1. Do I Need Hormones? Dr Johnnie Ham, MD Coastal Prestige Medical Services and Clinic Pismo Beach, California

2. What are Hormones? Hormones are BioChemical MessengersHormones are BioChemical Messengers Hormones control numerous functions in the bodyHormones control numerous functions in the body One of the Two Major Controllers in your bodyOne of the Two Major Controllers in your body

4. Unique Targets

5. Where do they come from?

6. Focus on the Major Sex Hormones EstrogenEstrogen Estradiol – the major playerEstradiol – the major player Estrone – less active, post-menopausalEstrone – less active, post-menopausal Estriol – the pregnancy estrogenEstriol – the pregnancy estrogen ProgesteroneProgesterone “pro” “gestational”“pro” “gestational” TestosteroneTestosterone

7. Estradiol Performs over 240 functions in the bodyPerforms over 240 functions in the body In contrast, Testosterone performs about 110; Thyroid Hormone performs about 15In contrast, Testosterone performs about 110; Thyroid Hormone performs about 15 Produced by the month’s stimulated follicles in the ovaryProduced by the month’s stimulated follicles in the ovary So, no stimulated follicles, no estradiolSo, no stimulated follicles, no estradiol

8. Testosterone improves oxygen uptake throughout the bodyimproves oxygen uptake throughout the body controls blood sugarcontrols blood sugar regulates cholesterolregulates cholesterol increases lean body massincreases lean body mass prevents osteoporosisprevents osteoporosis maintains immune functionmaintains immune function maintains cardiac functionsmaintains cardiac functions Stimulates neurological function and repairStimulates neurological function and repair

9. Prevalence of Hypogonadism Using Bioavailable Testosterone and Free Androgen Index From Morley JE, Perry HM. Andropause: an old concept in new clothing. Clinics in Geriatric Medicine 2003; Vol 19, No 3. Table 2. Prevalence of hypogonadism in older men. Age (y) Percent Hypogonadal Baltimore Longitudinal Mayo Clinic Canadian Physicians Baltimore Longitudinal Mayo Clinic Canadian Physicians 40-49 32 32 37 37 41 41 50-59 49 49 66 66 61 61 60-69 64 64 70 70 76 76 70-79 78 78 94 94 95 95 80+ 98 98 -- --

10. Symptoms of Testosterone Deficiency in Women AND Men Decreased or absent libidoDecreased or absent libido Erectile or Sexual dysfunctionErectile or Sexual dysfunction Decreased muscle massDecreased muscle mass Decreased muscle strengthDecreased muscle strength OsteoporosisOsteoporosis Heart diseaseHeart disease Sleep disordersSleep disorders Memory failureMemory failure IrritabilityIrritability Decreased energy levelDecreased energy level Mood swingsMood swings Depression Depression AnxietyAnxiety Increased painIncreased pain Cold intoleranceCold intolerance Decreased self-confidenceDecreased self-confidence Decreased cognitionDecreased cognition Loss of sense of well-being

11. Serum testosterone (a) and free testosterone concentrations (b) in patients receiving testosterone gel 5 (closed circles), 7.5(closed squares), and 10g/d(closed triangles). The dotted lines represent the adult male reference range Jockenhovel F et al. The good, the bad, and the unknown of late onset hypogonadism: the urological perspective. Journal of Men’s Health and Gender. September 2005, Vol 2, No. 3.

12. Is there anything I can do without taking hormones? Lots….Lots…. ExerciseExercise DietDiet Herbal SupplementsHerbal Supplements Stress Reduction techniquesStress Reduction techniques Chiropractic careChiropractic care Massage therapyMassage therapy

13. So Why Treat?

17. Managing Hormones Basic Level Start with symptomsStart with symptoms Educate on risks, benefits, alternativesEducate on risks, benefits, alternatives Begin therapy, monitor the resultsBegin therapy, monitor the results Incrementally add or subtract whatever is needed for your personal desired effectIncrementally add or subtract whatever is needed for your personal desired effect Once everything is “perfect” then measure to get a baselineOnce everything is “perfect” then measure to get a baseline Generally, using Estradiol, Testosterone, and sometimes progesteroneGenerally, using Estradiol, Testosterone, and sometimes progesterone

18. How much does it Cost? If not covered by insurance:If not covered by insurance: Testosterone and estradiol cream thru the Women’s International Pharmacy is $19.50 per month eachTestosterone and estradiol cream thru the Women’s International Pharmacy is $19.50 per month each Most insurance companies cover estradiol for women and testosterone for men, including MediCareMost insurance companies cover estradiol for women and testosterone for men, including MediCare Most men are willing to pay $19.50 for testosterone for their wives…Most men are willing to pay $19.50 for testosterone for their wives…

19. More Info? Strongly Recommend:Strongly Recommend: “Perfect Balance” by Dr Robert Greene, featured on Oprah, bestseller“Perfect Balance” by Dr Robert Greene, featured on Oprah, bestseller “The Life Extension Revolution” by Philip Lee Miller, MD, Los Gatos Longevity Center“The Life Extension Revolution” by Philip Lee Miller, MD, Los Gatos Longevity Center “Natural Hormone Balance for Women” by Uzzi Reiss, UCLA“Natural Hormone Balance for Women” by Uzzi Reiss, UCLA Caution – be careful about what you read on the Internet!Caution – be careful about what you read on the Internet!