This document summarizes key points about balancing thyroid, adrenal, and sex hormones for optimal health and mental wellness. It discusses how these hormone systems can become imbalanced, leading to fatigue, depression, and other symptoms. The document contrasts an "optimal" level of hormone functioning with merely being in the "normal" range. It also critiques conventional medical approaches and advocates an integrated approach considering all aspects of these hormone systems.
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Thyroid, Adrenals, & Sex Hormones: A Balancing Act
1. Thyroid, Adrenals & Sex Hormones: A Balancing Act Louis B. Cady, MD – CEO & Founder – Cady Wellness Institute Adjunct Professor – University of Southern Indiana Adjunct Professor – Indiana University School of Medicine Integrative Medicine for Mental Health Conference Sedona, Arizona September 17-18, 2011
2. Framework for this presentation: “ Slumber not in the tents of your fathers. The world is advancing. Advance with it.” - Giuseppe Mazzine
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4. American Journal of Health Promotion; November/December, 2002 19% of those surveyed were completely healthy with high levels of both physical and mental health and a low level of illness . 18.8% completely unhealthy, defined as having low levels of health with high levels of illness. Two-thirds of the adults reported some degree of mental or physical illness that kept them from being completely healthy. “ Incompletely healthy.” HEALTH continuum DEAD OPTIMAL 66% “ Incompletely healthy”
9. “ Age management” “Conventional practice” There are fuel additives we can use to keep our cars burning cleaner and preserve engines. No fuel additives should be used. They are unnatural. Gas is all that is required. We should use optimal quality of gas. Cheap gas causes “pinging” which is hard on the engine. The quality of the gas is irrelevant. Anything that the motor will burn is adequate. We should take our car in for preventive maintenance before anything breaks. Preventive maintenance? This is silly! Wait until something breaks, then have the car towed in so the mechanic can really tell what is wrong.
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13. Stahl, SM. Symptoms & Criuits, Part 1 Major Depressive Disorder. “Brainstorms.” J Clin Psych 64:11, Nov 2003:1282-1283. “ Each symptom may be mediated by separate and distinct neuronal [AND PHYSIOLOGICAL – (Cady)] circuits.”
14. Toward an INTEGRATED approach: Death Optimal Health Traditional Medicine Functional & Informed Lab Testing No Disease = Health Vitamins , HRT, Nutrition, Exercise INTEGRATED Medicine Diagnose and Treat Disease New Drugs New Surgical Techniques Forestall and PREVENT Disease – Optimize Mood & Function
23. “ Thyrotropin (Thyroid-Stimulating Hormone or TSH). Measuring TSH is the most sensitive indicator of hypothyroidism. ” (hunh?!) http://www.umm.edu/patiented/articles/how_serious_hypothyroidism_000038_6.htm Accessed: 9/5/2011
24. “ the foot soldier” “ the evil twin ” CORTISOL Se
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26. Transthyretin (a systemic amyloid precursor) may be protective for Alzheimer’s (Why?) Li X et al. J Neurosci 2011 Aug 31;31(55):12483-90
27. Per HRSD – 17, remission in: 15.9% on Li 24.7% on T3 Per QIDS-SR16, remission in: 13.2% on Li 24.7% for T3 * * Fava & Covino: Augmentation/Combination Therapy in STAR*D Trial, Medscape Psychiatry LEVEL III RESULTS:
34. The state of adrenal exhaustion can be determined Early-stage Chronic Stress Response Mid-stage Chronic Stress Response End-stage (exhausted) Chronic Stress Response
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36. 334 citations on “DHEA with energy” – as of 07 29 2011
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38. Modern Medicine ’s Paradigm: 2 Standard Deviations – a model “ NORMAL” OPTIMAL
39. 432 citations on DHEA with depression as of 9/5/2011 “ Neuroeconomic paramaters predicted to be related to suicidal behavior. ” DHEA is related to these, acting in amygdala. Low levels of DHEA/DHEA-S assoc. with depression, as per Western studies. “DHEA was significantly assoc. w/ [Chinese] Geriatric Depression Scale (GDS).”
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41. Source: Maninger, N et al : Front Neuroendocrinol. 2009 Jan;30(1):65-91. Epub 2008 Dec 3.
54. Hx of Baseline Health Characteristics (total # of participants 16,608) 37% 11% 2%
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70. “ Hence, among older men reporting excellent asymptomatic health , age has no effect on serum T or E2 with a minor increase in DHT while obesity decreases serum androgens…”
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73. T vs Cognitive Function Rosario ER. JAMA . 292(2004):1431-2
74. T vs Cognitive Function Rosario ER. JAMA . 292(2004):1431-2 “ Testosterone depletion likely precedes and thus may contribute t o rather than result from the development of AD, since low brain testosterone is observed in men with early indications of AD neuropathology”
79. HOW OBVIOUS DOES IT HAVE TO BE? The Challenge of Empathic Listening & CREATIVE THINKING Ron Hunt lost an eye but suffered no brain damage after a freak accident with a large drill bit. (ABCNEWS.com)
80. Do you really want to try 100,000 miles without changing the oil?
81. Definition of ‘normal’ – “where your hormone levels are as lousy as everyone else’s.” Neal Rouzier, MD “ NORMAL” OPTIMAL
82. American Journal of Health Promotion; November/December, 2002 HEALTH continuum DEAD OPTIMAL 66% “ Incompletely healthy ” * *“treatment resistant”?
83. “ For me, the practice of medicine has opened the door to the greatest adventure in life. Medicine is like a hallway lined with doors, each door opening into a different room, and each room opening into another hallway, again lined with doors. Medicine is always wonderful and never will be finished. ” - Charles H. Mayo, M.D.
84. Extra slides for further background follow in notes Contact info: Louis B. Cady, M.D. www.cadywellness.com Office: 812-429-0772
85. Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity. - World Health Organization
89. Indole-3-Carbinol – good with or without HRT (for women AND men) Estradiol 16 alpha-OH Estrone (Ca) 4-OH Estrone (B) 2-OH Estrone (B) I3C “ I-3 C raises the 2:16-OH Estrogen ratio” N.B.: available from LabCorp
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Editor's Notes
Giuseppe Mazzini (22 June 1805 – 10 March 1872), nicknamed "Soul of Italy,"[1] was an Italian politician, journalist and activist for the unification of Italy. His efforts helped bring about the independent and unified Italy[2] in place of the several separate states, many dominated by foreign powers, that existed until the 19th century. He also helped define the modern European movement for popular democracy in a republican state. [ citation needed ] – Source - Wikipedia
Depressed mood is the most commonly cited symptom in major depressive disorder. Studies have shown that fatigue and reduced energy are nearly as common as depressed mood. As many as 94%-97% of patients may experience reduced energy and fatigue, while 73% may complain of tiredness. Impaired concentration is also common and occurs in as many as 84% of patients. Hypersomnia, or excessive sleepiness as opposed to physical weariness, is less common and occurs in 10%-16% of patients.
Addison ’s disease, like so many medical conditions, has a history of being ignored, hidden, and misunderstood. It is a rare disease that affects about one in every 100,000 Americans and is usually diagnosed around age forty.
Asian J Androl. 2011 Aug 29. doi: 10.1038/aja.2011.116. [Epub ahead of print] Low DHEAS levels are associated with depressive symptoms in elderly Chinese men: results from a large study. Wong SY, Leung JC, Kwok T, Ohlsson C, Vandenput L, Leung PC, Woo J. Source School of Public Health and Primary Care, School of Public Health, The Chinese University of Hong Kong, Hong Kong, China. Abstract This study investigated the association between depressive symptoms in elderly Chinese men and the total testosterone, dehydroepiandrosterone (DHEA), DHEA sulphate (DHEAS), oestradiol and sex hormone-binding globulin (SHBG) levels, and the free androgen index. Cross-sectional data from 1147 community-dwelling elderly men, aged 65 and older, were used. Depressive symptoms were measured using the Chinese Geriatric Depression Scale (GDS). Total testosterone, free testosterone, DHEA, DHEAS, total oestradiol, the free androgen index and SHBG levels were assessed. DHEA was significantly associated with GDS score, and there was a trend towards DHEAS association, but this was not significant (β=-0.110, P=0.015; β=-0.074, P=0.055). However, no association was seen between depressive symptoms and total testosterone levels, free testosterone levels, oestradiol levels or SHBG levels. In terms of the presence of clinically relevant depressive symptoms, there were no statistically significant differences between patients in the lowest quartile of sex steroid hormone levels and those in other quartiles of sex steroid hormone levels. Similarly to Western studies, our study shows that DHEA and DHEAS levels are associated with depressive symptoms.Asian Journal of Andrology advance online publication, 29 August 2011; doi:10.1038/aja.2011.116.
Front Neuroendocrinol. 2009 Jan;30(1):65-91. Epub 2008 Dec 3. Neurobiological and neuropsychiatric effects of dehydroepiandrosterone (DHEA) and DHEA sulfate (DHEAS). Maninger N, Wolkowitz OM, Reus VI, Epel ES, Mellon SH. Graphic summary from the article, by the authors: Mechanisms of action of DHEA and DHEAS in neurons. “This cartoon summarizes many of the actions of DHEA and DHEAS described in detail in the text. DHEA and DHEAS have inhibitory effects (red blocking arrow) at the GABA A receptor (section 6 and 7.1). DHEA and DHEAS act as agonists (green arrow) at the σ 1 receptor (section 6 and 7.1), which subsequently may activate the NMDA receptor. DHEA inhibits Ca 2+ influx (red blocking arrow) into the mitochondria (section 7.1). DHEA influences embryonic neurite growth through stimulation (green arrow) of the NMDA receptor (section 7.2). DHEA increases (green arrow) kinase activity of Akt and decreases apoptosis, while DHEAS decreases (red blocking arrow) Akt and increases apoptosis (section 7.4). DHEAS increases (green arrows) TH mRNA and TH protein abundance (section 7.5) leading to increased catecholamine synthesis. DHEA and DHEAS stimulate (green arrows) actin depolymerization and submembrane actin filament disassembly and (green arrows), increasing secretion of catecholamines (“da” and “ne”) from secretory vesicles (section 7.5). DHEA and DHEAS inhibit (red blocking arrow) reactive oxygen species (ROS) activation of transcription mediated by NF-κB (section 7.6 and 7.7). DHEA inhibits (red blocking arrow) nuclear translocation of the glucocorticoid receptor (GR) (section 7.8). Mechanisms of action not pictured in this graph are: alterations of brain derived neurotrophic factor (BDNF) synthesis, inhibition of stress-activated protein kinase 3 (SAPK3) translocation, and inhibition of 11β-hydroxysteroid dehydrogenase type 1 (11β-HSDl) activity. Abbreviations: σ 1 , sigma 1 receptor; Akt, serine-threonine protein kinase Akt; Ca 2+ , calcium; da, dopamine; GABA A , γ-aminobutyric acid type A receptor; GR, glucocorticoid receptor; ne, norepinephrine; NF-κB, nuclear factor kappa B; NMDA, N -methyl-D-aspartate receptor; ROS, reactive oxygen species; TH, tyrosine hydroxylase.”
One goal is to rectangularize the health span curve. I.e. to improve vitality from middle age onward.
These symptoms correlate to decrease in bioavailable testosterone
RIA (in-house after diethylether extraction) Total testosterone - T (RIA) 208-1141ng/dL, average 536+/-153ng/dL Bioavailable testosterone - BT (calculated) 78-470ng/dL, average 236+/-63ng/dL
Hypogonadal if TT < 200ng/dL or FT < 0.9ng/dL