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Bioidentical Hormone Restoration Best Medical Practice

Bioidentical Hormone Restoration Best Medical Practice

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Bioidentical Hormone Restoration Best Medical Practice

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  1. Bioidentical Hormone RestorationBest Medical Practice This presentation is available online.

  2. Hormone Restoration • Medically Necessary • Safe • Improves Health and Quality of Life • Prevents and Treats Many Diseases • Restores Sexuality • Reduces need for: • Blood sugar, blood pressure, cholesterol meds • Anti-depressant, anti-anxiety, pain, sleep meds • Osteoporosis meds

  3. Hormones • Neuro-endocrine-immune system • Travel via blood to tissues • Control cellular metabolism, functions • Themostpowerfulmolecules in biology • Optimal levels are Essential for Health • Bioidentical:Same molecular structure as our natural hormones

  4. Gonadal Steroids:Not Just “Sex Hormones” • Estradiol, Progesterone, Testosterone • Essential to all tissues in both sexes! • Brain function • Immune system • Blood vessel health • Blood lipids, clotting factors • Connective tissue—skin, hair, muscle, bone

  5. CRH, TRH, etc. control pituitary GH, FSH, LH, TSH, and ACTH control other glands T4, T3 Cortisol, DHEA, Aldosterone, Pregnenolone Insulin Adrenalin Estradiol, Progesterone Testosterone Testosterone

  6. Bioidentical Hormones are NOTDrugs • Inherently safe,Non-toxic • Properfitin receptors,easily eliminated • No allergic reactions • No “side effects” • Monitordose with usual blood tests • Only potential problems: • Excessive dose • Lack of balance with other hormones • Unphysiological delivery: route, timing, etc.

  7. The Tyranny of the Lab Report • Reference Range=95% of the population • NOT the optimal range for any person • Male free testosterone: 35-1555x! • Female free testosterone: 0.0-2.2! • Free T4: 0.6-1.83x! • AM serum cortisol 5-255x! • Within RR:pharmaceuticals for symptoms • Below RR (<97.5%): replace to within-RR • Disease/No Disease instead of Continuum

  8. Hypometabolism—Thyroid and Cortisol Insufficiencies • Thyroid sets throttle • Cortisol delivers the fuel • Insufficiencyreduced metabolic ratefatigue, brain dysfunction, depression, pain • Usual tests are insensitive • Optimization improves health and quality of life

  9. Cortisol • Adrenal glands • Maintains blood sugar (delivers the fuel) • Modulates immune system, brain function • Need higher amounts with stress, disease • Too muchDiabetes, HTN, osteoporosis • Too littlehypoglycemia, fatigue, depression, aches, autoimmune diseases, allergies • Insufficiencymore prevalent than excess!

  10. Mild-to-Moderate Cortisol Insufficiency • Central: brain (H-P) fails to maintain levels • Common cause of chronic fatigue, pain • Clue: Mood, energy improved on prednisone • Saliva testing reveals free cortisol levels at 4 times during a normal day

  11. Normal Saliva Cortisol Profile

  12. Cortisol Insufficiency

  13. Common Dysfunctional Pattern

  14. Cortisol Restoration • Mild— stress, rest, nutrients, other hormones • Moderate-to-severe—cortisol restoration • Low physiological doses are safe • 40 years’ experience: see Dr. Jeffries’ Safe Uses of Cortisol

  15. Thyroid Hormones T4 T3 • Maintain metabolism, mood, and energy • T4 (Synthroid, Levoxyl) is bioidentical, but must be converted to T3 • Thyroid gland makes T4and T3; we should restore both hormones • Can have thyroid hormone resistance

  16. Continuum: Higher Thyroid Hormone Levels within the RRs: • 50% reduction in severe atherosclerosisClin Cardiol. 2003 Dec;26(12):569-73 • Lowers cardiac risk factors: cholesterol, triglycerides, C-reactive protein, homocysteine and lipoprotein(a) • Lowers blood pressure, dilates arteries • Reduces tendency to form blood clots • Relieves depression • Helps weight loss

  17. Continuum:Weight vs. Free T4Within the RR J Clin Endocrinol Metab July 2005, 90(7):4019-4024

  18. Thyroid Insufficiency • Mental fog • Fatigue, depression, anxiety • Cold extremities • Aches and pains • Hair loss, esp. in women • Weight gain • Constipation • Puffy ankles and face • Elevated cholesterol

  19. Diagnosing Thyroid Insufficiency • Signs and Symptoms plus free T4 or free T3 levels below mid-point of RR • High TSH = thyroid gland failure • Normal/Low TSH = H-P dysfunction • Trial of thyroid hormone supplementation using T4 and T3

  20. The Fatigue, Fibromyalgia, and Depression Epidemic • Pre-1970s: T3andT4for symptoms • Post-1970s: T4-only to “normalize” TSH • Doses lowered by 30-50% • TSH “normalizing” T4doselow free T3, weight gain, persistence of symptoms • People with fatigue, fibromyalgia, and depressionoften improve with T3/T4optimization

  21. Cortisol and Thyroid Optimization Any Questions?

  22. The Controversy What do we do about hormones lost to normal aging?

  23. Adrenopause DHEA-S Levels with Age

  24. Somatopause Growth Hormone (GH) J Clin Endocrinol Metab 1999; 84(6):2013-2019

  25. Thyropause Free T3 Endocr Rev. 1995 Dec;16(6):686-715

  26. Male Andropause—Testosterone Baltimore Longitudinal Study of Aging (BLSA). Harman et al., 2001

  27. Andropause vs. Menopause Men Women Testosterone Progesterone average pg/ml Estradiol ♂ ♀ ♀ ♂ DHEA-S 5,000,000pg/ml Cortisol 100,000 pg/ml!

  28. Conventional View of Aging • The loss of hormones is adaptive • Higher levels cause heart attacks, breast and prostate cancers • Pharmaceutical Corporation Agenda:Takedrugs instead of replacing hormones.

  29. Against the Conventional View • Aging is an auto-destruct program. • Starts around age 25! • Glands andcontrol systemsdeteriorate •  in weight, BP, cholesterol, cancers, heart attacks, autoimmune diseases, etc. • Occur years afterhormonelosses begin • Occur moreoften in those with lower levels • Hormonerestorationimproves parameters, does not cause increased disease.

  30. Women Killers • Cardiovascular disease (CVD), breast cancer and osteoporosis are rare in premenopausalwomen • They begin in perimenopause when progesterone and testosterone arelow. • After menopause, CVD rises faster than in men • Higher risk than men after 65 • Higher mortality after 70 • Surgical menopause  2-7x risk of heart attacks Engl J Med 1987 Apr 30;316(18):1105-10 Am J Obstet Gynecol. 1981 Jan;139(1):47-51.

  31. DHEA—Most Abundant Steroid • Precursor of testosterone and estradiol • Lower levels assoc. with  risk of death, disease • Anabolic—builds tissues, improves immunity • Reducespain by increasing endorphins • Anti-inflammatory • Improves immune system function • Anti-atherosclerotic • Reduces platelet aggregation--blood clotting • Anti-cancer effects

  32. Male Andropause:“Just Gettin’ Old” • Testosterone levels declineslowly • Fatigue • Reduced mental function • Passivity and moodiness • Loss of muscle and bone mass • Increased abdominal fat • Loss of libido, no spontaneous morning erections

  33. Testosterone is Your Friend • Improves mood and sociability • Improves energy • Improves cognition, protects against Alzheimer’s diseaseNeurology. 2004 Jan 27;62(2):188-93. • Improves libido and erectile function • Increases muscle and bone mass • Reduces abdominal fat, improves insulin sensitivity, lowers blood pressure--counteracts metabolic syndrome

  34. Testosterone is Good for your Heart • Lowtestosterone levels correlate with coronary artery disease and stroke Arterioscler Thromb. 1994; 14:701-706 Eur Heart J 2000; 21; 890–4 Int J Cardiol. 1998 Jan 31;63(2):161-4 Arterioscler Thromb Vasc Biol. 1996 Jun;16(6):749-54 • T dilates coronary arteries • T improves endothelial function • T increases heart muscle size, strength • Tdecreases fibrinogen levels—prevents blood clotsEndocr Res. 2005;31(4):335-44

  35. Testosterone Does Not Cause Prostate Cancer • Testosterone promotes prostate growth to a point. • Castration slows prostate cancer growth temporarily. • Men with higher T levels don’t have higher risk of prostate cancer. • Testosterone restoration does not increase the risk of prostate cancer. • LowT levels associated with more aggressiveprostate cancers.

  36. Where’s the Beef? “These results argue against an increased risk of prostate cancer with testosterone replacement therapy.” Testosterone replacement therapy and prostate risks: where's the beef? Morgentaler A. Can J Urol. 2006 Feb;13 Suppl 1:40-3

  37. Hormones and AgingTestosterone For Men Any Questions? Coming up: Estradiol, Progesterone, and Testosterone for Women

  38. Female Endocrinology:Balance in a Complex System • Reproduction makes special demands on the female body • Breasts, uterus and ovaries undergo a monthly cycle of proliferation and breakdown • No similar process in males • Defects in this cycle can lead to cancers andother medical disorders.

  39. Estrogen—Progesterone Complementarity in Women • Estrogenpromotes tissue proliferation and growth • Progesterone stopsproliferationand promotes differentiation • Differentiated cells can’t become cancers • High average progesterone/estrogen ratio prevents cancers

  40. Anti-Estrogenic Actions of Progesterone • Decreases synthesis of estradiol receptor molecules • Increases conversion of estradiol to estrone (weak estrogen) in tissues • Inhibits conversion of estrone to estradiol • Increases sulfation of estrogens (inactivation) Williams Text. of Endocrinology, 10th Ed., p. 612

  41. Normal Cycle and Balance Ovulation Menstrual Cycle

  42. Perimenopause Luteal Insufficiency=Estrogen Dominance Inadequate Luteal Phase shorter periods, early spotting Ovulation Menstrual Cycle

  43. Perimenopause Anovulation with Estrogen Dominance High estrogen, low progesterone ’d risk of cancer Menstrual Cycle

  44. Menopause Estrogen and Progesterone Deficiency

  45. Allergies Autoimmune disease Anxiety, irritability Insomnia Decreased sex drive Depression Bloating and edema Fibrocystic breasts Uterine fibroids Breast cancer Ovarian cancer Uterine cancer Thyroid dysfunction Gallbladder disease Heavy/painful menses Migraines Seizures Endometriosis Imbalance: Estrogen Dominance

  46. Perimenopause is Dangerous • Females born with a fixed no. of oocytes (eggs) • Aging  fewer oocytes of lower quality are leftreduced progesterone productionestrogen dominance • Anovulation noprogesteroneestrogen dominancebreast and uterine cancer

  47. Menopause: Estradiol Deficiency • Irritability, depression, insomnia, • ’d risk of Alzheimer’s dz. • Fatigue, aches and pains • Genital atrophy • Loss of libido • Atrophy and wrinkling of skin • BP,  LDL cholesterol, heart disease • Osteoporosis

  48. Female Andropause • Female testosterone levels decline 50% between age 20 and 45. Menopause. 2003 Sep-Oct;10(5):390-8 • Birth control pills and menopausal HRT 25 to 40%  in free testosterone and DHEAS levels Obstet Gynecol. 1997 Dec;90(6):995-8 • DHEAdeclines with age—main source of androgens

  49. Testosterone for Women • Improves energy, mood • Reduces anxiety • Improves sexual function • Increases muscle strength, stamina • Increases bone density J Reprod Med. 1999 Dec;44(12):1012-20 • Probably decreases risk of heart attack J Womens Health. 1998 Sep;7(7):825-9