Do I Need Hormones?Do I Need Hormones?

Dr Johnnie Ham, MDDr Johnnie Ham, MD

Coastal Prestige Medical Services and Coastal Prestige Medical Services and ClinicClinic

Pismo Beach, CaliforniaPismo Beach, California

What are Hormones?What are Hormones?

• Hormones are BioChemical Hormones are BioChemical MessengersMessengers

• Hormones control numerous Hormones control numerous functions in the bodyfunctions in the body

• One of the Two Major Controllers One of the Two Major Controllers in your bodyin your body

Unique Unique TargetsTargets

Where do they come from?Where do they come from?

Focus on the Major Sex Focus on the Major Sex HormonesHormones

• ProgesteroneProgesterone• ““pro” “gestational”pro” “gestational”

• TestosteroneTestosterone• EstrogenEstrogen

• Estradiol – the major playerEstradiol – the major player• Estrone – less active, post-Estrone – less active, post-

menopausalmenopausal• Estriol – the pregnancy estrogenEstriol – the pregnancy estrogen

EstradiolEstradiol

• Performs over 240 functions in the Performs over 240 functions in the bodybody• In contrast, Testosterone performs In contrast, Testosterone performs

about 110; Thyroid Hormone performs about 110; Thyroid Hormone performs about 15about 15

• Produced by the month’s stimulated Produced by the month’s stimulated follicles in the ovaryfollicles in the ovary• So, no stimulated follicles, no estradiolSo, no stimulated follicles, no estradiol

Some Functions of Some Functions of EstradiolEstradiol

• promote formation of female promote formation of female secondary sex characteristics

• accelerate accelerate metabolism (burn fat) (burn fat) • increase increase vaginal lubrication • thicken the thicken the vaginal wall wall • maintenance of vessel and skin maintenance of vessel and skin • reduce reduce bone resorption, increase bone , increase bone

formation formation

• protein synthesis synthesis • increase hepatic production of binding increase hepatic production of binding

proteins proteins • increase circulating level of increase circulating level of factors 2, , 7, ,

9, , 10, , plasminogen• increase increase platelet adhesiveness adhesiveness

• Lipid Lipid • increase increase HDL, triglyceride , triglyceride • decrease LDL, fat deposition decrease LDL, fat deposition

• Fluid balance Fluid balance • salt (sodium) and water retention salt (sodium) and water retention

• Hormones Hormones • increase cortisol, SHBG increase cortisol, SHBG

• Gastrointestinal tract Gastrointestinal tract • reduce bowel motility reduce bowel motility • increase cholesterol in bile increase cholesterol in bile

• Melanin Melanin • increase pheomelanin, reduce eumelanin increase pheomelanin, reduce eumelanin

• Lung function Lung function • promotes lung function by supporting promotes lung function by supporting

alveolialveoli

• BrainBrain• Stimulates endorphins, promotes Stimulates endorphins, promotes

seratonin and dopamine release and seratonin and dopamine release and productionproduction

Symptoms of Estradiol Symptoms of Estradiol DeficiencyDeficiency

• Mood disturbancesMood disturbances• Hot flashesHot flashes• Night sweatsNight sweats• DepressionDepression• AnxietyAnxiety• Dry skinDry skin• Decreased libidoDecreased libido

• IncontinenceIncontinence• Vaginal drynessVaginal dryness• InsomniaInsomnia• Memory LossMemory Loss• Weight GainWeight Gain• Skin thinningSkin thinning• Abnormal lipidsAbnormal lipids

Is Estradiol Safe?Is Estradiol Safe?

• Bio-Identical Hormones – exact Bio-Identical Hormones – exact copiescopies

• Bio-Similar Hormones – close, Bio-Similar Hormones – close, generally function like the hormonegenerally function like the hormone

• Bio-Limited Hormones – a few Bio-Limited Hormones – a few functions onlyfunctions only

• Bio-Antagonists – block functionsBio-Antagonists – block functions

Is Estradiol Safe?Is Estradiol Safe?

• BioIdentical Estradiol is the same BioIdentical Estradiol is the same chemical structure as what your chemical structure as what your body produces…so was it unsafe body produces…so was it unsafe when you were making it?when you were making it?

• Of course not…..Of course not…..

Breast Cancer and Breast Cancer and EstradiolEstradiol

• Does Estradiol cause Breast Does Estradiol cause Breast Cancer?Cancer?• Women in China have virtually no Women in China have virtually no

incidence of breast cancer….yet are incidence of breast cancer….yet are exposed to estradiol for 40 years of exposed to estradiol for 40 years of their livestheir lives

• No study has ever shown a link No study has ever shown a link between bio-identical estradiol and between bio-identical estradiol and breast cancerbreast cancer

But I heard it causes But I heard it causes Breast Cancer….Breast Cancer….

The Womens Health InitiativeThe Womens Health Initiative• Very large study in 1997 looking for Very large study in 1997 looking for

benefits of HRT in post-menopausal benefits of HRT in post-menopausal womenwomen

• Average age of inclusion – 65Average age of inclusion – 65• No previous HRT useNo previous HRT use• Used PremPro – then the second most Used PremPro – then the second most

common medication 2.5 million womencommon medication 2.5 million women

Prem-ProPrem-Pro

• Combination of Premarin and Combination of Premarin and ProveraProvera• Premarin “Premarin “prepregnant gnant marmare’s ure’s urinine”e”• Contains 12 different xeno-estrogensContains 12 different xeno-estrogens• Only one is “similar” to estradiolOnly one is “similar” to estradiol• Activity of the other 11???Activity of the other 11???• PatentablePatentable• Provera – methylprogesterone – not Provera – methylprogesterone – not

bioidenticalbioidentical

So what happened?So what happened?

• Study was terminated in 2002, Study was terminated in 2002, because a study limit was exceeded because a study limit was exceeded – a “reported” 26% increase in the – a “reported” 26% increase in the risk of breast cancerrisk of breast cancer

• Actual risk of control group 2.0%Actual risk of control group 2.0%• Increased risk of study group 2.5%Increased risk of study group 2.5%• …….the change from 2.0% to 2.5% is .the change from 2.0% to 2.5% is

26%26%

And now for the rest of And now for the rest of the story…..the story…..

• Larger decrease in risk to colon Larger decrease in risk to colon cancercancer

• Decrease in overall mortalityDecrease in overall mortality• In 2009, in OBGYN News…those in In 2009, in OBGYN News…those in

the WHI who developed Breast the WHI who developed Breast Cancer AND were on PremPro Cancer AND were on PremPro survived their breast cancer far more survived their breast cancer far more than those who were in the placebo than those who were in the placebo group…..group…..

WHI PerspectiveWHI Perspective

• Abnormal study groupAbnormal study group• Abnormal hormones used – not Abnormal hormones used – not

bioidenticalbioidentical• Slight increase risk in breast ca, Slight increase risk in breast ca,

greater decrease in colon cancergreater decrease in colon cancer• Greater survival if develops breast Greater survival if develops breast

caca

TestosteroneTestosterone

• improves oxygen uptake throughout the body improves oxygen uptake throughout the body • controls blood sugarcontrols blood sugar• regulates cholesterolregulates cholesterol• increases lean body massincreases lean body mass• prevents osteoporosisprevents osteoporosis• maintains immune function maintains immune function • maintains cardiac functionsmaintains cardiac functions• Stimulates neurological function and repairStimulates neurological function and repair

Symptoms of Testosterone Symptoms of Testosterone Deficiency in Women Deficiency in Women ANDAND

MenMen

• Decreased or absent libido Decreased or absent libido • Erectile or Sexual Erectile or Sexual

dysfunction dysfunction • Decreased muscle mass Decreased muscle mass • Decreased muscle strength Decreased muscle strength • Osteoporosis Osteoporosis • Heart disease Heart disease • Sleep disorders Sleep disorders • Memory failure Memory failure • IrritabilityIrritability

• Decreased energy levelDecreased energy level• Mood swingsMood swings• DepressionDepression• AnxietyAnxiety• Increased painIncreased pain• Cold intoleranceCold intolerance• Decreased self-Decreased self-

confidenceconfidence• Decreased cognitionDecreased cognition• Loss of sense of well-

being

Is there anything I can do Is there anything I can do without taking hormones?without taking hormones?

• Lots….Lots….• ExerciseExercise• DietDiet• Herbal SupplementsHerbal Supplements• Stress Reduction techniquesStress Reduction techniques• Chiropractic careChiropractic care• Massage therapyMassage therapy

Managing Hormones Managing Hormones Basic LevelBasic Level

• Start with symptomsStart with symptoms• Educate on risks, benefits, alternativesEducate on risks, benefits, alternatives• Begin therapy, monitor the resultsBegin therapy, monitor the results• Incrementally add or subtract whatever is Incrementally add or subtract whatever is

needed for your personal desired effectneeded for your personal desired effect• Once everything is “perfect” then Once everything is “perfect” then

measure to get a baselinemeasure to get a baseline• Generally, using Estradiol, Testosterone, Generally, using Estradiol, Testosterone,

and sometimes progesteroneand sometimes progesterone

How much does it Cost?How much does it Cost?

• If not covered by insurance:If not covered by insurance:• Testosterone and estradiol cream thru the Testosterone and estradiol cream thru the

Women’s International Pharmacy is $19.50 Women’s International Pharmacy is $19.50 per month eachper month each

• Most insurance companies cover estradiol for Most insurance companies cover estradiol for women and testosterone for men, including women and testosterone for men, including MediCareMediCare

• Most men are willing to pay $19.50 for Most men are willing to pay $19.50 for testosterone for their wives…testosterone for their wives…

Costs?Costs?

• How much do you pay for How much do you pay for antidepressants, blood pressure antidepressants, blood pressure medication, cholesterol meds, or medication, cholesterol meds, or Viagra?Viagra?

• What is your personal cost of What is your personal cost of Osteoporosis, or Low Back PainOsteoporosis, or Low Back Pain

• What is an improved sense of well-What is an improved sense of well-being worth?being worth?

More Info?More Info?

• Strongly Recommend:Strongly Recommend:• ““Perfect Balance” by Dr Robert Greene, Perfect Balance” by Dr Robert Greene,

featured on Oprah, bestsellerfeatured on Oprah, bestseller• ““The Life Extension Revolution” by Philip The Life Extension Revolution” by Philip

Lee Miller, MD, Los Gatos Longevity CenterLee Miller, MD, Los Gatos Longevity Center• ““Natural Hormone Balance for Women” by Natural Hormone Balance for Women” by

Uzzi Reiss, UCLAUzzi Reiss, UCLA

• Caution – be careful about what you Caution – be careful about what you read on the Internet!read on the Internet!