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  • August 24, 2019 2:56 PM | Rebecca Storms (Administrator)

    A recent paper claimed that nonalcoholic fatty liver disease is an unrecognized epidemic. There is no FDA approved drug for treating and reversing NAFLD, however, sustained weight loss can reduce the risk of cardiovascular events and diabetes. Unfortunately, the article did not address how to be successful with weight loss. Weight loss attempts have obviously been unsuccessful if NAFLD is now epidemic. “Both NAFLD and CAD represent end-organ manifestations of the same systemic metabolic insult, all related to insulin resistance.” What the authors did not address is that the cause of the insulin resistance is hyperinsulinemia, and not the other way around. (Thank you, Jason Fung, for introducing this concept). In my last newsletter I described the lack of success and the increase in harm we have recently encountered with commonly prescribed diabetic medicines. Not only are we not making a dent in CVD prevention, but we now see an epidemic of NAFLD as over 70% of diabetics have NAFLD, which apparently is not being controlled by standard diabetes treatments. And I wouldn’t expect it to as I now have an understanding that diabetic meds don’t get rid of serum glucose, rather they drive the glucose into another compartment: the cell.  I believe that this increase in NAFLD is due to our inability to understand the mechanism of current medicines which increase production of, or function of, insulin that drives glucose into the cells.  Overloading the cell with glucose is not the solution. Rather, preventing intake of glucose by diet, maintaining a fasting state to provide ketosis to reduce visceral and intra-organ fat, preventing storage of glucose into glycogen and fat, increasing metabolism of fat, and increasing excretion of glucose, as opposed to sweeping it under the carpet or into the cell, is the solution. And the basic underlying problem is hyperalimentation of glucose and sugars that result in hyperinsulinemia when the cell cannot handle the increased glucose load caused by the hyperalimentation.

    Professor Samuel Klein states that 2 million people have cirrhosis caused by NAFLD.  However, the main cause of death is not liver failure but is CVD and the incidence of CVD continues to increase despite multiple drugs used to prevent DM and CVD. It’s the hyperinsulinemia that increases fat deposition in the liver and adipose tissue. Weight loss reduces visceral and liver fat, but this is difficult to implement. Well, not if you know how to do it. Jason Fung and his staff will take us through the educational process to understand how to be successful in treating ourselves and our patients. Nevertheless, not everyone can be successful as our hypothalamic set point fights us by slowing down our metabolism to maintain a set weight and body mass index, which can be difficult to overcome.  I too will demonstrate my success with patients in helping them maintain optimal metabolism, which maintains weight loss.  I will also provide all the literature support and studies demonstrating safety and efficacy of optimizing hormones, but probably different to what others are accustomed to doing. I will also provide all the studies that practitioners should be familiar with when optimizing HRT. Our focus should be on prevention, treatment, and reversal of disease which has not occurred in the majority of trials for CVD prevention using conventional medications.

    The following are excerpts from recent papers from JAMA and NEJM:

    “However, a resurgence of diabetes complications has appeared in national statistics and in the epidemiology literature. An increase in diabetes-related amputations has occurred nationally. Updated national statistics indicate that the recent increase in complication rates is occurring in middle-aged adults, among whom the risk of hyperglycemic crisis, AMI, CVA, and amputations each increased by more than 25%.” We obviously are not doing something right. “Most counties in the U.S. have seen an increase in cardiovascular disease mortality among adults.” Hmmm, just what is it that we are doing wrong that’s not working? Rather, what should we be adding that we are not? Perhaps not giving drugs that drive glucose into the cell should be a start. Other than type I diabetes, I know of no other disease entity in which there is a deficiency of glucose entering the cell.  If the cell is storing glucose as fat, triglycerides, and glycogen, then the cell is already overloaded and getting plenty of glucose on its own. If the liver, kidney, pancreas, and visceral organs are all storing excess glucose as fat, then there is plenty of glucose getting into the cells. Enter diet, exercise and life-style change. Secondly, we should be disposing of the glucose by every other means possible and keep it out of the cell. Next we should be preventing the glucose from getting into the cell by metabolizing it in muscle and liver. Enter hormones. Next we should be providing less glucose into the body in the first place.  Enter Jason Fung. (I’m currently fasting as I write this, and it really is easy.).  Lastly, we should be disposing of and excreting the glucose that enters the body.  Enter the new diabetic drugs. Perhaps we should be preventing this metabolic insult instead of just treating the disease by pushing serum glucose into the cells. That has been Dana’s goal for 20 years-establishing a medical academy that focuses on health and wellness, and promotion of that concept to physicians. This next Hormones and Beyond Cardio-Metabolic Symposium brings all this to fruition. Other medical academies attempt to reach this goal but have failed. And that’s why I am so excited about the upcoming Hormones and Beyond Symposium. 

    “This means that the future direction of diabetes complications has enormous collective implications for health and costs.” (JAMA 2019;321(19):1867-68). Yes, but why do studies show that CVD and outcomes are getting worse? And why is it that spending billions of dollars on health care and medications do not result in less CVD?  Here’s why as explained in JAMA.

    “Optimal diabetes care is predicated on balancing the immediate and long-term sequelae of the disease and its therapies and improving patient health and well-being. Professional societies have focused on HgBA1C levels to gauge the quality of diabetes care. The preferential use of HgBA1C levels in research, policy, and practice stems from the demonstrated association between lower HgBA1C levels and disease endpoints. (Observation does not prove causation and a correlate does not a surrogate make).  However, these studies did not demonstrate improvements in outcomes that are most meaningful to patients such as CVD, stroke, and mortality. Thus, HgBA1C level is a surrogate marker for a proxy of uncontrolled disease. (Remember, just because high levels portend harm does not mean that lowering HgBA1C fixes the problem. And that depends on how one lowers the HgBA1C by either driving glucose into the cell ((bad)) or metabolizing it ((good))).”

     “Similarly, for clinicians, HgBA1C level is an effective monitoring tool that is responsive to real-time changes in blood sugar control. Nevertheless, even though HgBA1C level is a valuable forewarning of future events in patients with diabetes and has an important role in reflecting the patient’s average level of glycemia, it (HgBA1C) should not be the outcome that matters most or that is prioritized at the expense of meaningful outcomes that are important to patients (and us).”

    “Fallacy of the Surrogate: The rationale for using HgBA1C level as a surrogate marker for diabetes outcomes is predicated on the assumption of its direct correlation with improved outcomes that patients and doctors value like MI, CVA, and quality of life. Yet, the strength of this relationship has been called into question as the outcomes can be worse (even though the HgBA1C is lower). Meta-analyses revealed a null association between intensive glycemic control and these cardiovascular outcomes.”

    “However, the importance of glycemic control for patients with type II diabetes cannot be extrapolated from data developed among patients with type 1 diabetes.  The glucose-centric model of type 1 diabetes cannot be transferrable to the management of type II diabetes.” (In type I DM there is a deficiency of insulin and intracellular glucose whereas in type II there is excess insulin and intracellular glucose). Moreover, HgBA1C level may be misleading and its singular prioritization could lead to patient harm.” Yikes!

    “The new GLP-1 RA and SGLT-2 inhibitors were demonstrated to reduce major macrovascular events and death independent of glycemic control.” (In other words, these new meds can lower CVD disease by other mechanisms other than lowering serum glucose). Then, what parameters and outcomes should we measure and follow? “Consideration should be given to reverse the routine use of surrogate markers like HgBA1C and instead refocus on the following outcomes that are important: CVD. Encouraging clinicians to embrace patient centered care unencumbered by the constraints of the HgBA1C level could allow them to instead focus on the outcomes like CVD. To improve the quality of value of diabetes care, it will be necessary for patients and all those involved in their care to focus on what truly matters-that which improves their lives and outcomes, and not their laboratory numbers.” (JAMA 2019;321(9):1865-67). Bingo!

    I hope that the foregoing was as enlightening for you as it was for us. I’ve stopped chasing HgBA1C levels and the fruitless administration of expensive diabetic meds that lower HgBA1C but not disease outcomes. I now focus on lowering HgBA1C levels by other means. Instead I chase waist circumference, visceral fat, body weight and BMI, vascular responses, lipid levels, plaque scores, quality of life, and patient satisfaction. That’s what Hormones and Beyond is all about. Hope to see you in Austin.

    Click Here To Access Articles Referenced

  • August 14, 2019 6:21 PM | Rebecca Storms (Administrator)

    Dear Colleagues:

    The timing was perfect as it could not have happened at a more opportune time. Two articles in JAMA made claim to the fact that our treatment of diabetic patients with typical diabetic medicines increases the risk of MI and CVD. What? I thought that we needed tighter BS control to lower the risk of CVD and diabetic vascular disease? Later, the NEJM published a study that tight BS control did not improve CVD outcomes and even showed an increase in CVD events. What, how can that be?  Is everything that I/we have been teaching, preaching and doing for the last 30 years incorrect? Now, after reading Jason Fung’s book I understand why that is. It is true that the higher the HgBA1C level, the worse the prognosis and the sooner one dies from the foregoing diseases. However, just because high levels of HgBA1C are associated with increased morbidity and mortality, that does not mean that lowering the HgBA1C results in less disease, or that lowering the blood sugar is of benefit. It makes sense to lower BS and gain tighter control and lower HgBA1C levels if high levels increase the risk of disease, but the outcomes prove otherwise. Why? Maybe because what we have been doing, and falsely misled to believe, is wrong. Lowering blood glucose is correct and appropriate, however, how we lower it is the key to understanding why using one method improves but the other worsens outcomes.

    A recent TV ad for a GLP-1 analog claimed that there was no increase in MI or CVD events with this medication; their selling point was that there was no increased risk of MI? Yay, yippee, finally a drug that does not increase heart attacks! Wait. What? Why are we giving drugs to lower BS that in turn increase heart attacks, cause significant weight gain, and increase morbidity and mortality?  I thought that lowering BS was good. For years I kept increasing diabetes meds, trying to maintain tighter BS control. But the patients all gained weight and their disease got worse.  So, I added more meds and started long-acting insulin and they gained even more weight. I once bet a patient that if he lost 20 pounds I would give him $10,000. He failed.  Then I went double or nothing. Not only did he fail but he gained weight. I blamed him but little did I know and realize that it was my fault and not his. This was before I read Jason Fung’s book The Diabetes Code and learned how and why DM meds made CV disease worse. My heart sank.

    A recent video on Medscape made reference to the fact that “Cardio-Metabolic Disease” should be made a new specialty.  Based on all the GLP-1 analogs and sodium-glucose cotransporter 2 inhibitors reducing weight, disease, and MI risks, the specialty is definitely changing and gaining momentum.  So why are these new drugs any different? Although these meds work by various mechanisms to lower BS, lower HgBA1C levels, and improve CVD outcomes, the main importance is that they lower BS by different mechanisms other than increasing beta cell function, insulin levels, and driving glucose into the cell. These new wonder drugs decrease appetite, slow down glucose absorption, decrease gluconeogenesis, and increase glycosuria through the kidneys. The most important take away is the ability to decrease BS by different mechanisms other than driving glucose into the cell which all past drugs did, particularly insulin. By cramming all the excess glucose into the cell, the cell becomes overloaded with glucose which the cell must dispose of by storing it as fat and glycogen or converting it into triglycerides. Hence, the onset of fatty liver, fatty pancreas, fatty kidneys, dyslipidemia, NAFLD and NASH. I blamed all my patients for their weight gain and disease progression.  And I blamed myself for not being more vigilant in maintaining tighter BS control. I had no clue.  Mea culpa, mea culpa, mea maxima culpa.

    In June, Reaven published in the NEJM that intensive glucose control in type 2 DM patients proved just as likely to cause a MI as standard therapy. Patients also gained weight and had worse disease outcomes. Perfect. There was no better outcome in MI, CVA, CHF, CVD, death, DM complications, or QOL scores. Even after 15 years of tight control, no benefit. So, what was their suggestion to improving outcomes? The researchers recommend treating DM even sooner and much more aggressively, as though 15 years of tight BS control was not enough? (Einstein said insanity is doing the same thing over and over again but expecting different results!) Professor Simmons stated that the data from the VADT study was consistent with findings from other studies. She finally admits that perhaps we should decrease medications if the risks outweigh the benefits. The authors do note that these results are before the GLP-1 receptor agonists and SGLT2 inhibitors were available. However, their treatment suggestion was to use more and more drugs that consistently do not work.  Hmmm. Those thousands of researchers need to read and grasp Jason’s book in order to see why they, and their patients, fail.

    In the REWIND study, dulaglutide reduced MI risk by 12%. That’s relative risk and not absolute risk which was much smaller. (The RR was 12% but the absolute risk (AR) was only 1.4%, with 3.4% MI in control group and 2.0% in treatment group=1.4% AR).  It was the first major study that proved superiority over standard care, which has been consistently harmful. (An absolute risk reduction of 1.4% is quite underwhelming, but the researchers jumped for joy). So, there is less harm with the new drugs than in comparison to standard therapy (which increased risk), but what about with control groups? “In assessing the individual components of the composite outcome, Gerstein noted that there was no discernable effect observed for nonfatal MI with dulaglutide and a neutral effect observed for CV death.” You mean, no benefit? That is correct, no benefit. No benefit after spending millions of dollars on drugs and they do not work to reduce CVD? Hmmm. Their conclusion was that dulaglutide “could be considered for the management of glycemic control.” Could be? Why didn’t they state, “should be or must be?” Because the results were underwhelming and the cost $900/month!

    There are better, safer, tried and true solutions to the above. That is what Part V Hormones and Beyond is all about. Jason Fung will review his secrets and insight for success. I will review all the medical literature demonstrating what we should be doing as well as what we should not be doing. Hope to see you in October.

  • August 06, 2019 3:30 PM | Christiaan Killian (Administrator)

    Dear Colleagues,

    You will find a new level of confidence as you move from the basics of Part I to the advanced protocols in Part II. The Part II course provides the experienced practitioner with training that is essential for mastering more complex cases. The course will serve as a short refresher, but will highlight new important therapies, clinical pearls, tricks of the trade, controversies and everything that I could not cram into Part I that you still need to know. The field of age management medicine continues to grow at a rapid rate, and we only seem to get busier, making it difficult to stay abreast of all the changes. This is why we’ve condensed an inordinate amount of material into 2 ½ days—in fact, there are over 1,300 slides of information (Yikes! I’ll talk fast).

    My favorite part of this course are the informal discussions and Q&A sessions at the end of the day where we discuss anything that you want to discuss. This is one of the most interactive ways that new attendees expand their clinical knowledge by learning and sharing experiences, audience discussions, difficult cases, controversies, legal issues, suggestions, medical board issues, trials and tribulations from other seasoned attendees. I’ve yet to find anywhere else where can one go to participate in such a gathering and meeting of HRT practitioners that share their successes and challenges. This discussion is a wonderful prelude to the topics covered throughout the remainder of the weekend:

    Section A
    Antiaging, definitions of, and why we call it that. This is a review of the medical literature articles that shows us why we refer to BHRT as antiaging and provides credence for why we do what we do.

    Section B
    Longevity medicine and which hormones have a proven record of extending health, wellness, and longevity. Yes, optimization of HRT does extend life.


    Section 1 – Review and Critique of the WHI and HERS Study
    Making sense out of the many HRT studies, the critiques, and the rebuttals. Putting the pieces together will make you an expert on all the ifs, ands, and buts. It is the knowledge and command of this scientific literature (that your colleagues will never know) that makes you the expert.

    Section 2 – Bioidentical HRT: A Critical Literature Review
    The positive and negative articles on BHRT. Laying to rest estriol as the worthless metabolite it is. What the literature shows we should use and shouldn’t use, and disproving what many others are teaching without any basis.

    Section 3 -  Hormones and Cancer Protective or Causative
    “There are no studies that prove BHRT is different than synthetic HRT.” Baloney! Many studies contrast the BHRT with SHRT.  Know when it’s safe to prescribe and when

    Section 4 – Important Articles on HRT, Don’t Ignore the Literature
    A literature review proving that HGH, testosterone, estrogen, progesterone, DHEA, and melatonin protect against cancer. 

    Section 5 – Progesterone Optimization
    This section is “R” rated for language and me acting out: Optimization of progesterone and case examples, multiple studies that prove transdermal cream is worthless and harmful, and saliva testing for monitoring therapy is fraught with error. Scientific studies prove where your levels should be for maximum protection, and where they should not be if one wants to protect against cancer. Case studies with labs show the good and bad.

    Section 6 – Testosterone, New and Different Administration
    New and different methods for raising testosterone in men and women besides creams: Oral, SQ, IM, HCG, Clomid, which are the cheapest and which are the best.

    Section 7 – Oral vs Transdermal Estrogen
    Oral vs. transdermal estrogen, relative risks for both, safest vs. most beneficial. Which, when, why and how the ESTHER study guides us.

    Section 8 – Thyroid and CVD vs Osteoporosis
    A literature update of thyroid for cardiovascular protection and osteoporosis protection. So you think you know thyroid? More literature backing for why we do what we do.

    Section 9 – Cardiovascular Disease Prevention

    Cardiovascular disease protection, cardiac markers, eicosinoids, diet, EFA’s, insulin, inflammation.

    Sections 10 – Cardiology Case Management
    Cardiovascular disease protection, cardiac markers, eicosinoids, diet, EFA’s, insulin, inflammation. 

    Section 11 – Complex cases with Lab Review
    Cardiovascular case studies with management beyond statins.

    Section 12 – More Literature Review for HRT
    Diagnosis and treatment of the most common premenopausal endocrinopathy that everyone fails (misses) to diagnosis, and it’s relation to CAD, breast CA, and uterine CA.

    Section 13 – Question with Answers

    Section 14 – PCOS

    Polycystic Ovary Syndrome is the most common endocrine disorder in premenopausal women.  It’s more common than you think, learn to recognize and treat this condition

    Section 15 – Osteoporosis and Estrogen Metabolites

    Treatment of osteoporosis beyond biphosphonates: E2, D3, Vit K, strontium, & ipraflavone. Measuring and monitoring NTX & CTX. Estrogen metabolites- do they or do they not predict breast cancer and should we waste money on testing? 2OH-E1 vs. 16αOH-E1?

    Section 16 – Estrogen and Progesterone in Men
    Importance of optimization of estrogen in men too and the harm of suppression. The harm of giving progesterone to men that increases inflammatory cytokines and ED (what are they thinking)?

    Section 17 – Chronic Fatigue Syndrome and Cortisol
    Cortisol for fatigue and CFS, how and when to use it, how to monitor it, and test it with ACTH.

    Section 18 - References
    Complex cases, labs, adjustments, fun and interesting cases, and lots of WWND (What Would Neal Do?)

    Thanks everyone hope to see many of you in Indianapolis!

    – Neal

  • July 03, 2018 10:54 AM | Christiaan Killian (Administrator)

    Dear Colleagues,

    It is now time to start to prepare the lectures for Part V, which I start organizing a year in advance.  It is also time for everyone to block out October 5-7 on their calendar, so you can attend this year’s WLM symposium. My interest/focus this year will be the brain, breasts, prostate, and mitochondria. And I’m pleased to announce this conference as our 20-year anniversary event.  Dana has worked long and hard to make this reunion special. And so have I by organizing a review of the most recent profound literature that we should all be aware of. It is my annual update of literature that I can’t cram into the courses but that we should have command of to better treat our patients.

    During my toxicology fellowship we were taught that the best treatment for a poisoning was to prevent the poisoning in the first place.  The same concept applies to dementia and Alzheimer’s disease. After 30 years of failure by the pharmaceutical industry to develop a cure for Alzheimer’s disease, we still have no treatment after billions of dollars in research.  However, the best treatment still is to prevent the disease in the first place.  There is an amazing plethora of data proving loss of hormones is culpable and replacement is protective.  Our ignorance is embarrassing when it comes the research showing benefit.  “Yea but…the WHI showed…” I hope that I can cram all the articles that I want to show you into 3 hours of lecture demonstrating many different hormones affect the brain.  UCLA is one of the outstanding universities that has a special section devoted to treating dementia, with Dr. Bredesen heading that endeavor.  Unfortunately, he will not be presenting but Dr. Sharlin will review UCLA’s protocols as well as functional medicine treatments that have been shown to provide reversal of cognitive decline and improvement in symptoms.  SPECT scans demonstrate plaque reversal with BHRT but not so with SHRT.  It’s impressive. Patients can now go to you for treatment/prevention without having to travel to UCLA.

    As you know I used to run at the front of the pack.  In the last 10 years I have moved to the back of the pack, choosing not to fight the fight I used to fight, allowing the naïve specialists to have the upper hand.  The pendulum has now swung back in the opposite direction.  Patients should not have to suffer the inadequacies of their specialists nor should we have to play second fiddle.  I’m tired of dealing with physicians that don’t understand why we do what we do or ignore the literature that supports it.  It’s time to show and prove to the specialists that which they should know but don’t. Yes, I do pity them because there is no venue for them to learn this information other than WLM.  Unfortunately, it is the patient that suffers the consequences of the physician’s lack of knowledge. Thus, I’ve taken on the role of being the patient’s advocate, empowering them to understand an alternative treatment or prevention that is all evidenced based, but that which is going to be rejected by their PMD’s.  I now provide articles to patients supporting the important benefits of testosterone in prostate cancer patients, progesterone and testosterone in breast cancer patients, and the safety and efficacy in prevention and treatment of these diseases.  I will provide and review all the studies that you should have in your quiver to present to patients and their physicians that reject what we do because the physicians have not a clue.  I’m tired of letting the patients endure the consequences of physician ignorance. All new and recent evidence will be presented. Please utilize these studies to provide direction and support to your colleagues and patients.

    The diagnosis and treatment of prostate cancer continues to evolve yet remains controversial.  Dr. Bernadette Greenberg from Desert Medical Imaging will present the update in diagnosis and treatment as well as the use of genomics to predict outcomes. This will be the most captivating lecture you will ever hear as I have never experienced any lecturer as dynamic as this lady. Be prepared to be blown away by her knowledge and presentation.

    We at WLM are pleased to now have a 2-hour presentation before Part I to help attendees “figure me out.”  This is presented by Dr. David Kern who has the same sarcasm and insight as I do.  He will be presenting all the data on how glucose affects the brain, dysglycemia, and protein glycation.

    A new addition to WLM is a separate course on PRP, injection techniques, and the latest literature by Dr. Nacouzi.  Unfortunately, the PRP course sells out due to the popularity of this new and easy treatment.  We’ll learn why it is so popular and how to incorporate this procedure into your practice.

    We have tried to introduce new and promising concepts that we can incorporate into our practices. I know nothing about genetic testing, epigenetics, when to test, and what to do with the results. What I have read in JAMA is confusing and perhaps political. Dr. Stickler will enlighten us as to what, when, and why to test and then what to do with the results.

    I also know little about cannabis, cannabinoids, CBD, etc.  Are they a safe and effective alternative to opiates now that we suffer from opiate paranoia?  I have had many patients request it with excellent results.  Now that it is legal in California and other states, pot shop owners know more about cannabis than physicians. So, we have chosen Dr. Felice to enlighten us about what we should know about this alternative for pain and sleep management.

    Our resident attorney and business consultant that teaches the WLM business course will provide an update on practice management, compliance, and how to avoid hassles with insurance and regulatory agencies. As far as hormones are concerned I have focused in this course primarily on breast cancer, prostate cancer, and mitochondrial dysfunction. 

    I would like to focus on the recent literature as it pertains to my personal situation and how HRT has helped me in this regard as well as the medical literature as it pertains to pain. After 30 joint surgeries, joint sepsis, 5 back surgeries, and over 20 IV antibiotics that have played havoc with my gut that resulted in significant inflammation, I’m an expert in pain management and gut dysbiosis.  Pain can affect our psyche and sleep cycles.  I’ll review the recent literature as it pertains to opiates effects on hormones. Concurrently, hormones have been shown to have a significant impact on multiple nociceptive pathways that result in significant pain improvement.  Unfortunately, do to my snips, opiates and cannabis don’t work for me but I’ll present literature and as to what does work and why.

    Lastly, and most disturbingly, is a topic that I must address but with grave reservation and frustration, and that is our legal environment.  It is a complete system failure, from the process of medical board complaints, to medical board handling of complaints, to reliance on completely inappropriate endocrine guidelines as if they were case law.  I will review all the cases (with fake names, case scenarios, and circumstances of course) that I have had to deal with so that history doesn’t repeat itself. More importantly, I will discuss my solution to the issues and how everyone can help.  This will be an audience participation time, Q & A, discussion by Dr. Kadambi (esteemed endocrinologist that totally gets it), and how we can all help each other through this process.  Number one on my current bucket list is to educate the medical boards to the literature as well as stop using worthless and outdated guidelines to sanction physicians that only make their patients better. WLM attendees should be the experts that review these cases, not a specialty that has no understanding of the literature and current studies. I will enlist everyone’s assistance in doing so.  We will spend an entire evening addressing these issues and concerns.

    Last year’s Beyond Hormones conference at the Lied Lodge will be hard to beat.  However, we are going to try to make this anniversary celebration better than last year with great food and entertainment at a fabulous resort in Tucson.  I’m looking forward to a great reunion this October and hope to see everyone there. 

    Kindest regards, Neal


    Neal Rouzier, M.D.
    Faculty Chairman

    Course Details & Registration

  • April 02, 2018 6:33 AM | Taylor Hill (Administrator)
    Dr.Nacouzi, M.D.

    Dear Doctors and Practitioners,

    When planning a weekend-long course to learn and incorporate a significant clinical advancement such as PRP, it should be thought of carefully. The presented material and exercises need to be clinically relevant, succinct, and applicable.

    After attending many PRP-specific conferences, I recognized that the same contents and formats were endlessly being recycled. The hands-on exercises often left me wanting and in the worst cases, left me questioning the clinical experience of the instructors. As presented, to try and apply these experiences the next day in my own practice would be unreasonable, if not unsafe.

    There needed to be a format that would allow attendees to easily apply the information they were presented. Thus, after performing over 2500 procedures in our office, I decided to put together a course summarizing the up-to-date thinking on PRP along with a way to establish confidence in those performing some of the most common procedures encountered.

    As a result, my colleagues and I have summarized the majority of our experience thus far with PRP. We have read and abridged hundreds of articles regarding preparation, dosage, activation, and implementation of PRP into an easily applicable format. We then developed a system of reference for each step of implementation, including: functional diagrams, planning methods, safe zones, dosing, adjunct product use, pearls of injection, caution zones, follow-up, and discussion of relevant challenges encountered.

    In addition, we will share the intricacies and important modifications needed for PRP preparation. The latest recommendations and reasoning proposed by leading European and international researchers.

    In order to make the most of our time together, we will substitute more long-winded pathway lectures with hands on need to know material, and the complete reference material will be distributed to attendees in advance for their conference.

    Every slide in our program will be relevant material aimed to benefit attendees in their own practice. As such, we will have two one-hour open discussion periods based on the questions asked at registration. The hands-on-lab will offer over ten live cases to participate in and will include the application of neuromodulators (Botulinum A toxins), Hyaluronic filler injections, facial volumetric remodeling, and other relevant procedures. In addition to our hands-on-lab, 5 conference attendees will be able to volunteer for 5 independent procedures guided by myself and my colleague.

    We welcome you to our conference.

    Dr. Nacouzi, MD

    Course Details & Registration
  • October 02, 2017 4:12 PM | Christiaan Killian (Administrator)

    Dear Colleagues,

    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 15 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 prostate after we produce a mapping of the prostate 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 2.5 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 soon in Fort Worth, TX!




    Neal Rouzier

    Course Details & Registration

  • February 13, 2017 4:14 PM | Christiaan Killian (Administrator)


    Dear Neal,

    Has there been any progress on new reference ranges on progesterone? My patients are coming back with levels of 2-5 ng/mL which was confusing to me until I read on the forum about the reagent. I’d appreciate any update.

    Based on looking at many recent tests, I think the new range should be at least >2. Still working on that with LabCorp.  Again it is completely arbitrary and nebulous. Unfortunately the manufacturer of the new reagent, nor LabCorp Executives, have recommended a certain level of normal or optimal to shoot for. Just goes to show how these numbers are picked and how they should be used as only a guide.

    The consensus meeting of OB/GYNS in Europe last year felt that a level of 10 ng/dl was adequate for endometrial protection.  Unfortunately that number was established using the old reagent but has now been discontinued.  Ultimately the number that will be decided on will be based on negotiations between me and a few pathologists at LabCorp.  Now how scientific is that?  Hard to believe that LabCorp would suddenly start using a new reagent without reference ranges and without alerting the public as to their doing so.

    Use the number as a guide but keep an eye on bleeding or spotting.  Based on doing this for 20 years, I still feel that the doses we prescribe (100mg SL or 200mg PO) should be adequate for most women.  The OB/GYN community does not follow levels like I do, so a lot of their dosing is based on the studies that show 200mg PO is protective, which in our experience results in P4 levels of at least > 10ng/dl.  In my experience, about 20% will require more progesterone to prevent endometrial proliferation.  Use your clinical judgement as well as inform the patient to be alert for any abnormal bleeding/spotting which would then require an endometrial ultrasound/biopsy and dosage increase of progesterone.  So we never will truly know the exact or best level to shoot for, however with time and experience we will eventually come to know what level to shoot for in most women, with a few outliers requiring more.  Remember all women are like snowflakes, all are different and will respond differently depending on cellular sensitivity to progesterone and intestinal absorption.

    We hope this preliminary information is helpful, please comment as we all work collectively to resolve this issue.  Thanks to many of you for reaching out with your initial concerns, it has helped us to better figure out what is happening as we reach out to LabCorp to re-establish some starting guidelines.  As soon as we have more definitive information Dana will send along an update.


    – Neal

  • August 19, 2016 4:15 PM | Christiaan Killian (Administrator)


    Dear Fellow Colleagues,

    In addition to learning about dysbiosis and all the effects that probiotics play on health and wellness, I thought that it would be interesting to learn and review from an expert all that we should know about gut flora, health and wellness.  I personally have been on 8 different potent IV antibiotics since January and have completely messed up my intestines, only to be saved by gut healing supplements and probiotics.  Dr. Dirk Parvus will review how he assisted me in recovering.  Eric Serrano sent a care package to my home with all of the necessary elements to heal my leaky gut and put me back to normal.  What a tough road it’s been, but I’m finally back to normal thanks to these docs.  I’ll review their treatments that led to my healing when nothing conventional worked.  And I’m sure you’re interested in hearing where I’ve had stem cells injected, why, and the results.  Although you may never administer stem cells, we feel it is extremely important that you become aware of the modality, what it can be used for, and when you should utilize it. Dr. Herman Pang will enlighten us with everything you should know about stem cells and where to refer your patients for the various treatments with PRP and stem cells, as well as where I sent my own patient that had an ejection fraction of 15% with class IV CHF.

    The administration of growth hormone has always been complex and confusing, and many practitioners and zealots still try to convince everyone that growth hormone is illegal to prescribe based on their misinterpretation and misunderstanding of some law they say applies to growth hormone.  Fortunately,  it’s up to the law makers to enact laws and the courts to interpret them, and NOT the FDA or pundits that claim to.  We’ll review case law on legalities of HGH and put the false claims to rest that are intended to scare practitioners away from prescribing HGH.  If it is illegal to prescribe HGH, then I know about 10,000 doctors that are breaking the law.  Really?  Are all of us breaking the law?  Nope, not to worry, I’m not going to turn you in because you prescribed HGH.  However, I will discuss the various cases that I’ve had to defend (medical board cases), issues regarding the use of HGH, and how to prescribe and document so that you will never have any concern with prescribing growth hormone for medical reasons.  Don’t make the mistakes that others are making.

    We will review 100 studies on diagnosing, prescribing, monitoring and troubleshooting HGH.  Old landmark articles will be reviewed, as well as the most recent literature showing benefits.  We’ll review tricks to maximize response and raise IGF-1 levels.  We’ll also review various types, costs, where to go to prescribe for best cost, alternatives to HGH, and the important facts that you need to document when you prescribe growth hormone for off-label use.  Ever hear of ipramoralin, tesamorilin, or ibutamorin?  We’ll review both injectable HGH and PO secretagogues, which ones work and for how long. The use and clinical utility of pharmaceutical secretogogues and the lack of efficacy of non-pharmaceutical secretogogues will be reviewed. Recent evidence proves significant protection against Alzheimer’s disease by HGH and various secretagogues.  Just how illegal is it to prescribe growth hormone?  I’ll review the reasons why I don’t prescribe growth hormone, as well as the reasons why I DO prescribe growth hormone.  We’ll review supply and demand, cost and availability, andeverything else you need to know before prescribing growth hormone, including the necessary verbiage for documenting and defending its use.  It may take me several hours to get through the material, but I hope to cover everything of importance that I feel you should know about HGH. And of course, it goes without saying:  WWYLYLTB?

    Five years ago, I put together a lecture on the brain that I gave at AMMG.  Three years later I added a second lecture that consisted ofnewer articles not included in the first lecture.  Earlier this year I put together a third lecture from all recent data that addresses the various treatments for dementia and Alzheimer’s disease.  It is thoroughly amazing that the experts who write the articles on Alzheimer’s disease and dementia have no understanding of the pathophysiology of hormones on the brain.  They just don’t get it.  However, you will by the time I finish the third lecture.  I will convince you of how bad estrogen is for the brain, and the same goes for testosterone.  Then, in my usual style, I will show you all the bad effects of not using hormones to protect the brain. Recently there have been several studies proving the harm of estrogen in older women, as well as demonstrating the harm in having high baseline levels of estradiol that have been associated with an increase in Alzheimer’s disease and dementia. That is absolutely true as you can’t argue the results, only the extrapolation. But in fact, their conclusion couldn’t be further from the truth.  Unfortunately, researchers still don’t understand that association does not prove causation.  We will review the medical literature that demonstrates protection of the brain with various hormones for both men and women.  After 20 years and billions of dollars of research we are no better off in treating Alzheimer’s disease.  Aricept and Namenda have been disappointing in treating symptoms, and no drug reverses the disease process as it progresses. We will review all the EBM that medical academies and pharmaceutical companies ignore, which instruct us on how to prevent dementia as opposed to treating once the disease becomes established. Can/should we treat Alzheimer’s disease with estrogen?  Yes, absolutely, if you want to reverse the disease process. Unfortunately, the pharmaceutical industry fails to read and appreciate all the data for the various hormones in preventing the disease in the first place.  There is definitive evidence that CEE≠E2 and MP≠MPA, particularly when it comes to the brain and this is demonstrated in SPECT scans.  Finally, there is only one drug that reverses (removes) beta amyloid plaque from neurons, which is what the pharmaceutical industry has been searching for to treat AD.  Well, we found it, but we are going to keep it a secret!  It doesn’t make me any less sarcastic, but it does make me think clearer so that I can be even more sarcastic.

    Recently while in China, I read about another promising Alzheimer’s disease drug that failed to improve AD or reverse beta-amyloid plaque deposition.  After 50 years and billions of dollars spent, there is no successful treatment or preventive drug therapy for AD.  And now we have good data to show the harm of HRT which logically calls for yanking out ovaries, heuvos, and your pituitary gland.  Fortunately, those are all observational studies that suggest harm of hormones, in contrast to RCT’s that show and prove protection.  This then leads us to another section where we will learn how to evaluate medical journal articles and interpret their results, which are usually the opposite of what the real data shows.  We will review a multitude of studies whereby the ultimate results are different than what the authors originally claimed.  I hope to make you better students by teaching you how to interpret and review studies for bias, political correctness and economic agendas.

    I have also invited two hormone experts, both internationally recognized, that have completely opposite opinions on HRT.  You will find their debate on hormones enlightening and be amazed how two experts can have  completely different views of HRT.  Listening to them both will give you a new perspective on life.

    Lastly, I have found the most profound article on BHRT that I have ever seen or read.  Finally, someone has published exactly what I have been teaching and preaching on thyroid administration for the last 20 years. In spite of the fact that it’s in the bible of endocrinology not to suppress TSH, endocrinologists, ENT surgeons, and psychiatrists suppress TSH with impunity, but you can’t.  Regardless of this right of certain physicians to suppress TSH, a landmark study reviewed why and how we came to fear suppression of TSH.  Unfortunately,  all of the studies that showed harm of TSH suppression were from extrapolation from Grave’s disease which causes harmful effects due to an autoimmune disorder and not from elevated levels of thyroid hormone.  Years of studies of suppressing TSH by endocrinologists, psychiatrists using high doses of T3 for depression, and ENT surgeons suppressing TSH for treatment of DTC, none showed any harm.  We will review this study and recent other studies showing the benefits of thyroid optimization and lack of harm with TSH suppression. In fact, proper treatment involves TSH suppression. I could not sleep after reading this article and I’m sure that you will feel the same.

    We’ll review all the articles that review PCV vs erythrocytosis, as well as review outcome studies. High hematocrit is predictive of stroke and heart attacks but only in patients with PCV, not erythrocytosis.  Got that?  Well most don’t got it and here’s why.  Fifty years of study prove no harm to physiologic erythrocytosis.  Don’t assume and don’t extrapolate but everyone does because they don’t get it. However you’ll get it.  Need studies, documentation that erythrocytosis is harmless, need to understand why checking a CBC is in the endocrine guidelines? No I don’t go by (incorrect) endocrine guidelines.

    We’ll review the physiology of erythrocytosis that the hematology world doesn’t comprehend, and look at how and why they confuse PCV with erythrocytosis.  The mechanism and physiology of erythrocytosis is thoroughly amazing and none of my hematologists know or understand the physiology behind normocytosis, erythrocytosis, and extreme erythrocytosis, as well as when, and when not, to phlebotomize each.   I’ve saved interesting cases of PCV with lab reviews.

    How to analyze a medical study:  Examples of studies that state one thing and prove another.  Review and critique a study before even reading it.  DBRCT’s, RCT’s, prospective studies, retrospective studies, observational studies and confabulation.  How to design a study to prove or disprove anything that you want by using sensitivity, specificity, relative risk vs. absolute risk, number to treat, underdiagnose and overdiagnosis.  We’ll make it fun!

    Hope to see you in October!

    Sarcastically yours, Neal

    P.S.  I just heard from Einstein and he’s coming all the way from Tokyo.

  • May 04, 2016 9:05 AM | Christiaan Killian (Administrator)


    Hormone Facts You Should Know But Probably  Don’t

     By Neal Rouzier, MD

    Recently the medical community has undergone criticism for journalistic articles and medical studies that promote one drug or treatment over another. There are often political or economic gains behind the purpose or results of the studies, which leads to inappropriate and biased conclusions or recommendations in these articles. This has negatively impacted the credibility of some authors and journals. Some medical journals provide a study rating score so that the reader may be able to discern any bias of a study’s treatment or product. In addition, medical journals and textbooks now use the term “evidence-based medicine” (EBM) in order to assert credibility for a medical treatment based on peer-reviewed studies or meta-analysis. The purpose of this introduction is to prevent the reader from being led astray by the political and economic bias from paid authors of medical journal papers with misleading agendas.

    Many treatments, suggestions, lab tests and information presented in lectures, books and age management seminars do not follow foregoing standards of evidence-based medicine either.  Exposure to these non-peer-reviewed teachings and conclusions has led me to perform extensive literature searches. I have  discovered significant literature that refutes many teachings and conclusions of these anti-aging academies. For example, the trend to lower estrogen in men is contrary to scientific literature that supports the opposite. Estrogen is touted as harmful to men, causing an increase in prostate cancer; however, the literature has demonstrated a beneficial effect of estrogen in treating prostate cancer, and estrogen loss in men leads to an increase in Alzheimer’s, coronary artery disease and osteoporosis. A recent article in the NEJM proved that lowering men’s estrogen with aromatase inhibitors increases cholesterol and body fat and lowers libido and sexual function. Yet I constantly hear lecturers recommend that physicians prescribe aromatase inhibitors to men in spite of the lack of EBM to support this and the EBM that demonstrates harm of doing so.

    Physicians who misunderstand the scientific literature also con- tinue to prescribe estrogen for women in a transdermal cream to prevent the thromboembolic complications of oral estrogen, the increased incidence of which is only 4/10,000 (as per the  WHI for CEE). The loss of cardiovascular protection would be negatively realized in a substantial number of women if transdermal estrogen was preferred over oral estrogen. Every NIH study and recent European studies demonstrate the cardiovascular protective effects of oral estradiol over transdermal estradiol, a fact that most physicians fail to appreciate. However, the transdermal estrogen would be expected to protect only a few women from DVT, or 4 per 10,000, but in turn lose the cardiovascular protection afforded by oral E2. The majority of cardiovascular protective benefits are attained only from oral and not transdermal estrogen. Using a transdermal estrogen prevents the cardio- vascular protection provided by oral estrogen and puts 90% of women at increased risk of cardiovascular mortality, certainly devastating in comparison to protecting 4 out of 10,000 from venous thrombosis (again for CEE). Every study to date (KEEPS, EPAT, WEST, CORA, DANISH, ELITE) where oral estradiol (E2) was utilized, the relative risk (RR) for DVT has been < 1.0 indicating no risk of DVT with oral E2, which is contrary to what everyone believes. True, there is a risk of DVT with oral es- trogen, but that is seen only with oral CEE, and not oral E2. As a result, millions of women lose the most protective cardiovascular benefits of oral estrogen because physicians fear an increase in DVT that does not exist for oral E2, only for oral CEE (and that risk is not statistically significant). Still, I continuously hear that we should use only transdermal E2 over oral E2. This is why the most powerful ongoing RCT (ELITE) uses only oral E2 and not transdermal E2.

    This concept also applies to testing hormones levels. Physicians are typically taught that if a serum level of a hormone is within a normal range, then that is all that is required. However, the medical literature refutes that concept as many patients, both men and women, will feel and function better when their levels are raised or brought to optimal levels rather than normal levels. Understanding this requires review of studies that prove a receptor site resistance, or cellular hypofunction, as is commonly understood with insulin resistance but is also present with other hormones as well. The literature provides evidence that normal is an average of a population whereas optimal is what the medical literature proves is best for you. Physicians must be taught to recognize the difference between normal and optimal hormone levels and the benefits of optimization as demonstrated by cur- rent medical studies.

    Most compounding pharmacies have begun dispensing newer, cheaper yam-based estrogen (as opposed to soy-based), but physicians fail to test serum levels of hormones and thereby cannot guarantee a therapeutic serum level of estradiol, not realizing that yam sources of the estrogen prevent attaining a therapeutic level due to poor absorption and lack of micronization. Also, using a transdermal E2 that does not provide adequate serum levels, or using estriol in preference to E2 that provides no in- creased level of E2, will forego all of the protective musculoskeletal and cardiovascular benefits of estrogen. Many physicians promote the use of transdermal progesterone that does not provide adequate therapeutic serum levels for breast and uterine protection as per some peer-reviewed studies. Other hormone levels such as progesterone are also critical to maintain at optimal levels. In fact, the only substance shown to prevent breast cancer is progesterone, but only if high optimal serum levels are maintained. Failure to maintain these serum levels puts women at risk for breast and uterine cancer—and it must be serum levels that we optimize and not saliva levels. Many studies demonstrate that therapeutic levels of progesterone in saliva are worthless in protecting breast and uterine tissue.

    Progesterone is also being promoted and used by some pharmacists and physicians for prostate protection in men, whereas there no basis in fact for its use in men. On the contrary, medical literature shows that progesterone use in men has been a successful “salt peter” and increases instances of erectile dysfunction and loss of libido. Prescribing progesterone to men has also demonstrated increased vascular inflammation and risk of MI and CVA, which is the opposite of the effect seen in women. The “Y” chromosome seems incompatible with progesterone, making it harmful to men in spite of the protective benefits seen in women. Unfortunately, most physicians and pharmacists remain unaware of the phenomena associated with the various sources, forms and levels of these and other hormones. Pharmacists, physicians, and patients alike trust that all hormones dispensed are beneficial and therapeutic. However, when serum levels are tested and significantly low levels are found; this can attest to the failure of some compounded hormones to provide any benefit in spite of all the claims, which is also why ACOG and NAMS caution against BHRT.

    The goal of my lectures and teaching seminars is not only to provide the physician with evidence-based literature to guide our therapy, but also to provide research that discredits commonly accepted but misguided therapies. This provides confidence and credence for the therapy the public is now demanding. To assure benefit, they must conform to the scientific standards set forth in our literature. Do not assume that any bioidentical hormone prescribed provides protective levels or is of any benefit. Physicians must ascertain  that  the  compounding  pharma-  cy they recommend to their patients is a quality PCAB accredited pharmacy. The only method of assuring adequacy of compounding  pharmacies  is  to  brazenly  ask questions about quality standards and processes. In addition, the only method of assuring adequacy or benefit of a therapy is by measuring biologic endpoints, or serum markers, as is carried out in the NIH trials. Monitoring therapy and assuring adequate replacement that conforms to FDA standards should be a priority of every physician and pharmacist in order to make this therapy credible. Whatever protocol one might choose, one should then follow those research protocols that support the validity of our therapy, and then copy it to assure therapy efficacy.

    Through my continuous, intensive search of the scientific liter- ature, I’ve been able to design the BHRT lectures and courses to encourage rethinking our customary practice due to data     or studies that support the opposite of what some academies practice or teach based on misleading articles and studies. The lectures and seminars that I teach are a potpourri of fun and interesting articles from the top peer-reviewed medical journals without bias or hidden agenda. The intent is to provide evidence-based literature to challenge our thinking, guide our practice, and prove that commonly prescribed therapies dispensed by many physicians may be harmful or lack efficacy and should be changed to conform to industry and peer-reviewed standards. The physician reviews that follow further explain the intensity of the courses and past experiences of attendees.

  • February 22, 2016 9:08 AM | Christiaan Killian (Administrator)

    My Fellow Colleagues, The agenda, schedule, faculty, location and amenities for the new Worldlink Medical Course have finally come to fruition. Many of you asked for a Part V and many others asked for different topics related to lifestyle, preventive medicine, vitamins and supplements, and perhaps something beyond just hormones. So Dana Burnett has put together a faculty to do just that.

    Welcome to our newest course: Beyond Hormones for 21st Century Wellness Medicine

    Attending the BHRT series is NOT a requirement to attend this course, and it includes all-new material that we are excited to bring you. As the Faculty Chairman for this event we combined new topics on the gut, the microbiome, and inflammatory issues that oftentimes not only prevent hormones from doing their job, but also wreak havoc on many other body systems. Dr. Dirk Parvus will explore what to look for, how to diagnose and treat, and how to prevent inflammatory conditions that we so commonly see but don’t understand how to treat. And no discussion would be complete without the evidence-based research to support what we do, as has always been our mantra in the past.

    As for me, I get to spend time on fun stuff (topics) I never seem to get to in Parts I – IV, namely growth hormone and everything you could possibly want to know about this important hormone. HGH will be split into diagnosing, treating and adjusting with complex case studies. There is a plethora of medical data that demonstrate benefits we should all be aware of. We will look at the attempt of the FDA and AACE to limit and restrict use of HGH based on extrapolation of a law that does not apply to physicians, but is often quoted as to make everyone think that HGH is illegal to prescribe. We proved in court that is not the case and we will review those legal proceedings.

    Speaking of legal issues, they are most uncomfortable for physicians to deal with and dissect. I would prefer to just pretend that I will be lucky enough to avoid legal issues. Although it is painful for physicians to review, we all should be aware of the legal arena surrounding HRT and how best to document and prepare our practices to be bullet proof, both for legal defense and, more importantly, to use to teach our colleagues a scientific method rather than what they heard or were taught. That still may not prevent lightning from striking so I will review the most common cases now making the rounds, and how I have defended them using the medical literature provided during this review. We must use science and literature to defend how we practice and protect the lives of our patients despite the legal profession using recent guidelines to bring suit. Plaintiffs’ attorneys wish they would have never met me! Important issues pertaining to HRT commonly addressed by opposing attorneys (which I will counter in the medical literature review) are concerns about AACE guidelines which restrict use, concerns that testosterone causes blood clots that polycythemia is harmful, and that estradiol levels should be monitored and lowered to prevent the harm of elevated estrogen. Each one of the aforementioned is so important that I will provide separate lectures on each.

    • Levels are meaningless for symptom improvement and diagnosis.
    • More in depth review of polychthemia and lack of harm of erythrocytosis.
    • More review of articles on estrogen in men.
    • How I used the articles to prove to a jury that the hematologist was wrong.

    Next, let’s get really good at interpreting the medical literature. I find it so fascinating that physicians can continuously misinterpret medical studies and the results of those studies. I hated statistical analysis taught in my training. However, we will make it fun to analyze and critique studies before looking at the conclusions. Almost every study has an agenda, a bias, and a purpose for being published which makes me leery of any study, thereby making it necessary to understand the methods and bias before even reading a study. The more we review and understand medical literature, the better we are able to extract meaning and purpose of our science. We should all be able to speak and defend our therapy with confidence and this review will better enable us to confidently defend the work we do as we look to grow this field. I for one cannot do this work alone. You all play a vital role in how we take care of root causes and provide preventive care to our patients.

    Finally, no 21st Century medical discussion would be complete without an update on stem cells. I am the proud recipient of several stem cell injections and will share my knowledge along with Dr. Herman Pang’s experience with stem cells.

    I am so excited for this debut event and hope you plan to join us October 7-9, 2016, in San Antonio, TX. Let’s make it a reunion event! I hope to have dinner discussions featuring those of you who wish to tell us unusual and profound success stories. Dana needs to know numbers early, therefore she is offering a super early bird discount of $895.00 if you register by March 31st, See you all later this year for this inaugural Worldlink Medical event.


    Neal Rouzier

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