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Title: Bioidentical Hormone Restoration Best Medical Practice


1
Bioidentical Hormone RestorationBest Medical
Practice
  • Henry_at_hormonerestoration.com

2
Hormones
  • Neuro-endocrine-immune system
  • Travel via blood to cells receptors
  • Control cells proliferation, protein
    manufacture, metabolic rate, etc.
  • Most powerful molecules in our bodies
  • Optimal levels essential for health and quality
    of life

3
(No Transcript)
4
Hormones and Aging
  • Why Doctors Dont Get It

5
Bioidentical Hormone Restoration is Common Sense
  • If a hormone is missing, replace it!
  • If present but insufficient, optimize it!
  • Type 1 Diabetes bioidentical insulin
  • Hypothyroidism bioidentical T4
  • Growth hormone def. bioidentical GH
  • Adrenal insufficiency bioidentical cortisol
  • But what about hormones lost to aging?

6
PregnenoloneMother Steroid
J Clin Endocrinol Metab. 1997 Aug82(8)2396-402.
7
DHEA ? DHEA-S
J Clin Endocrinol Metab. 1997 Aug82(8)2396-402.

8
Growth Hormone (GH)
Somatopause
Normal Adults Pituitary Disease

Sufficiency
fatigue
Log scale
J Clin Endocrinol Metab. 1999 Jun84(6)2013-9.
9
Testosterone Progesterone Estradiol
Andropause Menopause
pg/ml
?
?
?
?
DHEA10,000 pg/ml, DHEA-S 5,000,000 pg/ml !
10
Hormonal Changes With Aging
  • Hormones that build tissues and improve immunity
    decline with age by 50-80 (DHEA, Testosterone,
    GH)
  • Progesterone starts to decline at age 30.
  • Estradiol disappears at ?50menopause
  • Thyroid hormone production and sensitivity
    decline
  • Insulin output declines?Diabetes
  • By age 5020 years of hormonal deficiency

11
Conventional View of Hormones and Aging
  • The loss of hormones is adaptivehelps us to live
    longer
  • Persistence of youthful levels of hormones would
    cause more heart attacks and cancers as we age
  • Losing our hormones is good for us(?!)
  • Fits the Pharmaceutical Agenda Take drugs for
    every symptom and disorder caused by hormone loss!

12
Against the Conventional View
  • Aging is a self-destruct program that kicks in at
    age 25 in humans
  • Aging is natural degeneration!
  • 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!
  • Studies of balanced hormone restoration show the
    expected benefits and no proof of harm!!

13
Example Growth Hormone
  • Declines 14 per decade after age 25
  • IGF-1 of many adults equal to hypopituitary
    patients (only 80-110 vs. 350 _at_25yrs.old)
  • Deficiency ??heart disease, frailty, depression,
    body fat, bone loss
  • GH restoration reduces abdominal fat, lowers
    blood sugar and blood pressure
  • Improves cognition, mood, sleep, energy
  • Increases muscle, decreases fat cholesterol
  • Improves bone density, skin thickness
  • Downside high cost, nightly injections

14
The Endocrinology of Aging
  • Endocrine glands and their feedback control
    systems deteriorate with age
  • Our bodies cease to regulate our hormones for
    optimal health
  • Hormone losses speed our general deterioration
    a vicious cycle.
  • The symptoms of hormone loss are warning signs of
    physical deterioration
  • Win-Win Hormone restoration makes you feel
    better and improves your health!

15
Since the Loss of Hormones is Harmful,THEN
  • Restoring youthful hormone levels is
  • essential preventative medicine
  • essential to the treatment of disease
  • essential to Quality of Life!
  • We have the need and the right to
    restore hormones lost to aging!

16
Hormones and Aging
  • Any Questions?

17
Human Steroid Hormones
Estradiol
Testosterone
DHEA
Progesterone
Cortisol
18
Where Do They Come From?
  • All steroid hormones (including substitutes) are
    chemically synthesized from diosgenin (wild
    Mexican yams, soy, and other plants).

19
Not Just Sex Hormones
  • Estrogen, progesterone, testosterone and DHEA
    essential to cellular growth and function in all
    tissues in both sexes!
  • Maintain brain functionmodulators of mood,
    cognition, pain, etc.
  • Maintain the immune systemprogesterone and
    testosterone are immunosuppressants
  • Maintain connective tissue skin, hair, bone,
    muscle, and blood vessels

20
Female Endocrinology
  • Nature makes special demands on the female body
    for reproduction
  • Breast, uterine and ovarian tissues undergo a
    monthly cycle of proliferation, differentiation,
    and breakdown
  • Defects in this cycle can lead to cancers in
    female organs and to many medical disorders.

21
EstrogenProgesterone Complementarity
  • Estrogen promotes breast/uterine tissue
    proliferation and growth
  • Progesterone stops proliferation and promotes
    maturation and differentiation
  • Differentiated cells cant become cancer cells
  • High average progesterone/estrogen ratio
    suppresses proliferation and prevents cancers of
    female organs

22
Progesterone Deficiency? Estrogen Dominance
  • Allergies
  • Autoimmune diseases
  • 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 periods
  • Migraines
  • Seizures

Progesterone and Iodine/Kelp reduce estrogen
dominance
23
Historical Perspective
  • Throughout most of human history, women were
    usually
  • Pregnanthigh progesterone
  • Breastfeedinglow estrogen
  • (both protect against breast cancer)
  • Women cycled for 4 years avg. today many cycle
    for 35 years
  • Cycling?risk of estrogen dominance and other
    hormonal disorders

24
Perimenopause
  • Females born with a fixed no. of oocytes which
    are continually lost to age and ovulation
  • With aging, fewer oocytes of lower quality are
    left?reduced progesterone production beginning
    around age 30?estrogen dominance
  • No ovulationno progesterone
  • Estrogen swings from very high to very lowoften
    for several years.

25
Normal Progesterone Dominance
Ovulation
Menstrual Cycle
26
Perimenopause Luteal InsufficiencyEstrogen
Dominance
Inadequate Luteal Phase shorter periods, early
spotting
Ovulation
Menstrual Cycle
27
Perimenopause AnovulationEstrogen
Dominance
Menstrual Cycle
28
Menopause
Estrogen and Progesterone Deficiency
29
Also Uterine and Ovarian Cancer
30
Menopause
  • Estrogen Deficiency
  • Progesterone Deficiency
  • Testosterone Deficiency
  • After menopause, women depend upon their
    adrenal glands for androgens and estrogens, so
  • Menopause
  • Adrenal Insufficiency
  • BIG TROUBLE

31
Effects of Combined Sex-Hormone Deficiency
  • Irritability, insomnia, brain dysfunction
  • Alzheimers dementia
  • Fatigue, aches and pains.
  • Osteoporosis?fractures, loss of teeth
  • Genital atrophy, vaginal dryness
  • Atrophy of skin and connective tissue
  • Heart diseasehigher risk than men after 65,
    higher mortality after 70!

32
Estradiol Restoration
  • Eliminates hot flashes
  • Restores mood and mental function
  • Probably protects against Alzheimers disease
  • Maintains genital/vaginal skin and lubrication
  • Increases thickness, fullness of skin and hair
  • Prevents heart disease
  • Prevents colon cancer and macular degeneration
  • Improves insulin sensitivityhelps diabetes
  • Prevents osteoporosis and osteoarthritis

33
Speroff L, Fritz M Clinical Gynecologic
Endocrinology and Fertility, 7th Ed.
34
Osteoporosis
  • In menopause 5 bone loss each year for first 5
    years25all due to loss of estrogen!
  • 20 yrs. post menopause50 reduction in
    trabecular bone, 30 in cortical bone
  • 50 of women gt65 yrs. old have spinal compression
    fractures
  • 14 lifetime risk of hip fracture for 50 yr.old
    woman, 30 for 80 yr. old.

Speroff L, Fritz M Clinical Gynecologic
Endocrinology and Fertility, 7th Ed.
35
Osteoporosis
  • A hormone deficiency diseasethe proper treatment
    is hormone restoration!
  • Estrogen prevents resorption of old bone while
    testosterone, progesterone, DHEA and GH build new
    bone
  • J Clin Endo Metab. 1996 8137-43.
  • J Reprod Med. 1999 Dec44(12)1012-20.
  • Combined BHR increases bone density far better
    than Fosamax? and preserves normal bone
    remodeling (no rotting jaw, eye inflammation,
    ?Ca).

36
Estrogen, Progesterone, and Osteoporosis
  • Any Questions?

37
Total and Free Testosterone in Men
Baltimore Longitudinal Study of Aging (BLSA).
Harman et al., 2001
38
Andropause in Men
  • Testosterone levels decline slowly in menJust
    getting old.
  • Fatigue, reduced mental function
  • Passivity and moodinessloss of drive and
    ambition
  • Loss of muscle mass, increased abdominal fat
  • Lastly loss of libido, no morning erections
  • Increased risk of heart and prostate disease
  • Increased risk of Alzheimers dementia
  • Increased risk of autoimmune diseases

39
Testosterone Restoration
  • Improves mood and sociability
  • Restores energy and ambition
  • Improves cognition
  • Increases libido and sexual performance
  • Increases muscle and bone mass
  • Reduces abdominal fat, improves insulin
    sensitivity, lowers blood pressure--counteracts
    metabolic syndrome

40
Testosterone and the Heart
  • Low testosterone levels, correlate with coronary
    artery disease and stroke
  • Arterioscler Thromb. 1994 14701-706
  • Eur Heart J 2000 21 8904
  • Int J Cardiol. 1998 Jan 3163(2)161-4
  • Arterioscler Thromb Vasc Biol. 1996
    Jun16(6)749-54
  • T dilates coronary arteriesimproves angina
  • T increases heart muscle size, strength
  • T decreases fibrinogen levelsprevents blood
    clots
  • Endocr Res. 200531(4)335-44.

41
Testosterone and the Prostate
  • Higher testosterone levels do not increase the
    risk of prostate cancer.
  • Studies of testosterone supplementation have
    shown no increase in prostate cancereven though
    so many men have it!
  • Low testosterone correlated with more aggressive
    prostate cancers
  • Testosterone promotes prostate growth to a point,
    but not prostate cancer

42
Wheres 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? Can J Urol. 2006 Feb13
    Suppl 140-3.

43
Estrogen Dominance Theory of Prostate Disease
  • In many men, free testosterone declines gt
    estradiol
  • Estrogen dominance is a probable cause of
    prostrate enlargement and a possible cause of
    prostate cancer
  • Elevated estrogen/Test. ratios in BPH
    Scandinavian Journal of Urology and Nephrology,
    1995 29 65-68.
  • High levels of estradiol and estrone found in BPH
    tissues
  • Estradiol upregulates oncogenes

44
Female Andropause
  • Young womans free testosterone level in serum is
    2x her free estradiol
  • Female testosterone levels decline 50 between
    age 20 and 45
  • Birth control pills??testosterone and DHEA levels
  • DHEA declines with agemain source of androgens
    in women

45
Testosterone for Women
  • Improves energy, mood
  • Improves sexual desire and response
  • Increases muscle strength and reduces muscle and
    joint aches
  • With estradiol, increases bone density
  • J Reprod Med. 1999 Dec44(12)1012-20.
  • Probably decreases risk of heart attack
  • J Womens Health. 1998 Sep7(7)825-9.
  • Given with estradiol and progesterone, reduces
    risk of breast cancer
  • Menopause. 2003 Jul-Aug10(4)292-8, Endocr Rev.
    2004 Jun25(3)374-88.
  • Menopause. 2004 Sep-Oct11(5)531-5, FASEB J.
    2000 Sep14(12)1725-30.

46
Testosterone
  • Any Questions?

47
My doctor says that hormone replacement is
dangerous and theres no evidence that
bioidentical hormones are safer!
48
Two Approaches to Medicine
  • Natural-ScientificIdentify the deficiency/excess
    at the molecular level and correct it with
    bioidentical molecules
  • PharmaceuticalCreate non-natural, patentable
    substances that will produce some improvement
  • Natural Science should be primary
    Pharmaceutical Science secondary.

49
Problems with Pharmaceuticals
  • Alien molecules not recognized, not easily
    eliminated
  • Negative functions disrupt normal physiology by
    blocking receptors, inhibiting enzymes, etc.
  • Toxic
  • Side effects even at low doses
  • Allergic reactions
  • Long-term damage

50
Pharmaceutical Billions
  • Mission Sell pharmaceuticals
  • Information controljournals, CME, med. schools,
    professional org.s, etc.
  • Strategy Suppress competition (natural
    vitanutrients and hormoneshuman physiology!!)
  • Conventional Docs Unaware
  • Result Unfounded fear of hormone optimization
    unfounded confidence in toxic drugs

51
History of Hormone Replacement Therapy
  • Horse-derived Premarin? approved in 1942
  • Progesterone synthesized in 1942. Poorly
    absorbed orally
  • Chemically altered to make progestinsamong the
    first drugs to be patented.
  • HRT came to mean the use of alien molecules
    that had hormone-like effects
  • Drug co.s became dependent on HRT profits
  • Drug co.s push doctors to use hormone substitutes
    and to ignore or fear natural hormones!!

52
Dirty Secret Conventional HRT is really HST!
  • Progesterone substitutes
  • medroxyprogesterone acetate (MPA-Provera?) and
    30 other progestins
  • Estradiol substitutes conjugated equine
    estrogens (CEE-Premarin?) and ethinyl estradiol
    (birth control pills)
  • Testosterone substitute oral methyltestosterone
  • Patented drugsnot hormones!
  • Most docs dont know the difference!

53
Premarin?Conjugated Equine Estrogens (CEE)
Human Horse
Estradiol-17ß
Dihydroequilin-17ß
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 20058(Suppl 1)363
54
EE in Birth Control Pills
Estradiol
Ethinyl estradiol
Acetylene
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
55
Progesterone vs. Progestins
Progesterone MPA (Provera?)
Megestrol
?
Every progestin has a different spectrum of
androgenic, estrogenic, glucocorticoid, and
progestational effects!
56
Progestin Zoo
Progesterone
Kuhl, Climacteric 20058(Suppl 1)
NAMS-Call em all Progestogens
57
Testosterone Substitution
Headlines Testosterone therapies increase risk
of breast cancer.
Methyltestosterone
Testosterone
Methyltestosterone (in Estratest?) aromatizes to
an alien estrogen and increases risk of breast
cancer, also causes liver damage and breast
enlargement in bodybuilders
58
Sex Bias
  • If a Mans testes are removed or non-functional,
    bioidentical testosterone replacement is started
    immediately
  • If a womans ovaries are removed or
    non-functional, she is offered horse hormones or
    hormone-like drugs or is told to Live with it
    .
  • It IS a Mans World!

59
Birth Control Hormone Substitution is Dangerous
  • 2x risk of stroke, heart attack
  • 2-30x risk of blood clots
  • 1-3x risk of breast cancer
  • Increased blood sugar, blood pressure
  • 1.5x risk systemic lupus erythematosis
  • Liver tumors
  • Diagnose and fix the hormonal disorder
  • Use a copper IUD for contraception!!

UpToDate 2006
Instead
60
2002 WHI StudyMenopausal Prempro? HST is
Dangerous!
  • Oral CEE (Premarin?) alone had adverse effects in
    the first year (strokes, blood clots)
  • Adding MPA (Provera?, PremPro?) caused more
    adverse effects (breast cancers, heart attacks)
  • CEE/MPA caused a large increase in dementia

And we know why these forms of hormone
substitution are dangerous!
61
Dangers of Oral Estrogen Replacement
  • First-pass effect on the liver??IGF-1, ?SHBG,
    ?CRP, ?clotting factors ? blood clots, strokes,
    heart attacks in the first year
  • Smokers have greater risk of clots
  • EE increases clotting much more than estradiol,
    Premarin
  • Transdermal estradiol has none of these effects!

62
Dangers of Estrogen-only HRT
  • Estrogen alone, estrogen-progestin HST and BCPs
    all reduce DHEAS and testosterone levels 25-60
  • Estrogen without progesterone and
    testosterone?estrogen dominance and ? risk of
    breast cancer and other medical disorders

63
Provera? ? Progesterone
Scientific studies show that
Progestins are Dangerous
  • Maintains pregnancy
  • Improves mood
  • Improves sleep
  • Diuretic
  • Lowers blood sugar
  • Maintains estrogen-induced arterial dilation
  • Improves lipid profile
  • No evidence of ? CVD
  • Reduces estrogenic stimulation of breasts
  • Prevents breast cancer
  • Causes birth defects
  • Can cause depression
  • Insomnia, irritability
  • Fluid retention
  • Raises blood sugar
  • Counteracts estrogen-induced arterial dilation
  • Worsens lipid profile
  • Causes heart attacks
  • Increases estrogenic stimulation of breasts
  • Causes breast cancer

64
Atherosclerosis and Clotting
  • 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.
  • Climacteric. 2003 Dec6(4)293-301

65
Progesterone and Breast Cancerthe Evidence
  • Premenopausal women with low P levels had 5.4
    times greater risk of early breast cancer, 10x
    greater risk for all cancers
  • Am J Epidem 1981114209-17.
  • Breast cancer victims have signs of progesterone
    resistance
  • Br J Obstet Gynaecol. 1998
    Mar105(3)345-51.
  • P downregulates BRCA1 and induces apoptosis in
    breast cancer cell lines.
  • Anticancer Res. 2005 Jan-Feb25(1A)243-8
    .

66
Progesterone and Breast Cancerthe Evidence cont.
  • Estrogen cream applied to the breast induces
    proliferation, adding progesterone cream reduces
    proliferation to baseline
  • Fertil Steril 1995 63785-91
  • Estrogen is carcinogenic in breast cell cultures
    unless progesterone is present
  • J Steroid Biochem Mol Biol. 2003
    Oct87(1)1-25.
  • Estrogen upregulates cancer-promoting gene bcl-2,
    progesterone downregulates it.
  • Ann Clin Lab Sci. 1998 Nov-Dec28(6)360-9.

67
E3N-EPIC Study
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?
Int J Cancer. 2005 Apr 10114(3)448-54.
Bioidentical estradiol plus progesterone
decreased the risk of breast cancer!
68
ORDET Study
Int. J. Cancer 112 (2004) (2), pp. 312318.
6,000 women 5 yr. F/U
Higher progesteronelower risk of breast cancer
69
Progesterone and Breast CancerConclusion
  • The balance of the in vivo evidence is that
    progesterone does not have a cancer-promoting
    effect on breast tissue.
  • J Steroid Biochem Mol Biol. 2005
    Jul96(2)95-108
  • In fact, the balance of the evidence indicates
    that progesterone protects against breast cancer!
  • Sowomen can be given estradiol as long as its
    balanced by progesterone and testosterone!

70
Pharmaceutical Corps Dilemma
  • They need to control the HRT market
  • Their progesterone and estradiol substitutes are
    dangerous
  • They cant patent natural hormones
  • Pharm. Corps. have to get FDA-approval for every
    natural hormone preparation
  • Compounding pharmacies can dispense natural
    hormones cheaply

71
Pharm. Corps Choices
  • Stop compounding pharmacies so they can control
    of the BHR market?Wyeths appeal to the FDA,
    media propaganda blitz
  • Suppress BHR in favor of their substitutes
  • Keep looking for substitutes that will provide
    benefits without risks
  • Result Your doctors will never learn the truth
    about hormones unless he/she goes looking for it

72
Common Sense
  • Substitutes are alien molecules!
  • Problems caused by hormone substitutes cannot be
    attributed to human hormones until proven
    otherwise.
  • Bioidentical hormone restoration should be
    considered safe until proven otherwise!

73
Hormone Substitution
  • Any Questions?

74
Metabolic Regulators Thyroid and Cortisol
  • Thyroid sets throttle, cortisol delivers fuel
  • Deficiency?reduced metabolic rate?fatigue, brain
    dysfunction, depression, pain
  • Subtle deficiency?symptoms and disease
  • Usual blood tests are insensitive
  • Irrational fear of supplementation
  • Underdiagnosed, undertreatedDocs prescribe
    pharmaceuticals (SSRIs) instead

75
Hormone Ignorance the Tyranny of the Lab Report
  • Reference Range95 of normal people ? optimum
  • Male free testosterone 35-155 5x
  • Female free testosterone 0.0-2.2 ?
  • Free T3 1.8-3.2 2x
  • TSH 0.3-5 17x
  • If within normal limits no diagnosis
    pharmaceuticals for symptoms
  • If below normal, just replace to WNL

76
HypothyroidismSymptoms
  • Mental fog, depression, anxiety
  • Fatigue
  • Cold extremities
  • Aches and pains
  • Hair falling out
  • Weight gain
  • Constipation
  • Self-Test Basal body temperature lt97.8F
    axillary in bed in AM

77
Thyroid HormoneT3
  • Maintains metabolism, mood, and energy
  • Controlled partly by thyroid stimulating hormone
    (TSH) from the pituitary gland
  • TSH test is indirect does not measure T3 levels
    or effects in various tissues
  • Docs prescribe T4 only (Synthroid? and
    Levoxyl?)prohormone that must be converted to T3
  • Docs rarely measure free T3 levels!

78
We Need Optimal T3 Levels
  • Incidence of severe atherosclerosis doubled with
    lower T3 or higher TSH levels within the normal
    range
  • Clin Cardiol. 2003 Dec26(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
  • Prevents weight gain

79
Fatigue, Fibromyalgia and Depression Epidemic
  • Pre-TSH Treat the patients symptoms
  • Post-TSH Treat the test (?)
  • 1970sDoctors lowered doses by 30
  • TSH-normalizing T4 dose?low T3 levels!
  • Williams Textbook of Endocrinology.
    Saunders, Philadelphia, pp 357-488)
  • T3 alone often effective in fibromyalgia
  • T3 alone relieves depression even if tests
    normal!
    J Affect Disord. 2006 Feb

80
Rational Approach to Thyroid Restoration
  • If S/S of hypothyroidism Treat!
  • Give T4 plus T3 (Armour, Cytomel)
  • Endocrinology 19961372490-2502
  • Increase dose until symptoms gone or S/S of
    excess appear
  • Safe--even moderate TSH suppression does not
    cause
  • bone loss Horm Res. 200564(6)293-8. Epub 2005
    Nov 1.
  • cardiac abnormalities J Clin Endo Metab. 2000
    Jan85(1)159-64.
  • muscle wasting Am J Phys Endol Metab. 2005
    Jun288(6)E1067-73.

81
Pharmaceuticals, Labs, and Thyroid
  • Any Questions?

82
Cortisol
  • Made in the adrenal glands
  • Maintains blood sugar (delivers the fuel)
  • Modulates immune system
  • Need high amounts when stressed
  • Too much?Diabetes, HTN, osteoporosis
  • Too little?hypoglycemia, fatigue, autoimmune
    diseases, aches and pains

83
Cortisol Deficiency
www.adrenalfatigue.org
  • Fatigue, depression
  • Aches and pains
  • Cant stay asleep
  • Cant deal with exercise, stress, or illness
  • 2nd wind late at night
  • Hypoglycemia, feels better after eating
  • Nausea, abdominal discomfort, diarrhea
  • Allergies, autoimmune diseases
  • Hard to gain, hard to lose weight
  • Low blood pressure, salt and sugar cravings

84
Mild-to-ModerateCortisol Deficiency
  • Blood tests are insensitive, need diurnal
    salivary cortisol profile
  • Underdiagnosed Docs taught only about severe
    adrenal insufficiency due to physical
    destruction of the adrenal glands (Addisons
    Disease) or pituitary
  • Common cause of chronic fatigue, pain
  • Clue Felt great when taking prednisone

85
Normal Saliva Cortisol Profile
86
Cortisol Deficiency
87
Cortisol DeficiencyNormal Waking Cortisol
88
DepressionElevated PM Cortisol
89
Cortisol Restoration
  • Mild deficiency can resolve with ?stress, ?rest,
    nutrient restoration
  • Moderate-to-severeneed cortisol, not cortisol
    substitutes like prednisone
  • Physiological doses (5 to 20mglt1-4mg
    prednisone)NOT excessive doses that cause
    hypertension, diabetes, osteoporosis, etc.
  • Fears of low-dose cortisol unfounded
  • Dr. William Jeffries Safe Uses of Cortisol

90
DHEAThe Other Adrenal Hormone
  • Most abundant steroid hormone yet ignored
  • Cells make testosterone and estradiol with it
  • Levels decline with age, stress and disease
  • Anabolicbuilds tissues, improves immunity
  • Reduces abdominal fat
  • Reduces painrestores natural endorphins
  • Reduces inflammation (?IL-6, TNF-?, ?IL-2)
  • Anti-cancer effect in animal, in vitro studies
  • Lower levels assoc. with ?disease, ?mortality

91
Fatigue, Depression, and Pain
  • 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.

92
Cortisol and DHEA
  • Any Questions?

93
What Else Can Hormone Replacement Help?
  • Infertility, PMS, heavy bleeding
  • Insomniaalmost always helps
  • Heart failure
  • Mental disorders
  • Autoimmune diseases (systemic lupus
    erythematosis, rheumatoid arthritis, ulcerative
    colitis, Crohns disease, etc.)
  • Allergies, skin diseases

94
Hormone Restoration
  • Unresolved issuesmore investigation needed
  • Need more long-term randomized studies to study
    long-term results
  • Questions about delivery and monitoring
  • Medical profession should be studying
    bioidentical hormones instead of hormone
    substitutes!

95
Local Compounding Pharmacies
  • Winola PharmacyRt. 307 at Lake Winola, 378-2885
  • Harrolds PharmacyWilkes-Barre, 822-5794
  • Finos PharmacyDallas, 675-1141
  • Hazle Drugs ApothecaryHazelton phone
    1-800-439-2026

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Doing BHRT
  • History, consent, fees online
  • Initial visit order tests
  • F/U visit Resultsprescriberetest
  • Repeat until stabilized at proper dose
  • Follow-up office visit once every 6 months, test
    only as needed.
  • Telephone and e-mail contactcharges for clinical
    decisions, refills, etc.

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Costs
  • Physician time only as required--first year
    200-400 then lt200/yr.
  • No insurance billing may submit claim for
    recognized diagnosis
  • Hormones10 to 70/month, some covered by
    insurance (GH adds 130/mo.)
  • Diurnal salivary cortisol test120
  • Blood testsinsurance may pay, lab kits
    170-220, Saliva/blood kit299
  • Out-of-pocket expenses tax-deductible

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For More Information
  • The Miracle of Natural Hormones David
    Brownstein, MD
  • How to Achieve Healthy AgingLook, Live, and Feel
    Fantastic After 40 Neal Rouzier, MD
  • The Hormone SolutionStay Younger Longer Thierry
    Hertoghe, MD
  • Life Extension Foundation (www.lef.org)
  • BHRT info. and hundreds of abstracts at
    www.hormonerestoration.com.
  • Contact me Henry_at_hormonerestoration.com
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