Friday

8:00 – 8:05  a.m.

Welcome and Introduction

8:05 – 9:00 a.m.

Does HRT Really Slow the Aging Process?  A new perspective for 2023 

For decades HRT was prescribed for symptoms of menopause and to maintain long term health, i.e., as an anti-aging therapy.  Then came the fallout from the egregiously misreported Women’s Health Initiative Trial and the mantra changed to for symptoms only and for the shortest time necessary.  However, recent research using the newest molecular markers of aging, the IgG glycome and DNA methylation clocks, has demonstrated that indeed menopause accelerates aging and HRT can retard and even reverse this effect.  I will review the basics of these biomarkers and show how they can be used in clinical practice to assess and monitor long term use of HRT.

Faculty: Joseph Raffaele, MD

Faculty: Joseph Raffaele, MD

9:00 – 10:30 a.m.

Women:  The Hormone Research you Need to Have (articles are included)

Estrogen and blood clots: The longest and largest E2 study to date proves a decrease in breast cancer, breast cancer mortality, CVE mortality, all-cause mortality, and a DECREASE IN BLOOD CLOTS.  The PDR disagrees but the PDR does not differentiate CEE fro E2

Progesterone protects against CVD, cerebrovascular disease, and breast cancer: Micronized P4 improves endothelial function and foam cell formation more than E2.  A review of the literature proving that all menopausal women should be/must be on P4.

Breast Cancer: After five years of hormone therapy (anti estrogen) for breast cancer, estrogen blockers stop working and tumors become hormone (estrogen) independent.  The mechanism of action of the breast cancer recurrence and how to avoid these complications.  The most common cause of mortality in breast cancer patients is CVD.  The mechanism of action of breast cancer recurrence and CVD is the same

Faculty Chairman: Neal Rouzier, MD

10:30-11:00 a.m.Exhibitor Break

11:00 – 12:30 p.m.

A Continuation of the Morning Lecture

Faculty Chairman: Neal Rouzier, MD

12:30 – 1:45 p.m. – Lunch

1:45 – 2:45 p.m.

Biohacking Insulin Resistance: When Hormones Are Not Enough (Clinical Applications)

Do you have patients that struggle with stubborn belly fat and other signs or symptoms of insulin resistance despite adequate hormonal optimization? In this talk, we will dive into dietary techniques and tools that can be used to fully optimize your patient. We will review the pathophysiology of insulin resistance and discuss real clinical cases to teach dietary interventions and behavioral changes that restore insulin sensitivity.

Faculty: Nicole Lovat, MD, PhD

2:45 – 3:45 p.m.

Managing Cellular Health to Prevent, Preserve and Perpetuate Optimal Health

Health is usually defined as the absence of disease; but all disease begins at the cellular level, often before any criteria are reached to diagnose disease. If disease begins at the cellular level, then health must begin in the cell as well. 

We will look at cellular components, physiology, and pathways to help us define cellular health and the ways we can use this knowledge to optimize our overall health and longevity. We will look directly at ways we sabotage cellular health and then explore ways we can create and maintain cellular health through repair and   restoration of mitochondrial  function – the energy factories of the cell. We will examine ways we can use hormetic stressors to aid in cellular recovery as well. 

Faculty: Connie Casad, MD

3:45 – 4:15 p.m. Break

4:15 – 5:15 p.m.

Cash Practice Compliance: Best Practices for Telehealth, Consents and Price Structuring

Post-Covid Telemedicine is changing, what you were doing during Covid may no longer be acceptable.  It’s important to be in the know with controlled vs non controlled prescribing both in state and across state lines.  Know when multi state DEA numbers are required and know the rules for seeing, evaluating and prescribing across state lines.  It may be more complex then you think.  I’ll have specific case scenarios and will be available to answer all your questions

Faculty: Jim Eischen, Esq

Adjourn

Saturday

8:00 – 9:00 a.m.

Brain Energy: The Metabolic and Mitochondrial Theory of Mental Illness.

This lecture will provide a broad overview of the current state of the mental health field, the different lines of evidence that support the theory (clinical, epidemiological, basic science, neuroimaging, genetic, etc), and an overview of treatments that can play a role

Keynote Guest Faculty: Christopher Palmer, MD

9:00 – 10:30 a.m.

Men:  The Hormone Research you Need to Have (articles are included)

E2 and men, the final chapter: Why it’s good, why it’s bad, you are the expert, how to rebut the rebuttals.  Hypogonadism results in gynecomastia that is reversed with testosterone and E2.  Its gynecomastia vs mastalgia vs insulin resistance vs estrogen dominance.  Studies to prove AI’s dont work, they only make the forgoing worse over time. Should we prescribe E2 to men, a literature review, DHT reduces sub Q fat, E2 reduces visceral fat. Over 50% of testosterone’s protective effect is related to the aromatization in E2.  A complete literature review will demonstrate the benefit of optimizing E2 in men as well as harm of lowering E2.

High hemoglobin and hematocrit (H&H) from physiologic erythrocytosis does not cause harm (MACE) in any study; however, polycythemia vera (PCV) does. The mechanism of harm with PCV is not increased blood viscosity as everyone says, but rather platelet dysfunction, platelet aggregation, and thrombocythemia that all contribute to thrombocytosis (MI, CVA, DVT, PE) in patients with PCV.  Patients with testosterone-induced physiologic erythrocytosis (secondary polycythemia) do not require phlebotomy per current hematology literature.  We will review the hematology literature outlining the treatment for PCV in contrast to the treatment (or lack thereof) for physiologic erythrocytosis.  Understanding why hematologists and cardiologists get concerned, how to approach it and what to do about it with literature in hand.

Blood clots and congenital thrombophilia: Several recent published papers tate and claim that the increase in blood clots observed in patients with congenital thrombophilias while taking testosterone is due to the aromatization of testosterone into E2 thereby necessitating the concomitant use of AI’s.  Authors claim that estradiol-induced thrombophilia causes blood clots in men.  DES increased VTE and MI in men treated for prostate cancer, however, E2 does not increase VTE in any randomized controlled trial, not does elevated levels of E2 from testosterone administration – a detailed review.

Faculty Chairman Neal Rouzier, MD

10:30-11:00 Exhibitor Break

11:00 – 12:30

Faculty Chairman: Neal Rouzier, MD

A Continuation of the Morning Lecture

12:30 – 1:45 – Lunch.  Non-CME lecture sponsored by Belmar Pharma Solutions

1:45 – 2:45 p.m.

Beyond the Bedroom: Understanding Erectile Dysfunction and Prostate Cancer in Primary Care Practice”

Pearls of wisdom in the diagnosis and treatment of erectile dysfunction, tips and tricks that might be helpful in performing procedures, and brief, useful updates for diagnosis and treatment of prostate cancer.

Faculty: Clifford Gluck, MD

2:45 – 3:45 p.m.

A Hormonal Guide to Curbing Addiction (Clinical Applications)

Much like obesity, addiction has a strong relationship with hormonal problems. Whether you have a PCOS patient who struggles with alcohol addition, or an insulin resistance patient on opiates for chronic pain, there are hormonal tools which curb their cravings and assist in achieving sobriety. We will discuss some of the reward pathways and hormonal issues that give rise to addiction and fuel the disease as well as ways to improve the quality of life of your patients by helping them resist the substances ruining their lives.

Faculty: Nicole Lovat, MD, PhD

3:45 – 4:15 p.m. – BREAK

4:15 – 5:15 p.m.

Talk title and speaker TBA

Sunday

8:00 – 9:00 a.m.

Let’s Play a Game – Updating my Journey with Prostate Cancer.

I’m going to make a case that how we treat cancers in general is seriously flawed.  We tend to treat with MTD (maximum tolerated dosage) until patient develops resistance, and then we go to another agent, again with MTD.  Our cancers have the ability to fall back upon the entire human genome; no wonder we lose at this game.  But, we can use game theory to try to beat the cancer.  I am going to expound more on just how this might work to cure metastatic disease, using me as the prime example.

Faculty: Herman Pang, MD

9:00 – 10:00 a.m.

Case Study Hour

We will be reviewing 4-5 interesting and complex case studies submitted by your colleagues

10:00 – 10:15 a.m. Exhibitor Break

10:15 – 12:15 p.m.

The Hormone Research you Need to have for Both Men and Women (articles provided)

The importance of informed consent, informed refusal, shared decision making and signed documentation.  Although there is no harm to BHRT, remember to document that you advised of the harm of SHRT when prescribing BHRT.  A literature review of both.

The U.S. Preventive Service Task Force (USPSTF) confuses CEE with E2 and warns of the dangers.  Estradiol is safe and efficacious for preventing chronic disease.

Estrogen dominance is a misnomer and myth.  Estrogen dominance is simply insulin resistance that should be treated with E2 in both women and men.  AI’s increase estrogen dominance and IR and decrease glucose utilization by muscle cells

How to reverse plaque.  We will look at the most recent JAMA review of randomized controlled trials demonstrating that statins are not beneficial in most patients unless they have elevated cholesterol.  Dyslipidemia/IR drives most CVD and inflammation.  Statins decrease CVD and morality in secondary prevention studies but not so much in primary prevention studies.  However statins do increase the risk of breast cancer, diabetes, insulin resistance, visceral whit fat, triglycerides, lipoprotein(a) and coronary calcification.  Estradiol does the opposite and protects against/reverses the forgoing.  Statins induce dyslipidemia via an increase in visceral (white) fat and by reducing metabolically active brown fat.  Statins only benefit patients with normal triglycerides and HDL according to the recent meta-analysis in JAMA, what else can be done?

Literature review for the mechanism of action for how and why oral estradiol protects against heart disease and should be prescribed to every menopausal woman and man.  The main benefit of oral E2 in reducing CVD events is via conversion of echolucent plaque to echogenic plaque thereby stabilizing and reducing plaque.

Lowering lipoprotein(a): Prominent lipidologists claim it cannot be lowered.  We’ll review the evidence that it can be lowered.  Lowering lipoprotein(a) can also prevent blood clots by oral E2 not transdermal E2.

Thyroid Review: Literature proving T4 does not work in subclinical hypothyroidism and should not be used to improve symptoms as demonstrated in two studies we will review.  T4 suppressed T3 thereby resulting in no improvement in symptoms or CVD markers.  Symptomatic improvement only occurs when free T3 is increased – the top ten papers you will want to have on hand.

How to avoid hypometabolism and the problem with weight loss medications that suppress appetite but also suppress metabolism and hypothalamic set points.  

Faculty Chairman: Neal Rouzier, MD

Adjourn