Making Hormone Replacement Work For You

THEKEYSTOHEAL
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MAKINGHORMONEREPLACEMENT
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JamesLaVal
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THE KEYS TO HEALTHY AGING:

MAKING HORMONE REPLACEMENT WORK FOR YOU
By James LaValle, R.Ph, ND, CCN
Published by Fourth Avenue Health Group, LLC
ADDRESS: 245 NE 4th AvenueSuite 201, Delray Beach, FL 33483 | 1-800-681-2402
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700SHRB
The Keys to Healthy Aging:

Making Hormone Replacement Work for You
James LaValle, R.Ph, ND, CCN
Nationally recognized expert on natural therapies, founder of the LaValle Metabolic Institute, and
Executive Editor of The Healing Prescription.
Contents
What You Dont Know May Be Hurting You............................................................................... 1
Hormones: A Key Factor in Healthy Aging................................................................................. 3
Lous Story................................................................................................................................. 4
Sex Hormone Imbalances.......................................................................................................... 6
Hormone Replacement: Confused About What To Do? . .......................................................... 7
Problems with Conventional Hormone Replacement Therapy (HRT)........................................ 7
Bio-Identical Hormones The Difference................................................................................. 9
The Three Types of Estrogen Your Body Makes...................................................................... 10
The Effects of Declining Estrogen Levels................................................................................ 11
Replacing Estrogen.................................................................................................................. 12
Estrogen Metabolism: What Men and Women Need to Know . .............................................. 13
Dietary Changes to Improve the 2:16 Ratio ................................................................... 14
Lifestyle Changes to Improve the 2:16 Ratio . ................................................................ 14
Dietary Supplements to Improve Estrogen Metabolism ................................................. 15
Melatonin................................................................................................................................. 17
Progesterone........................................................................................................................... 17
Women and Testosterone ....................................................................................................... 18
Male Menopause? .................................................................................................................. 19
Testosterone How Much Do You Need?..................................................................... 22
Dietary Supplements for Male Enhancement.................................................................. 24
II
The Roots of Hormonal Balance For Men and Women: The Other Hormones that Matter..... 25
Cortisol ........................................................................................................................... 25
Growth Hormone ............................................................................................................ 27
DHEA The Fountain of Youth Hormone ................................................................... 28
Pregnenolone.................................................................................................................. 30
Insulin.............................................................................................................................. 30
Thyroid Hormones........................................................................................................... 31
Brain Neurotransmitters The Sparks that Make You Feel Sharp . ...................................... 32
Sex Hormones and Other Hormones Recap........................................................................... 33
Bio Identical Hormone Replacement....................................................................................... 35
The Value of the Compounding Pharmacist ........................................................................... 38
How to Take Bio-Identical Hormones The Dosage Forms ................................................. 39
Pill Form........................................................................................................................... 39
Transdermal . .................................................................................................................. 39
Injectables (Testosterone)................................................................................................ 40
Pellet Implants (Testosterone) ........................................................................................ 40
Troches and Mini Troches .............................................................................................. 40
Lab Tests . ............................................................................................................................... 40
Conclusion............................................................................................................................... 42
Appendix - Dietary Supplement Chart..................................................................................... 44
References............................................................................................................................... 48
TOTAL HEALTH BREAKTHROUGHS

245 NE 4th AvenueSuite 201, Delray Beach, FL 33483 | 1-800-681-2402
III
From the Desk of James LaValle, R.Ph, ND, CCN

Dear Value Reader:
Thank you for purchasing The Keys to Healthy Aging: Making Hormone Replacement Work for You. I
am particularly excited about this book because hormone replacement is rapidly becoming one of the
most important and controversial health topics of our generation. Its important because we are living
longer today, and we begin our second adulthood in our 50s.
In the year 1900 the average person was already dead by age 50! Today, you can expect to live another 3 decades beyond that, but how you will live it is another matter. Balancing your hormone performance will help determine whether you will age gracefully with vitality. I believe if done correctly,
hormone replacement will also help you to reduce the risks of developing Alzheimers, diabetes, heart
disease, and cancer.
It is not just about anti-aging therapy hormone replacement is about the ability to create a regenerative health approach. And, as you will see, it is much more than just taking sex hormones.
Hormone replacement is controversial because it is a bit tricky and must be done right. I cant emphasize this enough. When hormone replacement first started getting popular, some progressive
practitioners jumped in full force with their patients. But unfortunately, they were not making sure their
patients were properly metabolizing the replacement hormones or measuring the balance between
those hormones and other metabolic hormones. We have learned that this can actually increase
health risks!
This practice combined with the fact that there is a great degree of misunderstanding on the differences between the various types of hormone replacement therapy has caused hormone replacement
to come under the scrutiny of the FDA.
I take a more conservative approach to hormone replacement and use the safest versions available.
But make no mistake when your hormones are low, you can take the steps to replace them to an
age-appropriate level and feel tremendously better, while reducing risks not increasing them.
Because this is such a sensitive topic and it is somewhat more involved than other health issues, it
takes a higher degree of understanding. You may find parts of this report a bit technical, but it is necessary in order to make sure you do not plunge into hormone replacement without taking the proper
steps.
I appreciate your patience with the reading and I promise you, it will be worth your time.
In Good Health,
Jim LaValle
IV
The Keys to Healthy Aging:

Making Hormone Replacement Work for You
James LaValle, R.Ph, ND, CCN
What You Dont Know May Be Hurting You

Most of us today realize that we are going to live longer due to breakthroughs in medicine. The real
question is, how do you want to age? Staying active, sharp minded and enjoying family, friends and
travel? Or existing from one doctors appointment to the next, unable to fully engage in the things
you love to do and worked so hard to attain?
I hear the story all the time about how someones granddad smoked unfiltered cigarettes, drank
whiskey, and ate bacon every day and lived to be to 100. Bravo!! That is someone that won the
longevity lottery. Some of the factors affecting aging back in granddads day are different from what
is affecting our aging process today. The truth is, at the turn of the century, that is 1900, the average
life expectancy for a man in the U.S. was 47 and for women it was 48.
Today, we have to be productive into our 60s and even 70s. How many times do you hear of someone who worked hard, was successful in his or her business and then retires only to feel as if
their very life has been sucked out of them by the years of hard work? Its a common mistake to
focus only on financial planning for retirement and ignore the signs that your body is breaking down
with each year passing.
Just as you wisely plan out your financial future, you have to invest in your health and plan how
your body is going to age.
Have you ever wondered why there are people who reach the age of 85 in very good physical and
mental condition, while others have trouble with their memory and/or develop osteoporosis or heart
disease by the age of 60? By the year 2050 the population over the age of 65 is expected to almost
triple from 6.9% to 16.9% according to the World Health Organization.
Aging affects all your body functions: cardiovascular health, glucose and insulin regulation, brain
function, muscle and skeletal health, endocrine (hormonal) function, the immune system, and oxidative stress levels.
Unfortunately, age sneaks up on us unexpectedly, and there is no escaping the fact that we are all
growing one year older every 365 days. However, if you take preventive measures now, you can
manage the hormonal and other metabolic imbalances that lead to accelerating the deterioration of
your health and invite the aging of your body. Why not choose to become proactive and participate
in protecting and regenerating your health?
You can break down aging into two buckets: factors that you can control and then factors that you
may not be able to control. There is also the natural aging process and the changes that occur to
your metabolism with each decade.

Factors you can control include:

Stress (less work and behavioral modification)
Dietary choices (reducing intake of high refined carbohydrate and sugars, trans fats and not
overeating)
Lifestyle choices (getting more exercise, eliminating high alcohol consumption and smoking)
Environmental toxins (reduce exposure to heavy metals in foods, household chemicals, etc.)
Getting adequate sleep
Excessive drug use (both prescription and over-the-counter)
Factors you may not be able to control include:
Genetics
Some forms of stress (care of an ailing parent, death of a loved one, accidents)
Some environmental toxins (occupational, air and water pollution)
If you look into aging and vitality, there is a consistent theme that surfaces in the research. Science
has shown when hormones get out of balance or fall to low levels, it cannot only trigger symptoms
and the progression to a disease, it can literally shorten your life.
I used to think that sex hormone changes occurred in people when they hit their 50s and 60s. But
in the last decade of practice and by working with Maureen Pelletier, M.D. at the LaValle Metabolic
Institute, I have seen otherwise. We have treated countless men and women who had hormone
imbalances in their 20s, 30s, and 40s and these imbalances were accelerating their aging process.
The point is that you dont want to wait until you are 60 to look at the changes in hormones that have
occurred in you. The good news is that if you are 50, you can take advantage of regenerating your
health through balancing hormonal performance; and after all, 50 really is the beginning of your
second adulthood. Our core belief at LMI is that you deserve vitality at every stage of life.
Any combination of the factors listed above can lead to changes in your hormone production, putting excess stress on your metabolism and accelerate aging. In the past, you heard in the news that
taking hormonal therapies like estrogen could lead to increased cancer and heart disease risk. But
there is more to the whole story that you need to know!
You may not realize this, but hormonal balance is intimately connected with the health of the nervous system and immune system and ultimately it will determine how well you are going to age.1
And dont think that hormonal balance issues are just for women men are equally affected.
Although the science of aging is new and evolving, there are obvious steps you can take today to
affect your future health. One of the most important steps is to assess your hormones and then take
action to restore them to age appropriate optimal levels.

As men and women age, their hormones change. This hormonal change can be slow and gradual
or sudden, bringing with it health issues associated with aging. Right now you could be noticing
depression and mood changes, weight gain, achiness and joint stiffness, blood pressure changes,
diabetes, loss of muscle and strength, cognitive decline, and even changes in your sex drive. You
may not realize these issues are related to changes in your hormones.
How the hormones in your body are working is 100% influenced by the balance among different
hormones, whether your body is metabolizing (processing) them properly, and if any environmental
toxins are blocking their effects. So its not just your sex hormones, like estrogen or testosterone
its also the inter-relationship of all the hormones. It is also important to realize that the term sex
hormone is somewhat limiting. New research is pointing to the fact that sex hormones do much
more for your body than just maintain libido!!
This e-book is about one of the hottest topics in anti-aging and regenerative medicine today hormone replacement therapy. We will explore some of the ways hormonal imbalances can be corrected using methods that help to balance the delicate link between our hormones and our health.
The goal is to rebalance your individual hormonal metabolism and help you age gracefully and
regain vitality.
Hormones: A Key Factor in Healthy Aging

Estrogen, progesterone, testosterone, cortisol, DHEA, growth hormone, thyroid, and insulin are
the main hormones that affect your mood, energy, sex drive, appetite, and metabolism. Current research also points out that these hormones determine how long you most likely will live. Hormone
levels can change significantly during aging or when influenced by other lifestyle factors.
In men for example, low testosterone levels can increase the prevalence of metabolic syndrome,
which includes high cholesterol levels, high blood pressure, erectile dysfunction, insulin resistance,
and obesity.2
In post-menopausal women, low levels of DHEA have been associated with musculoskeletal pain3
and imbalances in estrogens and progesterone that may play a pivotal role in the development of
obesity and belly fat accumulation.4
And did you know that in both men and women, chronic stress increases the hormone cortisol in
your blood? Cortisol has a multitude of negative effects on your body such as inflammation, increasing blood glucose and insulin levels, decreasing thyroid hormone production, impairing immunity,
and causing weight gain.5 Your brain chemistry is also influenced by hormonal balance. Imbalances
in thyroid, cortisol, DHEA, and sex hormones can lead to depression, anxiety, insomnia, and most
importantly, cognitive decline.
The bottom line is that hormone imbalances can create dramatic changes in your metabolism
leading to accelerated aging and send you down the path of chronic and even life-threatening illnesses.

So as you can see, the basics for achieving optimal health throughout life includes balancing the
hormones that keep your nervous system, immune system, endocrine system, and metabolic performance functioning the best they can. As I discussed in my book, Cracking the Metabolic Code,
this balancing act can be achieved through smart food choices, exercise, managing stress response, nutritional supplementation, and identifying the weak spots in your metabolism.
A key factor that the book didnt discuss in depth was the value of bio-identical hormone replacement therapy. Done right, under supervision, hormone replacement can be one of the best things
you ever do for your health as you age. And to do it right, you need to look at your total hormone
picture.
Here are some examples:
Thyroid hormones make your sex hormone receptors work properly and are crucial in energy
production for every cell in your body.
Excessive insulin production causes you to release inflammatory hormones like cortisol and
store visceral fat.
Reduced growth hormone production doesnt allow for your body to repair itself like it should.
DHEA is the building block for hormones that acts to protect your brain against memory loss.
Educating yourself about hormones is a necessary step in what we call a Pro-Active Metabolic
Aging Strategy (PAMAS). If you know what the signs and symptoms are of hormonal deficiencies
or imbalances, you can take the steps toward achieving hormonal balance before you spiral downward into chronic illness.
The statistics dont lie people are living longer now than ever before. So knowing how to positively influence hormones gives you the power to keep those years much healthier. Before we look
at the issues involved in achieving hormonal balance, I want to share a story that will demonstrate
how important healthy hormone balance can be for you or a loved one.
Lous Story
Lou came into my office at the end of May 2008. He was a 53-year-old owner of a printing company. Throughout his life, Lou struggled with obesity. He had food cravings and was a mountain
of a man at 6 foot 2 inches tall. He did heavy exercises regularly (4-5 times a week) and had a
relatively good diet. But his weight had ballooned to 450 pounds, he was falling asleep in the
middle of the day, his back was stiff, he was unable to stand up straight, his knees ached, his
mood had eroded to the point of depression, and his will to live had even dwindled. To top it off,
his aging mother was being placed in a nursing home and it was very tough on him emotionally.
Normally very engaged in life, he enjoyed his hobby of collecting cars of all sorts from models
to the real thing. But now Lou just felt flat. He went home, sat in his lounger, and waited to start
the next day. When he did go to bed he was up several times to urinate, and his snoring rumbled

the house. His breathing became labored with all the extra weight and fluid he was carrying.
Lous doctors had just checked him and said, Lou, your cholesterol is normal and blood pressure is a little high so we will prescribe a drug for you; but other than that you are OK. But his
wife cornered me in tears, as did her son, over the state of health of their loved one. Lou called
me and asked for my help. What was different about this case? Lou is my older brother!
He and I enjoyed a very close relationship, but as for listening to my approach to health, Lou
was not sold on it over the years and lets just say he was a little stubborn so I never
pushed my opinions out of respect for his right to choose his own path. But now he was desperate, and I was grateful that he asked for my help.
Lou is the perfect example of what happens to us as we get older we think that all the signs
and symptoms are a normal part of aging and that it is just a slow downhill slide from 53 to
death. What would we find after running Lous labs? I was scared to find out. But nonetheless,
Dr. Huber and I began tearing apart his chemistry. And in addition to ordering the necessary lab
tests and scans, we took an in-depth look at Lous hormone pattern.
He had every reason in the world to feel like he did. To our surprise, he had no heart failure: he
had hormone failure. I will highlight the important issues because I want you to read this report
thinking of a real person and not just a lab value. In fact, my brother insisted that I share this
story with as many people as possible.
Heres what we found when we analyzed Lous lab work:

Vitamin D: Very Low

Lou had almost no vitamin D. Vitamin D runs your immune system, helps hormones to work,
helps with mood, and is necessary for insulin receptors to function. Not to mention, it is known
to reduce risks of breast, prostate, and colon cancer.
Testosterone: Very Low

Never mind whether or not my brother had libido or not he felt so bad it wasnt on his mind.
Low testosterone leads to increased heart disease risk, osteoporosis, depression, loss of cognition, joint aches, insulin resistance and diabetes, loss of stamina, and muscle tone not to
mention the dreaded erectile dysfunction. Low testosterone also causes the accumulation of
belly fat along with sleep disturbances, including the mid-day nap.
Estrone and Estradiol: High

Like most men his age, Lou made more estrogens than testosterone. In men, this accelerates
weight gain and can make the prostate begin to enlarge (There are also other issues, but at
least my brother was not changing his favorite color from black to pink!)
Sex Hormone Binding Globulin: High

SHBG is produced to bind up a percentage of the hormones that you make. Since Lous SHBG
was too high, the little bit of testosterone he was making was not even available for him to
use.

Cortisol: High
Like most small business owners that are successful, Lou pushed hard through the years. His
high cortisol level meant disturbed sleep, depressed mood, elevated blood pressure, poor thyroid hormone balance, big weight gain, and extreme fatigue.
Glucose: Borderline High

Recent studies point to the fact that glucose that is even borderline high is damaging to your
kidneys, heart, and brain. Lou did have compromised kidney function. With a strong family history of diabetes, this was a concern.
Thyroid TSH: High; Free T4 and T3: Low

When you dont have enough thyroid hormones, your metabolism comes to a screeching halt.
Fats and glucose dont burn well, your brain cant use its neurotransmitters like it needs to, you
dont absorb nutrients like you should, and it can even compromise your heart function. This
explained Lous inability to lose weight and why his mood was so flat.
Fast Forward: Twelve weeks later my brother dedicated himself to our Metabolic Code/ Insulin
Resistance Phase Diet and implemented our plan using natural products and a couple of bioidentical hormones. He also temporarily began taking one medication for blood pressure. Here
is the result:

Loss of 60 pounds
Sleeping through the night and not snoring
No more back aches or pains
Not sleeping at his desk in the middle of the day
Back to the gym working out
Voice is coming back
His mood is much better (as a brother I can attest) the old Lou is back
Fluid is gone from lungs, he is breathing without being labored
He no longer craves the pasta and pizza and cold beer chaser that he was using to comfort
himself.
Best of all, Lou now has his energy back and is engaged in doing things and as we are cut
from the same cloth of overdoing things, he recently swept his 150-foot driveway by hand, got
up on a ladder to fix the gutters, and cleaned out his prized garage all in one weekend!!
We still have more work to do to optimize Lous metabolism, but he is well on his way. How did we
do it? Youll just have to read on.
Sex Hormone Imbalances

Its a fact the longer you live, the more your sex hormone levels will drop, causing a significant
change in your quality of life and increasing your risk for chronic illnesses. While once thought of
as primarily a womens health issue, sex hormones begin to drop dramatically at about age 40 in

both men and women. Because the average life expectancy is 78 years in the US, we can easily
live nearly 40 years past the time our hormones start to drop significantly.
In the year 1900, people were not expected to live much past the age of 50; hormone levels that
dropped near the end of life didnt matter much. But today, failing to replace sex hormones to age
appropriate and functional levels when needed can increase disease risks. And more importantly,
replacing hormones can significantly improve how you are going to feel as you grow older.
There are two main effects you can experience from low or imbalanced sex hormones:
1. Uncomfortable symptoms that can begin to change how you feel and think at middle age and
beyond. This is a quality of life issue.
2. Increased risks to your health including heart disease, osteoporosis, diabetes, and certain cancers that are associated with imbalances in hormones. This affects how long you will live and
how difficult the journey will be.
Before we get into the discussion of bio-identical hormone replacement, I want to emphasize this
important point. Simply replacing any hormones in your body without improving the way you process and utilize them could be a disaster. That means if you want to maximize the benefit of hormonal replacement, changes in lifestyle will be in order. Eating healthier, getting more sleep, and
exercising are essential components to successful hormone management. So lets dig in and learn
about this fascinating topic.
Hormone Replacement: Confused About What To Do?

We get influenced by snippets of information on health from the media all the time. One of the more
dramatic examples is in regards to estrogen replacement. The topic of estrogen replacement is
complex and most people still end up making decisions based on an incomplete and often inaccurate story.
Estrogen replacement has gotten a bad rap in regards to its value for women much of it based
on studies reporting that it increased cancer risks and was not cardio-protective.6,7 On the surface,
the decision to minimize estrogen therapy seemed clear-cut. But different forms of estrogen and
other factors need to be considered before making this decision.
This matter was brought to the forefront by Suzanne Somers in her books, The Sexy Years and
Ageless. She was one of the first well-known people to promote bio-identical hormone replacement
therapy (BHRT) as a safer alternative to conventional synthetic hormones.
Problems with Conventional Hormone Replacement Therapy (HRT)

The average ratio of estrogens in synthetic conjugated estrogen (the kind prescribed for years by
mainstream medicine) is 52% percent estrone, 4% estradiol, and 43% equilenin, a horse estrogen
which obviously is foreign to humans. Although synthetic HRT therapy may reduce the symp
toms of menopause, components of it are clearly not bio-identical. Research has found that these
hormones may lead to serious health consequences and in a minute you will understand why.
In 2002, the Womens Health Initiative (WHI) study of postmenopausal women with an average age
of 65 and older found that taking PremPro, a synthetic conjugated estrogen in combination with
progestin, increased the risk of breast cancer (26%), heart disease (29%), stroke (41%), and blood
clots (200%) versus women who were taking placebo.6
Another part of the WHI found that women on PremPro had double the risk of developing dementia
in the 65 and up age group.7 This was even more alarming since according to conventional medical
thinking, the addition of estrogen and progesterone should have improved brain function.
Beginning at 4 months into treatment, hormone-treated women were also more than three times
as likely to report weekly episodes of stress incontinence, or leaking urine when they laughed,
coughed, sneezed, strained or lifted due to weakness in the muscles that hold back urine.8 Not a
good thing to have happen when youre struggling with the aging processes.
Side effects of synthetic progestin included weight gain, bloating, irregular bleeding, and extreme
breast tenderness, causing many of the women in the study to stop taking the synthetic hormones.
Synthetic progestin may actually increase the growth of certain breast cancers in some women.9
One study found that up to two thirds of women put on HRT discontinued using the hormones within
the first two years.10
After the WHI study results were announced, there was a 30% drop in sales of Premarin and PremPro.11 Fortunately, recent studies are finding a drop in breast cancer rates as a result.12 But for many
women who stopped taking HRT, their menopausal symptoms came back in some cases with a
roar!!
Here are the key concepts to understand in regard to the WHI study itself and the synthetic hormones that were tested.
No individualized assessment for hormone needs was performed on the study participants.
No evaluation of how the estrogens would be metabolized by individuals was looked at (more
on this in a minute).
The synthetic hormones that were tested were not cycled like your bodys natural hormones.
Estrone (a type of estrogen) is in high concentration in HRT formulations. Estrone is associated with the development of breast cancer. (In men, elevated estrone is linked to prostate
cancer.)
Equilenin or horse mare estrogen is not easy for your body to recognize, and its metabolites
can create significant damage to DNA.
It has been found that orally taken synthetic estrogens can cause an increase in C reactive
protein an inflammatory marker that is associated with increased cancer and heart disease
risk. This same risk does not seem to apply to bio-identical trans-dermal (topical) estradiol.
Progestins (synthetic progesterone) have a long list of side effects associated with them. They
are different in structure from natural progesterone and so are metabolized differently. Pro
gestins do not function in the body the same way as bio-identical progesterone. For example,
progestins increase breast cancer risk while bio-identical progesterone will lower breast cancer
risk.

So when you look at the problems highlighted in the Womens Health Study it was specific for the
type of hormones given (synthetic) and how they were given. The result was that the study led to
all hormone replacement being condemned the media has incited a fear in women of all types
of hormone replacement that has potentially done more harm than good.
Most importantly, the WHI highlighted the commonly practiced one-size fits all approach to sex
hormone replacement it was not compatible with the natural cycling of hormones and did not
take into account other metabolic issues. This, in my opinion, is flat out dangerous.
Another problem seen with the use of synthetic female sex hormones is drug-induced nutrient
depletion. Estrogen replacement therapy can deplete the key nutrients, vitamin B6 and magnesium
from the body.13 Magnesium has many positive influences on the body. It helps the release and
activity of insulin and helps balance glucose levels, leading to improved insulin regulation.14
Although women in menopause are predisposed to bone loss due to estrogen deficiency, bone fragility increases even more with magnesium deficiency.15 One government study reported that 75%
of Americans consumed less than the Recommended Daily Allowance (RDA) of magnesium on a
daily basis. So taking medications that lower magnesium levels even more could imbalance your
metabolism, leading to other symptoms like restless legs, palpitations, muscle weakness, muscle
cramps, and eventually deteriorate your health!16
Likewise, vitamin B6 is involved in the production of the feel good brain neurotransmitter, serotonin.17 When your serotonin levels drop, you become anxious and even depressed. Your appetite
will also increase for comfort food when serotonin levels drop.
The synthetic progestins found in conventional HRT can cause significant depletion of many nutrients including B vitamins, tyrosine, CoQ10, vitamin E, and folic acid just to name a few.
Taking synthetic HRT by mouth can also increase imbalances in the natural gut flora, causing increases in Candida (yeast) populations. This can lead not only to vaginal yeast disturbances, it can
put significant stress on your immune function.
Bio-Identical Hormones The Difference

Estrogen replacement with bio-identical hormones has tremendous value if it is done correctly. As
you have learned, all estrogens do not behave the same in the body. Later on, we will also discuss
the different ways men and women can use bio-identical hormones for the highest safety and least
risk.
When the WHI study came out in 2002, many women were instructed or chose to get off their
hormones. Since then, I have listened to women trying to cope with painful periods, fibroids, hot

flashes, vaginal dryness, bladder leakage, mood swings, and significant memory decline not to
mention weight gain and loss of sex drive.
At LMI, we responsibly use bio-identical hormones for many women because it helps them to get
over these significant issues that strike women in their 30s on into their transition to menopause.
But, unlike most traditional practitioners, we individualize womens care and take into consider
ation other factors that could be affecting their sex hormones.
The Three Types of Estrogen Your Body Makes

Lets take a look at the principal hormones that need to be managed for graceful aging. Men and
women have all of these hormones but they are in different levels depending on gender.
Estrone (E1), the main estrogen made by women after menopause is implicated in breast, uterine,
and in men, prostate cancer. Prior to menopause, women make all three estrogens and progesterone. While some estrone can be made from oxidized estradiol, the majority of estrone is made in
the liver, the adrenal glands, and the fat cells. After menopause, estradiol and progesterone production drop drastically, and their health protective effects are lost.
The estrone production from the fat cells, the liver, and the adrenal glands, however, continues, and
even rises. Low progesterone combined with higher estrone is what sets a woman up for increased
breast cancer risk.
Since estrone is the most cancer-promoting, it is no surprise that the majority of breast cancer
cases occur in post-menopausal women. It is interesting to note that obese women have a higher
rate of breast cancer and increased estrone production is thought to be a significant factor.18
Alcohol consumption also makes your body favor estrone production that could be the reason
for the association between alcohol intake and breast cancer.19
Estradiol (E2), the strongest estrogen, is produced in the ovaries and has many protective effects
including maintaining bone density, improving growth hormone production and vascular flexibility,
keeping your blood from getting sticky, supporting cognitive function and mood, assisting in growth
hormone release, and improving your lipid profile.
Estradiol is also the primary cardio-protective estrogen. Too much estradiol can be associated with
estrogen-related cancers, but deficiencies can lead to osteoporosis, heart disease, dementia and
other diseases of aging.
Estriol (E3) is the weakest of the three estrogens and has a protective role in breast tissue. It is
believed to protect vaginal and urethral tissue as well. Estriol helps to reduce hot flashes in women,
protects the urinary tract, and plays a role in retention of bone density. It can help increase good
HDL and decrease bad LDL cholesterol, so it is heart protective. One compelling study showed
that taking estriol can reverse brain lesions in women with multiple sclerosis.108
10
Estriol blocks the effects of estrone by occupying estrogen receptor sites. This is an important
anti-cancer initiation mechanism. Remember, in the WHI study, the drug (PremPro) contained 52%
estrone and no estriol, so there was no counter balance to the estrogen receptor activity from the
drug.
After the WHI study, estriol was the topic of intense debate among pharmacists, consumers, physicians, and the FDA. Compounding pharmacists had been regularly making bio-identical hormones
that included estriol. The FDA claimed that it was not an approved drug and moved to block its use.
After an intense campaign by consumers and health care professionals, the right to use estriol has
been preserved.
The Effects of Declining Estrogen Levels

As women age, their estradiol levels goes down and their estrone levels increase. In men, their
relative estradiol and estrone levels go up. Both men and women will make more estrogens if
they accumulate visceral (belly) fat. Excessive estrogen makes cells grow. So it stimulates tissue
growth. This can affect the ovaries and breasts in women and the prostate tissue in men.
Estrogen is particularly needed in women to make serotonin receptors function in the brain serotonin remember, is a feel good hormone. With no estrogen, your mood can change to anxiousness
and depression. Estradiol has cardio-protective effects, so as women enter menopause and lose
their estradiol production, they actually have higher heart disease risks than men.
Estrogen also helps keep bones strong women will lose up to 25% of their bone density in the
first year of menopause. Skin wrinkling is accelerated as estrogen is lost from a womans body.
Cognitive function, such as critical thinking and short-term memory, is also eroded with the loss of
estrogen production.
Below is a list of symptoms related to out-of-balance estrogen in women:
Low Estrogen
Weight gain
Painful intercourse
Bladder incontinence and infection
Foggy headedness
Mood changes/depression
Irritability
Insomnia
Fatigue
Low libido
Weepiness
Heart palpitations
Hot flashes
Osteoporosis
11
Excess Estrogen or Estrogen Dominance

Puffiness
Weight gain around the hips
Heavy bleeding
Vaginal or oral yeast (thrush)
Fibrocystic breasts
Mood swings/easy to tear
Low libido
Tender breasts
Cravings for carbohydrates
Headaches or migraines
Replacing Estrogen
Estrogen replacement is familiar to most people because of its use in menopause. Menopause
occurs when the monthly menstrual cycle ends. The ovaries, the twin organs that produce and
release an egg during each monthly period, also produce the female hormone, estradiol. Estradiol
gets converted to estrone and estriol.
As mentioned above, after menopause the ovaries production of estradiol slows to a trickle, and
so does estriol. While other organs may try to make up for the deficit of these two estrogens by
continuing to make estrone, there is not enough of the needed estradiol to protect the bones and
heart and help with cognitive functioning. The severity of effects and symptoms from the increased
estrone will vary from woman to woman depending on the levels of each of their hormones.
For most women, the estrone production is not enough to overcome hot flashes, cognitive and
mood changes, and protect the bones. In fact, if a women has very few hot flashes and is overweight, she may be overproducing estrone.
There is a variety of ways to consider addressing the issue of hormone deficiency. The most common has been to replace the estrogen the body no longer produces with a synthetic estrogen
called Premarin, manufactured from the urine of pregnant mares. The other alternative has been
a combined synthetic estrogen-progestin drug called PremPro. (PremPro is also produced from
pregnant mares urine.) These two drugs are considered the conventional form of hormone replacement for women.
Chemical derivatives of estradiol are the strongest form of estrogen and the kind used in conventional HRT. These synthetic hormones have 200 times the binding affinity for estrogen and progesterone receptors than weaker bio-identical hormones. This makes them much more of a risk factor
for hormone-dependent cancers than bio-identical estrogens.
In a young, healthy woman, the estrogen ratio generally averages as follows: 90% estriol, 7% estradiol, and 3% estrone. While these levels vary from one individual to another, the goal of bio-identical
hormone restoration therapy is to recreate a more natural balance in the levels of estrogen and in
combination with all the other sex hormones. The key is that dosing is individualized to your needs
some women may need more of a specific bio-identical estrogen, while others need less.
12
Estrogen Metabolism: What Men and Women Need to Know

How your body metabolizes estrogen is just as important as how much you have or dont have.
The following information is crucial if you are a man or a woman who is considering bio-identical
hormone replacement therapy or if you just want to evaluate hormonal wellness. This evaluation
should be considered even while you still have your menstrual cycle so you can take steps to improve how your body breaks down the estrogen you make.
Estrogens convert into several metabolites. Estrone, for example, may convert into three different
forms:
2-hydroxyestrone, protective
4-hydroxyestrone, carcinogenic and active
16-alpha-hydroxyestrone, carcinogenic and active
Scientists have identified 2-hydroxyestrone as a good estrogen metabolite while 16-alpha-hydroxyestrone and 4-hydroxyestrone (bad estrogens) have been associated with the development
of certain types of cancer, like breast and ovarian.18 These bad estrogens are also associated with
uterine fibroids, ovarian cysts, and fibrocystic breasts.
In men, this same estrone metabolism issue can cause age-related prostate problems and prostate
tissue growth.
Metabolism of estrogens occurs in several areas of the body however, the main spots are the
liver and GI tract. Diets high in refined sugar and low in fiber feed the unfriendly flora in the intestines, causing them to over produce and create new metabolic by-products.
One of the by-products of unfriendly bugs, is an enzyme called beta-glucuronidase. Estrogen is
processed in the liver by a reaction called glucuronidation. This is known as a conjugation reaction
and it means that estrogen gets a handle put on it to carry it out of the body. But when too much
beta-glucuronidase is produced, it breaks the handle off the estrogen. This means the estrogen
metabolites cant be excreted and they build up in your tissues over time.
The relationship between 2-hydroxyestrone and 16-alpha-hydroxyestrone is expressed as the 2:16
ratio. The minimum acceptable number for this ratio is 2 and ideally is greater than 4. Why is this
ratio important to know? We regularly see 2:16 ratios in women with breast and ovarian cancers and in men with prostate cancer. By increasing the ratio of 2-hydroxyestrone to 16-alpha-hydroxyestrone, you can reduce the risk of these hormone-related cancers.20
You can easily have your urine tested for this ratio. This is a simple in-home urine test that can give
you invaluable information on how you metabolize estrogen, and insight into what your relative
risks are for breast cancer, prostate health, and even weight management. We find it invaluable in
our practice for both men and women.
So how do you increase this ratio and enhance your bodys ability to process estrogen correctly?
13
This is important to know if you are considering bio-identical hormone replacement therapy. Well
address that issue now.
Dietary Changes to Improve the 2:16 Ratio

There are great foods that can help improve the conversion of estrogen into good metabolites and
away from bad metabolites. These foods include insoluble dietary fibers such as lignin found in
flaxseeds, bran, beans, and seeds.21 The reason that dietary fiber, especially lignin is so beneficial
is that it can bind unconjugated (harmful) estrogens in the digestive tract, so they can be excreted
in the feces instead of being reabsorbed.
Second, dietary fiber improves the composition of intestinal bacteria and reduces beta-glucuronidase, so that harmful estrogen metabolites can be excreted from the body. Dietary fiber intake also
increases serum concentrations of SHBG, the protein that binds to estrogen. This helps to reduce
levels of free estrogens and the chance of developing estrogen receptor positive cancers like most
breast cancers.22 Dietary fiber also decreases the conversion of testosterone into estrogens in fat
and breast cells.
On the other hand, over-consumption of simple carbohydrates like refined sugars and grains,
causes unfriendly flora to grow in the GI tract. These foods also raise blood glucose and insulin
levels, resulting in adverse influences in sex hormone balance.23
Excess carbohydrates have been associated with post-menopausal breast cancer risk among
overweight women, and women with a large waist circumference.24 Carbohydrate intake may also
be associated with estrogen receptor-negative breast cancer.25
The next step is to avoid animal protein that has been raised with hormones whenever possible.
(Europe wont accept hormone-laden U.S. beef because of the health risks.) Look for grass-fed
organic beef which is lower in saturated fat and richer in omega-3 fatty acids that will act to reduce
inflammation and help your hormone receptors to function properly.
But dont forget about chicken it is also shot full of drugs (with the exception of growth hormone).
Instead eat free range chicken that is drug and antibiotic free.
Finally, choose to eat organic vegetables, fruits, nuts, seeds, beans, and grains. I regularly tell
people that they should consider a three-vegetable for every fruit rule. And dont forget to choose
pesticide-free produce whenever possible. Pesticides are known to cause hormonal imbalances.
In fact, certain pesticides are called endocrine (hormone) disruptors!
Lifestyle Changes to Improve the 2:16 Ratio

Your lifestyle may expose you to environmental estrogens that can disrupt your bodys natural balance or interfere with BHRT. Here are some tips to reduce your exposure.
14
1. Limit drinking out of plastic containers.

2. Do not microwave food in plastic containers or covered in plastic.
3. Avoid using personal care items such as face creams, shampoos, and toiletries that contain
estrogens and particularly phthalates.
Phthalates are synthetic substances found in many plastics. They have estrogenic properties and
are banned as a toxic substance in Europe.
Dietary Supplements to Improve Estrogen Metabolism

Diindolylmethane (DIM) is a phytochemical found in cruciferous vegetables like broccoli and cauliflower. It shifts estrogen metabolism to favor the friendly or harmless estrogen metabolites.26 Several clinical trials have demonstrated the ability of DIM to significantly increase the urinary excretion
of the bad 2:16 hydroxyestrone in as little as four weeks.27
2-Methoxyestrone (2OH) is one of the safest and most protective forms of estrogen metabolites
in the body. Low levels of 2OH are associated with the development of high blood pressure and
weight gain in healthy postmenopausal women. The DIM found in cruciferous vegetables helps to
convert estrone into the 2OH form, which has a protective effect on all estrogen-sensitive tissues.
For women in peri-menopause (the transition phase), progesterone levels usually drop. By naturally increasing 2OH estrogens, the ovaries are stimulated to make more progesterone and ease
the transition into menopause. DIM has another added benefit. It helps to convert estradiol to 2methoxy estradiol, a metabolite with an anti-proliferative (anti-cancer) effect on cells.
DIM also has a direct effect on breast cancer tissue. It binds to estrogen receptors and stimulates
a process called apoptosis (death) so cells live their normal lives and die.28 The typical dose of DIM
is 75-300 mg per day. (See p.16 for DIMs effect on male estrogen metabolism.)
Omega-3 fatty acids (fish oils) contain eicosapentaenoic acid (EPA), which has been reported in
laboratory studies to help control estrogen metabolism and decrease the risk of breast cancer.29 As
there are a multitude of benefits from taking fish oils, this should be a part of your daily supplement
intake. Eating grass-fed organic beef also supplies these fats.
Calcium d-glucarate is a natural compound found in fruits and vegetables like apples, Brussels
sprouts, broccoli, and cabbage. Calcium d-glucarate inhibits beta-glucuronidase, the enzyme that
contributes to breast, prostate, and colon cancers. It also reduces re-absorbed estrogen from the
digestive tract.
Calcium d-glucarate has been found in animal studies to lower estradiol levels and inhibit the initiation, promotion, and progression of cancer. 30 Although the research has mainly been in animals,
clinically I have found that this does help manage estrogen levels and metabolism. The dose for
calcium d-glucarate is typically 500-1500 mg per day.
15
Probiotics (beneficial intestinal flora) like Acidophilus bifidus and Lactobacillus help to maintain
an acidic pH in the colon that assists in reducing
beta-glucuronidase production. Make sure you get
human-strain probiotics that have live cultures at
the time of purchase. Consider taking 10-60 billion
units per day.
Plant Phytoestrogens. Various phytoestrogens
(plant-based compounds with estrogen-like activity) can bind to estrogen receptors in the body
and appear to have both estrogenic and anti-estrogenic effects.34 Phytoestrogens are currently
being extensively investigated as a potential
alternative therapy for a range of conditions
associated with estrogen imbalance including
menopausal symptoms, PMS, and endometriosis. They are also being evaluated as a breast
and prostate cancer preventive and for protection
against cardiovascular disease and osteoporosis.
Phytoestrogens can be found in plants such as
soy, kudzu, red clover, and pomegranate. Resveratrol is a bioflavonoid antioxidant that occurs
naturally in grapes and red wine and has been reported to inhibit breast cancer cell growth in laboratory studies.35
Black cohosh is an herb thats been used for centuries by Native Americans for hormonal balance
in women. Over the last 30 years, European physicians helping women through menopausal transition have used it extensively. Continued studies
on this herb have revealed even more value for
women with breast cancer.36
DIMs Effect on Male Estrogen Metabolism

In men, there is an age-related increase in
estrogen accumulation in the prostate gland.
The higher the levels, the more enlarged the
prostate can become. In addition, estrogen
accumulation can make PSA levels go up.
Interestingly though, PSA production can be
inhibited by 2-methoxy estradiol. DIM helps to
make estradiol in men convert to 2-methoxy
estradiol.27
As men age and testosterone drops, their
body composition takes on more visceral fat
(belly fat), which produces more estrogen. As
estrogen levels go up in men, their ability to
dissolve blood clots goes down. But there is
preliminary evidence that 2-methoxy estradiol, 2OH and methoxy-estrones may prevent
plaque formation in the arteries and act as
powerful antioxidants to reduce oxidation of
LDL cholesterol.31
Last but not least, DIM reduces inflammatory
signaling by decreasing the production of inflammatory chemicals produced in the body.32
So, now you can see why controlling estrogen
metabolism by the use of DIM is so valuable
in men. BioResponse DIM is a special form
of DIM that has been shown to enhance the
absorption of DIM.33 Indole-3-carbinol (I3C)
is the precursor to DIM and is also available
in supplement form, but there is some controversy over whether it may actually stimulate abnormal cells. So at this time only DIM
should be considered for self-care.
It was previously thought that black cohosh had phytoestrogenic effects. But more recently it was
found to work on the hypothalamus-pituitary system (master glands), producing a hormonal balancing effect in the female reproductive system.37 In human studies, black cohosh effectively decreases hot flashes associated with menopause, but did not have any impact on vaginal dryness
or urethral urine leakage.37
Unlike conventional estrogen effects on individuals predisposed to breast cancer, black cohosh
16
extracts have been shown in laboratory studies to inhibit proliferation of estrogen receptor-positive
and -negative human breast carcinoma cell lines. In a human study of 949 breast cancer cases and
1524 controls, it was found that black cohosh offered significant protective effects against breast
cancer development.38
Black cohosh may also improve bone density, important in those susceptible to osteoporosis.39
Recently, some controversy arose over liver damage in two Canadian women taking black cohosh.
Although the warning from this controversy was heard in every medical venue, what was not heard
was that the Canadian government investigated and found that the women had taken a related
plant but did not actually take black cohosh.
There was even a study done comparing an estrogen drug (conjugated estrogens) with black cohosh. The results showed that black cohosh did just as well for bone density and hot flashes as the
estrogen.40 So black cohosh is a true botanical star when it comes to hormonal health. I have even
recommended black cohosh in men who are suffering from hot flashes with hormone therapy after
prostate cancer.
Melatonin
Melatonin is an antioxidant hormone produced in the pineal gland that, among other functions,
helps regulate sleep cycles. Melatonin levels decline with the aging process, and in women may
lead to the sleep disturbances that are seen during menopause.41
Melatonin has been shown in laboratory studies to inhibit the growth of breast cancer cells, thus
behaving as an anti-estrogenic hormone.42 Its use can delay the characteristic hormonal changes
that occur during the course of menopause.43 Melatonin has tremendous value as a hormone. It
acts as an anti-inflammatory and antioxidant in the brain and other tissues like the intestine.
Studies show that low melatonin levels increase breast cancer risk in women. So if you are getting up in the middle of the night and cant get to sleep, then you may need to consider 3-6 mg of
melatonin before you go to bed. Not only will it help you to sleep better, but it could offer additional
protection against future breast cancer risk.
Progesterone
Estrogen is only part of understanding sex hormones. Progesterone is equally important in sex
hormonal balance in women and in some cases men. In a healthy young woman, progesterone
serves as a counterbalance to estrogen. They work together, ideally in harmony. Progesterone
levels rise during the middle of the cycle, while estrogen builds up in the first half of a menstrual
cycle.
Progesterone helps to prepare the uterus for implantation with a healthy fertilized egg and supports
pregnancy in its early stages. If no implantation occurs, progesterone levels drop, and another
cycle begins. Progesterone levels have the ability to keep certain cancer cells from growing, includ17
ing breast cancer cells.44 Breast cancer is also found to be less common in women with adequate
progesterone levels.45
Progesterone receptors are found in the brain and are highly concentrated there. In the brain,
progesterone acts to protect your nerve cells and supports the myelin sheath that covers neurons.
It also helps to calm your nerves and can help you to sleep at night. In addition, because progesterone stimulates bone growth, it can help you to maintain bone health. I have seen progesterone
improve bone density many times over the years in my practice.
Sometimes, when using bio-identical progesterone replacement, the progesterone can be converted to cortisol, making you feel on edge and wired. Although this is rare, you should look for this
sign if you decide to use bio-identical progesterone. A general guideline for women on estrogen and
progesterone is a blood ratio level of 8-10 (estrogen) to 1 (progesterone).
If the progesterone to estrogen ratio is too high you will store too much fat and tend toward insulin
resistance. If the ratio is too low, you become at risk for breast cancer and other estrogen dominant
conditions discussed earlier. Remember, how you feel is a good indicator of your hormones being
balanced. If necessary, consult a healthcare professional to help you figure it out.
Progesterone production can decrease with low levels of thyroid hormone, the use of antidepressants, chronic stress, deficiencies in the vitamins A, B6, C, or zinc, and as mentioned above, a diet
high in refined sugar and saturated fat.
Here are some guidelines on how you may feel with an imbalance of progesterone.
Low Progesterone
Too Much Progesterone
Anxiety/Depression
Increased insulin resistance
Trouble sleeping
Increased fat storage
Fibrocystic breasts
Elevated cortisol
PMS
Increased craving patterns
Premenstrual headaches
Reduced growth hormone
Bones loss
Reduced immune function balance
There are certain natural supplements that can help support healthy progesterone levels. Chasteberry for instance has both progestogenic- and estrogenic-like activity.46 Chasteberry is a good balancing herb for the relationship between estrogen and progesterone it acts at the pituitary gland
which regulates all of your hormones. Chasteberry helps to stimulate luteinizing hormone release in
the brain, which helps turn on your own production of hormones. It can also be taken for reducing
the symptoms of PMS and endometriosis.
Women and Testosterone

As many as 20% of women are low in testosterone and therefore have a low sex drive. Testosterone
therapy is known to improve the signs and symptoms of hypoactive sexual desire in women.47
18
But there are other benefits related to testosterone replacement for women, including retention of
muscle mass, bone density retention, improved mood, and reduced cardiovascular risks. Levels
of testosterone should be checked in the blood to see if you are low before using any type of bioidentical testosterone or even herbs that may raise testosterone levels. Too much testosterone can
cause masculinization and lead to weight gain.
We will discuss the value of testosterone replacement for men in detail in the following section.
Male Menopause?
My belief is that if men would find out and track their testosterone level as they age, it could well be
the most important single thing they do to protect their vitality and health. Men come into our practice complaining of feeling emotionally flat, achy, and having low stamina. They have a belly, notice
a change in their memory, and worse of all sexual performance has dropped way off.
The lowering of testosterone levels in men leads to some significant problems, including loss of
sex drive, erectile function, and libido.1 Until recently, andropause or a drop in hormones in men as
they age, was basically ignored. But today, it is obvious that low testosterone can have a dramatic
impact not only on quality of life, but also on increasing your risks for serious illnesses and even
earlier death.
Here are some other warning signs that your testosterone levels can be dropping:

You lose strength, stamina, and muscle mass

You feel fatigued
You experience loss of focus and drive
You feel anxious, even depressed.
You have more muscle and joint aches
You notice your memory isnt what it used to be
You are gaining belly fat and cant figure out why
You can have decreased bone strength
These are all big enough reasons to replace testosterone because they strike at the very heart
of quality of life as you are aging. But the biggest reason to consider testosterone replacement is
because of the risk reduction of many chronic diseases and absolute improvement in life expectancy.
The lack of male sex hormones and associated hormonal imbalances can play a role in developing
insulin resistance and diabetes, heart disease, Alzheimers disease, osteoporosis, and cancer. A
recent important finding pointed out that lower testosterone levels, even in the low normal range,
increases your risk of developing heart disease.48
Testosterone is produced in the testicles at the rate of about 10 milligrams a day in a healthy young
male. You can also make testosterone from DHEA, which is produced in the adrenal glands. Al19
most all of the testosterone (about 98%) that is in the blood stream is attached to proteins, making
it unavailable. The other 2% known as free testosterone, is responsible for the various affects on
your metabolism.
Normal levels of testosterone are basically between 241-827 ng/dL for total testosterone, and between 6.8-21.5 pg/mL for free testosterone. About half of the testosterone men produce is bound
by sex hormone binding globulin (SHBG), which strongly holds the testosterone so that it cant be
accessed.
The other half is more readily available because it is weakly bound to other proteins like albumin.
This fraction is called bioavailable testosterone. In some lab reports, you will see reported: testosterone, % free testosterone, bioavailable testosterone, dihydrotestosterone (DHT), and SHBG.
This gives you a very complete picture of what is going on with your testosterone levels.
As men age, their SHBG starts to increase leading to a decrease in free testosterone. At the same
time, their estrogen levels start to increase. This is partly because aging men convert much of their
testosterone into estradiol.49 Of the remaining testosterone, much of it is bound to SHBG. As long
as free testosterone is low and relative estrogen (estradiol and estrone) is high, a man will store fat
around his belly, hence the pot belly.50
Low plasma levels of SHBG and free testosterone have been linked to increased insulin resistance
and risk for type 2 diabetes in males.51 As men age, their testosterone gets further broken down to
DHT by the enzyme, 5-alpha reductase. Some men genetically make more DHT, which leads to
male pattern baldness and prostate inflammation (hyperplasia).
Studies have found that men with low circulating testosterone have higher levels of DHT, which can
lead to an increase in the risk of developing prostate cancer.52 What makes matters worse is that
the testosterone that doesnt get turned into DHT is available to be converted to estradiol by the
enzyme, aromatase.
Aromatase is very active in belly fat, and the more belly fat you have, the more estrogen you will
make. Elevations of estrogen in men are also being implicated in prostate disease, cancer risk,
and male breast development.53 It really is a vicious cycle. I am explaining these enzymes because
there are natural products we will discuss that can help you to block these negative effects on testosterone that occur with aging.
Other factors like stress, smoking, and excess alcohol intake can also lower testosterone concentrations.54 Sleep disturbances can disrupt the normal testosterone rhythm in men.53 And if you are
low in testosterone, you may also develop osteoporosis. Two out of ten cases of osteoporosis are
now in men.
Alarmingly, a recent study found a link between low levels of testosterone and increased risk for
mortality from all causes in adult men of all ages.55 That means that if you have low testosterone,
chances are you are more likely to die earlier than someone with a normal level.
20
Recent studies have found that as many as 25% of males by age 35 will have lowered testosterone levels. If they have an average life expectancy, 25% of men over age 70 will meet laboratory
criteria for testosterone deficiency.56 So, one in four men will be clear candidates for testosterone
replacement.
But there is more to managing testosterone responsibly than just getting a shot every two weeks,
having a pellet inserted, or applying a topical gel or cream. You also need to evaluate PSA, SHBG,
cortisol, DHEA, LH (luteinizing hormone), estradiol and estrone levels, DHT, insulin, and growth
hormone.
It is important to monitor all of these hormones regularly so that you dont convert your testosterone
replacement into dangerous metabolites and to ensure that there are no other factors that could influence your production and metabolism of testosterone. When managed poorly, the side effects of
testosterone therapy can include acne, hair loss, depression, moodiness, swelling in the arms and
legs, gynecomastia (breast growth in males), breast pain, high blood pressure, decreased libido,
and nervousness.57
When done safely however, testosterone replacement can change your life and give you back the
vitality you once had. Many men have expressed their gratitude for the work we do at LMI to help
them overcome hormonal deficiencies.
The following chart outlines the normal ranges of the most important hormones. It can be used as
a quick reference check as you monitor your current hormone levels.
Normal Hormone Ranges For Men
Hormone
Testosterone
Total
Free
Dihydrotestosterone
(DHT)
Range
Approximate
Optimal Level
Natural Product
Support
241-827 ng/dL
Above 550
Zinc
6.8-21.5 pg/mL
Above 14.0
Eurycoma longifolia (longjack)
30-85 ng/dL
65 or less
Progesterone
Saw Palmetto
Nettle Root
DHEA/For age range

20-29
30-39
40-49
50-59
60-69
70
Prostate Specific
Antigen (PSA)
208-771 ng/dL
146-850
107-745
131-538
82-338
69-252
>500 ng/dL
>600
>500
>350
>250
>150
0.0-4.0
<2
Supplemental DHEA (given only if levels

are measured)
Saw palmetto
Pygeum
Stinging nettle root
Zinc
21
Hormone
Range
Approximate
Optimal Level
Estrone
12-72 pg/mL
<40
Estradiol
0-53pg/mL
<30
Natural Product
Support
DIM
Pomegranate
Flaxseed
Calcium d-glucarate
Progesterone
0.3-1.2 ng/mL
0.7-0.9 ng/mL
Vitex
Progesterone cream
Vitamin D3
32-100 ng-dL
50-70 ug/dL
Vitamin D3
Cortisol (8 am serum)
3.1-22.4 ug/dL
10-14 ug/dL
Adrenal Cortex (New Zealand source, if

low)
American and Korean ginseng
Relora
Holy Basil
Insulin (2 hour post-prandial)
3-23 ug/dL
<10-15 ug/dL
Glucokine
GTF chromium
Alpha-lipoic acid
Cinnamon
Glucose (2 hour postprandial)
65-105 mg/dL
80-90 mg/dL
See insulin above
Glucose fasting
65-99 mg/dL
70-85 mg/dL
TSH
0.350-5.50 uIU/m
<2
Selenium
Free T3
2.3-4.2 pg/mL
3-3.6 pg/mL
Iodine
Tree T4
0.76-1.76 ng/dL
1.1-1.5 ng/dL
Tyrosine
TPO
0-34 IU/mL
<34
Chromium
Antithyroglobulin Ab
0-40 IU/mL
<40
Guggul
Bacopa
Ashawagandha
Growth Hormone
(urinary, a.m.)
IGF-1
IGF-1 binding protein 3
L-Glutamine at bedtime
Alpha GPC at bedtime
94-252 ng/mL
150-220 ng/mL
Testosterone How Much Do You Need?

Here is the trick with testosterone replacement. You need to have the dose individualized to get the
proper response. Not everyone feels good at the exact same level in the body. So dont get hung
up on the numbers unless they are way out of bounds in either direction.
Many men are concerned that testosterone replacement will somehow lead to increased prostate
22
cancer risk. This has been studied and proven not to be a concern. If you have a history of, or an
existing prostate cancer though, then you should not consider testosterone replacement.
Once again, the best way to achieve success with testosterone replacement is to consult with an
experienced healthcare professional who takes into account all the influences on your metabolism.
For example, it is important to consider that high cortisol levels due to stress will hinder your bodys
ability to use testosterone replacement. So its important to dampen those stress hormones first.
You could also be low in zinc, which could end up causing you not to be able to make testosterone.
Here is a hypothetical example of how hormone levels can predict the perfect storm for a 53-yearold-man, who is 50 pounds overweight.
Estrone: 138
Estradiol: 120
Dihydrotestosterone (DHT): 70
2-Hour post-prandial glucose: 130 ug/dL (high)
2-Hour post-prandial insulin: 60 (high)
Cortisol: 20.3 (high)
Vitamin D3: 18 (low)
PSA: 2.1 (borderline)
DHEA: 80 (very low)
Total testosterone: 230 (very low)
Free testosterone 3% (low)
This middle-aged man is percolating heart disease, diabetes, and prostate cancer in his near future. He has low testosterone and much of it is being converted to estrogens and DHT. He is insulin
resistant so his body is an inflammation engine and his blood pressure is starting to creep upward.
His Vitamin D level is so low that his immune system is compromised, his insulin receptors dont
work well, and his prostate tissue is unprotected.
His stress hormone, cortisol, is trending high and that is making him use up available DHEA. Because he is overweight, his fat cells are making aromatase and turning his available testosterone
to estradiol. Many of these factors influence his mood he is grumpy and cognitively less sharp.
His ability to maintain an erection is gone. This may sound like a hopeless case but you know
what? It can be turned around.
Ill tell you how with a story about Mike B. who came to our practice recently. Mike was an old friend
who I hadnt seen in 25 years. We actually had done some Native American healing ceremonies
together. My memory of Mike was of a short, overweight guy who was willing to lend a hand. He
was full of energy and his smile was contagious.
The new Mike walked in my office with a long list of complaints. He was fatigued, depressed, his
sex drive was down, his mental sharpness had left him, and his stamina was simply gone. Mike was
very anti-drug and made it clear that he was not going down that path.
23
We tested his blood sugar in the office and it was 352 fasting. Mike was an undiagnosed diabetic
but there was more to it than that. He was 60 pounds overweight and now at age 53, he was a
metabolic train wreck. His total testosterone and % free testosterone were both low, his SHBG was
low, his DHEA was low, his estrogens were high, and his cortisol was high.
We immediately put Mike on the Metabolic Code insulin resistance phase diet and gave him various
nutritional supplements to support his chemistry. In addition, we added testosterone cream. Mike
started to exercise, followed his diet, and took the supplements we prescribed. Within 12 weeks
Mike had a fasting blood sugar in the eighties without drug therapy. He lost 40 pounds (mostly water and fat), his sex drive came back, but most importantly, the Mike with the contagious smile, wily
wit, and the energy to pitch in was back. For him, it was like being 30 again!
Dietary Supplements for Male Enhancement

So how can you help support healthy testosterone levels naturally? Well, optimizing testosterone
levels in men requires a multi-faceted approach including lifestyle changes, proper diet and nutrition, dietary supplements where warranted, exercise, and bio-identical hormone replacement
therapy if necessary. Your healthcare provider can test your levels of total testosterone, available
testosterone, and free testosterone in blood, saliva, or by what is known as a blood spot.
In men, luteinizing hormone (LH) stimulates the production of testosterone, so providing supplements such as chasteberry that can help increase LH would be of benefit. If hormone replacement
is called for, the drug, Human Chorionic Gonadotropin (HCG),a bio-identical compound is used to
stimulate the gonads in men to produce testosterone. Compounding pharmacies can even compound HCG into a topical cream or a sublingual lozenge, so injections are not needed.
Another supplement, tongkat ali, also known as eurycoma (Eurycoma longifolia) has been traditionally used as an aphrodisiac and for sexual enhancement. Laboratory research supports the
use of eurycoma in these areas.58 In our practice, we have found that clinically, this herb works well
to improve the % free testosterone, but does not necessarily increase total testosterone.
Eurycoma helps to lower sex hormone binding globulin. If your SHBG is low and your % and total
testosterone are low, it is doubtful that you will gain benefit from this herb. In this case, you can take
some additional zinc, get enough sleep, and get regular exercise.
Zinc is necessary to maintain normal serum testosterone. Inadequate zinc levels prevent the pituitary gland from releasing luteinizing and follicle-stimulating hormones, which stimulate testosterone production.59 Zinc also inhibits the aromatase enzyme, which converts testosterone into
estrogen. If these measures dont work, you may need testosterone replacement.
One of the biggest areas in which dietary supplements are used is for male enhancement. Supplements for male enhancement are very popular for low sex drive and muscle building. Many are
claimed to increase testosterone production. The supplements used in many of these male supplements include the herbs muira puama (Ptychopetalum olacoides), tribulus (Tribulus terrestris),
24
and horny goat weed (Epimedium sagittatum). Although they have been used in China for centuries for male potency, these herbs have limited science behind them to prove their value.60 I do
expect that there will be emerging evidence that some of the herbs in the correct standardization
may provide benefits for men.
Its much more efficient to balance hormone levels naturally by eating a healthy diet, decreasing
the effects of stress on your chemistry, and taking dietary supplements to help decrease oxidative stress and balance metabolism. All of these steps work to increase sexual vitality. And when
needed, bio-identical hormones (BHRT) can be used responsibly.
The Roots of Hormonal Balance For Men and Women: The Other
Hormones that Matter
Hormones are small messenger compounds that help regulate all functions of our body. They are
regulated by the hypothalamic pituitary adrenal-thyroid axis (HPA-T), a group of glands that plays a
central role in balancing and controlling metabolism. Stress, a poor diet, nutrient depletions, or exposure to environmental toxins can imbalance the HPA-T axis, leading to imbalances in hormones.
Because these hormones are so intimately connected, balancing the HPA-T axis is key to providing
hormonal support during aging.
Cortisol
You cannot evaluate sex hormones without including the evaluation and management of the stress
hormone, cortisol. Like any other hormone, too much or too little cortisol can create drastic and
unfriendly changes to your metabolism. Chronic stress increases levels of certain hormones in the
body, including cortisol and neurotransmitters such as epinephrine and norepinephrine.
Your adrenal glands produce cortisol as well as producing sex hormones. When excessive levels
of cortisol are produced over long periods of time, it promotes inflammation, alters blood sugar
control, causes fat storage, affects immune function, and alters sex hormone production. The adrenal glands make about 35% of womens hormones before menopause and as much as 50%
post-menopause. When the adrenals are busy making stress hormones, it depletes the reservoir
of DHEA, which should have eventually been converted to sex hormones.
Cortisol is made from progesterone. So if you make lots of cortisol, the progesterone pool goes
down causing a shift in the estrogen to progesterone levels. Cortisol will also block progesterone
receptors, making the imbalance even greater. Women could forever try to balance out estrogen
and progesterone, but without managing cortisol, they can never get to a stable pattern of hormone
replacement. This is the same problem for men. When cortisol takes away progesterone, men
cant make as much testosterone.
With elevations in cortisol, blood sugar and insulin levels also rise. At the same time, serotonin (the
calming brain chemical) levels drop leading to feelings of anxiety, nervousness, or depression.
Food cravings will also increase a common problem in obese people. As serotonin levels drop,
25
your sleep patterns are also altered. The shift in sleep and serotonin levels leads to a chronic craving for comfort foods, high in carbohydrates and sugars (like chocolate, chips, and pretzels).
Studies have found that individuals who sleep 5 hours a night or less are 73% more likely to become obese.61 In addition, it has been established that those with insomnia are more prone to poor
blood sugar regulation. Reduced sleep can lower testosterone production, and negatively affect
other hormones like thyroid hormone. This is really a vicious cycle especially for men, because the
reduced sleep lowers their testosterone, increases their insulin resistance and heart disease risks,
and flattens their mood.
Now the Lazy Boy lounger and remote control syndrome starts making a lot of sense. When cortisol
goes up, it uses up DHEA and so there isnt as much DHEA available to make sex hormones. Besides, as you will learn shortly, DHEA has numerous protective benefits for your heart and brain.
The reality is, it is difficult to avoid many stressors. I regularly suggest to people that they should
use a dietary supplement to reduce the impact of stress on their body. You can actually feel the
difference. Stress response can be managed through exercise and by taking dietary supplements
like Relora, a patented blend of two Chinese herbs.
Relora helps people who have high stress levels because stress hormones raise blood sugar levels. In addition, Relora seems to help control mild anxiety and some of the symptoms associated
with stress, such as irritability, emotional ups and downs, restlessness, tense muscles, poor sleep,
fatigue, and difficulty concentrating. An unpublished clinical trial measured cortisol and DHEA levels in patients with mild to moderate stress.62 A two-week regimen of Relora caused a significant
increase in salivary DHEA (227%) and a significant decrease in morning salivary cortisol levels
(37%).
Holy basil (Ocimum sanctum) is an herb native to India, where it is known as tulsi. It is sacred in
the Hindu religious tradition and regarded as one of the most important plants used in Ayurvedic
medicine. Holy basil contains antioxidant phytochemicals that can help decrease oxidation associated with aging and may help decrease stress-related cortisol output.63
A randomized, placebo-controlled, crossover single blind trial found that administration of an extract of holy basil produced a significant decrease in fasting and postprandial blood glucose levels
during treatment when compared with placebo.64,65 Holy basil extracts are potent antioxidants, and
have been reported in laboratory studies to decrease the oxidative stress that targets cholesterol.
L-Theanine is an amino acid contained in green tea leaves. It helps decrease both mental and
physical stress, leading to improved sleep patterns. Theanine helps to decrease the amount of
PEA (phenylethylamine) that is produced in your brain. PEA is the neurotransmitter that makes
your mind keep thinking over the days events and what has to be done tomorrow when you are
supposed to be falling asleep.
Theanine binds to glutamate receptors to calm them down. Glutamate is the primary excitatory
neurotransmitter in your brain. Unlike pharmaceutical drugs, L-theanine doesnt make you drowsy,
26
but rather it is effective in slowing down an overactive mind. In fact, studies have shown that Ltheanine improves your focus and ability to concentrate.66 It has also shown promising results in
lowering blood pressure and improving immune function.
Growth Hormone
Growth hormone (GH) is secreted by the pituitary gland to help fuel growth during your childhood
and to help maintain your tissues and organs throughout life. Deficiencies in growth hormone have
been linked to an increase in cardiovascular risks and cancer.67 After about the age of 30, the secretion of growth hormone by the pituitary gland tends to decline.68 Your diet can also affect your GH
levels, since consuming high glycemic foods stimulates the release of insulin, which contributes to
a reduction in GH.69
The effects of decreasing levels of GH have prompted many people to turn to human growth hormone (hGH) injections as a way to fight the aging
Do You Have the Signs and Symptoms of
process or for conditions like post-surgical healing
Chronic Stress Chemistry?
or Crohns disease.
Although hGH is popular for its anti-aging potential, taking synthetic human growth hormone injections can cause a number of side effects, including:

Swelling in your arms and legs

Arthritis-like symptoms
Carpal tunnel symptoms
Headaches
Bloating
Muscle pain
Type 2 diabetes
Abnormal growth of bones and internal organs
Hardening of the arteries
High blood pressure
Because of the potential for side effects, hGH
may not be for you in your fight against the aging
process. In my opinion, only until the 7th or 8th
decades of life should hGH injections be used to
help counterbalance low growth hormone levels
in aging. First of all, the injections are very expensive. Secondly, once you initiate the therapy, you
are tied to it to maintain levels in the body.
27
1. Do you have strong cravings for comfort foods

like sweets, breads, or chips?
2. Do you have trouble falling asleep or staying
asleep?
3. Do you feel anxious, depressed, or emotionally
flat?
4. Do you have problems with your short-term
memory or your mind being not as sharp?
5. Are you fatigued mid-day?
6. Is your sex drive going down?
7. Are you gaining weight around the belly?
These signs can all be related to chronic stress.
Quick Tips to Lower Stress
Exercise 20 minutes a day at least 3 days a
week. It helps to burn off cortisol and reduce
insulin resistance. For men, it has the added
benefit of stimulating testosterone production.
Over time, try to get in 30-60 minutes of exercise 3-4 times a week. Learn how to do the
2-minute deep breathing exercise discussed in
the special report, 14 Days to Less Stress and
Better Sleep available at http://www.web-purchases.com/700SSAS/W700J906/landing.html.
Try taking Relora, Holy basil, or theanine to help
combat the effects of everyday stress.
Get no less than 7 hours of sleep every night.
Since natural growth hormone is secreted in pulses, mostly during the early hours of sleep, it is difficult to measure. It can be measured indirectly, however, by measuring the plasma concentration
of insulin-like growth factor-1 (IGF-1). IGF-1 is produced and released by the liver (and perhaps
other tissues) in response to growth hormone changes.
Plasma IGF-1 concentrations decline with advancing age in healthy adults. Less than 5% of the
healthy men 20 to 40 years old have plasma IGF-1 values of less than 350 units per liter. On the
other hand, 30% of healthy men over 60 have values below this level.69 Recently, a morning urinary
growth hormone test has become available which many practitioners are beginning to utilize because it gives a more direct measurement of growth hormone.
Using dietary supplements and exercise is another way to help balance the pituitary gland, which
may become desensitized during the aging process. This can also help balance levels of hGH and
other interrelated hormones.
Alpha-GPC (L-alpha-glycerylphosphorylcholine) is a natural compound concentrated in nerve
membranes in the brain. Made from the lipid lecithin, Alpha-GPC supports brain function and learning processes by directly increasing the synthesis and secretion of the neurotransmitter acetylcholine.70 Alpha-GPC protects neurons and improves signal transmission by serving as a precursor to
membrane phospholipids. It also helps to stimulate hGH release from the pituitary.
Other nutrients will support a healthy pituitary gland. The herb chasteberry has been reported to
help balance pituitary hormone release, and the amino acids L-arginine and L-glutamine may
improve growth hormone regulation.71
So before you consider injections, first improve your metabolism by decreasing stress, eat a healthy
diet to improve insulin resistance and decrease inflammation, and use dietary supplements to help
control imbalances in pituitary release of GH.
DHEA The Fountain of Youth Hormone

DHEA (dehydroepiandrosterone) is a natural pro-steroidal hormone secreted by the adrenal gland,
the gonads, and the brain. It produces estrogen and to a lesser extent, testosterone. Studies show
that higher levels of DHEA as you age are associated with longevity. DHEA helps slow the aging
process by reducing the production of two inflammatory compounds called TNF-alpha and interleukin-6 that are instigators in a variety of chronic illnesses.72
Although women usually have less than men, both sexes lose DHEA at about the same rate, suggesting that its decline is age related.73 Peak levels are typically reached when men and women are
in their 30s they then begin to lose approximately 2% per year.
During periods of chronic stress, the release of the stress hormone cortisol can decrease levels of
DHEA, lowering immunity and potentially accelerating the aging processes.74 Studies have found
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that DHEA therapy in women with adrenal insufficiency can help decrease the sexual side effects
often seen during menopause, such as decreased libido.75
Low levels of DHEA have also been linked to increased weight gain and a decrease in bone mineral
density (which can lead to osteoporosis).76,77 DHEA is also involved in the regulation of glucose6-phosphate, which can increase oxidative stress and inflammatory signaling, leading to glucose
regulatory problems.78
In one study, three different hormones were looked at for 3-year survival of men with chronic heart
failure. In this study, testosterone, IGF-1, and DHEA were tested. The results were startling:79
If the men had no lowered levels in these hormones their survival was 83%
A deficiency in one of the hormones meant 74% survival
A deficiency of two of two of the hormones indicated 55% survival
If they were deficient in all three hormones, their survival at 3 years plummeted to just 27%
If that is not a clear message that managing the balance of all your hormones is important, I dont
know what is!
In another significant study, men with higher levels of DHEA and testosterone had less arterial stiffness, which means they are at less risk for cardiovascular events.80 Another study cell showed that
DHEA had the ability to turn off the inflammatory process inside of the lining of arteries.72
One of the most important reasons to measure DHEA is that low levels in combination with high
cortisol levels put you at risk for memory loss. Originally it was thought that high cortisol was the
culprit in damaging the hippocampus, your brains memory center. But new studies report that the
brain has a high concentration of DHEA when this concentration drops, the protective effects of
DHEA on the brain are lost.
This is supported by the finding that people with Alzheimers have lower DHEA levels. DHEA protects brain cells from the beta-amyloid protein that is associated with Alzheimers. Studies have
also shown that neurodegenerative patients have a high ratio of cortisol to DHEA.81
People with declining levels of DHEA seem to respond to DHEA supplementation. Appropriate
replacement doses are generally between 5-75 mg per day, depending on your current levels.
Supplementation appears to have positive effects on aging, including anabolic growth factor which
increases muscle strength and lean body mass, activated immune function, and enhanced quality
of life with no significant adverse effects.82
So get your DHEA and DHEA sulfate levels checked to find out if you are deficient. They can be
checked by saliva or blood testing. Both have plenty of documentation to support this method of
testing.
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Pregnenolone
Pregnenolone is known as the mother hormone because it is the precursor to a number of hormones including DHEA, testosterone, cortisol, progesterone, and estrogen. Pregnenolone is synthesized directly from cholesterol and is responsible for countless functions in our bodies.
By the age of 75 however, the bodys production of this valuable hormone has declined by as much
as 60%, and levels of the hormones for which pregnenolone is a precursor have also diminished.
Studies have demonstrated that pregnenolone has a stimulatory effect on memory.83 For many
people, pregnenolone will raise DHEA serum levels to reduce the need for DHEA supplementation.
Unlike DHEA, which converts to estrogen (the three types) and testosterone, pregnenolone is
converted directly to progesterone. Therefore, it is often an excellent choice for estrogen-sensitive
women or testosterone-sensitive men (such as those with a history or risk of prostate cancer).
Insulin
Studies have found that insulin resistance is a predictor of age-related diseases.84 Once insulin is
elevated, it can reduce the production of DHEA which is needed to build sex hormones. And when
insulin stimulates belly fat production, the fat accumulation can alter hormone function as well.
Insulin resistance is associated with an increased level of the potent inflammatory compound, TNFalpha in the body. When healthy older men and healthy young men with normal glucose tolerance
were given a high glycemic diet for a sustained period of time, the older men failed to show a normal suppression in TNF-alpha production under high glycemic load conditions but the younger
men did.85 So when you eat high sugar and high carbohydrate foods day after day, even if you are
healthy, the increase in TNF-alpha can lead to significant inflammation in your body, along with
imbalanced hormones and a disrupted metabolism.
Low testosterone levels have also been found to increase the production of TNF-alpha86 and other
inflammatory chemicals. Men who are insulin resistant are also more likely to have reduced testosterone secretion.87
There is another way that insulin resistance can accelerate the aging process. It can lead to glycation a process in which glucose reacts with protein in an undesired way. This reaction results
in sugar-damaged proteins (similar to browning food in the oven) called advanced glycation end
products (AGEs).
The formation of AGEs happens in everyone and is a major factor in the aging process itself. However, AGE formation is increased under conditions like hormonal imbalances, oxidative stress, and
insulin resistance. AGEs may lead to premature signs of aging like wrinkles and brown spots, and
may eventually lead to the development of type 2 diabetes, cataracts, macular degeneration, kidney disease, cardiovascular diseases, and even cancer.88,89
30
Insulin resistance can be improved with dietary changes and the use of dietary supplements like
magnesium, bitter melon, Glucosol, and chromium. Consider taking a patented extract from Germany called Glucokine, which blends a highly concentrated and standardized bitter melon concentrate with GTF chromium.
The mineral magnesium plays a critical role in carbohydrate metabolism and preventing metabolic
syndrome. Magnesium seems to influence the release and activity of insulin and help balance glucose levels.90 Glucosol has been reported to enhance the utilization of glucose in the body.91
Research suggests that extracts of banaba (L. speciosa) may be effective in helping the body control plasma glucose levels in those with type 2 diabetes.92 Testosterone replacement has a significant impact on improving blood sugar and reversing the trend toward insulin resistance.
Eating foods high in sugar like soft drinks and candies, pasta, and white breads can lead to insulin resistance and the associated issue of hormone disruption so will being overweight, highly
stressed, having low thyroid function, and having poor sleep habits.93,94 It is essential to learn how
to eat healthy to maximize hormone performance while aging.
Thyroid Hormones
Many people have a condition called subclinical hypothyroidism (SH) characterized by normal serum concentrations of free thyroxine and elevated serum concentrations of thyroid-stimulating hormone (TSH). At subclinical levels, imbalances of T3 in the cells lower oxygen consumption, which
contributes to lipid peroxidation and free radical damage.
Some of you may have gone to the doctor to find out if your thyroid is functioning properly. Well, at
the levels that thyroid hormones are considered normal, you might slip though the cracks and actually be low in thyroid hormone, but not low enough to be considered hypothyroid by conventional
testing methods.
Low levels of thyroid hormone decrease the metabolism of fats and increase serum lipids. Low
levels also decrease the availability of essential fatty acids, increase inflammation and oxidative
stress, and lead to weight gain and fatigue. Physical, mental, and environmental stresses can also
inhibit the conversion of T4 to T3, thus decreasing the amount of active thyroid hormone available
to the cells.
As T3 levels become lower in tissues, the number of mitochondria in the cells decreases, causing
a reduction in energy production and fuel burning. In addition, with depressed thyroid function, the
number of insulin receptors can be turned off by as much as 20%.
Balanced levels of T4 and T3 are closely involved in sex hormone balance and a robust metabolism. Low thyroid function inhibits the production of pregnenolone which is needed to build sex
hormones. When thyroid hormones are low it can disrupt the majority of metabolic pathways in your
body. Nutrients arent absorbed, hormones dont bind to receptors as well, and tissues cant get
31
the nutrients they need to function the manufacturing capacity of your whole body is shut down.
(Refer to the chart on page 22 for optimal thyroid hormone levels.)
If you find your thyroid hormone levels are low or imbalanced, supplements can help. Iodine,
selenium, zinc, chromium, selenium, vitamin A, vitamin C, vitamins B2, B3, and B6, seaweed (Fucus vesiculosus), bacopa (Bacopa monnieri), guggul (Commiphora mukul), and ashawagandha
(Withania somniferum) have all been shown to balance thyroid hormone levels.
Brain Neurotransmitters The Sparks that Make You Feel Sharp

Hormone levels in your body heavily impact neurotransmitter function. In order to maintain health
as you are aging, it is important to help your brain maintain its ability to produce, release, and process neurotransmitters in the brain and the rest of the body.
Neurotransmitters are chemicals found all over our body and most importantly, in the brain. They
affect how we think, how we feel, and the ways we behave. Being happy or sad, feeling energetic
or tired, staying calm, or getting irritable are all functions of neurotransmitters. Neurotransmitters
include serotonin, dopamine, norepinephrine, and epinephrine (adrenaline).
If there are fluctuations in other hormonal levels during aging, such as estrogen, testosterone, thyroid, or cortisol, then many of your body and brain functions begin to change. These changes can
lead to depression, low energy, and impaired mental function.
The pituitary gland located in the brain secretes hormones and keeps them balanced, so maintaining optimal hormonal function in the brain is a key component to overall hormonal balance. An
example of this inter-relationship is during menopause when estrogen levels decline. Many women
will also notice a decline in cognitive function and memory.95
Healthy levels of estrogen have been reported to be closely related to levels of the calming neurotransmitter serotonin, which is also involved in insulin regulation and appetite control.96 Studies
have also reported that low levels of the male hormone testosterone (in both men and women) can
cause symptoms of depression, fatigue, a decreased sex drive, and irritability.97
Other studies have found that when the thyroid hormones are imbalanced, alterations in insulin
receptors and brain neurotransmitters occur.98 The pituitary gland can become desensitized in the
aging process, and subsequently hormones may become imbalanced. Mucuna (Mucuna pruriens)
is an herb with protective effects on brain neurotransmitters, including restoring the neurotransmitters, dopamine, norepinephrine, and serotonin to healthy levels.99
5-Hydroxytryptophan (5-HTP) is a nutritional supplement that functions as an antioxidant and increases levels of serotonin within the central nervous system.100 5-HTP is the intermediate metabolite of the amino acid, L-tryptophan (LT) in the serotonin pathway. 5-HTP crosses the blood brain
barrier and is one step closer to making serotonin than its precursor, L-tryptophan. Technically, the
supplement bypasses the conversion of L-tryptophan into 5-HTP by the enzyme tryptophan hydrolase, which is the rate-limiting step in the synthesis of serotonin.
32
Serotonin production can also be inhibited by certain factors like stress, insulin resistance, vitamin
B6 and folic acid deficiency, and insufficient magnesium. The herb rhodiola (Rhodiola rosea) influences the levels and activity of brain chemicals such as serotonin, dopamine, and norepinephrine
in the cerebral cortex, brain stem, and hypothalamus. These adaptogenic properties help to balance the hypothalamus-pituitary adrenal axis and balance hormonal levels.101
All this ties in with the balance of hormones and the balance of metabolism Ive been talking about.
You must balance the nervous system, the immune system, and the hormonal system to achieve
metabolic health. Estrogen or testosterone creams, gels, or pills alone wont solve all your health
problems.
You must take into consideration diet, exercise, nutrient status, hormonal levels, stress levels,
sleep patterns, and blood sugar control when dealing with hormonal imbalances. The more you
know about each of the hormones we have mentioned and what they do when they are out of balance, the more you will realize what the benefits of hormone replacement can be. Here is a recap
of some of these important hormones.
Sex Hormones
Estradiol
Aids the absorption of calcium, magnesium, and zinc minerals which are important for our
bones, teeth, blood sugar regulation, and immunity.
Increases HDL good cholesterol and lowers total cholesterol, LDL bad cholesterol and triglycerides, to protect against heart disease.
Increases serotonin, the neurotransmitter that helps us feel calm and peaceful. Serotonin is
converted into melatonin, the hormone that makes us fall asleep and stay asleep.
Increases endorphins, brain chemicals that can give us a feeling of euphoria and help control
pain.
Increases blood flow to the brain while protecting the effectiveness of the blood brain barrier.
Estriol

Helps with hot flashes, insomnia, and vaginal dryness.

Helps to maintain the good bacteria in the intestine.
Helps increase HDL cholesterol and reduce LDL cholesterol.
Helps to block estrone by occupying estrogen receptors on breast tissue.
Estrone

Main estrogen made post menopause.

Stimulates breast and uterine tissue growth and may increase cancer risks.
Protective conversion of estrone to estradiol stops at menopause.
Also made by fat cells, so obese women have greater and more dangerous estrone/estradiol
ratios.
33
Progesterone

Principal hormone to balance estrogen.

Helps to keep you calm and improve sleep.
Helps to lower blood pressure.
May protect against breast cancer.
Lowers cholesterol.
Normalizes sex drive.
Helps estrogen to protect blood vessels.
Supports strong bones.
Testosterone
Increases sexual interest.
Increases emotional well-being and self confidence in men.
Increases muscle mass.
Maintains memory.
Decreases excessive belly fat accumulation in men.
Supports strong bones.
Can act as an anti-depressant.
Increases stamina and reduces joint pain in men.
DHEA
Helps with management of cholesterol.
Reduces formation of fatty deposits.
Prevents blood clots.
Improves bone growth.
Promotes weight loss.
Improves brain function.
Supports immune function.
Supports blood sugar regulation.
Pregnenolone
Precursor to other sex hormones.
Other Hormones
Cortisol - Influences:
Blood sugar levels.
Weight control.
Immune system response.
34
Bone turnover.
Mood.
Mineral balance.
Blood pressure.
Sleep.
Stress response.
Thyroid Hormones

Regulate fat burning.

Help neurotransmitters like serotonin to function properly.
Help regulate blood glucose.
Control the absorption and metabolism of nutrients.
Are essential in heart health.
Needed for skin, nail, and hair health.
Help with normal bowel movements.
Keep body temperature normal.
Help with cholesterol regulation.
Help signal nutrient absorption.
Growth Hormone (GH)

Responsible for regulation of insulin.

Regulates protein synthesis to improve muscle mass.
Helps increase mineralization of bone.
Helps to rebuild and rejuvenate tissues.
Weve looked at the key players in achieving hormonal balance. I know you thought you only had
to worry about your estrogen or testosterone levels, but the relationship of all these hormones is
of the utmost importance in achieving health. Lets look at a natural method to help bring hormonal
balance back so that you can provide a healthy environment for your metabolism to flourish.
Bio-identical Hormone Replacement

Hormonal health is crucial in maintaining a balanced metabolism. The health of your sex hormones
depends on their inter-relationship with other hormones in the body like insulin, growth hormone,
cortisol, and thyroid hormone. So how can people with hormonal imbalances correct them without
using potentially harmful synthetic hormones?
Since the negative aspects of chemically produced hormone replacement were made known with
the publication of the Womens Health Initiative (WHI) trial, women and their doctors have been
looking for other ways to treat menopausal symptoms, including bio-identical hormone therapy
(BHRT).
35
BHRT is the use of sex hormones from either plant sources (usually soy and wild yam) or made
synthetically that are exactly the same as those found in your body. BHRT brings hormones back
to a normal level and alleviates uncomfortable symptoms of deficiency. Bio-identical estrogens will
often be prescribed for women after blood, saliva, and urine testing shows deficiencies. Estrogen
replacement can be part of a comprehensive hormone restoration program that also includes bioidentical progesterone, pregnenolone, DHEA, human chorionic gonadotropin (hCG), LH, thyroid
hormones, and testosterone if needed.
The use of BHRT is now very popular. Celebrities like Suzanne Somers have brought bio-identical
hormones onto center stage. In her books and in media appearances to promote them, she describes how bio-identical hormones relieved her menopause symptoms and changed her life. As a
result, more and more women ask Are bio-identical hormones for me?
Here is what is known so far about BHRT. First and foremost, for women, BHRT has been found
to be effective in reducing the number and intensity of hot flashes, as well as to improve sleep and
other negative symptoms of peri-menopause and menopause.102
But are there risks?
The primary risk to be concerned about in hormonal replacement for women is breast cancer. Its a
fact that increased estrogens in a womans body can increase her risk of breast cancer. However, it
should be noted that low progesterone to estrogen ratios are playing an important role in that risk.
If a woman has low progesterone levels, it is correlated with a fivefold increased risk of pre-menopausal breast cancer.102 And progesterone cream has been found to reduce the over proliferation
of what are called epithelial cells in breast tissue (epithelial cells may develop into abnormal tissue
growth).103
This protective, anti-proliferative effect of bio-identical progesterone is not seen with synthetic progestins. Natural progesterone does not bind to the androgen receptor and therefore does not exert
androgenic side effects, like increased hair on the body.104
Compared to the increased risks for cognitive decline on HRT, natural progesterone has been
found to enhance the repair processes in the brain, help with reducing anxiety, improve sleep patterns, and preserve cognitive function with age.105
So far, the studies on BHRT are limited, but they do look promising. One French study looked at
over 3000 women using natural progesterone and estradiol. This study found no increased health
risks.106 Another larger French study compared women using HRT to women using BHRT and
found that those using HRT had significantly greater risk of developing breast cancer than those
on BHRT.107
When used properly, here are some of the benefits of BHRT for women:
Hot flashes reduced or eliminated.
Bone loss (osteoporosis) may be retarded and new bone growth encouraged.
36
Vaginal dryness decreased.

Decreased risk of fibrocystic breasts.
Skin elasticity improved.
Improved energy and blood flow.
Accelerated fat burning for improved weight loss.
Sleep disturbances (insomnia and night sweats) reduced.
Emotional disturbances reduced (mood swings, depression, nervousness, irritability, anxiousness).
Breast problems reduced (tenderness, fibrocystosis, etc.).
Menstrual problems (heavy menses) improved.
Improved libido and sex drive.
Improved mental acuity (lapses of memory, foggy thinking, concentration, etc.).
Reduced incontinence.
Men also experience symptoms from hormone imbalances. BHRT can have the following benefits
for men:
Muscle tone improvement.
Skin elasticity improved.
Improved energy and strength.
Protection against heart disease.
Reduced depression.
Sleep disturbances reduced.
Improved libido and sex drive.
Improved memory and concentration.
Improved bone growth and blood flow.
Improved mood.
Weight loss.
However, BHRT is not risk free. As with any estrogen, a natural estrogen can raise breast cancer
risk if your levels go too high and especially if you are not metabolizing your estrogen properly, as
I mentioned before. At our clinic, we advise women to always get a mammogram, breast MRI, or
breast thermography before starting the process of BHRT.
In addition, to use BHRT safely, you must work with your doctor to evaluate your estrogen levels
and how your body is processing its estrogen. Remember, the estrogens that were found to have
heightened risk in the WHI study were from horse urine and a predominance of estrone, which
is rather unfriendly to a womans metabolism. Even men should have their estrogen levels measured.
One bio-identical hormone preparation available through compounding pharmacies by prescription
is Biest, which contains a combination of 80% estriol and 20% estradiol. Another bio-identical product is Triest, which contains a combination of three forms of estrogen: 10% estradiol, 10% estrone,
and 80% estriol.
37
Remember, without knowing your true hormonal status through saliva, blood, and urine testing, its
like trying to buy a pair of shoes without first trying them on. Levels of sex hormones like estradiol,
estrone, progesterone, testosterone, SHBG, FSH, LH, and DHEA can be checked individually, and
then an individual BHRT can be prepared.
Levels of other hormones like cortisol, growth hormone, thyroid hormones, and insulin should also
be tested so appropriate dietary changes can be made and nutritional supplements can be used to
help correct imbalances. This will help you to achieve metabolic health.
The reason BHRT may not work in some individuals is because all their hormones are not balanced and therefore they will not achieve positive results. For example, balancing just the sex
hormones does not achieve health if you are under chronic stress and your body is making excess
cortisol. This imbalance in excess cortisol can cause disruption in your metabolism, leading to further imbalances in sex hormones and other hormones like thyroid, insulin, and growth hormone.
If these underlying imbalances are not corrected, inflammatory chemicals can lead to a host of
other problems like lack of sleep and insulin resistance that may bombard the body with inflammatory signaling.
Take the example of Suzanne Somers again. Since BHRT helped her survive breast cancer, she is
a big proponent of bio-identical estrogen as the cornucopia for hormonal imbalances. Well, if you
just use estrogen as a hormonal replacement, what about your progesterone levels? What about
your thyroid hormone levels? Your cortisol levels? Are you under stress? Do you have insulin resistance? Are your brain neurotransmitters balanced?
You can see how important it is to know your total hormone profile and to be tested for more than
just estrogen levels. The bottom line is, you have to correct underlying hormonal imbalances, not
just replace sex hormones with BHRT.
The Value of the Compounding Pharmacist

When I was a child my mother worked in a pharmacy complete with the soda fountain. Since I was
actually a pretty sickly child, my earliest memories were watching the pharmacist mix compounds
up for his customers and give good advice to them for managing their health. This is one of the
reasons I went into pharmacy. The opportunity to create medicines that were individualized to meet
peoples needs seemed like a great service and pharmacists after all were considered the most
trusted healthcare professional.
Today I recognize the need and value of individualized pharmaceutical care and pharmacists that
specialize in this area are a great service to the community. I teach for an organization called the
Professional Compounding Centers of America. This organization trains pharmacists to become
specialists in innovative methods for delivering both natural products and prescription drugs.
Because of this relationship, I have a great network of friends and colleagues who specialize in
this area. Pharmacists are only allowed to work with drugs that are FDA approved. They are not
38
allowed to duplicate a commercial product that is already on the market. So the pharmacist can
make a drug that is additive free, they can change the release pattern of it, and make it into a different dosage form like a cream versus a pill. The dosage forms can have different effects on your
chemistry.
How to Take Bio-Identical Hormones The Dosage Forms

The best dosage form is one of the hotly contested issues of BHRT. I am going to give you my
opinion based on my own experience, discussions with other practitioners, and the evidence that
we currently have.
Most healthcare providers can prescribe bio-identical hormones in any number of pills, sublinguals,
creams, gels, and injections to help you re-establish hormonal balance in your metabolism. I am
offering you what I consider to be the safest suggestions, because as much as it looks like BHRT
can safely improve many aspects of your health, we still need to learn more. However, I really believe that BHRT is safe if you regularly monitor levels of the sex hormones, and manage the other
hormones mentioned earlier.
Pill Form
For some women, taking hormones in pill form is the most effective option. However, it is also the
least desirable form of BHRT because it has significantly increased risks for cancers and blood
clots.10
There have also been studies showing that if you take a hormone in tablet form, it is metabolized
differently than if it is taken topically, by injection, or in sublingual form (under the tongue). Why is
this so important? Because increased side effects and the potential for adverse metabolic shifts
can occur.
When you take a pill orally, the liver breaks down the hormones (first pass effect) and renders some
of it useless. And orally taken hormones can be made into unfriendly metabolites depending on
your liver function.
So if you can give less of the hormone by another method like a cream and still reduce the symptoms of your specific hormone deficiency, thats the better option!
Transdermal
Many practitioners rely on BHRT that is made up by a compounding pharmacist in a cream form.
The hormones are fat-soluble so this is usually an efficient method. The doctors at LMI like transdermal creams because it is the best way to minimize peak and trough effects in your bloodstream
so there is less fluctuation in your hormones. Transdermal creams also allow for more most flexibility in dosing.
This method also avoids the liver metabolism problem seen with oral hormones. Additionally, studies have shown that transdermal estrogen doesnt trigger inflammatory chemistry while the use of
39
oral estrogen does. In the case of testosterone for men, gels and creams work well, and there tends
to be less conversion to estrogens and dihydrotestosterone. The biggest issue with transdermal
delivery is the matter of convenience. You may have to apply the creams 1-2 times a day.
Transdermal patches are another option. There are two patches that are commonly used Vivelle and similar products are bio-identical estradiol patches that are applied once or twice a week
depending on the brand. The other widely used patch, Androderm, is for male testosterone replacement and is used daily. Transdermal patches are convenient to use, so compliance is easy.
Injectables (Testosterone)
Testosterone can be given by injection. You could choose to get a shot for testosterone and the
schedule would be every 1 to 4 weeks depending on your initial needs. This method does create a
peak and trough, and when it peaks, you could be more prone to convert some of the testosterone
to undesired DHT and estrogens. At LMI, we monitor hormone levels and if the creams fail, injectables are recommended.
Pellet Implants (Testosterone)

In this method, a pellet is implanted under the skin and testosterone is then released over six
months. With pellet implants, I have a concern over the ability to adjust levels and adjust to other
factors such as stress or changes in conversion to estrogens and DHT. The physicians at LMI do
not tend to support this method as a first or second choice.
Troches and Mini Troches

A troche is a medicated lozenge that dissolves in the mouth, usually under the tongue. Testosterone and progesterone are most commonly given by troche. This is a good delivery system, but it
has to be taken daily and sometimes two times a day, depending on your needs.
Lab Tests
How do doctors find out what supplements and hormone replacement products are right for you?
As we discussed earlier, hormone replacement should be tailored to the individual for best results.
Hormones can be tested through non-invasive tests from blood, urine, and saliva.
Currently, saliva testing can determine levels of estradiol, estriol, estrone, progesterone, testosterone, DHEA, melatonin, and cortisol. With salivary testing, your doctor takes samples of your saliva
to see the levels of hormones you are producing and to determine if you have any deficiencies.
Unlike blood tests, the saliva hormone tests will show the levels of free hormones in your body.
Free hormones are the hormones that arent bound to proteins, but instead are able to move into
cells. Because about 95% or more of your blood hormones are bound, the salivary tests measure
only the remaining 1-5% of free hormone. The results may be much lower than that which you see
on your blood test results. As with hormones, testing of cortisol to determine your stress levels is
best performed with a saliva test.
40
Some pros and cons with salivary testing for hormone levels include:
Advantages
Collecting a saliva sample is easy it can be done anytime and anywhere. A blood sample
has to be given in a doctors office, and these settings can be stressful.
Saliva contains exceptionally stable steroid hormones which allow for convenient collection
and shipment at room temperature by inexpensive means. Blood, on the other hand, requires
qualified personnel (phlebotomist), special procedures (needles and serum collection tubes),
and equipment (centrifuge and lab space to house it), as well as specialized shipping vessels
(ice pack) and express delivery (overnight). Moreover, hormone concentrations can vary depending on the time of day and month, making blood collection especially difficult to schedule
at optimal collection times. Overall, the convenience in testing salivary hormones makes it better for patients in lowering overall costs, as well as lowering costs for the healthcare provider
and insurance carrier.
Disadvantages
Although salivary testing has many advantages over serum testing, there are still some disadvantages that should be acknowledged.
Technically, saliva testing is more challenging than blood testing, limiting the number of laboratories that are capable of performing the tests. Blood levels of steroid hormones are, on average, about 10 to 100 times higher than saliva levels and commercial test kits and ranges are
based on these higher serum hormone levels. Therefore, laboratories performing saliva testing
must have the technical expertise to either create their own tests or modify commercial test
kits. Significant hurdles beyond the technical expertise of most commercial testing laboratory
personnel must be overcome to make this transition.
Certain factors can interfere with salivary testing. Foods, beverages such as coffee, and drugs
taken just before collecting saliva can interfere or cause a transient shift in hormone levels.
Some chewing gums and cottons used for saliva collection contain substances that interfere
with certain saliva tests, resulting in abnormally high hormone levels. Sugar in regular chewing
gum can interfere with some saliva tests. If bleeding of the gums is present, especially if the
individual has advanced periodontal disease, salivary levels of hormones can be significantly
off. Since 95-99% of hormones are blood-bound, small amounts of blood in saliva could cause
changes in hormones that are not truly representative of the bio-available fraction of the hormone.
Exact replacement levels for hormones and saliva are still being established and more studies
need to me done to validate the true effects.
It should be noted that blood tests were used to do the research on most of the disturbances in sex
hormones. Many of the studies that show the benefit of hormone replacement were also reported
from serum testing.
Another form of blood testing that has potential is the use of a home blood spot test. In this test, a
41
simple finger stick and drops of blood are placed on a piece of paper and sent in for analysis from
the home. Blood spot collection for various hormones has been utilized in third world countries for
years. Testosterone is ideally collected in the morning at its peak concentration. It is important to
get your hormones drawn at the same time of the day for repeat testing.
Another method for evaluating hormone levels is urinary testing. A 24-hour urine collection is done
at home and tests for all the metabolites of your sex hormones and determines levels of production
in the body.
Lab testing is an emerging field of medicine. Research on the best testing methods is currently
being gathered by leading labs such as ZRT Labs. These labs have collected and analyzed over 1
million samples. So clearly, the validation of testing methods to optimize and improve the safety for
use of bio-identical hormones is ever improving.
One of the lessons I learned over the years from working with Doctor Pelletier who has extensive
experience with bio-identical hormones is to balance hormones to symptoms, not necessarily to a
blood, urine, or saliva value. I say this because I have run into practitioners who swear by different
forms of lab testing as the only way to have success. Although we regularly use blood tests, we
have also used urine and saliva collection as well.
If youre seeking out a healthcare professional to help you with hormonal replacement therapy,
make sure you find someone qualified to work with balancing all your hormonal levels, not just the
sex hormones. Your doctor needs to make sure that the sex hormones are being properly metabolized, because if they arent, dangerous metabolites can build up, causing further imbalances in
metabolism. He or she also needs to understand all types of testing and know what testing method
is appropriate for your situation.
Conclusion
Aging should not be dreaded its a natural part of being human. However, the quality of life during the aging process can be significantly improved with regular exercise, proper sleep (at least 7-8
hours a night), plenty of quality water, improving your diet, and taking dietary supplements when
needed.
Dietary changes should include a decrease in carbohydrates and cutting out refined sugars, white
breads, and processed foods like deli meats and fast foods. Eating plenty of fresh vegetables (organic preferred) helps ensure that you are getting key nutrients for the body, such as vitamins and
minerals.
We are beginning to understand the relationship between aging and age-related deterioration and
diseases. Along with decreasing oxidation and dietary changes, the impact of hormones is a key
focus in longevity science. Research in bio-identical hormone replacement therapy is one of the
most exciting and promising areas in managing metabolic changes that occur with aging. If you are
a women, remember, you should cycle your hormone use during the course of the month, mimicking what your body did in the years you were menstruating.
42
While BHRT has been surrounded by some controversy, after seeing the benefits in countless
people, I am convinced that optimizing hormonal balance can provide rewarding results for your
health and will help to manage the initiation of disease-causing inflammation and other destructive
mechanisms that steal your vitality.
We live in a time of unprecedented opportunity to maximize our aging potential. In the US, the
average life expectancy at birth has increased from 49 years in 1900 to over 77 years today. Most
readers of this book will make it to age 85, and many of you have a good shot at celebrating your
100th birthday. But with current trends, half of our future 85-year-olds will need help with simple
daily tasks due to age-related infirmities acquired along the way.
Which will you be independent, vigorous, and active or needy, disabled, and frail? Now is the
time to decide. Its up to you to age gracefully, to look good and feel vital, and remain energetic.
Yes we all will age, but healthy aging is possible.
Our newsletters and E-books will continue to give you sound advice and explore the various facets
of aging and keeping your metabolic code on track. In this E-book, we have tried to show you how
hormonal health relates to total body health. How well we maintain hormonal balance is a vital part
of healthy aging.
Good Luck and a Wish of Good Health,
James B. LaValle RPh, ND, CCN

Founder, the LaValle Metabolic Institute
43
Appendix
Dietary Supplement Chart
Supplement
Uses
Helps balance
serotonin, the brain
neurotransmitter
5-HTP
Alpha-GPC
Dosage
Patient Information
50-100 mg up to 3 times Do not use if you are taking antidepressant

a day
medications unless under the supervision
of a healthcare provider
May help decrease

cravings seen in
stress-related weight
gain
Helps support healthy
brain function
5-9 grams daily in divided dosages
None known
Adaptogen (helps
support the body during stress)
450-900 mg daily, standardized to 1.5% with

anolides
Use with caution in sedatives and hypnotics such as barbiturates (reported to

increase the effects of these drugs)
Use with caution in patients on anticoagulants or anti-platelet therapy
Ashawagandha
Ashawagandha is rich in iron; use caution

in individuals taking iron supplementation
or on low-iron diets
Bacopa
Bitter melon
(Glucokine)
Black cohosh
Used to support
healthy thyroid hormone levels
100 mg, 1-4 times a

day, standardized to
contain 20% bacosides
A and B
None known

blood sugar levels
500 mg, 2-3 times a

day, 1 hour before
meals Standardized to
10% Charantin
None known

estrogen levels
20-40 mg, 2 times a

day, standardized to 1
mg
triterpenes (27-deoxyactein)
Do not use if you are taking hormonal

medications such as birth control or HRT
unless under the supervision of a healthcare provider
May help support

healthy bones
Do not use if liver problems exist

May cause muscle weakness in long-term
use
Contraindicated in pregnancy and lactation
Calcium
d-glucarate
Chasteberry
or Vitex

estrogen metabolism
1500 mg daily in divided Regularly taking large doses of calcium

dosages
may interfere with the absorption of zinc,
iron, and magnesium

hormonal balance
200-400 mg every
morning, preferably
on an empty stomach,
either 1 hour before or
2 hours after breakfast,
standardized to contain
at least 0.5% agnuside
and 0.6% aucubin

pituitary gland function
44

Supplement
Uses
Dosage
Helps support healthy 600-2000 mcg (microChromium

blood sugar levels
grams) daily
(GTF chromium)
DHEA
550 mg daily


estrogen metabolism
75-300 mg daily

Medications that decrease stomach acid
such as antacids, cimetidine (Tagamet), or
ranitidine (Zantac) may cause DIM not to
be metabolized
Increases free testosterone
Glucosol
None known
Support of healthy
DHEA hormone
levels
Diindolylmethane (DIM)
Tongkat Ali
(eurycoma)
Patient Information

sexual function in
men
25 mg daily for 4 weeks; Do not use if prone to prostate conditions

for long term use, take 2
such as BPH or prostate cancer
days on and 2 or more
days off; or take every
other day or every third
day

blood sugar levels
16-48 mg daily
None known
Used to support
healthy thyroid hormone levels
500-1500 mg, 3 times

a day, standardized to
2.5-5% guggulsterones
(E and Z)
If you are taking any of the following medications, talk to you healthcare provider
before taking guggul:
Guggul
Anticoagulants (blood thinning agents)

including aspirin
Cholesterol lowering medications
Blood pressure medications such as diltiazem (Cardizem) and propranolol (Inderal)
May cause muscle aches/pains; if this
occurs stop immediately and contact your
doctor
Holy basil
Helps decrease cortisol related stress
400800 mg, one to two None known

times a day, standardized to 1-2.5% ursolic
acid

estrogen metabolism
200-800 mg daily
Indole-3-carbinol
(I3C)

medications, such as birth control or HRT
Medications that decrease stomach acid
such as antacids, cimetidine (Tagamet) or
ranitidine (Zantac) may cause I3C not to
be metabolized appropriately
45
Supplement
Uses
thyroid hormone
levels
50-250 mcg daily
Iodine
Chronic excessive intake of iodine can

cause an enlargement of the thyroid gland
resembling goiter, called iodine goiter

estrogen levels
500 mg to 2 grams
daily, standardized to
contain 125 mg of isoflavones

Kudzu
Dosage
Patient Information
Use only under the supervision of a healthcare professional if you are predisposed to
developing breast cancer
L-arginine
L-theanine
May help balance

pituitary release of
growth hormone
2-3 grams daily in divided dosages
None known
Helps decrease
physical and mental
stress
100-200 mg, 1-3 times

a day
None known

glucose metabolism
and regulate metabolic function
250-750 mg daily;
most absorbable forms
include magnesium
citrate, glycinate, and
amino acid chelate
None known
Helps regulate sleep

cycles
1-6 mg, one hour before Consult a healthcare provider if using for
bedtime
more than 4 weeks
Helps balance neurochemicals in the brain
Magnesium
Melatonin
May help support

healthy insulin levels
brain function
Mucuna
100 mg, 1-2 times a day If you are taking any of the following medistandardized to 60%
cations, talk to you healthcare provider
L-dopa
before taking mucuna:
Antidepressant medications
Medications for Parkinsons disease
Omega-3 fatty
acids (fish oil)
Pomegranate
Helps supports
healthy estrogen
metabolism
2-4 grams daily
Antioxidant
200 mg daily standard- Do not use if you are taking hormonal

ized to 40% punicosides

estrogen levels
Cardiovascular protection
Use under the supervision of a healthcare

provider if you are taking blood thinning
medications such as aspirin or warfarin
(Coumadin)
46
Supplement
Uses
estrogen
Dosage
40-80 mg daily of a
standardized extract
Red clover
Patient Information
Relora
Helps decrease cortisol related stress
200 mg, 3 times daily

for at least 7 days
May cause drowsiness in sensitive individuals
Antioxidant
40-80 mg, 2 times daily

standardized to contain
8% resveratrols
None known
150-300 mg, 1-3 times

daily, standardized to
contain at least 3-5%
rosavins and less than
1% salidrosides
If you are taking any of the following medications, talk to you healthcare provider
before taking rhodiola:
Anti-aging benefits
Resveratrol

estrogen levels
Cardiovascular protection
May help decrease
protein glycation
Adaptogen (helps
with stress on the
body)
Rhodiola
Helps with cortisol

related stress
ACE inhibitors
Antidiabetic drugs/insulin
Antihypertensive drugs
Antiarrhythmia drugs

estrogen levels
100-300 mg daily, standardized to contain at

least 15% saponins
Soy

unless under the supervision of a healthcare providerUse soy only under the
supervision of a healthcare professional if
you are predisposed to developing breast
cancer
Do not use if you are taking thyroid medications or have thyroid disorders unless
under the supervision of a healthcare
provider
Zinc

testosterone levels
25-50 mg daily

metabolism
47
None known
References
1. Straub RH, Cutolo M, Zietz B, et al. The process of aging changes the interplay of the immune, endocrine and nervous systems.
Mech Ageing Dev. 2001;122(14):1591-611.
2. Rodriguez A, Muller DC, Metter EJ, et al. Aging, androgens, and the metabolic syndrome in a longitudinal study of aging. J Clin
Endocrinol Metab. 2007;92(9):3568-72.
3. Finset A, Overlie I, Holte A. Musculo-skeletal pain, psychological distress, and hormones during the menopausal transition.
Psychoneuroendocrinology. 2004;29(1):49-64.
4. Munoz J, Derstine A, Gower BA. Fat distribution and insulin sensitivity in postmenopausal women: influence of hormone replacement. Obes Res. 2002;10(6):424-31.
5. Andrews, RC, O. Herlihy, DE Livingstone, W et al. Abnormal cortisol metabolism and tissue sensitivity to cortisol in patients with
glucose intolerance. The Journal of Clinical Endocrinology. 2002;87(12): 5587-5593.
6. Rossouw JE, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the
Womens Health Initiative randomized controlled trial. JAMA 2002:288:321-333.
7. Shumaker SA, et al. Estrogen plus progestin and the incidence of dementia and mild cognitive impairment in postmenopausal
women: the Womens Health Initiative Memory Study: a randomized controlled trial. JAMA 2003;289:2651-2662.
8. Steinauer JE, Waetjen LE, Vittinghoff. Postmenopausal hormone therapy: does it cause incontinence? Obstet Gynecol.
2005;106(5 Pt 1):940-5.
9. Purmonen S, Manninen T, Pennanen P, Ylikomi T. Progestins regulate genes that can elicit both proliferative and antiproliferative effects in breast cancer cells. Oncol Rep. 2008;19(6):1627-34.
10. Den Tonkelaar I, Oddens BJ. Determinants of long-term hormone replacement therapy and reasons for early discontinuation.
Obstet Gynecol 2000;95:507-512.
11. http://www.pharmafocus.com/cda/focusH/2,2109,21-0-0-JUN_2004focus_news_detail-0-225648,00.html.
12. Radvin, P, Cronin KA, Howlader N. The decrease in breast-cancer incidence in 2003 in the United States. New England Journal
of Medicine, April 19, 2007; vol 356: pp 1670-1674.
13. Haspels AA, Bennink HJ, Schreurs WH. Disturbance of tryptophan metabolism and its correction during oestrogen treatment in
postmenopausal women. Maturitas. 1978;1(1):15-20.
14. He K, Song Y, Belin RJ, Chen Y. Magnesium intake and the metabolic syndrome: epidemiologic evidence to date. J Cardiometab Syndr. 2006;1(5):351-5.
15. Rude RK, Gruber HE. Magnesium deficiency and osteoporosis: animal and human observations. J Nutr Biochem.
2004;15(12):710-6.
16. Rude RK. Magnesium deficiency: A cause of heterogeneous disease in humans. J Bone Miner Res 1998;13:749-58.
17. [No Authors Listed]. Vitamin B6 (pyridoxine and pyridoxal 5-phosphate) - monograph. Altern Med Rev. 2001;6(1):87-92.
18. Adly L, Hill D, Sherman ME, Sturgeon SR, et al. Serum concentrations of estrogens, sex hormone-binding globulin, and androgens and risk of breast cancer in postmenopausal women. Int J Cancer. 2006;119(10):2402-7.
19. Deandrea S, Talamini R, Foschi R, et al. Alcohol and breast cancer risk defined by estrogen and progesterone receptor status:
a case-control study. Cancer Epidemiol Biomarkers Prev. 2008;17(8):2025-8.
20. Kabat GC, OLeary ES, Gammon MD, et al. Estrogen metabolism and breast cancer. Epidemiology. 2006;17(1):80-8.
21. Bradlow HL et al. Indole-3-carbinol: A novel approach to breast cancer prevention. Ann NY Acad Sci 1996;768:180-200.
22. Saarinen NM, Wrri A, Airio M, Smeds A, Mkel S. Role of dietary lignans in the reduction of breast cancer risk. Mol Nutr Food
Res. 2007;51(7):857-66.
23. Wayne SJ, Neuhouser ML, Ulrich CM, et al. Dietary fiber is associated with serum sex hormones and insulin-related peptides
in postmenopausal breast cancer survivors. Breast Cancer Res Treat. 2007. [Epub ahead of print].
24. Hu Y, Block G, Norkus EP, et al. Relations of glycemic index and glycemic load with plasma oxidative stress markers. Am J Clin
Nutr. 2006;84(1):70-6; quiz 266-7.
25. Lajous M, Boutron-Ruault MC, Fabre A, Clavel-Chapelon F, Romieu I. Carbohydrate intake, glycemic index, glycemic load, and
risk of postmenopausal breast cancer in a prospective study of French women. Am J Clin Nutr. 2008;87(5):1384-91.
26. Wang TT, Milner MJ, Milner JA, Kim YS. Estrogen receptor alpha as a target for indole-3-carbinol. J Nutr Biochem.
2006;17(10):659-64.
27. Reed GA, Peterson KS, Smith HJ, et al. A phase I study of indole-3-carbinol in women: tolerability and effects. Cancer Epidemiol Biomarkers Prev. 2005;14:1953-1960.
28. Weng JR, Tsai CH, Kulp SK, Chen CS. Indole-3-carbinol as a chemopreventive and anti-cancer agent. Cancer Lett.
2008;262(2):153-63.
29. Karmali RA. n-3 fatty acids and cancer. J Intern Med Suppl. 1989;731:197-200.
30. [No authors listed]. Calcium-D-glucarate. Altern Med Rev. 2002;7(4):336-9.
31. Tomaszewski M, Charchar FJ, Maric C, et al. Association between lipid profile and circulating concentrations of estrogens in
young men. Atherosclerosis. 2008 Jun 17. [Epub ahead of print].
32. Cho HJ, Seon MR, Lee YM, Kim J, Kim JK, Kim SG, Park JH. 3,3-Diindolylmethane suppresses the inflammatory response to
lipopolysaccharide in murine macrophages. J Nutr. 2008;138(1):17-23.
48
33. Anderton MJ, Manson MM, Verschoyle R, et al. Physiological modeling of formulated and crystalline 3,3-diindolylmethane
pharmacokinetics following oral administration in mice. Drug Metab Dispos. 2004;32(6):632-8.
34. Rice S, Whitehead SA. Phytoestrogens, oestrogen synthesis and breast cancer. J Steroid Biochem Mol Biol. 2008;108(35):186-95.
35. Furimsky AM, Green CE, Sharp LE, et al. Effect of resveratrol on 17beta-estradiol sulfation by human hepatic and jejunal S9
and recombinant sulfotransferase 1E1. Drug Metab Dispos. 2008;36(1):129-36.
36. Einbond LS, Wen-Cai Y, He K, Wu HA, Cruz E, Roller M, Kronenberg F. Growth inhibitory activity of extracts and compounds
from Cimicifuga species on human breast cancer cells. Phytomedicine. 2008;15(6-7):504-11.
37. [No authors listed]. Cimicifuga racemosa. Monograph. Altern Med Rev. 2003;8(2):186-9.
38. Rebbeck et al, A restrospective case control study of the use of hormone related supplements and association with breast
cancer. Int J Cancer: 2007{Epub ahead of print}.
39. Li JX, Liu J, He CC, Yu ZY, Du Y, Kadota S, Seto H. Triterpenoids from Cimicifuge rhizoma, a novel class of inhibitors on bone
resorption and ovariectomy-induced bone loss. Maturitas. 2007;58(1):59-69.
40. Wuttke et al; The cimicifugia preparation BNO 1055 vs conjugated estrogens in a double blind placebo controlled study: effects
on menopausal symptoms and bone markers. Mauritis. 2003 Mar 14;44 Suppl 1s67-77.
41. Eichling PS, Sahni J. Menopause related sleep disorders. J Clin Sleep Med. 2005;1(3):291-300.
42. Cos S, Martnez-Campa C, Mediavilla MD, Snchez-Barcel EJ. Melatonin modulates aromatase activity in MCF-7 human
breast cancer cells. J Pineal Res. 2005;38(2):136-42.
43. Diaz BL, Llaneza PC. Endocrine regulation of the course of menopause by oral melatonin: first case report. Menopause.
2008;15(2):388-92.
44. Sitruk-Ware R. Progestogens in hormonal replacement therapy: new molecules, risks, and benefits. Menopause. 2002;9(1):615.
45. Jerry DJ. Roles for estrogen and progesterone in breast cancer prevention. Breast Cancer Res. 2007;9(2):102.
46. Hu Y, Hou TT, Zhang QY, Xin HL, Zheng HC, Rahman K, Qin LP. Evaluation of the estrogenic activity of the constituents in the
fruits of Vitex rotundifolia L. for the potential treatment of premenstrual syndrome. J Pharm Pharmacol. 2007;59(9):1307-12.
47. Hubayter Z, Simon JA. Testosterone therapy for sexual dysfunction in postmenopausal women. Climacteric. 2008;11(3):18191.
48. Muller M, Van Den Beld AW, Bots ML, Grobbee DE, Lamberts SW, Van Der Schouw YT. Endogenous Sex Hormones and Progression of Carotid Atherosclerosis.in Elderly Men. Circulation. 2004 May 4;109(17):2074-9.
49. Khaw KT, Barrett-Connor E. Lower endogenous androgens predict central adiposity in men. Ann Epidemiol. 1992;2(5):67582.
50. Tsai EC, Matsumoto AM, Fujimato WY, et al. Association of bioavailable, free, and total testosterone with insulin resistance.
Diabetes Care. 2004;27:861-68.
51. Abate N, Haffner SM, Garg A, et al. Sex steroid hormones, upper body obesity, and insulin resistance. J Clin Endocrinol Metab.
2002;87(10):4522-7.
52. Andriole G, Bruchovsky N, Chung LW, et al. Dihydrotestosterone and the prostate: the scientific rationale for 5alpha-reductase
inhibitors in the treatment of benign prostatic hyperplasia. J Urol. 2004;172(4 Pt 1):1399-403.
53. Oettel M, et al. Selected aspects of endocrine pharmacology of the aging mal. Exper Gerentol. 2003,38: 189-198.
54. Tan RS, Pu SJ. Is it andropause? Recognizing androgen deficiency in aging men. Postgrad Med. 2004;115(1):62-6.
55. ENDO 2008: The Endocrine Society 90th Annual Meeting: Abstract OR35-1. Presented June 17, 2008. ENDO 2008.
56. Seidman SN. Androgens and the aging male. Psychopharmacol Bull. 2007;40(4):205-18.
57. Archer, J, Birring, SS, Wu, FCW, The association between testosterone and aggression among young men: empirical ndings
and meta-analysis. Aggressive Behav. 1998;24:41420.
58. Ang HH, Lee KL, Kiyoshi M. Sexual arousal in sexually sluggish old male rats after oral administration of Eurycoma longifolia
Jack. J Basic Clin Physiol Pharmacol. 2004;15(3-4):303-9.
59. Leake A, Chisholm GD, Habib FK. The effect of zinc on the 5 alpha-reduction of testosterone by the hyperplastic human prostate gland. J Steroid Biochem. 1984;20(2):651-5.
60. Saudan C, Baume N, Emery C, Strahm E, Saugy M. Short term impact of Tribulus terrestris intake on doping control analysis
of endogenous steroids. Forensic Sci Int. 2008;178(1):e7-10.
61. Gangwisch JE, Malaspina D, Beoden-Albala B, et al. Short sleep duration as a risk factor for hypertension: analyses of the first
National Health and Nutrition Examination Survey. Hypertension. 2006;47(5):833-9.
62. Data on file, Next Pharmaceuticals.
63. Gupta P, Yadav DK, Siripurapu KB, Palit G, Maurya R. Constituents of Ocimum sanctum with antistress activity. J Nat Prod.
2007;70(9):1410-6.
64. Geetha RK, Vasudevan DM. Inhibition of lipid peroxidation by botanical extracts of Ocimum sanctum: in vivo and in vitro studies. Life Sci. 2004;76(1):21-8.
65. Agrawal P, Rai V, Singh RB. Randomized placebo-controlled, single blind trial of holy basil leaves in patients with noninsulindependent diabetes mellitus. Int J Clin Pharmacol Ther. 1996;34(9):406-9.
66. [No Authors Listed]. L-theanine. Monograph. Altern Med Rev. 2005;10(2):136-8.
49
67. Finkelstein JW, Boyar RM, Roffwarg HP, Kream J, Hellman L. Age-related change in the twenty-four-hour spontaneous secretion of growth hormone. J Clin Endocrinol Metab. 1972; 35:665-70.
68. Clemmons DR, Van Wyk JJ. Factors controlling blood concentration of somatomedin C. Clin Endocrinol Metab 1984; 13:11343.
69. Rudman D, Kutner MH, Rogers CM, Lubin MF, Fleming GA, Bain RP. Impaired growth hormone secretion in the adult population: relation to age and adiposity. J Clin Invest 1981; 67:1361-9.
70. Parnetti L, Abate G, Bartorelli L, et al. Multicentre study of l-alpha-glyceryl-phosphorylcholine vs ST200 among patients with
probable senile dementia of Alzheimers type. Drugs Aging. 1993;3(2):159-64.
71. Campbell BI, La Bounty PM, Roberts M. The ergogenic potential of arginine. J Int Soc Sports Nutr. 2004;1(2):35-8.
72. Kipper-Galperin M gallilly R et al Dehydroepiandrosterone selectively inhibits production of tumor necrosis factor alpha and
interleukin 6 in astrocytes. Int J Dev Neurosci. 1999; Dec;17(8):765-75
73. Tannenbaum C, Barrett-Connor E, Laughlin GA, Platt RW. A longitudinal study of dehydroepiandrosterone sulphate (DHEAS)
change in older men and women: the Rancho Bernardo Study. Eur J Endocrinol. 2004;151(6):717-25.
74. Buford TW, Willoughby DS. Impact of DHEA(S) and cortisol on immune function in aging: a brief review. Appl Physiol Nutr
Metab. 2008;33(3):429-33.
75. Panjari M, Davis SR. DHEA therapy for women: effect on sexual function and wellbeing. Hum Reprod Update. 2007;13(3):23948.
76. Bednarek-Tupikowska G, Tworowska-Bardzinska U, Tupikowski K, et al. The correlations between endogenous dehydroepiandrosterone sulfate and some atherosclerosis risk factors in premenopausal women. Med Sci Monit. 2008;14(1):CR37-41.
77. Villareal DT. Effects of dehydroepiandrosterone on bone mineral density: what implications for therapy? Treat Endocrinol.
2002;1(6):349-57.
78. Parks J, Choe SS, Choi AH, et al. Increases in glucose-6-phosphate dehydrogenase in adipocytes stimulates oxidative stress
and inflammatory signals. Diabetes. 2006;55(11):2939-49.
79. Jankowska EA et al. Anabolic deficiency in men with chronic heart failure: prevalence and detrimental impact on survival. Circulation. 2006; Oct 24;114(17):1829-37.
80. Hougaku H, Fleg JL, Najjir SS, et al. Relationship between androgenic hormones and arterial stiffness, based on longitudinal
hormonal measurements. Am J Physiol Endocrinol Metab. 2006 ;Feb;290(2):E234-42.
81. Genazzani AD, Lanzoni C Genazzani AR, Might DHEA be considered beneficial replacement therapy in the elderly? Drugs Aging. 24(3):173-185, 2007.
82. Yen SS, Morales AJ, Khorram O. Replacement of DHEA in aging men and women. Potential remedial effects. Ann N Y Acad
Sci. 1995;774:128-42.
83. Mayo W, George O, Darbra S, et al. Individual differences in cognitive aging: implication of pregnenolone sulfate. Prog Neurobiol. 2003;71(1):43-8.
84. Facchini FS, Hua N, Abbasi F, Reaven GM. Insulin resistance as a predictor of age-related diseases. J Clin Endocrinol Metab.
2001;86(8):3574-8.
85. Kirwan JP, Krishnan RK, Weaver JA, Del Aguila LF, Evans WJ. Human aging is associated with altered TNF-alpha production
during hyperglycemia and hyperinsulinemia. Am J Physiol Endocrinol Metab. 2001;281(6):E1137-43.
86. Malkin CJ, Pugh PJ, Jones RD, et al. The effect of testosterone replacement on endogenous inflammatory cytokines and lipid
profiles in hypogonadal men. J Clin Endocrinol Metab. 2004;89(7):3313-8.
87. Tsai EC, Matsumoto AM, Fujimato WY, et al. Association of bioavailable, free, and total testosterone with insulin resistance.
Diabetes Care. 2004;27:861-68.
88. Yamagishi S, Matsui T, Nakamura K. Possible link of food-derived advanced glycation end products (AGEs) to the development
of diabetes. Med Hypotheses. 2008. [Epub ahead of print].
89. Gasser A, Forbes JM. Advanced glycation: implications in tissue damage and disease. Protein Pept Lett. 2008;15(4):385-91.
90. Belin RJ, He K. Magnesium physiology and pathogenic mechanisms that contribute to the development of the metabolic syndrome. Magnes Res. 2007;20(2):107-29.
91. Shi L, Zhang W, Zhou YY, et al. Corosolic acid stimulates glucose uptake via enhancing insulin receptor phosphorylation. Eur
J Pharmacol. 2008;584(1):21-9.
92. Klein G, Kim J, Himmeldirk K, Cao Y, Chen X. Antidiabetes and Anti-obesity Activity of Lagerstroemia speciosa. Evid Based
Complement Alternat Med. 2007;4(4):401-7.
93. Gonzlez C, Daz F, Alonso A. Neuroprotective effects of estrogens: cross-talk between estrogen and intracellular insulin signalling. Infect Disord Drug Targets. 2008;8(1):65-7.
94. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine and premenstrual syndrome. J Am Coll Nutr. 1993;12(4):442-58.
95. Amin Z, Canli T, Epperson CN. Effect of estrogen-serotonin interactions on mood and cognition. Behav Cogn Neurosci Rev.
2005;4(1):43-58.
96. Lam DD, Heisler LK. Serotonin and energy balance: molecular mechanisms and implications for type 2 diabetes. Expert Rev
Mol Med. 2007;9(5):1-24.
50
97. Almeida OP, Yeap BB, Hankey GJ, Jamrozik K, Flicker L. Low free testosterone concentration as a potentially treatable cause
of depressive symptoms in older men. Arch Gen Psychiatry. 2008;65(3):283-9.
98. Azam M, Gupta BL, Baquer NZ. Effect of hyperthyroidism and hypothyroidism on rat red blood cell insulin receptors and catecholamines: relationship with cellular ageing. Biochem Int. 1990;21(1):135-44.
99. Manyam BV, Dhanasekaran M, Hare TA. Neuroprotective effects of the antiparkinson drug Mucuna pruriens. Phytother Res.
2004;18(9):706-12.
100. den Boer JA, Westenberg HG. Behavioral, neuroendocrine, and biochemical effects of 5-hydroxytryptophan administration in
panic disorder. Psychiatry Res. 1990;31:267-278.
101. Stancheva SL, Mosharrof A. Effect of the extract of Rhodiola rosea L. on the content of the brain biogenic monoamines. Med
Physiol. 1987;40:85-87.
102. Leonetti HB, et al. Transdermal progesterone cream for vasomotor symptoms and postmenopausal bone loss. Obstet Gynecol.
1999;94:225-228.
103. Formby B. Wiley TS. Progesterone inhibits growth and induces apoptosis in breast cancer cells: inverse effects on Bcl-2 and p
53. Ann Clin Lab Sci. 1998;28:360-369.
104. Sitruk-Ware R. Progestogens in hormonal replacement therapy: new molecules, risks, and benefits. Menopause. 2002;9(1):615.
105. Schumacher M et al. Local synthesis and dual actions of progesterone in the nervous system: neuroprotection and myelination.
Growth Horm IGF Res. 2004:14:S18-S33.
106. De Lignieres B. et al. Combined hormone replacement therapy and risk of breast cancer in a French cohort study of 3175
women. Climacteric. 2002;5:332-340.
107. Fournier A. et al. Breast cancer risk in relation to different types of hormone replacement therapy in the E3N-EPIC cohort. Int J
Cancer. 2005;114:448-454.
108. Solden SS, varez, Retuerto AI, Sicotte NL, Voskuhl RR. Immune modulation of multiple sclerosis patients treated with the pregnancy hormone estriol. J Immunol. 2003 Dec 1:17(11):6267-74.
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THEKEYSTOHEAL

THE KEYS TO HEALTHY AGING:

Mary Ellen Tribby - Publisher | Melanie Segala - Managing Editor

The Keys to Healthy Aging:

TOTAL HEALTH BREAKTHROUGHS

From the Desk of James LaValle, R.Ph, ND, CCN

The Keys to Healthy Aging:

What You Dont Know May Be Hurting You

MAKING HORMONE REPLACEMENT WORK FOR YOU

Factors you can control include:

MAKING HORMONE REPLACEMENT WORK FOR YOU

Hormones: A Key Factor in Healthy Aging

MAKING HORMONE REPLACEMENT WORK FOR YOU

MAKING HORMONE REPLACEMENT WORK FOR YOU

Vitamin D: Very Low

Testosterone: Very Low

Estrone and Estradiol: High

Sex Hormone Binding Globulin: High

MAKING HORMONE REPLACEMENT WORK FOR YOU

Glucose: Borderline High

Thyroid TSH: High; Free T4 and T3: Low

Sex Hormone Imbalances

MAKING HORMONE REPLACEMENT WORK FOR YOU

Hormone Replacement: Confused About What To Do?

Problems with Conventional Hormone Replacement Therapy (HRT)

MAKING HORMONE REPLACEMENT WORK FOR YOU

MAKING HORMONE REPLACEMENT WORK FOR YOU

Bio-Identical Hormones The Difference

MAKING HORMONE REPLACEMENT WORK FOR YOU

The Three Types of Estrogen Your Body Makes

MAKING HORMONE REPLACEMENT WORK FOR YOU

The Effects of Declining Estrogen Levels

Bladder incontinence and infection

MAKING HORMONE REPLACEMENT WORK FOR YOU

Excess Estrogen or Estrogen Dominance

Weight gain around the hips

Vaginal or oral yeast (thrush)

Mood swings/easy to tear

Cravings for carbohydrates

MAKING HORMONE REPLACEMENT WORK FOR YOU

Estrogen Metabolism: What Men and Women Need to Know

MAKING HORMONE REPLACEMENT WORK FOR YOU

Dietary Changes to Improve the 2:16 Ratio

Lifestyle Changes to Improve the 2:16 Ratio

MAKING HORMONE REPLACEMENT WORK FOR YOU

1. Limit drinking out of plastic containers.

Dietary Supplements to Improve Estrogen Metabolism

MAKING HORMONE REPLACEMENT WORK FOR YOU

DIMs Effect on Male Estrogen Metabolism

MAKING HORMONE REPLACEMENT WORK FOR YOU

MAKING HORMONE REPLACEMENT WORK FOR YOU

Too Much Progesterone

Increased insulin resistance

Increased fat storage

Increased craving patterns

Reduced growth hormone

Reduced immune function balance

Women and Testosterone

MAKING HORMONE REPLACEMENT WORK FOR YOU

You lose strength, stamina, and muscle mass

MAKING HORMONE REPLACEMENT WORK FOR YOU

MAKING HORMONE REPLACEMENT WORK FOR YOU

Eurycoma longifolia (longjack)