Dr. Gordon’s Comments: I find DHEA is useful and I have taken it for years, 50 mg a day. We always need to learn more about it to avoid side effects and achieve the optimal dose. One study showed cancer patients survive far longer if they receive DHEA and oral melatonin. 

Garry F. Gordon MD,DO,MD(H)
President, Gordon Research Institute
www.gordonresearch.com

Link: http://articles.mercola.com/sites/articles/archive/2011/03/19/the-most-common-mistakes-in-bioidentical-hormone-replacement.aspx

Excerpt:

Supplementing With THIS Hormone Can Lead to Tumors and Insomnia 
Posted By Dr. Mercola | March 19 2011 

Before I begin this article I want to state very clearly that hormones are not my primary specialty. I have used them clinically but I found the science quite controversial, so this is a summary as I best understand it.

If you are a clinician with considerable experience in this area I invite you to present your views to update the information on DHEA.

There will always be controversies around Bioidentical Hormone Replacement Therapy but the attached review article at the bottom helps to bring out some very useful information. I particularly appreciate this since it strongly encourages the use of Progesterone Creams either from over the counter or from compounding pharmacies. I strongly favor that approach and feel that there is useful information here about the limitations of various approaches to hormone testing. 

All of that being said, we still need to understand Estrogen Receptor Sites and why I fear the estrogen mimics, which are not discussed in most discussions regarding BHRT. Also the ongoing need to balance these chemicals out with I3C, DIM, glucosinolates, as in MACA, and the wonderful all natural approach we have with PUERARIA (H.R.T. Plus) acting at the molecular level, as a selective estrogen receptor modulator S.E.R.M. beta, which then leads into advanced concepts to protect breasts, bones, brains etc. This approach alone, however, will never provide total support, as topical progesterone will always be needed. 

Read Dr John Lee’s books but today we must add additional information if we are to achieve our maximum intended useful lifespan. Today we hear about the need for supplementation of iodine to maintain healthy breasts and thyroid etc. Some advocate aggressive supplementation with iodine and if we realize that some toxins like fluorine, bromine etc are blocking iodine the need for aggressive iodine supplementation makes more sense. Dramatic reversals of Fibrocystic breast disease and even cases of breast cancer responding to systemic and in some cases topical Iodine treatment directly to the breasts are being reported world-wide today. 

Why do we seem to need such high intakes of Iodine? Let’s look at toxins and their effect on hormone function. 

We have seen documented improvement in growth hormone levels in chelated patients where pituitary function was restored, as mercury levels we lowered. We have seen thyroid function return, as Lead levels were lowered with chelation. There are hundreds of toxins in all of us today and these toxins makes it necessary to use far higher levels of many nutrients including Iodine, Magnesium, Selenium, Vitamin C etc than are usually recommended in nutritional texts to achieve OPTIMAL health in our patients today. 

This is the link to a well written analysis of an OPRAH show on BHRT that may help you in counseling your patients who will easily get confused about all this.

Sincerely,

Garry F. Gordon MD,DO,MD(H)
President, Gordon Research Institute
www.gordonresearch.com

Link: http://www.virginiahopkinstestkits.com/bioidenticalhormonebreastcancer.html

Excerpt:

Dear Oprah,
Your show on bioidentical hormones will surely help millions of women lead healthier lives, and inspire thousands of doctors to learn more about prescribing them. Once again you’ve shown amazing courage in speaking out on a touchy but important subject. Bioidentical hormones are on Big Pharma’s blacklist, and we know how many millions of advertising dollars they bring to television. I also applaud your choice of Dr. Christiane Northrup as an intelligent, rational, informed voice in bioidentical hormone replacement. She has been an articulate spokesperson for bioidenticals for many years.

Dr. G’s comments:

Why are our tissues so calcified when we age? What has vitamin D got to do with it???

I have lectured on this for over 35 years now and we all suffer a tendency toward secondary hyperparathyroidism. This is because our SAD diet supplies on average 1400 mg of phosphorus and only 800 mg of calcium. This stresses our endocrine system and we get secondary hyperparathyroidism, as a result that leads to weak bones and hard calcified arteries. See text and CALCIPHYLAXIS by Hans Selye published by Univ of Chicago Press.

What this article shows you is that higher levels of vitamin D clearly help overcome this serious but nearly epidemic Endocrine condition. Vitamin D then can lead to less bone pathology and if bones are better mineralized, less of the calcium will wind up in blood vessels and you can achieve better blood vessel elasticity.

Garry F. Gordon MD,DO,MD(H)
President, Gordon Research Institute
www.gordonresearch.com

Link: http://www.nhiondemand.com/hsjarticle.aspx?id=987&utm_source=NHI+OnDemand+Newsletter+List&utm_campaign=49b87e5f60-HSJ_Jan18_2011&utm_medium=email

Excerpt:

“Hyperthyroidism” is when the thyroid gland is overactive instead of underactive. It secretes too much thyroid hormone. In this case, more of a good thing is definitely not better. Excess thyroid hormone can cause rapid heartbeat. Body temperature is elevated. The hyperthyroid individual may experience extreme weight loss, in spite of a huge appetite, because they burn up calories too fast. Hyperthyroidism can make a person nervous, emotionally unstable, and unable to sleep.

Bisphenol A is found in most plastic food containers today. Not only is it found in plastic containers, but also in the lining of most cans. BPA is essentially a synthetic estrogen that enters the body when one consumes food or beverages out of plastic or plastic-lined containers. This is not only harmful to the male reproductive system, but has been found to also stimulate breast cancer growth in women. Knowing this, it should be of no surprise that the sperm count of the average Western male is on a steady decline as many males are becoming more and more feminine. What most people don’t know is that Bisphenol A was actually considered as the form of estrogen to be used in estrogen pills going back to the 1930s.

Everyone should detox regularly and continually on a daily basis.  Everyone needs my F.I.G.H.T. program! It is not just the Lead and Mercury; it is toxins like Bisphenol A but most people have no idea how they get these toxins!  Bisphenol A is what made all the lean brown Agouti mice turn yellow and become obese and diabetic for all time in Randy Jirtle’s  research (Duke) covered by PBS (Nova) as “Ghost In Your Genes” that causes the epigenetic change overnight.

There is defective methylation to handle all toxins, which is why BIOEN’R-G’Y C comes with Trimethylglycine and Methylsulfonomethane, as a true vitamin C delivery system to help fight this Bisphenol A toxin induced need for more methylation support. So get sublingual Beyond B12 and have methyl cobalamin delivered sublingually instead of having to give B12 IM, as oral B12 is about 1-2 % absorbed and we must help our loved ones and patients F.I.G.H.T. back.

Everyone has 10,000 times more phthalates today than was present just 10 years ago. Watch this video and then watch it again and learn my F.I.G.H.T. program, as you and your patients need to feel as good as I do and I know how toxic you are unless you are using my power drink and zeolite!

Watch this YouTube Video and make your OWN decision…
Bisphenol A (BPA) Contaminating Our Food
http://www.youtube.com/watch?v=N3_cYZKksvI&feature=player_embedded

Garry F. Gordon MD,DO,MD(H)
President, Gordon Research Institute
www.gordonresearch.com

November 3, 2009 (Chicago, Illinois) — The practice of administering short-term hormone therapy to men with low-risk prostate cancer who undergo radiation therapy is not necessary.

The treatment does not improve survival in these men, according to the “greatly anticipated results” of a new study presented here during the plenary session of the American Society for Radiation Oncology (ASTRO) 51st Annual Meeting.

This definitively establishes no benefit in men with low-risk disease.
“This is a landmark, practice-changing study,” said Matthew Smith, MD, who acted as a study discussant. Dr. Smith, who is from Harvard Medical School in Boston, Massachusetts, suggested that the broad use and uncertain benefits of short-term androgen deprivation fueled the anticipation about results.

 
Dr. Christopher U. Jones (Courtesy of ASTRO)
“This definitively establishes no benefit in men with low-risk disease,” he continued. “Unquestionably, this is a setting where less is more,” he said, after detailing the therapy’s adverse effects.

However, short-term hormone therapy benefited men undergoing radiation for intermediate-risk prostate cancer, said Christopher U. Jones, MD, who presented the results on behalf of the Radiation Therapy Oncology Group (RTOG) 94-08 and is from Radiological Associates of Sacramento in California.

“The study is the first compelling evidence of survival benefit in men with intermediate risk,” agreed Dr. Smith.

Despite these enthusiasms, both Dr. Jones and Dr. Smith explained that the new study is not the final word on short-term hormone therapy in intermediate-risk patients.

The radiation doses and techniques used in the current study, which started enrolling patients in 1994, are now dated, Dr. Jones said at a meeting press conference.

The study is the first compelling evidence of survival benefit in men with intermediate risk.
“In current practice, these intermediate-risk patients get a higher dose of radiation,” he said, suggesting that modern radiation might eliminate the need for androgen deprivation in these patients.

Another RTOG study (08-15) is underway to evaluate more modern high-dose radiation methods and hormone therapy in these intermediate-risk patients, both he and Dr. Smith pointed out.

Comparable Outcomes in Low-Risk Patients

The landmark study presented at the meeting, with 1979 participants, is the largest prostate cancer study to date, and is still ongoing, Dr. Jones noted.

Originally, the study was designed to evaluate the treatment of men with low-risk prostate cancer only, but the definition of low risk evolved as the study got underway, Dr. Jones explained

“When we started this study in 1994, all of these patients were considered low risk,” he said. As prostate-specific antigen (PSA) testing matured as a tool, it became clear that the study group could be further defined. “With the advent of PSA screening, we were able to further refine low- and intermediate-risk patients,” he said.

Study participants were randomized to short-term androgen-deprivation therapy (2 months before and 2 months during radiation) plus radiation, or radiation therapy alone.

About a third of the patients were low risk (n = 685), which was defined as a Gleason score of 6 or less with a PSA level of 10 ng/mL or less and a tumor stage of T2a or less.

About one half of the patients were intermediate risk (n = 1068), which was defined as a Gleason score of 7, a Gleason score of 6 or less and a PSA of 10 to 20 ng/mL, or a Gleason score of 6 or less and stage T2b disease.

The remaining patients were high risk (n = 226), with Gleason scores of 8 to 10.

At 8 years, the overall and disease-specific survival rates were comparable in low-risk patients treated with hormones and radiation therapy than in those treated with radiation therapy alone.

“The combination of these 2 survival indicators suggests no need for hormone therapy in low-risk patients,” Dr. Jones remarked.

Specifically, the overall survival rate at 8 years for patients treated with hormones and radiation therapy was 76%, compared with 73% for those treated with radiation therapy alone (hazard ratio [HR], 1.07; 95% confidence interval [CI], 0.83 – 1.39).

Low-risk patients do not need to undergo the toxicities of hormone therapy.
The disease-specific survival rate at 8 years for patients treated with hormones and radiation therapy was 98%, compared with 99% for those treated with radiation therapy alone (HR, 1.07; 95% CI, 0.83 – 1.39).

“Low-risk patients do not need to undergo the toxicities of hormone therapy,” said Dr. Jones at a press conference, referring to hot flashes, loss of sexual function, liver toxicities, and other adverse effects.

Effective Therapy for Intermediate-Risk Patients

In the study, total androgen suppression was achieved with flutamide 250 mg twice daily and either goserelin 3.6 mg once a month or leuprolide 7.5 mg once a month.

The hormone therapy apparently benefited men with intermediate-risk disease.

At 8 years, the overall and disease-specific survival rates were favorable in intermediate-risk patients treated with hormones and radiation therapy, compared with those treated with radiation therapy alone.

Specifically, the overall survival rate at 8 years for patients treated with hormones and radiation therapy was 72%, compared with 66% for those treated with radiation therapy alone (HR, 1.23; 95% CI, 1.02 – 1.49).

“Among the intermediate-risk patients, there was a 23% greater chance of dying each year for patients treated with radiation alone,” said Dr. Jones.

The disease-specific survival rate at 8 years for patients treated with hormones and radiation therapy was 98%, compared with 92% for those treated with radiation therapy alone (HR, 2.44; 95% CI, 1.47 – 4.04). “Patients treated with radiation alone were nearly 2 and a half times more likely to die from prostate cancer,” said Dr. Jones.

The outcomes for the patients with high-risk disease were not as impressive as those for intermediate-risk disease, which probably reflects the fact that high-risk disease requires longer-term hormone therapy, Dr. Smith told the plenary audience.

Meaningful Results

“We wanted to know who needed short-term hormone therapy,” said incoming ASTRO president Anthony Zietman, MD, about the original impetus behind the new study.

Although Dr. Jones’s presentation emphasized 8-year data, the median follow-up time in the trial is a little more than 9 years, which approaches the length of time needed for meaningful results in prostate cancer, Dr. Zietman, who is from Harvard Medical School in Boston, told Medscape Oncology in an earlier interview. “Results need to be at least 10 years out to be meaningful.”

He explained that the use of short-term androgen deprivation is not as widespread now as it has been in the past.

The use of short-term hormone therapy, especially leuprolide (Lupron), in low-risk prostate cancer patients undergoing radiation therapy jumped from about 10% of all such patients to about 50% during the mid- to late-1990s. “This almost became the norm with urologists,” said Dr. Zietman.

The use tailed off somewhat when financial incentives to use the therapy ended, he said.

Although leuprolide use in low-risk patients was partly fueled by financial considerations, it was also probably spurred on by clinicians not sticking to evidence-based medicine, Dr. Zietman explained. “Clinicians took the evidence too far,” he noted, referring to studies such as RTOG 86-10, in which the short-term therapy provided a number of benefits to men with locally advanced prostate cancer.

The new results provide some direction for clinicians, suggested Dr. Jones. “The study provides strong scientific evidence that shows us when to deliver hormone therapy with radiation in patients with localized prostate cancer,” he said in a press statement.

American Society for Radiation Oncology (ASTRO) 51st Annual Meeting: Latebreaker. Presented November 2, 2009.

However, as first author Dr. Peggy M. Cawthon noted in an email to Reuters Health, the causal association between low bioavailable testosterone and frailty “has yet to be proven in a randomized clinical trial. Thus, we suggest that the next step is to include assessment of frailty status in clinical trials of testosterone supplementation.”

Dr. Cawthon from California Pacific Medical Center, San Francisco and colleagues note in their report that as men age, the prevalence of frailty in men increases and the levels of androgens fall. Yet, “little is known about the relation between these factors.”

To investigate, they assessed cross-sectional and longitudinal associations between frailty and sex hormones (estradiol, bioavailable estradiol, testosterone, bioavailable testosterone, and sex hormone binding globulin) in 1469 men who were at least 65 years old at baseline. The men were participants in the multicenter US observational Osteoporotic Fractures in Men (MrOS) study.

Frailty was assessed in all 1469 men at baseline and in 1245 men 4.1 years later using a standard scale. “For frailty assessment, we measured five areas: weakness (lowest 20% in grip strength), slowness (slow 20% in walking speed), activity level (lowest 20% by questionnaire), shrinking/sarcopenia (worst lean body mass for height and percent fat), and exhaustion (questionnaire),” Dr. Cawthon explained.

Men with three or more of these five factors were considered frail; those who met the criteria in one or two of these factors were considered intermediate, and men who did not meet the criteria for any of the factors were considered robust.

 At baseline, 682 men (46.4%) were classified as robust, 675 (46.0%) as intermediate and 112 (7.6%) as frail.

Roughly 11% of men in the lowest quartile of bioavailable testosterone (<165 ng/dL) were frail at the baseline exam, compared with 5.4% in the highest quartile (241.9 ng/dL or greater).

In multivariate cross-sectional analyses, men in the lowest quartile of bioavailable testosterone had a 1.39-fold increased likelihood of greater frailty status compared to men in the highest quartile, the report indicates.

“This association persisted even after we took into account a variety of factors, including age and co-existing medical conditions,” Dr. Cawthon said.

“There was also the suggestion of an association between bioavailable testosterone levels and frailty status measured about 4 years later,” she said, “suggesting that the association between bioavailable testosterone and frailty persisted over time.”

More specifically, at the second assessment, 437 men (35.1%) were classified as robust, 517 (41.5%) were intermediate, 131 (10.5%) were frail, and 160 (12.9%) had died.

In age-adjusted longitudinal analyses, men in the lowest versus the highest quartile of bioavailable testosterone had a 1.51-fold increased likelihood of greater frailty status 4.1 years after baseline. However, this association was largely attenuated (OR, 1.32) on multivariate analysis.

The researchers did not see an association between frailty and any of the other hormones that they measured.

The mechanisms by which bioavailable testosterone may influence frailty status are not well known, Dr. Cawthon and colleagues note in their report. Declining levels of testosterone, they say, may contribute to muscle shrinking and weakness as well as a proinflammatory state, which has been linked to poor physical performance and frailty.

“Further research into the biological underpinnings of the bioavailable testosterone and frailty relationship is needed,” the study team concludes.

J Clin Endocrinol Metab. 2009;94:3806-3815.