BHRT Complexities

Polycystic Ovary Syndrome (PCOS): The Most Overlooked Endocrine Disorder - What is PCOS and why it matters. It is the most common endocrine disorder in women. Assume all women have it until proven otherwise. PCOS 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 PCOS 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 PCOS 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 PCOS and its systemic consequences. Faculty: Kristi Hales, RPh

Introduction to Endocrine Disrupting Chemicals (EDC) - 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)
• Overview of the endocrine system and it's functions
• Importance of hormonal balance for human health
• Where are they most commonly found

Fertility Issues in Men and Women - Fertility issues in both men and women are multifactorial and can result from hormonal, structural, genetic, environmental, or lifestyle-related causes. In women, common factors include ovulatory disorders (e.g., polycystic ovary syndrome, hypothalamic amenorrhea), diminished ovarian reserve and endometriosis. In men, infertility is frequently linked to impaired spermatogenesis, manifesting as low sperm count, hypogonadism and endocrine disorders. Both sexes may also be affected by systemic conditions such as obesity, insulin resistance, chronic inflammation, and lifestyle factors, which disrupt reproductive function. Comprehensive evaluation and management require a multidisciplinary approach addressing underlying medical, endocrine, and lifestyle contributors.

• Why does this matter:
  • Avoiding artificial hormones
  • Natural approach to family planning
  • Addressing root causes i.e. PCOS
• Optimizing Reproduction:
  • Medications
  • Progesterone
  • Thyroid
  • Human chorionic gonadotropin (HCG)
  • Clomiphene
  • Letrozole
  • Gonadorelin
  • Enclomiphene

Connie Casad, MD

Sexual Dysfunction in Men and Women - Sexual dysfunction in both men and women encompasses a range of disorders affecting desire, arousal, orgasm, and pain, often with multifactorial etiologies including physiological, psychological, hormonal, and vascular components. In men, common presentations include erectile dysfunction, premature ejaculation, and hypogonadism-related libido loss, frequently associated with comorbidities such as diabetes, cardiovascular disease, and androgen deficiency. In women, dysfunction may manifest as hypoactive sexual desire disorder, arousal difficulties, or orgasmic disorder often influenced by hormonal changes (e.g., menopause). Integrating medical management, hormonal optimization, and additional treatments.

• Sexual disorders:
  • Anorgasmia
  • Hypoactive desire
  • Erectile dysfunction
  • Premature ejaculation
  • Low libido
• Importance of vaginal health
• Evaluation and Treatment:
  • PT 141
  • Oxytocin
  • Apomorphine
  • Flibanserin
  • PDE-5 inhibitors
  • Aromatase inhibitors
  • Sleep apnea
  • BHRT

Clifford Gluck, MD

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”

Carrie Blades, 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 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

Carrie Blades, MD

Hormones and Prostate Cancer - Testosterone and estradiol play complex, context-dependent roles in prostate cancer pathophysiology. Traditionally, prostate cancer has been viewed as androgen-dependent, with testosterone fueling tumor growth via activation of androgen receptors (AR); this underpins the rationale for androgen deprivation therapy (ADT) as a mainstay of treatment. However, emerging evidence suggests that both low and high levels of testosterone may influence prostate cancer risk in non-linear ways, with some data supporting the “saturation model,” which posits that beyond a certain threshold, additional testosterone does not further stimulate prostate tissue. Estradiol, derived from aromatization of testosterone, may exert both proliferative and protective effects in the prostate through estrogen receptor subtypes (ERα and ERβ), with ERβ activation thought to have anti-proliferative and pro-apoptotic effects..

• Literature review of testosterone and estradiol and prostate cancer
• Role of testosterone in prostate cancer
• The harm of blocking estrogen
• Benefits of E2 in men
• E2 vasculoprotective effects in men
• The higher the estradiol, the lower the risk of cancer
• Treating prostate cancer with E2?
• E2 possesses both anti-angiogenic and pro-apoptotic properties
• Safety and efficacy of testosterone in prostate cancer survivors
• Can testosterone be protective in prostate cancer?
• ADT increases mortality in men with prostate cancer

Clifford Gluck, MD

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

Carrie Blades, MD

Hairloss - Hair loss, or alopecia, in clinical practice requires a nuanced, multifactorial evaluation encompassing hormonal, nutritional, autoimmune, and genetic factors. In men, androgenetic alopecia is most common, driven by dihydrotestosterone (DHT) acting on genetically predisposed follicles, or is it? In women, patterns are more diffuse and may involve androgen excess, thyroid dysfunction, polycystic ovary syndrome (PCOS), or telogen effluvium due to systemic stressors or nutrient deficiencies (e.g., iron, vitamin D, zinc). Alopecia areata, an autoimmune variant, presents with patchy loss and may co-occur with other autoimmune diseases.

• Research on hair loss for men and women
• Genetics
• Hormonal changes
• Stress and emotional factors
• Autoimmune conditions
• Age
• Environmental
• Underlying health issues and lifestyle factors
• Medications and treatment