Bio-identical HRT:  A review of all the evidence both for and against BHRT with the positives and negatives (E2 vs. E3).  And which natural estrogen is worthless and which one is very protective as per EBM.  Let the literature and science guide us as to which one to use, and how much, and which one should be avoided.  We will disprove the concept that estriol is the safe estrogen.  E3 does not protect against breast cancer or any other estrogen related deficiency. We’ll prove that E2 is the safe and most beneficial estrogen.  Do not make unsubstantiated claims about E3.

 

Review the hormone paradox and the myths and controversies of the oncogenic effects of hormones as to whether they are causative or protective against cancer.  A literature review of HGH & testosterone in men will show benefits of protecting against cancer as opposed to the incorrect common opinion of testosterone causing cancer.  As for women, estrogen and progesterone are also accused of causing cancer in spite of the literature support for the contrary.  Studies will be reviewed that evaluate whether they cause cancer or protect against cancer and how optimization protects against cancer. Well review all the literature that proves MPA ≠ OMP. Finally, testosterone is second to progesterone in protecting against breast cancer.  Can estrogen be safely used in cancer survivors?   Over 40 studies prove it can and should be used.  Not replacing hormones increases morbidity and mortality which proves the oncologic world doesn’t know their own literature. What level of progesterone is best for breast cancer protection and what level of testosterone is most appropriate?  All hormones have been demonstrated to protect against cancer and it is the loss of hormones that increases that risk.  Only one hormone increases cancer risk and that is a drug and not a hormone.  It is amazing what medical experts do not know or understand about hormones and will make incorrect assumptions to avoid HRT whereas doing so increases morbidity and mortality.  They cause harm by not utilizing HRT but they don’t understand that they don’t know.

 

Review the hormone paradox and the myths and controversies of the oncogenic effects of hormones as to whether they are causative or protective against cancer.  A literature review of HGH & testosterone in men will show benefits of protecting against cancer as opposed to the incorrect common opinion of testosterone causing cancer.  As for women, estrogen and progesterone are also accused of causing cancer in spite of the literature support for the contrary.  Studies will be reviewed that evaluate whether they cause cancer or protect against cancer and how optimization protects against cancer. Well review all the literature that proves MPA ≠ OMP. Finally, testosterone is second to progesterone in protecting against breast cancer.  Can estrogen be safely used in cancer survivors?   Over 40 studies prove it can and should be used.  Not replacing hormones increases morbidity and mortality which proves the oncologic world doesn’t know their own literature. What level of progesterone is best for breast cancer protection and what level of testosterone is most appropriate?  All hormones have been demonstrated to protect against cancer and it is the loss of hormones that increases that risk.  Only one hormone increases cancer risk and that is a drug and not a hormone.  It is amazing what medical experts do not know or understand about hormones and will make incorrect assumptions to avoid HRT whereas doing so increases morbidity and mortality.  They cause harm by not utilizing HRT but they don’t understand that they don’t know.

 

Testosterone’s risks and benefits from JCEM and NEJM meta-analysis, new guidelines, and alternative methods of prescribing testosterone for men and women.  Learn all the alternative methods of raising testosterone levels besides transdermal creams. When to avoid transdermal, when to avoid IM, when to use HCG vs. clomiphene, and when to use oral testosterone?  Which are the cheapest, which are the best, and which ones should be avoided.  Basically everything you could possibly ever need to know about optimizing testosterone.  A literature review (EBM) will support the many alternative methods to raising testosterone.

 

A literature review of the battle and controversy over oral vs. transdermal estrogen, which type, how, when, why, and how the ESTHER study guides us.  Knowledge is power when it comes to estrogen administration, the risks and benefits of both.  Review of HRT and clotting and how to evaluate the risk and decrease the risk.  And just what is that relative risk anyway that everyone always alludes to?  Please don’t tell me the risk of clotting-rather give me the numbers. The importance of SHBG in prescribing E2 as it pertains to CA and CAD.  Thrombophilia work-up, test panels with case examples of + labs and how patients should be treated.  Develop a treatment plan that encompasses the foregoing but that requires in-depth knowledge of the vast literature and relative risks.  Finally, OK, what to do when someone develops a clot while on HRT and has a negative work-up, or that has had a prior clot, even if provoked.  Review the harm of transdermal estradiol and the null set.

Thyroid update and cardiovascular review articles of the importance of T3 optimization for cardiac disease prevention and lipid improvements.  Thyroid replacement does not cause osteoporosis- an extensive literature review.  So you think you know thyroid?  More cases, labs, and articles.  More literature support for optimizing T3 in spite of AACE recommendations to the contrary.  U.S. Pharmacopia report on desiccated thyroid. Stock up now because desiccated thyroid is going away thanks to big Pharma.

 

11

Complex cases, labs, adjustments, fun and interesting cases, and lots of WWND (What Would Neal Do) cases. Lab updates that utilize the new reagents with comparisons with the old labs and reagents.  Conversion to the new reference ranges. 

 

12

Literature review of HRT, new and most recent that was not covered in Part I.  Everyday there is something new and this is the venue that keeps us up to date.

13

Case Study Questions and Answers

 

Osteoporosis:  Diagnosis and treatment using DEXA scan and NTX urine metabolites to monitor bone loss.  Treatment of osteoporosis beyond bisphosphonates: HRT, Vitamin D, Vitamin K, strontium, ipraflavone.  Measuring and monitoring improvements in NTX- a lab review. 

Estrogen metabolites- do they or do they not predict breast cancer and should we waste money on testing.  Lab review of 2 OH-E1 vs. 16α OH-E1.  DIM? Do you really need it and does it really work?  I didn’t know that estradiol caused cancer?  A look at EBM and studies from JNCI that refute confabulation.

Estrogen and Progesterone in men:  What the literature supports in so far as harmful effects of low vs. high levels.  Use of aromatase inhibitors in men or how to increase the risk of CAD, CVD, dementia, osteoporosis, and ED by blocking estrogen.  The harm of prescribing progesterone in men unless you want to increase the risk of MI or ED and inflammation.  Use EBM to guide your therapy, not what someone theorizes.