Diabetics! UNDERSTANDING the Role of Testosterone Therapy for Men with Insulin Requiring Diabetes Mellitus
  36. 36. Oral Therapy is Not Enough for Type II Diabetics! UNDERSTANDING the Role of Testosterone Therapy for Men with Non-Insulin Requiring Diabetes Mellitus
  37. 37. Fact-4: A4M attendees heard it first! ―All Diabetic Men are Testosterone Deficient!‖  A4M: 1998 Lichten keynote speaker  JAMA: 2006 Ding EL. Harvard Medical group “Higher levels of testosterone are protective”  A4M: 1998 Lichten: Add-back testosterone  JAMA: 2006 Ding: Higher bio-testosterone Cross-sectional studies indicated that testosterone level was significantly lower in men with type 2 diabetes ....Similarly, prospective studies showed that men with higher testosterone levels (range, 449.6-605.2 ng/dL) had a 42% lower risk of type 2 diabetes Eric L. Ding, BA; Y. Song MD et al. Sex Differences of Endogenous Sex Hormones and Risk of Type 2 Diabetes. JAMA. 206; 295: 1288-99.
  38. 38. Fact-5: Need energy Why Testosterone? Physiology of Diabetes- Cells Need Energy as well as Insulin  Glucose must be cleared from the blood stream to minimize AGEs, accumulated glycogen end-products, that „clog‟ the cell.  Energy is needed for facilitative transportation to move glucose across the cell membrane.  The ATP Cycle that produces Energy is activated by bio-available sex hormones.  In the male, the key bio-available sex hormone is TESTOSTERONE. Low levels of testosterone predict death. Shores MM. Low Serum Testosterone and mortality in male veterans. Arch Inter. Med 2006 Aug 14; 166(15): 1660-5. After adjusting for age, medical morbidity, and other clinical covariates, low testosterone levels continued to be associated with increased mortality (hazard ratio, 1.88; 95% CI, 1.34-2.63; P<.001)
  39. 39. Fact-6: Two keys to cell wall dynamics: insulin and testosterone in men There are two keys to opening the cell wall to transport glucose 1. INSULIN: discovered by Banting and Best in 1922 2. Sex Hormone Binding-Sex Hormone ligand discovered in 1955 but not recognized for its role in glucose transport until today
  40. 40. Understanding SHBG  Sex Hormone Binding Globulin (SHBG) when bound to the sex hormone of TESTOSTERONE or ESTRADIOL is the ligand that affixes to and changes the 3-dimensional cellular wall characteristics to facilitate entry of not only hormones but glucose and nutrients.
  41. 41. Examples of better glycemic control in Type I diabetics ―Since Harvard now agrees with the A4M‘s lecturer Dr. Lichten that all diabetic men are testosterone deficient‖ First, and Foremost ADD-BACK BIO-IDENTICAL TESTOSTERONE To all diabetic men
  42. 42. Insulin Dependent Diabetes Mellitus Testosterone IM Reduces Insulin Requirements  72 yo. White male in Dropping Insulin Requirements with year 1997. Testosterone Testosterone Injections reduced hyperglycemia and almost all of the 40 400 45 350 40 Insulin Use units/day of insulin 35 300 required in 2 months! 30 in case of serum glucose 250  T-2 protocol: 200 25 Gangrene 20 Testosterone injections 150 15 100mg IM twice a week. 100 10 glucose 50 5  Gangrene unresolved- 0 0 1/2 testosterone amputation necessary. 1 2 3 4 5 6 7 8 9 10 11 dose every third-to-fourth day visits daily drug: insulin
  43. 43. Insulin Dependent Diabetes Mellitus Testosterone IM Improved Glycemic Control  A.M. 50 year old Black Male 18 presented on 16units/insulin/day 16 – HgB-A1c >18% 14 – Glucose fasting: 488mg/ml 12 10  T1-protocol: increased insulin 8 while starting add-back Hgb A1c 6 Testosterone weekly IM 4  20 weeks later: 2 0 – HgB-A1c = 7.4% 2006 2006 2006 – Glucose fasting: 47 mg/ml in AM Jul Sep Nov asymptomatic
  44. 44. Fact-7: Testosterone improves glycemic control in IDDM men Insulin Dependent Diabetic Men  12 IDDM patients have 140 completed Testopel© for first 3 120 months, then none. 100  All individuals required 80+ 80 units of insulin per day and 60 were able to reduce their 40 insulin required by HALF! 20  All maintained or improved 0 their glycemic control 0 1 2 3 4 5 6 7  After three month wash-out Insulin units/day vs. months their need for insulin returned http://www.usdoctor.com/SUMI1.htm to baseline. IRB Study 907 –96 Providence Hospital, Southfield, MI
  45. 45. The Key to Tight Glycemic Control is that men on Testosterone rarely experience HYPOGLYCEMIC Crash!  Hypoglycemia and impending coma 488 in brittle, insulin-requiring diabetics 359 is the reason doctors err on keeping 268 the blood sugar high. 185  Testosterone allows tighter control 99 by preventing symptomatic 47 hypoglycemia and coma.
  46. 46. Fact-8: Testosterone prevents hypoglycemia The Key to IDDM Control is that Testosterone Prevents Hypoglycemia Stored Tissue Glycogen Testosterone  ATP Energy Cycle Insulin Glucagon Blood Stream Glucose As effectively as Testosterone improves clearance of glucose from the blood stream, it reconverts glycogen to glucose preventing hypoglycemia.
  47. 47. Protecting Men Diabetics from Hypoglycemia  Is Unique to Testosterone  Makes addition of Testosterone MANDATORY for OPTIMAL DIABETIC CONTROL!! This may well be one of the most important healthcare discovery in the last 100 years!
  48. 48. Fact-9: Only Injectables are Effective How Do We Now Treat Insulin Requiring Diabetic Men? Insulin and injected Testosterone The reason we do not use the Androgel© or compounded bio-creams or the Androderm© patch is that (1) absorption from the skin is poor in older individuals and (2) the skin aromatizes testosterone to estrogen, negating the positive effect of testosterone replacement. K.S. Nair MD PhD et al. DHEA in Elderly Women and DHEA or Testosterone in Elderly Men. NEJM. 2006; 355: 1647-91. “Serum levels of testosterone increased only 20% of expected based on FDA submitted data”
  49. 49. How Do We Now Treat Insulin Requiring Diabetic Men? Testosterone Enanthate $ 25/mo Deca-Durabolin $ 50/mo Testopel© $100/mo NO! Androgel©or Testoderm© $330/mo EXCEPTIONS: All need CBC, comprehensive, lipids, PSA and prostate examination before starting testosterone replacement. EXCEPTIONS: Prostate or testicular cancer cases or Prostate Specific Antigen greater than 2.5 needs urologist‟s clearance.
  50. 50. Conclusion: Type I and II-late need testosterone and insulin Insulin Requiring Diabetic Men (Type I and Type II late) Need Testosterone to improve their glycemic control and reduce their requirements for insulin. What about Type II diabetic men?
  51. 51. Adult Onset Diabetes Mellitus: has the same complications as Type I  Hyperglycemia and Hyperinsulinemia precede  DIABETES: – OBESITY – HEART DISEASE – RETINOPATHY – GANGRENE and  Shortened life expectancy by up to 10 years!
  52. 52. Adult Onset Diabetic Men need Testosterone!! Before and 1-year after testosterone replacement: year 1997-8 Abnormal GTT-I Low Testosterone Normal GTT-I „Normalized‟ Testosterone
  53. 53. Fact-4: All Diabetic Men are Testosterone Deficient Fact-10: All NIDDM, Diabetic men may benefit from Testosterone Non-insulin Dependent Diabetes Testosterone Improves Hyperglycemia  Discontinues 20mg of micronase and Dropping Micronas Requirementswith e Tes terone Injection tos lowers fasting glucose on T-2 300 25 protocol with twice 20 200 cose level weekly testosterone 15 10 glucose injections 100 5 glu 0 0 1/2 testosterone 1 2 3 4 5 6 7 8 9 dose every third-to-fourth day daily drug visits
  54. 54. Fact-11: Testosterone improves glycemic control with/out weight loss Testosterone improves Hemoglobin A1c  Without meds, change in diet, 11 • exercise, or 10 weight loss, DB was able to drop • 9 his HgBA1c from 11 to 6.5 in 8 • 4 months • 7 without oral Hemoglobin A1c !! agents. JULY AUG SEPT OCT 2001 http://www.usdoctor.com
  55. 55. Fact-12: Screen everyone for diabetes with fasting glucose, HgB-A1c, lipids-- and for men, bio-available testosterone Screen Everyone for Diabetes and pre-diabetes (metabolic syndrome)  Fasting: – Glucose normal < 105 mg/dl – Insulin normal < 10 uIU/ml – Hemoglobin A1c normal < 6 percent – Triglycerides normal < 130 mg/dl  Testosterone: – Total Testosterone normal > 450 ng/dl – Sex Hormone Binding normal < 15 nmol/L – Estradiol normal < 25 pg/ml
  56. 56. Perform the GTT-Insulin Test: with hourly insulin levels 400  CR 66 year old AA male with HgB-A1c=9.0 350  GTT- abnormal 300 – Sum Insulin = 62 250  Testopel© protocol 200 Insulin – effective. 150 GTT  Based on GTT-I, he might need 100 insulin in the future, but not •Glucose 50 now since the testosterone has 0 sensitized his cells to insulin 0 2 and increased his ATP energy. hour hour
  57. 57. Add-Back Testosterone and follow the improved HgB-A1c Hemoglobin A1c 9 8 7 6 July Aug Sept Oct Nov 2006 Same 66 year old dentist. Treatment with Testopel© every month resulted in normalization to HgB-A1c of 6.0 in 12 weeks. Testosterone therapy appropriate even in presence of minor cerebral vascular accident before T.
  58. 58. U.K. Treats Diabetic Men with IM Testosterone  D. Kapoor in 2006 published  Statistical findings double-blind cross-over study – Reduce insulin resistance confirming that “testosterone – Reduced insulin required replacement therapy – Reduced fasting glucose reduces insulin resistance – Reduced HgB-A1c and improves glycaemic – Reduced waist measure control in hypo-gonadal – Reduced total cholesterol men with type 2 diabetes.”  10 men on insulin pre-study  14 men not on insulin Kapoor D, Goodwin E, Channer KS, Jones TH. Testosterone replacement therapy improves insulin resistance, glycaemic control, visceral adiposity and hypercholesterolaemia in hypogonadal men with type 2 diabetes. Eur J Endocrinol, 154(6): 899-906 2006
  59. 59. Adult Onset Diabetes Mellitus: When treating a 35+ years old male, with sexual complaints Brain: libido, mood or medical conditions… Muscle/ Bone: strength Demand a measurement of Liver: synthesis proteins Bio-available Testosterone! Sex Organs: penile Because Testosterone affects growth, reproduction every cell in a man‟s body
  60. 60. Measurement of Bio-Available Testosterone  Serum Testosterone Levels – Total Testosterone __[Testosterone total]__ – Free Testosterone FAI= 30x [SHBG]  Sex Hormone binding globulin  Free Androgen Index (FAI) – Ratio of Testosterone/SHBG – Ideal: 0.7 to 1.0
  61. 61. Diabetic Men are Testosterone Deficient! (also Obese, Heart, Lipid, Hypertensive)  The Europeans measure „unbound‟ testosterone as the FREE ANDROGEN INDEX [TT]/[SHBG]  Normal: Ratio greater than .7 Male Normal Metabolic Syndrome Total Testosterone 450 ng/dl 250 ng/dl Sex Hormone BG 15 nmol/L 50 nmol/L Free Androgen Index >1.0 - 0.7 0.1 to 0.4
  62. 62. Avoid treating Type II-early diabetes with oral agents (sulfonylureas, insulin sensitizers) It is bad practice to treat the symptom (of hyperglycemia) while ignoring the scientific proof that these „protocol‟ medications may accelerate destruction of the pancreatic islet cells…
  63. 63. FACTS to REMEMBER  1: GTT-I needed to classify type of  7: Testosterone improves glycemia for diabetes IDDM: Insulin dependent diabetic men  2: Type I (autoimmune) and Type II late  8: Testosterone may help prevent (burn out) are similar: insulin requiring hypoglycemia, crisis and coma  3: Oral hypoglycemic agents are rarely  9: Only Injectable forms of Testosterone indicated are Effective for Diabetes  4: All diabetic men are testosterone  10: All NIDDM men may benefit from deficient Testosterone  5: Glucose movement takes energy:  11: Testosterone may improve glycemic energy takes testosterone control with or without weight loss  6: Insulin and Sex Hormone+SHBG  12: Screen everyone for diabetes with ligand are keys to cell wall permeability fasting glucose, HgB-A1c, lipids --and for men, testosterone measurements
  64. 64. Putting it all together  INSULIN is still involved in facilitated (glucose) transport but transport takes ENERGY!  TESTOSTERONE is the source of ATP energy from the Kreb‟s (citric acid) cycle that facilitates the action of insulin! INSULIN & GLUCOSE
  65. 65. Hippocratic Oath: Above all, physician, Do No Harm! Practicing the Standard Medical Treatment Protocols for Adult Diabetic Men 1. Ignores the appropriate treatment of one scientifically recognized cause of Diabetes in men: testosterone deficiency 2. Exposes the patients to unnecessary drugs, side-effects and expense. The annual cost of diabetic outpatient medications are
  66. 66. Health Care is in Flux  Paradigm Shift from „prescription Pharma‟ to prevention is being fueled by 50 million paying „baby-boomers‟ who are taking an active role in maintaining and improving their physical and mental health. This is called “Anti-Aging!” – Exercise and diet – Vitamins and supplements – Reading, researching and exploring new and alternative medical avenues for prevention.
  67. 67. We have learned today that Gender-Specific hormones are the key to living well  “I don‟t buy the Pharma story” “I‟ll do what is best for me!”  Nutrition, exercise, avoid toxic smoke, food and environments.. – But most importantly  Take Bio-Identical Hormones!
  68. 68. Pharma is flooding U.S. with more useless Diabetic Drugs  FDA approving drugs of questionable value – Byetta© : gila monster saliva at $600/month – Rezulin© : Removed from market causing deaths $300/mo and now Avandia© leaving Actos© against dissenters  Pharmaceutical Companies continue to bring to market unproven and barely helpful „wonder drugs‟ – Novartis: Astra-Zenica Bristol-Myers Squibb – Merck: Pfizer: a new insulin nose spray  No New Cures or Breakthroughs expected from Stem Cell Research for diabetes
  69. 69. So we are offering our patients FDA approved injected testosterone at a cost of $15 per month and, an „entirely new concept‟ that Testosterone Alone may herald in the End of the Pharmaceutical Stranglehold on Diabetic and Medical Practice
  70. 70. Are you an Evidence Based ‗protocol‘ puppet of Big Pharma?  Writing for oral agents for  Incretin mimics „burned out‟ diabetics? – Amylin and Lilly -Byetta © – Micronase©, Gliberide©  Gliptins – Glipizide©, Glucotrol© – Merck - Januvia© – Amaryl©, Starlyx © – Novartis - Glavus© (on hold)  Writing for expensive and ineffective insulin- sensitizing  PPAR gamma insulin sensitizers agents? – AstraZeneca; tesaglitazar ©  Thiazolidinediones – Bristo-Myers Squibb -muraglitazar © – Actos  Inhaled insulin – Rezolin© and Avandia© – Pfizer© -Exubera© removed by FDA
  71. 71. Or a U.S. DOCTOR who puts his patients‘ first? Endocrine Today: October 2006 American Association of Diabetic Educators, Donna Rice MBA, RN, CDE president Diabetes Education: Screen, test, treat: low testosterone and diabetes Men with diabetes have a 2x greater risk of having total testosterone less than 300 ng/dl.
  72. 72. You need to decide  Testosterone Injections and Pellets can be dispensed in your office practice  Along with better medical care
  73. 73. TESTOSTERONE is the key to life for men…period. Testosterone has been studied and used since 1939; before there was an F.D.A. Higher levels of testosterone are associated with living longer and is truly, “Anti-aging” medicine
  74. 74. If you learn only one thing today, remember You, Doctors, are the Masters of Medicine For you and your patients, Staying Healthy and Treating Disease is by keeping us all Anabolic! Say Yes to Testosterone!
  75. 75. The purpose of science is not to cure us of our sense of mystery... but to constantly reinvent and reinvigorate it. Robert M Sapolsky, M.D., professor of biology and neurosciences, Stanford University and author of The Trouble with Testosterone. Simon and Schuster. NY. 1997
  76. 76. So Become the Anti-Aging Doctor of the future Be the doctor that knows the science behind the causes of diabetes Be the doctor in your area with the knowledge to truly treat the disease, naturally Be the doctor that shows your patients they can discontinue the synthetic, Pharmaceutical expensive oral agents and reduce their insulin and have less complications and feel better and have better sex!
  77. 77. The Future of Medicine Is in your hands
  78. 78. I hope I have done that for you today. Edward M. Lichten, M.D., FACS, FACOG WEBSITE: www.USDOCTOR.com Office: (248) 593.9999 Lichten Wellness Center – 180 East Brown Street – Birmingham, MI 48009  Email: drlichten@yahoo.com  For copies of this lecture or study course, http://www.USDOCTOR.com/A4M.ppt
  79. 79. Insulin Resistance predicts Age- Related Disease including Cancer  Metabolic Syndrome (Increased Fasting Insulin, Exaggerated Insulin Response, or Reduced Insulin Response to glucose load) predicts Heart Disease, Obesity, Dyslipidemia, Hypertension, and Diabetes  GM Reaven MD shocked the medical establishment by following 208 apparently healthy men and women for 4 to 11 years. Those in the upper 1/3 of steady-state plasma glucose (or area under 2hr-OGTT insulin curve) had 28 of 40 clinical events including cancers. Middle 1/3 had 12. Lower 1/3 had none!  FS Facchini, GM Reaven. Insulin Resistance as a Predictor of Age-Related Diseases. Journal Clinical Endocrinology Metab 2001:86;3574-3578
  80. 80. Hypothesis: Add Back Testosterone is Anti-Aging  Men who are testosterone deficient by FAI will live longer and better because they will have less METABOLIC SYNDROME  Measured as lower fasting insulin, normalized GTT-I are associated with reduced risk factors: obesity, heart disease, hyperlipidemia and hypertension
  81. 81. Personal and Medical Experience My own andropause at 45 trigger my interest and I knew 50 that without finding that natural treatment, I would not have been here with you today!

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