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  • July 05, 2013 9:37 AM | Christiaan Killian (Administrator)

    Dear Part I Attendees,

    WorldLink Medical has worked with me to rebuild the 2013 courses by replacing old articles with new content and updated articles, and placing them all on PowerPoint slides to make the overhead slides a thing of the past. In fact, those of you who attended the last Part I course in Salt Lake City have already experienced many of those changes. Anyone attending the Part II course in September will also have the opportunity to see these improvements.

    The Part II course goes beyond the basics of Part I to explore advanced protocols that are critical to mastering complex cases not taught in my Part I course. In addition, since the field of age management medicine continues to grow at a rapid rate, the redesigned Part II course will help you stay ahead of the changes by covering a remarkable amount of material (over 1,300 slides), including highlights of new and important therapies, clinical pearls, tricks of the trade, recent controversies and every crucial element that I could not fit into Part I.

    My favorite part of this course is the Saturday night informal discussion, which involves a question and answer session with me. This discussion explores difficult cases, controversies, legal issues and tribulations from seasoned attendees. It also expands your clinical knowledge through sharing experiences and feedback in round table discussions. There is no other place where you can participate in such a gathering of the minds.

    For this year's nutrition lectures, WorldLink has teamed up with Dr. Alan Gaby. He has extensively researched and written on this topic, and in my opinion there is no greater authority on vitamins and nutrition. Dr. Gaby will lecture Friday morning before I take over in the afternoon.

    Here is a summary of Part II topics:

    Section 1:
    Anti-aging (definitions and why we call it that). Reviewing articles that make us refer to BHRT as anti-aging and providing credibility for why we do what we do.

    Section 2:
    Longevity medicine and which hormones have a proven record for extending health, wellness and longevity.

    Section 3:
    Making sense out of the many HRT studies, the critiques and the rebuttals. Putting the pieces together will make you an expert on all of the if’s, and’s or but’s.

    Section 4:
    The positive and negative articles on BHRT. Laying to rest that estriol is a worthless metabolite, what the literature shows we should and shouldn’t use, and disproving what many are teaching without any facts.

    Section 5:
    “There are no studies that prove BHRT is different from synthetic HRT.” Baloney!

    Section 6:
    A literature review proving that HGH, testosterone, estrogen, progesterone, DHEA and melatonin protect against cancer. The perfect solution to Obamacare.

    Section 7:
    This includes optimization of progesterone and case examples, multiple studies that prove transdermal cream is worthless and harmful, and a discussion that saliva testing for monitoring therapy is worthless. Scientific studies prove where your levels should be for maximum protection and where they should not be in order to protect against cancer.

    Section 8:
    Beyond transdermal testosterone cream - New and different methods for raising testosterone in men and women: oral, SQ, IM, HCG, and Clomid.

    Section 9:
    Oral vs. transdermal estrogen - The relative risks of both and the safest versus the most beneficial.

    Section 10:
    A literature update on HGH, DHEA, and thyroid treatments for cardiovascular and osteoporosis protection.

    Section 11:
    What can you do to prevent and treat weight gain and bloating as far as hormones are concerned?

    Sections 12:
    Cardiovascular disease protection, cardiac markers, eicosinoids, diet, EFA’s, insulin, and inflammation.

    Section 13:
    Cardiovascular case studies with management beyond statins.

    Section 14:
    Diagnosis and treatment of the most common premenopausal endocrinopathy that everyone fails to diagnosis, and its relation to cardiovascular disease, breast cancer, and uterine cancer.

    Section 15:
    Hair loss in men and women, TE, hirsutism, and the effects of hormones on skin.

    Section 16:
    Treatment of osteoporosis beyond biphosphonates: vitamin D3, vitamin K, strontium, and ipraflavone. Estrogen metabolites - do they or do they not predict breast cancer?

    Section 17:
    The importance of estrogen optimization in men and the harm of suppression. The harm in giving progesterone to men as it increases inflammatory cytokines.

    Section 18:
    Cortisol and fatigue - How and when to use it, how to monitor it, and how to test it with ACTH.

    Section 19:
    Complex cases, labs, adjustments, fun and interesting cases, and lots of WWND (What Would Neal Do?).

    Section 20:
    Hormones and cancer. The myths & controversies of the oncogenic effects of hormones. Literature review showing protection against cancer by optimization of hormones.

    Section 21:
    The last hour includes 100 pertinent questions and answers with discussion.

    Dr. Gaby and I look forward to seeing everyone in Salt Lake City, Utah on September 27, 2013.

    Best,

    - Neal Rouzier, M.D.

     


  • May 02, 2013 9:38 AM | Christiaan Killian (Administrator)
    Gregory Petersburg, DO

    Why does a cup of coffee cost more at a trendy café like Starbucks than it does at the corner diner or when brewed at home? It’s the value that the experience holds for the individual that determines the worth of the offering and the work of the business. Marketers understand this principle and the market value of experiences to consumers. Automobile ads don’t sell cars; they sell the driving experience. Restaurants advertise the ‘fine dining experience.’ Travel agents no longer book vacations; they book ‘adventures’. And let’s not forget the granddaddy of experience sellers: Disneyland. The product they sell is ‘experiences’. You may not have given it much thought, but the same principle applies to your medical practice.

    Just delivering great service to your patients is no longer a winning strategy. Aging baby boomers already expect great service. And if you’re still competing on the basis of price, then you are offering little or no true differentiation from the competition. What would your patients really value? Better yet, for what would they pay a premium? Experiences!

    It’s not that we don’t give our patients experiences. In fact, the medical profession already has a long history of creating patient experiences. It’s just that these experiences are not particularly positive, more often than not. How many patients can honestly say they enjoy and look forward to going to the doctor? Not many. That’s because, in large part, the experiences patients have are mostly unintended, the result of not understanding the principles of experience design and execution. Yet, the kinds of experiences we could create for patients hold the potential to significantly improve clinical outcomes, patient compliance, patient satisfaction and loyalty, provider satisfaction, and, yes, even profit margins. Ideal patient experiences can give them hope and inspiration, and are powerful catalysts for them to take action. In essence, experiences are what change lives. With a little planning you can create meaningful and memorable experiences that improve the quality of your practice and your patient’s life.

    The following steps will guide you through the processes of creating unique experiences in your practice:

    1. Make the Experience Intentional

    What is the ultimate take-away experience you want your patient to have? Inspiration? Motivation? Transformation? Begin with the end in mind and engineer backwards, tweaking all of your practice processes in ways that contribute to the experience. Choosing a theme for your work is a helpful starting point for creating powerful experiences. How likely would you be to finish reading a novel if it had no theme? You would probably close the book before finishing the first chapter. A theme is essential, as it conveys the central idea of a story (or your work) and is necessary in order to fully and effectively engage an audience (i.e., your patients). Themes can be based on almost anything: people, places, events, times, ideas, messages, etc. Once you have your theme, build a story around it.

    2. Make the Experience Individual

    Give each patient the feeling that every interaction with him or her, and everything you do for him or her, is just for him or her. (-Or – Give your patients the feeling that every interaction with them, and everything you do for them, is just for them). You can personalize everything, such as phone calls, appointments, and patient handouts.

    ‘Mass customization’ is one way: Make small but personalized modifications and additions to standardized services, materials, or products that otherwise are the same for all patients. ‘Organizational memory’ is a way to give the patient the feeling that everyone in your organization knows and remembers the patient in a personal way. Your medical records already include the patient’s date of birth, so that information can help everyone in your organization to remember and celebrate the patient’s birthday. Similarly, you could collect personalized information in a new patient intake form that could be used in a variety of ways: favorite foods and music, who they admire and why, what kinds of things inspire them, where they go to ‘recharge their batteries’, what they list as personal strengths/weaknesses/fears, etc.?

    3. Make the Experience Interactive

    Expand the patient experience to include the time and space before, during, and after the visit. Examples might include pre- and post-visit phone calls, newsletters, interactive web tools, and ‘homework’ assignments.

    4. Interpret the Experience

    All work is theatre. Yes, even health care! Your office is the stage, the rooms in your office are different sets, stethoscopes and blood pressure cuffs are props, your white lab coat is your costume, you and your staff (nurse, receptionist, etc.) are the actors playing different roles, the things you say to patients (greetings, patient interview, advice for each medical condition, etc.) are the scripts. The reason for an appointment might be a ‘subplot’ in the patient’s life journey. Thinking of your theme and storyline (see above), imagine ways that your work processes can be applied or modified to fully and effectively engage your patient (the audience) in the story. How will you choreograph your ‘performance’, the sets, props, costumes, actors’ roles, scripts, etc.?

    5. Make the Experience Inspiring

    Become a storytelling organization. Medical practitioners have become so fixated on data as the focus of communication with patients that we have forgotten the most time-proven method in all of human history for passing along understanding and wisdom, for inspiring and motivating – storytelling. Data and information need stories to give them context. Stories add flesh and bone to the data and information. But the way stories are told is often as important as the story itself. Tell stories that are authentic to you and tell them with passion. Don’t be afraid to share your own story. Tap into timeless methods employed by every culture, religion, and organization to inspire: rituals, traditions, and ceremonies. Add them or incorporate them into your work and use them often.

    6. Institute the Experiences

    Incorporate these design principles and the delivery of patient experiences into all of the organization’s operational systems. Make it a permanent and ongoing part of the overall organizational culture, and commit it to words in an organizational ‘manifesto’ (A manifesto is a published/public declaration of your principles, intentions, and objectives). Tie measures (e.g., patient experience surveys rather, than service satisfaction surveys) of the effectiveness of your designed experiences to financial rewards, or give them teeth that bite (e.g., financially), if we fail to fulfill.

    More about Dr. Petersburg 

  • March 26, 2013 9:40 AM | Christiaan Killian (Administrator)

    The information contained on this blog is for educational purposes only. Titles and institutional affiliation for individuals who contribute to this blog are for identification purposes only. The opinions expressed are solely those of the blog post author and do not represent the views of any organization that the post author is affiliated with or with the opinions of any other author who publishes on this blog.

    Neal Rouzier, MD

    In September 2012, a jury in Salt Lake City, Utah awarded a breast cancer survivor $5.1 million in a court case against the pharmaceutical company, Wyeth (also known as Pfizer), alleging that the use of Premarin-Provera (Prempro) was responsible for the development of her breast cancer.1 This is one of many lawsuits against Wyeth, since the Women’s Health Initiative trial (WHI) was published in 2002. The general matter for this case is whether Wyeth withheld data and failed to inform the public concerning the risk of breast cancer with the use of the synthetic hormones, Prempro. There have been over 10,000 cases filed against Wyeth, which has paid $896 million to resolve over 6,000 lawsuits. Furthermore, they have set aside an additional $330 million to resolve the remaining lawsuits.

    Despite the knowledge Wyeth had of the increased risk, they made no effort to alert the public. For several years, Prempro was marketed without an advisory label or black box warning. This warning would discourage any woman from taking the drug, but it also resolves any future litigation for Wyeth, as they would not be blamed for a failure to warn the public.

    While Prempro now contains a black box warning label, it is puzzling that millions of women still take it in spite of recognized harm. What is even more puzzling is that physicians continue to prescribe Prempro, even when safer alternatives are available. Wyeth downplays the harm of synthetic hormones by marketing against safer hormone alternatives. In this review, I will explain the literature and science demonstrating breast cancer, the chance of risk, and the process of how the jury came to award a plaintiff verdict in this and other cases filed against Wyeth.

    Failing to Warn the Public

    Any cigarette carton carries a warning that smoking tobacco will kill you. Yet for many years, the tobacco industry misled the public and hid the overwhelming amount of research that proved tobacco causes cancer and heart disease. Until the tobacco industry issued warning labels on their products, several lawsuits were filed against them for their failure to warn the public. These labels are meant to pardon the tobacco industry from future lawsuits. Similarly, the black box warning on the Prempro label prevents any future lawsuits against Wyeth and they can no longer be held accountable for failure to inform.

    In spite of the scientifically-proven harm, the former president of the North American Menopause Society (NAMS), Dr. Wolfe Utian, at a recent NAMS meeting advised physicians to continue prescribing conventional hormones and avoid prescribing natural or bioidentical hormones. The continual promotion of Prempro and simultaneous marketing against the safer alternatives can be seen as points of contention against Wyeth. At first, many healthcare providers (myself included) may have felt sorry for the pharmaceutical company in being sued. However, once I heard firsthand the comments Dr. Utian made to denigrate bioidentical hormones and still recommend conventional HRT, I realized the promotion was instigated by Wyeth and therefore agreed with the jury.

    I believe a jury of physicians most likely would not find judgment against Wyeth, due to the fact that breast cancer can be caused by factors other than synthetic hormones. Therefore, it is impossible to sort the blame. However, a jury that does not consist of physicians or medical experts, who understand the intricacies of cancer and hormones, can easily find fault based on the inappropriate actions taken by Wyeth.

    Wyeth, ACOG, NAMS, and many of us well-read physicians know perfectly well that there is a safe alternative to Prempro. When the pharmaceutical industry markets against the safer alternatives, they are putting their profits ahead of women’s health. It is unsuitable to continually bash the bioidentical hormone industry and promote a scientifically-proven harmful, conventional hormone therapy. Regardless, the public knows of the harm and typically refuses to take harmful synthetic HRT, even if their doctor recommends it. Everyday more physicians are turning to safer alternatives, primarily based on patient demand. Physicians are certainly ignoring the promotion of Wyeth and the medical academies, as this is evidenced by the large number of doctors attending HRT training seminars. These physicians value the safety supported in the literature and want to be educated in the use of bioidentical hormones.

    Risks & Benefits of Various Hormone Therapies

    For physicians who have attended HRT training courses, it is quite obvious which hormones provide the best protection as is seen from the medical studies. However, the inexperienced physician and patient may not understand the reasoning behind preferred hormone therapies. I have included a review of the medical literature that supports why we do what we do. This will provide greater understanding of the risks and benefits of various hormones, and perhaps help us better comprehend the jury’s decision in this case.

    A recent article that appeared in the Lancet Oncology journal demonstrated that women in the WHI trial who received estrogen-only (Premarin without Provera) experienced a 23% lower incidence of breast cancer when compared to the placebo group.2 This translates to suggest that there was a decrease in breast cancer risk in women who took just estrogen "Unless it was shown that Provera was only taken for a short period of time, blame should have been shared with the physician." without Provera. Research from the WHI also demonstrated that the use of estrogen-only did not result in an increased risk of breast cancer, but was actually associated with a decrease in breast cancer.3 These results are difficult to grasp seeing that everyone believes estrogen causes cancer. Estrogen may stimulate cancer to grow once cancer is established; however, estrogen does not cause it to occur in the first place. As is mentioned in the article published in Lancet Oncology, Premarin has become less popular in recent years, because many patients have switched to estradiol - a natural bioidentical estrogen that resembles estrogen naturally found in the body.

    The addition of Provera to Premarin is what causes the harm of Prempro’s association with breast cancer. Provera is added to Premarin to protect against uterine cancer, but it has also resulted in an increase in stroke, heart attack, deep venous thrombosis, deep vein thrombosis, pulmonary embolism, breast cancer, and diabetes. Provera is generally prescribed to protect against uterine cancer, because the uterus is the only organ that seems to like it. All other organs – the heart, brain, blood vessels, and visceral fat – do not like Provera.

    In the case of Mrs. Okuda versus Wyeth, it is most confusing that she took both Premarin and Provera after she had a hysterectomy at age 47. The only reason to use Provera is to protect the uterus against uterine cancer. The treatment is never indicated in women who have undergone a hysterectomy. The question remains as to the length of time Mrs. Okuda took Prempro, as opposed to just Premarin. Taking Prempro for a short period of time most likely would not influence the development of her breast cancer and it would be impossible to predict the effect Prempro would have for a short duration of time. This would make a vote in favor of Wyeth in this settlement. Yet, whose fault was it that she was taking Provera? Since she should not have been prescribed Provera in the first place, her increased risk could be blamed on the physician. What were they thinking? Unless it was shown that Provera was only taken for a short period of time, blame should have been shared with the physician. Unfortunately, we are not told the length of time that Mrs. Okuda took Provera.

    Prempro & Breast Cancer Risks

    Understanding the above complexities indicates how difficult it would be to render judgment in this case. In the post-commentary section of this article, I found the comment made by the “sanityinutah” reader most interesting, as they referred to the difficulty in having an uninformed jury that has no understanding of the medicine, science, literature, or pathophysiology of HRT. I believe the jury truly had no idea as to whether or not the hormones were responsible for the cause of breast cancer in Mrs. Okuda, nor should they have been able to comprehend all the aforementioned facts. I also believe that the jury voted against the drug company, not necessarily for the patient, Mrs. Okuda. I say that simply because 50% of the cases have been won by the pharmaceutical company and 50% have not. Once it can be shown that a drug company failed to warn of potential danger, particularly if they had good evidence ahead of time or hid data, then the jury would most likely vote in favor of the patient. Wyeth “failed to disclose, misstated, downplayed, and understated” the risks of Prempro, which lost the case for them.

    So, now what? It is firmly proved in science and the courts that Prempro contributes to the increased risk of breast cancer. Do current warning labels pardon Wyeth from further wrongdoing? Apparently so, because this pharmaceutical company continues to manufacture and advertise Prempro. Why would a pharmaceutical company continue to manufacture Provera or Prempro with these inherent risks? Experts now recommend the HRT regimen should only be taken in the lowest dose and for the shortest period of time to control menopausal symptoms, after which time the HRT regimen should be stopped in hopes of avoiding any harm. Knowing the scientific facts, it seems unreasonable for a physician to continue prescribing Prempro. However without estrogen, women lose all of the tremendous health benefits and may suffer an increase in morbidity and mortality from estrogen deprivation.

    Does Estrogen Cause Cancer?

    What about estrogen-only? There is no evidence in recent medical literature that shows prescribing estrogen without a progestin increases the risk of developing breast cancer. The WHI trial and other recent studies amazingly prove a decrease incidence of breast cancer in women taking estrogen-only. In the CORA study, there were fewer cases of breast cancer in the estrogen (estradiol) group when compared to the placebo group.4 To date, a lawsuit has not been brought against any pharmaceutical company with the claim that taking estrogen-only caused breast cancer. All studies demonstrate a decrease in morbidity and mortality, which encourages physicians to recommend estrogen for all women. Preliminary "There is no evidence in recent medical literature that shows prescribing estrogen without a progestin increases the risk of developing breast cancer." Preliminary data from the recent completed KRONOS study of hormones found no increased risk of breast cancer in women taking estrogen and progesterone.5 The recently published DANISH study also demonstrated no increased risk of breast cancer in women taking estradiol for ten years.6 These results should be in the headlines of every newspaper. Yet, this research is not negative sensationalism and uninteresting to the media.

    To this day, the most powerful scientific studies demonstrate that estrogen does not cause or stimulate the development of breast cancer. A recent study entitled “Aromatase Inhibitors: A Time For Reflection” critiqued the commonly prescribed estrogen-blockers termed aromatase inhibitors, which are commonly used in patients with breast cancer to block estrogen receptor sites on breast cancer cells.7 This renders the cancer cells to be insensitive to any stimulatory effect from estrogen. Estrogen does not cause cancer to occur; however, once breast cancer develops, estrogen can stimulate its growth as the tumor becomes estrogen-sensitive. In women with active cancer, this is an important treatment modality to prevent estrogen from stimulating breast cancer cells to grow.

    These aromatase inhibitors have become standard care in women with breast cancer and are usually continued for five years after breast cancer is diagnosed. Pharmaceutical companies are pushing these drugs to be continued beyond the five-year recommendation with the hope and intent of preventing any further recurrence of breast cancer. So far, studies have demonstrated a very small decrease in the recurrence of breast cancer when these agents are used indefinitely. However, this article published in the journal Menopause refutes these suggestions and recommendations to continue the use of estrogen-blockers indefinitely. The study claims there is increased harm in blocking estrogen long-term, along with an increase of morbidity and mortality associated with loss of estrogen.

    Remember that in the WHI trial the use of estrogen-only provided protection against breast cancer with an incidence of eight less breast cancer cases per 10,000 women treated with estrogen-only and that is the same protection against breast cancer as seen with aromatase inhibitors. Studies show that both medicines are equal for cancer protection. Estrogen-blockers increase the symptoms of menopause, whereas estrogen therapy eliminates those symptoms and improves quality of life. The aromatase inhibitor article goes on to say, "Estrogens play a critical role in multiple systems. The loss of estrogen is associated with an accelerated loss of bone, an accelerated progression of atherosclerosis and MI. If estrogen is started at menopause, there is a 60% reduction in coronary calcification, a 50% reductin in MI, and a 35% reduction in overall mortality. Estrogen deprivation causes decrease in cognition, mood, and memory. There is accelerated expression of neurodegenerative disease like Alzheimer's and Parkinson's disease. Evidence shows that neurodegenerative disease can be prevented by estrogen replacement."

    Alternative Treatments for HRT

    Is there an alternative to Provera if the patient wants uterine protection without the risks and complications observed with Provera? By now, we should understand and appreciate all of the benefits of estrogen, but we cannot provide estrogen without some type of estrogen opposition to protect the uterus. This is provided by Provera and it is the sole purpose of this prescription. If Mrs. Okuda had taken Premarin (estrogen) with natural, micronized progesterone instead of Provera, would she have filed against Wyeth? Certain medical academies claim that there is no difference between synthetic and bioidentical hormones; yet, I’ve never heard of a breast cancer patient sue when taking Premarin with micronized progesterone.

    Are we missing something here? A recent article demonstrated an increased relative risk of breast cancer with use of Provera, in comparison to progesterone with no increased risk.8 Interestingly, the new progestin, norethindrone, which is the recommended replacement for Provera, has a two-fold increased risk of breast cancer.9 This is even worse than Provera and makes it seem unreasonable that a physician would prescribe a medicine proven to increase breast cancer risk, when the data supports a safer alternative – micronized progesterone. Another study, the EPIC-E3N trial has found consistent results for over 10 years that demonstrate an increased risk of breast cancer with the addition of a progestin and a decreased risk in breast cancer with the use of progesterone.10 The implications of this study are enormous. Which hormone regimen would you rather take?

    While ACOG and NAMS currently recommend that HRT only be taken in the lowest dose for the shortest period of time, it would be more appropriate to inform women on the many studies that demonstrate neither estradiol or progesterone have been associated with an increased risk of breast cancer. This combination is safe and effective. However, OB-GYN academies do not clarify these findings, which cause us to disdain pharmaceutical companies and the medical academies they support. I personally find the denigration of the bioidentical hormone industry by these medical academies to be erroneous. Micronized progesterone’s proven record of safety has worldwide implications for women’s health.

    Jury’s Reasoning for Opposing Wyeth

    I personally do not believe that taking Provera for a short period of time had anything to do with Mrs. Okuda development of breast cancer. From my many years of research, writing, and teaching, I have gained a sound understanding of the published literature and science surrounding HRT. The very small increased risk of breast cancer that is associated with Provera, the short duration of Provera use (no statement was made as to how long it was taken), and the protective effect of Premarin-alone makes the increased risk of cancer in this case relatively small. Nevertheless, I can understand the jury’s reasoning to vote against Wyeth, based on the unsuitability of their prior actions, refusal to acknowledge the scientifically-proven risks, and disregard to advise the public of the risks. My personal dissatisfaction for Wyeth is based on their continual denial of a safe alternative, persistent marketing of harmful synthetic hormones, and continued production of a medicine shown to be harmful to women’s health. Fortunately, the public is becoming more aware of these deficiencies and is now refusing to accept synthetic hormone prescriptions.

    The European studies demonstrate that the majority of physicians and patients avoid synthetic HRT, such as Prempro, in which the majority of women are taking the bioidentical hormones estradiol and progesterone. Interestingly, the pressure on drug companies that exists in Europe does not exist in the United States. For now, I expect Wyeth will continue to be reproved with large jury awards and front- page headlines. Perhaps the major harm in this controversy is that women may still refuse to take estrogen out of media induced fear; and thereby, suffer the consequences of estrogen depletion.

    Closing Thoughts on Wyeth Lawsuit

    Which HRT would you prefer – conventional or bioidentical hormones? How would you have voted on the jury? In this article, I suggested that there should have been shared responsibility between the pharmaceutical company and the physician who prescribed Provera, when it was unnecessary for the patient to take it after a hysterectomy. This case would have never existed if Mrs. Okuda had not been prescribed Provera. Based on the foregoing paragraphs discussing the benefit of progesterone and lack of breast cancer risk, perhaps the third responsible party is the medical establishment that fails to acknowledge a scientifically-proven alternative. There is very adequate evidence to support a strong preference for micronized, natural progesterone over synthetic progestins. ACOG and NAMS may consider a safer alternative, instead of standing by the pharmaceutical industry to support the continued administration of problematic progestin. Until the OB-GYN academies acknowledge the alternatives, there will continue to be disapproval of the pharmaceutical industry and filed lawsuits.

     
     

    References

    1. Adams B. Jury decides hormone therapy caused Utah woman's breast cancer. Salt Lake Tribune. 2012 Sept 7. Accessed on March 14, 2013 from http://m.sltrib.com/sltrib/mobile2/54835575-218/cancer-breast-okuda-drug.html.csp
    2. Anderson GL, Chlebowski RT, Aragaki AK, et al. Conjugated equine oestrogen and breast cancer incidence and mortality in postmenopausal women with hysterectomy: extended follow-up of the Women's Health Initiative randomised placebo-controlled trial. Lancet Oncol. 2012 May;13(5):476-86.
    3. Rossouw E. Anderson GL, Prentice RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial, JAMA. 2002;288:321–333.
    4. Windler E, Zyriax BC, Eidenmüller B, Boeing H. Hormone replacement therapy and risk for coronary heart disease. Data from the CORA-study--a case-control study on women with incident coronary heart disease. Maturitas. 2007 Jul 20;57(3):239-46.
    5. Harman SM, Brinton EA, Cedars M, et al. KEEPS: The Kronos Early Estrogen Prevention Study. Climacteric. 2005 Mar;8(1):3-12.
    6. Mouridsen HT, Møller S, Christiansen P. Danish Breast Cancer Cooperative Group. Ugeskr Laeger. 2012 Oct 15;174(42):2532.
    7. Birge SJ. Aromatase inhibitors: a time for reflection. Menopause. 2007 Nov-Dec;14(6):971-2.
    8. Stanczyk FZ, Hapgood JP, Winer S, Mishell DR Jr. Progestogens Used in Postmenopausal Hormone Therapy: Differences in Their Pharmacological Properties, Intracellular Actions, and Clinical Effects. Endocr Rev. 2012 Dec 13.
    9. Neubauer H, Ruan X, Schneck H, et al. Overexpression of progesterone receptor membrane component 1: possible mechanism for increased breast cancer risk with norethisterone in hormone therapy. Menopause. 2012 Dec 30.
    10. Fournier A, Berrino F, Riboli E, Avenel V, Clavel-Chapelon F. Breast cancer risk in relation to different types of hormone replacement therapy in the E3N-EPIC cohort. Int J Cancer. 2005 Apr 10;114(3):448-54.


  • March 07, 2013 9:41 AM | Christiaan Killian (Administrator)

    Dear Part I Attendees,

    During the last Part I course in Salt Lake City, Utah, I taught from a wheelchair in a snowstorm. For those of you who attended this conference, the content, format, and articles for my PowerPoint presentation were completely new and different from my past Part I course. Since then, Nancy Gardner and Dana Burnett from WorldLink Medical, as well as myself, have painstakingly reorganized Part II. We plan to redo and revamp all of the courses for 2013 by getting rid of old articles, replacing them with new, updated articles, and placing them all on PowerPoint slides to make the overhead slides a thing of the past. Part II has a new format, content, and articles.

    Due to popular demand, Part II is being held on the east coast in Fort Lauderdale, Florida.  While I prefer the powder of the Wasatch Mountains to a sandy beach, the surf is sounding pretty good since I can’t ski this year (recovering with crutches and IV antibiotics). For all of you on the east coast who are ready to dig out of the snow, come join us in Fort Lauderdale for a new Part II course and beautiful weekend in the sun.

    You learned the basics in Part I, so Part II gives the experienced practitioner an opportunity to explore the advanced protocols that are important to mastering complex cases that are not taught in Part I. The field of age-management medicine continues to grow at a rapid rate making it difficult to stay ahead of the changes. Part II will serve as a short refresher and highlight new important therapies, clinical pearls, tricks of the trade, controversies, and every crucial element that I could not fit into Part I. Our update to Part II will condense an excessive amount of material into 2 ½ days. Dana has advised me that there are over 1300 slides (Yikes! I’ll talk fast).

    My favorite part of this course is the Saturday night informal discussion, which involves a question and answer session on anything that you want to discuss. Expand your clinical knowledge by learning and sharing experiences, round table discussions, difficult cases, controversies, legal issues, suggestions, trials, and tribulations from seasoned attendees. There is no other place where you can participate in such a gathering and meeting of the minds.

    The following is a summary of Part II topics:

    Section 1:
    Anti-aging (definitions of and why we call it that). This section reviews articles that make us refer to BHRT as anti-aging and provides credibility for why we do what we do.

    Section 2:
    Longevity medicine and which hormones have a proven record for extending health, wellness, and longevity.

    Section 3:
    Making sense out of the many HRT studies, the critiques, and the rebuttals. Putting the pieces together will make you an expert on all of the “ifs”, “ands”, or “buts”.

    Section 4:
    The positive and negative articles on BHRT. Laying to rest that estriol is a worthless metabolite, what the literature shows we should and shouldn’t use, and disproving what many are teaching without any facts.

    Section 5:
    “There are no studies that prove BHRT is different from synthetic HRT.”  Baloney!

    Section 6:
    A literature review proving that HGH, testosterone, estrogen, progesterone, DHEA, and melatonin protect against cancer. The perfect solution to Obamacare.

    Section 7:
    This includes optimization of progesterone and case examples, multiple studies that prove transdermal cream is worthless and harmful, and a discussion that saliva testing for monitoring therapy is worthless. Scientific studies prove where your levels should be for maximum protection and where they should not be in order to protect against cancer.

    Section 8:
    Beyond transdermal testosterone cream - New and different methods for raising testosterone in men and women: oral, SQ, IM, HCG, and Clomid.

    Section 9:
    Oral vs. transdermal estrogen - The relative risks of both and the safest versus the most beneficial.

    Section 10:
    A literature update on HGH, DHEA, and thyroid treatments for cardiovascular and osteoporosis protection.

    Section 11:
    What can you do to prevent and treat weight gain and bloating as far as hormones are concerned?

    Sections 12:
    Cardiovascular disease protection, cardiac markers, eicosinoids, diet, EFA’s, insulin, and inflammation.

    Section 13:
    Cardiovascular case studies with management beyond statins.

    Section 14:
    Diagnosis and treatment of the most common premenopausal endocrinopathy that everyone fails to diagnosis, and its relation to cardiovascular disease, breast cancer, and uterine cancer.

    Section 15:
    Hair loss in men and women, TE, hirsutism, and the effects of hormones on skin.

    Section 16:
    Treatment of osteoporosis beyond biphosphonates: vitamin D3, vitamin K, strontium, and ipraflavone. Estrogen metabolites - do they or do they not predict breast cancer?

    Section 17:
    The importance of estrogen optimization in men and the harm of suppression. The harm in giving progesterone to men as it increases inflammatory cytokines.

    Section 18:
    Cortisol and fatigue - How and when to use it, how to monitor it, and how to test it with ACTH.

    Section 19:
    Complex cases, labs, adjustments, fun and interesting cases, and lots of WWND (What Would Neal Do?).

    Section 20:
    Hormones and cancer. The myths & controversies of the oncogenic effects of hormones. Literature review showing protection against cancer by optimization of hormones.

    Section 21:
    The last hour includes 100 pertinent questions and answers with discussion.

    I have removed my section on vitamins and nutrition. What I know and teach is nothing in comparison to the knowledge and expertise of Dr. Gaby’s book on vitamins and nutrition. Dr. Gaby has extensively researched and written on this topic and in my opinion there is no greater authority on vitamins and nutrition. WorldLink has teamed up with Dr. Gaby to provide the health and nutrition lectures that are offered in the remaining courses. Dr. Gaby will lecture Friday morning before I take over in the afternoon.

    Dr. Gaby and I look forward to seeing everyone in Fort Lauderdale, Florida on March 15, 2013.

    Best,

    - Neal Rouzier, M.D.
  • October 11, 2012 9:43 AM | Christiaan Killian (Administrator)


    Three years after the Women’s Health Initiative published that hormone replacement therapy (HRT) increased the incidence of certain health risks, clinical researchers at nine centers in the U.S. started the Kronos Early Estrogen Prevention Study (KEEPS). This study was anticipated to be a turning point to determine the benefits of HRT on cardiovascular health. Researchers posed the question, “Does HRT slow the progression of cardiovascular disease in post-menopausal women?” Results were finally released last week, in which the critical question was left unanswered and results seemed disappointing. Dr. Joseph Raffaele clearly explains the strengths, drawbacks, and overall conclusion of the KEEPS clinical investigation.

    Read Dr. Raffaele's full article on the KEEPS Study

    About Dr. Raffaele

    Joseph Raffaele, M.D., the co-founder of PhysioAge Medical Group, a clinical practice in New York City that is at the leading edge of the emerging field of medicine focused on scientifically sound approaches to staying younger longer. He has been a featured speaker at numerous events sponsored by WorldLink Medical.

     


  • September 07, 2012 10:01 AM | Christiaan Killian (Administrator)

    Brain lapses, memory loss, blank stares, confusion. Do you feel like you are losing your mind as you get older? What you may classify as old age and impaired brain function may truly be related to a decrease in estrogen.

    Cognitive Decline as a Disease of Aging

    Cognitive decline is a common concern for an aging population, in which the growing rate of Alzheimer’s disease and dementia has led researchers to look for ways to prevent cognitive degeneration. By the year 2050, it is estimated that 13 million Americans will have Alzheimer’s disease.1 While hormone replacement therapy is not considered a treatment for cognitive degeneration, it has been considered a benefit for female patients to delay age-related cognitive decline and sustain healthy cognition.2

    Estrogen and Cognition

    A large concentration of estrogen receptors are found in the hippocampus - an area in the brain that regulates memory and learning.4,5 Estrogen’s role in cognitive function is to support communication between neurons, aid the development of neuronal processes, and sustain the synthesis of neurotransmitters.6,7

    Overall, estrogen benefits cognition to:

    • Support regulation of the neurotransmitters, acteylcholine and glutamate8
    • Improve communication between neurons in the hippocampus2
    • Protect nerve cells from free radical and excitotoxin damage9,10

    Summary of Estrogen Studies

    Several studies have observed the effects of estrogen on cognitive function in older women. Researchers have found that among women who are over 65 years old, those that take estrogen replacement therapy (ERT) perform better on cognitive tests and show less cognitive deterioration over time.11,12,13,14 One study recruited 288 postmenopausal women that were either taking or not taking estrogen replacement therapy.15 Researchers found that women taking ERT had better visual memory when compared to those not taking the treatment. A similar study followed 788 older women for over two years to find that those taking ERT had better cognition than those who were not taking ERT.16 A series of studies found that women had higher scores on verbal and fine motor skills tests when estrogen levels were at their peak in their menstrual cycle. Additionally, these women performed better on speed and accuracy tests.17

    The Impact of a Healthy Lifestyle

    Estrogen therapy may not be a main treatment for cognitive function, but it can help inhibit memory loss and cognitive impairment in women who already take HRT to treat their menopausal symptoms. It is important for the female patient to recognize that healthy cognitive function comes by living a healthy lifestyle. Along with balancing hormone levels, diet, nutrient supplementation, exercise, staying socially active, and a fascination to continue learning can help prevent age-related cognitive decline.18

    References

    1. Shumaker SA, et al. Conjugated equine estrogens and incidence of probably dementia and mild cognitive impairment in postmenopausal women: women’s health initiative memory study. JAMA. 2004;291(24):2947-58.
    2. 1 Shumaker SA, et al. Conjugated equine estrogens and incidence of probably dementia and mild cognitive impairment in postmenopausal women: women’s health initiative memory study. JAMA. 2004;291(24):2947-58.
    3. 2 Sherwin BB. Estrogen and cognitive functioning in women. Endocrine Reviews. 2003;24(2):133-151.
    4. 3 Jaffe AB, Toron-Allerand CD, Greengard P, Gandy SE. Estrogen regulates metabolism of Alzheimer amyloid B-precursor protein. J Biol Chem. 1994;269:13065-13068.
    5. 4 Gazzaley AH, Weiland NG, McEwen BS, Morrison JH. Differential regulation of NMDAR1 mRNA and protein by estradiol in the rat hippocampus. J Neurosci. 1996;16:6830.
    6. 5 Luine VN. Estradiol increases choline acetyltransferase activity in specific basal forebrain nuclei and projection areas of femail rats. Exp Neurol. 1985;89:484.
    7. 6 Sherwin BB. Can estrogen keep you smart? Evidence from clinical studies. J Psychiatry Neuroscience. 1999;24(4):315-321.
    8. 7 Morley BJ, Rodriguez-Sierra JF, Clough RW. Increase in hypothalamic nicotinic acetylcholine receptors in prepubertal female rats administered estrogen. Brain Res. 1983;278:262.
    9. 8 Luine VN, Khylchevskaya RI, McEwen BS. Effect of gonadal steroids on activities of monoamine oxidase and choline acetylase in rat brain. Brain Res. 1975;86:293–306.
    10. 9 McEwen BS. Clinical review 108: The molecular and neuroanatomical basis for estrogen effects in the central nervous system. J Clin Endocrinol Metab. 1999;84:1790.
    11. 10 McEwen BS. Estrogen action throughout the brain. Recent Prog Horm Res. 2002;57:357–384.
    12. 11 Yaffe K, Lui L, Grady D, Cauley J, et al. Cognitive decline in women in relation to non-protein-bound oestradiol concentrations. Lancet. 2000;356:708-712.
    13. 12 Matthews K, Cauley J, Yaffe K, Zmuda JM. Estrogen replacement therapy and cognitive decline in older community women. J Am Geriatr Soc. 1999;47:518-523.
    14. 13 Grodstein F, Chen J, Pollen DA, Albert MS, et al. Postmenopausal hormone therapy and cognitive function in healthy older women. J Am Geriatr Soc. 2000;49:746-752.
    15. 14 Rice MM, Graves AB, McCurry SM, Gibbons LE, et al. Postmenopausal estrogen and estrogen-progestin use and 2-year rate of cognitive change in a cohort of older Japanese American women: the Kame project. Arch Intern Med. 2000;160:1641-1649.
    16. 15 Resnick SM, Metter EJ, Zonderman AB. Estrogen replacement therapy and longitudinal decline in visual memory. A possible protective effect? Neurology. 1997 Dec;49(6):1491-1497.
    17. 16 Jacobs DM, Tang MX, Stern Y, Sano M, et al. Cognitive function in nondemented older women who took estrogen after menopause. Neurology. 1008 Feb;50(2):368-373.
    18. 17 Hampson E, Kimura D. Cognitive pattern in men and women is influenced by fluctuations in sex hormones. Curr Dir in Psychol Sci. 1994;3:57-61.
    19. 18 Fillit HM, Butler RN, OConnell AW, et al. Achieving and maintaining cognitive vitality with aging. Mayo Clin Proc. 2002;77:681-696.


  • June 07, 2012 10:02 AM | Christiaan Killian (Administrator)

    Hormone expert Neal Rouzier, M.D. had a recent discussion with a Physician enquiring about certain hormones and their relationship to cancer. He thought it was worth sharing, and we agree.

    Dear John Doe,

    I do not know why your tumor marker is elevated but you have had it elevated for some time. We do not use tumor markers here [in the U.S.] to diagnosis cancer. We only use them to monitor the progression of cancer once it is treated with chemo. Tumor markers can be elevated in normal people that don't have tumors or cancer, so it is not a good diagnostic modality. If you are concerned, then do an upper and lower endoscopy. In addition, a PET CT scan will pick up any cancer that you may have. I doubt that you have cancer and I truly believe that the elevated tumor marker is not diagnostic of cancer. We see them elevated all the time and never indicate a cancer. Again we use them to monitor a cancer once it is diagnosed, but never to diagnosis them. The only marker that we use is the PSA and that is not diagnostic for cancer but makes us go further to R/O any cancer.

    The Effect of Testosterone on Cancer Risk

    With all due respect, the Japanese doctor that suggests that HRT causes cancer is perhaps unaware of the medical literature. Testosterone does not cause cancer. It may cause it to grow once prostate cancer is established, but no study shows that testosterone causes the cancer. On the contrary, our studies show that higher levels of testosterone are associated with a decreased risk of prostate cancer and less severe types of cancer if one develops a cancer. In fact low levels of testosterone are associated with a greater risk of prostate cancer and a more severe and aggressive type of prostate cancer. We used to think, and many of us were taught, that testosterone causes cancer whereas the overwhelming evidence shows the opposite. Several recent studies showed that testosterone treatment decreased morbidity and mortality from all causes, including heart disease and all cancer. The theory is that testosterone decreases insulin resistance and diabetes which greatly enhances the formation of many cancers. There are several recent studies where researchers (Morganthaler) are treating men with active prostate cancer and are seeing no increase in growth of these cancers. A meta-analysis study reviewed the world's literature and the conclusion from a multidisciplinary team of specialists concluded that there is no evidence from all the studies that testosterone administration causes cancer. Articles from all specialty journals from endocrinology, urology, cancer, and epidemiology, all published that testosterone does not cause cancer, and in most circumstances, protects against cancer.

    The fact that a famous Japanese doctor claims that testosterone causes cancer is very incorrect and not supported by any clinical or scientific evidence. What is more disconcerting is that this physician is misinforming, and perhaps scaring, many Japanese doctors into not prescribing or recommending testosterone which is doing just the opposite of what he has intended. It may increase the morbidity and mortality of many doctors who now resist taking testosterone. I never suggest, teach, lecture, or make any claim unless what I state can be very well supported by scientific evidence. May I make the same suggestion to your fellow physician before he makes reference to hormones causing cancer.

    Fear Stemmed from the WHI Trials

    It is very true that a synthetic female hormone (medroxyprogesterone acetate or Provera in this country) was demonstrated to cause breast cancer in women. We should not extrapolate this to include all hormones. Most physicians in this country also think that hormones cause cancer, so your famous physician is not too far off base from them. The medical and lay media in this country have scared all women into thinking that hormones cause cancer and this is very unfortunate. It is very true that our synthetic hormones have increased the risk of breast cancer and this has been demonstrated in many studies. As a result of this, there is an inherent fear that hormones cause cancer and there is a human tendency to extrapolate this to include all hormones. The medical literature supports that this is entirely not true. There are two Japanese Physicians that have recently attended Part II of the hormone courses that we offer here in the U.S. They both have the syllabus and 2 hour lecture material that I presented that demonstrates that the hormones in our body do not cause cancer in spite of the inherent fear instilled in us by the media and extrapolation from the WHI trial. Please contact them so that they may present to you all of the literature so that you may come to understand that the hormones in our body do not cause cancer, when in fact they are protective against cancer.

    A Brief Summary of the WHI Studies

    Without going into detail, I will summarize these studies. A meta-analysis of estrogen demonstrated that estrogen (alone and not with MPA mentioned above) administration decreases morbidity and mortality from all cause, both coronary artery disease, cancer, and osteoporosis. The WHI trial demonstrated that estrogen alone (that was the CEE arm that did not include MPA with the estrogen) was not associated with breast cancer. A most recent analysis just published demonstrated a statistically significant decrease (yes decrease) incidence of breast cancer in those that took estrogen alone in comparison with placebo. In addition, let us not forget that the estrogen only arm demonstrated a significant 27% decrease in colon cancer also. The theory is again the decrease in visceral fat and protection against diabetes that may play a major role in cancer protective effects of estrogen, similar to that of testosterone mentioned above.

    The Protective Effects of Estrogen

    Except in certain circumstances, which is beyond the scope of this letter, estrogen protects against heart disease, strokes, Alzheimer's, dementia, osteoporotic fractures, and cancer as proved in the meta-analysis along with a decrease in morbidity and mortality from all cause including cancers. Based on this, would you like your wife, mother, sister to be on estrogen or not? It is very unfortunate that your doctors and the world misinterpret the hormones and cancer issue.

    The Difference: Bioidentical vs. Synthetic

    There is a plethora of data and studies that demonstrate increased longevity and decreased morbidity and mortality when levels of our hormones are maintained at optimal. This benefit applies to estrogen, testosterone, progesterone, DHEA, and growth hormone. As our hormone levels fall with age, so does the protection against cancer. Replacement of hormones reverses this harm. Replacement with chemically altered hormones (medroxyprogesterone and norethindrone) has always increased the risk of cancers. As per the medical literature, we must not equate them to be the same nor should your doctor. I certainly hope that this lengthy explanation reverses your misunderstanding and that you can pass this along to your fellow physicians.

    Respectfully yours,

    Neal Rouzier, M.D.


  • April 04, 2012 10:03 AM | Christiaan Killian (Administrator)

    Can hormone replacement therapy replace antidepressants? Antidepressant medication, also known as selective serotonin reuptake inhibitors (SSRIs), has been shown to have a number of side effects, including insomnia, nervousness, sleep problems, headaches, joint and muscle pain, stomach upset, sexual dysfunction, and bleeding problems. Even so, antidepressants are the third most widely prescribed group of medications in the United States. Many individuals may be taking antidepressants for minor complaints, without considering the potential risks. What some may not realize is that hormone replacement therapy may be considered a safer, effective alternative to SSRIs.

    Hormone imbalances can lead to depression.

    In men, low testosterone levels can cause mood and emotional issues. If male patients choose to take SSRIs to treat depression, they increase their risk of infertility and sperm quality damage. SSRIs have been shown to reduce sperm count in men by 50 percent, as well as damage the motility and shape of the sperm.1 2

    In contrast, hormone replacement therapy (HRT) restores the body’s natural production of hormones, including testosterone, to relieve depression and emotional issues that are related to hormone imbalances. Men that are concerned about the side effects associated with antidepressant medications may find HRT to be a safe and effective alternative.

    Research has suggested that HRT and antidepressant therapy may have similar molecular targets.

    When the results of the Women’s Health Initiative were published, many women immediately stopped HRT; a subsequent increase in the use of antidepressants is well documented. Women who were using HRT had climacteric symptoms reduced, including depression. 3 Estrogen therapy has been suggested to effectively treat perimenopause women with depressive disorders.4 5

    HRT goes beyond just relieving depression to provide overall health benefits on cognitive function, cardiovascular health, weight management, energy, sexual health, and quality of life that result in confidence and a better mood. Even so, does this make hormone replacement the answer for treating depression? If a patient’s depression is related to hormone imbalances, then HRT can dramatically improve mood without the side effect of common antidepressants and anti-anxiety medications. Yet, HRT may not be the answer for everyone.

    Start by reviewing the Big Picture

    Overall, it is best to determine the method of treatment on an individual basis. Start by reviewing the big picture, which includes nutrition, exercise, and lifestyle habits.

    Dr. Louis Cady, known for studying the connection between psychiatry, hormones, and wellness, explains, “In many cases I found that I could not make them better working from the neck up, and that no matter how good my potions were they didn’t get better. And then I began looking a little bit further. I got more professional education and began to understand this mind-body divide in contemporary medicine. Where if a conventionally trained physician can’t diagnose somebody in terms of really what is going on, they will say, “Well, it is all in your head” and then I will get them. And I will find many times that it is not just in their head. It may be in their thyroid or it may be in other parts of their body. They may have a sleep disorder. And so I decided that instead of just limiting myself to pushing pills all day I was going to do what I was trained to do, which was to be a complete physician.”

    Establish the basics.

    The best solutions to consider for depression or any other health complaints are proper nutrition, exercise, behavior modification, and natural hormone balancing. All of these are crucial elements to increase well-being, vitality, and health. While SSRI's still serve a necessary purpose for many people, instead of first looking at an antidote to fix the problem, it is best to look at what is needed to maximize the patient’s overall health and happiness.

    References

      1. Hendrick V, Gitlin M, Altshuler L, Korenman S. Antidepressant medications, mood and male fertility. Psychoneuroendocrin. 2000 Jan;25(1):37-51.
    1. Tanrikut C, Feldman AS, Altemus M, Paduch DA, Schlegel PN. Adverse effect of paroxetine on sperm. Fertil Steril. 2010 Aug;94(3):1021-1026.
    2. McIntyre RS, Konarski JZ, Grigoriadis S, Fan NC, et al. Hormone replacement therapy and antidepressant prescription patterns: a reciprocal relationship. CMAJ. 2005 Jan;172(1):57-59.
    3. De Novaes Soares C, Almeida OP, Joffe H, et al. Efficacy of estradiol for the treatment of depressive disorders in perimenopausal women: a double blind, randomized, placebo-controlled trial. Arch Gen Psychiatry. 2001 Jun;58(6):529-534.
    4. Schmidt PJ, Nierman L, Danaceau MA, et al. Estrogen replacement in perimenopausal-related depression: a preliminary report. Am J Obstet Gynecol. 2000;183:414-¬420.


  • February 21, 2012 10:23 AM | Christiaan Killian (Administrator)

    Hormone Replacement and the Skin

    As women age, they start to recognize a dramatic change in their skin. This is often due to a decline of estrogen in the body, which causes the inactivity of estrogen receptors and loss of estrogen production in the skin. Dry, rough, burning, and thin skin, as well as fine lines and wrinkles, can develop when estrogen is no longer being produced1.

    Studies have indicated that estrogen therapy can increase collagen and hyaluronic acid production to improve skin thickness and hydration. A study published in the American Journal of Clinical Dermatology found that estrogen therapy restores skin thickness, decreases wrinkle depth, and improves collagen production and hydration. One study showed that women using hormone replacement therapy had a 10 to 20 percent increase in skin thickness, when compared to those not being treated. HRT also reduced atrophy (fragile, fading skin) that occurs in aging skin1.

    HRT Can Speed Surgery Recovery

    Hormonal changes often cause an age-related delay in the healing of body tissue and skin. An estrogen deficiency can dramatically decrease the rate of cellular response to injuries2. Restoring healthy hormone levels, particularly estrogen, can increase the rate of healing among individuals recovering from injuries or surgical procedures.

    Patient Demand for Youthful Health and Appearance

    Cosmetic surgery is commonly used among postmenopausal women to bring back a more youthful appearance. Hormone replacement therapy (HRT) is an added bonus for cosmetic surgery patients, because it supports the healing process and speeds recovery from surgery.

    Dr. Neal Rouzier explains the benefits of using HRT among cosmetic surgery patients; “I personally have found longevity and preventive medicine to be a natural extension of cosmetic surgery. Patients find they can surgically reverse the effects of gravity and aging through face-lifts, eyelifts and liposuction. When I prescribe HRT to a patient before surgery, they heal faster and feel better postoperatively. If the patient continues the natural hormone supplements post operatively, two wonderful things happen. First, they will probably experience improved results of the tummy tuck or face lift, due to the strengthening and thickening of the skin. Second, they will begin to feel good with increased energy, libido, skin texture, muscle-to-fat distribution, and improved mental clarity. Most of all, I give my surgical patients a choice in how they age after their cosmetic surgery.”

    Choosing the right form of HRT

    While HRT has been shown to benefit aging skin, all HRT is not created equal. As an important reminder, synthetic HRT is considered harmful, as certain risk factors are associated with this type of treatment. Bioidentical HRT, hormones that are similar to those produced in the body, is a safer alternative to conventional HRT. This form of therapy protects women from health ailments related to the loss of hormones that comes with aging. Plus, bioidentical HRT has incredible benefits on improving skin quality. Remember, it is always best to support HRT guidelines that are based on peer-reviewed studies and protocols that have been tried and tested.

    References

    1. Vaillant L, Callens A. Hormone replacement treatment and skin aging. Therapie. 1996;51(1):67-70.
    2. Ashcroft GS, Ashworth JJ. Potential role of estrogens in wound healing. Am J Clin Dermatol. 2003;4(11):737-743.
    3. Shu YY, Maibach HI. Estrogen and skin: therapeutic options. Am J of Clin Derm. 2011 Oct;12(5):297-311.


  • November 30, 2011 10:24 AM | Christiaan Killian (Administrator)

    Fatigue, weight gain, forgetfulness, mood swings…did the holidays just hit? Or are these symptoms an indication of hypothyroidism? While you might struggle with the holiday season to maintain energy and sanity, these persistent symptoms are a few of the signs related to low thyroid function, also known as hypothyroidism.

    What Is Hypothyroidism?

    More commonly found in women, approximately 5% of Americans have hypothyroidism, which occurs when the thyroid gland is unable to produce enough thyroid hormone to support several metabolic functions in the body. The thyroid gland secretes two main hormones, thyroxine (T4) and triiodothyronine (T3). T4 is the hormone that is principally produced by the thyroid gland which is then converted in the liver and kidney to the metabolically active T3 hormone. It is the T3 that is responsible for regulation of metabolism, energy production, body temperature, body fat, cholesterol, cognitive function, and symptom improvement.

    How do you know if your thyroid levels are low?

    There are over 200 symptoms related to low thyroid function that improve with optimal thyroid replacement:

    • Colder body temperature
    • Symptoms of poor circulation in the hands and feet
    • Fatigue
    • Depression
    • Forgetfulness and fuzzy thinking
    • Muscle and joint pain
    • Dry skin and brittle nails
    • Digestive ailments (constipation, IBS, etc.)
    • Menstrual irregularities and infertility
    • Emotional instability
    • High cholesterol
    • Weight Gain

    Recommended Treatment from Dr. Rouzier:

    Optimizing thyroid function by replacing thyroid hormones to optimal (upper range of normal) can significantly increase energy, metabolism, and well being. Many studies (NEJM & JCEM) demonstrate that raising Free T3 levels in addition to T4 levels is essential to obtaining these results. Traditionally physicians have prescribed thyroid hormone in a form of T4 only, also known as Synthroid®, Levoxyl®, or L-thyroxine. Recent studies, however, have demonstrated that this may not be sufficient in many patients to truly feel well. Many thyroid treated patients commonly request even more thyroid, knowing that more makes them feel and function better. The patient might not have realized how lousy they felt until they felt better. This might not be accomplished, as per recent literature, until these patients have improved or optimized T3 replacement as it is the T3 at the cell level that is responsible for thyroid function, and not T4. Nevertheless, it is usually only the T4 preparations that physicians are taught to use for thyroid replacement. Unfortunately using primarily a T4 only preparation typically does not allow for adequate conversion to T3 and therefore improvement in symptoms is often not adequate. Many factors play in the inadequate conversion of T4 into T3 and are related to a defective function of the 5’-deiodinase enzyme responsible for this conversion. Whatever the cause for the inadequate conversion of T4 to T3, many patients have persistent low thyroid symptoms despite adequate T4 replacement. Several landmark studies demonstrate that this can be overcome by simply adding T3 on to the T4 regimen. Improvement in T3 levels can be attained by compounding both T4 and T3 together into a capsule or through the use of the commercially available desiccated thyroid preparations that contain T4 and T3 together in tablet form. The commonly prescribed T4 preparations of L-thyroxine, sometimes referred to as synthetic thyroid and contain only T4 and no T3, might not convert to the active form of T3 which is especially critical for patients who are not able to properly and adequately convert T4 to T3.

    A paper published in JAMA demonstrated the importance of T3 in predicting morbidity, mortality, and functional decline. Neither TSH nor T4 were predictive, thereby further establishing that T3 should be the main marker utilized for thyroid replacement.”

    Dr. Rouzier recommends physicians review the excellent articles published in NEJM, JCEM, and JAMA to further appreciate the importance of T3 optimization for health and well-being.

    Utilizing a combination of both T4 and T3, as suggested by recent literature, most effectively raises the active thyroid hormone at the cell level called T3. Science has proven that it is the T3 level, and not the T4 level, that is responsible for maintenance of normal cholesterol levels. Commercially available combinations of T4 and T3, commonly called desiccated or natural thyroid, will provide more optimal levels of T3 than commercially available T4 only preparations. Since T3 is the more metabolic hormone, low T3 levels result in poor metabolism and symptoms of low thyroid. When pure T4 is given in the form of Synthroid®, Levoxyl®, or L-thyroxine, T3 levels improve only minimally due to poor conversion of T4 to T3. Many physicians including endocrinologists believe that T4 alone is the only thyroid preparation necessary to prescribe for hypothyroidism. Their reasoning is the belief that the body will automatically (physiologically) convert T4 into T3 if the body needs it. If the body doesn’t need it, then it won’t make it. This commonly held belief, however, is not what is born out in the medical literature for optimal thyroid function. Recent studies show that use of T4 alone does not adequately convert into T3. Although many patients do improve on pure T4 supplementation alone, adding T3 to the T4 preparation allows us to optimize T3 levels that are not usually achievable with pure T4 preparations alone. It is only supplementation of T3 that augments the antidepressant of thyroid hormone, not T4.

    Treatment should restore thyroid to OPTIMAL levels and not just normal.

    Conventional treatment for thyroid disorders involves restoring TSH into the normal range which might still maintain levels of T3 in the low normal range in spite of normal TSH levels. Restoring T3 levels into the upper range of normal is now regarded as necessary to achieve improvement in health and well-being. Normal laboratory levels are the average of a population for the age but do not reflect that which would be best for symptom improvement and health. In other words, normal does not mean optimal or what is best for the patient. A recent article in “Gerontology” demonstrated that thyroid replacement in euthyroid men (normally not needing thyroid replacement) into the upper or high range resulted in improvement in cognition, memory, and overall function. This study is just one of many that consistently demonstrate that optimization of all hormones, including low thyroid, provides better metabolism, health, well-being, and disease prevention than does maintaining “normal” levels for the age. Keep in mind that normal levels (average for the age) of estradiol, progesterone, and testosterone are zero in menopausal women. Even though that is the level typically measured in a menopausal woman as menopausal women no longer make these hormones, normal (zero level) is not where the level should be for symptom improvement and health protective benefits (cardiovascular and musculoskeletal). The same applies to thyroid. Low T3 levels were predictive of an increase in fracture rate whereas TSH and T4 levels were not predictive or protective. Where would you like your levels to be? The Rotterdam study (Annals of Internal Medicine) demonstrated that normal levels of thyroid (in the lower 50% of normal) were predictive of a 2.2 fold increase risk of cardiovascular disease, and these were levels in the “normal” range. There is now significant data to support that we physicians should conform to the literature recommendations and understand that in every circumstance optimal levels of all hormones, including thyroid, are very important for health optimization and improvement in symptoms, and subsequently our quality of life.

    By simply restoring TSH levels to “normal” blood levels for your age might not be in the best interest for the patient. Lab tests can indicate normal or low normal thyroid levels, but patients can still have symptoms associated with hypothyroidism. According to the BMJ, goals of thyroid replacement should be to treat the patient until the Free T3 and Free T4 levels are in the high normal range. Some patients might require levels that are above normal (suppressed TSH) to feel normal, a concept that we physicians are not taught to trained to do. Researchers emphasize that TSH is not predictive of symptoms or symptom improvement, only T3 is as this is the active hormone at the cell level. Although TSH is very predictive of biochemical hypothyroidism, it is not predictive at all of clinical symptomatology. Rather than treating the patient’s lab tests, researchers suggest that physicians should treat the patient’s symptoms and not the TSH level as we are often taught. Researchers emphasize that if the Free T3 and Free T4 levels are kept within the upper end of normal, in spite of suppressed TSH levels, then overt hyperthyroidism is averted. Thyroid hormone serum levels that are in the optimal range that thereby result in a reduction of hypothyroid symptoms indicate healthy thyroid function.

    Benefits of Optimal Thyroid Treatment

    Optimal thyroid replacement can effectively restore health and well-being by improving:

    • Temperature regulation and metabolism
    • Increased energy
    • Fat breakdown for healthy bodyweight and cholesterol
    • Protection against cardiovascular disease
    • Protection against depression and mood disorders
    • Cerebral function and cognition
    • Healthy skin, hair and nails
    • Protection against functional decline

    References

    1. Applehof BC, Fliers E, Wekking EM, Schene AH, et al. Combined therapy with levothyroxine and liothyronine in two ratios, compared with levothyroxine monotherapy in primary hypothyroidism: a double-blind, randomized, controlled clinical trial. J Clin Endocrinol Metab. 2005 May;90(5):2666-2674.
    2. Bunevicius R, Kazanavicius R, et al. Effects of thyroxine as compared with thyroxine plus triiodothyronine in patients with hypothyroidism. N Engl J Med. 1999; 340(6): 424-429.
    3. Gussekloo J, van Exel E, de Craen AJ, Meinders AE, et al. Thyroid status, disability and cognitive function, and survival in old age. JAMA. 2004 Dec;292(21):2591-2599.
    4. Hak AE, Pols HA, Visser TJ, Drexhage HA, et al. Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: the Rotterdam Study. Ann Intern Med. 2000 Feb;132(4):270-278.
    5. Klein I, Ojamaa K. Thyroid hormone and the cardiovascular system. N Engl J Med. 2001; 344(7): 501-509.
    6. Meier C, Trittibach P, Guglielmetti M, Staub J, Muller B. Serum thyroid stimulating hormone in assessment of severity of tissue hypothyroidism in patients with overt primary thyroid failure: cross sectional survey. BMJ. 2003 Feb;326(7384):311-312.
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