Dear DV Well, I am very excited about anti-aging medicine, because we teach what we need to learn, and I am very excited about what I am learning, avidly study all the time, and pass on my learning to my patient/clients.  You can read a little about what I specifically do at my website:  http://www.stress-medicine.com/  and in general about anti-aging medicine at the American Academy of Anti-Aging Medicine  http://www.worldhealth.net/   and the Life Extension Foundation  http://www.lef.org/  , both excellent websites.  

In particular, what I do is evaluate a person for physiological decline in several areas:  Hormonal, Cardiovascular, Immune System, Brain-Nervous System, Gastro-Intestinal System,  and Musculo-Skeletal System, and work with them to bring them back to "Prime of Life" function or keep them there if they are functioning well.  I use Bio-Identical hormones when necessary, Natural Supplements, Diet and Exercise Recommendations, and sometimes prescription medications when necessary. My basic concept is that we are still "designed" to be herd animals, and as such, herd survival depends on the older members disappearing from the heard as soon as they pass the age of reproduction and prime hunting age.  That would be us.  So our body is conspiring with Mother Nature to wipe us out by compromising our cellular integrity, our muscular strength, our sleep cycle, our hormonal balance, even our ability to absorb nutrients from food.  We further compromise ourselves by eating a diet that is completely incompatible with our physiology and sets us up for more degenerative disease, because of the extremely high percentage of Omega-6 fats, which are highly inflammatory, and the excessive amount of grains and dairy in our diet which our digestive systems are not designed to absorb or incorporate into our cells. So we too, conspire with Mother Nature in our own demise.  

One of the things that can happen with thyroid hormone replacement when you are producing antibodies to your own thyroid converting enzymes (thyroid peroxidase) and thyroid carrying protein (thyroglobulin) is that your own thyroid can down regulate, as the body is used to the lower functioning levels after years of your immune system attacking your thyroid hormone, and rendering it ineffective.  That is why we are measuring your temperature BP and pulse on a daily basis, and putting it on a chart.  One, to make sure you don't get too high a pulse and BP and on the other hand to see how your body responds.  It is not uncommon for the body to react by lowering your own hormone.  You were already making an inadequate amount of thyroid and your pituitary was "satisfied" with that, even though you had symptoms of low thyroid function.  That means we have to increase again.  I suggest patients increase the dose according to the specific instructions we discuss, based on symptoms temperature and pulse and less frequently on blood levels.  We are using very small incremental increases in dosage.  Continue to measure your BP. pulse and temp and note the new dose on your chart. If after a week, there is still no improvement in temp, BP pulse or energy (change in hair and skin will take longer) then increase to the next incremental dosage, and stay at that dose, while continuing to chart daily and bring your chart with you when you come for your appointment in two weeks.

Thyroid adjustments take awhile, especially as we started low, and we will work in partnership on this, as you learn to sense how your metabolism works and we both learn how your body responds to thyroid hormone.  I would like to say you will feel great in two weeks but that is not usually how it works.  It usually takes several months to get everything in balance.  The longer you have been living in a low thyroid state and the more organ systems that have been affected by chronic hypothyroidism, the longer it takes your body to recover.

Your body will learn to adjust to having a healthier hormone balance, and we will both learn what the exact right dosage of each hormone is for you. It is an individual balancing act and your body teaches us as I teach you.  It's not a "blind" groping for the right dose, though.  We use your positive response, side effects, blood levels, vital signs and changes over time to assess whether we are on the right track.  The hormones all augment each other and help each other be more effective too, so as time goes on, having better estrogen/progesterone balance will improve your thyroid function and visa versa.  Having better B-12 and folate levels will improve your hormone metabolism.  Having adequate Melatonin levels improves your ability to convert T4 to T3, and having adequate Growth Hormone improves the function of many organs including the pituitary gland and the organs that it affects.

I hope that makes some sense to you.  I will answer any questions you have as we go along, and I definitely want to know if and when you aren't feeling well or if you feel you are having a negative reaction.

If a woman is peri-menopausal and has symptoms like migraines and mood swings, she will probably feel better faster if she keeps her hormone levels at a steady state.  Men naturally have testosterone "peaks' twice a day, and dosing testosterone twice a day works well for them.  A woman who has been menopausal for awhile may not require nor respond well to such a quick and steady rise in hormone level and I usually take it more slowly with them. and often dose once a day.

Do you ever prescribe progesterone to men?  I read Dr. Uzzi Reiss’s book “Natural Hormone Balance for Women”.  He stated in the book he himself used these hormones (HGH, progesterone, testosterone, melatonin, pregnenolone, DHEA) – all except for estradiol which I know men don’t want too much of as they get older.  My husband used 10 mg of OTC Progestacare for men per day and likes it. 

You asked me to have my blood drawn on day 18-21 of my cycle.  I’ve talked to a couple of other anti-aging physicians (one was Dr. Ron Rothenberg in Encinitas) who have their blood drawn somewhere between days 20 – 23 when progesterone is supposed to be at its peak.  I know you’re an expert, but I just wondered why you look at day 18 rather than later in the cycle?  Also, do you always use testosterone, progesterone, and estrogen in cream form?  If a person doesn’t absorb the progesterone well, do you ever prescribe sublingual or oil-based pills?  Also, what compounding pharmacies do you use?

Well Ron Rothenberg is an expert too, he is right that progesterone levels will be higher on day 20.  Progesterone is at it's absolute maximum peak, at that point, but on day 18, progesterone is well on it's way to peak, and some women, especially if they have shorter than 28 day cycles may have their peak hormone levels earlier.  Estrogen is just slightly past it's peak and testosterone is at it's peak, so it's the time to get all three hormones at what should be fairly high levels if your ovaries producing well, and if they aren't your FSH should be "complaining" in order to get your ovaries to respond.  If it isn't then you could have a pituitary problem. If FSH is extremely high with poor ovarian response, then menopause is the likely answer.

What form do you usually prescribe the testosterone in men (gels, creams, pellets, sublinguals, etc).

Typically as an alcohol based topical gel. but sometimes as in Subcutaneous injection when men cannot properly absorb it topically.  I can prescribe SL, and sometimes do for women who need it to reduce SHBG levels.

After the initial blood work, how often does the blood work usually need to be repeated?  Does every test have to be repeated or just the hormone panel?

It depends on the person, and their treatment program, but I do not repeat the entire profile except for yearly check-ups.  I follow-up with hormone checks to make sure we are in the right range and are not producing too many cancer-causing metabolites a few months after starting hormone replacement and every 3 to 6 months to make adjustments.  I do that with Lipids and cardiovascular inflammatory factors too.

Do you ever prescribe testosterone patches for men?  You mentioned you prescribe testosterone sublingually sometimes for women, how about for men?  Do you prescribe estradiol patches for women?  Do you ever prescribe a testosterone thick gel for women to put directly on their labia? 

What other conditions do you treat? I understand you treat other kinds of conditions.

I treat people who have multi-system complaints, which can be hormonal in nature, or infections, such as virus and Lyme disease. I also treat people using the Wilson Temperature Syndrome protocol, and treat Chronic Fatigue Syndrome and Fibromyalgia.