1. Conquer DIABETES with Gender-Specific Bio-Identical TESTOSTERONE
Edward Lichten, M.D.
FACS, FACOG, FABAAM
American Academy of
Anti-Aging Medicine
December 14-15, 2007

2. The Worst Diabetic Male
If you were faced with
The Worst Diabetic Male
50 years old, dark skinned man on insulin
No regular source of work, food, healthcare
Junk food and history of homelessness
Confused and disoriented
What Would You Do?

3. What Would You Do? Send him to the hospital?
Refer him to an endocrinologist, who handle 75% of all diabetics?
Treat him?
Even if you were a Board Certified Gynecologist?

4. Hemoglobin A1c= 18: Uncontrolled Diabetic
Anthony

5. There is a new way of thinking about staying healthy..
And it is called
“Anti-Aging” Medicine
“Ageless” 75 year old Mary won the Alcatraz swim by going directly across San Francisco Bay

6. Ten Years Ago the Future of Anti-Aging Medicine was
Using Bio-Identical Hormones that identically match the hormones produced in the body
Sustained release
T4 and T3 thyroid
DHEA
Pregnenolone

7. Ten Years Ago the Future of Anti-Aging Medicine was
Using Gender-Specific Hormones
Estradiol and Estriol for women
Progesterone for women
Testosterone for women
Testosterone for men
Because a man and a woman are different, their body respond differently. Medical therapy must be based on matching their innate ratio of natural sex hormones.
And that was good and the A4M increased in members

8. Bio-Identical Hormones
Because of the Ground Breaking Exposure to B-HRT from the A4M and the Life Extension Foundation
There is a Greater Awareness that Staying Healthy can be assisted by Replacing and Maintaining, these Natural,
Bio-Identical
Hormones
But we must remember 1991:
A4M LOFTY GOALS: “Anti-Aging medicine seeks to identify the root cause of one’s symptoms...We age because our hormones decline, our hormones don’t decline because we age.” Michael Galitzer, M.D.

9. The problem with Anti-Aging Medicine
Is that our Antidotal Reports
do not have a
Scientific Methodology:
Therefore, our detractors say we are ‘snake-oil’ salesmen

10. And why not? Our products—vs– their products
Compounded thyroid
Estradiol topical cream
Progesterone micronized
Testosterone cream
Armour thyroid
Estrasorb©
Prometrium© capsule
Androgel©
Not much different!

11. Scientifically,
Hypothalamus
Pineal
Pituitary
There are 6 Endocrine Glands in the human body that release biologic hormones
Thyroid
Adrenal
Pancreas
Ovaries-Testes

12. When in Balance 12 MAJOR HORMONES
Calciferol
When in Balance
Growth Hormone
Thyroxin & T3
12 MAJOR HORMONES
Released by these six endocrine glands
work together,
‘Exciting’ your body to
Energy and Health
DHEA & Cortisol
Insulin & Glucagon
Testosterone
Estradiol &
Progesterone

13. for age-related diseases
In Suzanne Somer’s book it is
Suggested that proper replacement of bio-identical hormones holds great promise in the future in slowing the aging process, and as a
Treatment
for age-related diseases

14. When you have a Disease like Diabetes
no Balance,
No Energy,
And Inadequate levels of
Bio-identical Hormones

15. When you have Diabetes
This imbalance
may shorten life expectancy 10 years and be the cause of multiple end-organ failures

16. 21st Century Diabetic Epidemic
With twice as many MORE still to be diagnosed!

17. The Future of Anti-Aging Medicine is here!
Treating Diabetes
With
Bio-identical
Testosterone In Men

18. Diabetes Mellitus
Today, we will re-teach the physiology of diabetes. Diabetes Mellitus is the leading cause of morbidity, mortality and 80% of non-cancer medical office visits: it is the primary cause of
heart disease
high blood pressure
Cholesterol elevation
cerebral vascular stokes and
obesity.

19. Diabetes Mellitus What do we really know about
1. The cause of diabetes?
2. The diagnostic tests for diabetes?
3. Best medication to control diabetes?
4. The mechanism of action of the medications available for diabetes?
5. The future for treating diabetes?

20. The Definition of Diabetes Mellitus
The Webster’s Deluxe Unabridged Dictionary Second Edition defines diabetes mellitus as:
Diabetes mellitus is a chronic form of disease characterized by excess of sugar in the blood and urine, hunger, thirst, and gradual loss of weight: also called sugar diabetes.
Wikipedia incorporates a more scientific description
Diabetes mellitus is a disorder of carbohydrate metabolism. It is a disease characterized by persistent hyperglycemia (high blood sugar levels). It is a metabolic disease that requires medical diagnosis, treatment and lifestyle changes.
Medical Practice
The presence of abnormally elevated glycogenated hemoglobin is diagnostic of diabetes mellitus
The World Publishing Company- William Collins Publishers, Inc. 1979

21. The Cause of Diabetes Mellitus:
The ancient Egyptians, Chinese, Macedonians (Hippocrates) and Romans (Aretaeus of Cappadocian) recognized this disease to be one of excessive urine (polyuria), leading to wasting and death. Today, we scientifically characterize this disease by its specific anomaly of carbohydrate metabolism
Type I: Inability to make insulin
Type II: Resistance to the insulin made

22. The Cause of Diabetes Mellitus:
Type I: Insulin Deficiency
characterized by
Destruction of the pancreatic islet cells by some infection or autoimmune reaction
Typically occurring in a child or adolescent
Type II: Resistance to the Action of Insulin
Resistance to insulin at the cellular level with the initial excessive insulin production being unable to clear glucose from the blood stream
Pre-Diabetes: Metabolic Syndrome is a pre-diabetic condition with excessive insulin production effectively keeping the glycogenated hemoglobin in normal range.

23. What are the Diagnostic Tests for Diabetes Mellitus?
Screening tests
Urine: presence of glucose
Blood: elevated glucose level
Diagnostic tests
Blood: elevated fasting serum glucose
Insulin: elevated fasting insulin level
Red Cell: elevated glycogenated hemoglobin measured directly or as Hemoglobin A1c
Comprehensive testing
Glucose Tolerance Test with Insulin levels

24. Glucose Tolerance Test with Insulin Levels
Fact- 1: GTT-I needed to classify type of diabetes
Glucose Tolerance Test with Insulin Levels
The GTT shows the dynamic response of glucose being cleared from the blood after the stress of a glucose load.
GTT-I was described by Kraft in 1976; any glucose >145 or insulin >50 is strongly suggestive of obesity and/or the metabolic syndrome.
Glucose Levels
RL Kraft, M.D. Chairman, Dept. Of Pathology, St. Joseph’s Hospital, Chicago, Ill. In Radio-assay: Clinical Concepts. Proceedings from a Symposium On Radioimmunoassay Held in Washington, DC January 28-29, 1974;

25. The Glucose Tolerance Test with Insulin Levels
The GTT-I shows the dynamic response of insulin in presence of the stress of a glucose load.
Normal 4 fold increase at first hour; 50% drop at 2hr
Type II diabetes is a progressive disease characterized by increasing demands for insulin.
Normal Insulin Levels
Hollenbeck C, Reaven GM. Variations in Insulin-Stimulated Glucose
Uptake in Healthy Individuals with Normal Glucose Tolerance. JCEM 1987;64:

26. Type-I and Type-II late AODM lack an insulin dynamic response
Fact-2: Type I and Type II late have inadequate, flat insulins < 70
Type-I and Type-II late AODM lack an insulin dynamic response
Type I: SumI <70
Normal: SumI
Type II-late SumI <70
Type II-early SumI >130

27. The Standard of Care protocol for treating diabetes mellitus is
Based on the hospital approved Evidence Based Protocols
The Standard of Care protocol for treating diabetes mellitus is
Type I: add subcutaneous insulin
Type II: add oral hypoglycemic agents, insulin- sensitizers and newer oral and injectable agents
Type II-late: add insulin injections if all else fails
With the goal is to control hyperglycemia

28. But since Type I and Type II late are practically identical!
Type I diabetes
Normal screened group
Obese, aging population
Type II diabetes
Early
Late
GTT-I: no Insulin changes
GTT-I: normal or metabolic syndrome based on normal
GTT-I: hyperglycemia and higher insulin release
GTT-I: No or poor insulin response
Why would you treat Type-I or Type-II late differently?!

29. Scientific Method: Lab Tests must dictate treatment
Fact-3: Hypoglycemic agents are not indicated for Type I or late Type II
Scientific Method: Lab Tests must dictate treatment
Scientific Methodology
1. Cannot treat NIDDM without a GTT-I
2. Type I and Type II-late are virtually identical
3. Stop oral hypoglycemic agents Type I & II late.
4. Ask “why would a U.S. Doctor start oral agents to temporarily treat hyperglycemia while accelerating the transition from Type II early to Type II late?” Especially when we now know that better bio-identical treatments exist?

30. The Failure of Evidence Based Medicine
American physicians have been taught to treat
by protocol the diseases like heart, diabetes, obesity and high blood pressure.
DIABETES MELLITUS GIVES US A CHANCE TO THROW AWAY THE PROTOCOLS AND TREAT THE ‘CAUSE’.

31. But You Already Know the Cause and Treatments? Right?!
Type I is an autoimmune disease that destroys the Beta islet cells that produce insulin. Treat with insulin.
Type II is caused by insulin resistance. Treat with oral hypoglycemic agents.

32. NORMAL PHYSIOLOGY is Facilitated Transport Promotes glucose storage
CELL
Only in the presence of INSULIN is GLUCOSE taken into the cell.
GLUCOSE (Sugar Bag)
INSULIN (Big Cheese)

33. Is the Cause of Poor Type I diabetic control unavailability of physician supervised Insulin?No

34. Type I Diabetes Mellitus Treatment: Injectable Insulin
FACT: Ideal control of Diabetes, “lowest possible Hemoglobin-A1c” is the single, most important predictor of a long-life and freedom from complications. M Rizzo, ADA
FACT: Adding insulin alone brought less than 40% of volunteers to HgB-A1c of 8.1-2
Mathew Riddle, M.D. Letter to the Editor: JAMA. 1997; 297(19): 1523.
Hayward RA. Maning WG, Kaplan SH, Wagner EH. Greenfield S. Starting insulin therapy in patients with type 2 diabetes: effectiveness, complications and resource utilization. JAMA 1997; 278:
3. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. New England J Medicine 11993;

35. Insulin Therapy is Not Enough for Type I Diabetics!
UNDERSTANDING
the Role of
Testosterone Therapy for Men with Insulin Requiring Diabetes Mellitus

36. Oral Therapy is Not Enough for Type II Diabetics!
UNDERSTANDING the Role of
Testosterone Therapy for Men with Non-Insulin Requiring Diabetes Mellitus

37. “All Diabetic Men are Testosterone Deficient!”
Fact-4: A4M attendees heard it first!
“All Diabetic Men are Testosterone Deficient!”
A4M: Lichten keynote speaker
JAMA: 2006 Ding EL. Harvard Medical group
“Higher levels of testosterone are protective”
A4M: Lichten: Add-back testosterone
JAMA: 2006 Ding: Higher bio-testosterone
Cross-sectional studies indicated that testosterone level was significantly lower in men with type 2 diabetes ....Similarly, prospective studies showed that men with higher testosterone levels (range, ng/dL) had a 42% lower risk of type 2 diabetes
Eric L. Ding, BA; Y. Song MD et al. Sex Differences of Endogenous Sex Hormones and Risk of Type 2 Diabetes. JAMA. 206; 295:

38. Physiology of Diabetes- Cells Need Energy as well as Insulin
Fact-5: Need energy
Why Testosterone?
Physiology of Diabetes- Cells Need Energy as well as Insulin
Glucose must be cleared from the blood stream to minimize AGEs, accumulated glycogen end-products, that ‘clog’ the cell.
Energy is needed for facilitative transportation to move glucose across the cell membrane.
The ATP Cycle that produces Energy is activated by bio-available sex hormones.
In the male, the key bio-available sex hormone is TESTOSTERONE.
Low levels of testosterone predict death. Shores MM. Low Serum Testosterone and mortality in male veterans. Arch Inter. Med 2006 Aug 14; 166(15): After adjusting for age, medical morbidity, and other clinical covariates, low testosterone levels continued to be associated with increased mortality (hazard ratio, 1.88; 95% CI, ; P<.001)

39. There are two keys to opening the cell wall to transport glucose
Fact-6: Two keys to cell wall dynamics: insulin and testosterone in men
There are two keys to opening the cell wall to transport glucose
INSULIN: discovered by Banting and Best in 1922
2. Sex Hormone Binding-Sex Hormone ligand discovered in 1955 but not recognized for its role in glucose transport until today

40. Understanding SHBG
Sex Hormone Binding Globulin (SHBG) when bound to the sex hormone of TESTOSTERONE or ESTRADIOL is the ligand that affixes to and changes the 3-dimensional cellular wall characteristics to facilitate entry of not only hormones but glucose and nutrients.

41. ADD-BACK BIO-IDENTICAL TESTOSTERONE
Examples of better glycemic control in Type I diabetics “Since Harvard now agrees with the A4M’s lecturer Dr. Lichten that all diabetic men are testosterone deficient”
First, and Foremost
ADD-BACK BIO-IDENTICAL TESTOSTERONE
To all diabetic men

42. Insulin Dependent Diabetes Mellitus Testosterone IM Reduces Insulin Requirements
72 yo. White male in year Testosterone reduced hyperglycemia and almost all of the 40 units/day of insulin required in 2 months!
T-2 protocol: Testosterone injections 100mg IM twice a week.
Gangrene unresolved- amputation necessary.
Insulin Use in case of Gangrene

43. Insulin Dependent Diabetes Mellitus Testosterone IM Improved Glycemic Control
A.M. 50 year old Black Male presented on 16units/insulin/day
HgB-A1c >18%
Glucose fasting: 488mg/ml
T1-protocol: increased insulin while starting add-back Testosterone weekly IM
20 weeks later:
HgB-A1c = 7.4%
Glucose fasting: 47 mg/ml in AM asymptomatic

44. Insulin Dependent Diabetic Men
Fact-7: Testosterone improves glycemic control in IDDM men
Insulin Dependent Diabetic Men
12 IDDM patients have completed Testopel© for first 3 months, then none.
All individuals required 80+ units of insulin per day and were able to reduce their insulin required by HALF!
All maintained or improved their glycemic control
After three month wash-out their need for insulin returned to baseline.
Insulin units/day vs. months
IRB Study 907 –96 Providence Hospital, Southfield, MI

45. The Key to Tight Glycemic Control is that men on Testosterone rarely experience HYPOGLYCEMIC Crash!
Hypoglycemia and impending coma in brittle, insulin-requiring diabetics is the reason doctors err on keeping the blood sugar high.
Testosterone allows tighter control by preventing symptomatic hypoglycemia and coma.
488
359
268
185 99 47

46. The Key to IDDM Control is that Testosterone Prevents Hypoglycemia
Fact-8: Testosterone prevents hypoglycemia
The Key to IDDM Control is that Testosterone Prevents Hypoglycemia
Stored Tissue Glycogen
Testosterone  ATP Energy Cycle
Glucagon
Insulin
Blood Stream Glucose
As effectively as Testosterone improves clearance of glucose from the blood stream, it reconverts glycogen to glucose preventing hypoglycemia.

47. Protecting Men Diabetics from Hypoglycemia
Is Unique to Testosterone
Makes addition of Testosterone MANDATORY for OPTIMAL DIABETIC CONTROL!!
This may well be one of the most important healthcare discovery in the last 100 years!

48. How Do We Now Treat Insulin Requiring Diabetic Men?
Fact-9: Only Injectables are Effective
How Do We Now Treat Insulin Requiring Diabetic Men?
Insulin and injected Testosterone
The reason we do not use the Androgel© or compounded bio-creams or the Androderm© patch is that (1) absorption from the skin is poor in older individuals and (2) the skin aromatizes testosterone to estrogen, negating the positive effect of testosterone replacement.
K.S. Nair MD PhD et al. DHEA in Elderly Women and DHEA or Testosterone in Elderly Men. NEJM. 2006; 355: “Serum levels of testosterone increased only 20% of expected based on FDA submitted data”

49. How Do We Now Treat Insulin Requiring Diabetic Men?
Testosterone Enanthate $ 25/mo
Deca-Durabolin $ 50/mo
Testopel© $100/mo
NO! Androgel©or Testoderm© $330/mo
EXCEPTIONS: All need CBC, comprehensive, lipids, PSA and prostate examination before starting testosterone replacement.
EXCEPTIONS: Prostate or testicular cancer cases or Prostate Specific Antigen greater than 2.5 needs urologist’s clearance.

50. Insulin Requiring Diabetic Men (Type I and Type II late)
Conclusion: Type I and II-late need testosterone and insulin
Insulin Requiring Diabetic Men
(Type I and Type II late)
Need Testosterone to improve their glycemic control and reduce their requirements for insulin.
What about Type II diabetic men?

51. Adult Onset Diabetes Mellitus: has the same complications as Type I
Hyperglycemia and Hyperinsulinemia precede
DIABETES:
OBESITY
HEART DISEASE
RETINOPATHY
GANGRENE and
Shortened life expectancy by up to 10 years!

52. Adult Onset Diabetic Men need Testosterone!!
Before and 1-year after testosterone replacement:
year
Abnormal GTT-I
Low Testosterone
Normal GTT-I ‘Normalized’ Testosterone

53. Non-insulin Dependent Diabetes Testosterone Improves Hyperglycemia
Fact-4: All Diabetic Men are Testosterone Deficient
Fact-10: All NIDDM, Diabetic men may benefit from Testosterone
Non-insulin Dependent Diabetes Testosterone Improves Hyperglycemia
Discontinues 20mg of micronase and lowers fasting glucose on T-2 protocol with twice weekly testosterone injections

54. Testosterone improves Hemoglobin A1c
Fact-11: Testosterone improves glycemic control with/out weight loss
Testosterone improves Hemoglobin A1c
Without meds, change in diet, exercise, or weight loss, DB was able to drop his HgBA1c from 11 to 6.5 in 4 months without oral agents. 11 10 9 8 7
Hemoglobin A1c !!
JULY AUG SEPT OCT 2001

55. Screen Everyone for Diabetes and pre-diabetes (metabolic syndrome)
Fact-12: Screen everyone for diabetes with fasting glucose, HgB-A1c, lipids-- and for men, bio-available testosterone
Screen Everyone for Diabetes and pre-diabetes (metabolic syndrome)
Fasting:
Glucose normal < 105 mg/dl
Insulin normal < 10 uIU/ml
Hemoglobin A1c normal < percent
Triglycerides normal < 130 mg/dl
Testosterone:
Total Testosterone normal > 450 ng/dl
Sex Hormone Binding normal < 15 nmol/L
Estradiol normal < 25 pg/ml

56. Perform the GTT-Insulin Test: with hourly insulin levels
CR 66 year old AA male with HgB-A1c=9.0
GTT- abnormal
Sum Insulin = 62
Testopel© protocol
effective.
Based on GTT-I, he might need insulin in the future, but not now since the testosterone has sensitized his cells to insulin and increased his ATP energy.
Glucose

57. Add-Back Testosterone and follow the improved HgB-A1c
Hemoglobin A1c 9 8 7 6
July Aug Sept Oct Nov 2006
Same 66 year old dentist. Treatment with Testopel© every month resulted in normalization to HgB-A1c of 6.0 in 12 weeks. Testosterone therapy appropriate even in presence of minor cerebral vascular accident before T.

58. U.K. Treats Diabetic Men with IM Testosterone
Statistical findings
Reduce insulin resistance
Reduced insulin required
Reduced fasting glucose
Reduced HgB-A1c
Reduced waist measure
Reduced total cholesterol
10 men on insulin pre-study
14 men not on insulin
D. Kapoor in 2006 published double-blind cross-over study confirming that “testosterone replacement therapy reduces insulin resistance and improves glycaemic control in hypo-gonadal men with type 2 diabetes.”
Kapoor D, Goodwin E, Channer KS, Jones TH.  Testosterone replacement therapy improves insulin resistance, glycaemic control, visceral adiposity and hypercholesterolaemia in hypogonadal men with type 2 diabetes. Eur J Endocrinol, 154(6):   2006

59. Adult Onset Diabetes Mellitus:
When treating a 35+ years old male, with sexual complaints or medical conditions…
Demand a measurement of Bio-available Testosterone!
Because Testosterone affects every cell in a man’s body
Brain: libido, mood
Muscle/ Bone: strength
Liver: synthesis proteins
Sex Organs: penile growth, reproduction

60. Measurement of Bio-Available Testosterone
Serum Testosterone Levels
Total Testosterone
Free Testosterone FAI=
Sex Hormone binding globulin
Free Androgen Index (FAI)
Ratio of Testosterone/SHBG
Ideal: 0.7 to 1.0
__[Testosterone total]__
30x [SHBG]

61. Diabetic Men are Testosterone Deficient
Diabetic Men are Testosterone Deficient! (also Obese, Heart, Lipid, Hypertensive)
The Europeans measure ‘unbound’ testosterone as the FREE ANDROGEN INDEX [TT]/[SHBG]
Normal: Ratio greater than .7
Male
Normal
Metabolic Syndrome
Total Testosterone
450 ng/dl
250 ng/dl
Sex Hormone BG
15 nmol/L
50 nmol/L
Free Androgen Index
>
0.1 to 0.4

62. It is bad practice to treat the symptom
Avoid treating Type II-early diabetes with oral agents (sulfonylureas, insulin sensitizers)
It is bad practice to treat the symptom
(of hyperglycemia) while ignoring the scientific proof that these ‘protocol’ medications may accelerate destruction of the pancreatic islet cells…

63. FACTS to REMEMBER 1: GTT-I needed to classify type of diabetes
2: Type I (autoimmune) and Type II late (burn out) are similar: insulin requiring
3: Oral hypoglycemic agents are rarely indicated
4: All diabetic men are testosterone deficient
5: Glucose movement takes energy: energy takes testosterone
6: Insulin and Sex Hormone+SHBG ligand are keys to cell wall permeability
7: Testosterone improves glycemia for IDDM: Insulin dependent diabetic men
8: Testosterone may help prevent hypoglycemia, crisis and coma
9: Only Injectable forms of Testosterone are Effective for Diabetes
10: All NIDDM men may benefit from Testosterone
11: Testosterone may improve glycemic control with or without weight loss
12: Screen everyone for diabetes with fasting glucose, HgB-A1c, lipids --and for men, testosterone measurements

64. Putting it all together
INSULIN is still involved in facilitated (glucose) transport but transport takes ENERGY!
TESTOSTERONE is the source of ATP energy from the Kreb’s (citric acid) cycle that facilitates the action of insulin!
Testosterone
INSULIN & GLUCOSE

65. Hippocratic Oath: Above all, physician, Do No Harm!
Practicing the Standard Medical Treatment Protocols for Adult Diabetic Men
Ignores the appropriate treatment of one scientifically recognized cause of Diabetes in men: testosterone deficiency
Exposes the patients to unnecessary drugs, side-effects and expense. The annual cost of diabetic outpatient medications are
$30 billion

66. Health Care is in Flux
Paradigm Shift from ‘prescription Pharma’ to prevention is being fueled by 50 million paying ‘baby-boomers’ who are taking an active role in maintaining and improving their physical and mental health. This is called “Anti-Aging!”
Exercise and diet
Vitamins and supplements
Reading, researching and exploring new and alternative medical avenues for prevention.

67. We have learned today that Gender-Specific hormones are the key to living well
“I don’t buy the Pharma story” “I’ll do what is best for me!”
Nutrition, exercise, avoid toxic smoke, food and environments..
But most importantly
Take Bio-Identical Hormones!

68. Pharma is flooding U.S. with more useless Diabetic Drugs
FDA approving drugs of questionable value
Byetta© : gila monster saliva at $600/month
Rezulin© : Removed from market causing deaths $300/mo and now Avandia© leaving Actos© against dissenters
Pharmaceutical Companies continue to bring to market unproven and barely helpful ‘wonder drugs’
Novartis: Astra-Zenica Bristol-Myers Squibb
Merck: Pfizer: a new insulin nose spray
No New Cures or Breakthroughs expected from Stem Cell Research for diabetes

69. Testosterone Alone End of the Pharmaceutical Stranglehold on
So we are offering our patients FDA approved injected testosterone at a cost of $15 per month and, an ‘entirely new concept’ that
Testosterone Alone
may herald in the
End of the Pharmaceutical
Stranglehold on
Diabetic and Medical Practice

70. Are you an Evidence Based ‘protocol’ puppet of Big Pharma?
Writing for oral agents for ‘burned out’ diabetics?
Micronase©, Gliberide©
Glipizide©, Glucotrol©
Amaryl©, Starlyx ©
Writing for expensive and ineffective insulin- sensitizing agents?
Thiazolidinediones
Actos
Rezolin© and Avandia©
removed by FDA
Incretin mimics
Amylin and Lilly -Byetta ©
Gliptins
Merck - Januvia©
Novartis - Glavus© (on hold)
PPAR gamma insulin sensitizers
AstraZeneca; tesaglitazar ©
Bristo-Myers Squibb -muraglitazar ©
Inhaled insulin
Pfizer© -Exubera©

71. Or a U.S. DOCTOR who puts his patients’ first?
Endocrine Today: October 2006
American Association of Diabetic Educators, Donna Rice MBA, RN, CDE president
Diabetes Education:
Screen, test, treat: low testosterone and diabetes
Men with diabetes have a 2x greater risk of having total testosterone less than 300 ng/dl.

72. You need to decide
Testosterone Injections and Pellets can be dispensed in your office practice
Along with better medical care

73. TESTOSTERONE is the key to life for men…period.
Testosterone has been studied and used since 1939; before there was an F.D.A.
Higher levels of testosterone are associated with living longer and is
truly, “Anti-aging” medicine

74. For you and your patients,
If you learn only one thing today, remember
You, Doctors, are the Masters of Medicine Staying Healthy and Treating Disease is by keeping us all Anabolic! Say Yes to Testosterone!
For you and your patients,

75. The purpose of science is not to cure us of our sense of mystery
The purpose of science is not to cure us of our sense of mystery... but to constantly reinvent and reinvigorate it.
Robert M Sapolsky, M.D., professor of biology and neurosciences, Stanford University and author of The Trouble with Testosterone. Simon and Schuster. NY

76. So Become the Anti-Aging Doctor of the future
Be the doctor that knows the science behind the causes of diabetes
Be the doctor in your area with the knowledge to truly treat the disease, naturally
Be the doctor that shows your patients they can discontinue the synthetic, Pharmaceutical expensive oral agents and reduce their insulin and have less complications and feel better and have better sex!

77. The Future of Medicine
Is in your hands

78. Edward M. Lichten, M.D., FACS, FACOG
I hope I have done that for you today.
Edward M. Lichten, M.D., FACS, FACOG
WEBSITE:
Office: (248)
Lichten Wellness Center
180 East Brown Street
Birmingham, MI 48009
For copies of this lecture or study course,

80. Insulin Resistance predicts Age- Related Disease including Cancer
Metabolic Syndrome (Increased Fasting Insulin, Exaggerated Insulin Response, or Reduced Insulin Response to glucose load) predicts Heart Disease, Obesity, Dyslipidemia, Hypertension, and Diabetes
GM Reaven MD shocked the medical establishment by following 208 apparently healthy men and women for 4 to 11 years. Those in the upper 1/3 of steady-state plasma glucose (or area under 2hr-OGTT insulin curve) had 28 of 40 clinical events including cancers. Middle 1/3 had 12. Lower 1/3 had none!
FS Facchini, GM Reaven. Insulin Resistance as a Predictor of Age-Related Diseases. Journal Clinical Endocrinology Metab 2001:86;

81. Hypothesis: Add Back Testosterone is Anti-Aging
Men who are testosterone deficient by FAI will live longer and better because they will have less METABOLIC SYNDROME
Measured as lower fasting insulin, normalized GTT-I are associated with reduced risk factors: obesity, heart disease, hyperlipidemia and hypertension

82. Wow!

83. Personal and Medical Experience
My own andropause at 45 trigger my interest and I knew that without finding that natural treatment, I would not have been here with you today! 50