This course is the second part of the NPI BHRT lecture series, utilizing didactic as well as a case-based approach designed to help physicians and other health care providers successfully and knowledgeably treat BHRT management patients. The focus on case-centered learning and group discussions has been validated at top educational institutions. Participation in the part 1 course is highly recommended before participating in part II.
Answers to seemingly straightforward questions will be covered, and the material presented in depth:
By the end of this education activity, participants should be better able to:
- Appreciate how hormonal optimization, done meticulously on a 1:1 and constant feedback method, is ethically and financially justified – for both patient and physician.
- Master the medical literature undergirding each hormone examined and discuss the rationale for optimal levels.
- Review of synthetic vs. bioidentical hormones.
- Explain to patients and colleagues the difference between “normal levels” and “optimal levels” of hormones and review the benefits or detriments as demonstrated by current evidence-based medical studies.
- Easily and intuitively know (based on medical literature, clinical history, and laboratory examination) how to set about balancing all of a patient’s hormones, not just one or two.
- Examine therapeutic management of andropause based on studies reported in medical journals.
- Review and identify types, doses, and methods for administering testosterone to men and women.
- Discuss how to prescribe testosterone for men and women, including complications, precautions, potential side effects, and monitoring.
- Review the utilization of Finasteride, Dutasteride, and Anastrozole as they pertain to the management of side effects with testosterone administration.
- Master some of the “minor characters” in the hormonal universe: Melatonin, Vitamin D, and the trifecta of Adrenal hormones: Cortisol, Aldosterone, and DHEA.
- Examine the correct dosing of adrenal hormones with an emphasis on maximizing adrenal function and its importance.
- Master strategies for the effective uses of DHEA and pregnenolone including correct dosing and monitoring.
- Learn how to talk to your female patients about the perceived risks of hormone therapy and the flawed WHI Trials on estrogen treatment.
- Review in some detail the use of progesterone and estradiol together, and why they are both important.
- Discuss the latest literature and questions and answers that demonstrate the beneficial effects of hormones including improved health and healing and a better quality of life.
- Explain current concepts of thyroid replacement and compare and contrast different options available for thyroid replacement.
- Recognize various methods of hormonal interventions including oral and transdermal hormone therapy.
- Review FDA-approved “BHRT” strategies available by prescription at the patient’s pharmacy and in your own PDR.
- Implement best clinical practices in diagnosing, prescribing, monitoring, and adjusting of BHRT for improved health and quality of life.
- Accurately diagnose cancer and implement appropriate screenings for cancer.
- Review how to how to educate your patients about BHRT.
- Analyze and review treatment protocols in case management for both simple and complex cases as it pertains to BHRT.
- Review writing prescriptions for compounded hormones to pharmacies, as well as FDA approved dosing forms, and recognize how different formulations can affect absorption, efficacy, and side effects.
- Practice hands-on kinesthetic learning with samples of dosing devices.
- Correct any insufficient or inappropriately prescribed hormone therapy to conform to evidence-based scientific standards.
- Implement current strategies into practice to improve the level of care and patient compliance in the treatment of adult hormone deficiencies.
- Assure that prescribed hormones (bio-identical compounded agents or otherwise) meet health care standards based on attaining adequate serum levels and symptom improvement.
- Recognize the ambiguity with some of the benefits/challenges with conjugated equine estrogens and bio-identical estrogen.
- Discuss the dual options of compounded vs. FDA approved and regulated hormones, appropriate/inappropriate use of compounded hormones, and conditions that cannot be addressed without compounded hormones.
- Discuss that biologic endpoints (lab tests) are the only reliable assessments to assure that the hormone prescribed is as efficacious as pharmaceutical bioidenticals utilized in the literature.
- Apply current prescribing strategies for maintaining adequate hormone levels, which serum levels to follow and which tests not to use (saliva).
- Analyze new treatment protocols to best diagnose, prescribe, monitor, and adjust BHRT for improved function and quality of life.
- Participate in class learning exercises with a review of labs of participants and their patients (anonymized).
- Strategize your future BHRT treatment.
- Learn what your superpower is as a physician or health care provider leader and assess your Unique Talent.
2025 Course Accreditation
The Texas Academy of Family Physicians designates this live activity for a maximum of 16.00 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Application for CME credit has been filed with the American Academy of Family Physicians. Determination of credit is pending.
Learn more about our accreditation.
7:30 – 8 a.m.
- Registration and breakfast
Day One
SECTION 1
8 – 10 a.m. – 2 CME Credits
Medical Ethics: Avoiding Burnout, Medical Conditions, Mental Health Issues, and Financial Stresses for the Health Care Provider and their Patients
- Identify issues within the health care system and discuss why so many people are aging and dying before their time.
- Discuss how physicians, other health care providers, and their patients are “living lives of quiet desperation” and address the medical ethics of boundaries and limits.
- Discuss how physicians and other health care providers can protect themselves from despair and suicidal risk in today’s medical practice climate.
- Discuss how hormones can be a natural way to begin to address obesity, cancers, cardiovascular and metabolic diseases, and mental health conditions.
- Identify stresses that are making patients sicker, more depressed, suicidal, and even unemployed.
10 – 10:15 a.m. – Break
SECTION 2
10:15 a.m. – 12 p.m. – 1.75 CME Credits
Review of Hormone Replacement Therapy
- Review concepts of the benefits of testosterone, estrogen, thyroid, and adrenal hormones including synthetic versions of each.
- Discuss how the appropriate and judicious use of hormones can significantly contribute to the prevention of the explosive epidemic of cardiovascular disease and diabetes.
- Emphasize that normal levels are not necessarily optimal levels.
- Discuss that simply replacing hormones to normal levels is typically not what is best for health and well-being and the goal is to reach optimal levels.
- Complete a review of the hormones to consider, use, and treat with, as well as practical step-by-step instructions on how to dose them.
- Review the benefits of testosterone, estrogen, thyroid, and adrenal hormones including synthetic versions.
- Discuss the health benefits and quality of life benefits from use of these hormones.
- Review the Women’s Health Initiative’s recommendations and address these with your patients.
- Review the medical literature on clots and stroke risk for patients on testosterone and establish informed consent and clarity for the provider and the patient.
- Discuss the causes of low testosterone.
- Discuss the physiological flux of testosterone and its relevance to replacement HRT.
- Discuss the treatment of potential side effects and monitoring.
- Review the use of DHT, Estradiol, Finasteride, Anastrozole, 5α-reductase inhibitors, and Aromatase inhibitors.
- Review how simply replacing hormones to normal levels may not improve patient health or relieve symptoms and how to appropriately get patient to optimal levels.
12 – 1 p.m. – Lunch
SECTION 3
1 – 3 p.m. – 2 CME Credits
Getting to Know You; Getting to Know All About You – (Your Labs, Your Patients’ Labs, or Both)
NOTE: Please have the names blanked. Leave sex and age in place. Remove any and all identifying information.) We will also do patient centered learning exercises. The lab list recommendations that I would recommend that you PERSONALLY HAVE DONE and in hand before class will be e-mailed to you with your course registration material. Your participation in obtaining your personal labs before class is not mandatory. It is NOT a pre-requisite to attendance. However, it is the most powerful way to master this material, because then it will be personally relevant to you.
- Conduct clinical conversations about patient and personal lab results.
3 – 3:30 p.m. – Break
SECTION 4
3:30 – 5 p.m. – 1.5 CME Credits
PCOS, DUB/AUB, and PSA, Oh My!
Part 1 – PCOS
- Review the incidence, hormonal abnormalities, clinical manifestations, and comorbidities of Polycystic Ovarian Syndrome (PCOS).
- Discuss how a patient’s weight may not exclude a diagnosis of PCOS.
- Identify reasonable and logical points of intervention for PCOS.
Part 2 – AUB = Abnormal Uterine Bleeding (DUB = Dysfunctional Uterine Bleeding)
- Discuss the origins of pathological disturbances in the uterine bleeding cycle. Identify metabolic and carcinogenic causes of AUB.
- Identify metabolic and carcinogenic causes.
- Identify situations in physicians and patients with AUB where we should be alarmed.
- Discuss the endometrial stripe dimensions and why you should commit these to memory.
- Review hormonal interventions of AUB and discuss what we should warn our patients about with hormonal interventions.
- Learn the causes of AUB and run a quick differential on the spot.
Part 3 – The Prostate Cancer and Strokes/Cardiovascular Events
- Discuss the incidence of prostate cancer and cardiovascular events.
- Review current practice guidelines for prostate surveillance vs. actual methods health care professionals do in practice.
- Adequately assess prostate cancer risk with PSA, free PSA, and prostate cancer screening.
- Review when to use testosterone after a patient is treated for prostate cancer.
- Discuss the order of operations for a prostate work-up, including PSA/Free PSA changes and velocity, MRI localization and stereotactic biopsy, reasonable surgical and chemotherapeutic options, and state of the art treatment for prostate cancer which can preserve sexual function.
- Discuss other causes for increased PSA and follow the percentage of Free PSA to decide when to intervene.
SECTION 5
5 – 6 p.m. – 1 CME Credit
Peptides – What’s All the Fuss About?
- Discuss how peptides work and when and why to consider using them.
- Identify rational expectations of results with use of peptides.
- Review where to get them and how to dose them for each individual patient.
Day Two
SECTION 6
8 – 9 a.m. – 1 CME Credit
Q&A and Reflection from Day 1
- Review any questions from labs and patient cases reviewed during day 1 discussions.
- Review the thyroid and discuss monitoring and appropriate levels.
SECTION 7
9 – 10 a.m. – 1 CME Credit
Improved Prescribing of BHRT
Review best practices for prescribing of hormones.
- Utilize patient-centered learning exercises to discuss best practice prescribing of hormones.
10 – 10:15 a.m. – Break
SECTION 8
10:15 a.m. – 12 p.m. – 1.75 CME Credits
Menopause: A Quadruple Storm of Estrogen, Progesterone, Testosterone, and Adrenal Insufficiency
- Discuss how estrogen and progesterone are typically thought to be deficient in menopause, but testosterone and adrenal function (particularly DHEA-sulfate) are absolutely necessary for health and well-being.
- Review potential health benefits, including symptom relief and address the potential for better patient outcomes with use of hormones in menopause.
- Implement informed consent for stopping HRT and the potential harm of hormone deprivation.
- Review types of estrogen.
- Compare transdermal vs. oral administration of estrogen and review the benefits and harms of each method.
- Discuss the dangers of locked-in dosing rations of estrogen and progesterone in some FDA-approved medications.
- Compare the use of compounded DHEA pV versus pharmaceutical solutions.
- Discuss how a patient’s age can make a difference in HRT.
- Review problems with synthetic vs. bioidentical vs. compounded progesterone or the progestins.
- Review new evidence that contradicts the conclusions of the WHI and HERS Trials.
- Implement different strategies for managing PMS, perimenopause, menopause, bleeding problems, side effects, and complications.
12 – 1 p.m. – Lunch
SECTION 9
1 – 2 p.m. – 1 CME Credit
Setting up Preventive Medicine in my Practice: New Ideas and New Techniques
Outline, worksheet, forms, and consents
- Discuss differential billing and financial options and different types of programs.
- Review the necessary equipment to perform pellet insertions and why you might want or not want to do this procedure.
- Adequately evaluate different pharmacies and laboratories that are best for your patient’s health care and financial situation.
- Review tips, tools, items, and processes to recognize before starting to treat patients with hormones.
SECTION 10
2 – 3 p.m. – 1 CME Credit
Your Unique Talent as a Physician Leader
NOTE: Please bring in the responses that you have solicited before this course. If you don’t have them and would like to participate in class discussion, we can work on these onsite.
- This educational activity will use small groups and discussion for brainstorming and finding your Unique Talent™.
- Learn about the concept of the “Flow” state.
- Learn how to protect your adrenals.
- Learn and clearly establish in your mind why and what you are offering in terms of patient care is congruent with your Unique Talent.
- Discuss the meaning for your future career growth, as well as personal and professional satisfaction with what you do.
3– 3:15 p.m. – Break
SECTION 11
3:15 – 5 p.m. – 1.75 CME Credits
Putting It All Together
- Conduct patient and lab reviews.
- Discuss office hormone reviews including implementation of plans and strategies.
- Conduct class discussions, Patient-Centered Learning Cases, and Q&A.
- Address any additional topics of interest that you would like to know more about.
SECTION 12
5 – 5:15 p.m. – 0.25 CME Credits
Lightning Round! Final Q&A
- Get final questions and patient cases answered.
- Review of any material the class desires.
TOTAL CME CREDITS: 16