Bio-Identical Hormone Replacement Therapy

Credit

Debbie L. Brinkman, CMA

Credit

Debbie L. Brinkman, CMA

Dr. Julie Marchiol, DC, FIMA

Growing old is not for sissies
Be prepared !!


Goal is to replace and restore natural
hormones that decrease as we age to
optimum levels
Improve one's well being and quality of life
Promote a longer and healthier life span: the
essence of preventive and restorative medicine


Prescribe only natural hormones that are
made by our human body for our body
Molecular structure is biologically identical
to the hormones found in the human body
Vital steroid hormones are derived from soy
and yam oils


1999-2000


2003-2010 offered BHRT, weight loss, and
sexual dysfunction to my patients
Outsourced through an independent Ob-Gyn
Wonderful synergy with cosmetic surgery
practice with various anti-aging modalities
Longevity and preventive medicine is a natural
extension of cosmetic surgery
Optimized surgical healing and recovery


Sense of Well Being
Improved Libido

Improved Health
Prevention of Medical
Diseases

Bio-Identical Hormone Replacement With
Testosterone Pellet Therapy

August 17-19, 2012
September 7-9, 2012
October 19-21, 2012

Anti-Aging Clinic
BHRT
Nutrition
Weight Management
Stress Reduction
Exercise
Cardiac Health
Anti-inflammatory
Management

Osteoporosis
Antioxidants
Detoxification
Nutraceuticals
Supplements
Patient Lifestyle
Changes


Natural hormones
Hormones that are produced by our body for
our body
Molecular structure is biologically identical
and exact to the hormones in our body

Natural Versus Synthetic
CH3
C

O

CH3
O

O

Progesterone

CH3
Provera
Progesterone

C

O
O C

O
CH3

Goal is to replace and restore hormones that
decrease as we age to optimum levels
Optimum levels are those of young adults in
their mid-twenties and early thirties
Improves one‟s quality of life and sense of
well being
Longer and healthier life

What are hormones?
Hormones are chemical messengers
produced and secreted by endocrine
cells into the bloodstream
Hormones regulate, integrate and
control cellular functions downstream

Endocrine Glands
Pineal
Hypothalmus
Pituitary
Thyroid

Adrenals
Ovaries
Testes

What are target cells?
Target cells refer to cells that contain
specific receptors (binding sites) for a
particular hormone
Once a hormone binds to receptors on
a target cell, a series of cellular events
unfold that is dependent upon gene
expression

Growth Hormone Binding To
Growth Hormone Receptors On
Target Cells

Growth Hormone

Growth Hormone Bound
To Cell Receptor

Are hormones harmful or beneficial?
Are they safe?
Medical studies demonstrate the severe harm
associated with use of synthetic hormones
Synthetic hormones are dangerous and
should not be used
The real harm occurs when we lose our own
natural hormones
There is no harm when using bio-identical
hormones

If BHRT is so good for you, then why has
my doctor not offered it to me?
Western medicine is an “allopathic based”
medical system
Allopathic medicine uses medications, drugs,
or surgery to treat and/or suppress symptoms
of diseases

Stroke

MI

Uterine CA

If BHRT is so good for you, then why has
my doctor not offered it to me?
Post graduate medical education is heavily
influenced by Wall Street…money talks
Semantics: real confusion exist between
„synthetic‟ and „bio-identical‟ hormones in the
medical journals, medical literature and media
False premise prevails to give hormone therapy
to control symptoms for the shortest period of
time

What happens when our natural
hormones are not replaced?
Macular degeneration is an eye disease
of aging that is a major cause of blindness
Women who are treated with bio-identical
estrogen experience 80% less chance of
developing macular degeneration

Women who have taken natural
estrogen for 15 years or more
have a very low incidence
of Alzheimer‟s disease
Several studies demonstrate that
bio-identical estrogen protects
against dementia

Estrogen protects against bone
loss and osteoporosis
In women over 65 years of age or
older who suffer hip fractures,
50% die within 2 years

Most physicians fail to advise their female
patients of their loss of protection against
breast cancer from loss of progesterone
Progesterone decreases breast density
and down regulates breast receptor sites,
thereby lowering the risk of breast cancer


Vital Hormones Lost With Aging
Testosterone
Estrogen
Progesterone
Pregnenolone
DHEA
Cortisol

Human Growth
Hormone
Thyroid
Oxytocin
Melatonin

PATIENTS CAN SENSE,
“THINGS ARE JUST
NOT RIGHT”
MOST FREQUENT COMPLAINTS
Tiredness
Less Energy
Poor Sleep

↓ Sex Drive
Hot Flashes
Night Sweats
Vaginal Dryness
Dry Skin
Anxiety
Mood Swings
Headaches
Weight Gain
Depression
Memory Loss
Palpitations

Osteoporosis
Hair Loss
Food Cravings
Irritability
Painful Joints
Loss of Pubic Hair
Painful Intercourse
Irregular Menstruation
Overly Emotional
Lack of Self Esteem
Restless Leg Syndrome
Chronic Fatigue Syndrome
Poor Sexual Performance
Erectile Dysfunction
Urinary Frequency

Benefits of testosterone
therapy in women

Women
≠
Estrogen

Women ≠ Estrogen
15-20 times more testosterone
Testosterone has been ignored except for
it's role in sexual function and libido
Androgen receptors found in brain,
bones, heart, blood vessels, nerves,
muscles, skin breast, uterus, ovaries, etc
Testosterone is the major substrate for
estradiol

therapy in women
Improvement in:
Sense of well being
Memory
Improved sleep
Self-assertiveness
Energy levels

therapy in women
Improvement in:
Muscle mass
Decreased fat
Bone density
Sexual desire and
satisfaction
Clitoral sensitivity

therapy in women
Improvement in:
Depression and anxiety
Migraine or menstrual
headaches
Decreased aches, pains,
and stiffness
Skin quality (increase
collagen and elastin)

therapy in women
Prevents against:
Visceral fat
Muscle loss
Ligament injury
Bone loss

therapy in women
Prevents against:
Loss of cognition
Loss of libido
Loss of emotional
stability

therapy in women
Indications
Any women at any age with symptoms
of testosterone deficiency
Any women with low testosterone levels
Any women that wants to improve their
health, wellness, strength, confidence,
and aesthetics

Contraindication of Testosterone Therapy
Pregnancy
Planned pregnancy

Side effects of testosterone
therapy in women

Side effects of testosterone
therapy in women
Too high levels of testosterone may cause
Increase in facial hair
Mild acne breakout
Increased Libido
Treat by lowering the testosterone dose
Treat with Spironolactone 100 mg/day

WAYS TO ADMINISTER
TESTOSTERONE IN WOMEN
PILLS ~ CREAMS ~
INJECTIONS ~ PATCHES

Variability of hormone
concentrations from one hour
to next (half life too short)
Concentration elevates quickly
and in short time falls…roller
coaster effect
Prone to non-compliance

Testosterone Treatment with Subcutaneous
Pellet Implants

Testosterone Treatment with Subcutaneous
Pellet Implants
History of hormone pellet implants

Subcutaneous hormone implants have
been used in Europe, US and Australia
since 1938
Superior to other methods of hormone
delivery (oral, IM, topical)
Deliver consistent, effective levels of
physiologic hormones
Mishnell 41, Greenblatt 49, Thom 81, Stanczyk 88

Testosterone in Men
Bottom line:
Raising a man’s testosterone levels
through natural hormone replacement
helps to revitalize every aspect of his
life!

EVERY MALE PATIENT IS DEFICIENT OR
WILL BECOME DEFICIENT IN
TESTOSTERONE

Why do men lose testosterone ?
Andropause
After age 30, the amount of testosterone
declines and continues throughout life
The decline is poorly understood and
controversial
90-95% of testosterone is produced by the
Leydig cells in the testes

What happens when men
lose testosterone ?

lose testosterone ?
Men in forties and older experience a
decrease in hormone levels
Morning erections cease
Muscle definition fades
Men get flabby around the middle

lose testosterone ?
Men start to worry about sexual their
performance
Maintain an erection during sex ?
Dependent upon an ED drug ?

lose testosterone ?
Erectile Dysfunction

Growing older should not be the
end of a man’s sex life

lose testosterone ?
Symptoms of andropause slowly
worsens over time
Male ego and psyche at risk
Medical health risks greatly increases

Bio-Identical Hormone Replacement
Therapy
Sense of Well Being
Improved Libido

Improved Health
Prevention of Medical
Diseases

What happens when men lose testosterone ?

Increased risk of:
CAD and CVD
Osteoporosis
Visceral fat
Loss of the sense of well being

Testosterone
Routes of Delivery
Injectable
 Painful
 Roller-coaster effect

Patches: not user friendly
Troche: poor levels

Testosterone
Routes of Delivery

Transdermal cream
 ETOH gels 10% maximum = 100 mg/gm
Lipoderm cream: maximum = 200 mg/gm
Androgel 1%: 10 mg/gm
 More expensive

Compliance concerns
Accidental transference concerns

Testosterone
Routes of Delivery

Pellets:





Preferred method of choice
No Compliance issues
No transference concerns
Even, steady state release

Testosterone’s side effectsin men
Acne; oily skin
Aggression ? No !
Decrease sperm count (concern
in younger men and family planning)
Decrease in testicular size
Transference to others
Increase red blood cell count

Testosterone’s side effectsin men
Testosterone does not cause
prostate cancer
In men with prostate cancer,
testosterone may cause the
cancer to grow more rapidly
Mild prostate enlargement
Rectal exams and PSA levels
are a medical necessity

Indications for Testosterone
Any man or woman that wishes to improve
quality of life, decrease morbidity or
mortality, or increase longevity as
documented in the medical literature

Menopause is much
more than not having
a period for 12 months
MOST FREQUENT COMPLAINTS
Tiredness
Less Energy
Poor Sleep

↓ Sex Drive
Hot Flashes
Night Sweats
Vaginal Dryness
Dry Skin
Anxiety
Mood Swings
Headaches
Weight Gain
Depression
Memory Loss

Palpitations
Osteoporosis
Hair Loss
Food Cravings
Irritability
Painful Joints
Loss of Pubic Hair
Painful Intercourse
Irregular Menstruation
Overly Emotional
Lack of Self Esteem
Restless Leg Syndrome
Chronic Fatigue Syndrome
Bloating

Women‟s Health Initiative
Message:
Don’t fear bio-identical
estrogen or progesterone
Fear the loss of these natural
hormones
Do not replace with synthetic,
chemically altered hormones

Estrogen
Bottom Line

Optimum levels of natural estrogen
are necessary for every aging woman
It builds bone, protects the heart, and
prevents Alzheimer’s in its tracks

Which Estrogen is Most Important ?
Estradiol
Is the most important and vital estrogen
for health and wellness management
Is the estrogen that we will monitor and
replace when needed

What happens when
women lose estrogen ?
Increased risk of:
Coronary Artery Disease
Stroke
Diabetes Mellitus
Alzheimer’s disease
Osteoporotic fractures

What happens when
Increased risk of:
Urogenital atrophy
Macular Degeneration
Colon cancer
Tooth loss

What happens when
Estrogen‟s benefit:
Improves memory
Prevents Alzheimer’s disease
Decreases symptoms of menopause
Decreases insulin resistance
Prevents osteoporosis
Protects against heart disease

What happens when
Breast cancer in women
2012, the estimated number of deaths
claimed from breast cancer was 39,510

©2012, American Cancer Society, Inc., Surveillance Research

What happens when
Heart disease in women
The risk of heart disease in women
increases with age
Is the leading cause of death in
women over 40 years old, especially
after menopause
Every year, more than 400,000 U.S.
women die of heart disease

What happens in women
with too much estrogen ?
Estrogen‟s side-effects in high doses:
Increased body fat
Increased fluid retention
Headaches
Irritability

with too much estrogen?
The 5 B‟s
Breast tenderness
Bleeding
Bloating (fluid retention)
Bitchiness (crying, mood swings)
Break out
Due to estrogen dominance;
either too much or too sensitive

with too much estrogen ?
Estrogen dominance
Due to excess blood levels
Due to increased receptor site sensitivity
Treatment:
 Lower dose of estradiol
 Balance (oppose) with progesterone

Estrogen Replacement
Annual Requirements
Annual PAP, pelvic exam, and
mammogram
Monitor HRT levels

Estrogen Replacement
Estradiol
Is the most important estrogen for
health benefits
Delivery







Capsule
Sublinqual
Cream
Patch
Vaginal
Pellet

What about estrogen for men?
Estrogen is falsely accused of being harmful
in men
Medical literature does not demonstrate that
endogenous estrogen in men is harmful
Over emphasized and over-hyped
No study supports lowering estrogen in men
No study supports that high levels are
harmful

What about estrogen for men?
Protects against
Bone loss and osteoporosis
Alzheimer's disease and dementia
CVD, DM, IR
Optimal levels are associated with less CAD,
morbidity, and mortality
Low levels are harmful in both men and
women

Healthy Benefits of Progesterone
Bottom Line
Progesterone used in conjunction with
adequate levels of estrogen provides
women significant relief to many diseases
and symptoms associated with aging and
menopause
Progesterone protects against breast and
uterine cancer

Progesterone
Estrogen’s natural sidekick
Important to treat and maintain natural
balance between estrogen and
progesterone
Reduces symptoms of PMS
Reduces estrogen dominance and
related untoward symptoms

Progesterone
After menopause, women cease to
make progesterone
Without progesterone’s protective
properties, estrogen dominance occurs
and over-stimulation of receptor sites
in the breast and uterus leading to an
increase risk of cancer

J. Natl Cancer Inst.
92(4):328-332
Adding the synthetic, chemically altered,
Provera® (progestin) to estrogen
replacement therapy, markedly increases
the risks of breast cancer 29% over
baseline

Progesterone protects against
Breast cancer
Uterine cancer
Coronary artery disease
Osteoporosis

Progesterone protects and provides
Lower cholesterol
Satisfactory quality of life
Enhancement of estrogen’s benefits
Vaginal atrophy
Relief of PMS

Progesterone protects against
Menstrual cramps, mood swings, heavy
bleeding, depression, bloating, and
menstrual migraines
Post menopausal symptoms
Overall feelings of dysphoria and loss of
well-being

Progesterone
Formulations
Oral
 Sublingual triturate
 Rapid dissolve tablet (RDT)
 Cream
Dose QD, BID, QID
Pellets

What are the side effects of progesterone?

Natural progesterone has no harmful
side effects
In oral form taken at night, may cause
sleepiness

DHEA
One of the most abundant hormones
in the body
Precursor „mother‟ hormone because
DHEA converts into:
 Estrogen
 Testosterone
 Progesterone

DHEA Decline and Aging
4000

DHEA-S
(ng/ml)

3500
3000
2500
Men
Women

2000
1500
1000
500
0
10 20 30 40 50 60 70 80

Age (years)

DHEA
Powerful antioxidant
One of the best biochemical markers
for chronological age… age gauge
Produced by the adrenals, gonads
and brain

DHEA
Acts as a neurosteroid
Induces an improved sense of mental,
psychological and emotional health
Restores energy, joy and motivation

Benefits of DHEA
Prevents and treats:

Cardiovascular disease
Diabetes
Hypertension
Loss of sex drive
Depression

Benefits of DHEA

Fibromyalgia
Rheumatoid arthritis
Lupus
Crohn‟s disease
Herpes

Benefits of DHEA

Cancer
Osteoporosis
Alzheimer‟s
Asthma and allergies
Stress

Pregnenolone

The Brain Hormone

Healthy Benefits of Pregnenolone
Pregnenolone
Produced in the brain and adrenal
glands
Keeps our brain functioning at peak
capacity

Pregnenolone
Precursor to the other hormones
Functions as a memory enhancer
Promotes cellular repair in the
brain and nervous tissue

Pregnenolone protects
Cerebral function
Against cerebral atrophy
Against neuronal injury
Against Alzheimer‟s disease

Pregnenolone improves
Arthritis
Depression
Fatigue
Moodiness

Risk of Pregnenolone
Extremely safe
Rare acne
Rare drowsiness
Responds to lower dose

Cortisol

The Hormone of Stress

Cortisol
Produced by the adrenal glands…the same
glands that produce DHEA
Body's way of dealing with physical or
psychological demands of life

40% of hypothyroid patients are found to
have adrenal insufficiency or fatigue

Cortisol
Vital for life in order to cope with stressful
situations and conditions
Body's way of dealing with physical or
psychological demands of life

Designed more for acute stress situations
rather than chronic ones

Hydrocortisone

Diurnal Cortisol Release

Morning peak at 9am

Midnight trough
06:00

12:00

18:00

24:00

06:00

Cortisol
Low production of cortisol results

In an increased susceptibility to illness
Longer recovery times
System is geared more for acute conditions;
chronic may result in adrenal deficiency

Hydrocortisone

Symptoms of Adrenal Fatigue
Cortisol deficiency causes
Fatigue, especially in the afternoon
Stress
Sugar/Salt cravings
Low blood sugar

Hydrocortisone

Allergies, asthma, sinusitis
Chemical sensitivity (perfume, detergents, odors)
Eczema
Aches, pains (especially neck and back)

Hydrocortisone

Muscle stiffness, joint pain, arthritis
Hives, itching, skin sensitivity, reaction
to bug bites, acne
Weak immune system, repeated infections,
pneumonia

Hydrocortisone

Autoimmune diseases (thyroiditis, Crohns
disease, inflammatory bowel disease)
Low blood pressure, low fluid volume
(dehydrates easily)

Hydrocortisone

Cortisol
Chronic Stress Can Cause
Heart disease
High blood pressure
High blood sugars
Sleep problems
Decrease bone
formation
Muscle wasting
Digestive problems

Depression
Obesity
Decrease breakdown
of fat
Memory impairment
Immune suppression
Skin problems

Melatonin

Much More Than A sleep Aid

Healthy Benefits of Melatonin
Chemical structure identified in 1958
Sleep aid
Potent antioxidant
Mood enhancer
Immune system booster
Cancer inhibitor
Treatment for blood pressure
Treatment for migraine headaches

Melatonin Synthesis
Made from the essential amino acid
tryptophan and serotonin
Made predominantly at night in the
pineal gland
Freely diffuses into the bloodstream
and crosses the brain barrier

Melatonin

Melatonin

Melatonin levels decreases with age
Brownstein, David. The Miracle of Natural Hormones, 3 ed., Medical Alternative Press. 2003.
rd

Growth Hormone

Growth Hormone Bound
to Receptor

Growth Hormone

HGH half life is 20 minutes
IGF-1 levels remain fairly constant
throughout the day
IGF-1 levels are are used to monitor hGH
therapy

Growth Hormone
The safest hormone

One of the most beneficial hormone
The most abused hormone,especially
in the sporting world

1986

2003

2005

Growth Hormone
The most maligned hormone

The most over-hyped hormone
The most expensive hormone

1986

2003

2005

Thyroid Hormone
 Affects every cell in body
 Cannot achieve optimum health
without a properly functioning thyroid
gland
 Hypothyroidism may be the most
commonly missed diagnosis today
 40% of the population may have
undiagnosed hypothyroidism
Brownstein, David. The Miracle of Natural Hormones, 3rd ed., Medical Alternative Press. 2003.

Thyroid Hormone
Regulates
 Temperature
 Metabolism
 Cerebral function
 Energy

Thyroid Hormone
 Increases fat breakdown resulting
in weight loss
 Lowers cholesterol
 Protects against cardiovascular disease
 Protects against cognitive impairment
 Prevents memory loss
 Prevents fatigue

Thyroid Production
Thyroid

T4

T3

Effects On Body

Thyroid Replacement and Preventative
Medicine

“Low normal thyroid levels result in increased
cholesterol, increased heart disease, fatigue,
low energy, depression, and memory loss.
Thyroid replacement eliminates these risks. No
study has shown any harm or adverse effect of
treatment.”
Consultant 2000 Dec: 2397-2399.

.

Treatment of Hypothyroidism
Armour Thyroid, Westhyroid, and Natural
Thyroid (desiccated thyroid)


Composed of T1, T2, T3, and T4



Porcine derivative



Doses are in tablets

1/4 1/2 1 2
3 grain (60 mg)
15 30 60 120 180 mg

Oxytocin

More Than A Hormone of Labor &
Delivery

Oxytocin

Important features
“Love hormone”
Improves organism in women and men
Increases clitoral/ penile „erection‟
Help mothers be moms
Reduces anger
Reduces stress

Oxytocin

Important features
Increase social bonding
Increases trust
Increases generosity
Increases healing
Diet Aid, reduces appetite
Reduces pain

Oxytocin

Deficiency is associated with
Autism
Schizophrenia
Low Estrogen
Low Thyroid
Depression
AIDS
CMV Infection

Oxytocin

Deficiency is associated with
Autism
Schizophrenia
Low Estrogen
Low Thyroid
Depression
AIDS
CMV Infection

Multiple Sclerosis
Fibromyalgia
Chronic Stress
Opioid Dependency
Parkinsons Disease
Loneliness
Anxiety Disorders

Oxytocin

Risk factors associated with deficiency
Loneliness
Lack of familial and social contacts
Fear
Anger
Drug abuse
Detachment
Bad social experiences
Prolonged or even short negative stress
Drinking excessive amounts of fluid/water

http://vitalitmed.com/what-is-hormone-therapy/

Bio-Identical Hormone Replacement Therapy

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