Healthcast 620 - Menopause Causes Insomnia and Sleep Apnea, if you don’t replace Testosterone and Estradiol

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Every day in my office I hear horror stories about how my female patients are dismissed by the doctors they trusted to help them resolve their problems such as:

 

·      Hot Flashes and night sweats

·      Loss of libido

·      Rapid weight gain

·      Brain Fog

·      Insomnia

·      Arthritis associated with lack of hormones

·      Anxiety/Depression starting in their late 30s

·      New irritability

·      New Migraine headaches

·      Lack of motivation

·      Fatigue

 

There doctors dismissed them, telling them they were just getting old, or they were “babies” because they can’t stand a few hot flashes, the doctor changed the subject, or my most unfavorite response to a plea for help, “It is just in your head”. Many other demeaning responses have been recorded, but I am appalled at these responses.  For a patient it takes so much strength to ask these questions, and patients are literally at the doctor’s mercy.  In case you didn’t get it, the doctor who says these things is covering up for his/her own ignorance.  These are methods used by a person in charge who is challenged to answer a question he or she doesn’t have an answer for.  In general, these doctors are men and women, however women have been trained by men and they taught women to do what they had been doing for years.  These “medical” responses are used to belittle the patient to hide their own lack of knowledge. If you are dismissed in this way you should not put up with it.  You can just never schedule with that doctor or practice again or you can find a new doctor who will hear your distress and treat you or tell you they don’t know how to help and refer you to someone who does. You shouldn’t put up with dismissive doctors. 

Another dismissive phrase used by many doctors since the inaccurate WHI study is you’re your doctor tells you that he doesn’t BELIEVE in hormone replacement. You should respond that hormone replacement is not a religion, it is a medically necessary treatment for menopause! Board certified OBGYNs and Family Doctors should be trained in this treatment. 

We women have not only been dismissed by doctors, but also by the Colleges (eg. American College of Obstetrics and Gynecology) that tell doctors how to practice.  In my OBGYN training I was taught that most of women’s complaints were because they were depressed so they told us to put women on anti-depressants that just make them numb, but that did not treat our symptoms.   Misogyny is alive and well in the practice of medicine, even in the group of doctors who are supposed to dedicate their lives to the health of women, Obstetricians/Gynecologists.

Discrimination CAN be taught, and I believe medical training still teaches these male oriented beliefs to new doctors who are almost 50% women. Medical schools allow women to become doctors because we are qualified, and they can’t discriminate anymore.  When I was trained and for a few decades after I became a doctor, you would think I was a second-class citizen. I was left out of resident training run by the residents (almost all men).  Those older male doctors treated me like and. Interloper and some even told me I was not supposed to be a doctor because of my sex. …I was never treated as if I was an equal from the minute, I started medical training and women now practicing over the age of 50-something were all trail blazers and were told all women were hysterical and complainers.   I never accepted this view but now know that women complain because we are not believed and not treated with a treatment that really relieves our symptoms.

 After my hysterectomy 2002 I was in private practice with like-minded women in Balanced Care for Women, and they tried to help me but admitted they didn’t have the knowledge. I had terrible symptoms that I now know was from lack of testosterone.  The endocrinologists and primary doctors I sought help from belittled me and treated me like I was making the symptoms up!  The worst experience I had was with endocrinologists who were women just saying what their male counterparts had taught them without really thinking.  They “drank the Kool-Aid “from their male teachers and treated me like I was crazy because they were unwilling to admit they didn’t know what was wrong with me!  I grew up in medicine (1977-now) under a cloud of sex discrimination and when I needed them most at the age of 47 my sister-doctors failed me…I know intimately how my patients feel when seeing doctors that demean them.

 

There has been a Federal Law to protect women since 1972, when the US government passed Title IX a Federal Civil Rights Law amendment, but in my experience the law was violated all the time.

 

Title IX 1972 (my interpretation is simplified and not the actual word for word amendment)

Sex discrimination is unlawful in choosing an employee, a medical student, funding for sports at the collegiate level.

 

I am a champion for women and women’s rights. We should require every medical student to be taught about this so the teaching from one generation to another doesn’t contaminate young doctors.  Without this action the misogyny in medical care will continue. Recently The DEA required doctors to take an 8-hour course to help them learn to communicate with substance users in a more kind and sympathetic manner. The course’s direction to be compassionate and supportive to substance users should be taken for treating women as well. That would be a giant step for all of us.  Wiping out discrimination takes generations but must start somewhere and that should be taught at the beginning of medical training.

After we conquer the minds of physicians then we will have to work toward equity in drug development (all drugs are tested on men, but women were not tested on new drugs until 2014), the FDA, the DEA, and Pharmaceutical companies.  To make this happen patients will have to take part and not accept dismissive and discriminatory behavior by their treating doctors.

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That is a strong statement, however I am confident in saying that belly fat can put you at risk for Alzheimer’s disease, because it is a fact supported by medical research. These studies reveal that obesity, especially abdominal obesity (Beer belly, Gut, “Dunlap’s disease”…..), increases the onset and rate of Alzheimer’s dementia! Another reason to change your lifestyle to benefit your longevity.

Abdominal obesity can come from fat accumulation right underneath your skin (the fat you can pinch between 2 fingers) OR the fat that grows inside your abdomen like an apron draped over the intestines. It is called “visceral fat”, and this type of fat is what places you in the crosshairs for several diseases of aging including Alzheimer’s Disease, heart disease, stroke, diabetes, and rapid aging.  A large belly is more common in men, but it is still a risk for women if they develop an apple shaped body.

Below is a picture of visceral fat, and a diagram of what it looks like in an artist’s sketch of a normal weight person. When the yellow fat doubles and triples in thickness the abdomen pushes out to look like a “beer belly”.  

Visceral fat extends from your stomach over the transverse colon and your small intestines like an apron.  This fat pad thickens with alcohol abuse (beer belly), high carbohydrate diet, overeating, junk food, under exercise and creates a large pad of fat that secretes inflammatory cells.  The resulting inflammation is the vehicle that damages your brain leading to Alzheimer’s disease and damages your arteries leading to heart disease and stroke.

In my office we use INBODY machines that measure your Visceral fat, BMI, and percent body fat.  Normal visceral fat is below #10 on our machine, BMI less than or equal to 25, and fat % for men < 19% and for women < 26%.

The Research: A recent study correlated the size of patient’s belly (visceral belly fat), and obesity with the amount of amyloid plaque (the cause of Alzheimer’s disease) in their brain. This was measured by MRI in the study subjects’ brains.  The age of the patients studied was between 40-60.

The study found that the amount of visceral fat (fat inside your abdomen) is directly correlated with the amount of amyloid plaque and inflammation in the brain!  That causes Alzheimer’s Disease.

If that doesn’t motivate you to lose your belly fat, then you are making a choice to eventually suffer from Alzheimer’s disease, a heart attack, a stroke or arthritis.  If you are thinking that you will just wait for “something to happen”, then not making a decision to change your lifestyle is making a decision to take on illness in the future.

We have new medications to help you lose that belly fat and they really work. You should ask your doctor to help you and if they don’t understand the importance of arriving at ideal weight then look for a different doctor who will help you.

Even with medication you will have to put in the work and self-control to turn down unhealthy foods when others are being unhealthy.  You will also have to add daily exercise to your schedule if you really want to avoid Alzheimer’s Disease, heart attack, stroke and early death.

The possible meds and habits that can help you lose your “belly”:

·     Limit calories and or carbohydrates

·     Increase daily exercise

·     Diet pills (amphetamines that older patients usually can’t take)

·     Xenical (Orlistat)-Side effect is fatty diarrhea

·     Qsymia (topiramate/Phentermine) can increase BP

·     Contrave for craving (naltrexone/bupropion) can decrease sex-drive

·     Semelanotide (Imcivree-new), darkens the skin, expensive

·     Metformin ER an oral, effective medication to treat insulin resistance, and promote weight-loss

·     Victoza and Saxenda injections are diabetic treatments, that can cause GI reflux, however they work well for patients who have Type II Diabetes who need to lose weight.

Even though many patients lost weight with these medications, many could not tolerate the drugs listed above because of the side effects.  These side effects limited our ability to help all patients lose weight…until now!

Now, for the first time we have an effective way to help most people lose their dangerous visceral (belly fat). If you have a big belly you are at high risk for inflammatory diseases like Alzheimer’s dementia, obesity, heart disease, diabetes, cancer and stroke.

The new weight loss drug’s generic name is Semaglutide, and has been marketed under several names: Wegovy, Ozempic, and Rybelsus. A second generic drug that is in the same family of drugs is called Tirzepetide, includes Mounjaro (for diabetics) and Zepbound (for weight loss). All of these drug’s work for weight loss, pre-diabetes and Type 2 Diabetes.  Most insurance companies do not cover weight loss and they require a precertification for you to get the medication covered by insurance.  This precertification process is time consuming for the doctor and her staff, which costs the doctor an increase in her overhead to employ a nurse to provide this service for the patient. In general people with a BMI under 30 will not be covered for Semaglutide or Tirzapeptide, however if their BMI is over 30, there is a chance insurance will pay for one of these drugs for a period of time.

The market price at the pharmacy is between $900/$1200 per month if you pay out of pocket to your pharmacy. Because of this fact and because we have so many patients whose pellets are not paid for by insurance, we provide access to the generic form of these drugs through a compounding pharmacy. The cost is a fraction of the normal out of pocket cost, about $560 for 3 months supply. In this way we have been able to treat many people who cannot afford to pay the exorbitant going rate for this medication.

Because it is costly for a patient to receive the medication no matter how they are able to get it, It is very important for weight loss patients to be compliant and follow a low carbohydrate diet, exercise daily and to refrain from alcohol consumption while they are taking weight loss medications.  We require our patients who request these drugs to be seen at least every 2 months by one of our NPs or our weight loss specialist to help them get the best results possible.

These drugs work for weight loss and diabetes by multitasking.  The ways the medication actually works are listed below: Semaglutide and Terzapeptide,

·      decrease hunger between meals  

·     you feel full faster than normal so you eat less

·     decrease sugar and alcohol-craving

·     decrease the release of sugar from the liver when you are fasting, which turns into fat

·     Prevent hypoglycemia which causes hunger and fat gain

·     Makes patients more insulin sensitive.

Obesity is not just a lifestyle problem; it is a disease that should be treated with medicine PLUS lifestyle changes. These drug actions take place in the brain, stomach hormones, pancreas and liver, as well as in all the cells in your body.

At Bio Balance Health® have years of experience in treating patients with bio-identical testosterone pellets and we have observed that weight loss plus testosterone pellets for patients over 40 allows patients to lose fat without losing muscle. Now we add these weight loss medications to T pellets, and we have the perfect combo for safe weight-loss (really fat loss).

The biggest worry for patients is that they may not be able to get off this drug after they achieve ideal weight.  I have found that the longer you have been overweight and the more overweight you are, the higher the risk of needing maintenance medications to maintain your ideal weight. We try to wean our patients off injectable meds by switching them to Metformin ER, a drug that insurance will pay for.

With these effective meds we finally, we have an effective preventive treatment to add to our testosterone and estradiol pellets for those people who view Alzheimer’s as their worst nightmare, and for those patients who are worried about heart disease, diabetes and stroke  we can prevent the diseases that can ruin our “golden years”.  

KCM

Research:

People with large amounts of visceral fat as they age may have higher risk of Alzheimer’s disease.

NBC News (11/20, Carroll) reports, “People who have large amounts of” visceral fat “as they age may be at higher risk of developing Alzheimer’s disease, a new study suggests.” The findings were presented at the Radiological Society of North America’s annual meeting.

HealthDay (11/20, Thompson) reports that investigators “compared brain scans of 54 people between the ages of 40 and 60 with their levels of belly fat, BMI, obesity and insulin resistance.” The investigators “found that people who had more visceral fat compared with fat found just under their skin tended to have higher amyloid levels in the precuneus cortex.” The “relationship was worse in men than in women, and higher visceral fat measurements also were related to increased inflammation in the brain.”

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At Bio Balance Health I order blood tests to evaluate my future patients before I even have my first appointment with them.  I use them to find a baseline for an individual patient, and to see if hormones will help them with their symptoms.  Blood tests work well for establishing a diagnosis but are not the only factor in determining an ideal dose of hormone that works for that patient.  Symptoms and medical history supply most of the information for determining dosage as well as help me find other medical problems to treat at the same visit. Many diseases in the early stages are not treated by primary care doctors because they are overwhelmed with their number of patients and the short-time they are allowed to see them.  Our goal is to prevent disease that have been missed or treat conditions at an early stage before they become severe.

 

Blood tests establish and confirm both hormone deficiencies and provide a baseline level before treatment and the optimal level for each individual patient.   That blood level may or may not be within the range that is expected for a treatment success (written on the lab report). You are an individual and it is my job to find the ideal blood level of hormones for you.

 

Why would the blood level not tell the whole story?

 

Your body is genetically programed to both PRODUCE hormones from your endocrine glands and ACCEPT those same hormones in each cell.  Every person is an individual and each person makes hormones based on their genetic map and environment. Everyone is programed genetically to accept hormones into their cells in an individual manner. This is the key to understanding the differences between patients’ responses to an equivalent dose of hormones, either excreted from their own glands or absorbed through their chosen delivery system (oral, vaginal, transdermal or subdermal pellets) after their glands have aged and don’t produce enough hormone, like estradiol and testosterone.

 

I was in Cambridge in 2014 for the release of my first book, The Secret Female Hormone, when I visited a medical bookstore.  I discovered a large red book that weighed no less than 10 lbs was titled Testosterone.  I looked through this book and found that there was information that I had not discovered in my research of the American medical journals and books, so I bought it and read some of it on the long flight home to St. Louis, MO. I found that this book had answers to questions I had uncovered in my then,13 years of hormone medical practice. My biggest question at that time was why 2 people of the same sex having the equivalent blood level of free testosterone often feel completely different. For example, I was trained that if a man had a blood level of free testosterone that was above 129 pg/ml and under 350 pg/ml (using Quest Diagnostics lab), then he should feel normal, like he did when he was in his thirties (barring any other illnesses interfering). However, I observed that some men felt great at 110 pg/ml while others at 130 continued to have the symptoms of low T. This puzzled me, but at that time I had no answer. Then I read the first chapter of Testosterone.

 

The answer is found in the individual differences in the receptors on each cell for that hormone, the receiving end of the hormone physiology.  It informed me that receptor sites are genetically created differently in each individual and that one-size-does-not-fit-all!

 

You can bathe a person’s cells with what is considered an adequate blood concentration of testosterone for most people, let’s say men since that was the subject of the first chapter, of the book Testsosterone, but some men would receive and use only a small portion of the circulating hormone. Their cells were “resistant”, therefore they required a higher concentration of hormone, to activate their cells. This very important fact in endocrinology has been ignored until recently when we began to use genetics to find the differences between individuals’ receptor sites for all hormones and all peptide communicators. In the last 10 years we have found that receptor sites are the missing link in determining a person’s required dose of a hormone, and they are genetically determined.

 

Here is an example from the book in a very simplified translation. Think of a key and lock. Each cell has “locks” or receptor sites all over it, and the keys are the testosterone molecules.  Some people’s cells have locks that are easy to open and turn on a cell. They are “sensitive” to that hormone.  Some cells have difficult “locks” and they must be bombarded with a hormone “keys” to turn the cells on. This led the researchers to look for the snips of DNA that were responsible for the difference. They found them and then tested men from all over the world to see if there were regional groups, genetic groups, that contained more sensitive receptor sites or more resistant.

 

The results are quite telling and explain the differences between races and peoples in terms of how their bodies use the testosterone hormones available.  The men with the most sensitive receptor sites live closer to the equator: Mediterranean, African, Brazilian, and those men with more resistant receptors had DNA from ancestors who came from closer to both North and South poles: Scandinavia, Canada, Europe, South Africa, Southern Argentina etc.  The results mean that if you have a clear genetic line from one of these groups, we can predict whether you need a higher dose or lower dose to get the same resolution of symptoms. Most people in America are mixtures of genes so most patients don’t give me any information from their ancestry.

 

However, there are two catches to this system of determining an individual’s receptor site sensitivity; 1) In this century we are able to travel and find a mate on the other side of the globe and have been able to do so for generations, therefore we are “mutts”, or people who have multiple genetic sources in our DNA and therefore how we look or where we are from is not a good predictable factor for how we will accept our testosterone. 2) There is no commercially available test to evaluate the sensitivity of our receptors. Currently, the best science has found is to test DNA for the snips that predict sensitivity or resistance to testosterone!

 

This too will come to the practice of medicine, but “medicine” moves slowly and the government and people in control are always looking for a one-size-fits-all approach to illness and or aging, which makes me think this type of test will not be embraced by general American medicine.

 

At this point all I can tell you about dosing and blood levels is that you have an individual level that is good for you, so I try to figure out what that is, and “mark it” with your “perfect blood level”.  I proceed with is the knowledge that there are many other factors that affect the blood level of free-testosterone (active form) and the effect it has on individual patients.  This leads me to practice individualized medicine like a tailor makes a dress or suit that fits one person only. I have a lot of experience to recognize resistant or sensitive T receptor patients and I now know how to approach their care.  It is NOT by trying to adjust their hormones into the very inaccurate free T levels printed on the blood lab sheet, however I do look at those numbers to establish a baseline for that person, and I do listen to my patients when they tell me whether their symptoms are resolved or not. Resolving all SYMPTOMS is the real sign of a successful replacement of testosterone in both men and women.

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When I tell my patients that they need a high protein diet, all they can think of is meat…but protein sources are found in many parts of our diet and eating a variety of protein sources is the key to health, we should find out what we should eat and why?

Protein contains amino acids that are the major building blocks to make our muscles, skin, connective tissue, tendons, ligaments and bones.  It also supplies the components of our skin, hair and nails, and carries with it calcium (the major component of bones and connective tissue).  Protein is found in cheese, milk, all milk products, whey for protein shakes, pea protein, fish, all seafood, chicken, lamb, eggs, Quinoa and beans for building muscle. Pieces of proteins make up every fluid the body makes, including hormones, enzymes, peptide communicators, the immune globulins, semen, breast milk, and vaginal discharge….is it any wonder that I tell my patients to increase protein in their diets!

Despite the need for amino acids and short chains of amino acids called peptides, we also need a variety of foods, all colors at every meal to provide the other building blocks of our body.  For example, fat is a very necessary food for every person, at every meal.  When I was pregnant, I wanted to feed my baby everything she needed to build a healthy beautiful brain, so I ate Braun Schweiger every day (made from liver) for lunch with a salad.  The Braun Schweiger provided Rachel, my daughter, with the building blocks for an amazing brain. Our brains are almost all fat.  That is the type of tissue that nerves are made of, but nerves also need B12 to work properly and B12 is primarily from animal products. It is relatively easy to include fat in our diets, but it is truly difficult to get enough protein to build muscle on a vegan diet. My vegan patients must be experts in obtaining protein from their diet and must be aware of the components in all the food they eat to get the proper nutrition.

Carbohydrates are made for “action”.   Carbohydrates are required for exercise, walking and brains also burn carbohydrates when you are doing “brain work”. Carbohydrates are stored as fat if we eat them but don’t exercise!  Think before you eat carbohydrates about your next 12 hours and whether you are going to exercise to burn the carbohydrates in your diet.

So How Much Protein Do We Need?

Growing teenagers, people who lift weights and try to gain muscle, pregnant women (need a minimum of 100 grams a day) and patients like mine on testosterone need more protein in their diet than the average sedentary, adult.

To quantitate the number of grams of protein you need to sustain your body with a high percentage of muscle, a person needs more than ½ their weight in grams of protein. For example, a 125 lb. woman with average to high muscle mass will need more than 62.5 grams of protein a day. A person with higher muscle mass will need more than that.

For athletes, weight lifters, patients trying to lose weight and sustain their current muscle mass, they need to eat the equivalent number of grams of protein to their weight, every day. 

To do this a person will have to know how many grams are in each serving of their current foods and if they aren’t eating enough, they should add high protein, low carb protein shakes times before or after they work out or exercise.  A typical protein shake will have 15 to 20 grams per serving and less than 5-10 grams of carbohydrate.

An average size  hamburger has about 20 grams of protein.  Add beans, peas, cheese, yogurt, butter, ricotta cheese, milk, eggs, custard, chicken, fish fillets, shrimp, and protein bars.  Be careful not to overeat carbohydrate with your protein which can cause you to gain fat, while you make muscle.

Why do we need more protein on the days we work out, especially with weights?  Weight training is a great muscle builder, in fact it is the best form of exercise for increasing your muscle mass.  But why do people who engage in this type of activity require more protein than those who walk?  The answer is in the physiology of human muscle when stressed by weight training exercises. 

When you work out with weights you put specific stress on your muscles, and during the hour or hours you engage in this type of exercise your muscles are broken down. That’s right, initially you LOSE MUSCLE! The act of physical labor on the human body that uses weights against gravity causes stress on the muscle fibers and they are broken down, their components (all made of protein) are then excreted from the body.  We don’t recycle much of the broken-down muscle! Instead, we must provide new building blocks, or amino acids that are circulated to the muscles from our diet, tp build back the muscle and even build more than was there the day before your exercised! This is the reason weight-lifters work out the top half of their body one day and let it rest (to build muscle) the next day while they exercise the bottom half of their body!

Now let’s talk about protein necessary for aerobic exercise like running or fast walking.  Distance running does not build muscles in the legs (or anywhere else), because this type of aerobic activity breaks down muscles that are working hard, but they are not stressed against gravity enough to build muscle, unless the runner is obese. Obese people who do or do not exercise have huge calves not because they work out, but because their legs have to hold up more weight than it is designed to support so their lower legs lift a fat body every day!  Runners, however, are usually slender, and their calves, quads, and hamstrings are slender too.  They do not build muscles while running.  The purpose of running is the production of endorphins for enjoyment, and the aerobic benefit to the cardiovascular system.  Running also burns alot calories so carbohydrates are needed to give the current muscles energy to run.  If you have ever looked at runners’ legs, they are not “cut” like lifters legs, that show the muscle bellies of the legs, but they are narrow long and smooth. These people don’t need as much protein as a lifter even though they are running every day, because they don’t require as much protein to build back what they already have plus more protein to make the muscles bigger! They just must sustain the muscle mass that is being used.  Their need is in carbohydrates that give them energy to feed the muscle fibers.

As people age, they lose muscle mass unless they take testosterone and eat a high protein diet. Left to nature their muscle mass decreases by 3-8 % EVERY YEAR between the ages of 40 and 90, unless you take a healthy dose of testosterone.  Aging adults are advised to eat more protein to prevent this catabolism but truly it doesn’t work if you don’t replace the hormone that signals muscles to grow which is testosterone.

Remember that protein comes primarily from animal products but can also be found in many kinds of beans and peas, but not in any fruit. Remember to grow muscle you need.

 

·      Protein in grams per day equal to your weight

·      Varied colorful diet with enough fat and carbohydrates.

·      Testosterone

·      Weight bearing exercise

Another reason supplements might not be necessary: “Protein is in every food group except fruit,” Dr Webb says.

Every human was born to eat a variety of foods to satisfy all their daily nutritional needs. The benefits of variety include the types of protein sources. Meat is an obvious source of protein, but “thankfully we can find protein in a multitude of plant-based sources, including lentils, tempeh, tofu, and beans,” Corwin says.

Barkoukis, a researcher on protein and nutrition, advises that "Variety in diet is the best plan,” she says. “Beans are an amazing powerhouse," however they do not have all the amino acids the body needs to sustain life. “Not all protein sources are alike, or equivalent. Animal proteins are “complete” in that they contain all nine essential amino acids, while most plant proteins often have some—but not all—of those aminos that we cannot make in our bodies, so we must get them from a food source.” Quinoa has all the essential proteins; beans are incomplete and should be combined with other sources.

For those who always ask how food work, here it is taken from a book called Human How do the proteins from foods, denatured or not, get processed into amino acids that cells can use to make new proteins? When you eat food the body’s digestive system breaks down the protein into the individual amino acids, which are absorbed and used by cells to build other proteins and a few other macromolecules, such as DNA. Nutrition.

1.    In the mouth your saliva begins the metabolism of proteins with amylase that is produced in your salivary glands. Your chewing breaks protein down into small pieces to help digestion.

2.    In the stomach acids (Hydrochloric acid from gastric juices and an enzyme pepsin to break down protein. Proteins take longer in the stomach to break- down so you feel full longer when you eat proteins.

3.    The small intestine is the major player in protein digestion. Here the Pancreas secretes trypsin and chymotrypsin These enzymes break food protein into amino acids.

4.    At the end of your small intestine there are specialized cells that transport protein into the bloodstream, and it circulates to where it is stored to make vital enzymes and building blocks for when you haven’t been eating.

5.    Amino acids are recycled to make new proteins (muscle, enzymes, skin hair, etc. Amino acids to build other biological molecules containing nitrogen.

 

“It is critical to maintain amino acid levels by consuming high-quality proteins in the diet, or the amino acids needed for building new proteins will be obtained by increasing protein destruction from other tissues (stealing protein from your muscles) within the body, especially muscle. This amino acid pool is less than one percent of total body-protein content. Thus, the body does not store protein as it does with carbohydrates (as glycogen in the muscles and liver) and lipids (as triglycerides in adipose tissue). such as DNA, RNA, and to some extent to produce energy.”  Eating protein is vital to life!

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There are almost as many different human metabolic variations as there are people in the world.  Our genetics make us all unique in ways that vary the way we can lose weight or even gain weight. On the other hand, we all had to descend from humans who survived famine, lack of water and lack of nutrition sources, so in one way we are all the same…we have genes that helped us survive times that required of us the ability to maintain our weight even without eating!  The people who genetically were unable to gain fat and keep it to hold them over during famine just didn’t make it to an age they could procreate. The rest of us whose ancestors survived, have given the majority of us the genes to maintain body fat.

 

Unfortunately, we have been blindly unaware of what man’s evolution and progress has led us to physically, and most of us are over-fat, and have trouble losing it!  The very genes that allowed us to survive the beginning of man’s existence, are the same ones that make it hard to become slender. In addition, in our current societies in the western world, food is plentiful and inexpensive.  Our genes have not changed, but our environment has, and we are becoming sick because of our obesity…how do we survive this “new world”?

You may hear a lot about insulin resistance, and I talk about it a lot on my Healthcasts, but it is insulin resistance that has allowed us to survive and has also led us to obesity today.  The humans who were insulin resistant who also held on to their fat in times of starvation are also the humans who have become obese in the face of plenty. We can’t change our genes, but we can turn some of the obesity genes off through lifestyle and sometimes with the help of medication.

Despite our basic sameness, we are also each individual, and genetically programed so that some of us lose weight if we restrict calories, others lose weight only if they exercise; Some of us don’t lose weight with exercise; some people don’t lose weight with carbohydrate restriction or fat restriction, and some do.  This is the ugly truth that lies behind the millions of books on diet, none of which work for more than a small number of us, and because it is a diet we can’t maintain it...what we need is to determine is the best weight loss program for each of us, by using trial and error, or by using genetic testing that tells us what our best pathway to a normal weight looks like.

 

To begin we must take baby steps and learn about food and what the words mean that we use when referring to food.  Because there are many people who may have several hurdles to jump before they can live at their healthy weight, we need to all speak the same language of weight loss.

 

So let’s start with a bit of education about food.

 

WHAT IS A SIMPLE SUGAR?

 

A simple sugar is a nutrient meant to give you energy for physical activity. Eating a small amount of a simple or a complex sugar before exercise is a good idea. However, if you sit most of your day, working with your brain instead of your body, simple sugars can increase your fat storage because you aren’t physically working. This is true whether restricting sugar is your genetic method of weight loss or not. Too many simple sugars make you hungry and cause everyone to overeat.….causing weight gain and fat gain. So what are simple sugars?

 

Examples of simple sugars:

 

·      Sugar, white, cane  and brown

·      Molasses

·      Regular Soda

·      Agave

·      Honey

·      Syrup-maple or any

·      Rice, white and brown

·      Cereals-all

·      Oatmeal

·      Donuts

·      White potatoes

·      Bread

·      Pancakes/waffles

·      Noodles

·      All Grains: wheat, oats, rice, corn and anything made from them including flour

·      Sweet tea

·      All Cakes, brownies, candy, chips, and many energy bars

·      All bagged snacks like pretzels, chips, cookies, and fruit with sugar added

·      Pies and most desserts, except fresh or frozen fruit.

·      Dried Fruit (has sugar added eat frozen fruit instead.)

·      All non-milk-based salad dressings except plain Olive oil and vinegar.

 

Note: All diet sodas have chemicals that stimulate insulin like sugar.  There are a few brands that use Stevia (an herb that is sweet, and not a chemical) and they are the exception so you can drink those without stimulating fat production.  Other options are unsweetened bubble water or plain water.

 

 

Eventually eating a diet filled with simple sugars leads to obesity, and diabetes no matter who you are, therefore if you are in not working physically with your body all day, every day ( machinists, farmers -in the summer, factory workers, outdoor laborers) you should not eat these foods except in small amounts with a protein to lengthen the time until you feel hungry again.

The rest of us should rarely eat these foods. They should be considered foods for “special events”.

 

 

If you exercise aerobically and/or with weights for more than an hour at a time, then you may eat a small amount of simple sugars but eating small amount of complex sugars is healthier to help you maintain your muscle mass and your exercise stamina while losing fat.

 

 

 

COMPLEX CARBOHYDRATES: EAT INSTEAD OF SIMPLE SUGARS

 

 

SWEET POTATOES

 

Sweet potatoes taste sweet and have complex Carbohydrates so it takes longer for them to be digested which means they do not stimulate the secretion of insulin as fast or as high as white potatoes. They are a complex sugar.

 

Sweet Potatoes also have several health benefits including antioxidant healing role and anti-inflammatory properties.

 

CHICKPEAS (GARBANZO BEANS, BLACK BEANS AND LENTILS)

Legumes like chickpeas, black beans, and lentils are not only complex carbohydrates buy are a great source of dietary fiber, making them wise choices for a filling you up and satisfying the pre-workout carbohydrate requirement.

 

QUINOA

 

Quinoa is a good source of plant protein. It can be a substitute for bread or pasta.

 

WHOLE GRAIN BREADS LIKE DAVE’S LOW CARB & HIGH PROTEIN BREAD

 

Whole grain bread like Dave’s Bread has enough fiber and nut protein to prevent excessive stimulation of your insulin. Too much insulin leads to insulin resistance and causes fat gain instead of giving your cells energy.

One piece of bread per meal is all you should eat if you are overweight and or have Type II diabetes in your family. Make sure you are not eating more than 25 grams of carb in any meal.

 

WILD RICE- is a seed and not a “rice”

 

You should eat wild rice instead of any other type of rice and only in small amounts.  All complex carbs should be eaten in small portions because in large portions they act just like simple carbs and increase weight gain.

 

 

NUTS: Cashews, Almonds, Walnuts, Chestnuts,

 

Nuts of all kinds can be a substitute for carbs in any form.  A handful of nuts should be enough to decrease your hunger and increase your protein as well as decrease insulin response to eating.

 

The Combination of foods that you eat is also important.  If you are going to eat any carbohydrate it should be paired with a protein and or a fat.

 

For example: If you are going to eat a piece of bread, then you can eat it with butter and or peanut butter or cheese or eggs.  This slows the absorption of the carbohydrate from the bread and prevents your blood sugar from surging and plummeting after you eat, leaving you fatigued and sleepy.

 

In The Dr. Maupin’s Diet in my book the Secret Female Hormone, I recommend eating multiple times a day and controlling simple carbs and carbs from sugar and grains.  Scientifically it is a fact that if you eat 25 grams or less of carbohydrate foods from sugar or grains per meal then you can prevent Insulin resistance and the additional fat that follows insulin resistance.  It is also a good way to lose fat.  In my diet a person can eat as much fruit and veggies as they desire, except white potatoes and bananas.

 

WHAT YOU EAT, IS AS IMPORTANT

AS HOW MUCH YOU EAT!

 

Other Strategies for weight loss include eating a protein with each carb which decreases the total volume of food you eat and increases satiety.

 

·      Saving your carbs to be eaten before exercise.

 

·      Portion Control of all food.

 

·      Limit alcohol.  0- 4 drinks a week

 

·      Daily exercise for over an hour/day.

 

·      Drink a glass of water before you eat.

 

·      Skip dessert

 

·      Eat a salad daily

 

·      Eat more than half your weight in grams of protein (Meat, cheese, eggs, milk products, whey protein and more)

 

 The basic information was from my over 45 years of practice and Information provided by Inbody.

 If you know by experience or you have had your genetics tested to reveal that limiting carbohydrates is needed for you to lose fat, then I hope this blog helped you understand what I mean when I tell you to limit your carbohydrate intake to less than 25 grams per meal.

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This subject is for men who have had a high PSA and who have been advised that they need a prostate biopsy to determine if they have cancer. Many men go into the doctor for the biopsy necessary for diagnosis without expecting the “blind biopsy” procedure that is done through the rectum and is extremely painful when the doctor blindly takes pieces of the prostate…over and over again.   Blindly, means he is randomly picking a place to biopsy without a real target….with the urologist biopsying everywhere in the prostate 10 or more times. Finding a small cancer with this random or “blind” biopsy method is a less than effective way to find a small area of prostate cancer. Men who have had this procedure done rarely agree to a second round, under any circumstances and I agree with them.

I always do a PSA test before I treat a man with testosterone so I often am faced with the question of what advice I should give him in this situation before I feel it is safe to give him testosterone. Of course, if he has prostate cancer, even a high PSA, I will not give a man testosterone until his urologist says he is safe to receive it.

 Until recently there was no radiologic way to screen a for prostate cancer. Now urologists use Ultrasound or MRIs to find an abnormality in the prostate that they can biopsy.  This makes the procedure both more accurate and less painful.

The way this procedure was done in the past, and is still done throughout the US, always caused me to wonder why urologists hadn’t figured out a way to do it in a way that accurately biopsied a high risk area of the prostate, with one or two biopsies.  Now Urologists use rectal ultrasound or MRI, like Gynecologists use vaginal ultrasounds to find and drain or biopsy ovarian masses, or to harvest eggs in IVF. The urologists have even borrowed the idea to use numbing medicine as well to make it comfortable.  In the last 2 years I have found a few Urologists who have embraced the new, accurate biopsy procedure that used the MRI to find high risk areas and ultrasound to locate suspicious areas for biopsy, then used the same radiologic method to locate and  treat discrete focal areas of abnormality with cryotherapy (freezing) or focused ultrasound. 

Finally in August of 2023,  a research article titled, “Focal Therapy for Localized Prostate Cancer in Older Men”, was published in the Journal of Urology.

This article describes a much more accurate method of treating prostate cancer that resulted in the diagnosis and treatment of  low grade prostate cancer without recurrence and without complications, allowing men to have a conservative treatment for low grade prostate cancer, following a less painful and invasive diagnostic procedure. Compassion has finally come to diagnosis and  treatment of prostate cancer. We applaud the authors.

August 22, 2023

Focal Therapy for Localized Prostate Cancer in Older Men

Allan S. Brett, MD, reviewing Habashy D et al. J Urol 2023 Jul Lomas DJ and Frendl DM. J Urol 2023 Jul

In an observational study, focal therapy was compared with radical treatment.

At some centers, focal ablative therapy (generally with high-intensity focused ultrasound or cryotherapy) is a treatment option for selected patients with localized prostate cancer. This option could be attractive for some older patients with comorbidities who might be candidates for radical prostatectomy or radiotherapy (according to tumor grade) but who wish to avoid complications from radical intervention.

Using data from national registries, U.K. researchers compared 262 patients (age, ≥70; median age, 74) who underwent focal ablative therapy with 262 propensity-score–matched patients who underwent radical treatment (mostly radiotherapy with androgen-deprivation therapy). At baseline, nearly all patients had intermediate- or high-risk disease. Estimated 5-year failure-free survival (the composite primary outcome, which included absence of salvage radical treatment, systemic treatment, distant metastases, or prostate cancer–specific death) was significantly higher in the radically treated group than in the focal-therapy group (96% vs. 82%). Estimated 5-year overall survival with focal therapy was 96%.

COMMENT

The better failure-free survival with radical treatment than with focal therapy (a 14 percentage-point difference) is not surprising. The challenge for individual decision making is to balance that difference against the higher rate of complications with radical treatment in older men — especially men with substantial comorbidities. We don't have long-term data from randomized trials to compare focal therapy versus radical treatment, active surveillance, or watchful waiting. But in the meantime, editorialists from Mayo Clinic conclude that focal therapy is “a reasonable strategy in older patients.”

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They insert a needle through the wall of your rectum and into the prostate to extract the cells for testing. This is a “transrectal biopsy.” Doctors usually take a dozen samples from various parts of the prostate. In some cases, they do the biopsy by inserting a needle through the skin between the scrotum and the anus.May 29, 2023

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Are you menopausal and have any of the following symptoms?

·      Hot Flashes

·      Night Sweats

·      Dry Vagina

·      Painful intercourse

·      Dry skin

·      Lack of sex drive

·      Lack of motivation

·      Fatigue

·      Depression and or anxiety

·      Change in body composition, with fat collection in the abdomen

·      Loss of Muscle Mass and strength

·      Irritability

·      Inability to remember names and places

·      Decreased ability to problem solve

·      Insomnia

·      Arthritis

·      Body pain

 

These are all symptoms we currently are aware of associated with menopause and low testosterone.  These symptoms can be treated and reversed with bioidentical estradiol and testosterone pellets.  

Menopause should be treated like an illness that is universal but more severe in some women compared with others.  If your symptoms affect your lifestyle, relationships and work then you should see a doctor who treats hormone deficiency and accept treatment!  

However, if you allow yourself to be manipulated by a male-dominated medical system that teaches all doctors to believe that menopause is normal as women age and don’t seek out hormone replacement, then you just may be setting yourself up for years of symptoms that are treated with handfuls of medications, but never get you back to normal. 

Just think about this for a minute: Men develop erectile dysfunction and experience muscle loss as they age, but medicine doesn’t consider ED or Sarcopenia a natural aging process for men, they advocate and endorse treatment with testosterone, ED medications, injections for ED and therapy for ED, and in most cases pay for it!  If the male mentality would include women we would all be treated with estrogen and testosterone when we got to age 50 (or menopause).

 

It is not just about the symptoms that E-T replacement can cure, but the diseases that you can avoid by taking estrogen and testosterone after menopause.  These avoidable diseases of aging include:

·      Osteoporosis leading to broken bones and spinal stenosis.

·      Heart disease and stroke

·      Diabetes

·      Alzheimer’s Dx and dementia

·      Obesity

·      Low muscle mass and inability to walk or move independently.

·      Autoimmune diseases

·      Loss of blood flow to Lower extremity, resulting in amputations and inhibiting walking and running

·      Severe arthritis

·      Gout

·      Worsening depression and anxiety

·      Frailty which is what causes most older people to be placed in a nursing home.

Just think it is not fate that gives you these conditions.  It is genetics plus lifestyle plus whether you replace your sex hormones or not! This decision is in your control.  If you really want a life free of debilitating disease and symptoms that are require constant medical care, then you must buck the system (that was designed to keep us from maintaining our mind and body) and look for a doctor to replace your testosterone and estradiol in a non-oral delivery system and maintain it for life.

By stopping ERT or Testosterone like the ACOG doctors tell you to, you will start the symptoms all over again.  My job is to offer you the right type of help to reverse the effects of menopause…both symptoms and diseases. Your job is to decide whether you want to get help and become healthy by taking nonoral estrogen and testosterone for the rest of your life.

Think of menopause as a disease and you will be more prepared to fight for your right to be treated by the medical system. 

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Even though all women eventually stop having periods and stop making estrogen, testosterone, and progesterone we all have symptoms of menopause, even if you don’t recognize them as symptoms relating to loss of estrogen, testosterone, and progesterone after menopause.  However, every woman experiences menopause differently. Some of us are devastated in every way by the multitude of symptoms that loss of our sex-hormones can create, on the other hand some women merely endure painful intercourse, hot flashes, headaches, and fatigue…or are told by their doctors that their

symptoms are “getting older” and they have to live with it!  Aren’t your symptoms enough for you to demand treatment?

What I See:

Every day in the office and even in my private life I run into women who complain about their symptoms of hormone loss. When I offer a solution for their symptoms of menopause and low T, I am often shot down by my patient’s “fear” of hormones. For example, I was at a 70^th birthday party recently and a flood of women came up to me and told me how young and heathy I looked.  When they asked me what I do to achieve that, and I explain that I have taken hormone pellets with T and E2 since I was 47 and they can get the same results, they immediately say, “I’m not doing that!  I don’t want breast cancer!  Or “that will cause heart disease or gain weight! “. The media and their doctors who are not up to date in their reading of research have frightened them away from treatment for their symptoms!  The doctors should read more and not depend on 40-year-old information (med school and residency).  They just told me I was doing something right, but then the fear that society has instilled in them shuts the door on a chance to be healthy, mobile and at ideal weight forever.  The opposition to us is strong and this is really brainwashing women away from taking care of themselves!

 The recent (last 10-15 years) research has revealed that medicine has been wrong about much of the advice that we give patients based on flawed research and the need for the media to scare women into dangerous action (not taking hormones).  These groups are literally making women suffer, take too many medications, and literally to be ill during the second half of their lives!  The power of the press causes women to comply.

 

Here are the “facts” doctors were taught over the last 4 decades: that are lies!

1. Genetics hold your future. The new study of Epigenetics has revealed that we can turn off our “bad” genes with a healthy lifestyle.
2. Diet—the Food pyramid lied to the American people to make money for America. They advised us to eat grains and sugar, and now we know that that caused Americans to be obese and diabetic.
3. Exercise—Jogging long distances is healthy. Lie!  Exercise helps weight loss in a percentage of patients however most patients who exercise to extreme are less healthy than other people who are moderate in their exercise.  Moderation prevents the need for knee and hip replacements, the stress on the heart and kidneys causes early circulatory and renal disease.
4. “Hormones” –cause Breast Cancer. Estrogen doesn’t cause breast cancer however it can increase growth in estrogen receptor positive women. Not a cause, in fact women on ERT (without provera) had fewer breast cancers and less aggressive ones than women who took nothing!
5. Testosterone is a MALE hormone, and we can’t have any! Lie! We make three times as much testosterone in our ovaries as we do estradiol when we are fertile!

 Do you see that we are manipulated into following false truths because our doctors are too busy to keep up and fear sells newspapers, magazines, and other news agencies. This is how we are discouraged from treatment by our gynecologists, our friends and society. Women are continually barraged with misleading information that makes us think that menopause is no big deal and we just have to live with it and get old gracefully, like our mothers did!  However, our mothers did get estrogen and other treatments for menopause!  Medicine has been completely revamped in the last 50 years, so we should be healthier, happier and have a better quality of life, yet we are prevented from achieving that through instilling fear in women.

While we are dissuaded from treating the symptoms of menopause that take away our productivity and quality of life, we are put in an untenable position. We are discriminated against because we are menopausal.  The most recent example of this mission to cripple women’s success was on national TV when Former Governor Nikki Hayley, the 52 yr. old female Senator who is running for president, was described as inadequate because she was  “past her Prime”, by a male politician who is in a party that touts the ability of an 81 year old man in that position to act as president of the US.   This is one example of millions of examples as to how we are denied treatment to give us powerful and productive lives while we are denied the medicines to make that possible!

The powers that control us, Congress, Senate, the President, the FDA, and the NIH are for by our tax dollars, but they aren’t working for us.  They perpetuate the myth that women are addled and inadequate because of our menopausal status, and then make it come true by lying to women about the risks of taking the hormone replacement that can make the second half of our lives productive.  The people who make decisions about this subject use fear to “manage” us. Headlines and Titles of articles are the weapons they use.

The second hormone women need is testosterone, however testosterone is still claimed by men and they won’t share!  Men have over 20 forms of FDA approved forms of testosterone while women have none!  Testosterone deficiency causes many of the symptoms women experience but don’t associate with testosterone loss.  Fatigue, lack of sex drive, loss of muscle, weight gain, belly fat, arthritis, inability to think, depression and anxiety that begins before 40.  Doctors answer women’s questions about these symptoms by saying, “You are just getting old”, and then refuse to treat or help except with an easy but ineffective treatment, anti-depressants!  That’s how doctors are trained.  It’s disgusting that doctors just ignore our symptoms.

 

The facts:

Women make 3 times as much testosterone before menopause as we do estradiol, yet testosterone is still referred to by “experts”, including the American College of OBGYN who teaches doctors taking care of women’s menopause. So women are “held down” and discriminated against by the majority of men, who still run everything :  the FDA  who won’t approve Testosterone replacement for women; the government who won’t pay for testosterone replacement or non-oral bioidentical hormone replacement (which is how we receive our T); and the group that I will discuss today—the journalists who title research articles to scare us, not  to educate us, and write them like we are children who need to be placated and brainwashed instead of  just treating  a uniquely female disease….MENOPAUSE!,,,with estradiol and testosterone.

We have allowed ourselves to be manipulated and we repeat the rhetoric men have initiated. Why aren’t we asking questions and making our doctors listen to us?  They should be helping us.  We are half the problem.  We find it easier to buy into the lies and do nothing rather than treat our symptoms.  We ignore the fact that doing nothing for ourselves is doing something negative for ourselves, one of their tactics used against us, is to scare us from seeking treatment for menopause with the current headlines (Like Hormone Replacement Therapy Causes Cancer and Heart Diseases). and messages barraging us to scare us away from treatment of our painful symptoms, while our decisions destroy our power to continue what we are still accomplishing after age 50.

Here are the titles of the medical and public articles recently in the news that scare women into thinking that they are damaged after menopause and have no safe treatment.

NEWS 7.2023 Ovarian cancer risk among women with

PCOS doubles after menopause

HealthDay (6/27, Murez) reports,

__________________________

Women Who Undergo Bilateral Oophorectomy Before Menopause May Have Greater Risk Of Developing Parkinson’s Disease Years Later, Study Suggests

HealthDay (11/8 Norton) reports,

Removal of both ovaries before menopause tied to risk of chronic health conditions

MedPage Today (9/13, Robertson) reports

 

Gout risk higher for postmenopausal women Full Story: Healio (free registration) (8/14)

___________________________-

The association between perimenopausal age and greater posttraumatic stress disorder and depression symptoms in trauma-exposed women

Michopoulos, Vasiliki PhD; Huibregtse, Megan E. PhD; Chahine, E. Britton MD, NCMP; Smith, Alicia K. PhD; Fonkoue, Ida T. MD, PhD; Maples-Keller, Jessica PhD; Murphy, Amy BA; Taylor, Linzie BS; Powers, Abigail PhD; Stevens, Jennifer S. PhD

You get the idea. The underlying message of all of these articles is “Menopause causes illness and death”, yet what it doesn’t say is that treating menopause can treat and reverse everything about menopause except fertility. It is true that the symptoms of lack of estradiol and testosterone and the diseases that follow menopause can be treated with hormonal replacement, and risk of diseases of aging and the symptoms of estradiol and testosterone deficiency can be treated with Bioidentical E2 and T pellets!  I see it every day in my BioBalance® Practice!

This describes the past, only you and other women can change the future!

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Often in medicine, doctors discover a new use for an old treatment or a treatment that is approved for one use and serendipitously doctors find a new use for a drug or medical device.

I have used a specific type of IUD in menopausal women on estradiol to prevent postmenopausal bleeding. The Mirena or Kyla IUD produces progesterone into the uterus to suppress the effects of estrogen on the endometrium, preventing post-menopausal bleeding and growth of fibroids.

In the May 2023 Journal of OBG Management the experts have discovered that these special IUDs can be used for more than just birth control.  They don’t contain any estrogen, but they deliver the progesterone (progestin) where it is needed to the lining of the uterus for 8 years!

The cost of one IUD/8 years vs that of daily progesterone reveals a great cost savings by using a Mirena or Lyetta or Kyla (for uteruses that have not been pregnant) and a time savings for patients who are having difficulty with post-menopausal bleeding while on estradiol pellets, or any form of estrogen after menopause.

The way these IUDs work is that the soft plastic material of the IUD has a packet of progestin attached to it that slowly dissolves over 8 years. In general, I don’t advise the use of Progestins orally as it increases risk of breast cancer and heart disease ONLY when it is taken orally.  The small dose that circulates locally in the uterus is only beneficial and is not circulated throughout the bloodstream.

The Mirena (I will use “Mirena” to represent all IUDs of the same genre because it was the first one FDA approved) is placed in the uterus in the GYN office, and a short string is left to stick out of the cervix to be palpable by the patient or the doctor to show that the IUD has not exited the uterus (which is rare in women not having periods, menopause).

Generally the patient is given a week of progesterone to cause her to evacuate the remaining lining of the uterus before the IUD is placed. This will decrease the spotting and bleeding after the procedure. If it is a difficult insertion of the IUD, the GYN will often do a post insertion Ultrasound of the uterus to make sure the IUD is in place. 

There are a few menopausal women who cannot have an IUD after menopause.  Those patients who have had an ablation of the lining of the uterus usually has scarring of the uterine lining so that an IUD would not be inserted easily or at all.  A patient with a uterine septum is not a cancidate for an IUD. Patients who have had a perforation of the uterus in the past are not a candidate for this treatment either. Patients with fibroids on the inside of the uterine cavity are not a candidate either, because the IUD may rub against the fibroid and cause it to bleed.

However if you have a uterus and are on estradiol or oral estrogen and take progesterone or progestin with it to protect your uterus, and have trouble remembering the progestin or progesterone dose every night or you continue to bleed even on progesterone/progestin, then a Mirena would be a good solution for you!

There is a novel treatment for those women who we have been unable to give estrogen to because of uterine bleeding, and the Mirena IUD or one of its sisters is the answer!

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My medical practice at BioBalance® Health brings me many interesting issues that my patients have had to struggle with, before they finally come to me for T Pellets. The latest complaint that men bring to me on their first visit is their reticence to try T pellets because they already tried T cream, or T gel or T patches and they did not get the results that they expected and needed, so they believe T Pellets won’t help them either.  Another problem the other forms of T can pose for men is that they try non-pellet forms of T and tell me that they felt a little bit better and they tell me that is all they thought they would get from any form of T replacement….they settle for feeling slightly better instead of feeling Completely Well!

Compared to FDA approved Testosterone Creams, Gels, and Patches, Testosterone Pellets at BioBalance Health are superior in every way!  When deciding on a treatment or even when buying an important item for your home you should do your homework!  I am going to tell you today why men should switch to long-acting Bio-identical testosterone pellets instead of the other forms.

 

Deciding between various forms of Testosterone

 

#1 Effectiveness of each form of Testosterone

When making a decision about which treatment to employ, you should look at whether the treatment will completely treat my symptoms, or just some of them/ and what are the side effects (what is the downside)? Below is a comparison from my book for men, “Got Testosterone?” that compares T pellets to other forms. Note that Creams/Gels/patches are all “Transdermal”, or delivered through the skin:

The reasons for why the quality of the treatment is different for trans-dermals and pellets is because the up to 80% of testosterone converts into estrogen as it is absorbed by the skin. Men don’t need or tolerate estrogens like women do, in fact estrogen binds up testosterone so it can’t be used by the body.  So, gels, creams and patches give a man a small amount of T, but soon it inactivates the testosterone, and doctors think the dose is too low, so they raise the dose. The same thing happens over again and finally both doctor and patient give up and generalize the treatment failure and assume the man cannot take Testosterone (in any form).

Pellet testosterone dissolves under the skin in a layer of fat and goes directly into the bloodstream where it goes to work and attached to Testosterone receptor sights. A small amount is converted into estrogen, but it is not enough to inactivate the testosterone from the pellet, so the effectiveness of Pellet Testosterone is quite different from transdermal forms of testosterone, and is greatly superior.

 

#2 Side Effects/Risks

 

The flipside of whether a medical treatment of any kind is right for you, is the risks of the treatment and the likelihood of side effects.  Knowing the effectiveness of a treatment and the risks, helps you decide whether it will work for you.  Knowing these two most important factors help a patient make a decision on which treatment he wants to try.

There are risks that may not apply to you, however you should look to the side effects or risks that apply to you, to make your decision.  In the table the highest risk is noted with three Xs, and the lowest risk is one X. The side effects of T in Pellets are much lower than other forms of Testosterone. You must review whether these are risks for you individually or not.

For example, if you are still of childbearing age or you still want more children than the lowest risk of infertility is offered by T Pellets, however there is still a risk. For those men who don’t have hemochromatosis then this risk is not a risk at all. This really means that risks must be individualized for each man just like dosage.

 

#3 Ease of Complying with Dosage and #4 Cost

 

Whether you can actually continue treatment for a long period of time is pivotal to determine whether you should take a type of Testosterone replacement. You should look at these factors:

·      Can I realistically follow the dosing schedule?

·      How many times a year do I have to go to the doctor’s office for this treatment?

·      How much time will I waste a month waiting in a doctor’s office to get the treatment?

·      Is it administered at home or at the doctor’s office?

The next part of this equation is the cost of treatment.  Most testosterone medications are not paid for by insurance.  If they are paid for, they have a high copay for most insurance. If you get your testosterone from a pharmacy, then to compute your fee you should multiply the copay by 11 months. If you have to go to the doctor to get the script, you should add the doctor’s fee as well.

I have compiled the cost of each kind of treatment based on the initial dose, which might not be adequate for people who use trans-dermal testosterone and need to increase the dose multiple times.

As for dosing, If you can’t remember your vitamins, your medicine or to brush your teeth before you go to bed I can guarantee that you won’t be able to remember your testosterone cream or gel, or pill.

 

In the End it is Your decision

Everyone must make their own decision about what type of Testosterone to use.  Only you know whether you can be compliant with a daily regimen or would be better to come to an office to get your testosterone twice a year.  Only you know whether an effective form of T like pellets is worth the cost of treatment, however, to make a good decision you should compute the daily or monthly cost of the pellets to compare apples to apples.

I see many men who have tried T shots, gels and patches, and come to me as a last chance to treat their low T symptoms with pellets.  98% of them are extremely happy and continue treatment, noting the difference between pellets and their previous T treatment.  If you continue to use gels and creams because the FDA approves of it, or because your PCP orders it, but you don’t feel better, then you should try T pellets!