The document discusses hormone replacement therapy and how to approach it in a medical setting. It addresses determining goals and assessing which hormones to target, using diagnostic tools like medical histories, physicals and lab tests. The document outlines evaluating common hormone axes like thyroid, adrenal, pancreatic and gonadal and restoring balance through treatments like addressing sleep, diet and medication impacts, and administering hormones topically, orally or parenterally. The overall approach involves a team effort between clinician and patient to comprehensively diagnose and treat hormone imbalances.

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