AAG HEALTH S GUIDE TO HORMONE THERAPY AAG HEALTH w w w. a a g h e a l t h. c o m 1-800-325-1325
Thanks to AAG Health, I m now as active as I was back in my twenties. I ve achieved a level of physical fitness and mental ability I never thought possible. John M. - West Palm Beach, FL 2010 AAG Health - All rights reserved. No part of this publication may be reproduced, stored or transmitted by any means, electronic, mechanical or photocopied or otherwise, without the prior authorization and written permission of AAG Health.
Table of Contents I. What is Hormone Therapy?...2 What are hormones?...3 Get back to feeling great with hormone therapy...3 Do I need my hormones optimized?...4 The first step - detection...5 What exactly are symptoms of a hormone deficiency?...5 Hormone deficiency questionnaire...6 Hormones used in hormone therapy and what they may do...10 II. Hormone Therapy for Men...12 Male Menopause: Fact or Fiction?...12 How can AAG Health help me?...13 III. Hormone Therapy for Women...15 What are bio-identical hormones?...16 Bio-identical hormones: Estrogen, Testosterone and Progesterone...17 What are Menopause, Premenopause, Perimenopause and Postmenopause?...18 IV. An Introduction to HGH Therapy...19 Ask Yourself These Questions...19 What is HGH?...20 Coping with Adult Growth Hormone Deficiency (AGHD)...20 Effects of HGH...20 V. An Introduction to Testosterone Therapy...23 The First Step - Detection...23 What is Testosterone?...24 When Does it Decline?...24 Benefits of Testosterone Therapy...25 Some Facts About Testosterone...26 VI. AAG Health FAQ s...27 VII. What the experts are saying...30 VIII. What our patients are saying...32 VIV. Partial List of AAG Health Advisory Board Members...33 1 www.aaghealth.com
What is Hormone Therapy? As the aging process takes place, hormones in both men and women naturally decline. By the time we reach middle age, hormones may get so low we start to experience problems that affect our mental, sexual and physical health. Some common problems associated with a hormone deficiency are: Reduced libido and sexual dysfunction Increased body fat and decreased muscle mass Fatigue and lethargy Depression, anxiety and irritability Loss of drive, creativity and self confidence Hormone therapy using prescribed hormone medications under a physician s care can alleviate many of the above symptoms. AAG Health specializes in hormone therapy for men and women. Hormone therapy is a medical treatment, focused on regaining and maintaining good health and wellness. Improving your metabolic function and optimizing hormones like testosterone, HGH, estrogen and others, can provide many individuals a better opportunity for a healthy and vigorous life. AAG Health has the knowledge and the expertise to maximize your potential for improvement through physician prescribed hormone therapy. When combined with good nutrition and regular exercise, hormone therapy can have a significant and positive impact on your health. Please take time to read the following information to learn more about hormone therapy and find out if it should be part of your health care strategy. If you have any questions regarding the treatments we offer, or to find a physician in your area who can help you, please call us at 1-800-325-1325. 2 www.aaghealth.com
What are Hormones? Hormones are our body s chemical messengers. Some of the more familiar hormones are insulin, testosterone, estrogen, cortisol, growth hormone (HGH), progesterone and thyroid hormones. They are released by specific glands and travel in the bloodstream to the areas where they do their work. Once hormones are released into the bloodstream they travel to particular target cells to deliver their chemical messages and cause a specific biological response. Hormones affect all aspects of body function including growth and development, tissue repair and regeneration, metabolism, reproduction and even emotional well-being. Hormones exist in a delicate balance and work within the cells accurately and reliably. But hormone imbalances become increasingly common with age and the link between declining hormones and the subsequent decline in our quality of life is well known. I. What is Hormone Therapy? Get Back to Feeling Great with Hormone Therapy Reversing a hormonal decline and boosting sub-optimal hormone levels may be the answer to the problems you are experiencing. If you are feeling burnt out, starting to experience quality of life issues or are just going through the often talked about mid-life crisis, call us to learn about our comprehensive medical evaluation that may show you have a hormone deficiency. Hormone therapy is not for everyone. But those who benefit see significant health and wellness improvements. After years of fatigue, lack of motivation and weight gain wouldn t you like to feel young, lean and energized again? We live in a day and age where we can all benefit from plastic surgery, hair transplants, liposuction and even teeth whitening. An AAG Health hormone therapy is another treatment you should consider to maintain and improve your health and well-being. 3 www.aaghealth.com
Do I need my hormones optimized? You may be a good candidate for hormone therapy if you are experiencing the following: Low energy, fatigue or weakness Declining libido, sexual desire or erectile dysfunction Lack of enthusiasm, drive or motivation Loss of figure or muscle tone Poor focus or concentration If the above apply, you could be living with sub-optimal hormone levels and have yet discovered it! AAG Health has encountered thousands of individuals who have been under diagnosed and even misdiagnosed by their health care providers. This happens because hormone levels are often not checked in a standard blood test. Your doctor may check your thyroid hormones at best, along with the usual blood chemistry, lipid panels and complete blood counts. But in most cases, a simple hormone panel test, to check HGH/ IGF-1, testosterone, estrogen, progesterone, DHEA and others, is completely over looked. Many people are living through their 40 s and 50 s with low hormones and don t even know it. This is the period of life when we need our vigor and vitality most. We have to build our businesses and careers, provide for our families, and live an active healthy life so we can try to fend off age related disease and degenerative problems. What we are striving for is to be disease resistant, physically fit, mentally sharp and maintain self esteem so we can live well. But this is difficult to achieve with low hormones especially when we don t even know that they are low and don t have access to a progressive health care provider. Some of our patients have lived with serious issues related to low hormones and then discovered they were using the wrong medications. After years of using ED meds, anti-depressants, ADD/ADHD medications, synthetic ERT and others, they found no improvement to their health condition at all. It s interesting to note that when these patients started hormone therapy and used hormone medications many of the problems that plagued them for years went away. 4 www.aaghealth.com
The First Step - Detection Blood levels of many different hormones peak during our teens and twenties, then decline throughout life. Lethargy and lack of vitality are early signs that hormones are diminishing. I. What is Hormone Therapy? As we age some hormones decline quickly, such as estrogen and progesterone at menopause, and other hormones decline slowly and steadily over the decades, including human growth hormone (HGH), testosterone, thyroid hormones, DHEA, and melatonin. Your first step to detect a possible hormone deficiency is to get a blood test. Blood testing is the most accurate way to determine whether hormone therapy is medically indicated. Although saliva tests are used by some health care providers, we believe that blood tests allow a much more accurate assessment. Laboratory testing is used to scientifically determine whether hormone levels are normal or have become deficient. If you are a suitable candidate for hormone therapy an individualized treatment plan can then be designed. Call us at 1-800-325-1325 to arrange a blood test. What Exactly Are Symptoms of a Hormone Deficiency? In general, symptoms of a hormone deficiency affect three areas: mental health, physical health and sexual health. In many cases individuals are deficient in not just one but several hormones. On the following pages you will find a series of questionnaires to determine if you have a probable hormone deficiency. Take time to complete each of the questionnaires to see if you would be a good candidate for hormone therapy based on your answers. 5 www.aaghealth.com
Hormone Deficiency Questionnaire The following questionnaires are designed to assess your hormonal health. Allow yourself thirty minutes to an hour to take each relevant questionnaire. Don t take too long on each question but don t rush it either. Testosterone SIGNS & SYMPTOMS (Men & Women) My face has become slack and more wrinkled. I ve lost muscle tone. My belly tends to get fat. I am constantly tired. I feel like making love less often than I used to. (Men Only) My breasts are getting fatty. I feel less self-confident and more hesitant. My sexual performance is poorer than it used to be. I have hot flashes and sweats. I tire easily with physical activity. NEVER SOMETIMES REGULARLY OFTEN CONSTANTLY Add up your overall score : For Women: 5 or less: Satisfactory level Between 6 and 10: Possible testosterone deficiency 11 or More: Probable testosterone deficiency HGH For Men: 10 or less: Satisfactory level Between 11 and 20: Possible testosterone deficiency 21 or more: Probable testosterone deficiency SIGNS & SYMPTOMS My hair is thinning. My cheeks sag. My gums are receding. My abdomen is flabby./i ve got a spare tire. My muscles are slack. My skin is thin and/or dry. It s hard to recover after physical activity. I feel exhausted. NEVER SOMETIMES REGULARLY OFTEN CONSTANTLY I don t like the world. I tend to isolate myself. I feel continuously anxious and worried. Add up your overall score : Overall total is 10 or less: Satisfactory level Between 11 and 20: Possible growth hormone deficiency 21 or more: Probable growth hormone deficiency 6 www.aaghealth.com
DHEA Thyroid SIGNS & SYMPTOMS My hair is dry. My skin and eyes are dry. My muscles are flabby. My belly is getting fat. I don t have much hair in the pubic area (0=plenty; 4= hairless). I don t have much fatty tissue in the pubic area (flat mound of Venus in women). 0=padded/ 4= fat. My body doesn t have much of a special scent during sexual arousal. I can t tolerate noise. My libido is low. NEVER SOMETIMES REGULARLY OFTEN CONSTANTLY Add up your overall score : Overall total is 10 or less: Satisfactory level Between 11 And 20: Possible DHEA deficiency 21 or More: Probable DHEA deficiency I. What is Hormone Therapy? Melatonin SIGNS & SYMPTOMS I m sensitive to cold. My hands and feet are always cold. In the morning my face is puffy and my eyelids are swollen. I put on weight easily. I have dry skin. I have trouble getting up in the morning. I feel more tired at rest than when I am active. I am constipated. My joints are stiff in the morning. I feel like I m living in slow motion. NEVER SOMETIMES REGULARLY OFTEN CONSTANTLY Add up your overall score : Overall total is 10 or less: Satisfactory level Between 11 and 20: Possible Thyroid hormone deficiency 21 or more: Probable Thyroid hormone deficiency SIGNS & SYMPTOMS I look older than I am. I have trouble falling asleep at night. I wake up during the night. NEVER SOMETIMES REGULARLY OFTEN CONSTANTLY 7 www.aaghealth.com
Estrogen Progesterone And I can t get back to sleep. My mind is busy with anxious thoughts while I m trying to fall asleep. My feet are too hot at night. When I get up, I don t feel rested. I feel like I m living out of sync with the world, going to bed late, and waking up late. I can t tolerate jet lag. I smoke, drink, and/or use a beta-blocker or a sleep aid. Add up your overall score : Overall total is 10 or less: Satisfactory level Between 11 And 20: Possible Melatonin deficiency 21 or More: Probable Melatonin deficiency SIGNS & SYMPTOMS (Women only) I am losing hair on top of my head. I m getting thin, vertical wrinkles above my lips. My breasts are droopy. My face is too hairy. My eyes are dry and easily irritated. I have hot flashes. I feel tired constantly. I am depressed. NEVER SOMETIMES REGULARLY OFTEN CONSTANTLY My menstrual flow is light. (0= moderate/1-3=low/4=none). Women with periods: My cycles are irregular, too short (<27 days), or too long (>31 days). Women without periods: I do not feel like making love anymore. Add up your overall score : Overall total is 10 or less: Satisfactory level Between 11 and 20: Possible Estrogen deficiency 21 or more: Probable Estrogen deficiency SIGNS & SYMPTOMS (Women only) My breasts are large. My close friends complained I m nervous and agitated. I feel anxious. I sleep lightly and restlessly. The following questions are for women who have not yet reached menopause, and menopausal women who are taking hormone replacement therapy (estrogen or estrogen and progesterone) NEVER SOMETIMES REGULARLY OFTEN CONSTANTLY 8 www.aaghealth.com
My breasts are swollen and tender or painful before my period. My lower belly is swollen I m irritable and aggressive. I lose my self-control. I have heavy periods. And they are continuously painful. Add up your overall score : Post-menopausal women not treated with hormone replacement therapy (Estrogen or Estrogen and Progesterone): 4 or less: Satisfactory level Between 5 and 8: Possible Progesterone deficiency 9 or more: Probable Progesterone deficiency. I. What is Hormone Therapy? Pregnenolone Menstrual women and menopausal women taking hormone replacement therapy (Estrogen or Estrogen and Progesterone): 10 or less: Satisfactory level Between 11 and 20: Possible Progesterone deficiency 21 and more: Probable Progesterone deficiency. SIGNS & SYMPTOMS I have memory loss. My joints hurt (fingers, wrists, elbows, feet, ankles, knees). I m feeling drained and I have a hard time handling stress. I don t see colors as brightly as before. I have lost interest in art; I don t appreciate art as much anymore. I don t have much hair under my arms or in the pubic area. (0=plenty or hair/4=hairless). NEVER SOMETIMES REGULARLY OFTEN CONSTANTLY My muscles are flabby. I have abundant, light-colored urine during the day. I have low blood pressure. I crave salty food. Add up your overall score : Overall total is 10 or less: Satisfactory level Between 11 and 20: Possible Pregnenolone deficiency 21 or more: Probable Pregnenolone deficiency Many people are surprised to learn that the symptoms they ve been dealing with over the years are really signs of hormone imbalance. Aging is difficult enough for men and women without having to suffer from declining hormone levels. The above questionnaires are an educational experience and not an objective scientific analysis. But if you have scored poorly with your answers, we recommend you take it further and undergo a hormone evaluation starting with a blood test. Call us at 1-800-325-1325 to learn more. Regardless of how you scored, chances are you can do better with simple changes to your diet, lifestyle and mental attitude. However, if you have tried a healthier lifestyle and you re not feeling great or looking good, you may need hormone medications. 9 www.aaghealth.com
Hormones Used In Hormone Therapy and What They May Do... HGH Rejuvenates every cell in the body Aids fat loss and muscle gain Helps the body heal faster Boosts energy to youthful levels Improves quantity and quality of life Testosterone Boosts male and female libido Encourages heart health Helps prevent osteoporosis Fights fat Increases muscle strength DHEA Lowers blood cholesterol Improves heart health Slows onset of progressive diabetes Favorable impact on arthritis Reverses declining mental acuity Thyroid Hormone Controls cell growth and metabolism Helps weight maintenance Improves health and vascular health Renews energy Aids concentration Regulates body temperature 10 www.aaghealth.com
Melatonin Restores youthful sleep patterns Effectively treats jet lag Boosts immune system Estrogen Relieves menopausal symptoms Increases female life expectancy Protects against coronary artery disease Boosts brain function Helps prevent osteoporosis Protects against Alzheimer s disease Improves skin and muscle quality I. What is Hormone Therapy? Progesterone Natural antidepressant and tranquilizer Improves female libido Protects against cancer Boosts thyroid action Helps body use fat rather than store it Helps prevent osteoporosis Pregnelonone Precursor of many other hormones Fights the effects of fatigue and stress Relieves arthritis pain Improves heart health Boosts immune system Protects against coronary artery disease Improves mood and memory Essential to full brain function Protects against Alzheimer s disease 11 www.aaghealth.com
Hormone Therapy for Men Thanks to better healthcare and improved life-style, men are living longer and living healthier. But there is an important men s health issue that mainstream health care is failing to address, and as a result, you may be getting the wrong care and missing out on the right treatment. Modern medicine has made enormous strides in the last 20 years. The diagnostic tools, surgical procedures and advanced research techniques have changed medical care for the better. Open heart surgery finds the patient at home after several days. Many cancers, including prostate and colon cancer, are more treatable and have a higher survival rate. The list of these advances can fill several text books. Hormone therapy programs, utilizing prescribed hormone medications monitored by progressive physicians is quickly taking up place in these text books. Male Menopause: Fact or Fiction? In the past most doctors didn t take hormone treatments for men seriously. Even today many doctors deny that declining hormones like testosterone, HGH, DHEA, thyroid hormones and others can cause problems. Problems associated with low hormone levels: Irritability Sleep Problems Diminished Libido Erectile Dysfunction Muscle Loss Weight Gain Memory Loss Thinning Hair Decreased Bone Density Depression 12 www.aaghealth.com
Many of us are getting to the point where we can really start to enjoy our life but our bodies can t keep up. We ve begun to feel more tired and we have less enthusiasm. We seem to get sick much more frequently. Our sexual stamina and performance are not what they used to be and to add insult to injury we are storing fat in places we never thought possible. If your doctor says, It s a normal part of aging, get used to it or you have to exercise more and eat better or You re depressed, here s a prescription for an antidepressant or take an ED pill, this may not be what you want to hear especially if you ve gone down that road before and it didn t help you out at all. II. Hormone Therapy for Men The experience I had at AAG Health was fantastic. After a complete evaluation I decided on an HGH treatment. The results have been phenomenal. I feel like a new man! - Andrew S., Miami, FL How can AAG Health help me? Starting around age 35, hormones decline and men will experience symptoms of male menopause otherwise known as andropause. Important hormones like testosterone, HGH, DHEA, melatonin and others get so low men experience a downward shift in strength and energy. You may lose your enthusiasm for life s challenges which you previously enjoyed. You start to lose your competitive edge, and you may start to get sick more frequently. Other common problems include: Disorders of mood - particularly anxiety, irritability and depression Sexual function and libido decline - Erectile dysfunction may develop Body muscle mass decrease and breast tissue and waistline enlarge Focus, concentration and brain function starts to decline Fat seems to accumulate and is no longer easy to get rid of Gym workouts require extra effort and results are longer in the making AAG Health s focus is to optimize hormones so you can overcome the above issues in a safe and effective manner. However, a successful AAG Health hormone therapy relies on a healthy lifestyle, including a well-balanced diet, appropriate nutritional supplementation, and regular physical exercise. 13 www.aaghealth.com
AAG Health s treatments are a medical specialty founded on advanced scientific and medical technologies. Based on sound and responsible medical principles, our hormone therapies are provided by skilled physicians and are consistent with those applied in other preventive health specialties. AAG Health hormone treatments are: Well documented. The benefits of hormone therapy for men appear in many peer-reviewed journals including Aging, American Journal of Cardiology, Journal of the American Geriatrics Society, Journal of the American Medical Association, Journal of Clinical Endocrinology and Metabolism, Lancet, and many others. Synergistic. Hormone treatments combined with good diet, nutritional supplements and regular exercise deliver greater results and benefits than by administering single therapies alone. Evidence based. At AAG Health, hormone therapies for men and women are based on a unique process for acquiring data in order to formulate an objective assessment upon which treatment is recommended. Holistic. AAG Health s hormone treatments utilize an organized framework for the head-to-toe diagnostic assessment, and subsequent design of a treatment regimen. When recommending a therapy after a comprehensive evaluation, our physicians will listen to your needs and goals and will work with you to design a personalized treatment plan. Our findings suggest that endogenous testosterone, estrone and free IGF-1 levels may play a protective role in the development of atherosclerosis (coronary heart disease) in aging men. - Dept. of Internal Medicine, Erasmus University Medical Center - Published 2003 14 www.aaghealth.com
Hormone Therapy for Women In this day and age it is quite normal for a woman to balance a career with being a mother, wife and running a home. As a result of these responsibilities, it s easy to forget about your good health and general well being. For most women, being well informed about health and wellness is becoming increasingly important. It s common knowledge that women are far better at visiting their doctors than men and in general, take better care of themselves. You are different from a man in many respects. You have female hormones that can protect you from some diseases yet put you at risk from others. You are vulnerable to osteoporosis, breast and ovarian cancer along with many other conditions. You also have to consider the impact of pregnancy on your body. You have to face menopause, losing your figure and aging skin. Good health is not just about looking good and performing to the best of your abilities, it s also about being informed on what s out there that could benefit you, your health and quality of life. III. Hormone Therapy for Women As we age, hormones like estrogen, progesterone, oxytocin, HGH (human growth hormone) thyroid hormones and testosterone decline. This decline causes an imbalance that can trigger sexual, mental and physical problems. Women in their mid-thirties and forties can suffer from pre-menopause and women in their fifties and beyond can suffer from menopause: Symptoms of Pre-menopause include: Irregular Menstrual Cycle Length Increased Breast Tenderness Irritability, Anxiety & Mood Swings Water Retention Weight Gain Increased Inability to Cope Poor Concentration Reduced Libido/Sex Drive Symptoms of Menopause include: Exercise & Diet Resistance Weight Gain Breast Tenderness & Headaches Anxiety & Tearfulness Hot Flashes & Insomnia Reduced Libido/Sex Drive Fatigue, Mood Swings & Depression Foggy Thinking & Confusion 15 www.aaghealth.com
Traditionally, women suffering from these symptoms have been prescribed a contraceptive pill to regulate periods, or anti-depressants to settle down or benzodiazepines like valium to calm down. This approach does not get to the root of the problem. In many cases a simple hormone therapy program, combining exercise, diet, nutritional supplements and bio-identical hormone medications, if medically indicated, can improve many of the symptoms that aging women suffer from. AAG Health s focus is to optimize hormone levels to address your symptoms in a safe and effective manner. We can help improve your health, performance and appearance, enabling you to get back on track. What are Bio-identical Hormones? Many women have turned to bio-identical hormones as an alternative form of HRT. These are female hormones normally manufactured by our endocrine system, principally the ovaries - estrogen, progesterone and testosterone - which decline as the ovaries stop releasing eggs. By bio-identical, we mean that the biochemical structure of the hormone is identical to the hormone produced in a woman s body. And the origin of the bioidentical hormone is from a natural plantbased source. What took so long for bio-identical hormones to gain acceptance? The answer is that pharmaceutical companies actually developed synthetic estrogens and progestins in order to patent their drugs. True bio-identical hormone replacement therapy involves medications made by a compounding pharmacy that, after the physician measures a woman s hormone levels, customizes the dose. AAG Health uses bio-identical hormone replacement therapy (BHRT) that is individually customized to help treat symptoms associated with hormone deficiencies. Hormone therapy can help a number of conditions such as Adult Onset Growth Hormone Deficiency Syndrome, Pre-Menopause, Menopause, etc. 16 www.aaghealth.com
Hormone therapy can not only help alleviate symptoms associated with the previously mentioned conditions, but can also help: Enhance the immune system Improve memory & cognitive function Increase sexual energy Improve skin tone & texture Increase muscle mass while reducing body fat Increase energy levels Look and feel years younger Bio-identical Hormones: Estrogen, Testosterone and Progesterone As described in Suzanne Somer s book The Sexy Years, the state-of-the-art in HRT therapy is the transdermal administration of bio-identical estrogen, testosterone and progesterone with a safe and convenient daily cream. Patients on HRT previously received a variety of doses, preparations and regimens, often raising their hormone levels to concentrations far in excess of normal physiologic levels and without regular monitoring of levels. III. Hormone Therapy for Women Here at AAG Health, our programs include the individual tailoring of doses to restore youthful, physiologic, early adult levels of estrogen, testosterone and progesterone, the current state-of-theart in hormone therapy. Before knowing about this program, I had endless days of fatigue, many aches and pains, and I was very unhappy with who I was becoming. I did not know what was wrong. My doctors wanted to label it as depression along with other medical mysteries. I did not feel we were getting to the root of my problems. I then learned about AAG Health. What sense it all makes! AAG Health has helped me get back to myself. I have lost weight and regained my energy. - Sandra M., Los Angeles, CA 17 www.aaghealth.com
What are Menopause, Pre-Menopause, Perimenopause and Postmenopause? In the past few years, the term perimenopause has been adopted to denote these symptoms that occur in the 5 to 10 years prior to menopause. Menopause, is traditionally defined after a woman has gone twelve months without having a period. Estrogen levels are low and can cause hot flashes, difficulty concentrating and memory problems. In addition, the loss of bone accelerates at this point, and in the first five years after menopause, a woman loses bone at a faster rate than at any time in her life. Other symptoms such as vaginal dryness, decreased libido, dry skin, and decreased mood and energy intensify. After five years, the period referred to as post menopause, a woman s body settles into a lower estrogen state. Cardiovascular disease rates increase; osteoporosis and fracture rates increase; diabetes rates increase; Alzheimer s disease rates increase. AAG Health s physicians can intervene before menopause takes place. We can help you during the pre-menopause stage, to treat the symptoms and long term consequences that result from less-than-optimal hormone levels. Thank you for saving my life, my marriage and for giving me back my energy and self worth...i feel 500% better and you were wrong about me feeling 35. I feel 25! - Denise H., Tampa, FL 18 www.aaghealth.com
An Introduction to HGH Therapy Until recently the effects of low HGH in adults were unknown. It is now recognized as a specific clinical syndrome with a number of different physiological and psychological consequences that affect the following: Changes in body composition Central obesity and fat accumulation Lipids in the blood Muscle strength Bone composition Exercise capacity and energy Cardiovascular risk Psychological well-being All the evidence shows that HGH is one of the safest drugs we have. 1,000 s of patients have been followed for the last 16 years. - Dr. Pinchas Cohen, UCLA - Published 2003 You know HGH is a hormone that declines as you age, but do you know the specific problems low HGH levels can cause? Ask yourself these questions: Is your abdomen flabby? Are your muscles slack and weak? Do you have sleep problems? Have you experienced weight gain? Is your hair thinning? Do you feel exhausted most of the time? Is recovery after exercise too long? You may be surprised to learn some of the psychological problems low HGH is also likely to cause. Problems like: anxiety or nervousness, sadness or depression, feelings of hopelessness, shyness and withdrawal from others. IV. An Introduction to HGH Therapy If you can identify with the above symptoms, the physicians at AAG Health may be able to help you. We specialize in treating adults, in otherwise good general health, who are experiencing symptoms associated with low HGH levels enabling them to lead healthy, active and vigorous lifestyles. 19 www.aaghealth.com
What is HGH? HGH is a hormone. Hormones can be thought of as messengers that are produced by the endocrine glands and then sent all over the body to stimulate specified activities. Growth, digestion, reproduction, and sexual function are all triggered by hormones and they all depend on each other to work properly. HGH in particular, is critical for tissue repair, healing, muscle growth, bone strength, brain function, physical and mental health, energy, and metabolism. HGH Secretion (in micrograms) Growth Hormone Decline 2000 1500 1000 500 10 20 30 40 50 60 70 80 90 AGE IN YEARS The production of HGH, and its metabolite IGF-1, decreases with age, approximately 2-4% each year on average. We normally produce about 800 micrograms of HGH daily at age 20. By age 80, the daily production falls to 60 (or less) micrograms and many doctors consider IGF-1 levels below 200 ng/dl to be HGH deficient. In August of 1996, the FDA approved injectable r-dna HGH for the use in adult patients for the first time. Before this change, it was only authorized for use to help children grow a few more inches if they had very short stature. Coping with Adult Growth Hormone Deficiency (AGHD) The medical term for low HGH in adults is Adult Growth Hormone Deficiency, or AGHD. This can mean you experience several different symptoms, many of which directly affect not just your body composition but also your mood and emotions. This is thought to occur because HGH plays an important part in managing psychological feelings besides helping growth and other physical processes to occur. 20 www.aaghealth.com
Listed below are some of the most commonly reported symptoms experienced by people with AGHD. You should know that not everyone with AGHD experiences all of these symptoms, but if you are experiencing them, there are effective HGH therapies available if you qualify for treatment. Physical Symptoms Decreased sexual desire Weight gain Lack of energy or fatigue Muscle weakness Sleep problems Psychological Symptoms Sadness or depression Nervousness or anxiety Withdrawal from others Feelings of hopelessness Shyness Effects of HGH The first major study showing the promise of HGH therapy was published in the New England Journal of Medicine (Rudman; 323:1-6 1990). This study was orchestrated by Dr. Daniel Rudman. It divided 21 men (between the ages of 60 and 80) with IGF-1 levels less than 350 IU per liter into two groups: 12 test subjects and 9 control subjects. IV. An Introduction to HGH Therapy A six-month period of data collection was followed by a six-month period in which the 12 test subjects received HGH injections and the 9 control subjects did not. The results were promising: increases in lean muscle mass, decreases in adipose fat tissue, and increases in vertebral bone height. All test subjects had measurable increases in HGH levels, as measured by IGF-1 blood values. The control group had none of these results. The effects of six months of HGH on body mass and adipose-tissue mass were equivalent in magnitude to the changes incurred during the 10-20 years of aging. This study has become the definitive point of reference for all HGH therapy protocols. Since Rudman s landmark study, leading physicians and healthcare professionals worldwide have performed many studies and the current consensus amongst these specialists is that HGH is effective and safe. 21 www.aaghealth.com
Potential Effects of HGH Therapy: SKIN - Increased skin elasticity, texture, and tightness ENERGY - Increased energy and emotional stability BONE - Improved bone strength SEXUAL POWER - Increased sexual potency and frequency MUSCLE - Increased muscle strength and mass FAT - Decreased fat tissue MEMORY - Improved mental functioning and strength HEART - Improved cardiovascular strength and lower blood pressure KIDNEY - Improved kidney function IMMUNE SYSTEM - Improved immunity and healing HAIR - Improved hair texture CHOLESTEROL - Elevated HDL and lowered LDL A great deal of research on HGH has been conducted, carefully monitoring and evaluating the effects, protocols and patients of HGH therapy. Many AAG Health physicians are leaders in the field of HGH therapy. HGH therapy imparts great psychological, psychosocial and cardiovascular health benefits. The treatment adds greatly to the quality of life and to maintaining a healthy lifestyle. Dr. Carol Ann Ryser - Health Centers of America - Published 2002 22 www.aaghealth.com
An Introduction to Testosterone Therapy You may be reading this because you are not your normal self. You re lethargic and your energy level is not what it was...your body is becoming soft and flabby...you re having problems with focus and concentration...your sex drive is down and you may be having difficulties achieving an erection. According to the U.S. Food and Drug Administration (FDA) 4-5 million American men may suffer from low testosterone, but only 5% are currently treated. What about the remaining 95%? Could you be one of them? The first step - Detection When it comes to treating and eliminating the symptoms of low testosterone, detecting the problem is a critical first step. Are your testosterone levels low? Take the 10-point quiz below to find out: 1. Are you over 35? 2. Do you have poor muscle tone? 3. Are you prone to weight gain, particularly around the mid-section? 4. Do you frequently feel weak and tired without any apparent reason? 5. Is your recovery from exercise slow? 6. Do you have a low sex drive or symptoms of sexual dysfunction? 7. Do you feel depressed, irritable or unmotivated? 8. Do you have difficulty coping with stress? 9. Do you have trouble getting a good night s sleep? 10. Do you smoke cigarettes, drink alcohol, or take prescription meds? If you answered yes to more than half of these questions, chances are your testosterone levels are less than optimal and you may be deficient. You may be going through the male menopause, a condition known as andropause. Andropause refers to a set of gradual physical and psychological changes that men generally go through. Every man experiences a decline in bio-available testosterone, but some men s levels drop lower than others. V. An Introduction to Testosterone Therapy 23 www.aaghealth.com
Testosterone therapy is the best treatment option for andropause and may also prolong lifespan by reducing the severity of age associated diseases that are among the leading causes of disability and death. What is Testosterone? Testosterone is a hormone produced in the testes of men. Testosterone is responsible for the development of male characteristics such as body and facial hair, muscle growth and strength, and a deep voice. Normal levels of testosterone also influence the production of sperm and promote sex drive. Though testosterone is thought of as an exclusively male hormone, it is not unique to males. Testosterone is also produced in the ovaries and adrenal glands in women and starts to decline as women age too. Testosterone replacement therapy enhances muscle strength and lean body mass, decreases leptin, and may enhance cognitive function, bone mineral density, and has positive effects on the cardiovascular system. - Dr. Anton Dotson - Cenegenics Medical Institute When does it decline? Testosterone begins to decline in men at about age 25. Testosterone levels decline gradually over the years and because it comes on slowly, most men often accommodate the symptoms and do not realize how much they have lost. The chart on the right gives you an idea on the rate of decline that most men and women experience over time. Many men, after 35 or so, often have a hard time rising to the occasion and challenge of daily stress. It has only been recently that andropause has received attention and recognition, but why the holdup? Testosterone Secretion (Ng/dl) Testosterone Decline 6000 4000 2000 0 0 20 40 50 60 AGE OF DECLINE Doctors and scientists are well aware of the ramifications due to the absence of estrogen and progesterone in women. In the meantime, men have kept their focus from themselves and their own hormonal induced weaknesses. Why? 24 www.aaghealth.com
The fact that a decline in testosterone comes on so gradual, is the reason why many men accommodate to the change. When the change happens we put it down to being burnt out at work, having a mid-life crisis or just getting old. Ignorance. Men do not talk or complain since it is not the manly thing to do. We are taught to rise above our afflictions and never give the slightest indication of weakness. Male pride is often our greatest strength and our greatest weakness! We are blasted with a reality check during our forties. We are told that the problems we are experiencing are all part of aging and we should throw in the towel and settle into old age. At AAG Health, our patients talk openly about their symptoms and what they are going through. But each of them would also admit that they had difficulty making that first call and that they still cannot admit or talk to their friends about their dysfunctions associated with low testosterone. Benefits of Testosterone Therapy Individuals who receive testosterone therapy regularly report that they feel sexier, stronger and healthier. They say that it makes them feel as they did when they were in their prime. Testosterone therapy can stop and reverse the physical decline that robs men of their energy, strength and libido. Testosterone can restore muscle tone and improve stamina. Testosterone can restore healthy sexual excitement and desire, which in turn, results in an improvement in mood and overall well being. All too often, men automatically assume that as they age, their sexual capacity will diminish. There is no need to accept this loss of sexuality. We should be able to live our life with the same excitement and enthusiasm we enjoyed during our youth. V. An Introduction to Testosterone Therapy We live in an age where we can take an active role in our healthcare. Hair transplants, plastic and cosmetic procedures are readily available for men. Testosterone therapy is another choice we have and deserves serious consideration. 25 www.aaghealth.com
Potential Testosterone therapy results: MUSCLE Increased muscle strength and mass. SEXUAL POWER Increased sexual potency and frequency. CHOLESTEROL Lowers cholesterol levels. ENERGY Increased energy, stamina and endurance. MEMORY Improved mental functioning and ability. MOOD Improves mood and feeling of well-being. HEART Protects against heart disease. CONCENTRATION Improved concentration and focus. I had terrible problems with my sex drive, erection, mood and depression. The medications my PCP prescribed just did not work. I decided to enroll in a testosterone program and the results have been tremendous. - Thomas D. Chicago, IL Some Facts About Testosterone Testosterone starts to decline in our mid 20 s. That is when the aging process begins in earnest. It is estimated that testosterone levels will drop to abnormally low levels in 20% of men after age 50. In men over 40, lower testosterone levels affect physical, sexual and cognitive function. Low testosterone levels are not normal for your age. Andropause is a health problem that requires treatment. A 40 year old man has less than half the testosterone a 25 year old man. Testosterone therapy is not for everyone. Individuals with certain medical conditions should avoid testosterone therapy, and AAG Health doctors only prescribe testosterone therapy after a comprehensive in-house medical evaluation. 26 www.aaghealth.com
AAG Health FAQ s What does AAG Health do? We are a network of physician s offices that specialize in preventative medicine with an emphasis on hormone therapy and optimization for adult men and women. Where are you located? Our main location is in South Florida, however we have numerous locations throughout the United States. We are always adding affiliate doctors so please check with us to see if we have a doctor in your area. Am I required to see one of your doctors? Yes. All of our patients are required to see an AAG affiliated doctor for the physical exam and consultation. How do I get started? Call AAG Health at 1-800-325-1325 to get started today. The process starts with a blood test at a local lab. If I go to one of your physicians, will I automatically qualify for treatment? No. First you are required to do lab work and have a physical examination as part of the clinical evaluation. Our physicians will only treat patients with clinically diagnosed hormonal deficiencies, including Adult Growth Hormone Deficiency, Hypogonadism/Andropause, Menopause or Hypothyroidism. If your hormone levels are optimal, or there are contraindications to treatment, then hormone therapy will not be prescribed. How are the hormones optimized? Testosterone is administered using either injections or a transdermal topical cream formulated to your individual needs. Estrogen and progesterone is best taken via a specially formulated cream. Oxytocin, DHEA, melatonin and thyroid hormones are taken orally by pill. HGH is taken by injection only. Do you accept insurance? No. In order to provide the best treatment options we do not accept any third party payments including insurance, Medicare, or Medicaid. In addition, we will not fill out any paperwork or respond to any inquiry from insurance companies. VI. AAG Health s FAQ 27 www.aaghealth.com
What are your prices? At AAG Health we do not offer a one size fits all approach to programs. Everyone is unique, therefore our programs are designed based on your specific needs and formulated based on lab work, physical exam, symptoms and other factors. We can only give exact pricing after you have been seen and evaluated by the physician. However, you can call us at 1-800-325-1325 to get some cost estimates for various treatment programs. Is hormone therapy safe? Yes. Although no medical treatment is completely risk free, there are numerous studies that have come out over the past years that have attested to the general safety of natural hormone replacement. Remember, all AAG Health s programs are physician supervised and medically monitored to offer you confidence and security. We only prescribe physiological dosages and we use only bio-identical hormones in our therapy. Are there side effects? As with any medical program there is always a chance of side effects. Because our doctors only prescribe medically appropriate dosages, the potential for side effects is minimized. In fact, less than 5% of our patients experience minor side effects. These side effects generally go away by reducing the dosage of the medication. All of our programs include follow up lab testing to ensure the correct dosage and minimize side effects even further. When should I think about replacing my hormones? In the average man and woman, hormones start to decline in the mid to late twenties. By age 35, declines are sufficient that symptoms may be evident. The best time to start replacing hormones is when you start to notice symptoms that affect your quality of life. In most people this happens between the ages of 35 and 50. However, we have men in their 80 s that have successfully benefited from our therapies. How do I know if the program is working? Typically you will notice that you are feeling better within four to six weeks. However, we also do lab testing, body composition tests and a bone density test while you are on the program. These tests will show you exactly the improvements you are making. We carefully monitor you and fine-tune your treatment to its optimum levels. 28 www.aaghealth.com
I ve seen other clinics advertised. Why is AAG Health the best place to go? Be careful with any clinic that does not require a physical exam with a doctor. This is unsafe and unethical. AAG requires all patients to see a doctor before starting the program. The doctor is the person who decides if HRT is right for you and will only prescribe if there is medical need. Some other clinics push hormones to everyone, regardless of medical need. Our programs also include all medications, the initial follow up lab work, all follow up consultations, and all follow up exams in pricing. Other companies charge extra for lab work and charge fees every time you talk to a doctor. Therefore when you get a price from us, you are confident that there are no hidden charges, fees, lab charges, or other hidden costs. Do you recommend replacing testosterone, HGH and other hormones at the same time? If the doctor feels that you have a growth hormone deficiency, a testosterone deficiency or other hormone deficiency, he may recommend a combination treatment. If you only have a deficiency in one hormone, he will only recommend replacing that hormone. HGH has a bad reputation in the media. Why is that? This bad reputation is unfortunate and not justified. The reason this reputation exists is because it has recently been the drug of choice by athletes. These athletes take superhuman dosages that are generally more than ten times greater than what our doctor will prescribe. Taking amounts this large often does lead to serious side effects that get exaggerated by the media. We only prescribe HGH if you need HGH. This need is determined by your IGF-1 levels and your symptoms. Will hormone therapy help sexual dysfunction? Sexual dysfunction can have many causes; however replacing hormones can lead to significant improvement. We suggest raising your testosterone to a healthy level to boost your sex drive. If there is still need for assistance, there are other treatment options available after talking to our doctor. If testosterone levels are low, hormone replacement has been successful in over 90% of patients with sexual dysfunction. Is hormone therapy the same thing as steroid abuse? No. When we treat patients we only treat those patients with deficiencies. We also only use bioidentical hormones which are identical in structure to what your body already produces. We also only prescribe therapeutic dosages intended to bring your levels to an optimal level that is still within the clinically normal range. Athletes who abuse steroids generally have normal levels to begin with. They take steroids in order to increase muscle mass or get an unfair advantage in competitive sports, not to treat a medical condition. These athletes are seeking super physiological dosages that are usually greater than five times the recommended therapeutic dosage. They also usually take blends or stacks of designer anabolic steroids that are not bioidentical in nature. This is very dangerous and can lead to serious medical conditions. To arrange a free phone consultation, please call AAG Health today at 1-800-325-1325. VI. AAG Health s FAQ 29 www.aaghealth.com
What The Experts Are Saying... The results of our study show that the use of short-term treatment with growth hormone during a standardized program of low calorie diet and physical exercise is effective in reducing the loss of muscle mass and increasing the loss of fat mass. Dr. Silvia Savastano, PhD University of Naples - Published 2009 Supplemental testosterone produced significant gains in total and appendicular lean mass, muscle strength, and aerobic endurance with significant reductions in whole-body and trunk fat. Outcomes appeared to be further enhanced with HGH supplementation. Journal of Clinical Endocrinology & Metabolism Published 2009 In older adults, increased HGH has resulted in significant improvements in muscle mass and endurance. Dr. George R. Merrimam University of Washington - Published 2006 Side effects of HGH therapy for adult deficiency are minor, dose-related, and totally reversible. New England Journal of Medicine - Published 1999 Studies have demonstrated that adults with HGH deficiency are both physically and psychologically less healthy that their age-matched peers, and that HGH therapy results in substantial and sustained benefits. Growth Hormone Research Society Scientific Committee - Published 2001 It is well accepted that with age, many hormone levels decline. However, if you wish to maintain normal function then you need to modulate your hormone level. This is especially true with HGH and the sex hormones (testosterone, estrogen, progesterone). Dr. Victor Shabanah - Medical Director, AAG Health 2007 30 www.aaghealth.com
After 3 months of HGH, the subjects required less time to fall asleep and reported better quality of sleep. Mood was improved as well. Division of Endocrinology - University of Erlangen-Nurnberg - Published 2003 The study lasted 10 full years and at the end of 10 years, only those on HGH had increased their lean muscle mass Other benefits were mood elevation and reduced heart attack risk. Department of Medicine - St. Thomas Hospital, UK - Published 1999 Higher levels of testosterone in men, far from being dangerous, may actually protect them against damage to the coronary arteries. Columbia University College of Physicians & Surgeons After the Institute of Medicine examined the effectiveness and safety of testosterone treatment, the committee found no compelling evidence of major side effects resulting from testosterone therapy. American Academy of Family Physicians Administration of adequate testosterone replacement therapy leads to improvements in libido and erectile function. Dr. Laurence Katznelsn Harvard Medical School The short term treatment risks of adverse side effects over 3 to 4 years of testosterone treatment appear to be predictable and easy to monitor and manage. Dr. J. Lisa Tenover - Ph.D. - Mayo Clinic Our results show that replacement doses of testosterone increase lean body mass and strength in men with low testosterone levels. American Journal of Respiratory & Critical Care Medicine Long term testosterone gel treatment maintains beneficial effects on sexual function, lean and fat mass and bone mineral density. Journal of Clinical Endocrinology & Metabolism 31 www.aaghealth.com
What Our Patients Are Saying... My hormone deficiency was affecting my work and my social life. I had no idea going into this treatment that the results would be so life altering. Kyle R., Austin, TX I have been using HGH for the past 3 years and I am delighted with the ongoing results and progress I ve experienced. Peter O., Fort Lauderdale, FL Thank you for helping to restore my health and quality of life. My IGF-1 levels are now optimal and the change is dramatic. Patricia M., Los Angels, CA As a result of taking hormones, I am feeling much more energized, my friends are often commenting on how vibrant I look and my sex life has wondrously improved. David H., Naples, FL I have always been very active, kind of a health nut really, but things really slowed down in my thirties. Since following AAG Health s testosterone protocol, I feel much better and I m now responding to my work out routine. Philip A., Miami, FL After years of seeing my body and mental ability deteriorate, I had no idea it was declining testosterone that was the culprit. I ve been using testosterone treatments on and off for 3 years and I couldn t imagine my life without it. Ronald G., Dallas, TX Testosterone therapy has addressed many of my health concerns. AAG Health is a great clinic with knowledgeable doctors and courteous support staff. Terry P., Buffalo, NY 32 www.aaghealth.com
AAG Health Medical Advisory Board As an extension of our commitment to quality health care and scientific integrity, AAG Health established an advisory board comprising of leading experts in the field of anti-aging medicine and age management. Our advisory board members are selected as highly respected experts who provide both depth and range of experience in their specialties. AAG Health s advisory board members have the responsibility to establish standards of treatment and protocols. Our advisory board members play an integral role in patient support and care and help educate and train AAG Health affiliate doctors on the principles of hormone therapy. Partial list of AAG Health Advisory Board members Victor H. Shabanah M.D. Medical Director, AAG Health. Dr. Victor Shabanah is the Medical Director of the AAG Health Physicians Network and is based at AAG Health Aventura, Florida. He is a recognized leader in age management medicine focusing on hormone replacement therapy. He has received extensive training in various cosmetic procedures and his field of specialty for the last seven years has been preventive medicine, hormone modulation and age based aesthetic procedures. Victor Shabanah M.D., received his Medical Degree in 1963 from McGill University in Montreal, Canada. He has a surgical background and is board certified. He has practiced in Florida for 30 years where he specialized in Thoracic and Cardiovascular surgery. He attended a fellowship in cardiac and vascular surgery at Baylor College of Medicine in Houston, Texas where he became interested in and started practicing cosmetic procedures and a number of anti aging treatments. Dr. Shabanah is a member of the American Academy of Anti Aging and Regenerative Medicine, The Age Management Medicine Group and The Endocrine Society. 33 www.aaghealth.com
Better energy, sleep and attitude. If only I discovered AAG Health s hormone treatment plans sooner. It works! - Michael A., Atlanta, GA