Bioidentical Hormone Restoration

Best Medical Practice

This presentation available online

Topics

Hormone Loss with Age

Estradiol and Progesterone for Menopause

Progesterone vs. Breast Cancer

Pharmaceutical Hormone Substitution

Testosterone for Women and Men

Hypometabolism: Cortisol and Thyroid

Compounding Pharmacies

Practical Issues

HormonesParts of our integrated neuro-endocrine-immune system

Travel via blood to all cells

Control proliferation, differentiation, protein synthesis, metabolic rate, etc.

The most powerful molecules in biology

Optimal levels and effects are essential for health and quality of life

Master Gland

Central Control

TSH

ACTH

LH/FSH

T3, T4

Cortisol, DHEAAldosterone

Estradiol, ProgesteroneTestosterone

Testosterone

Human Steroid Hormones

Testosterone Estradiol

Progesterone Cortisol

DHEA

Drug companies have patented ~5 to 100 variations of each molecule.

Aldosterone

Bioidentical Hormones are not Drugs

Same molecule—functions properly at receptors, normal metabolism/elimination

Non-toxic:No side effects, only effectsNo interactions with drugsNo allergic reactions

Safe in youthful physiological levels/balance

Bad effects if dose is excessive, delivery route is wrong, or lack of balance with other hormones

Bioidentical Hormone Restoration is Good Medical

PracticeIf 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 cortisolWhat do we do about mild-moderate

deficiencies and deficiencies due to aging?

DHEA DHEA-S

J Clin Endocrinol Metab. 1997

Aug;82(8):2396-402

Adrenopause

Endocr Rev. 1995

Dec;16(6):686-715

Thyropause

0

20

40

60

80

100

120

B-19yrs 20-39yrs 40-59yrs 60-79yrs 80-99yrs

TSH

TSH response to low T4 (2.7-3.2g/dL)

Carle, Thyroid. 2007 Feb;17(2):139-44

Growth Hormone (GH) Somatopause

Modified from Jull A et al., J. Clin. Endo. Metab. 1994; 78: 744-752

Steroid Loss in Women>>Men

pg/ml

DHEA-S 5,000,000pg/ml Cortisol 100,000 pg/ml

0

1000

2000

3000

4000

5000

6000

7000

8000

Young Old Young Old

T

P

E

♀ ♀♂ ♂

Men WomenProgestero

neaverage

Testosterone

0-31 pg/mlLess

estrogenthan

old men!(25-55 pg/ml)

AndropauseTestosterone in Men

Common View

The 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 (?)

Fits the Pharmaceutical Agenda: Take drugs for every symptom and disorder caused by hormone loss (!?!)

Against the Common View

Aging is a self-destruct program that kicks in around age 25 in humans

Obesity, high blood pressure, heart attacks, autoimmune diseases, and many cancers increase years after hormone deficiencies set in and occur more often in those with lower hormone levels!

Studies of balanced hormone restoration show the expected benefits and no proof of harm!!

Why Docs Don’t Get It: “Reference Range

Endocrinology”“Normal” ranges are misunderstood:

95% of all persons tested (only 2.5% low)95% of tested persons of same ageOptimal values (glucose, cholesterol)

Docs assume that all ranges are optimals!

Male free testosterone: 35-155 5x!Female free testosterone: 0.0-2.2 !Thyroid - Free T4: 0.6-1.8 3x!AM serum cortisol 5-25 5x!

“Normal”no hormonal dx/rxdrugs

Either

Horm

on

e E

ffect

Hormone Level

0 1 2

95/5 population range

Too Little

Disease

“Everything is Normal”

Too much

DiseaseNo Disease

Reference Range Endocrinology

FT4 ng/dL

Thyroid Hormone Testing

Horm

on

e E

ffect

Hormone Level

0 1 2

Too Little?

Too much?

Intelligent Endocrinology

Optimal??

FT4 ng/dL

80/20 range

80/20 range based on carefully screened young healthy population

Individualized Diagnosis and Treatment

New Paradigm: Restorative

EndocrinologyEndocrine glands and their feedback control systems deteriorate with age.

Our bodies cease to regulate our hormones for optimal health.

Partial hormone deficiencies are harmful.

The restoration of youthful/optimal nutrient and hormone levels is:

Essential to preventative medicine

Essential to the treatment of disease

Essential to our quality of Life!

Not Just “Sex Hormones” Estradiol, progesterone, testosterone and

DHEA are required for the function, growth, and maintenance, of all tissues in both sexes!

Maintain brain function and health—neurosteroids affect mood, cognition, memory, pain, etc.

Maintain the immune system—progesterone and testosterone are mild immunosuppressants

Maintain connective tissue: skin, hair, bone, muscle

Improve insulin sensitivity

Reduce blood pressure—improve endothelial function

Prevent atherosclerosis (plaques in arteries)

Women Killers and Hormones

Cardiovascular disease (CVD), osteoporosis, and breast cancer are all rare before menopause.

All three diseases are clearly related to hormone deficiency or imbalance.

Youthful estradiol/progesterone/testosterone hormonal milieu protects women from these diseases.

Coronary Heart Disease vs. Age

AIHW Heart, stroke and vascular diseases - Australian facts 2004.

Female

Breast Cancer Rate vs. Age

National Cancer Institute. SEER cancer statistics review 1975-2002. Table IV-3.

Menopause

Loss of ovarian functionhigher risk of breast cancer

Ovarian function

Estrogen Replacement Prevents Alzheimer’s

Disease

Zandi PP, et al., Cache County Study. JAMA. 2002 Nov 6;288(17):2123-9.RR 0.46 in Kawas C, The Baltimore Longitudinal Study of Aging. Neurology 1997;48:1517-1521

RR 0.65 Paganini-Hill A, Arch Intern Med 1996;156:2213-2217. RR 0.4, Tang M-X, Lancet 1996;348:429-432.

72% used Premarin only

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

30

Osteoporosis

In menopause 5% bone loss each year for first 5 years=25%—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, 7th Ed.

Osteoporosis Prevention and Treatment A hormone deficiency disease—the proper prevention and treatment is hormone restoration.Estradiol prevents resorption of old bone while testosterone, progesterone, DHEA and GH build new bone. Raisz LG, J Clin Endo Metab. 1996; 81:37-43

Barrett-Connor E, J Reprod Med. 1999 Dec;44(12):1012-20

Hormone restoration increases measured bone density better than bisphosphonates and preserves normal bone remodeling Bisphosphonate drugs cause Ca++, esophageal inflammation and cancer, and suppression of normal bone formationpoor fracture healing, late non-traumatic fractures, and “rotting jaw”.

Female EndocrinologyNature makes special demands on the female body for reproduction.

More complex hormonal system than men

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.

Estradiol—Progesterone Complementarity

Estradiol (human estrogen) promotes breast/uterine proliferation and growth.

Progesterone stops proliferation and promotes maturation and differentiation.

Differentiated cells can’t become cancers.

Progesterone withdrawalsloughing and necrosis of uterine lining and breast duct epithelium. Longacre TA, Am J Surg Pathol. 1986 Jun;10(6):382-93

High progesterone/estradiol ratio suppresses proliferation and prevents cancers

Estradiol is safe if opposed by progesterone.

Progesterone’s Anti-Estrogenic Actions in Uterus

and BreastDecreases synthesis of estradiol receptors

Increases conversion of estradiol to estrone (weak estrogen) by inducing 17β-hydroxysteroid dehydrogenase Type 2

Reduces conversion of estrone to estradiol by inhibiting 17β-HSD Type 1

Increases sulfation (inactivation) of estrogens Williams Text. of Endocrinology, 10th Ed., p. 612

Progesterone Deficiency Estrogen Dominance

AllergiesAutoimmune diseasesAnxiety, irritabilityInsomniaDecreased sex driveDepressionBloating and edemaFibrocystic breastsUterine fibroids

Breast cancerOvarian cancerUterine cancerThyroid dysfunctionGallbladder diseaseHeavy periodsMigrainesSeizuresEndometriosisProgesterone restoration is the only

effective treatment for estrogen dominance

Aging Ovaries

Females born with a fixed no. of oocytes which are continually lost

With aging, fewer oocytes of lower quality are leftreduced estradiol and progesterone production beginning as early as age 30

Lower progesteroneestrogen dominance

No ovulation=no progesterone

Normal Progesterone Dominance

Ovulation

Menstrual Cycle

Ovulation

Perimenopause Luteal Insufficiency=Estrogen Dominance

Menstrual Cycle

Inadequate Luteal Phaseshorter periods, early spotting’d risk of breast cancer

Ovulation

Anovulation=Estrogen Dominance

Menstrual Cycle

’d risk of breast and uterine

cancers

Menopause

Estradiol and Progesterone Deficiency

Menopause=Estradiol Deficiency

Hot flashesIrritability, insomnia, depressionFatigue, aches and painsPoor memory, ’d risk of Alzheimer’s dementiaOsteoporosisspine and hip fractures, loss of teethGenital atrophy, vaginal drynessAtrophy of skin and connective tissueEndothelial dysfunction, blood pressureIncreased blood sugarAtherosclerosis, heart disease

Estradiol RestorationEliminates hot flashes, restores sleepProtects cognitive function, improves moodMaintains thickness, fullness of skin and hairProtects against colon cancer and macular degenerationProtects against dementiaPrevents atherosclerosis, hypertensionMaintains genital/pelvic healthImproves insulin sensitivity—prevents diabetesPrevents osteoporosis and osteoarthritisMaintains gynecoid fat distribution

Q: But won’t estradiol restoration increase the risk of breast cancer?

A: No, not if given with progesterone.

E3N-EPIC Study

E2 plus progesterone decreased risk of breast cancer!

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

Cohort study55,000 women8 years f/uc/w WHI--16,000, 6 yr. f/uTD-E2=transdermal estradiol

See also: De Lignieres B, de Vathaire F, Fournier S, et al. Combined hormone replacement therapy and risk of breast cancer in a French cohort study of 3175 women. Climacteric 2002;5:332–40.

No HRT

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 vs. Breast Cancer in menstruating women

Risk of breast cancer

Progesterone vs. Breast Cancer

Progesterone cream applied to the breast reduces proliferation. Chang KJ, Fertil Steril 1995; 63:785-91

Barrat J, J Gynecol Obstet Biol Reprod (Paris). 1990;19(3):269-74 Foidart JM, Fertil Steril. 1998

May;69(5):963-9

Estradiol is carcinogenic in breast cell cultures unless progesterone is present.

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

Normal breast cells proliferate after E2 treatment, but become quiescent when P is added. Malet C, J Steroid Biochem Mol Biol. 2000 Jun;73(3-4):171-81

Foidart JM, Fertil Steril.1998 May;69(5):963-9

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

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

Progesterone vs. Breast CancerPremenopausal women with low progesterone levels had 5.4x risk of early breast cancer

Cowan LD, Am J Epidem 1981;114:209-17

Breast cancer victims have progesterone resistance Simpson HW, Br J Obstet Gynaecol. 1998 Mar;105(3):345-51

Progesterone decreases proliferation and induces apoptosis in breast cancer cell lines.

Ansquer Y, Anticancer Res. 2005 Jan-Feb;25(1A):243-8 Groshong SD, Mol Endocrinol. 1997 Oct;11(11):1593-607

Progesterone receptor positivity predicts better long-term survival with breast cancer Costa SD, Eur J Cancer. 2002 Jul;38(10):1329-34

Lamy PJ, Breast Cancer Res Treat. 2002 Nov;76(1):65-71

Key: Hormones within the Breasts

Breast fatty tissue produces estradiol locally from adrenal androgens (DHEA, androstenedione)Compared to the premenopausal breast, postmenopausal breast nipple aspirate fluid has:

Same estradiol concentration (youthful serum conc.)Much lower progesterone concentration

Chatterton RT Clin Endocrinol Metab. 2005 Mar;90(3):1686-91

Breasts must get progesterone from blood, and they concentrate it by a factor of 3 to 4x.

Gann PH, Cancer Epidemiol Biomarkers Prev. 2006 Jan;15(1):39-44

In peri-menopause/menopause: No progesterone estrogen dominance in the breastsbreast cancer.

Top European Researchers Agree!

“The hypothesis of progesterone …decreasing the proliferative effect of estradiol in the postmenopausal breast remains highly plausible and should be, until the coming of new evidences, the first choice for symptomatic postmenopausal women.” Modena MG, Sismondi P, Mueck AO, Kuttenn F, Lignieres B, Verhaeghe J, Foidart JM, Caufriez A, Genazzani AR; The TREAT. Maturitas. 2005 Sep 16;52(1):1-10.

So why are most doctors saying that

hormone replacement for menopause is

dangerous?

Pharmaceutical “Hormone Replacement Therapy”

Horse-urine Premarin approved in 1942

Synthesis of first human steroid hormone, progesterone, in 1942. Poorly absorbed orally

Progesterone altered to make “progestins”—among the first drugs to be patented.

“HRT”= alien molecules with hormone effects

Drug Co.s became dependent on HRT profits

1942 to present—Drug Co.s push doctors to use hormone substitutes and to ignore or fear natural hormone restoration!

Conventional HRT is really HST: Hormone Substitution

Therapy! Estradiol substitutes: conjugated equine estrogens (CEE-Premarin) and ethinyl estradiol (in birth control pills)=“estrogen”

Progesterone substitutes: medroxyprogesterone acetate (MPA-Provera) and 30+ other “progestins”

Testosterone substitute: methyltestosterone

Patented drugs—not human hormones!

Most docs don’t know the difference!

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 highly thrombogenicDVTs, pulmonary emboli

EE in Birth Control Pills

Acetylene

Contraceptive Hormone Substitution is DangerousEE with alien progestin, shuts down ovariesLowers testosterone and DHEAS levels’d risk of blood clots, stroke, heart attack1-3x risk of breast cancer’d blood sugar, blood pressureLiver tumors

Diagnose and fix the hormonal disorderUse a copper IUD for contraception!!

UpToDate 2006

Instead of using BCPs::

Premarin

Conjugated Equine Estrogens

Estrone Equilin Equilenin

CEE contains at least 10 estrogens, only 3 are human; also contains horse androgens and

progestins. Klein R The Composition of Premarin.

1998 Int J Fertil 43:223

Human Horse Horse

Oral Estrogen Replacement is Dangerous

First-pass effect on the liverIGF-1, SHBG, CRP, clotting factors blood clots, strokes, heart attacks in the first year

Transdermal estradiol has none of these effects! “Oral but not transdermal estrogen is associated with an increased VTE risk.”

Canonico M, ESTHER study. Circulation. 2007 Feb 20;115(7):840-5

Transdermal estradiol improves insulin sensitivity, oral estrogens do not.

Progestins Progesterone

Progesterone Provera Drospirenone

Progestins are often called “progesterone”, even in scientific papers!

YasminPrempro

Progestin Zoo

Kuhl, Climacteric 2005;8(Suppl 1)

progesterone

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

progestational effects!

Provera Progesterone

• Maintains pregnancy• Improves mood • Improves sleep• Diuretic• No effect on 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

Scientific studies show that:

2002 WHI Study—Menopausal HST is

Dangerous!Premarin alone given to older postmenopausal women had adverse effects in the first year (strokes, blood clots) (as with all oral estrogens)

Adding Provera (Prempro) caused more adverse effects (breast cancers, heart attacks)

Prempro caused a large increase in dementia, probably vascular.

Thousands of lawsuits pending; drug companies running a legal-protection propaganda campaign to paint all “hormones” as equally dangerous!

As Women Choose Bioidenticals: ACOG Caves In to Pharma Pressure

October 31, 2005, ACOG NEWS RELEASE No Scientific Evidence Supporting Effectiveness or Safety of Compounded Bioidentical Hormone Therapy Washington, DC – “hormone therapy does not belong to a class of drugs with an indication for individualized dosing…ACOG recommends that all of them should be considered to have the same safety issues as those hormone products that are approved by the FDA and may also have additional risks unique to the compounding process.”

(So…….No differences exist between any: women, estrogens, progestins, bioidentical and alien molecules, or oral vs. transdermal estrogens. All “hormone” therapies are the SAME! )

ACOG is funded by Pharmaceutical Corporations that make hormone

substitutes.ACOG’s physicians individually receive money from these same Pharm. Corps.

Common Sense

Substitutes are alien molecules!

Problems caused by hormone substitutes cannot be attributed to human hormones until proven otherwise.

Problems caused by oral estrogens don’t apply to transdermal estradiol.

Bioidentical hormone restoration to restore the youthful hormonal milieu must be considered safe until proven otherwise!

Menopausal Hormone Restoration

Daily transdermal estradiol combined with progesterone (sublingual, transdermal, or oral). May stop for 5 days each month.

No need to cycle and bleed—uterine lining remains thin.

No need to stop hormones, ever

Most women need testosterone and DHEA for optimal results.

Menopause:Bioidentical Estradiol

and Progesterone vs.

Hormone Substitutes

Any Questions?

Female AndropauseYoung woman’s free testosterone level is 2x her free estradiol

DHEAS declines with age—main source of androgen effect in women

Female testosterone levels decline 50% between age 20 and 45.

Oral estrogens and birth control pills reduce free testosterone and DHEAS levels

Testosterone for WomenImproves energy and mood

Improves sexual desire and sensation

Increases muscle and tissue strength

With 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

Opposes estradiol-induced breast stimulation and reduces risk of breast cancer

Menopause. 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

Andropause in Men Testosterone levels decline slowly in men—“just getting old.”

Fatigue, reduced mental function

Passivity and moodiness—loss of drive and ambition

Loss of muscle, increased abdominal fat

Increased blood sugar and blood pressure

Loss of libido, spontaneous erections, and eventually erectile function.

Testosterone Restoration for Men

Improves mood and sociability

Restores energy and ambition

Improves cognition, protects against Alzheimer’s disease

Increases libido and sexual performance

Increases muscle and bone mass

Reduces abdominal fat, improves insulin sensitivity, lowers blood pressure--counteracts metabolic syndrome (X)

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

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

Jun;16(6):749-54

Testosterone 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 ProstateLower testosterone levels increase the risk of prostate cancer. Endogenous sex hormones and prostate cancer: a collaborative analysis of 18 prospective studies. J Natl Cancer Inst. 2008 Feb 6;100(3):170-83, also Morgenthaler A, Urology 2006;68:1263-7

Testosterone supplementation does not increase the risk of prostate cancer. Morgentaler A, Testosterone replacement therapy and prostate risks: where's the beef? Can J Urol. 2006 Feb;13 Suppl 1:40-3

Low testosterone associated with more aggressive prostate cancers Slater S, Drugs Aging 2000 Dec;17(6):431-9

Testosterone promotes prostate growth to a point, but does not promote prostate cancer.

Testosterone for Women and Men

Any Questions?

Hypometabolism: Thyroid and Cortisol

InsufficiencyThyroid sets throttle, cortisol delivers the fuel

Our health and quality of life require optimal levels of both hormones!

Deficiencyreduced metabolic ratefatigue, brain dysfunction, depression, pain

Usual blood tests are insensitive

Docs have an irrational fear of cortisol and thyroid supplementation unless a lab is low (L)

Underdiagnosed, undertreated—Docs prescribe pharmaceuticals (SSRIs) instead.

Cortisol

Dexamethasone (70x)

Decadron®

Methylprednisolone (5-6x)

Medrol®

Glucocorticoids (“Steroids”)

Prednisolone (4-5x) Prednisone (4-5x)

Cortisol

Made in the adrenal glands

Maintains blood sugar (delivers the fuel)

Modulates the immune system

We need higher levels with stress, disease

Too muchDiabetes, HTN, osteoporosis

Too littlefatigue, depression, anxiety, autoimmune diseases, hypoglycemia, allergies, aches & pains

Women have lower cortisol levels/effects and much more low-cortisol-related problems than men.

Mild-to-ModerateCortisol Insufficiency

Blood tests are insensitive, need diurnal salivary cortisol profile

Undiagnosed: Docs only taught to recognize Addison’s Disease (total adrenal gland failure)

Common cause of chronic fatigue, pain

Common cause of thyroid hormone intolerance

Clue: Felt better on prednisone, often needs steroids

Normal Saliva Cortisol Profile

Cortisol Deficiency

Cortisol RestorationMild deficiency can resolve with stress, rest, adrenal supplements

Moderate-to-severe deficiency—needs cortisol restoration

Physiological doses of 15-40mg daily do not cause hypertension, osteoporosis, diabetes

Docs’ fear of low-dose cortisol unfounded

See Dr. William Jeffries’ Safe Uses of Cortisol

DHEA—The Other Adrenal Hormone

Most abundant steroid hormone; yet ignored

Cells make testosterone and estradiol with it

Anabolic—builds tissues, improves immunity

Reduces abdominal fat

Reduces pain—restores natural endorphins

Reduces inflammation (IL-6, TNF-, IL-2)

Anti-cancer effect in animal, in vitro studies

Cortisol and DHEA

Any Questions?

HypothyroidismMental fog, poor concentration

Depression

Fatigue, need for excessive sleep

Cold extremities

Aches and pains

Thinning scalp hair

Weight gain

Constipation

Ankle swelling, puffy face

Thyroid TestingDoctors often order only a TSH test--Inadequate.

Thyroid stimulating hormone (TSH) is a pituitary hormone. It is NOT a thyroid hormone.

Docs sometimes measure free T4 but rarely measure free T3 levels!

Need free T4 and free T3 levels

Hypothyroidism present if symptoms exist and one or both hormones are below middle of reference ranges; severe hypothyroidism when both are in lower third of ranges.

We Need Optimal T3 Levels

Incidence of severe atherosclerosis doubled with lower T3 levels within the reference 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-1970s: Treat the patient’s symptoms with T4 and T3 (desiccated porcine thyroid--Armour )

Post-1970s: Treat TSH test using T4 only!

Doctors lowered doses by 30-50%!

TSH-normalizing T4 dose oftenlower free T3 levels, weight gain, persistence of symptoms

Thyroid optimization helps many symptomatic patients with “low- normal” thyroid levels, especially those with fatigue, fibromyalgia, and depression

Rational Thyroid Restoration

If sign/symptoms of hypothyroidism: Restore!

Do not rely on TSH test to diagnose or to guide treatment Fraser WD, Are biochemical tests of thyroid function of any value in monitoring patients receiving thyroxine replacement? Br Med J (Clin Res Ed). 1986 Sep 27;293(6550):808-10

Give T4 plus T3 (Armour, Cytomel+T4)

Increase dose until symptoms are gone or S/S of excess dosing appear

Safe: No bone loss if Vit. D and hormones are restoredNo cardiac abnormalities J Clin Endo Metab. 2000 Jan;85(1):159-64

No muscle wasting Am J Phys Endol Metab. 2005 Jun;288(6):E1067-73

Thyroid Restoration

Any Questions?

Growth HormoneDeclines 14% per decade after age 25IGF-1 of many adults equal to hypopituitary patients (only 80-110 vs. 300 @25yrs.old)Deficiency heart disease, frailty, depression, body fat, bone loss GH restoration for GH-deficient adults:

reduces abdominal fatlowers blood sugar, cholesterol, and BPImproves cognition, mood, sleep, energy, staminaIncreases muscle, decreases fat Improves bone density, skin thickness

Downside: at least $185/mo., daily injections

What Else Can Hormone Restoration Help?

Infertility, PMS, heavy bleeding, endometriosis

Insomnia—almost always

Heart failure, Angina

Mood/Anxiety/Cognitive disorders

Autoimmune diseases (Systemic Lupus Erythematosis, Rheumatoid Arthritis, Ulcerative Colitis, Crohn’s Disease, etc.)

Allergies, skin diseases

Every disease/disorder!!

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

Compounding Pharmacies

USP-certified bioidentical hormones mixed into creams, sublingual tablets, capsules. Inexpensive!Winola Pharmacy—Rt. 307 at Lake Winola, 378-2885

Harrold’s Pharmacy—W-B, 822-5794Fino’s Pharmacy—Dallas, 675-1141Hazle Drugs Apothecary—Hazelton 1-800-439-2026

Controversies

Best delivery methods

Ideal doses

Variations between compounding pharmacies

When/how to measure levels and effects

To cycle or not to cycle estradiol and progesterone

Estriol?

Bioidenticals, especially compounded, not well studied—no money.

Doing HRHistory, consent, contract forms online

Get saliva and blood tests before visit, or Dr. Lindner can order tests at initial visit.

Individualized adjustment, trial and error

Follow-up office visits as needed; at least every 6 months initially, once/year when stable.

Telephone follow-ups as needed. Brief e-mail responses are free.

CostsPhysician time only as required @ $4/min

No Medicare or insurance billing; may submit claim for recognized diagnoses

Hormones—$10 to $80/month from compounding pharmacy, often covered by insurance

Diurnal salivary cortisol test—$138, or insurance

Blood tests—insurance usually covers, or pay for discount labs ~$50 to $300

Out-of-pocket professional fees and prescription hormones are tax-deductible

For More InformationThe Hormone Solution—Stay Younger Longer Thierry Hertoghe, MD

The Miracle of Natural Hormones David Brownstein, MD

How to Achieve Healthy Aging—Look, Live, and Feel Fantastic After 40 Neal Rouzier, MD

Life Extension Foundation (www.lef.org)

Information and hundreds of abstracts at www.hormonerestoration.com.

Contact me: Henry@hormonerestoration.com