1. Bioidentical Hormone Restoration Best Medical Practice Henry@hormonerestoration.com

4. Hormones and Aging Why Doctors Don’t Get It

6. Pregnenolone—Mother Steroid J Clin Endocrinol Metab. 1997 Aug;82(8):2396-402.

7. DHEA  DHEA-S J Clin Endocrinol Metab. 1997 Aug;82(8):2396-402.

8. Growth Hormone (GH) Somatopause J Clin Endocrinol Metab. 1999 Jun;84(6):2013-9. Normal Adults Pituitary Disease fatigue Sufficiency Log scale

9. Testosterone Progesterone Estradiol pg/ml DHEA–10,000 pg/ml, DHEA-S 5,000,000 pg/ml ! ♀ ♀ ♂ ♂ Andropause Menopause

16. Hormones and Aging Any Questions?

17. Human Steroid Hormones Testosterone Estradiol Progesterone Cortisol DHEA

25. Normal Progesterone Dominance Ovulation Menstrual Cycle

26. Perimenopause Luteal Insufficiency=Estrogen Dominance Ovulation Menstrual Cycle Inadequate Luteal Phase shorter periods, early spotting

27. Perimenopause Anovulation=Estrogen Dominance Menstrual Cycle

28. Menopause Estrogen and Progesterone Deficiency

29. Also Uterine and Ovarian Cancer

33. Speroff L, Fritz M Clinical Gynecologic Endocrinology and Fertility, 7 th Ed.

36. Estrogen, Progesterone, and Osteoporosis Any Questions?

37. Total and Free Testosterone in Men Baltimore Longitudinal Study of Aging (BLSA). Harman et al., 2001

46. Testosterone Any Questions?

47. “ My doctor says that hormone replacement is dangerous and there’s no evidence that bioidentical hormones are safer!”

53. Premarin  Conjugated Equine Estrogens (CEE) Estradiol-17 β Dihydroequilin-17β CEE contains at least 10 estrogens, only 3 are human . CEE contains 3x more Dihydroequilin than Estradiol . DHE has 10% higher binding affinity for est. receptors. DHE binds far less to SHBG and has a slower metabolic clearance The most abundant estrogen in CEE is Equilin sulfate . Kuhl H, Climacteric 2005;8(Suppl 1):3–63 Human Horse

54. Estradiol Ethinyl estradiol EE cannot be inactivated by normal oxidation! EE does not interact with estrogen receptor  ! EE is 12,000-60,000 times more potent by weight! EE is much more thrombogenic than estradiol EE in Birth Control Pills Acetylene

55. Progesterone vs. Progestins Progesterone MPA (Provera  ) Megestrol  Every progestin has a different spectrum of androgenic, estrogenic, glucocorticoid , and progestational effects!

56. Progestin Zoo Kuhl, Climacteric 2005;8(Suppl 1) Progesterone NAMS-”Call ‘em all Progestogens”

57. Testosterone Substitution Testosterone Methyltestosterone Methyltestosterone ( in Estratest  ) aromatizes to an alien estrogen and increases risk of breast cancer , also causes liver damage and breast enlargement in bodybuilders Headlines: “Testosterone therapies increase risk of breast cancer.”

67. E3N-EPIC Study Bioidentical estradiol plus progesterone decreased the risk of breast cancer ! Int J Cancer. 2005 Apr 10;114(3):448-54. Cohort study 54,000 women 5.8 years f/u c/w WHI-- 16,000, 6 yr. f/u No Evidence that BHRT is safer?

68. ORDET Study Int. J. Cancer 112 (2004) (2), pp. 312–318. Higher progesterone= lower risk of breast cancer 6,000 women 5 yr. F/U

73. Hormone Substitution Any Questions?

81. Pharmaceuticals, Labs, and Thyroid Any Questions?

85. Normal Saliva Cortisol Profile

86. Cortisol Deficiency

87. Cortisol Deficiency —Normal Waking Cortisol

88. Depression —Elevated PM Cortisol

92. Cortisol and DHEA Any Questions?