PAUL E. COX MD, MSOCULUS SKINCARE, LASER AND

LONGEVITY

Bio-identical Hormone Optimization for Women

What is Regenerative or Integrative Medicine?

the field of scientific research aimed at the early detection, prevention, treatment and reversal of age related decline.

the optimization of the body’s mechanisms of self repair with hormones, lifestyle and neutraceuticals ( vitamins and herbal supplements).

Why Regenerative Medicine

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

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.

Steroid Hormone Pathway

Why do hormone systems fail?

StressDecline with ageChronic disease (Diabetes)Medications ( pain, cholesterol, blood

pressure )Genetic factors Environmental factors (pesticides, plastics,

pollution)Poor nutritionSurgical intervention

Thyroid hormone function

Lights the furnace of the body

The main hormone responsible for metabolism

Symptoms of deficiency may resemble other hormone deficiencies.

Often “normal” but not optimal

Peri-menopause

A period of gradual ovarian dysfunctionIrregular periodsIncreased irritability, mild hot flashesAnxietyLow libidoSkin and hair drying and thinningMild weight gain

Menopause

The absence of menstrual periods for at least one year.

The actual problem is the failure of the ovaries.

Ovarian failure means sudden loss of the female hormones estrogen and progesterone and a decrease in testosterone.

Loss of these hormones leads to the typical symptoms of menopause.

Symptoms of Menopause

Tired Moody Tense/Anxious Sleepless Forgetful

• Uninterested in sex

• Depressed• Hot flash(y)• Sweaty• Fat

Could HRT be right for me?

Documented deficiency on labs.

Symptoms of deficiency on surveys or questionnaires.

No contraindications to treatment.

Bio-identical or Human identical Hormones

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

Non Bio-identical Hormones

Examples of non bio-identical hormones include Conjugated Equine Estrogens (CEE) which is known as Premarin. This compound has a higher risk of blood clots and is not easily metabolized by the body

Progestins are progesterone like compounds invented for the use in oral contraceptive pills. These compounds do not protect breast tissue and may lead to an increased risk of heart disease and breast cancer.

HRT Safety

Randomized controlled and observational studies indicate that the addition of synthetic progestins to estrogen increases the risk of BC much more than estrogen alone.

A study on a French cohort suggests that when natural progesterone is used instead of synthetic progestins in HRT the risk of BC is not increased.

HRT Safety

The findings come from 2 large cohort studies carried out in France, where oral micronized progesterone has been used by large numbers of menopausal women over 2 decades.

One study followed over 3000 women for 8.9 years found that women receiving estrogen plus progesterone or a non MPA progestin had no increased risk for BC.

HRT Safety

The E3N0EPIC cohort study on over 54,000 HRT naïve women followed these women for 5.8+/- 2.4 years found that oral micronized progesterone did not increase risk of breast cancer in women treated with micronized progesterone.

HRT Safety

What is the consequence of non-bio-identical use? (Prempro or equillin and progestin) WHI study of 2002 Breast cancer- 26% increase Stroke -41% increase Blood clots (doubled) Heart disease -22% increase

Estrogen Patches

Might have an adhesive problem, especially with athletic activity or sweating/hot flashes.

Need to be changed 1-2 times weekly.Absorption varies individually.Available commercially (Vivelle, Alora).Low risk of blood clots and low testosterone

levels.

Estrogen Gels

Must be applied to skin daily at specific sites.

Will have peak/valley effect.Not everyone absorbs creams or gels

well.Available commercially or compounded.Must be careful about transference to

loved ones and friends (not ideal if small children are often present).

Estrogen Implants

Proven technology for over 60 years

Steady state of hormone release closely mimics the body’s

Less roller coaster effectEasy dosing, most people need

them 2-3 times yearly

Testosterone for Women

Maintains lean muscle mass

Necessary for Libido (sex drive)

Prevents osteoporosis

Not FDA approved for women in US (used widely in Europe and Australia)

Available as compounded gels or implants

Progesterone for Women

Available as a pill commercially (Prometrium) or compounded

Available as a gel from compounding pharmacies.

Hormone Considerations:

• Not all hormone therapies are created equal

• Hormone replacement therapy is not a “one-size-fits-all” approach.

• You deserve a program created just for you based on your medical history, family history and lifestyle

references

J Steroid boichem mol Biol 2005 July: 96 (2) 95-108