by Shera Raisen, M.D.
Serving Santa Monica & Los Angeles County
As a member of the International Hormone Society, I follow the cutting edge research about hormones. At the most recent conference that I attended February 2011, I expanded my knowledge about my current practices, and learned about the use of newer hormones that are available.
The balancing of a person’s hormones can provide relief from many symptoms, improve their daily quality of life, and prevent diseases and deterioration in the body.
The goal of the treatments is to treat many physical and mental symptoms, such as weight gain, fatigue, and depression, and to prevent many diseases, such as heart disease. For instance, the heart is a muscle, and like the other muscles in the body, it responds to testosterone to stay strong; many research studies demonstrate that people with low testosterone levels develop heart disease. So, by optimizing a person's hormones, he can have a better quality of life now (good energy and mood) and prevent future diseases (e.g. heart disease and osteoporosis).
In my practice I prescribe bio-identical versions, if possible, of hormones for my patients. For instance, for women's sex hormones, I prescribe a combination of estradiol and estriol; progesterone, and testosterone. Bio-identical means that the molecules of the medications look the same as the molecules that a woman's body produces. With aging and other situations, a woman's hormones may become out of balance. For men, I often prescribe DHEA as a pill or sublingual for, and testosterone as a cream or a shot. When I give these prescriptions to both men and women, they say that their mood is better, their bodies develop more muscle and lose fat, and that they have better sex lives. I follow the patients closely with questions and lab tests to insure the right doses of the hormones.
By a careful and comprehensive analysis of a patient: physical examination, lab test results, and her complaints; we prescribe tailored medications for her. The body's hormones work together like a symphony. I prescribe "compounded hormones" often, which are a made at a compounding pharmacy, versus a large pharmaceutical factory. This method enables me to prescribe both customized forms and strengths of medications, based on the patient as well as the properties of the hormone.
For instance, I prescribe a compounded progesterone capsule to be taken by mouth at bedtime for women who have low progesterone and also have poor sleep. This is because the oral form of progesterone metabolizes into a form that promotes relaxed sleep, and affects the brain like a natural "Valium". Some men take a testosterone cream, but their body converts it into too much estrogen (estradiol); in that situation, I may add a medication such as Arimidex which inhibits the enzyme that converts the testosterone into estrogen. In men who also complain of poor sleep and fatigue that is not relieved by testosterone, they often respond well to supplementing their growth hormone with daily injections.
I prescribe hormones in the forms of creams, gels, sublingual drops, capsules and more. When hormones are absorbed via the skin, they avoid "first pass" through the liver, and don't cause certain side effects in the liver. This variety allows me to customize the form and concentration of each medication to suit each patient's needs.
A partial list of hormones and glands that I evaluate and treat are:
- Adrenal gland: Dhea; cortisol; aldosterone
- Ovaries: Estradiol, estriol, testosterone
- Thyroid: thyroxin and T3, tri-iodorone
- Parathyroid: forteo or PTH; calcitonin
- Testes: Testosterone
- Pituitary: oxytocin, vasopressin, growth hormone, melanocyte-stimulating hormone
- Pineal gland: melatonin
- IGF-1 is produced primarily by the liver as an endocrine hormone as well as in target tissues in a paracrine/autocrine fashion. Production is stimulated by growth hormone (GH)
- Pregnenolone is synthesized from cholesterol. It is a steroid hormone involved in the steroidogenesis of progesterone, mineralocorticoids, glucocorticoids, androgens, and estrogens. As such it is a prohormone.
I also evaluate a person's nutritional status, and by asking the patient questions, doing lab tests, and doing a physical examination, I then recommend different nutritional supplements. Again, I prescribe some compounded nutrients, like a topical magnesium, or prescribe B12 shots for a more potent response. If indicated, I recommend more specialized lab tests for a patient, that may involve collection of their saliva or stool. The results give causes of their different symptoms and can be treated.
For the hormone therapies to have the maximal effects, a person must have a conscientious and healthy lifestyle. I recommend such things as; avoiding any sugar, and rigorously limit simple carbs; avoid alcohol; avoid nitrites in grilled meats. I recommend drinking 2 liters of filtered water per day; exercising; soaking all nuts about 24 hours before eating them; and eating about 8 ounces of any types of meat a day to give the body its protein building blocks for the hormones.
The balancing of a person's hormones can provide relief to many symptoms, improve quality of life, and prevent some diseases and deterioration in the body.