Clinical Use of Hormones in Age Management Medicine - Part 3
Courses are Enduring Materials from a Clinical Applications for Age Management Medicine Conference
Course is the third in a series of lectures designed to provide clinicians with focused lectures on the topic of Clinical Hormone Use. Speakers will discuss optimization of hormone levels within the context of Age Management Medicine using providing the evidence in the form of cases, studies and references to support their materials.
Faculty & Agenda
There are 2 recent controversies on the use of growth hormone. The first controversy is the link of cancer and growth hormone. The history of growth hormone will be reviewed. In addition, subsets of population (children and adults on GH, Laron syndrome (Low IGF-1) and acromegalics (high IGF-1) will be analyzed for the risk of cancer. The second controversy of growth hormone is it good or detrimental to aging? On one side of the argument increasing IGF-1 levels is considered the fountain of youth. The other side of the argument is that growth hormone (in acromegaly) can accelerate the aging process. Data will be reviewed on both sides of this area of controversy, including the new study of growth hormone reversing aging.
Edwin N. Lee, M.D., FACE
Assistant Professor of Internal Medicine, University of Central Florida, College of Medicine, Orlando, FL
Founder, Institute for Hormonal Balance, Orlando, FL
Member, AMMG Conference Planning Committee
It has become customary to use aromatase inhibitors to block formation of estrogen in men. Even though the use of AI’s is commonly taught, the utilization is not necessarily supported by the medical literature. However, I will make the case for the use of AIs in men based on multiple studies suggesting that high levels of estrogen in men are associated with CVD harm and symptoms. This can have significant adverse consequences on men’s health. The purpose of this lecture is to present the literature demonstrating the need to block estrogen in men with aromatase inhibitors. Using the medical literature, we will come to understand the importance of keeping estrogen levels low in men The medical literature will be cited as it pertains to the harm of elevated levels of estrogen in men.
Neal Rouzier, M.D.
Director, The Preventive Medicine Clinics of the Desert, Palm Springs, CA
Since testosterone went “underground” in the 1970’s, shortly after it became a controlled substance following the “performance enhancing drug” legislation by Congress, many have come to believe that it was important to block its conversion into the “female” hormone, Estradiol. This concept was further enhanced by observational literature that showed an “association” with elevated Estradiol and many disease conditions in men. It has since become an “accepted dictum” that Estradiol should be blocked during the course of Testosterone therapy in men. However, higher quality prospective studies published more recently, show that when Estradiol is blocked (such as in the treatment of prostate and other cancers), severe medical consequences follow and when Estradiol is allowed to rise without blocking, less disease and debility ensue. This discussion will review significant recent literature showing that allowing Estradiol levels to rise with Testosterone treatment is not only safe but medically essential.
John C. Carrozzella, M.D., MSMS
Director & Founding Physician, CEO, Florida Center for Hormones and Wellness
Estradiol is a pleiotropic hormone that has instrumental influence over numerous critical functions related to the cardiac and vascular system, bone and mineral metabolism, cognition, memory, mood, balance, age related neurodegenerative disorders and lipolysis of fat. Evidence suggests that estradiol has neurotrophic and neuroprotective properties and promotes the survival and viability of intimate brain structures. The benefits of estradiol on neuroprotection are attributed to genomic and non-genomic signaling, regulation of mitochondrial energy and antioxidant action. Damaged neurons increase the production of aromatase, the enzyme that is responsible for the conversion of androgens into estradiol. Our own astrocytes after suffering trauma increase aromatase expression to exert the numerous benefits of estrogen to these intimate structures. Knowing all this to be an evident truth, why then do some clinicians insist on blocking the aromatization of testosterone into the ever-important, pleiotropic hormone estradiol? Attendees will learn the importance of allowing the natural aromatization of testosterone into estradiol to occur and how blocking this important conversion will do long term harm to these numerous systems.
Rob Kominiarek, D.O., FACOFP
Member, AMMG Planning Committee
Director, ReNue Health, Springboro, OH
Assistant Clinical Professor, Ohio University College of Osteopathic Medicine
Panel Discussion: An Interactive Conversation with Experienced Age Management Physicians: Issues and Controversies in Treatments, Estrogen Use in Men
Moderator: Rob Kominiarek, M.D.
Panel: John C. Carrozzella, M.D., MSMS & Neal Rouzier, M.D.
When treating male patients with testosterone, the PSA can often rise either from prostate cancer or other reasons. Learn how to prevent false rises in PSA and also how to manage false elevated PSA levels in men without prostate cancer on testosterone. This lecture will help you evaluate these patients with falsely elevated PSA levels and hopefully prevent you from sending them to the Urologist for an unnecessary negative prostate biopsy.
Brian Gerber, M.D.
Attending Urologist & Chief of Surgery, St. Joseph Hospital, Elgin, IL
Urology Care Center / Optimal Aging Institute
There are long term studies and literature support for testosterone improving longevity and decreasing the diseases of aging. However, testosterone has also been implicated in significant side effects, the most common of which is termed polycythemia. Therefore, it has become customary to phlebotomize men on testosterone therapy that experience an elevated hemoglobin/hematocrit, which is the most common side effect of testosterone therapy. The Endocrine Guidelines require regular monitoring of therapy for this elevated hematocrit, commonly referred to as polycythemia. However, despite what most believe, testosterone does not cause polycythemia vera (PCV) nor does it cause an increase in arterial or venous thrombosis as commonly seen with PCV. Nevertheless, the erythrocytosis that is prevalent with testosterone administration is commonly extrapolated to be just as harmful as polycythemia vera, which is a blood disorder that increases the risk of blood clots, both arterial and venous. This is both an incorrect and inappropriate extrapolation due to misunderstanding of the terms. Although the widespread use of phlebotomy as the treatment of erythrocytosis is common, erythrocytosis is not polycythemia vera nor should the harm of PCV be extrapolated to be the same for physiologic erythrocytosis. The literature supports no harm of physiologic erythrocytosis caused by either testosterone or living at altitude, and this elevation of red blood cells does not require treatment even though it has been the typical standard operating procedure for decades. Erythrocytosis does not result in the same harm as true PCV and assuming that it does is both incorrect and leads to inappropriate treatment. We should not extrapolate or misconstrue the two entities, although most hematologists and cardiologists will disagree. The purpose of this lecture is to present the literature support of lack of harm of testosterone-induced erythrocytosis or the need to phlebotomize men with erythrocytosis, even though multiple medical society guidelines recommend regular monitoring and phlebotomy. The safety of erythrocytosis and the difference between erythrocytosis and thrombo-producing PCV will be reviewed. The importance of following evidence-based standards, and not public opinion, will be explained and demonstrated. Reality is not consensus of opinion, yet this seems to be the case when it comes to testosterone-induced erythrocytosis or altitude-induced erythrocytosis. However, it has become customary to phlebotomize men with an elevated.
Neal Rouzier, M.D.
Director, The Preventive Medicine Clinics of the Desert, Palm Springs, CA
Progesterone’s primary function in the reproductive tract is to protect the uterus from endometrial proliferation. “Conventional wisdom” and a source of controversy in hormone replacement therapy contend that women having undergone a hysterectomy no longer need progesterone. Anti-aging specialists need to know that progesterone has profound global effects due to receptors in the kidney, cardiovascular, respiratory,GI, central nervous, and bone remodeling systems. The earliest signs of progesterone deficiency occur when women enter the perimenopausal years. Progesterone is the first hormone to devolve, resulting in agitation, irritability, insomnia, poor libido, headaches, and short temperedness. The North American Menopause Society and the Endocrine Society recommend antidepressants, antihypertensive agents, and synthetic progesterone for symptom relief. Their literature confuses progestogens, synthetic progesterone, a proven carcinogen, with plant-based natural progesterone. Women have progesterone, not fluoxetine deficiencies! This lecture explores the pros and cons of progesterone therapy post-hysterectomy. We provide the learner with fifty-four (54) peer-reviewed references answering the question, Yeah or Nay? Progesterone after Hysterectomy. It provides a template to send to insurance companies and fellow physicians who cling to the outdated notion that one does not need progesterone if one does not have a uterus.
William Clearfield, D.O.
Medical Director, Clearfield Family Medicine, Reno, NV
Executive Director, American Osteopathic Society of Rheumatic Diseases