Download Hormones --- a control signal to

Synthetic vs. Bio-Identical
Hormones
Richard Adelman MD
Natural: definitions.
 1.
In accordance with what is found
or expected in nature.
 2. Produced or existing in nature;
real; not artificial or manufactured.
(Nature is neither good nor bad. It
can be exhilarating or excruciating.)
Where do replacement
hormones come from?
 Almost
all hormones are made
from soy beans. It used to be
Mexican yams.
 Some still comes from pregnant
horse urine. Premarin.
Steroid Hormones – small changes
make big differences
How can you call it bio-identical if it is
synthesized from soy beans in a lab?
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It is natural or bio-identical because it is
exactly the same as the molecules made by
and used by the human body. Def #1, not #2.
Our bodies manufacture steroid hormones
from cholesterol. Labs manufacture identical
hormones from sterol rings found in soy.
It’s the sameness of the molecules that is
important, the body doesn’t know the
difference. Synthetic or foreign steroids can
also be made from soy and often are.
Bio-identical Hormone Replacement
Richard Adelman MD
OB/GYN – in Panama City since 1984
Phlebology = Vein Specialist since 2004
Cosmetic Procedures: skin rejuvenation,
laser hair removal, botox, fillers,
liposuction, spider veins
Law School finished 1996
Why are you here? 2-11-09
First Suzanne Somers, and now Oprah Winfrey
have sung praises for bio-identical hormones
for menopause.
“For two years, Oprah suffered from
menopausal symptoms and a low thyroid
condition. She wasn't herself, and doctors she
had no answers. Three days after starting bioidentical hormones, her menopausal problems
were gone and she was singing praises. “
Thanks for the media buzz
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Bio-identical hormone use has enjoyed
growing popularity for 15 years.
Pioneered by Dr. John Lee and Dr. Joel
Hargrave and many others.
Given a boost by the 2002 WHI study
that destroyed any confidence in
synthetic hormones.
BIO-IDENTICAL HORMONES?
I
was introduced to bio-identical
hormones for menopause by Dr.
Randolph in Jacksonville 5 years
ago.
 That initial view has widened over
the years to include thyroid and
adrenal problems as well as men.
Two Goals Today.

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1. To show the logic of using the same
hormones for replacement as those
that the body makes and recognizes.
2. To consider the value of hormone
replacement when hormones fall as
part of the aging process -- to improve
quality of life and promote healthy
metabolism. (the opposite of disease)
Warning – science slides ahead
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Increasing knowledge about how hormones
act and interact with each other are changing
how we view their role in aging and illness.
Bio-identical hormone replacement is
worthless if it is a marketing gimmick, a cool
trend or “alternative.”
So the science is important (and explains
the superior results).
Hormones are more than hot flashes.
LIFE = Metabolism.
 Metabolism
is the set of chemical
reactions that occur in living
organisms in order to maintain life.
These processes allow organisms
to grow and reproduce, maintain
their structures, and respond to
their environments.
Tear Down and Build Up
 Catabolism
breaks down organic
matter, for example to harvest
energy in cellular respiration.
Anabolism, on the other hand,
uses energy to construct
components of cells such as
proteins and nucleic acids.
Hormones are control signals that
often work by regulating enzymes
The chemical reactions of
metabolism are organized into
metabolic pathways, in which one
chemical is transformed into another
by a sequence of enzymes.
 Enzymes also allow the regulation of
metabolic pathways in response to
changes in the cell's environment or
signals from other cells.

Hormones and Homeostasis
As the environments of most organisms are
constantly changing, the reactions of
metabolism must be finely regulated to
maintain an ideal set of conditions within
cells, a condition called homeostasis.
Hormones play important roles in this
regulation.
Long distance communication;
Hormones are messengers

Many cell signals are carried by molecules
that are released by one cell and move to
make contact with another cell. Endocrine
signals are called hormones. Hormones
are produced by endocrine cells and they
travel through the blood to reach all parts
of the body.
Summary:
Hormones are part of our bodies
control mechanisms.
They help the body to deal with a
changing environment by
regulating our metabolism toward
an optimal state.
Hormones bring the message by
binding or fitting into a receptor.
ANALOGY:
Hormones are keys. Bio-Identical hormones
are the correct keys. Altered hormones are
imperfect keys.
Receptors are locks. Our bodies can only
make natural receptors and will not begin to
make altered receptors because we take
altered hormones.
Hormone Receptor
Usually, only one hormone can fit
in a receptor and turn it on
strongly – each hormone/receptor
pair is unique.
A progesterone receptor typically
binds progesterone for a short
time. It directs the activity of
specific enzymes that create the
desired effect in the cell –
example: making mucin.
Receptor binding activities
Our very precise signaling system gets
gummed up by foreign hormones
This receptor is sitting on the
cell surface waiting … if the
right hormone comes and
binds then it will do its job.
If a foreign hormone
(synthetic hormone) comes
along it may bind too long
and cause a prolonged effect
or it may bind other types of
receptors as well.
Receptor binding activities
Progesterone vs. Provera
WHI 2002
Hormones help the body function
properly and that feels good!
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Doctors/patients should consider
hormone imbalance as a possible root
cause for many complaints. Fatigue.
Sleep disturbance. Weight gain.
Depression. Anxiety. Poor concentration.
Some phases in life are characterized by
falling hormones – menopause and less
dramatically andropause.
Hormone Evaluation
 Lots
of questions. 10 pages.
 Physical exam.
 Lab work.
considering hormonal systems
Adrenal Gland # 1
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“The General” – overpowers all
other hormone systems!
Fight or Flight. Survival first.
When cortisol is too often high
or low, nothing else works
properly either.
considering hormonal systems
Thyroid Gland #2
Basic metabolic control
 Is low thyroid function very common?
 Lab tests often fail to confirm low
thyroid symptoms and this suggests
that thyroid test normal ranges are
faulty. TSH normal (0.4-4.5) but
optimal is (0.4-2.0).
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considering hormonal systems
Ovaries and Testes #3
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estrogen, progesterone and testosterone are
found in both male and female
Progesterone and testosterone are often low
in both menopause and andropause
Estrogen falls in menopause but not as
dramatically as progesterone
High estrogens may be present in older
women and men and are worrisome
(increased cancer initiation and growth)
Lab work – confirms clinical diagnosis
No testing in the past for ovarian hormones!
Blood testing. Necessary for thyroid testing.
Pretty good for men.
Saliva testing. Very convenient. Good for
steroid hormones. A huge data base of
samples/symptoms of both untreated and
treated patients.
No pills.
The portal circulation refers
to the arrangement of
vessels that bring
substances absorbed from
the gut to the liver before
they go into the general
circulation.
Drugs taken as pills go to
the liver which changes
them into unwanted
metabolites.
Gonads deliver hormones into the
general circulation. So do skin creams,
patches, shots and pellets. Not pills.
Typical Replacement -- Women
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Pre-menopause: progesterone. Starts
falling in the 40s.
Natural menopause: progesterone and
often estrogen. Sometimes testosterone
for low energy and low libido.
Ovaries removed: same but more
dramatic and more likely to need
testosterone.
Typical Replacement – Men.
Testosterone. Patches, injections or
pellets.
 Estrogen often high and needs to be
reduced. DIM. Calcium D glucarate.
 Progesterone. Blocks conversion to
DHT.
 Monitor PSA. Prostate cancer 1:6.
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Why do we treat?
 Alleviate
the problems caused by
hormone deficiencies.
 Live while you live.
Know the reason for replacement
Thank You for your attention.
 Questions?
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