Bioidentical Hormone Restoration

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Hormone Restoration

Medically Necessary Safe Improves Health and Quality of Life Prevents and Treats Many Diseases Restores Sexuality Reduces need for: Blood sugar, blood pressure, cholesterol meds Anti-depressant, anti-anxiety, pain, sleep meds Osteoporosis meds

Hormones

Neuro-endocrine-immune system Travel via blood to tissues

Control

cellular metabolism, functions The most

powerful

molecules in biology

Optimal

levels are

Essential

for Health

Bioidentical:

Same molecular structure as our natural hormones

Gonadal Steroids: Not Just “Sex Hormones”

Estradiol, Progesterone, Testosterone Essential

to

all

tissues in

both sexes

!

Brain function Immune system Blood vessel health Blood lipids, clotting factors Connective tissue—

skin, hair, muscle, bone

GH, FSH, LH, TSH, and ACTH control other glands Insulin Testosterone CRH, TRH, etc. control pituitary T4, T3 Cortisol, DHEA, Aldosterone, Pregnenolone Adrenalin Estradiol, Progesterone Testosterone

Bioidentical Hormones are NOT Drugs

Inherently safe

,

Non

toxic Proper

fit

in receptors, easily eliminated

No No

allergic reactions “side effects” Monitor dose with usual blood tests Only potential problems : Excessive dose Lack of

balance

with other hormones Unphysiological delivery: route, timing, etc.

The

Tyranny

of the Lab Report

Reference Range=

95% of the population NOT

the

optimal range

for any person

Male

free testosterone: 35-155

Female

free testosterone:

0.0

-2.2

Free T4: 0.6-1.8

5x!



!

3x!

AM serum cortisol 5-25

5x!

Within RR:

pharmaceuticals for symptoms

Below RR

(<97.5%): replace to within-RR

Disease/No Disease

instead of

Continuum

Hypometabolism

—Thyroid and Cortisol

Insufficiencies Thyroid sets throttle Cortisol delivers the fuel Insufficiency  reduced metabolic rate 

fatigue, brain dysfunction, depression, pain

Usual tests are

insensitive

Optimization improves health and quality of life

Cortisol

Adrenal glands Maintains blood sugar (delivers the fuel) Modulates immune system, brain function Need

higher

amounts with stress, disease Too much  Diabetes, HTN, osteoporosis Too little  hypoglycemia, fatigue, depression, aches, autoimmune diseases, allergies

Insufficiency

more prevalent than

excess

!

Mild-to-Moderate

Cortisol Insufficiency

Central:

brain (H-P) fails to maintain levels

Common

cause of chronic fatigue, pain

Clue:

Mood, energy improved on prednisone

Saliva testing

reveals

free cortisol

levels at 4 times during a normal day

Normal Saliva Cortisol Profile

Cortisol Insufficiency

Common Dysfunctional Pattern

Cortisol Restoration

Mild—  hormones stress,  rest, nutrients, other

Moderate-to-severe

—

cortisol restoration Low physiological doses are safe

40 years’ experience: see Dr. Jeffries’

Safe Uses of Cortisol

Thyroid Hormones T

4 

T

3 Maintain metabolism, mood, and energy

T 4

(Synthroid  , Levoxyl  ) is bioidentical, but must be converted to

T 3

Thyroid gland makes

T 4

and

T 3

; we should restore both hormones Can have thyroid hormone resistance

Continuum: Higher Thyroid Hormone Levels within the RRs:

50% reduction in severe atherosclerosis 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 Relieves depression Helps weight loss

Continuum: Weight vs. Free T

4

Within the RR

J Clin Endocrinol Metab July 2005, 90(7):4019-4024

Thyroid

Insufficiency Mental fog Fatigue, depression, anxiety Cold extremities Aches and pains Hair loss, esp. in women Weight gain Constipation Puffy ankles and face Elevated cholesterol

Diagnosing Thyroid

Insufficiency Signs and Symptoms

T 3 plus

free

T 4

or free levels below mid-point of RR High TSH = thyroid gland failure Normal/Low TSH = H-P dysfunction Trial of thyroid hormone supplementation using

T 4

and

T 3

The Fatigue, Fibromyalgia, and Depression Epidemic Pre-1970s: T 3 and T 4 for symptoms Post-1970s: T 4 -only to “ normalize ” TSH Doses lowered by 30-50% TSH “normalizing”

T 4

dose  low free

T 3

, weight gain, persistence of symptoms People with fatigue, fibromyalgia, and depression often improve with

T 3 /T 4 optimization

Cortisol and Thyroid Optimization

Any Questions?

The Controversy

What do we do about hormones lost to normal aging ?

Adrenopause

DHEA-S Levels with Age

Somatopause

Growth Hormone (GH)

J Clin Endocrinol Metab 1999; 84(6):2013-2019

Thyropause Free T 3 Endocr Rev. 1995 Dec;16(6):686-715

Male Andropause—

Testosterone

Baltimore Longitudinal Study of Aging (BLSA). Harman et al., 2001

pg/ml 8000 7000 6000 5000 4000 3000 2000 1000 0

Andropause

vs.

Menopause

Men Women

Testosterone Estradiol

Young ♂ Old ♂

Progesterone average

Young ♀ Old ♀

DHEA-S 5,000,000pg/ml Cortisol 100,000 pg/ml!

T P E

Conventional View of

Aging The loss of hormones is

adaptive

Higher levels cause heart attacks , breast and prostate cancers

Pharmaceutical Corporation Agenda

:

Take drugs

instead of replacing hormones.

Against the Conventional View

Aging

is an

auto-destruct program.

Starts around age 25!

Glands

and

 control systems in weight, BP, cholesterol,

deteriorate

cancers , heart attacks , autoimmune diseases , etc.

Occur

years after

hormone

losses

begin Occur

more often

in those with

lower

levels Hormone restoration improves parameters, does not cause increased disease.

Women

Killers Cardiovascular disease (CVD), breast cancer and osteoporosis are

rare

in

premenopausal

women They begin in

perimenopause

when progesterone and testosteron e are

low

.

After menopause, CVD rises faster than in men Higher risk than men after 65 Higher mortality after 70 Surgical menopause  2-7x risk of heart attacks Engl J Med 1987 Apr 30;316(18):1105-10 Am J Obstet Gynecol. 1981 Jan;139(1):47-51.

DHEA—Most Abundant Steroid

Precursor of testosterone and estradiol Lower levels assoc. with  risk of death, disease Anabolic —builds tissues, improves immunity Reduces

pain

by increasing endorphins Anti-inflammatory Improves immune system function Anti-atherosclerotic Reduces platelet aggregation--blood clotting Anti-cancer effects

Male

Andropause

:“Just Gettin’ Old”

Testosterone levels decline slowly Fatigue Reduced mental function Passivity and moodiness Loss of muscle and bone mass Increased abdominal fat Loss of libido, no spontaneous morning erections

Testosterone is Your Friend

Improves mood and sociability Improves energy Improves cognition, protects against Alzheimer’s disease Neurology. 2004 Jan 27;62(2):188-93.

Improves libido and erectile function Increases muscle and bone mass Reduces abdominal fat, improves insulin sensitivity, lowers blood pressure- counteracts metabolic syndrome

Testosterone is Good for your 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):749-54

T

dilates coronary arteries

T

improves endothelial function

T

increases heart muscle size, strength

T

decreases fibrinogen levels—prevents blood clots Endocr Res. 2005;31(4):335-44

Testosterone Does Not Cause Prostate

Cancer Testosterone point.

promotes prostate growth to a Castration slows prostate cancer temporarily.

Men with higher

T

risk of levels prostate cancer.

don’t

growth have higher Testosterone restoration does not increase the risk of prostate cancer .

Low

T

levels associated with

more aggressive

prostate cancers .

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? Morgentaler A. Can J Urol. 2006 Feb;13 Suppl 1:40-3

Hormones and

Aging

Testosterone For Men

Any Questions?

Coming up: Estradiol, Progesterone, and Testosterone for Women

Female Endocrinology: Balance in a Complex System

Reproduction

makes special demands on the female body Breasts, uterus and ovaries undergo a

monthly cycle

of proliferation and breakdown No similar process in males

Defects

in this cycle can lead to cancers and other medical disorders.

Estrogen—Progesterone Complementarity in Women

Estrogen promotes tissue proliferation and growth Progesterone stops proliferation and promotes differentiation Differentiated cells can’t become cancers High average progesterone/estrogen ratio prevents cancers

Anti-Estrogenic Actions of Progesterone

Decreases synthesis of estradiol receptor molecules Increases conversion of estradiol to estrone (weak estrogen) in tissues Inhibits conversion of estrone to estradiol Increases sulfation of estrogens (inactivation) Williams Text. of Endocrinology, 10 th Ed., p. 612

Normal Cycle and Balance

Ovulation

Menstrual Cycle

Perimenopause Luteal Insufficiency=Estrogen Dominance

Ovulation

Inadequate Luteal Phase

shorter periods, early spotting

Menstrual Cycle

Perimenopause Anovulation with Estrogen Dominance High estrogen, low progesterone



’d risk of cancer Menstrual Cycle

Menopause Estrogen and Progesterone Deficiency

Imbalance: Estrogen Dominance

Allergies Autoimmune disease 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/painful menses Migraines Seizures Endometriosis

Perimenopause is

Dangerous Females born with a

fixed

uterine cancer no. of oocytes (eggs) Aging  fewer oocytes of lower quality are left  reduced progesterone production  estrogen dominance

Anovulation

 no progesterone  estrogen dominance  breast and

Menopause:

Estradiol Deficiency

Irritability, depression, insomnia,  ’d risk of Alzheimer’s dz.

Fatigue, aches and pains Genital atrophy Loss of libido Atrophy and wrinkling of skin  BP,  LDL cholesterol,  heart disease Osteoporosis

Female Andropause

Female

50%

testosterone levels decline between age 20 and 45. Menopause. 2003 Sep-Oct;10(5):390-8 Birth control pills and menopausal HRT  25 to 40%  in free testosterone and DHEAS levels Obstet Gynecol. 1997 Dec;90(6):995-8 DHEA declines with age —main source of androgens

Testosterone for Women

Improves energy, mood Reduces anxiety Improves sexual function Increases muscle strength, stamina 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

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

Osteoporosis

In menopause

5%

of bone mass is lost each year for first 5 years=

25% 50% of women

>65 yrs. old have spinal compression fractures

14% lifetime risk of hip fracture

50 yr.old woman,

30%

for for 80 yr. old.

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

Osteoporosis

A

hormone deficiency

disease (incl. Vit. D) Estradiol controls resorption of old bone Testosterone , progesterone , DHEA , and GH

build

new bone J Clin Endo Metab. 1996; 81:37-43 J Reprod Med. 1999 Dec;44(12):1012-20 Combined hormone restoration density better than Fosamax  increases bone

and

preserves normal bone remodeling

Perimenopause and Menopause and Their Disorders

Any Questions?

Coming: The Problems with “HRT”: Breast Cancer , Strokes , and Heart Attacks

So Why is Everyone Saying that Hormone Replacement is

Dangerous

?

Q: What “hormones”? Given how?

Bioidentical Human Steroid Hormones

Complex Interactive System

Testosterone Estradiol Progesterone DHEA Do Not Substitute Cortisol

“HRT” has Always been Hormone

Substitution!

Pregnant mare’s urine: Premarin  in 1942 Progesterone synthesized in 1942, altered to make “ progestins ” “HRT” = pills containing

alien

molecules Drug Co.s pushed doctors to use hormone substitutes and ignore bioidenticals !

Confusion:

Beware of the “HRT” Literature!

“Estrogen”

means anything with estrogen like effects

“Progesterone”

like Provera  , often used for levonorgestrel “progestins” , etc.

“Testosterone”

can mean alien molecules like methyltestosterone

Biochemistry 101:

Different molecules are not the same and do not have the same effects!

Premarin  :

Close, but Not Human

Human Horse

Estradiol-17β Dihydroequilin-17β

CEE contains at least 10 estrogens, only 3 are found in humans . CEE is similar to human estrogens and has similar benefits .

The Problems with

Oral

Estrogens

First-pass effect on the liver  IGF-1 (growth hormone),  SHBG,  CRP  clotting factors  blood clots and strokes Transdermal estradiol has none of these effects—does not cause blood clots! Circulation. 2007 Feb 20;115(7):840-5

Birth Control Pills: Very

Unnatural

Estradiol Ethinyl Estradiol Acetylene

EE cannot be inactivated by normal oxidation!

EE does not interact with estrogen receptor  !

Oral EE is more thrombogenic than Premarin  or estradiol

The BIGGEST Problem

:

Progestins Progesterone MPA (Provera



) Megestrol



Many Doctors Do not Know the Difference!

Scientific studies show that:

Progesterone



Provera

 • Maintains pregnancy • Improves mood • Improves sleep • Diuretic • Lowers blood sugar • Maintains estradiol-induced arterial dilation • Improves lipid profile • Prevents heart attacks • Reduces estrogenic stimulation of breasts • Decreases risk of breast cancer • Causes birth defects • Can cause depression • Insomnia, irritability • Fluid retention • Raises blood sugar • Reduces estradiol-induced arterial dilation • Worsens lipid profile • Causes heart attacks • Increases estrogenic stimulation of breasts • Increases risk of breast cancer

Progestin

Zoo Provera



Progesterone

Kuhl, Climacteric 2005;8(Suppl 1)

2002 WHI Study:

“HRT”

is

Dangerous!

>30 studies showed long term protection against heart disease with Premarin  WHI: 60-70 y.o.’s started on “HRT” Premarin  caused adverse effects in the

first year

( blood clots Adding Provera  and (Prempro strokes  ) ). caused many more adverse effects ( breast cancers and heart attacks ). Large increase in dementia —probably vascular in origin

Progestins

cause

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

.” Thomas T, Rhodin J, Clark L, Garces A. Progestins initiate adverse events of menopausal estrogen therapy. Climacteric. 2003 Dec;6(4):293-301.

Cardiovascular Disease

My Conclusions:

Youthful levels of steroid hormones

protective

.

Estradiol and progesterone are more protective than testosterone Oral , not transdermal, estradiol increases the risk of thrombi and strokes Estradiol

reduces

atherosclerosis in the long run.

Some progestins inflammation , cause persistent endothelial atherosclerosis , and  clotting .

Best Preventative Strategy—maintain youthful levels of sex-steroid hormones!

Breast Cancer:

Verdict: Progesterone is Innocent

“The balance of the in vivo evidence is that progesterone does not have a cancer-promoting tissue.” effect on breast

Progestins and progesterone in hormone replacement therapy and the risk of breast cancer. J Steroid Biochem Mol Biol.

2005

Jul;96(2):95-108.

That’s the conservative interpretation of the evidence!

In Fact: Progesterone Prevents

Breast Cancer

55,000 women 8 years f/u

c/w WHI- 16,000, 6 yr. f/u No Hormones

TD-E2=Transdermal Estradiol E3N-EPIC Cohort study

Int J Cancer. 2005 Apr 10;114(3):448-54

More Progesterone=Less

Breast Cancer

6,000 women 5 yr. F/U

Less Breast Cancer More Progesterone ORDET Study: Int. J. Cancer 112 (2004) (2), pp. 312–318. See also Cancer Causes Control. 2004 Feb;15(1):45-53.

Many Kinds of Evidence

Progesterone breast tumors prevents estradiol -induced in rats as well as Tamoxifen  Jpn J Cancer Res. 1985 Aug;76(8):699-704 Premenopausal women with low 5.4 times greater risk of early P levels had breast cancer Am J Epidem 1981; 114:209-17 Breast cancer victims have signs of progesterone resistance Br J Obstet Gynaecol. 1998 Mar;105(3):345-51.

More Evidence

Estradiol cream applied to the breast induces proliferation , adding progesterone reduces proliferation to baseline Fertil Steril 1995; 63:785-91 Estradiol upregulates cancer-promoting gene bcl-2, progesterone downregulates it.

Ann Clin Lab Sci. 1998 Nov-Dec;28(6):360-9

In vitro

: adding progesterone estradiol -induced proliferation eliminates and cancers in normal breast cells Eur J Cancer. 2000 Sep;36 Suppl 4:S90-1 J Steroid Biochem Mol Biol. 2000 Jun;73(3-4):171-81

Testosterone Prevents

Breast Cancer

in Estradiol-Replete Women

Testosterone opposes estradiol-induced breast stimulation .

Menopause. 2003 Jul-Aug;10(4):292-8 Endocr Rev. 2004 Jun;25(3):374-88.

FASEB J. 2000 Sep;14(12):1725-30.

Addition of testosterone to estrogen/progestin reduces breast cancer incidence to baseline.

Menopause. 2004 Sep-Oct;11(5):531-5 Testosterone and DHT inhibit

in vitro

growth of breast cancer cell lines.

Gynecol Endocrinol 2002; 16: 113-120 Testosterone is an effective treatment for breast cancer .

Cancer Detect Prev. 1992;16(1):31-8(review)

Breast Cancer

My Conclusions:

Estradiol promotes breast cancer .

Some progestins promote breast cancer .

Progesterone and testosterone help prevent breast cancer .

Estradiol restoration

is

safe if

accompanied by sufficient

progesterone

and

testosterone

to restore youthful

balance .

Hormone Restoration for Women

Keeping a woman

premenopausal

by restoring hormones in the

most physiological way

and

in natural balance

should be considered

beneficial

until proven otherwise.

Since menopausal hormone deficiencies are

known

to be

harmful and to diminish quality of life ,

those who would

deny

women the

restoration

of their hormones have the

burden of proof that there is harm

that outweighs the

benefits .

Where Do They Come From?

Chemically synthesized from diosgenin (wild Mexican yams and soy) Compounding pharmacists prepare creams, tablets, etc. using USP-certified hormones

FAR less expensive

and

more convenient

than similar FDA-approved comm. products

Wyeth Corp. Propaganda: What Your OB/GYN is Told

ACOG NEWS RELEASE

October 31, 2005 The American College of Obstetricians and Gynecologists

Washington, DC

- There is no scientific evidence to support claims of increased efficacy or safety for individualized estrogen or progesterone regimens prepared by compounding pharmacies ,… all of them should be considered to have the same safety issues as those hormone products that are approved by the FDA (including Prempro  , BCPs) and may also have additional risks unique to the compounding process… Furthermore, hormone therapy does not belong to a class of drugs with an indication for individualized dosing …

ACOG to Women: Suffer from Deficiencies or Die from Our Substitutes!

“HRT”

,

Breast Cancer

,

Strokes,

and

Heart Attacks Any Questions?

What Else Can Hormone Restoration Help?

Infertility, PMS, heavy bleeding Headaches and insomnia—almost always Heart failure, angina Mental disorders Autoimmune diseases (SLE, rheumatoid arthritis, ulcerative colitis, Crohn’s, etc.) Intra-abdominal fat (pot belly) Allergies, skin diseases

Every

disease/disorder?!

Doing HR

Cost—Hourly rate Forms available online Initial visit: order tests F/U visits: Review results—prescribe—retest Repeat until stabilized at proper dose Follow-up office visit every 6 months, test only as needed.

Telephone Consults—same hourly rate E-mail—usually no charge

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: www.lef.org

Hormonerestoration.com

.

[email protected]

Office: 570-836-0359