Presentation on theme: "Conquer DIABETES with Gender-Specific Bio-Identical TESTOSTERONE"— Presentation transcript:
1Conquer DIABETES with Gender-Specific Bio-Identical TESTOSTERONE Edward Lichten, M.D.FACS, FACOG, FABAAMAmerican Academy ofAnti-Aging MedicineDecember 14-15, 2007
2The Worst Diabetic Male If you were faced withThe Worst Diabetic Male50 years old, dark skinned man on insulinNo regular source of work, food, healthcareJunk food and history of homelessnessConfused and disorientedWhat Would You Do?
3What 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?
4Hemoglobin A1c= 18: Uncontrolled Diabetic Anthony
5There 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
6Ten Years Ago the Future of Anti-Aging Medicine was Using Bio-Identical Hormones that identically match the hormones produced in the bodySustained releaseT4 and T3 thyroidDHEAPregnenolone
7Ten Years Ago the Future of Anti-Aging Medicine was Using Gender-Specific HormonesEstradiol and Estriol for womenProgesterone for womenTestosterone for womenTestosterone for menBecause 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
8Bio-Identical Hormones Because of the Ground Breaking Exposure to B-HRT from the A4M and the Life Extension FoundationThere is a Greater Awareness that Staying Healthy can be assisted by Replacing and Maintaining, these Natural,Bio-IdenticalHormonesBut 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.
9The problem with Anti-Aging Medicine Is that our Antidotal Reportsdo not have aScientific Methodology:Therefore, our detractors say we are ‘snake-oil’ salesmen
11Scientifically,HypothalamusPinealPituitaryThere are 6 Endocrine Glands in the human body that release biologic hormonesThyroidAdrenalPancreasOvaries-Testes
12When in Balance 12 MAJOR HORMONES CalciferolWhen in BalanceGrowth HormoneThyroxin & T312 MAJOR HORMONESReleased by these six endocrine glandswork together,‘Exciting’ your body toEnergy and HealthDHEA & CortisolInsulin & GlucagonTestosteroneEstradiol &Progesterone
13for age-related diseases In Suzanne Somer’s book it isSuggested that proper replacement of bio-identical hormones holds great promise in the future in slowing the aging process, and as aTreatmentfor age-related diseases
14When you have a Disease like Diabetes no Balance,No Energy,And Inadequate levels ofBio-identical Hormones
15When you have DiabetesThis imbalancemay shorten life expectancy 10 years and be the cause of multiple end-organ failures
1621st Century Diabetic Epidemic With twice as many MORE still to be diagnosed!
17The Future of Anti-Aging Medicine is here! Treating DiabetesWithBio-identicalTestosterone In Men
18Diabetes MellitusToday, 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 ofheart diseasehigh blood pressureCholesterol elevationcerebral vascular stokes andobesity.
19Diabetes 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?
20The 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 descriptionDiabetes 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 PracticeThe presence of abnormally elevated glycogenated hemoglobin is diagnostic of diabetes mellitusThe World Publishing Company- William Collins Publishers, Inc. 1979
21The 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 metabolismType I: Inability to make insulinType II: Resistance to the insulin made
22The Cause of Diabetes Mellitus: Type I: Insulin Deficiencycharacterized byDestruction of the pancreatic islet cells by some infection or autoimmune reactionTypically occurring in a child or adolescentType II: Resistance to the Action of InsulinResistance to insulin at the cellular level with the initial excessive insulin production being unable to clear glucose from the blood streamPre-Diabetes: Metabolic Syndrome is a pre-diabetic condition with excessive insulin production effectively keeping the glycogenated hemoglobin in normal range.
23What are the Diagnostic Tests for Diabetes Mellitus? Screening testsUrine: presence of glucoseBlood: elevated glucose levelDiagnostic testsBlood: elevated fasting serum glucoseInsulin: elevated fasting insulin levelRed Cell: elevated glycogenated hemoglobin measured directly or as Hemoglobin A1cComprehensive testingGlucose Tolerance Test with Insulin levels
24Glucose Tolerance Test with Insulin Levels Fact- 1: GTT-I needed to classify type of diabetesGlucose Tolerance Test with Insulin LevelsThe 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 LevelsRL 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;
25The 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 2hrType II diabetes is a progressive disease characterized by increasing demands for insulin.Normal Insulin LevelsHollenbeck C, Reaven GM. Variations in Insulin-Stimulated GlucoseUptake in Healthy Individuals with Normal Glucose Tolerance. JCEM 1987;64:
26Type-I and Type-II late AODM lack an insulin dynamic response Fact-2: Type I and Type II late have inadequate, flat insulins < 70Type-I and Type-II late AODM lack an insulin dynamic responseType I: SumI <70Normal: SumIType II-late SumI <70Type II-early SumI >130
27The Standard of Care protocol for treating diabetes mellitus is Based on the hospital approved Evidence Based ProtocolsThe Standard of Care protocol for treating diabetes mellitus isType I: add subcutaneous insulinType II: add oral hypoglycemic agents, insulin- sensitizers and newer oral and injectable agentsType II-late: add insulin injections if all else failsWith the goal is to control hyperglycemia
28But since Type I and Type II late are practically identical! Type I diabetesNormal screened groupObese, aging populationType II diabetesEarlyLateGTT-I: no Insulin changesGTT-I: normal or metabolic syndrome based on normalGTT-I: hyperglycemia and higher insulin releaseGTT-I: No or poor insulin responseWhy would you treat Type-I or Type-II late differently?!
29Scientific Method: Lab Tests must dictate treatment Fact-3: Hypoglycemic agents are not indicated for Type I or late Type IIScientific Method: Lab Tests must dictate treatmentScientific Methodology1. Cannot treat NIDDM without a GTT-I2. Type I and Type II-late are virtually identical3. 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?
30The Failure of Evidence Based Medicine American physicians have been taught to treatby 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’.
31But 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.
32NORMAL PHYSIOLOGY is Facilitated Transport Promotes glucose storage CELLOnly in the presence of INSULIN is GLUCOSE taken into the cell.GLUCOSE (Sugar Bag)INSULIN (Big Cheese)
33Is the Cause of Poor Type I diabetic control unavailability of physician supervised Insulin? No
34Type 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, ADAFACT: Adding insulin alone brought less than 40% of volunteers to HgB-A1c of 8.1-2Mathew 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;
35Insulin Therapy is Not Enough for Type I Diabetics! UNDERSTANDINGthe Role ofTestosterone Therapy for Men with Insulin Requiring Diabetes Mellitus
36Oral Therapy is Not Enough for Type II Diabetics! UNDERSTANDING the Role ofTestosterone 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 speakerJAMA: 2006 Ding EL. Harvard Medical group“Higher levels of testosterone are protective”A4M: Lichten: Add-back testosteroneJAMA: 2006 Ding: Higher bio-testosteroneCross-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 diabetesEric L. Ding, BA; Y. Song MD et al. Sex Differences of Endogenous Sex Hormones and Risk of Type 2 Diabetes. JAMA. 206; 295:
38Physiology of Diabetes- Cells Need Energy as well as Insulin Fact-5: Need energyWhy Testosterone?Physiology of Diabetes- Cells Need Energy as well as InsulinGlucose 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)
39There are two keys to opening the cell wall to transport glucose Fact-6: Two keys to cell wall dynamics: insulin and testosterone in menThere are two keys to opening the cell wall to transport glucoseINSULIN: discovered by Banting and Best in 19222. Sex Hormone Binding-Sex Hormone ligand discovered in 1955 but not recognized for its role in glucose transport until today
40Understanding SHBGSex 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.
41ADD-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 ForemostADD-BACK BIO-IDENTICAL TESTOSTERONETo all diabetic men
42Insulin 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
43Insulin Dependent Diabetes Mellitus Testosterone IM Improved Glycemic Control A.M. 50 year old Black Male presented on 16units/insulin/dayHgB-A1c >18%Glucose fasting: 488mg/mlT1-protocol: increased insulin while starting add-back Testosterone weekly IM20 weeks later:HgB-A1c = 7.4%Glucose fasting: 47 mg/ml in AM asymptomatic
45The 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.4883592681859947
46The Key to IDDM Control is that Testosterone Prevents Hypoglycemia Fact-8: Testosterone prevents hypoglycemiaThe Key to IDDM Control is that Testosterone Prevents HypoglycemiaStored Tissue GlycogenTestosterone ATP Energy CycleGlucagonInsulinBlood Stream GlucoseAs effectively as Testosterone improves clearance of glucose from the blood stream, it reconverts glycogen to glucose preventing hypoglycemia.
47Protecting Men Diabetics from Hypoglycemia Is Unique to TestosteroneMakes addition of Testosterone MANDATORY for OPTIMAL DIABETIC CONTROL!!This may well be one of the most important healthcare discovery in the last 100 years!
50Insulin Requiring Diabetic Men (Type I and Type II late) Conclusion: Type I and II-late need testosterone and insulinInsulin 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?
51Adult Onset Diabetes Mellitus: has the same complications as Type I Hyperglycemia and Hyperinsulinemia precedeDIABETES:OBESITYHEART DISEASERETINOPATHYGANGRENE andShortened life expectancy by up to 10 years!
52Adult Onset Diabetic Men need Testosterone!! Before and 1-year after testosterone replacement:yearAbnormal GTT-ILow TestosteroneNormal GTT-I ‘Normalized’ Testosterone
53Non-insulin Dependent Diabetes Testosterone Improves Hyperglycemia Fact-4: All Diabetic Men are Testosterone DeficientFact-10: All NIDDM, Diabetic men may benefit from TestosteroneNon-insulin Dependent Diabetes Testosterone Improves HyperglycemiaDiscontinues 20mg of micronase and lowers fasting glucose on T-2 protocol with twice weekly testosterone injections
54Testosterone improves Hemoglobin A1c Fact-11: Testosterone improves glycemic control with/out weight lossTestosterone improves Hemoglobin A1cWithout 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.1110987Hemoglobin A1c !!JULY AUG SEPT OCT 2001
55Screen 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 testosteroneScreen Everyone for Diabetes and pre-diabetes (metabolic syndrome)Fasting:Glucose normal < 105 mg/dlInsulin normal < 10 uIU/mlHemoglobin A1c normal < percentTriglycerides normal < 130 mg/dlTestosterone:Total Testosterone normal > 450 ng/dlSex Hormone Binding normal < 15 nmol/LEstradiol normal < 25 pg/ml
58U.K. Treats Diabetic Men with IM Testosterone Statistical findingsReduce insulin resistanceReduced insulin requiredReduced fasting glucoseReduced HgB-A1cReduced waist measureReduced total cholesterol10 men on insulin pre-study14 men not on insulinD. 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
59Adult 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 bodyBrain: libido, moodMuscle/ Bone: strengthLiver: synthesis proteinsSex Organs: penile growth, reproduction
60Measurement of Bio-Available Testosterone Serum Testosterone LevelsTotal TestosteroneFree Testosterone FAI=Sex Hormone binding globulinFree Androgen Index (FAI)Ratio of Testosterone/SHBGIdeal: 0.7 to 1.0__[Testosterone total]__30x [SHBG]
61Diabetic 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 .7MaleNormalMetabolic SyndromeTotal Testosterone450 ng/dl250 ng/dlSex Hormone BG15 nmol/L50 nmol/LFree Androgen Index>0.1 to 0.4
62It 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…
63FACTS to REMEMBER 1: GTT-I needed to classify type of diabetes 2: Type I (autoimmune) and Type II late (burn out) are similar: insulin requiring3: Oral hypoglycemic agents are rarely indicated4: All diabetic men are testosterone deficient5: Glucose movement takes energy: energy takes testosterone6: Insulin and Sex Hormone+SHBG ligand are keys to cell wall permeability7: Testosterone improves glycemia for IDDM: Insulin dependent diabetic men8: Testosterone may help prevent hypoglycemia, crisis and coma9: Only Injectable forms of Testosterone are Effective for Diabetes10: All NIDDM men may benefit from Testosterone11: Testosterone may improve glycemic control with or without weight loss12: Screen everyone for diabetes with fasting glucose, HgB-A1c, lipids --and for men, testosterone measurements
64Putting 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!TestosteroneINSULIN & GLUCOSE
65Hippocratic Oath: Above all, physician, Do No Harm! Practicing the Standard Medical Treatment Protocols for Adult Diabetic MenIgnores the appropriate treatment of one scientifically recognized cause of Diabetes in men: testosterone deficiencyExposes the patients to unnecessary drugs, side-effects and expense. The annual cost of diabetic outpatient medications are$30 billion
66Health Care is in FluxParadigm 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 dietVitamins and supplementsReading, researching and exploring new and alternative medical avenues for prevention.
67We 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 importantlyTake Bio-Identical Hormones!
69Testosterone 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’ thatTestosterone Alonemay herald in theEnd of the PharmaceuticalStranglehold onDiabetic and Medical Practice
71Or a U.S. DOCTOR who puts his patients’ first? Endocrine Today: October 2006American Association of Diabetic Educators, Donna Rice MBA, RN, CDE presidentDiabetes Education:Screen, test, treat: low testosterone and diabetesMen with diabetes have a 2x greater risk of having total testosterone less than 300 ng/dl.
72You need to decideTestosterone Injections and Pellets can be dispensed in your office practiceAlong with better medical care
73TESTOSTERONE 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 istruly, “Anti-aging” medicine
74For you and your patients, If you learn only one thing today, rememberYou, 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,
75The 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
76So Become the Anti-Aging Doctor of the future Be the doctor that knows the science behind the causes of diabetesBe the doctor in your area with the knowledge to truly treat the disease, naturallyBe 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!
78Edward M. Lichten, M.D., FACS, FACOG I hope I have done that for you today.Edward M. Lichten, M.D., FACS, FACOGWEBSITE:Office: (248)Lichten Wellness Center180 East Brown StreetBirmingham, MI 48009For copies of this lecture or study course,
80Insulin 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 DiabetesGM 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;
81Hypothesis: Add Back Testosterone is Anti-Aging Men who are testosterone deficient by FAI will live longer and better because they will have less METABOLIC SYNDROMEMeasured as lower fasting insulin, normalized GTT-I are associated with reduced risk factors: obesity, heart disease, hyperlipidemia and hypertension