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Bioidentical Hormone Restoration Best Medical Practice

Bioidentical Hormone Restoration Best Medical Practice. This presentation is available online. Hormones. Neuro-endocrine-immune system Travel via blood to tissues Control cells’ metabolism, functions The most powerful molecules in biology Optimal levels Essential for Health

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Bioidentical Hormone Restoration Best Medical Practice

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  1. Bioidentical Hormone RestorationBest Medical Practice This presentation is available online.

  2. Hormones • Neuro-endocrine-immune system • Travel via blood to tissues • Control cells’ metabolism, functions • Themostpowerfulmolecules in biology • Optimal levels Essential for Health • Bioidentical:Same molecular structure as our natural hormones

  3. CRH, TRH, etc. control pituitary GH, FSH, LH, TSH, and ACTH control other glands T4, T3 Cortisol, DHEA, Aldosterone, Pregnenolone Insulin Adrenalin Estradiol, Progesterone Testosterone Testosterone

  4. Bioidentical Hormones are NOTDrugs • No side effects, interactions, or reactions • Non-toxic, inherently safe • Properfitin receptors,easily eliminated • Blood levels can be monitored • Restore health vs. modify disease • The only potential problems: • Excessive dose • Lack of balance with other hormones • Unphysiological delivery: route, timing, etc.

  5. Hormone Ignorance:The Tyranny of the Lab Report • Reference Range=95%of the population • Neither a normal nor an optimalrange! • Disease/No Disease instead of Continuum • Male free testosterone: 35-1555x! • Female testosterone: 2-4522x! • Free T4: 0.6-1.83x! • AM serum cortisol: 5-255x! • Within RR: No diagnosis; pharmaceuticals • Below RR (<97.5%): replace to within-RR

  6. Hypometabolism—Thyroid and Cortisol Insufficiencies • Thyroid sets throttle (metabolic rate) • Cortisol delivers the fuel (glucose) • Optimal levels of both are required for health • Even mild deficienciesreduced cellular metabolismfatigue, brain dysfunction, depression, pain, and disease • Usual lab tests and ranges (TSH, AM cortisol) are insensitive • Underdiagnosis, Undertreatment

  7. Mild-to-Moderate Cortisol Insufficiency • Partial Secondary Insufficiency: brain (H-P) fails to maintain levels • Fatigue, depression, pain, allergies, inflammation, hypoglycemia, low blood pressure, nausea, insomnia • Clue:Prednisone improves mood, energy • Diagnosis: saliva testing reveals free cortisol levels 4 times during the day

  8. Normal Saliva Cortisol Profile

  9. Common Dysfunctional Pattern

  10. Cortisol Insufficiency

  11. Addison’s Disease

  12. Cortisol Restoration • Mild insufficiency—improves with stress, rest, and nutrients • Moderate-to-severe insufficiency—requires cortisol restoration • Low physiological doses are safe • 40 years’ experience: see Dr. Jeffries’ Safe Uses of Cortisol

  13. Thyroid Insufficiency • Mental fogginess • Fatigue, depression, anxiety • Cold extremities, low body temperature • Aches and pains • Thinning hair, dry skin • Weight gain • Constipation • Puffy ankles and face • Elevated cholesterol

  14. Continuum: Higher Thyroid Hormone Levels within the RRs: • Reduced risk of severe atherosclerosis by50%Clin Cardiol. 2003 Dec;26(12):569-73 • Lower cardiac risk factors: cholesterol, triglycerides, C-reactive protein, homocysteine and lipoprotein(a) • Lower blood pressure, dilates arteries • Reduced tendency to form blood clots • Relieve depression • Reduced weight, increased weight loss

  15. The Increase in Fatigue, Fibromyalgia,and Depression • Pre-1970s: Dessicated thyroid extract: T2, T3 and T4dosed to eliminate symptoms • Post-1970s: T4-only to “normalize” TSH • TSH: Patient’s doses lowered by 30-50% • TSH “normalizing” T4doselow free T3, persistence of symptoms, weight gain • Symptomatic persons with within-RR labs often improve with T3/T4optimization

  16. Cortisol and Thyroid Optimization Any Questions?

  17. The Big Controversy What do we do about hormones lost to normal aging?

  18. DHEA—The Most Abundant Steroid Hormone In our Bodies • Precursor of testosterone and estradiol • Lower levels assoc. with risk of death, disease • Anabolic—builds tissues, improves immunity • Reducespain by increasing endorphins • Anti-inflammatory—approved forSLE • Improves immune system function • Anti-atherosclerotic—may prevent heart disease • Reduces platelet aggregation Ann N Y Acad Sci. 1995 Dec 29;774:281-90 • Anti-cancer effects in animal studies

  19. Adrenopause DHEA-S Levels with Age

  20. Somatopause Growth Hormone (GH) Clinical Chemistry48, No. 12, 2002

  21. Thyropause Free T3 Endocr Rev. 1995 Dec;16(6):686-715

  22. Male Andropause—Testosterone Baltimore Longitudinal Study of Aging (BLSA). Harman et al., 2001

  23. Andropause vs. Menopause Men Women Testosterone Progesterone average pg/ml Estradiol ♂ ♀ ♀ ♂ DHEA-S 5,000,000pg/ml Cortisol 100,000 pg/ml!

  24. Conventional View of Aging • The loss of hormones is adaptive • Higher levels cause heart attacks, cancers of the breast and prostate • Fits Pharmaceutical Agenda: Don’t restore hormone levels: Takedrugs for all problems caused by loss of hormones.

  25. Gonadal Steroids:Not Just “Sex Hormones” • Estradiol, Progesterone, Testosterone • Essential to all tissues in both sexes! • Brain—Improve function, protect against Alzheimer’s Dz. • Immune System • Heart and blood vessel health • Blood lipids, clotting • Connective tissues—skin, muscle, bone

  26. Menopause: Estradiol Deficiency • Hot flashes • Fatigue, aches and pains • Dry eyes and vagina, genital atrophy • Loss of libido • BP,  LDL cholesterol, heart disease • Atrophy of skin and bone (osteoporosis) • Poor memory, depression, insomnia • ’d risk of Alzheimer’s Disease

  27. Estrogen Replacement PreventsAlzheimer’s Disease Zandi PP, et al., Cache County Study. JAMA. 2002 Nov 6;288(17):2123-9.

  28. Women Killers • Cardiovascular disease (CVD), breast cancer and osteoporosis are rare in premenopausalwomen • They begin in perimenopause when progesterone and testosterone levels arelower. • After menopause (loss of estradiol) osteoporosis accelerates and CVD rises faster than in men • Higher risk of CVD than men after 65 • Higher mortality after 70 • Surgical menopause  2-7x risk of heart attacks Engl J Med 1987 Apr 30;316(18):1105-10 Am J Obstet Gynecol. 1981 Jan;139(1):47-51.

  29. Menopause and Cardiovascular Disease

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

  31. Osteoporosis • In menopause 5% of bone mass is lost each year for first 5 years=25% • 50% of women >65 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.

  32. Male Andropause:“Just Gettin’ Old” • Testosterone levels declineslowly • Fatigue, passivity and moodiness • Reduced mental function • Loss of muscle and bone mass;  fat • Loss of libido and spontaneous morning erections • BP,  blood sugar, heart disease, Alzheimer’s Disease, autoimmune dz.

  33. Hormone Loss with Aging is BAD for Us • Aging is an auto-destruct program. • Starts around age 25! • Glands and control systemsdeteriorate •  weight, BP, diabetes, heart attacks, autoimmune diseases, osteoporosis, etc. • Occur years afterhormonelosses begin • Occur moreoften in those with lower levels • Hormonerestorationhelps prevent these diseases, and does not cause disease.

  34. Hormones and Aging Any Questions? Coming up: Male and Female Hormone Replacement

  35. Testosterone is Man’s Best Friend • Improves mood and sociability • Improves energy • Improves cognition, protects against Alzheimer’s diseaseNeurology. 2004 Jan 27;62(2):188-93 • Improves libido and erectile function • Increases muscle and bone mass • Reduces abdominal fat, improves insulin sensitivity, lowers blood pressure--counteracts metabolic syndrome X

  36. Testosterone is Good for your Heart • Lowtestosterone levels associated with coronary artery disease and strokeArterioscler 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 • T dilates coronary arteries • T improves endothelial function • T increases heart muscle size, strength • Tdecreases fibrinogen levels—prevents blood clotsEndocr Res. 2005;31(4):335-44

  37. Testosterone Does Not Cause Prostate Cancer • Testosterone promotes prostate growth to a point. • Castration slows prostate cancergrowth temporarily. • Higher T levels don’t increase risk of prostate cancer. • Testosterone restoration does not increase the risk of prostate cancer. • LowT levels associated with more aggressiveprostate cancers.

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

  39. Testosterone For Men Any Questions? Coming up: Estradiol, Progesterone, and Testosterone for Women

  40. Female Endocrinology:Balance in a Complex System • Reproduction makes special demands on the female body • Breasts, uterus and ovaries undergo a monthly cycle of proliferation and breakdown • No similar process in males • Defects in this cycle can lead to cancers andother medical disorders.

  41. Estrogen—Progesterone Complementarity in Women • Estrogenpromotes tissue proliferation and growth which can lead to cancer • Progesterone inactivates estrogen, stopsproliferationand promotes differentiation • Differentiated cells can’t become cancers • High average progesterone/estrogen ratio prevents breast, uterine cancers

  42. Normal Cycle and Balance Ovulation Menstrual Cycle

  43. Perimenopause Luteal Insufficiency=Estrogen Dominance Inadequate Luteal Phase shorter periods, early spotting Ovulation Menstrual Cycle

  44. Perimenopause Anovulation with Estrogen Dominance High estrogen, low progesterone ’d risk of cancer Menstrual Cycle

  45. Menopause Estrogen and Progesterone Deficiency

  46. Allergies Autoimmune disease 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/painful menses Migraines Seizures Endometriosis Estrogen Dominance: Progesterone Deficiency

  47. Estradiol for Menopause • Eliminates hot flashes • Eliminates dryness of eyes and vagina • Improves memory and mental function • Maintains skin, bones • Reduces risk of heart disease • Reduces risk of Alzheimer’s disease • Reduces blood sugar, blood pressure • Improves energy, reduces aches

  48. Testosterone for Women • Female testosterone levels decline 50% between age 20 and 45. Menopause. 2003 Sep-Oct;10(5):390-8 • Improves energy, mood • Improves libido, sexual sensation • Increases muscle strength, stamina • Increases bone density J Reprod Med. 1999 Dec;44(12):1012-20 • Probably decreases risk of heart attack Womens Health. 1998 Sep;7(7):825-9

  49. Osteoporosis • A hormone deficiency disease (including Vit.D) • Estradiolreduces resorption of old bone • Testosterone, progesterone, DHEA, and GHbuildnew boneJ Clin Endo Metab. 1996; 81:37-43 J Reprod Med. 1999 Dec;44(12):1012-20 • Combined hormone restorationincreases bone density muchbetter than Fosamax and preserves normalboneremodeling

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