This course utilizes a case study approach designed to help physicians and practitioners successfully and knowledgeably treat their age management patients. This intense 2-day mini residency teaches everything you should know about hormones, the various types of hormones, both good and bad, problematic, and life-saving, synthetic (non-human) vs. pharmaceutical bioidentical (human identical) vs. compounded (human identical but not FDA tested or approved). Learners will get the real nuts and bolts needed to prescribe hormone replacement therapy (HRT), which ones to use and which ones to avoid, how much, when, and why. Participants will learn about monitoring and adjusting HRT through literature presentations, case studies, and open discussions. Emphasis is placed on understanding the difference between normal and optimal levels of hormones based on our medical studies.
Day two involves extensive review of thyroid hormones, plus cases that involve laboratory evaluation, prescribing, adjusting, troubleshooting, and discussing various hormone therapies for different scenarios for both men and women. Throughout the course, the practice of hormone replacement therapy will be based on peer-reviewed medical research and a wealth of clinical experience. This is the most comprehensive course taught on evidence-based medicine, designed to give you practical information and skills that can be used on a daily basis. The curriculum is an evidence-based program on preventive medicine designed to enhance diagnostic and prescribing skills when optimizing hormones for both men and women.
Although most clinicians are fully aware of the need to replace hormones in cases of sub-normal hormone levels, most have not been trained to optimize hormone levels if the baseline hormone level is "normal". Many participants frequently inquire why a patient is treated with various hormones when the baseline lab test indicates “normal.” Just as confusing is the realization that the medical literature supports that normal is simply not optimal. A multitude of studies support optimization of all hormones regardless of the baseline levels, both for maintenance of quality of life and for future health benefits. In addition, the medical literature demonstrates that optimization of hormones results in relief of symptoms, improvement in well-being, and a decrease in morbidity and mortality by attaining levels in the upper range of normal. It is imperative that practitioners understand both the need and benefit for optimization, what levels are considered to be optimal, as well as have command of the literature that supports it. One important aspect of this course is the extensive review of the medical literature that provides the credence and support as to why we optimize with certain hormones as well as avoid the use of non-isomolecular hormones. Remember that normal is definitely not optimal when it comes to hormone replacement and this applies to both men and women.
By the end of this activity, the participant should be better able to:
- Evaluate and become proficient in the medical literature that supports biologically identical hormone replacement in contrast to chemically altered hormones and realize that “all hormones are not the same” as demonstrated in the literature.
- Implement therapeutic management of andropause based on studies reported in prestigious medical journals.
- Identify the types, doses and methods for administering testosterone to men and women and discuss the prescribing of testosterone for men and women, including complications, precautions, potential side effects, and monitoring.
- Discuss the utilization of Finasteride, Dutasteride, and Anastrozole as they pertain to the management of side effects with testosterone administration.
- Identify the uses of melatonin including correct dosing and monitoring.
- Apply strategies for the effective uses of DHEA and pregnenolone including correct dosing and monitoring.
- Evaluate new evidence that contradicts the experts’ conclusions from the HERS and WHI Trials on estrogen treatment in women.
- Demonstrate an understanding of the health benefits of estrogen and progesterone in contrast to the health detriments and harm of synthetic estrogen and progestin and describe the types, doses, and methods used to administer estrogen and progesterone.
- Discuss that different formulations can affect absorption, efficacy, side effects, and complications.
- Review lab tests that demonstrate that some compounded hormones are poor in quality, not micronized, and result in reduced efficacy and low serum markers.
- Discuss recent literature, questions and answers that demonstrate the beneficial effects of hormones such as improved function and healing and a better quality of life.
- Explain current concepts of thyroid replacement and compare and contrast different options available for thyroid replacement as supported in the medical literature.
- Recognize various methods of testing for thyroid deficiencies and what labs and approaches are best and discuss and analyze interesting and complicated cases that involve hormone replacement therapy, which hormones are absorbed best, and when to use oral vs. transdermal HRT.
- Recognize the difference between “normal levels” and “optimal levels” of hormones and the benefits or detriments as demonstrated by current evidence-based medical studies.
- Implement best clinical practices in diagnosing, prescribing, monitoring, and adjusting of BHRT for improved function and quality of life.
- Develop and apply business management principles to set up a preventive medicine practice.
- Analyze and review treatment protocols in case management for both simple and complex cases as it pertains to BHRT.
- Evaluate the lack of peer-reviewed studies for any compounded hormones in comparison to the standardized, pharmaceutical bioidentical hormones which are the only natural hormones utilized in the medical literature.
- Describe how to write prescriptions for compounded hormones to pharmacies, and how different formulations can affect absorption, efficacy, and side effects.
- Correct any insufficient or inappropriately prescribed hormone therapy to conform to scientific standards as seen in medical literature.
- Implement current strategies into your practice to improve the level of care and patient compliance in the treatment of adult hormone deficiencies.
- Assure that prescribed hormones meet industry standards based on attaining adequate serum levels and symptom improvement.
- Discuss that some compounded hormones are poor in quality, poorly absorbed, not micronized, and usually prescribed in very inadequate amounts to conform to scientific standards of maintaining therapeutic levels.
- Discuss that biologic endpoints (lab tests) are the only reliable assessments to assure that the HRT prescribed is as efficacious as pharmaceutical bioidenticals utilized in the literature.
- Realize that it is the responsibility of the medical practitioner to assure that their compounding pharmacy dispenses only high-quality hormones from either a European or U.S. made source to guarantee efficacy and therapeutic endpoints.
- Apply current prescribing strategies for maintaining adequate hormone levels, which serum levels to follow, which tests not to use (saliva), and the literature supporting each.
- Analyze new treatment protocols to best diagnose, prescribe, monitor, and adjust BHRT for improved function and quality of life.
2023 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.
The AAFP has reviewed Mastering Protocols for Optimization in HRT and deemed it acceptable for AAFP credit. Term of approval is from 02/23/2023 to 09/10/2023. This session is approved for 16.00 Live in-person AAFP Prescribed credits. Physicians should claim only the credit commensurate with the extend of their participation in the activity.
Learn more about our accreditation.
7:30 - 8 a.m.
- Registration and continental breakfast
Day One
8 - 10 a.m. — 2 CME credits
Introduction to Hormone Replacement Therapy
- Importance of optimization of all hormones as per the medical literature
- Health and quality of life benefits
- Maintain well-being and reduce morbidity and mortality
- Normal is not optimal, and optimal is best
- Understand that simply replacing hormones to normal levels is not what is best for health and well-being
- Examples of optimal labs vs. normal labs
- HRT replacement: Have we been doing it incorrectly all this time?
- What we should know about hormones but were never taught
- Why we do what we do based on the medical literature
10 - 10:15 a.m. — Break
10:15 a.m. - 12 p.m. — 1.75 CME credits
Testosterone: Safe and necessary for both men and women
- Overview
- Clinical vignettes, with labs
- Review of studies and citations for the use of testosterone in both men and women
- Review of putative risks and benefits for testosterone
- Worrisome differences, as well as similarities, of alkylated androgens (non-bioidentical testosterone) vs. bi0-identical testosterone
- Clots and Strokes - The "WHI" moment for testosterone: A dispassionate and rigorous review of the literature, Establishing informed consent and clarity in the mind of the prescriber
- Applications: How, where, when, and WHAT to apply or exogenously supplement and why
- What levels are normal and what levels are optimal, and how to decide
- Physiological flux of testosterone and its relevance to replacement HRT
- Treatment of potential side effects and monitoring
- DHT, Estradiol, Finasteride, Anastrozole, 5α-reductase inhibitors, and aromatase inhibitors
- Assessment of prostate cancer risk with PSA, free PSA, and prostate cancer
12 - 1 p.m. — Lunch
1 - 2 p.m. — 1 CME credit
Wrap-up of male testosterone continued
Testosterone for Women: It's a feel-good hormone with profound benefits
- What, What, Where, and When
- Extensive literature review of benefits in women
- Improvement in breast cancer risk?
- What types, doses, and levels work best
- Application: How, where, when, why to apply
- Dosing options
- Side effects and treatment with Spironolactone
2 - 3 p.m. — 1 CME credit
Pregnenolone, DHEA and Melatonin hormones provide health benefits including the following
- Pregnenolone: The mother of all sex hormones.
- Memory enhancer? And what about cancer?
- DHEA: How DHEA improves health and longevity
- DHEA: How to prescribe, monitor, and adjust for maximum benefit
- A literature review supporting optimal levels
- Melatonin: The great sleep and immune enhancer
- Treatment and prevention for cancer, HTN, migraines
- Administration and monitoring: How much is enough?
- Side effects and use of spironolactone
- A literature review of these hormones
- Administration, monitoring and adjusting
3 - 3:15 p.m. — Break
3:15 - 4:15p.m. — 1 CME credit
Menopause: Estrogen and progesterone are absolutely necessary for health and well-being
Estrogen is very complex to decipher and understand
- Natural vs. synthetic estrogen; risk vs. benefit — a literature review of types of estrogens
- Health benefits and feel-good benefits of HRT
- Don’t fear it: The most recent consensus views
- Informed consent for stopping HRT and harm of hormone deprivation
- What types of estrogen: How, what, where, and why?
- ACOG and NAMS: no study to show efficacy of BHRT — wrong!
- Doses, monitoring levels, adjusting, selection: What works best and when
- The importance of serum monitoring
- Transdermal vs. oral: Benefits and harm of each
- Does age make a difference?
- Indication and contraindications: Problems with synthetic vs. bioidentical vs. compounded
- New evidence that contradicts the conclusions of the WHI Trial and HERS
- Different strategies for managing PMS, perimenopause, menopause, bleeding, problems, side effects and complications
4:15 - 5:15 p.m. — 1 CME credit
Progesterone: Just as important as estrogen
- Absolutely necessary in all women at whatever age
- A literature review: There is not one negative study
- Protection against breast cancer, uterine cancer, heart disease
- MP ≠ MPA, natural vs. synthetic, safe vs. unsafe
- If some is good, more is better?
- Dosing, monitoring, adjusting, and the importance of optimization
- Serum vs. saliva testing and harm of progesterone deprivation
Compounded BHRT: The good, the Bad, and the Ugly
From worthless to lifesaving: It all depends on quality, correct dosing, and monitoring
5:15 - 5:30 p.m. — Break
5:30 - 6:30 p.m. — 1 CME credit
Summary and Review
- Completion of material from day 1
- Interesting cases
- HRT indications, contra-indications, risks, benefits
- Side effects, problems, complications
- Dosing and adjustment of various types of HRT with lab reference comparisons
- Cautions, suggestions, things to do, and mistakes to avoid
Day Two
8 - 10 a.m. — 2 CME credits
Thyroid: Why patients demand it
- The most misunderstood and ignored hormone
- Thyroid test is normal, but symptoms persist, So now what?
- Types of hyperthyroidism
- Does your patient need their thyroid to be optimal? You bet!
- Understanding lab values
- What is responsible for low thyroid symptoms when TSH is normal?
- Types of thyroid hormones, dosing, monitoring, adjusting
- Treatment of fatigue: TSH or Free T3?
- Endocrine viewpoint (labs) vs. patient perspective (symptoms)
- Signs and symptoms of sub-optimal thyroid replacement and treatment
- Literature support for optimization: Treat the labs or the patient?
- Improvement of health and well-being through optimization
- the consequences of low normal Free T3 as per JAMA
- Q & A on dosing
10 - 10:15 a.m. — Break
10:15 a.m. - 11: 45 a.m. — 1.5 CME credits
GROWTH HORMONE - The "missing module"
- Why did you prescribe hormones if the levels were normal?
- Administration and appropriate dosing
- The nuts and bolts for practicing HRT correctly: Everything you should know
- Monitoring the patient and adjustment for optimization
- Proper case management, problems, and complications
- "Non-growth hormone solutions"
- Mistakes to avoid
- Lab interpretation and lab comparisons
- Different optimal levels for different laboratories
11: 45 - 12 p.m. — 0.25 CME credits
Q & A Session, Morning Wrap-up
12 1 p.m. — Lunch
1 - 2 p.m. — 1 CME credit
Hormone dosing review - all hormones, all dosing.
- Different approaches outlined.
- Specific doses, various methods of compounding reviewed.
- Q & A on all hormones covered.
2 - 2:45 p.m. — 0.75 CME credits
“Setting up my Preventive Medicine in my Practice: What Works and What Doesn’t"
- Outline, worksheet, forms, letters and consents
- Differential billing and financial options.
- Different types of programs
- Necessary equipment if you want to perform pellet insertions.
- Evaluating pharmacies and laboratories
- Products and services
- Almost everything you will need to know before starting Monday morning
2:45 - 3 p.m. — Break
3 - 4:45 p.m. — 1.75 CME credits
Putting it all together
- Lab review
- What did you learn and can you apply it?
- Troubleshooting and case management
- Wrap-up Q & A
100 Written Questions and Answers Patient Cases
TOTAL CME CREDITS: 16
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