anti aging medicine

Hormone Balance Hormone Balance for Men and for Men and

WomenWomen

An Introduction to Age An Introduction to Age Management MedicineManagement Medicine

Paul Navar M.D.Paul Navar M.D.

Age Management Medicine:Age Management Medicine: A New Paradigm A New Paradigm

Preventive/Health Based v. Disease BasedPreventive/Health Based v. Disease Based

Orthomolecular vs. Pharmaceutical Orthomolecular vs. Pharmaceutical

Aging treated as a disease rather than a Aging treated as a disease rather than a normal inevitable processnormal inevitable process

Optimal range v. “normal” rangeOptimal range v. “normal” range

Rejects the notion of “class effect”Rejects the notion of “class effect”

Where are you on the Health span Curve?

0

25

50

75

100

20 40 60 80 100 120

Age (years)

%

Optimum Health

Sub-optimum Health

Undiagnosed Conditions

Development

Vitality

Degeneration

Morbidity

Reserve Capacity (% of Maximum Function)

Morbidity Extension keeps you alive…with your diseases

0

25

50

75

100

20 40 60 80 100 120

Age (years)

%

Morbidity Extension


Morbidity Compression maximizes vitality & ‘health span’

0

25

50

75

100

20 40 60 80 100 120

Age (years)

% Morbidity Compression

Vitality Extension


Orthomolecular vs. Orthomolecular vs. Pharmaceutical MedicinePharmaceutical Medicine

Orthomolecular ParadigmOrthomolecular Paradigm—Find the —Find the biomolecular cause and correct it using biomolecular cause and correct it using bioidentical molecules bioidentical molecules

Pharmaceutical ParadigmPharmaceutical Paradigm—Find a —Find a non-natural, patentablenon-natural, patentable substance substance (possibly toxic) that will improve the (possibly toxic) that will improve the disorder in some waydisorder in some way

Pharmaceutical should be secondary Pharmaceutical should be secondary to Orthomolecular, not primaryto Orthomolecular, not primary

The Problem with The Problem with PharmaceuticalsPharmaceuticals

Alien molecules:Alien molecules: body does not body does not recognize them or know how to eliminate recognize them or know how to eliminate themthem

Negative functions:Negative functions: disruptdisrupt physiology physiology by by blocking blocking receptors, receptors, inhibitinginhibiting enzymes, enzymes, etc.etc.

Toxic:Toxic: AllAll have have sideside effects and both effects and both known and unknown known and unknown deleteriousdeleterious long-term long-term effects (not true of effects (not true of bioidenticalsbioidenticals!!)!!)

Bioidentical HormonesBioidentical Hormones

Are chemically converted from yams or soy and Are chemically converted from yams or soy and are identical in composition to human hormonesare identical in composition to human hormones

Are not patentableAre not patentable Have been used in Europe over 40 yearsHave been used in Europe over 40 years Have been extensively researchedHave been extensively researched Estradiol, progesterone, and testosterone are Estradiol, progesterone, and testosterone are

FDA approvedFDA approved In balance, the do NOT have the same risks as In balance, the do NOT have the same risks as

CHRTCHRT

Conventional MedicineConventional Medicine

Too much information, not enough time to Too much information, not enough time to do independent research, super-do independent research, super-specialization, not taught that wayspecialization, not taught that way

Info. controlled by pharmaceutical corps Info. controlled by pharmaceutical corps who promote who promote pharmaceutical paradigmpharmaceutical paradigm and and ignore or suppress non-patentable ignore or suppress non-patentable natural natural vitanutrients vitanutrients and and hormoneshormones

Result: Unfounded Result: Unfounded fearfear of of hormone hormone optimizationoptimization; unfounded ; unfounded confidenceconfidence in in toxic toxic drugsdrugs




Aging treated as a disease rather than Aging treated as a disease rather than a normal inevitable processa normal inevitable process



Conventional View of Hormones Conventional View of Hormones and Agingand Aging

The loss of hormones is The loss of hormones is adaptiveadaptive––helps us to live longerhelps us to live longer

Persistence of youthful levels of Persistence of youthful levels of hormones would cause more heart hormones would cause more heart attacks and cancers as we ageattacks and cancers as we age

Losing our hormones is Losing our hormones is good for usgood for us Pharmaceutical Agenda:Pharmaceutical Agenda: Don’t replace Don’t replace

hormones; take a hormones; take a drugdrug for every for every problem.problem.

Against the Conventional ViewAgainst the Conventional View All animals designed/evolved with a limited All animals designed/evolved with a limited

lifetime—a lifetime—a self-destruct program self-destruct program that that kicks in at age kicks in at age 25 25 in humansin humans

Aging is the degenerative disease that Aging is the degenerative disease that affects us all!affects us all!

Cancers, heart attacks, autoimmune Cancers, heart attacks, autoimmune diseases, etc. occur diseases, etc. occur years after years after hormone hormone deficienciesdeficiencies begin begin andand occur occur moremore often in often in people with people with lowerlower hormone levels! hormone levels!

Studies of balanced BHRT show tremendous Studies of balanced BHRT show tremendous benefits with benefits with no proof of harmno proof of harm!!!!

Conventional Thinking: Conventional Thinking: The Tyranny of the Lab ReportThe Tyranny of the Lab Report

Ranges are Ranges are population statspopulation stats, not , not optimalsoptimals Male free testosterone: Male free testosterone: 35-15535-155 5x5x Female free testosterone: Female free testosterone: 0.0-6.20.0-6.2 Free T3: Free T3: 1.8-4.21.8-4.2 2.5x2.5x TSH: TSH: 0.3-50.3-5 17x17x If test is “normal”—no diagnosis or Rx, If test is “normal”—no diagnosis or Rx,

pharmaceuticalspharmaceuticals for symptoms for symptoms If below “normal”, If below “normal”, maybe maybe to “normal” to “normal”

Common Sense Regarding “Class Effect” Common Sense Regarding “Class Effect”

Problems caused by Problems caused by hormonehormone substitutes substitutes should should not not bebe attributed attributed to our to our naturalnatural human human hormoneshormones until proven otherwiseuntil proven otherwise..

Bioidentical hormone replacement Bioidentical hormone replacement to to restorerestore youthful levels and balance youthful levels and balance should be considered safe should be considered safe until until proven otherwiseproven otherwise!!

Components of Age Components of Age ManagementManagement

Diet

Hormone

Therapy

Conventional

Treatments

Exercise

Supplements

Lifestyle

Age Management MedicineAge Management Medicine 5 Basic Principles: 5 Basic Principles:

Education and Knowledge enables self Education and Knowledge enables self determinationdetermination

Lifelong attention to diet and normal Lifelong attention to diet and normal weight maintenance enables the reduction weight maintenance enables the reduction of chronic inflammationof chronic inflammation

Exercise promotes Health and Weight Exercise promotes Health and Weight MaintenanceMaintenance

Nutritional/Nutraceutical therapies Nutritional/Nutraceutical therapies preferred; pharmaceuticals when indicatedpreferred; pharmaceuticals when indicated

Hormone modulation and replenishment Hormone modulation and replenishment with bio-identical hormoneswith bio-identical hormones

HormonesHormones

Intercellular communication devices Intercellular communication devices Travel via blood to cells’ receptors Travel via blood to cells’ receptors Control Control cells’ proliferation, protein cells’ proliferation, protein

manufacture, metabolic rate, etc. manufacture, metabolic rate, etc. Most powerful molecules in biologyMost powerful molecules in biology OptimalOptimal levels essential for health levels essential for health

and quality of lifeand quality of life

Hormonal Decline With AgingHormonal Decline With Aging

Hormones that build tissues and improve Hormones that build tissues and improve immunity immunity declinedecline with age by 50-80% with age by 50-80% (DHEA, Testosterone, HGH)(DHEA, Testosterone, HGH)

Progesterone starts to decline at age 30.Progesterone starts to decline at age 30. Estradiol disappears at Estradiol disappears at 50—menopause. 50—menopause. Thyroid hormone production and sensitivity Thyroid hormone production and sensitivity

decline with agedecline with age Insulin output and sensitivity Insulin output and sensitivity

declinesdeclinesDiabetesDiabetes By age 50— we’ve experienced By age 50— we’ve experienced 20 years20 years of of

hormonal declinehormonal decline

Endocrine Deterioration of AgingEndocrine Deterioration of Aging Endocrine glands and their feedback Endocrine glands and their feedback

control systems deteriorate with agecontrol systems deteriorate with age Our bodies Our bodies cease to regulatecease to regulate our our

hormones for hormones for optimal healthoptimal health Hormone losses speed our general Hormone losses speed our general

deterioration: deterioration: a vicious cyclea vicious cycle.. The symptoms of hormone loss are The symptoms of hormone loss are

warning signs warning signs of physical deteriorationof physical deterioration Win-Win: Hormone levels that are Win-Win: Hormone levels that are better better

for your healthfor your health also make you also make you feel better!feel better!

Common Sense Hormone Common Sense Hormone ReplacementReplacement

If a hormone is missing, replace itIf a hormone is missing, replace it If present but insufficient, optimize by If present but insufficient, optimize by

supplementation if necessarysupplementation if necessary Type 1 Diabetes: give human insulinType 1 Diabetes: give human insulin Hypothyroidism: give thyroid hormoneHypothyroidism: give thyroid hormone Growth hormone deficiency: give HGHGrowth hormone deficiency: give HGH Adrenal insufficiency: give CortisolAdrenal insufficiency: give Cortisol What about hormone loss due to aging?What about hormone loss due to aging?

BHRT is Smart MedicineBHRT is Smart Medicine

Restoring youthful hormone levels Restoring youthful hormone levels is essential is essential preventative preventative medicinemedicine

Restoring youthful hormone levels Restoring youthful hormone levels is essential to the is essential to the treatment treatment of of allall diseases!diseases!

Restoring youthful hormone levels Restoring youthful hormone levels is essential to is essential to Quality of Life!Quality of Life!

Hormone TherapyHormone Therapy

Remember: We age because our hormones Remember: We age because our hormones decline, our hormones don’t decline decline, our hormones don’t decline because we age. This is the because we age. This is the Neuroendocrine Theory of Aging. Neuroendocrine Theory of Aging.

In this seminar, we will discuss the most In this seminar, we will discuss the most important hormones:important hormones:Estrogen: yes, you need itEstrogen: yes, you need itProgesterone: the great balancerProgesterone: the great balancerTestosterone: the feel good hormoneTestosterone: the feel good hormoneThyroid: the under-diagnosed deficiencyThyroid: the under-diagnosed deficiencyGrowth Hormone: the Healing HormoneGrowth Hormone: the Healing Hormone

Hormonal Deficiency SymptomsHormonal Deficiency Symptoms Weight GainWeight Gain Loss of Muscle MassLoss of Muscle Mass Degenerative Diseases (Diabetes, Cancer, Heart Degenerative Diseases (Diabetes, Cancer, Heart

Disease, Osteoporosis)Disease, Osteoporosis) A Compromised Immune SystemA Compromised Immune System Wrinkling and Thinning of the SkinWrinkling and Thinning of the Skin Depression and AnxietyDepression and Anxiety Cognitive DeclineCognitive Decline Insulin ResistanceInsulin Resistance Loss of Sex DriveLoss of Sex Drive FatigueFatigue Sleep DisordersSleep Disorders

The Seven Dwarves of The Seven Dwarves of MenopauseMenopause

MenopauseMenopause

Estrogen DeficiencyEstrogen Deficiency Progesterone DeficiencyProgesterone Deficiency Testosterone DeficiencyTestosterone Deficiency After menopause, women depend After menopause, women depend

upon their adrenal glands for upon their adrenal glands for androgens and estrogens, so:androgens and estrogens, so:

MenopauseMenopause ++Adrenal InsufficiencyAdrenal Insufficiency

== BIGBIG TROUBLETROUBLE

Progesterone Deficiency/Estrogen Progesterone Deficiency/Estrogen Dominance SymptomsDominance Symptoms

Mood Swings, PMSMood Swings, PMS Anxiety, Irritability, Depression, FatigueAnxiety, Irritability, Depression, Fatigue Fibrocystic breasts, breast tenderness, cystsFibrocystic breasts, breast tenderness, cysts Uterine fibroids, heavy bleedingUterine fibroids, heavy bleeding Weight gain, water retention, bloatingWeight gain, water retention, bloating Headaches, infertilityHeadaches, infertility Symptoms of low thyroidSymptoms of low thyroid Increased risk of breast and uterine cancerIncreased risk of breast and uterine cancer

Estrogen DeficiencyEstrogen Deficiency

Hot flashes, night sweatsHot flashes, night sweats Vaginal dryness, urgency, Vaginal dryness, urgency,

incontinenceincontinence Foggy thinking, memory lapsesFoggy thinking, memory lapses Tearful, depressedTearful, depressed InsomniaInsomnia Heart palpitationsHeart palpitations Bone loss, aches, painsBone loss, aches, pains Thinning skin, hair lossThinning skin, hair loss

Testosterone Deficiency in WomenTestosterone Deficiency in Women

Decreased libidoDecreased libido Decreased energy, fatigue, lack of Decreased energy, fatigue, lack of

enduranceendurance Decreased concentration, memory lossDecreased concentration, memory loss Bone loss, muscle mass lossBone loss, muscle mass loss Increased heart disease (CAD,CHF) & Increased heart disease (CAD,CHF) &

diabetesdiabetes Aches, pains, decreased coordinationAches, pains, decreased coordination Hot flashes, vaginal dryness, incontinenceHot flashes, vaginal dryness, incontinence Dry, thinning skin, wrinkles, hair loss Dry, thinning skin, wrinkles, hair loss

Long Term Effects of Combined Long Term Effects of Combined Sex-Hormone DeficiencySex-Hormone Deficiency

Irritability, insomnia, Irritability, insomnia, brain brain dysfunctiondysfunction

Possibly Alzheimer’s Possibly Alzheimer’s dementiadementia Fatigue, aches and pains.Fatigue, aches and pains. OsteoporosisOsteoporosisfractures, loss of teethfractures, loss of teeth Genital atrophyGenital atrophy, vaginal dryness, vaginal dryness AtrophyAtrophy of skin and connective tissue of skin and connective tissue Heart diseaseHeart disease—higher risk than men —higher risk than men

after 65, higher mortality after 70!after 65, higher mortality after 70!

Known Benefits of Estradiol ReplenishmentKnown Benefits of Estradiol Replenishment

Eliminates hot flashesEliminates hot flashes Restores mood and mental functionRestores mood and mental function Protects against Alzheimer’s diseaseProtects against Alzheimer’s disease Maintains genital/vaginal skin and lubricationMaintains genital/vaginal skin and lubrication Increases thickness, fullness of skin and hairIncreases thickness, fullness of skin and hair Prevents osteoporosis and osteoarthritisPrevents osteoporosis and osteoarthritis Prevents heart diseasePrevents heart disease Prevents colon cancer and macular Prevents colon cancer and macular

degenerationdegeneration Improves insulin sensitivity—helps diabetesImproves insulin sensitivity—helps diabetes

Benefits of Bio-identical Progesterone Benefits of Bio-identical Progesterone Helps balance estrogen Helps balance estrogen Protects against endometrial cancer, may protect Protects against endometrial cancer, may protect

against breast cancer against breast cancer Helps you sleep, has a natural calming effect Helps you sleep, has a natural calming effect Aids in use and elimination of fats Aids in use and elimination of fats Helps normalize libido Helps normalize libido Has an anti-proliferative effect (decreases the Has an anti-proliferative effect (decreases the

rate of cancer) on all progesterone receptors, not rate of cancer) on all progesterone receptors, not just the ones in the uterus) just the ones in the uterus)

Natural diuretic Natural diuretic Natural antidepressant Natural antidepressant

Testosterone for WomenTestosterone for Women

Improves energy, moodImproves energy, mood Improves sexual desire and responseImproves sexual desire and response Increases muscle strength and reduces Increases muscle strength and reduces

muscle and joint achesmuscle and joint aches With With estradiolestradiol, increases bone density, increases bone density

J Reprod Med. 1999 Dec;44(12):1012-20. J Reprod Med. 1999 Dec;44(12):1012-20.

Probably Probably decreasesdecreases risk of risk of heart attackheart attack J Womens Health. 1998 Sep;7(7):825-9.J Womens Health. 1998 Sep;7(7):825-9.

Given with Given with estradiolestradiol and and progesteroneprogesterone, , may reduce risk of may reduce risk of breast cancerbreast cancerMenopause. 2003 Jul-Aug;10(4):292-8., Endocr Rev. 2004 Jun;25(3):374-88.Menopause. 2003 Jul-Aug;10(4):292-8., Endocr Rev. 2004 Jun;25(3):374-88.

Hormone ReplenishmentHormone Replenishment

Treatment of Peri-menopause and Menopause:Treatment of Peri-menopause and Menopause:Aimed at restoring levels to physiologic range Aimed at restoring levels to physiologic range

for 25-35 year oldfor 25-35 year oldReplenish and balance low levels ofReplenish and balance low levels of

–Testosterone, Estrogens, Progesterone, Testosterone, Estrogens, Progesterone, DHEA, ThyroidDHEA, Thyroid

Reduce high levels ofReduce high levels of– Insulin, CortisolInsulin, Cortisol

Use Natural (Bio-identical) hormonesUse Natural (Bio-identical) hormonesMonitor with regular serum levelsMonitor with regular serum levels

Other Hormone ReplenishmentOther Hormone Replenishment

DHEA – precursor hormoneDHEA – precursor hormonePregnenolone – another precursorPregnenolone – another precursor– May improve memoryMay improve memory– May moderate Cortisol levelsMay moderate Cortisol levelsMelatoninMelatonin– Improves Stage III and IV sleepImproves Stage III and IV sleep– Most significant antioxidant for the brainMost significant antioxidant for the brain– Stimulates immune systemStimulates immune system– May reduce breast cancer riskMay reduce breast cancer risk– May prevent migraines May prevent migraines

OsteoporosisOsteoporosis

In menopause 5% bone loss each year In menopause 5% bone loss each year for first 5 years=25%—all due to for first 5 years=25%—all due to lossloss of of estrogenestrogen!!

20 yrs. post menopause—50% 20 yrs. post menopause—50% reduction in trabecular bone, 30% in reduction in trabecular bone, 30% in cortical bonecortical bone

50% of women50% of women >65 yrs. old have >65 yrs. old have spinal compression fracturesspinal compression fractures

14% lifetime risk of 14% lifetime risk of hip fracturehip fracture for for 50 yr.old woman, 50 yr.old woman, 30%30% for 80 yr. old. for 80 yr. old.

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

OsteoporosisOsteoporosis

A A hormone deficiencyhormone deficiency disease—the disease—the proper treatment is proper treatment is BHRT!BHRT!

EstrogenEstrogen prevents resorption of old bone prevents resorption of old bone while while testosteronetestosterone, , progesteroneprogesterone, , DHEADHEA and and GHGH build new bone build new boneJ Clin Endo Metab. 1996; 81:37-43. J Clin Endo Metab. 1996; 81:37-43. J Reprod Med. 1999 Dec;44(12):1012-20. J Reprod Med. 1999 Dec;44(12):1012-20.

Combined BHRT Combined BHRT increases bone density increases bone density far better than Fosamaxfar better than Fosamax and and preserves preserves normalnormal bone remodeling (no “rotting jaw”, bone remodeling (no “rotting jaw”, eye inflammation, eye inflammation, CaCa++++).).

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

The Mighty ThyroidThe Mighty Thyroid

Regulates temperature, metabolism and Regulates temperature, metabolism and cerebral function.cerebral function.

Increases fat breakdown, resulting in wt. loss & Increases fat breakdown, resulting in wt. loss & lowers cholesterol.lowers cholesterol.

Symptoms of hypothyroid are more common in Symptoms of hypothyroid are more common in women & elderly:women & elderly:– FatigueFatigue– Lower than normal body temp.Lower than normal body temp.– Greater susceptibility to colds & virusesGreater susceptibility to colds & viruses– Depression & mood swingsDepression & mood swings– Weight gain and resistance to weight lossWeight gain and resistance to weight loss– Dry skin/brittle nailsDry skin/brittle nails– High cholesterolHigh cholesterol

Diagnosing HypothyroidismDiagnosing Hypothyroidism

Must check T4, T3, and TSH. Most docs only Must check T4, T3, and TSH. Most docs only measure TSH. But, a high T4 (which is measure TSH. But, a high T4 (which is inactive) will depress the TSH, even though the inactive) will depress the TSH, even though the T3 might be low and the patient suffering all T3 might be low and the patient suffering all the symptoms of low thyroid functioning! the symptoms of low thyroid functioning!

Also, autoimmune thyroiditis causing Also, autoimmune thyroiditis causing hypothyroidism (Hashimoto’s thyroiditis) is hypothyroidism (Hashimoto’s thyroiditis) is quite common, particularly in women. A test quite common, particularly in women. A test called TPO (thyroid antibodies) is necessary to called TPO (thyroid antibodies) is necessary to diagnose this.diagnose this.

Thyroid Optimization: Thyroid Optimization: Not Just for Quality of LifeNot Just for Quality of Life

Incidence of severe Incidence of severe atherosclerosis atherosclerosis doubleddoubled with lower T with lower T33 or higher TSH or higher TSH levels levels within the normal rangewithin the normal range

Clin Cardiol. 2003 Dec;26(12):569-73Clin Cardiol. 2003 Dec;26(12):569-73

LowersLowers cardiac risk factors: cholesterol, cardiac risk factors: cholesterol, triglycerides, C-reactive protein, triglycerides, C-reactive protein, homocysteine and lipoprotein(a)homocysteine and lipoprotein(a)

LowersLowers blood pressure, dilates arteriesblood pressure, dilates arteries ReducesReduces tendency to form blood clots tendency to form blood clots

Age Management Approach to Age Management Approach to Thyroid ReplacementThyroid Replacement

Restore iodine sufficiencyRestore iodine sufficiency If classic S/S present, give thyroid hormones If classic S/S present, give thyroid hormones in in

spitespite of “low normal” blood tests of “low normal” blood tests Give TGive T3 3 in addition to Tin addition to T4 4 (Armour, Cytomel)(Armour, Cytomel)

Endocrinology 1996;137:2490-502.Endocrinology 1996;137:2490-502.

Increase dose until symptoms are gone or S/S Increase dose until symptoms are gone or S/S of excess appearof excess appear

Often must suppress TSH to lower limitOften must suppress TSH to lower limit No bone loss, cardiac abnormalities, or muscle No bone loss, cardiac abnormalities, or muscle

wasting with moderate TSH suppressionwasting with moderate TSH suppression

AndropauseAndropause

Andropause in Men Andropause in Men Testosterone levels decline Testosterone levels decline slowlyslowly in menin men

—”Just getting old.”—”Just getting old.” Fatigue, reduced mental functionFatigue, reduced mental function Passivity and moodiness—loss of drive and Passivity and moodiness—loss of drive and

ambitionambition Loss of muscle mass, increased abdominal fatLoss of muscle mass, increased abdominal fat Lastly:Lastly: loss of libido, no morning erections loss of libido, no morning erections Low Testosterone levels are associated with a Low Testosterone levels are associated with a

higher risk of depression, heart disease, higher risk of depression, heart disease, osteoporosis, fracture rates, frailty and even osteoporosis, fracture rates, frailty and even dementia dementia Salazar, J, Risks of testosterone replacement therapy in Salazar, J, Risks of testosterone replacement therapy in ageing men. Summary Expert Opinion on Drug Safety. November 2004, Vol. ageing men. Summary Expert Opinion on Drug Safety. November 2004, Vol. 3, No. 6, Pages 599-606 3, No. 6, Pages 599-606

Testosterone Levels and AgeTestosterone Levels and Age

Testosterone and the HeartTestosterone and the Heart LowLow testosterone levels, correlate with testosterone levels, correlate with

coronary artery disease and strokecoronary artery disease and strokePhillips et al., Arterioscler Thromb. 1994; 14:701-706. Phillips et al., Arterioscler Thromb. 1994; 14:701-706.

English et al., Eur Heart J 2000; 21; 890–4.English et al., Eur Heart J 2000; 21; 890–4.Zhao SP et al., Int J Cardiol. 1998 Jan 31;63(2):161-4.Zhao SP et al., Int J Cardiol. 1998 Jan 31;63(2):161-4.Arterioscler Thromb Vasc Biol. 1996 Jun;16(6):749-54.Arterioscler Thromb Vasc Biol. 1996 Jun;16(6):749-54.

Treatment with Testosterone Treatment with Testosterone Dilates coronary arteries—improves anginaDilates coronary arteries—improves angina Increases heart muscle size, strengthIncreases heart muscle size, strength Decreases fibrinogen levels—prevents Decreases fibrinogen levels—prevents

blood clotsblood clotsDemirbag et al., Endocr Res. 2005;31(4):335-44. Demirbag et al., Endocr Res. 2005;31(4):335-44.

Testosterone and the ProstateTestosterone and the Prostate

Higher testosterone levels Higher testosterone levels do notdo not increase risk of prostate cancer.increase risk of prostate cancer.

Studies of testosterone Studies of testosterone supplementation have shown supplementation have shown no no increaseincrease in prostate cancer in prostate cancer

In fact, low testosterone correlated with In fact, low testosterone correlated with more aggressivemore aggressive prostate cancers prostate cancers

Testosterone may promote the growth Testosterone may promote the growth of an existing prostate cancerof an existing prostate cancer

Monitor with bi-yearly PSA testsMonitor with bi-yearly PSA tests

Testosterone and prostate cancerTestosterone and prostate cancer

““There is no clinical evidence that the risk of There is no clinical evidence that the risk of either prostate cancer or benign prostatic either prostate cancer or benign prostatic hypertrophy increases with testosterone hypertrophy increases with testosterone replacement therapy.”replacement therapy.”(from the Mayo Clinic (from the Mayo Clinic Proc. 2000)Proc. 2000)

““These results argue against an increased These results argue against an increased risk of prostate cancer with testosterone risk of prostate cancer with testosterone replacement therapy.”replacement therapy.”

Testosterone replacement therapy and prostate Testosterone replacement therapy and prostate risks: where's the beef? Can J Urol. 2006 Feb;13 risks: where's the beef? Can J Urol. 2006 Feb;13 Suppl 1:40-3. Suppl 1:40-3.

Testosterone ReplacementTestosterone Replacement

Improves mood and sociabilityImproves mood and sociability Restores energy and ambitionRestores energy and ambition Improves cognition Improves cognition Increases libido and sexual performanceIncreases libido and sexual performance Increases muscle and bone massIncreases muscle and bone mass Reduces abdominal fat, improves insulin Reduces abdominal fat, improves insulin

sensitivity, lowers blood pressure--sensitivity, lowers blood pressure--counteracts counteracts metabolic syndromemetabolic syndrome

Methods of ReplacementMethods of ReplacementInjections: Generally once per week. Injections: Generally once per week. Cream: Rubbed into the skin, alcohol based or Cream: Rubbed into the skin, alcohol based or

cream based used once each daycream based used once each dayOral: Not good for the liver and is metabolized Oral: Not good for the liver and is metabolized

in only about 4 hrs. Doesn’t give good blood in only about 4 hrs. Doesn’t give good blood level. Not physiologic.level. Not physiologic.

Patch: Some insurances will pay for these-Patch: Some insurances will pay for these-good blood level, but some men don’t like good blood level, but some men don’t like the plastic patch. Cannot use sauna with the the plastic patch. Cannot use sauna with the patch—get too high blood level.patch—get too high blood level.

Testosterone pellets: about the size of a grain Testosterone pellets: about the size of a grain of rice, pellets are injected under the skin of rice, pellets are injected under the skin every 6-8weeksevery 6-8weeks

Rhoden, E. L. et al. N Engl J Med 2004;350:482-492

Growth HormoneGrowth Hormone

Growth HormoneGrowth Hormone Somatopause – decline of Somatopause – decline of

release of human growth release of human growth hormone by pituitary with hormone by pituitary with aging.aging.

Proponents feel that Proponents feel that Somatopause is Somatopause is responsible for the decline responsible for the decline of of – Muscle to fat ratioMuscle to fat ratio– Immune functionImmune function– Sense of well beingSense of well being– Bone and cartilageBone and cartilage– YOUTHYOUTH

Growth Hormone vs. AgeGrowth Hormone vs. Age

Expected Benefits of HGH restored Expected Benefits of HGH restored to 30 year old level to 30 year old level

Increased exercise capacityIncreased exercise capacity– Increased skeletal muscle mass & strengthIncreased skeletal muscle mass & strength– Increased cardiac outputIncreased cardiac output– Decreased fat mass (10%-14%) with first 6 mo. of Decreased fat mass (10%-14%) with first 6 mo. of

therapy.therapy.– Improved bone density after 1 yr.Improved bone density after 1 yr.

Improved quality of lifeImproved quality of life– Less fatigueLess fatigue– Greater staminaGreater stamina– Increased physical performanceIncreased physical performance– Improved mental acuity Improved mental acuity – Improved sexual functionImproved sexual function

Conventional Endocrinology & Age Conventional Endocrinology & Age Management Medicine agree up to a point!Management Medicine agree up to a point!

Pathological GH deficiency Pathological GH deficiency is a disease which should is a disease which should be treatedbe treated

GH secretion declines with GH secretion declines with agingaging

GH decline is responsible GH decline is responsible for part of the clinical for part of the clinical syndrome of agingsyndrome of aging

Aging and GH decline are Aging and GH decline are normal, DON’T TREAT.normal, DON’T TREAT.

Pathological GH deficiency Pathological GH deficiency is a disease which should is a disease which should be treated.be treated.

GH secretion declines with GH secretion declines with agingaging

GH decline is responsible GH decline is responsible for part of the clinical for part of the clinical syndrome of agingsyndrome of aging

Aging and GH decline is a Aging and GH decline is a deficiency disease which deficiency disease which CAN and SHOULD BE CAN and SHOULD BE TREATEDTREATED

Methods of ReplacementMethods of Replacement Given each day as an Given each day as an

injectioninjection– Oral growth hormone Oral growth hormone

does not work-does not work-infomercials, radio ads-infomercials, radio ads-worthless!worthless!

Side effects: edema & Side effects: edema & arthralgia related to arthralgia related to high doses given 2-high doses given 2-3x/wk. Best to take 3x/wk. Best to take dailydaily

Carpal tunnel Carpal tunnel syndrome, elevated syndrome, elevated glucose, abn. Growth glucose, abn. Growth of feet & other organs. of feet & other organs.

BHRT—A New ScienceBHRT—A New Science

Unresolved issues—more investigation Unresolved issues—more investigation neededneeded

Need more long-term randomized studies Need more long-term randomized studies to study long-term effects.to study long-term effects.

Questions about delivery and monitoringQuestions about delivery and monitoring Medical profession should be studying Medical profession should be studying

bioidentical hormonesbioidentical hormones instead of instead of hormone hormone substitutes!substitutes!

We have the right to replace the hormones We have the right to replace the hormones we lose to the disease of aging!!we lose to the disease of aging!!

What I do:What I do:

Diet

Hormone

Therapy

Conventional

Treatments

Exercise

Supplements

Lifestyle

Morbidity Compression maximizes vitality & ‘healthspan’

0

25

50

75

100

20 40 60 80 100 120

Age (years)

% Morbidity Compression

Vitality Extension


Maintaining Quality of LifeMaintaining Quality of Life

Thank you for Thank you for attendingattending

The Center for Optimal HealthThe Center for Optimal HealthPaul Navar MD Paul Navar MD

166 N. 300 W. Suite #3166 N. 300 W. Suite #3St. George, Utah 84770St. George, Utah 84770

(435) 688-8582(435) 688-8582Email: [email protected]: [email protected]

www.agemanagementmedicine.netwww.agemanagementmedicine.net

DHEA-S levels vs. AgeDHEA-S levels vs. Age

Worst Side Effect?Worst Side Effect?

anti aging medicine

Documents