Transcript Natural Hormone Replacement Therapy

Bioidentical
Hormone Restoration
Best Medical Practice
This presentation is available online.
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
CRH, TRH, etc.
control pituitary
GH, FSH, LH,
TSH, and ACTH
control other glands
T4, T3
Cortisol, DHEA,
Aldosterone, Pregnenolone
Insulin
Adrenalin
Testosterone
Estradiol, Progesterone
Testosterone
Bioidentical Hormones are
NOT Drugs
Inherently safe, Non-toxic
Proper fit in receptors, easily eliminated
No allergic reactions
No “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
5x!
Female free testosterone: 0.0-2.2
!
Free T4: 0.6-1.8
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— stress, rest, nutrients, other
hormones
Moderate-to-severe—cortisol
restoration
Low physiological doses are safe
40 years’ experience: see Dr. Jeffries’
Safe Uses of Cortisol
Thyroid Hormones T4 T3
Maintain metabolism, mood, and energy
T4 (Synthroid, Levoxyl) is
bioidentical, but must be converted to T3
Thyroid gland makes T4 and T3; 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 T4 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 plus free T4 or free
T3 levels below mid-point of RR
High TSH = thyroid gland failure
Normal/Low TSH = H-P dysfunction
Trial of thyroid hormone supplementation
using T4 and T3
The Fatigue, Fibromyalgia, and
Depression Epidemic
Pre-1970s: T3 and T4 for symptoms
Post-1970s: T4-only to “normalize” TSH
Doses lowered by 30-50%
TSH “normalizing” T4 doselow free T3,
weight gain, persistence of symptoms
People with fatigue, fibromyalgia, and
depression often improve with T3/T4
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 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, 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 deteriorate
 in weight, BP, cholesterol, 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 testosterone 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 promotes prostate growth to a
point.
Castration slows prostate cancer growth
temporarily.
Men with higher T levels don’t have higher
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
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, 10th Ed., p. 612
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
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 no. of
oocytes (eggs)
Aging  fewer oocytes of lower
quality are leftreduced progesterone
productionestrogen dominance
Anovulation no progesterone
estrogen dominancebreast and
uterine cancer
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 testosterone levels decline
50% 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, 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.
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 increases bone
density 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 “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 estrogenlike effects
“Progesterone” often used for “progestins”
like Provera, levonorgestrel, 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
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 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
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•
•
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•
•
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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

Provera
•
•
•
•
•
•
•
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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
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 testosterone
Oral, not transdermal, estradiol increases the risk
of thrombi and strokes
Estradiol reduces atherosclerosis in the long run.
Some progestins cause persistent endothelial
inflammation, 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 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
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 prevents estradiol-induced
breast tumors in rats as well as Tamoxifen
Jpn J Cancer Res. 1985 Aug;76(8):699-704
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.
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 eliminates
estradiol-induced proliferation 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