Every year I struggle with the decision as to what topic would be the most appropriate for the next APIM Annual Summit. Three years ago, at Hormones & Beyond Symposium 2019, we reviewed diabetes, fasting, treatment options, and pathophysiology. Two years ago, we covered How Estrogenics are making you Fat, Sick, and Infertile. Last year, we reviewed cancer, hormones, cardiovascular disease, and prostate cancer. So, now what? Fortunately, the FDA has recently approved the first and only treatment for Alzheimer’s Disease. This was extremely political and controversial. Also recently, I attended a lecture by Dale Bredesen from U.C.L. A., a world’s expert on dementia and Alzheimer’s Disease. As a result of the foregoing, the topic for this year’s symposium was easy.
In the first course, Testosterone for Women (Part I), I reviewed the current controversy in prescribing testosterone to women. In a separate consensus paper that is different from the one discussed in the first course, the authors recommend testosterone replacement based on symptoms and signs and not on serum levels. In fact, in this second consensus paper from “experts that have experience in the field of testosterone administration,” the authors stressed the importance of replacing testosterone to improve symptoms and not by being guided by numbers or levels. These authors specifically emphasized that testosterone should be supplemented based on symptoms and not just on serum levels alone, as testosterone levels do not correlate with symptoms as per much of the medical literature. The authors also suggested that testosterone should be dosed and adjusted based on symptom improvement, and not by testosterone levels. The authors reiterated that no number (or testosterone level) denotes a deficiency as symptoms denote a deficiency. Furthermore, improvement in symptoms do not correlate with numbers either as all women will respond differently and not based on any number. So, in contrast to men where the guidelines state that we must follow levels and numbers, these guidelines for women recommend that we do not test baseline levels nor treatment levels, rather symptoms should guide treatment initiation.
A 45 year old female presents to you complaining of fatigue, loss of energy, weight gain, muscle pain, and weakness in exercising.
She read about the benefit of hormones in treating her condition, but her PMD is against the use of hormones. Although she is open to taking hormones, her PMD scared her into thinking that testosterone is somehow harmful. You assure her that testosterone is not harmful and that many of her symptoms will improve on testosterone supplementation.
The previous course on thyroid optimization was intended to contrast and explain how and why the endocrine societies and the ATA frighten us into not using thyroid hormone. I introduced the concepts that the endocrinologists use when treating hypothyroid patients as well as their reluctance to prescribe thyroid hormone to SC hypothyroid patients. Despite the plethora of data and studies proving that patients DON’T improve on T4-alone therapy, the ATA and AACE reject all the studies demonstrating that patients DO benefit when T3 is added to T4, but also when DTE is used preferentially in place of T4-alone or T4 and low dose T3. When used correctly, most recent literature overwhelming proves that patients prefer DTE over any other thyroid preparation.
We continue to prescribe medicines that make IR, DM, CVD, and cancer worse, but we ignore the harm due to the therapeutic illusion that the benefits outweigh the risks. Yet we continue to ignore the plethora of data and studies demonstrating how to avoid these risks and protect against DM, CVD, and cancer.
Recently, a new cholesterol lowering drug was approved in the U.K. The press-release heralded Inclisiran, simply another PCSK-9 inhibitor, to be a game changer as it will save thousands of lives by lowering cholesterol. No, there are no outcome studies yet, only studies that demonstrate it lowers serum cholesterol 50% more than statins alone. The authors assume and extrapolate that lowering LDL cholesterol with this drug will result in thousands of lives saved. That is termed therapeutic illusion.
Controlling HgBA1C with Medications Does not Make Diabetes Disappear – It Lowers the Surrogate Marker HgBA1C
Although the pathophysiology is simple, the treatment and reversal of CVD and cancer is what is so confusing, complex, misunderstood, and ignored.