Bioidentical Hormone Restoration

Best Medical Practice

Henry@hormonerestoration.com

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

Hormones and Aging

Why Doctors Don’t Get It

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?

Pregnenolone—Mother Steroid

J Clin Endocrinol Metab. 1997 Aug;82(8):2396-

402.

DHEA DHEA-S

J Clin Endocrinol Metab. 1997

Aug;82(8):2396-402.

Growth Hormone (GH) Somatopause

J Clin Endocrinol Metab. 1999 Jun;84(6):2013-9.

Normal Adults Pituitary Disease

fatigue

Sufficiency

Log scale

Testosterone Progesterone Estradiol

pg/ml

DHEA–10,000 pg/ml, DHEA-S 5,000,000 pg/ml !

0

1 0 0 0

2 0 0 0

3 0 0 0

4 0 0 0

5 0 0 06 0 0 0

7 0 0 0

8 0 0 0

Y o u n g O ld Y o u n g O ld

T

P

E

♀ ♀♂ ♂

Andropause Menopause

Hormonal Changes With AgingHormones 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 50—menopauseThyroid hormone production and sensitivity decline Insulin output declinesDiabetesBy age 50—20 years of hormonal deficiency

Conventional View of Hormones and AgingThe loss of hormones is adaptive–helps 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!

Against the Conventional ViewAging is a self-destruct program that kicks in at age 25 in humansAging 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!!

Example: Growth HormoneDeclines 14% per decade after age 25IGF-1 of many adults equal to hypopituitary patients (only 80-110 vs. 350 @25yrs.old)Deficiency heart disease, frailty, depression, body fat, bone lossGH restoration reduces abdominal fat, lowers blood sugar and blood pressureImproves cognition, mood, sleep, energyIncreases muscle, decreases fat & cholesterolImproves bone density, skin thicknessDownside: high cost, nightly injections

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

Since the Loss of Hormones is Harmful,THEN…

Restoring youthful hormone levels is:essential preventative medicineessential to the treatment of diseaseessential to Quality of Life!

We have the need and the right to

restore hormones lost to aging!

Hormones and Aging

Any Questions?

Human Steroid Hormones

Testosterone Estradiol

Progesterone Cortisol

DHEA

Where Do They Come From?All steroid hormones (including substitutes) are chemically synthesized from diosgenin (wild Mexican yams, soy, and other plants).

Not Just “Sex Hormones”Estrogen, progesterone, testosterone and DHEA essential to cellular growth and function in all tissues in both sexes! Maintain brain function—modulators of mood, cognition, pain, etc.Maintain the immune system—progesterone and testosterone are immunosuppressantsMaintain connective tissue: skin, hair, bone, muscle, and blood vessels

Female EndocrinologyNature 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.

Estrogen—Progesterone ComplementarityEstrogen promotes breast/uterine tissue proliferation and growthProgesterone stops proliferation and promotes maturation and differentiationDifferentiated cells can’t become cancer cellsHigh average progesterone/estrogen ratio suppresses proliferation and prevents cancers of female organs

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

Historical PerspectiveThroughout most of human history, women were usually:

Pregnant—high progesterone

Breastfeeding—low 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

PerimenopauseFemales born with a fixed no. of oocytes which are continually lost to age and ovulationWith aging, fewer oocytes of lower quality are leftreduced progesterone production beginning around age 30estrogen dominanceNo ovulation=no progesteroneEstrogen swings from very high to very low—often for several years.

Normal Progesterone Dominance

Ovulation

Menstrual Cycle

Perimenopause Luteal Insufficiency=Estrogen Dominance

Ovulation

Menstrual Cycle

Inadequate Luteal Phaseshorter periods, early spotting

Perimenopause Anovulation=Estrogen Dominance

Menstrual Cycle

Menopause

Estrogen and Progesterone Deficiency

Also Uterine and Ovarian Cancer

MenopauseEstrogen DeficiencyProgesterone DeficiencyTestosterone Deficiency

After menopause, women depend upon their adrenal glands for androgens and estrogens, so:

Menopause +Adrenal Insufficiency

= BIG TROUBLE

Effects of Combined Sex-Hormone DeficiencyIrritability, insomnia, brain dysfunctionAlzheimer’s dementiaFatigue, aches and pains.Osteoporosisfractures, loss of teethGenital atrophy, vaginal drynessAtrophy of skin and connective tissueHeart disease—higher risk than men after 65, higher mortality after 70!

Estradiol RestorationEliminates hot flashesRestores mood and mental functionProbably protects against Alzheimer’s diseaseMaintains genital/vaginal skin and lubricationIncreases thickness, fullness of skin and hairPrevents heart diseasePrevents colon cancer and macular degenerationImproves insulin sensitivity—helps diabetesPrevents osteoporosis and osteoarthritis

Speroff L, Fritz M Clinical Gynecologic Endocrinology and Fertility, 7th Ed.

OsteoporosisIn menopause 5% bone loss each year for first 5 years=25%—all due to loss of estrogen!20 yrs. post menopause—50% reduction in trabecular bone, 30% in cortical bone50% of women >65 yrs. old have spinal compression fractures14% lifetime risk of hip fracture for 50 yr.old woman, 30% for 80 yr. old.

Speroff L, Fritz M Clinical Gynecologic Endocrinology and Fertility, 7 th Ed.

OsteoporosisA hormone deficiency disease—the proper treatment is hormone restoration!Estrogen prevents resorption of old bone while testosterone, progesterone, DHEA and GH build new boneJ Clin Endo Metab. 1996; 81:37-43. J Reprod Med. 1999 Dec;44(12):1012-20.

Combined BHR increases bone density far better than Fosamax and preserves normal bone remodeling (no “rotting jaw”, eye inflammation, Ca++).

Estrogen, Progesterone, and Osteoporosis

Any Questions?

Total and Free Testosterone in Men

Baltimore Longitudinal Study of Aging (BLSA). Harman et al., 2001

Andropause in Men Testosterone levels decline slowly in men—”Just getting old.”Fatigue, reduced mental functionPassivity and moodiness—loss of drive and ambitionLoss of muscle mass, increased abdominal fatLastly: loss of libido, no morning erectionsIncreased risk of heart and prostate diseaseIncreased risk of Alzheimer’s dementiaIncreased risk of autoimmune diseases

Testosterone RestorationImproves 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

Testosterone and the HeartLow testosterone levels, correlate with coronary artery disease and stroke

Arterioscler Thromb. 1994; 14:701-706 Eur Heart J 2000; 21; 890–4Int J Cardiol. 1998 Jan 31;63(2):161-4Arterioscler Thromb Vasc Biol. 1996 Jun;16(6):749-54

T dilates coronary arteries—improves anginaT increases heart muscle size, strengthT decreases fibrinogen levels—prevents blood clots

Endocr Res. 2005;31(4):335-44.

Testosterone and the ProstateHigher testosterone levels do not increase the risk of prostate cancer.Studies of testosterone supplementation have shown no increase in prostate cancer—even though so many men have it!Low testosterone correlated with more aggressive prostate cancersTestosterone promotes prostate growth to a point, but not prostate cancer

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? Can J Urol. 2006 Feb;13 Suppl 1:40-3.

Estrogen Dominance Theory of Prostate DiseaseIn many men, free testosterone declines > estradiol

Estrogen dominance is a probable cause of prostrate enlargement and a possible cause of prostate cancerElevated 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

Female AndropauseYoung woman’s free testosterone level in serum is 2x her free estradiolFemale testosterone levels decline 50% between age 20 and 45Birth control pillstestosterone and DHEA levelsDHEA declines with age—main source of androgens in women

Testosterone for WomenImproves energy, moodImproves sexual desire and responseIncreases muscle strength and reduces muscle and joint achesWith estradiol, increases bone densityJ Reprod Med. 1999 Dec;44(12):1012-20.

Probably decreases risk of heart attack J Womens Health. 1998 Sep;7(7):825-9.

Given with estradiol and progesterone, reduces risk of breast cancerMenopause. 2003 Jul-Aug;10(4):292-8, Endocr Rev. 2004 Jun;25(3):374-88.Menopause. 2004 Sep-Oct;11(5):531-5, FASEB J. 2000 Sep;14(12):1725-30.

Testosterone

Any Questions?

“My doctor says that hormonereplacement is dangerous and

there’s no evidence that bioidentical hormones are safer!”

Two Approaches to Medicine

Natural-Scientific—Identify the deficiency/excess at the molecular level and correct it with bioidentical molecules

Pharmaceutical—Create non-natural, patentable substances that will produce some improvement

Natural Science should be primary; Pharmaceutical Science secondary.

Problems with PharmaceuticalsAlien molecules: not recognized, not easily eliminatedNegative functions: disrupt normal physiology by blocking receptors, inhibiting enzymes, etc.Toxic:

1. Side effects even at low doses 2. Allergic reactions3. Long-term damage

Pharmaceutical BillionsMission: Sell pharmaceuticalsInformation control—journals, CME, med. schools, professional org.s, etc.Strategy: Suppress competition (natural vitanutrients and hormones—human physiology!!) Conventional Docs: Unaware Result: Unfounded fear of hormone optimization; unfounded confidence in toxic drugs

History of “Hormone Replacement Therapy”Horse-derived Premarin approved in 1942Progesterone synthesized in 1942. Poorly absorbed orallyChemically altered to make “progestins”—among 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 profitsDrug co.s push doctors to use hormone substitutes and to ignore or fear natural hormones!!

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 drugs—not hormones! Most docs don’t know the difference!

PremarinConjugated Equine Estrogens (CEE)

Estradiol-17β Dihydroequilin-17βCEE 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 2005;8(Suppl 1):3–63

Human Horse

Estradiol Ethinyl estradiol

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

EE in Birth Control Pills

Acetylene

Progesterone vs. Progestins

Progesterone MPA (Provera) Megestrol

Every progestin has a different spectrum of androgenic, estrogenic, glucocorticoid, and progestational effects!

Progestin Zoo

Kuhl, Climacteric 2005;8(Suppl 1)

Progesterone

NAMS-”Call ‘em all Progestogens”

Testosterone Substitution

Testosterone Methyltestosterone

Methyltestosterone (in Estratest) aromatizes to an alien estrogen and increases risk of breast cancer, alsocauses liver damage and breast enlargement in bodybuilders

Headlines: “Testosterone therapies increase risk of breast cancer.”

Sex BiasIf a Man’s testes are removed or non-functional, bioidentical testosterone replacement is started immediately

If a woman’s 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 Man’s World!

Birth Control Hormone Substitution is Dangerous2x 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::

2002 WHI Study—Menopausal 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!

Dangers of Oral Estrogen ReplacementFirst-pass effect on the liverIGF-1, SHBG, CRP, clotting factors blood clots, strokes, heart attacks in the first yearSmokers have greater risk of clotsEE increases clotting much more than estradiol, Premarin®

Transdermal estradiol has none of these effects!

Dangers of Estrogen-only HRT

Estrogen alone, estrogen-progestin HST and BCPs all reduce DHEAS and testosterone levels 25-60%

Estrogen without progesterone and testosteroneestrogen dominance and risk of breast cancer and other medical disorders

Provera Progesterone

• 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

Progestins are DangerousScientific studies show that:

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 Dec;6(4):293-301

Progesterone and Breast Cancer—the 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 1981;114:209-17.

Breast cancer victims have signs of progesterone resistance

Br J Obstet Gynaecol. 1998 Mar;105(3):345-51.

P downregulates BRCA1 and induces apoptosis in breast cancer cell lines.

Anticancer Res. 2005 Jan-Feb;25(1A):243-8.

Progesterone and Breast Cancer—the Evidence cont.Estrogen cream applied to the breast induces proliferation, adding progesterone cream reduces proliferation to baseline

Fertil Steril 1995; 63:785-91

Estrogen is carcinogenic in breast cell cultures unless progesterone is present

J Steroid Biochem Mol Biol. 2003 Oct;87(1):1-25.

Estrogen upregulates cancer-promoting gene bcl-2, progesterone downregulates it.

Ann Clin Lab Sci. 1998 Nov-Dec;28(6):360-9.

E3N-EPIC Study

Bioidentical estradiol plus progesterone decreased the risk of breast cancer!

Int J Cancer. 2005 Apr 10;114(3):448-54.

Cohort study54,000 women5.8 years f/uc/w WHI--16,000, 6 yr. f/u

No Evidence that BHRT is safer?

ORDET Study

Int. J. Cancer 112 (2004) (2), pp. 312–318.

Higher progesterone=lower risk of breast cancer

6,000 women5 yr. F/U

Progesterone and Breast Cancer—Conclusion “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 Jul;96(2):95-108

In fact, the balance of the evidence indicates that progesterone protects against breast cancer!So…women can be given estradiol as long as it’s balanced by progesterone and testosterone!

Pharmaceutical Corps’ Dilemma

They need to control the HRT market

Their progesterone and estradiol substitutes are dangerous

They can’t patent natural hormones

Pharm. Corps. have to get FDA-approval for every natural hormone preparation $$$

Compounding pharmacies can dispense natural hormones cheaply

Pharm. Corps’ Choices

Stop compounding pharmacies so they can control of the BHR marketWyeth’s 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

Common SenseSubstitutes 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!

Hormone Substitution

Any Questions?

Metabolic Regulators: Thyroid and Cortisol

Thyroid sets throttle, cortisol delivers fuelDeficiencyreduced metabolic ratefatigue, brain dysfunction, depression, painSubtle deficiencysymptoms and diseaseUsual blood tests are insensitiveIrrational fear of supplementationUnderdiagnosed, undertreated—Docs prescribe pharmaceuticals (SSRIs) instead

Hormone Ignorance: the Tyranny of the Lab Report

Reference Range=95% of “normal people” optimumMale free testosterone: 35-155 5x

Female free testosterone: 0.0-2.2 Free T3: 1.8-3.2 2xTSH: 0.3-5 17xIf “within normal limits” no diagnosis; pharmaceuticals for symptomsIf below normal, just replace to “WNL”

Hypothyroidism—SymptomsMental fog, depression, anxietyFatigueCold extremitiesAches and painsHair falling outWeight gainConstipation

Self-Test: Basal body temperature <97.8°F axillary in bed in AM

Thyroid Hormone—T3

Maintains metabolism, mood, and energyControlled 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!

We Need Optimal T3 Levels

Incidence of severe atherosclerosis doubled with lower T3 or higher TSH levels within the normal range

Clin 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

Prevents weight gain

Fatigue, Fibromyalgia and Depression Epidemic

Pre-TSH: Treat the patient’s symptomsPost-TSH: Treat the test (?)1970s—Doctors lowered doses by 30%

TSH-normalizing T4 doselow T3 levels! Williams’ Textbook of Endocrinology. Saunders, Philadelphia, pp 357-488)

T3 alone often effective in fibromyalgiaT3 alone relieves depression even if tests “normal”! J Affect Disord. 2006 Feb

Rational Approach to Thyroid Restoration

If S/S of hypothyroidism: Treat!

Give T4 plus T3 (Armour, Cytomel) Endocrinology 1996;137:2490-2502

Increase dose until symptoms gone or S/S of excess appear Safe--even moderate TSH suppression does not cause:

bone loss Horm Res. 2005;64(6):293-8. Epub 2005 Nov 1.

cardiac abnormalities J Clin Endo Metab. 2000 Jan;85(1):159-64.

muscle wasting Am J Phys Endol Metab. 2005 Jun;288(6):E1067-73.

Pharmaceuticals, Labs, and Thyroid

Any Questions?

Cortisol

Made in the adrenal glands

Maintains blood sugar (delivers the fuel)

Modulates immune system

Need high amounts when stressed

Too muchDiabetes, HTN, osteoporosis

Too littlehypoglycemia, fatigue, autoimmune diseases, aches and pains

Cortisol DeficiencyFatigue, depressionAches and painsCan’t stay asleepCan’t deal with exercise, stress, or illness2nd wind late at nightHypoglycemia, feels better after eatingNausea, abdominal discomfort, diarrheaAllergies, autoimmune diseasesHard to gain, hard to lose weightLow blood pressure, salt and sugar cravings

www.adrenalfatigue.org

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 (Addison’s Disease) or pituitary

Common cause of chronic fatigue, pain

Clue: Felt great when taking prednisone

Normal Saliva Cortisol Profile

Cortisol Deficiency

Cortisol Deficiency—Normal Waking Cortisol

Depression—Elevated PM Cortisol

Cortisol Restoration

Mild deficiency can resolve with stress, rest, nutrient restorationModerate-to-severe—need cortisol, not cortisol substitutes like prednisonePhysiological doses (5 to 20mg=<1-4mg prednisone)—NOT excessive doses that cause hypertension, diabetes, osteoporosis, etc.Fears of low-dose cortisol unfoundedDr. William Jeffries’ Safe Uses of Cortisol

DHEA—The Other Adrenal HormoneMost abundant steroid hormone yet ignored Cells make testosterone and estradiol with itLevels decline with age, stress and diseaseAnabolic—builds tissues, improves immunityReduces abdominal fatReduces pain—restores natural endorphinsReduces inflammation (IL-6, TNF-, IL-2)Anti-cancer effect in animal, in vitro studiesLower levels assoc. with disease, mortality

Fatigue, Depression, and PainShould 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.

Cortisol and DHEA

Any Questions?

What Else Can Hormone Replacement Help?Infertility, PMS, heavy bleeding

Insomnia—almost always helps

Heart failure

Mental disorders

Autoimmune diseases (systemic lupus erythematosis, rheumatoid arthritis, ulcerative colitis, Crohn’s disease, etc.)

Allergies, skin diseases

Hormone RestorationUnresolved issues—more investigation neededNeed more long-term randomized studies to study long-term resultsQuestions about delivery and monitoringMedical profession should be studying bioidentical hormones instead of hormone substitutes!

Local Compounding PharmaciesWinola Pharmacy—Rt. 307 at Lake Winola, 378-2885

Harrold’s Pharmacy—Wilkes-Barre, 822-5794

Fino’s Pharmacy—Dallas, 675-1141

Hazle Drugs Apothecary—Hazelton phone 1-800-439-2026

Doing BHRTHistory, consent, fees online

Initial visit: order tests

F/U visit: Results—prescribe—retest

Repeat until stabilized at proper dose

Follow-up office visit once every 6 months, test only as needed.

Telephone and e-mail contact—charges for clinical decisions, refills, etc.

CostsPhysician time only as required--first year ~$200-$400; then <$200/yr. No insurance billing; may submit claim for recognized diagnosis Hormones—$10 to $70/month, some covered by insurance (GH adds $130/mo.)Diurnal salivary cortisol test—$120Blood tests—insurance may pay, lab kits $170-$220, Saliva/blood kit—$299 Out-of-pocket expenses tax-deductible

For More InformationThe Miracle of Natural Hormones David Brownstein, MD How to Achieve Healthy Aging—Look, Live, and Feel Fantastic After 40 Neal Rouzier, MDThe Hormone Solution—Stay Younger Longer Thierry Hertoghe, MD Life Extension Foundation (www.lef.org) BHRT info. and hundreds of abstracts at www.hormonerestoration.com. Contact me: Henry@hormonerestoration.com