1. P A U L E . C O X M D , M S
O C U L U S S K I N C A R E , L A S E R A N D L O N G E V I T Y
What you must know about
hormone optimization for Men

2. Paul E. Cox MD, MS
 Master’s in Exercise Physiology, UT Knoxville, 1995
 University of Tennessee Medical School, Memphis,
1999
 Board Certified in Family Medicine 2002, 2009
 Fellowship trained in Anti-Aging Medicine 2008
 Board Certified in Anti-Aging Medicine 2009
 Oculus Skincare, Laser and Longevity center 2012

3. What is Regenerative or Integrative Medicine?
 The field of scientific research aimed at the early
detection, prevention, treatment and reversal of age
related decline.
 We accomplish this by the optimization of the body’s
mechanisms of self repair with hormones, lifestyle
and neutraceuticals (vitamins and herbal
supplements).

4. Integrative medicine
 We focus on the unique biochemistry of each
person to tailor unique interventions to restore
balance.
 Current medical model is broken
 Short office visits with long wait times
 Impersonal service with a prescription to cover up
symptoms but not address the real problem

5. Why Regenerative Medicine
 No education provided to patients to explain the
difference between disease and optimal health
 Stressed and overworked doctors are unaware of the
latest medical evidence
 The current medical model is dedicated to preserving
compromised health rather than improving health

6. Functional Medicine
 Functional medicine is the integrative ,science based
approach to healthcare that treats illness and
promotes wellness by focusing on the unique
biochemistry of each person to tailor unique
interventions to restore balance.

7. Steroid Hormone Pathway

8. Why do hormone systems fail?
 Stress
 Decline with age
 Chronic disease (Diabetes)
 Medications ( pain, cholesterol, blood pressure )
 Genetic factors
 Environmental factors (pesticides, plastics,
pollution)
 Poor nutrition

9. Thyroid disorders
 The most common autoimmune disease causes
thyroid hormone deficiency.
 Lack of thyroid hormone can cause hair loss, weight
gain, intellectual slowing and depression.
 More common in women than men and frequently
runs in families.

10. Thyroid hormone pathway

11. Why does Testosterone matter?
 More than 14 million men in the US over 45 have low
testosterone
 Low testosterone is associated with a higher risk of
diabetes, cardiovascular disease and bone mineral
loss (osteoporosis).
 A 2006 Study showed a higher mortality rate in
veterans with low testosterone (35%) than those with
normal levels (20%)

12. Andropause (testosterone deficiency)
 As men age testosterone levels decline 1-2% yearly
from the late 20’s on average.
 Testosterone maintains muscle mass, bone density
and sexual health.
 Unlike menopause in women, loss of testosterone is
usually gradual so men may not realize it is
happening.

13. Symptoms of Andropause
 Depressed
 Fat
 Sleepless
 Tired/ Anxious
 Disinterested
• Achy
• Fatigued
• Memory loss or brain
fog
• Loss of sexual desire
or function

14. How do I know if I need hormone replacement?
 Documented deficiency on labs.
 Symptoms of deficiency on surveys or
questionnaires. Apathy, ED, low libido, fat gain, low
energy, poor sleep, irritability, “half a man”
 No contraindications to treatment

15. Testosterone and the Prostate
 Testosterone does not cause prostate cancer
 Low testosterone levels may be a risk for prostate
cancer
 A testosterone metabolite can cause BPH symptoms
in some men

16. Testosterone optimization
• Non Bio-
identical
• Anabolics
Injectables
• Winstrol
• Dyanabol
• Bio-identical
• Gels
• Solutions
• Implants
• hCG

17. Bio-identical Hormones
 Really “Human identical”
 What does it mean?
 The exact same chemical structure that your body would
produce.
 Why is that important?
 Allows the body to
 Recognize
 Utilize
 Metabolize

18. What Labs do I need?
 TSH-
 Free T3-
 Free T4-
 Testosterone-
 Estradiol-
 LH*-
 PSA
 CBC- to monitor blood cell production after starting
therapy

19. hCG
 Used to stimulate the production of testosterone by
the body.
 A favored plan for young men who desire continued
fertility.
 Must be injected 1-3 times weekly.
 May not work in all cases.

20. Testosterone gels
 Androgel/Fortesta/ Testim/compounded
 Applied to skin daily at specific sites.
 Not everyone absorbs gels well.
 Available commercially (insurance might
pay)
 Must be careful about transference to
loved ones and friends.
 Odor may be objectionable (testim).

21. Testosterone solution
 Axiron
 Applied to the underarm/side area daily
 Usually better absorbed than gels
 May be messy
 Insurance may pay
 Risk of transference or product wasting due to
difficulty with usage.

22. Testosterone Implants
 Proven technology for over 60 years
 Steady state of hormone release closely
mimics the body’s
 Easier to obtain optimal levels
 Less roller coaster effect
 Easy dosing, most people receive them 2
times yearly

23. Testosterone Implants
 Convenient for those who travel
 Minimally invasive procedure
 Must decrease exercise for 1-2 weeks while incision
heals.

24. Hormone Optimization
• Not all hormone therapies are created
equal
• Hormone replacement therapy is not a
“one-size-fits-all” approach
• You need a program based on your
personal/family history and your lifestyle.

25. After hormone optimization
 The age optimized person is hormonally,
nutritionally, cardiovascularly, metabolically,
aesthetically and neurologically balanced.

26. Expected benefits
 Increased energy levels
 Restored interest in life
 Increased sexual drive
 Consistency in moods
 Relief from anxiety and depression
 Increased mental clarity
 Decreased body fat and better exercise tolerance
 Better sleep

27. Patient Testimonial
“I go my life back! I feel like I am 25, not 54. I am
able to work out and be active again. This is a
miracle that continues to amaze me and
everyday I am thankful for it.”
Kristie B.

28. “After two appointments of hormone replacement
implant therapy, my life has really changed. People
at work have commented on how sharp my
memory is. My energy level is higher than most of
the younger people I work with. And since my wife
is also receiving implant therapy, we are both
thrilled at the change in our libido. We are back to
the way we were when we first met; our marriage
really couldn’t be better!”
William H.
Patient Testimonial