1. Bioidentical Hormone Restoration Best Medical Practice

2. Hormones Neuro-endocrine-immune system
Travel via blood to cells’ receptors
Control cells’ proliferation, protein manufacture, metabolic rate, etc.
Most powerful molecules in our bodies
Optimal levels essential for health and quality of life

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

5. Bioidentical Hormone Restoration is Common Sense
If a hormone is missing, replace it!
If present but insufficient, optimize it!
Type 1 Diabetes: bioidentical insulin
Hypothyroidism: bioidentical T4
Growth hormone def.: bioidentical GH
Adrenal insufficiency: bioidentical cortisol
But what about hormones lost to aging?

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

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

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

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

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

11. Conventional View of Hormones and Aging
The loss of hormones is adaptive–helps us to live longer
Persistence of youthful levels of hormones would cause more heart attacks and cancers as we age
Losing our hormones is good for us(?!)
Fits the Pharmaceutical Agenda: 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 humans
Aging is natural degeneration!
Weight gain, high blood pressure, high cholesterol, cancers, heart attacks, autoimmune diseases, etc. occur years after hormone deficiencies begin and occur more often in people with lower hormone levels!
Studies of balanced hormone restoration show the expected benefits and no proof of harm!!

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

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

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

16. Hormones and Aging
Any Questions?

17. Human Steroid Hormones
Testosterone
Estradiol
DHEA
Progesterone
Cortisol

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

19. Not Just “Sex Hormones”
Estrogen, progesterone, 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 immunosuppressants
Maintain connective tissue: skin, hair, bone, muscle, and blood vessels

20. Female Endocrinology
Nature makes special demands on the female body for reproduction
Breast, uterine and ovarian tissues undergo a monthly cycle of proliferation, differentiation, and breakdown
Defects in this cycle can lead to cancers in female organs and to many medical disorders.

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

22. 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
Progesterone and Iodine/Kelp reduce estrogen dominance

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

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

25. Normal Progesterone Dominance
Ovulation
Menstrual Cycle

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

27. Anovulation=Estrogen Dominance
Perimenopause
Anovulation=Estrogen Dominance
Menstrual Cycle

28. Menopause
Estrogen and Progesterone Deficiency

29. Also Uterine and
Ovarian Cancer

30. Menopause Menopause +Adrenal Insufficiency = BIG TROUBLE
Estrogen Deficiency
Progesterone Deficiency
Testosterone Deficiency
After 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 dysfunction
Alzheimer’s dementia
Fatigue, aches and pains.
Osteoporosisfractures, loss of teeth
Genital atrophy, vaginal dryness
Atrophy of skin and connective tissue
Heart disease—higher risk than men after 65, higher mortality after 70!

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

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

34. Osteoporosis
In menopause 5% bone loss each year for first 5 years=25%—all due to loss of estrogen!
20 yrs. post menopause—50% reduction in trabecular bone, 30% in cortical bone
50% of women >65 yrs. old have spinal compression fractures
14% lifetime risk of hip fracture for 50 yr.old woman, 30% for 80 yr. old.
Speroff L, Fritz M Clinical Gynecologic Endocrinology and Fertility, 7th Ed.

35. Osteoporosis
A hormone deficiency disease—the proper treatment is hormone restoration!
Estrogen prevents resorption of old bone while testosterone, progesterone, DHEA and GH build new bone
J Clin Endo Metab. 1996; 81:37-43.
J Reprod Med 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 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 mass, increased abdominal fat
Lastly: loss of libido, no morning erections
Increased risk of heart and prostate disease
Increased risk of Alzheimer’s dementia
Increased risk of autoimmune diseases

39. Testosterone Restoration
Improves mood and sociability
Restores energy and ambition
Improves cognition
Increases libido and sexual performance
Increases muscle and bone mass
Reduces abdominal fat, improves insulin sensitivity, lowers blood pressure--counteracts metabolic syndrome

40. Testosterone and the Heart
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
T dilates coronary arteries—improves angina
T increases heart muscle size, strength
T decreases fibrinogen levels—prevents blood clots
Endocr 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 cancers
Testosterone promotes prostate growth to a point, but not prostate cancer

42. Where’s the Beef?
“These results argue against an increased risk of prostate cancer with testosterone replacement therapy.”
Testosterone replacement therapy and prostate risks: where's the beef? Can J Urol Feb;13 Suppl 1:40-3.

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

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

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

46. Testosterone
Any Questions?

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

48. Two Approaches to Medicine
Natural-Scientific—Identify the deficiency/excess at the molecular level and correct it with bioidentical molecules
Pharmaceutical—Create non-natural, patentable substances that will produce some improvement
Natural Science should be primary; Pharmaceutical Science secondary.

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

50. Pharmaceutical Billions
Mission: Sell pharmaceuticals
Information control—journals, CME, med. schools, professional org.s, etc.
Strategy: Suppress competition (natural vitanutrients and hormones—human physiology!!)
Conventional Docs: Unaware
Result: Unfounded fear of hormone optimization; unfounded confidence in toxic drugs

51. History of “Hormone Replacement Therapy”
Horse-derived Premarin approved in 1942
Progesterone synthesized in Poorly absorbed orally
Chemically altered to make “progestins”—among the first drugs to be patented.
“HRT” came to mean the use of alien molecules that had hormone-like effects
Drug co.s became dependent on HRT profits
Drug 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 methyltestosterone
Patented drugs—not hormones!
Most docs don’t know the difference!

53. Premarin Conjugated Equine Estrogens (CEE)
Human Horse
Estradiol-17β Dihydroequilin-17β
CEE 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
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 much more thrombogenic than estradiol

55. Progesterone vs. Progestins
Progesterone MPA (Provera) Megestrol 
Every 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 Substitution
Testosterone
Methyltestosterone
Methyltestosterone (in Estratest) aromatizes to
an alien estrogen and increases risk of breast cancer, also
causes liver damage and breast enlargement in bodybuilders

58. Sex Bias
If a Man’s testes are removed or non-functional, bioidentical testosterone replacement is started immediately
If 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 attack
2-30x risk of blood clots
1-3x risk of breast cancer
Increased blood sugar, blood pressure
1.5x risk systemic lupus erythematosis
Liver tumors
Diagnose and fix the hormonal disorder
Use a copper IUD for contraception!!
UpToDate 2006
Instead::

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 dementia
And we know why these forms of hormone substitution are dangerous!

61. Dangers of Oral Estrogen Replacement
First-pass effect on the liverIGF-1, SHBG, CRP, clotting factors  blood clots, strokes, heart attacks in the first year
Smokers have greater risk of clots
EE 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 testosteroneestrogen dominance and  risk of breast cancer and other medical disorders

63. Provera  Progesterone
Scientific studies show that:
Progestins are Dangerous
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
Lowers blood sugar
Maintains estrogen-induced arterial dilation
Improves lipid profile
No evidence of  CVD
Reduces estrogenic stimulation of breasts
Prevents 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 cancers
Am J Epidem 1981;114:
Breast cancer victims have signs of progesterone resistance
Br 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 baseline
Fertil Steril 1995; 63:785-91
Estrogen is carcinogenic in breast cell cultures unless progesterone is present
J 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 study
54,000 women
5.8 years f/u
c/w WHI--
16,000, 6 yr. f/u
E3N-EPIC Study
Int 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 women
5 yr. F/U
ORDET Study
Higher 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):95-108
In 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 market
Their progesterone and estradiol substitutes are dangerous
They can’t patent natural hormones
Pharm. Corps. have to get FDA-approval for every natural hormone preparation $$$
Compounding pharmacies can dispense natural hormones cheaply

71. Pharm. Corps’ Choices
Stop compounding pharmacies so they can control of the BHR marketWyeth’s appeal to the FDA, media propaganda blitz
Suppress BHR in favor of their substitutes
Keep looking for substitutes that will provide benefits without risks
Result: 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!

73. Hormone Substitution
Any Questions?

74. Metabolic Regulators: Thyroid and Cortisol
Thyroid sets throttle, cortisol delivers fuel
Deficiencyreduced metabolic ratefatigue, brain dysfunction, depression, pain
Subtle deficiencysymptoms and disease
Usual blood tests are insensitive
Irrational fear of supplementation
Underdiagnosed, undertreated—Docs prescribe pharmaceuticals (SSRIs) instead

75. Hormone Ignorance: the Tyranny of the Lab Report
Reference Range=95% of “normal people”  optimum
Male free testosterone: x
Female free testosterone: 
Free T3: x
TSH: x
If “within normal limits” no diagnosis; pharmaceuticals for symptoms
If below normal, just replace to “WNL”

76. Hypothyroidism—Symptoms
Mental fog, depression, anxiety
Fatigue
Cold extremities
Aches and pains
Hair falling out
Weight gain
Constipation
Self-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 gland
TSH test is indirect: does not measure T3 levels or effects in various tissues
Docs prescribe T4 only (Synthroid and Levoxyl)—prohormone that must be converted to T3
Docs 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 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-TSH: Treat the patient’s symptoms
Post-TSH: Treat the test (?)
1970s—Doctors lowered doses by 30%
TSH-normalizing T4 doselow T3 levels!
Williams’ Textbook of Endocrinology. Saunders, Philadelphia, pp )
T3 alone often effective in fibromyalgia
T3 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 appear
Safe--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 system
Need high amounts when stressed
Too muchDiabetes, HTN, osteoporosis
Too littlehypoglycemia, fatigue, autoimmune diseases, aches and pains

83. Cortisol Deficiency www.adrenalfatigue.org Fatigue, depression
Aches and pains
Can’t stay asleep
Can’t deal with exercise, stress, or illness
2nd wind late at night
Hypoglycemia, feels better after eating
Nausea, abdominal discomfort, diarrhea
Allergies, autoimmune diseases
Hard to gain, hard to lose weight
Low blood pressure, salt and sugar cravings

84. Mild-to-Moderate Cortisol Deficiency
Blood tests are insensitive, need diurnal salivary cortisol profile
Underdiagnosed: Docs taught only about severe “adrenal insufficiency” due to physical destruction of the adrenal glands (Addison’s Disease) or pituitary
Common cause of chronic fatigue, pain
Clue: Felt great when taking prednisone

85. Normal Saliva Cortisol Profile

86. Cortisol Deficiency

87. Cortisol Deficiency—Normal Waking Cortisol

88. Depression—Elevated PM Cortisol

89. Cortisol Restoration
Mild deficiency can resolve with stress, rest, nutrient restoration
Moderate-to-severe—need cortisol, not cortisol substitutes like prednisone
Physiological doses (5 to 20mg=<1-4mg prednisone)—NOT excessive doses that cause hypertension, diabetes, osteoporosis, etc.
Fears of low-dose cortisol unfounded
Dr. William Jeffries’ Safe Uses of Cortisol

90. DHEA—The Other Adrenal Hormone
Most abundant steroid hormone yet ignored
Cells make testosterone and estradiol with it
Levels decline with age, stress and disease
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
Lower 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.

92. Cortisol and DHEA
Any Questions?

93. What Else Can Hormone Replacement Help?
Infertility, PMS, heavy bleeding
Insomnia—almost always helps
Heart failure
Mental disorders
Autoimmune 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 results
Questions about delivery and monitoring
Medical 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—retest
Repeat until stabilized at proper dose
Follow-up office visit once every 6 months, test only as needed.
Telephone and contact—charges for clinical decisions, refills, etc.

97. Costs
Physician time only as required--first year ~$200-$400; then <$200/yr.
No insurance billing; may submit claim for recognized diagnosis
Hormones—$10 to $70/month, some covered by insurance (GH adds $130/mo.)
Diurnal salivary cortisol test—$120
Blood tests—insurance may pay, lab kits $170-$220, Saliva/blood kit—$299
Out-of-pocket expenses tax-deductible

98. For More Information
The Miracle of Natural Hormones David Brownstein, MD
How to Achieve Healthy Aging—Look, Live, and Feel Fantastic After 40 Neal Rouzier, MD
The Hormone Solution—Stay Younger Longer Thierry Hertoghe, MD
Life Extension Foundation (
BHRT info. and hundreds of abstracts at
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