Bioidentical Hormone Restoration Best Medical Practice

1. Bioidentical Hormone RestorationBest Medical Practice Henry@hormonerestoration.com

2. 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

4. Hormones and Aging Why Doctors Don’t Get It

5. 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?

6. Pregnenolone—Mother Steroid J Clin Endocrinol Metab. 1997 Aug;82(8):2396-402.

7. DHEA  DHEA-S J Clin Endocrinol Metab. 1997 Aug;82(8):2396-402.

8. Somatopause Growth Hormone (GH) Normal Adults Pituitary Disease Sufficiency fatigue Log scale J Clin Endocrinol Metab. 1999 Jun;84(6):2013-9.

9. TestosteroneProgesteroneEstradiol Andropause Menopause pg/ml ♂ ♀ ♀ ♂ DHEA–10,000 pg/ml, DHEA-S 5,000,000 pg/ml !

10. Hormonal Changes With Aging • Hormones that build tissues and improve immunity declinewith age by 50-80% (DHEA, Testosterone, GH) • Progesteronestarts to decline at age 30. • Estradioldisappears at 50—menopause • Thyroid hormone production and sensitivity decline • Insulin output declinesDiabetes • By age 50—20 years of hormonal deficiency

11. Conventional View of Hormones and Aging • 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 • Losing our hormones is good for us(?!) • Fits the Pharmaceutical Agenda:Takedrugs for every symptom and disorder caused by hormone loss!

12. Against the Conventional View • Aging is a self-destruct programthat kicks in at age 25in humans • Aging 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!!

13. Example: Growth Hormone • Declines 14% per decade after age 25 • IGF-1 of many adults equal to hypopituitary patients (only 80-110 vs. 350 @25yrs.old) • Deficiency heart disease, frailty, depression, body fat, bone loss • GH restoration reduces abdominal fat, lowers blood sugar and blood pressure • Improves cognition, mood, sleep, energy • Increases muscle, decreases fat & cholesterol • Improves bone density, skin thickness • Downside: high cost, nightly injections

14. The Endocrinology of Aging • Endocrine glands and their feedback control systems deteriorate with age • Our bodies cease to regulate our hormones for optimal health • Hormonelossesspeed our general deterioration: a vicious cycle. • The symptoms of hormone loss are warning signs of physical deterioration • Win-Win: Hormone restoration makes you feel better and improves your health!

15. Since the Loss of Hormones is Harmful,THEN… Restoring youthful hormone levels is: • essentialpreventative medicine • essential to the treatmentof disease • essential to Quality of Life! We have the need and the rightto restore hormones lost to aging!

16. Hormones and Aging Any Questions?

17. Human Steroid Hormones Estradiol Testosterone DHEA Progesterone Cortisol

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

19. Not Just “Sex Hormones” • Estrogen, progesterone, testosteroneandDHEAessential to cellular growth and function in all tissues in both sexes! • Maintainbrain function—modulators of mood, cognition, pain, etc. • Maintain the immune system—progesterone and testosteroneare immunosuppressants • Maintainconnective tissue: skin, hair, bone, muscle, and blood vessels

20. Female Endocrinology • Nature 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.

21. Estrogen—Progesterone Complementarity • Estrogenpromotes breast/uterine tissue proliferation and growth • Progesterone stops proliferationand promotes maturation and differentiation • Differentiated cells can’t become cancer cells • High average progesterone/estrogen ratio suppresses proliferation and prevents cancers of female organs

22. 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 Deficiency Estrogen Dominance Progesterone and Iodine/Kelp reduce estrogen dominance

23. Historical Perspective • Throughout most of human history, women were usually: • Pregnant—high progesterone • Breastfeeding—low estrogen (bothprotect against breast cancer) • Women cycled for 4 years avg.; today many cycle for 35 years • Cycling=riskof estrogen dominance and other hormonal disorders

24. Perimenopause • Females born with a fixed no. of oocytes which are continually lost to age and ovulation • With aging, fewer oocytes of lower quality are leftreduced progesterone production beginning around age 30estrogen dominance • No ovulation=noprogesterone • Estrogen swings from very high to very low—often for several years.

25. Normal Progesterone Dominance Ovulation Menstrual Cycle

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

27. Perimenopause Anovulation=Estrogen Dominance Menstrual Cycle

28. Menopause Estrogen and Progesterone Deficiency

29. Also Uterine and Ovarian Cancer

30. Menopause • Estrogen Deficiency • Progesterone Deficiency • Testosterone Deficiency After menopause, women depend upon their adrenal glands for androgens and estrogens, so: Menopause +Adrenal Insufficiency = BIGTROUBLE

31. Effects of Combined Sex-Hormone Deficiency • Irritability, insomnia, brain dysfunction • Alzheimer’s dementia • Fatigue, aches and pains. • Osteoporosisfractures, loss of teeth • Genital atrophy, vaginal dryness • Atrophy of skin and connective tissue • Heart disease—higher risk than men after 65, higher mortality after 70!

32. Estradiol Restoration • Eliminates hot flashes • Restores mood and mental function • Probably protects against Alzheimer’s disease • Maintains genital/vaginal skin and lubrication • Increases thickness, fullness of skin and hair • Prevents heart disease • Prevents colon cancer and macular degeneration • Improves insulin sensitivity—helps diabetes • Prevents osteoporosis and osteoarthritis

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

34. Osteoporosis • In 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 bone • 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.

35. Osteoporosis • A hormone deficiency disease—the proper treatment is hormone restoration! • Estrogen prevents resorption of old bone while testosterone, progesterone, DHEA and GH build new bone J 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++).

36. Estrogen, Progesterone, and Osteoporosis Any Questions?

37. Total and Free Testosterone in Men Baltimore Longitudinal Study of Aging (BLSA). Harman et al., 2001

38. Andropause in Men • Testosterone levels declineslowlyin men—”Just getting old.” • Fatigue, reduced mental function • Passivity and moodiness—loss of drive and ambition • Loss of muscle mass, increased abdominal fat • Lastly: loss of libido, no morning erections • Increased risk of heart and prostate disease • Increased risk of Alzheimer’s dementia • Increased risk of autoimmune diseases

39. Testosterone Restoration • Improves 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

40. Testosterone and the Heart • Lowtestosterone 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 • T dilates coronary arteries—improves angina • T increases heart muscle size, strength • T decreases fibrinogen levels—prevents blood clots Endocr Res. 2005;31(4):335-44.

41. Testosterone and the Prostate • Higher 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! • Lowtestosterone correlated with more aggressive prostate cancers • Testosterone promotes prostate growth to a point, but not prostate cancer

42. 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.

43. Estrogen Dominance Theory of Prostate Disease • In many men, free testosterone declines > estradiol • Estrogen dominance is a probable cause of prostrate enlargement and a possible cause of prostate cancer • Elevated estrogen/Test. ratios in BPHScandinavian Journal of Urology and Nephrology, 1995; 29: 65-68. • High levels of estradiol and estrone found in BPH tissues • Estradiolupregulates oncogenes

44. Female Andropause • Young woman’s free testosterone level in serum is 2x her free estradiol • Female testosterone levels decline 50% between age 20 and 45 • Birth control pillstestosterone and DHEA levels • DHEAdeclines with age—main source of androgens in women

45. Testosterone for Women • Improves energy, mood • Improves sexual desire and response • Increases muscle strength and reduces muscle and joint aches • With estradiol, increases bone density J 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 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.

46. Testosterone Any Questions?

47. “My doctor says that hormone replacement is dangerous and there’s no evidence that bioidentical hormones are safer!”

48. 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.

49. Problems with Pharmaceuticals • Alien molecules: not recognized, not easily eliminated • Negative functions:disrupt normal physiology by blocking receptors, inhibiting enzymes, etc. • Toxic: • Sideeffects even at low doses • Allergic reactions • Long-term damage

50. Pharmaceutical Billions • Mission:Sell pharmaceuticals • Informationcontrol—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