Estrogen

Estrogen is a hormone found naturally in the human body, both in women and in lesser levels in men. A hormone is a chemical made by cells in your body that travel through the body to affect other cells.

Estrogen is made in the adrenal glands on top of the kidneys in both men and women. Women also make estrogen in the cells of the ovaries and some in breast tissue.
As women age there production of estrogen diminishes due to normal age related changes, genetics and as the outcome of certain disease processes. As this decline occurs the symptoms of menopause begin such as hot flushes, vaginal dryness, urinary stress incontinence, temperature regulation issues, dizziness, fatigue, irritability, and sweating. Other less obvious processes begin with this decline such as loss of estrogen’s protection against heart disease, stroke, osteoporosis, Alzheimer’s disease and memory disorders.

Replacement begins at menopause or surgical menopause although some symptoms can be relieved in “pre” and “peri” menopausal women.

Replacement is focused on prescribing Estradiol 2 (E2) as that is the primary form of estrogen that provides symptom abatement and long term protection.

In order to customize the estrogen replacement specific to you, we will measure your current level of estrogen and will review your symptoms of possible estrogen depletion. This will include a complete history and physical examination. After we review the benefits and any possible side effects of treatment and if you are agreeable, we will begin treatment. Any other medications or medical problems will be taken into consideration. We will trend over time your estrogen levels (E2) with your response to treatment by following your symptoms of estrogen depletion until you are in proper balance.

We will continue to monitor you to minimize any possible side-effects from too little or too much estrogen and monitor you for any other related medical problems.

Thyroid

The thyroid is a gland located in the lower, front portion of the neck. The thyroid gland itself is controlled by another gland, pituitary, located in the brain. The thyroid gland secretes two thyroid hormones, mostly T4 (thyroxine) but also some T3. T3 is the active hormone that is used at the cellular level. T4 has to be converted first into T3. These hormones regulate the many expressions of the body’s metabolism.

The thyroid regulates many things in the body including temperature, metabolism, cerebral function, and energy levels. It also increases fat breakdown resulting in weight loss as well as lowering cholesterol. When functioning normally, it protects against cardiovascular disease, cognitive impairment, fatigue, weight gain, and memory loss.

Since T3 is so widely used in the body there are over 200 symptoms related to thyroid deficiency including: weakness, coldness, tiresome, fatigue, thin hair, dry skin, thin nails, weight gain, increased body fat, loss of energy, loss of motivation, loss of cognition, loss of memory, mood disturbances, and a poor overall sense of well-being.

The symptoms of low thyroid vary widely but are notoriously for being nonspecific and mimicking many of the normal changes of aging. Frequently thyroid hormone levels fall slowly over time so the symptoms of low thyroid are slow in onset and insidious. Many times we attribute our symptoms to aging when in fact something can be done about it!

In order to customize thyroid replacement specific to you, we will measure your current level of thyroid hormones and will review your symptoms of possible thyroid depletion. This will include a complete history and physical examination. After we review the benefits and any possible side effects of treatment and if you are agreeable, we will begin treatment. Any other medications or medical problems will be taken into consideration. We will trend over time your thyroid levels with your response to treatment by following your symptoms of low thyroid until you are in proper balance.

We will continue to monitor you to minimize any possible side-effects from too little or too much thyroid and monitor you for any other related medical problems.

DHEA

Dehydroepiandrosterone (DHEA) is a hormone secreted primarily by the adrenal glands. DHEA itself is not felt to be active but it is a precursor to the active androgen hormones, testosterone and dihydrotestosterone. It results in a shift of a catabolic state to an anabolic or protein building state. By doing this it reduces cardiovascular risks by increasing lipolysis (decrease visceral fat). Studies suggest that it helps to stimulate the immune system, restore sexual vitality improves moods, decreases cholesterol and body fat. DHEA improves memory, increases energy, and is thought to have anti-cancer properties by enhancing the immune system. Declines in DHEA may contribute to loss of sleep, osteoporosis, and atherosclerosis.

Studies suggest that optimal DHEA levels reduce insulin requirement, plays a role in restoring immunity, preventing osteoporosis, increasing bone density, prevent diabetes, prevent heart disease, decreases visceral fat, it can improve mood and a sense of well-being, improves energy and memory.

Most people do not need supplement DHEA. In order to properly screen for potential benefit from DHEA replacement, we will measure your current level of DHEA hormones and will review your overall symptoms of health. This will include a complete history and physical examination. After we review the benefits and any possible side effects of treatment and if you are agreeable, we will begin treatment. Any other medications or medical problems will be taken into consideration. We will trend over time your DHEA levels with your response to treatment by following your symptoms until you are in proper balance.

We will continue to monitor you to minimize any possible side-effects from too little or too much thyroid and monitor you for any other related medical problems.

Testosterone

Human Growth Hormone

Human Growth Hormone (HGH) is a hormone excreted by the pituitary gland in the brain mostly during deep sleep.

HGH declines cause fatigue, poor muscle development, excessive body fat, decreased initiative, decrease endurance and strength, poor healing, decreased immunity, thin bones, sagging muscles, increased wrinkles, slow hair growth, sagging skin, breast, and abdomen.

Must document symptoms and ITT and IGF-1 levels to treat. IGF-1 to adjust dose.
Goal 300

Vitamin D

Melatonin

Progesterone

Progesterone is secreted only by the ovary – therefore menopausal levels =0
• Excellent therapy for PMS- but only in high doses
• Excellent therapy for menopause
• It decreases headache and bloating associated with menstruation when used in high doses.
• Only treatment for perimenopause Natural progesterone (MP)(OMP) protects against uterine and breast carcinoma, osteoporosis, fibrocystic disease, ovarian cysts, CAD.
• Synthetic progestins (MPA) frequently cause bloating, headache, fatigue, weight gain, depression, increased symptoms of PMS by stimulating the estrogen receptor, CAD, CVD, DVT, PE, dementia, CA, DM
• Micronfzed progesterone (MP) is not associated with any of these complications
• In fact, progesterone does the opposite There are progesterone receptor sites in the uterus, breast, vagina, bloodvessels and brain.
• All menopausai women need progesterone, uterus or not
• All menopausai women must take progesterone for protection against breast
• All menopausai women must avoid progestins to avoid breast CA, CAD, CVD There are progesterone receptor sites throughout the body resulting in biologic effects
• Progesterone moderates many side effects of excess estrogen – reduces fluid retention, bloating, headache, bleeding, fibroids
« Progesterone is synergistic to estrogen’s effect on bone & lipids

Low T Quiz

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Testosterone Therapy in Men: Potential benefits and risks

Are you considering testosterone therapy to help you feel younger and more vigorous as you age? Get to know the risks and benefits before you make your decision.
Having testosterone therapy may sound like a great idea. The desire to feel 20 years younger may make testosterone sound attractive according to popular advertising. But is this the right treatment for you? There are a lot of misconceptions about what the treatment can and can’t do for you. As you get older, testosterone therapy may sound like the ultimate anti-aging formula.
What is Testosterone? Testosterone is the male sex hormone which is produced in the testicles. Hormones are important for physical and mental health.

Testosterone is essential for:
• Normal male sexual development and functions
• Develop male characteristics such facial/body hair and deeper voice
• Muscle strength and mass
• Production of sperm
• Male sex drive
• Red blood cell production
• Bone density
• Fat distribution

What are the symptoms of low testosterone?

  • Lower sex drive
  • Fewer spontaneous erections
  • Loss of body hair
  • Less beard growth
  • Loss of lean muscle mass & strength
  • Feeling very tired all the time (fatigue)
  • Increased body fat / Obesity (being overweight)
  • Lower energy, endurance, and physical strength
  • Swollen or tender breast tissue (gynecomastia)
  • Poor memory
  • Insomnia or trouble sleeping
  • Trouble with finding words to say
  • Poor focus
  • Feeling sad or depressed
  • Not doing well at work
  • Decreased bone density
  • Decrease in motivation and self confidence
  • Erectile dysfunction

What Causes Low Testosterone? There are many reasons for low testosterone. Basically your testicles for whatever reason are producing less testosterone. In addition testosterone gradually declines with age — typically about 1 percent a year after age 30 or 40. It is important to determine in older men if a low testosterone level is simply due to the decline of normal aging or if it is due to a disease (hypogonadism). Hypogonadism is a disease in which the body is unable to produce normal amounts of testosterone due to a problem with the testicles or with the pituitary gland that controls the testicles. Low testosterone is a blood level lower than 300 ng/ dl in combination with any of the symptoms listed below.

  • Aging
  • Obesity (overweight)
  • Harm to testicles by accident
  • Removal of testicles (because of cancer or other reasons)
  • Chemotherapy or radiation
  • Medication side effects such as
  • Opioid or antidepressant use
  • Thyroid problems
  • Depression
  • Medical conditions you may be born with
  • Diabetes
  • Infection
  • Pituitary gland disease leading to low hormone production
  • Autoimmune disease

How is low testosterone diagnosed? The most important test for low testosterone is your total blood testosterone level. If you are worried, you should see your doctor to talk about your symptom. During your consultation, your doctor will check the following:
• Blood tests for testosterone level, other hormone levels, blood lipids, and a blood count for red blood cell level
• Complete medical history, including diseases and medications
• Complete physical exam including:

  • BMI or waist circumference for obesity
  • Metabolic syndrome (high blood pressure, high blood sugar, too much body fat around the waist, and high cholesterol levels)
  • Hair pattern, amount, and location
  • Enlarged breasts
  • Whether testicles are present and their size
  • Prostate size and any abnormalities

Testosterone replacement therapy can improve the signs and symptoms of low testosterone in these men. Doctors may prescribe testosterone as injections, pellets, patches or gels.

Can testosterone therapy promote youth and vitality?
Testosterone therapy can help reverse the effects of hypogonadism, but it’s unclear whether testosterone therapy would have any benefit for older men who are otherwise healthy. Although some men believe that taking testosterone medications may help them feel younger and more vigorous as they age, some scientific studies have demonstrated mixed results.

What are the risks and benefits of testosterone therapy?
Treating normal aging with testosterone replacement therapy (TRT) is not currently recommended by the government and some scientific organizations. Supporters of testosterone therapy for symptoms of low testosterone approach claim that testosterone is safe and have few side effects. There is already a large body and a growing body of scientific articles to support the health benefits of testosterone therapy. Testosterone may have the following benefits:
• Reduced or no increase cardiovascular events in men with androgen deficiency
• Improved cardiac function,
• Improve serum glucose levels and HgbA1C.
• Improve insulin resistance in men with diabetes and prediabetes.
• Reduced intra-abdominal (visceral) fat, obesity, and fat mass and increase in lean mass.
• Improve exercise capacity in patients with congestive heart failure.
• Low testosterone levels are associated with increased mortality.
• Mayo Clinic Proceedings (2016) states “There is no credible evidence at this time that testos-terone therapy increases cardiovascular risk and substantial evidence that it does not. Indeed, there is a strong signal that testosterone therapy may offer cardiovascular benefits to men”.
• TRT for hypogonadism does not increase PSA or the risk for prostate cancer.
• Testosterone therapy may increase red blood cells but there is no increase in venous thrombosis.

Testosterone may have the following risks:
• Cause acne or other skin reactions initially
• Temporary increase in fluid retention and / or leg swelling
• Cause enlarged or tender breasts if excessive testosterone
• Limit sperm production or cause testicle shrinkage

Talk to your doctor about testosterone therapy?
If you wonder whether testosterone therapy might be right for you, talk with your doctor about the risks and benefits. Your doctor will measure your testosterone levels before discussing whether testosterone therapy is an option for you. You can naturally boost testosterone by losing weight and increasing muscle mass through resistance exercise.

Male Hormone Replacement

Low levels of testosterone in men can affect a man in the following ways:
– Loss of sexual interest and function
– Erection problems
– Increased breast size
– Hot flashes
– Problems with memory and concentration
– Mood problems such as irritability and depression
– Smaller and softer testicles
– Loss of muscle strength and weakened bones

Testosterone is the most important hormone in men. While it helps to maintain sex drive, sperm production, pubic hair and body hair, testosterone is also responsible for maintaining muscles and bones.

When testosterone production is low in men, sexual dysfunction is a common complaint; but other nonspecific symptoms such as depression, mood changes, weight gain, or fatigue, have been reported.
Testosterone is a steroid hormone which is made in the testes in males and in the ovaries in women (a minimal amount is also made in the adrenal glands).

Testosterone production is regulated by hormones released from the brain. The hypothalamus and pituitary gland, located in the brain, produce hormonal signals that ultimately result in the production of testosterone. These hormones travel through the bloodstream to activate the sex organs in both men and women.

Men with diabetes are more likely to have low testosterone. Moreover, men with low testosterone are more likely to develop diabetes later. Testosterone helps the body’s tissues take up more blood sugar in response to insulin. Men with low testosterone more often have insulin resistance.

Note: Scientists aren’t sure whether diabetes causes low testosterone, or the other way around. Still, a link between diabetes and low testosterone is well established.

Research has shown that nearly 40% of obese men over age 45 have a low testosterone blood levels. Men with very low testosterone also are more likely to become obese. Losing weight through exercise can increase testosterone levels. Testosterone supplements in men with low testosterone also can slightly reduce obesity.

Many people with low testosterone have no symptoms. Only a blood test can determine a person’s testosterone levels. The Endocrine Society considers 300 to 1,200 nanograms per deciliter (ng/dL) normal, and that less than 300 is low. Doctors usually use a blood test and a number of symptoms to make a diagnosis and to determine whether treatment is needed.

Alcohol is directly toxic to the testicles where testosterone is produced, and it seems to affect the release of other hormones related to men’s sexual function and fertility. Shrunken testicles are a common sign of low testosterone in alcoholic men with liver disease, as well as lower libido and sexual potency. Enlarged breasts are common in heavy drinkers because alcohol may help convert testosterone into the female hormone estrogen.

Up to 9 out of 10 men who have symptoms of low testosterone may not seek treatment. They may attribute their symptoms to other conditions or think their symptoms are a normal part of aging. Guys, if you have symptoms and believe they are having an impact on your quality of life and well-being, talk to your doctor.