a4 m 5 19-12 comprehensive hormone replacement therapy v 1.1

Professional Education Series

David S. Klein, MD, FACA, FACPMStages of Life Medical Institute

Longwood, Florida

Comprehensive Hormone

Replacement Therapy

In the Traditional Medical Setting

Hormone Replacement Therapy?

¨ Where do you start?

¨ What are your goals?

¨ What tools do you have at your disposal?

(c) 2012 Stages of Life Medical Institute

What is Hormone Replacement Therapy• More importantly,

– What hormones do we address?– What hormones are most critical to assess?– How do you plan your assessment?– In what order, and in what manner do you

initiate corrective/therapeutic action?


Natural Hormone Therapy or Xenohormone Therapy?


The first responsibility of the clinician is to determine the most precise diagnosis possible.

This is accomplished first with a detailed history, physical, and only then, laboratory measurement.


Why are we concerned with hormone balance, anyway?

• What are hormones?• Why are they important?• What happens when the system

breaks?• What options are available to correct

and restore balance?


Command and Control

¨ Hard wired mechanisms– Nerve

¨ Wireless mechanisms– Hormonal– Humoral– Chemical


Physiological Command and Control Mechanisms

• Neuronal– Motor

• Distinct & precise

– Sensory• Regional,

predictable, broader areas

– Autonomic• Global

• Hormonal• Regional, organs &

tissues?• Global


Common Endocrine Concerns

• Common– Thyroid Axis– Adrenal Axis– Pancreatic Axis– Gondal Axis– Parathyroid


Populations at risk• Thyroid Disease affects 1/3 of the American Adult

population.• Diabetes, pre-diabetes and ‘metabolic syndrome X’

affect 1/3 or more of the American population.• Adrenal Dysfunction affects 15% of the American

population.• Gonadal Hormone dysfunction will affect nearly

100% of the adult population, at some time.

“Do you feel lucky…., punk..” Clint Eastwood


Bodily Fluid Analysis• Serum

– Traditional– Influenced by diurnal variation & timing

• Urine– Gives indication of cellular function from the

‘back end.’• Saliva

– Assumes neutrality of salivary tissues relative to metabolism.

– Assumes lack of concentration issues


Advantages & Disadvantages

• Each testing tells a part of the story

• No single part tells it all

• Each piece adds to an understanding of the whole picture.


Estrogen Dominance

Definition: Elevated ratio of measured estrogen level, relative to

progesterone level.

Second only to Thyroid Dysfunction,

Estrogen Dominance is the Most Common Dysfunction in Females


Causes of Imbalance

• 1. Gonadal Dysfunction– Ovarian Dysfunction

• 2. Pain – Narcotic

• 3. Medication side-effect• 4. Stress• 5. Dietary Imbalance, over

time(c) 2012 Stages of Life Medical

Institute

Libido Decreases with Estrogen Dominance

• Progesterone imbalance leads to vaginal dryness.

• Relative estrogen elevation leads to emotionality, lability and irrationality.

• Sexuality is a sign of health.


A Decrease in Libido is a

Sign of Illness


Medical Evaluation

• Detailed medical/social history.– An ongoing process.– Many factors & facts are noted over time.

• Assume that the depression is secondary to the problem.

• Begin with hormonal evaluation.


Saliva Testing

• Estrogen– Estradiol– Estriol

• Testosterone• Progesterone• Cortisol• DHEA


Hormonal Blood Testing• Estrogens, Total

– Estradiol & Estrone• Progesterone• Testosterone, total• DHEAs• Androstendione• Insulin• Thyroid

– T3, T4, TSH, TPA, Anti-thyroglobulin


Cellular Testing

• Micronutrients• Anti-oxidants• Trace Minerals


Testosterone, Estrogen & Progesterone Balance


HRT is all about Balance


Medical Treatment

• Restore normal sleep cycle.• Restore normal hormone levels.• Eliminate or reduce medications

that may result in dysfunctional States.


Hormone Replacement Priorities

• Always start with the Thyroid

• Next, address the Adrenals

• Then, deal with the Gonadals.


Administration Techniques

¨ Transdermal Route– Creams– Patches– Sub Lingual, trans-clitoral

¨ Oral Route

¨ Parenteral Approach


Success Results From a Team Effort.


Questions?


a4 m 5 19-12 comprehensive hormone replacement therapy v 1.1

Health & Medicine

medical treatment

females c

overtime c

traditional medical

antithyroglobulin c

sign of illness c

lack of concentration

gonadal hormone dysfunction