A4 m 5 19-12 comprehensive hormone replacement therapy v 1.1
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Transcript of A4 m 5 19-12 comprehensive hormone replacement therapy v 1.1
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Professional Education Series
David S. Klein, MD, FACA, FACPMStages of Life Medical Institute
Longwood, Florida
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Comprehensive Hormone
Replacement Therapy
In the Traditional Medical Setting
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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
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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
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Natural Hormone Therapy or Xenohormone Therapy?
(c) 2012 Stages of Life Medical Institute
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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
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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
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Command and Control
¨ Hard wired mechanisms– Nerve
¨ Wireless mechanisms– Hormonal– Humoral– Chemical
(c) 2012 Stages of Life Medical Institute
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Physiological Command and Control Mechanisms
• Neuronal– Motor
• Distinct & precise
– Sensory• Regional,
predictable, broader areas
– Autonomic• Global
• Hormonal• Regional, organs &
tissues?• Global
(c) 2012 Stages of Life Medical Institute
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Common Endocrine Concerns
• Common– Thyroid Axis– Adrenal Axis– Pancreatic Axis– Gondal Axis– Parathyroid
(c) 2012 Stages of Life Medical Institute
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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
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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
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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
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Estrogen Dominance
Definition: Elevated ratio of measured estrogen level, relative to
progesterone level.
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Second only to Thyroid Dysfunction,
Estrogen Dominance is the Most Common Dysfunction in Females
(c) 2012 Stages of Life Medical Institute
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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
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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
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A Decrease in Libido is a
Sign of Illness
(c) 2012 Stages of Life Medical Institute
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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
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Saliva Testing
• Estrogen– Estradiol– Estriol
• Testosterone• Progesterone• Cortisol• DHEA
(c) 2012 Stages of Life Medical Institute
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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
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Cellular Testing
• Micronutrients• Anti-oxidants• Trace Minerals
(c) 2012 Stages of Life Medical Institute
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Testosterone, Estrogen & Progesterone Balance
(c) 2012 Stages of Life Medical Institute
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HRT is all about Balance
(c) 2012 Stages of Life Medical Institute
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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
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Hormone Replacement Priorities
• Always start with the Thyroid
• Next, address the Adrenals
• Then, deal with the Gonadals.
(c) 2012 Stages of Life Medical Institute
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Administration Techniques
¨ Transdermal Route– Creams– Patches– Sub Lingual, trans-clitoral
¨ Oral Route
¨ Parenteral Approach
(c) 2012 Stages of Life Medical Institute
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Success Results From a Team Effort.
(c) 2012 Stages of Life Medical Institute
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Questions?
(c) 2012 Stages of Life Medical Institute