Hormone Balance 2004

1. Hormone Balance & Health Riverpoint Pharmacy Catherine Hudek, RPh Edie Ward, RPh Vickie Landkammer, PharmD

2. BALANCE Hormones in balance are the key to health As hormones decline, health declines and aging accelerates Hormone imbalance can occur at any age Diet and lifestyle are extremely important to hormone balance Every person is a unique individual

3. Conventional HRTWomen's Health Initiative Trial Prempro, Premphase, Provera, (Premarin) 41% increase in strokes 29% increase in heart attacks 26% increase in breast cancer Twice the rate of blood clots Possible contributor to Alzheimer's vs. Estrogen alone arm

4. Synthetic Progestins Increase the risk of breast cancer Increase the risk of heart disease (coronary vasoconstrictor) Not protective against osteoporosis Fluid retention and edema Cause weight gain Increase incidence of blood clots (DVT/PE)

5. Synthetic Progestins (cont.) Cause DEPRESSION Increase anxiety and nervousness Increase the risk of dementia Can cause headaches Hair loss and skin discoloration Decrease thyroid action Patentable�profitable

6. Provera is not Progesterone

7. Bioidentical Hormones Are chemically converted from yams or soy and are identical in composition to human hormones Are not patentable Have been used in Europe over 40 years Have been extensively researched Estradiol, progesterone, and testosterone are FDA approved

9. Estrogens Estrone (E1)��SHBG metabolites Estradiol (E2)�..SHBG metabolites Estriol (E3) Found in balance in the human body

10. Functions of Estrogen Estrogens have over 400 functions in the body Stimulates the production of choline acetyltransferase, an enzyme which prevents Alzheimer�s disease Improves insulin sensitivity Helps prevent muscle damage Improves sleep Regulates body temperature Glucose transport in the brain

11. Functions of Estrogen Cont. Reduces the risk of cataracts and macular degeneration Decreases blood pressure Helps maintain memory Maintains the amount of collagen in skin Reduces the overall risk of heart disease by 40-50% Maintains bone density Decreases the risk of colon cancer

12. Estrone (E1) Stronger Estrogen Made in the ovaries and adrenal glands Converted from androgens in fat cells (aromatized) Major source of post-menopausal estrogen High levels may increase the risk of breast and endometrial cancer Weight gain in the hips and thighs Premarin is 60% estrone

13. Estradiol (E2) Stronger Estrogen High, unopposed levels may increase the risk of breast, uterine, and prostate cancer High levels are found in premenopausal females but the majority is bound to SHBG Important for health in both women and men Vital for heart, brain, bones, joints, and immune system health

14. Estriol (E3) Weaker estrogen balancing E1 & E2 Breast protective estrogen Does not stimulate the uterine lining Does not increase the risk of blood clots High levels are found during pregnancy Significant improvement of symptoms in women with Multiple Sclerosis Mother Natures Designer Estrogen

15. Progesterone Balances other hormones in the body Protects the breast, uterus, and prostate Natural antidepressant, anxiolytic-binds GABA receptor Helpful in PMS Osteoblast mediated new bone formation Coronary vasodilator Restores libido

16. Progesterone cont. Improves sleep Helps the body use and eliminate fats Lowers cholesterol Increase metabolic rate by decreasing TBG-thermogenic Improves estrogen receptor sensitivity Progestational

17. Progesterone cont. Myelenation of nerves Neuro-regeneration properties Increases cognitive function Decreases brain edema in stroke and brain injury Natural diuretic-blocks aldosterone receptors Precursor hormone to cortisol, aldosterone, and androstendione

18. Testosterone Anabolic hormone that improves muscle mass and bone density Improves mental sharpness, memory, and concentration Increases energy level Improves flexibility, mobility, and coordination Prevents aches, pains, and arthritis Restores sex drive and libido

19. Testosterone (cont.) Protects against Alzheimer�s dementia, Parkinson�s disease, AODM, complications of diabetes, abdominal obesity, depression, inflammatory-related syndromes, and cardiovascular disease Levels decline with age, by age 70, 40-50% of men are testosterone deficient Does not cause prostate cancer Does not cause liver failure

20. DHEA ( dehydroepiandrosterone) Precursor hormone for both testosterone and the estrogens Low levels have been associated with cancers, depression, autoimmune diseases, heart disease and other chronic diseases Low levels and high levels have been associated with increased risk of breast cancer Chronic stress, illness ie. RA, Lupus, MS predispose to low levels Can help decrease visceral and subcutaneous fat, increase insulin sensitivity and increase IGF-1

21. Functions of DHEA Decreases cholesterol Decreases formation of fatty deposits Prevents blood clots Increases bone growth Promotes weight loss Increases brain function Helps the body repair itself and maintain tissues

22. Replacement of DHEA can: Increase muscle strength and lean body mass Activate immune function Increase quality of life Improve sleep Increase feeling of wellness Decrease joint soreness Increase sensitivity of insulin Decrease triglycerides Stop the damaging effects of stress

23. Thyroid Main hormone responsible for metabolism and energy Every cell depends on adequate thyroid hormone levels to function properly Slight deficiency can impact health Levels decline with age Not rely on blood tests alone for diagnosis AACE guidelines suggest TSH<3.0 (0.5-2.0) Critical for heart health and immune function

24. Wren 1971 347 patients, ages 43-86, high risk/sx. Heart dz. 9% low thyroid by testing Treated all patients with Thyroid hormone -Mortality decreased by 50% -70% reduction in episodes of chest pain -50% reduction in heart attacks -22% reduction in cholesterol -80% of patients felt better, more alert & motivated

25. Cortisol Produced in the adrenal gland from progesterone It is the body�s major defense against stress, including infections & injuries Natural anti-inflammatory hormone Critical for function of the immune system Involved in blood sugar regulation Every living cell in the body requires a cortisol molecule to function

26. Functions of Cortisol Sleep Influences testosterone/estrogen ratio Influences DHEA/insulin ratio Affects the pituitary/thyroid/adrenal system

27. Pregnenolone Precursor hormone to DHEA, estrogens, progesterone and testosterone �Mother Hormone� Produced in the brain, promotes greater growth of brain cells. Potent memory and mood enhancer Used to treat fatigue and depression Prevents age-related decline in neurogenesis in the hippocampus. Hypothyroidism can cause low pregnenolone http://www.lef.org

28. Functions of Pregnenolone Regulates the balance between excitation and inhibition in the nervous system. Increases resistance to stress Improves energy both physically and mentally Enhances nerve transmission and memory Reduces pain and inflammation

29. Pregnenolone Used in the Treament of Arthritis Depression Memory loss Fatigue Moodiness

30. Melatonin Improves sleep disorders and prevents jet lag Potent antioxidant Low levels have been seen in cancer patients High doses have been used to treat breast cancer Levels decline after age 45

31. Functions of Melatonin Sleep Mood Immune function Antioxidant activity Blocks estrogen from binding to estrogen receptors Stimulates the parathyroid gland which regulates bone-formation. Stimulates the production of growth hormone.

32. Estrogen Dominance Condition in which there is too much estrogen (E1, E2, xenoestrogens) in proportion to progesterone and phytonutrients

33. Etiology of Estrogen Dominance Insufficient production of progesterone Overproduction of estrone and estradiol Conventional Hormone Replacement Therapy Chemicals/ Pollutants Insulin Resistance (refined carbohydrates) Stress (elevated cortisol) Lack of Phytonutrients found in fruits and vegetables Lack of fiber

34. Symptoms Mood Swings, PMS Anxiety, Irritability, Depression, Fatigue Fibrocystic breasts, breast tenderness, cysts Uterine fibroids, heavy bleeding Weight gain, water retention, bloating Headaches, infertility Symptoms of low thyroid, increased TBG Increased risk of breast, uterine cancer, and prostate cancer

35. Prevention of Estrogen Dominance Progesterone supplementation Bioidentical HRT (balanced) Stress reduction Get rid of chemicals, pesticides etc. Improved diet, reduce carbohydrates, whole foods Exercise Fiber / supplements / flaxseed / I3C / DIM

36. Estrogen Deficiency Hot flashes, night sweats Vaginal dryness, urinary urgency, incontinence Foggy thinking, memory lapses Tearful, depressed Insomnia Heart palpitations Bone loss, aches, pains Thinning skin, hair loss

37. Progesterone Deficiency Hot flashes, night sweats Vaginal dryness, incontinence Foggy thinking, memory lapses, depression Insomnia Heart palpitations Bone loss, aches, pains FCB, water retention, anxiety, PMS Increased risk of breast & uterine cancer Hair loss on top of the head, unwanted body hair

38. Progesterone Excess Sleepiness Breast tenderness Mild depression Bloating Water retention Increased insulin resistance Weight gain

39. Testosterone Deficiency Decreased libido, erectile dysfunction Decreased energy, fatigue, lack of endurance Decreased concentration, memory loss Bone loss, muscle mass loss (cardiac muscle) Increased heart disease (CAD,CHF) & diabetes Aches, pains, decreased coordination Hot flashes, vaginal dryness, incontinence Dry, thinning skin, wrinkles, hair loss, graying hair

40. Testosterone Deficiency cont. Increased BMI Increased waist circumference Elevated insulin levels Elevated glucose levels Elevated systolic and diastolic blood pressure Elevated total cholesterol and LDL Elevated triglycerides Reduction in healthy HDLs

41. Androgen Excess Excessive facial hair (women) Loss of scalp hair (women) Tender breasts (women) Acne, oily skin Anxiety, aggression

42. Cortisol Deficiency Usually caused by constant emotional and physical stressors Can also be caused by low progesterone as seen in perimenopause or in women who have had their ovaries removed Overwhelming fatigue Immune dysfunction Sugar cravings Salt cravings Low blood pressure, weak rapid heartbeat

43. Cortisol Deficiency cont. Allergies, asthma, hives, itching Sinusitis, chemical sensitivities, dermatitis Aches, pain, muscle stiffness Arthritis Hair loss in patches or from the top of the head

44. What happens before you actually �burn out� your adrenal glands and you�re living the high stress lifestyle with chronically elevated cortisol?

45. Consequences of Cortisol Excess Fatigue Sleep disturbances Bone loss Weight gain waist, increased belly fat Loss of muscle mass, thinning skin Anxiety Memory lapse Irritability

46. Consequences of Cortisol Excess Decreased immune system Increased risk for osteoporosis Sugar cravings Low energy Night sweats Binge eating Increased cholesterol, triglycerides and blood sugar

47. Chronic Stress/ Elevated Cortisol Suppresses the immune system Affects hormone balance - Increases estrogen dominance (decreases SHBG, induces aromatase, competes with Progesterone receptors) - Suppresses testosterone - Elevates insulin - Major source of hot flashes

48. Stress Related Illness Cancers Heart Disease, High Blood Pressure Depression, headaches Chronic fatigue, chronic pain Ulcers, Inflammatory Bowel Disease Colds, flu Graying hair, hair loss

49. Thyroid Deficiency Basal Body T < 97, TSH > 3.0, low T4 or T3 Decreased metabolism, weight gain Fatigue, lack of endurance, fibromyalgia Muscle weakness, aches, pains, joint stiffness Headaches, decreased concentration, brain fog, memory problems Depression, mood swings, irritability, PMS Elevated cholesterol Dry skin, dry brittle hair, hair loss (balding all over)

50. Thyroid Excess Weight loss/gain Fatigue, weakness, decreased muscle mass Shakiness, restlessness, rapid heartbeat Shortness of breath Heat intolerance, increased thirst, sweating Anxiety, panic attacks Anemia, hives, itching Hair loss, brittle nails

51. Elevated Insulin Increases estrogen dominance (decreases SHBG, elevates cortisol, effects ER, increases aromatase) and the risk of breast cancer Increases inflammation: increases the risk of heart disease, arthritis, and cancer Increases hunger and obesity Increases LDL & Triglycerides/decreases HDL Decreases lifespan

52. Hormone Imbalance Symptoms overlap Men and women at any age GET TESTED blood vs. saliva vs. 24h urine �Low normal� levels may not be optimal

53. Conclusion It�s all about balance Hormones in balance are the key to health Each person is a unique individual Levels must be measured and treatments customized It only makes sense to restore hormones with their bioidentical equivalent Hormone balance is about disease prevention The patient must be an active participant

54. Bioidentical Hormone ReplacementCompounding Pharmacy Capsules (oral) SR or oil capsules Creams/gels (skin or mucous membranes) Sublingual troches/drops/tablets Injections (HGH, testosterone cypionate) Vaginal Suppositories, Troches, and Creams

55. Oral Capsules Convenient Absorb best with a fatty meal First pass through the liver (metabolites) Testosterone converts to estradiol and is rapidly degraded Conventional HRT has been shown to cause liver damage and increase the risk of thrombosis Variability in absorption

56. Creams & Gels Variability in absorption: individual, site, surface area, and the thickness of skin Maintains a consistent level of hormones in the bloodstream avoiding the peaks and valleys Avoids first pass through the liver Does not increase the risk of blood clots Easy to adjust dosage

57. Mucous Membrane Application Consistent absorption Do not store in fatty tissue No need for a separate vaginal preparation Single cream Cost effective

58. Vaginal Suppositories & Creams Used for their effect on vaginal/bladder tissue Reverse incontinence Treat vaginal dryness, urgency, and UTI�s Low systemic absorption

59. SL Tablets, Drops & Troches Avoids first pass through the liver Rapid onset of action Convenient Careful not to swallow saliva Multiple doses to maintain blood levels Drops make it easy to increase or decrease dosage which is useful in perimenopause Variability of absorption

60. Men USP Testosterone (cream/gel, sublingual tablet, patch, injection) DHEA SR 25 to 50mg capsule Progesterone Cream (5-10 mg./day) Arimidex, Zn, Saw palmetto, B6, Chrysin, nettle etc. DRE and PSA(<2.6) prior to starting therapy PSA @ 3, 6, & 12 mos. If PSA > 4.0 prostate bx. FU estradiol & testosterone levels @ 3-6 mos.

61. Women Progesterone cream, gel, troche, sl drops, or tabs DHEA 5 to 10mg./day Bi-Estrogen with Progesterone (cream, gel, oral capsules, sublingual tablets, troches, or drops) Testosterone (cream, gel, sl tablets, troche, or drops) Combination cream (E3, E2, P, T, DHEA, Pr)

62. Conclusion BALANCE Individual Levels Bioidentical Hormones Diet and Lifestyle Disease Prevention Active Participant

63. Recommended Reading www.lef.org www.lammd.com What Your Doctor May Not Tell You About Breast Cancer John Lee/David Zava What Your Doctor May Not Tell You About Menopause / Perimenopause John Lee The Testosterone Syndrome Shippen/Fryer Natural Hormone Balance Uzzi Reiss Natural Woman, Natural Menopause Laux/Conrad The Hormone Solution Thierry Hertoghe Adrenal Fatigue James Wilson

64. Recommended Reading cont. Safe Uses of Cortisol William Mck. Jefferies Hypothyroidism: The Unsuspected Illness Broda O. Barnes Thyroid Power Richard Shames The Thyroid Solution Ridha Arem Solved: the Riddle of Illness Stephen E. Langer The Wisdom of Menopause Christine Northrup The Miracle of Natural Hormones David Brownstein The Sexy Years Suzanne Somers

65. Websites/Links http://scholar.google.com/ Search engine http://www.salivatest.com/store/bhrt_index.html Data/Abstracts http://www.lef.org/protocols/prtcls-txt/t-prtcl-130.html Testosterone protocol http://lammd.com/A3R_brief_in_doc_format/progesterone.cfm#ProgesteroneandMen http://www.lammd.com/A3R_brief_in_doc_format/Estrogen_Dominance.cfm

66. Websites/Links http://www.drlam.com/A3R_brief_in_doc_format/progesterone.cfm Progesterone http://www.lammd.com/A3R_brief_in_doc_format/adrenal_fatigue.cfm Adrenal fatigue http://www.lef.org/protocols/prtcls-txt/t-prtcl-104.html Thyroid protocol http://www.lef.org/protocols/prtcls-txt/t-prtcl-022.html Breast cancer protocol

67. Websites/Links http://www.sogc.org/SOGCnet/sogc_docs/common/guide/pdfs/ps142.pdf HRT in women with breast cancer http://www.thorne.com/pdf/journal/2-6/soyisoflavones.pdf Information on Soy