Brain lapses, memory loss, blank stares, confusion. Do you feel like you are losing your mind as you get older? What you may classify as old age and impaired brain function may truly be related to a decrease in estrogen.
Cognitive decline is a common concern for an aging population, in which the growing rate of Alzheimer’s disease and dementia has led researchers to look for ways to prevent cognitive degeneration. By the year 2050, it is estimated that 13 million Americans will have Alzheimer’s disease.1 While hormone replacement therapy is not considered a treatment for cognitive degeneration, it has been considered a benefit for female patients to delay age-related cognitive decline and sustain healthy cognition.2
A large concentration of estrogen receptors are found in the hippocampus - an area in the brain that regulates memory and learning.4,5 Estrogen’s role in cognitive function is to support communication between neurons, aid the development of neuronal processes, and sustain the synthesis of neurotransmitters.6,7
Overall, estrogen benefits cognition to:
Several studies have observed the effects of estrogen on cognitive function in older women. Researchers have found that among women who are over 65 years old, those that take estrogen replacement therapy (ERT) perform better on cognitive tests and show less cognitive deterioration over time.11,12,13,14 One study recruited 288 postmenopausal women that were either taking or not taking estrogen replacement therapy.15 Researchers found that women taking ERT had better visual memory when compared to those not taking the treatment. A similar study followed 788 older women for over two years to find that those taking ERT had better cognition than those who were not taking ERT.16 A series of studies found that women had higher scores on verbal and fine motor skills tests when estrogen levels were at their peak in their menstrual cycle. Additionally, these women performed better on speed and accuracy tests.17
Estrogen therapy may not be a main treatment for cognitive function, but it can help inhibit memory loss and cognitive impairment in women who already take HRT to treat their menopausal symptoms. It is important for the female patient to recognize that healthy cognitive function comes by living a healthy lifestyle. Along with balancing hormone levels, diet, nutrient supplementation, exercise, staying socially active, and a fascination to continue learning can help prevent age-related cognitive decline.18
Hormone expert Neal Rouzier, M.D. had a recent discussion with a Physician enquiring about certain hormones and their relationship to cancer. He thought it was worth sharing, and we agree.
I do not know why your tumor marker is elevated but you have had it elevated for some time. We do not use tumor markers here [in the U.S.] to diagnosis cancer. We only use them to monitor the progression of cancer once it is treated with chemo. Tumor markers can be elevated in normal people that don't have tumors or cancer, so it is not a good diagnostic modality. If you are concerned, then do an upper and lower endoscopy. In addition, a PET CT scan will pick up any cancer that you may have. I doubt that you have cancer and I truly believe that the elevated tumor marker is not diagnostic of cancer. We see them elevated all the time and never indicate a cancer. Again we use them to monitor a cancer once it is diagnosed, but never to diagnosis them. The only marker that we use is the PSA and that is not diagnostic for cancer but makes us go further to R/O any cancer.
With all due respect, the Japanese doctor that suggests that HRT causes cancer is perhaps unaware of the medical literature. Testosterone does not cause cancer. It may cause it to grow once prostate cancer is established, but no study shows that testosterone causes the cancer. On the contrary, our studies show that higher levels of testosterone are associated with a decreased risk of prostate cancer and less severe types of cancer if one develops a cancer. In fact low levels of testosterone are associated with a greater risk of prostate cancer and a more severe and aggressive type of prostate cancer. We used to think, and many of us were taught, that testosterone causes cancer whereas the overwhelming evidence shows the opposite. Several recent studies showed that testosterone treatment decreased morbidity and mortality from all causes, including heart disease and all cancer. The theory is that testosterone decreases insulin resistance and diabetes which greatly enhances the formation of many cancers. There are several recent studies where researchers (Morganthaler) are treating men with active prostate cancer and are seeing no increase in growth of these cancers. A meta-analysis study reviewed the world's literature and the conclusion from a multidisciplinary team of specialists concluded that there is no evidence from all the studies that testosterone administration causes cancer. Articles from all specialty journals from endocrinology, urology, cancer, and epidemiology, all published that testosterone does not cause cancer, and in most circumstances, protects against cancer.
The fact that a famous Japanese doctor claims that testosterone causes cancer is very incorrect and not supported by any clinical or scientific evidence. What is more disconcerting is that this physician is misinforming, and perhaps scaring, many Japanese doctors into not prescribing or recommending testosterone which is doing just the opposite of what he has intended. It may increase the morbidity and mortality of many doctors who now resist taking testosterone. I never suggest, teach, lecture, or make any claim unless what I state can be very well supported by scientific evidence. May I make the same suggestion to your fellow physician before he makes reference to hormones causing cancer.
It is very true that a synthetic female hormone (medroxyprogesterone acetate or Provera in this country) was demonstrated to cause breast cancer in women. We should not extrapolate this to include all hormones. Most physicians in this country also think that hormones cause cancer, so your famous physician is not too far off base from them. The medical and lay media in this country have scared all women into thinking that hormones cause cancer and this is very unfortunate. It is very true that our synthetic hormones have increased the risk of breast cancer and this has been demonstrated in many studies. As a result of this, there is an inherent fear that hormones cause cancer and there is a human tendency to extrapolate this to include all hormones. The medical literature supports that this is entirely not true. There are two Japanese Physicians that have recently attended Part II of the hormone courses that we offer here in the U.S. They both have the syllabus and 2 hour lecture material that I presented that demonstrates that the hormones in our body do not cause cancer in spite of the inherent fear instilled in us by the media and extrapolation from the WHI trial. Please contact them so that they may present to you all of the literature so that you may come to understand that the hormones in our body do not cause cancer, when in fact they are protective against cancer.
Without going into detail, I will summarize these studies. A meta-analysis of estrogen demonstrated that estrogen (alone and not with MPA mentioned above) administration decreases morbidity and mortality from all cause, both coronary artery disease, cancer, and osteoporosis. The WHI trial demonstrated that estrogen alone (that was the CEE arm that did not include MPA with the estrogen) was not associated with breast cancer. A most recent analysis just published demonstrated a statistically significant decrease (yes decrease) incidence of breast cancer in those that took estrogen alone in comparison with placebo. In addition, let us not forget that the estrogen only arm demonstrated a significant 27% decrease in colon cancer also. The theory is again the decrease in visceral fat and protection against diabetes that may play a major role in cancer protective effects of estrogen, similar to that of testosterone mentioned above.
Except in certain circumstances, which is beyond the scope of this letter, estrogen protects against heart disease, strokes, Alzheimer's, dementia, osteoporotic fractures, and cancer as proved in the meta-analysis along with a decrease in morbidity and mortality from all cause including cancers. Based on this, would you like your wife, mother, sister to be on estrogen or not? It is very unfortunate that your doctors and the world misinterpret the hormones and cancer issue.
There is a plethora of data and studies that demonstrate increased longevity and decreased morbidity and mortality when levels of our hormones are maintained at optimal. This benefit applies to estrogen, testosterone, progesterone, DHEA, and growth hormone. As our hormone levels fall with age, so does the protection against cancer. Replacement of hormones reverses this harm. Replacement with chemically altered hormones (medroxyprogesterone and norethindrone) has always increased the risk of cancers. As per the medical literature, we must not equate them to be the same nor should your doctor. I certainly hope that this lengthy explanation reverses your misunderstanding and that you can pass this along to your fellow physicians.
Neal Rouzier, M.D.
Can hormone replacement therapy replace antidepressants? Antidepressant medication, also known as selective serotonin reuptake inhibitors (SSRIs), has been shown to have a number of side effects, including insomnia, nervousness, sleep problems, headaches, joint and muscle pain, stomach upset, sexual dysfunction, and bleeding problems. Even so, antidepressants are the third most widely prescribed group of medications in the United States. Many individuals may be taking antidepressants for minor complaints, without considering the potential risks. What some may not realize is that hormone replacement therapy may be considered a safer, effective alternative to SSRIs.
In men, low testosterone levels can cause mood and emotional issues. If male patients choose to take SSRIs to treat depression, they increase their risk of infertility and sperm quality damage. SSRIs have been shown to reduce sperm count in men by 50 percent, as well as damage the motility and shape of the sperm.1 2
In contrast, hormone replacement therapy (HRT) restores the body’s natural production of hormones, including testosterone, to relieve depression and emotional issues that are related to hormone imbalances. Men that are concerned about the side effects associated with antidepressant medications may find HRT to be a safe and effective alternative.
When the results of the Women’s Health Initiative were published, many women immediately stopped HRT; a subsequent increase in the use of antidepressants is well documented. Women who were using HRT had climacteric symptoms reduced, including depression. 3 Estrogen therapy has been suggested to effectively treat perimenopause women with depressive disorders.4 5
HRT goes beyond just relieving depression to provide overall health benefits on cognitive function, cardiovascular health, weight management, energy, sexual health, and quality of life that result in confidence and a better mood. Even so, does this make hormone replacement the answer for treating depression? If a patient’s depression is related to hormone imbalances, then HRT can dramatically improve mood without the side effect of common antidepressants and anti-anxiety medications. Yet, HRT may not be the answer for everyone.
Overall, it is best to determine the method of treatment on an individual basis. Start by reviewing the big picture, which includes nutrition, exercise, and lifestyle habits.
Dr. Louis Cady, known for studying the connection between psychiatry, hormones, and wellness, explains, “In many cases I found that I could not make them better working from the neck up, and that no matter how good my potions were they didn’t get better. And then I began looking a little bit further. I got more professional education and began to understand this mind-body divide in contemporary medicine. Where if a conventionally trained physician can’t diagnose somebody in terms of really what is going on, they will say, “Well, it is all in your head” and then I will get them. And I will find many times that it is not just in their head. It may be in their thyroid or it may be in other parts of their body. They may have a sleep disorder. And so I decided that instead of just limiting myself to pushing pills all day I was going to do what I was trained to do, which was to be a complete physician.”
The best solutions to consider for depression or any other health complaints are proper nutrition, exercise, behavior modification, and natural hormone balancing. All of these are crucial elements to increase well-being, vitality, and health. While SSRI's still serve a necessary purpose for many people, instead of first looking at an antidote to fix the problem, it is best to look at what is needed to maximize the patient’s overall health and happiness.
As women age, they start to recognize a dramatic change in their skin. This is often due to a decline of estrogen in the body, which causes the inactivity of estrogen receptors and loss of estrogen production in the skin. Dry, rough, burning, and thin skin, as well as fine lines and wrinkles, can develop when estrogen is no longer being produced1.
Studies have indicated that estrogen therapy can increase collagen and hyaluronic acid production to improve skin thickness and hydration. A study published in the American Journal of Clinical Dermatology found that estrogen therapy restores skin thickness, decreases wrinkle depth, and improves collagen production and hydration. One study showed that women using hormone replacement therapy had a 10 to 20 percent increase in skin thickness, when compared to those not being treated. HRT also reduced atrophy (fragile, fading skin) that occurs in aging skin1.
Hormonal changes often cause an age-related delay in the healing of body tissue and skin. An estrogen deficiency can dramatically decrease the rate of cellular response to injuries2. Restoring healthy hormone levels, particularly estrogen, can increase the rate of healing among individuals recovering from injuries or surgical procedures.
Cosmetic surgery is commonly used among postmenopausal women to bring back a more youthful appearance. Hormone replacement therapy (HRT) is an added bonus for cosmetic surgery patients, because it supports the healing process and speeds recovery from surgery.
Dr. Neal Rouzier explains the benefits of using HRT among cosmetic surgery patients; “I personally have found longevity and preventive medicine to be a natural extension of cosmetic surgery. Patients find they can surgically reverse the effects of gravity and aging through face-lifts, eyelifts and liposuction. When I prescribe HRT to a patient before surgery, they heal faster and feel better postoperatively. If the patient continues the natural hormone supplements post operatively, two wonderful things happen. First, they will probably experience improved results of the tummy tuck or face lift, due to the strengthening and thickening of the skin. Second, they will begin to feel good with increased energy, libido, skin texture, muscle-to-fat distribution, and improved mental clarity. Most of all, I give my surgical patients a choice in how they age after their cosmetic surgery.”
While HRT has been shown to benefit aging skin, all HRT is not created equal. As an important reminder, synthetic HRT is considered harmful, as certain risk factors are associated with this type of treatment. Bioidentical HRT, hormones that are similar to those produced in the body, is a safer alternative to conventional HRT. This form of therapy protects women from health ailments related to the loss of hormones that comes with aging. Plus, bioidentical HRT has incredible benefits on improving skin quality. Remember, it is always best to support HRT guidelines that are based on peer-reviewed studies and protocols that have been tried and tested.
Fatigue, weight gain, forgetfulness, mood swings…did the holidays just hit? Or are these symptoms an indication of hypothyroidism? While you might struggle with the holiday season to maintain energy and sanity, these persistent symptoms are a few of the signs related to low thyroid function, also known as hypothyroidism.
More commonly found in women, approximately 5% of Americans have hypothyroidism, which occurs when the thyroid gland is unable to produce enough thyroid hormone to support several metabolic functions in the body. The thyroid gland secretes two main hormones, thyroxine (T4) and triiodothyronine (T3). T4 is the hormone that is principally produced by the thyroid gland which is then converted in the liver and kidney to the metabolically active T3 hormone. It is the T3 that is responsible for regulation of metabolism, energy production, body temperature, body fat, cholesterol, cognitive function, and symptom improvement.
There are over 200 symptoms related to low thyroid function that improve with optimal thyroid replacement:
Optimizing thyroid function by replacing thyroid hormones to optimal (upper range of normal) can significantly increase energy, metabolism, and well being. Many studies (NEJM & JCEM) demonstrate that raising Free T3 levels in addition to T4 levels is essential to obtaining these results. Traditionally physicians have prescribed thyroid hormone in a form of T4 only, also known as Synthroid®, Levoxyl®, or L-thyroxine. Recent studies, however, have demonstrated that this may not be sufficient in many patients to truly feel well. Many thyroid treated patients commonly request even more thyroid, knowing that more makes them feel and function better. The patient might not have realized how lousy they felt until they felt better. This might not be accomplished, as per recent literature, until these patients have improved or optimized T3 replacement as it is the T3 at the cell level that is responsible for thyroid function, and not T4. Nevertheless, it is usually only the T4 preparations that physicians are taught to use for thyroid replacement. Unfortunately using primarily a T4 only preparation typically does not allow for adequate conversion to T3 and therefore improvement in symptoms is often not adequate. Many factors play in the inadequate conversion of T4 into T3 and are related to a defective function of the 5’-deiodinase enzyme responsible for this conversion. Whatever the cause for the inadequate conversion of T4 to T3, many patients have persistent low thyroid symptoms despite adequate T4 replacement. Several landmark studies demonstrate that this can be overcome by simply adding T3 on to the T4 regimen. Improvement in T3 levels can be attained by compounding both T4 and T3 together into a capsule or through the use of the commercially available desiccated thyroid preparations that contain T4 and T3 together in tablet form. The commonly prescribed T4 preparations of L-thyroxine, sometimes referred to as synthetic thyroid and contain only T4 and no T3, might not convert to the active form of T3 which is especially critical for patients who are not able to properly and adequately convert T4 to T3.
A paper published in JAMA demonstrated the importance of T3 in predicting morbidity, mortality, and functional decline. Neither TSH nor T4 were predictive, thereby further establishing that T3 should be the main marker utilized for thyroid replacement.”
Dr. Rouzier recommends physicians review the excellent articles published in NEJM, JCEM, and JAMA to further appreciate the importance of T3 optimization for health and well-being.
Utilizing a combination of both T4 and T3, as suggested by recent literature, most effectively raises the active thyroid hormone at the cell level called T3. Science has proven that it is the T3 level, and not the T4 level, that is responsible for maintenance of normal cholesterol levels. Commercially available combinations of T4 and T3, commonly called desiccated or natural thyroid, will provide more optimal levels of T3 than commercially available T4 only preparations. Since T3 is the more metabolic hormone, low T3 levels result in poor metabolism and symptoms of low thyroid. When pure T4 is given in the form of Synthroid®, Levoxyl®, or L-thyroxine, T3 levels improve only minimally due to poor conversion of T4 to T3. Many physicians including endocrinologists believe that T4 alone is the only thyroid preparation necessary to prescribe for hypothyroidism. Their reasoning is the belief that the body will automatically (physiologically) convert T4 into T3 if the body needs it. If the body doesn’t need it, then it won’t make it. This commonly held belief, however, is not what is born out in the medical literature for optimal thyroid function. Recent studies show that use of T4 alone does not adequately convert into T3. Although many patients do improve on pure T4 supplementation alone, adding T3 to the T4 preparation allows us to optimize T3 levels that are not usually achievable with pure T4 preparations alone. It is only supplementation of T3 that augments the antidepressant of thyroid hormone, not T4.
Conventional treatment for thyroid disorders involves restoring TSH into the normal range which might still maintain levels of T3 in the low normal range in spite of normal TSH levels. Restoring T3 levels into the upper range of normal is now regarded as necessary to achieve improvement in health and well-being. Normal laboratory levels are the average of a population for the age but do not reflect that which would be best for symptom improvement and health. In other words, normal does not mean optimal or what is best for the patient. A recent article in “Gerontology” demonstrated that thyroid replacement in euthyroid men (normally not needing thyroid replacement) into the upper or high range resulted in improvement in cognition, memory, and overall function. This study is just one of many that consistently demonstrate that optimization of all hormones, including low thyroid, provides better metabolism, health, well-being, and disease prevention than does maintaining “normal” levels for the age. Keep in mind that normal levels (average for the age) of estradiol, progesterone, and testosterone are zero in menopausal women. Even though that is the level typically measured in a menopausal woman as menopausal women no longer make these hormones, normal (zero level) is not where the level should be for symptom improvement and health protective benefits (cardiovascular and musculoskeletal). The same applies to thyroid. Low T3 levels were predictive of an increase in fracture rate whereas TSH and T4 levels were not predictive or protective. Where would you like your levels to be? The Rotterdam study (Annals of Internal Medicine) demonstrated that normal levels of thyroid (in the lower 50% of normal) were predictive of a 2.2 fold increase risk of cardiovascular disease, and these were levels in the “normal” range. There is now significant data to support that we physicians should conform to the literature recommendations and understand that in every circumstance optimal levels of all hormones, including thyroid, are very important for health optimization and improvement in symptoms, and subsequently our quality of life.
By simply restoring TSH levels to “normal” blood levels for your age might not be in the best interest for the patient. Lab tests can indicate normal or low normal thyroid levels, but patients can still have symptoms associated with hypothyroidism. According to the BMJ, goals of thyroid replacement should be to treat the patient until the Free T3 and Free T4 levels are in the high normal range. Some patients might require levels that are above normal (suppressed TSH) to feel normal, a concept that we physicians are not taught to trained to do. Researchers emphasize that TSH is not predictive of symptoms or symptom improvement, only T3 is as this is the active hormone at the cell level. Although TSH is very predictive of biochemical hypothyroidism, it is not predictive at all of clinical symptomatology. Rather than treating the patient’s lab tests, researchers suggest that physicians should treat the patient’s symptoms and not the TSH level as we are often taught. Researchers emphasize that if the Free T3 and Free T4 levels are kept within the upper end of normal, in spite of suppressed TSH levels, then overt hyperthyroidism is averted. Thyroid hormone serum levels that are in the optimal range that thereby result in a reduction of hypothyroid symptoms indicate healthy thyroid function.
Optimal thyroid replacement can effectively restore health and well-being by improving:
What is considered the normal range for testosterone levels in men? It may seem like an easy question to answer, as traditionally serum testosterone levels are observed to be anywhere between 300 to 1,200 ng/dL. Yet, the answer to this question is not as simple as it may seem.
Hypogonadism, or an androgen deficiency, affects an estimated four to five million men in the United States. More than 60% of men over 65 years old have low free testosterone levels. Even so, hypogonadism often goes undiagnosed and older men experience a rapid decline in their health. Low testosterone levels can be observed through serum tests, but what are normal testosterone levels? What are optimal testosterone levels? The answer to this question depends on who you ask and varies widely amongst healthcare practitioners. Hormone Doctor, Neal Rouzier. M.D. gave his expert opinion in a recent interview.
“An important point is the difference between optimal and normal. Normal for one’s age is not optimal for one’s age. The medical literature supports replacement levels to that of a younger age, typically 20 to 30 years old. At these levels, optimal health is attained, as well as the feel-good effects. The problem is how one defines normal and optimal. Normal for a 70-year-old is not normal for a 20-year-old. If a 20- year-old man has the testosterone level of a 70-year-old man, he will not feel well. If a 70-year-old man has the level of a 70-year-old man, this is considered normal. No man should have the testosterone level of a 70-year-old as supported in our medical literature. In reality we are not trying to be 30; however our goal is to optimize levels to those we would see in a 20 to 30 year-old. A free testosterone lab value of 25 may be interpreted as optimal when in fact this level is quite low. A lab value of 40 would be interpreted as being too high when in reality it is a perfect level and our goal for a younger person. All the medical studies utilize hormone dosages resulting in levels on the upper end of the physiologic range. These are levels found in young adults.
In past years, various labs would list the testosterone ranges for all ages next to the lab results. Today, the labs publish only the normal levels based on a person’s age. This does not provide the appropriate indication of optimal levels as it is age specific. For example, normal free testosterone levels for a 60-year-old man range from 5 to 25. Optimal is therefore expected to be 25. A traditional medical doctor would interpret 25 as optimal. But remember, our goal is to replace free testosterone levels to that of a younger male. These free testosterone levels would be 30 to 40. A lab value of 40 would be interpreted by the lab as being too high, when in reality the level of 40 is perfect and is always our goal.
Optimal levels are conducive to optimal health. Having good testosterone in your system decreases incidents of heart attacks, strokes, Alzheimer’s, diabetes, high blood pressure. It has a beneficial effect in protecting against cardiovascular disease in every study. It decreases the instance of heart attacks because of its effect on blood vessels. It has a beneficial effect of improving your good cholesterol and lowering your bad cholesterol. It has a beneficial effect of improving all of the good lipoproteins and reducing all the bad lipoproteins.
Critics perhaps don’t understand that the more that you have, the better off you are, and every longevity study says the same thing: the higher level, the longer you’ll live, the less risk of heart disease that you'll have. Where would you like your levels to be?”
What are the signs of a deficiency?
Restoring optimal testosterone levels can deter these health risks and improve bone mineral density, sexual function, muscle mass/strength, and mood. Furthermore, quality of life is improved overall.
If you are considering testosterone replacement, a healthcare provider who is trained in evidence-based Hormone Replacement can help you restore hormone levels to an optimal point that reduces or eliminates symptoms and improves quality of life without causing significant side effects. If you are a health practitioner, it is recommended that you understand the medical literature supporting optimal hormone levels before treating patients with testosterone replacement therapy.
Dr. Neal Rouzier recently shared a an email thread between him and Dr. Dirk Parvus. We found it to be quite moving and thought it would be useful to post.
I am attending a hormone conference in Chicago as part of a series given by the Institute for Functional Medicine (IFM). I am interested in their approach to treating chronic disease. A lecturer from IFM refers to several studies that are using CEE and progestins. Some of the studies concluded that hormone replacement, even testosterone, increase breast cancer risk and should not be used long term. Also, his conclusions on estriol differ from mine and from what you teach. He also points out that the FDA, ACOG, and Endocrine Societies do not recommend bioidentical hormones, which I feel is crazy and disturbing. Unfortunately, he does not refer to, or may not know about, the numerous articles you use to base your recommendations. It saddens me that his conclusions are so diametrically opposite from ours. Depending on the experts they listen to, doctors are giving very different treatment recommendations to their patients.
Yours in health,
It is absolutely amazing what is being taught and promoted. If this doctor attended our courses, he would be just as disgusted with us, as we are with him. As you have heard in my lectures, the most upsetting consequence to all of this is that practitioners who abide by these teachings mistreat so many patients. None of them follow any scientific methods. As you can imagine, I am not very popular when I lecture [at similar conferences], because I use the medical literature to debunk all that they teach. Please note that there are hundreds of alternatively trained physicians that will disagree with me. I'm glad you can identify the teachings that don't hold any credible scientific backing. I frequently get into discussions and debates on a multitude of topics, as our teaching is diametrically opposed to their beliefs. Unfortunately for them, they always lose the argument, because I use the medical literature and science to counter almost everything they propose.
Please don't feel disturbed that ACOG and NAMS don't recommend bioidentical hormones. I agree with them 100% (and so do you). You see, they are not recommending bioidentical hormones that are utilized by this IFM physician. This doctor will recommend estriol and progesterone creams that do not raise hormone serum levels or provide endometrial protection. ACOG and NAMS are against this type of prescribing and promotion, and so are we. In contrast, the literature is full of data and studies demonstrating the beneficial effects of pharmacologic bioidentical hormones, which I simply copy.
Many doctors from IFM attend my courses and think I'm crazy, because what they are initially taught is contrary to what I teach. I am pleased that you have the insight many others lack. I am frustrated with the incorrect principles being taught, but that just fuels my passion.
Thank you so much for taking the time to give me a detailed answer. I have referred many colleagues to your courses and plan to retake level 2 and 3 in the next year. The knowledge you provide has enabled me to talk to anyone (including other doctors) about bioidentical hormone optimization. I am able to practice safe, effective medicine for my patients, and when it exists I have been able to recognize flawed reasoning in hormone lectures I have attended. On behalf of all of us who follow your teaching, thank you for your passion and for all of the work you do to summarize the correct way for us.
I must say that your response is the most moving that I have ever received. I just spent the last two days at my computer researching, writing, re-organizing, and trying to improve the courses. This was my only weekend off in months, and I wasted it doing trivial tasks. However, based on your response, it is the most rewarding activity. It drives my wife crazy, but the knowledge and insight that I gain from the research, as well as the responses I receive from physicians and patients, makes all of the effort worthwhile. Thanks again and I hope to see you in September at Part II (which I have changed about 50%).
Look-young concoctions and feel-good elixirs. The anti-aging market is well-established and only getting stronger, as over 70 million aging baby boomers are driving the movement to look and feel younger. Currently at $80 billion, the anti-aging market size is expected to reach more than $114 billion by 2015.
With a prevalent focus to stay young, many anti-aging interventions have developed over the years, including hormone replacement therapy, anti-aging supplements, and surgical treatments. Are these treatments safe and effective? This is a main question for several medical professionals, as they claim anti-aging interventions, especially hormone replacement therapy, can be ineffective and cause harm.
The majority of fears about hormone replacement therapy stems from the highly publicized Women’s Health Initiative, which warned thousands of menopausal women to stop taking HRT. (See Hormones and Cancer blog post). Regrettably, critics fail to see that the negative outcomes from the WHI were applied to one form of treatment, and only for one specific age group of women.
By stopping HRT, women were put at greater risk for developing cardiovascular disease, stroke, and cancer. Fortunately, there are alternatives to anti-aging interventions that may be harmful. Unlike conventional HRT, medical studies purport bioidentical hormones (BHRT) are a safe and effective treatment for women with hormone deficiencies. One particular study is currently being conducted by the Kronos Longevity Research Institute to clarify the safety and efficacy of BHRT.
The benefits of hormones can be further explained by Dr. Neal Rouzier, who has been teaching Worldlink Medical's anti aging conference for over 10 years. He stated in his recent anti aging seminar, “Yes hormones are good. Just use the right ones in the right way. If hormones were so bad in women, we would yank their ovaries out when they were 30. We used to do that, and they all died sooner and had a miserable life before they died. Now we don’t take the ovaries out, we leave those ovaries in. Why? Well, because they feel better, they function better, and they live longer, happier and healthier. So, hormones do have a beneficial effect. The Women’s Health Initiative showed that the hormones were harmful. Well which is it? Are they good or are they bad? In the body they’re good. Out of the body, in a chemically altered form, they’re bad and all of the studies show that. Well, let’s look at the most recent studies, perhaps at a natural estradiol. All of the studies show it is very beneficial, and long term use will make you live longer, happier, less heart attacks, less stroke, less osteoporosis, less depression, less mood swings, less Alzheimer’s disease, and less dementia. Why don’t we use that one?... Let’s not look at these other studies with the synthetic chemically altered [hormones], let’s look at estradiol [i.e. from the Kronos Study http://www.keepstudy.org/keeps/why.cfm]. That’s the one that has shown to be beneficial, that’s the one that we lose when we go through menopause. We’ve replaced that one, in the correct form, and we haven’t seen any problems with it.”
Not all anti-aging interventions are created equal. There are some products and gimmicks for which you should be weary. The market is saturated with hormone balancing creams, wrinkle-fading dreams, and lose-weight quick schemes, but such products may not live up to all they claim to be.
Anti-aging products can pop up while browsing the internet, making statements that are often not backed by scientific evidence. Generally, these products are advertised as free trials. Yet, they truly turn into a monthly commitment to buy a product that doesn’t live up to its promised benefits. Several consumers easily purchase these products only to be later disappointed and stuck in a purchasing obligation that can only be stopped through a difficult cancellation process.
How do you decipher the anti-aging facts from fiction? Find a physician or healthcare practitioner who is well trained and open to the idea of hormone replacement. Also, one who treats patients based on a multitude of medical evidence and has not been deterred by the WHI. It’s not about the “Fountain of Youth”. It’s about living healthier and happier during a potentially difficult age. This is accomplished by thorough clinical analysis including food testing, replenishing lost hormones, fitness scheduling, coaching, etc. Some call it alternative healthcare, while others call it ‘upstream medicine.’
Wow, this looks like a long post! Well, quite frankly it is. But hang in there, because we are willing to bet that you will get some practical takeaways. Whether you are just starting a practice or simply seeking to increase your patient base, at some point you will have to implement a marketing plan-of-action, so your prospective patients can connect to the health services you offer. At the same time, you are a medical professional with places to go and patients to see. Therefore, we will explain some of the best medical practice marketing tips, while still focusing on what you do best.
You may be thinking, “I already have patients lined up at the door,” or better yet, “All of my patients come from word of mouth.” Even if the appointment books are full, you still need to maintain a presence with your target audience. Why, you ask? Let’s put it this way- THINGS CAN CHANGE. Whether it is health reform, an economic downturn, increased competition, or someone invents the “fountain of youth”, there are many regulatory or societal changes that can pose a threat to your practice’s financial health. Because of this, you need to stay ahead of the game by making yourself known in the community. This way you never get lost in the crowd.
Before you launch your efforts towards the marketing tactics available for your practice, start with the big picture. It is crucial to set budgets based on the goals you have set for your practice. How many new patients would you like to gain per month? Per quarter? Also, how much are you willing to invest to acquire new patients? Once the big picture is fully understood, you have a foundation to make sound investment choices. If you don’t have the capital to “flood the channels” all at once, then it is best to allocate a percentage of monthly revenue towards marketing expenses. Perhaps start with 5%.
Additionally, set budgets and goals that are within reason. To do this, answer the following questions to the best of your knowledge:
a) What are the strengths and weaknesses of my practice?
b) What is the market size in my area? (population, income, age, etc.)
c) How many competitors do I have? How easy are they to find online?
d) What makes our practice different? What are the key features and benefits that we offer?
Take advantage of free advertising that takes only a few minutes to setup. Online search engines, such as Google and Bing, have local listings that are often found at the top of organic search results. Envision this as what used to be a phone book listing, only free and more accessible. All you have to do is fill out basic information such as a business name, location, specialty, etc. With this listing, you can even take a video tour of your practice, and people can write reviews about you on the listing. Furthermore, it is likely that your listing will show up when patients in your area type specific keywords, i.e. “OBGYN in La Jolla, CA.” Check out Google Places or Bing Business Portal to get started.
Research indicates that websites are responsible for over 54% of purchasing decisions1. Also, there is no doubt that our society receives information online at an increasing rate, as people are less likely to pick up a newspaper or even dial a phone number. Start your marketing expenditures by building a website that clearly communicates your services, is emotionally captivating, and genuinely expresses your benefit-driven knowledge. In other words, make sure your website depicts you as the thought leader in your local market, so that your patients are more likely to make an appointment or sign up for your e-newsletter.
There are two ways email marketing can be used to drive business. First, purchase a third party email list based on the demographic you are seeking to reach. Typically, these lists are provided on a “cost per use” basis. Therefore, your email message must have a strong call-to-action that stimulates a website visit or office call to redeem a special offer. Generally speaking, it is not recommended to take a “shotgun” approach by merely sending one message, but it can be done successfully if the call-to-action is strong ( i.e. contest to win a free ipad, first visit is free, etc.)
The second way to utilize email marketing is by sending regular messages or newsletters to your database of accumulated email addresses. These emails can be sent on a weekly, semi-weekly, or in some cases a daily basis. The key in this situation is to send information that has relevant interest and/or value to your patients. Overtime, you will establish enough touch points with these prospective patients for them to make an appointment with you when the time is right. There are many cost effective tools that provide user-friendly email services such as Constant Contact or Vertical Response.
PPC is an internet advertising model used to direct traffic to websites. Advertisers pay the hosting service when the ad is clicked on. This involves choosing a variety of keywords that your target audience is likely to enter, when using an online search engine such as Google, Bing or Yahoo. For example, ‘weight loss wellness center’ or ‘bioidentical hormone doctor in texas’ are keywords that patients may enter to find your practice. With PPC advertising, you can bid on these keywords. When your ad appears and is clicked on by an internet user, you pay a fee for that click and the user is directed to your website or landing page. This process can be setup using Google Adwords or Microsoft Ad Center.
PPC advertising is one of the most effective ways to start generating traffic quickly. Also, it is great place to start learning the keywords your patients are using from which to optimize your website
In contrast to Pay-Per-Click advertising, Search Engine Optimization (SEO) is the process of strengthening the content on your website, so that it is more likely to be found in the organic search results when your patients enter key search terms. Once an effective SEO strategy is established and maintained, not only do the ‘clicks’ become free, but patients are more likely to trust an organic search result than a paid advertisement. In fact, research shows that if your website appears in a combined organic and paid search result (from PPC advertising), internet users are more likely to click on your website listing than if you were only listed as one or the other. There are a variety of ways to boost your website’s search rankings, but the best place to start is by enriching your website content with the top performing keywords identified by your PPC campaign. Work with a web developer to maximize SEO and you will reap the benefits of lower advertising costs over the long haul. Speaking of lower costs, one of the best sources of ‘free’ involves using social media to your advantage.
You probably have a profile or even a number of profiles on social me
dia and networking sites. Facebook, Twitter, LinkedIn, Google+, YouTube and many other social sites are great ways to increase your fan base and widen the reach of your messages and promotions. Additionally, social media is interrelated with Search Engine Optimization, meaning the more active you are on social sites, the more likely you will be found from a patient’s keyword search.
With the ability to gain followers and fans, your messages have the opportunity to spread like wildfire throughout the online community. For instance, say you have 100 followers on Twitter and they are all in your metropolitan area. You write a tweet that says, “The first 20 people who reserve a free medical evaluation will be entered to win a free night’s stay at the ABC Resort and Spa.” Now, say that 25 of your followers see this tweet and are so excited about it, that they re-tweet the same message to their own list of followers. Their followers tweet the message again, and the process repeats. Voilà! Your offer has just been passed exponentially over the online social space. Also, social media is a great way to link patients to your, “How to beat the winter sniffles” blog post. Or better yet, try posting on Facebook, “check out my three minute video on how to naturally improve sexual vitality.” Do you think your followers will respond?
Although Direct Mail Marketing has decreased with the prevalence of the internet, it can still be an incredibly useful form of advertising, especially if it provokes your patients to go online. As mentioned in the email section of this blog, you can purchase a mailing list based on demographics. Keep in mind that your mailers are best sent repeatedly to the same audience over time to gain brand awareness and eventual action from your patients. You can increase the results of your mailers by using emotional imagery, captivating language, and (as always) a compelling call-to-action that sparks your patient to contact you. One of the newest tricks of the commercial printing trade includes personalizing your mailers by implementing each recipient’s name into the headline of the mailer (not just the label). This can increase response rates anywhere from 1 – 3%.
[Gasp] Okay, are you still with us? Good. Because we cannot help but be direct when we say THIS IS THE MOST IMPORTANT MARKETING POINT TO TAKE AWAY from this list. Content is king.. think about it. Why do you watch action movies? Why do you buy books from your favorite author? Why did you purchase every Beatles album known to mankind (even on vinyl)? And why do you order the same Mocha Latte on your way to work every day? Because you enjoy the contents of what you are buying or subscribing to.
Relevant content is what inspires and motivates us to learn more (and buy more) about our specific interests. In the prevention and wellness industry, there are an ever increasing number of patients seeking a healthy, proactive lifestyle. They want to look better, feel better, and be inspired by the content, services and products you offer. As a marketer, this is your primary responsibility. Be the “thought leader” in your field and in your demographic. Share free information about health and wellness that your prospective patients will crave, and in-turn they will follow you, talk about you, ‘tweet’ you, and choose you to be their health coach. Thirty minutes to an hour a day would be a sufficient amount of time to write a blog, make a quick YouTube video, or even write a “health tip of the day”. Your expertise and knowledge will take any marketing objective and turn it into real connections and more patients.
That’s easy- have someone else do it. You are a healthcare provider, an expert, a thought leader. Spend your professional time on spreading your knowledge for the health benefits of others- whether that is through a life changing medical treatment or an insightful podcast¬. Let someone else manage your relevant and valuable information, and find the best ways to deliver that content to your prospective patients. Hire an intern, a nephew, a marketing consultant or even an advertising agency. Within your business model, find the most cost-effective way to get a return on your marketing investment by working with a knowledgeable marketer who will assist you in choosing the most appropriate methods of marketing communication. Once this is established, all you have to do is focus on what you do best; treat patients and stay up-to-date on the latest information within your specialty. Sounds like a relationship for success, doesn’t it? Stick to tips #1 and #9 and your practice will thank you.
Clinical studies have demonstrated that DHEA has a beneficial effect on immune response, sex drive, metabolism and emotional stability. DHEA benefits the immune system and reduces visceral fat associated with diabetes mellitus. Other health-related benefits include support of cognitive function, helping the body cope with stress, and protection against heart disease through its effects on lipids and body fat.
Melatonin regulates the circadian rhythm as well as the deep stages of sleep. Studies suggest that the immune system depends on melatonin's effects of deep sleep. In the January 1997 issue of the New England Journal of Medicine, melatonin was demonstrated to be a powerful antioxidant hormone that can protect against cancer. There are hundreds of studies showing that melatonin can scavenge free radicals, and be a safe sleep-enhancing hormone.
Failure of memory and lack of mental clarity can be among the most frustrating aspects of aging. Studies indicate that pregnenolone might be beneficial against age-related cognitive decline.
This metabolic hormone secreted by the thyroid gland regulates temperature, metabolism and cerebral function. Insufficient thyroid levels result in fatigue, increased cholesterol levels and increased risk of coronary artery disease. With age, thyroid hormone levels gradually decline resulting in a decreased metabolism, which affects all cells and organs. Low thyroid causes low energy, and thinning of hair, skin and nails. The dictum that normal levels are not optimal levels is extremely important when it comes to thyroid.
Although testosterone is the primary male hormone, women also benefit from its supplementation. Levels of testosterone decline with age in men and women. At optimal levels, research shows testosterone increases bone density and bone formation, enhances energy and sex drive, decreases body fat, increases muscle strength, lowers blood pressure and modulates cholesterol levels. Testosterone is a hormone that neither man nor women should be without and we'll present the scientific evidence to support this.
Over 50 years of studies demonstrate that loss of estrogen increases cardiovascular disease, Alzheimer's Disease, osteoporotic fractures, urogenital atrophy, macular degeneration and depression. Recent studies sort out the confusion created by the WHI (Women's Health Initiative) and conclude that certain types of hormones cause harm in some women, whereas different hormones avoid the harm and provide a significant protection. A thorough literature review helps sort out the differences and provides credence and confidence for the use of bioidentical estrogens as based on our medical evidence.
Data demonstrates that synthetic progestins increase the risk of breast cancer, heart disease, strokes, bleeding, and depression. Studies demonstrate that not only does micronized progesterone not increase these risks, but it also protects against them. Studies demonstrate a synergistic effect of progesterone with estrogen, whereas progestins negate estrogen's positive benefits. This literature review will demonstrate the difference between progesterone and progestins and how this difference is the key to understanding the importance of progesterone.
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