Heartbreak and Heart Failure

screen-shot-2016-11-06-at-2-48-11-pmSometimes life, work and study all seem  to dovetail and everything makes sense for just a few glorious moments. Cardiology was like that for me, in between the Frank Starling curves.

Last year we had a case study of a woman with congestive heart failure (CHF.)  Her husband had renal failure and needed dialysis, and she worked at a job she didnt love. She slowly developed worsening heart failure over the course of the case, with  shortness of breath, edema, high blood pressure, and poor circulation, eventually dying from it. I was impacted by the apathy she displayed in her efforts to recover – unwilling to eat more grains and greens, decrease salt,  get outside, exercise regularly, investigate psychotherapy, or better her personal life in any way. Instead, she just declined in health, adding a new prescription per year to mange her symptoms until she  – drowned. In her grief. Of heart disease.

This. Story. Happens. Every Day.

And not only in the US, or Canada or Europe. World-Wide.

The multitudes of meta-analysis risk factor evaluations like the Framingham, Whitehall and Rekjavic studeis have concretely illustrated important evidence about the facts of heart disease: atherosclerotic fatty streaks in arteries, high blood sugar, and  inflammation are the undeniable Holy Trinity of heart disease. What is not being avidly reported is the rate of divorce, or mood disorders in these same subjects. The sexual dissatisfaction. The childhood trauma. Socioeconomics and race are sometimes studied, and African Americans and Latinos have higher rates of heart disease. Nobody is surprised. Russia has the highest rate of ischemic heart disease in the world, along with some African nations and Indonesia. These countries also have horrible human rights records, with well documented transphobia, homophobia and police brutality.

screen-shot-2016-11-09-at-9-01-58-pmIf we are going to turn around heart disease, do we not need to acknowledge the humanity of the heart? The same  epidemiological study quoted deep within the content:

“Additional reports from this study have shown inverse associations between fair and respectful treatment at work and CHD [Congestive Heart Disease],and job control with future CHD risk.

Similarly, hypertension, which is the harbinger of heart disease through its effect on cardiac structure and function,  is hugely mediated by the stress response.

screen-shot-2016-11-09-at-9-11-31-pmI was talking to Dr. Stein, an internist specializing in HIV and also our OMS II course director, about this theory that heart failure is so rampant because we have no real medicine for soul-problems like dissatisfaction, grief, sorrow, envy, loneliness and such. He said the links between depression, elevated cortisol, hypertension and CHF are well documented and clearly evidenced.

He reiterated that it is known that People of Color have higher blood pressures because their lives are more stressful due to systemic and personally experienced racism aka “stress.” It is also well evidenced that African Americans with CHF respond better to different medications than other races – Hydralazine, a vasodilator that decreases resistance,  improves survival with  isosorbide dinitrate rather than the ACE inhibitors and Beta Blockers commonly used. Ha, decreasing [systemic institutionalized] resistance as a keystone in improving survival? I need to know more about the MOA of these drugs to understand why decreasing the catecholamines isnt enough for this population; maybe its because of the deleterious and constant push and pull the sympathetic blockers have on the heart receptors of someone living in the actual adrenergic rut of an unsafe society.

3f0a8388-0078-4c4f-88ef-36078365eae5Our cardiologist professor Dr. Glass stated that the average person with hypertension is on 3.4 medications to manage it. These are usually layers of diuretics to decrease the blood volume and drain edema (decreasing preload), and beta blockers to decrease cardiac work and improve cardiac output,  and/or other meds like diphydropyridines and nitrates. But guess what – it just came out recently that hypertensive medications may be CAUSING depression/ mood disorders while working to decrease blood pressure.  What a double whammy.  This was a big study from a database of a single hospital containing 525,046 patients over 5 years. This 2016 article stated:

Major depressive and bipolar disorders predispose to atherosclerosis, and there is accruing data from animal model, epidemiological, and genomic studies that commonly used antihypertensive drugs may have a role in the pathogenesis or course of mood disorders.”

  • Patients on angiotensin converting enzyme inhibitors or angiotensin receptor blockers had the lowest risk for mood disorder admissions
  • those on β-blockers (hazard ratio=2.11; [95% confidence interval, 1.12–3.98]; P=0.02) and calcium antagonists (2.28 [95% confidence interval, 1.13–4.58]; P=0.02) showed higher risk
  • those on no antihypertensives (1.63 [95% confidence interval, 0.94–2.82]; P=0.08) and thiazide diuretics (1.56 [95% confidence interval, 0.65–3.73]; P=0.32) showed no significant difference.

To summarize the findings,  calcium antagonists and β-blockers may be associated with increased risk, whereas angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may be associated with a decreased risk of mood disorders. (Hypertension. 2016;68:1132-1138. DOI: 10.1161/HYPERTENSIONA HA.116.08188.)

It appears, the drugs that most directly affect the heart muscle itself are thus linked to more mood disorders, while those that work indirectly and decrease the work for the heart seem to have less impact on mood.

This is such a broad topic and there are so many layers to heart failure – blood pressure, kidney regulation of blood pressure, nutritional effects, blood lipids, blood volume, inflammatory mediators, free radicals and antioxidants, sleep quality and more – but I think that too often we lose sight of some of the most basic truths of happiness and heart health. And we also forget the deeply sensitive creatures that most of us are and fool ourselves that pharmacy could possibly be enough to cure a heart that is systemically broken, or the effects of a chronically hypervigilant nervous system.

imagesWIDJJQD2I am going to need to become proficient at cardiology as an Internal Medicine doc. But without a degree in psychiatry, or soul medicine, or archangel intervention, how can I possibly hope to help people recover their failing hearts when the intersections cut so deep? I am scared of all of those people that have no willingness, or ability, to look deep within and make the simple and profound choices towards life. This is the part of being a physician I most fear. The medical failures; the broken hearts.

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Frequently Asked Questions: Hormone Tx

Many people have questions about the safety and efficacy of hormone treatments. I provide individualized hormone treatment programs. Every patient undergoes our complete metabolic bloodwork panel; a physical exam including breast exam, and a full 90-minute initial intake to make sure that hormone treatment is safe and recommended for you.

Here are some common questions, asked in our free 30 minute screening consults.

Will I need to stay on hormone treatment forever?

Current evidence shows that estrogen and progesterone bioidentical replacement therapy is safe for up to 15 years. After 15 years the risk of hormonal cancers increases very slightly. I encourage our patients to follow their own instincts around the duration of bHRT. Many women reach a point where they want to try coming off the hormones, to see how they feel. (Many then come back on the hormones for the feelings of well being they provide!) There is no “right answer” for the duration of hormones treatment; instead, your ongoing health and feelings of wellness may be the most important indicator to measure this.

What is a Bioidentical hormone?

Bio –meaning, of the body and Identical meaning, exactly like = hormones that are exactly like those your body naturally produces.

Why use Bioidentical hormones?

Generic and brand name hormones made by pharmaceutical companies all have biochemical additions to the basic hormone structures like pharma-signatures that make the drug patented (and profitable.) Bioidentical hormones are made as liquids, creams, troches, rapid dissolve tablets, injections or suppositories by a compounding pharmacy laboratory like Apothecary by Design to make them exactly like the hormones your body would naturally be producing. Drug companies cannot make money off of this form of hormone because they are universal; therefore their use is discouraged by big pharma. We know that bioidentical hormones are the safest, most effective way to replace hormones in your body. We only use compounded, bioidentical estrogen, progesterone, and testosterone at Age Management Center.

Do hormones cause cancer?

The Women’s Health Initiative study in 2001 did show an increased risk of not only breast cancer, but also heart disease in women taking the medications in the study. What is KEY here is that the hormone medications used in the study were the horse-based estrogen Premarin and a synthetic version of progesterone called progestin, brand name Provera. The study was separated into just Premarin users and Premarin + Provera “Prem-Pro” users. The Provera Rx was clearly indicated as the causative factor for the increased risk of breast cancer in clinical data. In further studies on bioidentical progesterone it has been evidenced that 200 mg of bioidentical progesterone is actually protective against the development of breast cancer.

It was the synthetic pharmaceutical analogue Progestin that is linked to cancer development, not either bioidentical estrogen or progesterone. Having said that, if you already have an estrogen positive cancer growing in your body, additional hormone replacement therapy can feed the tumor growth. We encourage all of our patients to get screening mammograms yearly during menopausal hormone replacement therapy, and actively support anti-cancer nutrition and antioxidant supplementation as part of our treatment protocols.

What about heart disease in women and estrogen use?

One of the most surprising results of the Women’s Heath Initiative was the increased risk of cardiovascular health issues like blood clots resulting from plaque rupture in women using Premarin. Estrogen is in fact protective for the cardiovascular system as it increases elasticity in all systems including the blood vessels. More elastic, flexible arteries means healthier blood flow. However, when combined with risk factors for atherosclerosis (plaques in the arteries) like elevated cholesterol, high blood sugar, smoking and being overweight the benefits and the risks need to be weighed to assess what is best for each woman.

At Age Management Center our complete metabolic blood work panel and 90 minute initial consult is in part to ensure that your body is metabolically able to handle additional bioidentical estrogen, and that you are a good candidate for hormone treatment. Some women need to do additional metabolic and cardiovascular work to reduce risk factors before estrogen-based therapy is indicated. Oral estrogen (taken by mouth) was associated with more risk for plaque rupture than topical estrogen. We start all women on a topical mix of bioidentical estradiol and estriol plus additional progesterone to manage symptoms while navigating risk, ultimately improving metabolic and cardiovascular health for effective anti-aging.

I thought testosterone was only for men?

Want to know a secret? Testosterone is like magic for womens health. It is actually the most abundant hormone across our entire lifetime because our body continues to produce it after menopause (if all goes well.) Testosterone is extremely valuable for women’s health because it is the “vitality” hormone that leads to physical and mental strength, bone health, leadership qualities, sexual appetite, sexual satisfaction, mood stability and more. Testosterone levels naturally start to get lower around 40, but the adrenal glands take over testosterone production when periods stop completely. We see low testosterone in women of all ages; we use testosterone supplementation in most of our menopausal treatments, because it helps you feel great! This hormone has been part of menopausal treatments since 1937. There is not much excitement generated about it in traditional medicine because who wants strong, sexual, healthy, happy, active, passionate postmenopausal women? I do!

Will taking testosterone make me look manly? (Facial hair, lower voice etc)

My job is to replace and optimize hormones to their natural levels. When testosterone levels are optimized for your body, it is unlikely you will have complications like black facial hairs, voice lowering, acne, or other classic side effects. However, this of course depends on your genetics and sensitivity to hormones. We start with the lowest possible dose after our thorough initial exam, an adjust dosages based on your personal experience plus laboratory testing. If you happen to be someone who does have side effects like facial hair or pimples, these are immediately reversible by lowering your dose.

At Age Management Center I also provide transition support for transgender and transsexual individuals. These dosages of hormones are significantly higher than doses used for hormone replacement, and do have permanent and reversible side effects that are usually considered desirable by the people using them.

Do you accept insurance?

Age Management Center is a concierge medical practice. We offer the best of modern regenerative medicine, guided by cutting edge evidence based research, in a relaxed, comprehensive manner. Our hormone programs are simple. Once a month fees include all doctor visits, emails, and phone calls, as well as your administrative support and foundational hormones. We operate outside the insurance system so that we can offer the high touch personalized medicine that our patients have come to rely on. We do not bill insurance companies for our services; however we can give you an itemized “superbill” for your services that you can submit on your own for reimbursement. We invite you to come in for our free 30-minute consultation to learn more about our concierge medical programs and how these might work for you.

Can I use my insurance for the comprehensive metabolic bloodwork?

We prefer that our patients use our cash-based in house laboratory services as it allows for consistent lab results and lab values, speedy results, streamlined workflow and improved coordinated care. We thoroughly research the best prices for lab work, and pass those savings on to our patients. For example, our complete metabolic blood work is priced at $1800 through insurance billing. We offer it at $395, passing on our physician pricing to you. Many of our patients have tried to use their insurance to run the blood work, and with deductibles and co-pays have ended up paying at least $600-800 for the same work.

Furthermore, many insurance companies and PCP’s will not cover some of the hormonal blood work evaluations we consider crucial to accurately understanding your metabolic and hormonal health. By having all of your blood work arrive in time for your initial visit, we are better able to serve you in a timely and effective manner. Laboratory, physician and clinical services can all be claimed as health expenses on your taxes, and can be part of your deductible.th

Can I use my Health Savings Account or Flex Spending Account?

Yes. Age Management Center services are billable through HSA and FSA’s.

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Fertility is the New Holy Grail

Resolve to know more about the underling factors affecting conception and alternative family possibilities. * This article was originally written for the February 2015 Digital Issue of Essential Living Maine*

I had two stepmothers who were infertile for various reasons, and have an adopted baby brother. Several of my close friends and family member have used IVF to conceive, and I have my eggs cryopreserved. A few of my good friends have fostered and adopted, and others have intentionally chosen childfree lives. As lesbian and gay marriage has normalized, and divorce rates have climbed, more and more alternative families are being created using sperm banks, surrogates, egg donors, known sperm donors and more. The quest for fertility is all around us, and has been for the past 30 years in ever-increasing numbers.

The Internet has an enormous amount of information available on this topic, as the World Wide Web offers an enormous cross cultural support network for women trying to conceive (#TTC.) Infertility is usually a silent disease without any visible disability associated; however, it draws deeply on the mind/body and soul in underground ways that cannot be explained to those who do not have to undergo its trails and tribulations. Thus, the web is a great way to connect, share information, and do research while maintaining public anonymity.

220px-Sangreal-1Integrative Medicine is key to enhancing fertility. Integrative Medicine combines the best of modern medicine (reproductive technology) with time-honored complementary and alternative medicines (botanical therapies, clinical nutrition, homeopathy, acupuncture, and stress management support.) The quest to get pregnant (and stay pregnant!) has been a calling of doctors and midwives since the beginning of time and across all cultures.

After ten years of fertility specialization, here are my Top Ten Integrative Medicine Fertility Fundamentals to know about when mapping your journey:

  1. First, while on oral contraceptive pills, rings, or IUD’s and for at least 6 months coming off them, it is important to supplement with a good quality multivitamin that contains at least 10-20mg of all of the B vitamins, magnesium, vitamin C, and 800mg folic acid. These are depleted by synthetic estrogens, and a deficiency can cause long term fertility issues down the road.
  1. If you have a family hx of miscarriage, have had a miscarriage yourself, or have any anemia or high homocysteine on lab work, you may want to test for a genetic defect called MTHFR that leads to a folic acid absorption issue. http://www.apothecarybydesign.com/blog/archives/332
  1. DHEA is a fat-soluble antioxidant and hormone precursor produced by the adrenal glands. DHEA is also a key player in egg health, showing improved embryo quality and higher live birth rates than controls. Studies have used 75 mg of DHEA daily. 1 DHEA supplementation also evidenced higher rates of spontaneous pregnancies in long-term poor responders to IVF in another study using 25 mg three times per day. 2 DHEA supplementation slows the aging process by preventing lipid oxidation while improving energy and metabolism.
  1. CoQ10 is imperative to egg health. Egg division from 46 to 23 chromosomes requires effective mitochondrial function. 3. It has been suggested that mitochondrial DNA defects that effect metabolic capacity may be a cause of failure in egg maturation, fertilization, or early embryonic development. 4. Aged eggs have decreased mitochondrial energy which can result in deficient energy to divide properly resulting in Downs’s syndrome and other genetic anomalies. All women over 30 who are still considering pregnancy should be on 100mg of ubiquinol daily to maintain efficient mitochondrial activity.
  1. Test your hormones early, and keep testing every few years for an objective measurement of fertility reserves. Follicle Stimulating Hormone (FSH) levels must be tested on day 3 of the menstrual cycle with Anti Mullerian Levels (AMH) levels before beginning fertility protocols. FSH reflects the relationship between the ovaries and pituitary and higher levels indicate perimenopause and poor ovarian function. Therefore, levels of FSH under 10 are best. AMH is also called the “egg timer” as it gives an accurate level of the follicular reserves of the ovaries. AMH levels do not fluctuate throughout a cycle and can be tested at any time. Serum AMH levels decline throughout ones reproductive life cycle, and are undetectable after menopause; therefore, higher levels are more desirable.
  1. Don’t wait too long to consider IVF. If you have been #TTC for more than 9 months and have not become pregnant with regular, timed inseminations, IUI’s or intercourse, make appointments with a fertility clinic and an Integrative fertility specialist. Having a Plan B will decrease stress, and it takes time to consider the financial and medical burdens associated with reproductive technology. However, it is worth it to have that baby in your arms! If IVF is needed, committing to the process earlier in your fertility journey can increase your chances for that #BFP (Big Fat Positive) on your first attempt.
  1. Don’t forget the men! At least 30% of infertility is male factor. Too often one half of the couple is doing everything possible (yoga, clean eating, no caffeine, no alcohol, meditation, support group, acupuncture, etc) while the other half is the root cause of the issue. Getting a sperm analysis is one of the first steps in a fertility evaluation, and can bypass months of angst from non-conception.
  1. Sperm need fertility enhancing supplements too! Omega 3 fats, 15 mg zinc, and stress busting herbs like Maca or Ashwaganda will improve sperm health, tonify libido and boost fertility.
  1. Have your thyroid hormones including TSH, Free T3 and Free T4 and your progesterone levels tested. Low thyroid function leads to low progesterone, which leads to frequent miscarriage in a classic vicious cycle. Some Endocrinologists and Family Docs may have conservative opinions on these levels and may use outdated reference ranges or be unwilling to test for Free T3. Consulting an Integrative Medicine Doc, Naturopathic Doctor or anti-aging Hormone Doctor may give you more information about optimizing your hormone levels rather than operating at a subclinical deficiency.
  1. Consider alternatives to the traditional nuclear family. There are many beautiful babies who want safe, stable, loving homes and need fostering and adoption. I know three amazing families of beautiful fostered babies! There are also women able and willing to carry babies to create families that are not their own. While a biological birth is what we are taught to dream for, this is not the answer for some. Infertility is tragic and real for people who have always assumed they would be able to birth when they are ready. Allow your self to grieve as a couple, but do not close the door on other options even if they seem inconceivable at first.

On another note, childfree living also has many blessings. Our culture is slowly shifting away from the definition of having a (nuclear) family as the ultimate success. Childfree living allows for a more relaxed and abundant lifestyle with more freedom, ability to travel, and heightened romance for a couple. We are an overpopulated planet, and I know from my life, having an auntie that is invested and involved in my life is incredibly valuable. Here are many ways to be a part of a family, and each version needs to be recognized as equally valuable and important!

I could keep typing another ten set of treatments supports, and probably another ten after that,  I am so passionate about fertility! However, as I said earlier the Internet is a rich resource. Some other articles I have written on the topic include:

I wish each of you success on your Holy Grail of Fertility. May your journey connect you to your own Divine nature as you experience one of the great, uncontrollable mysteries of life: Conception!

References

  1. Addition of Dehydroepiandrosterone (DHEA) for poor-responder patients before and during IVF treatment improves the pregnancy rate: a randomized prospective study. Hum Reprod.  2010; 25(10): 2496-500Accessed September 13 2013
  1. Leonidas mamas, Eudoxia Mamas. Dehydroepiandrosterone supplementation in assisted reproduction: rationale and results. Current Opinion in Obstetrics and Gynecology 2009, 21:306-308.
  1. David Meldrum, MD. Aging gonads, glands, and gametes: immutable or partially reversible changes? Fertility and Sterility 2013; 99:1-4.
  1. The use of mitochondrial nutrients to improve the outcome of infertility treatment in older patients. Fertility and Sterility 2010; 93:272-5.

To book an appointment:

http://www.agemanagementcenter.com/contact-amc/  or call 207-774-1356

Clinical Practice:

www.agemanagementcenter.com

www.facebook.com/AgeManagementCenter

For more information about Infertility see:

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LGB Trans HRT ~ New Program, Fresh Vision, New You

imagesWIDJJQD2The flame of Trans* Health has been burning steadily brighter in my life over the past 3 years. I was keen on the practice while still living and working in Toronto, ON but without a scope of prescribing hormones, my work with the Trans* community was peripheral medicine – acupuncture, restoration of transman fertility, anxiety support etc. I continued to take trainings in the hormone and lab protocols to better understand the medical aspects of transition, without the vision of guiding transition myself.

Once I moved to Maine in 2011, my scope of practice as a ND changed. Naturopathic Doctors have different abilities to prescribe and order diagnostic lab work in each state and province. Most of the west coast states plus British Columbia have full prescribing rights, can do IV therapies, and can act like primary care docs for their patients. In the more conservative middle North America and east coast, Vermont and New Hampshire are the only states/provinces with a full scope of practice. However, for me, from Ontario, the ability to prescribe most hormones and antibiotics was a big change of pace!

I mentored and practice with Dr. Michael Bedecs, an Osteopathic Doctor specializing in hormone therapies for the past  3 years. Under his guidance (plus several conferences on trans health, anti-aging and hormone optimization) I have come to better understand the intricacies of the endocrine system, and how they interrelate through reproductive, thyroid, adrenal, pancreatic and pituitary pathways. All this time, my brain has been making subtle connections in Trans* health, drawing pathways to hormonal optimization the bridges the cultural and gender fluidity required with treating the LGBT community with medical advancements in metabolism, subclinical hypothyroidism, fertility, adrenal exhaustion, cortisol excess, insulin resistance and more.

Dr. Bedecs and I have created a new program called LBGT HRT that includes the dynamic possibilities of gender and hormone variation, bioidentical hormone replacement, transsexual transition and transgender health. We will be offering this through our concierge style practice at Age Management Center in Portland, Maine.

Age Management Center is a cash based practice. We do not accept any insurance plans for visits, medication or laboratory services. Some patients are able to pay for our services through Health Savings Accounts, or get third party reimbursement. Working outside of insurance allows us to provide a standard of care far above  the norm. We offer blood work here in our clinic, at physician pricing. Because we are not limited by the current scope of insurance, we are able to test for and evaluate metabolic parameters that are essential to our complete understanding of hormonal health and wellness.  We spend an average of 90 minutes for first visits, and offer a free 30 minute consult before any commitment is required. Furthermore, within our framework of concierge medicine, each visit is not priced and ticketed; rather, the ongoing support of our doctors, nurses and medical staff is included in the program, allowing you unlimited access for questions, concerns, and follow up until your program is fine tuned and ship shape.

We know this style of medicine is not accessible for all members of the LGB and Trans community. Therefore, I created a monthly sliding scale clinic at Justice in The Body the first Monday of each month from 9am – 12pm to meet the needs of the lower income members of the gender queer and Trans* community here in Portland, Maine, and beyond. This clinic is limited in that a prescribing MD, NP or DO is still required to Rx the Testosterone for FTM and Spironolactone or Cyproterone for MTF; however, I am able to order lab work through insurance in Maine and can work with your prescriber to optimize current hormone protocols and work on supporting the Integrative aspects of general health and wellness that come with transitioning. Many of my patients at the Trans* Health Clinic have been fully transitioned, and we are working on other aspects of preventative medicine and optimized health through the lens of Trans* medicine. I am currently working on expanding the scope of the JITB Trans * Health Clinic by finding a prescriber to work directly with us in house. Stay Tuned!

Follow me on Twitter for Trans* Health @LGBTHRT

Follow me on Facebook for monthly updates about the Trans Health Clinic at JITB

Note: Trans* is a new-ish term. The asterisk denotes that the term is encompassing the entire transgender, transsexual and gender fluid spectrum of individuals without having to write all of that every time.

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5 Steps for Fertility Preservation Over 35

1Rope_Cross. CoQ10 preserves the quality of the eggs mitochondria  – essential for replication and good “egg energy” aka ATP for cell division. 100-400 mg daily prevention, 400 mg twice daily during a stimulation cycle.  ( The use of mitochondrial nutrients to improve the outcome of infertility treatment in older patients. Fertility and Sterility 2010; 93:272-5. )

2. DHEA is a lipid antioxidant and youth-reviving hormone precursor. I suggest 10 mg daily for prevention,  25 mg daily 6 weeks before stimulation cycle. Up to 75mg daily is evidenced to improve egg and embryo quality and enhance spontaneous conception. (Addition of Dehydroepiandrosterone (DHEA) for poor-responder patients before and during IVF treatment improves the pregnancy rate: a randomized prospective study. Hum Reprod.  2010; 25(10): 2496-500 Accessed September 13 2013)

3. This is your individualized medicine step – what do you need to tonify your specific reproductive patterns and enhance the chances of conception?

4. Fertility Massage is key for addressing muscular and ligament stress lodged deep in the pelvis that could mechanically impair the ability to maintain pregnancy. Concomitant castor oil packs clear debris from the ovaries and fallopian tubes, flushing lymphatic channels for a more balanced local immune response. The self massage/ hands on aspect maintains a connection between the cerebral, medicalized experience of ART and the physical sensations of the lower belly while reducing emotional stress. http://natural-fertility-info.com/fertility-massage.

5. Optimize your nutritional status with: extra leafy greens on a regular basis; superfoods especially in smoothies;daily  fresh vegetables; and choosing clean meat and dairy whenever possible. Reduce or eliminate sugar during high intensity hormone treatments including birth control pills.

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Women need Testosterone

When I say Testosterone, what do you think?

Most people think: men, male. Some people think trans,*  transgender, or FTM. Very few people will think “the most abundant sex hormone across a women’s lifespan and an important sex hormone for all genders.”

All of the above is the correct answer.

Estrogen and Testosterone have been sequestered into gendered boxes, but both are equally important sex hormones for human health. Functional and biologically active androgenic receptors are located throughout the body in both sexes. Testosterone receptors are found in the breasts, heart, blood vessels, digestive tract, lung, brain, spinal cord, nerves, bladder, uterus, ovaries, skin, bone, bone marrow, muscles and fat cells of all women. This wide diversity of receptor locations illustrates the panorama of body systems that rely on adequate levels of testosterone for optimal female  function.

And yet, this important hormone is routinely ignored in women of all ages and especially those in their 30’s and 40’s who are exhibiting signs of testosterone deficiency including: dysphoric mood, muscle loss, cognitive decline, insomnia, breast pain, rheumatic and other pain, incontinence and sexual dysfunction.

Think you might be T deficient? Take our Eve test now! http://www.agemanagementcenter.com/eve-scale/

Around menopause, testosterone and other pro-androgens like DHEA, DHEA-S, and androstenedione become the primary hormones available as estrogen and progesterone levels decline. The ovaries stop becoming the major source of hormonal production, and the adrenal glands take over. As early as 1937, testosterone was used as a successful and important bioidentical hormone replacement option for menopausal women.  Seventy-seven years later, doctors still do not routinely address testosterone deficiency in this population, nor do they even test for it!

Symptoms are not enough to assess hormonal balance. Accurate bloodwork including Total Testosterone, Free Testosterone, Sex Hormone Binding Globulin, Estradiol, Total Estrogen, Progesterone and DHEA-S must be assessed to have a clear picture of hormone health for all genders.

Many endogenous hormones can be converted into other hormones, like Testosterone being aromatized to Estradiol and DHEA-S into Testosterone or Estrogen. Understanding these pathways and monitoring the blood levels over time is the best way to achieve optimized hormone status. No hormone should be ignored based on presenting gender or sex, as it is the delicate interplay of hormones that creates vibrant wellness.

For more information on women and testosterone make an appointment to consult with Dr. Wright now. To schedule bloodwork to assess your testosterone and other hormone levels, call Kristen at 207 774-1356. Free initial consults are available.  www.agemanagementcenter.com

References:

Transdermal testosterone therapy improves wellbeing, mood, and sexual function in premenopausal women. Goldstat, Rebecca MPH1; Briganti, Esther MD2; Tran, Jane MD1;
Wolfe, Rory PhD2; Davis, Susan R. MD, PhD1 Menopause. September 2003 – Volume 10 – Issue 5 – pp 390-398

Testosterone therapy in women: Myths and misconceptions Rebecca Glasera,b,∗, Constantine Dimitrakakisc, Maturitas 74 (2013) 230– 234

Current perspectives on testosterone therapy for women. Susan Davis MB, Bs, FRAC-P, PhD., Sonia Davidson MB, Bs, FRAC-P, PhD.  Menopausal Medicine. Volume 2 0 , No. 2 — Ma y 2 0 1 2

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Counter-Response to the Multivitamin Controversy

This post was originally written for Apothecary By Design in December 2013 http://www.apothecarybydesign.com/blog/

Stop Wasting Money on Vitamin and Mineral Supplements! 5 medical doctors cried out in an editorial piece first released in the Annals of Internal Medicine, and then circulated through all major newspapers and social media outlets early this week.  The articles released in the New York Times, Wall Street Journal, LA Times, and countless other newspapers pointed out that multivitamins have failed to show benefit in several large scale studies; however, the evidence reviewed was not as clear as we were led to believe. As with every evidence based study, it is important to look at the information behind the research, the studies cited, and the actual information the studies gathered.

The quality of multivitamins IS a true concern for consumers. The studies supporting multivitamins have been mixed, and we acknowledge this. If you are going to take a multivitamin it is not an effective use of money to buy a low quality product (like the one illustrated below) that is not well absorbed and/or is coated in toxic chemicals and fillers. A very good diet may reduce or eliminate the need for a daily dose of essential nutrients. Some multivitamins may be a waste of money, not because studies illustrate a lack of benefit, but because of the abysmal quality of the product itself. Choosing an appropriate multivitamin is another question – one that Apothecary by Design’s wellness specialists welcome.

The following studies were used to support the evidence that multivitamins are not worth taking:

fmgt4Yi09-XGE8j8WdSI0z2key4wGe5glRyJ-QC8wH2_S3x8dxi0mHnxUERU0zmV047v=s1001.     Multivitamins and cognitive decline in men 65 or older

For example, in the first study on cognition, the multivitamin assessed was a well-known  common multivitamin that provides low level nutrients in the cheapest, least bioavailable forms. These poor quality minerals generally include  oxides and sulphates. For example, magnesium sulfate is epsom salt, like you would use in a bath. Magnesium citrate is a better quality, more absorbable mineral. (See label) Check out the “other ingredients” as well – 3 artificial colors including the noxious FD&C Red #40.

Regardless of the supplement quality, cognition issues are not primarily related to vitamin/ mineral deficiencies, but are a long term response to heavy metal toxicity, poor cerebral perfusion (not enough blood to the brain), omega 3 deficiency, hormone deficiency, environmental contamination, stress and elevated cortisol levels, head trauma, prescription medication side effects and many more individual variants.

For example, how many of the physicians studied were also taking statin drugs? These ubiquitous prescription medications are known to have memory impairment, loss of memory and amnesia as potential side effects.

When presenting strong statements like multivitamins are a waste of money, it is responsible to use evidence that considers a straighter line between cause and effect.

2.     Multivitamins failed to reduce cardiovascular events in men and women with previous myocardial infarction

The second study cited as proof that multivitamins are a waste of money was a 2012 study evaluating the effects of chelation therapy on men and women over 65 with history of a heart attack.

This study had significant setbacks.  Chief among them were the high drop-out rates due to the strenuous protocol of 30 weekly chemical chelation infusions followed by 10 maintenance infusions two to eight weeks apart.

It is difficult to assess the effect of a multivitamin on long term health with such invasive chemical and vitamin therapies being administered at the same time, and it certainly clouds what is presented as a black and white result.

Antioxidants, nutritional counseling and botanical therapies are also first line treatments in the Integrative health world to repair myocardial function. Once again, the true nature of the study being cited is obscured by the dramatic headlines.

2.     Multivitamins did not prevent the development of chronic disease or death.

If only a simple, cheap, low dose, poor quality multivitamins could save the world from chronic disease….

Quality matters in the food we eat, the medications we take and the supplements we buy. Chronic disease is a complex, multifactorial health concern whose cure cannot be reduced to oversimplified statements like these.

Finally – the original article states “….beta carotene, vitamin E and possible high dose vitamin A supplements increase mortality.” What they leave out, is that high dose beta-carotene increases risk of … lung cancer in smokers (only.) And alpha-tocopherol vitamin E increases the risk of heart disease …but full spectrum vitamin E with both tocopherols and tocotrienols reduce the risk.  Limiting the information sensationalizes the story, obscures the evidence and limits its relevance.

The great thing about this editorial is that it exposes the poor quality multivitamins out there for what they can be: a sense of false security. No one can eat fast food regularly, take a poor quality low dose multivitamin, not practice any preventative measures, and not develop chronic disease eventually. That much IS true.

A multivitamin needs to be able to be absorbed, with high quality minerals and therapeutic dosages of vitamins at the very least to offer prevention and protection. These remain a worthwhile investment for people wanting to maximize their nutritional value. Furthermore, high quality children’s multivitamins remain a good nutritional adjunct for picky eaters and kids with behavioral or health issues. Multivitamins are not a substitute for a healthy lifestyle with good quality food choices, exercise, and stress reduction.

http://www.mayoclinic.org/medicalprofs/trial-to-assess-chelation-therapy-cvuv10n4.html

http://www.ncbi.nlm.nih.gov/pubmed/10359235

http://www.medscape.org/viewarticle/501471

http://www.nleducation.co.uk/resources/reviews/the-next-generation-vitamin-e-how-tocotrienols-benefit-the-heart-brain-and-liver/

Enough Is Enough: Stop Wasting Money on Vitamin and Mineral Supplements. Annals of Internal Medicine. Eliseo Guallar, MD, DrPH; Saverio Stranges, MD, PhD; Cynthia Mulrow, MD, MSc, Senior Deputy Editor; Lawrence J. Appel, MD, MPH; and Edgar R. Miller III, MD, Phd p. 850

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Reflections from the Philadelphia Trans Health Conference 2013

What a phenomenal catalyst for change. June 13-15 was the 12th annual Trans Health Conference in Philly. It was a massive collection of workshops on many different aspects of Transgender, Transsexual and differently gendered health and healing including medical, legal, spiritual, practical aspects, self-empowerment and so much more. I was honored to be a presenter this year on Naturopathic Medicine and Trans Health. It was my first time attending the conference, and I am so impressed by the caliber of the event. I primarily attended medical style workshops including presentations on the most recent research being done with the trans community.

My talk was a great learning process for me. Not only from the questions asked by the diverse and well informed crowd, but also as a reflection of self. I am very comfortable in the trans community, consider myself an ally, and am aware of the multidimensional and sometimes fragile nature of trans identities. And yet, twice during my presentation I wrongly identified someone as a woman and a man when calling on people for questions. Under pressure, my highly educated nervous system switched back to my reptilian brain of the binary He-She world – and this with all the *knowing* that I have of the great diversity of gender expression. I was disappointed in myself.  It is a lesson that in working with this community, it is especially important to be conscious of language. The old ways of thinking are simply not progressive enough to enter the dialogue. For example, when referencing  people, we as a society need to step outside of classifying people by sex (and race.) Instead of saying “the woman in the yellow shirt”, say “the person in the yellow shirt is ….” The majority of the time our binary classification may be right, but there is a significant proportion of times when our 2D classifiers are actually incorrect, and those can be very painful moments for the individual inhabiting the misread gender identity.

I also talked about adrenal health, and was pleased to learn of new research that evidences salivary cortisol levels are indeed raised higher in the transitioning trans population than in controls. Meaning – stress is huge. Everyone working with trans people of all identifications will need to do stress management and adrenal support. Adrenals are also a source of endogenous hormones including DHEA, which could be a resource for transmasculine and transfeminine people not taking hormones as it has the potential to shift to both testosterone and estrogen internally.  There were many questions about the use of botanicals that have been evidenced to have steroid-like action. This is an area I need much more clinical experience in.

I was heartened to meet 3 other Naturopathic Doctors and two herbalists working in this field at the conference, all of who gave presentations as well.  They reminded me of some of the important preventative medicine aspects of working with people on hormone therapies like hypertension, osteoporosis, calcium quality, high cholesterol and so much more. There were also acupuncturists, and ayruvedic practitioners offering other traditional perspectives. Next year I hope to cultivate a workshop where we all meet to share information! I know I was left with more questions than answers.

I learned important information about our trans youth, and ways to support them better from both a practical level in schools, around mental health, and medically. Dori Midnight, a Massachusettes healer and fairy witch did workshops in mental health, herbalism and ancestral trans magics. I also got to share a room with her, which was a delightful meeting of the minds with gluten-free snacks. There were many sessions on identity development and closed meetings for specific gendered health care needs that looked inspiring and transformational. There were many fantastic workshops I did not get a chance to attend, including a 2 day medical training stream which I will certainly do next year.

Overall, the experience was one that provoked intense introspection and profound leaps of knowledge. It was an event that is crucially important to modern medicine, to understand not only the vernacular but also the urgency of the need for competent health care providers AND self care within the transgender, transsexual and gender non-conforming communities.

A few links and resources from the conference:

http://www.trans-health.org/

http://www.dorilandia.com/html/home.html

http://thirdroot.org/

http://www.rainbowhealthontario.ca/admin/contentEngine/contentDocuments/Gender_Independent_Children_final.pdf

www.riverstoneconsult.com

www.gendercreativekids.ca

www.fenwayhealth.org/transhealth

 

 

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Naturopathic Trans Health 101

** This is a handout from PTHC June 2013 – Please email me at thewrightnd@gmail.com with your experiences using natural medicines in transition! **

Naturopathic Medicine is: licensed in the state of Maine and many other states and Canadian provinces. We provide primary care using medical and alternative medicine. Naturopathic philosophy is based on the premise your body knows how to heal itself, and medicines from nature can help you overcome obstacles to health.

Naturopathic Doctors tools are: Botanical Medicine, Homeopathy, Nutrition, Lifestyle Counseling, Stress Management. Some ND’s also provide hands-on treatments (Chiropractic, Massage, CranioSacral Therapy,) Prescription medication (thyroid and female hormones, antibiotics, some Lyme medications, topical products),  Acupuncture, Traditional Chinese Medicine and IV Therapies.

FOUNDATIONAL NATUROPATHIC SUPPORT – FOR ALL GENDERS

  • Green tea 1-2 cups daily– anti-cancer, antioxidant, immune system support
  • Adrenal support – adrenals are a major source of hormone production when the gonads are taken out of the picture as is evidenced in menopause and andropause. B5, vit C, Siberian ginseng, Ashwaganda, Rhodiola, Licorice.
  • Probiotics – the digestive tract is the seat of our vitality and overall health.
  • Cruciferous vegetables, fresh ground flax seeds, green tea, sprouts all enhance excess (endogenous and environmental) estrogen elimination – important for every body!

GENERAL TRANSMALE SUPPORT

–       Support adrenals with herbs known to increase testosterone production.

–       Testosterone metabolizes into Dihydrotestosterone (DHT) – a biologically active metabolite of testosterone 30x more potent because of its increased affinity for T receptors. DHT is known to promote hair loss. This conversion can be modulated with SAW PALMETTO – stops the conversion of T –> DHT. PLus ZINC 10-30mg daily.

–       Nettle Tea – decreases bound T/ increases free (active) T, lymphatic support.

–       Reservage Keratin Booster  – prevention of baldness.

GENERAL TRANSWOMAN SUPPORT

–       Breast health! Reduce methylxanthine chemicals found in coffee, black tea, caffeine, and chocolate. At least monthly breast massage for lymphatic health using herbal oils.

–       Aerobic exercise.

–       Freshly ground flax seeds help the body eliminate excess estrogen – add to smoothies or yogurt with fresh fruit and maple syrup. Cancer prevention.

–       What is a phytoestrogen? Plant compounds that bind to estrogen receptors throughout the body.  Soy Isoflavones, Alfalfa (Medicago Sativa), Burdock (Arctium Lappa), Dong Quai (Angelica Sinensis), Evening Primrose, Pau D’arco (Tabebuia Avellanedae), Red Clover (Trifolium Pretense), Saw Palmetto (Serenoa Repens.)

–       Organic non-GMO soy 1-3 times week if tolerated.

–       HRT Companion by Vitanica** Great prevention product for long term use.

–       Reduce systemic inflammation for optimal long-term health – estrogen is protective for heart and bone health, but it can also be inflammatory. How to reduce inflammation? (CRP, homocysteine measures on bloodwork.)

SEXUAL TONIC HERB REVIEW– from The Male Herbal by James Green

Ashwaganda – WITHANIA SOMNIFERA Withanaloid chemicals resemble steroids biochemically. They are classified as an adaptogens to enhance libido and restore fertility and sexual potency.

PANAX QUINQUEFOLIUM – American ginseng.  PANAX GINSENG – Asian Ginseng. All ginsengs provide ginsenoside compounds that effect hormonal balance. Their overall chemistry supports strong sexual function through tonifying activity. They can also increase nitrous oxide levels, improving blood flow where needed. Panax ginseng is classically only used for men as it is too Yang for women’s health unless specifically prescribed.

Horny Goat Weed – EPIDEMIUM SAGITTATUM, EPIDEMIUM GRANDIFLORUM Exhibits moderate androgen-like effect.  Contains flavonoid ICARIIN which is a cGMP-specific PDE-5 inhibitor (like Cialis, Viagra and Levitra)

Muira Puama  – PTCHOPETALUM OLACOIDES Increases circulation, nervous system tonic, improves sexual weakness and diminished sexual desire in all genders.

Maca – LEPIDIUM MEYENII, L. PERUVIANUM ** Nutritive tonic for all genders. Simulates ovarian and erectile functions. **  – Could restore fertility for FTM’s who decide to want to conceive after testosterone use.

Gokshura  – TRIBULUS TERRESTRIS ** Prostate and urinary system tonic. Contains saponin, a steroidal plant chemical to improve libido with impotence. Improves sexual desire, fantasy life and sexual self-confidence. May prolong duration of intercourse before ejaculation. Increases endogenous LH levels. May stimulate endogenous testosterone production in men and women.  ** May also stimulate ovarian or testicular action in ways that are not desired. Use with caution.

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