Presentation on theme: "Bioidentical Hormone Restoration Best Medical Practice"— Presentation transcript:
1 Bioidentical Hormone Restoration Best Medical Practice
2 Hormones Neuro-endocrine-immune system Travel via blood to cells’ receptorsControl cells’ proliferation, protein manufacture, metabolic rate, etc.Most powerful molecules in our bodiesOptimal levels essential for health and quality of life
4 Why Doctors Don’t Get It Hormones and AgingWhy 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 insulinHypothyroidism: bioidentical T4Growth hormone def.: bioidentical GHAdrenal insufficiency: bioidentical cortisolBut what about hormones lost to aging?
10 Hormonal Changes With Aging Hormones that build tissues and improve immunity decline with age by 50-80% (DHEA, Testosterone, GH)Progesterone starts to decline at age 30.Estradiol disappears at 50—menopauseThyroid hormone production and sensitivity declineInsulin output declinesDiabetesBy age 50—20 years of hormonal deficiency
11 Conventional View of Hormones and Aging The loss of hormones is adaptive–helps us to live longerPersistence of youthful levels of hormones would cause more heart attacks and cancers as we ageLosing our hormones is good for us(?!)Fits the Pharmaceutical Agenda: Take drugs for every symptom and disorder caused by hormone loss!
12 Against the Conventional View Aging is a self-destruct program that kicks in at age 25 in humansAging 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 25IGF-1 of many adults equal to hypopituitary patients (only vs.Deficiency heart disease, frailty, depression, body fat, bone lossGH restoration reduces abdominal fat, lowers blood sugar and blood pressureImproves cognition, mood, sleep, energyIncreases muscle, decreases fat & cholesterolImproves bone density, skin thicknessDownside: high cost, nightly injections
14 The Endocrinology of Aging Endocrine glands and their feedback control systems deteriorate with ageOur bodies cease to regulate our hormones for optimal healthHormone losses speed our general deterioration: a vicious cycle.The symptoms of hormone loss are warning signs of physical deteriorationWin-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:essential preventative medicineessential to the treatment of diseaseessential to Quality of Life!We have the need and the right to restore hormones lost to aging!
17 Human Steroid Hormones TestosteroneEstradiolDHEAProgesteroneCortisol
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, testosterone and DHEA essential to cellular growth and function in all tissues in both sexes!Maintain brain function—modulators of mood, cognition, pain, etc.Maintain the immune system—progesterone and testosterone are immunosuppressantsMaintain connective tissue: skin, hair, bone, muscle, and blood vessels
20 Female EndocrinologyNature makes special demands on the female body for reproductionBreast, uterine and ovarian tissues undergo a monthly cycle of proliferation, differentiation, and breakdownDefects in this cycle can lead to cancers in female organs and to many medical disorders.
21 Estrogen—Progesterone Complementarity Estrogen promotes breast/uterine tissue proliferation and growthProgesterone stops proliferation and promotes maturation and differentiationDifferentiated cells can’t become cancer cellsHigh average progesterone/estrogen ratio suppresses proliferation and prevents cancers of female organs
22 Progesterone Deficiency Estrogen Dominance AllergiesAutoimmune diseasesAnxiety, irritabilityInsomniaDecreased sex driveDepressionBloating and edemaFibrocystic breastsUterine fibroidsBreast cancerOvarian cancerUterine cancerThyroid dysfunctionGallbladder diseaseHeavy periodsMigrainesSeizuresProgesterone and Iodine/Kelp reduce estrogen dominance
23 Historical Perspective Throughout most of human history, women were usually:Pregnant—high progesteroneBreastfeeding—low estrogen(both protect against breast cancer)Women cycled for 4 years avg.; today many cycle for 35 yearsCycling=risk of estrogen dominance and other hormonal disorders
24 PerimenopauseFemales born with a fixed no. of oocytes which are continually lost to age and ovulationWith aging, fewer oocytes of lower quality are leftreduced progesterone production beginning around age 30estrogen dominanceNo ovulation=no progesteroneEstrogen swings from very high to very low—often for several years.
25 Normal Progesterone Dominance OvulationMenstrual Cycle
30 Menopause Menopause +Adrenal Insufficiency = BIG TROUBLE Estrogen DeficiencyProgesterone DeficiencyTestosterone DeficiencyAfter menopause, women depend upon their adrenal glands for androgens and estrogens, so:Menopause+Adrenal Insufficiency= BIG TROUBLE
31 Effects of Combined Sex-Hormone Deficiency Irritability, insomnia, brain dysfunctionAlzheimer’s dementiaFatigue, aches and pains.Osteoporosisfractures, loss of teethGenital atrophy, vaginal drynessAtrophy of skin and connective tissueHeart disease—higher risk than men after 65, higher mortality after 70!
32 Estradiol Restoration Eliminates hot flashesRestores mood and mental functionProbably protects against Alzheimer’s diseaseMaintains genital/vaginal skin and lubricationIncreases thickness, fullness of skin and hairPrevents heart diseasePrevents colon cancer and macular degenerationImproves insulin sensitivity—helps diabetesPrevents osteoporosis and osteoarthritis
33 Speroff L, Fritz M Clinical Gynecologic Endocrinology and Fertility, 7th Ed.
34 OsteoporosisIn 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 bone50% of women >65 yrs. old have spinal compression fractures14% 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 OsteoporosisA hormone deficiency disease—the proper treatment is hormone restoration!Estrogen prevents resorption of old bone while testosterone, progesterone, DHEA and GH build new boneJ Clin Endo Metab. 1996; 81:37-43.J Reprod Med Dec;44(12):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 MenTestosterone levels decline slowly in men—”Just getting old.”Fatigue, reduced mental functionPassivity and moodiness—loss of drive and ambitionLoss of muscle mass, increased abdominal fatLastly: loss of libido, no morning erectionsIncreased risk of heart and prostate diseaseIncreased risk of Alzheimer’s dementiaIncreased risk of autoimmune diseases
39 Testosterone Restoration Improves mood and sociabilityRestores energy and ambitionImproves cognitionIncreases libido and sexual performanceIncreases muscle and bone massReduces abdominal fat, improves insulin sensitivity, lowers blood pressure--counteracts metabolic syndrome
40 Testosterone and the Heart Low testosterone levels, correlate with coronary artery disease and strokeArterioscler Thromb. 1994; 14:Eur Heart J 2000; 21; 890–4Int J Cardiol Jan 31;63(2):161-4Arterioscler Thromb Vasc Biol Jun;16(6):749-54T dilates coronary arteries—improves anginaT increases heart muscle size, strengthT decreases fibrinogen levels—prevents blood clotsEndocr Res. 2005;31(4):
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!Low testosterone correlated with more aggressive prostate cancersTestosterone 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 Feb;13 Suppl 1:40-3.
43 Estrogen Dominance Theory of Prostate Disease In many men, free testosterone declines > estradiolEstrogen dominance is a probable cause of prostrate enlargement and a possible cause of prostate cancerElevated estrogen/Test. ratios in BPH Scandinavian Journal of Urology and Nephrology, 1995; 29:High levels of estradiol and estrone found in BPH tissuesEstradiol upregulates oncogenes
44 Female AndropauseYoung woman’s free testosterone level in serum is 2x her free estradiolFemale testosterone levels decline 50% between age 20 and 45Birth control pillstestosterone and DHEA levelsDHEA declines with age—main source of androgens in women
45 Testosterone for Women Improves energy, moodImproves sexual desire and responseIncreases muscle strength and reduces muscle and joint achesWith estradiol, increases bone densityJ Reprod Med Dec;44(12):Probably decreases risk of heart attackJ Womens Health Sep;7(7):825-9.Given with estradiol and progesterone, reduces risk of breast cancerMenopause Jul-Aug;10(4):292-8, Endocr Rev Jun;25(3):Menopause Sep-Oct;11(5):531-5, FASEB J Sep;14(12):
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 moleculesPharmaceutical—Create non-natural, patentable substances that will produce some improvementNatural Science should be primary; Pharmaceutical Science secondary.
49 Problems with Pharmaceuticals Alien molecules: not recognized, not easily eliminatedNegative functions: disrupt normal physiology by blocking receptors, inhibiting enzymes, etc.Toxic:Side effects even at low dosesAllergic reactionsLong-term damage
50 Pharmaceutical Billions Mission: Sell pharmaceuticalsInformation control—journals, CME, med. schools, professional org.s, etc.Strategy: Suppress competition (natural vitanutrients and hormones—human physiology!!)Conventional Docs: UnawareResult: Unfounded fear of hormone optimization; unfounded confidence in toxic drugs
51 History of “Hormone Replacement Therapy” Horse-derived Premarin approved in 1942Progesterone synthesized in Poorly absorbed orallyChemically altered to make “progestins”—among the first drugs to be patented.“HRT” came to mean the use of alien molecules that had hormone-like effectsDrug co.s became dependent on HRT profitsDrug co.s push doctors to use hormone substitutes and to ignore or fear natural hormones!!
52 Dirty Secret: Conventional “HRT” is really HST! Progesterone substitutes:medroxyprogesterone acetate (MPA-Provera) and 30+ other “progestins”Estradiol substitutes: conjugated equine estrogens (CEE-Premarin) and ethinyl estradiol (birth control pills)Testosterone substitute: oral methyltestosteronePatented drugs—not hormones!Most docs don’t know the difference!
53 Premarin Conjugated Equine Estrogens (CEE) Human HorseEstradiol-17β Dihydroequilin-17βCEE contains at least 10 estrogens, only 3 are human.CEE contains 3x more Dihydroequilin than Estradiol.DHE has 10% higher binding affinity for est. receptors.DHE binds far less to SHBG and has a slower metabolic clearance The most abundant estrogen in CEE is Equilin sulfate.Kuhl H, Climacteric 2005;8(Suppl 1):3–63
54 EE in Birth Control Pills EstradiolEthinyl estradiolAcetyleneEE 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 much more thrombogenic than estradiol
55 Progesterone vs. Progestins Progesterone MPA (Provera) MegestrolEvery progestin has a different spectrum of androgenic, estrogenic, glucocorticoid, and progestational effects!
56 Progestin Zoo Progesterone NAMS-”Call ‘em all Progestogens” Kuhl, Climacteric 2005;8(Suppl 1)NAMS-”Call ‘em all Progestogens”
57 Testosterone Substitution Headlines: “Testosterone therapies increase risk of breast cancer.”Testosterone SubstitutionTestosteroneMethyltestosteroneMethyltestosterone (in Estratest) aromatizes toan alien estrogen and increases risk of breast cancer, alsocauses liver damage and breast enlargement in bodybuilders
58 Sex BiasIf a Man’s testes are removed or non-functional, bioidentical testosterone replacement is started immediatelyIf a woman’s ovaries are removed or non-functional, she is offered horse hormones or hormone-like drugs; or is told to “Live with it ”.It IS a Man’s World!
59 Birth Control Hormone Substitution is Dangerous 2x risk of stroke, heart attack2-30x risk of blood clots1-3x risk of breast cancerIncreased blood sugar, blood pressure1.5x risk systemic lupus erythematosisLiver tumorsDiagnose and fix the hormonal disorderUse a copper IUD for contraception!!UpToDate 2006Instead::
60 2002 WHI Study—Menopausal Prempro HST is Dangerous! Oral CEE (Premarin) alone had adverse effects in the first year (strokes, blood clots)Adding MPA (Provera, PremPro) caused more adverse effects (breast cancers, heart attacks)CEE/MPA caused a large increase in dementiaAnd we know why these forms of hormone substitution are dangerous!
61 Dangers of Oral Estrogen Replacement First-pass effect on the liverIGF-1, SHBG, CRP, clotting factors blood clots, strokes, heart attacks in the first yearSmokers have greater risk of clotsEE increases clotting much more than estradiol, Premarin®Transdermal estradiol has none of these effects!
62 Dangers of Estrogen-only HRT Estrogen alone, estrogen-progestin HST and BCPs all reduce DHEAS and testosterone levels 25-60%Estrogen without progesterone and testosteroneestrogen dominance and risk of breast cancer and other medical disorders
63 Provera Progesterone Scientific studies show that:Progestins are DangerousProvera ProgesteroneCauses birth defectsCan cause depressionInsomnia, irritabilityFluid retentionRaises blood sugarCounteracts estrogen-induced arterial dilationWorsens lipid profileCauses heart attacksIncreases estrogenic stimulation of breastsCauses breast cancerMaintains pregnancyImproves moodImproves sleepDiureticLowers blood sugarMaintains estrogen-induced arterial dilationImproves lipid profileNo evidence of CVDReduces estrogenic stimulation of breastsPrevents breast cancer
64 Atherosclerosis and Clotting “In both peripheral and cerebral vasculature (of live animals), synthetic progestins caused endothelial disruption, accumulation of monocytes in the vessel wall, platelet activation and clot formation, which are early events in atherosclerosis, inflammation and thrombosis. Natural progesterone or estrogens did not show such toxicity.”Climacteric Dec;6(4):
65 Progesterone and Breast Cancer—the Evidence Premenopausal women with low P levels had 5.4 times greater risk of early breast cancer, 10x greater risk for all cancersAm J Epidem 1981;114:Breast cancer victims have signs of progesterone resistanceBr J Obstet Gynaecol Mar;105(3):P downregulates BRCA1 and induces apoptosis in breast cancer cell lines.Anticancer Res Jan-Feb;25(1A):243-8.
66 Progesterone and Breast Cancer—the Evidence cont. Estrogen cream applied to the breast induces proliferation, adding progesterone cream reduces proliferation to baselineFertil Steril 1995; 63:785-91Estrogen is carcinogenic in breast cell cultures unless progesterone is presentJ Steroid Biochem Mol Biol Oct;87(1):1-25.Estrogen upregulates cancer-promoting gene bcl-2, progesterone downregulates it.Ann Clin Lab Sci Nov-Dec;28(6):360-9.
67 E3N-EPIC Study No Evidence that BHRT is safer? Cohort study54,000 women5.8 years f/uc/w WHI--16,000, 6 yr. f/uE3N-EPIC StudyInt J Cancer Apr 10;114(3):Bioidentical estradiol plus progesterone decreased the risk of breast cancer!
68 ORDET Study Higher progesterone=lower risk of breast cancer Int. J. Cancer 112 (2004) (2), pp. 312–318.6,000 women5 yr. F/UORDET StudyHigher progesterone=lower risk of breast cancer
69 Progesterone and Breast Cancer—Conclusion “The balance of the in vivo evidence is that progesterone does not have a cancer-promoting effect on breast tissue.”J Steroid Biochem Mol Biol Jul;96(2):95-108In fact, the balance of the evidence indicates that progesterone protects against breast cancer!So…women can be given estradiol as long as it’s balanced by progesterone and testosterone!
70 Pharmaceutical Corps’ Dilemma They need to control the HRT marketTheir progesterone and estradiol substitutes are dangerousThey can’t patent natural hormonesPharm. Corps. have to get FDA-approval for every natural hormone preparation $$$Compounding pharmacies can dispense natural hormones cheaply
71 Pharm. Corps’ ChoicesStop compounding pharmacies so they can control of the BHR marketWyeth’s appeal to the FDA, media propaganda blitzSuppress BHR in favor of their substitutesKeep looking for substitutes that will provide benefits without risksResult: Your doctors will never learn the truth about hormones unless he/she goes looking for it
72 Common Sense Substitutes are alien molecules! Problems caused by hormone substitutes cannot be attributed to human hormones until proven otherwise.Bioidentical hormone restoration should be considered safe until proven otherwise!
74 Metabolic Regulators: Thyroid and Cortisol Thyroid sets throttle, cortisol delivers fuelDeficiencyreduced metabolic ratefatigue, brain dysfunction, depression, painSubtle deficiencysymptoms and diseaseUsual blood tests are insensitiveIrrational fear of supplementationUnderdiagnosed, undertreated—Docs prescribe pharmaceuticals (SSRIs) instead
75 Hormone Ignorance: the Tyranny of the Lab Report Reference Range=95% of “normal people” optimumMale free testosterone: xFemale free testosterone: Free T3: xTSH: xIf “within normal limits” no diagnosis; pharmaceuticals for symptomsIf below normal, just replace to “WNL”
76 Hypothyroidism—Symptoms Mental fog, depression, anxietyFatigueCold extremitiesAches and painsHair falling outWeight gainConstipationSelf-Test: Basal body temperature <97.8°F axillary in bed in AM
77 Thyroid Hormone—T3 Maintains metabolism, mood, and energy Controlled partly by thyroid stimulating hormone (TSH) from the pituitary glandTSH test is indirect: does not measure T3 levels or effects in various tissuesDocs prescribe T4 only (Synthroid and Levoxyl)—prohormone that must be converted to T3Docs rarely measure free T3 levels!
78 We Need Optimal T3 Levels Incidence of severe atherosclerosis doubled with lower T3 or higher TSH levels within the normal rangeClin Cardiol Dec;26(12):569-73Lowers cardiac risk factors: cholesterol, triglycerides, C-reactive protein, homocysteine and lipoprotein(a)Lowers blood pressure, dilates arteriesReduces tendency to form blood clotsPrevents weight gain
79 Fatigue, Fibromyalgia and Depression Epidemic Pre-TSH: Treat the patient’s symptomsPost-TSH: Treat the test (?)1970s—Doctors lowered doses by 30%TSH-normalizing T4 doselow T3 levels!Williams’ Textbook of Endocrinology. Saunders, Philadelphia, pp )T3 alone often effective in fibromyalgiaT3 alone relieves depression even if tests “normal”! J Affect Disord Feb
80 Rational Approach to Thyroid Restoration If S/S of hypothyroidism: Treat!Give T4 plus T3 (Armour, Cytomel)Endocrinology 1996;137:Increase dose until symptoms gone or S/S of excess appearSafe--even moderate TSH suppression does not cause:bone loss Horm Res. 2005;64(6): Epub 2005 Nov 1.cardiac abnormalities J Clin Endo Metab Jan;85(1):muscle wasting Am J Phys Endol Metab Jun;288(6):E
81 Pharmaceuticals, Labs, and Thyroid Any Questions?
82 Cortisol Made in the adrenal glands Maintains blood sugar (delivers the fuel)Modulates immune systemNeed high amounts when stressedToo muchDiabetes, HTN, osteoporosisToo littlehypoglycemia, fatigue, autoimmune diseases, aches and pains
83 Cortisol Deficiency www.adrenalfatigue.org Fatigue, depression Aches and painsCan’t stay asleepCan’t deal with exercise, stress, or illness2nd wind late at nightHypoglycemia, feels better after eatingNausea, abdominal discomfort, diarrheaAllergies, autoimmune diseasesHard to gain, hard to lose weightLow blood pressure, salt and sugar cravings
84 Mild-to-Moderate Cortisol Deficiency Blood tests are insensitive, need diurnal salivary cortisol profileUnderdiagnosed: Docs taught only about severe “adrenal insufficiency” due to physical destruction of the adrenal glands (Addison’s Disease) or pituitaryCommon cause of chronic fatigue, painClue: Felt great when taking prednisone
89 Cortisol RestorationMild deficiency can resolve with stress, rest, nutrient restorationModerate-to-severe—need cortisol, not cortisol substitutes like prednisonePhysiological doses (5 to 20mg=<1-4mg prednisone)—NOT excessive doses that cause hypertension, diabetes, osteoporosis, etc.Fears of low-dose cortisol unfoundedDr. William Jeffries’ Safe Uses of Cortisol
90 DHEA—The Other Adrenal Hormone Most abundant steroid hormone yet ignoredCells make testosterone and estradiol with itLevels decline with age, stress and diseaseAnabolic—builds tissues, improves immunityReduces abdominal fatReduces pain—restores natural endorphinsReduces inflammation (IL-6, TNF-, IL-2)Anti-cancer effect in animal, in vitro studiesLower levels assoc. with disease, mortality
91 Fatigue, Depression, and Pain Should be considered as due to a nutrient, thyroid, cortisol, or DHEA deficiency until proven otherwise by testing and by trials of nutrient and hormone restoration.
93 What Else Can Hormone Replacement Help? Infertility, PMS, heavy bleedingInsomnia—almost always helpsHeart failureMental disordersAutoimmune diseases (systemic lupus erythematosis, rheumatoid arthritis, ulcerative colitis, Crohn’s disease, etc.)Allergies, skin diseases
94 Hormone Restoration Unresolved issues—more investigation needed Need more long-term randomized studies to study long-term resultsQuestions about delivery and monitoringMedical profession should be studying bioidentical hormones instead of hormone substitutes!
95 Local Compounding Pharmacies Winola Pharmacy—Rt. 307 at Lake Winola,Harrold’s Pharmacy—Wilkes-Barre,Fino’s Pharmacy—Dallas,Hazle Drugs Apothecary—Hazelton phone
96 Doing BHRT History, consent, fees online Initial visit: order tests F/U visit: Results—prescribe—retestRepeat until stabilized at proper doseFollow-up office visit once every 6 months, test only as needed.Telephone and contact—charges for clinical decisions, refills, etc.
97 CostsPhysician time only as required--first year ~$200-$400; then <$200/yr.No insurance billing; may submit claim for recognized diagnosisHormones—$10 to $70/month, some covered by insurance (GH adds $130/mo.)Diurnal salivary cortisol test—$120Blood tests—insurance may pay, lab kits $170-$220, Saliva/blood kit—$299Out-of-pocket expenses tax-deductible
98 For More InformationThe Miracle of Natural Hormones David Brownstein, MDHow to Achieve Healthy Aging—Look, Live, and Feel Fantastic After 40 Neal Rouzier, MDThe Hormone Solution—Stay Younger Longer Thierry Hertoghe, MDLife Extension Foundation (BHRT info. and hundreds of abstracts atContact me: