Bioidentical hormone restoration best medical practice l.jpg
This presentation is the property of its rightful owner.
Sponsored Links
1 / 98

Bioidentical Hormone Restoration Best Medical Practice PowerPoint PPT Presentation

  • Uploaded on
  • Presentation posted in: General

Bioidentical Hormone Restoration Best Medical Practice. [email protected] . Hormones. Neuro-endocrine-immune system Travel via blood to cells’ receptors Control cells’ proliferation, protein manufacture, metabolic rate, etc. Most powerful molecules in our bodies

Download Presentation

Bioidentical Hormone Restoration Best Medical Practice

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript

Bioidentical hormone restoration best medical practice l.jpg

Bioidentical Hormone RestorationBest Medical Practice

[email protected]

Hormones l.jpg


  • Neuro-endocrine-immune system

  • Travel via blood to cells’ receptors

  • Control cells’ proliferation, protein manufacture, metabolic rate, etc.

  • Most powerful molecules in our bodies

  • Optimal levels essential for health and quality of life

Hormones and aging l.jpg

Hormones and Aging

Why Doctors Don’t Get It

Bioidentical hormone restoration is common sense l.jpg

Bioidentical Hormone Restoration is Common Sense

  • If a hormone is missing, replace it!

  • If present but insufficient, optimize it!

  • Type 1 Diabetes: bioidentical insulin

  • Hypothyroidism: bioidentical T4

  • Growth hormone def.: bioidentical GH

  • Adrenal insufficiency: bioidentical cortisol

    But what about hormones lost to aging?

Pregnenolone mother steroid l.jpg

Pregnenolone—Mother Steroid

J Clin Endocrinol Metab. 1997 Aug;82(8):2396-402.

Dhea dhea s l.jpg


J Clin Endocrinol Metab. 1997 Aug;82(8):2396-402.

Growth hormone gh l.jpg


Growth Hormone (GH)

Normal Adults Pituitary Disease



Log scale

J Clin Endocrinol Metab. 1999 Jun;84(6):2013-9.

Slide9 l.jpg


Andropause Menopause


DHEA–10,000 pg/ml, DHEA-S 5,000,000 pg/ml !

Hormonal changes with aging l.jpg

Hormonal Changes With Aging

  • Hormones that build tissues and improve immunity declinewith age by 50-80% (DHEA, Testosterone, GH)

  • Progesteronestarts to decline at age 30.

  • Estradioldisappears at 50—menopause

  • Thyroid hormone production and sensitivity decline

  • Insulin output declinesDiabetes

  • By age 50—20 years of hormonal deficiency

Conventional view of hormones and aging l.jpg

Conventional View of Hormones and Aging

  • 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

  • Losing our hormones is good for us(?!)

  • Fits the Pharmaceutical Agenda:Takedrugs for every symptom and disorder caused by hormone loss!

Against the conventional view l.jpg

Against the Conventional View

  • Aging is a self-destruct programthat kicks in at age 25in humans

  • Aging is natural degeneration!

  • Weight gain, high blood pressure, high cholesterol, cancers, heart attacks, autoimmune diseases, etc. occur years after hormone deficiencies begin and occur more often in people with lower hormone levels!

  • Studies of balanced hormone restoration show the expected benefits and no proof of harm!!

Example growth hormone l.jpg

Example: Growth Hormone

  • Declines 14% per decade after age 25

  • IGF-1 of many adults equal to hypopituitary patients (only 80-110 vs. 350 @25yrs.old)

  • Deficiency heart disease, frailty, depression, body fat, bone loss

  • GH restoration reduces abdominal fat, lowers blood sugar and blood pressure

  • Improves cognition, mood, sleep, energy

  • Increases muscle, decreases fat & cholesterol

  • Improves bone density, skin thickness

  • Downside: high cost, nightly injections

The endocrinology of aging l.jpg

The Endocrinology of Aging

  • Endocrine glands and their feedback control systems deteriorate with age

  • Our bodies cease to regulate our hormones for optimal health

  • Hormonelossesspeed our general deterioration: a vicious cycle.

  • The symptoms of hormone loss are warning signs of physical deterioration

  • Win-Win: Hormone restoration makes you feel better and improves your health!

Since the loss of hormones is harmful then l.jpg

Since the Loss of Hormones is Harmful,THEN…

Restoring youthful hormone levels is:

  • essentialpreventative medicine

  • essential to the treatmentof disease

  • essential to Quality of Life!

    We have the need and the rightto restore hormones lost to aging!

Hormones and aging16 l.jpg

Hormones and Aging

Any Questions?

Human steroid hormones l.jpg

Human Steroid Hormones






Where do they come from l.jpg

Where Do They Come From?

  • All steroid hormones (including substitutes) are chemically synthesized from diosgenin (wild Mexican yams, soy, and other plants).

Not just sex hormones l.jpg

Not Just “Sex Hormones”

  • Estrogen, progesterone, testosteroneandDHEAessential to cellular growth and function in all tissues in both sexes!

  • Maintainbrain function—modulators of mood, cognition, pain, etc.

  • Maintain the immune system—progesterone and testosteroneare immunosuppressants

  • Maintainconnective tissue: skin, hair, bone, muscle, and blood vessels

Female endocrinology l.jpg

Female Endocrinology

  • Nature makes special demands on the female body for reproduction

  • 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.

Estrogen progesterone complementarity l.jpg

Estrogen—Progesterone Complementarity

  • Estrogenpromotes breast/uterine tissue proliferation and growth

  • Progesterone stops proliferationand promotes maturation and differentiation

  • Differentiated cells can’t become cancer cells

  • High average progesterone/estrogen ratio suppresses proliferation and prevents cancers of female organs

Progesterone deficiency estrogen dominance l.jpg


Autoimmune diseases

Anxiety, irritability


Decreased sex drive


Bloating and edema

Fibrocystic breasts

Uterine fibroids

Breast cancer

Ovarian cancer

Uterine cancer

Thyroid dysfunction

Gallbladder disease

Heavy periods



Progesterone Deficiency Estrogen Dominance

Progesterone and Iodine/Kelp reduce estrogen dominance

Historical perspective l.jpg

Historical Perspective

  • Throughout most of human history, women were usually:

    • Pregnant—high progesterone

    • Breastfeeding—low estrogen

      (bothprotect against breast cancer)

  • Women cycled for 4 years avg.; today many cycle for 35 years

  • Cycling=riskof estrogen dominance and other hormonal disorders

Perimenopause l.jpg


  • Females born with a fixed no. of oocytes which are continually lost to age and ovulation

  • With aging, fewer oocytes of lower quality are leftreduced progesterone production beginning around age 30estrogen dominance

  • No ovulation=noprogesterone

  • Estrogen swings from very high to very low—often for several years.

Slide25 l.jpg

Normal Progesterone Dominance


Menstrual Cycle

Slide26 l.jpg


Luteal Insufficiency=Estrogen Dominance

Inadequate Luteal Phase

shorter periods, early spotting


Menstrual Cycle

Slide27 l.jpg


Anovulation=Estrogen Dominance

Menstrual Cycle

Slide28 l.jpg


Estrogen and Progesterone Deficiency

Slide29 l.jpg

Also Uterine and

Ovarian Cancer

Menopause l.jpg


  • Estrogen Deficiency

  • Progesterone Deficiency

  • Testosterone Deficiency

    After menopause, women depend upon their adrenal glands for androgens and estrogens, so:


    +Adrenal Insufficiency


Effects of combined sex hormone deficiency l.jpg

Effects of Combined Sex-Hormone Deficiency

  • Irritability, insomnia, brain dysfunction

  • Alzheimer’s dementia

  • Fatigue, aches and pains.

  • Osteoporosisfractures, loss of teeth

  • Genital atrophy, vaginal dryness

  • Atrophy of skin and connective tissue

  • Heart disease—higher risk than men after 65, higher mortality after 70!

Estradiol restoration l.jpg

Estradiol Restoration

  • Eliminates hot flashes

  • Restores mood and mental function

  • Probably protects against Alzheimer’s disease

  • Maintains genital/vaginal skin and lubrication

  • Increases thickness, fullness of skin and hair

  • Prevents heart disease

  • Prevents colon cancer and macular degeneration

  • Improves insulin sensitivity—helps diabetes

  • Prevents osteoporosis and osteoarthritis

Slide33 l.jpg

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

Osteoporosis l.jpg


  • In menopause 5% bone loss each year for first 5 years=25%—all 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.

Osteoporosis35 l.jpg


  • A hormone deficiency disease—the proper treatment is hormone restoration!

  • Estrogen prevents resorption of old bone while 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 BHR increases bone density far better than Fosamax and preserves normal bone remodeling (no “rotting jaw”, eye inflammation, Ca++).

Estrogen progesterone and osteoporosis l.jpg

Estrogen, Progesterone, and Osteoporosis

Any Questions?

Slide37 l.jpg

Total and Free Testosterone in Men

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

Andropause in men l.jpg

Andropause in Men

  • Testosterone levels declineslowlyin men—”Just getting old.”

  • Fatigue, reduced mental function

  • Passivity and moodiness—loss of drive and ambition

  • Loss of muscle mass, increased abdominal fat

  • Lastly: loss of libido, no morning erections

  • Increased risk of heart and prostate disease

  • Increased risk of Alzheimer’s dementia

  • Increased risk of autoimmune diseases

Testosterone restoration l.jpg

Testosterone Restoration

  • Improves mood and sociability

  • Restores energy and ambition

  • Improves cognition

  • Increases libido and sexual performance

  • Increases muscle and bone mass

  • Reduces abdominal fat, improves insulin sensitivity, lowers blood pressure--counteracts metabolic syndrome

Testosterone and the heart l.jpg

Testosterone and the Heart

  • Lowtestosterone 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—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 l.jpg

Testosterone and the Prostate

  • Higher testosterone levels do not increase the risk of prostate cancer.

  • Studies of testosterone supplementation have shown no increase in prostate cancer—even though so many men have it!

  • Lowtestosterone correlated with more aggressive prostate cancers

  • Testosterone promotes prostate growth to a point, but not prostate cancer

Where s the beef l.jpg

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

Estrogen dominance theory of prostate disease l.jpg

Estrogen Dominance Theory of Prostate Disease

  • In many men, free testosterone declines > estradiol

  • Estrogen dominance is a probable cause of prostrate enlargement and a possible cause of prostate cancer

  • Elevated estrogen/Test. ratios in BPHScandinavian Journal of Urology and Nephrology, 1995; 29: 65-68.

  • High levels of estradiol and estrone found in BPH tissues

  • Estradiolupregulates oncogenes

Female andropause l.jpg

Female Andropause

  • Young woman’s free testosterone level in serum is 2x her free estradiol

  • Female testosterone levels decline 50% between age 20 and 45

  • Birth control pillstestosterone and DHEA levels

  • DHEAdeclines with age—main source of androgens in women

Testosterone for women l.jpg

Testosterone for Women

  • Improves energy, mood

  • Improves sexual desire and response

  • Increases muscle strength and reduces muscle and joint aches

  • 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.

  • Given with estradiol and progesterone, reduces risk of breast cancer

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

    Menopause. 2004 Sep-Oct;11(5):531-5, FASEB J. 2000 Sep;14(12):1725-30.

Testosterone l.jpg


Any Questions?

Slide47 l.jpg

“My doctor says that hormone

replacement is dangerous and there’s no evidence that bioidentical hormones are safer!”

Two approaches to medicine l.jpg

Two Approaches to Medicine

  • Natural-Scientific—Identify the deficiency/excess at the molecular level and correct it with bioidentical molecules

  • Pharmaceutical—Create non-natural, patentable substances that will produce some improvement

    Natural Science should be primary; Pharmaceutical Science secondary.

Problems with pharmaceuticals l.jpg

Problems with Pharmaceuticals

  • Alien molecules: not recognized, not easily eliminated

  • Negative functions:disrupt normal physiology by blocking receptors, inhibiting enzymes, etc.

  • Toxic:

    • Sideeffects even at low doses

    • Allergic reactions

    • Long-term damage

Pharmaceutical billions l.jpg

Pharmaceutical Billions

  • Mission:Sell pharmaceuticals

  • Informationcontrol—journals, CME, med. schools, professional org.s, etc.

  • Strategy:Suppress competition (natural vitanutrients and hormones—human physiology!!)

  • Conventional Docs: Unaware

  • Result: Unfounded fear of hormone optimization; unfounded confidence in toxic drugs

History of hormone replacement therapy l.jpg

History of “Hormone Replacement Therapy”

  • Horse-derived Premarin approved in 1942

  • Progesterone synthesized in 1942. Poorly absorbed orally

  • Chemically altered to make “progestins”—among the first drugs to be patented.

  • “HRT” came to mean the use of alien molecules that had hormone-like effects

  • Drug co.s became dependent on HRT profits

  • Drug co.s push doctors to use hormone substitutes and to ignore or fear naturalhormones!!

Dirty secret conventional hrt is really h s t l.jpg

Dirty Secret: Conventional “HRT” is really HST!

  • Progesterone substitutes:

    medroxyprogesterone acetate (MPA-Provera) and 30+ other “progestins”

  • Estradiol substitutes: conjugated equine estrogens (CEE-Premarin) and ethinyl estradiol (birth control pills)

  • Testosteronesubstitute: oral methyltestosterone

    Patented drugs—not hormones!

    Most docs don’t know the difference!

Premarin conjugated equine estrogens cee l.jpg

PremarinConjugated Equine Estrogens (CEE)


Estradiol-17β Dihydroequilin-17β

CEE contains at least 10 estrogens, only 3 are human.

CEE contains 3x more Dihydroequilin than Estradiol.

DHE has 10% higher binding affinity for est. receptors.

DHE binds far less to SHBG and has a slower metabolic clearance The most abundant estrogen in CEE is Equilin sulfate.

Kuhl H, Climacteric 2005;8(Suppl 1):3–63

Slide54 l.jpg

EE in Birth Control Pills

Ethinyl estradiol



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 much more thrombogenic thanestradiol

Progesterone vs progestins l.jpg

Progesterone vs. Progestins

Progesterone MPA (Provera) Megestrol

Every progestin has a different spectrum of androgenic, estrogenic, glucocorticoid, and progestational effects!

Slide56 l.jpg

Progestin Zoo


Kuhl, Climacteric 2005;8(Suppl 1)

NAMS-”Call ‘em all Progestogens”

Testosterone substitution l.jpg

Headlines: “Testosterone therapies increase risk of breast cancer.”

Testosterone Substitution



Methyltestosterone (in Estratest) aromatizes to

an alien estrogen and increases risk of breast cancer,also

causes liver damage and breast enlargement in bodybuilders

Sex bias l.jpg

Sex Bias

  • If a Man’s testes are removed or non-functional, bioidenticaltestosterone replacement is started immediately

  • If a woman’s ovaries are removed or non-functional, she is offered horse hormones or hormone-like drugs; or is told to “Live with it ”.

    It IS a Man’s World!

Birth control hormone substitution is dangerous l.jpg

Birth Control Hormone Substitution is Dangerous

  • 2x risk of stroke, heart attack

  • 2-30x risk of blood clots

  • 1-3x risk of breast cancer

  • Increased blood sugar, blood pressure

  • 1.5x risk systemic lupus erythematosis

  • Liver tumors

  • Diagnose and fix the hormonal disorder

  • Use a copper IUD for contraception!!

UpToDate 2006


2002 whi study menopausal prempro hst is dangerous l.jpg

2002 WHI Study—Menopausal PremproHST is Dangerous!

  • Oral CEE (Premarin) alone had adverse effects in the first year (strokes, blood clots)

  • Adding MPA (Provera, PremPro) caused more adverse effects (breast cancers, heart attacks)

  • CEE/MPA caused a large increase in dementia

And we know why these forms of hormone substitution are dangerous!

Dangers of oral estrogen replacement l.jpg

Dangers of Oral Estrogen Replacement

  • First-pass effect on the liverIGF-1, SHBG, CRP, clotting factors blood clots, strokes, heart attacks in the first year

  • Smokers have greater risk of clots

  • EE increases clotting much more than estradiol, Premarin®

  • Transdermal estradiol has none of these effects!

Dangers of estrogen only hrt l.jpg

Dangers ofEstrogen-only HRT

  • Estrogen alone, estrogen-progestin HST and BCPs all reduceDHEAS and testosterone levels 25-60%

  • Estrogen withoutprogesterone and testosteroneestrogen dominance and  risk of breast cancer and other medical disorders

Provera progesterone l.jpg

Maintains pregnancy

Improves mood

Improves sleep


Lowers blood sugar

Maintains estrogen-induced arterial dilation

Improves lipid profile

No evidence of  CVD

Reduces estrogenic stimulation of breasts

Prevents breast cancer

Causes birth defects

Can cause depression

Insomnia, irritability

Fluid retention

Raises blood sugar

Counteracts estrogen-induced arterial dilation

Worsens lipid profile

Causes heart attacks

Increases estrogenic stimulation of breasts

Causes breast cancer

Scientific studies show that:

Provera  Progesterone

Progestins are Dangerous

Atherosclerosis and clotting l.jpg

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.”

    Climacteric. 2003 Dec;6(4):293-301

Progesterone and breast cancer the evidence l.jpg

Progesterone and Breast Cancer—the Evidence

  • Premenopausal women with lowP levels had 5.4 times greater risk of early breast cancer, 10x greater risk for all cancers

    Am J Epidem 1981;114:209-17.

  • Breast cancer victims have signs of progesteroneresistance

    Br J Obstet Gynaecol. 1998 Mar;105(3):345-51.

  • P downregulates BRCA1 and induces apoptosis in breast cancer cell lines.

    Anticancer Res. 2005 Jan-Feb;25(1A):243-8.

Progesterone and breast cancer the evidence cont l.jpg

Progesterone and Breast Cancer—the Evidence cont.

  • Estrogen cream applied to the breastinduces proliferation, adding progesterone cream reduces proliferation to baseline

    Fertil Steril 1995; 63:785-91

  • Estrogen is carcinogenic in breast cell cultures unless progesterone is present

    J Steroid Biochem Mol Biol. 2003 Oct;87(1):1-25.

  • Estrogen upregulates cancer-promoting gene bcl-2, progesterone downregulates it.

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

E3n epic study l.jpg

No Evidence that BHRT is safer?

Cohort study

54,000 women

5.8 years f/u

c/w WHI--

16,000, 6 yr. f/u

E3N-EPIC Study

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

Bioidentical estradiol plus progesterone decreased the risk ofbreast cancer!

Ordet study l.jpg

Int. J. Cancer 112 (2004) (2), pp. 312–318.


6,000 women

5 yr. F/U

Higher progesterone=lower risk of breast cancer

Progesterone and breast cancer conclusion l.jpg

Progesterone and Breast Cancer—Conclusion

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

    J Steroid Biochem Mol Biol. 2005 Jul;96(2):95-108

  • In fact, the balance of the evidence indicates that progesterone protects against breast cancer!

  • So…women can be given estradiol as long as it’s balanced by progesterone and testosterone!

Pharmaceutical corps dilemma l.jpg

Pharmaceutical Corps’ Dilemma

  • They need to control the HRT market

  • Their progesterone and estradiol substitutes are dangerous

  • They can’t patent natural hormones

  • Pharm. Corps. have to get FDA-approval for every natural hormone preparation $$$

  • Compounding pharmacies can dispense natural hormonescheaply

Pharm corps choices l.jpg

Pharm. Corps’ Choices

  • Stopcompounding pharmacies so they can control of the BHR marketWyeth’s appeal to the FDA, media propaganda blitz

  • Suppress BHR in favor of their substitutes

  • Keep looking for substitutes that will provide benefits without risks

  • Result: Your doctors will never learn the truth about hormones unless he/she goes looking for it

Common sense l.jpg

Common Sense

  • Substitutes are alien molecules!

  • Problems caused by hormone substitutes cannot beattributedto human hormonesuntil proven otherwise.

  • Bioidentical hormone restoration should be considered safe until proven otherwise!

Hormone substitution l.jpg

Hormone Substitution

Any Questions?

Metabolic regulators thyroid and cortisol l.jpg

Metabolic Regulators: Thyroid and Cortisol

  • Thyroid sets throttle, cortisol delivers fuel

  • Deficiencyreduced metabolic ratefatigue, brain dysfunction, depression, pain

  • Subtle deficiencysymptoms and disease

  • Usual blood tests are insensitive

  • Irrational fear of supplementation

  • Underdiagnosed, undertreated—Docs prescribe pharmaceuticals (SSRIs) instead

Hormone ignorance the tyranny of the lab report l.jpg

Hormone Ignorance: the Tyranny of the Lab Report

  • Reference Range=95% of “normal people” optimum

  • Male free testosterone: 35-1555x

  • Female free testosterone: 0.0-2.2

  • Free T3: 1.8-3.22x

  • TSH: 0.3-517x

  • If “within normal limits” no diagnosis; pharmaceuticals for symptoms

  • If below normal, just replace to “WNL”

Hypothyroidism symptoms l.jpg


  • Mental fog, depression, anxiety

  • Fatigue

  • Cold extremities

  • Aches and pains

  • Hair falling out

  • Weight gain

  • Constipation

  • Self-Test: Basal body temperature <97.8°F axillary in bed in AM

Thyroid hormone t 3 l.jpg

Thyroid Hormone—T3

  • Maintains metabolism, mood, and energy

  • Controlled partly by thyroid stimulating hormone (TSH) from the pituitary gland

  • TSH test is indirect: does not measure T3levels or effects in various tissues

  • Docs prescribe T4 only (Synthroid and Levoxyl)—prohormone that must be converted to T3

  • Docs rarely measure free T3 levels!

We need optimal t 3 levels l.jpg

We Need Optimal T3Levels

  • Incidence of severe atherosclerosis doubled with lower T3 or higher TSH levels within the normal 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 l.jpg

Fatigue, Fibromyalgia and DepressionEpidemic

  • Pre-TSH: Treat the patient’s symptoms

  • Post-TSH: Treat the test (?)

  • 1970s—Doctors lowered doses by 30%

  • TSH-normalizing T4doselowT3levels!

    Williams’ Textbook of Endocrinology. Saunders, Philadelphia, pp 357-488)

  • T3alone often effective in fibromyalgia

  • T3 alone relieves depression even if tests “normal”! J Affect Disord. 2006 Feb

Rational approach to thyroid restoration l.jpg

Rational Approach to Thyroid Restoration

  • If S/S of hypothyroidism: Treat!

  • Give T4 plus T3 (Armour, Cytomel)

    Endocrinology 1996;137:2490-2502

  • Increase dose until symptoms gone or S/S of excess appear

  • Safe--even moderate TSH suppression does not cause:

    • bone loss Horm Res. 2005;64(6):293-8. Epub 2005 Nov 1.

    • cardiac abnormalities J Clin Endo Metab. 2000 Jan;85(1):159-64.

    • muscle wasting Am J Phys Endol Metab. 2005 Jun;288(6):E1067-73.

Pharmaceuticals labs and thyroid l.jpg

Pharmaceuticals, Labs, and Thyroid

Any Questions?

Cortisol l.jpg


  • Made in the adrenal glands

  • Maintains blood sugar (delivers the fuel)

  • Modulates immune system

  • Need high amounts when stressed

  • Too muchDiabetes, HTN, osteoporosis

  • Too littlehypoglycemia, fatigue, autoimmune diseases, aches and pains

Cortisol deficiency l.jpg

Cortisol Deficiency

  • Fatigue, depression

  • Aches and pains

  • Can’t stay asleep

  • Can’t deal with exercise, stress, or illness

  • 2nd wind late at night

  • Hypoglycemia, feels better after eating

  • Nausea, abdominal discomfort, diarrhea

  • Allergies, autoimmune diseases

  • Hard to gain, hard to lose weight

  • Low blood pressure, salt and sugar cravings

Mild to moderate cortisol deficiency l.jpg

Mild-to-ModerateCortisol Deficiency

  • Blood tests are insensitive, need diurnal salivary cortisol profile

  • Underdiagnosed: Docs taught only about severe “adrenal insufficiency” due to physical destruction of the adrenal glands (Addison’s Disease) or pituitary

  • Common cause of chronic fatigue, pain

  • Clue: Felt great when taking prednisone

Slide85 l.jpg

Normal Saliva Cortisol Profile

Slide86 l.jpg

Cortisol Deficiency

Slide87 l.jpg

Cortisol Deficiency—Normal Waking Cortisol

Slide88 l.jpg

Depression—Elevated PM Cortisol

Cortisol restoration l.jpg

Cortisol Restoration

  • Mild deficiency can resolve with stress, rest, nutrient restoration

  • Moderate-to-severe—need cortisol, not cortisol substitutes like prednisone

  • Physiological doses (5 to 20mg=<1-4mg prednisone)—NOT excessive doses that cause hypertension, diabetes, osteoporosis, etc.

  • Fears of low-dose cortisolunfounded

  • Dr. William Jeffries’ Safe Uses of Cortisol

Dhea the other adrenal hormone l.jpg

DHEA—The Other Adrenal Hormone

  • Most abundant steroid hormone yet ignored

  • Cells make testosterone and estradiol with it

  • Levels decline with age, stress and disease

  • Anabolic—builds tissues, improves immunity

  • Reduces abdominal fat

  • Reduces pain—restores natural endorphins

  • Reduces inflammation (IL-6, TNF-, IL-2)

  • Anti-cancer effect in animal, in vitro studies

  • Lower levels assoc. with disease, mortality

Fatigue depression and pain l.jpg

Fatigue, Depression, and Pain

  • Should be considered as due to a nutrient, thyroid, cortisol, or DHEA deficiency until proven otherwise by testing and by trials of nutrient and hormone restoration.

Cortisol and dhea l.jpg

Cortisol and DHEA

Any Questions?

What else can hormone replacement help l.jpg

What Else Can Hormone Replacement Help?

  • Infertility, PMS, heavy bleeding

  • Insomnia—almost always helps

  • Heart failure

  • Mental disorders

  • Autoimmune diseases (systemic lupus erythematosis, rheumatoid arthritis, ulcerative colitis, Crohn’s disease, etc.)

  • Allergies, skin diseases

Hormone restoration l.jpg

Hormone Restoration

  • Unresolved issues—more investigation needed

  • Need more long-term randomized studies to study long-term results

  • Questions about delivery and monitoring

  • Medical profession should be studying bioidentical hormones instead of hormone substitutes!

Local compounding pharmacies l.jpg

Local Compounding Pharmacies

  • Winola Pharmacy—Rt. 307 at Lake Winola, 378-2885

  • Harrold’s Pharmacy—Wilkes-Barre, 822-5794

  • Fino’s Pharmacy—Dallas, 675-1141

  • Hazle Drugs Apothecary—Hazelton phone 1-800-439-2026

Doing bhrt l.jpg

Doing BHRT

  • History, consent, fees online

  • Initial visit: order tests

  • F/U visit: Results—prescribe—retest

  • Repeat until stabilized at proper dose

  • Follow-up office visit once every 6 months, test only as needed.

  • Telephone and e-mail contact—charges for clinical decisions, refills, etc.

Costs l.jpg


  • Physician time only as required--first year ~$200-$400; then <$200/yr.

  • No insurance billing;may submit claim for recognized diagnosis

  • Hormones—$10 to $70/month, some covered by insurance (GH adds $130/mo.)

  • Diurnal salivary cortisol test—$120

  • Blood tests—insurance may pay, lab kits $170-$220, Saliva/blood kit—$299

  • Out-of-pocket expenses tax-deductible

For more information l.jpg

For More Information

  • The Miracle of Natural Hormones David Brownstein, MD

  • How to Achieve Healthy Aging—Look, Live, and Feel Fantastic After 40Neal Rouzier, MD

  • The Hormone Solution—Stay Younger LongerThierry Hertoghe, MD

  • Life Extension Foundation (

  • BHRT info. and hundreds of abstracts at

  • Contact me:[email protected]

  • Login