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Bioidentical
Hormone Restoration
Best Medical Practice
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Topics
Introduction
The Problem with Reference Ranges
Hypometabolism: Cortisol and Thyroid
Hormone Loss with Age
Estradiol and Progesterone for Menopause
Progesterone prevents Breast Cancer
Pharmaceutical Hormone Substitution
Testosterone for Women and Men
Compounding Pharmacies
Practical Issues
Hormones
Parts of our integrated neuro-endocrineimmune system
Travel via blood to all cells
Control cells’ 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
Central Control
Master Gland
TSH
T3, T4
Cortisol, DHEA
Aldosterone
ACTH
LH/FSH
Testosterone
Estradiol, Progesterone
Testosterone
Human Steroid
Hormones
Bioidentical Molecules
Testosterone
DHEA
Estradiol
Progesterone
Aldosterone
Cortisol
Drug companies have patented ~5 to 200 variations of each molecul
Bioidentical Hormones are
not Drugs
Correct molecular structure—same action
at receptors, same metabolism and
elimination
Non-toxic:
No side effects, only effects
No interactions with drugs
No allergic reactions
Safe in youthful physiological levels/balance
Negative effects: Due to excessive dose,
wrong delivery method, or imbalance with
Bioidentical Hormone
Restoration is Good Medical
Practice
If a hormone is missing, replace it!; if
present but deficient, optimize it!
Type 1 Diabetes: bioidentical insulin
Hypothyroidism: bioidentical T4
Growth hormone def.: bioidentical GH
Adrenal insufficiency: bioidentical cortisol
The Controversies:
How do we diagnose deficiency?
How do we decide which dose is right?
What do we do about deficiencies due to
aging?
Why Docs Don’t Get It:
Reference Range
Endocrinology
“Normal” ranges on reports are
misunderstood:
May
mean
95% of all persons tested (only 2.5% low)
or 95% of tested persons of same age
or Optimal values (glucose, cholesterol)
Docs assume that all ranges are optimals!
Male free testosterone: 35-155
Female free testosterone: 0.0-2.2
Thyroid - Free T4: 0.6-1.8
AM serum cortisol 5-25
5x!
!
3x!
5x!
“Normal” resultno hormonal dx/rxdrugs
Reference Range Endocrinology
95% population range
Hormone Effect
0
FT4 ng/dL
“Everything is
“No Thyroid Disease”
Normal”
Too much
Disease
But Hormone Effects vary
continuously with
concentration!
0.6
1
1.8
Hormone Level
2
Intelligent Endocrinology
Tighter range based on young healthy persons and on physiological
research
Individualized Diagnosis and Treatment
Hormone Effect
0
FT4 ng/dL
Optimal??
1
1.3
Hormone Level
1.6
2
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
Conventional tests are insensitive to most
deficiencies
Irrational fear of thyroid and cortisol
supplementation
Underdiagnosed, undertreated—Docs prescribe
pharmaceuticals instead (SSRIs, amphetamines,
Glucocorticoids (“Steroids”)
Cortisol
(hydrocortisone)
Methylprednisolone (5x)
Medrol®
Dexamethasone
(70x)
Prednisone (4x)
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, aches & pains,
anxiety, hypoglycemia, autoimmune diseases,
allergies
Women have lower cortisol levels/effects than
men, much greater incidence of cortisol
Mild-to-Moderate
Cortisol Insufficiency
Serum cortisol and ACTH stimulation tests are
insensitive, need to do saliva testing throughout
day
Unrecognized: Docs taught to recognize only
Addison’s Disease (total adrenal gland failure)
Common cause of chronic fatigue, pain
Common cause of thyroid hormone intolerance
Clues: Feels much better on prednisone, often
needs steroids for allergies, illnesses, etc.
Normal Saliva Cortisol Profile
Cortisol Deficiency
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
Doctors fear of low-dose cortisol unfounded
See Dr. William Jeffries’ Safe Uses of Cortisol
DHEA
Most abundant steroid hormone; yet ignored
Cells make testosterone and estradiol with it
Counteracts cortisol, the two must be in balance
Cortisol supplementation lowers DHEA, must
replace
Anabolic—builds tissues, improves immunity
Reduces intra-abdominal fat
Reduces pain—restores natural endorphins
Reduces inflammation (IL-6, TNF-, IL-2)
Anti-cancer effect in animal, in vitro studies
Bioidentical Hormones,
Reference Ranges,
Cortisol and DHEA
Any Questions?
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
Thyroid Testing
Doctors often order only a TSH test--Inadequate
Thyroid stimulating hormone (TSH) is a pituitary
hormone. It is NOT a thyroid hormone, it is not a
measure of thyroid hormone levels.
Must test free T4 and free T3 levels
Hypothyroidism: symptoms plus one or both
hormone levels below middle of reference
ranges
Severe hypothyroidism: signs and symptoms
plus both hormones in lower third of ranges.
We Need Optimal T3 Levels
Incidence of severe atherosclerosis doubled
with lower T3 levels within the reference
range
Clin Cardiol. 2003 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
Fatigue, Fibromyalgia and
Depression Epidemic
Fatigue, fibromyalgia, and depression are due to
low cortisol and/or low thyroid until proven
otherwise
Pre-1970s: Treat the patient’s signs and
symptoms with T4 and T3 (desiccated thyroid-Armour )
Post-1970s: Treat TSH test using T4 only!
Doctors often lowered doses by 30-50%!
TSH-normalizing T4 dose oftenlower free T3
levels weight gain, persistence of symptoms
Thyroid optimization helps most patients with
Rational Thyroid Restoration
If sign/symptoms of hypothyroidism: Restore!
Do not rely on TSH test for diagnosis or
treatment Fraser WD, Are biochemical tests of thyroid function of any value in
monitoring patients receiving thyroxine replacement? Br Med J (Clin Res Ed). 1986
Sep 27;293(6550):808-10
Give T4 plus T3 (Armour, Cytomel+T4)
Adjust dose according to symptoms and free
hormone levels
Safe:
No bone loss if Vit. D and hormones are
restored
No cardiac abnormalities J Clin Endo Metab. 2000 Jan;85(1):159-64
Thyroid Restoration
Any Questions?
What should we do
about hormones that are
lost to normal aging?
Adrenopause
DHEA

DHEA-S
J Clin Endocrinol Metab. 1997 Aug;82(8):2396-
Thyropause
Endocr Rev. 1995 Dec;16(6):686-
120
80%
decline
100
715
TSH response to low T4 (2.7-3.2g/dL)
80
60
TSH
40
20
0
B-19yrs
20-39yrs
40-59yrs
60-79yrs
80-99yrs
Carle, Thyroid. 2007 Feb;17(2):139-
Somatopause
Growth
Hormone (GH)
Clinical Chemistry 48, No. 12,
Andropause
Testosterone in Men
Steroid Loss in Women>>Men
8000
7000
6000
5000
pg/ml
4000
3000
2000
1000
0
Men
Testosterone
50% loss
Women
Progesteron
e
average
90% Loss
T
P
E
Young ♂ Old ♂ Young ♀ Old ♀
Less
estrogen
than
old men!
DHEA-S 5,000,000pg/ml Cortisol 100,000 pg/ml
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 (!?!)
Against the Common View
Aging is a natural 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!!
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!
Aging and Hormones
Any Questions?
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: prevent diabetes, fatty
liver
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.
Coronary Heart Disease vs.
Age
Female
Menopause
AIHW Heart, stroke and vascular diseases - Australian facts
Estrogen Replacement and
CAD
Prior to WHI Study
Oral conjugated equine estrogens (CEE)
shown to reduce risk of heart disease in 40
observational and case-control studies, and
one randomized study
Four angiographic studies: Estrogen reduced
atherosclerosis 50-80%.
EPAT: RPC trial showed less increase in
carotid intimal thickness with CEE vs.
placebo.
But there is a problem with oral estrogens…
Estrogen Replacement
Prevents Alzheimer’s
Disease
Longer Estrogen Use
Women without
Estrogen
Men
72% used Premarin only
Zandi PP, et al., Cache County Study. JAMA. 2002 Nov 6;288(17):2123-9.
RR 0.46 in Kawas C, The Baltimore Longitudinal Study of Aging. Neurology 1997;48:1517-1521
RR 0.65 Paganini-Hill A, Arch Intern Med 1996;156:2213-2217.
RR 0.4, Tang M-X, Lancet 1996;348:429-432.
30
Speroff L, Fritz M Clinical Gynecologic Endocrinology and Fertility, 7th Ed.
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.
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. 1999
Dec;44(12):1012-20
Hormone restoration including Vit. D
increases bone density better than
bisphosphonates and preserves normal bone
remodeling
Bisphosphonate drugs cause Ca++,
esophageal inflammation and cancer, pain, and
Female Endocrinology
Nature makes special demands on the
female body for reproduction.
Much 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.
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. 1986
Jun;10(6):382-93
High progesterone/estradiol ratio suppresses
proliferation and prevents cancers
Progesterone’s Anti-Estrogenic
Actions in Uterus and Breast
Decreases synthesis of estradiol receptors
Increases conversion of estradiol to estrone
(weak estrogen) by inducing 17βhydroxysteroid 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
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
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
Normal Progesterone Dominance
Ovulation
Ovulation
Menstrual Cycle
Perimenopause
Luteal Insufficiency=Estrogen Dominance
Inadequate Luteal Phase
shorter periods, early spotting
’d risk of breast cancer
Ovulation
Menstrual Cycle
Anovulation=Estrogen Dominance
’d risk of breast and
uterine cancers
Menstrual Cycle
Menopause
Estradiol and Progesterone Deficiency
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
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
Q: OK, estradiol restoration has
many benefits, but won’t it
increase the risk of breast
cancer?
A: Not if progesterone is also
restored.
E3N-EPIC Study
TD-E2=transdermal estradiol
Cohort study
55,000 women
8 years f/u
c/w WHI-16,000, 6 yr. f/u
No HRT
Int J Cancer. 2005 Apr
10;114(3):448-54
E2 plus progesterone: no increased risk of breast
See also: De Lignieres B, de Vathaire F, Fournier
S, et al. Combined hormone replacement therapy and risk of
cancer!
breast cancer in a French cohort study of 3175 women. Climacteric 2002;5:332–40.
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
Progesterone vs. Breast
Cancer
Progesterone cream applied to the breast
reduces proliferation.
Chang KJ,
Fertil Steril 1995; 63:785-91
Biol Reprod (Paris). 1990;19(3):269-74
JM, Fertil Steril. 1998 May;69(5):963-9
Barrat J, J Gynecol Obstet
Foidart
Estradiol is carcinogenic in breast cell
cultures unless progesterone is present.
Russo J, J Steroid Biochem Mol Biol. 2003
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. 2000 Jun;73(3-4):171-81
Foidart JM, Fertil Steril.1998
May;69(5):963-9
Estrogen upregulates cancer-promoting gene
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. 1998 Mar;105(3):345-51
Progesterone decreases proliferation and
induces apoptosis in breast cancer cell lines.
Feb;25(1A):243-8
Oct;11(11):1593-607
Ansquer Y, Anticancer Res. 2005 JanGroshong SD, Mol Endocrinol. 1997
Progesterone receptor positivity predicts better
long-term survival with breast cancer
Costa SD, Eur J Cancer. 2002
Jul;38(10):1329-34
Nov;76(1):65-71
Lamy PJ, Breast Cancer Res Treat. 2002
Key: Hormones within the
Breasts
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. 2005 Mar;90(3):1686-91
Breasts produce estradiol locally from adrenal
androgens (DHEA, androstenedione)
Breasts must get progesterone from blood, and
they concentrate it by a factor of 3 to 4x.
Gann PH, Cancer Epidemiol Biomarkers Prev. 2006 Jan;15(1):3944
In peri-menopause/menopause: No
progesterone estrogen dominance in the
breastsbreast cancer.
Breast Cancer Rate vs.
Age
Loss of ovarian functionhigher risk of breast cancer
Menopause
Ovarian function
National Cancer Institute. SEER cancer statistics review 1975-2002. Table IV-3.
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. 2005 Sep 16;52(1):1-10.
So why are most doctors
saying that hormone
replacement for
menopause is dangerous?
Pharmaceutical “Hormone
Replacement Therapy”
Horse-urine Premarin approved in 1942
Synthesis of first human steroid hormone,
progesterone, in 1942. 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—Pharm. Corps. pushed
doctors to use hormone substitutes and to
ignore or fear natural hormone restoration!
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 (MPAProvera) and 30+ other “progestins”
Testosterone substitute: methyltestosterone
Patented drugs—not human hormones!
Most docs don’t know the difference!
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
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
UpToDate 2006
Instead of using BCPs::
Diagnose and fix the hormonal disorder
Use a copper IUD for contraception

Premarin
Conjugated Equine Estrogens
Human
Horse
Estrone
Equilin
Horse
Equilenin
CEE contains at least 10 estrogens, only 3 are human; also
contains horse androgens and progestins.
Klein R The Composition of Premarin. 1998 Int J
Fertil 43:223
Oral Estrogens are 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. 2007 Feb
20;115(7):840-5
Transdermal estradiol improves insulin
sensitivity, oral estrogens do not.
Progestins  Progesterone
Provera
Progesterone
Drospirenone

Prempro
Yasmin
Confusion:
Progestins are often called “progesterone”, even in
scientific papers!
Progestin Zoo
~200 of them!
progesteron
e
Kuhl, Climacteric 2005;8(Suppl 1
Every progestin has a different spectrum of androgenic,
estrogenic, glucocorticoid, and progestational effects!
Scientific studies show that:
Provera
•
•
•
•
•
•
•
•
•
•

Causes birth defects
Can cause depression
Insomnia, irritability
Fluid retention
Raises blood sugar
Counteracts estrogeninduced arterial dilation
Worsens lipid profile
Causes heart attacks
Increases estrogenic
stimulation of breasts
Causes breast cancer
Progesterone
•
•
•
•
•
•
•
•
•
•
Maintains pregnancy
Improves mood
Improves sleep
Diuretic
No effect on blood sugar
Maintains estrogeninduced arterial dilation
Improves lipid profile
No evidence of  CVD
Reduces estrogenic
stimulation of breasts
Prevents breast cancer
2002 WHI Study—“HRT” 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!
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.”
Your doctor has been told that No differences exist between
any: women, estrogens, progestins, bioidentical and alien
molecules, or oral vs. transdermal estrogens. All “hormone”
therapies the SAME!
ACOG is funded by Pharmaceutical Corporations that
make the hormone substitutes.
ACOG’s physicians individually receive money from
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!
Menopausal Hormone
Restoration
Daily transdermal estradiol combined with
progesterone (sublingual, transdermal). May
stop for 5 days each month.
No need to cycle and bleed—uterine lining
remains thin.
Replace hormones for the rest of one’s life
Most women need testosterone and DHEA
for optimal results.
Estradiol and Progesterone
Restoration for Menopause
Any Questions?
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
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. 1999
Dec;44(12):1012-20
Probably decreases risk of heart attack
J Womens Health. 1998
Sep;7(7):825-9
Opposes estradiol-induced breast stimulation
and reduces risk of breast cancer
Menopause.
2003
Jul-Aug;10(4):292-8,
Menopause.
2004
Sep-Oct;11(5):531-5,
Endocr
Rev.
2004
J.
2000
Jun;25(3):374-88
Sep;14(12):1725-30
FASEB
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.
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 (Syndrome
X)
Testosterone and the Heart
Low testosterone levels correlate with
coronary artery disease and stroke
Arterioscler Thromb. 1994; 14:701-706
Eur Heart J 2000; 21; 890–4
Int J Cardiol. 1998 Jan 31;63(2):161-4
Arterioscler Thromb Vasc Biol. 1996 Jun;16(6):74954
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
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. 2008 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.
2006 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.
Prostate cancer growth can be temporarily
slowed only by eliminating testosterone from
Testosterone for Women
and Men
Any Questions?
Growth Hormone
Declines 14% per decade after age 25
IGF-1 of many adults equal to hypopituitary
patients (only 80-110 vs. 300 @25yrs.old)
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
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!!
Where Do They Come From?
All steroid hormones (including substitutes)
are chemically synthesized from diosgenin
(wild Mexican yams, soy, and other plants).
Compounding
Pharmacies
USP-certified bioidentical hormones mixed
into creams, sublingual tablets, capsules.
Convenient, low cost, locally made
Individual preparations not studied, the
hormones themselves are extremely wellstudied.
Winola Pharmacy—Rt. 307 at Lake Winola,
378-2885
Harrold’s Pharmacy—W-B, 822-5794
Fino’s Pharmacy—Dallas, 675-1141
Hazle Drugs—Hazelton 1-800-439-2026
Controversies
Best delivery methods
Ideal doses
Variations in absorption among 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.
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,
thyroid/cortisol adjustments can take many
months
Follow-up office visits as needed; at least
every 6 months initially, once/year when
stable.
Telephone follow-ups as needed. Brief e-mail
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
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 (www.lef.org)
Information and hundreds of abstracts at
www.hormonerestoration.com.
Contact me:
[email protected]