BHRT Part 4: Mastering the Practice

Prerequisites:

• Part I: Discover the Power of BHRT
• Part II: Expand Treatment Options

Recommended Prerequisites: 

• Part III: Solve Troubling Symptoms

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)

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.