Carolina Mobile MD - "Medical House Calls"

Menopause & Natural (Bio-identical) Hormone Replacement Therapy

by J.P. Saleeby, MD

 

Hormones and their Functions

 

Hormones are chemical messengers, produced by the endocrine system (produced by one organ), that circulate in your bloodstream giving instructions to your cells (another organ/system). For example, the thyroid gland's hormone, thyroxine (T4), governs and monitors your body's rate of metabolism and energy production.

 

The hormones that are most vulnerable to the aging female are called sex steroid hormones produced by a woman's ovaries.

 

Sex (Gonadal) Steroid Hormones

 

Estrone (E1), Estradiol (E2), and Estriol (E3): Categorized as 'the estrogens', each of these ovarian hormones has its particular functions. Estradiol, the most potent estrogen, primarily aids in the cyclic release of eggs from the ovaries for potential fertilization and preparation of the uterus for pregnancy. In addition to its role in cycling and pregnancy, estradiol also has powerful beneficial effects on heart, bone, brain and colon. It is the reduction in the level of estradiol that causes common menopausal symptoms such as hot flashes and night sweats. Estriol is produced in large quantities during pregnancy and is considered by some to be the 'gentle' estrogen providing some of the protection without exposure to the risks associated with stronger estrogens. Estrone, which can be converted to estradiol in some women, is the primary estrogen in postmenopausal women and is generated in fat cells.

 

Progesterone: Produced cyclically by the ovaries, progesterone maintains the uterine endometrium to nurture a fertilized egg and allows for fetal development throughout a pregnancy. Progesterone has been labeled the body's anti-estrogen, partnering with estradiol to maintain the delicate balance required between a woman's reproductive hormones. A woman's progesterone level diminishes, along with that of estradiol, as she approaches and enters menopause and, in most women, drops to low postmenopausal values.

 

As a woman ages (in her 40’s or 50’s)there is the slow decline of ovarian hormone production beginning with the irregular cycling of perimenopause which can last several years followed by menopause which is defined as not having cycled for twelve consecutive months. Though menopause brings with it a variety of desirable changes in a woman's life such as no more menstrual cycles, contraception or PMS, there can be many undesirable symptoms. These include:

 

  1. Hot flashes, night sweats
  2. Vaginal dryness
  3. Dryness and thinning of skin, nails, hair
  4. Bone loss
  5. Mood swings
  6. Decrease in libido (sex drive)
  7. Memory problems
  8. In addition to the decline in estradiol and progesterone levels, a woman's testosterone and DHEA levels continue to drop throughout her lifetime and are responsible for some menopausal symptoms.

 

Surgically Induced Menopause

 

Removal of a woman's ovaries will result in immediate menopause creating a series of rapid and intense symptoms that can be debilitating and can be addressed successful0ly with the appropriate form of hormonal intervention.

 

Diseases Associated with Hormones and the Aging Process

  • Heart disease is the number one killer in America and the leading cause of death in women over age 65. As a woman's estradiol level decreases, her risk of heart disease increases. Older women are 10 times more likely to die from heart disease than breast cancer.
  • Osteoporosis, a disease that occurs when bone is breaking down faster than it is being rebuilt, makes bones more fragile and susceptible to fracture.  Testosterone has also been shown to help protect against osteoporosis.
  • Alzheimer's Disease affects more than four million Americans a year with women at greater risk than men. Women taking estrogen therapy have a significantly lower risk of the dementia. In addition, recent animal studies indicate that testosterone may also have a protective effect against Alzheimer's Disease.
  • Colon cancer is the second leading cause of cancer death in the United States with women at greater risk than men. Estradiol is now being studied as providing protection against this disease though the mechanism is still unclear.

What is Hormone Replacement Therapy?

 

HRT is the administration of steroid hormones (either natural, synthetic or animal-derived) to make up for the decline in those hormones (that drop naturally with age). Natural HRT or bio-identical HRT refers to a regimen of hormones that is bio-identical in structure and physiological activity to what the body produces. Importantly it also refers to the correct ratios of hormones.  For example the correct ratio of E1:E2:E3 and E2:P.  Natural progesterone is derived from Mexican Wild Yam, but must be manipulated in the lab.  The wild yam is only active in humans once pharmaceutical conversion has taken place.  Natural HRT brings with it the following benefits:

  • Better tolerance (less unwanted side effects) such as blood clots, gallbladder disease.
  • Better therapeutic profile, since the ratios are correct for humans.
  • Improved long term patient acceptance.

Currently, more and more women and men are opting for natural HRT. Given both the short and long term health benefits, HRT is now considered by many healthcare providers as the preventive medicine of the 21st century for women and men in the second half of life. On the average, a female HRT user can expect to live up to 3 years longer than a non-user.

 

Replacing the body's declining hormones with natural, bio-identical hormone replacement is quite different from what might be considered 'natural' menopausal choices that can include:

  • Maintenance of a healthy lifestyle such as frequent exercise, no smoking and minimal stress
  • Dietary intervention with plant estrogens (such as those in soy products)
  • Herbal intervention such as with dong quai, black cohosh or licorice (see below)

While there are scientific studies showing that some of these solutions do address short-term symptoms such as hot flashes, research is on going as to the long-term benefits of natural, non-hormonal solutions. This topic is evoking much interest especially with breast cancer patients and survivors who are experiencing severe menopausal symptoms and hesitate to intervene with hormones. While there is some concern about the estrogenic effects of these phytoestrogens they are weak at best and do not come close to the potency of E2.  It is said that about 25% of postmenopausal women with breast cancer and 15% of postmenopausal women without breast cancer use these products.  This is the conclusion by researchers at the Univ. of Pittsburgh studying the effects of Dong quai, vitex, Chinese ginseng, American ginseng, black cohosh, red raspberry leaf, licorice root, wild yam root.

 

Soy based compounds such as tofu, soy milk, roasted soy nuts, (and in one study 60 grams of soy protein daily caused a 33% decrease in not flashes after 4 weeks and 45% reduction after 12 weeks) are useful in reducing menopausal symptoms.

 

Vitamin E (800 IU per day) has been shown in studies as far back as the late 1940’s to alleviate menopausal symptoms.  A trial period of no less than 3 months is recommended.

 

Vitamin C (1200 mg daily) was studied in the mid 1960’s and reports concluded that in combination with the bioflavonoid hesperidin ameliorate menopausal symptoms.

 

Herbals with weak estrogen-like actions have similar effects they include Licorice, Alfalfa, Red clover, Black cohosh, Vitex, Dong quai, Ginseng and Sage (useful in profuse sweating) have been tested by Germany’s Commission E.  It is recommended that before starting any herbal patients should consult with their physician especially a nutritionally minded physician.  While herbal preparations are somewhat effected the compounded NHRT creams and prescriptions are the most potent form of replacing low hormone levels.

 

Women who lead sedentary lifestyles are more likely to have menopausal symptoms.  In one trial menopausal symptoms were reduced immediately after aerobic exercise.  Aerobic exercise is certainly recommended for other health benefits as well. 

 
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Andropause: The Male Menopause
 
by J.P. Saleeby, MD
 

Testosterone is a major player in the complex mielu of hormones (cellular messengers) that direct our bodies to function.  In men who are over the age of 40, there is a significant drop in this level of this hormone.  Until recently (maybe 10- years ago) it was considered taboo to replace this important hormone.  But today most doctors realize what scientific studies over the past decade have taught us. 

 

As with women who have gone through the change of life, replacement of their sexual hormones (estrogen, progesterone and testosterone) enact major health benefits such as osteoporosis prevention, heart disease prevention (in some studies) and increases in cognitive function.  Likewise for older male subjects the benefits of the addition of testosterone under careful physician management is a crucial aspect of maintaining good health.  I wish in this article to dispel some misconceptions about Testosterone Replacement Therapy and provide a list to readers of the benefits of this simple and rather safe treatment.  First of all there is overwhelming evidence in the scientific literature that testosterone does not cause prostate cancer.  In actuality it is the unbalanced estrogen excess in man that is implicated in prostate cancer.  The caveat here is that once there is prostate cancer, testosterone which is an anabolic (building) hormone can promote cancer growth.

 

With advancing age in men Testosterone levels drop while estrogen levels rise and compete for binding sites on the prostate gland as well as other cells in the body causing a hormonal havoc.  Such problems as an increase in adipose tissue with midsection obesity, a decrease in muscle mass, generalized hormonal imbalances (growth hormone, estrogen, thyroid), depression, increased cholesterol and lipid dysfunction, glucose and insulin imbalance, decreased coronary artery elasticity, elevated blood pressure and loss of a feeling of well being result from low testosterone levels.  Supplementing Testosterone in the appropriate candidates reverses these unwanted outcomes, but it is not as simple as taking a pill.  There are enzymes in our body that can change exogenous testosterone into other undesirable hormones such as Estrone/Estrodiol and dihydrotestosterone (DHT).  Therefore, a physician that understands the balancing act and has the ability to monitor these other hormones is best to treat such a disorder.

 

Along with the correct replacement modality (cream, gel or patch) there are other considerations which halt the trend of testosterone conversion and these are usually supplemented along with testosterone.  Such supplements are Saw Palmetto, Zinc and Nettle extract to name a few.  There are also pharmaceuticals that do the same.  In a recent study of the Androderm patch after a 12-month period a depression score dropped by nearly one half with testosterone replacement alone.  Again men with complaints of fatigue receiving testosterone in one study had symptoms of fatigue drop for 79% to 10%.  A Medline medical literature search reveals many more positive outcomes of testosterone replacement.  For those interested in finding out more about their bodies, there is a non-invasive home testing kit available which allows men to evaluate the levels of testosterone in circulation.  The prescription and management of natural bio-identical hormone therapy is no simple task and I have been managing men for over a decade for excellent results.

 
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Myers’ Cocktail Infusion
 
by J.P. Saleeby, MD
 

There is a treatment of rapid intravenous infusion containing high dose vitamins and minerals for the treatment for a variety of ailments.  It is becoming wildly popular and  that sparked my attention some years ago.   There are hundreds of physicians in this country that use it as a stand-alone therapy or also as replacement therapy for those receiving chelation therapy.  This infusion is something referred to as the “Myers’ Cocktail” or the “Gaby-Wright Cocktail.”

 

As fate would have it I attended a symposium in February 2001 in New York City entitled “Nutritional Therapy in Medical Practice” given by non other than Dr. Alan R. Gaby.  This symposium was sponsored by the Beth Israel Medical Center and St. Luke’s- Roosevelt Hospital in New York City.  Its focus was on nutritional therapies and nutritional medicine.  Of the five hundred or so in attendance from around the country I was hoping to bring back some real pearls of wisdom to Savannah, GA.  This most fascinating course included many lectures on the importance of nutrition in daily life and in treating and preventing disease. Every lecture was supported and referenced by evidence found in the medical literature both in this country and abroad.  Alan R. Gaby, MD as well as Jonathan V. Wright, MD are both luminaries in the field of nutritional / integrative medicine and the conference was illustrative.

 

Dr. Gaby would speak often of the Myers’ Cocktail uses in his clinical practice.  First introduced by Dr. John Myers of Maryland in the mid 20th century and then forgotten until it was re-introduced by Drs. Gaby and Wright a decade ago, it is a mixture of relatively high doses of five vitamins and two minerals.  Very often it is customized with varying doses of each agent and can also include Adrenal cortical extract (ACE), Glyceron (an extract from the licorice plant named glycerrhizin, which by the way has been shown by recent studies in the Orient as one of the best ways to treat SARS) and Glutathione (a potent antioxidant).

 

It is quickly (within 30 minutes) infused through an IV and in some patients the effects may last weeks.  The theory behind high dose and quick infusions is that these vitamins and minerals are forced into the cells by sheer overload and are hence “trapped” intracellularly, where their effects last long beyond the expected short time following the slow infusion.  Recently Dr. Gaby and Dr. Harry Adelson have conducting a pilot study into the effects of the Myers’ Cocktail at the Naturopathic Medical Center at the University of Bridgeport in Bridgeport, CT.  Independently, my center is also collecting data on hundreds of infusions in my patients.  The prospects are exciting.  Will the data back up the case studies and anecdotal claims that have been made over the decades?  Double blinded placebo controlled studies have yet to be performed, however, case studies speak loudly in favor of this therapy.

 

The treatment is recommended and has been used with great success in treating Chronic Fatigue Syndrome, Chronic Depression, Fibromyalgia, Asthma (both acute flair-ups and the chronic condition), Urticaria, Seasonal Allergic Rhinitis, Chronic Sinusitis, Congestive Heart Failure, Ischemic Vascular Disease, Dementia, Reflex Sympathetic Dystrophy, Bronchitis, Interstitial Cystitis, Multiple Sclerosis and especially Acute Viral and Bacterial infections.   I have used this therapy to recover people quickly from the flu, acute Hepatitis A and B infections and Infectious Mononucleosis.  It has also be used to quicken the recovery phase in elite athletes in training and during competition.  This therapy is also being used post-DMSA chelation of heavy metals to replace the good minerals and trace elements lost in this therapy.

 
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Dr. J.P. Saleeby  is an integrative medical doctor who administers the Myers’ Cocktails.  He is the regional expert on the use of Myers’ Cocktail infusions in the treatment of disease.  Persons interested in receiving Myers’ Cocktails should contact Dr. Saleeby.   He can be reached at jpsaleeby@aol.com, www.saleeby.net or www.carolinamobilemd.com.  Infusions typically take 15 to 20 minutes and are administered by butterfly needle IV.  Cost is approximately $120/infusion.
 
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Thyroid Replacement Therapy: Fighting A Hidden Disease
 
By JP Saleeby, MD
 

The thyroid gland and the hormones it secretes play a crucial role in our health and well being.  The thyroid hormones act as messengers for body function, performance and metabolism.  For example they play a major role in weight gain and loss.  Thyroid hormones are a mixture of mono-, di-iodothryonine, T3 (triiodotyrosine) and T4 (thyroxine).  The hormones most traditional physicians are concerned with and replace is the singular thyroxine or T4 and usually in a synthetic form (levothyroxine under brand names such as Unithroid, Synthroid and Levothroid).  Occasionally traditional physicians will prescribe a synthetic T4-T3 drug liotrix (Thyrolar) and very rarely will they add something called liothyronine (Cytomel) a T3 synthetic.  These prescribing habits are based on the education of the vast majority of American physicians after the advent of synthetic thyroid preparations.  Much money has been spent by pharmaceutical companies who produce the synthetic hormones to promote their products to physicians.  Hence, most of the post graduate education on thyroid replacement therapy is obtained from representatives and their “educational” material distributed by these companies.  The use of desiccated natural animal thyroid glandulars (usually of porcine tissue) fell out of favor for no other reason than the “new” products emerging in the market place. 

 

Is the synthetic thyroid drug better than the natural?  No, just the contrary and I will outline it here very simply.  Detractors of natural thyroid bark about the levels of the commercially available products such as Armour Thyroid, Nathroid, and Westhroid as not being reliable and consistent from one pill to the next.  This may have been true 40 years ago, but today’s pharmaceutical processing and manufacturing techniques can assure quality and consistency.  The problems lie not in the natural, but in the manufacturing practices of the synthetic thyroid hormones.  Since Synthroid, manufactured by Abbott Pharmaceutical company (formerly by Knoll), came to market prior to 1962 it was never officially approved by the FDA and consequently had to file for New Drug Approval (NDA) last year. If you follow the news recently the FDA had to step in and demand one manufacturer to cease production until the product was approved.  Therefore, the physicians who “banter on” about the pitfalls of Armour Thyroid have no license to do so. 

 

Despite the many controversies synthetic thyroid has had over the years, it still remains the 3rd most prescribed drug in America with over $541 million in sales in 2000.  Industry greed can be seen in that from the year 2000 to 2001 there was an increase in the cost of this drug to consumer by eight and a half (8 ½) times the rate of inflation. Never the less, a historically well tolerated and well manufactured “natural” hormone is still available and FDA approved for thyroid disorders and should be embraced by more physicians in this country. 

 

How is Thyroid disease diagnosed?  Hypothyroidism (low levels of circulating thyroid hormone) affects 2% of the American population, so it is very important for routine screening to occur.  The American Thyroid Association recommends testing Thyroid Stimulating Hormone (TSH) at age 35 and every 5 years thereafter especially in women.

 

Traditionalists use the basic TSH and T4 serum tests to diagnose hypothyroidism.  However, thyroid dysfunction can occur in individuals with “normal” levels of serum TSH and T4.  When a patient exhibits signs and symptoms of hypothyroidism the hunt should go on to diagnose the disease instead of relying on just these two lab tests.  In my practice I use a hypersensitive TSH (hsTSH) and check for Free T4 and Free T3 levels (Free indicating non-protein bound hormone).  I may also screen for something called reverse T3 or rT3, which may be elevated when T4 is not converted to T3 in the peripheral tissues. Reverse T3 (rT3) is not bioactive and cannot exert the same effect as T3.  When the enzyme that converts T4 to T3 is deficient, T4 gets converted to rT3 in greater quantities.  This is commonly referred to as Sick Euthyroid Syndrome.  While levels of TSH and T4 may be normal, levels of Free T3 are low and rT3 are higher.  Here is where many with “lab-normal” hypothyroidism are missed.

 

T4 has a longer half-life than the converted T3, but T3 is about four (4) times more potent and exacts much more effect as a “messenger.”   Incidentally T3 is better absorbed by the intestines when taken orally than is T4, so a combination of T3/T4 makes even more sense in this setting of hormone replacement.

 

There are also other thyroid disorders that occur when the body produces antibodies against the hormone or the gland itself.  These have to be tested for as well.  Women are at more risk for thyroid disease than are men and there are a large number of women who develop thyroid disease 6 to 8 weeks postpartum (after childbirth).  Dosing of thyroid in pregnant hypothyroid women is also tricky and may require an increased of 45% of the usual dose to achieve balance.  Mothers-to-be are especially important patients to monitor.  Those suffering from “acute depression” should also have hypothyroidism ruled out before antidepressant drugs are prescribed.  Gross changes in body weight, skin texture, hair loss and energy levels should also alert the physician to test for hypothyroidism.

 

Dr. J.P. Saleeby, MD is an integrative practitioner who makes house calls via Carolina Mobile MD and has years of experience with  Natural HRT (for men and women).  He administers Myer's Cocktails in home all across the Carolinas.  He can be reached at www.carolinamobilemd.com or at www.saleeby.net.   Dr. Saleeby can also be reached  by e-mail at jpsaleeby@aol.com

 
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© 2009
 
 More articles can be found on a variety of medical/health topics on
Dr. Saleeby's blogs
 
Dr. Saleeby's Blog
 
WellSphere Blog
 
Books
 
In 2006 Dr. Saleeby published his first paperback book on Adaptogen Herbs.  Thebook entitled: Wonder Herbs: A guide to Three Adaptogens  (Xlibris) is available from the publisher at www.xlibris.com/wonderherbs  and for a signed copy speak with Dr. Saleeby directly.  Also available at fine bookstores and online retailers (Amazon.com, Barnsandnoble.com)
 
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