Case Studies From Practicing BioTE® Clinicians
Hormone Optimization and Menopause
Ruthann Rees, MD
L. D. is a 48-year-old gravida 3 para 3 white female with a history of stage 0 intraductal carcinoma in situ found serendipitously at the time of a reduction mammoplasty many years ago. Before her breast reduction, her mammograms were normal. Because of her mother's history of colon cancer, she decided to undergo a prophylactic bilateral mastectomy with immediate reconstruction. L. D. had BRCA and Colaris gene testing and was negative.
She came to discuss menopausal symptoms she had been experiencing for many years. Her symptoms of vaginal atrophy were so severe that she had not been able to have sex for over a year. She had daily hot flashes, night sweats, difficulty sleeping, and fatigue. Her prior Gynecologist had refused even to discuss hormone replacement therapy.
After an extensive discussion of her personal history of breast cancer, she decided to try testosterone therapy. She started on testosterone hormone optimization. At her 6-week follow-up, she was elated with the vast improvement she experienced in relief of menopausal symptoms; especially with her sexual relations with her husband. She felt they were able to reconnect now on a physical and emotional level like they had not done in years. She reports this has saved her marriage.
Hormone Optimization and Heart Health
Christina M. Bove, MD FACC
Several years ago, after almost two decades of practicing traditional cardiology, I began a new, more functional medicine approach to cardiovascular disease. This started with a new focus on nutrition and diet, followed by the addition of bioidentical hormone replacement (BHRT) to my services in 2017. With this approach I quickly found I was able to prevent and reverse disease, rather than merely treat symptoms of disease. I have been able to get my patients off anti-hypertensives, statins, and diabetic medications while improving their overall health, functional capacity, and quality of life. As a cardiologist, my daily focus is on cardiovascular prevention, as well as treatment of established disease. As CV disease is a disease of inflammation, I focus on metabolic markers, advanced cardiac inflammatory panels, CIMT (measures the thickness of the inner two layers of the carotid artery and alerts physicians to any thickening when patients are asymptomatic), and coronary calcium scores, rather than traditional lipid panels to establish patient’s cardiovascular risk and treatment protocols.
I have seen first-hand in my patients the reversal of metabolic syndrome, diabetes, obesity, abnormal body composition, abnormal inflammatory markers, and dyslipidemia. Clinical studies have shown improvements in atherosclerosis and beneficial changes in heart muscle structure and function on CV imaging in patients receiving BHRT. From a cardiovascular standpoint, the anti-inflammatory, vasodilatory, endothelial function, vascular remodeling and atherosclerosis benefits of testosterone therapy are compelling. I believe that, with proper screening and follow up, women using non-oral bioidentical hormones may benefit not only with marked symptom improvement, but reduction in atherosclerosis and CV and overall mortality.
Hormone Optimization and Brain Health
Brian Cox, MD
A 69-year-old female who underwent a left breast lumpectomy for breast cancer (1999) and who was diagnosed with mild, early Alzheimer's came to see me 1/2018 for HRT. Was on small amounts of testosterone by another provider. Patients past medical history was also significant for osteoporosis, hyperlipidemia, type 2 diabetes, hypothyroidism and rheumatoid arthritis.
Initial labs revealed total testosterone of 37. Her testosterone level showed she was clearly not optimized and moreover was symptomatic. She was started on Testosterone 2% cream via daily topical application along with DIM 150 mg (a nutraceutical known to increase free testosterone). Later increased to 4% testosterone cream due to low serum levels on 4/2018. Finally, she achieved optimal levels with a serum level of 282 at the 4% dose.
Patient noted feeling better after a few months and husband says her mood was better as well. Patient seen on 9/26/2019 for follow up and husband states they recently saw her neurologist who tested her, he was amazed at her significant improvement and does not believe she has Alzheimer's but a milder former of dementia. What a relief for the patient and her husband.
Hormone Optimization and Bone Health
G. DeAn Strobel, MD, FACOG
I am a Board-Certified OB/GYN and practice in an area with a large geriatric population. When I first started my practice in 1999, I was overwhelmed with the number of osteopenia and osteoporosis patients I encountered. I became so intrigued with the spectrum of disease, that I pursued certification with the International Society of Clinical Densitometry (ISCD). I purchased my first DEXA machine in 2002.
Once ISCD-certified, I began to appreciate the nuances of DEXA interpretation and began to discover many otherwise asymptomatic patients with osteoporosis-related fractures. From what I understand, I was the first gynecologist in the state approved to prescribe and use teriparatide for patients with severe osteoporosis. I have also used all the various bone medications including SERMs, bisphosphonates, PTH-analogs, and even calcitonin. I have followed patients with serial DEXA scans for many years.
When I was initially trained by Dr. Donovitz and learned that pellet therapy can increase bone mineral density by up to 8.3% per year, I was apprehensive. It wasn’t until a year or so after I began to use the pellets in patients that I began to see such dramatic improvements in their bone density scans. I have had many patients who have had DEXA scans change from T-scores in the osteopenia range to normal range, and I even have had some who have had complete reversal of osteoporosis! I am now a true believer!
My prescription numbers for bisphosphonates and other osteoporosis medications have dramatically decreased, and my patients’ results have dramatically increased since I started using bioidentical hormone pellets and hormone optimization in my practice.
Hormone Optimization and Thyroid Health
As with testosterone insufficiency, the patient’s story tells us the reality if our therapy is working or not. Unfortunately, many practitioners have become dependent on lab tests and forgotten the most important question — ”How does the patient feel?”
Dr. R had a 35-year-old female come in with a diagnosis of hypothyroidism. She had been treated with Synthroid for 5 years. TSH 2.5, FT3 3.0. She had symptoms of weight gain, cold hands/feet, hair thinning, dry skin, and mild constipation.
He changed her over to a desiccated thyroid (NP) which contained both T4 and the active thyroid hormone T3 and repeated her thyroid labs in 8 weeks. TSH 0.5, FT3 3.8 — her active thyroid hormone was now in the optimal range. More importantly, her weight decreased 5 pounds; she no longer had cold intolerance; was starting to see healthier hair as well as normal bowel function. She felt overall so much better.