Drs Cady and Gabhart of the Cady Wellness Institute deliver a "command performance" at the Kannise Hair Salon in Owensboro - apparently a hotbed interest site for information pertaining to thyroid dysfunction in women. (Hair stylists hear about it all the time!). This was a fun example of staff at CWI "taking it on the road" out to our communities to educate the lay public on topics of self-empowerment.

1. Two Docs Talk:
Thyroid, Adrenals & Sex
Hormones - A Balancing Act
Louis B. Cady, MD – CEO & Founder – Cady Wellness Institute
Adjunct Professor – University of Southern Indiana
Adjunct Professor – Indiana University School of Medicine
Whitney W. Gabhart, ND
Cady Wellness Institute
Kennise Salon - Owensboro, KY
April 30, 2012

2. Orientation to this talk
• Sketch in the fundamental differences
between “wnl” and OPTIMAL
• Quick review of hormones having to do with
FATIGUE and DEPRESSION:
– Thyroid
– DHEA
– Testosterone/estradiol/progesterone
– IGF-1 (“food soldier” of growth hormone)
• Exposure to the literature/stimulation

3. American Journal of Health Promotion;
November/December, 2002
66% 19% of those
18.8%
“Incompletely healthy” surveyed were
completely
completely
unhealthy,
healthy with
defined as
high levels of
having low
both physical
levels of health
and mental
with high Two-thirds of the adults health and a
levels of reported some low level of
illness. degree of mental
illness.
or physical
illness that kept them
from being completely
healthy.
OPTIMAL
“Incompletely healthy.”
DEAD
HEALTH continuum

4. VISION: “We dramatically
transform the lives of our
patients and clients to levels of
peak physical and mental health,
supporting a lifetime of
maximum performance and
happiness.”

5. Critical area of concern for men &
women. Things that will make them:
• Tired &/or depressed
• Unable to cope
• “Mean”
• Stressed
• Demented
• Deficient in libido or in the bedroom

6. How would you take care of a classic?

7. “Age management” “Conventional practice”
There are fuel additives No fuel additives should
we can use to keep our be used. They are
cars burning cleaner and unnatural. Gas is all that
preserve engines. is required.
We should use optimal The quality of the gas is
quality of gas. Cheap gas irrelevant. Anything that
causes “pinging” which is the motor will burn is
hard on the engine. adequate.
We should take our car in Preventive maintenance? This
for preventive is silly! Wait until something
breaks, then have the car
maintenance before
towed in so the mechanic can
anything breaks.
really tell what is wrong.

9. Toward an INTEGRATED approach:
Traditional INTEGRATED
Optimal Health
No Disease = Health
Medicine Medicine
Forestall and
Diagnose and PREVENT Disease –
Treat Disease Optimize Mood &
Death
Function
New Drugs Functional
New Surgical & Informed
Techniques Lab Testing
Vitamins, HRT, Nutrition, Exercise

10. Interesting lab values – Cady – 3/11/03:
Lab Value Cenegenics Normal
a.m.glucose 87 mg/dl 65 – 85 65 – 109
Fasting insulin 3 u U/ml <5 <20
HgB A1C 4.9 % <5.1% < 6.0 %
Cholesterol 241 mg/dl <200 <200
Triglycerides 42 mg/dl <120 <150
Cor. Risk ratio 3.3 <4.0 Av = 5 – 6
Homocysteine 7.9 <8.0 5.4-11.4
DHEA-S 148 350 – 500 59 – 452

13. Modern Medicine’s Paradigm:
Two Standard Deviations – “if you are not
sick, then you must be well.”
“NORMAL”
OPTIMAL

14. 4

15. “But the doctor told me my thyroid
was fine.”
• Can be “wnl” but suboptimal.
• TSH frequently only thing checked.
• Nothing known about Free T4 or Free T3.
• Free T4 can be converted to Reverse T3 under
stress (cortisol)
• Free T4 can be underconverted to T3.
• Can have normal levels (or slightly elevated
levels) of everything and have auto-immune
thyroid disease.

18. “the foot soldier” “the evil twin”

19. “Thyrotropin (Thyroid-Stimulating
Hormone or TSH). Measuring TSH is the
most sensitive indicator of
hypothyroidism.” (hunh?!)
http://www.umm.edu/patiented/articles/how_serious_hypothyroidism
Accessed: 9/5/2011

20. Rev T3
Se
CORTISOL
“the foot soldier” “the evil twin”

21. Yes, T-3 DOES get into the brain
(Transthyretin = carrier protein)
Or: The idiocy of T4 only thyroid treatment…
• Terasaki, T. and Pardridge, W.M.: Stereospecificity of triiodothyronine
transport into brain, liver, and salivary gland: role of carrier- and
plasma protein-mediated transport. Endocrinology, 121(3):1185-1191,
1987.
• http://www.kingpharm.com/uploads/pdf_inserts/Cytomel_PI.pdf.
• Mooradian, A.D.: Blood-brain transport of triiodothyronine is reduced in
aged rats. Mech. Ageing Dev., 52(2-3):141-147, 1990.
• Cheng, L.Y., Outterbridge, L.V., Covatta, N.D., et al.: Film
autoradiography identifies unique features of [125I]3,3'5'-(reverse)
triiodothyronine transport from blood to brain. J. Neurophysiol.,
72(1):380-391, 1994.
• Rudas, P. and Bartha, T.: Thyroxine and triiodothyronine uptake by the
brain of chickens. Acta Vet. Hung, 41(3-4):395-408, 1993.

22. “No duh” obvious thyroid teaching
points:
• You must get ALL of your thyroid checked -
(not just “TSH.”)
• Stress and/or selenium deficiency can
PROFOUNDLY alter it.
• Do you want “normal” or “optimal”?

23. Fatigue from Adrenal FAILURE- The Worst
Case Scenario:
Addison’s Disease

24. Signs & Symptoms of Adrenal FATIGUE
• Difficulty getting up in a.m.
• Ongoing lethargy during the day.
• Continued fatigue not relieved by sleep.
• Craving for salt or salty foods.
• Increased effort to do daily tasks
• LESS PRODUCTIVE
• Decreased sex drive
• Decreased ability to handle stress.
• Light-headed when standing up quickly
• Increased recovery time for illness
• Generally less happy about life.

25. “Hypoadrenia”: The Adrenal Problem that most
conventionally trained physicians don’t know about.
• Non-Addison’s hypoadrenia
• Subclinical hypoadrenia
• Neurasthenia
• Adrenal neurasthenia
• Adrenal apathy
• Adrenal fatigue
• “Adrenal burnout”
• “Chronic fatigue syndrome”?!!

26. “Where did this new-fangled
diagnosis come from, anyway?”

28. Case report:
• 55 year old male entrepreneur
• Runs company with 200 employees – multi
hundred million dollar budget
• Stressed with economy
• Very tired in the a.m.
• “Crashes” at night.
• Still golfing, exercising.
• Looks marvelous.

29. The state of adrenal exhaustion can
be determined
Early-stage Chronic Mid-stage Chronic End-stage (exhausted)
Stress Response Stress Response Chronic Stress
Response

30. DHEA – the critical hormone most
doctors never check
• Produced in the adrenal cortex
– Humans and primates are unique in secreting large
amounts
• Immune system booster
• Insulin regulator
• Energy increase – remarkable
• Boosts growth hormone
– 20% in men; 30% in women in one study
• [Yen, Morales Khorram – one year double-blind placebo
controlled crossover experiment – with 100mg DHEA]

31. 334 citations on “DHEA with energy” – as of
07 29 2011

32. Other functions of DHEA
• Boosts immune system
• Sensitizes insulin receptors to work better
• Neuroprotective
• Has antidepressant effects – known to
decrease suicide risk
• Helps with bone retention in all ages of
women

33. Why isn’t adrenal fatigue diagnosed?
• Not a medical emergency.
• Patient is blamed”
– “just neurotic”
– “avoidant”
• “Functional medicine” testing not
typically done (& rarely is DHEA-S
checked)
• Modern medicine focuses on
NORMAL, rather than OPTIMAL.
function.
• “Bell Curve” paradigm

34. Modern Medicine’s Paradigm:
2 Standard Deviations – a model
“NORMAL”
OPTIMAL

35. “Women’s issues”

36. One destigmatizing notion:
Estrogen as MAOI
• Estrogen & Testosterone (!) decrease
MAO
– Luin, VN. Brain Res. 1975;86:273-306
• Platelet MAO levels inversely
correlated to estradiol levels
– Klaiber EL et al. Psychoneuroendo-
crinology. 1997 Oct;22(7):549-58.
• Estrogen decreases MAO-A & MAO-B
– Holschneider DP et al. Life Sci. 1998;63(3):155-60

37. Estrogen-related mood disorders –
reproductive life cycle factors.
Douma SL et al. Adv. Nursing Sci. 2005. 28 (4):364-375
• “Clinical recovery from depression
postpartum, perimenopause, and
postmenopause through
restoration of stable/optimal
levels of estrogen has been
noted.”

38. Symptoms of estrogen imbalances*:
 Hot flushes or flashes; night sweats
 Mood swings
 DEPRESSION, and/or anxiety, panic attacks
 “Concentration” issues: Memory, communication,
and attention span loss, “brain fog.” (Think:
“MORE MAO.”)
 Insomnia
 Weight gain – “appetite changes”
 SOMATIC symptoms : aches and pain
 General deterioration: Incontinence, digestive
disturbances, sensory function loss, aging skin . . .
thinning, wrinkles, sagging* Adapted from Whitney Gabhart, N.D.

39. Psychoactive Progesterone*
 Increases energy and libido
 Has a calming effect, acting like a
benzodiazepine to the brain (HS dosing)
 Enhances mood
 Balances blood sugar (appetite)
 Regulates fluid balance, sodium mineral balance
 Necessary for fertility
 Helps relieve menopausal symptoms
 Decreases risk of endometrial cancer and may help protect
against breast cancer, fibrocystic breasts, and
osteoporosis * Adapted from Whitney Gabhart, N.D.

40. Testosterone: The “sexist” bias
against women
• Fall in the circulating testosterone and the adrenal
preandrogens most closely parallel increasing
age.
• Accelerated decrease occurs in the years
preceding menopause (like estrogen).
• Their loss affects: libido, vasomotor symptoms
(hot flashes), mood, well-being, bone structure,
and muscle mass.
– Burd, Bachmann. Androgen replacement in menopause.
Curr Womens Health Rep. 2001 Dec; 1(3):202-5.

41. Traditional vs.
Bio-identical “HRT”:
• Synthetic means that the molecule is not
natural to the human body.
• Bio-identical hormone is one whose
molecule is identical to that made by a
human organ.
SV2003- 41

42. Women’s Health Initiative Study
• Flawed study - it was designed as a
“Premarin & Provera” study, not a
bioidentical estrogen study.
• Premarin is a non-bio-identical
substance
• Provera is a non-bio-identical
substance
• Premarin is an equine derived array
of 30+ female horse hormones.
SV2003- 42

43. Women’s Health Initiative
Study
• The results presented did not justify
their overall broad conclusion:
• “Premarin & Provera yielded these
findings; therefore, Hormone
Replacement Therapy is not
appropriate for women.”
SV2003- 43

44. Women’s Health Initiative Study
THE PARTICIPANTS:
• 2/3 of the women in the study were older
than sixty
• Of these women, most were first-time users
of HRT.
• Had already experienced cessation of
endogenous hormone production (for a
DECADE!!!), therefore, at risk for:
– Heart attacks, strokes, clots, cancer
SV2003- 44

45. Women’s Health Initiative Study
Facts You Should Know
• In the first 1-3 years there was a higher
incidence of M.I.’s.
• Patients who stayed on that program
beyond the 8th year started to actually
outperform women on placebo.
• WHY????
SV2003- 45

46. Women’s Health Initiative Study
Facts You Should Know
• When the W.H.I. Study was
organized, the subjects were not
prescreened for heart disease.
• Without prescreening, a group of
women was included with pre-
existing heart disease.
•
SV2003- 46

47. Hx of Baseline Health Characteristics
(total # of participants 16,608)
Disease HRT Placebo
Hypertension 37% 3039 2949
High Cholesterol 11% 944 962
Myocardial Infarction 2% 139 157
Angina 288 234
Stroke 61 77
Embolism 79 62
Family Breast Cancer 1286 1175
Diabetes 374 360
Fracture 1031 1029

48. Traditional vs.
Bio-identical “HRT”:
• Premarin raises C-reactive protein
significantly.
• CRP is an inflammation marker.
• Inflammation is either the root
cause (e.g., rupturing plaque), or a
strongly contributing cause, of both
Cancer & Heart Disease.
SV2003- 48

49. Some of the “10 reasons” to be happy
[Studd J. Menopause Int. 2010 Mar;16(1):44-6
• Trans-derm safer than • HRT protects intervertebral
oral discs
– Coag factors not induced in • Est + T helps “reproductive
liver depression”
• Safe for tx of flushes, • Improves energy & libido
sweats, vaginal dryness
• Reduces incidence of heart
• Estrogens prevent attakcs.
osteoporotic fractures –
• Beneficial effects on collagen
should be FIRST
CHOICE rather • Note 1 % increased lifetime
bisphosphonates risk of breast cancer

50. 50’ish year old female, post-
menopausal, on no hormones
• On aggressive supplement regimen with
daily MVI and others
• Not ill
• Top rated medical care with previous labs
done
• Nothing identified as seriously abnormal
• “Just interested in having my hormones
checked.”

55. Treatment for this “normal” patient
1. Armour thyroid – ¼ grain for 1 week, then ½ grain.
(Aiming for T3 in “high 3’s.”
2. DHEA – 25 mg SR micronized, compounded – in
a.m.
3. Progesterone – 50 mg SR compounded – at night.
4. Testosterone – 3mg topical per day x 1 wk, then 6
mg. “Decrease dosing as needed for side effects.”
5. Vitamin D – 5,000 IU twice daily x 3 weeks, then
decrease to one dose per day.
6. Fish oil – 4.6 grams (c. 1660 mg EPA and 1,250 mg
DHA by compound weight, plus misc. Omega 3)

57. What’s life like now?
• “it’s like the colors of the rainbow have gotten more into the
pink.”
• “My computer will survive – I use to ‘lose it’ over
my computer. I would swear obscenities.”
• “I’ve gotten into a zen like mode. Handling
everything that life can throw at me.”
• “It’s almost as if I’ve taken a pill or drug that jus
makes me handle everything that life is throwing at
me. I can roll with it.”
• “I’m not irritable any more. Time pressure has just
one away.”

60. Special needs - Zinc
• Low Zinc- associated with low testosterone
– Per USDA, 60% of US men between 20 – 49
years of age do not get enough.
– N.B.: Do not supplement with > 50 mg daily
(can interfere with Cu+ metabolism)
• Tsai, E.C., Boyko, E.J., Leonetti, D.L., & Fujimoto,
W.Y. (2000). Low serum testosterone level as a
predictor of increased visceral fat in Japanese-
American men.
International Journal of Obesity and Related Metabolic Dis
24, 485-491

61. Testosterone functions (Men AND
Women)
• Enhances sex drive
• Builds muscle & decreases
fat
• Elevates mood
• Prevents osteoporosis
• Improves memory
• Lowers cholesterol
• Protects against heart
disease

62. “Hence, among older men reporting excellent
asymptomatic health, age has no effect on
serum T or E2 with a minor increase in DHT
while obesity decreases serum androgens…”

63. Testosterone (Men)
• Decline in male sex steroids not as
abrupt as menopause, but equally
debilitating
–Between 40 – 70, average male
loses:
• Nearly 2" of height
• 15% of bone density
• 10 – 20 pounds of muscle
• At 70 yoa, 15% completely
impotent

64. Andropause: Characteristics of
Change
• Insidious & unpredictable onset
• Slow progression
• Subtle & variable manifestations
• Cannot be linked directly to a decrease in
the hormone testosterone
• Very different from menopause in women!
• (Hubby reference: www.isitlowt.com)
Charlton R. JMHG. 1(2004): 55-9
Kaufman JM. Endocrine Reviews. 26(2005):833-76

65. T vs Cognitive Function
• 400 independently living men, 40-80yo
– 100 in each age decade
– MMSE 21-30, average 28
– TT: 208-1141ng/dL; Bio-avail T 78-470ng/dL
• HIGHER T = better cognitive performance in
OLDEST AGE category
• Men with lowest 1/5 T = worse than men with
highest 1/5 T
• Highest Bio-available T more significant
than TT, age, intelligence level, mood,
smoking, and alcohol.
Muller M. Neurology. 64(2005):866-71

66. T vs Mood in men
• Study: 278 men, >45yo, followed 2 years
• Compared to eugonadal patients,
hypogonadal men w/TT <200ng/dL had
– 4-fold increase risk of depression
– Significantly shorter time to depression
diagnosis
• Depression risk inversely related to TT
w/statistical significance <280ng/dL
Shores MM, Arch Gen Psychiatry. 61(2004):162-7

67. Treatment options – not just
“the needle”

68. Testosterone and “Prostate Cancer risk”
• Prostate CA found 2.15 & 2.26 times more
likely in lowest compared to highest tertile
of total and free testosterone
• “. . . there are several papers showing a
relationship between LOW testosterone
and prostate cancer. Specifically, low
testosterone has been associated with
high-grade tumors, advanced stage of
presentation, and worse prognosis.”
Morgentaler A. Eur Urol. 50(2006):935-9
Morgentaler A. Urology. 68(2006):1263-7

70. HOW OBVIOUS DOES IT HAVE TO BE?
The Challenge of Empathic Listening
& CREATIVE THINKING
Ron Hunt lost an eye but suffered
no brain damage after a freak
accident with a large drill bit.
(ABCNEWS.com)

71. Do you really want to try 100,000
miles without changing the oil?

72. Definition of ‘normal’ – “where your
hormone levels are as lousy as
everyone else’s.” Neal Rouzier, MD
“NORMAL”
OPTIMAL

73. “For me, the practice of medicine has
opened the door to the greatest adventure in
life. Medicine is like a hallway lined with
doors, each door opening into a different
room, and each room opening
into another hallway,
again lined with doors.
Medicine is always
wonderful and never will
be finished.”
- Charles H. Mayo, M.D.