Balance Your Hormones - Balance Your Life! with Bio-Identical Hormone Pellet Therapy

Marcia A. Harris, MD, LHD
Patients Medical

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Integrative Medicine


This evening’s speaker:
Marcia A. Harris, MD, LHD
Holistic Gynecologist
Anti-Aging Medicine


 Received MD from Columbia University College of
Physicians and Surgeons
 Awarded the Rudin Scholarship
 Internship in Internal Medicine at Harlem Hospital Center
 Residency in Obstetrics and Gynecology at NY
Hospital, Weill Cornell
 Post-Graduate training at the American Academy of Anti-
Aging Medicine (A4M)
 37 years’ experience


 Specialties include
 Hormone Balancing
 Nutrition
 Detoxification
 Weight Loss
 Intravenous therapy
 Neuropathy
 Thyroid Balancing
 Feminine Wellness
 Pain Management
 Anti-Aging Medicine


 Cycles
 Balance
 Transitions


Progesterone, Estrogen and Testosterone
 Have over 400 functions in the body
 When lacking, cause previous symptoms and
subsequent disease


 1st uniquely female hormone
 Considered the main female
hormone
 Xenoestrogens-Man made
estrogen
 Phytoestrogens-Plant estrogen


Type of Estrogen Name

E1 Estrone
• Made in fat tissue
• Holds cancer-causing properties
E2 Estradiol
• Made by the ovary
• Active: relieves symptoms
E3 Estriol
• Highest amount in pregnancy
• Weak estrogen
• Not much help with symptoms


Estrone Estradiol Estriol
Stage
(E1) (E2) (E3)

Premenopausal 10-20% 10-20% 60-80%

Post-
60-80% 10-20% 10-20%
menopausal

Premarin
50% 0.5% 0%
(CEE)


 Regrowth of menstrual tissue
 Growth of follicle into an egg
 Growth of breast
 Support vaginal tissue
 Develop sex characteristics
 STORES FAT!
 Decreases thyroid hormone

20

 Breast tenderness
 Depression
 Fatigue
 Poor concentration
 Endometriosis
 Fibrocystic breasts
 PMS
 Fibroids
 Water retention and bloating
 Fat gain around hips and thighs
 Breast and Uterine Cancer

21

 2nd uniquely female hormone
 Made by the ovary after
ovulation
 Can be made from wild
yam and soy beans
 Provera and
Depo Provera - Are not
progesterone


 Pro-Gestation
 Promote development of the fertilized egg
 Natural Diuretic
 Uses fat for energy
 Natural antidepressant (calming effect)
 Restores sex drive
 Promotes regular sleep patterns
 Protects against cancer
 Balances Estrogen (growth)


 Breast tenderness
 Depression
 Fatigue
 Poor concentration
 Endometriosis
 Fibrocystic breasts
 PMS
 Fibroids
 Water retention and bloating
 Fat gain around hips and thighs
 Breast and Uterine Cancer

24

 As you age, the ovaries produce less estrogen
hormones
 Puberty  Turbulence
 The Reproductive Years
 Estrogen, progesterone, testosterone are in optimum
balance
 High energy
 Strong sex drive!


Peri-menopause is associated
with estrogen dominance.

 Increased PMS  Mood swings
 Breast swelling  Depression
 Headaches  Fluid retention
 Decreased sex drive  Fibroids
 Weight gain  FCBD
 Foggy thinking  Migraine headaches


 Permanent cessation of menstruation
 Caused by decreased production of ovarian
hormones
 Most commonly occurs between ages 48-52
 It’s not a disease, but a natural transition
from one life cycle to another
 Progesterone falls disproportionately greater
 This creates estrogen dominance


 Mood Swings  Decreased Sex Drive
 Depression  Erectile Dysfunction
 Panic Attacks  Vaginal Dryness
 Irritability  Painful Intercourse
 Bloating  Irregular Cycles
 Indigestion  Palpitations
 Gas  Dizzy Spells
 Brain Fog  Insomnia
 Difficulty Focusing  Difficulty Sleeping
 Osteoporosis  Night Sweats
 Varicose Veins  Hot Flashes
 Lower Back Pain  Urinary Leakage
 Body Aches  Crawly Skin
 Chronic Fatigue  Thinning Hair
 Weight Gain  Facial Hair (in women)


 Menopause is NOT an estrogen deficiency
condition
 External estrogen exposure is unchanged
 Hot flashes diminish in 2-5 years
 Rx with natural progesterone is effective in
60% of menopausal women
 Doesn’t have the advantages of exogenous
replacement


In the 1930’s several significant things
happened
 Adolph Friedrich Johann Butenandt won the
Nobel Prize for isolating the sex hormone (1939)
 Schering Pharmaceuticals (who sponsored his
work) introduced
 Progynum (synthetic estrogen)
 Prolutum (synthetic progesterone)
 Testorion (synthetic testosterone)


 1938: Diethyl Stilbesterol (synthetic Estrogen)
 Given to pregnant women to prevent
miscarriage
 9 out of 10 daughters of women who took DES
had genetic abnormalities
 5 out of 10 were never able to conceive
 2 out of 10 had rare Adeno Carcinoma of the
reproductive system and testicular cancer in
males


 1941 Study: Journal of Cancer Research –
Estrogen is a very important factor in Uterine
Carcinogenesis
 1942: Ayerst (Now Wyeth) put Premarin on
the market
 Pregnant
 Mares’ Premarin!
 Urine


Pregnant Mares’ Urine
#1 Prescribed STILL!


 1970’s Premarin – Gold Standard
 1971: FDA revokes approval of DES
 1975: Studies Endometrial Cancer Black Box
Warning
 Unopposed estrogen = Cancer
 Progestin: to oppose the estrogen
 No safer, actually more dangerous but for 20
years they reigned supreme!


1993-1998 by the NIH
 17,000 healthy women
 55-79 years old
 All had uterus
 Prevention of heart disease and hip fracture
 Re: Breast and Colon Cancer
 Not designed to address benefits for
treatment of menopausal symptoms


1. Estrogen only (CEE)
2. Estrogen (0.625 mg CEE) + Progestin
(2.5 mg medroxyprogesterone acetate –
Prempro)
3. Sugar Pill (placebo)


 Used conjugated equine estrogen (CCE) with
50% E1, E2, no E3 and 40% equine estrogen.
 They also used medroxyprogesterone
Acetate (MPA).
 The Premarin only arm showed a decreased
risk in hip fracture and colon cancer.
15 JAMA 2004: 291: 1701-1712
15 JAMA 01-2000, 283:485-491
36 Cancer 2003; 97: 1387-1392
J Natl. Cancer Inst. 92 (4): 328-332, 2000


 2002 – stopped study
 35% initially enrolled, but dropped out
 20% dropped out due to side effects or fear


The Prempro Arm was halted 22% Increase in total CV Disease
July 9, 2002, three years early 26% Increase in Breast Cancer
due to increased breast 29% Increase in Heart Attacks
cancer and cardiovascular 33% Decrease in Hip Fractures
disease in women. 37% Decrease in Colorectal Cancer

41% Increase in Strokes

60% Leg blood clot
JAMA 7/17/2002 Vol. 288, 3
200% Alzheimer’s ,Dementia


 54% Ovarian Cancer with Prempro
 43% Ovarian Cancer with Estrogen alone
 No improvement in most quality of life issues
 Sleep
 Hormonal health
 Sexual health
 Did relieve
 Night sweats
 Hot flashes

 Herbal remedies
 Phytoestrogens:
▪ Black Cohash
▪ St. John’s Wort
▪ Dong Quai
▪ Dietary Soy
▪ Evening Primrose
▪ Flax Seed
▪ Wild Yam
Can help relieve symptoms, but do little to fix the problem….

Biochemically, the body is not set up to convert
plant hormones into bio-identical human
molecular structures from raw botanicals
(although natural the body does not recognize
and can’t use these efficiently).


 BHRT
 Clinically proven
 Safe
 Effective
 Replaces hormone deficiency
 Biochemically resolve the problem at the cellular
level


 Uses hormones made from soy
and wild yam
 Biologically identical in chemical
structure to the hormones
synthesized in our bodies
 Overwhelming research that using
bio-identical hormones to treat
menopause and andropause has
fewer side effects than synthetics
and gives the best results!
 Perfectly safe!


A molecular structure that occurs in nature
cannot be patented.

The Keys that Fit!
 Relative
 Binding
 Affinity


 BHRT: RBA 100%
 At a cellular level, the body
 Recognizes
 Accepts
 and Uses
…BHRT just as it would human hormones.


SYNTHETIC HORMONES
BIO-IDENTICAL HORMONES
(PREGNANT MARE’S URINE)

49

What is synthetic?
 “Patented” or “Conventional” or “Artificial”
 Usually not found in nature or at least not in
humans
 Chemically altered form of human hormone
 Not identical in structure or activity to natural
hormones they try to emulate


 Dictates how the hormone is
metabolized and what bi-products result
 Changes in the position of even one
substituent can lead to inactive isomers
Speroff 2005 pg 28


Are very different in molecular structure and function from
Bio-Identical Estrogens Progesterone and Methyl Testosterone.


Natural Hormones are Bio-
Equivalent, also known as Bio-
Identical.
 Patches
 Creams
 Gels
 Sprays
 Pellets


 Peak and Trough daily has
liver bypass therefore
increasing clotting factors
 CEE has higher conversion
to 16OH Estrone which has a
higher conversion rate to
Quinones.
 Oral Testosterone is
Methyltestosterone which
can be liver toxic


 Can be administered through patches, gels, sprays or creams
 No liver bypass so they have the benefit of no increased clotting
factors and therefore decreased CV risk
 Gels, Sprays, and Creams peak and trough daily
 Patches Peak and Trough bi-weekly or weekly depending on the
preparation
 Must remember to rub it in daily
 Risk contamination with gym equipment, spouse or kids
 Timing: have to wait to get dressed and use after showering only
 Gels are alcohol based and lose some of active hormone when
alcohol evaporates (including androgel for men)
 Transdermal preparations loose efficacy over time due to
saturation of skin receptors and this usually occurs after about 1
to 3 years N Engl J Med 1997; 336-683-690
J Clin Endocrin Metab 2001; 86:3629-3644
Lancet 2003; 362:428-432


 Estradiol levels are better than pills but still
get peak and troughs
 Maintains E2-E1 ratio of 1:1
 Adhesive problem very common maintains
 Need to change 2 times per week or weekly
 Transdermal estrogen has no effect on liver
synthesis of proteins or binding proteins and
therefore no effect on clotting factors.


 Good symptom relief
 Some are toxic
 Weekly or monthly Peaks & Troughs….


PELLET THERAPY (Subcutaneous Implants)
 Discovered in 1935 In Europe, original studies done in
1939 by Dr. Greenblatt at the University of Georgia on
hysterectomized women.
 No liver bypass so no increased clotting factors and
therefore decreased CV risk.
 No Peak and Trough effects so delivers daily customized
doses and subsequent significantly different in symptom
relief due to customized dosing.
 Downside is breakthrough bleeding in non-
hysterectomized women when progesterone levels are
not physiologic.


No roller coaster effect (i.e. no peaks and valleys)
 Keep E2-E1 ration at 2-1
which is physiologic
 24/7 availability of
hormones to the body
(This may last for 3-8
month at a time ).
 Adapts to the daily needs
of the body.
 The difference in relief of
symptoms is night and day
compared to other form of
BHRT


 Rate in 2001 was 7%
 WHI Study was halted because they saw an
INCREASE of 8%
 So more than doubled your risk!!!

# at 7% = 7/100 → 17,000 (in study) → 1190
8% incr. = 8/100 → 17,000 → 1360
2550


Arizona Study – 976 Women
# at 7% = 7/100 → 976 (in study) → 70
8% incr. = 8/100 → 976 → 80
150

There was only ONE breast cancer in the group!
Similar statistics for Endometrial Cancer.
ALMOST appears to be protective.


 Definitely “cardio sparing” (protects the
heart)
 “Bone sparing” (protects the bone
 Does NOT increase dementia


 Bio-identical is misleading (the chemical
structure is not exactly the same)
 No BHRT has met federal standards for
approval
 Prometrium (approved in 1998)
 Estrogel (approved in 2004)
 BHRT is unregulated
 Made from FDA and USP registered materials
 Is regulated by state boards of pharmacy


 The day of one size fits all hormone
replacement regimen used in
traditional medicine is over
 Bio-identical HRT allows for custom
balancing hormones based on the
individual patient.
 No two persons have the same
genetic make up, medical history,
symptom environment or nutrition.
 Custom dosing is clearly appropriate
and most advantageous!


 Natural decrease in male hormones
 Starts as early as late 20’s
 Very gradual, so not as dramatic (1-2% per year)
 Weight gain (especially belly fat)
 Lifestyle-related
 Fatigue - can be debilitating
 Urinary problems
 Depression, brain fog/anxiety
 Decrease in physical agility
 Decreased libido/erectile dysfunction
 May be related to “mid-life” crisis behavior
 Must replace testosterone and DHEA


 Money: Big pharma
 Most MD’s only know what the drug rep tells
them (actual studies in the 80’s)
 Managed care environment
 Dr. Phil, Oprah, Dr. Oz and Suzanne Somers
 Ageless
 The Sexy Years
 Breakthrough


1. Education
2. Consultation
3. Blood draw and evaluation
4. Implant
5. 4-6 weeks repeat blood draw
6. Booster (if needed)
7. Enjoy life!


Q and A with the Doctor.

68

Get back on track with your
health with Dr. Harris and
Patients Medical.

69

Get started TODAY by making an appointment
with Dr. Harris.
Call 212-661-4441 or email
media@patientsmedical.com


Stress Incontinence:
Why it Happens and How to Reverse it
Dr. Harris will explain how this uncomfortable and
embarrassing condition can be treated without dangerous
drugs or surgery.
Wednesday, April 3rd at 6:30pm


Spring Cleaning: Easy and Delicious Detox
Dr. Vivian DeNise explains why everyone needs to
detox and healthy chef, Elisa Haggarty will show
you how easy and tasty it can be!
Tuesday, April 9th at 6:30pm


Get Fit for Spring with the HCG Diet
Dr. Harris demystifies the secret of the HCG Diet and why
there is so much buzz around it. Learn how you can safely and
effectively lose the weight and keep it off!
Wednesday, April 10th at 6:30pm


Just for MEN: Boost Your Mojo Naturally
Dr. DeNise and Nutritionist/Personal Trainer, Judy Penta
explain how to improve your focus, physique, libido and
energy without dangerous OTC or prescription drugs.
Tuesday, April 23rd at 6:30pm


Come See Our Holistic Ophthalmologist
Dr. Ayman Matta will be seeing patients on
Friday, March 22nd in the afternoon.
See one of our staff members for details and scheduling.


Dr. Rashmi Gulati, Dr. Kamau Kokayi, Dr. Marcia A. Harris
Dr. Stuart Weg, Dr. Vivan
Medical Director Holistic and Chinese Holistic GYN and
Alternative Pain DeNise, Integrative
Medicine Internal Medicine
Management Internal Medicine and
Peds

Dr. Eileen DiFrancesco Dr. Paul A. Dreschnack Dr. Victor I. Rosenberg
Dr. Gino Bottino Dr. L. Deanna Howard
Psychopharmacology Plastic Surgery Plastic Surgery
Holistic Oncology Holistic GYN

To get more information or to schedule an
appointment,
call 212-661-4441 or
email media@patientsmedical.com


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