Navigating Hormone Complexities

Polyendocrine Metabolic Ovarian Syndrome (PMOS): The Most Overlooked Endocrine Disorder - What is PMOS and why it matters. It is the most common endocrine disorder in women. Assume all women have it until proven otherwise. PMOS extends far beyond reproductive implications—it is associated with metabolic disturbances, including insulin resistance, dyslipidemia, and increased risks for coronary artery disease, diabetes, and certain cancers of the breast, uterus, and ovaries. Distinguishing PMOS from adrenal hyperplasia is essential for accurate diagnosis and management. Emerging evidence highlights the roles of sex hormone-binding globulin (SHBG), GLP-1 agonists, and the interplay between PMOS and nonalcoholic fatty liver disease (NAFLD). While conventional treatments such as metformin, thyroid optimization, progesterone, and spironolactone offer partial benefit, questions remain regarding their long-term efficacy and impact on weight management. This presentation will explore current literature, therapeutic strategies, and clinical insights through a focused case review to deepen understanding of PMOS and its systemic consequences.

Kristi Hales, RPh

Introduction to Cancer and Hormones - This section looks to reframe cancer not simply as a genetic disease of random mutations, but as a complex, metabolic disorder driven by disruptions in the cellular environment and regulatory systems. The emphasis is that cancer is a disease of dysregulated growth, rooted in dysfunctional cellular communication and influenced heavily by chronic insulin elevation, inflammation, and hormonal imbalances—particularly hyperinsulinemia and insulin resistance. Rather than focusing solely on DNA mutations, Dr. Jason Fung in his book The Cancer Code, proposes that cancer results from a breakdown in the body's natural checks on growth and repair, largely triggered by lifestyle factors such as poor diet, obesity, and chronic stress. He also critiques the limitations of the traditional mutation-centric model and advocates for a paradigm that integrates evolutionary biology and metabolic regulation to better understand—and prevent—cancer through systemic and lifestyle-based interventions.

• What is cancer and why has it alluded us
• Myths and controversies surrounding ‘hormones cause cancer

Gayle Frazzetta MD

• How hormones relate to or are affected by these cancers
• To recommend or not recommend
• What the emerging literature says

Gayle Frazzetta, MD

Vaginal Atrophy and Dysfunctional Bleeding - During menopause, women lose estrogen which causes a myriad of side effects other than hot flashes and nightsweats. During this change women experience genitourinary symptoms that can be embarrassing and debilitating such as vaginal dryness, loss of libido, stress or urgency incontinence, and recurrent urinary tract infections. These symptoms can be chronic and progressive and need intervention to improve. Even though it’s estimated that about half of women experience these symptoms, only a small percentage discuss these challenges with their providers. Abnormal and dysfunctional uterine bleeding can occur to a woman during any stage of life. It is important for any practitioner who treats women to be able to understand what these terms mean and how to treat these patients. This lecture will review the pathophysiology, clinical presentation, and evaluate literature for management strategies of vaginal atrophy, abnormal and dysfunctional uterine bleeding.

• Terms
  • Vaginal atrophy
  • Vulvar atrophy
  • Genitourinary Syndrome of Menopause (GSM)
  • Abnormal uterine bleeding
  • Dysfunctional uterine bleeding
  • Treatment
    • Non prescription probiotics for vaginal health
    • DHEA
    • Testosterone
    • Estradiol
    • Tranexamic Acid
    • Progesterone
    • IUDs
    • Oral contraceptives

    Connie Casad, MD

Hormones and Breast Cancer - The controversy surrounding breast cancer and hormones, particularly hormone replacement therapy (HRT), stems from conflicting data on whether exogenous hormones—especially synthetic estrogens and progestins—increase breast cancer risk. The Women's Health Initiative (WHI) study in the early 2000s linked certain forms of HRT to a modest rise in breast cancer incidence, prompting widespread fear and decline in hormone use. However, subsequent analyses have revealed that the risks vary significantly based on hormone type, route of administration, timing of initiation, and individual patient factors. Emerging evidence suggests that bioidentical hormones, particularly estradiol and micronized progesterone, may carry a more favorable safety profile. The ongoing debate highlights the need for further education on the latest evidence and underscores distinctions between synthetic and bioidentical hormone therapies in evaluating breast cancer risk.

• Historical look at the WHI and differentiating estradiol and progesterone vs CEE and progestins
• Current literature review on the use of estradiol and breast cancer
• The use of tamoxifen in the treatment of breast cancer
• BRCA genetic testing
• Current literature review on the use of progesterone in breast cancer

Gayle Frazzetta MD

What are EDC’s: How they Affect Hormones and What to do About Them - The endocrine system is an intricate network of glands and hormones that orchestrate numerous physiological processes, including metabolism, growth, reproduction, and homeostasis. Optimal health depends on the maintenance of hormonal balance within this system. Endocrine Disrupting Chemicals (EDCs) are exogenous substances that interfere with the synthesis, secretion, transport, binding, action, or elimination of natural hormones, thereby altering endocrine function and potentially leading to adverse health outcomes. These compounds are pervasive in modern environments, commonly found in plastics, personal care products, pesticides, and industrial pollutants. Understanding the mechanisms and health implications of EDC exposure is essential for clinicians and researchers committed to safeguarding endocrine health.

• Definition of Endocrine Disrupting Chemicals (EDC's)
• Organs that are affected by EDC
• Common sources of EDC exposure

Kristi Hales, RPh

Fertility Issues in Women - Female fertility is influenced by hormonal, ovarian, metabolic, structural, environmental, and lifestyle factors. This session will examine common contributors to impaired fertility, including ovulatory dysfunction, PMOS, hypothalamic amenorrhea, diminished ovarian reserve, endometriosis, thyroid dysfunction, insulin resistance, and exposure to endocrine-disrupting chemicals (EDCs). Participants will explore an evidence-based approach to evaluation and treatment, including strategies to address underlying contributors and support reproductive function. Clinical considerations for progesterone, thyroid optimization, hCG, clomiphene, letrozole, and other appropriate interventions will be discussed.

Connie Casad, MD

Fertility Issues in Men - Male fertility can be affected by hormonal, testicular, metabolic, environmental, and lifestyle factors that impair testosterone production and spermatogenesis. This session will examine common causes of male infertility, including hypogonadism, impaired sperm production, obesity, insulin resistance, medication effects, and exposure to endocrine-disrupting chemicals (EDCs). Participants will explore evidence-based approaches to evaluation and treatment, with particular attention to preserving or restoring fertility while addressing hormonal dysfunction. Clinical considerations for hCG, clomiphene, enclomiphene, gonadorelin, and other fertility-supportive interventions will be discussed.

Clifford Gluck, MD

Hair Loss - Hair loss, or alopecia, in clinical practice requires a nuanced, multifactorial evaluation that encompasses nutritional, autoimmune, and genetic factors. This discussion will cover common types of hair loss, including telogen effluvium resulting from systemic stressors and alopecia areata, an autoimmune condition characterized by patchy hair loss that may coexist with other autoimmune diseases and more. Current scientific evidence and clinical literature will also be reviewed, highlighting less commonly discussed treatment approaches alongside real-world case examples..

• Research on hair loss for men and women
• Stress and emotional factors
• Autoimmune conditions
• Age
• Environmental
• Medications and treatment

Carrie Blades, MD