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Transcript of HORMONAL MODULATION HORMONAL MODULATION AND ANTI-AGING MEDICINE Dr Odilza Vital M.D. Endocrinologist...
HORMONAL MODULATIONHORMONAL MODULATION
AND
ANTI-AGING MEDICINE
Dr Odilza Vital M.D.Endocrinologist
Geriatrician
LIFE EXPECTANCY LIFE EXPECTANCY REQUIRES HORMONAL REQUIRES HORMONAL
MODULATION THERAPYMODULATION THERAPY
WHY IS THAT?WHY IS THAT?
HORMONAL MODULATION =
HORMONAL BALANCE
o HORMONES ACT SYNERGISTICALYo ONE AFFECTS THE OTHERS FUNCTIONo PRODUCTIONo RESPONSE
o CELL RECEPTORS SENSITIVITY
WHAT TO DO IN HORMONAL MODULATION?
CORRECTION OF HORMONAL DEFICIENCY
CORRECTION OF HORMONAL OVERPRODUCTION
HORMONAL MODULATION
• AGING PROCESS IS ASSOCIATED WITH DECREASE OF MOST OF HORMONES LIKE: SEXUAL HORMONES, DHEA, HGH, T4? MELATONIN
• AGING PROCESS IS ASSOCIATED WITH INCREASE OF SOME HORMONES LIKE: INSULIN, CORTISOL, PTH
BENEFITS OF THE USE OF HGH IN ADULTS WITH DEFICIENCY
SUPPORT THE SHARP DECLINE IN THE ELDERLY
20 y
60 y
HGH
IT ACCELERATES THE HEALING OF SURGICAL WOUNDS
AN IMPORTANT ROLE IN THE IMMUNE SYSTEM
USED TO PREVENT AND REVERSE CACHEXIA IN HIV PATIENTS
HGHHGHo SECRETION IN PULSES SECRETION IN PULSES
o THE HGH IS A SINGLE CHAIN OF 191 THE HGH IS A SINGLE CHAIN OF 191 AMINO ACIDS 75%AMINO ACIDS 75%
o 22 KD PROTEIN, 20 KD22 KD PROTEIN, 20 KD
o NO GLYCOGENNO GLYCOGEN
o HAS TWO BRIDGES S = SHAS TWO BRIDGES S = S
HGH VALUES RANGE FROM UNDETECTABLE TO
40MCG/DL
THE SECRETION IS AFFECTED BY FOOD
DECREASED IN HYPERGLYCEMIA
INCREASED BY AMINO ACIDS AND HYPOGLYCEMIA
FACTORS THAT INCREASE SECRETION OF HGH
• SOMATOTROPIN: GH-RH(HYPOTHALAMUS)
• HYPOGLYCEMIA
• AMINO ACIDS
• ACUTE STRESS
FACTORS THAT REDUCE THE SECRETION OF HGH
• IGFs= SOMATOMEDIN C (NEGATIVE FEED-BACK)
• HYPERGLYCEMIA
• CHRONIC STRESS
• AGING PROCESS
HGH
• IGF SMALL MOLECULE PRODUCED BY MOST TISSUES, ESPECIALLY LIVER
• FREE : IGF
• LINKED TO PROTEIN: IGF-BP 1,2,3,4,5
HGH• THE IGF-1 MEDIATE THE
PHYSIOLOGICAL ACTIONS OF HGH
• THE IGF-BPs MODULATE THE ACTIONS OF IGFs IN THE TARGET CELLS
• IGF-BPs CHANGE BIOAVAILABILITY OF IGFs TO THE TISSUES
DIAGNOSIS HGH DEFICIENCY
IGFs: SECRETION REFLECTS THE OVERALL PRODUCTION IN THE LAST 24 HOURS
USED IN ADULTS WITH DEFICIENCY
DIAGNOSIS
IN PATHOLOGICAL DEFICIENCY - DYNAMIC TEST IN CHILDREN ONLY: CLONIDINE, INSULIN, L-DOPA, PROPANOLOL, GLUCAGON :
TEST : HGH
IN AGING PROCESS : TEST :IGFs
SYMPTOMS
LOSS OF PSYCHOLOGICAL WELL-BEING REDUCED VITALITY AND ENERGY DECREASED PHYSICAL ACTIVITY DEPRESSED MOOD EMOTIONAL LABILITY ANXIETY DISORDERS OF SEXUAL FUNCTION SOCIAL ISOLATION
SIGNSSIGNS
CHANGES IN BODY COMPOSITION REDUCTION OF LEAN BODY MASS INCREASED FAT INCREASED VISCERAL FAT REDUCTION OF BODY WATER REDUCTION OF BONE DENSITY
SIGNSSIGNS
DECREASED MUSCLE STRENGTH
DECREASED ABILITY TO EXERCISE
INCREASED BODY MASS INDEX (BMI)
INCREASED WAIST / HIP RATIO
ABNORMAL LIPID PROFILEABNORMAL LIPID PROFILE
INCREASE IN TOTAL CHOLESTEROL
INCREASED LDL
REDUCTION OF HDL
INCREASED RISK OF CVDINCREASED RISK OF CVD
• INCREASED PAI-1 (PLASMINOGEN ACTIVATION INHIBITOR)
• INCREASED OF FIBRINOGEN
CURRENT CONCEPTSCURRENT CONCEPTS
THE GROWTH HORMONE RESEARCH SOCIETY SUGGESTS:
INCREASING DOSES OF GH, NOT BASED ON WEIGHT
DOSESDOSES
PATIENTS SHOULD START TREATMENT
WITH LOW DOSES (0.15 TO 0.3 MG / DAY
OR 0.45 TO 0.9 IU / DAY); (RARELY EXCEEDS 1 MG / DAY: 3 IU /
DAY)
MONITORING THE DOSE GRADUALLY ACCORDING TO CLINICAL AND BIOCHEMICAL RESPONSES
WOMEN REQUIRE HIGHER DOSES, THE
ELDERLY REQUIRE LOWER DOSES
CONTRAINDICATIONS FOR USE OF HGH:
• NON COMPENSATED DIABETES MELLITUS
• HEART FAILURE
• SMOKING
• MALIGNANT TUMORS OF ANY ORIGIN
IN ACTIVITY
DIABETES;HYPERTENSION;CARDIOVASCULAR DISEASE; IATROGENIC ACROMEGALY;
CANCER???
SIDE EFFFECTS OF GH ABUSE
CLIMACTERIC SYNDROMECLIMACTERIC SYNDROME
PRE-MENOPAUSEPRE-MENOPAUSE HORMONAL CHANGES : LOSS OF CYCLE
2nd phase
CLINICAL MANIFESTATIONS
SIGNS AND SYMPTOMS
LABORATORY : LOW PROGESTERONE
MENOPAUSEMENOPAUSE
DEFINITION: AMENORRHEA HORMONAL CHANGES CLINICAL MANIFESTATIONS SIGNS AND SYMPTOMS LABORATORY
EFFECTS OF FEMALE EFFECTS OF FEMALE SEXUAL HORMONESSEXUAL HORMONES
• ESTROGENS ARE PRODUCED IN FOLICULAR CELL: STIMULATES CELL PROLIFERATION
• PROGESTERONE IS PRODUCED BY CORPUS LUTEUM: MATURE CELLS STIMULATED BY ESTROGENS
ENDOMETRIAL HYPERPLASIA EXACERBATION OF PMS MENSTRUAL IRREGULARITIES BREAST CANCER?
CLINICAL CHANGES OF CLINICAL CHANGES OF PROGESTERONE PROGESTERONE
DEFICIENCYDEFICIENCY
CHANGES OF CLINICAL CHANGES OF CLINICAL ESTROGEN DEFICIENCY ESTROGEN DEFICIENCY
• VASOMOTOR SYMPTOMS• BONE LOSS• ATHEROSCLEROSIS AND CVD• INSOMNIA• EMOTIONAL LABILITY• UROGENITAL ATROPHY• DEMENTIA
• DECREASED LIBIDO;
• REDUCTION OF MUSCLE MASS;
• BONE LOSS;
• DEPRESSION?
CLINICAL CHANGES OF TESTOSTERONE
DEFICIENCY
HORMONAL MODULATION AND HRT SHOUD BE DONE WITH
BIO – IDENTICAL HORMONESSAME CHEMICAL STRUTURE OF BODY PRODUCTION
ESTRADIOL
ESTRONE
ESTRIOL•TESTOSTERONE
PROGESTERONE
DIFFERENT SCHEMES FOR DIFFERENT SCHEMES FOR REPLACEMENT AT REPLACEMENT AT
DIFFERENT AGESDIFFERENT AGES AND AND DIFFERENT PURPOSESDIFFERENT PURPOSES
CYCLICAL SCHEDULECYCLICAL SCHEDULEPOST-MENOPAUSEPOST-MENOPAUSE
1º 27º
1º 27º
15º 27º
TESTOSTERONE
ESTROGEN
PROGESTERONE
M
DOSESDOSES
• ORAL 2mg estradiol
2mg estriol
27 to 28 days
• PROGESTERONE 300mg progesterone
12 to 14 days
ONGOING SCHEMESONGOING SCHEMES POS-MENOPAUSE
E2 + E3 ( 0,5 to 2 mg/day ) + P4 ( 50 to 200mg/day )27 d/m
Testosterone (0.25 to 1mg/day ) 27 d/m
COMPLETE CLINICAL EXAMINATION
LABORATORY:
COMPLETE BLOOD COUNT GLUCOSE LIPID PROFILE LIVER ENZYMES URIC ACID UREA CREATININE
EVALUATION FOR HORMONE REPLACEMENT
ESTRADIOL PROGESTERONE TESTOSTERONE PROLACTIN DHEA IGF1 CORTISOL TSH
EVALUATION IN FEMALE HORMONE REPLACEMENT
• PAP SMEAR
• MAMMOGRAM
• BREAST ULTRASOUND
• TRANSVAGINAL ULTRASOUND
• BONE DENSITOMETRY
EVALUATION IN FEMALE HORMONE REPLACEMENT
IN MY 20 Y EXPERIENCE: HORMONE REPLACEMENT
THERAPY WITH BIO-IDENTICAL HORMONES DOES NOT INDUCE
BREAST CANCER
CANCER
• GENETICS
• LIFESTYLE: SMOKING, SEDENTARY, STRESS, ALCOHOL, PSYCHOTROPIC DRUGS, INADEQUATE DIET
• IRRADIATION
• REPLACEMENT WITH SYNTHETIC HORMONES
- DECREASED PRODUCTION OF DECREASED PRODUCTION OF TESTOSTERONETESTOSTERONE
- REDUCTION OF LEYDIG CELLS- REDUCTION OF LEYDIG CELLS
ANDROPAUSEANDROPAUSE
- LOSS OF LIBIDO- ERECTILE DYSFUNCTION- NERVOUSNESS- DEPRESSION- IMPAIRMENT OF MEMORY- INABILITY TO CONCENTRATE- FATIGUE- INSOMNIA
- HOT FLASHES AND SWEATING
ANDROPAUSEANDROPAUSE
PATHOLOGY?
ASSOCIATED WITH DEGENERATIVE DISEASES: OSTEOPOROSIS,
ALZHEIMER'S, DIABETES, CANCER,
CARDIOVASCULAR DISEASE
ANDROPAUSEANDROPAUSE
FACTORS THAT INTERFERE: STRESSALCOHOL ABUSESURGERIES: VASECTOMYMEDICATIONSSMOKINGOBESITYOTHER DISEASES
ANDROPAUSEANDROPAUSE
ANDROPAUSEEVALUATION FOR MALE HORMONE
REPLACEMENT
CLINICAL: FULL CLINICAL EXAMINATION DIGITAL RECTAL EXAM ASSESSMENT OF EMOTIONAL STATE LIBIDO ASSESSMENT OF SEXUAL
PERFORMANCE
LABORATORY:• BLOOD CELLS COUNTING
• GLUCOSE • LIPID PROFILE • LIVER ENZYMES • URIC ACID • UREA • CREATININE
• PSA
ANDROPAUSEEVALUATION FOR MALE HORMONE
REPLACEMENT
ESTRADIOL TOTAL AND FREE TESTOSTERONE SHBG PROLACTIN DHEA IGF1 CORTISOL, TSH PROSTATE ULTRASOUND BONE DENSITOMETRY
ANDROPAUSEEVALUATION TO MALE
HORMONE REPLACEMENT
ANDROPAUSE
TREATMENT:
TESTOSTERONE REPLACEMENT
CORRECTION FACTORS THAT INTERFERE WITH THE ACTION OF THE HORMONE
LABORATORY CRITERIA FOR TESTOSTERONE REPLACEMENT IN MEN
Levels below 300 to 400 ng / dl;
ANDROPAUSETESTOSTERONE
TESTOSTERONE REPLECEMENT
INCREASE BONE MASS INCREASE MUSCLE MASS AND STRENGHT REVERSE INSOMNIA REDUCES DEPRESSION RECOVER FATIGUE STIMULATES IMMUNE SYSTEM PREVENT OSTEOPOROSIS
ANDROPAUSETESTOSTERONE
DOSES AND ADMINISTRATION
• TESTOSTERONE BIO - IDENTICAL PER CUTANEOUS: GEL 75 TO 200 MG /2ML DOSE: 1ML 2 X DAY
• TESTOSTERONE MICRONIZED SUB-LINGUAL TABLETS 50 TO 150 MG 2X OR 4X / DAY
• INTRA - MUSCULAR INJECTIONS 200 MG /ML ONCE A WEEK
DHEA DHEA DEHIDROEPIANDROSTERONEDEHIDROEPIANDROSTERONE
IN 1933 DHEA WAS ISOLATED IN THE URINE IN 1944 MUSON AND COL. ISOLATED THE
WHOLE DHEA-S IN 1960 EMILE BAULIEU SHOWED DHEA-S IS
PRODUCED IN ADRENAL GLANDS
DHEA
DHEA IS A STEROID HORMONE PRODUCED IN GREATER QUANTITY IN YOUNGER INDIVIDUALS
ESSENTIALLY ANABOLIC PROTEIN
PRECURSOR OF ALL STEROID HORMONES: CORTISOL, TESTOSTERONE, ESTRADIOL,
PROGESTERONE AND MINERALOCORTICOIDS
DHEA WHY SUPPLEMENT WITH DHEA? POPULATION AGING IS ASSOCIATED WITH
CHRONIC DEGENERATIVE DISEASES THE SHARP REDUCTION OF THIS STEROID
HORMONE IN OLD AGE THE MODULATING EFFECT OF DHEA IN HYPER
CORTISOL IN THE ELDERLY
DHEA
DHEA LEVELS START TO DECREASE AROUND 30 YEARS
DHEA DHEA LEVELS ARE 10 TO 25% LOWER IN
WOMEN;
LEVELS IN WOMEN DECREASE WITH AGE IN PARALLEL WITH MEN;
AFTER 80 YEARS OLD PRODUCTION IS JUST 25% OF THE YOUNG ADULT LEVELS;
DHEA
CONTROL OF THE LEVELS OF DHEA
DHEA AND DHEA-S ARE UNDER CONTROL OF ACTH
VARIATION AND CIRCADIAN RHYTHM ARE PARALLEL TO CORTISOL
DHEA BIOLOGICAL EFFECTS OF DHEA ON
CARDIOVASCULAR DISEASE
LOW LEVELS OF DHEA INCREASE THE INCIDENCE OF MYOCARDIAL INFARCTION AND ALSO THE FORMATION OF THROMBI
DHEA REDUCES THE FORMATION OF ATHEROMA PLAQUES
DHEA
THE IMMUNE SYSTEMTHE IMMUNE SYSTEM DHEA ENHANCES THE IMMUNE SYSTEM BOTH
IN ANIMALS AND HUMANS
REDUCTION OF INFECTIOUS AND DEGENERATIVE DISEASES
CLINICAL STUDIES YEN AND RASMUSSEN SHOWED THAT 50 MG OF DHEA FOR 20 WEEKS INCREASED MONOCYTES AND T LYMPHOCYTES (USED BEFORE VACCINES)
DHEA
EFFECTS ON THE NERVOUS SYSTEM AND EFFECTS ON THE NERVOUS SYSTEM AND HUMOR HUMOR
ADMINISTRATION OF DHEA PROMOTES ADMINISTRATION OF DHEA PROMOTES BENEFITS IN COGNITION AND MOOD BENEFITS IN COGNITION AND MOOD DISORDERSDISORDERS
DHEAADMINISTRATION ADMINISTRATION
o IN WOMEN: 25 TO 50 MG IN THE IN WOMEN: 25 TO 50 MG IN THE MORNING;MORNING;
o THE MEN: 50 TO 75 MG IN THE THE MEN: 50 TO 75 MG IN THE MORNING.MORNING.
DHEA
CONTRAINDICATIONSCONTRAINDICATIONS
o GYNECOLOGICAL CANCERS;GYNECOLOGICAL CANCERS;
o PROSTATE CANCER. PROSTATE CANCER.
CORTISOL
AFFECTED BY ACUTE AND CHRONIC STRESS
FOLLOW THE OPPOSITE COURSE OF DHEA
INCREASE IN AGING PROCESS IN ADRENOPAUSE: LOW ( ADDISON
SYNDROME)
CORTISOL
• PROTEIN CATABOLIC
• ATHEROGENIC
• DIABETOGENIC
• DECREASES IMMUNE SYSTEM
• HYPERTENSIVE
• INDUCES OBESITY
CORTISOL• HOW TO HANDLE HIGH CORTISOL?• STRESS MANAGEMENT• EXERCISES• DIET• DHEA SUPPLEMENTATION
- INTERFERES IN CORTISOL RECEPTOR
- COUNTER ACTS CATABOLIC EFFECTS
OF CORTISOL
INSULIN• INCREASED IN AGING PROCESS
• INDUCES HYPOGLICEMIA
• INSULINE RESISTANCE
• OBESITY
• HYPERTENTION
• CARDIOVASCULAR DISEASES
• CANCER
INSULIN• HOW TO HANDLE HIGH INSULIN ?
• LOW CARBOHYDRATE DIET
• WEIGHT LOSS
• EXERCISE
• STRESS MANAGEMENT
• METFORMIM
PTH
• INCREASE PROMOTING BONE LOSS• DUE TO VIT D DEFFICIENCY• INDOORS• NUTRITION• SEDENTARISM• ALCOHOL• DECREASE OF ANABOLIC HORMONES• OTHER DISEASES
WHO TO HANDLE HIGH PTH?
• CALCIUM SUPPLEMENTATION
• VIT D
• DIET
• EXERCISES
• ANABOLIC HORMONES TO
• CALCITONIN
MELATONIN
KEEPS CIRCADIAN RHYTHM PATTERN OF SLEEP- WAKEFULNESS HIGHLY LIPOPHILIC AND LOW
MOLECULAR WEIGHT ANTIOXIDANT RADICAL (OH)
HORMONAL MODULATIONHORMONAL MODULATION
INCENTIVES FOR THE PRODUCTIONINCENTIVES FOR THE PRODUCTION
1) PHOTORECEPTORS AND OSCILLATORS (LIGHT)
2) NEUROENDOCRINE AND HORMONAL EFFECTORS
HORMONAL MODULATIONHORMONAL MODULATION
MELATONIN IN THE PROCESS OF MELATONIN IN THE PROCESS OF AGING AGING
IN AGING THERE IS A DECLINE IN BODILY FUNCTIONS
REDUCTION OF ADAPTATION PROCESS REDUCTION IN CAPACITY TO RESTORE
HOMEOSTASIS
HORMONAL MODULATIONHORMONAL MODULATION
STATEMENT OF REPLACEMENT OF STATEMENT OF REPLACEMENT OF MELATONIN MELATONIN
INSOMNIA ....... DIFFICULTY FALLING ASLEEP IN JAT LAG
ON THE HORMONAL MODULATION
HORMONAL MODULATIONHORMONAL MODULATION
DOSES AND ADMINISTRATION DOSES AND ADMINISTRATION
INDIVIDUALS OVER 45 DOSES OF 0.5 MG TO 5 MG SUBLINGUAL, TIME RELEASE
INDIVIDUALS OVER 65 YEARS AT 5 TO 10 MG AT BEDTIME
HORMONAL MODULATIONHORMONAL MODULATION BIBLIOGRAPHY
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