1. Bioidentical Hormone Restoration Best Medical Practice
This presentation available online

2. 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

3. Hormones Parts 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

4. Estradiol, Progesterone
Central Control
Master Gland
TSH
T3, T4
ACTH
Cortisol, DHEA
Aldosterone
LH/FSH
Estradiol, Progesterone
Testosterone
Testosterone

5. Human Steroid Hormones
Testosterone
Estradiol
DHEA
Progesterone
Aldosterone
Cortisol
Drug companies have patented ~5 to 100 variations of each molecule.

6. Bioidentical Hormones are not Drugs
Same molecule—functions properly at receptors, normal metabolism/elimination
Non-toxic:
No side effects, only effects
No interactions with drugs
No 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

7. Bioidentical Hormone Restoration is Good Medical Practice
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
What do we do about mild-moderate deficiencies and deficiencies due to aging?

8. Adrenopause DHEA  DHEA-S
J Clin Endocrinol Metab Aug;82(8):

9. Thyropause TSH response to low T4 (2.7-3.2g/dL)
Endocr Rev Dec;16(6):
TSH response to low T4 ( g/dL)
Carle, Thyroid Feb;17(2):139-44

10. Somatopause Growth Hormone (GH)
Modified from Jull A et al., J. Clin. Endo. Metab. 1994; 78:

11. Steroid Loss in Women>>Men
Men Women
Testosterone
Progesterone
average
pg/ml
0-31 pg/ml
Less
estrogen
than
old men!
(25-55 pg/ml) ♂ ♂ ♀ ♀
DHEA-S 5,000,000pg/ml Cortisol 100,000 pg/ml

12. Andropause
Testosterone in Men

13. 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 (!?!)

14. 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!!

15. 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 age
Optimal values (glucose, cholesterol)
Docs assume that all ranges are optimals!
Male free testosterone: x!
Female free testosterone: !
Thyroid - Free T4: x!
AM serum cortisol x!
“Normal”no hormonal dx/rxdrugs
Either

16. Reference Range Endocrinology
Thyroid Hormone Testing
95/5 population range
Hormone Effect
Too Little
Disease
“Everything is Normal”
Too much
Disease
No Disease 1 2
FT4 ng/dL
Hormone Level

17. Intelligent Endocrinology
80/20 range based on carefully screened young healthy population
Individualized Diagnosis and Treatment
80/20 range
Hormone Effect
Too Little?
Too much?
Optimal?? 1 2
FT4 ng/dL
Hormone Level

18. New Paradigm: Restorative Endocrinology
Endocrine 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!

19. 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)

20. 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.

21. Coronary Heart Disease vs. Age
Female
AIHW Heart, stroke and vascular diseases - Australian facts 2004.

22. Breast Cancer Rate vs. Age
Loss of ovarian functionhigher risk of breast cancer
Menopause
Ovarian function
National Cancer Institute. SEER cancer statistics review Table IV-3.

23. Estrogen Replacement Prevents Alzheimer’s Disease
72% used Premarin only
Zandi PP, et al., Cache County Study. JAMA Nov 6;288(17):
RR 0.46 in Kawas C, The Baltimore Longitudinal Study of Aging. Neurology 1997;48:
RR 0.65 Paganini-Hill A, Arch Intern Med 1996;156:
RR 0.4, Tang M-X, Lancet 1996;348:

24. 30
Speroff L, Fritz M Clinical Gynecologic Endocrinology and Fertility, 7th Ed.

25. 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 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.

26. 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 Dec;44(12):
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 formationpoor fracture healing, late non-traumatic fractures, and “rotting jaw”.

27. Female Endocrinology
Nature 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.

28. 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 withdrawalsloughing and necrosis of uterine lining and breast duct epithelium Longacre TA, Am J Surg Pathol Jun;10(6):382-93
High progesterone/estradiol ratio suppresses proliferation and prevents cancers
Estradiol is safe if opposed by progesterone.

29. Progesterone’s Anti-Estrogenic Actions in Uterus and Breast
Decreases 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

30. Progesterone Deficiency Estrogen Dominance
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
Endometriosis
Progesterone restoration is the only effective treatment for estrogen dominance

31. Aging Ovaries
Females born with a fixed no. of oocytes which are continually lost
With aging, fewer oocytes of lower quality are leftreduced estradiol and progesterone production beginning as early as age 30
Lower progesteroneestrogen dominance
No ovulation=no progesterone

32. Normal Progesterone Dominance
Ovulation
Ovulation
Menstrual Cycle

33. Luteal Insufficiency=Estrogen Dominance
Perimenopause
Luteal Insufficiency=Estrogen Dominance
Inadequate Luteal Phase
shorter periods, early spotting
’d risk of breast cancer
Ovulation
Menstrual Cycle

34. ’d risk of breast and uterine cancers
Anovulation=Estrogen Dominance
’d risk of breast and uterine cancers
Menstrual Cycle

35. Menopause
Estradiol and Progesterone Deficiency

36. Menopause=Estradiol Deficiency
Hot flashes
Irritability, insomnia, depression
Fatigue, aches and pains
Poor memory, ’d risk of Alzheimer’s dementia
Osteoporosisspine and hip fractures, loss of teeth
Genital atrophy, vaginal dryness
Atrophy of skin and connective tissue
Endothelial dysfunction, blood pressure
Increased blood sugar
Atherosclerosis, heart disease

37. Estradiol Restoration
Eliminates hot flashes, restores sleep
Protects cognitive function, improves mood
Maintains thickness, fullness of skin and hair
Protects against colon cancer and macular degeneration
Protects against dementia
Prevents atherosclerosis, hypertension
Maintains genital/pelvic health
Improves insulin sensitivity—prevents diabetes
Prevents osteoporosis and osteoarthritis
Maintains gynecoid fat distribution

38. Q: But won’t estradiol restoration increase the risk of breast cancer?
A: No, not if given with progesterone.

39. E3N-EPIC Study E2 plus progesterone decreased risk of breast cancer!
Cohort study
55,000 women
8 years f/u
c/w WHI--
16,000, 6 yr. f/u
E3N-EPIC Study
TD-E2=transdermal estradiol
No HRT
Int J Cancer Apr 10;114(3):448-54
E2 plus progesterone decreased risk of breast cancer!
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.

40. Progesterone vs. Breast Cancer in menstruating women
Ordet Study: Int. J. Cancer 112 (2004) (2), pp. 312–318.
Progesterone vs. Breast Cancer
in menstruating women
6,000 women
5 yr. F/U
Risk of breast cancer
Higher progesterone=lower risk of breast cancer

41. Progesterone vs. Breast Cancer
Progesterone cream applied to the breast reduces proliferation Chang KJ, Fertil Steril 1995; 63: Barrat J, J Gynecol Obstet Biol Reprod (Paris). 1990;19(3): Foidart JM, Fertil Steril May;69(5):963-9
Estradiol is carcinogenic in breast cell cultures unless progesterone is present.
Russo J, J Steroid Biochem Mol Biol 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 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 Nov-Dec;28(6):360-9

42. Progesterone vs. Breast Cancer
Premenopausal 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 Mar;105(3):345-51
Progesterone decreases proliferation and induces apoptosis in breast cancer cell lines.
Ansquer Y, Anticancer Res Jan-Feb;25(1A): Groshong SD, Mol Endocrinol Oct;11(11):
Progesterone receptor positivity predicts better long-term survival with breast cancer
Costa SD, Eur J Cancer Jul;38(10):
Lamy PJ, Breast Cancer Res Treat Nov;76(1):65-71

43. 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 Mar;90(3):
Breasts must get progesterone from blood, and they concentrate it by a factor of 3 to 4x.
Gann PH, Cancer Epidemiol Biomarkers Prev Jan;15(1):39-44
In peri-menopause/menopause: No progesterone estrogen dominance in the breastsbreast cancer.

44. 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 Sep 16;52(1):1-10.

45. So why are most doctors saying that hormone replacement for menopause is dangerous?

46. Pharmaceutical “Hormone Replacement Therapy”
Horse-urine Premarin approved in 1942
Synthesis of first human steroid hormone, progesterone, in 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!

47. 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!

48. EE in Birth Control Pills
Estradiol
Ethinyl Estradiol
Acetylene
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 thrombogenicDVTs, pulmonary emboli

49. Contraceptive Hormone Substitution is Dangerous
EE with alien progestin, shuts down ovaries
Lowers testosterone and DHEAS levels
’d risk of blood clots, stroke, heart attack
1-3x risk of breast cancer
’d blood sugar, blood pressure
Liver tumors
Diagnose and fix the hormonal disorder
Use a copper IUD for contraception!!
UpToDate 2006
Instead of using BCPs::

50. Premarin Conjugated Equine Estrogens
Human Horse Horse
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 Int J Fertil 43:223

51. Oral Estrogen Replacement is Dangerous
First-pass effect on the liverIGF-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 Feb 20;115(7):840-5
Transdermal estradiol improves insulin sensitivity, oral estrogens do not.

52. Progestins  Progesterone
Progesterone Provera Drospirenone 
Prempro
Yasmin
Progestins are often called “progesterone”, even in scientific papers!

53. Progestin Zoo progesterone
Kuhl, Climacteric 2005;8(Suppl 1)
Every progestin has a different spectrum of androgenic, estrogenic, glucocorticoid, and progestational effects!

54. Provera  Progesterone
Scientific studies show that:
Provera  Progesterone
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
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

55. 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!

56. 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.

57. 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!

58. 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.

59. Menopause: Bioidentical Estradiol and Progesterone vs
Menopause: Bioidentical Estradiol and Progesterone vs. Hormone Substitutes
Any Questions?

60. Female Andropause
Young 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

61. Testosterone for Women
Improves energy and mood
Improves sexual desire and sensation
Increases muscle and tissue strength
With estradiol, increases bone density
J Reprod Med Dec;44(12):
Probably decreases risk of heart attack
J Womens Health Sep;7(7):825-9
Opposes estradiol-induced breast stimulation and reduces risk of breast cancer
Menopause Jul-Aug;10(4):292-8, Endocr Rev Jun;25(3):374-88
Menopause Sep-Oct;11(5):531-5, FASEB J Sep;14(12):

62. 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.

63. 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)

64. Testosterone and the Heart
Low testosterone levels correlate with coronary artery disease and stroke
Arterioscler Thromb. 1994; 14:
Eur Heart J 2000; 21; 890–4
Int J Cardiol Jan 31;63(2):161-4
Arterioscler Thromb Vasc Biol Jun;16(6):749-54
Testosterone 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

65. Testosterone and the Prostate
Lower 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 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 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.

66. Testosterone for Women and Men
Any Questions?

67. Hypometabolism: Thyroid and Cortisol Insufficiency
Thyroid sets throttle, cortisol delivers the fuel
Our health and quality of life require optimal levels of both hormones!
Deficiencyreduced metabolic ratefatigue, 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.

68. Glucocorticoids (“Steroids”)
Cortisol
Prednisolone (4-5x)
Prednisone (4-5x)
Methylprednisolone (5-6x)
Medrol®
Dexamethasone (70x)
Decadron®

69. Cortisol Made in the adrenal glands
Maintains blood sugar (delivers the fuel)
Modulates the immune system
We need higher levels with stress, disease
Too muchDiabetes, HTN, osteoporosis
Too littlefatigue, depression, anxiety, autoimmune diseases, hypoglycemia, allergies, aches & pains
Women have lower cortisol levels/effects and much more low-cortisol-related problems than men.

70. Mild-to-Moderate Cortisol 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

71. Normal Saliva Cortisol Profile

72. Cortisol Deficiency

73. Cortisol Restoration
Mild 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

74. 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

75. Cortisol and DHEA
Any Questions?

76. Hypothyroidism Mental fog, poor concentration Depression
Fatigue, need for excessive sleep
Cold extremities
Aches and pains
Thinning scalp hair
Weight gain
Constipation
Ankle swelling, puffy face

77. Thyroid Testing Doctors 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.

78. We Need Optimal T3 Levels
Incidence of severe atherosclerosis doubled with lower T3 levels within the reference range Clin Cardiol 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

79. 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 oftenlower 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

80. 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) 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 restored
No cardiac abnormalities J Clin Endo Metab Jan;85(1):159-64
No muscle wasting Am J Phys Endol Metab Jun;288(6):E

81. Thyroid Restoration
Any Questions?

82. Growth Hormone Declines 14% per decade after age 25
IGF-1 of many adults equal to hypopituitary patients (only vs.
Deficiency heart disease, frailty, depression, body fat, bone loss
GH restoration for GH-deficient adults:
reduces abdominal fat
lowers blood sugar, cholesterol, and BP
Improves cognition, mood, sleep, energy, stamina
Increases muscle, decreases fat
Improves bone density, skin thickness
Downside: at least $185/mo., daily injections

83. 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!!

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

85. Compounding Pharmacies
USP-certified bioidentical hormones mixed into creams, sublingual tablets, capsules. Inexpensive!
Winola Pharmacy—Rt. 307 at Lake Winola,
Harrold’s Pharmacy—W-B,
Fino’s Pharmacy—Dallas,
Hazle Drugs Apothecary—Hazelton

86. 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.

87. Doing HR History, 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.

88. Costs Physician 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

89. For More Information
The 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 (
Information and hundreds of abstracts at
Contact me: