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See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog If you are female who is menopausal and you have experienced your OBGYN or internist drawing your blood to check your hormone levels, (Estradiol, and LH and FSH) to see if you are menopausal or to see what your estradiol level is while on HRT, you may have heard your doctor tell you that your estradiol level is too high. That is what I would like to talk about today….. This often occurs when my patients take the blood work I order to another doctor who doesn't know anything about estrogen and just looks at the reference range on the lab sheet. Most of you have heard me talk about the fact that lab reports must be interpreted by the treating physician, because what is written on the lab sheet isn't tailored to your situation. The lab reference ranges for menopausal women are based on women who don't take any hormones, very low estradiol and high LH and FSH, which is not healthy and is the level that causes women overwhelming hot flashes and painful periods. Estradiol blood tests have a list of numbers that don't reflect the healthy estradiol level, but a level that makes women miserable. After I replace a woman's estradiol, their tests show blood levels of a young healthy woman who is pre-menopausal, and that brings them back to feeling like themselves. "I have my life back! Estradiol and Testosterone Pellets have cured all my symptoms (low libido, hot flashes, poor interrupted sleep, bladder spasms, depression, and I feel like myself again!" No other hormone replacement brings estradiol blood levels to (60-250ng/ml), patches, creams and gels just stop one symptom, hot flashes. There is a reason that your doctor doesn't know about hormones. The education that OBGYNs get in residency effects what they recommend to their patients for life, and they have very little training about hormones which means that no one is taking care of the hormones for women, and bioidentical estradiol is never discussed because it is not approved by the FDA which is why I DO! I have made it my business to know everything about women's hormones and have prescribed them to women for over 45 years. Therefore, when I am told that the primary care or internal medicine doctor told one of my patients that their estradiol and estrone are "too high", I am dismayed. Women must think about the fact that when they feel normal after menopause treatment, then that is the best treatment for them. My patients become better, healthier, and their relationships are more fulfilling with Estradiol replacement, and I know the range the Estradiol should be within (60-250), the same as when we were fertile and young. Estradiol taken non-orally (patch, cream or pellet) is safe and does not cause breast cancer or liver cancer or cause blood clots. What Should I Tell My Doctor about my estrogen replacement? Therefore, If your doctor tells you to stop estradiol, you can tell him that estradiol replacement decreases all causes of death in Menopausal women, it decreases heart disease, bladder disease, bladder infections, osteoporosis, and dementia/Alazheimer's Disease! Tell him or her that, they can stop worrying about your Estrogen because you are being prescribed it by a doctor who knows how to manage hormones. Breast Cancer Patients There is another type of patient who I often see in my office. Breast Cancer patients with estradiol receptors are taken off their estrogen, and they are given an estrogen blocker like Tamoxifen® (oral) or Anastrazole (Arimidex®) to get rid of the estrogen in their body which is to "starve" breast cancer cell that may have seeded other tissues in the body. These patients are miserable. I treat them with Testosterone pellets only and monitor their Estrogens. That works until their doctor sees an Estradiol level that is in the premenopausal range in a patient who hasn't had an estradiol pellet in a year. E2 pellets are tiny and friable, and they can't last longer than 6 months. What happens when the oncologist freaks them out saying it is the Estradiol pellet causing the E2, E1 levels. They are upset but this is estradiol from other sources (not the ovaries). Here are the facts: Estradiol pellets are 2-3 mm in size. They dissolve by blood flowing around the pellet located in the fat. Estradiol pellets dissolve completely over 3-4 months in most women. We cannot see them by ultrasound at 4 months. Therefore, a year later a woman who has estradiol over 60 The oncologist is not a hormone specialist and doesn't know the other sources of estradiol and estrone in the body. a prescribed amount of Estradiol (E2) is given every 4 months. The medium dose of E2 is 25mg and it lasts 120 – 180 days The size of an estradiol pellet = 2×2 mm Causes Of Continuing High Estrogen In a Woman Long After She Stops E2 Pellets: Tamoxifen given for Breast Cancer is an Estrogen and also an Estrogen Receptor modulator, but is really an Estrogen, which turns off the receiving end for E2 (the cellular receptors) so the breast cancer cannot be stimulated by circulating estrogens, but the rest of the body is. When on Tamoxifen it is not the pellets that are raising the blood level of E2, E1, it is the Medication. When someone is on Tomoxifen all their other organs are stimulated by estrogens from Tamoxifen, but the Breasts are not. That means that the estrogen in the blood is from the medication Tamoxifen and not the previous pellets. Obesity increases body fat and E2 is made in the fat and the less fat the lower the Estrone and estradiol. Other Medications and supplements can increase the E2 and E1 in the circulation but rarely help with menopausal symptoms. Your doctor should know what medications you can't take if you are trying to get rid of estradiol and estrone usually prior to Breast Cancer therapy. Drinking alcohol can prevent the liver from processing the estrogen that is meant to be removed normally so it builds up in the circulation. Liver disease causes an increase in E1 as well. Some medications increase estrogens in the body, but do not relieve symptoms of menopause, so have you doctor review your other medications you take. High intake of soy, edamame, soy nuts, soy in nut milk, Tofu, and other vegan (fake meat) is made of soy and soy is a phytoestrogen which can cause uterine bleeding but doesn't help the symptoms of menopause. Soy is in everything so read the labels. Genetic Diseases can cause high estrogen in menopausal women who are not taking estradiol for their symptoms. Some women have an aromatase defect, which is genetic and can't be cured but can be treated with anastrazole or Arimidex, the same medication. This means that they convert Testosterone into estradiol and estrone. Even before menopause women have very low testosterone, so this is not obvious when they come to my office. The test for the gene defect is very expensive and this is not a common occurrence. We diagnose this when a woman's estrogen is too high for the dose she is taking, AND her testosterone ran out too fast! We treat that condition with a testosterone + anastrazole pellet in the normal dose of T, and it corrects the conversion of T into E2, E1. Oral anastrazole also called Arimidex blocks that conversion too and is tolerated better by men but women get arthritis symptoms. DIM can treat this genetic conversion by blocking the enzyme at a different place than Arimidex. Fat Loss through dieting releases the estradiol stored in the body fat Obesity and weight loss can cause estradiol and estrone to be high in the blood. Estrogen is made and stored in fat tissue. The more you have, the more E1 and E2 you have in your fat. Obesity can store the hormone and slowly release it which fools us and makes us think we are seeing pellet E2 nd E1. The more fat you have the more estrogens you make! When people lose fat under the supervision of a doctor, they usually have somewhat rapid weight loss. This floods the blood with both estradiol, estrone, and triglycerides. It takes longer to clear the estrogens because the liver is also processing fat. PubMed https://pubmed.ncbi.nlm.nih.gov Does reducing body fat reduce estrogen? Making some lifestyle changes may help lower your estrogen levels. Your provider may recommend that you: Decrease your percentage of body fat. Decreasing your body fat can reduce the amount of estrogen that your fat cells secrete. Feb 9, 2022 Above is what your doctor should think about when diagnosing you for high estradiol long after a pellet is gone. There are some ovarian and adrenal specific problems that are also possible to be the reason E2, E1 are increased. I hope this gives you ammunition to discuss with the doctors who don't know anything about hormones, estradiol and menopausal women. Tell them what you know to be true and stop blaming a 2mmx2mm pellet that can't physically last more than 120 day.

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog This Blog post is for mature women to read. If you feel embarrassed by sex or offended that I am addressing these genuine female concerns, please skip this Blog. Among the many questions I have received, I am sharing a few with you in case you also have these questions but are hesitant to ask when you visit your gynecologist's office. At BioBalance Health, our doctors conduct consultations with new patients and follow-up visits that last an hour. During these consultations, patients are free to ask questions about their health including sexual questions. The atmosphere in our office is open to all questions, and the doctors offer hour-long visits, fostering a supportive environment for discussing embarrassing sexual situations, asking awkward questions, and addressing concerns about sexuality and aging. I am going to offer some of the questions I have been asked and the answers that I give to my patients who ask. Question 1:" Am I normal to think about sex and fantasize about having sex all the time now that I have testosterone pellets?" Yes, that is normal and healthy to think about sex…humans are sexual beings and thinking about or planning to have sex with your partner is normal. After Testosterone pellets are inserted for the first time, they have magnified sexuality for a few weeks. After that the sex drive of a patient goes back to what was normal for them when they were at their prime. Testosterone is necessary for a person, women and men to have a sexual drive. Those women and men who have had a healthy sex life before their testosterone was lost can still have sex, on their usual schedule, but what we think of sex DRIVE, won't be there without T….just the habit of having sex will make them continue to have an active sex life. Question 2: "Before pellets I didn't have any discharge in my underwear, and I thought that was a benefit of menopause but now I experience wetness/slight white discharge Am I OK?" When women are mature and have fertility, (women between 12 years old and menopause) have some discharge clear or white in their underwear. It is from the vagina, and it is a way of the vagina cleansing itself. Without the hormones estradiol and testosterone, as in menopause and when a woman takes low dose birth control pills, the vagina dries up and doesn't "cleanse itself". Vaginal lubrication stops, so does vaginal discharge, and painful intercourse is a real problem for women after they are not producing estradiol or replacing it with HRT. Experiencing normal vaginal discharge is a small price to pay to comfortable sex and a good sex drive. If the discharge changes, please watch or read my last Healthcast #685 or blog #685 to determine if you need to see a Gynecologist. Question 3: A question women ask me before they experience replacement of testosterone and estradiol. "Do I have Alzheimer's disease? I'm only 50 and I can't remember things. I lose words and I am always late because I can't remember appointments." One of the most important benefits of taking testosterone by pellet insertion is that my patients usually get their brain back! It is rare that anyone who is having trouble with their memory before age 55 is really starting to have an early onset dementia. By taking Estradiol and Testosterone pellets my patients regain their normal brain function in the first 8-12 months. Those women who are still struggling with memory after taking Estradiol and Testosterone Pellets should be evaluated by a psychiatrist or neurologist to test them to see if they are having the beginnings of a type of dementia. The sooner a person takes TE hormone pellet replacement, the longer they will have a clear and functional mind. If a woman takes T and or E2 pellets, they can delay the genetic onset of dementia by 10 years. That means if genetically you were wired to lose your ability to think at age 70, then you should get a ten-year delay in the onset of your dementia. E + T pellets are the only treatment I know can preserve your ability to think 10 years longer than if you didn't take them within 10 years of losing your Estrogen and Testosterone (around age 45). Question 4: "Now that I have pellets, I have great orgasms but I produce a lot of fluid when I come. Is that normal?" Yes. Estrogen increases vaginal wetness, and lubrication for sex. Testosterone stimulates the sensitivity of the area around and inside the vagina. Testosterone pellets are the only form I have heard of that can cause vaginal ejaculation, or forceful production of fluid from the vagina. Not everyone experiences this phenomenon, and some women love it as do their partners, and other women dislike it because it makes sex messier than usual. It is a testosterone dose dependent action, and lowering the T dose in pellets can decrease the response to sexual stimulation. Question 5: "My husband can't keep up with my sex drive. I have the same drive as I had when I was younger, but he is not able to keep up with my libido. What can I do?" My response has several options because every sexual partnership is different. You can use vibrators or sex toys to stimulate yourself. He can use the same toys to engage in sexual activity with you. You can lower your dose of T pellets to decrease your sex drive. You can invite your husband to visit us or another Pellet practice to have his level of T and Free T checked and replaced if it is low and he is a good candidate. Question 6: "My husband likes me to give him oral sex. I like it, but what do I do with the semen he produces? The eternal problem: to swallow ejaculate or not. You can only decide this for yourself and if you are uncomfortable with this, then have a washcloth or Kleenex handy to handle the fluid. Question 7:" I have had pellets for a year now, and I have never been so happy, and I feel young again, but my gynecologist examined me and said I had an enlarged clitoris, and she told me to stop pellets because of that! I don't get it! It doesn't bother me; why is she so upset? What should I do?" Your GYN is clearly not educated in hormone therapy using T pellets. She also seems to be uncomfortable with her own sexuality if she cannot see the benefit of having a clitoris that is slightly larger than normal, so it is easy for a partner to access. She may be recalling something from residency, that we were taught: "An enlarged clitoris is a sign of an ovarian tumor, and these tumors secrete high levels of testosterone-like hormone. This is not the same as a slight enlargement of the clitoris that is normal with T replacement. She has not considered that you are receiving Testosterone to replace what you are no longer producing. When we no longer make testosterone at fertile levels, our clitoris shrinks so small that it can hardly be found. Testosterone reverses that change reviving the size and function of the clitoris. Honestly, the change is minimal, and the size of the clitoris varies based on a woman's genetics and testosterone levels before the age of 40. The natural shrinkage of the clitoris after menopause corresponds with low levels of testosterone, along with the loss of clitoral sensitivity, which can lead to a decrease in orgasms! We are sexual beings, and testosterone is essential for sexual function. The ignorance of your gynecologist is both sad and common. In the last 20 years, there has been no training for OBGYNs in sexuality or hormone replacement during menopause. There is complete ignorance regarding treating women with testosterone. As in the general population that has a subset of people who are sexually inhibited, the group of board certified gyns carry their own attitude into the treatment room. Clitoral orgasms are the most common type of orgasm in women. After menopause, they can disappear without testosterone stimulation. That will stop sexual pleasure completely. Most of my patients don't complain about having a visible clitoris, and they say "I can see my clitoris again and my husband can find it now! It makes sex great again." Question 8: "My internist asked me why I wanted to have sex now that I am old! I'm 45! I am changing doctors, but what was she thinking? Again, the training of normal sexuality in residency programs is minimal. She might also be sexually unaware or inhibited, as she revealed when she told you that it is not normal to have sex as we age (over 40); clearly, she does not view it as an important part of her life, so it shouldn't be an important part of yours! Question 9: "Now that I am having sex again, I am shooting fluid out when I climax! What is that and where does it come from? By the way, my husband loves it!" This phenomenon is called "female ejaculation," and it is a normal, yet uncommon, part of great orgasms. Women can produce fluid through transudation via the vaginal wall (which is incorrectly dubbed "vaginal sweating"). There are no sweat glands in the vagina; the fluid comes from the abdomen and is known as peritoneal fluid. When a woman orgasms, her vagina contracts, and this fluid squirts out of the vagina with force. The second source of fluid is the Skene's glands, which are small glands located on either side of the urethra (the opening that leads to the bladder). They don't produce a large amount in most women, but it is possible for them to "squirt" fluid with force. Most men find this gratifying, as an unspoken sign that they did a great job. Women may find it upsetting and ask me to decrease their testosterone levels to lessen the likelihood of "making a mess" when she has sex; however, this also decreases the orgasmic experience. I will keep collecting questions that my patients ask me in my office to offer a continued version of "Embarrassing Questions" in future blogs. I hope this helped you answer some of your unanswered questions!

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog You can convince yourself of a fairy tale that the US government provides us with excellent advice on how to be healthy—for instance, what the percentages of each food group should be, like the food pyramid or the food plate. However, time has shown that they aren't focused on our health with their recommendations; rather, they are attempting to promote the food produced in the US. It's all about money. We now understand that the government-approved food pyramid has contributed to an increase in obesity, illness, and diabetes over the last 60 years, primarily because its main goal was to promote grains in the form of cereals to children. This has led to the unfortunate situation we face today, characterized by rising rates of diabetes and obesity. To make matters worse, iodine has been removed from bread and other foods, leaving many Americans with hypothyroidism. The allowed food additives extend shelf life (and profits) but diminish human longevity. Ultimately, the government should not dictate our dietary choices! Supplements are substances like minerals, vitamins, peptides, and glandulars intended to enhance the inadequate American diet; however, medical societies and the FDA do not endorse their use. Nonetheless, we need them to improve nutrition, prevent disease, and provide the building blocks for bones and muscles, as well as to counteract the chemicals present in our water, food, and air mandated by the government. Supplements help protect us from the poor advice and environmental pollution we encounter in everyday life. Environmental regulations and processes have resulted in increased illnesses, such as hypothyroidism, due to the addition of fluoride to our water instead of solely to our toothpaste. Fluoride depletes iodine levels in our breasts and thyroid, contributing to conditions like breast cysts, breast cancer, and hypothyroidism. Regarding water—are you aware that the water treatment managed by our local governments incorporates harmful chemicals into our drinking water, which may be carcinogenic, in an effort to prevent lead from leaching from very old pipes? This system is outdated because most of the population uses copper or plastic pipes, and lead has not been used in construction for more than 50 years. The anti-lead chemicals that are added can adversely affect our health. That is just the tip of the iceberg. Other examples of how our government prioritizes profit over the health of its citizens include allowing big pharma to price necessary medicines beyond the reach of the average person, all to enhance the stock value of these companies. The price of the same drug from the same manufacturer in other countries is significantly lower than for its own citizens. It should be the other way around. Even then, we are sicker and heavier than any other first-world country. Since you are not here to learn about politics, this serves as my segue into discussing the current denigration of the importance of vitamins and mineral supplements for our health. Just consider this: the average diet consists of processed foods lacking any nutritional value. Fast food contains additives that encourage us to eat more rather than less; portion sizes have increased, and the consumption of whole foods has declined over my lifetime. These are the most compelling reasons I have for taking nutritional supplements that we used to get from our diets before the 1960s. Since we know our patients are consuming chemicals that harm their health, my goal as a preventive medicine doctor, along with my nurses and nurse practitioners, is to keep our patients healthy, even when the government does not! You should heed our recommendations for specific supplements tailored to your individual symptoms and future health. Public health aims to make the group generically "healthier" by governmental standards, but medical care should prioritize our patients, striving for each individual to live a long, disease-free life. However, we face significant misinformation in this battle! Why don't mainstream medical groups recommend supplements? Their reasons include a focus on illness rather than wellness, making them more reactive than preventive in perspective. Additionally, most doctors lack training in nutrition and are often unhealthy and overweight. Another factor is that they primarily deal with medications and surgeries, which is what they typically recommend. In the twenty-first century, we all need supplemental nutrition. I don't have a single patient whom I believe is getting everything she needs from her diet without supplements. Supplements include minerals, vitamins, herbs, select foods, and animal glands that help maintain health and prevent illness by compensating for what modern food may lack. The supplements recommended by your BioBalance Health doctor and NPs are tailored to meet various individual needs, so please read about why we prescribe these supplements specifically for you. Supplements add to the nutrients that are missing from our modern diet. What health benefits can supplements offer? Act as alternatives to medication Enhance the activity of deficient hormones as people age Stimulate the production of hormones Provide the right form of a vitamin that you need and can't get from food Replace the minerals that are lacking in locally grown foods and water Supplements can replace the natural components of drinking water Supplements provide minerals and vitamins that prevent diseases like hypothyroidism. Supplemental animal glandulars are successful at reversing deficiencies that are not available in FDA-approved drugs. Preventive medicine physicians recommend supplements for various reasons: To improve your nutrition To mitigate genetic abnormalities such as elevated homocysteine levels. To counteract chemicals in the environment To treat medical conditions with no known medications To supply certain minerals that are deficient in your area of our country To treat abnormal hormone levels like low thyroid To treat certain symptoms and conditions that have no other solution To prevent future disease To stimulate the production of certain hormones to take the place of a prescription drug To detoxify your liver and gut To improve the absorption of nutrients in the gut To supply minerals and vitamins for osteoporosis To improve your mental health by improving the bacteria in your gut Assist in weight loss My goal is to educate people honestly about the tools they can use to maintain their health and extend their lifespan. A few words of caution should be added to complete this lesson. Please avoid using the cheapest vitamin or mineral supplement on Amazon unless your doctor has prescribed that specific brand. Many supplement companies are not "Medical Grade, " meaning they are not tested and approved by agencies that ensure you receive an effective supplement with your purchase. Amazon has been found to sell vitamins packaged in reputable brand bottles that contain capsules with none of the expected supplements inside! BioBalance Health and BioBalance Skin provide tested medical-grade products, ensuring you take the right supplements for the desired effect. We cannot expect the same quality from most supplements available online. Avoid taking a supplement just because someone else is using it; you might not need it, or worse, it could have negative effects. Trust experts to evaluate what you truly need and what you can do without. When you have a consultation with a BioBalance doctor or NP for your yearly visit, please bring a list of your medications and supplements to discuss with them. Please do not call our RN or email your list for their opinion. Evaluating your needs and aligning them with your supplements requires time.

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog Last time we reviewed why interpreting your lab may lead you to the wrong diagnosis and treatment. Today we continue our review of each lab panel and why the reference ranges on your lab results may not be the "Healthy Normal Range" that you should compare your results to. Lab reference ranges are established with a one-size-fits-all mentality, ignoring the numerous variables that influence blood results. Have you ever tried on a "one-size-fits-all "ANYTHING? Those clothes may fit 20% of the population but for the rest of us, the garment doesn't fit our width, weight or height! All one-size-fits-all lab reference ranges are much the same. For example, the standardized "reference ranges" in the US serve as a one-size-fits-all "ideal range" applied to everyone, despite genetic differences, varying latitudes, and the diverse diets that characterize the American multiethnic population. This presents the first problem with using a single range for all people: variations among individuals based on differing genetic needs. The second issue is that the ranges on the lab report indicate the minimum levels necessary for survival, not necessarily the healthiest blood levels for most individuals. Another example of one size doesn't fit all is the reference range for women's hormones. A range is displayed for cycling women, but there is no healthy range for menopausal women. Does the range displayed refer to menopausal women with HRT, or menopausal women without HRT to treat their menopausal symptoms? Is the range based on what is healthy, or what is average? We aren't sure. Labs don't ask patients questions that could help interpret lab values. Therefore, they cannot provide a truly diagnostic reference range for any illness. They only consider gender and age, as reference ranges are solely adjusted for these two factors. A doctor must interpret individual lab results alongside a patient's medical and surgical history, including established diseases, medications, supplements, hormonal treatments, and past lab values. For instance, laboratory companies should offer reference ranges based on whether a patient is menopausal, a woman is undergoing ERT, a man is receiving testosterone, a patient is on thyroid medication, a person is being treated for diabetes, or the diabetic tests are performed to diagnose diabetes. Some Reference Ranges are Based on comparing results to Misleading formulas The best example of this issue is the Lipid Panel. Doctors use this panel to determine a person's risk for heart attacks caused by atherosclerosis. Most doctors don't know the formula for determining Total Cholesterol. This test doesn't predict heart disease in most patients, as the formula used to arrive at that number is not indicative of the disease. However, doctors have been advised that when total cholesterol levels are high, a patient should start taking a statin, a drug that reduces blood cholesterol and sometimes lowers the rate of heart attacks in certain individuals, though it is rarely predictive in 50% of the population. The problem with the lipid panel is twofold: the LDL level indicates future atherosclerosis in only about 50% of the population and is not a specific test for future heart disease risk. Total cholesterol is even less predictive of heart disease because it stems from a flawed formula. Doctors interpret a high Total Cholesterol level as an indication that a patient may be at increased risk for heart disease in the future. When I test patients with elevated Total Cholesterol or high levels of LDL using a Cardiac Calcium Scan to measure plaque, only half of them actually produce plaque, and consequently, are not at risk for atherosclerotic heart disease. I believe that the Total Cholesterol number is derived from an inaccurate formula for determining a person's risk of future heart disease. The Total Cholesterol number is calculated using a flawed equation. The equation is as follows: LDL + 1/5 Triglycerides+ HDL = Total Cholesterol Total Cholesterol = LDL (bad cholesterol) + 1/5 Triglycerides (high risk factor) + HDL (good cholesterol) Let's examine this formula simply like this: Bad + Bad + Good does not equal Bad. Due to this incorrect formula, thousands, if not millions, of patients have been prescribed statin drugs for a lifetime without justification! Statins carry risks. The list of side effects is extensive and includes muscle deterioration and statin-associated dementia. Unfortunately, most people who experience statin side effects are women. Women tend to have higher HDL levels than men. Additionally, they typically do not have atherosclerotic plaque until menopause and usually do not develop it after menopause if they undergo estrogen replacement therapy! This gender issue is just one of the problems with laboratory reference ranges that are not adjusted for sex. The total cholesterol values were developed solely from the blood levels of men, who typically have lower HDL levels. Women were excluded from the tests conducted to create this blood panel. For women, I dispel the myth that high total cholesterol predicts heart disease by recommending a Cardiac Calcium Scan to check for plaque. If a woman has no plaque by the age of 50 and is taking estrogen, she is unlikely to develop plaque in the future. I still test them every 2-3 years to ensure that no metabolic changes have altered their risk, but I don't put much faith in the unreliable cholesterol blood panel. There is another blood test that has deceptive reference ranges: IGF-1 How about the GH-IGF-1 test, the test for Growth Hormone? IGF-1 is a metabolite of GH that we can measure to determine how much the patient produces. This hormone aids in healing and replenishing aging cells in patients after their growth is complete. The healthy normal range with which I was trained, (150-350 MIU), has been changed to an age-adjusted normal that compares a person to others in her age category who had their blood drawn the previous year. What is wrong with this? Growth hormone (GH) decreases with age and contributes to the declining health people experience as they grow older. Similarly, IGF-1 diminishes with age and illness, which means that the "reference range" essentially reflects that you are "average for the sick individuals who visit Quest to have their IGF-1 levels checked. " IGF-1 levels can be enhanced through weight loss, testosterone replacement, and an increase in muscle mass. The current reference range does not indicate health or illness; it merely shows whether you fall within the average for your age group. This non-scientific method of determining "health" is widespread in contemporary medicine. By comparing aging individuals to others within the same age group, for hormones that decline with age, based on samples from sick patients who visit a specific lab in the past year, these labs label patients as "healthy" even when they are as ill as other individuals their age who go to that lab! This practice constitutes age discrimination! Regarding hormones, the levels we maintained during our fertile and youthful years correspond to the blood levels indicative of health in all individuals ages. For example: People who check their IGF-1 (Growth Hormone) levels and see a low "52 ng/ml" might feel satisfied that they are within the standard range (50-280 ng/ml). However, they may not realize that this range applies to older, unhealthy individuals, not to healthy young ones (150-350 ng/ml). This is just one example of the issues that arise when non-medical individuals, who do not monitor these tests regularly, draw conclusions from the numbers. Some illnesses require more than one blood test for diagnosis If you consider only one of the three tests for diabetes or prediabetes (Fasting Blood Sugar, HbA1c, and Insulin), you cannot self-diagnose as diabetic, prediabetic, insulin resistance or healthy. Diabetes is a disease that has coincided with the rising number of obese individuals. Both conditions affect nearly 50% of the American population. Blood tests cannot be interpreted accurately unless a patient has fasted for 12 hours; all three tests should be evaluated. When diagnosing diabetes and insulin resistance, we perform three tests to assess whether a patient has insulin resistance, prediabetes, or diabetes. These tests guide our diagnosis and inform the treatment we provide based on their results. Fasting insulin is a highly misleading test. Over 15 years ago, a significant study was conducted that was believed to change the reference ranges for fasting insulin. The new range set for normal fasting insulin was less than 10 mIU/ml. By publishing the reference range less than 18 mIU/ml, they miss diagnosing many patients with insulin resistance HBA1C is a test that gives a value of average blood sugar over three months. The results are often used alone to determine prediabetes and diabetes; however, considering all three aspects makes the diagnosis and treatment plan more specific for the patient. FBS (fasting blood sugar) is the third diabetes test. It is generally used as a screening test that prompts the ordering of the other two blood tests; however, some patients exhibit symptoms of diabetes and insulin resistance without having elevated fasting insulin levels. Many medications can raise diabetic test values, causing a patient to seem diabetic when they are actually experiencing a side effect of the drug. One such medication is Atorvastatin. The solution is not treating diabetes but rather adjusting the medication. Hormone tests are especially challenging to interpret, Especially when testing free Testosterone in women Here are the problems with the free Testosterone test itself: Women have extremely low levels of free testosterone and testosterone compared to men. I have been informed by Quest that women's free testosterone levels are not reliable with current methods because they are not always reproducible when a test is conducted twice on the same day. This leads me to believe that hormone levels do not always reflect the actual blood levels of free testosterone and estradiol. The levels of testosterone in women are based on menopausal levels of T. Women have long been thought to not produce testosterone, so the "normal" levels are quite low, and 0 used to be considered normal- until one day I managed to persuade a medical director at Quest to increase it to 0.2! Women's testosterone is influenced by their production of E2 and E1, which inactivate free T. Women vary in how their cells respond to testosterone and estradiol. Receptor sites and their genetic acceptance of hormones can mean that the same blood level of testosterone in both sexes does not produce the same effects in all patients. Some women (and men) are resistant to E2 and T, or to one of the two. This indicates that the hormone-free T level may be optimal for one woman while being ineffective in alleviating any low T symptoms for another. The latter individual is T resistant, and we currently have no means outside of research labs to determine which women are sensitive and which are resistant. This requires that doctors and NPs look beyond typical reference ranges to effectively manage E2 and T replacement for women. Lastly some labs use the total testosterone level through a formula determine the free T. This carries inherent risks of reporting the wrong active level of testosterone. Total and free testosterone blood levels for men, are derived from results of older men, rather than from the blood levels that indicate health and the levels at which men experience no symptoms. This leads men to believe they are normal, even though they are symptomatic, and they can't get treatment. There is no time to discuss the reference ranges for LH, FSH, Estradiol, and Estrone; these topics will be addressed in a future blog. I hope I have encouraged you to review your blood work with your doctor or Nurse Practitioner, and not to act as your own doctor by interpreting your blood tests.

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog The newest miracle drug for weight loss is changing the lives of thousands of people who have battled obesity for extended periods of time….These GLP-1 medications are also treating or preventing the diseases that go with long term obesity: Diabetes, Heart Disease, Joint replacements, Arthritis, Sleep Apnea, and Alzheimer's Disease. Researchers are finding more indications every day for patients to take these weight loss medications. But like anything else there is no perfect answer to any problem. Among the few side effects of this drug, the most frequent side effect is reflux, also called acid indigestion, or GERD (gastroesophageal reflux disease). Often my patients don't even know what their diagnosis is, they just tell me about their symptoms. The symptoms of GERD include: Asthma symptoms A bad taste in the mouth Difficulty swallowing Dry, hacking, cough Chest pain after meals These symptoms are worse after a big meal, at bedtime, after spicy food, or dose related. Most of my patients don't want to discontinue the GLP-1 inhibitors because they are finally losing weight! We manage the GLP-1 side effect of GERD by decreasing dose of the medication and slowly increase the dose back to an effective level. We also offer lifestyle and dietary treatments before we offer prescription medication. Therefore, if reflux is not constant, and is not causing any lasting damage to the patient's esophagus, we can treat it with lifestyle changes and over the counter medication, to lower the stomach acid that is refluxing into the esophagus. The lifestyle changes patients can employ on their own are described below. Lifestyle changes needed to avoid or treat Gastric Reflux caused by GLP-1 agonists. What can you do to prevent and treat this side effect: Eat smaller meals: Large meals expand your stomach and put pressure on your lower esophageal sphincter (LES). Don't go to bed less than 2 hours after eating Avoid trigger foods see below Sleep on your left side Elevate the head of your bed Avoid tight clothing: Chew your food well– chew each bite for 20 seconds. Quit smoking: Smoking weakens your LES and makes your stomach more acidic. Stop drinking alcohol Chew (non-mint) sugar-free–gum In addition to changing your active lifestyle, changing your diet is necessary as well. There are trigger foods to avoid minimizing your reflux symptoms. tomato sauce and other tomato-based products high fat foods, such as fast food and greasy foods fried foods citrus fruit juices soda-diet and regular Caffeine Garlic onions mint of any kind milk based products My patients ask me, "So what can I eat?" …I admit I did take away some of the most exciting foods, however my patients ask me what they can eat so the list of foods that help avoid and treat GERD are listed below. High-fiber foods: vegetables, fruit, and whole grain bread. Alkaline foods. Foods fall somewhere along the pH scale (turns litmus paper blue). Drink alkalinized water (PH > 8) Ginger—fresh sushi Ginger from Asian food stores. Apple cider vinegar on salads and a Tablespoon in water every morning Lemon water—just squeeze a slice of lemon in your water. Coconut water Honey. Lean Protein including meat Low-Fat and Nonfat Dairy Products. Non-Citrus Fruits like apples, pears, bananas, and melons Vegetables like broccoli, Carrots, Corn, Cucumbers, Green Beans, Green peppers, Potatoes and Sweet potatoes For my patients who take herbal and other supplements, the following is a list of the supplements that may decrease your symptoms of GERD. Chamomile Tea Licorice Marshmallow Slippery Elm Tablets Probiotics-Mega Brand Prebiotics-Mega Digestive Enzymes Aloe Vera Juice Baking Soda Magnesium glycinate What happens when you have made all the lifestyle changes you can and have lowered your GLP-1 dose or changed to a different type of GLP-1 Agonist, and you still have GERD? As a physician I prescribe medications to help my patients treat their GERD, however most of the medications have been placed over the counter so I can recommend them to my patients, and they can buy the medication without a script. The class of medication that treats GERD include Antacids, H2 Blocker, and Proton Pump Inhibitor. Antacids neutralize stomach acid, but they typically only work for short periods. They are generally made of calcium. This type of medication is best used prn for symptom relief. Side effects of antacids may include constipation and diarrhea. The second option for treatment of GERD is an H2 blocker. These drugs reduce the amount of acid the stomach releases. Eg. Pepcid, Tagamet, Gaviscon. Proton pump inhibitors (PPIs): These drugs are available by prescription from a healthcare provider, and now some doses are over the counter. PPIs help reduce the amount of acid the stomach makes. They should be used for a two-week period only for severe attacks and then you should change to an H2 blocker or antacid. WHY stop a PPI after 2 weeks? Omeprazole is an example of a PPI. Theses medication kill the good bacteria in your intestines, change your breath and can affect how you absorb your nutrients. If you must take them chronically to treat and prevent the progression of damage to the esophagus. What if I did everything and GERD is still a problem: If your condition is severe, your doctor may recommend a consultation with a GI doctor for an endoscope or other diagnostic procedure. In addition, you may have to hold your GLP-1 Agonist for a period of time while you treat your esophageal inflammation. Just as in all medical issues there are many ways to treat side effects of drugs. Your provider will prescribe the medication that she or he is most comfortable with. What next? So if you have reflux and are on a GLP-1 inhibitor, you may be advised to decrease your dose or switch to Tirzepatide medication (Mounjaro, Zepbound). There are many steps you can take before you need prescribed medication. Your doctor may even change your GLP-1 agonist prescription or refer you to a GI doctor, but before this is necessary you should try the lifestyle and dietary changes that I recommend in this Blog first. This side effect of GLP-1 agonists doesn't affect every patient and can be managed as you see above, however the lifestyle changes and dietary changes can only be done by you, so the ball is in your court!

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog I am not sure if you play THE "WHAT'S THE DISEASE THAT I DON'T WANT TO HAVE GAME with yourself, but since I am a doctor I have spent a lot of time thinking about what diseases I do not want! I started my list in medical school when I witnessed what certain diseases can do to your life. Medicine has many cures and treatments, yet some diseases that are treated still can negatively change your life forever. Even though losing a limb and amputation were at the top of my list there is one disease that tops my list. Of course, I also have under stroke the usual scary situations like paralysis, or having an incapacitating heart attack that prevents an individual from taking care of himself or herself. However, my most feared diagnosis is having a STROKE! You may not fully comprehend how a stroke can change your life, but it can affect your speech, your ability to move, to think, to go places, to have a sense of humor, to write and communicate, even to have a sexual relationship with your loved one. A stroke essentially can take away your ability to be the person you have always been, AND it requires that someone must become your caretaker. That helplessness is something I am most afraid of….We all have our personal fears, but whether you fear having a stroke or not, you should try your hardest to avoid having one! DEFINITION: a stoke is a medical emergency that occurs when blood flow to the brain is blocked or a blood vessel bursts. This can damage or kill parts of the brain, which can lead to long-term disability, brain damage, or even death. This can cause s a loss of function, physical, mental, and emotional, and loss of one or more of the senses like sensation, speech, sight, hearing and taste and smell! In my practice at BioBalance Health we always work with our patients to prevent them having a stroke and or heart attack. These two conditions are the biggest villains that steal the joy of our "golden years" from us. From the start of my BioBalance Health practice, I have incorporated healthy diet training, exercise options and encouragement, how and what to take to supplement my patients' diet and how to outsmart their genetic makeup so they can be healthier than their parents. All of these lifestyle changes can decrease the risk of stroke and heart attack in a person. So what is it like to have a stroke? First let's go over what symptoms are typical of someone having a stroke. The symptoms of a stroke are multiple, and a person might not have all of them. Weakness on one side of the body Facial drooping on one side of the face Dizziness Numbness Loss of balance Sudden loss of vision. Trouble making sense when speaking Trouble talking, reading or understanding Sudden nausea and vomiting Brief loss of consciousness such as fainting, seizures, confusion, or coma. When someone has one or more of these symptoms it is an emergency, and you should call 911, then start asking the patient to open their eyes, smile, raise both arms and hold them up. Ask them to talk to see if their speech is impaired. Your findings will be helpful to the EMTs who come to the scene. An event is called a stroke, when there is a deficit in physical or mental function and that deficit continues and doesn't go away. If it the symptoms completely resolve, it is called a TIA- a transient Ischemic attack. It is a warning to see a doctor and make sure you don't have a stroke in the future and it is a wakeup call to stop all poor lifestyle choices. PREVENTING A STROKE: This last month, the American Heart and Stroke prevention Association released new Guidelines on how to prevent a stroke. I think talking about the risk factors for stroke and discussing how to prevent having one, is worthy of discussion. Recently the medical guidelines for stroke prevention have been revised, and even though I think a few more things should have been included, the fact that they made the first change in the guidelines in 10 years is a first step. Here is what they advise all people who are aging should do. #1 See your internal medicine or Family physician regularly, at least yearly #2. Stop sedentary behavior—walk/exercise/ do Yoga, just get out of the chair for the majority of your day! #3. If you are diabetic, they advocate going on Ozempic/Mounjaro to lose weight—that will lower your risk of a stroke, and heart attack.. #4 If you are hypertensive, take your BP medicine every day #5 Follow these lifestyle changes called Life's Essential 8: Your behavior and lifestyle put you at risk for having a stroke: Healthy diet, low carb Mediterranean diet, no junk food! Physical activity every day Achieve a healthy weight, Make sure your sleep is restful Stop use of tobacco products, No smoking or vaping Achieve healthy levels of blood glucose, and blood pressure. Don't drink more than one 4 oz glass of wine a day I add these recommendations to theirs for the care of my patients: Drink ½ your weight in water every day Wat at least half your weight in grams of protein a day Get a Cardiac calcium scan to see if you have arterial plaque. If you do have plaque (arteriosclerosis) then you are at risk for stroke as well. See a cardiologist to be treated preventatively and tested. Option other than a cardiac calcium scan, get a carotid ultrasound to make sure you don't have plaque in the neck vessels that lead to your brain.. Make sure your Homocysteine level is normal ( Take vitamin D3 and K2 to lower your risk of stroke. Women should take non-oral estrogen after menopause Take Testosterone pellets to decrease your risk of stroke caused by loss of elasticity of the vessels. Take Arteriosil® or Neo 40 every day to improve the nitric oxide in your arteries so they dilate, like when you were younger. Make sure you take electrolytes when you are sweating or working outside in the heat. Every third bottle of water should have NUUN sport or another electrolyte additive to prevent dehydration which raises pulse and lowers blood pressure (in a bad way) causing you to faint or have a stroke. Lower your cholesterol by treating a low thyroid, and or limiting your intake of carbohydrates (food from animals is ok, so are eggs and milk products) Decrease inflammation (which damages your blood vessels) by losing weight, exercise, supplements that lower inflammation. If you have done all of these things then monitoring your arteries with yearly cardiac calcium CT scans and blood work is a good way to see your improvement!

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog If you feel ignored and unheard by your doctor or nurse practitioner, your feelings are correct! As a group women are not listened to and often dismissed as emotional and not smart enough to understand "complicated" medical information, by the Misogynistic American medical community, the US governmental agencies who make the rules for what women need. If you feel unheard and dismissed by your doctor, your impression is probably right, and you need to vote with your feet and leave that doctor for someone who listens to you and treats your symptoms and conditions that undermine you and your productivity. The Myths that the majority of people believe are created by men and broadcast by premenopausal women and the media who have no first-hand knowledge of the problems that women contend with when they become pre-menopausal. Here are just a few of the lies and Myths that we must contend with. Women love the freedom of being in menopause! No worry about pregnancy or bleeding. LIE Women can't become president's companies or the President of the United States because we are going to hit the red button to destroy the world because we experience PMS before menopause, and after we just can't think or make educated decisions. LIE Symptomatic Menopausal Women are Over-reacting to a "normal" Phenomenon that "strong" women take in their stride. LIE Women complain about menopausal symptoms to get attention. LIE Women's menopausal symptoms are really from psychiatric disease. LIE Women who complain of bleeding all the time don't need a hysterectomy! Just use medication (that doesn't work). LIE Women's menopause symptoms are from behavior problems. They need counselling! LIE Menopause should be a wonderful time of your life! Right! LIE All these LIES are damaging to the women who need medical treatment. We don't need name-calling, subtle dismissal of our symptoms by our doctors, one size fits all non-medical treatment like vitamins and herbs, or basically categorizing our physical symptoms as imaginary or mental which allows doctors to be excused from treating our hormone deficiencies. No sex drive, painful sex, insomnia, fatigue, brain fog, weight gain, fatigue, hot flashes and sleep disturbances, migraines, loss of muscle weight gain and fatigue, depression and anxiety are physical symptoms of menopause and pre-menopause, that can all be treated with estradiol, testosterone and in some cases progesterone replacement. Menopause and the years leading up to it CAN BE TREATED safely and effectively but we aren't offered treatment by the doctors who work for our insurance companies! Refusing to provide the hormones you need at menopause is denying you the treatment for literally losing the hormones that made you, YOU is not only disturbing but scary! Medical care includes the replacement of waning hormones The only differences between menopause and testosterone loss and hypothyroidism, Cortisol deficiency (Addison's disease), Parathyroid deficiency, Growth hormone deficiency in children are all paid for by insurance and doctors willingly treat these illnesses because they are not only paid to do so but they have taken a Hippocratic oath to treat the symptoms and diseases of the patients who come to them. However, in my office I hear the struggles that women have had getting treatment for their symptoms. Their doctors generally use the excuse, "I don't believe in hormones." So, they get out of treating half of their patients over 50. Hormonal treatment isn't a religion, it is a condition that 50% of the population will have in their lifetimes. If your doctor is a PCP Primary Care Physician or OBGYN, then they have the training and the duty to treat you. Sadly, these lies have sculpted how women are looked at in the American and English-speaking countries. Misogynistic beliefs are meant to keep women in a second-class status. The result is ignoring the simplest and the most affordable menopausal treatment -Estrogen and testosterone- and profit from our menopausal pain by serving up very expensive treatments for each of the many complaints secondary to menopause that no women can afford. eg: one drug for dry vagina, another for just hot flashes, a third for4 the mood changes that occur with menopause, and another for osteoporosis. All these symptoms can be treated with a combination of testosterone and estradiol, and you can get your sex drive back too! If you think that your government is going to help you , remember the leaders in US government are mostly men who buy-in to the destructive misogynist group think! Lie #1: Women love the freedom of being in menopause! No worry about pregnancy or bleeding anymore. Menopause might have been a relief from bleeding every month however, we no longer worry about childbearing before menopause since the birth control pill was created in the 1960s. In contrast the women of the first half of the 1900's before Birth control, because menopause stopped women from having unwanted or unaffordable numbers of children. In reality, women living 100 years ago rarely lived past age 45 for women so most women didn't live to experience menopause! Women suffered then but they were gagged by societal rules, and no one cared how they felt after childbearing years. Now we are very integral to society at any age, not just for childbearing, and menopause is not freedom or enjoyable! We need one all encompassing answer. The answer is long-acting estradiol and testosterone pellets that can resolve all these symptoms and make the years of a woman's life after menopause like any other era. Lie #2. Women can't become presidents of companies or the President of the United States because we are too emotionally unstable. Women are portrayed as unreasonable, hysterical and unreliable. LIE! The belief that women can't be a CEO or president of an organization, or of the US, because we are too emotional before menopause, and after menopause we are not competent to make decisions, is based on uneducated beliefs and old wives tales (really old husband's tales). We are more competent than men before menopause because we can think of more than one thing at a time, and act on the information, and because we have outstripped men in high school and college class status for decades. As for after menopause, we are at least as competent to lead if we have our menopause treated as men who are aging and becoming addled. If we had the information that has been kept from us about the treatment for menopause, and if we were encouraged to get treatment instead of disparaged by our doctors of both sex in the US, and the US government, then we could hold any position we are qualified for, probably better than men. Even the "Societies" that say they are for women don't seem to be when they publish articles like the one, I read last week from the Medical Journal called "Menopause" women need counselling not medical treatment for the symptoms that we "imagine".

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog Do you ache all over? Are you weaker every year? Shorter and more bent over? Are your clothes hanging off your shoulders? Do you walk slower and hold on to things as you walk? If you notice these signs in yourself or someone you love it means you, or they are becoming frail. As a physician I had to become a people watcher…. or more accurately an observer of the people around me. Even if you aren't medical people, I am sure many of you are as well…. but being very observant is a requirement for a physician because there are many signs of illness that can be observed just from observing a patient who we I am treating. I always pay attention to how the patient I am consulting with walks, shakes my hand (their strength), and how well they care for themselves, the quality of their speech, whether they look well nourished, over-nourished or frail. All of these individual observations and more, become automatic to me as a doctor. They help me diagnose and treat my patients without a stethoscope or even an x-ray… Today I want to talk about frailty, what it is, and what it means to your doctor and you as a patient. Frailty can be defined as the visible qualities of loss of muscle mass, bone mass, energy, as and strength, as well as thinning of the skin, kyphosis of the spine (standing with your head looking down and your shoulders rounded), slow movements, weakness of strength and voice. Frailty is the visible sign of aging. The opposite of Frailty is the Quality of being robust. When we are young we are strong, energetic, our muscles are visible, our skin is clear and taught, our posture is straight and we appear healthy and strong….when we are young we are Robust! Frailty is the quality of being old and weak, in a catabolic state (or a state of tissue breakdown and "shrinking"). You can equate Frailty with aging, or physically being old. What does frailty mean to a doctor? When we take care of a patient who comes to us for the first time in a frail state we rule in or out a list of diseases of aging and physical problems. These include: Arthritis Osteoporosis Sarcopenia or severe loss of muscle mass and strength Inflammatory diseases like arthritis Heart disease Diabetes Dementia Inability to be independent Doctors must look for illness and decide on a treatment to remedy a disease, but frailty is not considered a disease that has a treatment. It is a sign that a patient is going through the last stage of life. Many studies have been done that equate frailty to a limited life span and a loss of quality of life, but no treatment has been employed by mainstream medicine to delay, avoid or treat frailty. Up to now this is all very depressing, however it is my well founded belief that the loss of testosterone after age 45 in women and 55 in men is the first step toward frailty, however if adequate testosterone is replaced soon after the symptoms of T deficiency starts, then frailty can be avoided as we age, and the eventuality of loss of quality of life will be delayed or avoided all together. It is a fact that nothing other than the hormone testosterone can reverse frailty and stop it from progressing. With T treatment my patients increase their muscle mass, create stronger muscles, and improved their mental and physical stamina. To me this is such an easy one-hormone-answer to actually improve my patients lives, at any stage in the aging process, however the pharmaceutical companies that control American medicine much prefer to treat each symptom with a different drug. There are millions of aging folks in nursing homes who could have maintained their independence, and avoided the use of many drugs if they were treated with testosterone before their frailty reduced their mobility so they need help to perform daily activities of living independently. Sadly, medicine in the US basically gives up on frail and aging patients and we doctors are taught to make frail patients "comfortable", just treating their symptoms without hope of reversing frailty and the outcomes of that condition. Of course, it is much healthier to prevent frailty by replacing the essential hormone testosterone early on, however your doctor will have to think out of the box to arrive at the Testosterone treatment, rather than follow the medical protocols that involve just keeping aging patients "comfortable". Research studies and articles to be read by doctors like the recent one in the New England Journal of Medicine that draws a direct line between aging and frailty, but only concentrates on the fact that frailty portends early death and discussed the best ways to make patients comfortable dictated by the severity of frailty. There is no treatment other than high protein diet and vitamins with physical therapy which will not "treat" this disease. I want to tell you about two very different patients in my practice. The first is a very successful man in his late 70s who came to me seeking weight loss because he had been an athlete and still enjoyed playing golf, but he was complaining of weakness and other symptoms of frailty, in addition to looking borderline frail when he first came to me. We did a body composition test, and he had a higher fat mass and a lower that ideal muscle mass which is the way frailty begins. We discussed the fact that weight loss (fat loss) obtained by more exercise and less carbohydrate in his diet might improve his Pre-diabetes and inflammation, but would not make him stronger, or increase his physical and mental stamina, in other words reverse his beginning frailty. He chose to embark on an exercise-based weight loss program combined with a high protein low carb diet. In the end he did not take my advice about the best way to lose weight without losing muscle which would have been to add Testosterone and Metformin to his treatment plan, however he wanted to be the one directing his own care (he was a business man and not a doctor) without a basic knowledge of physiology, or nutrition, or any training about aging and frailty. Let me note that if he was younger than 55, and he tried this weight loss program while he was making adequate Testosterone, he might have had a successful fat loss program and gained muscle density and strength while he lost fat, however, this gentleman is 78. You can guess the end of the story. He did lose weight, however he lost as much muscle as fat and was even weaker after 6 months. This is sometimes what happens when very successful people in one area of life think that makes them brilliant in all disciplines. Now, the flipside of the coin. I will tell you about an 82-year-old doctor who came to me almost too late. His much younger wife was already my patient, and she encouraged him to have a consult with me to see what I could do for him. He had the right attitude, but was already frail, and I could feel the humorous bone of his arm, when I ushered his into my office for his consultation. I explained what observing him and his lab told me more while he told me that he had almost every symptom of aging, and frailty. He told me that he was an athlete in college and that he always had a lot of muscle, and he watched every day as his muscles "melted away", despite his exercise daily. He was frustrated and had trouble with his memory as well because he had lost his testosterone long ago and he had done well for as long as he had because he had eaten a nutritious diet, taken supplements and worked out daily. We discussed his other medical problems, and some treatments for them, additional supplements to assist in building muscle and bone strength. He came back 5 months later after he had his T pellets inserted and he walked in with confidence, and the difference in his muscle mass was visible! He was no longer "frail looking". He told me he was thinking better, not completely yet, but his mind was getting progressively better. He had lost fat and gained muscle. He had turned the clock back 15 or more years. Testosterone in the right dose and delivery system can erase frailty and give a quality of life back to my patients who had no help from other doctors. Look around you if you aren't yet at the age that carries with it frailty or if you are without Testosterone and are experiencing frailty…look at those around you in the doctor's office or when you are waiting to board a plane…look at the pre-borders who can't walk the length of the ramp to the airplane and see if they have the visible characteristics I am talking about. If you are over 45 and female or 55 and male and not on Testosterone maybe you should consider having your testosterone replaced so you can keep your muscle mass and independence as long as you live.