This course utilizes a case study approach designed to help physicians and other healthcare providers successfully and knowledgeably treat their patients' various hormones. 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 reviews, case studies, and open discussions. Emphasis is placed on understanding the difference between normal and optimal levels of hormones based on our medical studies.
This course will provide an extensive review of thyroid hormones, plus patient 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 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 providers 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 not always optimal for each individual patient. 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 providers 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.
- 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 well as their risks – in 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.
- 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.
- 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 include preventive medicine in 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 in order 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.
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.
The AAFP has reviewed Mastering Protocols for Optimization in HRT and deemed it acceptable for AAFP credit. This session is approved for 16 Live AAFP Prescribed credits. Term of approval is from 05/01/2025 to 07/18/2025. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Learn more about our accreditation.
7:30 - 8 a.m.
- Registration and breakfast
Day One
8 – 10 a.m. — 2 CME Credits
Section 1 – Introduction to Hormone Replacement Therapy
- Discuss the importance of optimization of all hormones as per the medical literature.
- Review the health and quality of life benefits of hormone replacement therapy.
- Recognize how HRT can maintain well-being and reduce morbidity and mortality with the optimization of hormones.
- Discuss how normal hormone levels may not be optimal.
- Discuss how replacing hormones with normal levels may not be best for health and well-being.
- Review and discuss examples of optimal labs vs. normal labs.
- Discuss hormone replacement therapy and how some patients may not be doing it accurately.
- Discuss what physicians need to know about hormones but might not have been educated on in training.
10 – 10:15 a.m. — Break
10:15 a.m. – 12 p.m. — 1.75 CME Credits
Section 2A – Testosterone: Safe and Necessary for Both Men and Women
- Discuss a review of testosterone and its relevance in both men and women.
- Discuss various clinical case vignettes with lab results.
- Review of studies and citations for the use of testosterone in both men and women.
- Review of putative risks and benefits for testosterone.
- Identify some worrisome differences and similarities between alkylated androgens (non-bioidentical testosterone) vs. bio-identical testosterone.
- Discuss the review of the literature on clots and strokes in testosterone use and establish informed consent and clarity in the mind of the prescriber.
- Review how, where, when, and what to apply or exogenously supplement and why.
- Discuss the use of clomiphene and Human Chorionic Gonadotropin (HCG).
- Discuss the use of hormone pellets and review the literature to support their use.
- Review what levels are normal and what levels are optimal and be able to decide.
- Discuss the physiological flux of testosterone and its relevance to hormone replacement.
- Adequately provide proper treatment and monitoring of potential side effects.
- Review DHT, Estradiol, Finasteride, Anastrozole, 5α-reductase inhibitors, and aromatase inhibitors for treating side effects and discuss the potential dangers of finasteride.
- Adequately assess prostate cancer risk with PSA, free PSA, and prostate cancer.
12 – 1 p.m. — Lunch
1 – 2:30 p.m. — 1.5 CME Credits
Section 2B – Testosterone for Women: Benefits
- Discuss why, what, where, and when to utilize testosterone in women.
- Extensively review the literature and discuss benefits in women.
- Review if testosterone use in women can provide an improvement in breast cancer risk.
- Discuss what types, doses, and levels of testosterone work best in women.
- Review how to administer the application of testosterone for women, including how, where, when, why, and what to apply.
- Discuss the dosing options of testosterone in women.
- Identify side effects in women on testosterone therapy and discuss treatment with spironolactone.
2:30 – 3:30 p.m. — 1 CME Credit
Section 3 – Pregnenolone, DHEA, and Melatonin Health Benefits
- Discuss the use of pregnenolone as a sex hormone.
- Discuss if the use of pregnenolone can be a memory enhancer and its effect on the risks of cancer.
- Discuss how to prescribe, monitor, and adjust DHEA for maximum benefit and if it can improve patient health.
- Review the literature on DHEA and the data that supports optimal levels.
- Discuss the use of melatonin and its effects on patient sleep and immunity.
- Review how melatonin is used to treat and prevent cancer, hypertension, and migraines.
- Adequately administer and monitor the use of melatonin and discuss how much is enough.
- Review the side effects and use of spironolactone.
3:30 – 3:45 p.m. — Break
3:45 – 5:15 p.m. — 1.5 CME Credits
Section 4 – Estrogen and Progesterone in Menopause: Utilization for health and well-being
- Compare and contrast natural vs. synthetic estrogen and review the risks and benefits.
- Review of types of estrogens and assess the literature.
- Discuss the health benefits of HRT.
- Discuss informed consent for stopping HRT and review the harm of hormone deprivation.
- Review what types of estrogen to use and how, what, where, and why to use which types on which patients.
- Review the literature of studies on BHRT in ACOG and NAMS and what the data shows about efficacy.
- Review doses, monitoring levels, adjusting, and selection for estrogen, and appropriately decide what works best and when to use it.
- Discuss the importance of serum monitoring.
- Discuss the benefits and harms of Transdermal versus oral administration of estrogen.
- Discuss how age affects the type of estrogen and the dosing.
- Discuss the indications and contraindications of estrogen and recognize problems with synthetic vs. bioidentical vs. compounded.
- Discuss new evidence contradicting the conclusions of the WHI Trial and HERS.
- Utilize different strategies for managing PMS, peri-menopause, menopause, and bleeding problems and review side effects and complications.
5:15 – 5:30 p.m. — Break
5:30 – 6 p.m. — 0.5 CME Credits
Section 4, Cont. – Estrogen and Progesterone in Menopause: Utilization for health and well-being
- Compare and contrast natural vs. synthetic estrogen and review the risks and benefits.
- Review the types of estrogens and assess the literature.
- Discuss the health benefits of HRT.
- Discuss informed consent for stopping HRT and review the harm of hormone deprivation.
- Review what types of estrogen to use and how, what, where, and why to use which types on which patients.
- Review the literature of studies on BHRT in ACOG and NAMS and what the data shows about efficacy.
- Review doses, monitoring levels, adjusting, and selection and estrogen, and appropriately decide what works best and when to use it.
- Discuss the importance of serum monitoring.
- Discuss the benefits and harms of Transdermal versus oral administration of estrogen.
- Discuss how age affects the type of estrogen and the dosing.
- Discuss the indications and contraindications of estrogen and recognize problems with synthetic vs. bioidentical vs. compounded.
- Discuss new evidence contradicting the conclusions of the WHI Trial and HERS.
- Utilize different strategies for managing PMS, peri-menopause, menopause, and bleeding problems and review side effects and complications.
6 – 6:45 p.m. — 0.75 CME Credits
Section 5 – Progesterone: Just as important as estrogen
- Discuss how progesterone is absolutely necessary in all women at any age.
- Review the literature on progesterone and discuss how the studies are positive towards its use on women.
- Discuss how progesterone provides protection against breast cancer, uterine cancer, and heart disease.
- Discuss how Micronized Progesterone does not equal Medroxyprogesterone Acetate (natural vs. synthetic) and the safety of each hormone.
- Discuss proper dosing, monitoring, adjusting, and the importance of optimization of progesterone.
- Discuss serum vs. saliva testing and the potential harm of progesterone deprivation.
- Discuss how the safety and efficacy of BHRT depend on quality, correct dosing, and proper monitoring.
Day Two
8 – 10 a.m. — 2 CME Credits
Section 6 – Thyroid: Why patients demand it
- Discuss why some thyroid lab tests come back as normal and why a patient's symptoms persist.
- Review the different types of hypothyroidism.
- Review the literature and discuss when a patient is subclinically hypothyroid or euthyroid sick.
- Discuss why patients' thyroid levels should be altered to optimal levels and better interpret lab testing values.
- Discuss the causes of symptoms of low thyroid when the patient's TSH is normal.
- Review primary, secondary, and tertiary hypothyroidism from the top down to the thyroid and from the thyroid down to the receptor.
- Review the types of thyroid hormones, dosing, monitoring, and proper adjustments.
- Discuss how optimizing thyroid levels can assist with the treatment of fatigue: TSH or Free T3.
- Compare and contrast the literature review of the endocrine viewpoint (labs) vs. the patient perspective (symptoms).
- Identify the signs and symptoms of sub-optimal thyroid replacement and treatment.
- Discuss how adjusting thyroid levels can help in the improvement of a patient’s health and well-being through optimization.
- Review questions on proper dosing.
10 - 10:15 a.m. — Break
10:15 – 11:45 a.m. — 1.5 CME Credits
Section 7 – Growth Hormone: The “missing module”
- Discuss the benefits of reasonable IGF-1 levels.
- Discuss the growth hormone dialectic of when to treat or not treat.
- Discuss how to improve growth hormone levels without using growth hormones by using the growth hormone-releasing hormone (GHRH) agents and peptides.
- Discuss the proper administration and appropriate dosing for growth hormones.
- Adequately monitor the patient and proceed with proper adjustments for optimization.
- Recognize mistakes to avoid when prescribing growth hormones.
- Review how to conduct a proper lab testing interpretation and be able to do lab comparisons in patients.
- Discuss differential laboratories that may provide different optimal levels based on their guidelines.
11:45 a.m. — 12 p.m.
Learner Q&A and Morning wrap-up (Optional)
12 – 1 p.m. — Lunch
1 – 2 p.m. — 1 CME Credit
Section 8 – Hormone dosing review: All hormones, all dosing
- Review each hormone discussed and the appropriate dosing based on patient lab results.
- Discuss and practice prescription writing for compound hormones.
- Discuss specific doses and the various methods of compounding each hormone.
2 – 2:45 p.m. — 0.75 CME Credits
Section 9 – Setting up Preventive Medicine in my Practice: What Works and What Doesn’t
- Review patient outlines, worksheets, forms, and various consents needed.
- Discuss differential billing and financial options.
- Review different types of programs and services you can provide in your practice.
- Discuss the necessary equipment, such as equipment to perform pellet insertions.
- Learn to adequately evaluate pharmacies and laboratories that prescribe and/or compound these hormones.
3 – 3:15 p.m. — Break
3:15 – 5 p.m. — 1.75 CME Credits
Section 10 – Putting it all together
- Review and discuss multiple patient cases and various lab tests and results.
- Re-emphasize prostate cancer screening and prevention and know how to spot it.
- Adequately troubleshoot patient issues and provide proper case management
- Discuss any pending questions learners have on hormone replacement therapy.
TOTAL CME CREDITS: 16
