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  Appropriate Hormone Replacement Therapy HRT
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14.08.07

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Direct online shopping for your vitamins, minerals, supplements, herbal remedies, homeopathic remedies, alternative medicine - Healthspan Life - building sustainable healthMost People would rather not take a handful of pills each day...

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Mission Statement
Mission Statement On Appropriate Physiological Human Sex Hormone Replacement – Women And Men

Every week brings new conflicting headlines for and against sex hormone replacement for men and women.

The “sex" in sex hormones may be a major distraction, since the major long term health issue about universal sex hormone decline with aging is not primarily about sex and hot flashes, but about ensuring a vibrant useful active independent second half of life so that we die well – i.e. preventing the common major disabling aging diseases that rob us of decades of health.

It is about preventing the associated major risks of sudden death, or crippling diseases – obesity, diabetes, frailty, fractures, arthritis, heart attack, heart failure, stroke, visual and hearing loss, Parkinson’s, incontinence and dementia – and sexual impairment is sometimes the last complaint.

After insulin in 1922-3, human non-oral sex hormone replacement HRT was firmly established by 50 years ago by e.g. Schering AG and experts in USA, Canada, UK and Europe. Then Robert Wilson and Industry introduced oral patent xeno - (other species) -hormones (e.g. premarin and oral contraceptives- hormone therapy HT) for women’s convenience – and more profits.

Despite increasing warnings about cancer and thromboses with nonhuman especially oral hormones from the 1970s onwards, and sixty years of risk-free use of appropriate HT and especially balanced systemic Human sex hormones HuSH, the USA and Europe medical establishments then embarked determinedly in the 1990s with largely patent oral hormone therapy in the HERS, ESPRIT, Papworth, WHI, WISDOM, Oulu, HABITS and Stockholm trials – not just in elderly women, but in women with vascular disease and breast cancer. In elderly overweight women with established vascular and sub-clinical malignant disease, aggravation of these diseases especially with higher doses outweighed the reductions in fractures and colon cancer by such HT.

Up to WW2, there were few hormones, fast foods, TVs, cars or mechanical home / job aids, so most people were far more physically active and slimmer. Since then, technology has both extended life but also increasingly polluted it and reduced necessary exercise – with increasing obesity, feminization of nature , infertility, and consequently more diabetes, vascular disease – and sex hormone imbalance - in both men and women.

But, sixty years of use of physiological human hormone replacement – testosterone in men, estradiol – progesterone - testosterone; and appropriate conservative dose oral hormone therapy orally e.g. premarin + progestin in long term use - as in the Nurses Study, and the WHI and Oulu trials, in younger women – have shown reduced mortality and all aging major degenerative diseases without any significant adverse effects.

So even the world’s leading experts, even in the conservative strictly evidence-based International Menopause Society IMS and the International Society for Study of Aging Males ISSAM concur that there is no reason to withhold appropriate evidence-based HRT of the patient’s choice from hypogonadal men and women, since no individual modern chronic prescription designer drugs do as well.


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HRT for Women
Post-menopausal HRT - an anti-aging physician's perspective
Dr Craige Golding (specialist physician)
2007.06

"Today's truth is this: There is no magic hormone or combination of hormones that can be indiscriminately used by all women. Each women is an individual and hormonal balance must be the ultimate goal for all women".
Joseph Collins, N.D

What do we know about the synthetic hormone replacements?

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In postmenopausal women, appropriate lowdose estrogen reduces all disease and death risks: The latest evidence from the Women's Health Initiative WHI study June 2007 (1)

As we have known from evolution, physiology, and for the past 50 years since Masters and Johnsons’ pioneering studies, appropriate balanced bio-identical (BID) human sex hormone (HuSH) replacement does nothing but good.(2)

The WHI was badly designed (possibly in the commercial interests of the USA, Wyeth); and the WHI design caused gloom when published in 1998 (we stopped using such Premarin-type combinations where possible some 7years earlier). Fortunately the WHI did relatively little harm (although no good) for the elderly fat women so unwisely put on HT. But WHI confirms what we long knew - that in the under-sixties -from the earliest WHI (2002/4) papers, even PremPro lowered all-cause mortality, and breast cancer incidence, by 1/3. This correlates perfectly in the latest WHI paper with 60% reduction in coronary artery calcification in WHI with appropriate HT.

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HRT for Men
Is low testosterone linked to long-term risk of death?

Dr Garry F. Gordon MD,DO,MD(H) President, Gordon Research Institute says
I strongly support Testosterone supplementation particularly for those with low levels, as reported here, who are at greater risk of death. I find that the topical form of testosterone is generally adequate. I also use broader general hormone support whenever indicated. Therefore, I take Melatonin 3 mg at HS and I also generally recommend DHEA at levels of 10-25 mg for many of my patients, the lower dose for women. In the same topical formula many of my men patients also receive Progesterone and Chysin.
This research paper is one of only two that provides a decent rational to support my belief about the general benefits exceeding risks with testosterone supplementation.


He quotes the Low testosterone linked to long-term risk of death in over-50s study presented on June 5, 2007 at The Endocrine Society for publication in their ENDO 07 Research Summaries Book University of California, San Diego School of Medicine chief of the Division of Epidemiology Elizabeth Barrett-Connor, MD and colleagues evaluated data from nearly 800 men aged 50 to 91 who enrolled in the Rancho Bernardo Heart and Chronic Disease Study in the 1970s. Twenty-nine percent of the participants had testosterone levels at the lower limit of the normal range for their age at the beginning of the 1980s. These men experienced a 33 percent greater risk of dying from any cause over the ensuing 18 years than men with higher levels. Participants with decreased testosterone had a greater incidence of elevated inflammatory cytokines, as well as greater waist girth and other metabolic syndrome risk factors. "Conventional wisdom is that women live longer because estrogen is good and testosterone is bad," Dr Barrett-Connor stated. "We don't know. Maybe the decline in testosterone is healthy and comes with older age. Maybe the decline is bad and is associated with chronic diseases of aging." "The new study is only the second report linking deficiency of this sex hormone with increased death from all causes, over time, and the first to do so in relatively healthy men who are living in the community," announced coauthor Gail Laughlin, PhD, who presented the findings. "We have followed these men for an average of 18 years and our study strongly suggests that the association between testosterone levels and death is not simply due to some acute illness."

HealthSpanLife Dr Neil Burman comments:
All experience from evolution and since 1940 shows that appropriate physiological ie systemic human sex hormone replacement HuSHR (at least testosterone for men, testosterone-estradiol+- progesterone for women - not horse xenohormone pill doses as used in the elderly in the WHI) greatly extends health span and perhaps reduces premature mortality by one third (as does metformin to tolerance in this couch potato era); and probably fish oil, and combination of appropriate vigorous minerals- vitamins- other biological supplements
.

Whatever the dosing route and schedule used (avoiding hepatic first pass), HuSHR should be based on at least relative deficiency on lab tests; and the target should be to restore the vigorous mean levels of healthy active non-overweight young men and women, and avoid extreme highs and lows. Absorption from implants or transdermally( from cream, lotion or patch) is variable, so as well as clinical response one needs to monitor saliva or blood levels occasionally.

As with HuSH creams, we get excellent results with quarterly Nebido 1gm testo undecanoate deep sc for men and pro rata for women eg 100mg sc; and for the poor, with the old depot forms - testost enanthate or cypionate self-injected with an insulin syringe sc weekly ~ 70mg for men, ~7mg for women) or pro rata every 2-3 weeks depending on tolerance. For E2-deficient women we add physiological E2 as eg the valerate (ie Primogyn depot, or in Mixogen or Primodian depot) 0.5-1mg sc weekly or pro rata at longer intervals - as Masters and Grody(1953) pioneered in the first HRT RCT.

The WHI (2002) was not a trial of appropriate hormone replacement (HRT) but (mostly inappropriately in fat elderly women) of megadose (orohepatic) commercial xenohormone substitution therapy (HT) for human hormones (like anabolic steroid abuse) - although in more moderate dose in appropriately young and healthy women as in the under-sixties in WHI, and the 9year Oulu trial (Heikkinen ea 2006 0.7mg/day), even such oral HT did nothing but good eg estradiol.


Sex hormone deficiency (the commonest major hormone deficiency of all -affects >90% of the aging) is no different from all other endocrinology, it should be based on physiology and human hormone replacement, not reflex (gynaecologists' -Robert Wilson's) inappropriate arbitrary patent convenience pill therapy - which is what caused the post-WHI HRT ill-informed media hysteria ("thalidomide disaster" as infamously proclaimed by a German psychopharmacologist) that has led to tragedy for so many women denied appropriate HuSH.

Every week one sees lively ladies who were taken off longterm systemic testo+esto post WHI; apart from marked fatigue, they have often lost cms in height; and recently often developed deforming mixed OA/RA of the hands, heart failure; and rectal carcinoma; mind-numbingly currently treated with eg methotrex; indomethacin; furosemide; bisohexal, spiractone, perindop, indap preds, salazop; & trepiline; by different specialists on no supplements. The same applies to men - stopping any appropriate hormone replacement leads to progressive catchup disease.

Like HGH, there is little evidence in general to support DHEA HuSH unless the bloodlevels are frankly low in the slim elderly.

We have yet to find that adding (7keto)DHEA to testosterone +- estradiol/progesterone adds any benefit?


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