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Archive for the ‘Hormone Physician’ Category

Vail Daily column: Thyroid issues in the elderly often difficult to diagnosis – Vail Daily News

Aging is a normal process the body goes through, but not all of the symptoms that are frequently attributed to the normal aging process should be directly connected to aging some may be associated with other illnesses such as hyperthyroidism or hypothyroidism.

Hyperthyroidism, or too much thyroid hormone, in the elderly is often difficult to diagnosis. While multiple symptoms may be present in a younger population, the elderly may only present with one or two symptoms. According to the Cleveland Clinic, in the elderly population, "typical symptoms (such as weight loss, fatigue, tremors, palpitations, atrial fibrillation, anxiety, depression, shortness of breath, heat intolerance, eye symptoms and anemia) may be absent or attributed to aging or another chronic illness." As such, subtle signs should be looked for.

symptoms

Symptoms and signs of hypothyroidism may include weight gain, sleepiness, dry skin and constipation; however, a lack of these symptoms does not negate a diagnosis. To make a diagnosis in the elderly patient, doctors often need a high index of suspicion.

When attempting to diagnosis hypothyroidism in the elderly, doctors often look at a person's family history of thyroid disease, past treatment for hyperthyroidism or a history of extensive surgery and/or radiotherapy to the neck.

Due to the high incidence and prevalence of irregular heart rhythms, congestive heart failure, weight loss, nervousness and muscle weakness in our elderly, it is wise to carefully review with a physician the possibility of such illness being related to hypothyroidism.

Knowledge is the key. Tests, such as T4 and T3U (or T3 Uptake), can be performed to help evaluate the presence of either hyper or hypothyroidism. Replacement hormone therapy (L-T4) is effective in hypothyroidism, whereas in hyperthyroidism (the over production of thyroid hormone) an antithyroid medication is often prescribed to reduce production of the thyroid hormone with sedatives and beta-blockers utilized to treat the associated rapid heart rate and nervousness.

talk to your doctor

The issue here is that many seniors are never diagnosed properly as having hyper or hypothyroidism but, rather, are told their symptoms are typical of anyone in their stage of the aging process. It requires both the family and the physician of the elder to carefully review the mishmash of symptoms that plague us as we age, sort out what is "normal" in the aging process and what might be associated with some other diagnosis (such as hypothyroidism).

Simple tests can determine if the suspicions are valid. Treatment is relatively benign and, in the case of hyperthyroidism, can often be normalized in three to six months with subsequent medication therapy less aggressive in nature.

Bottom line: Don't simply assume that when a physician proclaims that you have an issue (i.e., high cholesterol) that you should begin to receive medication therapy to help reduce those cholesterol levels (given that diet and exercise did not lower the levels significantly); ask why the cholesterol is high to begin with you may find it's high due to hypothyroidism. Remember, knowledge is power.

Judson Haims is the owner of Visiting Angels Home Care in Eagle County. Contact him at 970-328-5526 or visit http://www.visitingangels.com/comtns.

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Vail Daily column: Thyroid issues in the elderly often difficult to diagnosis - Vail Daily News

A doctor is helping Silicon Valley execs live their best life for $40k a year – Quartz

Silicon Valley thinks our bodies need a reboot. PayPal founder and Donald Trump booster Peter Thiel, who plans to live for 120 years, has publicly discussed taking human-growth hormone (and expressed interest in blood transplants from young people). Google spun off Calico in 2013 to defeat the inevitability of aging. Software engineers fast for days and order custom stacks of nootropics, or brain-enhancing substances, to gain a cognitive edge. One venture capitalist, requesting anonymity, said at a dinner he recently attended several people opened up boxes to pop nootropic pills before the first course.

Theres no end to the experimentation people will undertake in pursuit of productivity, even if most treatments and supplements dont yet have strong evidence or FDA approval. That hasnt phased the patients that Dr. Molly Maloof sees in her Silicon Valley practice. This is a place where people dont give a flying fuck what they do with their minds and bodies, she said.

The general practitioner wants to see real medical rigor behind people trying to hack their health. Her concierge medicine practice in San Francisco serves a small number of patients for anywhere from $5,000 for an initial assessment to upwards of $40,000 per year for comprehensive care (every patient has a second, primary care physician as well). Her clients are often engineers and executives looking to hit peak performance, or recover from an over-stressed work-life. Maloof, who earned her medical degree from the University in Illinois in 2011, sees part of her work as ensuring they they are doing it safely, backed up by the maximum amount of evidence.

Too often, she says, executives and entrepreneurs place performance above health. All these people are not stupid but what used to be domain expertise is now everyone claiming to be the expert, she says.

Maloofs data-heavy approach begins with a battery of testsmeasuring thousands of biomarkers in allto understand her patients at the cellular level. By analyzing the results, she can prescribe food and lifestyle tailored to every individual, alongside standard western therapies. Only then does she consider pharmaceutical-grade supplements. If needed, she helps patients practice harm reduction with performance-enhancing substances from nootropics to micro-dosing LSD. Her philosophy, she says, is to do more than cure sickness, but to enhance health.

Investors are betting this approachoptimizing ones health through deep analysis of their genetics, physiology, and psychologybecomes the standard of care. Technology, they argue, will ultimately bring down prices so its affordable for almost everyone. Today, Maloof estimates less the 1% of private medical practices take this approach, but companies like Color Genomics, Forward, Nootrobox, Arivale, Metabolic Code, Habit, and Viome are already aiming to go mainstream.

Maloof is surprised at the cavalier acceptance of DIY health at the intersection of technology and personalized medicine. People will spend months researching which computer they will buy and then two minutes researching the nootropic brand theyre about to put into their body, she says.

Maloof sat down with Quartz to talk about her work and the future of personalized medicine. The interview was condensed and edited for clarity.

Can you describe your practice?

My practice has basically been an emergent phenomena: What if a doctor decided to optimize health instead of just fixing illness? The first thing Ive done differently is Ive positioned myself as a doctor who is aiming to improve the human condition rather than just get you from sick to not-sick.

Theres this spectrum of disease. Most people are in the sick-to-average part of that spectrum. The athletes and movie stars of the world are at the opposite end at the optimal part of the spectrum.

Theres this space between average and optimal that is a very grey area. Its been sort of commandeered by the wellness industry: the people who perpetuate mindfulness, fitness, and nutrition, but maybe dont have any rigorous medical training. And, as such, havent actually learned the basic science of the human body and how biology, physics, and chemistry works.

How did your practice begin?

I thought, if I was in a perfect world, What would I want my health experience to look like? I basically decided I would want a doctor to listen to me, and listen for a long time. In an ideal situation, it takes about two hours to ask all the questions I would want.

In a perfect world, your body is like the airplane and Im the co-pilot

The second thing is that, typically when you get blood drawn from a doctor, you might get 10 biomarkers or lab [tests]. Thats just not very much information. And they dont usually tell you theres something wrong with you unless its really wrong. In my practice, Im looking at 170 chemical biomarkers. Instead of normal or abnormal, Im looking at a range of whats good.

Instead of just looking at blood, Im looking at blood, urine, stool and saliva. Instead of just chemistry markers, Im looking at chemistry, metabolomics (chemical fingerprints of cellular processes), genomics, microbiome (microorganisms), hormone tests, and Im starting to look at immunology markers.

Thats a very different experience. In a perfect world, your body is like the airplane and Im the co-pilot and were using all these tools to identify if there are issues going wrong with the engine.

How does your typical day go? How would a patients visit to your office be different?

A typical patient is first going to have a meeting with me to go through all these questions, Ill gather all the data and then send a phlebotomist to their house [to draw blood].

I get all the information back and then I sit back down with the patient and we will go over all of the report together. And that will take up to an hour and a half.

At the end of that, we edit the decision together. So we decide what we we want to do. I come up with a summary, a one- to two-page summary, and then create a schedule for all their supplements and their nutrition, and then basically hand off the recommendations to any staff they have to help implement it, or just to them.

Then Ill check in with them in a couple weeks via text or via email or the phone and then well repeat the process. Well take some of the labs that we did and then well repeat that on a quarterly basis. And then well go over the changes we see over time.

Q: How long would a typical patient be with you?

The real benefit comes after working for a year. Six months to a year is the minimum amount of time that we should be working together. And the patients who tend to go off the program, they come back to me eventually and theyre like, Yeah, I fell off the wagon and I want to jump back on. But it takes some commitment because you want to optimize health.

The patients that dont do the best are the ones that think that everything is about the supplements, and everything is about the right supplements. Supplements are like the last mile of optimization.

The first and foremost thing you need to do is recognize that this is not an overnight fix. Youre not just going to feel amazing overnight. Its actually about building these changes over time, and it makes a lot of difference if you recognize its like compounding interest.

And the thing about it is that its not rocket science, but a lot of it is actually knowing what is right for your body and your lifestyle. And thats going to be different for different people.

Q: Thats tough what youre describing. How many stick with it?

I work with mostly entrepreneurs, investors, and executives. So I tend to work with people who, when I first evaluate whether or not theyre a fit for my practice, I can assess how willing are they to do the things that Im asking them to do? If theyre a six out of 10, then Im not going to ask them to do that.

The patients that dont do the best are the ones that think that everything is about the supplements, and everything is about the right supplements. Supplements are like the last mile of optimization. They can make a really big difference. But fundamentally, if your lifestyle is a disaster, for those people its about actually showing them whats happening in their lifestyle and showing them how food is affecting them, giving them continuous glucose monitors, getting them heart-rate variability monitors, so they can glean some real insight around whats happening day-to-day.

Q: What are some of the more dangerous things patients come in doing?

A big problem I see people buying everything they read on Bulletproof Coffee. Im just like, Guys, [Bulletproofs founder] Dave Asprey has not figured everything out. First and foremost hes a salesman and a marketer. And secondly he is a bio-hacker, and so lets get real.

Everything hes recommending! Bulletproof Coffee [which has as much as 4 tablespoons of fat or oil per cup) is probably the worst idea that a person can do in terms of their health. The problem is theres a large number of people that will have much higher rates of cholesterol, and some people will be fine on it. And people do it wrong: they add sugar to it, or eat sugary things, or dont have the right genetics for that level of fat consumption.

Ive seen three patients now with really, really high cholesterol levels. Way, way above normal. Im like, What are you drinking in the morning? What does your routine look like? They say, You know, I start my day with Bulletproof Coffee And Im like, Are you? Oh no.

Is what youre doing scalable?

What Im doing right now is not scalable at all. Ive been doing this practice in order to figure out what does scale. Because if you look at all this information, youll start to see things that make sense for larger populations of people, and I think this is where medicine could go if we had more convenience.

Can this become a standard of care for most people, or will it be concierge medicine forever?

Here are few things that have to happen.

The health care system needs to recognize that what they are doing isnt working for chronic disease, first and foremost. Second of all, we need large-scale studies on this kind of medicine.

Im looking at interventions from the perspective of what is the most sound, evidence-based recommendation I can make for this individual. If it doesnt have evidence, why doesnt it. Chinese medicine may not have much evidence in the western model but it has thousand of years of people using it. The question is, Is it totally bullshit? Well, probably not. Theres probably some truth in it.

Then we need doctors who want to learn how to do this. We have to be able to train them how to do this. When I was in med school, I thought there was a lot missing from my education: what about lifestyle, what about what happens after the patient goes home after the visit to the hospital?

The kitchen is no longer the medicine cabinet. The kitchen is now the place of ultra-toxicity and disease.

I saw this giant problem in my education, and I actually designed a course called, Physician Heal Thyself, Evidence-based lifestyle. I brought in all these doctors who are experts in sleep medicine, sleep, fitness nutrition, food as medicine, functional medicine, integrative medicine, osteopathy and acupuncture. I got them all in a room and said I want you to teach students what were missing. We need to make this medical school education and have to implement this into the board certification programs as well as board exams. If its not required, its not going to be taught.

Finally, we need to be able to prescribe these things. We need food companies to do the research to show their food has outcomes that can improve human health. If we believe its medicine, then we need to study food as medicine. And we have to put it through the same rigor that we put drugs through. Thats going to happen. Were not that far way, but one of the biggest things that needs to happen is a culture shift.

Where do you think a practice like yours will be in five years?

The way to explain this question is actually to look to the past. When I was trying to figure out if what I was doing was special, I started doing some research on doctors in antiquity. I found an interesting pattern.

Most people in Greek and Roman times considered their kitchen to be their medicine cabinet. The women of the world were responsible for managing a lot of illness through food. So food as medicine was fairly widespread, but the wealthy and the gladiators and the kings, all of these people had special doctors.

Theres always been doctors working with the elite and working with the athletes of the world. But the difference between now and then, is that the kitchen is no longer the medicine cabinet. The kitchen is now the place of ultra-toxicity and disease.

I think in five years, Im going to be, hopefully, speaking to the entire country through media and through public health campaigns (Im going to build a platform around this) trying to bring back what we knew for thousands of years about how food can treat our disease and how plants are a source of healing and how the way that we are living our lives in modern times is antithetical to optimal health.

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A doctor is helping Silicon Valley execs live their best life for $40k a year - Quartz

Sex super for women of any age: Implanted testosterone pellets ooze into your now-hot bod? – MyNewsLA.com

according to the doctors statement, the procedure is quick, painless, and doesnt require stitches. The pellets are inserted under the skin just above the hip, and will last three to four months.

The doctors office statement said that Forbes magazine recently reported on several studies regarding the effects of adding testosterone pellets to conventional hormone replacement therapy.

Researchers found that women taking testosterone have reduced incidences of breast cancer, and that testosterone can suppress breast cell proliferation and improve the common symptoms of menopause.

One patient, 44, had surgically induced menopause through a hysterectomy when she was 35.

I would say truthfully I felt a little dead inside, the doctors statement quoted her as saying.Nothing seemed fun anymore. I slept a lot. I had spurts of memory loss. I was just miserable.

That patient has been receiving both testosterone and estrogen pellets for nearly six years, and said its changed her life.

After the pellets are inserted, within 48 hours, I will wake up, and I will know my system has taken it in, she said. My brain fog is gone. I sleep better. You dont have the dips that come with oral medications. Its a more consistent release. The pellets have helped me with anxiety, weight loss, libido, mental clarity. Its like night and day.

Without hormone replacement therapy, Savage said, women are increasingly at risk for serious health consequences that also include osteoporosis, heart disease, Alzheimers and diabetes. The doctors statement came with the usual disclaimers making no promises and providing appropriate warnings.

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Sex super for women of any age: Implanted testosterone pellets ooze into your now-hot bod? - MyNewsLA.com

The Unexpected and Unwanted Side Effect of Hormone Therapy – SheKnows.com

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A new research study out of Brigham and Womens Hospital in Boston, Massachusetts, found a possible connection between hormones and hearing loss among menopausal women.

The study, which will be published in Menopause, the journal of the North American Menopause Society, focused on data collected from 80,972 postmenopausal women. The self-reported study indicated that menopausal women who undergo hormone therapy for extended periods of time are at a greater risk for hearing loss.

More: Is Hormone Replacement Therapy Right for You?

Previously, it was believed that hormone therapy would actually improve hearing loss in menopausal women.

The finding from this observational study that women who underwent menopause at a later age and used oral hormone therapy had greater hearing loss was unexpected but should lead to more testing in a randomized, clinical trial,says Dr. JoAnn Pinkerton, executive director of NAMS.

Menopause usually occurs in women over the age of 45 and brings with it symptoms like vaginal dryness, hot flashes and mood swings.

While the Brigham and Womens Hospital-led study does present a comprehensive set of facts supporting hearing loss among women who use HRT, the overall benefits and risks of undergoing hormone replacement therapy should be discussed with a physician.

More: It's Super-Common to Miss These Symptoms of Hormonal Imbalance

In an effort to make the conversation about menopause a more exhaustive one, the JAMA network published a one-sheet that can help women when speaking to their physicians.

By Vivian Nunez

Originally published on HelloFlo

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The Unexpected and Unwanted Side Effect of Hormone Therapy - SheKnows.com

Women of color less likely to have breast cancer test – CT Post

By Cara Rosner, Conn. Health I-Team Writer

A genetic test that helps doctors determine how best to treat breast cancer and whether chemotherapy is likely to help is significantly more likely to be administered to white women than blacks or Hispanics, a Yale University study has found.

The test, called Oncotype Dx, uses gene expression to gauge how early-stage breast cancer is affecting patients gene activity. It uses the information to determine how likely cancer recurrence would be, and physicians and their patients can use that knowledge to decide how to proceed with treatment.

Yale researchers analyzed a group of more than 8,000 Connecticut women who were diagnosed with hormone receptor positive breast cancer between 2011 and 2013, and found significant racial and ethnic disparities in use of this new gene test, said study leader Dr. Cary Gross, a member of Yale Cancer Center and professor of medicine and epidemiology at Yale School of Medicine.

It reinforces that, at the same time we are investing in developing new treatments and new testing strategies and were promoting them with great excitement, we really need to double-down our efforts to eliminate disparity, Gross said.

Breast test disparity

Here are some key statistics from a Yale University study about Oncotype Dx, a genetic test for breast cancer patients.

The study from that, among the Connecticut women for whom the test was recommended under national guidelines:

51.4 percent of white women received it

44.6 percent of black women received it and

47.7 percent of Hispanic women received it.

Among women for whom national guidelines did not recommend the test:

21.2 percent of white women received it

9 percent of black women received it and

9.7 percent of Hispanic women received it.

Among the Connecticut women for whom the test was recommended, Yale researchers found 51.4 percent of white women received it, compared with 44.6 percent of black women or 47.7 percent of Hispanic women.

One local doctor said the findings are disconcerting, but not surprising. Its long been known that women of color have lower rates of breast cancer screening, and are less likely to have mastectomies or breast reconstruction surgery, typically because they dont have access to or cant afford the services, said Dr. Denise Barajas, medical director of Griffin Hospitals Hewitt Center for Breast Wellness in Derby.

Research has also shown that minority women also are more likely to die from breast cancer.

This is just another area where were unfortunately seeing that certain groups dont have the same access, Barajas said.

Disparities found

The study also found disparity among women for whom national guidelines did not recommend the test. In that group, 21.2 percent of white women, 9 percent of black women and 9.7 percent of Hispanic women received it.

The findings were unsurprising not just to Barajas, but also to Dr. K. M. Steve Lo, a hematology oncologist and breast cancer expert at Stamford Hospitals Dorothy Bennett Cancer Center.

Its part of the overall problem with our health care system, Lo said. Minority women are less insured, underinsured, and have more out-of-pocket expenses to put out in one way or another. As a result, there will be less use of technology across the board. It needs to change but, unfortunately, I dont see a movement toward that in the near future. Its a systemic problem, and its a problem that we as a society need to address.

Barajas said that one of the most upsetting things about the Yale study, is that its first breast cancer-related disparity shes aware of involving a physician-led treatment. Mostly, Barajas said, its patients who opt not to have the treatment.

This test is offered by oncologists, for the most part," she said. Youd like to think that an oncologist would treat all women the same.

The only reason Barajas could think of for a woman who is eligible for the test not being offered it is that shes said she isnt interested in chemotherapy.

Removing guesswork

Having access to Oncotype Dx can greatly impact womens outcomes, Gross said. Even after a biopsy or tumor removal, he said, its still difficult to know which patients are at higher risk for their cancer coming back again. There are many, many subtypes of breast cancer. (The test) takes some of the guesswork out of it.

The test has become the standard of care for certain types of early-stage cancer, Lo said.

It helps physicians narrow down those women who really do benefit from treatments like chemotherapy, he said. That is crucial, he added, because it means many women who would not benefit from chemotherapy no longer are subjected to the process, the expense and the side effects.

Oncotype Dx is most frequently used on women who have stage 1 cancer that has not spread to the lymph nodes, Lo said, but its likely it will be used on women whose cancer has attached to lymph nodes.

In light of the studys findings, Gross team plans to examine data from a broader group of women to see why the disparities exist. Researchers will look at whether women are more or less likely to get the test depending on which hospital treats them, or whether there are disparities within hospitals.

Gross also said research should be done to determine if the tests $4,000 price tag though covered by many insurance companies is a barrier to some patients, and more breast cancer patients should be educated about national guidelines and recommendations.

This story was reported under a partnership with the Connecticut Health I-Team (www.c-hit.org)

Hearst Connecticut Media staff writer Amanda Cuda contributed to this report.

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Women of color less likely to have breast cancer test - CT Post

Successful Aging and the important role hormones play – Glendale Star

When it comes to aging well and living the optimal life, its hard to find a greater advocate than physician Theresa Ramsey. Hosts John Wenzlau and Millie Oakeson of Successful Aging on Independent Talk 1100 KFNX invited Ramsey back to the show to discuss the myriad of topics related to living life to the fullest and in the most pro-active healthy way possible.

Ramsey, from The Center for Natural Healing, is a physician, speaker, lifestyle expert and author. She is a regular expert guest on the television show, Your Life A to Z, and her focus in her clinical practice is in lifestyle and preventative aging with bio-identical hormone replacement.

Ramsey points out that our bodies eventually quit producing estrogen, progesterone and testosterone hormones when we go through menopause and andropause. In order to keep our cellular make up in the best shape possible to fight cancer, heart disease, osteoporosis and dementia, these hormones are essential. The added benefit to bio-identical hormone replacement is like having a newly charged battery - we will feel better, sleep sounder, have more energy and feel sharper.

Oakeson asked what role our thyroids play in overall good health and Ramsey said, The thyroid is my favorite hormone, because it turns on every cell. Its very important that your thyroid is functioning correctly, because, when it isnt, you become tired and lethargic. This prompted the questions of how important melatonin and vitamin D3 are to our bodies.

Ramsey said, Melatonin is the strongest antioxidant and it also helps us get that deep sleep at night that our brains and bodies need so desperately.

Equally important is vitamin D3, because it helps to absorb calcium and promote bone growth and strength.

As their conversation continued, it was apparent that our whole system works better when our cells are at ease and our hormones are in-sync. Lack of sleep, low energy, the inability to lose weight, foggy memory and stress are all due to the fact that we arent taking care of our health.

Ramsey kept emphasizing the need to keep our hormones at the optimal levels, but we also need to be cognizant of what we eat. By eliminating sugar and minimizing consumption of carbohydrates, eating vegetables and protein as our main food sources, we give our bodies the energy to thrive. As to the question of exercise, Ramsey says its best not to over exercise. Its healthy to increase your heart rate and then recover in a 10-minute span twice a day and it is very important to keep moving.

In closing, it was obvious they had only begun to scratch the surface of how to have optimal health throughout a lifetime, but it was also evident that Ramsey will continue her quest to inform and educate about the choices we can make to live a life well lived.

For more information on these topics or to ask a question, visit http://www.successfulaging.info. Tune in every Tuesday to Independent Talk KFNX 1100, as we continue to explore Successful Aging.

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Successful Aging and the important role hormones play - Glendale Star

Why Is The Risk Of Getting Cancer Higher Than It Used To Be? – Forbes


Forbes
Why Is The Risk Of Getting Cancer Higher Than It Used To Be?
Forbes
FSH and LH hormones are above the normal range when a woman is in menopause and this is a very reliable test for menopause that your doctor can order. Usually in menopause it is the progesterone that is no longer produced by the body because the ...

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Why Is The Risk Of Getting Cancer Higher Than It Used To Be? - Forbes

Bioengineered ‘Pancreas’ Effective in First Patient – The Scientist


The Scientist
Bioengineered 'Pancreas' Effective in First Patient
The Scientist
Type I diabetes had rendered a 43-year-old woman dependent on insulin, until doctors restored her body's ability to produce the hormone with engineered islet cells transplanted into her abdomen, according to a New England Journal of Medicine report ...

and more »

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Bioengineered 'Pancreas' Effective in First Patient - The Scientist

Hormone replacement therapy (male-to-female) – Wikipedia

Hormone replacement therapy (HRT) of the male-to-female (MTF) type is a form of hormone therapy and sex reassignment therapy that is used to change the secondary sexual characteristics of transgender and transsexual people from masculine (or androgynous) to feminine. It is one of two types of HRT for transgender and transsexual people (the other being female-to-male), and is predominantly used to treat transgender women. Some intersex people also receive this form of HRT, either starting in childhood to confirm the assigned sex or later if the assignment proves to be incorrect.

The purpose of this form of HRT is to cause the development of the secondary sex characteristics of the desired sex, such as breasts and a feminine pattern of hair, fat, and muscle distribution. It cannot undo many of the changes produced by naturally occurring puberty, which may necessitate surgery and other treatments (see below). The medications used in HRT of the MTF type include estrogens, antiandrogens, and progestogens.

While HRT cannot undo the effects of a person's first puberty, developing secondary sex characteristics associated with a different gender can relieve some or all of the distress and discomfort associated with gender dysphoria, and can help the person to "pass" or be seen as the gender they identify with. Introducing exogenous hormones into the body impacts it at every level and many patients report changes in energy levels, mood, appetite, etc. The goal of HRT, and indeed all somatic treatments, is to provide patients with a more satisfying body that is more congruent with their gender identity.

Some medical conditions may be a reason to withhold hormone replacement therapy because of the harm it could cause to the patient. Such interfering factors are described in medicine as contraindications.

Absolute contraindications those that can cause life-threatening complications, and in which hormone replacement therapy should never be used include histories of estrogen-sensitive cancer (e.g., breast cancer), thrombosis or embolism (unless the patient receives concurrent anticoagulants), or macroprolactinoma. In such cases, the patient should be monitored by an oncologist, hematologist or cardiologist, or neurologist, respectively.

Relative contraindications in which the benefits of HRT may outweigh the risks, but caution should be used include:

As dosages increase, risks increase as well. Therefore, patients with relative contraindications may start at low dosages and increase gradually.

Hormone therapy for transgender individuals has been shown in medical literature to be safe when supervised by a qualified medical professional.[1]

Inducers of CYP3A4 and other cytochrome P450 enzymes can reduce the effects of MTF HRT. (For a list of CYP3A4 inducers, see here.)

Estrogen is one of the two major sex hormones in women (the other being progesterone), and is responsible for the development and maintenance of female secondary sexual characteristics, such as breasts, wide hips, and a feminine pattern of fat distribution. Estrogens act by binding to and activating the estrogen receptor (ER), their biological target in the body. A variety of different forms of estrogen are available and used medically. The most common estrogens used in transgender women include estradiol (which is the predominant natural estrogen in women) and estradiol esters such as estradiol valerate and estradiol cypionate (which are prodrugs of estradiol). Conjugated equine estrogens (CEEs), marketed as Premarin, and ethinylestradiol are also sometimes used, but this is becoming less common. Estrogens may be administered orally, sublingually, transdermally (via patch), topically (via gel), by intramuscular or subcutaneous injection, or by an implant.

Prior to sex reassignment surgery, dosages of estrogen for transgender people are often higher than replacement dosages used for cisgender women. Hembree et al. (2009) recommend "maintain[ing] sex hormone levels within the normal range for the persons desired gender".[2] Dosages are typically reduced after an orchiectomy (removal of the testes) or sex reassignment surgery. However, that practice has been carried over from an era in which very high doses of estrogen were required to decrease testosterone, since antiandrogens were not used concurrently. Today, high doses of a less potent estrogen estradiol, which is endogenous to the human body, rather than the riskier ethinylestradiol and conjugated estrogens used in the past are recommended during the first ten or so years of HRT, with or without an orchiectomy or sex reassignment. After that period, dosages can be reduced.

Androgens, such as testosterone and dihydrotestosterone (DHT), are the major sex hormones in men, and are responsible for the development and maintenance of male secondary sexual characteristics, such as a deep voice, broad shoulders, and a masculine pattern of hair, muscle, and fat distribution. In addition, they stimulate sex drive and the frequency of spontaneous erections and are responsible for acne, body odor, and male-pattern scalp hair loss. Androgens act by binding to and activating the androgen receptor (AR), their biological target in the body. In contrast to androgens, antiandrogens are drugs that prevent the effects of androgens in the body. They do this by preventing androgens from binding to the AR or by preventing the production of androgens. The most commonly used antiandrogens in transgender women are cyproterone acetate, spironolactone[citation needed], and GnRH analogues.

The most commonly used antiandrogens for transgender women are steroidal: spironolactone and cyproterone acetate. Spironolactone, which is relatively safe and inexpensive, is the most frequently used antiandrogen in the United States. Cyproterone acetate, which is unavailable in the United States, is more commonly used in the rest of the world.

Spironolactone is a potassium-sparing diuretic that is mainly used to treat low-renin hypertension, edema, hyperaldosteronism, and low potassium levels caused by other diuretics. It can cause high potassium levels (hyperkalemia) and is therefore contraindicated in people who have renal failure or already-elevated potassium levels. Spironolactone prevents the formation of androgens in the testes (though not in the adrenal glands) by inhibiting enzymes involved in androgen production.[3][4][5] It is also an androgen receptor antagonist (that is, it prevents androgens from binding to and activating the androgen receptor).[6][7][8][9][10]

Cyproterone acetate is a powerful antiandrogen and progestin that suppresses gonadotropin levels (which in turn reduces androgen levels), blocks androgens from binding to and activating the androgen receptor, and inhibits enzymes in the androgen biosynthesis pathway. It has been used as a means of androgen deprivation therapy to treat prostate cancer. If used long-term in dosages of 150mg or higher, it can cause liver damage or failure.[11][12][13][14][15][16][17][18][19]

Non-steroidal antiandrogens used in HRT for transgender women include flutamide, nilutamide, and bicalutamide, all three of which are primarily used in the treatment of prostate cancer in cisgender men.[20][21] Unlike steroidal antiandrogens such as spironolactone and cyproterone acetate, these drugs are pure androgen receptor antagonists. They do not lower androgen levels; rather, they act solely by preventing the binding of androgens to the androgen receptor. However, they do so very strongly, and are highly effective antiandrogens. Bicalutamide has improved tolerability and safety profiles relative to cyproterone acetate, as well as to flutamide and nilutamide, and has largely replaced the latter two in clinical practice for this reason. Enzalutamide is a more recently introduced non-steroidal antiandrogen with even greater potency and efficacy as an antiandrogen than bicalutamide, but it is still under patent protection and in relation to this is currently (and for the foreseeable future) extremely expensive. Moreover, enzalutamide has been found to act as a negative allosteric modulator of the GABA receptor and has been associated with central side effects such as anxiety, insomnia, and, most notably, seizures (in 1% of patients), properties that it does not share with bicalutamide.

Non-steroidal antiandrogens may be an appealing option for those who wish to preserve sex drive and function[22] and/or fertility,[23] as well as for those who desire more selective action with fewer side effects than spironolactone and cyproterone acetate (which increase the risk of depressive symptoms, among other adverse effects).[24] Bicalutamide specifically may also be a safer drug than cyproterone acetate or spironolactone, as it has a much lower risk of hepatotoxicity relative to cyproterone acetate and, unlike spironolactone, has no risk of hyperkalemia or other antimineralocorticoid-associated adverse reactions. However, bicalutamide does have a very small risk of hepatotoxicity itself, as well as of interstitial pneumonitis.

In both sexes, the hypothalamus produces gonadotropin-releasing hormone (GnRH) to stimulate the pituitary gland to produce luteinizing hormone (LH) and follicle-stimulating hormone (FSH). This in turn cause the gonads to produce sex steroids such as androgens and estrogens. In adolescents of either sex with relevant indicators, GnRH analogues such as goserelin acetate can be used to stop undesired pubertal changes for a period without inducing any changes toward the sex with which the patient currently identifies. GnRH agonists work by initially overstimulating the pituitary gland, then rapidly desensitizing it to the effects of GnRH. After an initial surge, over a period of weeks, gonadal androgen production is greatly reduced. Conversely, GnRH antagonists act by blocking the action of GnRH in the pituitary gland.

There is considerable controversy over the earliest age at which it is clinically, morally, and legally safe to use GnRH analogues, and for how long. The sixth edition of the World Professional Association for Transgender Health's Standards of Care permit it from Tanner stage 2 but do not allow the addition of hormones until age 16, which could be five or more years later. Sex steroids have important functions in addition to their role in puberty, and some skeletal changes (such as increased height) that may be considered masculine are not hindered by GnRH analogues.

GnRH analogues are often prescribed to prevent the reactivation of testicular function when surgeons require the cessation of estrogens prior to surgery.

The high cost of GnRH analogues is a significant factor in their relative lack of use in transgender people. However, they are prescribed as standard practice in the United Kingdom.

Certain antiandrogens do not reduce testosterone or prevent its action upon tissues, but instead prevent its metabolite, dihydrotestosterone (DHT), from forming. These medications can be used when the patient has male-pattern hair loss and/or an enlarged prostate (benign prostatic hyperplasia), both of which DHT exacerbates. Two medications are currently available to prevent the creation of DHT: finasteride and dutasteride. DHT levels can be lowered up to 6075% with the former, and up to 9394% with the latter. These medications have also been found to be effective in the treatment of hirsutism in women.

Progesterone, a progestogen, is the other of the two major sex hormones in women. Unlike estrogen, progesterone is not overtly involved in the development of female secondary sexual characteristics, and is instead involved mainly in the menstrual cycle and pregnancy. For this reason, progestogens are not commonly prescribed for transgender women. However, there may be a role of progestogens in breast development (though controversial and disputed) and in regulation of skin and hair,[citation needed] and progesterone specifically may have positive effects on sex drive, sleep, and levels of anxiety. Moreover, due to their antigonadotropic and/or antiandrogen effects, progestogens can be useful in helping to suppress the effects of androgens in the body. The most common progestogens used in transgender women include progesterone and progestins (synthetic progestogens) like CPA and medroxyprogesterone acetate (MPA). These drugs are usually taken orally, but may also be administered by intramuscular injection.

High doses of progestogens exert negative feedback on the hypothalamic-pituitary-gonadal axis by activating the progesterone receptor. As a result, they have antigonadotropic effects that is, they suppress the gonadal production of sex hormones such as androgens. As such, sufficient dosages of progestogens, such as cyproterone acetate, gestonorone caproate, hydroxyprogesterone caproate, megestrol acetate, and MPA, can considerably lower androgen levels. In addition, certain other progestogens, such as cyproterone acetate, megestrol acetate, drospirenone, and nomegestrol acetate, bind to and block the activation of the androgen receptor.[25] On the other hand, certain other progestogens, including 19-nortestosterone derivatives like levonorgestrel, norgestrel, norethisterone, and norethisterone acetate, as well as, to a lesser extent, the 17-hydroxyprogesterone derivative MPA, have weak androgenic activity because they bind to and activate the androgen receptor similarly to testosterone, and may produce androgenic effects such as acne, hirsutism, and increased sex drive.[26][27][28]

Progestogens, in conjunction with the hormone prolactin, are involved in the maturation of the lobules, acini, and areola during pregnancy: mammary structures that estrogen has little to no direct effect on.[29] However, there is no clinical evidence that progestogens enhance breast size, shape, or appearance in either transgender women or cisgender women, and one study found no benefit to breast hemicircumference over estrogen alone in a small sample of transgender women given both an estrogen and an oral progestogen (usually 10mg/day medroxyprogesterone acetate).[30] However, the authors of the paper stated that the sample size was too small to make any definitive conclusions, and that further studies should be carried out to confirm whether progestogens significantly affect breast size and/or shape in transgender women.[30] As of 2014, no additional study had looked at the issue.[31] Anecdotal evidence from transgender women suggests that those who take progesterone supplements may experience more full breast development, including stage IV on the Tanner scale (many transgender women do not develop Tanner stage V breasts).[citation needed] However, there have been no formal studies with sufficiently large sample sizes to confirm this.[31]

Progestogens reportedly alter fat distribution (e.g., by increasing fat in the buttocks and thighs),[32][33] increase sex drive (specifically progesterone, via its active metabolite allopregnanolone; this does not occur through activation of the progesterone receptor),[34][35] cause increased appetite and weight gain (only in combination with estrogen),[33] produce a sense of calm (i.e., anxiolysis), and promote sleep (i.e., sedative and hypnotic effects).[36][37][38][39]

Progesterone specifically is essential for bone health[citation needed] and seems to have a role in skin elasticity and nervous system function.[40] Other effects seen with progesterone include reducing spasms and relaxing smooth muscle tone; reducing gallbladder activity; widening bronchi,[41] which helps respiration; reducing inflammation and immune response; and normalizing blood clotting and vascular tone, zinc and copper levels, cell oxygen levels, and use of fat stores for energy.[citation needed] Progesterone also assists in thyroid function and bone building by osteoblasts.[citation needed]

The main effects of HRT of the MTF type are as follows:[42]

The psychological effects of hormone replacement therapy are harder to define than physical changes. Because HRT is usually the first physical step taken to transition, the act of beginning it has a significant psychological effect, which is difficult to distinguish from hormonally induced changes.

Highly developed breasts of transgender woman induced by hormone therapy.

Breast, nipple, and areolar development varies considerably depending on genetics, body composition, age of HRT initiation, and many other factors. Development can take a couple years to nearly a decade for some. However, many transgender women report there is often a "stall" in breast growth during transition, or significant breast asymmetry. Transgender women on HRT often experience less breast development than cisgender women (especially if started after young adulthood). For this reason, many seek breast augmentation.Transgender patients opting for breast reduction are rare. Shoulder width and the size of the rib cage also play a role in the perceivable size of the breasts; both are usually larger in transgender women, causing the breasts to appear proportionally smaller. Thus, when a transgender woman opts to have breast augmentation, the implants used tend to be larger than those used by cisgender women.[44]

In clinical trials, cisgender women have used stem cells from fat to regrow their breasts after mastectomies. This could someday eliminate the need for implants for transgender women.[45]

In transgender women on HRT, as in cisgender women during puberty, breast ducts and Cooper's ligaments develop under the influence of estrogen. Progesterone causes the milk sacs (mammary alveoli) to develop, and with the right stimuli, a transgender woman may lactate. Additionally, HRT often makes the nipples more sensitive to stimulation.

The uppermost layer of skin, the stratum corneum, becomes thinner and more translucent. Spider veins may appear or be more noticeable as a result. Collagen decreases, and tactile sensation increases. The skin becomes softer,[46] more susceptible to tearing and irritation from scratching or shaving, and slightly lighter in color because of a slight decrease in melanin.

Sebaceous gland activity (which is triggered by androgens) lessens, reducing oil production on the skin and scalp. Consequently, the skin becomes less prone to acne. It also becomes drier, and lotions or oils may be necessary.[44][47] The pores become smaller because of the lower quantities of oil being produced. Many apocrine glands a type of sweat gland become inactive, and body odor decreases. Remaining body odor becomes less metallic, sharp, or acrid, and more sweet and musky.[citation needed]

As subcutaneous fat accumulates,[44] dimpling, or cellulite, becomes more apparent on the thighs and buttocks. Stretch marks (striae distensae) may appear on the skin in these areas. Susceptibility to sunburn increases, possibly because the skin is thinner and less pigmented.[citation needed]

Antiandrogens affect existing facial hair only slightly; patients may see slower growth and some reduction in density and coverage. Those who are less than a decade past puberty and/or whose race generally lacks a significant amount of facial hair may have better results. Patients taking antiandrogens tend to have better results with electrolysis and laser hair removal than those who are not. In patients in their teens or early twenties, antiandrogens prevent new facial hair from developing if testosterone levels are within the normal female range.[44][47]

Body hair (on the chest, shoulders, back, abdomen, buttocks, thighs, tops of hands, and tops of feet) turns, over time, from terminal ("normal") hairs to tiny, blonde vellus hairs. Arm, perianal, and perineal hair is reduced but may not turn to vellus hair on the latter two regions (some cisgender women also have hair in these areas). Underarm hair changes slightly in texture and length, and pubic hair becomes more typically female in pattern. Lower leg hair becomes less dense. All of these changes depend to some degree on genetics.[44][47]

Head hair may change slightly in texture, curl, and color. This is especially likely with hair growth from previously bald areas.[citation needed]Eyebrows do not change because they are not androgenic.[48]

The lens of the eye changes in curvature.[49][50][51][52] Because of decreased androgen levels, the meibomian glands (the sebaceous glands on the upper and lower eyelids that open up at the edges) produce less oil. Because oil prevents the tear film from evaporating, this change may cause dry eyes.[53][54][55][56][57]

The distribution of adipose (fat) tissue changes slowly over months and years. HRT causes the body to accumulate new fat in a typically feminine pattern, including in the hips, thighs, buttocks, pubis, upper arms, and breasts. (Fat on the hips, thighs, and buttocks has a higher concentration of omega-3 fatty acids and is meant to be used for lactation.) The body begins to burn old adipose tissue in the waist, shoulders, and back, making those areas smaller.[44]

Subcutaneous fat increases in the cheeks and lips, making the face appear rounder, with slightly less emphasis on the jaw as the lower portion of the cheeks fills in.

HRT causes a reduction in muscle mass and distribution towards female proportions.[citation needed]

Male-to-female hormone therapy causes the hips to rotate slightly forward because of changes in the tendons. Hip discomfort is not uncommon.

If estrogen therapy is begun prior to pelvis ossification, which occurs around the age of 25, the pelvic outlet and inlet open slightly. The femora also widen, because they are connected to the pelvis. The pelvis retains some masculine characteristics, but the end result of HRT is wider hips than a cisgender man and closer to those of a cisgender woman.[citation needed]

HRT does not reverse bone changes that have already been established by puberty. Consequently, it does not affect height; the length of the arms, legs, hands, and feet; or the width of the shoulders and rib cage. However, details of bone shape change throughout life, with bones becoming heavier and more deeply sculptured under the influence of androgens, and HRT does prevent such changes from progressing further.

The width of the hips is not affected in individuals for whom epiphyseal closure (fusion and closure of the ends of bones, which prevents any further lengthening) has taken place. This occurs in most people between 18 and 25 years of age.[citation needed] Already-established changes to the shape of the hips cannot be reversed by HRT whether epiphyseal closure has taken place or not.[citation needed]

Established changes to the bone structure of the face are also unaffected by HRT. A significant majority of craniofacial changes occur during adolescence. Post-adolescent growth is considerably slower and minimal by comparison.[58] Also unaffected is the prominence of the thyroid cartilage (Adam's apple). These changes may be reversed by surgery (facial feminization surgery and tracheal shave, respectively).

During puberty, the voice deepens in pitch and becomes more resonant. These changes are permanent and are not affected by HRT. Voice therapy and/or surgery may be used instead to achieve a more female-sounding voice.

Facial hair develops during puberty and is only slightly affected by HRT. It may, however, be eliminated nearly permanently with laser hair removal, or permanently with electrolysis.[citation needed]

Mood changes, including depression, can occur with hormone replacement therapy. However, many transgender women report significant mood-lifting effects as well. The risk of depressive side effects is more common in patients who take progestins. Medroxyprogesterone acetate, in particular, has been shown to cause depression in certain individuals,[59][60][61][62][63] perhaps by affecting dopamine levels.[64]

Some transgender women report a significant reduction in libido, depending on the dosage of antiandrogens. A small number of post-operative transgender women take low doses of testosterone to boost their libido. Many pre-operative transgender women wait until after reassignment surgery to begin an active sex life. Raising the dosage of estrogen or adding a progestogen raises the libido of some transgender women.

Spontaneous and morning erections decrease significantly in frequency, although some patients who have had an orchiectomy still experience morning erections. Voluntary erections may or may not be possible, depending on the amount of hormones and/or antiandrogens being taken.

Recent studies have indicated that hormone therapy in transgender women may reduce brain volume toward female proportions.[65]

All aforementioned physical changes can, and reportedly do, change the experience of sensation compared to prior to HRT. Areas affected include, but aren't limited to, the basic senses, erogenous stimulus, perception of emotion, perception of social interaction, and processing of feelings and experiences.

The most significant cardiovascular risk for transgender women is the pro-thrombotic effect (increased blood clotting) of estrogens. This manifests most significantly as an increased risk for thromboembolic disease: deep vein thrombosis (DVT) and pulmonary embolism, which occurs when blood clots from DVT break off and migrate to the lungs. Symptoms of DVT include pain or swelling of one leg, especially the calf. Symptoms of pulmonary embolism include chest pain, shortness of breath, fainting, and heart palpitations, sometimes without leg pain or swelling.

Deep vein thrombosis occurs more frequently in the first year of treatment with estrogens. The risk is higher with oral estrogens (particularly ethinylestradiol and conjugated estrogens) than with injectable, transdermal, implantable, and nasal formulations.[66] DVT risk also increases with age and in patients who smoke, so many clinicians advise using the safer estrogen formulations in smokers and patients older than 40.

Because the risks of warfarin which is used to treat blood clots in a relatively young and otherwise healthy population are low, while the risk of adverse physical and psychological outcomes for untreated transgender patients is high, pro-thrombotic mutations (such as factor V Leiden, antithrombin III, and protein C or S deficiency) are not absolute contraindications for hormonal therapy.[67]

Estrogens may increase the risk of gallbladder disease, especially in older and obese people.[68] They may also increase transaminase levels, indicating liver toxicity, especially when taken in oral form.[citation needed]

A patient's metabolic rate may change, causing an increase or decrease in weight and energy levels, changes to sleep patterns, and temperature sensitivity.[citation needed] Androgen deprivation leads to slower metabolism and a loss of muscle tone. Building muscle takes more work. The addition of a progestogen may increase energy, although it may increase appetite as well.[citation needed]

Both estrogens and androgens are necessary in all humans for bone health. Young, healthy women produce about 10mg of testosterone monthly,[citation needed] and higher bone mineral density in males is associated with higher serum estrogen. Both estrogen and testosterone help to stimulate bone formation, especially during puberty. Estrogen is the predominant sex hormone that slows bone loss, even in men.

In spite of the induction of breast development, HRT in transgender women does not appear to increase the risk of breast cancer.[69][70][71] Only a handful of cases of breast cancer have ever been described in transgender women.[70][71] This is in accordance with research in cisgender men in which gynecomastia has been found not to be associated with an increased risk of breast cancer.[72] On the other hand, men with Klinefelter's syndrome, who have two X chromosomes (similarly to cisgender women) in addition to hypoandrogenism, hyperestrogenism, and a very high incidence of gynecomastia (80%), show a dramatically (20- to 58-fold) increased risk of breast cancer that is between that of cisgender men and cisgender women (though closer to that of the latter).[72][73][74] The incidences of breast cancer in cisgender men (46,XY karyotype), men with Klinefelter's syndrome (47,XXY karyotype), and cisgender women (46,XX karyotype) are approximately 0.1%,[75] 3%,[73] and 12.5%,[76] respectively. Also of potential relevance is the case of women with complete androgen insensitivity syndrome, who are genetically male (i.e., 46,XY karyotype) and have normal and complete morphological breast development and in fact breast sizes that are on average larger than those of cisgender women[77][78] yet, similarly to cisgender men, appear to have little (or possibly even no) incidence of breast cancer.[79][80] The risk of breast cancer in women with Turner syndrome (45,XO karyotype) also appears to be significantly decreased, though this may be related to ovarian failure/hypogonadism rather necessarily than to genetics.[81]

Similarly to the case of breast cancer, prostate cancer is extremely rare in transgender women who have been treated with HRT for a prolonged period of time.[69][82][83] Whereas as many as 70% of men show prostate cancer by their 80's,[84] only a handful of cases of prostate cancer in transgender women have been reported in the literature.[69][82][83] As such, and in accordance with the fact that androgens are responsible for the development of prostate cancer, HRT appears to be highly protective against prostate cancer in transgender women.[69][82][83]

Migraines can be made worse or unmasked by estrogen therapy.[citation needed]

Estrogens can also cause prolactinomas. Milk discharge from the nipples can be a sign of elevated prolactin levels. If a prolactinoma becomes large enough, it can cause visual changes (especially decreased peripheral vision), headaches, depression or other mood changes, dizziness, nausea, vomiting, and symptoms of pituitary failure, like hypothyroidism.

Especially in the early stages of hormone replacement therapy, blood work is done frequently to assess hormone levels and liver function. The Endocrine Society recommends that patients have blood tests every three months in the first year of HRT for estradiol and testosterone, and that spironolactone, if used, be monitored every 23 months in the first year.[85] The optimal ranges for estradiol and testosterone are:

The optimal ranges for estrogen apply only to individuals taking estradiol (or an ester of estradiol), and not to those taking synthetic or other non-bioidentical preparations (e.g., CEEs or ethinylestradiol).[88]

Physicians also recommend broader medical monitoring, including complete blood counts; tests of renal function, liver function, and lipid and glucose metabolism; and monitoring of prolactin levels, body weight, and blood pressure.[89]

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A woman’s risk of stroke: Get to know the factors and the symptoms – SCNow

Stroke is the fifth leading cause of death for men. But for women, it is third. In this region, more women have strokes than men.

Stroke and blood pressure

Age is the No. 1 risk factor for stroke. High blood pressure is No. 2. Therefore, it is important that blood pressure is monitored.

Blood pressure is a risk factor that can be easily treated. No one can stop from getting older, but everyone can work with their physician to maintain their cholesterol and blood pressure. Keeping both of these within healthy limits will make a big difference.

A stroke also can occur during pregnancy. In fact, 5 to 10 percent of pregnant women will suffer from preeclampsia or some other hypertensive disorder. Preeclampsia is a condition where a pregnant woman has high blood pressure and significant amounts of protein in her urine.

Medical studies now indicate that anyone with a history of pregnancy and preeclampsia is at an increased risk of stroke later in life. And what has been discovered is that the issues the increased stroke risk are 30 or 40 years later in life.

The belief is that the combination of high blood pressure and pregnancy causes an injury to the lining of the blood vessels. This damage to the lining increases the stroke risk.

The take-home point here is to be sure to have your blood pressure checked during physician visits. Hormone therapy or oral contraceptives will also increase the risk of stroke for those with high blood pressure.

Migraine headaches are more common in women than men. Migraines can often be crippling, sending a woman to a quiet, darkened room to alleviate the pain.

Migraines are believed to put a woman at greater risk of stroke than even family history of heart problems or high cholesterol. Add smoking and oral contraceptives to the migraine mix and you have a potentially destructive combination.

A migraine by definition means one side of your head hurts, or pounds this is considered the "migraine" part of it. It is associated with nausea and head pain.

When there is an aura, it indicates one has a focal neurologic symptom that occurs prior to the headache. For instance, the arm goes weak, vision is lost on one side or the other and flashy lights might be seen.

These symptoms occur 15 to 20 minutes before the headache generally appears. So, for all women who suffer migraines (and remember, more women than men have migraines) and are on oral contraceptives and smoke cigarettes, there is an increased risk of having a stroke.

Disability is another huge issue with stroke. For people who have suffered a stroke, many are most likely living with a significant amount of disability. They may be unable to talk, see or work. Stroke also is the leading cause of serious long-term disability.

Fortunately, the overall incidence of stroke in the United States has decreased. We believe this is due to a focus on the treatment of blood pressure.

It is essential, if at all possible, to prevent a stroke from occurring, or at best, seek medical treatment quickly at the first onset of symptoms. Everyone should be able to recognize stroke symptoms and act quickly.

In both men and women, common symptoms include:

>> Sudden numbness or weakness of face, arm or leg especially on one side of the body.

>> Sudden confusion, trouble speaking or understanding.

>> Sudden trouble seeing in one or both eyes.

>> Sudden trouble walking, dizziness, loss of balance or coordination.

>> Sudden severe headache with no known cause.

Call 911 immediately if you have any of these symptoms.

Dr. Timothy Hagen is the medical director of stroke and neurology services at McLeod Regional Medical Center. He is board certified in neurology and sleep medicine. He received his medical degree from Western University in Pomona, California. Hagen completed an internal medicine residency at Good Samaritan Hospital in Cincinnati, Ohio, and a neurology residency at the University of Cincinnati.

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Clean Start Weight Loss

[vc_row][vc_column width=1/2][vc_column_text]The Clean Start Weight Loss program is a long-term weight loss solution that keeps the weight off. What makes this program unique is that no other program will:[/vc_column_text][vc_column_text]Reset you appetite, allowing you to eat less

Reset your metabolism to a normal range

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Reduce cravings[/vc_column_text][/vc_column][vc_column width=1/2][vc_column_text]Does the Clean Start Weight Loss Program Work?

To date over 60,000 people have participated in this protocol, so you are joining an established, safe, and very effective weight loss program.[/vc_column_text][vc_single_image image=7933 img_size=full alignment=center onclick=custom_link img_link_target=_blank title=Comprehensive Weight Loss Support Included link=http://cleanstartweightloss.com/the-program/][/vc_column][vc_column][/vc_column][vc_column][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]

The results I have seen are amazing. The first 43 day session I lost a total of 49 pounds went on a vacation to Hawaii for two weeks and with maintenance I was able to not gain a pound.

Wally | Patient Clean Start Weight Loss

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New "old" remedy for thyroid disease – WTAJ

At least 20 million Americans, 80 percent of them women, suffer from low levels of thyroid hormones, which can have major consequences. The thyroid gland regulates metabolism, heart, muscle and brain functions. An old, but rarely-used therapy may be a making a comeback among patients looking for a natural solution.

Cheryl Williams, 61, has a lot of energy these days for walking the dog and practicing yoga, but for years she had none and doctors had no idea why.

She said, "They'll say 'oh, everything looks great. All your levels are just great.' I'm going, 'well how come I need a wheelchair to get out of here?'"

Jane Sadler, M.D., a family physician at Baylor Scott and White Medical Center did tests which showed that Cheryl has a thyroid deficiency, hypothyroidism.

"Their body is going to run into problems with heart failure, osteoporosis, low heart rate," said Dr. Sadler.

Hypothyroidism is often treated with synthetic human thyroid hormone, but that didn't improve Cheryl's energy level so Dr. Sadler tried a seldom used remedy: pig thyroid extract. Doctors rarely prescribe the pig hormone because unlike the synthetic hormone, the concentration can vary. But it worked for Cheryl.

"It's rewarding, but I will emphasize that I have to monitor Cheryl's levels of thyroid much more closely than I would somebody on a synthetic thyroid hormone replacement," Dr. Sadler said.

"When I think back now, it's like wow, I can do these things without it being such a challenge and struggle," Cheryl said.

The American Thyroid Association said the number of Americans with thyroid deficiency could be as high as 60 million, with 60 percent undiagnosed. A simple blood test to measure TSH, thyroid stimulating hormone- will provide the answer.

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New "old" remedy for thyroid disease - WTAJ

Doctor says testosterone therapy can provide relief for women – The Macomb Daily

Testosterone, widely and misleadingly understood to be the male hormone, may provide relief to women experiencing the symptoms of menopause, according to a Shelby Township-based physician and many other experts.

Dr. Charles Mok recently published the book Testosterone: Strong Enough for a Man, Made for a Woman, which educates readers about the benefits of natural hormone replacement therapy.

Mok released the book, his first, in March. It costs $25.99 and is available on Amazon.

The evidence for testosterone therapy is overwhelming, and we want to get the message to doctors and, importantly, to their patients, Mok said.

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Men produce 10 times more testosterone than women, but in their early reproductive years women have 10 times more testosterone than estrogen coursing through their bodies.

Many experts believe that its the loss of testosterone, and not estrogen, that causes women in midlife to tend to gain weight, feel fatigue and lose mental focus, bone density and muscle tone as well as their libido. Mood swings, anxiety and hot flashes are other common symptoms.

Testosterone therapy, delivered in the form of a tiny pellet the size of a grain of rice that is inserted underneath the skin, is believed to keep women healthier and relieve many of the above symptoms.

Clinical research shows that testosterone reduces the risk of breast cancer by 50 percent to 75 percent, and natural estrogen cuts the risk of heart attacks by more than 70 percent if used long term, Mok said.

Additionally, theyll have better control of their weight, better energy, better sex, better moods and better hair and skin, Mok said.

Therapy isnt typically covered by health insurance. Treatment in his office is usually about $140 a month, Mok said.

In the book, Mok also explores the history of hormone replacement therapy in the 1940s through the 2002 Womens Health Initiative, which suggested women taking a combination of synthetic estrogen and progesterone had an increased risk of heart disease and breast cancer.

Unfortunately, that led many women away from getting help, Mok said.

Mok, an emergency room doctor, became interested in preventative care after recognizing that some of his patients conditions could have been avoided. Now, hes in the process of finalizing a hormone therapy book geared for men.

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Doctor says testosterone therapy can provide relief for women - The Macomb Daily

GenomeDx’s Decipher Post-Op Demonstrates Positive Impact on Physician, Patient Treatment Decisions in Multicenter … – Broadway World

SAN DIEGO, April 25, 2017 /PRNewswire/ GenomeDx Biosciences today announced the publication of interim results from an ongoing prospective clinical study of the impact of the Decipher Prostate Cancer Classifier Post-Op test (Decipher test) on physician and patient decision making after prostate surgery. The interim results showed that knowledge of Decipher test results was associated with a change in both physician and patient treatment decisions, as well as improved decision effectiveness for men with prostate cancer considering adjuvant radiation therapy (ART) or salvage radiation therapy (SRT) after radical prostatectomy (RP). The article, titled "Decipher Test Impacts Decision-Making among Patients Considering Adjuvant and Salvage Treatment following Radical Prostatectomy: Interim Results from the Multicenter Prospective PRO-IMPACT Study," was published online this month ahead of print in the journal Cancer.

Approximately 50% of patients will have one or more adverse tumor pathology features after prostate cancer surgery and will be at increased risk of recurrence, metastasis and death. In these men, a multi-modal treatment is often followed by combining surgery with radiation, and either with or without hormone therapy. While known to improve health outcomes, multi-modal therapy poses potential significant harm to the patient's quality of life, including impeding sexual and urinary functional recovery. The Decipher test provides a genomic assessment of the aggressiveness of the patient's tumor, and is used by physicians to determine the need for and timing of additional therapy after surgery.

"Making additional treatment decisions for men with adverse pathology after surgery is difficult. Prior to the development of genomic assessment for prostate cancer patients, there was a lot of uncertainty around which patients might benefit from postoperative radiation and when to begin treatment," said John Gore. M.D., M.S., Associate Professor of Urology at the University of Washington and Seattle Cancer Care Alliance. "This study demonstrates that Decipher is important to guiding the shared decisions physicians and patients need to make after surgery and provides more confidence in those decisions. We have now completed the trial and look forward to the final study analyses to determine whether the treatment recommendations led to actual treatment decisions and how the use of Decipher has impacted patients' health-related quality of life."

The study included a total of 265 patients who enrolled at 19 community and academic practice settings. At baseline, prior to receipt of Decipher test results, physicians recommended primarily a 'wait-and-see' approach for most patients, irrespective of established clinical risk factors. With knowledge of Decipher test results, 96% and 74% of men with low genomic risk in the adjuvant and salvage arms, respectively, as indicated by Decipher test results, were recommended to observation. Among men whose Decipher test results showed a high genomic risk of metastasis, 37% and 69% of men in the ART and SRT arms, respectively, were recommended to receive intensification to multi-modal therapy. The study also indicated that decision quality was improved for patients considering post-surgery radiation therapy when exposed to Decipher test results, and that the fear of prostate cancer recurrence in the adjuvant and salvage arms decreased among low-risk patients.

"The clinical utility of Decipher seen in this interim analysis demonstrates that knowledge of Decipher test results can influence treatment recommendations and improve decision quality among men with prostate cancer," said Doug Dolginow, M.D., chief executive officer of GenomeDx. "As men in our society are living longer than ever before, determining the appropriate treatment of prostate cancer, which may save or extend life, is important. We believe incorporating Decipher into clinical practice will allow for better stratification of risk, improve decision-making and allow patients to be more confident with the difficult choices they may have to make."

About Decipher GRID and Decipher Prostate and Bladder Cancer Classifier Tests

GenomeDx's Decipher Genomics Resource Information Database (GRID) contains genomic profiles of thousands of tumors from patients with urological cancers, and is believed by GenomeDx to be the largest shared genomic expression database in urologic cancer as well as one of the world's largest global RNA expression databases using cloud-based analytics. GRID is a platform for interactive research collaboration, and may enable more rapid discovery, development, commercialization and adoption of new genomic solutions for key clinical questions in cancer treatment.

Derived from GRID, GenomeDx's Decipher Prostate and Bladder Cancer Classifier tests are commercially available genomic tests that provide a genomic assessment of tumor aggressiveness for individual patients. Decipher Biopsy is indicated for men with localized prostate cancer at diagnosis, Decipher Post-Op is indicated for men after prostate removal surgery and Decipher Bladder is indicated for patients being considered for neoadjuvant chemotherapy prior to radical cystectomy. The Decipher tests are used by physicians to stratify patients into more accurate risk groups than determined by traditional diagnostic tools and to better determine which patients may be more likely to benefit from additional treatment. Each tumor analyzed with a Decipher test adds new data points to the GRID database, which is compiled into a Decipher GRID Profile that may reveal additional biological characteristics of the tumor for ongoing research purposes. Going beyond risk stratification, Decipher and GRID makes accessible genetic information for researchers to potentially better predict responses to therapy and more precisely guide treatment.

More information is available at http://www.deciphertest.com and http://www.deciphergrid.com

About GenomeDx Biosciences

GenomeDx has reimagined the use of genomics as a platform for mass collaboration to improve treatment and outcomes of people with cancer. GenomeDx has built Decipher GRID, a large and fast-growing genomics database in urologic cancer that provides a foundation for open and interactive research collaboration and knowledge creation. Using Decipher GRID and machine learning to analyze vast amounts of genomic data, GenomeDx develops and commercializes proprietary clinical tests that are intended to provide more accurate and useful diagnostic information than traditional diagnostic tools or existing genomic tests. GenomeDx's Decipher Biopsy, Decipher Post-Op and Decipher Bladder are commercially available prostate cancer genomic tests that provide an assessment of tumor aggressiveness based on a patient's unique genomic profile. GenomeDx is headquartered in Vancouver, British Columbia and operates a clinical laboratory in San Diego, California.

Learn more at http://www.GenomeDx.com

SOURCE GenomeDx Biosciences

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GenomeDx's Decipher Post-Op Demonstrates Positive Impact on Physician, Patient Treatment Decisions in Multicenter ... - Broadway World

Doctor’s Tip: The low-down on vitamin D – Glenwood Springs Post Independent

Vitamins are defined as organic substances occurring in many foods in small amounts that are necessary for the normal metabolic functioning of the body. Vitamin D is one of the fat-soluble vitamins. Our bodies can't manufacture vitamins but can manufacture hormones, and some experts feel that vitamin D should be classified as a hormone rather than a vitamin because our bodies manufacture it when exposed to the sun.

"Current Medical Diagnosis and Treatment 2016" notes that vitamin D deficiency "is increasing throughout the world as a result of diminished exposure to sunlight caused by urbanization, automobile and public transportation, modest clothing and sunscreen use."

Defining vitamin D deficiency can be confusing due to two ways of measuring level: nmol/liter and ng/ml (e.g. 112 nmol/liter is the same as 50 ng/ml). The latter is the way levels are usually reported and is what will be used in today's column. Significant vitamin D deficiency is defined as a level less than 20 ng/ml and this occurs in 29 percent of postmenopausal American women and 25 percent of American men older than 65. Severe deficiency is defined as a level less than 10 ng/ml and is present in 3.5 percent of Americans.

Almost all cells, organs and tissues in our bodies have vitamin D receptors, and vitamin D can also turn on hundreds of genes. Over the years, vitamin D supplementation has been touted as a panacea for all sorts of health problems, but according to Dr. Michael Greger's website nutritionfacts.org, better studies done in the last few years have discounted many of these claims. Here's what the current science tells us about vitamin D deficiency:

Vitamin D promotes calcium absorption by the intestines, and also stimulates the activity of bone-forming cells called osteoblasts. Deficiency can cause osteoporosis and osteomalacia, which like osteoporosis causes brittle bones and fractures, but is not exactly the same as osteoporosis. In children with developing bones, osteomalacia is called rickets, which can result in permanent skeletal deformities.

There are vitamin D receptors in our muscles and nervous systems including our brains, but as we age the number of receptors decreases. Elderly people with low vitamin D levels are more apt to suffer falls due to muscle weakness and balance problems.

Vitamin D boosts our immune system, and people with low D levels have an increased incidence of respiratory infections.

Low vitamin D levels are associated with increased all-cause mortality (i.e. you live longer if you maintain normal vitamin D levels).

Vitamin D helps fight inflammation. Asthma, ulcerative colitis and Crohn's disease all inflammatory diseases improve and in some cases even go into remission once D levels have normalized.

According to Dr. Joel Fuhrman, author of "Eat to Live" and other books, "Vitamin D regulates several genes and cellular processes related to cancer progression." People with low levels of D are more apt to get several cancers including breast and colon, and once they get cancer it is more likely to progress.

What are normal levels? Greger points out that the cradle of civilization was in equatorial Africa, "when people were running around outside naked." Vitamin D levels in African tribes living traditional lifestyles are around 50. Breast milk lacks vitamin D, and therefore breast-fed babies are given D supplements, which doesn't make sense from an evolutionary point of view. But if a breast-feeding mother's D level is 50 or greater, her breast milk does contain vitamin D. So while some guidelines say we should shoot for levels of D greater than 30, most of the science points to levels of 50 or more as ideal.

How much D should people take to achieve levels of 50 or above? For most people, 2,000 units a day achieves optimal D levels, with some caveats:

Vitamin D is stored in fat, so obese people need to take 4,000 units a day a day to achieve optimal levels.

Absorption is hampered in the elderly, so the American Geriatrics Society recommends 4,000 units in people 65 and older.

The type of vitamin D you should take is D3, which is what your body makes when exposed to sunlight; versus D2 present in yeast and mushrooms, which isn't as effective.

D is absorbed better if taken with a meal that contains some fat, such as nuts and seeds.

The practice of taking very high doses (e.g. 50,000 units) intermittently is now frowned upon, because the very high levels that result can cause problems.

How about just getting sun exposure rather than taking a supplement? The problem is that sun ages your skin and causes skin cancer. When outside you should cover up and apply sunscreen to exposed areas of your skin such as your face, but this interferes with vitamin D production. Tanning booths have the same problems as sun exposure, and aren't very effective in vitamin D production anyway.

Should everyone have their vitamin D levels tested? Most guidelines don't recommend this because:

Almost all Americans are lower than optimal in vitamin D.

Most insurance companies and Medicare won't cover the test when coded as a screen.

The test for vitamin D is done on a blood sample, and is not a very accurate test in that a lot of variation can occur between labs and even on the same sample tested repeatedly in the same lab.

Vitamin D is inexpensive and has no side effects except in very high doses, such as 10,000 units a day, which can result in dangerously high blood levels.

Dr. Feinsinger, who retired from Glenwood Medical Associates after 42 years as a family physician, now has a nonprofit Center For Prevention and Treatment of Disease Through Nutrition. He is available for free consultations about heart attack prevention and any other medical concerns. Call 970-379-5718 for an appointment. For questions about his columns, email him at gfeinsinger@comcast.net.

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Doctor's Tip: The low-down on vitamin D - Glenwood Springs Post Independent

I Tried Sound Wave Therapy For Stronger Erections. Here’s What Happened – Men’s Health


Men's Health
I Tried Sound Wave Therapy For Stronger Erections. Here's What Happened
Men's Health
He grinned the grin of a 60-plus-year-old doctor jacked up on growth hormone and testosterone. I think you're gonna be pretty happy. Let's get that numbing cream on, shall we? I grimaced, half-expecting him to snatch the syringe from my clutch and ...

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I Tried Sound Wave Therapy For Stronger Erections. Here's What Happened - Men's Health

Dr. Charles Mok Releases Innovative New Book on Women’s Health – Yahoo Finance

NEW YORK, April 10, 2017 /PRNewswire-iReach/ -- Physician and business leader Dr. Charles Mok today announced the publication of Testosterone: Strong Enough for a Man, Made for a Woman (available now). The book is published with ForbesBooks, the exclusive business book publishing imprint of Forbes Media.

In the book, Dr. Mok, who has persistently followed the research on hormone replacement therapy (HRT) and its health benefits for 30 years, confronts medical professionals for their slow integration of testosterone into HRT. With support from a wealth of peer-reviewed studies, he shows how testosterone therapy can help women facing menopause maintain their weight, increase their sexuality, and reduce the health risks associated with aging.

In his new book, Dr. Mok describes the dramatic transformation HRT has undergone in the past several decades. For years, synthetic hormones were widely prescribed to treat women in the United States experiencing menopause. HRT clinical trials in the early 2000s called the practice into question after observing an increase in health risks in women taking synthetic hormones. Those safety concerns, Dr. Mok argues, were valid, but misleading. Today's treatment protocolsusing natural hormones such as testosteroneare entirely different.

"Clinical studies show that testosterone therapy reduces the risk of breast cancer by 50 to 75 percent and relieves virtually all symptoms of menopause with no adverse effects," said Dr. Mok. "The benefits of implementing testosterone into hormone replacement therapy are virtually unprecedented, and yet the larger medical community continues to ignore the facts."

The book Testosterone: Strong Enough for a Man, Made for a Woman is now available for purchase on Amazon.com.

About ForbesBooks

Launched in 2016 in partnership with Advantage Media Group, ForbesBooks is the exclusive business book publishing imprint of Forbes Media, the 99-year-old global media, branding and technology company. ForbesBooks offers business and thought leaders an innovative, speed-to-market publishing model and a suite of services designed to strategically and tactically support authors and promote their expertise. For more information, visitwww.forbesbooks.com.

About Dr. Charles Mok

A speaker, author and authority in his field,Dr. Charles Mok has dedicated his life to helping patients gain confidence, feel younger and live a healthier lifestyle. After receiving his medical degree, Dr. Mok began a career in emergency medicine, eventually working as the vice chairman of the emergency department at Mt. Clemens General Hospital, now known as McLaren Macomb. During these years, he saw countless patients with health emergencies that were fully preventable. In 2003, Dr. Mok founded Allure Medical Spa, one of the largest and most successful medical practices in the state of Michigan, to improve the lives of patients with treatments including varicose veins, hair loss and fat reduction, cosmetic surgery, stem cell therapy, and more. His mission is to reveal the clinical research supporting natural hormone therapy's safety and effectiveness to educate and change the lives of many women for the better. For more information, visit http://www.drcharlesmok.com.

Media Contacts

Mary Scott, Allure Medical Spa, mscott@alluremedicalspa.com, (313) 3784651

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Dr. Charles Mok Releases Innovative New Book on Women's Health - Yahoo Finance

The Doctor Who Got Hitler Hooked on DrugsAnd the Plot to Take Him Down – Mental Floss

In Blitzed: Drugs in the Third Reich, author Norman Ohler reveals that the Nazis doped their soldiers with a stimulant they called Pervitina.k.a. methamphetamine. The drug helped the Germanswin key battles in the beginning of World War II.

But it wasnt just low-level soldiers who were using during the Second World War. Drug use went all the way up the Nazi leadership to Hitler himself. The dictators personal physician, Theodor Morell, regularly injected Patient A with hormone preparations and steroids he had created using animal glands and other dubious ingredientsand as Hitlers health worsened, Morell secretly began treating him with eukodal, otherwise known as oxycodone, in July 1943. Hitler received an injection every other daywhich is, Ohler notes, The typical rhythm of an addict and contradicts the idea of a purely medical application. The Fuhrer was hooked.

In July 1944, German senior military officials tried to kill Hitler with a bomb in the unsuccessful Operation Valkyrie. The explosion punctured both of Hitlers eardrums. Ear, nose, and throat doctor Erwin Giesing was called to Hitlers headquarters in Poland and began treating Hitler without consulting Morell, administering cocaine in the dictator's nasal passages with a cotton swab. Hitler quickly became addicted to cocaine, too.

Morell and Giesing hated and distrusted each other from the start. In fact, Giesing suspected Morell was poisoning Hitlerand he wasn't alone. In autumn 1944, the situation finally came to a head, as recounted in this excerpt from Blitzed.

You have all agreed that you want to turn me into a sick man. Adolf Hitler

The power of the personal physician was approaching a high point during that autumn of 1944. Since the attempt on his life Patient A needed him more than ever, and with each new injection Morell gained further influence. The dictator was closer to him than he was to anyone else; there was no one he liked to talk to as much, no one he trusted more. At major meetings with the generals an armed SS man stood behind every chair to prevent any further attacks. Anyone who wanted to see Hitler had to hand over his briefcase. This regulation did not apply to Morells doctors bag.

Many people envied the self-styled sole personal physician his privileged position. Suspicion about him was growing. Morell still stubbornly refused to talk to anyone else about his methods of treatment. Right until the end he maintained the discretion with which he had initially approached the post. But in the stuffy atmosphere of the haunted realm of the bunker system, where the poisonous plants of paranoia sent their creepers over the thick concrete walls, this was not without its dangers. Morell even left the assistant doctors Karl Brandt and Hanskarl von Hasselbach, with whom he could have discussed the treatment of Hitler, consistently in the dark. He had mutated from outsider to diva. He told no one anything, wrapping himself in an aura of mystery and uniqueness. Even the Fuhrers all-powerful secretary, Martin Bormann, who made it clear that he would have preferred a different kind of treatment for Hitler, one based more on biology, was banging his head against a wall when it came to the fat doctor.

As the war was being lost, guilty parties were sought. The forces hostile to Morell were assembling. For a long time Heinrich Himmler had been collecting information about the physician, to accuse him of having a morphine addiction and thus of being vulnerable to blackmail. Again and again the suspicion was voiced on the quiet: might he not be a foreign spy who was secretly poisoning the Fuhrer? As early as 1943 the foreign minister, Joachim von Ribbentrop, had invited Morell to lunch at his castle, Fuschl, near Salzburg, and launched an attack: while the conversation with von Ribbentrops wife initially revolved around trivial questions such as temporary marriages, state bonuses for children born out of wedlock, lining up for food and the concomitant waste of time, after the meal the minister stonily invited him upstairs, to discuss something.

Von Ribbentrop, arrogant, difficult, and blas as always, tapped the ash off his Egyptian cigarette with long, aristocratic fingers, looked grimly around the room, then fired off a cannonade of questions at the miracle doctor: Was it good for the Fuhrer to get so many injections? Was he given anything apart from glucose? Was it, generally speaking, not far too much? The doctor gave curt replies: he only injected what was necessary. But von Ribbentrop insisted that the Fuhrer required a complete transformation of his whole body, so that he became more resilient. That was water off a ducks back for Morell, and he left the castle rather unimpressed. Laymen are often so blithe and simple in their medical judgments, he wrote, concluding his record of the conversation.

But this was not the last assault Morell would bear. The first structured attack came from Bormann, who tried to guide Hitlers treatment onto regular, or at least manageable, lines. A letter reached the doctor: Secret Reich business! In eight points measures for the Fuhrers security in terms of his medical treatment were laid out, a sample examination of the medicines in the SS laboratories was scheduled, and, most importantly, Morell was ordered henceforth always to inform the medical supply officer which and how many medications he plans to use monthly for the named purpose.

In fact this remained a rather helpless approach from Bormann, who was not usually helpless. On the one hand his intervention turned Hitlers medication into an official procedure, but on the other he wanted as little correspondence as possible on the subject, since it was important to maintain the healthful aura of the leader of the master race. Heil Hitler literally means Health to Hitler, after all. For that reason the drugs, as detailed in Bormanns letter, were to be paid for in cash to leave no paper trail. Bormann added that the monthly packets should be stored ready for delivery at any time in an armored cupboard, and made as identifiable as possible down to the ampoule by consecutive numbering (for example, for the first consignment: 1/44), while at the same time the external wrapping of the package should bear an inscription to be precisely established with the personal signature of the medical supply officer.

Morells reaction to this bureaucratic attempt to make his activities transparent was as simple as it was startling. He ignored the instructions of the mighty security apparatus and simply didnt comply, instead continuing as before. In the eye of the hurricane he felt invulnerable, banking on the assumption that Patient A would always protect him.

In late September 1944, in the pale light of the bunker, the ear doctor, Giesing, noted an unusual coloration in Hitlers face and suspected jaundice. The same day, on the dinner table there was a plate holding apple compote with glucose and green grapes and a box of Dr. Koesters anti-gas pills, a rather obscure product. Giesing was perplexed when he discovered that its pharmacological components included atropine, derived from belladonna or other nightshade plants, and strychnine, a highly toxic alkaloid of nux vomica, which paralyzes the neurons of the spinal column and is also used as rat poison. Giesing indeed smelled a rat. The side-effects of these anti-gas pills at too high a dose seemed to correspond to Hitlers symptoms. Atropine initially has a stimulating effect on the central nervous system, then a paralyzing one, and a state of cheerfulness arises, with a lively flow of ideas, loquacity, and visual and auditory hallucinations, as well as delirium, which can mutate into violence and raving. Strychnine in turn is held responsible for increased light-sensitivity and even fear of light, as well as for states of flaccidity. For Giesing the case seemed clear: Hitler constantly demonstrated a state of euphoria that could not be explained by anything, and I am certain his heightened mood when making decisions after major political or military defeats can be largely explained in this way.

In the anti-gas pills Giesing thought he had discovered the causes of both Hitlers megalomania and his physical decline. He decided to treat himself as a guinea pig: for a few days Giesing took the little round pills himself, promptly identified that he had the same symptoms, and decided to go on the offensive. His intention was to disempower Morell by accusing him of deliberately poisoning the Fuhrer, so that Giesing could assume the position of personal physician himself. While the Allied troops were penetrating the borders of the Reich from all sides, the pharmacological lunacy in the claustrophobic Wolfs Lair was becoming a doctors war.

As his ally in his plot, Giesing chose Hitlers surgeon, who had been an adversary of Morells for a long time. Karl Brandt was in Berlin at the time, but when Giesing called he took the next plane to East Prussia without hesitation and immediately summoned the accused man. While the personal physician must have worried that he was being collared for Eukodal, he was practically relieved when his opponents tried to snare him with the anti-gas pills, which were available without prescription. Morell was also able to demonstrate that he had not even prescribed them, but that Hitler had organized the acquisition of the pills through his valet, Heinz Linge. Brandt, who had little knowledge of biochemistry and focused his attention on the side-effects of strychnine, was not satisfied with this defense. He threatened Morell: Do you think anyone would believe you if you claimed that you didnt issue this prescription? Do you think Himmler might treat you differently from anyone else? So many people are being executed at present that the matter would be dealt with quite coldly. Just a week later Brandt added: I have proof that this is a simple case of strychnine poisoning. I can tell you quite openly that over the last five days I have only stayed here because of the Fuhrers illness.

But what sort of illness was that exactly? Was it really icterusjaundice? Or might it be a typical kind of junkie hepatitis because Morell wasnt using properly sterile needles? Hitler, whose syringes were only ever disinfected with alcohol, wasnt looking well. His liver, under heavy attack from those many toxic substances over the past few months, was releasing the bile pigment bilirubin: a warning signal that turns skin and eyes yellow. Morell was being accused of poisoning his patient. There was an air of threat when Brandt addressed Hitler. Meanwhile, on the night of October 5, 1944, Morell suffered a brain edema from the agitation. Hitler was unsettled beyond measure by the accusations: Treachery? Poison? Might he have been mistaken for all those years? Was he being double-crossed by his personally chosen doctor, Morell, the truest of the true, the best of all his friends? Wouldnt dropping his personal physician, who had just given him a beneficial injection of Eukodal, amount to a kind of self-abandonment? Wouldnt it leave him high and dry, vulnerable? This was an attack that might prove fatal, as his power was based on charisma. After all, it was the drugs that helped him artificially maintain his previously natural aura, on which everything depended.

Since the start of the Fuhrers rapid physical decline these internecine struggles between the doctors turned into a proxy war for succession at the top of the Nazi state. The situation was becoming worse: Himmler told Brandt he could easily imagine that Morell had tried to kill Hitler. The Reichsfuhrer-SS called the physician to his office and coldly informed him that he had himself sent so many people to the gallows that he no longer cared about one more. At the same time, in Berlin, the head of the Gestapo, Ernst Kaltenbrunner, summoned Morells locum, Dr. Weber, from the Kurfurstendamm to a hearing at the Reich Security Main Office on Prinz-Albrecht-Strasse. Weber tried to exonerate his boss, and voiced his opinion that a plot was utterly out of the question. He claimed Morell was far too fearful for such a thing.

Finally the chemical analysis of the disputed medication was made available. The result: its atropine and strychnine content was far too small to poison anyone, even in the massive quantities that Hitler had been given. It was a comprehensive victory for Morell. I would like the matter involving the anti-gas pills to be forgotten once and for all, Hitler stated, ending the affair. You can say what you like against Morellhe is and remains my only personal physician, and I trust him completely. Giesing received a reprimand, and Hitler dismissed him with the words that all Germans were freely able to choose their doctors, including himself, the Fuhrer. Furthermore, it was well known that it was the patients faith in his doctors methods that contributed to his cure. Hitler would stay with the doctor he was familiar with, and brushed aside all references to Morells lax treatment of the syringe: I know that Morells new method is not yet internationally recognized, and that Morell is still in the research stage with certain matters, without having reached a firm conclusion about them. But that has been the case with all medical innovations. I have no worries that Morell will not make his own way, and I will immediately give him financial support for his work if he needs it.

Himmler, a dedicated sycophant, immediately changed tack: Yes, gentlemen, he explained to Hasselbach and Giesing, You are not diplomats. You know that the Fuhrer has implicit trust in Morell, and that should not be shaken. When Hasselbach protested that any medical or even civil court could at least accuse Morell of negligent bodily harm, Himmler turned abrasive: Professor, you are forgetting that as interior minister I am also head of the supreme health authority. And I dont want Morell to be brought to trial. The head of the SS dismissed Giesings objection that Hitler was the only head of state in the world who took between 120 and 150 tablets and received between 8 and 10 injections every week.

The tide had turned once and for all against Giesing, who was given a check from Bormann for ten thousand reichsmarks in compensation for his work. Both reichsmarks in compensation for his work. Both Hasselbach and the influential Brandt were out of luck as well, also damaging the latters confidant Speer, who had his eye on Hitlers succession. The three doctors had to leave headquarters. Morell was the only one who stayed behind. On October 8, 1944, he rejoiced in the happy news: The Fuhrer told me that Brandt had only to meet his obligations in Berlin. Patient A stood firmly by his supplier. Just as every addict adores his dealer, Hitler was unable to leave the generous doctor who provided him with everything he needed.

The dictator told his physician: These idiots didnt even think about what they were doing to me! I would suddenly have been standing there without a doctor, and these people should have known that during the eight years you have been with me you have saved my life several times. And how I was before! All doctors who were dragged in failed. Im not an ungrateful person, my dear doctor. If we are both lucky enough to make it through the war, then youll see how well I will reward you!

Morells confident reply can also be read as an attempt to justify himself to posterity, because the physician put it baldly on record: My Fuhrer, if a normal doctor had treated you during that time, then you would have been taken away from your work for so long that the Reich would have perished. According to Morells own account, Hitler peered at him with a long, grateful gaze and shook his hand: My dear doctor, I am glad and happy that I have you.

The war between the doctors was thus shelved. Patient A had put a stop to a premature dismissal. The price he paid was the continued destruction of his health by a personal physician who had been confirmed in his post. To calm his nerves the head of state received Eukodal, Eupaverin. Glucose i.v. plus Homoseran i.m.

Excerpt from BLITZED: Drugs in the Third Reich by Norman Ohler, translated by Shaun Whiteside. 2017 by Norman Ohler. English translation 2017 by Shaun Whiteside. Used by permission of Houghton Mifflin Harcourt Publishing Company. All rights reserved.

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The Doctor Who Got Hitler Hooked on DrugsAnd the Plot to Take Him Down - Mental Floss

Participation in a Weight Management Program Reduces Job … – Newswise (press release)

Newswise ORLANDOIndividuals with obesity who enrolled in a structured weight loss program report fewer hours missed from work after six months in the program, according to a study being presented Sunday at the Endocrine Societys 99th annual meeting in Orlando, Fla.

A concern shared by both employers and employees is that time spent in the program attending the physician and dietitian visits, and the vigilance required to maintain lifestyle modifications, might diminish time and productivity on the job, said Jennifer Iyengar, M.D., the studys lead author and an endocrinology fellow at the University of Michigan, Ann Arbor, Mich. However, we found that participation in our program was highly valued and had a positive impact at work.

The total economic cost of obesity in the U.S. includes indirect costs, such as missed time from work, lost productivity at work and premature death due to obesity-related health problems, research shows. Iyengar said little is known, though, about whether weight loss interventions can improve the job performance and attendance of employees with obesity. She and her co-workers studied this question in participants in the University of Michigan Weight Management Program.

The weight management program, according to its director and study senior investigator Amy Rothberg, M.D., Ph.D., is a two-year, multicomponent, multidisciplinary program for people with moderate to severe obesity that involves frequent visits with physicians and dietitians. It uses a very-low-calorie diet (800 calories per day) by total meal replacement for the first three months to promote 15 percent weight loss, followed by gradual transition to a low-calorie, food-based diet and interventions to support lifelong behavior changes and promote regular physical activity.

For this study, the researchers evaluated 92 participants with obesity (average weight of 253 pounds and average BMI of 40 kg/m2) who had completed six months in the program and were employed full time in a variety of different occupations. At the first visit and again at six months, participants completed a self-administered, scientifically validated questionnaire regarding their work absenteeism (working fewer hours than their employers expected) and their presenteeism, defined as the participants rating of their own work performance.

At the six-month point, participants lost an average of 41 pounds, the research team reported.

Before the program, participants reported that they worked, on average, 5.2 fewer hours per month than what their employers expected. After six months in the program, they described working 6.4 hours more than expected.

There was reportedly no significant change in how they rated their overall work performance (presenteeism) on a 10-point scale, with an average of 7.8 at the beginning and 7.9 at six months. It is possible that presenteeism will improve with longer participation in the program, Iyengar said.

Improved absenteeism did not correlate with the amount of weight loss, Iyengar reported. One possible explanation, she said, is that the change in absenteeism rates may reflect improvements in co-existing medical illnesses or depression.

She concluded, Our findings suggest that, through favorable effects on work attendance, participation in a weight management program may be mutually beneficial for workers and their employers. # # #

Endocrinologists are at the core of solving the most pressing health problems of our time, from diabetes and obesity to infertility, bone health, and hormone-related cancers. The Endocrine Society is the worlds oldest and largest organization of scientists devoted to hormone research and physicians who care for people with hormone-related conditions.

The Society has more than 18,000 members, including scientists, physicians, educators, nurses and students in 122 countries. To learn more about the Society and the field of endocrinology, visit our site at http://www.endocrine.org. Follow us on Twitter at @TheEndoSociety and @EndoMedia.

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Participation in a Weight Management Program Reduces Job ... - Newswise (press release)

Is adrenal fatigue real? Forget the label and treat the stress. – Napa Valley Register

Who isn't tired these days? We're constantly on call for work, family and friends, and often forget to take time for ourselves. Most of us recognize that chronic stress can take its toll on our health and well-being. But what if you're so fatigued that even getting more sleep doesn't seem to help?

Complementary and alternative medicine provide an explanation for stress-induced fatigue that offers hope to the chronically tired. According to naturopathic doctors, holistic nutritionists and others, adrenal fatigue is a condition where the adrenals, glands that sit above the kidneys, don't produce enough cortisol. Cortisol is a hormone that plays a role in managing stress and regulating metabolism, sleep, blood sugar and inflammation.

"Fatigue is probably the number one complaint among new patients in my practice," says Leila Kirdani, a family physician specializing in functional medicine. "Anyone with prolonged fatigue, with difficulty sleeping, who feels 'burned-out' or lack of enjoyment in life, may be suffering from adrenal fatigue."

Basically, the theory goes that too much stress wears out our adrenal glands - they get tired and don't produce enough cortisol for us to feel energized. So why aren't our family doctors telling us about this?

As a registered dietitian in private practice, I often get new clients who have been told by their naturopathic doctors that they have adrenal fatigue and need to follow a special diet and a regimen of supplements and herbs. Hours of searching the scientific literature has led to very little in terms of evidence-based dietary advice to help these individuals. Which raises the question . . .

- Is adrenal fatigue real?

The very existence of adrenal fatigue is a contentious issue. It isn't recognized by any endocrinology societies or endocrinologists, medical doctors who specialize in hormone-related health problems. A recent systematic review of the scientific literature found that there was no evidence for the existence of adrenal fatigue as a medical condition.

Theodore C. Friedman is an endocrinologist at Charles R. Drew University of Medicine and Science who describes himself as being open to complementary medicine. Like many medical doctors, he says adrenal fatigue doesn't exist: "It's something made up by naturopathic doctors; endocrinologists don't recognize it as a real condition."

Saul Marcus is a naturopathic doctor in Connecticut. "When it comes to adrenal fatigue, conventional medicine insists it doesn't exist. However, adrenal fatigue is essentially a stress reaction, and stress is very well understood as a cause of illness."

And so we see the bipolar worlds of conventional medicine and complementary and alternative medicine are firmly divided into two camps: adrenal fatigue doesn't exist vs. adrenal fatigue is an important medical issue.

Somewhere in the middle is the idea that adrenal fatigue is a term that encompasses a wide range of general symptoms rather than a discrete medical problem. Does the label matter?

- What's really going on with your adrenal glands?

According to Kirdani, "There is a distinct bias in the medical community when it comes to adrenal fatigue. For some reason, doctors think that either your adrenal glands are perfectly fine, or else they have ceased to function."

"Naturopaths have it wrong," Friedman explains. "They describe adrenal fatigue as a stress-induced condition where your adrenal glands don't produce enough cortisol. In fact, when you're stressed out, your adrenal glands make more cortisol."

What endocrinologists and other medical doctors do recognize is adrenal insufficiency, a disorder where the adrenals don't produce enough hormones. The adrenal glands make two hormones: cortisol and aldosterone. According to Friedman, "Aldosterone is often underappreciated or unrecognized by naturopaths." He also says that adrenal insufficiency is on a gradient: "You can have varying levels of cortisol deficiency, aldosterone deficiency or both."

Having low aldosterone causes salt to be lost in the urine, which leads to symptoms such as brain fog, feeling worse after exercise or feeling dizzy when you stand up. Friedman says that people with low aldosterone can be diagnosed by an endocrinologist and then can be treated with synthetic aldosterone, extra salt or licorice root. Because the role of aldosterone is often ignored by alternative medicine, this is one adrenal issue that your naturopath may not test for. (Marcus, the naturopathic doctor, says one reason naturopaths may not test for aldosterone is because it requires a blood test, and in some states they are not licensed to order bloodwork.)

Where cortisol is concerned, people can have low cortisol as a result of their pituitary gland not producing enough of a hormone that stimulates the release of cortisol from the adrenals. A smaller portion of people have Addison's disease, where the adrenal glands are attacked by antibodies. As a result, the adrenals won't produce enough cortisol. Friedman says that these patients need to see an endocrinologist and get on cortisol right away.

As Friedman puts it, people with adrenal insufficiency do have fatigue, so it makes sense to examine their adrenal glands. "It's the concept of the adrenals burning out that doesn't make sense."

- How do you get tested for adrenal fatigue or adrenal insufficiency?

Marcus says adrenal fatigue can be diagnosed in several ways. Many practitioners test cortisol levels in saliva, but these also can be diagnosed based on symptoms. "If someone is feeling tired and under some sort of stress, their adrenal function is probably not optimal, and it may be okay to try taking some supplements for the adrenals."

Friedman calls the saliva test used by natural-health practitioners unreliable and says a blood test is a far better way to measure cortisol levels.

The blood test measures levels of electrolytes (including sodium) as well as several hormones. This gives a picture of which hormones are out of the normal range and what could be causing issues.

- Taking care of your adrenals

Google "adrenal fatigue diet" and you'll find websites recommending everything from eliminating dairy to following a paleo diet that also vetoes grains and beans. At this point, there isn't any evidence to show that any of this will help you manage stress or feel more energized.

When my clients are dealing with stress and fatigue, I recommend eating whole foods, plenty of vegetables, heart-healthy fats and lean protein, limiting highly processed foods and added sugars, as well as cutting down on caffeine and alcohol, which can negatively affect sleep.

Choosing foods that stabilize your blood sugar and are lower on the glycemic index is also important, as your energy levels and mood are closely related to blood sugar. Go for slow-burning carbohydrates such as sweet potatoes, barley, quinoa and rolled oats, and always combine them with a protein such as beans or lentils, chicken, fish or lean meat. Get healthy fats from oily fish, olive oil, avocado, nuts or seeds at each meal and snack, and chances are you'll feel more energized.

Marcus, Kirdani and Friedman all say that whether you're dealing with stress or adrenal fatigue, taking care of your overall health helps.

Friedman feels that the naturopathic approach can be valuable, as talking to someone about stress and ways to cope can help. He also doesn't have a problem with people taking certain supplements that boost their immune system and energy levels, as long as those don't interact with other medications or supplements.

Marcus and Kirdani recommend supplementing with sea salt, B vitamins and herbs such as rhodiola or lemon balm. (Please see a medical professional before taking supplements or herbs to make sure they're safe for you.) Patients also may use an adrenal glandular, essentially ground-up adrenal glands (usually from pigs or cows), other tissues or extracts.

Friedman warns: "The naturopathic approach can be dangerous if cortisol or ground-up adrenals are prescribed. People often feel better on cortisol, but side effects include osteoporosis, weight gain and diabetes. As such, it shouldn't be prescribed lightly."

- Does it matter what we call it?

While the worlds of conventional and alternative medicine are divided on adrenal fatigue as a condition, everyone seems to agree that managing stress makes sense. So does eating well and treating any vitamin or mineral deficiencies, as well as getting regular physical activity and enough sleep. Working on all of these areas will help you boost energy, reduce fatigue and make you healthier. Whether these positive lifestyle changes are improving stress levels or healing adrenal fatigue is irrelevant.

What does matter is if treating so-called adrenal fatigue ends up preventing the diagnosis of a serious medical problem.

Friedman's take-home message is clear. "If you're experiencing fatigue, you need to see an endocrinologist to make sure you're getting at the real issue and not masking fatigue that's being caused by another health problem," he said. "If you do have an adrenal issue, it needs to be treated as soon as possible."

Brissette is a dietitian, foodie and president of 80TwentyNutrition.com. Follow her on Twitter @80twentyrule.

Here is the original post:
Is adrenal fatigue real? Forget the label and treat the stress. - Napa Valley Register

Highly Respected Naturopathic Physician, Dr. Jodie A. Dashore, OTD, MS (Neurology), HHP, will be Displayed in The … – PR NewsChannel (press release)

The International Association of HealthCare Professionals is pleased to welcome Dr. Jodie A. Dashore OTD, MS (Neurology), HHP, to their prestigious organization with her upcoming publication in The Leading Physicians of the World. She is a highly trained and qualified Naturopathic Clinician, Doctor of Occupational Therapy, Neuro-Sensory Integration, and Holistic health practitioner with an extensive expertise in all facets of her work, especially in Holistic all natural Management for Tick Borne Diseases, Complex Autism, Biotoxin Illness, and Chronic Inflammatory Response Syndrome. Dr. Dashore is currently serving patients as Clinical Director within her own practice, Integrative NeuroSensory Associates LLC, a functional therapeutic, biomedical and integrative therapy practice in Marlboro, New Jersey. Furthermore, she also serves as Clinical Director within Specialized Pediatrics Therapy Center LLC in New Jersey.

Dr. Dashore graduated Magna Cum Laude specializing in MS -Neurology from the University of Bombay in 1992. Subsequently, she relocated to the United States and earned her Advanced Clinical Doctorate in OT-Neurology and Evidence Based Medicine. Dr. Dashore then attended the University of Southern California, gaining her post-doctoral specialization in Neuro Sensory Integration.

Dr. Dashore is fully certified in Holistic and Energy therapeutic approaches, German Biological remedies, Homotoxicology, and Clinical Herbalism, having trained in the United Kingdom, Switzerland, and Germany. She is an internationally recognized AWARD Winning holistic clinician, author, and speaker. She works with children and adults from across the country and abroad who suffer from Autism, Sensory Integration Disorders, Lyme Disease, PANDAS, IBS, Chronic Fatigue, Autoimmune Disease, Mold and Biotoxin Illness, Endocrine and Hormone Imbalances, Methylation concerns, Cancer and Chronic Disease. Dr. Dashore utilizes the principles of homeopathy, herbology, homotoxicology, bioenergetic and European biological remedies in her practice for natural health and wellness.

She maintains professional memberships with the International Lyme and Associated Diseases Society, the American College for Advancement in Medicine (ACAM), American Holistic Medicine Association, The North American Society of Homeopaths, the American Association of Drugless Practitioners, and the American Occupational Therapy Association, among others. Dr. Dashore attributes her success to her one and only childs personal struggles and triumphs with chronic infection and illness. She also attributes her success to the various opportunities she has had to mentor with numerous world renowned pioneering physicians. In her free time, she enjoys nature walks, yoga, Meditation, spirituality, research, and spending time with her son.

View Dr. Jodie A. Dashores Profile Here: https://www.findatopdoc.com/doctor/8138151-Jodie-Dashore-Naturopathic-Physician-Marlboro-New-Jersey-07746

Learn more about Dr. Dashore here: http://dashoreintegrativerx.com/ and be sure to read her upcoming publication in The Leading Physicians of the World.

About FindaTopDoc.com

FindaTopDoc.com is a hub for all things medicine, featuring detailed descriptions of medical professionals across all areas of expertise, and information on thousands of healthcare topics. Each month, millions of patients use FindaTopDoc to find a doctor nearby and instantly book an appointment online or create a review. FindaTopDoc.com features each doctors full professional biography highlighting their achievements, experience, patient reviews and areas of expertise. A leading provider of valuable health information that helps empower patient and doctor alike, FindaTopDoc enables readers to live a happier and healthier life. For more information about FindaTopDoc, visit http://www.findatopdoc.com

Originally posted here:
Highly Respected Naturopathic Physician, Dr. Jodie A. Dashore, OTD, MS (Neurology), HHP, will be Displayed in The ... - PR NewsChannel (press release)

Is adrenal fatigue real? Forget the label and treat the stress. – Washington Post

By Christy Brissette By Christy Brissette April 5

Who isnt tired these days? Were constantly on call for work, family and friends, and often forget to take time for ourselves. Most of us recognize that chronic stress can take its toll on our health and well-being. But what if youre so fatigued that even getting more sleep doesnt seem to help?

Complementary and alternative medicine provide an explanation for stress-induced fatigue that offers hope to the chronically tired. According to naturopathic doctors, holistic nutritionists and others, adrenal fatigue is a condition where the adrenals, glands that sit above the kidneys, dont produce enough cortisol. Cortisol is a hormone that plays a role in managing stress and regulating metabolism, sleep, blood sugar and inflammation.

Fatigue is probably the number one complaint among new patients in my practice, says Leila Kirdani, a family physician specializing in functional medicine. Anyone with prolonged fatigue, with difficulty sleeping, who feels burned-out or lack of enjoyment in life, may be suffering from adrenal fatigue.

Basically, the theory goes that too much stress wears out our adrenal glands they get tired and dont produce enough cortisol for us to feel energized. So why arent our family doctors telling us about this?

As a registered dietitian in private practice, I often get new clients who have been told by their naturopathic doctors that they have adrenal fatigue and need to follow a special diet and a regimen of supplements and herbs. Hours of searching the scientific literature has led to very little in terms of evidence-based dietary advice to help these individuals. Which raises the question ...

[The DASH diet is proven to work. Why hasnt it caught on?]

Is adrenal fatigue real?

The very existence of adrenal fatigue is a contentious issue. It isnt recognized by any endocrinology societies or endocrinologists, medical doctors who specialize in hormone-related health problems. A recent systematic review of the scientific literature found that there was no evidence for the existence of adrenal fatigue as a medical condition.

Theodore C. Friedman is an endocrinologist at Charles R. Drew University of Medicine and Science who describes himself as being open to complementary medicine. Like many medical doctors, he says adrenal fatigue doesnt exist: Its something made up by naturopathic doctors; endocrinologists dont recognize it as a real condition.

Saul Marcus is a naturopathic doctor in Connecticut. When it comes to adrenal fatigue, conventional medicine insists it doesnt exist. However, adrenal fatigue is essentially a stress reaction, and stress is very well understood as a cause of illness.

And so we see the bipolar worlds of conventional medicine and complementary and alternative medicine are firmly divided into two camps: adrenal fatigue doesnt exist vs. adrenal fatigue is an important medical issue.

Somewhere in the middle is the idea that adrenal fatigue is a term that encompasses a wide range of general symptoms rather than a discrete medical problem. Does the label matter?

Whats really going on with your adrenal glands?

According to Kirdani, There is a distinct bias in the medical community when it comes to adrenal fatigue. For some reason, doctors think that either your adrenal glands are perfectly fine, or else they have ceased to function.

Naturopaths have it wrong, Friedman explains. They describe adrenal fatigue as a stress-induced condition where your adrenal glands dont produce enough cortisol. In fact, when youre stressed out, your adrenal glands make more cortisol.

What endocrinologists and other medical doctors do recognize is adrenal insufficiency, a disorder where the adrenals dont produce enough hormones. The adrenal glands make two hormones: cortisol and aldosterone. According to Friedman, Aldosterone is often underappreciated or unrecognized by naturopaths. He also says that adrenal insufficiency is on a gradient: You can have varying levels of cortisol deficiency, aldosterone deficiency or both.

[Why phosphate additives will be the next taboo ingredient]

Having low aldosterone causes salt to be lost in the urine, which leads to symptoms such as brain fog, feeling worse after exercise or feeling dizzy when you stand up. Friedman says that people with low aldosterone can be diagnosed by an endocrinologist and then can be treated with synthetic aldosterone, extra salt or licorice root. Because the role of aldosterone is often ignored by alternative medicine, this is one adrenal issue that your naturopath may not test for. (Marcus, the naturopathic doctor, says one reason naturopaths may not test for aldosterone is because it requires a blood test, and in some states they are not licensed to order bloodwork.)

Where cortisol is concerned, people can have low cortisol as a result of their pituitary gland not producing enough of a hormone that stimulates the release of cortisol from the adrenals. A smaller portion of people have Addisons disease, where the adrenal glands are attacked by antibodies. As a result, the adrenals wont produce enough cortisol. Friedman says that these patients need to see an endocrinologist and get on cortisol right away.

As Friedman puts it, people with adrenal insufficiency do have fatigue, so it makes sense to examine their adrenal glands. Its the concept of the adrenals burning out that doesnt make sense.

How do you get tested for adrenal fatigue or adrenal insufficiency?

Marcus says adrenal fatigue can be diagnosed in several ways. Many practitioners test cortisol levels in saliva, but these also can be diagnosed based on symptoms. If someone is feeling tired and under some sort of stress, their adrenal function is probably not optimal, and it may be okay to try taking some supplements for the adrenals.

Friedman calls the saliva test used by natural-health practitioners unreliable and says a blood test is a far better way to measure cortisol levels.

The blood test measures levels of electrolytes (including sodium) as well as several hormones. This gives a picture of which hormones are out of the normal range and what could be causing issues.

Taking care of your adrenals

Google adrenal fatigue diet and youll find websites recommending everything from eliminating dairy to following a paleo diet that also vetoes grains and beans. At this point, there isnt any evidence to show that any of this will help you manage stress or feel more energized.

When my clients are dealing with stress and fatigue, I recommend eating whole foods, plenty of vegetables, heart-healthy fats and lean protein, limiting highly processed foods and added sugars, as well as cutting down on caffeine and alcohol, which can negatively affect sleep.

[10 nutrition mistakes even really healthy people make]

Choosing foods that stabilize your blood sugar and are lower on the glycemic index is also important, as your energy levels and mood are closely related to blood sugar. Go for slow-burning carbohydrates such as sweet potatoes, barley, quinoa and rolled oats, and always combine them with a protein such as beans or lentils, chicken, fish or lean meat. Get healthy fats from oily fish, olive oil, avocado, nuts or seeds at each meal and snack, and chances are youll feel more energized.

Marcus, Kirdani and Friedman all say that whether youre dealing with stress or adrenal fatigue, taking care of your overall health helps.

Friedman feels that the naturopathic approach can be valuable, as talking to someone about stress and ways to cope can help. He also doesnt have a problem with people taking certain supplements that boost their immune system and energy levels, as long as those dont interact with other medications or supplements.

Marcus and Kirdani recommend supplementing with sea salt, B vitamins and herbs such as rhodiola or lemon balm. (Please see a medical professional before taking supplements or herbs to make sure theyre safe for you.) Patients also may use an adrenal glandular, essentially ground-up adrenal glands (usually from pigs or cows), other tissues or extracts.

Friedman warns: The naturopathic approach can be dangerous if cortisol or ground-up adrenals are prescribed. People often feel better on cortisol, but side effects include osteoporosis, weight gain and diabetes. As such, it shouldnt be prescribed lightly.

Does it matter what we call it?

While the worlds of conventional and alternative medicine are divided on adrenal fatigue as a condition, everyone seems to agree that managing stress makes sense. So does eating well and treating any vitamin or mineral deficiencies, as well as getting regular physical activity and enough sleep. Working on all of these areas will help you boost energy, reduce fatigue and make you healthier. Whether these positive lifestyle changes are improving stress levels or healing adrenal fatigue is irrelevant.

What does matter is if treating so-called adrenal fatigue ends up preventing the diagnosis of a serious medical problem.

Friedmans take-home message is clear. If youre experiencing fatigue, you need to see an endocrinologist to make sure youre getting at the real issue and not masking fatigue thats being caused by another health problem, he said. If you do have an adrenal issue, it needs to be treated as soon as possible.

Christy Brissette is a dietitian, foodie and president of 80TwentyNutrition.com. Follow her on Twitter @80twentyrule.

See the original post here:
Is adrenal fatigue real? Forget the label and treat the stress. - Washington Post

Hair loss could be caused by multitude of issues – NewsOK.com

By Robert Ashley, M.D. Published: April 4, 2017 12:00 AM CDT Updated: April 4, 2017 12:00 AM CDT

Hair loss could have many causes, including stress. [Thinkstock image]

Dear Doctor: I've been taking thyroid medication for several years, and my doctor says my blood tests are where they should be, but my face feels like sandpaper, my nails are brittle, and I'm losing so much hair that I can see my scalp. Could there be some underlying problem my physician is missing?

Dear Reader: Hair loss can be a distressing symptom, made all the more so when its cause is a mystery.

Your thyroid hormone levels are an obvious place to start, because both low and high thyroid levels can lead to hair and nail changes. Symptoms of high thyroid levels include hair loss, skin that is unusually smooth and warm, and nails that soften and loosen from the nail bed. The remaining hair becomes thinner, softer and does not hold a wave. Symptoms of low thyroid levels also include hair loss, including in the armpits and genital area, but the hair in this scenario is dull, coarse and fragile. As for the nails, they tend to be delicate, thin and have multiple grooves. That said, if your physician has done a complete panel of thyroid tests and the results have been normal, then most likely the function of your thyroid gland is not the cause of the brittle nails nor the hair loss.

That doesn't mean the thyroid isn't a factor. Autoimmune thyroid disease can lead to hair loss, both patchy and more diffuse, as well as inflammatory conditions of the skin. Such disease isn't always reflected in thyroid hormone levels. Checking anti-thyroid antibodies in the blood can identify autoimmune thyroid disease, and point you and your doctor in a clearer direction.

Hair loss also can be caused by androgenic alopecia, linked to an excess of androgens, a type of male hormone. These hormones are present in both men and women, but they're higher than normal in some women, such as those with congenital adrenal hyperplasia or polycystic ovarian disease, which is relatively common. Simply checking levels of testosterone and dehydroepiandrosterone (DHEA) can either rule out androgenic alopecia or suggest that it be explored further.

Another potential cause is medication. Some medications can lead to hair loss, so if your symptoms seem coincidental to starting a new medication, there might be an association.

Biotin deficiency, which is rare, can also cause hair loss and inflammation of the facial skin. But if you have a normal diet and eat eggs, you have a low likelihood of this condition. Nonetheless, it's something to rule out.

Iron deficiency also can lead to both brittle nails and hair loss. This doesn't explain the skin manifestations that you have, but if you are looking at other possibilities, checking the iron level of the blood should be part of the work-up.

Any major illness can lead to hair loss and nail changes, and psychological stress can lead to hair loss. So, if there have been major stressors in your life, either physical or psychological, consider that a potential culprit.

In summary, if your thyroid levels are normal, it would be wise to check your thyroid antibodies, androgens and iron levels and your level of stress.

Robert Ashley, M.D., is an internist and assistant professor of medicine at the University of California, Los Angeles. Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.

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Hair loss could be caused by multitude of issues - NewsOK.com

Dr. Christopher Holden’s Medical License on Probation for "Grossly Negligent" Care – OC Weekly

The bad doctor is in.

Matt Coker

"My vision is to create and share a meaningful and healthy life," reads Dr. Christopher Holden's "professional statement" for an online service that matches patients with physicians. "Imagine your life with higher standards, less clutter, less debt, less stress and less discontent."

Unfortunately, theOrange family medicine doctor could not live up to his vision for a 46-year-old woman with uterine cancer, according to court documents filed by theMedical Board of California, which placed Holden's license to practice in the state on probation for three years effective last Friday, March 24.

The discipline stems from Holden being "grossly negligent" in his care for thepatient identified only as "T.P.," according to the Medical Board. Her symptoms should have led the doctorto first exam her for uterine cancer before finding a basis to rule that out in favor of a diagnosis of something more benign, found the board, which notes he pretty much did the complete opposite. He never did diagnose the disease.

Since at least 2008, Holden saw T.P. at her home because she suffered from agoraphobia. It was early in these visits that she complained of vaginal bleeding, which Holden chalked up to her transitioning to menopause.However, he performed no tests to confirm his suspicions, with her Sept. 27, 2008, chart only noting a change in periods without stipulating the amount of bleeding or whether T.P. should be sent for a gynecological exam, the board points out. Holden diagnosed menometrorrhagiaheavy bleeding with prolonged and/or irregular menstrual periodsand prescribed a thyroid-stimulating hormone.

Irregular menses are included in the medical record for T.P.s Jan. 27, 2009, follow-up exam. Holden called for thyroid testing again, a female hormonal panel and neurotransmitter testing, although the Medical Board found he never documented whether those labs were completed.

On March 21, 2009, [Holden] diagnoses T.P. with piriformis syndrome, states the board in reference to a condition where a muscle in the buttocks region spasms and causes pain, but there is no history and no pertinent exam recorded.

Nine days later, T.P. was placed on iron medication for anemia, with Holden noting in her chart that her hypothyroidism was overcorrected. He also increased her thyroid medication and noted to check her labs in three months. At this point, the TSH [amount of thyroid-stimulating hormone in the blood] is 0.01, the board states. There is a span of two years before TSH is checked again. T.P.s TSH never normalizes while under the care of [Holden].

Duringa February 2010 examination,T.P. complained of increased bleeding, which Holden indicated was secondary to stress. On July 23 of that year, he diagnosed her with microcytic anemiausually an indication of an iron deficiencybut the board found he performed no rectal exam. Holden also diagnosed T.P. with a yeast infection in her intestines, but he did not state a basis for this conclusion in the history of present illness or in his exam, according to the board.

Dr. Christopher Holden

Zocdoc

T.P.s hemoglobin dropped dramatically in November 2010, as compared to the July visit, but all that was recommended for her was more iron. Holden told the board he advised the patient to see a gynecologist but no referral is documented in his records.

Noting T.P. was pale on Jan. 24, 2011, Holden ordered another complete blood count test. On Oct. 10, 2011, he stated she had seen a gynecologist and a PAP smear and ultrasound were planned, but for T.P.s next appointment a month later Holden did not follow up on whether she indeed saw the specialist. She had not, the board found. This time, Holden charted that T.P. had non-cancerous growths in her uterus.

Holden did not see T.P. on March 4, 2012, but he wrote in her chart that she was anemic and had low blood pressure and needed a transfusion. T.P. left Holden a message a week later saying she was still anemic and had been to the emergency room. The doctor did not indicate he planned to see his patient in light of this.

The last time Holden did see T.P. was on April 5, 2012, when he noted she had received a blood transfusion at Orange Coast Memorial Medical Center and was planning to go to a gynecologist for a possible procedure to treat abnormal uterine bleeding.

Twelve days later, a gynecologist could not perform a PAP smear nor a biopsy due to significant vaginal bleeding. That doctor suspected T.P. had cervical cancer, which was confirmed a month later.

According to the board's findingswhich Holdenand his attorneys Dennis K. Ames and Zarah B. Maginot accepted based on their signatures dated Jan. 3 on court documentsthe doctor had been grossly and repeatedly negligent when it came to T.P.'s care and had done a poor job of keeping records.

Under the terms of the probation, Holden mustobey all laws, refrain from supervising physician assistants, submit quarterly progress reports to the board, complete medical education and record-keeping courses and notify hospitals and other facilities where he has privileges of his probationary status.

Holden, who attended UC Irvine's medical school, writes near the end of his professional statement on the Zocdoc referral website with: "Imagine cultivating your passion until you cannot bare a day without pursuing it." Assuming his passion remains treating patients, he had better comply by the conditions of his probation if he wants to keep pursuing it.Failure to do so could result in board proceedings to revoke Holdens license to practice medicine in California.

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Dr. Christopher Holden's Medical License on Probation for "Grossly Negligent" Care - OC Weekly

Some states are using junk science to require doctors to tell women they can reverse an abortion – VICE News

A growing number of states are considering laws that would require abortion providers to tell women seeking a medical abortion that its possible to reverse the procedure a scientifically unsubstantiated claim that has been roundly rejected by the mainstream medical community.

Since 2012, a small group of doctors has promoted a method that they say can reverse a medical (non-surgical) abortion by flooding the body with the hormone progesterone. Two states Arkansas and South Dakota currently require abortion providers to tell women before they get a medical abortion that information is available about a way to reverse or stop the procedure.

Laws mandating that abortion providers tell women their abortion can be reversed have also been introduced this year in Georgia (the bill states, It may be possible to reverse the effects of a chemical abortion if the woman changes her mind, but that time is of the essence), North Carolina, Utah, and Idaho. In Arizona, lawmakers passed an abortion-reversal law in 2015, but the bill was quickly challenged in a lawsuit by Planned Parenthood and blocked.

On Feb. 27, Indiana lawmakers passed a bill in the House requiring that pregnant woman be informed orally and in writing before obtaining a medical abortion that the abortion may be possibly reversed. The patient must also be told that additional information about reversing medical abortions exists and should be sought as soon as possible.

At the same time, the Indiana measure seems to acknowledging the dubious science behind this information; it also requires women to be told that no scientifically validated medical study confirms that an abortion may be reversed after taking abortion-inducing drugs.

Nearly 3 million women have terminated pregnancies via medical abortion since the method was approved for use in the first 10 weeks of pregnancy in 2000. Patients take the drug mifepristone followed by a second drug, misoprostol, 24 to 72 hours later. Medical abortions, which now make up about a third of all abortions performed in the U.S., are safe and highly effective about 99 percent effective with almost zero complications, according to a 2012 study in the medical journal Obstetrics and Gynecology.

The mainstream medical community rejects claims that a medical abortion can be undone. The American Congress of Obstetricians and Gynecologists says that abortion-pill reversal is not supported by the body of scientific evidence and recommends against trying it. In up to 50 percent of cases where women dont follow up with the second pill (i.e., they take only mifepristone without taking the second dose of misoprostol), they still carry their pregnancies term, with or without taking progesterone, the group points out.

Taking a dose of progesterone in the hopes of reversing a medical abortion means that even if these doctors were to offer a large dose of purple Skittles, theyd appear to have worked to save the pregnancy about half the time, Cheryl Chastine, a formerabortion provider at South Wind Womens Center in Wichita, Kansas, told Talking Points Memo. Those numbers are consistent with what these people are reporting.

Most reproductive health experts point to the lack of scientific evidence on abortion reversal to criticize laws requiring doctors to tell women there is a way to stop the abortion pill. This is unethical and immoral legislation that makes women guinea pigs in an unmonitored, inappropriate experiment, said Vicki Saporta, the president of the National Abortion Federation.

The most visible proponent of abortion-pill reversal is George Delgado, a practicing family physician with the Culture of Life Family Services clinic in San Diego. He outlined the method in a 2012 paper, which remains the first and only study describing it. Delgados method consists of giving a woman a heavy dose of the hormone progesterone as soon as possible after taking mifepristone, the first pill in a medical abortion procedure. He says the progesterone counteracts the mifepristone by preventing the uterus from expelling its contents. The study, published in the medical journal Annals of Pharmacotherapy, was not a controlled trial and involved only six women, four of whom still carried their pregnancies to term after taking progesterone.

After publishing his study, Delgado founded the organization Abortion Pill Reversal to give women a second chance at choice if they so desire it, he said in an interview. APR is mainly a hotline that urges women who have taken the abortion pill to call and be connected with a network of more than 300 doctors Delgado says he has trained about the reversal method. We need to have a way for women to find out about this because women were not finding out about it in time, Delgado said.

Delgado is often cited as the face of abortion-pill reversal, but hes not the only doctor to promote the concept. The method was first put forward by Matthew Harrison, a practicing family doctor in North Carolina, who now works at Abortion Pill Reversal as the groups associate medical director. In 2006, Harrison was contacted by a woman who changed her mind after taking mifepristone and he says he came up with the idea to administer progesterone to stop the abortion. Two years later, Delgado said, he was approached by a woman in a similar situation and, without knowing about Harrisons case, had the same idea of giving the woman progesterone, which he says led to a successful reversal.

The research on the health effects of taking progesterone during pregnancy is mixed. Some doctors say that taking low doses of the hormone as a supplement can be beneficial, especially if a woman has had miscarriages in the past. But other research has shown that taking progesterone does basically nothing to improve a pregnancy and may come with some negative side effects. Progesterone, while generally well-tolerated, can cause significant cardiovascular, nervous system, and endocrine adverse reactions, as well as other side effects, according to ACOG.

The FDA has not approved the use of progesterone to reverse medical abortions, and Delgados 2012 study has been debunked and criticized by the mainstream medical community. In 2015, researchers examined the array of scientific literature concerning abortion reversal and found insufficient evidence to support any claims of the methods effectiveness. The study, published in Contraception Journal, criticized Delgados method and went so far as to write, in the conclusion: Legislation requiring physicians to inform patients about abortion reversal transforms an unproven therapy into law and represents legislative interference in the patientphysician relationship.

Delgado insists that there is plenty of evidence although none that has been tested in a controlled environment or peer reviewed to disprove these critiques. In 2015, he told MedPage that ACOGs criticisms in particular are biased, He said his next step is to submit his own research on the women hes treated through APR to a peer-reviewed medical journal.

Despite the lack of substantiated medical evidence to support it, Delgados organization is seeking to spread awareness of the abortion-pill reversal method. Some pregnancy resource centers organizations that offer anti-abortion counseling to pregnant women have started directing women to APR. Delgado says the organization has treated about 800 women, about 60 percent of whom carried their pregnancies to term, although he declined to provide any further evidence of reversed abortions.

Americans United for Life, one of the biggest anti-abortion organizations in the country, has lobbied hard for the passage of abortion-reversal information laws. AUL included abortion reversal in its 2016 model legislation handbook, which is the basis for many of the bills introduced in states this year.

Delgado said he did not have a direct role in drafting or lobbying for laws that require doctors to tell their patients about abortion reversal. But he did give expert testimony in favor of it in Colorado and Arizona when the bills in those states were being debated.

AUL repeatedly cites Delgado, his study, and his organization by name in its draft legislation. Delgados 2012 study is in fact the only citation AUL uses to back up its claims about abortion reversal.

AULs argument that women should know about the possibility of abortion reversal is the same argument behind other informed consent laws, which include measures requiring doctors to show women seeking abortions pictures of the fetus at its current point in gestation or to give medically disputed information about when the fetus can feel pain. Abortion-rights advocates say these regulations are merely another way to dissuade women from getting an abortion in the first place.

Moreover, reproductive rights experts say measures promoting the idea of abortion reversal, like many other informed consent regulations, offer a quasi-medical solution to a problem that doesnt actually exist. There is a misperception that women are uncertain about their abortion decisions, said Saporta, of the National Abortion Federation. The laws are based on a false premise. Women rarely change their minds after beginning a medical abortion.

One study published in 2013 found that 95 percent of women who decided to get an abortion felt it was the right decision a week later.

Follow Olivia Becker on Twitter: @oliviaLbecker

Clarification: An earlier version of this article referenced a Talking PointsMemo article quoting Cheryl Chastine, who was identified asanabortion provider at South Wind Womens Center in Wichita, Kansas. The center says Chastine is no longer affiliated with them.

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Some states are using junk science to require doctors to tell women they can reverse an abortion - VICE News

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