Schedule: BHRT Part II


8:00 – 10:00 a.m.

Section 1

Making sense out of the many HRT studies, the critiques, and the rebuttals.

A commentary as to why estrogen is not harmful in most circumstances.

A critique of the WHI trial and a meta-analysis demonstrating opposite conclusions of the WHI.  Putting the pieces together will make you an expert on all ifs, ands, or buts.  It is the knowledge and command of this scientific literature (that your colleagues will never know) that makes you the expert.  Estrogen replacement is so very complex and a full understanding of all the studies and data is necessary to prescribe and defend HRT.  Having a command of the literature will enable you to explain when estrogen is indicated, which one, and why, the safety of estradiol and potential harm of CEE, the harm of not utilizing estrogen and estrogen depravation, and the harm of assuming and extrapolating the harm of CEE to E2.

10:00 – 10:15 a.m. – Break

 10:15 – 12:15 p.m.

Section 2

Review the hormone paradox and the myths and controversies of the oncogenic effects of hormones as to whether they are causative or protective against cancer.  A literature review of HGH & testosterone in men will show benefits of protecting against cancer as opposed to the incorrect common opinion of testosterone causing cancer.  As for women, estrogen and progesterone are also accused of causing cancer in spite of the literature support for the contrary.  Studies will be reviewed that evaluate whether they cause cancer or protect against cancer and how optimization protects against cancer. Well review all the literature that proves MPA ≠ OMP. Finally, testosterone is second to progesterone in protecting against breast cancer.  Can estrogen be safely used in cancer survivors?   Over 40 studies prove it can and should be used.  Not replacing hormones increases morbidity and mortality which proves the oncologic world doesn’t know their own literature. What level of progesterone is best for breast cancer protection and what level of testosterone is most appropriate?  All hormones have been demonstrated to protect against cancer and it is the loss of hormones that increases that risk.  Only one hormone increases cancer risk and that is a drug and not a hormone.  It is amazing what medical experts do not know or understand about hormones and will make incorrect assumptions to avoid HRT whereas doing so increases morbidity and mortality.  They cause harm by not utilizing HRT but they don’t understand that they don’t know.

12:15 – 1:15 p.m.  Lunch Break

1:15 – 2:15 p.m.

Section 2 Continued

2:15 – 3:15 p.m.

Section 3

Interesting articles and facts on HRT:  A literature review of what the experts don’t tell you about risks and benefits of HRT.  Don’t ignore the world’s literature-the WHI does not negate all prior studies.  Become conversant in all the other studies in opposition to WHI.  Don’t assume or extrapolate the harm of CEE/MPA to E2/P4. It is amazing what medical experts do not know or understand about hormones and will make incorrect assumptions to avoid HRT whereas doing so increases morbidity and mortality.  They cause harm by not utilizing HRT, but they don’t realize that they truly don’t know or understand hormones. Literature review of HRT, new and most recent that was not covered in Part I.  Everyday there is something new and this is the venue that keeps us up to date.

 3:15 – 3:30 p.m. Break

 3:30 – 5:30 p.m.

Section 4

Testosterone’s risks and benefits from JCEM and NEJM meta-analysis, new guidelines, and alternative methods of prescribing testosterone for men and women.  Learn all the alternative methods of raising testosterone levels besides transdermal creams. When to avoid transdermal, when to avoid IM, when to use HCG vs. clomiphene, and when to use oral testosterone?  Which are the cheapest, which are the best, and which ones should be avoided.  Basically, everything you could possibly ever need to know about optimizing testosterone.  A literature review (EBM) will support the many alternative methods to raising testosterone.

 5:30 – 6:00 p.m.

Question and Answer



8:00 – 10:00 a.m.

Section 5

A literature review of the battle and controversy over oral vs. transdermal estrogen, which type, how, when, why, and how the ESTHER study guides us.  Knowledge is power when it comes to estrogen administration, the risks and benefits of both.  Review of HRT and clotting and how to evaluate the risk and decrease the risk.  And just what is that relative risk anyway that everyone always alludes to?  Please don’t tell me the risk of clotting-rather give me the numbers. The importance of SHBG in prescribing E2 as it pertains to CA and CAD.  Thrombophilia work-up, test panels with case examples of + labs and how patients should be treated.  Develop a treatment plan that encompasses the foregoing but that requires in-depth knowledge of the vast literature and relative risks.  Finally, OK, what to do when someone develops a clot while on HRT and has a negative work-up, or that has had a prior clot, even if provoked.  Review the harm of transdermal estradiol and the null set.

10:00 – 10:15 Break

10:15 – 11:15 a.m.

Section 6

Thyroid update and cardiovascular review articles of the importance of T3 optimization for cardiac disease prevention and lipid improvements.  Thyroid replacement does not cause osteoporosis- an extensive literature review.  So, you think you know thyroid?  More cases, labs, and articles.  More literature support for optimizing T3 in spite of AACE recommendations to the contrary.  U.S. Pharmacopeia report on desiccated thyroid. Stock up now because desiccated thyroid is going away thanks to big Pharma.

 11:15 – 12:15 p.m.

Section 7

Preventive cardiology or how to avoid CABG, stents, and MI when statins don’t work:  A literature review of hormones, toxic blood markers, prediction of CVD, and treatment without using common CVD drugs that don’t always work. Preferential use of hormones,  EFA, supplements, life style changes, and diet to prevent CVD and how to monitor effects via the NMR panel.  The expert recommendations are to no longer monitory cholesterol levels, as LDL may not predict CAD, but HDL does.  Then what should we monitor and what is predictive?  LDL particle number and small LDL particle numbers.  We’ll look at the cases and outcomes.

12:15 – 1:15 p.m.  Lunch Break

 1:15 – 2:15 p.m.

Section 8

Cardiology cases:  How to stop progression of the disease.  Management when statins don’t lower LDL-P and small LDL-P.  That which the cardiologists should use but don’t.  Putting all the pieces together using the best preventive strategies to avoid succumbing to that which kills 90% of us.  Use of NMR panel, LDL-P’s, apo-B, non-HDL cholesterol, cardiac markers, insulin, and inflammatory cytokines.  Does lowering cholesterol by means other than statins provide the same benefits? Lowering LDL is just a small piece of the pie. What can be/should be offered in addition to statins?

2:15 – 3:15 p.m.

Section 9

Complex cases, labs, adjustments, fun and interesting cases, and lots of WWND (What Would Neal Do) cases. Lab updates that utilize the new reagents with comparisons with the old labs and reagents.  Conversion to the new reference ranges.

 3:15 – 3:30 p.m. Break

 3:30 – 5:30 p.m.

Section 10

Questions and Answer case studies

5:30 – 6:00 pm

Questions and Answer with Group


8:00 – 10:00 a.m.

Section 11

Polycystic Ovary Syndrome:  Diagnosis and treatment of the most common pre-menopausal endocrinopathy that everyone fails to diagnosis.  Never miss it again because if you don’t specifically look for it, then you won’t find it.  PCOS increases risk of CAD, DM, breast cancer, & uterine cancer which further emphasizes the need for early detection and treatment.  Assume that everyone has PCOS until you prove that they don’t.  Unfortunately the most common treatments for PCOS don’t work. There is only one treatment that will work and that is the one that no one knows or appreciates.   We’ll review the before and after labs demonstrating improvement.  Quality of life and fertility relies on this one treatment.

 10:00 – 10:15 a.m. Break

 10:15 – 11:15 a.m.

Section 12

Osteoporosis:  Diagnosis and treatment using DEXA scan and NTX urine metabolites to monitor bone loss.  Treatment of osteoporosis beyond bisphosphonates: HRT, Vitamin D, Vitamin K, strontium, ipraflavone.  Measuring and monitoring improvements in NTX- a lab review.

Estrogen metabolites- do they or do they not predict breast cancer and should we waste money on testing.  Lab review of 2 OH-E1 vs. 16α OH-E1.  DIM? Do you really need it and does it really work?  I didn’t know that estradiol caused cancer, so why use DIM?  A look at EBM and studies from JNCI that refute confabulation.

 11:15 – 12:15 a.m.

Section 13

Estrogen and Progesterone in men:  What the literature supports in so far as harmful effects of low vs. high levels.  Use of aromatase inhibitors in men or how to increase the risk of CAD, CVD, dementia, osteoporosis, and ED by blocking estrogen.  The harm of prescribing progesterone in men unless you want to increase the risk of MI or ED and inflammation.  Use EBM to guide your therapy, not what someone theorizes.

 Section 14

Review of the chronic fatigue syndrome: Treatment by optimizing T3.  The use of cortisol for symptomatic relief of CFS:  A literature review.  Cortisol:  Prescribing, monitoring, adjusting, and use of ACTH stimulation test.  Addison’s disease vs. adrenal insufficiency vs. adrenal suppression and the use of ACTH stimulation test for diagnosis and tapering.  Just what is adrenal fatigue and how to diagnosis via saliva testing even when the serum cortisol level is normal?

12:15 p.m. Adjourn