http://worldhealth.net/orlando

HORMONAL MODULATIONHORMONAL MODULATION

AND

ANTI-AGING MEDICINE

Dr Odilza Vital M.D.Endocrinologist

Geriatrician

ANTI-AGING MEDICINE IS THE

PRESENT AND FUTURE!

THE ERA OF PREVENTIONTHE ERA OF PREVENTION !

THE HORMONAL MODULATION TO BALANCE

PHYSICAL, MENTAL AND EMMOTIONAL STATUS !

LIFE EXPECTANCY LIFE EXPECTANCY REQUIRES HORMONAL REQUIRES HORMONAL

MODULATION THERAPYMODULATION THERAPY

WHY IS THAT?WHY IS THAT?

QUALITY OF LIFE!

HORMONAL MODULATION =

HORMONAL BALANCE

o HORMONES ACT SYNERGISTICALYo ONE AFFECTS THE OTHERS FUNCTIONo PRODUCTIONo RESPONSE

o CELL RECEPTORS SENSITIVITY

MY EXPERIENCE WITH ANTI-AGING

AND BLUE TENT

MY EXPERIENCE WITH ANTI-AGINGAND

BLUE TENT

WHAT TO DO IN HORMONAL MODULATION?

CORRECTION OF HORMONAL DEFICIENCY

CORRECTION OF HORMONAL OVERPRODUCTION

HORMONAL MODULATION

• AGING PROCESS IS ASSOCIATED WITH DECREASE OF MOST OF HORMONES LIKE: SEXUAL HORMONES, DHEA, HGH, T4? MELATONIN

• AGING PROCESS IS ASSOCIATED WITH INCREASE OF SOME HORMONES LIKE: INSULIN, CORTISOL, PTH

ENDOCRINE SYSTEM… 

BIG ORCHESTRA

HORMONE DEFICIENCY AND OVERPRODUCTION PROMOTE DISEASES ASSOCIATED WITH THE AGING PROCESS

HGHHUMAN GROWTH

HORMONE

HGH STIMULATES PROTEIN SYNTHESIS,

CELL MULTIPLICATION

BENEFITS OF THE USE OF HGH IN ADULTS WITH DEFICIENCY

SUPPORT THE SHARP DECLINE IN THE ELDERLY

20 y

60 y

HGH

THE HGH RESTORES MUSCLE MASS AND STRENGTH OF THE ADULT WITH DEFICIENCY

HGH

IT ACCELERATES THE HEALING OF SURGICAL WOUNDS

AN IMPORTANT ROLE IN THE IMMUNE SYSTEM

USED TO PREVENT AND REVERSE CACHEXIA IN HIV PATIENTS

HGHHGHo SECRETION IN PULSES SECRETION IN PULSES

o THE HGH IS A SINGLE CHAIN OF 191 THE HGH IS A SINGLE CHAIN OF 191 AMINO ACIDS 75%AMINO ACIDS 75%

o 22 KD PROTEIN, 20 KD22 KD PROTEIN, 20 KD

o NO GLYCOGENNO GLYCOGEN

o HAS TWO BRIDGES S = SHAS TWO BRIDGES S = S

HGH VALUES RANGE FROM UNDETECTABLE TO

40MCG/DL

THE SECRETION IS AFFECTED BY FOOD

DECREASED IN HYPERGLYCEMIA

INCREASED BY AMINO ACIDS AND HYPOGLYCEMIA

FACTORS THAT INCREASE SECRETION OF HGH

• SOMATOTROPIN: GH-RH(HYPOTHALAMUS)

• HYPOGLYCEMIA

• AMINO ACIDS

• ACUTE STRESS

FACTORS THAT REDUCE THE SECRETION OF HGH 

• IGFs= SOMATOMEDIN C (NEGATIVE FEED-BACK)

• HYPERGLYCEMIA

• CHRONIC STRESS

• AGING PROCESS

HGHHGH

• HOW TO EVALUATE HGH DEFICIENCY IN AGING PROCESS?

IGFsInsulin Growth Factor-s

(Mediate HGH action)

HGH

• IGF SMALL MOLECULE PRODUCED BY MOST TISSUES, ESPECIALLY LIVER

• FREE : IGF

• LINKED TO PROTEIN: IGF-BP 1,2,3,4,5

HGH• THE IGF-1 MEDIATE THE

PHYSIOLOGICAL ACTIONS OF HGH

• THE IGF-BPs MODULATE THE ACTIONS OF IGFs IN THE TARGET CELLS

• IGF-BPs CHANGE BIOAVAILABILITY OF IGFs TO THE TISSUES

DIAGNOSIS HGH DEFICIENCY

IGFs: SECRETION REFLECTS THE OVERALL PRODUCTION IN THE LAST 24 HOURS

USED IN ADULTS WITH DEFICIENCY

DIAGNOSIS

IN PATHOLOGICAL DEFICIENCY - DYNAMIC TEST IN CHILDREN ONLY: CLONIDINE, INSULIN, L-DOPA, PROPANOLOL, GLUCAGON :

TEST : HGH

IN AGING PROCESS : TEST :IGFs

ADMINISTRATION : PARENTERAL

THE FIRST EVIDENCE OF BENEFICIAL USE OF HGH IN ADULTS WITH DEFICIENCY

1962

HGH

KEY FEATURES OF THE SYNDROME OF GH

DEFICIENCY IN ADULTS

SYMPTOMS

LOSS OF PSYCHOLOGICAL WELL-BEING REDUCED VITALITY AND ENERGY DECREASED PHYSICAL ACTIVITY DEPRESSED MOOD EMOTIONAL LABILITY ANXIETY DISORDERS OF SEXUAL FUNCTION SOCIAL ISOLATION 

SIGNSSIGNS

CHANGES IN BODY COMPOSITION REDUCTION OF LEAN BODY MASS INCREASED FAT INCREASED VISCERAL FAT REDUCTION OF BODY WATER REDUCTION OF BONE DENSITY

SIGNSSIGNS

DECREASED MUSCLE STRENGTH

DECREASED ABILITY TO EXERCISE

INCREASED BODY MASS INDEX (BMI)

INCREASED WAIST / HIP RATIO

ABNORMAL LIPID PROFILEABNORMAL LIPID PROFILE  

INCREASE IN TOTAL CHOLESTEROL

INCREASED LDL

REDUCTION OF HDL

INCREASED RISK OF CVDINCREASED RISK OF CVD

• INCREASED PAI-1 (PLASMINOGEN ACTIVATION INHIBITOR)

• INCREASED OF FIBRINOGEN

HGH DOSES

BY THE BODY WEIGHT ?

CURRENT CONCEPTSCURRENT CONCEPTS

THE GROWTH HORMONE RESEARCH SOCIETY SUGGESTS:

INCREASING DOSES OF GH, NOT BASED ON WEIGHT 

DOSESDOSES

PATIENTS SHOULD START TREATMENT

WITH LOW DOSES (0.15 TO 0.3 MG / DAY

OR 0.45 TO 0.9 IU / DAY);  (RARELY EXCEEDS 1 MG / DAY: 3 IU /

DAY)

MONITORING THE DOSE GRADUALLY ACCORDING TO CLINICAL AND BIOCHEMICAL RESPONSES

WOMEN REQUIRE HIGHER DOSES, THE

ELDERLY REQUIRE LOWER DOSES

THE ADMINISTRATION SHOULD BE DAILY, AT NIGHT,

SUBCUTANEOUSLY.

CONTRAINDICATIONS FOR USE OF HGH: 

• NON COMPENSATED DIABETES MELLITUS

• HEART FAILURE

• SMOKING

• MALIGNANT TUMORS OF ANY ORIGIN

IN ACTIVITY

DIABETES;HYPERTENSION;CARDIOVASCULAR DISEASE; IATROGENIC ACROMEGALY;

CANCER???

SIDE EFFFECTS OF GH ABUSE

FEMALE SEXUAL FEMALE SEXUAL HORMONESHORMONES 

CLIMACTERIC SYNDROMECLIMACTERIC SYNDROME

PRE-MENOPAUSEPRE-MENOPAUSE HORMONAL CHANGES : LOSS OF CYCLE

2nd phase

CLINICAL MANIFESTATIONS

SIGNS AND SYMPTOMS

LABORATORY : LOW PROGESTERONE

MENOPAUSEMENOPAUSE

DEFINITION: AMENORRHEA HORMONAL CHANGES CLINICAL MANIFESTATIONS SIGNS AND SYMPTOMS LABORATORY

EFFECTS OF FEMALE EFFECTS OF FEMALE SEXUAL HORMONESSEXUAL HORMONES

• ESTROGENS ARE PRODUCED IN FOLICULAR CELL: STIMULATES CELL PROLIFERATION

• PROGESTERONE IS PRODUCED BY CORPUS LUTEUM: MATURE CELLS STIMULATED BY ESTROGENS

TESTOSTERONE

LIBIDO BONE DENSITY MUSCLE STRENGTH MOOD

ENDOMETRIAL HYPERPLASIA EXACERBATION OF PMS MENSTRUAL IRREGULARITIES BREAST CANCER?

CLINICAL CHANGES OF CLINICAL CHANGES OF PROGESTERONE PROGESTERONE

DEFICIENCYDEFICIENCY 

CHANGES OF CLINICAL CHANGES OF CLINICAL ESTROGEN DEFICIENCY ESTROGEN DEFICIENCY 

• VASOMOTOR SYMPTOMS• BONE LOSS• ATHEROSCLEROSIS AND CVD• INSOMNIA• EMOTIONAL LABILITY• UROGENITAL ATROPHY• DEMENTIA

• DECREASED LIBIDO;

• REDUCTION OF MUSCLE MASS;

• BONE LOSS;

• DEPRESSION?

CLINICAL CHANGES OF TESTOSTERONE

DEFICIENCY 

HORMONAL MODULATION AND HRT SHOUD BE DONE WITH

BIO – IDENTICAL HORMONESSAME CHEMICAL STRUTURE OF BODY PRODUCTION

ESTRADIOL

ESTRONE

ESTRIOL•TESTOSTERONE

PROGESTERONE

DIFFERENT SCHEMES FOR DIFFERENT SCHEMES FOR REPLACEMENT AT REPLACEMENT AT

DIFFERENT AGESDIFFERENT AGES AND AND DIFFERENT PURPOSESDIFFERENT PURPOSES

CLIMATERIC SYNDROME

• USE OF PROGESTERONE: 12 -14 DAYs FROM 14º DAY

• 300 MG AT BEDTIME

CYCLICAL SCHEDULECYCLICAL SCHEDULEPOST-MENOPAUSEPOST-MENOPAUSE  

1º 27º

1º 27º

15º 27º

TESTOSTERONE

ESTROGEN

PROGESTERONE

M

DOSESDOSES

• ORAL 2mg estradiol

2mg estriol

27 to 28 days

• PROGESTERONE 300mg progesterone

12 to 14 days

ONGOING SCHEMESONGOING SCHEMES POS-MENOPAUSE

E2 + E3 ( 0,5 to 2 mg/day ) + P4 ( 50 to 200mg/day )27 d/m

Testosterone (0.25 to 1mg/day ) 27 d/m

ROUTES OF ADMINISTRATION

* ORAL

*TRANSDERMSAL

*INTRAVAGINAL

COMPLETE CLINICAL EXAMINATION

LABORATORY:

COMPLETE BLOOD COUNT GLUCOSE LIPID PROFILE LIVER ENZYMES URIC ACID UREA CREATININE

EVALUATION FOR HORMONE REPLACEMENT 

ESTRADIOL PROGESTERONE TESTOSTERONE PROLACTIN DHEA IGF1 CORTISOL TSH

EVALUATION IN FEMALE HORMONE REPLACEMENT 

• PAP SMEAR

• MAMMOGRAM

• BREAST ULTRASOUND

• TRANSVAGINAL ULTRASOUND

• BONE DENSITOMETRY

EVALUATION IN FEMALE HORMONE REPLACEMENT 

IN MY 20 Y EXPERIENCE: HORMONE REPLACEMENT

THERAPY WITH BIO-IDENTICAL HORMONES DOES NOT INDUCE

BREAST CANCER 

CANCER 

• GENETICS

• LIFESTYLE: SMOKING, SEDENTARY, STRESS, ALCOHOL, PSYCHOTROPIC DRUGS, INADEQUATE DIET

• IRRADIATION

• REPLACEMENT WITH SYNTHETIC HORMONES

ANDROPAUSEANDROPAUSE

MALE MENOPAUSEMALE MENOPAUSE  

- DECREASED PRODUCTION OF DECREASED PRODUCTION OF TESTOSTERONETESTOSTERONE

- REDUCTION OF LEYDIG CELLS- REDUCTION OF LEYDIG CELLS

ANDROPAUSEANDROPAUSE

THE TERM IS NOT RECOGNIZED THE TERM IS NOT RECOGNIZED BY THE W H OBY THE W H O

ANDROPAUSEANDROPAUSE

ANDROPAUSAANDROPAUSAJama 1944 – Heller e Meyers:

- LOW TESTOSTERONE LEVELS WITH

VARIOUS SYMPTOMS

- LOSS OF LIBIDO- ERECTILE DYSFUNCTION- NERVOUSNESS- DEPRESSION- IMPAIRMENT OF MEMORY- INABILITY TO CONCENTRATE- FATIGUE- INSOMNIA

- HOT FLASHES AND SWEATING

ANDROPAUSEANDROPAUSE

PATHOLOGY?

 ASSOCIATED WITH DEGENERATIVE DISEASES: OSTEOPOROSIS,

ALZHEIMER'S, DIABETES, CANCER,

CARDIOVASCULAR DISEASE

ANDROPAUSEANDROPAUSE

FACTORS THAT INTERFERE: STRESSALCOHOL ABUSESURGERIES: VASECTOMYMEDICATIONSSMOKINGOBESITYOTHER DISEASES

ANDROPAUSEANDROPAUSE

        

INSIDIOUS ONSET

30% OF MEN OVER 60 YEARS, REDUCED LEVELS OF

TESTOSTERONE

ANDROPAUSE

ANDROPAUSEANDROPAUSE

THE SPERMATOGENESIS REMAINS NORMAL DESPITE THE HORMONAL

DEFICIENCY

ANDROPAUSEEVALUATION FOR MALE HORMONE

REPLACEMENT 

CLINICAL: FULL CLINICAL EXAMINATION DIGITAL RECTAL EXAM ASSESSMENT OF EMOTIONAL STATE LIBIDO ASSESSMENT OF SEXUAL

PERFORMANCE 

LABORATORY:• BLOOD CELLS COUNTING

• GLUCOSE • LIPID PROFILE • LIVER ENZYMES • URIC ACID • UREA • CREATININE 

• PSA

ANDROPAUSEEVALUATION FOR MALE HORMONE

REPLACEMENT

ESTRADIOL TOTAL AND FREE TESTOSTERONE SHBG  PROLACTIN DHEA IGF1 CORTISOL, TSH PROSTATE ULTRASOUND BONE DENSITOMETRY 

ANDROPAUSEEVALUATION TO MALE

HORMONE REPLACEMENT

ANDROPAUSE

TREATMENT:

TESTOSTERONE REPLACEMENT

CORRECTION FACTORS THAT INTERFERE WITH THE ACTION OF THE HORMONE

LABORATORY CRITERIA FOR TESTOSTERONE REPLACEMENT IN MEN 

Levels below 300 to 400 ng / dl; 

ANDROPAUSETESTOSTERONE

TESTOSTERONE REPLECEMENT

INCREASE BONE MASS INCREASE MUSCLE MASS AND STRENGHT REVERSE INSOMNIA REDUCES DEPRESSION RECOVER FATIGUE STIMULATES IMMUNE SYSTEM PREVENT OSTEOPOROSIS

ANDROPAUSETESTOSTERONE

DOSES AND ADMINISTRATION 

• TESTOSTERONE BIO - IDENTICAL PER CUTANEOUS: GEL 75 TO 200 MG /2ML DOSE: 1ML 2 X DAY

• TESTOSTERONE MICRONIZED SUB-LINGUAL TABLETS 50 TO 150 MG 2X OR 4X / DAY

• INTRA - MUSCULAR INJECTIONS 200 MG /ML ONCE A WEEK

ANDROPAUSE

BENIGN PROSTATIC HYPERPLASIA

ASSOCIATION OF TESTOSTERONE WITH FINASTERIDE.

ANDROPAUSEIN MY EXPERIENCE OVER 12 YEARS: TESTOSTERONE DOES NOT INDUCE

PROSTATE CANCER

DHEADHEA(dehidroepiandrosterona)

DHEA DHEA : ADRENAL HORMONE

 

DHEA DHEA DEHIDROEPIANDROSTERONEDEHIDROEPIANDROSTERONE

IN 1933 DHEA WAS ISOLATED IN THE URINE IN 1944 MUSON AND COL. ISOLATED THE

WHOLE DHEA-S IN 1960 EMILE BAULIEU SHOWED DHEA-S IS

PRODUCED IN ADRENAL GLANDS

DHEA

DHEA IS A STEROID HORMONE PRODUCED IN GREATER QUANTITY IN YOUNGER INDIVIDUALS

ESSENTIALLY ANABOLIC PROTEIN

PRECURSOR OF ALL STEROID HORMONES: CORTISOL, TESTOSTERONE, ESTRADIOL,

PROGESTERONE AND MINERALOCORTICOIDS

DHEA WHY SUPPLEMENT WITH DHEA? POPULATION AGING IS ASSOCIATED WITH

CHRONIC DEGENERATIVE DISEASES THE SHARP REDUCTION OF THIS STEROID

HORMONE IN OLD AGE THE MODULATING EFFECT OF DHEA IN HYPER

CORTISOL IN THE ELDERLY 

DHEA

DHEA LEVELS START TO DECREASE AROUND 30 YEARS

DHEA DHEA LEVELS ARE 10 TO 25% LOWER IN

WOMEN; 

LEVELS IN WOMEN DECREASE WITH AGE IN PARALLEL WITH MEN;

 AFTER 80 YEARS OLD PRODUCTION IS JUST 25% OF THE YOUNG ADULT LEVELS;

DHEA

MINIMUM ACCEPTABLE LEVELS ARE:

5NG/DL IN MEN 4NG/DL IN WOMEN 

DHEA

CONTROL OF THE LEVELS OF DHEA 

DHEA AND DHEA-S ARE UNDER CONTROL OF ACTH

VARIATION AND CIRCADIAN RHYTHM ARE PARALLEL TO CORTISOL

DHEA BIOLOGICAL EFFECTS OF DHEA ON

CARDIOVASCULAR DISEASE

LOW LEVELS OF DHEA INCREASE THE INCIDENCE OF MYOCARDIAL INFARCTION AND ALSO THE FORMATION OF THROMBI

DHEA REDUCES THE FORMATION OF ATHEROMA PLAQUES  

DHEA

THE IMMUNE SYSTEMTHE IMMUNE SYSTEM   DHEA ENHANCES THE IMMUNE SYSTEM BOTH

IN ANIMALS AND HUMANS 

REDUCTION OF INFECTIOUS AND DEGENERATIVE DISEASES 

CLINICAL STUDIES YEN AND RASMUSSEN SHOWED THAT 50 MG OF DHEA FOR 20 WEEKS INCREASED MONOCYTES AND T LYMPHOCYTES  (USED BEFORE VACCINES)

DHEA

EFFECTS ON THE NERVOUS SYSTEM AND EFFECTS ON THE NERVOUS SYSTEM AND HUMOR HUMOR 

ADMINISTRATION OF DHEA PROMOTES ADMINISTRATION OF DHEA PROMOTES BENEFITS IN COGNITION AND MOOD BENEFITS IN COGNITION AND MOOD DISORDERSDISORDERS  

DHEAADMINISTRATION ADMINISTRATION 

o IN WOMEN: 25 TO 50 MG IN THE IN WOMEN: 25 TO 50 MG IN THE MORNING;MORNING;

o THE MEN: 50 TO 75 MG IN THE THE MEN: 50 TO 75 MG IN THE MORNING.MORNING.

DHEA

CONTRAINDICATIONSCONTRAINDICATIONS

o   GYNECOLOGICAL CANCERS;GYNECOLOGICAL CANCERS;

o PROSTATE CANCER. PROSTATE CANCER. 

CORTISOL

CORTISOL

AFFECTED BY ACUTE AND CHRONIC STRESS

FOLLOW THE OPPOSITE COURSE OF DHEA

INCREASE IN AGING PROCESS IN ADRENOPAUSE: LOW ( ADDISON

SYNDROME)

CORTISOL

• PROTEIN CATABOLIC

• ATHEROGENIC 

• DIABETOGENIC 

• DECREASES IMMUNE SYSTEM

• HYPERTENSIVE

• INDUCES OBESITY 

CORTISOL• HOW TO HANDLE HIGH CORTISOL?• STRESS MANAGEMENT• EXERCISES• DIET• DHEA SUPPLEMENTATION

- INTERFERES IN CORTISOL RECEPTOR

- COUNTER ACTS CATABOLIC EFFECTS

OF CORTISOL

INSULIN• INCREASED IN AGING PROCESS

• INDUCES HYPOGLICEMIA

• INSULINE RESISTANCE

• OBESITY

• HYPERTENTION

• CARDIOVASCULAR DISEASES

• CANCER

INSULIN• HOW TO HANDLE HIGH INSULIN ?

• LOW CARBOHYDRATE DIET

• WEIGHT LOSS

• EXERCISE

• STRESS MANAGEMENT

• METFORMIM

PTH

• INCREASE PROMOTING BONE LOSS• DUE TO VIT D DEFFICIENCY• INDOORS• NUTRITION• SEDENTARISM• ALCOHOL• DECREASE OF ANABOLIC HORMONES• OTHER DISEASES

WHO TO HANDLE HIGH PTH?

• CALCIUM SUPPLEMENTATION

• VIT D

• DIET

• EXERCISES

• ANABOLIC HORMONES TO

• CALCITONIN

 ANCIENT MOLECULE 

FOUND IN THE FLAGELLA

  PRODUCED THROUGHOUT THE ANIMAL

KINGDOM

MELATONIN

MELATONIN

DISCOVERY 40 YEARS AGO

 PRODUCED IN THE PINEAL GLAND OF MAMMALS

MELATONIN

KEEPS CIRCADIAN RHYTHM PATTERN OF SLEEP- WAKEFULNESS  HIGHLY LIPOPHILIC AND LOW

MOLECULAR WEIGHT ANTIOXIDANT RADICAL (OH)

HORMONAL MODULATIONHORMONAL MODULATION

INCENTIVES FOR THE PRODUCTIONINCENTIVES FOR THE PRODUCTION  

1) PHOTORECEPTORS AND OSCILLATORS (LIGHT) 

2) NEUROENDOCRINE AND HORMONAL EFFECTORS

HORMONAL MODULATIONHORMONAL MODULATION

MELATONIN IN THE PROCESS OF MELATONIN IN THE PROCESS OF AGING AGING   

IN AGING THERE IS A DECLINE IN BODILY FUNCTIONS

REDUCTION OF ADAPTATION PROCESS REDUCTION IN CAPACITY TO RESTORE

HOMEOSTASIS

HORMONAL MODULATIONHORMONAL MODULATION

STATEMENT OF REPLACEMENT OF STATEMENT OF REPLACEMENT OF MELATONIN MELATONIN 

INSOMNIA ....... DIFFICULTY FALLING ASLEEP IN JAT LAG

ON THE HORMONAL MODULATION

HORMONAL MODULATIONHORMONAL MODULATION

  DOSES AND ADMINISTRATION DOSES AND ADMINISTRATION 

INDIVIDUALS OVER 45 DOSES OF 0.5 MG TO 5 MG SUBLINGUAL, TIME RELEASE

INDIVIDUALS OVER 65 YEARS AT 5 TO 10 MG AT BEDTIME

THANK YOU

www.odilzavital.comodilzavital@hotmail.com

HORMONAL MODULATIONHORMONAL MODULATION BIBLIOGRAPHY

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