Transcript Natural Hormone Replacement Therapy

Bioidentical
Hormone Restoration
Best Medical Practice
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Hormones
Neuro-endocrine-immune system
Travel via blood to tissues
Control cells’ metabolism, functions
The most powerful molecules in biology
Optimal levels Essential for Health
Bioidentical: Same molecular structure
as our natural hormones
CRH, TRH, etc.
control pituitary
GH, FSH, LH,
TSH, and ACTH
control other glands
T4, T3
Cortisol, DHEA,
Aldosterone, Pregnenolone
Insulin
Adrenalin
Estradiol, Progesterone
Testosterone
Testosterone
Bioidentical Hormones are
NOT Drugs
No side effects, interactions, or reactions
Non-toxic, inherently safe
Proper fit in receptors, easily eliminated
Blood levels can be monitored
Restore health vs. modify disease
The only potential problems:
Excessive dose
Lack of balance with other hormones
Unphysiological delivery: route, timing, etc.
Hormone Ignorance:
The Tyranny of the Lab Report
Reference Range=95% of the population
Neither a normal nor an optimal range!
Disease/No Disease instead of Continuum
Male free testosterone: 35-155
5x!
Female testosterone: 2-45
22x!
Free T4: 0.6-1.8
3x!
AM serum cortisol: 5-25
5x!
Within RR: No diagnosis; pharmaceuticals
Below RR (<97.5%): replace to within-RR
Hypometabolism—Thyroid and
Cortisol Insufficiencies
Thyroid sets throttle (metabolic rate)
Cortisol delivers the fuel (glucose)
Optimal levels of both are required for health
Even mild deficienciesreduced cellular
metabolismfatigue, brain dysfunction,
depression, pain, and disease
Usual lab tests and ranges (TSH, AM cortisol)
are insensitive
Underdiagnosis, Undertreatment
Mild-to-Moderate Cortisol
Insufficiency
Partial Secondary Insufficiency: brain
(H-P) fails to maintain levels
Fatigue, depression, pain, allergies,
inflammation, hypoglycemia, low blood
pressure, nausea, insomnia
Clue: Prednisone improves mood, energy
Diagnosis: saliva testing reveals free
cortisol levels 4 times during the day
Normal Saliva Cortisol Profile
Common Dysfunctional Pattern
Cortisol Insufficiency
Addison’s Disease
Cortisol Restoration
Mild insufficiency—improves with
stress, rest, and nutrients
Moderate-to-severe insufficiency—
requires cortisol restoration
Low physiological doses are safe
40 years’ experience: see Dr. Jeffries’
Safe Uses of Cortisol
Thyroid Insufficiency
Mental fogginess
Fatigue, depression, anxiety
Cold extremities, low body temperature
Aches and pains
Thinning hair, dry skin
Weight gain
Constipation
Puffy ankles and face
Elevated cholesterol
Continuum: Higher Thyroid
Hormone Levels within the RRs:
Reduced risk of severe atherosclerosis by 50%
Clin Cardiol. 2003
Dec;26(12):569-73
Lower cardiac risk factors: cholesterol,
triglycerides, C-reactive protein, homocysteine
and lipoprotein(a)
Lower blood pressure, dilates arteries
Reduced tendency to form blood clots
Relieve depression
Reduced weight, increased weight loss
The Increase in Fatigue, Fibromyalgia,
and Depression
Pre-1970s: Dessicated thyroid extract: T2,
T3 and T4 dosed to eliminate symptoms
Post-1970s: T4-only to “normalize” TSH
TSH: Patient’s doses lowered by 30-50%
TSH “normalizing” T4 doselow free T3,
persistence of symptoms, weight gain
Symptomatic persons with within-RR labs
often improve with T3/T4 optimization
Cortisol and Thyroid
Optimization
Any Questions?
The Big Controversy
What do we do about
hormones lost to normal
aging?
DHEA—The Most Abundant
Steroid Hormone In our Bodies
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—approved for SLE
Improves immune system function
Anti-atherosclerotic—may prevent heart disease
Reduces platelet aggregation Ann N Y Acad Sci. 1995 Dec 29;774:281-90
Anti-cancer effects in animal studies
Adrenopause
DHEA-S Levels with Age
Somatopause
Growth Hormone (GH)
Clinical Chemistry 48, No. 12,
Thyropause
Free T3
Endocr Rev. 1995 Dec;16(6):686-715
Male Andropause—Testosterone
Baltimore Longitudinal Study of Aging (BLSA). Harman et al., 2001
pg/ml
Andropause vs. Menopause
Men
Women
8000
Testosterone
Progesterone
7000
average
6000
5000
4000
3000
2000
Estradiol
1000
0
Young ♂ Old ♂ Young ♀ Old ♀
T
P
E
DHEA-S 5,000,000pg/ml Cortisol 100,000 pg/ml!
Conventional View of Aging
The loss of hormones is adaptive
Higher levels cause heart attacks, cancers
of the breast and prostate
Fits Pharmaceutical Agenda: Don’t
restore hormone levels: Take drugs for
all problems caused by loss of hormones.
Gonadal Steroids:
Not Just “Sex Hormones”
Estradiol, Progesterone, Testosterone
Essential to all tissues in both sexes!
Brain—Improve function, protect
against Alzheimer’s Dz.
Immune System
Heart and blood vessel health
Blood lipids, clotting
Connective tissues—skin, muscle, bone
Menopause: Estradiol Deficiency
Hot flashes
Fatigue, aches and pains
Dry eyes and vagina, genital atrophy
Loss of libido
BP,  LDL cholesterol, heart disease
Atrophy of skin and bone (osteoporosis)
Poor memory, depression, insomnia
’d risk of Alzheimer’s Disease
Estrogen Replacement
Prevents Alzheimer’s Disease
Zandi PP, et al., Cache County Study. JAMA. 2002 Nov 6;288(17):2123-9.
Women Killers
Cardiovascular disease (CVD), breast cancer and
osteoporosis are rare in premenopausal women
They begin in perimenopause when progesterone
and testosterone levels are lower.
After menopause (loss of estradiol) osteoporosis
accelerates and CVD rises faster than in men
Higher risk of CVD 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.
Menopause and Cardiovascular
Disease
Speroff L, Fritz M Clinical Gynecologic Endocrinology and Fertility, 7th 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 for
50 yr.old woman, 30% for 80 yr. old.
Speroff L, Fritz M Clinical Gynecologic Endocrinology and Fertility, 7th Ed.
Male Andropause:“Just Gettin’ Old”
Testosterone levels decline slowly
Fatigue, passivity and moodiness
Reduced mental function
Loss of muscle and bone mass;  fat
Loss of libido and spontaneous morning
erections
BP,  blood sugar, heart disease,
Alzheimer’s Disease, autoimmune dz.
Hormone Loss with Aging is
BAD for Us
Aging is an auto-destruct program.
Starts around age 25!
Glands and control systems deteriorate
 weight, BP, diabetes, heart attacks,
autoimmune diseases, osteoporosis, etc.
Occur years after hormone losses begin
Occur more often in those with lower levels
Hormone restoration helps prevent these
diseases, and does not cause disease.
Hormones and Aging
Any Questions?
Coming up: Male and Female
Hormone Replacement
Testosterone is Man’s Best 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 X
Testosterone is Good for your Heart
Low testosterone levels associated 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 promotes prostate growth to a
point.
Castration slows prostate cancer growth
temporarily.
Higher T levels don’t increase risk of
prostate cancer.
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
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 which can lead to cancer
Progesterone inactivates estrogen,
stops proliferation and promotes
differentiation
Differentiated cells can’t become
cancers
High average progesterone/estrogen
ratio prevents breast, uterine cancers
Normal Cycle and Balance
Ovulation
Menstrual Cycle
Perimenopause
Luteal Insufficiency=Estrogen Dominance
Inadequate Luteal Phase
shorter periods, early spotting
Ovulation
Menstrual Cycle
Perimenopause
Anovulation with Estrogen Dominance
High estrogen, low
progesterone
’d risk of cancer
Menstrual Cycle
Menopause
Estrogen and Progesterone Deficiency
Estrogen Dominance:
Progesterone Deficiency
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
Estradiol for Menopause
Eliminates hot flashes
Eliminates dryness of eyes and vagina
Improves memory and mental function
Maintains skin, bones
Reduces risk of heart disease
Reduces risk of Alzheimer’s disease
Reduces blood sugar, blood pressure
Improves energy, reduces aches
Testosterone for Women
Female testosterone levels decline 50%
between age 20 and 45.
Menopause. 2003 Sep-Oct;10(5):390-8
Improves energy, mood
Improves libido, sexual sensation
Increases muscle strength, stamina
Increases bone density
Probably decreases risk of heart attack
J Reprod Med. 1999 Dec;44(12):1012-20
Womens Health. 1998 Sep;7(7):825-9
Osteoporosis
A hormone deficiency disease (including
Vit.D)
Estradiol reduces 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 increases
bone density much better than Fosamax
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
Estradiol
Testosterone
DHEA
Progesterone
Do Not
Substitute
Cortisol
“HRT” has Always been
Hormone Substitution!
Pregnant mare’s urine: Premarin in 1942
Progesterone synthesized in 1942, altered
to make patentable “progestins”
“HRT” = pills containing alien molecules
Drug Co.s pushed doctors to use hormone
substitutes and ignore bioidenticals!

Premarin :
Close, but Not
Human
Human
Estradiol-17β
Horse
Dihydroequilin-17β
CEE contains at least 10 estrogens, only 3 are found in humans.
CEE is similar to human estrogens and has similar long-term
benefits.
Birth Control Pills: 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 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 and does not cause blood
clots!
Circulation. 2007 Feb 20;115(7):840-5
The BIG Problem with HRT:
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 breast
stimulation
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 breast
stimulation
Increases risk of breast cancer
Progestin Zoo
Progesterone
Provera
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 and strokes).
Adding Provera (Prempro) 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 male testosterone
Oral, not transdermal, estradiol increases the risk
of thrombi and strokes
Some progestins cause endothelial inflammation,
atherosclerosis, and clotting.
Best Preventative Strategy—maintain youthful
levels of natural sex-steroid hormones!
But won’t that increase the risk of breast cancer?
Breast Cancer:
Verdict: Progesterone is Innocent
“The balance of the in vivo evidence
is that progesterone does not have a
cancer-promoting effect on breast
tissue.”
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
More Progesterone
6,000 women
5 yr. F/U
ORDET Study: Int. J. Cancer 112 (2004) (2), pp. 312–318.
See also Cancer Causes Control. 2004 Feb;15(1):45-53.
More Evidence
Estradiol cream applied to the breast induces
proliferation, adding progesterone reduces
proliferation to baseline
Fertil Steril 1995; 63:785-91
Premenopausal women with low P levels had
5.4 times greater risk of early 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
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
In vitro: Testosterone and DHT inhibit 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:
Unopposed 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
natural hormones in the most physiological
way and in natural balance should be
considered beneficial until proven otherwise.
Since perimenopausal and 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.
What Your OB/GYN is Told
ACOG NEWS RELEASE October 31, 2005
The American College of Obstetricians and Gynecologists
A private organization funded by drug companies
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 Premarin, Provera, 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…
“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 and disorder!
Why Use Compounded Hormones?
FAR less expensive than FDA-approved
bioidentical products ($10-30 vs. $200/mo.)
More convenient
Individualized
Physiological delivery—progesterone
Reliable: Compounding pharmacies are
PCCA members: standardized materials and
procedures (http://www.pccarx.com)
Where Do They Come From?
Chemically synthesized from diosgenin (wild
Mexican yams and soy)
Compounding pharmacists prepare creams,
tablets, etc. using USP-certified bulk hormones
Doing HR
Physician fee—according to time
Forms available online
Initial visit: order blood tests, saliva cortisol
F/U visits: Review results—prescribe—retest
F/U testing: blood, not saliva
Office visit every 6 months, test only as needed.
Telephone Consults—same hourly rate
E-mail—No charge for brief responses
Costs
Physician time only as required--first year
~$200-$500; then <$200/yr.
No Medicare or insurance billing; may
submit claim for recognized diagnosis
Hormones—$10 for 1 hormone, to
$80/month for all, ±covered by insurance
Diurnal salivary cortisol test—$120
Blood tests—insurance pays, lab kits $170$220, Saliva/blood kit—$299
Out-of-pocket expenses tax-deductible
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 (articles, abstracts)
[email protected]
Office: 570-836-0359