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BHRT Series – Part III

October 25-27, 2019

Fort Worth, Texas

Course Description:

The educational process for Part III is both didactic and interactive with maximum audience participation. All of the most complex, interesting, and confusing cases experienced by Dr.Rouzier over the last ten years are presented. The participants decide on the corrective management with literature reviews to guide therapy. Be forewarned, as in the past, many concepts taught in other academies are contrary to the medical literature presented in this course. The attendee will decide therapy based on evidence based guidelines rather than public opinion. Although there are no medical boards for this type of practice, Part III is similar to a medical board that digs deeper into the complexities of age management medicine. Clinical cases will be analyzed to formulate appropriate treatments and management to improve the understanding and level of care provided to patients. In Parts I & II the cases and studies are simple and straightforward.

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COURSE DESCRIPTION:

Part III: Mastering the Protocols for Optimization of Hormone Replacement Therapy - Complex Cases - May 2019

Workshop Schedule

Friday, 8:00 a.m. - 6:00 p.m.
Saturday, 8:00 a.m. - 6:00 p.m.
Sunday, 8:00 a.m. - 12:00 noon

Syllabus Information

All participants will receive an electronic and printed syllabus with their registration. The eSyllabus will be available for download at least one week prior to the course. An email notification will be sent when it is available for download and will include links and instructions. This early release provides an opportunity to download and review the materials prior to the course.

PLEASE NOTE: We request you download the material prior to the event as internet access in the meeting room may be limited. We will also have flash drives available for those that find this easier than downloading. The syllabus can be saved in Adobe Reader which allows participants to add "sticky notes" directly on the slide as the speaker is talking. THese notes can be saved permanently to your document. Other recommended applications include iBooks (for apple mobile devices) and iAnnotate (for mobile devices). Lastly, put perhaps most important for many of us, a printed syllabus is available with an option for good old fashioned note taking.

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COURSE OBJECTIVES:

Upon completion of this workshop the health care professional will be able to:

1. Develop proficiency in newer age management protocols not presented in Parts I or II: more recent pertinent literature update and reviews, lab updates, and complex and interesting cases.

2. Discuss the most current literature for bio-identical hormone replacement therapy (BHRT), thyroid, testosterone, DHEA, estrogen and progesterone.

3. Determine the risks and benefits of transdermal estrogen vs. oral estrogen, why one vs. the other one, and review the statistics that claim HRT increases blood clots, or does it?

4. Examine current policy statements for hormone replacement therapy by the North American Menopause Society (NAMS) and American College of Obstetricians and Gynecologists (ACOG), with a critique and review of their recommendations.

5. Describe rational approaches for the use of progesterone in treating PMS and PPD.

6. Discuss new therapies for prostate cancer as well as better diagnostic sensitivity and specificity of MRI-S scan.

7. Determine current management strategies for preventing loss of pregnancy in Polycystic Ovary Syndrome (PCOS) as well as improving pregnancy rates with aromatase inhibitors.

8. Describe the clinical evaluation including laboratory analysis and treatment of Vitamin D deficiency and how much is too much.

9. Examine literature reviews as to what level of Vitamin D helps protect against cancer, CAD, osteoporosis, dementia, type II DM and AMD.
10. Discuss the pathophysiology of vaginal atrophy and the use of rings, tabs, troches, creams, and DHEA.

11. Discuss the importance of sex hormone binding globulin (SHBG) in men and women and why it is predictive of CAD, MS and cancer.

12. Describe the data demonstrating that androgen suppression therapy, as well as estrogen deprivation, is associated with poor survival in men in comparison with placebo.

13. Outline advanced treatment protocols for over 100 clinical cases based on clinical presentation, laboratory analysis, treatment, and complications in the Q & A sections.

14. Discuss the inverse relationship of estrogen and prostate cancer.

15. Develop an understanding and treatment rationale for prostate cancer survivors through case presentations and literature review.
16. Appreciate the lack of efficacy of estriol in spite of purported benefits.

17. Describe the difference in clotting between Premarin®, Provera®, esterified estradiol, and micronized progesterone as per JAMA.

18. Recognize the data demonstrating that only certain types of estrogen increase the production of fatty acid esters that result in protection against atherosclerosis and plaque deposition at the blood vessel wall.

19. Demonstrate an understanding of the importance of maintaining low levels of aldosterone in patients with PCOS.

20. Demonstrate an understanding of the importance of body weight in determining which type of HRT to prescribe.

21. Critique the data demonstrating that testosterone can both increase and decrease CVD in women and learn to decipher the correct approach.

22. Identify the two mechanisms by which estrogen treats and protects against prostate cancer.

23. Present over 200 complex case studies to compare, contrast and analyze treatment protocols.

24. Demonstrate skills in case studies with interactive discussion to ensure interpretation and treatment protocols are as demonstrated in our evidenced based scientific literature.

25. Examine the medical literature to understand how hormones affect cardiovascular disease for both men and women.

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Agenda - Friday Saturday Sunday

Friday, October 25th, 2019

7:30 AM - 8:00 AM	Registration
8:00 AM - 9:00 AM	Section A • Vitamin D: Recent relevant literature review of a most important hormone. Everything that you could possibly want to know about vitamin D. • Vitamin D3: Diagnosing, prescribing, monitoring, adjusting, and optimizing. • How much is too much or not enough? Experts disagree on what is optimal. • How much is toxic per the literature, and what are the symptoms of toxicity? • Dosing based on serum levels, NTX, and DEXA results. • Lab review of baseline levels and treatment endpoints. Speaker: Dr. Neal Rouzier
9:00 AM - 10:00 AM	Section B • Diagnosis of PCOS vs. adrenal hyperplasia (21-hydroxylase deficiency) and use of 17α-hydroxyprogesterone to make the diagnosis. • What the books don’t tell you about complex cases of PCOS. • PCOS- adverse outcomes and prevention of CAD and cancer. • Weight loss in PCOS through administration of metformin and thyroid per the literature. • NAFLD, endothelial dysfunction, aldosterone, & aromatase inhibitors in treating PCOS. • Focus on the vagina and the various methods to treat and protect against urogenital atrophy. • Systemic vs. non-systemic absorption of vaginal estrogen. • Perimenopause = No Man’s Land! Treatment options. • Doctor, I’m bleeding!!! What to do? Simply follow the protocol. • A lab review with treatment guidelines for perimenopause. • Functional hypothyroidism and receptor site resistance. • Thyroid does not cause osteoporosis • Thyroid in the treatment of heart disease and dyslipidemia. Speaker: Dr. Neal Rouzier
10:00 AM - 10:15 AM	BREAK
10:15 AM - 12:15 PM	Section 1 50 Case Studies with Question and Answer Speaker: Dr. Neal Rouzier
12:15 PM - 1:15 PM	LUNCH
1:15 PM - 2:15 PM	Section C • The unifying hypothesis of estrogen’s effects on atherosclerosis progression, complications, and plaque vulnerability. • MMP, clotting factors, inflammatory proteins, and estradiol fatty acid esters in CAD. • Loss of estrogen associated with increased mortality and dementia. • The difference in early, mid, and late estrogen replacement. • The pharmaceutical-company push to block estrogen and the resultant harm of estrogen deprivation- “A Time For Reflection of Aromatase Inhibitors” from Menopause. • Going against the ACOG guidelines in order to save lives-the literature proves them wrong. All hormones are not the same, so don’t ignore this information. • The documented benefits of estrogen and the morbidity of loss of estrogen that is ignored. • A literature review to make sense of the misunderstanding for HRT. Mastering the literature will make you the expert amongst your peers that don’t understand HRT. Speaker: Dr. Neal Rouzier
2:15 PM - 4:00 PM	Section 2 50 Case Studies with Question and Answer Speaker: Dr. Neal Rouzier
4:00 PM - 4:15 PM	BREAK
4:15 PM - 5:00 PM	Section D • A historical perspective to determine why everyone preaches only transdermal estrogen. • A literature review proving transdermal estrogen is the safest estrogen. • A literature review proving oral estrogen is the best for saving lives. • Natural progesterone confers no risk of breast cancer or VTE. • What about JAMA, EPAT, CORA, WEST, KEEPS, & DANISH trials of oral E2? Why the NIH uses oral E2 and not transdermal. • Understanding relative risks as your guide for HRT replacement. • The anti-proliferative, oncostatic, immune stimulatory, and thrombopoetic effects of HRT. • What you should know about the literature before you speak out! Speaker: Dr. Neal Rouzier
5:00 PM - 6:45 PM	Section 3 50 Case Studies with Question and Answer Speaker: Dr. Neal Rouzier

Saturday, October 26th, 2019 - back to agenda

7:30 AM - 8:00 AM	Registration
8:00 AM - 9:00 AM	Section E • Importance of optimizing androgens in women for health and well-being. • Measurement of FAI and implications. • Does testosterone causes diabetes and breast cancer in women as per the literature? • SHBG drives the benefit of HRT and is the most important biological marker to predict CAD, MS, and cancer. • A literature review showing it’s not the testosterone but rather insulin resistance that is the culprit. • Association does not prove causation. • SHBG: The most important biological marker to predict DM, CAD, and breast cancer in both men and women. • It’s not testosterone’s fault but rather the SHBG, or lack thereof that is to blame. • How and why to safely and successfully raise SHBG? Speaker: Dr. Neal Rouzier
9:00 AM - 11:00 AM	Section 4 50 Case Studies with Question and Answer Speaker: Dr. Neal Rouzier
11:00 AM - 11:15 AM	BREAK
11:15 AM - 12:15 PM	Section F • Testosterone, SHBG, and diabetes in men. • Testosterone protects against IR→DM→CAD→MS→Cancer • Low SHBG predicts all-cause mortality, CAD, osteoporosis, and cancer in men. • Prostate cancer prevention by SHBG and testosterone? • The harm of ADT and how to reverse the complications of ADT. • Testosterone deprivation without estrogen deprivation. • Lab review of testosterone. • Sex hormones in men. A literature review demonstrating optimal levels of estrogen and testosterone are necessary for men’s health. • The harm of blocking estrogen with aromatase inhibitors. • The benefit of prescribing estrogen in men. Speaker: Dr. Neal Rouzier
12:00 PM - 1:00 PM	LUNCH
1:00 PM - 3:00 PM	Section 5 50 Case Studies with Question and Answer Speaker: Dr. Neal Rouzier
3:00 PM - 3:15 PM	BREAK
3:15 PM - 4:15 PM	Section G • Safety and efficacy of testosterone in prostate cancer survivors. • Incidence of prostate cancer and whether we should be treating men with testosterone. • Why testosterone has become incorrectly and inappropriately associated with prostate cancer. • All studies refute the prevailing wisdom that testosterone causes prostate cancer. • The lower the testosterone, the greater the risk of cancer = a paradigm shift. • Does or will testosterone protect against prostate cancer? • Dispelling the myths that testosterone and DHT cause prostate cancer. Proving Huggins wrong. • Peer literature review providing assurance and safety for prescribing testosterone in prostate cancer survivors. • Surgery vs. radiation vs. HIFU vs. cryotherapy vs. laser ablation for prostate cancer. Speaker: Dr. Neal Rouzier
4:15 PM - 6:15 PM	Section 6 50 Case Studies with Q and A Speaker: Dr. Neal Rouzier

Sunday, October 27th, 2019 - back to agenda

7:30 AM - 8:00 AM	Registration
8:00 AM - 9:00 AM	Section H • Proof, or lack thereof, that estrogen causes prostate cancer, or at least it does in rats. • Epidemiologic review of sex hormones and cancer. • The higher the estradiol, the lower the risk of cancer. • Collaborative analysis of 18 prospective studies of hormones and cancer. • ADT increases mortality in men with prostate cancer. • How to prevent the increased morbidity & mortality, CAD, and side effects of ADT. • Estrogen’s vasculoprotective effects in men. • It’s low estrogen that causes osteoporosis, not low testosterone. • Treatment and prevention of prostate cancer with estrogen. • Treatment of prevention of cardiovascular disease with estrogen. • Reversal of ADT side effects with estrogen. • Estrogen possesses both anti-angiogenic and pro-apoptotic effects not seen with LHRH- agonists. • The harm of estrogen blockers in men = same harmful effects as estrogen deprivation in women but these are in men. Speaker: Dr. Neal Rouzier
9:00 AM - 10:00 AM	Section 7 Speaker: Neal Rouzier
10:00 AM - 10:15 AM	BREAK
10:15 AM - 11:00 AM	Sections I and J • Postmenopausal HRT in clinical perspective with other standard treatments- a complex literature review of risk vs. benefit in comparison with other standard, commonly used medications. • The harm of statins and ASA versus the benefit of HRT: What are we thinking? • Use the scientific literature to guide our therapy. • Oral P4 reduces serum levels of estradiol whereas transmucosal does not. • Oral P4 reduces weight, transmucosal does not. • Functional hypothyroidism and receptor site resistance vs. resistance from mainstream medicine. • Thyroid update, thyroid resistance, osteoporosis and cardiovascular disease. • Progesterone in treatment of PMS, perimenopause, and post-partum depression. • Treating and monitoring of endometrial proliferation. • 5α-reductase inhibitors, depression, and sexual dysfunction. • Progesterone’s role in inflammation, cytokines, and promoting prostate cancer development = the opposite of what you have been misled to believe. Speaker: Dr. Neal Rouzier
11:15 AM - 12:15 PM	Sections 8,9,10 and Section K: HRT pearls, tricks, important points to know about HT Complex Cases with Q and A Section K: Complex Lab Review. Strange and unusual cases and labs that make no sense Speaker: Dr. Neal Rouzier
12:00 PM - 12:00 PM	ADJOURN

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SPEAKERS:

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Dr. Neal Rouzier

Dr. Neal Rouzier is a pioneer in the bio identical hormone replacement field, practicing almost since its inception in the early 1990’s. He has dedicated his life’s work to uncovering the medical literature that supports safe and effective protocols for unique and personalized patient care. He is the Director of the Preventive Medicine Clinics of the Desert, specializing in the medical management of aging and preventive care for men and women. He has treated more than 2,000 patients with natural hormone replacement therapy and is recognized as a renowned leader and expert in the field. Additionally, Dr. Rouzier is the author of Natural Hormone Replacement for Men and Women: How to Achieve Healthy Aging. He has over 16 years of experience as an educator and practicing physician, and 29 years of Emergency Medicine experience at Queen of the Valley Hospital in West Covina, CA.

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REGISTRATION:

	EARLY BIRD PRICE VALID NOW THRU: SEPT 20, 2019	REGULAR PRICE EFFECTIVE: SEPT 20, 2019
Medical Providers and Pharmacists	$1,195.00	$1,295.00

Support Staff and Returning Attendees	$675.00	$675.00
(MA, RN, Office Manager)

*Cancellation Policy

Cancellation and/or course change requests received more than 3 weeks in advance of the event will receive a full credit (less a $50.00 change fee) which will be applied to your account as a credit for use towards a future event/service. Any cancellations and/or changes received less than 3 weeks before the event, will incur a $350.00 processing fee and the remaining balance will be credited to your account.

Cancellations received less than 3 days prior to the start of the event are non-refundable. No shows are also non-refundable.

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ACCREDITATION:

AMA PRA Category 1 Statement

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the Foundation for Care Management (FCM) and Worldlink Medical. The Foundation for Care Management is accredited by the ACCME to provide continuing medical education for physicians.

FCM designates this educational activity for a maximum of 20 AMA PRA Category 1 CreditsTM.

Physicians should only claim credit commensurate with the extent of their participation in this activity.

The ACCME defines a “Commercial Interest” as any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.

Nursing Statement

The Foundation for Care Management is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

Pharmacy Statement

The Foundation for Care Management is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. Program 0347-9999-19-003-L01-P Objectives appropriate for pharmacists. This activity is 20 Contact Hours Pharmacy Credit. *This CME is Knowledge Based (K). Initial release May 4, 2018

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