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Hormone Replacement
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The goal of hormone replacement therapy is to replace these natural hormones, in balance, to youthful optimal levels. There are several important hormones you may receive depending on laboratory evaluation. Our physician prescribes FDA approved bio-identical hormones, natural hormones that are molecularly identical to the hormones in your body. Prior to any prescriptions, we perform a comprehensive blood and/or urine analysis which identify deficiencies and provide clinical data about general health and medical risk. Once patients start hormones and other medications, we perform frequent laboratory testing and periodic examination to ensure the safety and efficacy of treatment. All hormone prescriptions and individualized replacement plans are directed by our certified physician. Patients are also given nutritional and exercise guidance with direct access to a nutritionist and exercise specialist as these strategies all work together to give our patients the best results and medical benefits.
Hormone Treatments
Testosterone
The primary male sex hormone is found in men and women. A sharp decline in testosterone has disastrous consequences in males. Mainstream medicine now recognizes male “andropause”, or testosterone deficiency that causes symptoms with age. Testosterone declines around age 35 in most patients, with some variability. Free, or active, testosterone declines approximately 2% per year after age 35 in the majority of men. This rate is more rapid in some individuals. After age 50, the decline is more rapid for most males. Females commonly experience a decline in testosterone around the time of menopause. Low testosterone is associated with erectile dysfunction in males, low libido and decreased sexual response in both sexes and a host of medical issues. Deficiency is directly related to loss of muscle, increase in abdominal fat, loss of strength and conditioning, reduced bone mass, poor energy, drive and competitiveness, depression and mental slowing. Recent studies have demonstrated males with low testosterone have a greater incidence of heart disease, diabetes, metabolic syndrome and increased overall mortality compared to males with higher normal testosterone. This is an update from the teaching in medical school 20 years ago.
Benefits from testosterone replacement typically include:
Most doctors not familiar with detailed hormone replacement decline to replace testosterone unless your blood levels are below reference range. We believe replacing testosterone to the upper third of a healthy reference range assists with optimal function. Studies have demonstrated significant benefits and reduced risk in patients with testosterone in the top 25% compared to patients in the bottom 25%. We measure both total and free (active) testosterone. The aromatization of testosterone to estrogen is also important. We address estrogen through diet and prescription medicines to control your estrogen levels which minimizes side effects. Younger patients worried about partially depressing natural production may be prescribed HCG in small doses.
Side effects: When hormone replacement is properly monitored, there are few, if any, significant side effects. Your physician will review possible side effects at each visit. Patients with a history of breast and prostate cancer are not candidates for replacement in the program.
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Estrogen
Estrogen, the female sex hormone, is actually three hormones. In males, estrogen is primarily made from the conversion from testosterone via the aromatase enzyme. In females, estrogen is produced primarily in the ovaries until menopause. Low estrogen causes many symptoms in females, including: weakening of bones, abnormal cholesterol, increased arterial plaque in arteries, hot flashes, vaginal dryness, sleep disturbance, depression, poor energy and declining mental function, urinary and vaginal infections, elevated diabetes risk, Colon cancer, and possible increase in Alzheimer’s. A base level of estrogen is necessary for health in males but high levels can have repercussions, including: abdominal fat deposition, water retention, breast tissue enlargement, increased cardiovascular disease, and growth of the prostate gland. Your physician can direct you in specific dietary measures and medication to decrease your estrogen levels as necessary.
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DHEA
Known as the father hormone, DHEA is the most abundant hormone in the human body and serves many roles. DHEA is a weak androgen produced by your adrenal glands. DHEA is one of the first hormones to decline with age and contributes to the symptoms and decreased physical function with aging. By age 65, it is only a fraction of the level it was in your 20s. DHEA is a pre-cursor to other steroid hormones; it is converted by the body into other hormones such as testosterone and estrogen. DHEA itself can help improve body composition and has positive effects on the immune system and inflammatory markers. Some studies show that DHEA may be beneficial in autoimmune disease and chronic illness. Several clinical trials have shown DHEA to have anti-cancer properties and protective of bone. DHEA helps to counteract the destructive properties of excessive cortisol. As we age, our cortisol levels increase and our body’s slowly shift into a catabolic state, where tissues are damaged faster than they are repaired. There are other suspected benefits from DHEA. While it can be purchased over the counter, these supplements are not regulated and can contain impurities, contaminants, made from poor raw material and variable strength. Prescription and pharmaceutical grade compounds are superior. For patients that convert DHEA to estrogen, we may suggest a metabolite, 7-Keto DHEA.
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Growth Hormone
Human Growth Hormone (HGH) is responsible for the growth and repair of all tissues in the body, including: muscles, skin, bone, tendons, ligaments, and organs. HGH levels rise sharply before age 20, peak, and then decline thereafter. Most people have declining levels after age 35 but we may only replace HGH in patients significantly deficient from a pituitary cause under strict testing criteria. Stimulating natural production is preferred. Growth hormone deficiency contributes to the visible and physiologic effects of aging. While HGH is under scrutiny from its inappropriate use by athletes, we uphold the American Academy of Anti-Aging’s (A4M) & AMMG’s teaching on Growth Hormone replacement as being significantly beneficial to aging patients who are deficient in this hormone with minimal risks when properly dosed and monitored. We follow the A4M & AMMG guidelines for replacement only in severe deficiency; this is a very small number of our patients, who must meet strict criteria.
Clinical evidence is clear on the many benefits of replacing HGH in the deficient state. Potential side effects are easily managed with physiologic dosing and laboratory monitoring. Studies have verified benefits but also site potential side effects, such as: fluid retention, carpal tunnel symptoms, small increase in blood sugar and joint aches. Most of these studies used large doses and did not adjust medication amounts or performed laboratory IGF-1 monitoring. All of the potential side effects are reversible on withdrawal of the medicine. While Growth Hormone therapy may improve physical and mental function and relieve symptoms, it has not been shown to increase life span.
HGH’s replacement: changes seen in clinical studies
HGH has better results in combination with other hormone replacement with deficiency and combined with a healthy, low carbohydrate diet. HGH is effective only by prescription injection; oral formulations advertised do not work. At Premier Age Management, we only prescribe hormone stimulants/replacement for adults with documented deficiency and follow dosing schedules by endocrine societies. There has not been a consensus reached on the effect of growth hormones in a patient with established cancer. Therefore, we would not replace HGH in patients with active cancer, proliferative retinopathy, or advanced diabetes even if there is a clinical deficiency.
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Sermorelin/GHRP-6
Sermorelin is a biological analog of growth hormone releasing hormone (GHRH) that is produced in the brain to stimulate growth hormone release from the pituitary gland. Sermorelin stimulates production of the body’s own growth hormone. GHRP-6 is a ghrelin analogue and stimulates the pituitary to increase the magnitude of the natural HGH spike. Unlike growth hormone, Sermorelin and GHRP-6 affect a more primary and natural source of failure in the growth hormone axis, has even fewer potential side effects than growth hormone, and has positive effects on overall pituitary function. Sermorelin and GHRP-6 promote the release of your body’s own growth hormone in the natural hormonal axis of the body. The benefits of Sermorelin and GHRP-6 are similar to HGH replacement but may be milder.
The effects of Sermorelin and GHRP-6 are regulated at the pituitary gland through negative feedback by the release of somatostatin so any safety concerns associated with growth hormone overdose are minimized. By stimulating the pituitary, Sermorelin and GHRP-6 preserve more of the natural neuroendocrine axis. At Premier Health Clinic, we only prescribe to patients with growth hormone deficiency confirmed by symptoms and laboratory testing. Studies point to stimulants being less effective in elderly patients with significantly depressed pituitaries.
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Thyroid Hormones (T3 and T4)
Healthy thyroid function is critical to the function of all other hormones in the body. Low or borderline low thyroid is extremely common and often missed. Borderline hypothyroidism is increasingly common with age. At Premier Age Management, we screen all our patients for thyroid disorders prior to the program and monitor thyroid function throughout the treatment. Active Thyroid hormones regulate energy levels, cardiovascular function, mental function and overall metabolism. These medicines are prescribed in our Age Management if there is a mild decline in laboratory thyroid function producing symptoms.
Deficient thyroid hormones can cause many symptoms, including: fatigue, mental sluggishness, depression, infertility, weight gain, dry skin, constipation, high cholesterol, poor cardiovascular function, hair loss, cold intolerance, sexual dysfunction, joint and muscle aches, poor muscular function and more.
Severe deficiency or overproduction will require further work-up and treatment outside of the program and we may refer to endocrinology.
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Melatonin
Melatonin is a natural hormone that plays a major role in setting the body’s internal clock and circadian rhythms. Melatonin’s benefits include:
Melatonin and DHEA both decline rapidly in your late 30s and continue to plummet thereafter. Melatonin is also a potent anti-oxidant, which may slow free-radical cellular damage.
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Pregnenolone
Pregnenolone is known as the mother of all steroid hormones. Pregnenolone is used by the body to produce DHEA, Testosterone, Estrogen, and Progesterone. Optimal levels of Pregnenolone are important for mental health and ability. By age 70, this hormone has declined over 60%. Pregnenolone may increase acetycholine in certain areas of the brain and regulates other neurochemicals (GABA) and processes in the brain. Clinical research has shown pregnenolone to be effective in increasing job performance and learning in a cross section of individuals of various ages. They found pregnenolone helped test groups learn and remember difficult tasks compared to control groups. In a study of airline pilots under stressful situations, 50-100mg of pregenolone daily improved task performance with no side effects. Nearly all studies confirm that pregnenolone is well tolerated, even at high doses, with very few side effects. Studies done in patients with rheumatoid arthritis demonstrated improvements in inflammatory symptoms in the majority of patients.
Age management benefits typically include:
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Progesterone
(females) We use progesterone cream or micronized bioidentical oral pills for replacement in females. This is not the synthetic progesterone that was used during the woman’s health study. Progesterone has anti-cancer properties. It protects the lining of the uterus in post-menopausal women and decreases the risk of breast and uterine cancer. Progesterone has antidepressant/anti-anxiety properties, it is known to promote relaxation in the brain. Progesterone helps prevent fibrocystic breasts, stimulates bone building, helps use fat for energy, supports normal sexual function, promotes sleep, helps regulate mood, is a mild natural diuretic and facilitates thyroid hormone function.
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Vitamin D-3
Vitamin D is not only a vitamin, it's also a hormone. Vitamin D has long been known to increase calcium absorption and strengthen bones. Recent research has shown Vitamin D deficiency to increase the risk of Heart disease, many types of Cancer, Auto-immune disease, Blood Sugar control, Brain function, fatigue, muscle aches and mild depression "winter blues". We give deficient patients prescription or pharmaceutical grade Vitamin D-3 which is superior to over the counter products and monitor levels.
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