Guidelines for Hypothyroidism:
Optimizing thyroid for health and wellness, according to the literature

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.

Neal Rouzier, M.D.

Topics Discussed:

• So you think your thyroid is optimal? Understanding normal vs. optimal
• TSH vs. Free T4 vs. Free T3: Which hormone drives metabolism at the cell level?
• Do TSH levels correlate with symptoms? Which hormones do?
• Is a low Free T3 level maladaptive: point – counterpoint
• General guidelines for hypothyroidism and optimal thyroid function

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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.

Designing Powerful Patient Experiences:

6 steps to differentiate your practice from the competition, improve patient outcomes, and maximize profits.

Gregory Petersburg, DO

Why does a cup of coffee cost more at a trendy café like Starbucks than it does at the corner diner or when brewed at home? It’s the value that the experience holds for the individual that determines the worth of the offering and the work of the business. Marketers understand this principle and the market value of experiences to consumers. Automobile ads don’t sell cars; they sell the driving experience. Restaurants advertise the ‘fine dining experience.’ Travel agents no longer book vacations; they book ‘adventures’. And let’s not forget the granddaddy of experience sellers: Disneyland. The product they sell is ‘experiences’. You may not have given it much thought, but the same principle applies to your medical practice.

Just delivering great service to your patients is no longer a winning strategy. Aging baby boomers already expect great service. And if you’re still competing on the basis of price, then you are offering little or no true differentiation from the competition. What would your patients really value? Better yet, for what would they pay a premium? Experiences!

It’s not that we don’t give our patients experiences. In fact, the medical profession already has a long history of creating patient experiences. It’s just that these experiences are not particularly positive, more often than not. How many patients can honestly say they enjoy and look forward to going to the doctor? Not many. That’s because, in large part, the experiences patients have are mostly unintended, the result of not understanding the principles of experience design and execution. Yet, the kinds of experiences we could create for patients hold the potential to significantly improve clinical outcomes, patient compliance, patient satisfaction and loyalty, provider satisfaction, and, yes, even profit margins. Ideal patient experiences can give them hope and inspiration, and are powerful catalysts for them to take action. In essence, experiences are what change lives. With a little planning you can create meaningful and memorable experiences that improve the quality of your practice and your patient’s life.

The following steps will guide you through the processes of creating unique experiences in your practice:

1. Make the Experience Intentional

What is the ultimate take-away experience you want your patient to have? Inspiration? Motivation? Transformation? Begin with the end in mind and engineer backwards, tweaking all of your practice processes in ways that contribute to the experience. Choosing a theme for your work is a helpful starting point for creating powerful experiences. How likely would you be to finish reading a novel if it had no theme? You would probably close the book before finishing the first chapter. A theme is essential, as it conveys the central idea of a story (or your work) and is necessary in order to fully and effectively engage an audience (i.e., your patients). Themes can be based on almost anything: people, places, events, times, ideas, messages, etc. Once you have your theme, build a story around it.

2. Make the Experience Individual

Give each patient the feeling that every interaction with him or her, and everything you do for him or her, is just for him or her. (-Or – Give your patients the feeling that every interaction with them, and everything you do for them, is just for them). You can personalize everything, such as phone calls, appointments, and patient handouts.

‘Mass customization’ is one way: Make small but personalized modifications and additions to standardized services, materials, or products that otherwise are the same for all patients. ‘Organizational memory’ is a way to give the patient the feeling that everyone in your organization knows and remembers the patient in a personal way. Your medical records already include the patient’s date of birth, so that information can help everyone in your organization to remember and celebrate the patient’s birthday. Similarly, you could collect personalized information in a new patient intake form that could be used in a variety of ways: favorite foods and music, who they admire and why, what kinds of things inspire them, where they go to ‘recharge their batteries’, what they list as personal strengths/weaknesses/fears, etc.?

3. Make the Experience Interactive

Expand the patient experience to include the time and space before, during, and after the visit. Examples might include pre- and post-visit phone calls, newsletters, interactive web tools, and ‘homework’ assignments.

4. Interpret the Experience

All work is theatre. Yes, even health care! Your office is the stage, the rooms in your office are different sets, stethoscopes and blood pressure cuffs are props, your white lab coat is your costume, you and your staff (nurse, receptionist, etc.) are the actors playing different roles, the things you say to patients (greetings, patient interview, advice for each medical condition, etc.) are the scripts. The reason for an appointment might be a ‘subplot’ in the patient’s life journey. Thinking of your theme and storyline (see above), imagine ways that your work processes can be applied or modified to fully and effectively engage your patient (the audience) in the story. How will you choreograph your ‘performance’, the sets, props, costumes, actors’ roles, scripts, etc.?

5. Make the Experience Inspiring

Become a storytelling organization. Medical practitioners have become so fixated on data as the focus of communication with patients that we have forgotten the most time-proven method in all of human history for passing along understanding and wisdom, for inspiring and motivating – storytelling. Data and information need stories to give them context. Stories add flesh and bone to the data and information. But the way stories are told is often as important as the story itself. Tell stories that are authentic to you and tell them with passion. Don’t be afraid to share your own story. Tap into timeless methods employed by every culture, religion, and organization to inspire: rituals, traditions, and ceremonies. Add them or incorporate them into your work and use them often.

6. Institute the Experiences

Incorporate these design principles and the delivery of patient experiences into all of the organization’s operational systems. Make it a permanent and ongoing part of the overall organizational culture, and commit it to words in an organizational ‘manifesto’ (A manifesto is a published/public declaration of your principles, intentions, and objectives). Tie measures (e.g., patient experience surveys rather, than service satisfaction surveys) of the effectiveness of your designed experiences to financial rewards, or give them teeth that bite (e.g., financially), if we fail to fulfill.

More about Dr. Petersburg

5 Steps to “De-Fatigue” Your Patients:
Groundbreaking treatments for CFS and Fibromyalgia

Dr. Holtorf has published a number of peer-reviewed endocrine reviews, which include topics on the safety and efficacy of bioidentical hormones, inaccuracies of standard thyroid testing, testosterone replacement for men and women, the diagnosis and treatment of growth hormone deficiency and on the diagnosis and treatment of HPA axis dysfunction in chronic fatigue syndrome and fibromyalgia. He is also a reviewer for the journal Endocrine, Postgraduate Medicine and Pharmacy Practice.

Kent Holtorf, MD

Learning Objectives:

• Determine the role of thyroid and cortisol in CFS and FM.
• Identify the first step of healing by stabilizing the patient.
• Reveal the causes of mitchondrial dysfunction and offending agents.
• Discuss the importance of hormone balance for optimal quality of life.
• Identify and treat underlying chronic infections.
• Review maintenance techniques for ongoing symptom prevention.

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Kent Holtorf, M.D. is the medical director of the Holtorf Medical Group and the nation-wide Holtorf Medical Group Affiliate Centers, providing physicians a turn-key program for a successful cash-based anti-aging practice. Dr. Holtorf is also the medical director of the non-profit National Academy of Hypothyroidism; fellowship lecturer for ABAAM; The Endocrinology Expert for AOL Health and founding director of the non-profit Bioidentical Hormone Initiative.

Oxytocin Guidelines:
How Can Patients Benefit from the “Love Hormone”?

Objectives:

• Get an overview of oxytocin’s role in the human body.
• Discuss the effect of the “Love Hormone” on libido and vitality.
• Identify the relationship oxytocin has on the aging brain.
• Evaluate common symptoms that require treatment.
• Learn key takeaways to implement into practice.

Click Here to access this recorded webinar.

KEEPS Hormone Replacement Study:
A Response From Dr. Joseph Raffaele

Three years after the Women’s Health Initiative published that hormone replacement therapy (HRT) increased the incidence of certain health risks, clinical researchers at nine centers in the U.S. started the Kronos Early Estrogen Prevention Study (KEEPS). This study was anticipated to be a turning point to determine the benefits of HRT on cardiovascular health. Researchers posed the question, “Does HRT slow the progression of cardiovascular disease in post-menopausal women?” Results were finally released last week, in which the critical question was left unanswered and results seemed disappointing. Dr. Joseph Raffaele clearly explains the strengths, drawbacks, and overall conclusion of the KEEPS clinical investigation.

Read Dr. Raffaele’s full article on the KEEPS Study

About Dr. Raffaele

Joseph Raffaele, M.D., the co-founder of PhysioAge Medical Group, a clinical practice in New York City that is at the leading edge of the emerging field of medicine focused on scientifically sound approaches to staying younger longer. He has been a featured speaker at numerous events sponsored by WorldLink Medical.

Estrogen’s Impact on Cognitive Function

A Note from Neal: What To Expect at the Part II BHRT Course

WorldLink Medical Course Reviews and Testimonials

Check out the feedback we have been getting from our recent course attendees!

“Superior to other courses I have taken. Your course is a better value, no question. I will be back.”

Dan Weathers, MD
Anti-Aging/Metabolic Specialist

“This course is 100% packed with useful information for my practice. This rates as the best experience and education to practice BHRT.”

Stephen Goldstein, MD
Plastic Surgery

“Best conference I have attended in 40 years! The printed syllabus was GREAT!”

James Pollard, DO
Anesthesiology

“I feel that I got much more for my money and time. Thank You! Thank You!”

Brenda J. Weathers

“This is by far the highest quality course I have attended! This is what I thought medicine would be like when I went to medical school. After this course I am more excited about medicine than I have been in a long time.”

George Rice, MD
Family Medicine

“Price and location was easy to access and affordable. Content was superior.”

Rachel Cook, RN
Aesthetic Medicine

“Greatly enhanced understanding of using BHRT in my practice with medical studies to substantiate my use of hormones to my skeptical colleagues. This is the best age managment course I have attended. I appreciate the evidence-based approach. Looking forward to Part II.”

Elizabeth Bowler, MD
Psychiatry & Neurology

“Neal is very direct, factual, science based and knowledgeable. Easy for the non-physicians to understand too. Six of my staff members have attended. More will follow. Thanks for allowing us to best serve our community.”

Cheryl Briggs, RN

“I continue to understand hormones better with every course, even Part 1, despite 10 years of practicing HRT. He always improves my understanding and updates me.”

James Goodnight, MD
Plastic Surgery

“This was truly the most oustanding CME course I have attended.”

Roger Olsson, MD
Family Medicine

“This is a far greater value, in regards to learning received and price, than any other venue I have ever attended.”

Thomas Briggs, DO
Neurological Surgery

“I can go back with a complete sense of confidence that I am doing what is in the literature.”

David Turner, MD
Emergency Medicine

“It is probably the most gratifying thing I’ve done in my entire career.”

Randy Birken, MD
Obstetrics and Gynecology

“When I became a regular attender of WorldLink Medical Seminars, my growth in this field exponentially increased.”

Genester Wilson-King, MD
Obstetrics and Gynecology

“I couldn’t have done it without his course”

Harry Collins, MD
Family Medicine

“It has been a tremendous gift for my practice”

Theresa Ramsay, NMD
Naturopathic Medicine

“This is the most actionable CME program I have ever attended”

Louis B. Cady MD
Psychiatric Medicine

Hormone Levels in Women: An Overview including Estrogen and Progesterone

Objectives:

• Describe what happens when women lose hormones
• Describe what happens when women replace hormones
• Identify which hormones women should use and which ones they should not use
• Discuss what happens when you don’t replace hormones to optimal

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Presenter: Neal Rouzier, MD
Hormone Therapy Expert and Course Instructor
Worldlink Medical

This webinar will provide a general understanding for physicians, practitioners and patients regarding the use of hormone levels in women. A plethora of evidence demonstrates that loss of estrogen increases cardiovascular disease, Alzheimer’s Disease, osteoporotic fractures, urogenital atrophy, macular degeneration and depression. Furthermore, data demonstrates that synthetic progestins increase the risk of breast cancer, heart disease, strokes, bleeding, and depression. Recent studies sort out the confusion created by the WHI (Women’s Health Initiative) and conclude that certain types of hormones cause harm in some women, whereas different hormones avoid the harm and provide a significant protection. This webinar discussion will be based on the medical literature that Dr. Rouzier has uncovered throughout his experience as a provider of hormone replacement therapy and preventive medicine.

A Note from Neal: Part IV of Mastering the Protocols for Optimization of Hormone Replacement Therapy

For years Part III attendees have lamented, “So is that all there is? Can’t there be more? And can it be somewhere besides SLC?” OK, fine, so here’s Part IV. And we’ll go to another city. Although there are new articles, research, updates, literature critiques, and sarcasm (of course), the majority of this course will be problem solving, case management, mistakes to avoid, and tricks of the trade. The audience will consist of those with significant experience, questions, and issues which makes for an excellent experience for both me and participants, as we all learn from patients and ourselves. Extensive literature review in Parts I, II, & III have not allowed me to present all the interesting and complicated cases and situations that I have encountered in the last 15 years of practice. So bring your tough cases, comments, thoughts, and ideas and have another fun weekend with your talented peers. This will be a collection of the most talented and experienced physicians in this industry. Enjoy.

- Neal

Register I Objectives I Agenda

Dr. Rouzier Sets the Record Straight on Hormones and Cancer

Hormone expert Neal Rouzier, M.D. had a recent discussion with a Physician enquiring about certain hormones and their relationship to cancer. He thought it was worth sharing, and we agree.

Dear John Doe,

I do not know why your tumor marker is elevated but you have had it elevated for some time. We do not use tumor markers here [in the U.S.] to diagnosis cancer. We only use them to monitor the progression of cancer once it is treated with chemo. Tumor markers can be elevated in normal people that don’t have tumors or cancer, so it is not a good diagnostic modality. If you are concerned, then do an upper and lower endoscopy. In addition, a PET CT scan will pick up any cancer that you may have. I doubt that you have cancer and I truly believe that the elevated tumor marker is not diagnostic of cancer. We see them elevated all the time and never indicate a cancer. Again we use them to monitor a cancer once it is diagnosed, but never to diagnosis them. The only marker that we use is the PSA and that is not diagnostic for cancer but makes us go further to R/O any cancer.

The Effect of Testosterone on Cancer Risk

With all due respect, the Japanese doctor that suggests that HRT causes cancer is perhaps unaware of the medical literature. Testosterone does not cause cancer. It may cause it to grow once prostate cancer is established, but no study shows that testosterone causes the cancer. On the contrary, our studies show that higher levels of testosterone are associated with a decreased risk of prostate cancer and less severe types of cancer if one develops a cancer. In fact low levels of testosterone are associated with a greater risk of prostate cancer and a more severe and aggressive type of prostate cancer. We used to think, and many of us were taught, that testosterone causes cancer whereas the overwhelming evidence shows the opposite. Several recent studies showed that testosterone treatment decreased morbidity and mortality from all causes, including heart disease and all cancer. The theory is that testosterone decreases insulin resistance and diabetes which greatly enhances the formation of many cancers. There are several recent studies where researchers (Morganthaler) are treating men with active prostate cancer and are seeing no increase in growth of these cancers. A meta-analysis study reviewed the world’s literature and the conclusion from a multidisciplinary team of specialists concluded that there is no evidence from all the studies that testosterone administration causes cancer. Articles from all specialty journals from endocrinology, urology, cancer, and epidemiology, all published that testosterone does not cause cancer, and in most circumstances, protects against cancer.

The fact that a famous Japanese doctor claims that testosterone causes cancer is very incorrect and not supported by any clinical or scientific evidence. What is more disconcerting is that this physician is misinforming, and perhaps scaring, many Japanese doctors into not prescribing or recommending testosterone which is doing just the opposite of what he has intended. It may increase the morbidity and mortality of many doctors who now resist taking testosterone. I never suggest, teach, lecture, or make any claim unless what I state can be very well supported by scientific evidence. May I make the same suggestion to your fellow physician before he makes reference to hormones causing cancer.

Fear Stemmed from the WHI Trials

It is very true that a synthetic female hormone (medroxyprogesterone acetate or Provera in this country) was demonstrated to cause breast cancer in women. We should not extrapolate this to include all hormones. Most physicians in this country also think that hormones cause cancer, so your famous physician is not too far off base from them. The medical and lay media in this country have scared all women into thinking that hormones cause cancer and this is very unfortunate. It is very true that our synthetic hormones have increased the risk of breast cancer and this has been demonstrated in many studies. As a result of this, there is an inherent fear that hormones cause cancer and there is a human tendency to extrapolate this to include all hormones. The medical literature supports that this is entirely not true. There are two Japanese Physicians that have recently attended Part II of the hormone courses that we offer here in the U.S. They both have the syllabus and 2 hour lecture material that I presented that demonstrates that the hormones in our body do not cause cancer in spite of the inherent fear instilled in us by the media and extrapolation from the WHI trial. Please contact them so that they may present to you all of the literature so that you may come to understand that the hormones in our body do not cause cancer, when in fact they are protective against cancer.

A Brief Summary of the WHI Studies

Without going into detail, I will summarize these studies. A meta-analysis of estrogen demonstrated that estrogen (alone and not with MPA mentioned above) administration decreases morbidity and mortality from all cause, both coronary artery disease, cancer, and osteoporosis. The WHI trial demonstrated that estrogen alone (that was the CEE arm that did not include MPA with the estrogen) was not associated with breast cancer. A most recent analysis just published demonstrated a statistically significant decrease (yes decrease) incidence of breast cancer in those that took estrogen alone in comparison with placebo. In addition, let us not forget that the estrogen only arm demonstrated a significant 27% decrease in colon cancer also. The theory is again the decrease in visceral fat and protection against diabetes that may play a major role in cancer protective effects of estrogen, similar to that of testosterone mentioned above.

The Protective Effects of Estrogen

Except in certain circumstances, which is beyond the scope of this letter, estrogen protects against heart disease, strokes, Alzheimer’s, dementia, osteoporotic fractures, and cancer as proved in the meta-analysis along with a decrease in morbidity and mortality from all cause including cancers. Based on this, would you like your wife, mother, sister to be on estrogen or not? It is very unfortunate that your doctors and the world misinterpret the hormones and cancer issue.

The Difference: Bioidentical vs. Synthetic

There is a plethora of data and studies that demonstrate increased longevity and decreased morbidity and mortality when levels of our hormones are maintained at optimal. This benefit applies to estrogen, testosterone, progesterone, DHEA, and growth hormone. As our hormone levels fall with age, so does the protection against cancer. Replacement of hormones reverses this harm. Replacement with chemically altered hormones (medroxyprogesterone and norethindrone) has always increased the risk of cancers. As per the medical literature, we must not equate them to be the same nor should your doctor. I certainly hope that this lengthy explanation reverses your misunderstanding and that you can pass this along to your fellow physicians.

Respectfully yours,

Neal Rouzier, M.D.

Case Study: How A Conventionally Trained Psychiatrist Transformed His Practice by Integrating BHRT and Wellness.

Access the recorded webinar

Dr.Louis Cady, M.D. shared key takeaways drawn from his experience with integration of exciting new therapies into his practice. This webinar will provide an overview of what to expect during his lectures at the Part I course, which will include the following topics: Mental Health and Hormones, “Petal to the Metal” Allopathic Psychiatry for Generalists, How to Transition from an Allopathic Practice to a Hollistic and Integrated Medical Practice.

6 Benefits of Using Social Media for Your Practice

Medical Webinars:

Hormone Q&A

Neal Rouzier, M.D.

The Obesity Epidemic

Timothy McKnight, M.D.

Estrogen Optimization

Neal Rouzier, M.D.

Social media. What does it mean for you and your practice? When you think of social media, do you picture Twitter updates every 10 minutes or catchy blurbs posted on Facebook? In reality, social media is more than posting a personal update on every time you brush your teeth, but it is also a practical business tool for bringing attention and traffic to your medical practice.

By definition, social media is a method for sharing information with a widespread audience. It comes through several different communication channels, including radio, television, newspapers, blogs, Internet forums, and podcasts. Social media can often be confused with social networking, which describes a group of individuals that gather in an online community to discuss similar topics of interest. Networks include Facebook, LinkedIn, and MySpace. Social media and social networks are both commonly used in business to strengthen current relationships and attract new customers.

According to a survey by National Research Corporation, 20 percent of patients use social media for healthcare information. Facebook was the most commonly used social network for this purpose, in which patients follow links that are posted by medical professionals.

1. Spread the Word

Social media helps to raise awareness about your practice and provides opportunities to share information with your patients. It also allows you to build a stronger relationship with patients, as you share your health knowledge and respond to patient inquiries.

2. Connect with Other Professionals

You can share and obtain information from other professionals in your field to develop a larger network, as well as receive or give industry advice.

3. Establish Your Business Identity

With millions of people regularly logging on to social network sites, you can help ensure people are aware of your practice. Creating a business page through a social network is a way to provide information that can be passed on by your patients to their friends. This helps more people know that your practice exists; plus, they are more likely to contact you when they know their friends like your practice.

4. Increase Website Traffic

Using social media can help increase traffic to your medical practice website and create new customers.

5. Stay Connected to Patients

Social media helps physicians stay connected with their patients on a regular basis. You can follow the information and services they like by tracking the links they choose to click on.

6. Market Research

Opinions are openly expressed through social media sites. Patients can share their thoughts to help you improve patient satisfaction with the information, products, and services you provide.

SSRI’s Have Side Effects, but is Hormone Replacement the Answer?

April 4, 2012 WorldLink SSRI side effects Blog 0 comments

Medical Webinars:

Hormone Q&A

Neal Rouzier, M.D.

The Obesity Epidemic

Timothy McKnight, M.D.

Estrogen Optimization

Neal Rouzier, M.D.

Can hormone replacement therapy replace antidepressants? Antidepressant medication, also known as selective serotonin reuptake inhibitors (SSRIs), has been shown to have a number of side effects, including insomnia, nervousness, sleep problems, headaches, joint and muscle pain, stomach upset, sexual dysfunction, and bleeding problems. Even so, antidepressants are the third most widely prescribed group of medications in the United States. Many individuals may be taking antidepressants for minor complaints, without considering the potential risks. What some may not realize is that hormone replacement therapy may be considered a safer, effective alternative to SSRIs.

Hormone imbalances can lead to depression.

In men, low testosterone levels can cause mood and emotional issues. If male patients choose to take SSRIs to treat depression, they increase their risk of infertility and sperm quality damage. SSRIs have been shown to reduce sperm count in men by 50 percent, as well as damage the motility and shape of the sperm.^{1 2}

In contrast, hormone replacement therapy (HRT) restores the body’s natural production of hormones, including testosterone, to relieve depression and emotional issues that are related to hormone imbalances. Men that are concerned about the side effects associated with antidepressant medications may find HRT to be a safe and effective alternative.

Research has suggested that HRT and antidepressant therapy may have similar molecular targets.

When the results of the Women’s Health Initiative were published, many women immediately stopped HRT; a subsequent increase in the use of antidepressants is well documented. Women who were using HRT had climacteric symptoms reduced, including depression. ³ Estrogen therapy has been suggested to effectively treat perimenopause women with depressive disorders.^{4 5}

HRT goes beyond just relieving depression to provide overall health benefits on cognitive function, cardiovascular health, weight management, energy, sexual health, and quality of life that result in confidence and a better mood. Even so, does this make hormone replacement the answer for treating depression? If a patient’s depression is related to hormone imbalances, then HRT can dramatically improve mood without the side effect of common antidepressants and anti-anxiety medications. Yet, HRT may not be the answer for everyone.

Start by reviewing the Big Picture

Overall, it is best to determine the method of treatment on an individual basis. Start by reviewing the big picture, which includes nutrition, exercise, and lifestyle habits.

Dr. Louis Cady, known for studying the connection between psychiatry, hormones, and wellness, explains, “In many cases I found that I could not make them better working from the neck up, and that no matter how good my potions were they didn’t get better. And then I began looking a little bit further. I got more professional education and began to understand this mind-body divide in contemporary medicine. Where if a conventionally trained physician can’t diagnose somebody in terms of really what is going on, they will say, “Well, it is all in your head” and then I will get them. And I will find many times that it is not just in their head. It may be in their thyroid or it may be in other parts of their body. They may have a sleep disorder. And so I decided that instead of just limiting myself to pushing pills all day I was going to do what I was trained to do, which was to be a complete physician.”

Establish the basics.

The best solutions to consider for depression or any other health complaints are proper nutrition, exercise, behavior modification, and natural hormone balancing. All of these are crucial elements to increase well-being, vitality, and health. While SSRI’s still serve a necessary purpose for many people, instead of first looking at an antidote to fix the problem, it is best to look at what is needed to maximize the patient’s overall health and happiness.

References

1. Hendrick V, Gitlin M, Altshuler L, Korenman S. Antidepressant medications, mood and male fertility. Psychoneuroendocrin. 2000 Jan;25(1):37-51.
1. Tanrikut C, Feldman AS, Altemus M, Paduch DA, Schlegel PN. Adverse effect of paroxetine on sperm. Fertil Steril. 2010 Aug;94(3):1021-1026.
2. McIntyre RS, Konarski JZ, Grigoriadis S, Fan NC, et al. Hormone replacement therapy and antidepressant prescription patterns: a reciprocal relationship. CMAJ. 2005 Jan;172(1):57-59.
3. De Novaes Soares C, Almeida OP, Joffe H, et al. Efficacy of estradiol for the treatment of depressive disorders in perimenopausal women: a double blind, randomized, placebo-controlled trial. Arch Gen Psychiatry. 2001 Jun;58(6):529-534.
4. Schmidt PJ, Nierman L, Danaceau MA, et al. Estrogen replacement in perimenopausal-related depression: a preliminary report. Am J Obstet Gynecol. 2000;183:414-¬420.

Hormone Q&A: Round 2 of BHRT Guidelines and Takeaways

March 29, 2012 WorldLink HRT Guidelines Blog 0 comments

Due to an overwhelming number of responses from the 1st Q&A session, we decided to host another live web conference. But really, I think it has to do more with the fact that Dr. Rouzier has an addiction he cannot get away from- his willingness to go over the time limit to ensure all questions are answered. Get real HRT guidelines from this truly enlightening presentation.

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The following questions were answered during the web conference:

What is your usual starting dose of hormone replacement in perimenopause and menopause. If a woman has family history of breast cancer would you change your course of treatment?

What would be your typical dose of testosterone cream in perimenopause?

If a woman develops bleeding on treatment how would you adjust the dose?

Any specific time of the cycle you suggest to check serum hormone levels in perimenopausal lady, or random test?

A young woman with PCOS not obese, gained weight on Progesterone p.o and Metformin. Can progesterone cause that? Metformin should promote some weight loss so could it be Progesterone 100 mg qhs?

After attending Part 1, I have been doing full thyroid work ups and have found a lot of low, non-optimized free T3′s. Some of my patients are on levothroid/synthroid. What is the best course, increase the synthetic, add Armour and how much, or switch to Armour alone.

Please discuss your treatment protocol for providing estrogen and progesterone in a lady who is 5 years out breast cancer?

Can you discuss your treatment recommendations for patients who you believe would benefit from HgH but fearing prescribing this medication?

I can’t get around the problem of bleeding that happens in the early menopausal female who starts BHRT. Also the perimenopausal female who may not bleed for 6 weeks then gets heavy menses. I’ve tried pushing progesterone up to 400 mg daily but did not resolve.

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I have a pt on armour thyroid 60 mg daily. Her repeat thyroid labs show a suppressed TSH, with a low Free T3 (2.7) and Free T4 (<1). She did 4 point cortisol testing and this showed mild adrenal fatigue. Could this be the reason? How would you proceed?

Would you start HGH on a very physically active 53 yr old male with hypothyroidism, hypoandrogenism and pre metabolic syndrome, who has had DHEA, Testosterone, and Thyroid optimized, who been on a low glycemic high protein diet, but he remains frustrated with little improvement on abdominal and visceral adiposity. IGF -1 values baseline 129 and most recently 151.

I have many hypo gonadal male patients who experience dramatic improvement in mood, body composition and libido during the first four months of testosterone supplementation but these benefits seem to taper off after 9 to 12 months even though their hormone values have been optimized. Is this a reset of their expectations, receptor saturation or are they secretly not as rigorous in their diet and exercise routine.

Would supplementing a 45 yo man with transdermal testosterone in addition to HCG affect fertility?

A 48 year old male symptomatic of hypo gonadism with a free testosterone 74, still wanted to have children. I placed him on HCG 500 IU SQ QD with a repeat level in 8 weeks. My question is titrating the HCG up and how much. What are the risks of depressing spermatogenesis if I add Testosterone cream to the HCG?

With long standing insufficiency especially in elderly what is exp. with rate of replacement?

Why would the DHEA be high in someone on no hormonal supplements as yet? Does that effect my choice giving other hormones that may be DHEA precursors?

What is the best plan for a perimenopausal woman whose goal is to loose visceral fat?

How do you increase the increments of the hormonal dosing?

Nipple tenderness is a side effect of which hormone? How is it treated?

Bleeding is a side effect of estrogen only, correct?

If you place a woman on pregnenolone for memory improvement, would you see an increase in DHEA, progesterone, testosterone, or estrogen?

Which pharmacy do you recommend for the best price on Testosterone Cypionate 200mg/ml . Is it safe to use Testosterone that appears coagulated or crystalized upon delivery?

Are concerns or suggestions for women currently on Mirena IUD that are interested in starting BHRT. Please advise.

What labs, markers, and functional tests would you consider the nominal baseline for a new client? Vit. D? Full thyroid panel? VAP cholesterol? DXA, IMT, VO2 Max, EKG? Saliva cortisol?

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My internist would not renew my T therapy started elsewhere unless I underwent a Stress Echo [14.5 minutes out of 15] and an IMT [negligible plaque], probably because I had elevated cholesterol numbers and a family Hx of CAD. Cholesterol is not the defining factor I know, but would you want these baseline exams anyway in someone over 55?

What baseline labs do you draw to screen for thyroid?

How do you treat an elevate rT3?

What are your thoughts re bio identical HRT after breast cancer with positive estrogen receptors in DCIS? Are there clinical studies to support use of this type go HRT for this patient type?

What are the ideal levels of estradiol for men on HRT?

What are the most rationale strategies to combine HCG and Testosterone injections in patients?

Using Armour thyroid, I’m getting levels all over the map. I test at 11:30 am which is 6 hours after the dose. I’ve used bid dosing as well as larger am doses and I’m still getting a lot of variation. Words of wisdom?

I have a 52 yo male who’s testosterone level at 100mg bid, 150mg bid or 200mg bid is always below 500 (i.e., his latest level is 300 and that is on 200mg bid!?! Is he cheating, not taking it day of test, or is it possible that he just can’t absorb it?

Use of Progesterone in patient on Tamoxifen s/p breast cancer, mastectomy, receptors strongly positive for estrogen and progesterone: Is it indicated? If so, oral or cream? Is it contra-indicated? Her estrogen level is 500, Progesterone 0.5, DHEA Sulfate is 150, T3 is 2.4. Should I be thinking of DHEA or 7-Keto DHEA to optimize her levels?

Use of 17keto DHEA?

Transdermal vs oral estrogen therapy?

Should I treat patients under 40 for low testosterone?

Review the pro and cons of PO or cream bio identical hormones.

Thyroid: What is the best indicator TSH or Free T3?

Pro’s and con’s IM Testosterone vs. SQ and Test replacement with HCG combined.

Please comment on hormone replacement in type 1 diabetic, no other risk factors.

How do you treat Type 1 diabetes in 41 yo that is very symptomatic and blood sugars are getting worse and are all over the place? She is worried about stroke risk with estrogens.

My daughter has PCOS. She is not overweight. Her endocrinologist has her on BCPs. Can she take bioidentical progesterone along with her BCPs? She is 25 years old. She has not taken metformin.

My dad is 83 and early Alzheimer’s. My mom is 73 healthy but has a pancreatic duct stent for a stenosis likely resulting from an injury in childhood (Yes, thats what the GI guy says). How does one begin age management rx in an old feeble man and an older woman NOT on any HRT?

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Is there a way to improve the transdermal absorption of progesterone?

In men, do you prefer testosterone in lipoderm or carbogel and why? (HI NEAL)

If I want to add progesterone as a treatment for fibromyalgia patients, where would I begin?

If a 56 year old post-menopausal woman has been on premarin and provera for 10 years already…is it ok to have her stay on hormones (estradiol and prometrium) now?

I have a 50 yo woman with a carotid dissection history, otherwise healthy, going through menopause and her neurosurgeon warns her about HRT because it will increase her risk of strokes. Am I correct by advising her that transdermal estradiol and progesterone replacement are okay. What data do I have to support this?

I am constantly adjusting Armour for a female whose eyebrows are diminishing. She is up to 3 Gr. bid after 3 months, and the eyebrows are again starting to decrease. I will measure Iron and ferritin soon, but any other supplements that can help?

I am attending the A4M conference for another perspective, and the consensus of the speakers here is to not prescribe any oral post-menopausal estrogen due to the inflammatory component. Their preference is Bi-est. Your comments?

How do you assess for adrenal insufficiency/ adrenal fatigue?

What is your initial therapy (i.e. hormones and doses) for adrenal fatigue for women and for men?

What are the preferred options and doses for transdermal testosterone for initial replacement therapy?

Endometriosis- Patient is currently perimenopausal and symptoms are well controlled on BCP. Will changing from BCP to BHRT cause the endometriosis to recur

Prostate cancer and testosterone therapy. What parameters do you use to determine if/when safe for testosterone replacement. eg – pt is 2 years s/p proton radiation Rx for contained, gleason 7 tumor. current total psa= 0.5

Does spironolactone for acne decrease free testosterone levels?

Confusion about progesterone and estrogen use in women who have had breast cancer and the benefits the literature suggests. But they seem to lump all breast cancers and stages together. Can you help me – when to use hormone therapy (estrogen or progesterone) and which what types and stages. I was at the AMMG conference in Vegas and heard your talk 2011 which I found very enlightening.

Best time to measure serum testosterone? How many hours after using it transdermally?

Can you comment on each of the following determinants of penile blood flow and their contribution to correcting ED: exercise? plant-based diet and it’s favorable effects on Nitric Oxide? Testosterone supplementation? Can you prioritize this list with regards to treating ED?

48 yo patient who has markedly elevated FSH and LH and almost zero estradiol levels but is still having periods, can we start them on estrogen replacement or wait till at least 6 months till no periods?

For the perimenopausal patient, is there any advantage of only 2 weeks per month progesterone vs. continuous?

Please give pros and cons of route of administration of estrogen especially as some data suggests that transdermal may be the safest route with regards to risk of dvt.

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Does the “positivity “, estrogen or progesterone receptors of breast cancer cells have any significance in the treatment of a woman post breast cancer?

I had the understanding that breast cancer is an estrogen responsive tumor, but not progesterone responsive? Can you clarify?

Is it necessary in testosterone replacement, also to use HCG?

Is it possible for oral DHEA supplementation in men (50-100mg) to feedback and decrease endogenous testosterone production?

WHI showed that in the ERT group the results re: breast cancer were neutral or showed perhaps slight benefit as to reduction of breast cancer. We are also talking about protecting the breast with progesterone from the cancer promoting effects of bio identical estradiol. Is that relating only to endometrial cancer? Or is that being over cautious?

Does Braca or receptor status of breast cancer affect decision to give bio identical hormones in a patient after 5 year cure? E+, P+ HER, or triple negative? What about receptor status of breast cancer in a family member. Should that affect our decision making?

These questions are coming up from the women’s health practitioners who send me patients for cardiovascular risk stratification, and the patients are more worried about breast cancer risk!

References

Hormone Q&A: An Evidence-Based Web Conference

March 1, 2012 WorldLink BHRT Guidelines Blog,Medical Webinars 1 comment

On leap year day, we launched our first online Q&A session and received an outstanding response. It provided a wealth of knowledge and HRT guidelines for physicians and practitioners who are newbies, and for those who have been practicing it for years. This web conference was presented by Neal Rouzier, M.D.

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The following questions were answered during the web conference:

Would you please walk us through your bleeding algorithm for female patients on estrogen, progesterone, and testosterone therapy. i.e. from increasing progesterone dosage to referring out for embolization, ablation etc.

Will the FSH in a post-menopausal woman who is on adequate E2 replacement revert to follicular levels, or are the feedback receptors desensitized so it stays elevated?

What is the best way to follow a male’s testosterone level if he is maintained on a compounded transdermal cream?

When should we stop treating symptomatic postmenopausal females or symptomatic post-hysterectomy females with estrogen and estradiol?

Are there any post-menopausal or post-hysterectomy females who should not receive progesterone?

Should progesterone also be used on a peri-menopausal basis or for younger females with PMS symptoms?

When is the optimal time for testosterone to be rechecked in men who inject every 2 weeks?

What is your opinion on using Bhcg as an aid to weight loss?

What is the ideal route of testosterone supplementation?

What is your opinion and experience with sublingual testosterone drops?

What is your current opinion regarding the relationship between optimal thyroid hormone replacement and the risk for osteoporosis? If free T4 and free T3 are optimal, Is there a TSH blood level that you would consider too low?

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Do you think it is important to include pregnenolone in a balanced approach to promote healthy aging?

What is the cut off point for elevated h&h in patients that are being treated with testosterone?

What is your current treatment for hairloss in females when all your hormone adjusted levels are normal?

What is the best way to test for testosterone level and adjust the dose?

Can we replace the thyroid hormones only with T3 slow release?

What guidelines do you use when providing BHRT to women with a family history of breast cancer?

What clinical significance has elevated DHEA levels after oral supplementation has started with low dose (50-75mg day orally)?

What are some situations in which prolonged-release micronized progesterone is better than the regular-release micronized progesterone?

Use of testosterone after prostate cancer- how long do you wait?

Thyroid question: What do you think of patients that need increasing doses of thyroid meds?

Do you think there is evidence that we should prescribe T4 & T3 in a particular ratio?

Testosterone Cream vs IM : What are your considerations? (assuming patient has no preference and transfer is not an issue)

Is it possible to achieve the same levels of free and total testosterone using cream? Is there a significant difference in monthly cost to the patient?

Stage 4 sleep: At what age do men and women start losing it? What are typical subjective complaints and changes in lab values? How and when do you treat?

Starting BHRT on post-menopausal woman who starts vaginal bleeding. What steps should be taken and how do we introduce the estrogen, progesterone and testosterone (order and dosages) to prevent the bleeding?

Patient has a “breakout” (acne) on progesterone, how do we treat it so that we can get to therapeutic blood levels?

Since progesterone is only produced by the corpus luteum in the luteal phase of the cycle wouldn’t it seem contradictory to administer during the proliferative phase and likely interfere with the ovulation mechanism?

Recommended hormonal therapy for breast cancer patients on Anastrazole? Can they have some progesterone and testosterone back in a transdermal cream or even some estrol?

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Patient with TSH 10, free T3 3.7, free T4 1.35?

Post-menopausal bleed, sometimes it is not transitory. Now what?

Premenopausal women are starting to come to me wanting to start bioidentical progesterone and testosterone. I am concerned with the ones who chose to keep their IUD with progestin. Can they still receive progesterone and testosterone, their levels are low but they want to keep their IUD’s? Some of these women want to use bioidentical progesterone, I have not found a study to support this use?

Oral or transdermal estrogen: which is better & why?

What is your take on 17 keto DHEA?

Is it possible to increase estradiol levels using a cream to protective levels for bone and heart?

Indication for prolactin?

I am watching men on testosterone and the estradiol is getting quite high….can you review the issues there.

In women who already on estrogen, can you treat with progesterone only for extended periods of time?

I am finding that often Armour thyroid is not optimizing both T4 and T3 simultaneously, and I am thus reverting to liothyronine and levothyroxine. What has been your experience? Is it preferable to have thyroid compounded?

How to increase testosterone without supplementing or when supplementing is not enough?

Hair loss for women: their thyroid has already been treated.

How to handle irregular bleeding in perimenopause. Short cycles, long cycles, no cycles?

For male patients on trans-dermal testosterone replacement is high/increasing estradiol levels an indicator for increased risk of prostate cancer?

I have come across some BHRT practitoners including Progesterone and aromatase inhibitors to the transdermal testosterone formulation. What is your comment on this?

Is corionic gonadotrophin used in a man and when?

I get the impression that IM testosterone was good for muscle development, but peaked and dropped out too soon. Is it advisable to use IM testosterone twice weekly and use the creams in the off days to maintain levels? (Of course, appropriate monitoring of blood levels would be employed.) Would this not give the best of both worlds?

After 3 months of testosterone replacement (compounded transdermal), free and total blood levels have fallen off. Is this due to lack of absorption in some patients What would you recommend in the future, injections or pellets?

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Do “normal” FSH and LH levels in a woman on HRT mean that the HRT is adequate?

Should a woman with normal premenopausal levels be cycling?

With the changing healthcare environment, cost of overhead, and retirement looming, I would like to continue to provide hormones through an internet-based practice. What would be some concerns that need to be addressed to do this safely and legally?

Is there a commercial DHEA supplement that you like? or melatonin? Any good branded products?

Testosterone supplementation, either injectable or cream, causes significant rise in HCT. What is best resolution and/or replacement?

Please discuss preference and reasons for choosing armour thyroid or synthroid or other forms of compounded thyroid.

Oral, topical, or pellet form estrogen replacement. Which is the best form to use and in what case. There is argument about them being safer than oral. What guidelines do you suggest?

Cosmetic Procedures and Aging Skin: Can BHRT Help?

February 21, 2012 WorldLink bhrt cosmetic surgery Blog 0 comments

Medical Webinars:

Hormone Q&A

Neal Rouzier, M.D.

The Obesity Epidemic

Timothy McKnight, M.D.

Estrogen Optimization

Neal Rouzier, M.D.

Hormone Replacement and the Skin

As women age, they start to recognize a dramatic change in their skin. This is often due to a decline of estrogen in the body, which causes the inactivity of estrogen receptors and loss of estrogen production in the skin. Dry, rough, burning, and thin skin, as well as fine lines and wrinkles, can develop when estrogen is no longer being produced¹.

Studies have indicated that estrogen therapy can increase collagen and hyaluronic acid production to improve skin thickness and hydration. A study published in the American Journal of Clinical Dermatology found that estrogen therapy restores skin thickness, decreases wrinkle depth, and improves collagen production and hydration. One study showed that women using hormone replacement therapy had a 10 to 20 percent increase in skin thickness, when compared to those not being treated. HRT also reduced atrophy (fragile, fading skin) that occurs in aging skin¹.

HRT Can Speed Surgery Recovery

Hormonal changes often cause an age-related delay in the healing of body tissue and skin. An estrogen deficiency can dramatically decrease the rate of cellular response to injuries². Restoring healthy hormone levels, particularly estrogen, can increase the rate of healing among individuals recovering from injuries or surgical procedures.

Patient Demand for Youthful Health and Appearance

Cosmetic surgery is commonly used among postmenopausal women to bring back a more youthful appearance. Hormone replacement therapy (HRT) is an added bonus for cosmetic surgery patients, because it supports the healing process and speeds recovery from surgery.

Dr. Neal Rouzier explains the benefits of using HRT among cosmetic surgery patients; “I personally have found longevity and preventive medicine to be a natural extension of cosmetic surgery. Patients find they can surgically reverse the effects of gravity and aging through face-lifts, eyelifts and liposuction. When I prescribe HRT to a patient before surgery, they heal faster and feel better postoperatively. If the patient continues the natural hormone supplements post operatively, two wonderful things happen. First, they will probably experience improved results of the tummy tuck or face lift, due to the strengthening and thickening of the skin. Second, they will begin to feel good with increased energy, libido, skin texture, muscle-to-fat distribution, and improved mental clarity. Most of all, I give my surgical patients a choice in how they age after their cosmetic surgery.”

Choosing the right form of HRT

While HRT has been shown to benefit aging skin, all HRT is not created equal. As an important reminder, synthetic HRT is considered harmful, as certain risk factors are associated with this type of treatment. Bioidentical HRT, hormones that are similar to those produced in the body, is a safer alternative to conventional HRT. This form of therapy protects women from health ailments related to the loss of hormones that comes with aging. Plus, bioidentical HRT has incredible benefits on improving skin quality. Remember, it is always best to support HRT guidelines that are based on peer-reviewed studies and protocols that have been tried and tested.

References

1. Vaillant L, Callens A. Hormone replacement treatment and skin aging. Therapie. 1996;51(1):67-70.
2. Ashcroft GS, Ashworth JJ. Potential role of estrogens in wound healing. Am J Clin Dermatol. 2003;4(11):737-743.
3. Shu YY, Maibach HI. Estrogen and skin: therapeutic options. Am J of Clin Derm. 2011 Oct;12(5):297-311.

Nutrition Webinar: The Obesity Epidemic – How Can Practitioners Empower Patients to Reverse the Problem?

January 13, 2012 WorldLink course in nutrition, obesity epidemic Blog,Medical Webinars 0 comments

This nutrition webinar with Dr. Timothy McKnight reveals statistics for the Obesity Epidemic in America, along with case studies and proven solutions from his successful wellness program, Fit for Life. CLICK HERE for the recording.

Objectives:

Demonstrate clinical knowledge of America’s Nutritional Crisis

Describe the Health and Economic Impact

Implement techniques to maximize Nutritional Replenishment

Analyze the impact of food choices and supplementation

Empower patients to change behavior and FEEL BETTER

The World Health Organization has defined obesity as, “one of today’s most blatantly visible – yet most neglected – public health problems.” Also referred to as “globesity”, because it is affecting a large majority of the world population, obesity rates have increased more than three-fold since 1980. It is considered a complex health condition that reaches all ages and socioeconomic groups. Approximately 1 billion people are overweight worldwide, while over 300 million of these individuals are considered obese. This is a great concern to health practitioners, as obesity is a major risk factor for several chronic diseases, including high blood pressure, stroke, cancer, type 2 diabetes, and cardiovascular disease.

What has led to the obesity epidemic? Two main contributing factors are an increase in the consumption of nutrient-poor, calorie-dense foods and a reduction in physical activity. In more recent decades, there has been a change in society’s behavioral patterns, as urban living, passive leisure activities, and hours spent sitting at work or at home have led to more consumption of processed foods, a lack of physical activity, and consequently – a higher rate of obesity.

What can be done to reverse this epidemic? Dr. Timothy McKnight provides real answers for Practitioners from all backgrounds in this nutrition webinar.

Hypothyroid Symptoms But Normal TSH Levels? How to treat symptoms of low thyroid by optimizing free T3 levels.

November 30, 2011 WorldLink thyroid Blog 0 comments

Medical Webinars:

Hormone Q&A

Neal Rouzier, M.D.

The Obesity Epidemic

Timothy McKnight, M.D.

Estrogen Optimization

Neal Rouzier, M.D.

Fatigue, weight gain, forgetfulness, mood swings…did the holidays just hit? Or are these symptoms an indication of hypothyroidism? While you might struggle with the holiday season to maintain energy and sanity, these persistent symptoms are a few of the signs related to low thyroid function, also known as hypothyroidism.

What Is Hypothyroidism?

More commonly found in women, approximately 5% of Americans have hypothyroidism, which occurs when the thyroid gland is unable to produce enough thyroid hormone to support several metabolic functions in the body. The thyroid gland secretes two main hormones, thyroxine (T4) and triiodothyronine (T3). T4 is the hormone that is principally produced by the thyroid gland which is then converted in the liver and kidney to the metabolically active T3 hormone. It is the T3 that is responsible for regulation of metabolism, energy production, body temperature, body fat, cholesterol, cognitive function, and symptom improvement.

How do you know if your thyroid levels are low?

There are over 200 symptoms related to low thyroid function that improve with optimal thyroid replacement:

Colder body temperature

Symptoms of poor circulation in the hands and feet

Fatigue

Depression

Forgetfulness and fuzzy thinking

Muscle and joint pain

Dry skin and brittle nails

Digestive ailments (constipation, IBS, etc.)

Menstrual irregularities and infertility

Emotional instability

High cholesterol

Weight Gain

Recommended Treatment from Dr. Rouzier:

Optimizing thyroid function by replacing thyroid hormones to optimal (upper range of normal) can significantly increase energy, metabolism, and well being. Many studies (NEJM & JCEM) demonstrate that raising Free T3 levels in addition to T4 levels is essential to obtaining these results. Traditionally physicians have prescribed thyroid hormone in a form of T4 only, also known as Synthroid®, Levoxyl®, or L-thyroxine. Recent studies, however, have demonstrated that this may not be sufficient in many patients to truly feel well. Many thyroid treated patients commonly request even more thyroid, knowing that more makes them feel and function better. The patient might not have realized how lousy they felt until they felt better. This might not be accomplished, as per recent literature, until these patients have improved or optimized T3 replacement as it is the T3 at the cell level that is responsible for thyroid function, and not T4. Nevertheless, it is usually only the T4 preparations that physicians are taught to use for thyroid replacement. Unfortunately using primarily a T4 only preparation typically does not allow for adequate conversion to T3 and therefore improvement in symptoms is often not adequate. Many factors play in the inadequate conversion of T4 into T3 and are related to a defective function of the 5’-deiodinase enzyme responsible for this conversion. Whatever the cause for the inadequate conversion of T4 to T3, many patients have persistent low thyroid symptoms despite adequate T4 replacement. Several landmark studies demonstrate that this can be overcome by simply adding T3 on to the T4 regimen. Improvement in T3 levels can be attained by compounding both T4 and T3 together into a capsule or through the use of the commercially available desiccated thyroid preparations that contain T4 and T3 together in tablet form. The commonly prescribed T4 preparations of L-thyroxine, sometimes referred to as synthetic thyroid and contain only T4 and no T3, might not convert to the active form of T3 which is especially critical for patients who are not able to properly and adequately convert T4 to T3.

A paper published in JAMA demonstrated the importance of T3 in predicting morbidity, mortality, and functional decline. Neither TSH nor T4 were predictive, thereby further establishing that T3 should be the main marker utilized for thyroid replacement.”

Dr. Rouzier recommends physicians review the excellent articles published in NEJM, JCEM, and JAMA to further appreciate the importance of T3 optimization for health and well-being.

Utilizing a combination of both T4 and T3, as suggested by recent literature, most effectively raises the active thyroid hormone at the cell level called T3. Science has proven that it is the T3 level, and not the T4 level, that is responsible for maintenance of normal cholesterol levels. Commercially available combinations of T4 and T3, commonly called desiccated or natural thyroid, will provide more optimal levels of T3 than commercially available T4 only preparations. Since T3 is the more metabolic hormone, low T3 levels result in poor metabolism and symptoms of low thyroid. When pure T4 is given in the form of Synthroid®, Levoxyl®, or L-thyroxine, T3 levels improve only minimally due to poor conversion of T4 to T3. Many physicians including endocrinologists believe that T4 alone is the only thyroid preparation necessary to prescribe for hypothyroidism. Their reasoning is the belief that the body will automatically (physiologically) convert T4 into T3 if the body needs it. If the body doesn’t need it, then it won’t make it. This commonly held belief, however, is not what is born out in the medical literature for optimal thyroid function. Recent studies show that use of T4 alone does not adequately convert into T3. Although many patients do improve on pure T4 supplementation alone, adding T3 to the T4 preparation allows us to optimize T3 levels that are not usually achievable with pure T4 preparations alone. It is only supplementation of T3 that augments the antidepressant of thyroid hormone, not T4.

Treatment should restore thyroid to OPTIMAL levels and not just normal.

Conventional treatment for thyroid disorders involves restoring TSH into the normal range which might still maintain levels of T3 in the low normal range in spite of normal TSH levels. Restoring T3 levels into the upper range of normal is now regarded as necessary to achieve improvement in health and well-being. Normal laboratory levels are the average of a population for the age but do not reflect that which would be best for symptom improvement and health. In other words, normal does not mean optimal or what is best for the patient. A recent article in “Gerontology” demonstrated that thyroid replacement in euthyroid men (normally not needing thyroid replacement) into the upper or high range resulted in improvement in cognition, memory, and overall function. This study is just one of many that consistently demonstrate that optimization of all hormones, including low thyroid, provides better metabolism, health, well-being, and disease prevention than does maintaining “normal” levels for the age. Keep in mind that normal levels (average for the age) of estradiol, progesterone, and testosterone are zero in menopausal women. Even though that is the level typically measured in a menopausal woman as menopausal women no longer make these hormones, normal (zero level) is not where the level should be for symptom improvement and health protective benefits (cardiovascular and musculoskeletal). The same applies to thyroid. Low T3 levels were predictive of an increase in fracture rate whereas TSH and T4 levels were not predictive or protective. Where would you like your levels to be? The Rotterdam study (Annals of Internal Medicine) demonstrated that normal levels of thyroid (in the lower 50% of normal) were predictive of a 2.2 fold increase risk of cardiovascular disease, and these were levels in the “normal” range. There is now significant data to support that we physicians should conform to the literature recommendations and understand that in every circumstance optimal levels of all hormones, including thyroid, are very important for health optimization and improvement in symptoms, and subsequently our quality of life.

By simply restoring TSH levels to “normal” blood levels for your age might not be in the best interest for the patient. Lab tests can indicate normal or low normal thyroid levels, but patients can still have symptoms associated with hypothyroidism. According to the BMJ, goals of thyroid replacement should be to treat the patient until the Free T3 and Free T4 levels are in the high normal range. Some patients might require levels that are above normal (suppressed TSH) to feel normal, a concept that we physicians are not taught to trained to do. Researchers emphasize that TSH is not predictive of symptoms or symptom improvement, only T3 is as this is the active hormone at the cell level. Although TSH is very predictive of biochemical hypothyroidism, it is not predictive at all of clinical symptomatology. Rather than treating the patient’s lab tests, researchers suggest that physicians should treat the patient’s symptoms and not the TSH level as we are often taught. Researchers emphasize that if the Free T3 and Free T4 levels are kept within the upper end of normal, in spite of suppressed TSH levels, then overt hyperthyroidism is averted. Thyroid hormone serum levels that are in the optimal range that thereby result in a reduction of hypothyroid symptoms indicate healthy thyroid function.

Benefits of Optimal Thyroid Treatment

Optimal thyroid replacement can effectively restore health and well-being by improving:

Temperature regulation and metabolism

Increased energy

Fat breakdown for healthy bodyweight and cholesterol

Protection against cardiovascular disease

Protection against depression and mood disorders

Cerebral function and cognition

Healthy skin, hair and nails

Protection against functional decline

References

1. Applehof BC, Fliers E, Wekking EM, Schene AH, et al. Combined therapy with levothyroxine and liothyronine in two ratios, compared with levothyroxine monotherapy in primary hypothyroidism: a double-blind, randomized, controlled clinical trial. J Clin Endocrinol Metab. 2005 May;90(5):2666-2674.
2. Bunevicius R, Kazanavicius R, et al. Effects of thyroxine as compared with thyroxine plus triiodothyronine in patients with hypothyroidism. N Engl J Med. 1999; 340(6): 424-429.
3. Gussekloo J, van Exel E, de Craen AJ, Meinders AE, et al. Thyroid status, disability and cognitive function, and survival in old age. JAMA. 2004 Dec;292(21):2591-2599.
4. Hak AE, Pols HA, Visser TJ, Drexhage HA, et al. Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: the Rotterdam Study. Ann Intern Med. 2000 Feb;132(4):270-278.
5. Klein I, Ojamaa K. Thyroid hormone and the cardiovascular system. N Engl J Med. 2001; 344(7): 501-509.
6. Meier C, Trittibach P, Guglielmetti M, Staub J, Muller B. Serum thyroid stimulating hormone in assessment of severity of tissue hypothyroidism in patients with overt primary thyroid failure: cross sectional survey. BMJ. 2003 Feb;326(7384):311-312.
7. Prinz PN, Scanlan JM, Vitaliano PP, Moe KE, et al. Thyroid Hormones: Positive Relationships With Cognition in Healthy, Euthyroid Older Men. J Gerontol. 1999;54(3):M111-M116.
8. Rouzier N. How to achieve healthy aging. 2007. Salt Lake City, UT: WorldLink Medical Publishing.
9. Toft AD. Thyroid hormone replacement – one or two? N Engl J Med. 1999; 340(6): 468-470.

What Are Normal Testosterone Levels in Men? Dr. Neal Rouzier Makes a Recommendation.

October 28, 2011 WorldLink normal testosterone levels Blog 1 comment

Medical Webinars:

Hormone Q&A

Neal Rouzier, M.D.

The Obesity Epidemic

Timothy McKnight, M.D.

Estrogen Optimization

Neal Rouzier, M.D.

What is considered the normal range for testosterone levels in men? It may seem like an easy question to answer, as traditionally serum testosterone levels are observed to be anywhere between 300 to 1,200 ng/dL. Yet, the answer to this question is not as simple as it may seem.

Hypogonadism, or an androgen deficiency, affects an estimated four to five million men in the United States. More than 60% of men over 65 years old have low free testosterone levels. Even so, hypogonadism often goes undiagnosed and older men experience a rapid decline in their health. Low testosterone levels can be observed through serum tests, but what are normal testosterone levels? What are optimal testosterone levels? The answer to this question depends on who you ask and varies widely amongst healthcare practitioners. Hormone Doctor, Neal Rouzier. M.D. gave his expert opinion in a recent interview.

Dr. Rouzier’s Recommendation

“An important point is the difference between optimal and normal. Normal for one’s age is not optimal for one’s age. The medical literature supports replacement levels to that of a younger age, typically 20 to 30 years old. At these levels, optimal health is attained, as well as the feel-good effects. The problem is how one defines normal and optimal. Normal for a 70-year-old is not normal for a 20-year-old. If a 20- year-old man has the testosterone level of a 70-year-old man, he will not feel well. If a 70-year-old man has the level of a 70-year-old man, this is considered normal. No man should have the testosterone level of a 70-year-old as supported in our medical literature. In reality we are not trying to be 30; however our goal is to optimize levels to those we would see in a 20 to 30 year-old. A free testosterone lab value of 25 may be interpreted as optimal when in fact this level is quite low. A lab value of 40 would be interpreted as being too high when in reality it is a perfect level and our goal for a younger person. All the medical studies utilize hormone dosages resulting in levels on the upper end of the physiologic range. These are levels found in young adults.

In past years, various labs would list the testosterone ranges for all ages next to the lab results. Today, the labs publish only the normal levels based on a person’s age. This does not provide the appropriate indication of optimal levels as it is age specific. For example, normal free testosterone levels for a 60-year-old man range from 5 to 25. Optimal is therefore expected to be 25. A traditional medical doctor would interpret 25 as optimal. But remember, our goal is to replace free testosterone levels to that of a younger male. These free testosterone levels would be 30 to 40. A lab value of 40 would be interpreted by the lab as being too high, when in reality the level of 40 is perfect and is always our goal.

Optimal levels are conducive to optimal health. Having good testosterone in your system decreases incidents of heart attacks, strokes, Alzheimer’s, diabetes, high blood pressure. It has a beneficial effect in protecting against cardiovascular disease in every study. It decreases the instance of heart attacks because of its effect on blood vessels. It has a beneficial effect of improving your good cholesterol and lowering your bad cholesterol. It has a beneficial effect of improving all of the good lipoproteins and reducing all the bad lipoproteins.

Critics perhaps don’t understand that the more that you have, the better off you are, and every longevity study says the same thing: the higher level, the longer you’ll live, the less risk of heart disease that you’ll have. Where would you like your levels to be?”

Low Testosterone Symptoms

What are the signs of a deficiency?

Depression
Fatigue
Dementia
Osteoporosis
Low Libido
Heart disease
Stroke
Prostate Cancer
Abdominal Obesity
Type 2 Diabetes

Restoring optimal testosterone levels can deter these health risks and improve bone mineral density, sexual function, muscle mass/strength, and mood. Furthermore, quality of life is improved overall.

The Take-Away

If you are considering testosterone replacement, a healthcare provider who is trained in evidence-based Hormone Replacement can help you restore hormone levels to an optimal point that reduces or eliminates symptoms and improves quality of life without causing significant side effects. If you are a health practitioner, it is recommended that you understand the medical literature supporting optimal hormone levels before treating patients with testosterone replacement therapy.

References

1. Akishita M, Hashimoto M, Ohike Y, Ogawa S, et al. Low testosterone level as a predictor of cardiovascular events in Japanese men with coronary risk factors. Atherosclerosis. 2010 May;210(1):232-236.
2. Culley CC. Prevalence, Diagnosis and Treatment of Hypogonadism in Primary Care Practice. Boston University. Retrieved on October 26, 2011 from http://www.bumc.bu.edu/sexualmedicine/publications/prevalence-diagnosis-and-treatment-of-hypogonadism-in-primary-care-practice/
3. Harman SM, Metter EJ, Tobin JD, Pearson J, Blackman MR. Longitudinal effects of aging on serum total and free testosterone levels in healthy men: Baltimore Longitudinal Study of Aging. J Clin Endocrinol Metab 2001;86:724-31.
4. Morley JE, Kaiser FE, Perry HM III, et al. Longitudinal changes in testosterone, luteinizing hormone and follicle-stimulating hormone in healthy older men. Metabolism. 1997;46:410-3.
5. Rabijewski M, Zgliczynski W. Testosterone deficiency in elderly men. Pol Merkur Lekarski. 2009 Dec; 27(162):517-523.
6. Schubert M, Jockenhovel F. Testosterone and the metabolic syndrome. Urologe A. 2010 Jan;49(1):47-50.
7. Srinivas-Shankar U, Roberts SA, Connolly MJ, O’Connell MD, et al. Effects of testosterone on muscle strength, physical function, body composition, and quality of life in intermediate-frail and frail elderly men: a randomized, double-blind, placebo-controlled study. J Clin Endocrinol Metab. 2010 Feb;95(2):639-650.

Medical Webinar: 7 Things to Consider Before Changing Your Practice to Preventive-Aging Medicine.

October 5, 2011 WorldLink change practice Blog,Medical Webinars 0 comments

Dr. Gregory Petersburg effectively addresses how to change practice and integrate preventive-aging medicine. CLICK HERE for the recording.

Objectives

Learn the market conditions before integrating Preventive-Aging into practice.

Know where to start before making the switch.

Discover the risks and benefits of the industry.

Learn to differentiate yourself by creating unforgettable patient experiences.

Interact with a Preventive Medical Expert who has practiced for 11 years and teaches world-wide.

The FDA, ACOG, and NAMS Denounce Bioidentical Hormones: Dr. Neal Rouzier and Dr. Dirk Parvus Disagree

September 16, 2011 WorldLink Blog 5 comments

Medical Webinars:

Hormone Q&A

Neal Rouzier, M.D.

The Obesity Epidemic

Timothy McKnight, M.D.

Estrogen Optimization

Neal Rouzier, M.D.

Dr. Neal Rouzier recently shared a an email thread between him and Dr. Dirk Parvus. We found it to be quite moving and thought it would be useful to post.

Hi Neal,

I am attending a hormone conference in Chicago as part of a series given by the Institute for Functional Medicine (IFM). I am interested in their approach to treating chronic disease. A lecturer from IFM refers to several studies that are using CEE and progestins. Some of the studies concluded that hormone replacement, even testosterone, increase breast cancer risk and should not be used long term. Also, his conclusions on estriol differ from mine and from what you teach. He also points out that the FDA, ACOG, and Endocrine Societies do not recommend bioidentical hormones, which I feel is crazy and disturbing. Unfortunately, he does not refer to, or may not know about, the numerous articles you use to base your recommendations. It saddens me that his conclusions are so diametrically opposite from ours. Depending on the experts they listen to, doctors are giving very different treatment recommendations to their patients.

Yours in health,

Dirk

Hi Dirk,

It is absolutely amazing what is being taught and promoted. If this doctor attended our courses, he would be just as disgusted with us, as we are with him. As you have heard in my lectures, the most upsetting consequence to all of this is that practitioners who abide by these teachings mistreat so many patients. None of them follow any scientific methods. As you can imagine, I am not very popular when I lecture [at similar conferences], because I use the medical literature to debunk all that they teach. Please note that there are hundreds of alternatively trained physicians that will disagree with me. I’m glad you can identify the teachings that don’t hold any credible scientific backing. I frequently get into discussions and debates on a multitude of topics, as our teaching is diametrically opposed to their beliefs. Unfortunately for them, they always lose the argument, because I use the medical literature and science to counter almost everything they propose.

Please don’t feel disturbed that ACOG and NAMS don’t recommend bioidentical hormones. I agree with them 100% (and so do you). You see, they are not recommending bioidentical hormones that are utilized by this IFM physician. This doctor will recommend estriol and progesterone creams that do not raise hormone serum levels or provide endometrial protection. ACOG and NAMS are against this type of prescribing and promotion, and so are we. In contrast, the literature is full of data and studies demonstrating the beneficial effects of pharmacologic bioidentical hormones, which I simply copy.

Many doctors from IFM attend my courses and think I’m crazy, because what they are initially taught is contrary to what I teach. I am pleased that you have the insight many others lack. I am frustrated with the incorrect principles being taught, but that just fuels my passion.

Sincerely,

Neal

Hi Neal,

Thank you so much for taking the time to give me a detailed answer. I have referred many colleagues to your courses and plan to retake level 2 and 3 in the next year. The knowledge you provide has enabled me to talk to anyone (including other doctors) about bioidentical hormone optimization. I am able to practice safe, effective medicine for my patients, and when it exists I have been able to recognize flawed reasoning in hormone lectures I have attended. On behalf of all of us who follow your teaching, thank you for your passion and for all of the work you do to summarize the correct way for us.

Yours in health,

Dirk

Hi Dirk,

I must say that your response is the most moving that I have ever received. I just spent the last two days at my computer researching, writing, re-organizing, and trying to improve the courses. This was my only weekend off in months, and I wasted it doing trivial tasks. However, based on your response, it is the most rewarding activity. It drives my wife crazy, but the knowledge and insight that I gain from the research, as well as the responses I receive from physicians and patients, makes all of the effort worthwhile. Thanks again and I hope to see you in September at Part II (which I have changed about 50%).

Graciously,

Neal

Anti Aging Conference – Anti-Aging Seminar in USA

August 23, 2011 WorldLink Blog 0 comments

Medical Webinars:

Hormone Q&A

Neal Rouzier, M.D.

The Obesity Epidemic

Timothy McKnight, M.D.

Estrogen Optimization

Neal Rouzier, M.D.

Anti-Aging Market to hit $114 Billion: Let’s Separate the Gimmicks from the ‘Real Deal’

Look-young concoctions and feel-good elixirs. The anti-aging market is well-established and only getting stronger, as over 70 million aging baby boomers are driving the movement to look and feel younger. Currently at $80 billion, the anti-aging market size is expected to reach more than $114 billion by 2015.

With a prevalent focus to stay young, many anti-aging interventions have developed over the years, including hormone replacement therapy, anti-aging supplements, and surgical treatments. Are these treatments safe and effective? This is a main question for several medical professionals, as they claim anti-aging interventions, especially hormone replacement therapy, can be ineffective and cause harm.

Fears of harm and effectiveness are misleading

The majority of fears about hormone replacement therapy stems from the highly publicized Women’s Health Initiative, which warned thousands of menopausal women to stop taking HRT. (See Hormones and Cancer blog post). Regrettably, critics fail to see that the negative outcomes from the WHI were applied to one form of treatment, and only for one specific age group of women.

By stopping HRT, women were put at greater risk for developing cardiovascular disease, stroke, and cancer. Fortunately, there are alternatives to anti-aging interventions that may be harmful. Unlike conventional HRT, medical studies purport bioidentical hormones (BHRT) are a safe and effective treatment for women with hormone deficiencies. One particular study is currently being conducted by the Kronos Longevity Research Institute to clarify the safety and efficacy of BHRT.

Dr. Rouzier’s Take

The benefits of hormones can be further explained by Dr. Neal Rouzier, who has been teaching Worldlink Medical’s anti aging conference for over 10 years. He stated in his recent anti aging seminar, “Yes hormones are good. Just use the right ones in the right way. If hormones were so bad in women, we would yank their ovaries out when they were 30. We used to do that, and they all died sooner and had a miserable life before they died. Now we don’t take the ovaries out, we leave those ovaries in. Why? Well, because they feel better, they function better, and they live longer, happier and healthier. So, hormones do have a beneficial effect. The Women’s Health Initiative showed that the hormones were harmful. Well which is it? Are they good or are they bad? In the body they’re good. Out of the body, in a chemically altered form, they’re bad and all of the studies show that. Well, let’s look at the most recent studies, perhaps at a natural estradiol. All of the studies show it is very beneficial, and long term use will make you live longer, happier, less heart attacks, less stroke, less osteoporosis, less depression, less mood swings, less Alzheimer’s disease, and less dementia. Why don’t we use that one?… Let’s not look at these other studies with the synthetic chemically altered [hormones], let’s look at estradiol [i.e. from the Kronos Study http://www.keepstudy.org/keeps/why.cfm]. That’s the one that has shown to be beneficial, that’s the one that we lose when we go through menopause. We’ve replaced that one, in the correct form, and we haven’t seen any problems with it.”

Still beware of anti-aging gimmicks

Not all anti-aging interventions are created equal. There are some products and gimmicks for which you should be weary. The market is saturated with hormone balancing creams, wrinkle-fading dreams, and lose-weight quick schemes, but such products may not live up to all they claim to be.

Anti-aging products can pop up while browsing the internet, making statements that are often not backed by scientific evidence. Generally, these products are advertised as free trials. Yet, they truly turn into a monthly commitment to buy a product that doesn’t live up to its promised benefits. Several consumers easily purchase these products only to be later disappointed and stuck in a purchasing obligation that can only be stopped through a difficult cancellation process.

The Real Deal

How do you decipher the anti-aging facts from fiction? Find a physician or healthcare practitioner who is well trained and open to the idea of hormone replacement. Also, one who treats patients based on a multitude of medical evidence and has not been deterred by the WHI. It’s not about the “Fountain of Youth”. It’s about living healthier and happier during a potentially difficult age. This is accomplished by thorough clinical analysis including food testing, replenishing lost hormones, fitness scheduling, coaching, etc. Some call it alternative healthcare, while others call it ‘upstream medicine.’

References

1. Boomers will be spending millions to counter aging. (2011, August 17). Retrieved on August 18, 2011 from http://www.todaysthv.com/news/article/169384/126/Boomers-will-be-spending-billions-to-counter-aging
2. Weintraub A. Beware free trials of anti-aging products sold on the web. (2010, October 1). Retrieved on August 18, 2011 from http://health.usnews.com/health-news/family-health/womens-health/articles/2010/10/01/beware-free-trials-of-anti-aging-products-sold-on-the-web

The 7 Hormones Everyone Should Know

July 21, 2011 WorldLink Blog 0 comments

Medical Webinars:

Hormone Q&A

Neal Rouzier, M.D.

The Obesity Epidemic

Timothy McKnight, M.D.

Estrogen Optimization

Neal Rouzier, M.D.

DHEA

Clinical studies have demonstrated that DHEA has a beneficial effect on immune response, sex drive, metabolism and emotional stability. DHEA benefits the immune system and reduces visceral fat associated with diabetes mellitus. Other health-related benefits include support of cognitive function, helping the body cope with stress, and protection against heart disease through its effects on lipids and body fat.

Melatonin

Melatonin regulates the circadian rhythm as well as the deep stages of sleep. Studies suggest that the immune system depends on melatonin’s effects of deep sleep. In the January 1997 issue of the New England Journal of Medicine, melatonin was demonstrated to be a powerful antioxidant hormone that can protect against cancer. There are hundreds of studies showing that melatonin can scavenge free radicals, and be a safe sleep-enhancing hormone.

Pregnenolone

Failure of memory and lack of mental clarity can be among the most frustrating aspects of aging. Studies indicate that pregnenolone might be beneficial against age-related cognitive decline.

Thyroid

This metabolic hormone secreted by the thyroid gland regulates temperature, metabolism and cerebral function. Insufficient thyroid levels result in fatigue, increased cholesterol levels and increased risk of coronary artery disease. With age, thyroid hormone levels gradually decline resulting in a decreased metabolism, which affects all cells and organs. Low thyroid causes low energy, and thinning of hair, skin and nails. The dictum that normal levels are not optimal levels is extremely important when it comes to thyroid.

Testosterone

Although testosterone is the primary male hormone, women also benefit from its supplementation. Levels of testosterone decline with age in men and women. At optimal levels, research shows testosterone increases bone density and bone formation, enhances energy and sex drive, decreases body fat, increases muscle strength, lowers blood pressure and modulates cholesterol levels. Testosterone is a hormone that neither man nor women should be without and we’ll present the scientific evidence to support this.

Estrogen

Over 50 years of studies demonstrate that loss of estrogen increases cardiovascular disease, Alzheimer’s Disease, osteoporotic fractures, urogenital atrophy, macular degeneration and depression. Recent studies sort out the confusion created by the WHI (Women’s Health Initiative) and conclude that certain types of hormones cause harm in some women, whereas different hormones avoid the harm and provide a significant protection. A thorough literature review helps sort out the differences and provides credence and confidence for the use of bioidentical estrogens as based on our medical evidence.

Progesterone

Data demonstrates that synthetic progestins increase the risk of breast cancer, heart disease, strokes, bleeding, and depression. Studies demonstrate that not only does micronized progesterone not increase these risks, but it also protects against them. Studies demonstrate a synergistic effect of progesterone with estrogen, whereas progestins negate estrogen’s positive benefits. This literature review will demonstrate the difference between progesterone and progestins and how this difference is the key to understanding the importance of progesterone.

Estrogen Dominance in Men: Does Too Much Estrogen Cause Prostate Cancer?

July 7, 2011 WorldLink estrogen dominance in men Blog 4 comments

Medical Webinars:

Hormone Q&A

Neal Rouzier, M.D.

The Obesity Epidemic

Timothy McKnight, M.D.

Estrogen Optimization

Neal Rouzier, M.D.

The Role of Testosterone on E2 Levels

Testosterone replacement therapy has a significant role in protecting aging men’s health, including greater protection against heart disease, diabetes, and obesity.¹²³ However, it naturally increases estrogen levels in men, which has brought the benefits of testosterone therapy into question.

You may have heard the warning that high estrogen levels cause prostate cancer in men, but research supporting this claim is unclear. Some studies indicate that high estrogen levels can increase the development of prostate cancer cells, while other research finds high estrogen levels are not found in men with prostate cancer. High estrogen levels may be considered a health risk, but low estrogen levels can also be detrimental to men’s health. The body needs estrogen to avoid cardiovascular disease, type 2 diabetes, osteoporosis, and metabolic syndrome.⁴⁵

Let’s take a look at the two different arguments to understand the effects of raising estrogen levels via testosterone therapy.

Argument A: Raising Estrogen Levels is Harmful

As men age, circulating levels of estradiol increase and free testosterone levels decrease in the body. This sharp increase in estrogen has been related to prostate cancer. Prostate cancer has been suggested to originate from the presence of androgens, because testosterone is converted into estrogen by the enzyme aromatase.⁶ This depletes free testosterone levels and increases estrogen levels. However, the active form of testosterone, 5alpha-dihydrotestosterone, is not aromatized into estrogen and does not increase prostate cancer risks.7 Estrogen treatment has been shown to damage prostate DNA in animal studies and it is suggested that androgens act as a strong tumor promoter when estrogen, or specifically estradiol-17beta, is present.⁷ However, a closer look at these claims shows testosterone actually plays a significant role in sustaining prostate health and that androgens do not cause prostate cancer.

Argument B: High Estrogen Levels in Men are Actually Protective

While it has been argued testosterone therapy increases the risk of prostate cancer by raising estrogen levels, research has also shown the opposite is true. Low levels of testosterone increases prostate cancer risks. A literature review found that there is a limited capacity for androgens to stimulate the growth of prostate cancer cells.⁸ Another review of research did not find a significant association between testosterone or estrogen levels and prostate cancer.⁹ Only men that currently have prostate cancer should avoid testosterone therapy, as this is the time when androgens may further proliferate cancer cells.

Several studies indicate that low estrogen levels in men can be detrimental and raising estrogen levels has protective benefits, such as strong bones, sustained cognitive function, and cardiovascular health. In fact, increasing estrogen levels is not harmful when optimal testosterone levels are present. The ratio of estrogen to testosterone is what matters most, as low testosterone and high estrogen blocks testosterone receptor sites.¹⁰ Testosterone therapy is a beneficial way to restore healthy testosterone levels and balance the testosterone/estrogen ratio. Testosterone therapy was given to 207 men between the ages of 40 to 83, finding the therapy had a significant decrease on prostate volume, prostate-specific antigens (PSA) levels, and lower urinary tract symptoms.¹¹

Conclusion: Optimal Hormone Balance

So, what is the final verdict? Estrogen is not harmful to men. This can best be explained by Dr. Neal Rouzier, who in his most recent webinar stated,“Many conclude that estrogen may be responsible for the high prevalence of prostate cancer in men. That has been extrapolated to [imply that] estrogen causes cancer in men and now everyone thinks that it’s bad and everyone is on this kick to lower estrogen in men to protect against that. What does the literature say?…All of the studies to-date, 50 years of studies, where testosterone has been utilized to increase estrogen levels, show it aromatizes to estradiol and all of these levels [testosterone, estradiol and estrogen] are increased. There is no study to support any increased risk of cancer of the prostate when estrogen levels are raised.”

It is only when estrogen levels are too high and testosterone levels are too low that negative effects can occur in men’s health [Estrogen Dominance in Men]. Testosterone levels should be restored to their optimal range to avoid the detrimental effects of this imbalance. “Again, 50 years of studies demonstrate that testosterone administration, which raises serum estrogen levels, does not cause prostate cancer.”¹⁰

References

1. Wang C, Cunningham G, Dobs A, et al. Long-term testosterone gel (AndroGel) treatment maintains beneficial effects on sexual function and mood, lean and fat mass, and bone mineral density in hypogonadal men. J Clin Endocrinol Metab. 2004 May;89(5):2085-2098
2. Darby E, Anawalt BD. Male hypogonadism: an update on diagnosis and treatment. Treat Endocrinol. 2005;4(5):293-309.
3. Watt PJ, Hughes RB, et al. A holistic programmatic approach to natural hormone replacement. Fam Community Health . 2003; 25(1):53-63.
4. Miner MM, Seftel AD. Testosterone and ageing: what have we learned since the Institute of Medicine report and what lies ahead? Int J Clin Pract. 2007 Apr;61(4):622632.
5. Amin S, Zhang Y, Felson DT, Sawin CT, et al. Estradiol, testosterone, and the risk for hip fractures in elderly men from the Framingham Study. Am J Med. 2006 May;119(5):426-433.
6. Shibata Y, Ito K, Suzuki K, Nakano K, et al. Changes in the endocrine environment of the human prostate transition zone with aging: simultaneous quantitative analysis of prostatic sex steroids and comparison with human prostatic histological composition. Prostate. 2000 Jan;42(1):45-55.
7. Bosland MC. Sex steroids and prostate carcinogenesis: integrated, multifactorial working hypothesis. Ann NY Acad Sci. 2006 Nov;1089:168-176.
8. Morgentaler A, Traish AM. Shifting the paradigm of testosterone and prostate cancer: the saturation model and the limits of androgen-dependent growth. Eur Urol. 2009 Feb;55(2):310-320.
9. Roddam AW, Allen NE, Appleby P, Key TJ, et al. Insulin-like growth factors, their binding proteins, and prostate cancer risk: analysis of individual patient data from 12 prospective studies. Ann Intern Med. 2008 Oct;149(7):461-471.
10. Rouzier N. (2007). How to achieve healthy aging. Salt Lake City, UT: WorldLink Medical Publishing.
11. Pechersky AV, Mazurov VI, Semiglazov VF, Karpischenko AI, et al. Androgen administration in middle-aged and ageing men: effects of oral testosterone undecanoate on dihydrotestosterone, oestradiol and prostate volume. Int J Androl. 2002 Apr;25(2):119-125.

Transdermal vs. Oral Estrogen: Which is More Effective?

June 24, 2011 WorldLink Blog 0 comments

Medical Webinars:

Hormone Q&A

Neal Rouzier, M.D.

The Obesity Epidemic

Timothy McKnight, M.D.

Estrogen Optimization

Neal Rouzier, M.D.

While experts agree estrogen has far reaching benefits in menopausal women, researchers tend to disagree on how estrogen therapy should be administered.

Is Transdermal “Less Risky?”

The current trend is to prescribe transdermal estrogen cream. Why do some physicians choose transdermal instead of oral estrogen therapy? Many are worried about the health risks associated with oral estrogen. These concerns were initiated by the Women’s Health Initiative that found oral estrogen increases the risk of myocardial infarction, stroke and blood clots in menopausal women. Therefore, transdermal estrogen is commonly prescribed in lower doses to avoid the damaging atherosclerotic effects of oral conjugated equine estrogen (CEE). Furthermore, it is applied topically and absorbed through the skin. This route of administration bypasses the liver and directly enters the bloodstream to prevent circulatory risks.

What about the benefits of Oral Estrogen?

Transdermal estrogen may seem like a better choice for estrogen therapy, but oral estrogen offers more cardiovascular benefits. In fact, many studies claim transdermal estrogen does not provide any cardiovascular protection. It is estimated that 50-75% of estrogen’s benefits are on LDL and HDL cholesterol, fibrinogen, and fatty acid esters, because oral estrogen passes through the liver to improve cholesterol health. Since transdermal estrogen bypasses the liver to directly enter the bloodstream, it cannot provide advantageous lipid effects. To prevent a large majority of women from succumbing to coronary artery and cardiovascular disease, it is sensible to prescribe an oral estrogen therapy for maximum cardiovascular protection.

There is a safer and effective form of oral estrogen.

Hormone educator, Dr. Neal Rouzier states that “the medical literature does not support the use of creams and patches over oral bioidentical estrogen. Oral estrogen is far better at protecting women against cardiovascular problems as many studies show a significantly reduced incidence of both heart attacks and strokes with the use of oral as compared to the use of transdermal estrogen creams or patches. Transdermal estrogen has only a minimal effect on improving blood lipids (good and bad cholesterol and blood fats) — whereas oral estrogen has a much stronger value in doing this. Many medical studies have demonstrated that oral estrogen’s effect on total cholesterol, LDL and HDL-cholesterol provide greater overall protection, whereas transdermal provides much less protection and therefore they provide less cardiovascular protection in the long run. The patch and transdermal creams are not entirely without value. There are a few women with certain types health histories, where oral estrogen is contraindicated and transdermal estrogen replacement may be appropriately recommended. However, this is not the case for the great majority of women. Oral estrogen have many more health protective benefits than does transdermal estrogen and therefore the preferred form of estrogen.” (Dr. Rouzier’s webinar thoroughly discusses Estrogen in Women)

When it comes to oral estrogen, medical studies have found that oral e2 estradiol is the safest and most effective form, because it avoids inherent side effects related to oral CEE. The Women’s Estrogen for Stroke Trial (WEST) found oral estradiol was not associated with increased blood clots, but an increase in blood vessel inflammation and clotting was due to ten biologically active estrogens that are in CEE (Premarin). These active estrogens are not found in estradiol.

Conclusion

Prescribing the right form of estrogen should be considered on an individual basis. Older women (age>60) that have never taken oral estrogen are advised to take transdermal estrogen to avoid the risk of myocardial infarction or stroke. Additionally, transdermal estrogen is the best choice for women that have a history of clotting disorders. For women that do not have these established factors, oral estradiol is the best choice for protecting the heart from cardiovascular disease and hypertension risks that increase dramatically in menopausal women.

References

1. Billeci AM, Paciaroni M, Caso V, Agnelli G. Hormone replacement therapy and stroke. Curr Vasc Pharmacol. 2008;6(2):112-123.
2. Chu MC, Cosper P, Nakhuda GS, Lobo RA. A comparison of oral and transdermal short-term estrogen therapy in postmenopausal women with metabolic syndrome. Fertil Steril. 2006;86:1669-1675.
3. Hendrix SL, Wassertheil-Smoller S, Johnson KC, et al. Effects of conjugated equine estrogen on stroke in the Women’s Health Initiative. Circulation. 2006;113:2425– 2434.
4. Ho JY, Chen MJ, Sheu WH, Yi YC, Tsai AC, Guu HF, Ho ES. Differential effects of oral conjugated equine estrogen and transdermal estrogen on atherosclerotic vascular disease risk markers and endothelial function in healthy postmenopausal women. Hum Reprod. 2006;21(10):2715-2720.
5. Mendelsohn ME, Karas RH. Protective effects of estrogen on the cardiovascular system. N Engl J Med. 1999;340:1801–1811.
6. Menon DV, Vongpatanasin W. Effects of transdermal estrogen replacement therapy on cardiovascular risk factors. Treat Endocrinol. 2006;5(1):37-51.
7. Nelson HD, Humphrey LL, Hygren P, Teutsch SM, Allan JD. Postmenopausal hormone replacement therapy. Scientific review. JAMA 2002;288:872–881.
8. North American Menopause Society. Amended report from the NAMS Advisory Panel on postmenopausal hormone therapy. Menopause. 2003;10:6-12.
9. Scarabin PY, et al. Differential association of oral and transdermal oestrogen-replacement therapy with venous thromboembolism risk. Lancet. 2003;362(9382):428–432.
10. Smith NL, Heckbert SR, Lemaitre RN, Reiner AP, et al. Esterified estrogens and conjugated equine estrogens and the risk of venous thrombosis. JAMA. 2004 Oct;292(13):1581-1587.
11. Vehkavaara S, Silveira A, Hakala-Ala-Pietila T, Virkamaki A, et al. Effects of oral and transdermal estrogen replacement therapy on markers of coagulation, fibrinolysis, inflammation and serum lipids and lipoproteins in postmenopausal women. Thromb Haemost. 2001;85(4):619-625.
12. Verhoeven MO, Hemelaar M, Van Der Mooren MJ, Kenemans P, Teerlink T. Oral, more than transdermal, oestrogen therapy lowers asymmetric dimethylarginine in healthy postmenopausal women: a randomized, placebo-controlled study. J Intern Med. 2006;259:199-208.
13. Viscoli CM, Brass LM, Kernan WN, Sarrel PM, et al. A clinical trial of estrogen replacement therapy after ischemic stroke. N Engl J Med. 2001;345:1243-1249.
14. Vongpatanasin W, et al. Differential Effects of Oral Versus Transdermal Estrogen Replacement Therapy on C-Reactive Protein in Postmenopausal Women . J of Amer Coll Cardio. 2003;41(8):1358–1363.

Medical Webinar- The Evidence Behind Hormone Optimization: Estrogen in Women

June 17, 2011 WorldLink Blog,Medical Webinars 0 comments

As usual, Dr. Neal Rouzier attracted a massive crowd of students seeking to learn about natural estrogen replacement therapy. Definitely one of the most profound Q&A sessions I have experienced yet…CLICK HERE for the recording.

This age management webinar will review the literature supporting optimal hormone levels for Physicians and Healthcare Practitioners interested in Natural Hormone Therapy. Although most Physicians are fully aware of replacing hormones in cases of sub-normal levels, most have not been trained to optimize hormone levels no matter what the baseline level is. A multitude of studies will be discussed to provide Healthcare Practitioners with accurate knowledge regarding the risks and benefits when implementing BHRT into practice. Specifically the webinar will focus on Estrogen Levels in Women.

Objectives

Have command of the literature that supports optimization.

What type of estrogen is preferred and when?

Which estrogen is beneficial and which one is worthless?

Is the “safe” estrogen really that safe?

Clearing Up Controversy about Hormones and Cancer: Dr. Neal Rouzier, M.D. provides insight.

May 31, 2011 WorldLink Blog 0 comments

Medical Webinars:

Hormone Q&A

Neal Rouzier, M.D.

The Obesity Epidemic

Timothy McKnight, M.D.

Estrogen Optimization

Neal Rouzier, M.D.

Since the 2002 report known as The Women’s Health Initiative (WHI) Trial, Prempro sales have fallen to $161 million annually and more than 10,000 lawsuits have been filed against Pfizer by women, who declared the company’s HRT drug lead to their development of breast cancer and other health ailments. Pfizer Inc. recently set aside $772 million to settle these cases.

Hormone replacement therapy (HRT)

Hormone replacement therapy (HRT)- a $2.2 billion industry, has been promoted by the medical establishment as a means to reduce vasomotor symptoms and decrease postmenopausal health risks. During the 1990’s, Pfizer and Wyeth had a strong hold on the HRT industry by selling Premarin, Provera, and Prempro (a combination of the two) to more than six million women.

Fears of Hormones and Cancer

Fears of Hormones and Cancer- It wasn’t until 2002 that the WHI trial found these synthetic hormones increased breast cancer, heart disease, and stroke risks among menopausal women. Researchers admonished women to stop taking HRT, while critics asserted these results were inaccurate declaring HRT benefits outweighed the risks. With two opposing views, confusion escalated among physicians and patients.

Re-analysis of the WHI data and findings from other studies demonstrated that the health risks did not apply to women under 60 years old. While breast cancer risks increased when estrogen and progesterone were combined, further analysis of the WHI trial found that the estrogen-only group didn’t have an increase in breast cancer risks. In fact, breast cancer risks decreased in this group.

Clearing the Confusion

Clearing the Confusion- A review of the WHI trial may clarify the risks of synthetic HRT, but it doesn’t mean these hormones are harmless. According the National Institutes of Health, long-term use is not recommended, but taking HRT at the lowest possible dose for the shortest amount of time can provide some benefit for menopausal women, including a reduction in osteoporosis risks.

This statement, combined with media attention and the WHI study itself, have sparked extensive concern that hormones are harmful and should be taken for the shortest time necessary to control perimenopausal symptoms. Dr. Neal Rouzier has clarified this concern through intensive study, stating that, “I agree with this statement ONLY if the hormones are synthetic, like Premarin and Provera. The combination Premarin and Provera have demonstrated an increased risk of breast cancer, strokes and heart attacks. However, do not extrapolate the harm of synthetic hormones to bioidentical HRT. Natural progesterone has never been demonstrated, in any study, to increase these risks whereas Provera has definitely been shown to increase these risks. Natural progesterone has been shown to decrease the risk of breast cancer, whereas Provera increases breast cancer in every study to date. Natural estradiol has been proven to not have the clotting or inflammatory properties as does Premarin.”

The Natural Answer

The Natural Answer- Fortunately, there are sharply contrasting alternatives to synthetic HRT which actually have shown to help protect against cancer. Bioidentical HRT is a substantially effective treatment for menopausal symptoms that also protects women from the many other risks associated with low hormone levels. Over 50 years of studies indicate that restoring hormones to premenopausal levels protects women from health risks and encourages well-being. Bioidentical hormones are the safest and most effective way to ensure optimal hormone levels. Bioidentical hormones should not be confused with synthetic HRT, as they are far superior to their synthetic counterpart.

References

1. Campagnoli C, Clavel-Chapelon F, Kaaks R, Peris C, Berrino F. Progestins and progesterone in hormone replacement therapy and the risk of breast cancer. J Steroid Biochem Mol Biol. 2005; 96(2):95-108.
2. Gambrell RD. The Women’s Health Initiative reports: Critical review of the findings. The Female Patient. 2004; 29:25-41.
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Melatonin for Sleep and 4 Additional Ways to Improve Sleep Naturally.

May 23, 2011 WorldLink melatonin for sleep Blog 0 comments

Medical Webinars:

Hormone Q&A

Neal Rouzier, M.D.

The Obesity Epidemic

Timothy McKnight, M.D.

Estrogen Optimization

Neal Rouzier, M.D.

Dr. Rouzier recently provided some tips in response to an online publication writer who asked the question, “What are some tips on how to avoid sleep disruptions when season’s change?” I thought it would be appropriate to post here and expand on natural sleep in general. Read the tips below and feel free to provide your own based on your knowledge and experience.

1) Maintain a consistent sleep/wake cycle

Wake up at the same time EVERY morning and NEVER sleep-in to make up loss of sleep. Although your sleep may be slightly thrown off by a 1 hour time change, this will only have a minimal effect if your body already has a strong backbone of healthy sleep hygiene. What this means is if you wake up at the same time every morning, despite if you got 8 hours of sleep or 5 hours of sleep, your body will eventually fall into a natural sleep/wake cycle based on that wake up time. This will eventually turn into a regular 8 hours of sleep, or whatever amount your body naturally requires. This behavior modification is the most important component of strengthening your “body armor” against seasonal time changes.

2) Do not use sleep medication unless you have severe insomnia.

There are a variety of sleep medications out there that will certainly get you to sleep, but will make your body more dependent on them than that of seasonal change. Taking such medications will only contradict your body’s natural sleep wake cycle mentioned in tip #1.

3) Take a melatonin supplement to help you get into a regular sleep/wake cycle.

Melatonin is a natural hormone that is already produced by our bodies, and we depend on this hormone in order to fall asleep and stay asleep. Studies have shown that taking melatonin for sleep not only helps you to fall asleep, but also puts you into a deeper level of sleep, which is crucial to feeling rested during the day. Also, melatonin is non-addictive and will certainly make seasonal change less disruptive. If your Health Care Provider is not familiar with melatonin, then search for one who is well versed in natural hormones. This will determine what your optimal dose should be and to make sure you are taking a high quality melatonin supplement, typically dispensed by a compounding pharmacy. Melatonin is also a bio identical, natural hormone that is not a drug or addicting, only a healthy supplement that possesses many other health benefits. Recent studies demonstrate its protection against many different cancers.

4) Replacing estrogen and progesterone makes all the difference in the world as to how one sleeps and functions.

If a woman is newly menopausal, then she may be suffering sleep deprivation as the result of loss of her hormones, which also results in significant health detriments, as well as feeling poorly. We never advocate hormone replacement with chemically altered synthetic hormones which studies have shown to be harmful to a woman’s health. However studies demonstrate that loss of hormones is also very harmful to one’s health and well-being. Replacement must be in the form of the identical hormones that the body makes normally, commonly termed bio identical or natural hormones.

5) Limit caffeine during the day and alcoholic beverages at night.

Drinking coffee or caffeinated sodas during the day, particularly after 12pm, is likely to make falling asleep more difficult. If you drink too much alcohol at night, this will do one (or all) of three things: 1. Make you fall asleep at a lower quality of sleep 2. Make you become dependent on alcohol for sleep, which will of course defeat the purpose of maintaining a healthy sleep/wake cycle 3. May have an adverse effect and keep you awake.

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