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  • October 28, 2011 10:25 AM | Christiaan Killian (Administrator)

    What is considered the normal range for testosterone levels in men? It may seem like an easy question to answer, as traditionally serum testosterone levels are observed to be anywhere between 300 to 1,200 ng/dL. Yet, the answer to this question is not as simple as it may seem.

    Hypogonadism, or an androgen deficiency, affects an estimated four to five million men in the United States. More than 60% of men over 65 years old have low free testosterone levels. Even so, hypogonadism often goes undiagnosed and older men experience a rapid decline in their health. Low testosterone levels can be observed through serum tests, but what are normal testosterone levels? What are optimal testosterone levels? The answer to this question depends on who you ask and varies widely amongst healthcare practitioners. Hormone Doctor, Neal Rouzier. M.D. gave his expert opinion in a recent interview.

    Dr. Rouzier’s Recommendation

    “An important point is the difference between optimal and normal. Normal for one’s age is not optimal for one’s age. The medical literature supports replacement levels to that of a younger age, typically 20 to 30 years old. At these levels, optimal health is attained, as well as the feel-good effects. The problem is how one defines normal and optimal. Normal for a 70-year-old is not normal for a 20-year-old. If a 20- year-old man has the testosterone level of a 70-year-old man, he will not feel well. If a 70-year-old man has the level of a 70-year-old man, this is considered normal. No man should have the testosterone level of a 70-year-old as supported in our medical literature. In reality we are not trying to be 30; however our goal is to optimize levels to those we would see in a 20 to 30 year-old. A free testosterone lab value of 25 may be interpreted as optimal when in fact this level is quite low. A lab value of 40 would be interpreted as being too high when in reality it is a perfect level and our goal for a younger person. All the medical studies utilize hormone dosages resulting in levels on the upper end of the physiologic range. These are levels found in young adults.

    In past years, various labs would list the testosterone ranges for all ages next to the lab results. Today, the labs publish only the normal levels based on a person’s age. This does not provide the appropriate indication of optimal levels as it is age specific. For example, normal free testosterone levels for a 60-year-old man range from 5 to 25. Optimal is therefore expected to be 25. A traditional medical doctor would interpret 25 as optimal. But remember, our goal is to replace free testosterone levels to that of a younger male. These free testosterone levels would be 30 to 40. A lab value of 40 would be interpreted by the lab as being too high, when in reality the level of 40 is perfect and is always our goal.

    Optimal levels are conducive to optimal health. Having good testosterone in your system decreases incidents of heart attacks, strokes, Alzheimer’s, diabetes, high blood pressure. It has a beneficial effect in protecting against cardiovascular disease in every study. It decreases the instance of heart attacks because of its effect on blood vessels. It has a beneficial effect of improving your good cholesterol and lowering your bad cholesterol. It has a beneficial effect of improving all of the good lipoproteins and reducing all the bad lipoproteins.

    Critics perhaps don’t understand that the more that you have, the better off you are, and every longevity study says the same thing: the higher level, the longer you’ll live, the less risk of heart disease that you'll have. Where would you like your levels to be?”

    Low Testosterone Symptoms

    What are the signs of a deficiency?

    • Depression
    • Fatigue
    • Dementia
    • Osteoporosis
    • Low Libido
    • Heart disease
    • Stroke
    • Prostate Cancer
    • Abdominal Obesity
    • Type 2 Diabetes

    Restoring optimal testosterone levels can deter these health risks and improve bone mineral density, sexual function, muscle mass/strength, and mood. Furthermore, quality of life is improved overall.

    The Take-Away

    If you are considering testosterone replacement, a healthcare provider who is trained in evidence-based Hormone Replacement can help you restore hormone levels to an optimal point that reduces or eliminates symptoms and improves quality of life without causing significant side effects. If you are a health practitioner, it is recommended that you understand the medical literature supporting optimal hormone levels before treating patients with testosterone replacement therapy.

    References

    1. Akishita M, Hashimoto M, Ohike Y, Ogawa S, et al. Low testosterone level as a predictor of cardiovascular events in Japanese men with coronary risk factors. Atherosclerosis. 2010 May;210(1):232-236.
    2. Culley CC. Prevalence, Diagnosis and Treatment of Hypogonadism in Primary Care Practice. Boston University. Retrieved on October 26, 2011 from http://www.bumc.bu.edu/sexualmedicine/publications/prevalence-diagnosis-and-treatment-of-hypogonadism-in-primary-care-practice/
    3. Harman SM, Metter EJ, Tobin JD, Pearson J, Blackman MR. Longitudinal effects of aging on serum total and free testosterone levels in healthy men: Baltimore Longitudinal Study of Aging. J Clin Endocrinol Metab 2001;86:724-31.
    4. Morley JE, Kaiser FE, Perry HM III, et al. Longitudinal changes in testosterone, luteinizing hormone and follicle-stimulating hormone in healthy older men. Metabolism. 1997;46:410-3.
    5. Rabijewski M, Zgliczynski W. Testosterone deficiency in elderly men. Pol Merkur Lekarski. 2009 Dec; 27(162):517-523.
    6. Schubert M, Jockenhovel F. Testosterone and the metabolic syndrome. Urologe A. 2010 Jan;49(1):47-50.
    7. Srinivas-Shankar U, Roberts SA, Connolly MJ, O’Connell MD, et al. Effects of testosterone on muscle strength, physical function, body composition, and quality of life in intermediate-frail and frail elderly men: a randomized, double-blind, placebo-controlled study. J Clin Endocrinol Metab. 2010 Feb;95(2):639-650.


  • September 16, 2011 10:26 AM | Christiaan Killian (Administrator)

    Dr. Neal Rouzier recently shared a an email thread between him and Dr. Dirk Parvus. We found it to be quite moving and thought it would be useful to post.

    Hi Neal,

    I am attending a hormone conference in Chicago as part of a series given by the Institute for Functional Medicine (IFM). I am interested in their approach to treating chronic disease. A lecturer from IFM refers to several studies that are using CEE and progestins. Some of the studies concluded that hormone replacement, even testosterone, increase breast cancer risk and should not be used long term. Also, his conclusions on estriol differ from mine and from what you teach. He also points out that the FDA, ACOG, and Endocrine Societies do not recommend bioidentical hormones, which I feel is crazy and disturbing. Unfortunately, he does not refer to, or may not know about, the numerous articles you use to base your recommendations. It saddens me that his conclusions are so diametrically opposite from ours. Depending on the experts they listen to, doctors are giving very different treatment recommendations to their patients.

    Yours in health,

    Dirk

    Hi Dirk,

    It is absolutely amazing what is being taught and promoted. If this doctor attended our courses, he would be just as disgusted with us, as we are with him. As you have heard in my lectures, the most upsetting consequence to all of this is that practitioners who abide by these teachings mistreat so many patients. None of them follow any scientific methods. As you can imagine, I am not very popular when I lecture [at similar conferences], because I use the medical literature to debunk all that they teach. Please note that there are hundreds of alternatively trained physicians that will disagree with me. I'm glad you can identify the teachings that don't hold any credible scientific backing. I frequently get into discussions and debates on a multitude of topics, as our teaching is diametrically opposed to their beliefs. Unfortunately for them, they always lose the argument, because I use the medical literature and science to counter almost everything they propose.

    Please don't feel disturbed that ACOG and NAMS don't recommend bioidentical hormones. I agree with them 100% (and so do you). You see, they are not recommending bioidentical hormones that are utilized by this IFM physician. This doctor will recommend estriol and progesterone creams that do not raise hormone serum levels or provide endometrial protection. ACOG and NAMS are against this type of prescribing and promotion, and so are we. In contrast, the literature is full of data and studies demonstrating the beneficial effects of pharmacologic bioidentical hormones, which I simply copy.

    Many doctors from IFM attend my courses and think I'm crazy, because what they are initially taught is contrary to what I teach. I am pleased that you have the insight many others lack. I am frustrated with the incorrect principles being taught, but that just fuels my passion.

    Sincerely,

    Neal

    Hi Neal,

    Thank you so much for taking the time to give me a detailed answer. I have referred many colleagues to your courses and plan to retake level 2 and 3 in the next year. The knowledge you provide has enabled me to talk to anyone (including other doctors) about bioidentical hormone optimization. I am able to practice safe, effective medicine for my patients, and when it exists I have been able to recognize flawed reasoning in hormone lectures I have attended. On behalf of all of us who follow your teaching, thank you for your passion and for all of the work you do to summarize the correct way for us.

    Yours in health,

    Dirk

    Hi Dirk,

    I must say that your response is the most moving that I have ever received. I just spent the last two days at my computer researching, writing, re-organizing, and trying to improve the courses. This was my only weekend off in months, and I wasted it doing trivial tasks. However, based on your response, it is the most rewarding activity. It drives my wife crazy, but the knowledge and insight that I gain from the research, as well as the responses I receive from physicians and patients, makes all of the effort worthwhile. Thanks again and I hope to see you in September at Part II (which I have changed about 50%).

    Graciously,

    Neal


  • August 23, 2011 10:27 AM | Christiaan Killian (Administrator)

    Anti-Aging Market to hit $114 Billion: Let's Separate the Gimmicks from the 'Real Deal'

    Look-young concoctions and feel-good elixirs. The anti-aging market is well-established and only getting stronger, as over 70 million aging baby boomers are driving the movement to look and feel younger. Currently at $80 billion, the anti-aging market size is expected to reach more than $114 billion by 2015.

    With a prevalent focus to stay young, many anti-aging interventions have developed over the years, including hormone replacement therapy, anti-aging supplements, and surgical treatments. Are these treatments safe and effective? This is a main question for several medical professionals, as they claim anti-aging interventions, especially hormone replacement therapy, can be ineffective and cause harm.

    Fears of harm and effectiveness are misleading

    The majority of fears about hormone replacement therapy stems from the highly publicized Women’s Health Initiative, which warned thousands of menopausal women to stop taking HRT. (See Hormones and Cancer blog post). Regrettably, critics fail to see that the negative outcomes from the WHI were applied to one form of treatment, and only for one specific age group of women.

    By stopping HRT, women were put at greater risk for developing cardiovascular disease, stroke, and cancer. Fortunately, there are alternatives to anti-aging interventions that may be harmful. Unlike conventional HRT, medical studies purport bioidentical hormones (BHRT) are a safe and effective treatment for women with hormone deficiencies. One particular study is currently being conducted by the Kronos Longevity Research Institute to clarify the safety and efficacy of BHRT.

    Dr. Rouzier's Take

    The benefits of hormones can be further explained by Dr. Neal Rouzier, who has been teaching Worldlink Medical's anti aging conference for over 10 years. He stated in his recent anti aging seminar, “Yes hormones are good. Just use the right ones in the right way. If hormones were so bad in women, we would yank their ovaries out when they were 30. We used to do that, and they all died sooner and had a miserable life before they died. Now we don’t take the ovaries out, we leave those ovaries in. Why? Well, because they feel better, they function better, and they live longer, happier and healthier. So, hormones do have a beneficial effect. The Women’s Health Initiative showed that the hormones were harmful. Well which is it? Are they good or are they bad? In the body they’re good. Out of the body, in a chemically altered form, they’re bad and all of the studies show that. Well, let’s look at the most recent studies, perhaps at a natural estradiol. All of the studies show it is very beneficial, and long term use will make you live longer, happier, less heart attacks, less stroke, less osteoporosis, less depression, less mood swings, less Alzheimer’s disease, and less dementia. Why don’t we use that one?... Let’s not look at these other studies with the synthetic chemically altered [hormones], let’s look at estradiol [i.e. from the Kronos Study http://www.keepstudy.org/keeps/why.cfm]. That’s the one that has shown to be beneficial, that’s the one that we lose when we go through menopause. We’ve replaced that one, in the correct form, and we haven’t seen any problems with it.”

    Still beware of anti-aging gimmicks

    Not all anti-aging interventions are created equal. There are some products and gimmicks for which you should be weary. The market is saturated with hormone balancing creams, wrinkle-fading dreams, and lose-weight quick schemes, but such products may not live up to all they claim to be.

    Anti-aging products can pop up while browsing the internet, making statements that are often not backed by scientific evidence. Generally, these products are advertised as free trials. Yet, they truly turn into a monthly commitment to buy a product that doesn’t live up to its promised benefits. Several consumers easily purchase these products only to be later disappointed and stuck in a purchasing obligation that can only be stopped through a difficult cancellation process.

    The Real Deal

    How do you decipher the anti-aging facts from fiction? Find a physician or healthcare practitioner who is well trained and open to the idea of hormone replacement. Also, one who treats patients based on a multitude of medical evidence and has not been deterred by the WHI. It’s not about the “Fountain of Youth”. It’s about living healthier and happier during a potentially difficult age. This is accomplished by thorough clinical analysis including food testing, replenishing lost hormones, fitness scheduling, coaching, etc. Some call it alternative healthcare, while others call it ‘upstream medicine.’

    References

    1. Boomers will be spending millions to counter aging. (2011, August 17). Retrieved on August 18, 2011 from http://www.todaysthv.com/news/article/169384/126/Boomers-will-be-spending-billions-to-counter-aging
    2. Weintraub A. Beware free trials of anti-aging products sold on the web. (2010, October 1). Retrieved on August 18, 2011 from http://health.usnews.com/health-news/family-health/womens-health/articles/2010/10/01/beware-free-trials-of-anti-aging-products-sold-on-the-web


  • July 26, 2011 10:28 AM | Christiaan Killian (Administrator)

    Wow, this looks like a long post! Well, quite frankly it is. But hang in there, because we are willing to bet that you will get some practical takeaways. Whether you are just starting a practice or simply seeking to increase your patient base, at some point you will have to implement a marketing plan-of-action, so your prospective patients can connect to the health services you offer. At the same time, you are a medical professional with places to go and patients to see. Therefore, we will explain some of the best medical practice marketing tips, while still focusing on what you do best.

    What if I don’t need to advertise?

    You may be thinking, “I already have patients lined up at the door,” or better yet, “All of my patients come from word of mouth.” Even if the appointment books are full, you still need to maintain a presence with your target audience. Why, you ask? Let’s put it this way- THINGS CAN CHANGE. Whether it is health reform, an economic downturn, increased competition, or someone invents the “fountain of youth”, there are many regulatory or societal changes that can pose a threat to your practice’s financial health. Because of this, you need to stay ahead of the game by making yourself known in the community. This way you never get lost in the crowd.

    1. Set Budgets and Goals

    Before you launch your efforts towards the marketing tactics available for your practice, start with the big picture. It is crucial to set budgets based on the goals you have set for your practice. How many new patients would you like to gain per month? Per quarter? Also, how much are you willing to invest to acquire new patients? Once the big picture is fully understood, you have a foundation to make sound investment choices. If you don’t have the capital to “flood the channels” all at once, then it is best to allocate a percentage of monthly revenue towards marketing expenses. Perhaps start with 5%.

    Additionally, set budgets and goals that are within reason. To do this, answer the following questions to the best of your knowledge:

    a) What are the strengths and weaknesses of my practice?

    b) What is the market size in my area? (population, income, age, etc.)

    c) How many competitors do I have? How easy are they to find online?

    d) What makes our practice different? What are the key features and benefits that we offer?

    2. Get Listed

    Take advantage of free advertising that takes only a few minutes to setup. Online search engines, such as Google and Bing, have local listings that are often found at the top of organic search results. Envision this as what used to be a phone book listing, only free and more accessible. All you have to do is fill out basic information such as a business name, location, specialty, etc. With this listing, you can even take a video tour of your practice, and people can write reviews about you on the listing. Furthermore, it is likely that your listing will show up when patients in your area type specific keywords, i.e. “OBGYN in La Jolla, CA.” Check out Google Places or Bing Business Portal to get started.

    3. A Website is a Must

    Research indicates that websites are responsible for over 54% of purchasing decisions1. Also, there is no doubt that our society receives information online at an increasing rate, as people are less likely to pick up a newspaper or even dial a phone number. Start your marketing expenditures by building a website that clearly communicates your services, is emotionally captivating, and genuinely expresses your benefit-driven knowledge. In other words, make sure your website depicts you as the thought leader in your local market, so that your patients are more likely to make an appointment or sign up for your e-newsletter.

    4. Email Marketing

    There are two ways email marketing can be used to drive business. First, purchase a third party email list based on the demographic you are seeking to reach. Typically, these lists are provided on a “cost per use” basis. Therefore, your email message must have a strong call-to-action that stimulates a website visit or office call to redeem a special offer. Generally speaking, it is not recommended to take a “shotgun” approach by merely sending one message, but it can be done successfully if the call-to-action is strong ( i.e. contest to win a free ipad, first visit is free, etc.)

    The second way to utilize email marketing is by sending regular messages or newsletters to your database of accumulated email addresses. These emails can be sent on a weekly, semi-weekly, or in some cases a daily basis. The key in this situation is to send information that has relevant interest and/or value to your patients. Overtime, you will establish enough touch points with these prospective patients for them to make an appointment with you when the time is right. There are many cost effective tools that provide user-friendly email services such as Constant Contact or Vertical Response.

    5. Pay-Per-Click Advertising

    PPC is an internet advertising model used to direct traffic to websites. Advertisers pay the hosting service when the ad is clicked on. This involves choosing a variety of keywords that your target audience is likely to enter, when using an online search engine such as Google, Bing or Yahoo. For example, ‘weight loss wellness center’ or ‘bioidentical hormone doctor in texas’ are keywords that patients may enter to find your practice. With PPC advertising, you can bid on these keywords. When your ad appears and is clicked on by an internet user, you pay a fee for that click and the user is directed to your website or landing page. This process can be setup using Google Adwords or Microsoft Ad Center.

    PPC advertising is one of the most effective ways to start generating traffic quickly. Also, it is great place to start learning the keywords your patients are using from which to optimize your website

    6. Optimize Your Website for Natural Results

    In contrast to Pay-Per-Click advertising, Search Engine Optimization (SEO) is the process of strengthening the content on your website, so that it is more likely to be found in the organic search results when your patients enter key search terms. Once an effective SEO strategy is established and maintained, not only do the ‘clicks’ become free, but patients are more likely to trust an organic search result than a paid advertisement. In fact, research shows that if your website appears in a combined organic and paid search result (from PPC advertising), internet users are more likely to click on your website listing than if you were only listed as one or the other. There are a variety of ways to boost your website’s search rankings, but the best place to start is by enriching your website content with the top performing keywords identified by your PPC campaign. Work with a web developer to maximize SEO and you will reap the benefits of lower advertising costs over the long haul. Speaking of lower costs, one of the best sources of ‘free’ involves using social media to your advantage.

    7. Social Media to Gain Reach and Popularity

    You probably have a profile or even a number of profiles on social me
    dia and networking sites. Facebook, Twitter, LinkedIn, Google+, YouTube and many other social sites are great ways to increase your fan base and widen the reach of your messages and promotions. Additionally, social media is interrelated with Search Engine Optimization, meaning the more active you are on social sites, the more likely you will be found from a patient’s keyword search.

    With the ability to gain followers and fans, your messages have the opportunity to spread like wildfire throughout the online community. For instance, say you have 100 followers on Twitter and they are all in your metropolitan area. You write a tweet that says, “The first 20 people who reserve a free medical evaluation will be entered to win a free night’s stay at the ABC Resort and Spa.” Now, say that 25 of your followers see this tweet and are so excited about it, that they re-tweet the same message to their own list of followers. Their followers tweet the message again, and the process repeats. Voilà! Your offer has just been passed exponentially over the online social space. Also, social media is a great way to link patients to your, “How to beat the winter sniffles” blog post. Or better yet, try posting on Facebook, “check out my three minute video on how to naturally improve sexual vitality.” Do you think your followers will respond?

    8. Send a Hard Copy

    Although Direct Mail Marketing has decreased with the prevalence of the internet, it can still be an incredibly useful form of advertising, especially if it provokes your patients to go online. As mentioned in the email section of this blog, you can purchase a mailing list based on demographics. Keep in mind that your mailers are best sent repeatedly to the same audience over time to gain brand awareness and eventual action from your patients. You can increase the results of your mailers by using emotional imagery, captivating language, and (as always) a compelling call-to-action that sparks your patient to contact you. One of the newest tricks of the commercial printing trade includes personalizing your mailers by implementing each recipient’s name into the headline of the mailer (not just the label). This can increase response rates anywhere from 1 – 3%.

    9. Content is King

    [Gasp] Okay, are you still with us? Good. Because we cannot help but be direct when we say THIS IS THE MOST IMPORTANT MARKETING POINT TO TAKE AWAY from this list. Content is king.. think about it. Why do you watch action movies? Why do you buy books from your favorite author? Why did you purchase every Beatles album known to mankind (even on vinyl)? And why do you order the same Mocha Latte on your way to work every day? Because you enjoy the contents of what you are buying or subscribing to.

    Relevant content is what inspires and motivates us to learn more (and buy more) about our specific interests. In the prevention and wellness industry, there are an ever increasing number of patients seeking a healthy, proactive lifestyle. They want to look better, feel better, and be inspired by the content, services and products you offer. As a marketer, this is your primary responsibility. Be the “thought leader” in your field and in your demographic. Share free information about health and wellness that your prospective patients will crave, and in-turn they will follow you, talk about you, ‘tweet’ you, and choose you to be their health coach. Thirty minutes to an hour a day would be a sufficient amount of time to write a blog, make a quick YouTube video, or even write a “health tip of the day”. Your expertise and knowledge will take any marketing objective and turn it into real connections and more patients.

    How Do I Manage All of Those Marketing Ideas?

    That’s easy- have someone else do it. You are a healthcare provider, an expert, a thought leader. Spend your professional time on spreading your knowledge for the health benefits of others- whether that is through a life changing medical treatment or an insightful podcast¬. Let someone else manage your relevant and valuable information, and find the best ways to deliver that content to your prospective patients. Hire an intern, a nephew, a marketing consultant or even an advertising agency. Within your business model, find the most cost-effective way to get a return on your marketing investment by working with a knowledgeable marketer who will assist you in choosing the most appropriate methods of marketing communication. Once this is established, all you have to do is focus on what you do best; treat patients and stay up-to-date on the latest information within your specialty. Sounds like a relationship for success, doesn’t it? Stick to tips #1 and #9 and your practice will thank you.

    References

    1. Hopkins J. (2010 January) Research shows websites influence 97% of clients’ purchasing decision. Retrieved on July 26, 2011 from http://blog.hubspot.com/blog/tabid/6307/bid/5501/Research-Shows-Websites-Influence-97-of-Clients-Purchasing-Decisions.aspx


  • July 21, 2011 10:30 AM | Christiaan Killian (Administrator)

    DHEA

    Clinical studies have demonstrated that DHEA has a beneficial effect on immune response, sex drive, metabolism and emotional stability. DHEA benefits the immune system and reduces visceral fat associated with diabetes mellitus. Other health-related benefits include support of cognitive function, helping the body cope with stress, and protection against heart disease through its effects on lipids and body fat.

    Melatonin

    Melatonin regulates the circadian rhythm as well as the deep stages of sleep. Studies suggest that the immune system depends on melatonin's effects of deep sleep. In the January 1997 issue of the New England Journal of Medicine, melatonin was demonstrated to be a powerful antioxidant hormone that can protect against cancer. There are hundreds of studies showing that melatonin can scavenge free radicals, and be a safe sleep-enhancing hormone.

    Pregnenolone

    Failure of memory and lack of mental clarity can be among the most frustrating aspects of aging. Studies indicate that pregnenolone might be beneficial against age-related cognitive decline.

    Thyroid

    This metabolic hormone secreted by the thyroid gland regulates temperature, metabolism and cerebral function. Insufficient thyroid levels result in fatigue, increased cholesterol levels and increased risk of coronary artery disease. With age, thyroid hormone levels gradually decline resulting in a decreased metabolism, which affects all cells and organs. Low thyroid causes low energy, and thinning of hair, skin and nails. The dictum that normal levels are not optimal levels is extremely important when it comes to thyroid.

    Testosterone

    Although testosterone is the primary male hormone, women also benefit from its supplementation. Levels of testosterone decline with age in men and women. At optimal levels, research shows testosterone increases bone density and bone formation, enhances energy and sex drive, decreases body fat, increases muscle strength, lowers blood pressure and modulates cholesterol levels. Testosterone is a hormone that neither man nor women should be without and we'll present the scientific evidence to support this.

    Estrogen

    Over 50 years of studies demonstrate that loss of estrogen increases cardiovascular disease, Alzheimer's Disease, osteoporotic fractures, urogenital atrophy, macular degeneration and depression. Recent studies sort out the confusion created by the WHI (Women's Health Initiative) and conclude that certain types of hormones cause harm in some women, whereas different hormones avoid the harm and provide a significant protection. A thorough literature review helps sort out the differences and provides credence and confidence for the use of bioidentical estrogens as based on our medical evidence.

    Progesterone

    Data demonstrates that synthetic progestins increase the risk of breast cancer, heart disease, strokes, bleeding, and depression. Studies demonstrate that not only does micronized progesterone not increase these risks, but it also protects against them. Studies demonstrate a synergistic effect of progesterone with estrogen, whereas progestins negate estrogen's positive benefits. This literature review will demonstrate the difference between progesterone and progestins and how this difference is the key to understanding the importance of progesterone.


  • July 07, 2011 10:31 AM | Christiaan Killian (Administrator)

    The Role of Testosterone on E2 Levels

    Testosterone replacement therapy has a significant role in protecting aging men’s health, including greater protection against heart disease, diabetes, and obesity.123 However, it naturally increases estrogen levels in men, which has brought the benefits of testosterone therapy into question.

    You may have heard the warning that high estrogen levels cause prostate cancer in men, but research supporting this claim is unclear. Some studies indicate that high estrogen levels can increase the development of prostate cancer cells, while other research finds high estrogen levels are not found in men with prostate cancer. High estrogen levels may be considered a health risk, but low estrogen levels can also be detrimental to men’s health. The body needs estrogen to avoid cardiovascular disease, type 2 diabetes, osteoporosis, and metabolic syndrome.45

    Let’s take a look at the two different arguments to understand the effects of raising estrogen levels via testosterone therapy.

    Argument A: Raising Estrogen Levels is Harmful

    As men age, circulating levels of estradiol increase and free testosterone levels decrease in the body. This sharp increase in estrogen has been related to prostate cancer. Prostate cancer has been suggested to originate from the presence of androgens, because testosterone is converted into estrogen by the enzyme aromatase.6 This depletes free testosterone levels and increases estrogen levels. However, the active form of testosterone, 5alpha-dihydrotestosterone, is not aromatized into estrogen and does not increase prostate cancer risks.7 Estrogen treatment has been shown to damage prostate DNA in animal studies and it is suggested that androgens act as a strong tumor promoter when estrogen, or specifically estradiol-17beta, is present.7 However, a closer look at these claims shows testosterone actually plays a significant role in sustaining prostate health and that androgens do not cause prostate cancer.

    Argument B: High Estrogen Levels in Men are Actually Protective

    While it has been argued testosterone therapy increases the risk of prostate cancer by raising estrogen levels, research has also shown the opposite is true. Low levels of testosterone increases prostate cancer risks. A literature review found that there is a limited capacity for androgens to stimulate the growth of prostate cancer cells.8 Another review of research did not find a significant association between testosterone or estrogen levels and prostate cancer.9 Only men that currently have prostate cancer should avoid testosterone therapy, as this is the time when androgens may further proliferate cancer cells.

    Several studies indicate that low estrogen levels in men can be detrimental and raising estrogen levels has protective benefits, such as strong bones, sustained cognitive function, and cardiovascular health. In fact, increasing estrogen levels is not harmful when optimal testosterone levels are present. The ratio of estrogen to testosterone is what matters most, as low testosterone and high estrogen blocks testosterone receptor sites.10 Testosterone therapy is a beneficial way to restore healthy testosterone levels and balance the testosterone/estrogen ratio. Testosterone therapy was given to 207 men between the ages of 40 to 83, finding the therapy had a significant decrease on prostate volume, prostate-specific antigens (PSA) levels, and lower urinary tract symptoms.11

    Conclusion: Optimal Hormone Balance

    So, what is the final verdict? Estrogen is not harmful to men. This can best be explained by Dr. Neal Rouzier, who in his most recent webinar stated,“Many conclude that estrogen may be responsible for the high prevalence of prostate cancer in men. That has been extrapolated to [imply that] estrogen causes cancer in men and now everyone thinks that it’s bad and everyone is on this kick to lower estrogen in men to protect against that. What does the literature say?...All of the studies to-date, 50 years of studies, where testosterone has been utilized to increase estrogen levels, show it aromatizes to estradiol and all of these levels [testosterone, estradiol and estrogen] are increased. There is no study to support any increased risk of cancer of the prostate when estrogen levels are raised.”

    It is only when estrogen levels are too high and testosterone levels are too low that negative effects can occur in men’s health [Estrogen Dominance in Men]. Testosterone levels should be restored to their optimal range to avoid the detrimental effects of this imbalance. “Again, 50 years of studies demonstrate that testosterone administration, which raises serum estrogen levels, does not cause prostate cancer.”10

    References

    1. Wang C, Cunningham G, Dobs A, et al. Long-term testosterone gel (AndroGel) treatment maintains beneficial effects on sexual function and mood, lean and fat mass, and bone mineral density in hypogonadal men. J Clin Endocrinol Metab. 2004 May;89(5):2085-2098
    2. Darby E, Anawalt BD. Male hypogonadism: an update on diagnosis and treatment. Treat Endocrinol. 2005;4(5):293-309.
    3. Watt PJ, Hughes RB, et al. A holistic programmatic approach to natural hormone replacement. Fam Community Health . 2003; 25(1):53-63.
    4. Miner MM, Seftel AD. Testosterone and ageing: what have we learned since the Institute of Medicine report and what lies ahead? Int J Clin Pract. 2007 Apr;61(4):622632.
    5. Amin S, Zhang Y, Felson DT, Sawin CT, et al. Estradiol, testosterone, and the risk for hip fractures in elderly men from the Framingham Study. Am J Med. 2006 May;119(5):426-433.
    6. Shibata Y, Ito K, Suzuki K, Nakano K, et al. Changes in the endocrine environment of the human prostate transition zone with aging: simultaneous quantitative analysis of prostatic sex steroids and comparison with human prostatic histological composition. Prostate. 2000 Jan;42(1):45-55.
    7. Bosland MC. Sex steroids and prostate carcinogenesis: integrated, multifactorial working hypothesis. Ann NY Acad Sci. 2006 Nov;1089:168-176.
    8. Morgentaler A, Traish AM. Shifting the paradigm of testosterone and prostate cancer: the saturation model and the limits of androgen-dependent growth. Eur Urol. 2009 Feb;55(2):310-320.
    9. Roddam AW, Allen NE, Appleby P, Key TJ, et al. Insulin-like growth factors, their binding proteins, and prostate cancer risk: analysis of individual patient data from 12 prospective studies. Ann Intern Med. 2008 Oct;149(7):461-471.
    10. Rouzier N. (2007). How to achieve healthy aging. Salt Lake City, UT: WorldLink Medical Publishing.
    11. Pechersky AV, Mazurov VI, Semiglazov VF, Karpischenko AI, et al. Androgen administration in middle-aged and ageing men: effects of oral testosterone undecanoate on dihydrotestosterone, oestradiol and prostate volume. Int J Androl. 2002 Apr;25(2):119-125.
  • June 24, 2011 11:02 AM | Christiaan Killian (Administrator)

    While experts agree estrogen has far reaching benefits in menopausal women, researchers tend to disagree on how estrogen therapy should be administered.

    Is Transdermal “Less Risky?”

    The current trend is to prescribe transdermal estrogen cream. Why do some physicians choose transdermal instead of oral estrogen therapy? Many are worried about the health risks associated with oral estrogen. These concerns were initiated by the Women’s Health Initiative that found oral estrogen increases the risk of myocardial infarction, stroke and blood clots in menopausal women. Therefore, transdermal estrogen is commonly prescribed in lower doses to avoid the damaging atherosclerotic effects of oral conjugated equine estrogen (CEE). Furthermore, it is applied topically and absorbed through the skin. This route of administration bypasses the liver and directly enters the bloodstream to prevent circulatory risks.

    What about the benefits of Oral Estrogen?

    Transdermal estrogen may seem like a better choice for estrogen therapy, but oral estrogen offers more cardiovascular benefits. In fact, many studies claim transdermal estrogen does not provide any cardiovascular protection. It is estimated that 50-75% of estrogen’s benefits are on LDL and HDL cholesterol, fibrinogen, and fatty acid esters, because oral estrogen passes through the liver to improve cholesterol health. Since transdermal estrogen bypasses the liver to directly enter the bloodstream, it cannot provide advantageous lipid effects. To prevent a large majority of women from succumbing to coronary artery and cardiovascular disease, it is sensible to prescribe an oral estrogen therapy for maximum cardiovascular protection.

    There is a safer and effective form of oral estrogen.

    Hormone educator, Dr. Neal Rouzier states that “the medical literature does not support the use of creams and patches over oral bioidentical estrogen. Oral estrogen is far better at protecting women against cardiovascular problems as many studies show a significantly reduced incidence of both heart attacks and strokes with the use of oral as compared to the use of transdermal estrogen creams or patches. Transdermal estrogen has only a minimal effect on improving blood lipids (good and bad cholesterol and blood fats) — whereas oral estrogen has a much stronger value in doing this. Many medical studies have demonstrated that oral estrogen's effect on total cholesterol, LDL and HDL-cholesterol provide greater overall protection, whereas transdermal provides much less protection and therefore they provide less cardiovascular protection in the long run. The patch and transdermal creams are not entirely without value. There are a few women with certain types health histories, where oral estrogen is contraindicated and transdermal estrogen replacement may be appropriately recommended. However, this is not the case for the great majority of women. Oral estrogen have many more health protective benefits than does transdermal estrogen and therefore the preferred form of estrogen.” (Dr. Rouzier's webinar thoroughly discusses Estrogen in Women)

    When it comes to oral estrogen, medical studies have found that oral e2 estradiol is the safest and most effective form, because it avoids inherent side effects related to oral CEE. The Women’s Estrogen for Stroke Trial (WEST) found oral estradiol was not associated with increased blood clots, but an increase in blood vessel inflammation and clotting was due to ten biologically active estrogens that are in CEE (Premarin). These active estrogens are not found in estradiol.

    Conclusion

    Prescribing the right form of estrogen should be considered on an individual basis. Older women (age>60) that have never taken oral estrogen are advised to take transdermal estrogen to avoid the risk of myocardial infarction or stroke. Additionally, transdermal estrogen is the best choice for women that have a history of clotting disorders. For women that do not have these established factors, oral estradiol is the best choice for protecting the heart from cardiovascular disease and hypertension risks that increase dramatically in menopausal women.

    References

    1. Billeci AM, Paciaroni M, Caso V, Agnelli G. Hormone replacement therapy and stroke. Curr Vasc Pharmacol. 2008;6(2):112-123.
    2. Chu MC, Cosper P, Nakhuda GS, Lobo RA. A comparison of oral and transdermal short-term estrogen therapy in postmenopausal women with metabolic syndrome. Fertil Steril. 2006;86:1669-1675.
    3. Hendrix SL, Wassertheil-Smoller S, Johnson KC, et al. Effects of conjugated equine estrogen on stroke in the Women’s Health Initiative. Circulation. 2006;113:2425– 2434.
    4. Ho JY, Chen MJ, Sheu WH, Yi YC, Tsai AC, Guu HF, Ho ES. Differential effects of oral conjugated equine estrogen and transdermal estrogen on atherosclerotic vascular disease risk markers and endothelial function in healthy postmenopausal women. Hum Reprod. 2006;21(10):2715-2720.
    5. Mendelsohn ME, Karas RH. Protective effects of estrogen on the cardiovascular system. N Engl J Med. 1999;340:1801–1811.
    6. Menon DV, Vongpatanasin W. Effects of transdermal estrogen replacement therapy on cardiovascular risk factors. Treat Endocrinol. 2006;5(1):37-51.
    7. Nelson HD, Humphrey LL, Hygren P, Teutsch SM, Allan JD. Postmenopausal hormone replacement therapy. Scientific review. JAMA 2002;288:872–881.
    8. North American Menopause Society. Amended report from the NAMS Advisory Panel on postmenopausal hormone therapy. Menopause. 2003;10:6-12.
    9. Scarabin PY, et al. Differential association of oral and transdermal oestrogen-replacement therapy with venous thromboembolism risk. Lancet. 2003;362(9382):428–432.
    10. Smith NL, Heckbert SR, Lemaitre RN, Reiner AP, et al. Esterified estrogens and conjugated equine estrogens and the risk of venous thrombosis. JAMA. 2004 Oct;292(13):1581-1587.
    11. Vehkavaara S, Silveira A, Hakala-Ala-Pietila T, Virkamaki A, et al. Effects of oral and transdermal estrogen replacement therapy on markers of coagulation, fibrinolysis, inflammation and serum lipids and lipoproteins in postmenopausal women. Thromb Haemost. 2001;85(4):619-625.
    12. Verhoeven MO, Hemelaar M, Van Der Mooren MJ, Kenemans P, Teerlink T. Oral, more than transdermal, oestrogen therapy lowers asymmetric dimethylarginine in healthy postmenopausal women: a randomized, placebo-controlled study. J Intern Med. 2006;259:199-208.
    13. Viscoli CM, Brass LM, Kernan WN, Sarrel PM, et al. A clinical trial of estrogen replacement therapy after ischemic stroke. N Engl J Med. 2001;345:1243-1249.
    14. Vongpatanasin W, et al. Differential Effects of Oral Versus Transdermal Estrogen Replacement Therapy on C-Reactive Protein in Postmenopausal Women . J of Amer Coll Cardio. 2003;41(8):1358–1363.


  • May 31, 2011 11:03 AM | Christiaan Killian (Administrator)

    Since the 2002 report known as The Women’s Health Initiative (WHI) Trial, Prempro sales have fallen to $161 million annually and more than 10,000 lawsuits have been filed against Pfizer by women, who declared the company’s HRT drug lead to their development of breast cancer and other health ailments. Pfizer Inc. recently set aside $772 million to settle these cases.

    Hormone replacement therapy (HRT)

    Hormone replacement therapy (HRT)- a $2.2 billion industry, has been promoted by the medical establishment as a means to reduce vasomotor symptoms and decrease postmenopausal health risks. During the 1990’s, Pfizer and Wyeth had a strong hold on the HRT industry by selling Premarin, Provera, and Prempro (a combination of the two) to more than six million women.

    Fears of Hormones and Cancer

    Fears of Hormones and Cancer- It wasn’t until 2002 that the WHI trial found these synthetic hormones increased breast cancer, heart disease, and stroke risks among menopausal women. Researchers admonished women to stop taking HRT, while critics asserted these results were inaccurate declaring HRT benefits outweighed the risks. With two opposing views, confusion escalated among physicians and patients.

    Re-analysis of the WHI data and findings from other studies demonstrated that the health risks did not apply to women under 60 years old. While breast cancer risks increased when estrogen and progesterone were combined, further analysis of the WHI trial found that the estrogen-only group didn’t have an increase in breast cancer risks. In fact, breast cancer risks decreased in this group.

    Clearing the Confusion

    Clearing the Confusion- A review of the WHI trial may clarify the risks of synthetic HRT, but it doesn’t mean these hormones are harmless. According the National Institutes of Health, long-term use is not recommended, but taking HRT at the lowest possible dose for the shortest amount of time can provide some benefit for menopausal women, including a reduction in osteoporosis risks.

    This statement, combined with media attention and the WHI study itself, have sparked extensive concern that hormones are harmful and should be taken for the shortest time necessary to control perimenopausal symptoms. Dr. Neal Rouzier has clarified this concern through intensive study, stating that, “I agree with this statement ONLY if the hormones are synthetic, like Premarin and Provera. The combination Premarin and Provera have demonstrated an increased risk of breast cancer, strokes and heart attacks. However, do not extrapolate the harm of synthetic hormones to bioidentical HRT. Natural progesterone has never been demonstrated, in any study, to increase these risks whereas Provera has definitely been shown to increase these risks. Natural progesterone has been shown to decrease the risk of breast cancer, whereas Provera increases breast cancer in every study to date. Natural estradiol has been proven to not have the clotting or inflammatory properties as does Premarin.”

    The Natural Answer

    The Natural Answer- Fortunately, there are sharply contrasting alternatives to synthetic HRT which actually have shown to help protect against cancer. Bioidentical HRT is a substantially effective treatment for menopausal symptoms that also protects women from the many other risks associated with low hormone levels. Over 50 years of studies indicate that restoring hormones to premenopausal levels protects women from health risks and encourages well-being. Bioidentical hormones are the safest and most effective way to ensure optimal hormone levels. Bioidentical hormones should not be confused with synthetic HRT, as they are far superior to their synthetic counterpart.

    References

    1. Campagnoli C, Clavel-Chapelon F, Kaaks R, Peris C, Berrino F. Progestins and progesterone in hormone replacement therapy and the risk of breast cancer. J Steroid Biochem Mol Biol. 2005; 96(2):95-108.
    2. Gambrell RD. The Women’s Health Initiative reports: Critical review of the findings. The Female Patient. 2004; 29:25-41.
    3. Holtorf K. The bioidentical hormone debate: are bioidentical hormones (estradiol, estriol, and progesterone) safer or more efficacious than commonly used synthetic versions in hormone replacement therapy? Postgrad Med. 2009 Jan;121(1):73-85.
    4. Howard L. Pfizer to settle remaining hormone therapy lawsuits for $300 million minimum. Retrieved on May 26, 2011 from http://www.theday.com/article/20110514/BIZ02/305149926/1018
    5. Million Women Study Collaborators. Breast cancer and hormone-replacement therapy in the Million Women Study, Lancet. 2003;362:419–427.
    6. 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.


  • May 11, 2011 11:04 AM | Christiaan Killian (Administrator)

     Dr. Rouzier recently provided some tips in response to an online publication writer who asked the question, "What are some tips on how to avoid sleep disruptions when season's change?" I thought it would be appropriate to post here and expand on natural sleep in general. Read the tips below and feel free to provide your own based on your knowledge and experience.

    1) Maintain a consistent sleep/wake cycle

    Wake up at the same time EVERY morning and NEVER sleep-in to make up loss of sleep. Although your sleep may be slightly thrown off by a 1 hour time change, this will only have a minimal effect if your body already has a strong backbone of healthy sleep hygiene. What this means is if you wake up at the same time every morning, despite if you got 8 hours of sleep or 5 hours of sleep, your body will eventually fall into a natural sleep/wake cycle based on that wake up time. This will eventually turn into a regular 8 hours of sleep, or whatever amount your body naturally requires. This behavior modification is the most important component of strengthening your “body armor” against seasonal time changes.

    2) Do not use sleep medication unless you have severe insomnia.

    There are a variety of sleep medications out there that will certainly get you to sleep, but will make your body more dependent on them than that of seasonal change. Taking such medications will only contradict your body’s natural sleep wake cycle mentioned in tip #1.

    3) Take a melatonin supplement to help you get into a regular sleep/wake cycle.

    Melatonin is a natural hormone that is already produced by our bodies, and we depend on this hormone in order to fall asleep and stay asleep. Studies have shown that taking melatonin for sleep not only helps you to fall asleep, but also puts you into a deeper level of sleep, which is crucial to feeling rested during the day. Also, melatonin is non-addictive and will certainly make seasonal change less disruptive. If your Health Care Provider is not familiar with melatonin, then search for one who is well versed in natural hormones. This will determine what your optimal dose should be and to make sure you are taking a high quality melatonin supplement, typically dispensed by a compounding pharmacy. Melatonin is also a bio identical, natural hormone that is not a drug or addicting, only a healthy supplement that possesses many other health benefits. Recent studies demonstrate its protection against many different cancers.

    4) Replacing estrogen and progesterone makes all the difference in the world as to how one sleeps and functions.

    If a woman is newly menopausal, then she may be suffering sleep deprivation as the result of loss of her hormones, which also results in significant health detriments, as well as feeling poorly. We never advocate hormone replacement with chemically altered synthetic hormones which studies have shown to be harmful to a woman's health. However studies demonstrate that loss of hormones is also very harmful to one's health and well-being. Replacement must be in the form of the identical hormones that the body makes normally, commonly termed bio identical or natural hormones.

    5) Limit caffeine during the day and alcoholic beverages at night.

    Drinking coffee or caffeinated sodas during the day, particularly after 12pm, is likely to make falling asleep more difficult. If you drink too much alcohol at night, this will do one (or all) of three things: 1. Make you fall asleep at a lower quality of sleep 2. Make you become dependent on alcohol for sleep, which will of course defeat the purpose of maintaining a healthy sleep/wake cycle 3. May have an adverse effect and keep you awake.


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