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?

(c) 2012 Stages of Life Medical Institute

Natural Hormone Therapy or Xenohormone Therapy?

(c) 2012 Stages of Life Medical Institute

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.

(c) 2012 Stages of Life Medical Institute

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?

(c) 2012 Stages of Life Medical Institute

Command and Control

¨ Hard wired mechanisms– Nerve

¨ Wireless mechanisms– Hormonal– Humoral– Chemical

(c) 2012 Stages of Life Medical Institute

Physiological Command and Control Mechanisms

• Neuronal– Motor

• Distinct & precise

– Sensory• Regional,

predictable, broader areas

– Autonomic• Global

• Hormonal• Regional, organs &

tissues?• Global

(c) 2012 Stages of Life Medical Institute

Common Endocrine Concerns

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

(c) 2012 Stages of Life Medical Institute

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

(c) 2012 Stages of Life Medical Institute

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

(c) 2012 Stages of Life Medical Institute

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.

(c) 2012 Stages of Life Medical Institute

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

(c) 2012 Stages of Life Medical Institute

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.

(c) 2012 Stages of Life Medical Institute

A Decrease in Libido is a

Sign of Illness

(c) 2012 Stages of Life Medical Institute

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.

(c) 2012 Stages of Life Medical Institute

Saliva Testing

• Estrogen– Estradiol– Estriol

• Testosterone• Progesterone• Cortisol• DHEA

(c) 2012 Stages of Life Medical Institute

Hormonal Blood Testing• Estrogens, Total

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

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

(c) 2012 Stages of Life Medical Institute

Cellular Testing

• Micronutrients• Anti-oxidants• Trace Minerals

(c) 2012 Stages of Life Medical Institute

Testosterone, Estrogen & Progesterone Balance

(c) 2012 Stages of Life Medical Institute

HRT is all about Balance

(c) 2012 Stages of Life Medical Institute

Medical Treatment

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

that may result in dysfunctional States.

(c) 2012 Stages of Life Medical Institute

Hormone Replacement Priorities

• Always start with the Thyroid

• Next, address the Adrenals

• Then, deal with the Gonadals.

(c) 2012 Stages of Life Medical Institute

Administration Techniques

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

¨ Oral Route

¨ Parenteral Approach

(c) 2012 Stages of Life Medical Institute

Success Results From a Team Effort.

(c) 2012 Stages of Life Medical Institute

Questions?

(c) 2012 Stages of Life Medical Institute