A Note from Neal on Part III: Fun, Fast, & Furious: Fun, Fast, & Furious
Over the past 12 years of teaching HRT courses I have tried to modify the content to be what I thought best as far as practicing HRT. Part I begins with the didactic, evidence-based approach to demonstrate what we do and why we do it, based on the medical literature. Day two is designed to get you started on prescribing, monitoring and adjusting hormones based on symptoms and laboratory data. When I ran out of time and space, then Part II was developed to complete the Part I course. Part II consisted of finishing what I thought to be important facts, papers, and labs that I felt you should know but could not cram into Part I. Finally, we reviewed chronic fatigue, PCOS, hair loss, skin, osteoporosis and new lab markers. The most important section of Part II was demonstrating the anti-cancer benefit of our hormones, which most physicians and academicians have never read or seen. I had hoped to lay the groundwork for everything there is to know, based upon our literature, to have a firm understanding of preventive medicine. Unfortunately the sections on clinical pearls, tricks of the trade, and difficult and interesting cases I’ve accumulated were eliminated. Hence, Part III.
All 3 courses are in constant evolution. New to this Part III is the importance of SHBG, which is the most important and least recognized serum protein for predicting cardiovascular disease in both men and women. The literature demonstrates the importance of optimizing this protein. The literature also weighs in on which estrogen is best for long term health and it’s the opposite of what most are doing. Recent literature purports that testosterone has a longevity effect on men with treated prostate cancer. Unbelievably, some doctors are now treating men that have active prostate cancer with testosterone with no ill effects except improvement in longevity and well-being. We will also look at prevention and treatment of prostate cancer with estrogen, completely the opposite of what other academies are teaching. We’ll review how SHBG protects against cancer and how testosterone raises SHBG?
Part III involves new material and studies to further shape why we do what we do. However I have the most fun when we utilize the medical literature to debunk what other groups commonly teach and believe which is why I focus so much on evidence based teaching. Even though many theorize that estrogen is harmful in men, the literature entirely supports the opposite. In fact, recent literature supports estrogen’s role in treating and preventing prostate cancer, CAD, DM, osteoporosis, and dementia. We will review the literature to decide which estrogen to use in men, when, how much, and which ones to avoid. I will present the many cases of active prostate cancer that I have been treating for 10 years with only estrogen! Many practitioners are still being taught that estrogen causes prostate cancer despite estrogen having antiangiogenic and proapoptotic properties against prostate cancer. As for women, we will also review which vaginal estrogen to use, which ones to avoid, how much, when and why, which ones are absorbed systemically and which ones are not. In addition, the new treatment of choice for prostate cancer is HIFU and the best diagnostic test is the MRI-S. We should only biopsy the prostrate after we produce a mapping of the prostrate under MRI guidance. And if no tumor is seen, then no biopsy should be done.
At what level should a man’s serum estradiol level be maintained for optimal health? What estradiol level should be maintained to suppress the growth of active prostate cancer? This is counter to the teaching of A4M and AMMG, yet they have no scientific evidence to back up their unsupported claims that estrogen causes prostate cancer which is contrary to the studies showing the success of estrogen in treating prostate cancer. Let’s see who wins in this court of medicine. The pendulum now swings in the direction that optimal testosterone levels, with the resulting optimal estradiol levels, may be protective against prostate cancer. Lastly we will look at the literature supporting estrogen in the treatment of prostate cancer and review the cases where I have successfully treated prostate cancer with estrogen administration throughout the last 15 years.
The local osteoporosis expert can’t get NTX levels below 50. He is baffled as to how I get them below 20, then raise vitamin D levels to above 60, and get all DEXA scans to improve. He believes that I use toxic levels of vitamin D whereas studies prove what levels are toxic and the side effects associated with these toxic levels. The cardiologist wonders how I can lower cholesterol, triglycerides, lipoprotein and CRP levels, and get HDL up that high. And a local fertility expert is frustrated that I have made two of his patients pregnant whereas he could not (don’t go there!). It was simply due to the effect of Femara in blocking excess estrogen, maintaining adequate progesterone, thyroid, and metformin levels throughout pregnancy in patients with PCOS. The literature tells us how to prevent and treat post-partum depression. Fun and interesting cases will be reviewed that I did not have time to review in Parts I & II. There will be many cases involving “what to do when this happens,” that we couldn’t cover in the prior courses. Let’s see how you do with the 50 menopausal cases that review every type of problem you could possibly encounter in a menopausal woman. The amount of data and study that is available to support this therapy is amazing and I love to share and decipher these studies that are so important yet missed by most physicians and academies. As you know by my passion, this medicine is absolute fun!
The prescribing of HRT is relatively straightforward and that was very repetitiously covered in Parts I & II. However, it is that 10% of patients that have problems and complications that will challenge your knowledge and expertise. So, Part III is designed as a course that reviews tricks of the trade as it relates to problem cases, many ifs, ands, or buts, complications, and what to do and say to patients and their doctors when they challenge you. As in keeping with our tradition, more supportive and interesting articles from our literature will be analyzed to support our unique style of medicine. Following this letter will be a small sampling of questions that may pique your interest. After completing Part III you should feel confident in calling yourself an expert in preventive medicine and hormone replacement therapy.
So bring the Provigil and coffee and get ready for an intense two-day board review type of course. Past attendees have commented that it was the most fun course of the three because of the discussions. If you have signed up for the certification, WLM will present the third part of the certification test upon completion of Part III. In preparation for this we will review 500 questions and cases of clinical pertinence to understand the most difficult, interesting, fascinating, and controversial cases. In addition there will be an hour potpourri of interesting articles that don’t fit into any particular topic yet are so pertinent to our science. I hope to see you all next month in Clearwater, FL!
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