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| Mission
Statement |
Mission
Statement On Appropriate Physiological Human Sex Hormone
Replacement – Women And Men
Every
week brings new conflicting headlines for and against
sex hormone replacement for men and women.
The “sex" in sex hormones may be a major distraction,
since the major long term health issue about universal
sex hormone decline with aging is not primarily about
sex and hot flashes, but about ensuring a vibrant useful
active independent second half of life so that we die
well – i.e. preventing the common major disabling
aging diseases that rob us of decades of health.
It is about preventing the associated major risks of sudden
death, or crippling diseases – obesity, diabetes,
frailty, fractures, arthritis, heart attack, heart failure,
stroke, visual and hearing loss, Parkinson’s, incontinence
and dementia – and sexual impairment is sometimes
the last complaint.
After insulin in 1922-3, human non-oral sex hormone replacement
HRT was firmly established by 50 years ago by e.g. Schering
AG and experts in USA, Canada, UK and Europe. Then Robert
Wilson and Industry introduced oral patent xeno - (other
species) -hormones (e.g. premarin and oral contraceptives-
hormone therapy HT) for women’s convenience –
and more profits.
Despite increasing warnings about cancer and thromboses
with nonhuman especially oral hormones from the 1970s
onwards, and sixty years of risk-free use of appropriate
HT and especially balanced systemic Human sex hormones
HuSH, the USA and Europe medical establishments then embarked
determinedly in the 1990s with largely patent oral hormone
therapy in the HERS, ESPRIT, Papworth, WHI, WISDOM, Oulu,
HABITS and Stockholm trials – not just in elderly
women, but in women with vascular disease and breast cancer.
In elderly overweight women with established vascular
and sub-clinical malignant disease, aggravation of these
diseases especially with higher doses outweighed the reductions
in fractures and colon cancer by such HT.
Up to WW2, there were few hormones, fast foods, TVs, cars
or mechanical home / job aids, so most people were far
more physically active and slimmer. Since then, technology
has both extended life but also increasingly polluted
it and reduced necessary exercise – with increasing
obesity, feminization of nature , infertility, and consequently
more diabetes, vascular disease – and sex hormone
imbalance - in both men and women.
But, sixty years of use of physiological human hormone
replacement – testosterone in men, estradiol –
progesterone - testosterone; and appropriate conservative
dose oral hormone therapy orally e.g. premarin + progestin
in long term use - as in the Nurses Study, and the WHI
and Oulu trials, in younger women – have shown reduced
mortality and all aging major degenerative diseases without
any significant adverse effects.
So even the world’s leading experts, even in the
conservative strictly evidence-based International Menopause
Society IMS
and the International Society for Study of Aging Males
ISSAM
concur that there is no reason to withhold appropriate
evidence-based HRT of the patient’s choice from
hypogonadal men and women, since no individual modern
chronic prescription designer drugs do as well.
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| HRT
for Women |
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Post-menopausal
HRT - an anti-aging physician's perspective
Dr Craige Golding (specialist physician)
2007.06
"Today's truth is this: There is no magic
hormone or combination of hormones that can be indiscriminately
used by all women. Each women is an individual and hormonal
balance must be the ultimate goal for all women".
Joseph Collins, N.D
What do we know about the synthetic hormone replacements?
Read more
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In
postmenopausal women, appropriate lowdose estrogen reduces
all disease and death risks: The latest evidence from
the Women's Health Initiative WHI study June 2007 (1)
As we have
known from evolution, physiology, and for the past 50
years since Masters and Johnsons’ pioneering studies,
appropriate balanced bio-identical (BID) human sex hormone
(HuSH) replacement does nothing but good.(2)
The WHI was badly designed (possibly in the commercial
interests of the USA, Wyeth); and the WHI design caused
gloom when published in 1998 (we stopped using such Premarin-type
combinations where possible some 7years earlier). Fortunately
the WHI did relatively little harm (although no good)
for the elderly fat women so unwisely put on HT. But WHI
confirms what we long knew - that in the under-sixties
-from the earliest WHI (2002/4) papers, even PremPro lowered
all-cause mortality, and breast cancer incidence, by 1/3.
This correlates perfectly in the latest WHI paper with
60% reduction in coronary artery calcification in WHI
with appropriate HT.
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| HRT
for Men |
Is
low testosterone linked to long-term risk of death?
Dr Garry F. Gordon MD,DO,MD(H) President, Gordon Research
Institute says
I strongly support Testosterone supplementation particularly
for those with low levels, as reported here, who are at
greater risk of death. I find that the topical form of
testosterone is generally adequate. I also use broader
general hormone support whenever indicated. Therefore,
I take Melatonin 3 mg at HS and I also generally recommend
DHEA at levels of 10-25 mg for many of my patients, the
lower dose for women. In the same topical formula many
of my men patients also receive Progesterone and Chysin.
This research paper is one of only two that provides a
decent rational to support my belief about the general
benefits exceeding risks with testosterone supplementation.
He quotes the Low
testosterone linked to long-term risk of death in over-50s
study presented on June 5, 2007
at The Endocrine Society for publication in their ENDO
07 Research Summaries Book University of California, San
Diego School of Medicine chief of the Division of Epidemiology
Elizabeth Barrett-Connor, MD and colleagues evaluated
data from nearly 800 men aged 50 to 91 who enrolled in
the Rancho Bernardo Heart and Chronic Disease Study in
the 1970s. Twenty-nine percent of the participants had
testosterone levels at the lower limit of the normal range
for their age at the beginning of the 1980s. These men
experienced a 33 percent greater risk of dying from any
cause over the ensuing 18 years than men with higher levels.
Participants with decreased testosterone had a greater
incidence of elevated inflammatory cytokines, as well
as greater waist girth and other metabolic syndrome risk
factors. "Conventional wisdom is that women live
longer because estrogen is good and testosterone is bad,"
Dr Barrett-Connor stated. "We don't know. Maybe the
decline in testosterone is healthy and comes with older
age. Maybe the decline is bad and is associated with chronic
diseases of aging." "The new study is only the
second report linking deficiency of this sex hormone with
increased death from all causes, over time, and the first
to do so in relatively healthy men who are living in the
community," announced coauthor Gail Laughlin, PhD,
who presented the findings. "We have followed these
men for an average of 18 years and our study strongly
suggests that the association between testosterone levels
and death is not simply due to some acute illness."
HealthSpanLife Dr Neil Burman comments:
All experience from evolution and since 1940 shows that
appropriate physiological ie systemic human sex hormone
replacement HuSHR (at least testosterone for men, testosterone-estradiol+-
progesterone for women - not horse xenohormone pill doses
as used in the elderly in the WHI) greatly extends health
span and perhaps reduces premature mortality by one third
(as does metformin to tolerance in this couch potato era);
and probably fish oil, and combination of appropriate
vigorous minerals- vitamins- other biological supplements.
Whatever the dosing route and schedule used (avoiding
hepatic first pass), HuSHR should be based on at least
relative deficiency on lab tests; and the target should
be to restore the vigorous mean levels of healthy active
non-overweight young men and women, and avoid extreme
highs and lows. Absorption from implants or transdermally(
from cream, lotion or patch) is variable, so as well as
clinical response one needs to monitor saliva or blood
levels occasionally.
As with HuSH creams, we get excellent results with quarterly
Nebido 1gm testo undecanoate deep sc for men and pro rata
for women eg 100mg sc; and for the poor, with the old
depot forms - testost enanthate or cypionate self-injected
with an insulin syringe sc weekly ~ 70mg for men, ~7mg
for women) or pro rata every 2-3 weeks depending on tolerance.
For E2-deficient women we add physiological E2 as eg the
valerate (ie Primogyn depot, or in Mixogen or Primodian
depot) 0.5-1mg sc weekly or pro rata at longer intervals
- as Masters and Grody(1953) pioneered in the first HRT
RCT.
The WHI (2002) was not a trial of appropriate hormone
replacement (HRT) but (mostly inappropriately in fat elderly
women) of megadose (orohepatic) commercial xenohormone
substitution therapy (HT) for human hormones (like anabolic
steroid abuse) - although in more moderate dose in appropriately
young and healthy women as in the under-sixties in WHI,
and the 9year Oulu trial (Heikkinen ea 2006 0.7mg/day),
even such oral HT did nothing but good eg estradiol.
Sex hormone deficiency (the commonest major hormone deficiency
of all -affects >90% of the aging) is no different
from all other endocrinology, it should be based on physiology
and human hormone replacement, not reflex (gynaecologists'
-Robert Wilson's) inappropriate arbitrary patent convenience
pill therapy - which is what caused the post-WHI HRT ill-informed
media hysteria ("thalidomide disaster" as infamously
proclaimed by a German psychopharmacologist) that has
led to tragedy for so many women denied appropriate HuSH.
Every week one sees lively ladies who were taken off longterm
systemic testo+esto post WHI; apart from marked fatigue,
they have often lost cms in height; and recently often
developed deforming mixed OA/RA of the hands, heart failure;
and rectal carcinoma; mind-numbingly currently treated
with eg methotrex; indomethacin; furosemide; bisohexal,
spiractone, perindop, indap preds, salazop; & trepiline;
by different specialists on no supplements. The same applies
to men - stopping any appropriate hormone replacement
leads to progressive catchup disease.
Like HGH, there is little evidence in general to support
DHEA HuSH unless the bloodlevels are frankly low in the
slim elderly.
We have yet to find that adding (7keto)DHEA to testosterone
+- estradiol/progesterone adds any benefit?
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