Part IV in the BHRT Workshop Series
MASTERING THE PRACTICE FOR HORMONE OPTIMIZATION
Mastering the Protocols for Optimization of Hormone Therapy
Upcoming Course Dates
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Details
Course Description
Prerequisites:
Recommended Prerequisites:
There are new articles, research, updates, literature critiques, and sarcasm (of course) presented in our hormone optimization therapy BHRT Workshop Series, Part IV. It is the last in the series and should be the final preparation for certification in the series
The workshop will involve several components, including reviewing the latest NAMS recommendations. The medical literature will be used to support decision making rather than sole reliance on the WHI trial. Some of the exciting topics to be discussed include:
- Treatments for common gynecological issues (severe PMS, migraines, endometriosis, and abnormal bleeding, such as heavy bleeding, irregular menses, etc.)
- TBIs and Hypopituitarism – diagnosis and treatment
- Advanced prostate cancer treatment protocols (i.e – BAT therapy, proton gun, external beam radiation, etc.)
- Alternative treatments for vaginal atrophy and orgasmic disorders in women (testosterone, oxytocin, etc.)
- Male orgasmic disorders and treatments (topical testosterone applied to the glans of the penis, oxytocin spray, etc.)
The workshop will also provide an in-depth review of the evolution of opinion on testosterone replacement therapy, from the belief that it causes prostate cancer to its role in possibly protecting against cancer and how it may even be used to treat active cancer in some men and women.
Access: This workshop is offered in-person and/or virtually. You can choose if you would like to be shipped printed educational materials. We will also post a recording for each day that same evening. The recording will be available until Thursday of the week after the event to re-watch or catch up on anything you may have missed, but it will not be available after this time.
Accreditation: 20 AMA PRA Category 1 Credits | 20 Nursing Contact Hours (20 pharmacologic hours) | 20 Hours Pharmacy Credit (knowledge based)
Course Objectives
Upon completion of this workshop the health care professional will be able to:
- Review prognosis and complications for radical prostatectomy, proton gun radiation therapy, brachytherapy, cryotherapy, HIFU, laser ablation, as well as associated costs.
- Review management strategies and importance of testosterone utilization in prostate cancer survivors, as well as literature support. Learn the various mechanisms by which estrogen stops prostate cancer growth.
- Evaluate the association of testosterone and estradiol levels and the risk of developing prostate cancer. Should we raise, block, or administer estrogen based on the literature?
- Recognize that higher thyroid hormone levels are best, as recent studies determine that high TSH levels are associated with increased arterial stiffness and plaque thereby increasing CVD risk.
- Review the recent NAMS position statements that further distinguish the emerging differences in the therapeutic benefit-risk ratio between ERT & HRT at various ages and time intervals from onset of menopause.
- Recognize that some studies show high testosterone levels in women are associated with an increased risk of breast cancer. Also, understand that other studies demonstrate testosterone administration is protective against breast cancer and is apoptotic to cancer cells. This demonstrates that association does not prove causation and one should not extrapolate them to be the same.
- Recognizing high estrogen in men is associated with increased cardiovascular risk. However, estrogen administration in men protects against heart disease and prostate cancer. This demonstrates another example where association does not imply causation.
- Evaluate and discuss Dr. Neal Rouzier’s 50 most difficult management cases involving HRT, in addition to evaluating abnormal lab tests and various symptoms in complex and confusing cases.
- Identify current approaches to managing vaginal bleeding, DUB, and endometrial hyperplasia, as well as reviewing the dosing and administration of Tranexamic Acid to stop your patients from bleeding.
- Identify how Traumatic Brain Injury (TBI) affects quality of life by causing pituitary dysfunction. Also, learn when/how to test for it and how to not miss it.
- Evaluate recent literature demonstrating the mechanism by which synthetic progestins increase breast cancer development through the production of the RANKL protein.
- Utilize dual intravaginal therapy to maximize the effect on atrophic vaginitis, chronic UTI, incontinence, and sexual dysfunction, as well as how to treat the vagina with pills, patches, ring and things.
- Evaluate when to use estrogen in premenopausal women and when not to use it: anovulation vs. amenorrhea.
- Identify different types of estrogen and progesterone and when to prescribe each.
- Review various scenarios that dictate when to switch to alternate forms of HRT based on patient history, BMI, risks, and compliance.
- Discuss hair loss in women and current approaches to reverse hair loss.
- Describe various alternatives for testosterone administration in women.
- Discuss the current approach to preventing CVD in women with Syndrome W (X).
- Discuss HRT review, myths, updates, and alternatives when the standard routine is ineffective. Review management strategies for estrogen intolerance and progesterone intolerance.
- Identify current recommendations from NAMS for HRT and ERT and how they differ from past recommendations.
- Review the history as to why the medical community believes testosterone causes prostate cancer.
- Review further data demonstrating that E2 is the best estrogen but not the safest.
- Discuss the most recent FDA BBW for testosterone as it pertains to MI, CVA, and DVT, as well as a literature review of Spironolactone and its BBW.
- Engage in discussions among workshop participants on how these topics are used by physicians and nurses working in a clinic or independently. In addition, include pharmacists and their experience working with providers for hormone therapy to ensure synergy in prescribing, monitoring, and adjusting treatment protocols.
Speakers
Neal Rouzier, MD
Faculty Chairman
Neal Rouzier, MD
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.
Agenda
Friday
7:00 – 8:00 am
7:30 a.m. – Live Stream access opens
Registration
8:00 a.m.-12:00 p.m.
5-10 minute break at the top of every hour
Section A
- Appreciate a literature review of which type of estrogen to use in which circumstances and why. Oral vs transdermal, risks vs. benefits, and recent NIH studies.
- Evaluate the most important literature summary chapter on estrogen and progesterone that you will ever read proving the harm of estrogen deprivation and the benefit of replacement = a must for everyone’s library.
- Review all the long-term studies demonstrating the effect of estrogen on morbidity and mortality and the pathophysiology behind it all.
- Determine how to assess studies of association that do not prove causation in contrast to RCT’s that prove causation through interventional study.
- Do not extrapolate to prove a theory as one must intervene to prove causality.
Section B
Estrogen in men: Good, bad, or indifferent?
- Review the studies demonstrating estrogen is associated with an increased risk of heart disease and cancer in women as well as heart disease in men = an association.
- Review the extensive literature on the beneficial effect of estrogen in men in the treatment and prevention of prostate cancer and heart disease = proves benefit= causation.
- Understand the various methods for raising estrogen in men and consequences of each.
- Evaluating the literature and understanding the difference between cause and effect and how it pertains to hormones.
- Discuss how association does not prove causation and to prove this requires the need for RCT’s to differentiate.
- Practice HRT according to the EBM and not confabulation = don’t lower estrogen.
- Learn how to increase visceral fat, decrease libido, increase lipids, and increase dementia through aromatase inhibitors as per NEJM.
12:00 – 1:00 p.m. Lunch
1:00 – 6:00 p.m.
Section C:
Review the historical perspective of testosterone causing prostate CA or how easily we can be lead astray.
- Understand how Huggins was correct in his assumption but also very wrong in his conclusion. Huggins led us astray with just one patient!
- What level of testosterone is conducive to the growth of prostate cancer?
- What level of testosterone is safest to maintain for prostate cancer protection?
- Is it possible or safe to utilize testosterone in prostate cancer survivors and at what point in time?
- Using testosterone in men with active cancer? What does the literature support and under what circumstances.
- Understand the complexity of the saturation model that is demonstrated in the world’s literature.
- Does testosterone cause prostate cancer or does it not? Well it depends. Yes it does but treatment does not, rather endogenous does but exogenous does not.
- Review of the meta-analysis and world’s expert opinions.
Section D
Estrogen – What happens when we block, lose it, replace it?
- NAMS Recommendations and Commentary on Risks, Benefits, Side Effects, Problems, Complications, Indications, and Contraindications of HRT.
- Pearls that you should know but don’t.
Saturday
7:30 a.m. – Live Stream access opens
8:00 a.m. – 12:00p.m.
Section E
Genito-urinary Syndrome of Menopause (GSM)
- Alternative treatments for vaginal atrophy.
- Treatment for orgasmic disorders.
Section F
The Harm of Estrogen Deprivation in Men
- Estrogen’s Effects on Lipids in Men.
- Physiologic Effect of Low Estrogen in Men.
- State of the Art Treatment for Prostate Cancer.
- More Studies on Harm of Blocking Estrogen in Men.
Section G:
Discuss new insights into thyroid hormone replacement.
- Discuss use of T3 alone and what it does to lab values.
- Review the studies demonstrating genetics (DIO2 gene) predict response to T3 that explains the wide range of responsiveness.
- Discuss the plethora of data from pharmaceutical studies that prove that T3 is worthless and not needed.
- Explain how to design a study to prove that T3 does not work.
- Discuss why athyreotic patients don’t do well on T4.
- Thyroid for ED?
- Review the recent Medco advisory to stop Armour thyroid.
12:00 – 1:00 p.m. Lunch
1:00 – 6:00 pm
Section H:
Vaginal Bleeding Work-up and Treatment
- The Most Common Problem, Issue, Complication, Headache, and PITA Side Effect in Treating Women with HRT
- Vaginal Bleeding, Work-up and Treatment
- Cases of Vaginal Bleed with Lab Review
- Don’t Fear It
- Don’t Forget the Informed Consent
Section I:
- Estrogen vs. Statins vs. ASA for CVD Protection
- Relative Risk of Breast Cancer for Estrogen, Progesterone and MPA
- Traumatic Brain Injury
Section J:
Real Concerns and False Alarms of HRT
Sunday
7:30 a.m. – Live Stream access opens
8:00 a.m. – 12:00 p.m.
Section K:
50 complex cases, treatment and management.
12 pm: Adjourn
***
Sections 1- 7 are provided for your review in the digital version of the educational material, answers are provided so please use this as a review tool to test your understanding of the information
ACCREDITATION STATEMENTS
In support of improving patient care, this activity has been planned and implemented by The Foundation for Care Management (FCM) and Worldlink Medical. FCM is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team
20 AMA PRA Category 1 for CME
20 Nursing Contact Hours
20 Contact hours Pharmacy Credit. Program # XXXX-XXXX-XXX-XXX-X
This activity was planned by and for the healthcare team, and learners will receive (20 hours) Interprofessional Continuing Education (IPCE) credit for learning and change.
Location & Travel Details
Travel Details
Airport
Salt Lake City International Airport (SLC)
Address
Grand America
555 South Main Street
Salt Lake City, UT 84111
Info
Refund / Cancellations / Bulk Discounts / Course Credit
Early bird discount ($100.00 savings) is available up until 3 weeks prior to the event. This discount does not need a code but is applied automatically.
Up to 3 weeks prior to the course start date the cancellation fee is $100.00. If a cancellation is requested less than 3 weeks in advance the cancellation fee is $350.00. If a cancellation is received one week prior there are no refunds allowed.
To cancel a registration, a credit can be held on file without penalty so long as the cancellation is received more than 2 weeks in advance of the start date. This credit will be applied automatically to your next registration before a credit card is charged.
If two or more prescribers register as a group under one registration ticket there will be a 10% discount applied to each registration after the first one.