Archive for the ‘Hormone Physician’ Category

This article is about the family of polycyclic chemical compounds. For the drugs, also used as performance-enhancing substances, see Anabolic steroid. For the scientific journal, see Steroids (journal).

A steroid is an organic compound with four rings arranged in a specific configuration. Examples include the dietary lipid cholesterol, the sex hormones estradiol and testosterone[2]:1019 and the anti-inflammatory drug dexamethasone.[3] Steroids have two principal biological functions: certain steroids (such as cholesterol) are important components of cell membranes which alter membrane fluidity, and many steroids are signaling molecules which activate steroid hormone receptors.

The steroid core structure is composed of seventeen carbon atoms, bonded in four "fused" rings: three six-member cyclohexane rings (rings A, B and C in the first illustration) and one five-member cyclopentane ring (the D ring). Steroids vary by the functional groups attached to this four-ring core and by the oxidation state of the rings. Sterols are forms of steroids with a hydroxyl group at position three and a skeleton derived from cholestane.[1]:1785f[4] They can also vary more markedly by changes to the ring structure (for example, ring scissions which produce secosteroids such as vitamin D3).

Hundreds of steroids are found in plants, animals and fungi. All steroids are manufactured in cells from the sterols lanosterol (animals and fungi) or cycloartenol (plants). Lanosterol and cycloartenol are derived from the cyclization of the triterpene squalene.[5]

Space-filling representation

Ball-and-stick representation

Gonane, also known as steran or cyclopentaperhydrophenanthrene, the simplest steroid and the nucleus of all steroids and sterols,[6][7] is composed of seventeen carbon atoms in carbon-carbon bonds forming four fused rings in a three-dimensional shape. The three cyclohexane rings (A, B, and C in the first illustration) form the skeleton of a perhydro derivative of phenanthrene. The D ring has a cyclopentane structure. When the two methyl groups and eight carbon side chains (at C-17, as shown for cholesterol) are present, the steroid is said to have a cholestane framework. The two common 5 and 5 stereoisomeric forms of steroids exist because of differences in the side of the largely planar ring system where the hydrogen (H) atom at carbon-5 is attached, which results in a change in steroid A-ring conformation.

Examples of steroid structures are:

In addition to the ring scissions (cleavages), expansions and contractions (cleavage and reclosing to a larger or smaller rings)all variations in the carbon-carbon bond frameworksteroids can also vary:

For instance, sterols such as cholesterol and lanosterol have an hydroxyl group attached at position C-3, while testosterone and progesterone have a carbonyl (oxo substituent) at C-3; of these, lanosterol alone has two methyl groups at C-4 and cholesterol (with a C-5 to C-6 double bond) differs from testosterone and progesterone (which have a C-4 to C-5 double bond).

The following are some common categories of steroids. In eukaryotes, steroids are found in fungi, animals, and plants. Fungal steroids include the ergosterols.

Animal steroids include compounds of vertebrate and insect origin, the latter including ecdysteroids such as ecdysterone (controlling molting in some species). Vertebrate examples include the steroid hormones and cholesterol; the latter is a structural component of cell membranes which helps determine the fluidity of cell membranes and is a principal constituent of plaque (implicated in atherosclerosis). Steroid hormones include:

Plant steroids include steroidal alkaloids found in Solanaceae,[8] the phytosterols, and the brassinosteroids (which include several plant hormones). In prokaryotes, biosynthetic pathways exist for the tetracyclic steroid framework (e.g. in mycobacteria)[9] where its origin from eukaryotes is conjectured[10] and the more-common pentacyclic triterpinoid hopanoid framework.[11]

Steroids can be classified based on their chemical composition.[12] One example of how MeSH performs this classification is available at the Wikipedia MeSH catalog. Examples of this classification include:

The gonane (steroid nucleus) is the parent 17-carbon tetracyclic hydrocarbon molecule with no alkyl sidechains.[13]

Secosteroids (Latin seco, "to cut") are a subclass of steroidal compounds resulting, biosynthetically or conceptually, from scission (cleavage) of parent steroid rings (generally one of the four). Major secosteroid subclasses are defined by the steroid carbon atoms where this scission has taken place. For instance, the prototypical secosteroid cholecalciferol, vitamin D3 (shown), is in the 9,10-secosteroid subclass and derives from the cleavage of carbon atoms C-9 and C-10 of the steroid B-ring; 5,6-secosteroids and 13,14-steroids are similar.[14]

Norsteroids (nor-, L. norma; "normal" in chemistry, indicating carbon removal)[15] and homosteroids (homo-, Greek homos; "same", indicating carbon addition) are structural subclasses of steroids formed from biosynthetic steps. The former involves enzymic ring expansion-contraction reactions, and the latter is accomplished (biomimetically) or (more frequently) through ring closures of acyclic precursors with more (or fewer) ring atoms than the parent steroid framework.[16]

Combinations of these ring alterations are known in nature. For instance, ewes who graze on corn lily ingest cyclopamine (shown) and veratramine, two of a sub-family of steroids where the C- and D-rings are contracted and expanded respectively via a biosynthetic migration of the original C-13 atom. Ingestion of these C-nor-D-homosteroids results in birth defects in lambs: cyclopia from cyclopamine and leg deformity from veratramine.[17] A further C-nor-D-homosteroid (nakiterpiosin) is excreted by Okinawan cyanobacteriosponges Terpios hoshinota leading to coral mortality from black coral disease.[18] Nakiterpiosin-type steroids are active against the signaling pathway involving the smoothened and hedgehog proteins, a pathway which is hyperactive in a number of cancers.

Steroids and their metabolites often function as signalling molecules (the most notable examples are steroid hormones), and steroids and phospholipids are components of cell membranes. Steroids such as cholesterol decrease membrane fluidity.[19] Similar to lipids, steroids are highly concentrated energy stores. However, they are not typically sources of energy; in mammals, they are normally metabolized and excreted.

Steroids play critical roles in a number of disorders, including malignancies like Prostate Cancer, where steroid production inside and outside the tumour promotes cancer cell aggressiveness.[20]

Two classes of drugs target the mevalonate pathway: statins (used to reduce elevated cholesterol levels) and bisphosphonates (used to treat a number of bone-degenerative diseases).

The hundreds of steroids found in animals, fungi, and plants are made from lanosterol (in animals and fungi; see examples above) or cycloartenol (in plants). Lanosterol and cycloartenol derive from cyclization of the triterpenoid squalene.[5]

Steroid biosynthesis is an anabolic pathway which produces steroids from simple precursors. A unique biosynthetic pathway is followed in animals (compared to many other organisms), making the pathway a common target for antibiotics and other anti-infection drugs. Steroid metabolism in humans is also the target of cholesterol-lowering drugs, such as statins.

In humans and other animals the biosynthesis of steroids follows the mevalonate pathway, which uses acetyl-CoA as building blocks for dimethylallyl pyrophosphate (DMAPP) and isopentenyl pyrophosphate (IPP).[21][bettersourceneeded] In subsequent steps DMAPP and IPP join to form geranyl pyrophosphate (GPP), which synthesizes the steroid lanosterol. Modifications of lanosterol into other steroids are classified as steroidogenesis transformations.

The mevalonate pathway (also called HMG-CoA reductase pathway) begins with acetyl-CoA and ends with dimethylallyl pyrophosphate (DMAPP) and isopentenyl pyrophosphate (IPP).

DMAPP and IPP donate isoprene units, which are assembled and modified to form terpenes and isoprenoids[22] (a large class of lipids, which include the carotenoids and form the largest class of plant natural products.[23] Here, the isoprene units are joined to make squalene and folded into a set of rings to make lanosterol.[24]

Lanosterol can then be converted into other steroids, such as cholesterol and ergosterol.[24][25]

Steroidogenesis is the biological process by which steroids are generated from cholesterol and changed into other steroids.[27] The pathways of steroidogenesis differ among species. The major classes of steroid hormones, with prominent members and examples of related functions, are:

Human steroidogenesis occurs in a number of locations:

In plants and bacteria, the non-mevalonate pathway uses pyruvate and glyceraldehyde 3-phosphate as substrates.[22][30]

During diseases pathways otherwise not significant in healthy humans can become utilized. For example, in one form of congenital adrenal hyperplasia an deficiency in the 21-hydroxylase enzymatic pathway leads to an excess of 17-Hydroxyprogesterone (17-OHP) this pathological excess of 17-OHP in turn may be converted to dihydrotestosterone (DHT, a potent androgen) through among others 17,20 Lyase (a member of the cytochrome P450 family of enzymes), 5-Reductase and 3-Hydroxysteroid dehydrogenase.[31]

Steroids are primarily oxidized by cytochrome P450 oxidase enzymes, such as CYP3A4. These reactions introduce oxygen into the steroid ring, allowing the cholesterol to be broken up by other enzymes into bile acids.[32] These acids can then be eliminated by secretion from the liver in bile.[33] The expression of the oxidase gene can be upregulated by the steroid sensor PXR when there is a high blood concentration of steroids.[34] Steroid hormones, lacking the side chain of cholesterol and bile acids, are typically hydroxylated at various ring positions or oxidized at the 17 position, conjugated with sulfate or glucuronic acid and excreted in the urine.[35]

Steroid isolation, depending on context, is the isolation of chemical matter required for chemical structure elucidation, derivitzation or degradation chemistry, biological testing, and other research needs (generally milligrams to grams, but often more[36] or the isolation of "analytical quantities" of the substance of interest (where the focus is on identifying and quantifying the substance (for example, in biological tissue or fluid). The amount isolated depends on the analytical method, but is generally less than one microgram.[37][pageneeded] The methods of isolation to achieve the two scales of product are distinct, but include extraction, precipitation, adsorption, chromatography, and crystallization. In both cases, the isolated substance is purified to chemical homogeneity; combined separation and analytical methods, such as LC-MS, are chosen to be "orthogonal"achieving their separations based on distinct modes of interaction between substance and isolating matrixto detect a single species in the pure sample. Structure determination refers to the methods to determine the chemical structure of an isolated pure steroid, using an evolving array of chemical and physical methods which have included NMR and small-molecule crystallography.[2]:1019Methods of analysis overlap both of the above areas, emphasizing analytical methods to determining if a steroid is present in a mixture and determining its quantity.[37]

Microbial catabolism of phytosterol side chains yields C-19 steroids, C-22 steroids, and 17-ketosteroids (i.e. precursors to adrenocortical hormones and contraceptives).[38][39][40][41] The addition and modification of functional groups is key when producing the wide variety of medications available within this chemical classification. These modifications are performed using conventional organic synthesis and/or biotransformation techniques.[42][43]

The semisynthesis of steroids often begins from precursors such as cholesterol,[41]phytosterols,[40] or sapogenins.[44] The efforts of Syntex, a company involved in the Mexican barbasco trade, used Dioscorea mexicana to produce the sapogenin diosgenin in the early days of the synthetic steroid pharmaceutical industry.[36]

Some steroidal hormones are economically obtained only by total synthesis from petrochemicals (e.g. 13-alkyl steroids).[41] For example, the pharmaceutical Norgestrel begins from Methoxy-1-tetralone, a petrochemical derived from phenol.

A number of Nobel Prizes have been awarded for steroid research, including:

Steroid signaling

Agonists

Antagonists

Read more from the original source:
Steroid - Wikipedia

DIM (diindolylmethane), is a food-based compound found in cruciferous vegetables like broccoli, cabbage, cauliflower and Brussels sprouts.Studies have shown that it has the ability to reduce the risk of certain cancers, especiallythose influenced by excessive estrogen levels, such as breast, uterine and prostate. DIM can also stimulatefat breakdown and encourage an increase in muscle mass. I can attest, through my own personal experience supplementing with DIM as well as that of quite a few clients (both male and female), that DIM effectively modulates estrogen metabolism helping to do away with uncomfortable symptoms of PMS, perimenopause and prostate issues.

The following excerpt comes from Dr. Scott Rollins, MD, founder and Medical Director at the Integrative Medicine Center of Western Colorado (http://imcwc.com/news/index.php?id=3271124400587032289). Thisis a very well-written and comprehensive account of the effects of DIM and how to best use this supplement to make the most out of its incredible benefits:

Lower your risk of cancer, help lose weight and build muscle all remarkable benefits of a simple food supplement called DIM. For men or women, DIM is something to consider as part of an overall supplement program.

DIM, or diindolylmethane, is a plant based compound found in cruciferous vegetables, such as brussel sprouts,cabbage, broccoli and cauliflower. DIM has been shown in studies to reduce the risk of certain cancers, especiallythose driven by abnormally high estrogen levels, such as breast, uterus and prostate cancer. DIM can also stimulate the breakdown of fat while encouraging muscle development.

Estrogen hormones are naturally found in men and women and have many benefits such as preserving artery healthand brain function while fighting oxidative free radical damage. Higher estrogen levels found in women cause thefemale body shape with breast and hip development. Many women are estrogen dominant however, meaning theyhave too much estrogen accumulating in the body for the complementary progesterone to balance.

Natural estrogen dominance occurs as women near menopause, starting even ten years prior to menopause, where theyoften dont make as much progesterone to balance their estrogen. Symptoms such breast pain, water retention, heavypainful menstrual cycles, or irritable anxious moods are typical bothersome symptoms. Estrogens over-stimulation ofbreasts and uterus tissue can lead to breast cysts or adenomas and uterine growths both unpleasant and potentiallydangerous physical outcomes are too often accompanied by worrisome mammograms and hysterectomies.

Some women have estrogen dominance throughout their life for various reasons, such as low thyroid, high cortisol,exposure to environmental estrogen-like chemicals, or impaired detoxification pathways for estrogen.

Men often suffer from estrogen overload as well. With normal aging our testosterone levels drop as the conversion toestrogen increases, leading to a falling ratio of testosterone to estrogen. Higher estrogen levels in men lead to weightgain, loss of muscle mass, feminization of the body, further decreases in already falling testosterone levels, andincrease the risk of diseases such as heart disease and prostate cancer. The enzyme that normally converts testosteroneto estrogen is most abundant in fat, so as men put on weight the cycle of falling testosterone and rising estrogen simply picks up steam!

There are two main pathways in the liver for our estrogen to be normally metabolized and excreted. One pathwayleads to very good metabolites called 2-hydroxy estrogens. The other pathway leads to bad metabolites called 4 or 16-hydroxy estrogens. DIM stimulates the favorable 2-hydroxy pathway for estrogen metabolism and this is how DIMworks to improve our health.DIM is not a hormone, nor is it a hormone replacement. It is a plant compound that will improve our hormonebalance. By improving the metabolism of our natural estrogens DIM will help lower high levels of estrogen in thebody. This alone can help remedy estrogen dominant conditions and restore a healthy estrogen/testosterone ratio inmen and women.The favorable 2-hydroxy metabolites promoted by DIM are potent anti-oxidants and help prevent muscle breakdownafter exercise, as evidenced by female athletes having less muscle tissue breakdown after intense exercise than men.By reducing the estrogen dominance and also reducing the accumulation of cancer-promoting 4/16-hydroxymetabolites DIM can help lower the risk of cancer.The 2-hydroxy metabolites help increase the active testosterone levels in men and women by displacing inactiveprotein-bound testosterone to its active free portion. This leads to significant improvements in the ability to buildmuscle and enjoy the benefits of testosterone including better mood, increased stamina, endurance, sex drive anderectile function.The accumulation of fat around the belly, hips and buttocks is partly due to excess estrogen levels combined withfalling testosterone levels. DIM will help lower excess estrogen and promote the fat-burning 2-hydroxy metabolites.This can help you achieve a leaner body with less body fat.

More here:
DIM for Hormone Balance - blog.healthybynaturehwc.com

Leslie Carol Botha: I originally posted this article in 2009. Thought it was well-written then and still think so. However, in the past two weeks readers of my blog have dug back into the HHH archives and have commented on their own hormonal anxiety so I decided to repost it in June 2012. Now 288 posts later it appears that hormone imbalance has become a silent epidemic affecting women of all ages.

Hormone imbalance -in the form of estrogen dominance which can cause hormone-related anxiety, insomnia, weight gain, emotional rage, phobias, and diabetes is due to the plastics in our environment. throw out all of your plastic water bottles they contain high amounts of estrogen mimickers, AND DO NOT MICROWAVE IN PLASTIC. Estrogen mimickers are found in food, household chemicals and our water supply from the high amounts of synthetic estrogen being excreted into the water streams from synthetic birth control and HRT. I kid you not. There have been plenty of articles about fishing changing their sex because of excreted hormones.

Lastly we are now 3 to 4 generations into synthetic hormone suppression, i.e., birth control (pills, IUDs implants, injections, rings, and patches). All of the estrogen is being built up in the body and passed in-utero to the fetus. So you will note many young women who have posted comments about hormone imbalance too. This is sad. We are upsetting the hormone chemical balance in the body. Women are suffering. And if we do not correct the imbalance it will only get worse. Such is the nature of not taking care of our health.

I believe that most women experience hormonal anxiety in one form or another. Unfortunately, the medical and psychiatric professions are quick to diagnosis and label with syndromes and then proceed to treat with drugs.

Now we know that source of this misdiagnosis is, in most cases hormone imbalance it can be corrected through nutritional supplementation, and hormone balancing. Most women are estrogen dependent. I have been recommending Progessence Plus that contains a wild yam extract infused with essential oils that repair the DNA and clear off the receptor sites on our cells so that the natural progesterone can be absorbed into the cell and not remain in fatty tissue of the body.

ehow.com By Shelly Mcrae, eHow Editor

2009

Everyone experiences anxiety at one point or another, such as before an important test in school, an important presentation at work, during the holidays or when experiencing a crisis of any kind. Anxiety in these instances help you stay alert, focus on tasks at hand or make quick decisions.

But when anxiety turns into an ongoing sense of apprehension, or begins to manifest as debilitating fear, it may be due to personality disorder or a hormonal imbalance. Its important to determine the cause of your anxiety and determine how to treat it.

When these fears and paranoid thoughts manifest themselves and then fade within 30 minutes or so, it is referred to as a panic attack. You may be so overwhelmed by the mental and physical symptoms that you feel unable to go on and instead try to escape, literally going home or someplace you feel safe. In such cases, you may have a personality disorder.

In cases in which hormonal imbalances are the root cause, as opposed to a personality disorder, the anxiety may not be so severe as to be labeled a panic attack. Rather, it more closely resembles mood swings or depression. But rather than feeling sad or irritable, you feel apprehension and uneasiness.

Anxiety induced by hormonal imbalances, such as estrogen dominance in which the level of the hormone progesterone is very low, differs from those panic attacks associated with personality disorders such as bipolar or obsessive-compulsive disorders. But there are also similarities. Determining the root cause of the anxiety can determine which treatment is appropriate.

The inability to control the onslaught of negative thoughts is symptomatic in both panic attacks and anxiety. Anxiety, though, may be more consistent and you may display fewer physical symptoms. You may feel that it is all in your head.

The sense of anxiety may not be as exaggerated as for those suffering from personality disorders. Instead, you may feel uneasy in social situations, be reluctant to make decisions or continually worry over problems that are relatively minor.

But your anxiety may not be limited to the more subtle form. In cases of severe hormonal imbalance, you may suffer full-blown panic attacks in which fear, though irrational, overwhelms your reasoning. You may be unable to explain why you are reacting to a simple incident as if it were a life crisis.

One of the characteristics of both panic attack and anxiety due to hormonal imbalances is the levels of cortisol in the system. Cortisol is the chemical released by the adrenals that activates the fight or flight response.The hypothalamic-pituitary-adrenal (HPA) axis is the hormonal system that controls your mood. If you suffer from a hormonal imbalance, this system may go into overdrive. The result is that your body and mind will believe a threatening situation exists, which in turn results in feelings of apprehension, fear and dread.

Treatments for hormonal imbalance range from basic lifestyle changes to replacement hormone therapy. Bioidentical hormones, which are naturally occurring hormones found in plants and synthesized for human consumption, are a common treatment when anxiety is one of the symptoms of hormonal imbalance.

In the case of severe panic attacks, such medications as benzodiazepines and antidepressants may be necessary to control the attacks. These are common treatments for personality disorders. (I DO NOT AGREE WITH THIS STATEMENT. LB.)

Left untreated, mild anxiety can worsen, resulting in debilitating behavior patterns due to unwarranted fear. Whether the underlying cause is personality disorder or hormonal imbalance, effective treatment is available.

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Endocrinology (from Greek , endon, "within"; , krn, "to separate"; and -, -logia) is a branch of biology and medicine dealing with the endocrine system, its diseases, and its specific secretions known as hormones. It is also concerned with the integration of developmental events proliferation, growth, and differentiation, and the psychological or behavioral activities of metabolism, growth and development, tissue function, sleep, digestion, respiration, excretion, mood, stress, lactation, movement, reproduction, and sensory perception caused by hormones. Specializations include behavioral endocrinology[1][2][3] and comparative endocrinology.

The endocrine system consists of several glands, all in different parts of the body, that secrete hormones directly into the blood rather than into a duct system. Hormones have many different functions and modes of action; one hormone may have several effects on different target organs, and, conversely, one target organ may be affected by more than one hormone.

Examples of amine hormones

Endocrinology is the study of the endocrine system in the human body. This is a system of glands which secrete hormones. Hormones are chemicals which affect the actions of different organ systems in the body. Examples include thyroid hormone, growth hormone, and insulin. The endocrine system involves a number of feedback mechanisms, so that often one hormone (such as thyroid stimulating hormone) will control the action or release of another secondary hormone (such as thyroid hormone). If there is too much of the secondary hormone, it may provide negative feedback to the primary hormone, maintaining homeostasis.

In the original 1902 definition by Bayliss and Starling (see below), they specified that, to be classified as a hormone, a chemical must be produced by an organ, be released (in small amounts) into the blood, and be transported by the blood to a distant organ to exert its specific function. This definition holds for most "classical" hormones, but there are also paracrine mechanisms (chemical communication between cells within a tissue or organ), autocrine signals (a chemical that acts on the same cell), and intracrine signals (a chemical that acts within the same cell).[4] A neuroendocrine signal is a "classical" hormone that is released into the blood by a neurosecretory neuron (see article on neuroendocrinology).

Examples of steroid hormones

Griffin and Ojeda identify three different classes of hormone based on their chemical composition:[5]

Amines, such as norepinephrine, epinephrine, and dopamine (catecholamines), are derived from single amino acids, in this case tyrosine. Thyroid hormones such as 3,5,3-triiodothyronine (T3) and 3,5,3,5-tetraiodothyronine (thyroxine, T4) make up a subset of this class because they derive from the combination of two iodinated tyrosine amino acid residues.

Peptide hormones and protein hormones consist of three (in the case of thyrotropin-releasing hormone) to more than 200 (in the case of follicle-stimulating hormone) amino acid residues and can have a molecular mass as large as 30,000 grams per mole. All hormones secreted by the pituitary gland are peptide hormones, as are leptin from adipocytes, ghrelin from the stomach, and insulin from the pancreas.

Steroid hormones are converted from their parent compound, cholesterol. Mammalian steroid hormones can be grouped into five groups by the receptors to which they bind: glucocorticoids, mineralocorticoids, androgens, estrogens, and progestogens. Some forms of vitamin D, such as calcitriol, are steroid-like and bind to homologous receptors, but lack the characteristic fused ring structure of true steroids.

Although every organ system secretes and responds to hormones (including the brain, lungs, heart, intestine, skin, and the kidney), the clinical specialty of endocrinology focuses primarily on the endocrine organs, meaning the organs whose primary function is hormone secretion. These organs include the pituitary, thyroid, adrenals, ovaries, testes, and pancreas.

An endocrinologist is a physician who specializes in treating disorders of the endocrine system, such as diabetes, hyperthyroidism, and many others (see list of diseases below).

The medical specialty of endocrinology involves the diagnostic evaluation of a wide variety of symptoms and variations and the long-term management of disorders of deficiency or excess of one or more hormones.

The diagnosis and treatment of endocrine diseases are guided by laboratory tests to a greater extent than for most specialties. Many diseases are investigated through excitation/stimulation or inhibition/suppression testing. This might involve injection with a stimulating agent to test the function of an endocrine organ. Blood is then sampled to assess the changes of the relevant hormones or metabolites. An endocrinologist needs extensive knowledge of clinical chemistry and biochemistry to understand the uses and limitations of the investigations.

A second important aspect of the practice of endocrinology is distinguishing human variation from disease. Atypical patterns of physical development and abnormal test results must be assessed as indicative of disease or not. Diagnostic imaging of endocrine organs may reveal incidental findings called incidentalomas, which may or may not represent disease.

Endocrinology involves caring for the person as well as the disease. Most endocrine disorders are chronic diseases that need lifelong care. Some of the most common endocrine diseases include diabetes mellitus, hypothyroidism and the metabolic syndrome. Care of diabetes, obesity and other chronic diseases necessitates understanding the patient at the personal and social level as well as the molecular, and the physicianpatient relationship can be an important therapeutic process.

Apart from treating patients, many endocrinologists are involved in clinical science and medical research, teaching, and hospital management.

Endocrinologists are specialists of internal medicine or pediatrics. Reproductive endocrinologists deal primarily with problems of fertility and menstrual functionoften training first in obstetrics. Most qualify as an internist, pediatrician, or gynecologist for a few years before specializing, depending on the local training system. In the U.S. and Canada, training for board certification in internal medicine, pediatrics, or gynecology after medical school is called residency. Further formal training to subspecialize in adult, pediatric, or reproductive endocrinology is called a fellowship. Typical training for a North American endocrinologist involves 4 years of college, 4 years of medical school, 3 years of residency, and 2 years of fellowship. In the US, adult endocrinologists are board certified by the American Board of Internal Medicine (ABIM) or the American Osteopathic Board of Internal Medicine (AOBIM) in Endocrinology, Diabetes and Metabolism.

Endocrinology also involves study of the diseases of the endocrine system. These diseases may relate to too little or too much secretion of a hormone, too little or too much action of a hormone, or problems with receiving the hormone.

Because endocrinology encompasses so many conditions and diseases, there are many organizations that provide education to patients and the public. The Hormone Foundation is the public education affiliate of The Endocrine Society and provides information on all endocrine-related conditions. Other educational organizations that focus on one or more endocrine-related conditions include the American Diabetes Association, Human Growth Foundation, American Menopause Foundation, Inc., and Thyroid Foundation of America.

In North America the principal professional organizations of endocrinologists include The Endocrine Society,[6] the American Association of Clinical Endocrinologists,[7] the American Diabetes Association,[8] the Lawson Wilkins Pediatric Endocrine Society,[9] and the American Thyroid Association.[10]

In the United Kingdom, the Society for Endocrinology[11] and the British Society for Paediatric Endocrinology and Diabetes[12] are the main professional organisations. The European Society for Paediatric Endocrinology[13] is the largest international professional association dedicated solely to paediatric endocrinology. There are numerous similar associations around the world.

The earliest study of endocrinology began in China.[14] The Chinese were isolating sex and pituitary hormones from human urine and using them for medicinal purposes by 200 BCE.[14] They used many complex methods, such as sublimation of steroid hormones.[14] Another method specified by Chinese textsthe earliest dating to 1110specified the use of saponin (from the beans of Gleditschia sinensis) to extract hormones, but gypsum (containing calcium sulfate) was also known to have been used.[14]

Although most of the relevant tissues and endocrine glands had been identified by early anatomists, a more humoral approach to understanding biological function and disease was favoured by the ancient Greek and Roman thinkers such as Aristotle, Hippocrates, Lucretius, Celsus, and Galen, according to Freeman et al.,[15] and these theories held sway until the advent of germ theory, physiology, and organ basis of pathology in the 19th century.

In 1849, Arnold Berthold noted that castrated cockerels did not develop combs and wattles or exhibit overtly male behaviour.[16] He found that replacement of testes back into the abdominal cavity of the same bird or another castrated bird resulted in normal behavioural and morphological development, and he concluded (erroneously) that the testes secreted a substance that "conditioned" the blood that, in turn, acted on the body of the cockerel. In fact, one of two other things could have been true: that the testes modified or activated a constituent of the blood or that the testes removed an inhibitory factor from the blood. It was not proven that the testes released a substance that engenders male characteristics until it was shown that the extract of testes could replace their function in castrated animals. Pure, crystalline testosterone was isolated in 1935.[17]

The Graves' disease was named after Irish doctor Robert James Graves,[18] who described a case of goiter with exophthalmos in 1835. The German Karl Adolph von Basedow also independently reported the same constellation of symptoms in 1840, while earlier reports of the disease were also published by the Italians Giuseppe Flajani and Antonio Giuseppe Testa, in 1802 and 1810 respectively,[19] and by the English physician Caleb Hillier Parry (a friend of Edward Jenner) in the late 18th century.[20]Thomas Addison was first to describe Addison's disease in 1849.[21]

In 1902 William Bayliss and Ernest Starling performed an experiment in which they observed that acid instilled into the duodenum caused the pancreas to begin secretion, even after they had removed all nervous connections between the two.[22] The same response could be produced by injecting extract of jejunum mucosa into the jugular vein, showing that some factor in the mucosa was responsible. They named this substance "secretin" and coined the term hormone for chemicals that act in this way.

Joseph von Mering and Oskar Minkowski made the observation in 1889 that removing the pancreas surgically led to an increase in blood sugar, followed by a coma and eventual deathsymptoms of diabetes mellitus. In 1922, Banting and Best realized that homogenizing the pancreas and injecting the derived extract reversed this condition.[23] The hormone responsible, insulin, was not discovered until Frederick Sanger sequenced it in 1953.

Neurohormones were first identified by Otto Loewi in 1921.[24] He incubated a frog's heart (innervated with its vagus nerve attached) in a saline bath, and left in the solution for some time. The solution was then used to bathe a non-innervated second heart. If the vagus nerve on the first heart was stimulated, negative inotropic (beat amplitude) and chronotropic (beat rate) activity were seen in both hearts. This did not occur in either heart if the vagus nerve was not stimulated. The vagus nerve was adding something to the saline solution. The effect could be blocked using atropine, a known inhibitor to heart vagal nerve stimulation. Clearly, something was being secreted by the vagus nerve and affecting the heart. The "vagusstuff" (as Loewi called it) causing the myotropic (muscle enhancing) effects was later identified to be acetylcholine and norepinephrine. Loewi won the Nobel Prize for his discovery.

Recent work in endocrinology focuses on the molecular mechanisms responsible for triggering the effects of hormones. The first example of such work being done was in 1962 by Earl Sutherland. Sutherland investigated whether hormones enter cells to evoke action, or stayed outside of cells. He studied norepinephrine, which acts on the liver to convert glycogen into glucose via the activation of the phosphorylase enzyme. He homogenized the liver into a membrane fraction and soluble fraction (phosphorylase is soluble), added norepinephrine to the membrane fraction, extracted its soluble products, and added them to the first soluble fraction. Phosphorylase activated, indicating that norepinephrine's target receptor was on the cell membrane, not located intracellularly. He later identified the compound as cyclic AMP (cAMP) and with his discovery created the concept of second-messenger-mediated pathways. He, like Loewi, won the Nobel Prize for his groundbreaking work in endocrinology.[25]

Read more here:
Endocrinology - Wikipedia

Use a sprinkle of common sense and a dash of logic.

by John R. Lee, M.D.

The recent Lancet publication of the Million Women Study (MWS) removes any lingering doubt that there's something wrong with conventional HRT (see Million Woman Study in the UK, Published in The Lancet, Gives New Insight into HRT and Breast Cancer for details). Why would supplemental estrogen and a progestin (e.g. not real progesterone) increase a woman's risk of breast cancer by 30 percent or more? Other studies found that these same synthetic HRT hormones increase one's risk of heart disease and blood clots (strokes), and do nothing to prevent Alzheimer's disease. When you pass through puberty and your sex hormones surge, they don't make you sickthey cause your body to mature into adulthood and be healthy. But, the hormones used in conventional HRT are somehow not rightthey are killing women by the tens of thousands.

The question iswhere do we go from here? My answer iswe go back to the basics and find out where our mistake is. I have some ideas on that.

Over the years I have adopted a simple set of three rules covering hormone supplementation. When these rules are followed, women have a decreased risk of breast cancer, heart attacks, or strokes. They are much less likely to get fat, or have poor sleep, or short term memory loss, fibrocystic breasts, mood disorders or libido problems. And the rules are not complicated.

Rule 1. Give hormones only to those who are truly deficient in them.

The first rule is common sense. We don't give insulin to someone unless we have good evidence that they need it. The same is true of thyroid, cortisol and all our hormones. Yet, conventional physicians routinely prescribe estrogen or other sex hormones without ever testing for hormone deficiency. Conventional medicine assumes that women after menopause are estrogen-deficient. This assumption is false. Twenty-five years ago I reviewed the literature on hormone levels before and after menopause, and all authorities agreed that over two-thirds (66 percent) of women up to age 80 continue to make all the estrogen they need. Since then, the evidence has become stronger. Even with ovaries removed, women make estrogen, primarily by an aromatase enzyme in body fat and breasts that converts an adrenal hormone, androstenedione, into estrone. Women with plenty of body fat may make more estrogen after menopause than skinny women make before menopause.

Breast cancer specialists are so concerned about all the estrogen women make after menopause that they now use drugs to block the aromatase enzyme. Consider the irony: some conventional physicians are prescribing estrogens to treat a presumed hormone deficiency in postmenopausal women, while others are prescribing drugs that block estrogen production in postmenopausal women.

How does one determine if estrogen deficiency exists? Any woman still having monthly periods has plenty of estrogen. Vaginal dryness and vaginal mucosal atrophy, on the other hand, are clear signs of estrogen deficiency. Lacking these signs, the best test is the saliva hormone assay. With new and better technology, saliva hormone testing has become accurate and reliable. As might be expected, we have learned that hormone levels differ between individuals; what is normal for one person is not necessarily normal for another. Further, one must be aware that hormones work within a complex network of other hormones and metabolic mediators, something like different musicians in an orchestra. To interpret a hormone s level, one must consider not only its absolute level but also its relative ratios with other hormones that include not only estradiol, progesterone and testosterone, but cortisol and thyroid as well.

For example, in healthy women without breast cancer, we find that the saliva progesterone level routinely is 200 to 300 times greater than the saliva estradiol level. In women with breast cancer, the saliva progesterone/estradiol ratio is considerably less than 200 to 1. As more investigators become more familiar with saliva hormone tests, I believe these various ratios will become more and more useful in monitoring hormone supplements.

Serum or plasma blood tests for steroid hormones should be abandonedthe results so obtained are essentially irrelevant. Steroid hormones are extremely lipophilic (fat-loving) and are not soluble in serum. Steroid hormones carry their message to cells by leaving the blood flow at capillaries to enter cells where they bond with specific hormone receptors in order to convey their message to the cells. These are called free hormones. When eventually they circulate through the liver, they become protein-bound (enveloped by specific globulins or albumin), a process that not only seriously impedes their bioavailability but also makes them water soluble, thus facilitating their excretion in urine. Measuring the concentration of these non-bioavailable forms in urine or serum is irrelevant since it provides no clue as to the concentration of the more clinically significant free (bioavailable) hormone in the blood stream.

When circulating through saliva glands, the free nonprotein-bound steroid hormone diffuses easily from blood capillaries into the saliva gland and then into saliva. Protein-bound, non-bioavailable hormones do not pass into or through the saliva gland. Thus, saliva testing is far superior to serum or urine testing in measuring bioavailable hormone levels.

Serum testing is fine for glucose and proteins but not for measuring free steroid hormones. Fifty years of blood tests have led to the great confusion that now befuddles conventional medicine in regard to steroid hormone supplementation.

Rule 2. Use bioidentical hormones rather than synthetic hormones.

The second rule is also just common sense. The message of steroid hormones to target tissue cells requires bonding of the hormone with specific unique receptors in the cells. The bonding of a hormone to its receptor is determined by its molecular configuration, like a key is for a lock. Synthetic hormone molecules and molecules from different species (e.g. Premarin, which is from horses) differ in molecular configuration from endogenous (made in the body) hormones. From studies of petrochemical xenohormones, we learn that substitute synthetic hormones differ in their activity at the receptor level. In some cases, they will activate the receptor in a manner similar to the natural hormone, but in other cases the synthetic hormone will have no effect or will block the receptor completely. Thus, hormones that are not bioidentical do not provide the same total physiologic activity as the hormones they are intended to replace, and all will provoke undesirable side effects not found with the human hormone. Human insulin, for example, is preferable to pig insulin. Sex hormones identical to human (bioidentical) hormones have been available for over 50 years.

Pharmaceutical companies, however, prefer synthetic hormones. Synthetic hormones (not found in nature) can be patented, whereas real (natural, bioidentical) hormones can not. Patented drugs are more profitable than non-patented drugs. Sex hormone prescription sales have made billions of dollars for pharmaceutical companies Thus is women's health sacrificed for commercial profit.

Rule 3. Use only in dosages that provide normal physiologic tissue levels.

The third rule is a bit more complicated. Everyone would agree, I think, that dosages of hormone supplements should restore normal physiologic levels. The question ishow do you define normal physiologic levels? Hormones do not work by just floating around in circulating blood; they work by slipping out of blood capillaries to enter cells that have the proper receptors in them. As explained above, protein-bound hormones are unable to leave blood vessels and bond with intracellular receptors. They are non-bioavailable. But they are water-soluble, and thus found in serum, whereas the free bioavailable hormone is lipophilic and not water soluble, thus not likely to be found in serum. Serum tests do not help you measure the free, bioavailable form of the hormone. The answer is saliva testing.

It is quite simple to measure the change in saliva hormone levels when hormone supplementation is given. If more physicians did that, they would find that their usual estrogen dosages create estrogen levels 8 to 10 times greater than found in normal healthy people, and that progesterone levels are not raised by giving supplements of synthetic progestin such as medroxyprogesterone acetate (MPA).

Further, saliva levels (and not serum levels) of progesterone will clearly demonstrate excellent absorption of progesterone from transdermal creams. Transdermal progesterone enters the bloodstream fully bioavailable (i.e., without being protein-bound). The progesterone increase is readily apparent in saliva testing, whereas serum will show little or no change. In fact, any rise of serum progesterone after transdermal progesterone dosing is most often a sign of excessive progesterone dosage. Saliva testing helps determine optimal dosages of supplemented steroid hormones, something that serum testing cannot do.

It is important to note that conventional HRT violates all three of these rules for rational use of supplemental steroid hormones.

A 10-year French study of HRT using a low-dose estradiol patch plus oral progesterone shows no increased risk of breast cancer, strokes or heart attacks. Hormone replacement therapy is a laudable goal, but it must be done correctly. HRT based on correcting hormone deficiency and restoring proper physiologic balanced tissue levels, is proposed as a more sane, successful and safe technique.

Other Factors

Hormone imbalance is not the only cause of breast cancer, strokes, and heart attacks. Other risk factors of importance include the following:

Men share these risks equally with women. Hormone imbalance and exposure to these risk factors in men leads to earlier heart attacks, lower sperm counts and higher prostate cancer risk.

Conclusion

Conventional hormone replacement therapy (HRT) composed of either estrone or estradiol, with or without progestins (excluding progesterone) carries an unacceptable risk of breast cancer, heart attacks and strokes. I propose a more rational HRT using bioidentical hormones in dosages based on true needs as determined by saliva testing. In addition to proper hormone balancing, other important risk factors are described, all of which are potentially correctable. Combining hormone balancing with correction of other environmental and lifestyle factors is our best hope for reducing the present risks of breast cancer, strokes and heart attacks.

A much broader discussion of all these factors can be found in the updated and revised edition of What Your Doctor May Not Tell You About Menopause and What Your Doctor May Not Tell You About Breast Cancer.

More here:
Bioidentical Hormones: Dr. John R. Lee's Three Rules for BHRT

Posted by Dr. Nathan Goodyear on June 5, 2012 45 Comments

Nathan Goodyear, M.D.

Testosterone is the defining hormone of a man.Estrogen is the defining hormone of a woman.

So when we talk about estrogen, its that word men whisper in secret when the women in their lives seem a little hormonal, right? When people find out that my wife and I have 3 daughters, the resulting comment is usually, Wow, thats a lot of estrogen in your household! (Thankfully, I have a son, too, who helps balance the estrogen to testosterone ratio at our house!)

Im sorry to burst your bubble, guys, but estrogen is not exclusive to women. We make estrogen, too.In fact, some of us make aLOTof estrogen. Too much, in fact. And it creates some serious problems.

But before we talk about estrogen, we need to talk about testosterone.Testosterone levels in American men are at an all-time low! There are four major reasons for that: stress, weight, endogenous estrogens, and xenoestrogens. In this post, Ill address three of those stress, weight, and endogenous estrogen.

So lets get started learning four important facts about testosterone, estrogen, and men!

What problems do high estrogen levels create in men?

1. High estrogen = low testosterone.One of the primary causes of low testosterone is a high estrogen level.Estrogens can be endogenous (produced by your body) or exogenous (from the environment, also known as xenoestrogens).Estradiol and Estrone (two of the three kinds of estrogen produced by your body) feed back to the hypothalamus and pituitary and shut off testosterone production.

2. High estrogen = inflammation.Not only do high estrogen levels decrease testosterone in men, they also increaseinflammation. And this is VERY significant.Inflammation, just like stress, is a biochemical process.

Inflammation is the natural result of the immune system.Remember the last time you got a paper cut? It was incredibly painful, probably red, warm and swollen, allcardinal symptoms of inflammation.Inflammation, in the right setting, is actually the body protecting itself. However, when the immune system becomesimbalancedorchronically activated, the immune system causes damage through inflammation. For example, chronically activated immune cells in the brain (glial cells) play a pivotal role in the development of Alzheimers, Parkinsons, and Multiple Sclerosis.

Inflammation is a SERIOUS issue.Chronic inflammation has been linked to many of the chronic diseases of aging: Type II Diabetes, obesity, hypertension, and cancer.In fact, a new term has been coined to describe inflammation arising from the gut which results in many of the above listed disease states metabolic endotoxemia.

Weve established that high estrogen levels are bad for men, shutting down testosterone production and causing chronic inflammation leading to disease.

What causes high estrogen levels in men?

1. High aromatase activity = high estrogen.First, high endogenous estrogen levels in men come fromhigh aromatase activity.Aromataseis the enzyme that converts androstenedione and testosterone into estrone and estradiol respectively. Aromatase is present in many different tissues. But in men aromatase is highly concentrated in thatmid-life bulge.

Unfortunately, aromatase activity in menincreasesas we age due to stress, weight gain, and inflammation. None of us are going to get away from aging (its right there with death and taxes). And who do you know that has NO stress? (Remember, it is estimated that 90% of doctor visits are stress-related.) Typically, as we age we gain weight and have more inflammation.

That age-related tire around the mid-section is more than just unsightly. It is a hormone and inflammation-producing organ.Remember metabolic endotoxemia, the disease-producing state I mentioned earlier? Metabolic endotoxemia is inflammation arising from the GI system whichcausesobesity and then turns right around andproducesinflammation. Its a vicious cycle! And guess what is concentrated in fat? If you guessed aromatase activity, then you are absolutely correct. Aromatase activity in men accounts for80%of estrogen production.

Hormones are not just about numbers, but balance and metabolism as well (readmy recent post on the topic).

2. Overdosage of testosterone = high estrogen.As mentioned earlier, testosterone levels in men are at an all-time low. And the mass solution for this problem with most physicians is to increase testosterone without evaluating or treating the underlying causes for low testosterone. Unfortunately, this complicates the entire low testosterone problem. Overdosage of testosterone increases estrogen production.

What? You mean you can dose too high on testosterone? Yes, andmost of the patients I see who are being treated with testosterone have been, in fact,overdosed.

In fact, at Seasons Wellness Clinic and Seasons of Farragut, we have seen many men must donate blood due to excess production of hemoglobin and hematocrit, a by-product of testosterone overdosage. A 20-22 year old male normally produces5-10 mgdaily of testosterone. It is during this age range that men are at their physical peak of testosterone production. For me, this was during my college football years.

Does it make sense for 40-and-up men currently taking testosterone, that they didnotneed to donate blood monthly during their peak years of natural testosterone production, but are currently required to donate blood regularly with their current regimen of testosterone? Of course not. So, if you didnt have to donate blood with your peak testosterone production in your 20s, you shouldnt have to donate with testosterone therapy in your 40s and beyond either. Something is wrong here, right?

Thestartingdosage for one of the most highly-prescribed androgen gels is1 gram daily.Men, we didnt need 1 gram of testosterone in our early 20s, and we dont need it in our 30s and beyond.

80% of a mans Estrogen production occurs from aromatase activity, and aromatase activity increases as we age. So high doses of testosterone dont make sense. Doctors are just throwing fuel on the fire with these massive doses. More is not better if its too much, even when it is something your body needs.

Then, there is the delivery of testosterone therapy. The bodys natural testosterone secretion follows a normal diurnal rhythm. Testosterone is known to be greatest in early morning and lowest in the evening. But with many prescribing testosterone therapy today, it is very common to get weekly testosterone shots or testosterone pellets. This method of delivery does NOT follow the bodys natural rhythm. The shots and pellets delivery method of testosterone produce supra physiologic (abnormal) peaks. If the purpose of hormone therapy is to return the body to normal levels, then that objective can never be reached with this type of testosterone therapy.

The effects of Testosterone to estrogen conversion in men and women are different. Thats certainly no surprise. In men, high aromatase activity and conversion of testosterone to estrogen has been linked to elevatedCRP,fibrinogen, andIL-6.

Are these important?CRPis one of the best indicators of future cardiovascular disease/events (heart attacks and strokes), and is associated with metabolic syndrome. And yes, it is more predictive than even a high cholesterol level. Fibrinogen is another marker of inflammation that has been associated with cardiovascular disease and systemic inflammation. IL-6 is an inflammatory cytokine (immune signal) that has been implicated in increased aromatase activity (conversion of testosterone to estrogen) and at the same time is the result of increased testosterone to estrogen activity.

So, whats the big deal?The studies are not 100% conclusive, but it is clear thatinflammation increases the testosterone to estrogen conversionthrough increasedaromataseactivity. And the increased estrogen conversion is associated with increased inflammation in men. Itsa vicious cycle that will lead to disease states such asinsulin resistance, hypertension, prostatitis, cardiovascular disease, autoimmune disease,andcancer,to name a few.

You may be thinking, Is the testosterone I need leading me to disease?

The answer is, Yes, it sure can.If your testosterone therapy includes prescription of supra physiologic levels of testosterone, lack of follow-up on hormone levels, and no effort to balance hormones and metabolism, then yes, it sure can.

Is there a safe and effective way to balance hormones, lower estrogen and increase testosterone for men?

Effectively administering hormone therapy requires the following:

At Seasons of Farragut, Nan Sprouse and I are fellowship-trained (or completing fellowship training) specifically in the areas of hormone therapy and wellness-based medicine.

Our patient experience begins with an initial consultation to evaluate symptoms and develop an evaluation plan.

The next step is testing.In the case of hormone imbalance, we evaluate hormones withstate-of-the-arthormone testing via saliva, not just blood. As stated in a 2006 article, plasma levels of estradiol do not necessarily reflect tissue-level activity. Saliva has been shown to reveal the active hormone inside the cell at the site of action.

After initial testing and a therapy program, hormone levels are re-evaluated to ensure the progression of treatment and necessary changes are made to the treatment program. Testing and follow-up are key to proper balance of hormones (read myrecent post). At Seasons of Farragut, our approach to treatment and therapy is fully supported in the scientific research literature, and were happy to share that research with you if youd like to educate yourself.

The way estrogens aremetabolizedplays an equally pivotol role in hormone risk and effect. At Seasons of Farragut, our system of testing, evaluating, and monitoring is the only way to ensure that testosterone therapy for men is raising the testosterone and DHT levels instead of all being converted to estrogen. Hormone therapy is safe, but for it to work effectively, it must be properly evaluated, dosed, followed, and re-evaluated.

If you have questions or comments, please post them below and Ill respond as soon as possible. What is your experience with testosterone therapy? How has your physician tested and re-evaluated your therapy program?

For more information about the Seasons approach to wellness or to schedule an appointment, please contact our office at (865) 675-WELL (9355).

Filed under Bioidentical Hormone Replacement Therapy, Bioidentical Hormone Replacement Therapy, Cancer, Etcetera, From The Doctor's Desk, Heart Health, Hormone Balance, Hormone Balance, Hormone Symphony, Hormone Symphony, Men's Health, Mind Tagged with BHRT, bioidentical hormones, Conditions and Diseases, DHEA, Diabetes, Diabetes Mellitus Type 2, estrogen, Heart disease, Hormone, Hormone Balance, Hormone Imbalance, stress, Symptom

Here is the original post:
Man vs. Estrogen: It's Not Just A Woman Thing! | Seasons ...

by Stephen Pasquini PA-C

After reading a number of questions about acceptance into PA programs a prevailing theme has emerged.

Many international physicians stated that their interest in becoming PAs stems from dissatisfaction with the hours or volume of patients they are seeing in their own practices in their native countries.

So, what is my advice?

That you make an honest, soul-searching assessment of what it is you are seeking.

If you have a prevailing feeling that your MD is a superior credential and that you will be functioning as an "MD Surrogate" in the US, then perhaps you don't fully understand the concept of a PA/supervising MD team.

Every good PA knows very well our limits in scope of practice which have served us and our physician mentors very well for over 40 years.

We aren't, and never will be physicians!

Nor will you, if you practice as a PA within your scope of practice.

You may also want to investigate why you believe that coming to the United States to become a PA will ensure that your hours will be regular, predictable and better than what you have now.

Your hours will depend completely on the medical practice or hospital which hires you.

Expecting that as a PA you will have it easier than you have it as an MD may be a false assumption.

Many PAs work very long, grueling hours in emergency rooms, critical care, hospitals, public health facilities, family health care, community clinics and countless other fields in addition to volunteer work on their own time.

The person who inquired about coming to a US PA program because PAs in Canada are still new and not well respected might do well to step back for perspective.

PAs in the US are the single most serially tested group of medical providers in the world.

We are currently changing a decades-old requirement for national board certification exams every six years to maintain our treasured "C" on our credential, indicating board certification.

But if you look closely at the environment which mandated our test schedule it reveals that we have been regularly asked to "prove" our knowledge, skills, and trustworthiness for those same decades.

Each of us went through some version of facing the "newness" question about what is a PA and scrutiny and occasional rejection by physicians, nurses, and patients.

And most of us will tell you the struggle to prove ourselves is hard.

And at one time it may have been necessary.

But now, for most situations, when you join a medical practice, your patients already know what a PA is and how we function with their physicians.

In Canada, your PA profession, though in comparative infancy to the US, needs great people to choose it, build its competence and support its growth rather than abandon it and go to already proven territory.

If you believe in rigorous academic and clinical training then wouldn't you want to be in the vanguard in Canada demanding that rigor?

I treasure my life and work as a PA in California and Florida.

Anyone fortunate enough to come here as an immigrant looking for anopportunity to serve in the medical corps is warmly welcomed and will be honored by our ranks.

But when you choose this path to PA make sure you are seeing the good with the challengingand accepting that part of being in medical care.

Every place in the world demands a near total commitment of time and the humility to be comfortable caring for impoverished people, people of every cultural and ethnic background, just as you are doing wherever you currently live.

Your challenges are the same as ours in that regard.

The United States PA programs are unparalleled in preparing a workforce to address the overwhelming problem of inadequate access to health care.

But we may not be a panacea for overworked, over-scheduled and feeling unappreciated, at times.

Sincerely, and with good wishes for your success,

- Martie Lynch BS, PA-C

Today's post comes to us via the comments section and was written by physician assistant Margie Lynch, PA-C .

I receive many comments and emails from internationally trained doctors looking for career options here in the United States.

In fact, as an undergraduate, while working in the campus health clinic, I had the privilege of being trained by a foreign medical doctor from India who had transitioned to a laboratory tech in the United States.

The truth is, in many instances, a foreign medical degree is non-transferable and the barriers to practice prevent many highly skilled, well-intentioned international providers from coming to the United States. And like the MD I worked with, their skills and training may go to waste. This is a shame sad there are many clinics and hospitals in the US that would benefit from culturally competent bilingual practitioners.

And like the MD I worked with, their skills and training may go to waste. This is a shame sad there are many clinics and hospitals in the US that would benefit from culturally competent bilingual practitioners.

This is a shame as there are many clinics and hospitals in the US that would benefit from culturally competent, highly skilled, bilingual practitioners.

According to this NY Times Article, the United States already faces a shortage of physicians in many parts of the country, especially in specialties where foreign-trained physicians are most likely to practice, like primary care. And that shortage has gotten exponentially worse since the passage of the affordable healthcare act in 2014.

For years the United States has been training too few doctors to meet its own needs, in part because of industry-set limits on the number of medical school slots available. Today about one in four physicians practicing in the United States were trained abroad, a figure that includes a substantial number of American citizens who could not get into medical school at home and studied in places like the Caribbean.

But immigrant doctors, no matter how experienced and well trained, must run a long, costly and confusing gantlet before they can actually practice here.

The process usually starts with an application to a private nonprofit organization that verifies medical school transcripts and diplomas. Among other requirements, foreign doctors must prove they speak English; pass three separate steps of the United States Medical Licensing Examination; get American recommendation letters, usually obtained after volunteering or working in a hospital, clinic or research organization; and be permanent residents or receive a work visa (which often requires them to return to their home country after their training).

The biggest challenge is that an immigrant physician must win one of the coveted slots in Americas medical residency system, the step that seems to be the tightest bottleneck.

That residency, which typically involves grueling 80-hour workweeks, is required even if a doctor previously did a residency in a country with an advanced medical system, like Britain or Japan. The only exception is for doctors who did their residencies in Canada.

The whole process can consume upward of a decade for those lucky few who make it through.

The counterargument for making it easier for foreign physicians to practice in the United States aside from concerns about quality controls is that doing so will draw more physicians from poor countries. These places often have paid for their doctors medical training with public funds, on the assumption that those doctors will stay.

According to one study, about one in 10 doctors trained in India have left that country, and the figure is close to one in three for Ghana. (Many of those moved to Europe or other developed nations other than the United States.)

No one knows exactly how many immigrant doctors are in the United States and not practicing, but some other data points provide a clue. Each year the Educational Commission for Foreign Medical Graduates, a private nonprofit, clears about 8,000 immigrant doctors (not including the American citizens who go to medical school abroad) to apply for the national residency match system. Normally about 3,000 of them successfully match to a residency slot, mostly filling less desired residencies in community hospitals, unpopular locations and in less lucrative specialties like primary care.

In the United States, some foreign doctors work as waiters or taxi drivers while they try to work through the licensing process.

Is PA a reasonable alternative to foreign trained medical providers whose skills we desperately need here in the United States?

And just how many PA schools are eagerly opening their doors to these practitioners?

This, my friends, is a topic for another blog post.

Feel free to share your thoughts in the comments section down below.

Warmly,

-Stephen Pasquini PA-C

Are you or someone you know a foreign trained doctor or medical provider looking to practice as a PA in the US? Here are some useful resources from the internets:

by Stephen Pasquini PA-C

Welcome to episode 41of the FREE Audio PANCE and PANRE Physician Assistant Board Review Podcast.

Join me as Icover 10 PANCE and PANRE board review questions from the Academy course content following the NCCPA content blueprint.

This week we will be taking a break from topic specific board review and covering 10 generalboard review questions.

Below you will find an interactive exam to complement the podcast.

I hope you enjoy this free audio component to the examination portion of this site. The full genitourinary boardreview includes over 72 GUspecific questions andis available to all members of the PANCE and PANRE Academy.

If you can't see the audio player click here to listen to the full episode.

1. A mother brings her 6-year-old boy for evaluation of school behavior problems. She says the teacher told her that the boy does not pay attention in class, that he gets up and runs around the room when the rest of the children are listening to a story, and that he seems to be easily distracted by events outside or in the hall. He refuses to remain in his seat during class, and occasionally sits under his desk or crawls around under a table. The teacher told the mother this behavior is interfering with the child's ability to function in the classroom and to learn. The mother states that she has noticed some of these behaviors at home, including his inability to watch his favorite cartoon program all the way through. Which of the following is the most likely diagnosis?

Click here to see the answer

Answer: D. Attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder is characterized by inattention, including increased distractibility and difficulty sustaining attention; poor impulse control and decreased self-inhibitory capacity; and motor over activity and motor restlessness, which are pervasive and interfere with the individual's ability to function under normal circumstances.

Explanations

2. Which of the following is the treatment of choice for a torus (buckle) fracture involving the distal radius?

A. Open reduction and internal fixation B. Ace wrap or anterior splinting C. Closed reduction and casting D. Corticosteroid injection followed by splinting

Click here to see the answer

Answer:B. Ace wrap or anterior splinting

Atorus or buckle fracture occurs after a minor fall on the hand. These fractures are very stable and are not as painful as unstable fractures. They heal uneventfully in 3-4 weeks.

3. Which of the following can be used to treat chronic bacterial prostatitis?

A. Penicillin B. Cephalexin (Keflex) C. Nitrofurantoin (Macrobid) D. Levofloxacin (Levaquin)

Click here to see the answer

Chronic bacterial prostatitis (Type II prostatitis) can be difficult to treat and requires the use of fluoroquinolones or trimethoprim-sulfamethoxazole, both of which penetrate the prostate.

4. A 25 year-old male with history of syncope presents for evaluation. The patient admits to intermittent episodes ofrapid heart beating that resolve spontaneously. 12 Lead EKG shows delta waves and a short PR interval. Which ofthe following is the treatment of choice in this patient?

A. Radiofrequency catheter ablation B. Verapamil (Calan) C. Percutaneous coronary intervention D. Digoxin (Lanoxin)

Click here to see the answer

Answer:A. Radiofrequency catheter ablation

Radiofrequency catheter ablation is the treatment of choice on patients with accessory pathways, such as Wolff-Parkinson-White Syndrome.

Explanations

5. Which of the following pathophysiological processes is associated with chronic bronchitis?

A. Destruction of the lung parenchyma B. Mucous gland enlargement and goblet cell hyperplasia C. Smooth muscle hypertrophy in the large airways D. Increased mucus adhesion secondary to reduction in the salt and water content of the mucus

Click here to see the answer

Chronic bronchitis results from the enlargement of mucous glands and goblet cell hypertrophy in the large airways.

Explanations

6. Which of the following dietary substances interact with monoamine oxidase-inhibitor antidepressant drugs?

A. Lysine B. Glycine C. Tyramine D. Phenylalanine

Click here to see the answer

Answer:C. Tyramine

Monoamine oxidase inhibitors are associated with serious food/drug and drug/drug interactions. Patient must restrict intake of foods having a high tyramine content to avoid serious reactions. Tyramine is a precursor to norepinephrine.

Explanations

Lysine, glycine, and phenylalanine are not known to interact with MAO inhibitors.

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The Physician Assistant Life - Essay

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At age 25, the HGH level in our body is around 600ug. By age 60, the amount can gradually go down to 15%, or 90ug. When HGH decreases, our bodies age faster. Most hormones, like estrogen, progesterone, and testosterone, significantly decline as you age. Long ago, the medical community came up with ways to naturally or synthetically replace these hormones and to some extent slow the effects of aging. However, it's only been more recently that the focus has shifted to increasing the level of human growth hormones in our bodies.

To learn more about the many benefits of HGH, visit the HGH studies, information and resources and HGH, health and bodybuilding supplement ingredient and product info sections published at our HGH.com blog, where you will also find the latest fitness and bodybuilding tips from top athletes, trainers and IFBB professionals.

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HGH.com - Natural Human Growth Hormone Supplements

Aging is inevitable, but how you age is not! Americans are living longer, but are not necessarily healthier. We all want to be active and productive as long as possible. The good news is that our concept of aging is changing, and there are new medical approaches to living healthier as we age. Taking into account genetics, environmental influences, nutrition and lifestyle, hormonal balancing, digestive health, as well as minimizing markers of inflammation and oxidative stress are all vitally important to your overall health.

By combining both Functional Medicine and Age Management medicine, we can begin to bridge the gap between the traditional medical model and complimentary therapies. Functional Medicine and Age Management medicine both treat the whole person, and identifies the root cause of chronic diseases and symptoms of aging. It starts at the cellular level healthy cells lead to healthier bodies. Finding the right balance is the ultimate goal. It starts at the cellular level healthy cells lead to healthier bodies. Finding the right balance is the ultimate goal.

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Integrative Medicine Denver | Hormone Replacement Therapy

When it comes to health, hormones and gut bacteria have a much bigger effect than many people realize. In fact, these two factors can destroy health even if everything else (diet, supplements, etc.) is optimized.

Conversely, regulatinghormones and fixing gut bacteria can do a lot to boost health, even if not all the other factors are optimal. In fact, there are even studies about using certain hormone reactions to heal brain trauma.

If you doubt the very real power of hormones to affect everything from mood, to weight, to bowel health, ask the nearest pregnant woman if shes noticed any difference in these areas since becoming pregnant. Or ask the nearest 13 year old girl carefully

What factor contributes to weight gain during pregnancy? Hormone balance.

What causes weight fluctuations, bloating and other health symptoms throughout the course of a month? Hormones.

What causes men to naturally put on muscle more easily or lose weight more quickly? Hormones.

What is a huge contributing factor of growth in children? Hormones.

What controls ovulation, reproduction, pregnancy, etc? Hormones.

Yes, when it comes to losing weight or improving health, what do we focus on? Calories or micronutrients or diets. Those with symptoms likefatigue, skin issues, weight gain, weight around the middle, trouble sleeping, always sleeping, PMS, endometriosis, infertility, PCOS or other issues may find that addressing hormones is vital for recovery.

Hormones are your bodys chemical messengers. They travel in your bloodstream to tissues and organs. They work slowly, over time, and affect many different processes, including metabolism, sexual function, reproduction, mood and much more.

Endocrine glands, which are special groups of cells, make hormones. The major endocrine glands are the pituitary, pineal, thymus, thyroid, adrenal glands and pancreas. In addition, men produce hormones in their testes and women produce them in their ovaries. (source)

Hormones are produced in a complex process, but depend on beneficialfats and cholesterol, so lack of these important dietary factors can cause hormone problems simply because the body doesnt have the building blocks to make them. Toxins containing chemicals that mimic these building blocks or that mimic the hormones themselves are also problematic because the body can attempt to create hormones using the wrong building blocks. Mutant estrogen anyone?

Ive heard so many cases lately of people who have improved diet, started exercising, etc. but are still not losing weight or improving their health markers. After talking to many of these people, it seems that the factor they all have in common is an underlying problem with hormone balance.

Ive written about Leptin and thyroid hormones before, and these are just a small piece in the complicated hormone system in the body. In a given day or month, a womans body will have fluctuations in hormones like estrogen, progesterone, cortisol, lutenizing hormone, prolactin, oxytocin, leptin, ghrelin, thyroid hormones, melatonin, serotonin and others.

The endocrine system is a complex system that we will probably never completely understand, but there are some basic things you can do to boost your bodys ability to create and balance hormones:

Ivetalked about this before, but the body is simply not meant to consume the man-made fats found in vegetable oils. The fat content of the human body is largely saturated fat, with only about 3% of thebodys fat coming from other types.

The 3% of the body made up of polyunsaturated fats contains both Omega-3 fats and Omega-6 fats in about a 50:50 balance. This ratio is extremely important for health, and it is often ignored. Seed based vegetable oils (like canola oil, soybean oil, etc.) are very high in Omega-6 fats and low in Omega-3 fats. Since the 1950s, these seed based oils have replaced many sources of saturated fats and Omega-3s in the diet. This is one of the reasons that most people are not getting enough vital Omega-3 fatty acids from their diet.

Not only are we consuming way too many omega-6 fatty acids from polyunsaturated vegetable oils, but we are not consuming enough beneficial Omega-3s and saturated fats. These types of fats are vital for proper cell function and especially for hormone function, as these are literally the building blocks for hormone production. When we dont give the body adequate amounts of these fats, it must use what is available, relying on lower quality polyunsaturated fats.

The trouble is that polyunsaturated fats are less stable and oxidize easily in the body, which can lead to inflammation and mutations within the body. Emerging evidence suggests that that this inflammation can occur in arterial cells (potentially increasing the chance of clogged arteries), skin cells (leading to skin mutations) and reproductive cells (which may be connected to PCOS and other hormone problems).

Other types of fats, especially saturated fats, are vital for hormone health and balance as the body uses fats as building blocks for hormones. As this article explains:

When these important saturated fatty acids are not readily available, certain growth factors in the cells and organs will not be properly aligned. This is because the various receptors, such as G-protein receptors, need to be coupled with lipids in order to provide localization of function.

The messages that are sent from the outside of the cell to the inner part of the cell control many functions including those activated by, for example, adrenaline in the primitive mammalian fight/flight reactions. When the adrenal gland produces adrenaline and the adrenaline (beta-adrenergic) receptor communicates with the G-protein and its signal cascade, the parts of the body are alerted to the need for action; the heart beats faster, the blood flow to the gut decreases while the blood flow to the muscles increases and the production of glucose is stimulated.

The G-proteins come in different forms; the alpha subunit is covalently linked to myristic acid and the function of this subunit is important for turning on and off the binding to an enzyme called adenylate cyclase and thus the amplification of important hormone signals.

When researchers looked at the fatty acid composition of the phospholipids in the T-cells (white blood cells), from both young and old donors, they found that a loss of saturated fatty acids in the lymphocytes was responsible for age-related declines in white blood cell function. They found that they could correct cellular deficiencies in palmitic acid and myristic acid by adding these saturated fatty acids.

For this reason,Coconut Oilis amazing for hormone health. It provides the necessary building blocks for hormone production, can assist weight loss, reduce inflammation, and even has antimicrobial and antibacterial properties.My favorite way to consume it is toblend into coffeeor tea.This is the highest quality one Ive found. Other quality sources of fats include avocados, animal fats, olive oil, grass fed meats, pastured eggs, and raw dairy (for those who tolerate it). Quality seafood is also very important, as it is natures best source of naturally occurring Omega-3s.

Bottom line: Dont eat fats like vegetable oil, peanut oil, canola oil, soybean oil, margarine, shortening, or other chemically altered fats. Choose fats like coconut oil, real butter, olive oil (dont heat it!) and animal fats (tallow, lard) from healthy sources instead and eat lots of high Omega-3 fish.

I love coffee a lot, but the truth is that too much caffeine can wreakhavocon the endocrine system, especially if there are other hormone stressors involved, like pregnancy, presence of toxins, beneficial fat imbalance or stress.

Cut down the coffee if you can, or replace with beneficial herbal teas (here are my ten favorite DIY recipes). If you cant or wont cut the coffee, use it as a way to sneak in your beneficial fats by adding 1 tablespoon coconut oil to each cup and blending in the blender to emulsify. It is like a latte but with healthy fats! Here is the recipe I use and the only way I drink coffee.

Harmful chemicalsfound in pesticides, plastics, household cleaners, and even mattresses can contain hormone disrupting chemicals that mimic hormones in the body and keep the body from producing real hormones. Things likehormonal birth control can (obviously) do the same thing.

For those with a hormone imbalance or who are struggling to get pregnant, avoiding these unnecessary chemicalsis very important! Cook in glass or non-coated metal pans (no non-stick or teflon) and avoid heating or storing foods in plastic. Find organic produce and meat whenever possible and dont use chemical pesticides or cleaners. Hereis arecipe for a natural cleaner.

Here are some additional tips for avoiding indoor toxins:

Beauty products are another source of chemical exposure for many people. There are tens of thousands of chemicals in the personal care products we encounter daily, and most of these chemicals have not been tested for long-term safety. Avoiding these products can make a tremendous difference in achieving hormone balance. Start by making simple switches like homemade deodorant, and homemade lotion and even DIY makeup if youre feeling adventurous. Check out my full index of natural beauty recipes here.

I cant emphasize this one enough!Without adequatesleep, hormones will not be in balance. Period. (This is the one I struggle with the most!)

While youre sleeping, your body is extremely active removing toxins, recharging the mind, and creating hormones. Skimping on sleep, even for one night, can have a tremendous impact on hormones and even one night of missed or shortened sleep can create the hormone levels of a pre-diabetic (source).

Try some of these tips to help improve sleep::

Unfortunately, we live in a world where the food supply is often depleted of nutrients due to over-farming, the water is often contaminated with chemicals, and even the air can contain compounds that cause havoc in the body.

Ideally, we could get all of our nutrients from food, properly hydrate from water, and get enough Vitamin D from the sun on a daily basis. Wed get magnesium from the ocean and not get deficient in the first place since wed be consuming adequate minerals from eating fresh seafood. Since this is rarely the case, supplements can sometimes be needed! Ive sharedthe basic supplements that I take before, butcertain supplements are especially helpful for hormone balance.

NOTE: Make sure to check with your doctor or health care professional before taking any new supplements, especially if you are on medications or contraceptives.

Maca A hormone boosting tuber in the radish family with a long history of use in Peru. Women who use this often see improvements in fertility, reduction in PMS and better skin/hair. It can help men with sperm production, testosterone levels and muscle composition.Maca is a good source ofminerals and essential fatty acids, which is one of the ways it supports hormone balance. It is available inpowder form(least expensive option) or incapsules. Maca should be discontinued during pregnancy.

Magnesium Magnesium is vital for hundreds of functions within the human body and many of us are deficient in this master mineral (heres how to tell if you are). There are several different ways to getMagnesium:Inpowder form with a product like Natural Calmso that you can vary your dose and work up slowly,ionic liquid formcan be added to food and drinks and dose can be worked up slowly,ortransdermal form by using Magnesium oilapplied to the skin (this is my favorite method). Topical applicationis often the most effective option for those with a damaged digestive tract or severe deficiency.

Vitamin D & Omega-3s A pre-hormone is supportive of hormone function. Bestobtained from the sunif possible, or from aD3 supplementorCod Liver Oil(a good source of Omega-3 and Vitamin D and what I do in the winter). Make sure not to get too much, and optimally, get Serum Vitamin D levels checked to monitor levels.

Gelatin or Collagen-a great source of minerals and necessary amino acids. Gelatin and collagen powderssupport hormone production and digestive healthin various ways. Gelatin powder can actually gel and is useful in recipes like homemade jello and probiotic marshmallows, while collagen protein does not gel but is easily added to soups, smoothies, coffee, tea or any other food. (I get both gelatin powder and collagen peptides from here)

Natural Progesterone Cream PMS and menstrual troubles are often linked to specific hormone imbalances. Especially for those with short cycles or short second phase of their cycle (ovulation through start of menses), progesterone can be the issue. Ive seen people add only natural progesterone cream and see symptoms greatly reduce. If you do use progesterone cream, do you own research, make sure you have a goodbrand that is soy-freeand only use for the second half of your cycle (ovulation through menses). Check with a doctor or professional before using any hormone supplement.

For those withhormone imbalance, intense extended exercise can actually make the problem worse in the short term. Sleep is muchmore important, at least during the balancing phase, so focusing on relaxing exercises like walking or swimming and avoiding the extended running, cardio, and exercise videos, can help the body in the short term.

I personally likeRebounding, which is great gentle exercise and has additional health benefits.

While extended cardio can be bad, short bursts of heavy lifting (kettlebells, deadlifts, squats, lunges) can be beneficial since they trigger a cascade of beneficial hormone reactions. Aim for a few sets (5-7) at a weight that really challenges you, but make sure to get help with form and training if you havent done these before as bad form can be harmful.

Certain herbs and plants can also help the body bring hormones into balance. Of course, it is important to talk to a doctor before taking these, especially if a person is on hormonal contraceptives or other medications. Some herbs that Ive personally used are:

Vitex/Chaste Tree Berry Nourishes the pituitary gland and helps lengthen the luteal phase. It lowers prolactin and raises progesterone. For some women, this alone will improve symptoms.

Red Raspberry LeafA well know fertility herb that is also helpful in reducing PMS and cramping. It has a high nutrient profile and is especially high in calcium and is a uterine tonic. It is available incapsuleform, but makes an excellent hot or cold tea.

Adaptogens- Herbs that help the body handle stress and support the adrenals. They are a great and natural way to work toward hormone balance for many people. This is a good primer on understanding adaptogens.

The digestive system has much more of an impact on hormones than many of us realize. Not only is the digestive tract the source of many vital neurotransmitters in the body, butan imbalance in the gut can translate to an imbalance in neurotransmitter and hormones. Serotonin, a necessary neurotransmitter for sleep/stress balance is more concentrated in the gut than even in the brain! 70% of the immune system is found in the gut and it is quite literally the motherboard of many functions in the body. Even thyroid health has been linked to gut health.

What Hippocrates knew thousands of years ago seems just as true today that all disease beginsin the gut. Those who struggle with gut problems may have trouble ever achieving hormone balance without first addressing gut health. (This is the most comprehensive program Ive ever seen for addressing gut healthissues.)

Leptin is a master hormone, and if it is out of balance or if you are resistant to it, no other hormones will balance well. Fixing leptin will also help boost fertility, make weight loss easier, improve sleep, and lower inflammation. Dr. Jack Kruse, a neurosurgeon, has a whole system for getting leptin into balance.

The infographic below is a quick overview of steps to balance your hormones. Pin it or share it to save for later!

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Source: Wellness Mama

Have you struggled with hormone problems? What helped you? Share below!

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How to Balance Hormones Naturally | Wellness Mama

low hormone levels

Specializing in Hormone Replacement Therapy (HRT), Testosterone Replacement Therapy (TRT) and Human Growth Hormone Therapy (HGH), Elite HRToffers the most up to date treatment options available to optimize your physical and emotional health to the highest level possible, helping you to get your edge back.

Our fully personalized age management and wellness programs, incorporating Physician prescribed Hormone Replacement Therapy (HRT), wellness coaching and program monitoring will help to slow down and even reverse the signs and symptoms of aging so you can look and feel your absolute best at any age. How you look and feel as you age is entirely up to you, you can make the years to come the best years of your life. Take the first step toward a fitter, younger and healthier you. Our team of expert Physicians and wellness consultants are here to guide you every step of the way. Together, well help you to look better, feel younger and stay healthier.

Call us for a free private consultation, your call is completely confidential and no obligation is required, youll be glad you did. Prefer information via email? Submit your questions and concerns using one of our contact forms. One of our Physicians or wellness consultants will respond right away.

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Hormone Replacement Therapy Boca Raton - Hormone Doctor ...

Is hormone therapy (HRT) making a comeback?

A few years ago, the use of hormone replacement therapy (HRT) looked like a medical mess. For decades, women were told that HRT -- usually a combination of estrogen and progestin -- was good for them during and after menopause. Then the 2002 results of the Women's Health Initiative study seemed to show just the opposite: hormone replacement therapy actually had life-threatening risks such as heart attacks, strokes, and cancer.

"Women felt betrayed," says Isaac Schiff, MD, chief of obstetrics and gynecology at Massachusetts General Hospital in Boston. "They were calling their doctors, saying, 'How could you put me on this drug which causes heart attacks, strokes, and cancer?'"

Almost overnight, standard medical practice changed. Doctors stopped prescribing hormone replacement therapy and 65% of women on HRT quit, according to Schiff.

But some experts say hormone replacement therapy may be coming back. All along HRT remained an important treatment for menopause symptoms like hot flashes. And now, a number of recent studies show that hormone replacement therapy may have protective benefits for women who are early in menopause.

"I think we swung too positive on hormone therapy in the past and then we went too negative," says Schiff, who is also chair of the American College of Obstetricians and Gynecologists Task Force on Hormone Therapy. "Now we're trying to find a balance in between."

"We're definitely in a gray zone of uncertainty about hormone therapy," says Jacques Rossouw, MD, project officer for the federal Women's Health Initiative (WHI). "But when you're uncertain, you have to err on the side of safety."

While Rossouw concedes that new studies show some preventative benefit for younger women, he says any potential benefit is very slight. And, he notes, there is no evidence that any benefit would last if women kept taking hormones as they got older.

But increasing numbers of researchers say there should be a place for hormone replacement therapy as a preventive treatment for limited periods as it may help prevent disease in younger women around the age of menopause.

"We have evidence that hormone therapy can prevent heart disease, hip fractures, and osteoporosis, and that it cuts the risk of developing diabetes by 30% in younger women," says Shelley R. Salpeter, MD, a clinical professor of medicine at Stanford University's School of Medicine.

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Hormone Replacement Therapy - WebMD

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DIM (diindolylmethane), is a food-based compound found in cruciferous vegetables like broccoli, cabbage, cauliflower and Brussels sprouts.Studies have shown that it has the ability to reduce the risk of certain cancers, especiallythose influenced by excessive estrogen levels, such as breast, uterine and prostate. DIM can also stimulatefat breakdown and encourage an increase in muscle mass. I can attest, through my own personal experience supplementing with DIM as well as that of quite a few clients (both male and female), that DIM effectively modulates estrogen metabolism helping to do away with uncomfortable symptoms of PMS, perimenopause and prostate issues.

The following excerpt comes from Dr. Scott Rollins, MD, founder and Medical Director at the Integrative Medicine Center of Western Colorado (http://imcwc.com/news/index.php?id=3271124400587032289). Thisis a very well-written and comprehensive account of the effects of DIM and how to best use this supplement to make the most out of its incredible benefits:

Lower your risk of cancer, help lose weight and build muscle all remarkable benefits of a simple food supplement called DIM. For men or women, DIM is something to consider as part of an overall supplement program.

DIM, or diindolylmethane, is a plant based compound found in cruciferous vegetables, such as brussel sprouts,cabbage, broccoli and cauliflower. DIM has been shown in studies to reduce the risk of certain cancers, especiallythose driven by abnormally high estrogen levels, such as breast, uterus and prostate cancer. DIM can also stimulate the breakdown of fat while encouraging muscle development.

Estrogen hormones are naturally found in men and women and have many benefits such as preserving artery healthand brain function while fighting oxidative free radical damage. Higher estrogen levels found in women cause thefemale body shape with breast and hip development. Many women are estrogen dominant however, meaning theyhave too much estrogen accumulating in the body for the complementary progesterone to balance.

Natural estrogen dominance occurs as women near menopause, starting even ten years prior to menopause, where theyoften dont make as much progesterone to balance their estrogen. Symptoms such breast pain, water retention, heavypainful menstrual cycles, or irritable anxious moods are typical bothersome symptoms. Estrogens over-stimulation ofbreasts and uterus tissue can lead to breast cysts or adenomas and uterine growths both unpleasant and potentiallydangerous physical outcomes are too often accompanied by worrisome mammograms and hysterectomies.

Some women have estrogen dominance throughout their life for various reasons, such as low thyroid, high cortisol,exposure to environmental estrogen-like chemicals, or impaired detoxification pathways for estrogen.

Men often suffer from estrogen overload as well. With normal aging our testosterone levels drop as the conversion toestrogen increases, leading to a falling ratio of testosterone to estrogen. Higher estrogen levels in men lead to weightgain, loss of muscle mass, feminization of the body, further decreases in already falling testosterone levels, andincrease the risk of diseases such as heart disease and prostate cancer. The enzyme that normally converts testosteroneto estrogen is most abundant in fat, so as men put on weight the cycle of falling testosterone and rising estrogen simply picks up steam!

There are two main pathways in the liver for our estrogen to be normally metabolized and excreted. One pathwayleads to very good metabolites called 2-hydroxy estrogens. The other pathway leads to bad metabolites called 4 or 16-hydroxy estrogens. DIM stimulates the favorable 2-hydroxy pathway for estrogen metabolism and this is how DIMworks to improve our health.DIM is not a hormone, nor is it a hormone replacement. It is a plant compound that will improve our hormonebalance. By improving the metabolism of our natural estrogens DIM will help lower high levels of estrogen in thebody. This alone can help remedy estrogen dominant conditions and restore a healthy estrogen/testosterone ratio inmen and women.The favorable 2-hydroxy metabolites promoted by DIM are potent anti-oxidants and help prevent muscle breakdownafter exercise, as evidenced by female athletes having less muscle tissue breakdown after intense exercise than men.By reducing the estrogen dominance and also reducing the accumulation of cancer-promoting 4/16-hydroxymetabolites DIM can help lower the risk of cancer.The 2-hydroxy metabolites help increase the active testosterone levels in men and women by displacing inactiveprotein-bound testosterone to its active free portion. This leads to significant improvements in the ability to buildmuscle and enjoy the benefits of testosterone including better mood, increased stamina, endurance, sex drive anderectile function.The accumulation of fat around the belly, hips and buttocks is partly due to excess estrogen levels combined withfalling testosterone levels. DIM will help lower excess estrogen and promote the fat-burning 2-hydroxy metabolites.This can help you achieve a leaner body with less body fat.

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DIM for Hormone Balance - Healthy by Nature

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Metamorphosis Medical Center and Dr. Kristen Vierregger are dedicated to improving the overall health and well-being of members of the transgender community by providing medically supervised hormone therapy in an atmosphere that is compassionate, safe, and understanding.

You will feel confident that you are receiving the best care and best medicine available for gender transitioning. We can customize your hormone experience to reach the level you desire. We understand that not everyone has the same goal or endpoint in their transition. Everyone is unique.

In the area of gender transitioning and hormone therapy, where myth and ignorance sometimes exceeds knowledge within the medical community, Dr. Vierregger provides expert, professional, and empathetic hormone therapy. She really listens to your needs.

We at Metamorphosis Medical Center understand that transitioning is much more than a physical or superficial journey; transitioning is a rebirth of an individual long buried under the layers of self or societys imposed expectations. Like all births, it can be long, difficult, and full of doubts at times, but we can help facilitate the joy and expectation of a new life, a new beginning, a metamorphosis.

Dr. Vierregger is the doctor in residence at the LBGT The Center OC Trans*ition Program as well as her private practice.

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Transgender hormone therapy Clinic

The thyroid gland is located at the front of your neck. This gland secretes hormones that govern many of the functions in your body, such as the way the body uses energy, consumes oxygen and produces heat. Thyroid disorders typically occur when this gland releases too many or too few hormones. An overactive or underactive thyroid can lead to a wide range of health problems. (See the thyroid basics infographic for more.)

Hyperthyroidism is a thyroid disorder that occurs when the thyroid is overactive. It can cause several problems, including:

Several illnesses can cause hyperthyroidism, including Graves' disease or a viral infection of the thyroid gland. Treatment for hyperthyroidism usually involves medication to reduce the amount of hormones produced by the thyroid.

Hypothyroidism is a thyroid disorder that occurs when the thyroid does not produce enough hormones, which is the opposite of hyperthyroidism. This can cause:

Hypothyroidism is often caused by Hashimoto's disease, an autoimmune disease where the body's immune system attacks the thyroid gland. This condition can be treated using a drug called T4. Most patients must stay on T4 for their entire lives, and must be closely monitored by physicians.

Thyroid disorders can also occur because of thyroid nodules, which are growths on the gland. These small growths are usually harmless and can go unnoticed for years. Doctors can sometimes feel these nodules during routine examination. At times, thyroid nodules can be cancerous. If you have these nodules, your doctor may want to perform the following tests:

If the nodules are not cancerous, they will not need treatment in most cases. Sometimes they need to be removed. Cancerous nodules always need to be removed, followed by treatment with radioactive iodine.

If you think that you may have thyroid problems, talk to your doctor to see what tests need to be performed.

Link:
Information on Thyroid Disorders | Hormone Health Network

At Childrens Hospital of Pittsburgh of UPMC, we believe parents and guardians can contribute to the success of this treatment and invite you to participate. Please read the following information to learn about the treatment and how you can help.

In order for a child to grow, a gland deep inside the brain, called the pituitary, must release enough growth hormone (GH). Natural growth hormone is released during deep sleep. Many factors influence the release of GH, including nutrition, sleep, exercise, stress, medications, blood sugar levels, and other hormones present in the body. When a childs body does not produce or release enough GH, he or she may have several symptoms, the most noticeable being slow or no growth or facial features that make the child look a lot younger than his or her peers. Although being small has no effect on a childs intelligence, it may cause self-esteem issues and interfere with the development of mature social skills. For that reason, GH treatment may be prescribed to help a child reach his or her fullest growth potentialboth in height and in personal development.

Once a child has been diagnosed with GH deficiency, Turner Syndrome, or other conditions treatable with GH therapy, the pediatric endocrinologist will discuss the pros and cons of, and usually recommend, GH therapy. The GH used in treatment is manufactured in the laboratory to be identical to that produced by the pituitary gland, so it is safe and effective. GH is given through a subcutaneous (sub-Q-TAIN-ee-us) injection, which means that it goes into the fatty tissue just beneath the surface of the skin. GH can be given by a special injection device that looks like a pen. Because it is such a shallow injection, the needle is very small and does not hurt much at all.

The main thing to expect is growth! Although it takes about 3 to 6 months to realize any height differences, the important thing is that your child will grow probably 1 to 2 inches within the first 6 months of starting treatment. There may be a few other things you notice:

It may take a number of years for your child to reach his or her adult height, so you should be aware that GH treatment is often a long-term commitment. Routine visits with the pediatric endocrinologist will be needed, as will periodic blood tests and x-rays to monitor your childs progress on the treatment. Although the length of treatment varies, your child probably will have to stay on GH treatment until he or she has:

GH injections are quick and almost pain-free, so children ages 10 and up may be able to and often prefer to give themselves their own injections. It is important that a parent supervises the injection to make sure the child gives the correct dosage each day. Parents should give the injections to younger children. Because natural growth hormone is released mainly during sleep in children, GH treatment is more effective when taken at bedtime.

Learning how to give GH injections may sound intimidating at first, but once you and your child get used to it, it becomes just another daily habit. There are, however, some tips that you should know when you start GH therapy:

Storage

Time of Day

Injection Sites

Finishing A Cartridge

Because GH is very expensive, you should use up all of the medication in every cartridge.

Since GH does not interfere with other medications, it can be taken even if your child is mildly ill (colds, flu), unless your PCP tells you to stop.

Although infrequent, there are some possible side effects that you should be aware of. They are:

If the headache is persistent or severe, however, call the Endocrinology Fellow on call immediately. If you have questions about a reaction, or your child is experiencing a reaction, call the Endocrinology Clinic or office.

GH is sold under a number of different prescription brand names, but all of them contain the same medication. Which brand name your child will use, and the shape and color of the pen that delivers the medication, will depend upon your medical insurance.

Because GH is very expensive, Childrens Hospital works with insurance reimbursement specialists to determine which brand will be covered under your medical insurance. Within 2 to 4 weeks after your child has been prescribed HG treatment, an insurance reimbursement specialist will call your home. It is very important that you speak with the specialist please pick up or return the call! Your childs prescription will not be filled until you have spoken with the reimbursement specialist. You should receive your childs GH with 2 to 4 weeks after approval; if you havent heard from the reimbursement specialist after 4 weeks, call the Endocrinology Clinic.

If your insurance changes during the course of GH treatment, please notify the Endocrinology Clinic as soon as possible or the continuity of your childs treatment could be interrupted.

As soon as your childs GH starter kit arrives, call the Endocrinology Clinic to schedule your familys GH injection training session. Your child and both parents or guardians should attend the training sessions before your child can begin GH treatment. At the training session, the nurse consultant will teach you and your child how to:

If you have any questions or if your child has any special needs you feel the Endocrinology Clinic needs to know about, please call the nurse consultant at Childrens Hospital before your childs clinic appointment.

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Growth Hormone Treatment

Our vision is to provide our patients with personalized, physician-supervised care with an emphasis on preventive medicine, healthy aging and aesthetics. Our customized services and programs are created within a relaxed environment proven to give you superior results in your pursuit of optimal health and appearance.

Endorsements from celebrities like Suzanne Somers, Oprah Winfrey, Robin McGraw, Linda Evans and Rachel Ray have greatly increased public awareness of BHRT.

Like celebrities, many of our patients are busy juggling careers, family life and everything else. At the same time, they are trying to camouflage their symptoms trying to convince themselves that what they are experiencing is the normal aging process, when in fact, they are suffering from hormone imbalance associated with menopause or andropause.

Health conditions caused by hormone imbalances have started to generate a lot of attention. On her website, Oprah writes, After one day on bio-identical estrogen, I felt the veil lift. After 3 days the sky was bluer, my brain was no longer fuzzy, my memory was sharper. I was literally singing and had a skip in my step.

Although there is no magic recipe for relief from the symptoms of menopause and andropause, Doctor Trim feels that men and women should educate themselves about the options available and he applauds the celebrities that continue to keep the topic in the headlines.

Here are some of the benefits of BHRT : Improved libido (sex drive) Improved sleep Reduced risk of depression Better mood, concentration, and memory Help in the prevention of Osteoporosis and restoration of bone strength May protect against heart disease and stroke Reduced hot flashes and reduced vaginal dryness Muscle mass and strength are better maintained Improvement in cholesterol levels

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Atlantic Age Management - New Jersey Hormone Doctor ...

The CORNERSTONE of The Komer Method is the attitude that only OPTIMAL is acceptable.

This encompasses optimal levels for hormones, blood chemistry, nutrients, supplements, nutrition, exercise and behavior for each individual.

Many lab ranges are very wide and are accepted as normal. Large portions of these ranges include levels that are far from ideal. The Komer Method has developed its own set of optimal ranges, and strives to achieve these for each patient.

When physicians treat abnormal blood sugars or high cholesterol or high blood pressure, they choose the ideal standard as the levels for a healthy young adult. However, when the same physicians correct abnormal hormone levels, they do not follow this practice. In fact, they will accept aging and deterioration of hormone levels as a normal event. Dr. Komers belief, and what has worked so successfully in his practice, is that achieving these optimum levels at any age fine tunes the body to minimize the effects of age, time and stress. These levels result in men and women who are their healthiest. They lead to a reduction in long term illness and an increase in wellbeing.

These optimal values have been developed over years of experience, by research by Dr. Komer and others, and by patients reporting back what makes them feel their very best.

The Komer Method has developed its own protocols for diagnosis and for treatment for various conditions, and these have been tested and improved in thousands of individuals. Innovation and continuous improvement of all protocols is ongoing. Medical literature is reviewed daily to integrate new research into The Komer Method.

A major emphasis of the Komer Method has been dedicated to achieving ideal hormone levels in both genders, for such conditions as menopause in women and low testosterone in men.

Dr. Komer also treats other individuals, including both pro and amateur athletes, suffering from concussions or injuries. He has a particularly large percentage of men and women who are in the military, are police officers, correctional officers or firemen. These professions involve stress and long hours and sometimes trauma, which can lead to abnormal hormone levels. There is especially a need for understanding, assessment and treatment of these individuals.

Dr. Komer has been an innovator in bringing new techniques and new ideas to medicine and has, at times, stood alone in championing ideas that have turned out to be leading edge concepts in medicine. In his personal practice, he has over 12,000 women and 5,000 men in his program who are reaping the benefits of hormone restoration. They are feeling well and happy, functioning optimally and staying healthy.

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Dr. Komer The Komer Clinics - Treatment, Education ...

The CORNERSTONE of The Komer Method is the attitude that only OPTIMAL is acceptable.

This encompasses optimal levels for hormones, blood chemistry, nutrients, supplements, nutrition, exercise and behavior for each individual.

Many lab ranges are very wide and are accepted as normal. Large portions of these ranges include levels that are far from ideal. The Komer Method has developed its own set of optimal ranges, and strives to achieve these for each patient.

When physicians treat abnormal blood sugars or high cholesterol or high blood pressure, they choose the ideal standard as the levels for a healthy young adult. However, when the same physicians correct abnormal hormone levels, they do not follow this practice. In fact, they will accept aging and deterioration of hormone levels as a normal event. Dr. Komers belief, and what has worked so successfully in his practice, is that achieving these optimum levels at any age fine tunes the body to minimize the effects of age, time and stress. These levels result in men and women who are their healthiest. They lead to a reduction in long term illness and an increase in wellbeing.

These optimal values have been developed over years of experience, by research by Dr. Komer and others, and by patients reporting back what makes them feel their very best.

The Komer Method has developed its own protocols for diagnosis and for treatment for various conditions, and these have been tested and improved in thousands of individuals. Innovation and continuous improvement of all protocols is ongoing. Medical literature is reviewed daily to integrate new research into The Komer Method.

A major emphasis of the Komer Method has been dedicated to achieving ideal hormone levels in both genders, for such conditions as menopause in women and low testosterone in men.

Dr. Komer also treats other individuals, including both pro and amateur athletes, suffering from concussions or injuries. He has a particularly large percentage of men and women who are in the military, are police officers, correctional officers or firemen. These professions involve stress and long hours and sometimes trauma, which can lead to abnormal hormone levels. There is especially a need for understanding, assessment and treatment of these individuals.

Dr. Komer has been an innovator in bringing new techniques and new ideas to medicine and has, at times, stood alone in championing ideas that have turned out to be leading edge concepts in medicine. In his personal practice, he has over 12,000 women and 5,000 men in his program who are reaping the benefits of hormone restoration. They are feeling well and happy, functioning optimally and staying healthy.

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Dr. Komer, MD - Your Temporary Index

Thanks to our nationwide network of qualified physicians, safe & effective andropause treatment is available in a city near you.

Most men come to our website because they want to make informed decisions about their healthcare as they age. The internet is an excellent place to start your healthy aging research, but information gained online isnt worth much unless you can actually act on it!

At Renew Man, we make it easy to both learn about your treatment options andwhen youre comfortableimplement your treatment plan. Get the big picture from our website, and then reach out to a Renew Man doctor near you to learn more. Our network of doctors covers dozens of cities across the country, making our safe and effective andropause treatments available to thousands of men right in their local areas.

Unfortunately, many regular physicians dont fully understand andropause. They may not recognize your symptoms as signs of hormonal decline, and if this is the case they certainly wont be able to prescribe the right treatments. At Renew Man, we understand healthy aging. You can trust our network of doctors to provide superior relief from andropause symptoms and support for healthy aging because:

The information on our website is just the beginning when it comes to your health and well-being during andropause. If youd like to learn more, please feel to give us a call. We wont try to sell you anything; but we will do our best to provide answers that are fact-based, direct, and relevant. When youre ready, well connect you with a Renew Man doctor near you to provide even more personalized information.

You can reach us at 800-859-7511, or request a consultation through our contact form.

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Network Of Doctors - Renew Man

If any of the above pms, menstrual, or menopausal symptoms belong to you, you've come to the right place. We were searching for answers just like you are...and a lot of us discovered that using bio-identical, natural hormones was one of keys to restoring balance and health.

We also found that talking with each other was extremely helpful. Under why we use it you'll find some personal examples of how natural progesterone cream can change your life. In the forum you can talk to other women who have symptoms like yours and find out what works for them.

Natural progesterone cream, for instance, can be an extremely effective remedy for symptoms of PMS, infertility, osteoporosis, and menopause. There are wonderful resources available to help you decide if natural hormone replacment is right for you. We encourage you to explore some of the best resources available. Talk to your health care providers. Get reliable information from non-commercial websites. Talk to other women about what works for them...our new ebook (which is a fantastic resource) and the forum are great places to start. And you can download our free booklet A Woman's Guide to Natural Progesterone.

The more you learn, the better healthcare decisions you can make for yourself.

One more thing. Most sites have a link to their "privacy policy." Here is ours: We will not use your personal details for anything other than processing your order. PERIOD. We absolutely regard this as sacrosanct.

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A Natural Progesterone Cream by Resonance Direct

A recent study showed that nearly 13 million Americans may be unaware of and undiagnosed for their thyroid conditions. Are you one of them? Another study showed that if you are a pregnant woman and you have a low thyroid your child's IQ will be affected. Yet another recent study showed that if you an elderly woman with thyroid problems you will have an increased risk of heart disease

The big myth that persists regarding thyroid diagnosis is that an elevated TSH (thyroid stimulating hormone) level is always required before a diagnosis of hypothyroidism can be made. Normally, the pituitary gland will secrete TSH in response to a low thyroid hormone level. Thus an elevated TSH level would typically suggest an underactive thyroid.

If you find this information helpful click here to subscribe to the FREE weekly newsletter so you will get all the updates.

Click here to read my interview with Mary Shomon, the Thyroid guide from About.com.

Your Doctor Does Not Likely Understand How To Interpret Your Tests Properly

Thyroid function tests have always presented doctors with difficulties in their interpretation. Laboratory testing is often misleading due to the complexity and inherent shortcomings of the tests themselves. Many doctors not having an adequate understanding of what the test results mean, will often make incorrect assumptions based on them or interpret them too strictly. A narrow interpretation of thyroid function testing leads to many people not being treated for subclinical hypothyroidism.

Old Laboratory Tests Unreliable

Most all older thyroid function panels include the following:

These tests should be abandoned because they are unreliable as gauges of thyroid function. The most common traditional way to diagnose hypothyroidism is with a TSH that is elevated beyond the normal reference range. For most labs, this is about 4.0 to 4.5. This is thought to reflect the pituitary's sensing of inadequate thyroid hormone levels in the blood which would be consistent with hypothyroidism. There is no question that this will diagnose hypothyroidism, but it is far too insensitive a measure, and the vast majority of patients who have hypothyroidism will be missed.

Basal Body Temperature

Basal body temperature popularized by the late Broda Barnes, M.D. He found the clinical symptoms and the body temperature to be more reliable than the standard laboratory tests was provided. This is clearly better than using the standard tests. However there are problems with using body temperature.

New and More Accurate Way To Check for Hypothyroidism

This revised method of diagnosing and treating hypothyroidism seems superior to the temperature regulation method promoted by Broda Barnes and many natural medicine physicians. Most patients continue to have classic hypothyroid symptoms because excessive reliance is placed on the TSH. This test is a highly-accurate measure of TSH but not of the height of thyroid hormone levels.

New Range for TSH to Diagnose Hypothyroidism

The basic problem that traditional medicine has with diagnosing hypothyroidism is the so-called "normal range" of TSH is far too high: Many patients with TSH's of greater than 2.0 (not 4.5) have classic symptoms and signs of hypothyroidism (see below).

Free Thyroid Hormone Levels

One can also use the Free T3 and Free T4 and TSH levels to help one identify how well the thyroid gland is working. Free T3 and Free T4 levels are the only accurate measure of the actual active thyroid hormone levels in the blood.

When one uses free hormone levels one will find that it is relatively common to find the Free T4 and Free T3 hormone levels below normal when TSH is in its normal range, even in the low end of its normal range. When patients with these lab values are treated, one typically finds tremendous improvement in the patient, and a reduction of the classic hypothyroid symptoms.

Secondary or Tertiary Hypothyroidism

There are a significant number of individuals who have a TSH even below the new 1.5 reference range mentioned above, but their Free T3 (and possibly the Free T4 as well) will be below normal. These are cases of secondary or tertiary hypothyroidism, so, TSH alone is not an accurate test of all forms of hypothyroidism, only primary hypothyroidism.

Symptoms of Low Thyroid

Treatment of Hypothyroidism

You can click here for an article on how you can treat your thyroid problem with natural hormone therapy.

If you find this information helpful click here to subscribe to the FREE weekly newsletter so you will get all the updates.

If you are interested in a more comprehensive articles directed towards health care professionals click here. Also available is an excellent text book article on thyroid testing for those with more technical interests.

Mary Shomon is the http://www.about.com thyroid expert. Her $11 352 page book published in March of 2000 is one of the most cost effective and valuable resources that you could own on this subject. If you have thyroid disease this book should be in your library.

Click here to Purchase: Living Well With Hypothyroidism

The Los Angeles Times wrote: March 27, 2000 "Hypothyroidism is a common, very treatable disorder that is also poorly managed by doctors. In this first-rate book by Mary Shomon...the disorder, its myths, and medicine's successes and failures at dealing with it are thoroughly examined. This is not a book that rehashes old facts on thyroid disease. Shomon instead challenges patients and their doctors to look deeper and try harder to resolve the complicated symptoms of hypothyroidism...In a fascinating chapter, Shomon, who also has a Web site and an online newsletter about the disease, explores recent evidence that the addition of the thyroid hormone T3 to the standard T4 (levothyroxine) may help some people feel better. In addition, the section on babies born with hypothyroidism, although brief, has the best advice on how to give medication to an infant that I've seen. As Shomon writes: 'or years, thyroid problems have been downplayed, misunderstood and portrayed as unimportant.' With her advocacy, perhaps no more." -- Shari Roan

Dr. John Lowe, author of "Speeding Up to Normal" wrote:

Mary Shomon is the harbinger of the latest scientifically-sound information on hypothyroidism. With keen intellect, loyalty to truth, and plain language, she sweeps away the medical dogma that bars millions of patients from rational thyroid hormone therapies. In this book, she describes practical thyroid therapies that can improve patients' health and extend their lives. The book is vital for hypothyroid patients who want to get well, and for physicians who want to help them do so.

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Hypothyroidism Diagnosis, Symptoms, and Treatment

Why accept aging and all its potential problems? You have an option to forestall physical and mental deterioration through Bioidentical Hormone Replacement! Natural Hormone Therapy is a safe, effective and reliable medical therapy that combats the biological effects of aging.

Neal Rouzier MD is Medical Director of The Preventive Medicine Clinics in Palm Springs, California. Rouzier has been specializing in in Bioidentical Hormone Replacement since 1997. He can prescribe a therapy that is tailored to your unique needs.

Our focus is on PREVENTION of the diseases associated with aging. Of course, a healthy lifestyle is important, including diet and exercise. Along with the appropriate vitamins and supplements, bio-identical hormones are a key ingredient in our recipe for healthy aging.

The Preventive Medicine Clinic is located in the resort area of Palm Springs in Southern California. Rouzier sees new patients in California and Utah. Only one visit is necessary to perform a comprehensive history, interview, and education. Follow up evaluations, adjustments and balancing are done by phone or written communications a return visit to Dr. Rouzier is not necessary. But ongoing testing and adjustment is mandatory and performed through a laboratory convenient to your home.

In addition to the Palm Springs office, Rouziersees new patients in Pasadena, California, and Salt Lake City, Utah. Pasadena appointments will be held in the offices of the New Body Cosmetic Surgery Center. Please call Carolyn Rouzier on 760 320 4292for information and appointments.

Preventive Medicine Clinic 3001 E. Tahquitz Canyon Way Suite 108 Palm Springs, CA 92262

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Neal Rouzier, MD The Hormone Doctor