Download - hormone seminar
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“The compounding specialists”
Welcome
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Hormones
• Powerful chemical messengers• Derived from cholesterol• Made in the brain, ovaries, testicles, adrenal
glands and body fat• Affect every tissue in the body• Overall effect depends on the balance between
various hormones• Duration of exposure is as important as dose
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Bio-Identical Hormones
• Bio-Identical Hormones are chemically identical to those in the human bodyo Derived from cholesterol-like molecules called
saponins (extracted from soybeans and yams) Plants do not make hormones (only precursors)
o Some available without prescription (ProGest)o Others require prescription
a few manufactured products (eg: Vivelle, Estrace, Prometrium)
custom compounded medications
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Estrogens Estriol, Estradiol, Estrone
• Exert a stimulating effect on breast, uterus and brain
• Prevent bone loss by osteoclasts• Involved in vasodilation and improved
blood flow• Promote fat storage at hips • Maintain integrity of urogenital tract
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Progesterone
• There is only ONE progesterone • Works synergistically with estrogens
o Balances effect of estrogens in many cases slows cell growth normalizes blood clotting enhances estrogen’s cardiovascular benefits decreases fluid retention (bloating) improved fat metabolism
• Progesterone levels drop at peri-menopause
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Testosterone
• Anabolic hormone o builds and strengthens tissue, bone, urogenital
tract, muscle• Declines with age• Vasodilator• Balances effects of estrogen and cortisol• Important for sex drive/sexual response
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Dehydroepiandrosterone (DHEA)
• Made in the adrenal glands• Declines steadily with age• Has important roles in immune function,
ability to handle stress, and glucose disposal
• Balances cortisol• Can convert into testosterone and
estradiol
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Cortisol
• Made in the adrenal glands• Catabolic hormone: breaks down tissue
(part of the normal cycle of remodeling)• Balances testosterone• Stress hormone: modulates immune
function, raises blood glucose, stores fat for energy
• In excess: osteoporosis, muscle wasting, obesity, brain neuron atrophy
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Thyroid Hormone
• Determines metabolic rateo Nutrient utilization by tissue
(fats, carbs, and protein)o Effect protein synthesiso Regulate bone growtho Heat generation
• Interacts with cortisol, progesterone, testosterone and estradiol
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Female Hormone PatternsMenarche to Menopause
• Teenso Anovulatory cycles are common o Low Progesterone o Estrogen Dominance
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Female Hormone PatternsMenarche to Menopause
• 20 to 30 years oldo May have regular monthly bleeding but may
not be ovulatingo If stressed: PMSo Unbalanced hormone levels affect fertility and
pregnancy
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Female Hormone PatternsMenarche to Menopause
• 40 to 50 years oldo Peak progesterone level declineso Total progesterone output throughout the luteal
phase declines o Average estradiol level increases
May lead to estrogen dominanceo Ovaries may secrete more testosterone
instead of progesteroneo Anovulatory cycles with irregular bleeding
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Female Hormone PatternsMenarche to Menopause
• 40 to 50 years oldo Estrogen dominance o Functional hypothyroidism o Normal TSH, but classic symptoms of under-active
thyroid o Weight gaino Feeling coldo Dry skin, thinning scalp hairo Aching muscleso Fatigueo Low sex drive
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Female Hormone PatternsMenarche to Menopause
• 50+ & Menopauseo Estradiol level drops o Estrone level stays the same or rises o Ovary stops making progesterone and
testosterone
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Symptoms of Hormone Imbalance
• Estrogen Excess o Tender, swelling, and/or fibrocystic breastso Water retentiono Irritabilityo Weight gain at hipso Sometimes increased headaches or migraineso Hypothyroid symptoms
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Symptoms of Hormone Imbalance
• Estrogen Deficiency o Hot flashes & night sweatso Vaginal dryness (also lips, skin, eyes...)o “Brain fog” & memory problemso Urinary incontinence (stress incontinence)o Depressiono Bone loss
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Symptoms of Hormone Imbalance
• Estrogen Deficiency o Low percent of body fat = at risk for low
estrogen Estrogen CAN be made in body fat...if you have
enough! Women with enough body fat may not need
estrogen supplementation for menopause Women with low body fat may need extra estrogen
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Symptoms of Hormone Imbalance
• Progesterone Deficiency o Irregular periods (teens and pre-menopause) o Tender and/or fibrocystic breastso Water retentiono Irritabilityo Anxiety/depressiono Weight gain at hipso Migraineso Hypothyroid symptoms
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Symptoms of Hormone Imbalance
• Androgen (Testosterone) Excess o Acne, oily skino Facial hair growtho Weight gain at waisto High triglycerides o Seen in insulin resistance, polycystic ovary
syndrome, obesity
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Symptoms of Hormone Imbalance
• Androgen (testosterone) Deficiency o Depressiono Fatigueo Vaginal drynesso Low sex driveo Bone losso Decreased sense of well being
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Symptoms of Hormone Imbalance
• Cortisol (Stress Hormone) Excess o Irritability, anxiety, feel “burned out”o “Brain fog” & memory problemso Bone losso Insomnia & fatigueo Low sex driveo Weight gain at waist (“apple” profile)
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Symptoms of Hormone Imbalance
• Cortisol Deficiency “Adrenal Fatigue”o Usually preceded by prolonged stress/chronic
illness o Fatigue, feel “flat” or “burned out” o Allergies; immune function lowo Feel cold all the timeo Can’t get started in the morningo Low sex driveo Depressiono Unstable blood sugar
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Approach to Female Hormone Imbalances
• The solution isn’t always HRTo Stress reduction (good diet, sleep, exercise,
relaxation training) o Weight loss o Address insulin resistance o Nutrients o Herbs
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Male Hormone Patterns
• Young Males o High testosterone o Low estradiol o Low progesterone
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Male Hormone Patterns• 35 + years old • Testosterone drops about 1% per year • Estradiol and estrone may rise; Prog stays low• Gain weight around middle • Sleep problems associated with excess weight
may lead to increased cortisol• Abdominal fat converts testosterone to estradiol
under the influence of cortisol• Cortisol and estradiol directly oppose the action
of testosterone • High estradiol is sensed by the brain and may
shut down testosterone production
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Approach to Male Hormone Imbalances
• Weight loss • Weight training • Reduce dietary estrogen burden • Testosterone supplementation• Aromatase inhibitors
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Solving Hormone Problems
• History 85%• Physical examination 10%• Lab tests 5%• Respect individual differences • Endocrinology will always be somewhat of
an art, not an exact science
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Role of Testing
• Symptoms help us reach a tentative diagnosis
• Lab testing confirms or refutes the diagnosis
• Need to do comprehensive testing
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Thank You
John C. Richards Pharm.D.Barbara Dace Pharm.D.
Professional Village Pharmacy
916-483-3455www.ProfessionalVillageRx.com