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See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog Menopausal Symptoms I waited to announce the emerging research regarding the safety of post-menopausal hormone replacement therapy for breast cancer patients suffering from severe menopausal symptoms until the research finally supported my belief that women have the right to receive the treatment that they need if they accept the risks of that treatment. The past year of research (2024-2025) has produced a significant amount of research demonstrating the health risks associated from not taking hormone replacement therapy, as well as the safety of using testosterone after breast cancer and the limited risks of hormone replacement therapy following breast cancer. I have practiced women's medicine for over 40 years, and I believe that female patients should have the right to receive post-menopausal hormone therapy if they understand and accept the associated risks and benefits, as long as it is administered safely. Let me pause here to discuss how doctors ethically make decisions about treatment. First, the aim of medical treatment is to improve health and longevity while alleviating symptoms. It is a doctor's responsibility to evaluate, treat, and advise patients on the best course of therapy based on their medical training, practical experience, and the latest research. However, the third factor is often overlooked when advising patients about hormone replacement therapy after breast cancer. Doctors determine the best course of treatment by using this information and weighing the benefits of a treatment against its risks. We are trained to provide this information to patients to facilitate informed decision-making with the patient, not for the patient. This process requires time that doctors no longer have. Ah, and therein lies the problem. Doctors are trained to follow research related to the diseases and conditions they treat and to integrate that research into their practice. The basic decision-making process involves weighing the benefits of treatment (or no treatment) against the associated risks. When the benefits of a treatment outweigh its risks, it is recommended to the patient. “Recommended” means the doctor, based on current knowledge, believes it to be safer and more effective for the patient's health to pursue a specific treatment. However, this does not imply that the patient must follow the doctor's advice. A patient is autonomous and can assess the risks and benefits once informed, allowing them to refuse a treatment or request one that falls outside current medical guidelines. Doctors do not have to embark on a treatment they do not believe is beneficial or safe. Doctors have autonomy as well! Doctors in mainstream medicine adhere to “medical guidelines” established by our specialties, which represent the minimum level of care expected from a physician. However, these guidelines are often decades behind current research, meaning that the risks and benefits communicated to a patient may be outdated. A legal requirement known as informed consent mandates that a doctor inform the patient or include this information in a consent form that the patient reads and signs, detailing the procedure or treatment. If the treatment is newer than the guidelines, it is categorized as “off-label.” It is essential for the doctor to inform the patient that the treatment does not conform to current guidelines, and the patient must acknowledge the known risks associated with the treatment. At BioBalance Health®, we often find ourselves ahead of the guidelines, and my experience indicates it may take up to 20 years for the guidelines to catch up with us. Much of our treatment is considered off-label because it is current and ahead of the guidelines. It is superior to other treatments and remains safe, but risks are inherent in every treatment! Now, let's return to breast cancer and the roles of estradiol, testosterone, and progesterone replacement. Here are the facts about breast cancer: Most breast cancer patients are post-menopausal, and have symptoms of menopause Not all types of breast cancer are stimulated by estradiol or progesterone, and therefore for these cancers hormone replacement therapy is safe. Breast Cancer patients with negative nodes who have had a bilateral mastectomy are candidates for hormone replacement therapy after their treatment. The risks of estrogen replacement for ER+ breast cancer patients may promote the growth of cancer cells, while testosterone replacement lowers the risk of recurrence and alleviates certain menopausal symptoms. When testosterone is combined with estradiol, the risk of developing breast cancer in all women is reduced. Testosterone enhances the quantity and activity of cancer-fighting T-killer and T-helper white blood cells. All breast cancer patients can manage menopause symptoms using testosterone pellet therapy and vaginal estrogen without an increased risk of recurrence. Do you remember when I mentioned that the risks of treatment should be balanced with the benefits of that same treatment? Recently, numerous research articles have outlined the benefits of estradiol treatment, which I included in my 2017 book, “The Secret Female Hormone: How Testosterone Replacement Can Change Your Life.” In early 2025, the safety of taking estradiol for menopausal women confirmed the less publicized research that had come before. The Journal of Endocrinology and Metabolism reported that women who underwent estradiol replacement after the age of 60 live 20% longer than those who do not take hormone replacement therapy. This challenges the guideline that advises OB-GYNs to discontinue hormone replacement therapy before the age of 60. The Benefits of Estrogen replacement after menopause, based on multiple research studies over the last 20 years is as follows: ERT alleviates symptoms such as dry vagina, painful intercourse, insomnia, hot flashes, and night sweats. Estrogen replacement prevents and treats osteoporosis in women. Testosterone replacement in women with osteoporosis can reverse the process of bone loss, bringing bone back to normal strength and decreasing fracture risk. Non-oral Testosterone and Estradiol can prevent arteriosclerotic heart disease. ERT and HRT decreases the risk of diabetes with aging. Estradiol replacement during the first decade after menopause can delay the onset of Alzheimer's disease and dementia by ten years. If you are genetically predisposed to developing Alzheimer's or dementia by age 80, E2 replacement may postpone this onset until you turn 90. Testosterone replacement in the first 10 years after menopause postpones the onset of Alzheimer's disease and dementia for an additional ten years. Testosterone boosts immune function in both sexes and diminishes the onset and severity of infectious diseases. Aging causes cognitive decline, marked by challenges in memory and thinking, and menopause speeds up this process. Testosterone and estradiol replacement therapies may aid in reversing this decline. Muscle mass decreases after menopause due to a decline in testosterone but replacing testosterone with bio-identical pellets restores muscle mass to premenopausal levels.   The latest medical article that inspired me to create this podcast was published in the journal Menopause, which discussed the challenges many women face after breast cancer treatment without hormone replacement for their severe menopausal symptoms. Here are the quotes I think you should hear: (MHT = Menopause Hormone Therapy) “Among 226 breast cancer survivors.. the menopause symptom burden was high and women's experience of menopause-related breast cancer after-care was poor. Few women felt actively involved in menopause treatment decisions.  The NICE breast cancer guideline (NG101) states that women with a history of breast cancer can be offered MHT in “exceptional” circumstances if other treatments have failed (off-label use). However, NICE does not define what “exceptional” circumstances are or who gets to decide. Up to 50% of breast cancer survivors, especially those with debilitating menopausal symptoms, may choose to accept a small increase in risk in exchange for an improved quality of life and/or to mitigate future health risks associated with chronic estrogen deficiency.  “Allowing”. women to have MHT only in “exceptional” circumstance undermines patient autonomy and limits a clinician's ability to integrate clinical knowledge and judgment with the best currently available evidence (which is decades behind clinical guidelines). Clinicians have a legal and ethical responsibility to patients to make informed treatment choices. If you have had breast cancer and are experiencing symptoms you no longer want to endure, my advice is to find a doctor with whom you can make an informed decision based on the latest research. It's important to understand and accept the risks and to sign a High-Risk Consent for HRT.  If you aren't that brave, then seek a physician who will prescribe testosterone pellets along with vaginal estradiol to alleviate some of your post-menopausal symptoms. Life is too short to follow guidelines that are 20 years out of date when you are suffering.

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 There is a new federal rule for lab companies that requires them to report your blood tests to you as soon as they are finished, often even before your doctor has seen them.  This rule, deemed unreasonable, was established by individuals without medical expertise (politicians), who know little about interpreting lab data or the workings of doctor's offices. Sending your lab results to you before doctors can assess them is not a decision rooted in sound medical practice but rather in the notion of individual freedom. While this is important, it does not compare to having an expert interpret your results with you. The law requiring that your lab results be sent to you as soon as they are completed does not consider the fact that these results are not designed for laymen to interpret. Additionally, lab results are meant to be analyzed alongside a patient's medical history, age, gender, and medications.  The results are not tailored to report information specific to your situation, which is how a doctor would interpret them. Lab results often lack layperson-friendly explanations. This new protocol can cause anxiety, as patients may panic over results that appear abnormal, even if they are normal for their specific medical condition and treatment. Furthermore, lab companies only request your age and gender. The factors that doctors evaluate when interpreting your results are diverse and numerous, each influencing the overall interpretation. What are the considerations that doctors add to their interpretation? Menopausal status Medical conditions Healthy normal for young and healthy adults The newest recommended ranges for health Body weight Other lab values seen on the same report The problem with you getting your own lab and interpreting it as written is multifactorial: The lab is sent to you digitally with very little explanation except for reference ranges. There is no information about who you are being compared to. Other women, both men and women? Old women? Young women? Women with symptoms or women who are well without symptoms.  The reporting of the lab results to a patient directly may hide problems that need action or create fears that are unnecessary. Anxiety over your results will continue until your doctor's appointment to discuss … so you may experience unnecessary worry in many circumstances. Reference ranges make many assumptions, but labs don't input vital information about you into their computer. your age of menopause, your weight your height (or BMI) previous illnesses and your medications. if you are on hormones or testosterone   Here is a good example. The test for pituitary hormones FSH and LH. When a woman aged 45 is menopausal, and has a very high FSH and LH, the lab says it is “normal” (in the reference range), yet the woman is having severe hot flashes, night sweats, anxiety, and insomnia.  That is not healthy or “normal”. The same two tests can be used to determine if a person is menopausal. Let's say a 42-year-old woman has elevated FSH and LH, but her estradiol is very high (200-300). To the layperson, this looks like menopause, but in reality, it is the picture of ovulation, not menopause. One has to look at another test, estradiol, to determine whether she is premenopausal and ovulating or menopausal (her estradiol would be very low, and FSH and LH would be high). See the problem? Reference Ranges don't tell you what the doctor is looking for. The same two tests, FSH and LH, are used to diagnose polycystic ovaries (PCO) too.  In women without PCO, the FSH is higher than the LH, but if the LH is greater than the FSH, the diagnosis of PCO should be considered! There is no information about this interpretation in the lab report. Falling within the reference range doesn't guarantee health or absence of symptoms. If patients are to interpret their own lab results, reference ranges should reflect health in every possible scenario. FSH and LH are influenced by BCPs and menopausal HRT. Lab results should be interpreted considering the information regarding BCPs or ERT that the patient is taking. When women are on BCPs and HRT or ERT, their FSH and LH levels are suppressed to an extremely low point. If you are unaware that the patient is taking these hormones, it may appear that the diagnosis is pituitary failure affecting estrogen levels and ovulation. Only doctors can interpret this test. There should truly be a “normal” range for those undergoing hormone replacement therapy, along with a reference range that reflects overall health, rather than merely the average for your geographical area in the US or your age group. Please make an appointment with your doctor to review your lab results so you can understand how they are interpreted. If you have questions about your lab results that are concerning you, schedule a time to discuss them with your doctor. Doctors don't have the time to explain results over the phone or through email—that is what appointments are meant for. Phone calls to doctors' offices are not intended for lab result interpretation. You or your insurance will not compensate the doctor or NP for this service over the phone.   The reference ranges for many tests and medical situations are actually wrong. If you aren't trained as a doctor or Nurse practitioner who interprets metabolic lab results every day, you could get the wrong diagnosis!!! For example, when evaluating a patient for insulin resistance, the reference range was officially changed almost two decades ago. Still, the lab companies have left the normal range very high (insulin> 18). In the revised range, fasting insulin diagnoses insulin resistance if the value is > 10. The resulting outcome is that many people are not diagnosed at a time when they can be easily treated without drugs and are told that they are “normal” when they are really experiencing insulin resistance. This is misleading and just wrong! Lab values are not adjusted to your individual situation.   Many tests are adjusted for gender; however, some are specifically adjusted for women who are menstruating regarding H/H. In other words, men and women have different “normal” H/H levels in the reference range. Women who do not menstruate or who are menopausal should be compared to the same reference range as men, but that does not happen. This leads to menopausal women, who are normal, often being told they have too many red blood cells when that is not the case. Conversely, menopausal women who are truly anemic are told they are normal, which means it takes longer to diagnose their anemia from colon cancer! The H/H should have a reference range that is considered “normal” for a woman's stage in life, depending on whether she is experiencing menstrual periods or not. Many reference ranges are averages for regions of the US and vary between lab companies; therefore, they are not reliable values for comparing patients.   For instance, the Homocysteine test has a normal range that is relatively high, and each lab has different reference ranges. This test serves as a screening tool for MTHFR genetic risk related to embolic stroke and heart disease.   The suggested treatment involves methylated B vitamins; however, the interpretation on the lab printout advises taking B12 and folic acid, which, in my experience, tends to increase the number rather than decrease it. Reference ranges for nutrients, vitamins, and minerals reflect the minimum levels needed for survival, not optimal health. For example, B12 reference range levels for B12 blood levels are listed as 200-1100 pg/ml, yet I was trained to try to achieve 400 -1500 pg/ml. The lower range of the written reference range (200-400) is not healthy. The desired blood levels for vitamins are often controversial, and various medical colleges issue new recommendations on Vitamin D levels each month. Consequently, doctors must determine which level of Vitamin D to recommend for their patients. These institutions not only provide changing reference ranges but also offer differing advice on how frequently to test Vitamin D. This inconsistency arises primarily from the ongoing debate about the minimum acceptable level of Vitamin D. I have more information about your lab results next week that your doctor may not share with you. There is a lot of controversy surrounding the reference ranges on the lab sheet, and you should know the truth in case your doctor doesn't.

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 Almost every week I hear from my male patients that their PCP doctor has scared them by telling them to stop taking testosterone pellets because their Hematocrit is too high.  Alternatively, their doctor recommended a lower dose of T. These two recommendations are those doctors who don't understand all the good that the testosterone is doing for these men. My male patients come to me for Testosterone pellets to treat their ED, lack of libido, loss of muscle, inability to think, weight gain, lack of motivation, anxiety attacks, poor stamina, arthritis, loss of balance, and basically everything that makes a man a man!  The most amazing thing is that I can treat them with ONE hormone, Testosterone in pellet form, and cure all these problems! If a man stops taking Testosterone, they get these symptoms again and have to take a multitude of drugs to feel just a fraction better! The treatment for a high H/H is simple…it is a routine removal of blood, either a blood donation or a phlebotomy (removal of 500 cc of blood) in the office, every 2-6 months to keep their H/H under control. The advice their doctors give them is going to cause them great pain and actually shorten their lives and there is little risk if any to removing blood every few months! In the event that a man demands that I lower their dose…..and I do it…the next inevitable phone call is to complain that their symptoms are coming back!  They literally blame me for the advice of their PCP! I would like to tell these men that the same doctors who could not help them with their low T are the same ones who are giving them the advice to lower or stop their testosterone therapy with T pellets.  It is human nature and especially that of doctors to try to criticize the advice of the doctor who got better results with a patient than they did! So, if you develop a condition called erythrocytosis secondary to your testosterone replacement, then you can keep your T therapy, if you are compliant and follow your testosterone doctor's directions and get your blood removed when it is scheduled.  This should prevent any severe reaction from your doctor. This is a typical response to my patient who has concerns.  However, I have given my patients many sources of written and video information about every aspect of testosterone replacement, the risks and benefits including erythrocytosis.  These include my book, Got Testosterone? was given to them on the first visit.  We also have over 650 informational blogs and videos on You Tube, FAQs and a very extensive handout given to each of them on the first visit. They just have to read! I have read your concern about erythrocytosis and testosterone replacement that was brought up by your PCP.  It is true that T replacement increases the H/H in both sexes.  It is useful if you are anemic, but if you have a genetic response to testosterone that elevates your H/H above what is considered normal, then we advise blood donation or phlebotomy every 2-6 months. It is true that the dose of T can affect the H/H, but men often need a high dose of T to feel normal. The removal of blood is low risk and effective. I am a Specialist in   Hormone Replacement Medical care with a 38-year history of replacing bioidentical hormones and 23 years of experience replacing bioidentical hormones with T and E2 pellets.  You came to me because your doctors were not helping you with the symptoms of testosterone deficiency and because I have the most experience in the Midwest. #1.    The first issue that we must always consider while we treat anyone is the primary goals for treatment, the relief of low testosterone which is why you came to me. You made an appointment with me because you had un-addressed issues that your PCP (Primary Care Doctor) didn't treat satisfactorily Your symptoms were treated with testosterone pellets successfully at a dose that is individual to you. Your health as you get older is also dependent on your blood level of free Testosterone (the total T is not significant) by delaying the diseases of aging. The level that is required to treat your symptoms is the young healthy Free T blood level of a young and healthy man. Most labs give a reference range for older men which reflects the fact that free testosterone levels drop with age. Old men don't feel well BECAUSE they have low free T.  The low free T level is why you don't feel well. Our practice has found that everyone has an ideal free T level that we try to maintain, and these are young-healthy level but not old-man level.  That is what we have been trying to achieve for our patients. #2. The second issue is a side-effect that you, as an individual, have experienced with pellets and will experience with any T replacement that you receive that is a high enough dose to treat your symptoms.  Erythrocytosis is a side effect that some men experience on any form of testosterone, however its occurrence doesn't mean you are on too much testosterone, it means you have a side effect of having a normal free T level.  Erythrocytosis is genetic, and your free T blood level stimulates the production of too many red blood cells.  We don't stop the treatment that is making you better, to treat the side effects of it.  We treat the side effects. We treat this side effect with phlebotomies to keep your H/H within the safe range.  Did your medical doctor/cardiologist tell you why this is important?  We tell you: too many red blood cells can increase the work of the heart, however the Hematologists that we consult with give us the HCT% number we should stay below is 58%.  We like to keep your HCT% below 52% but that requires you to be compliant with your regular blood donated or phlebotomized in our office (that takes an appointment). You must be compliant to keep your H/H normal. These 2 issues are at odds with one another. I cannot give a man enough testosterone to treat his symptoms, without stimulating some production of RBCs.  I have no other low T treatment that doesn't stimulate your bone marrow to make red cells BUT I do have a simple treatment to remove your extra blood cells routinely to keep you from having too many blood cells circulating. Only you can make the decision to choose health with T pellets and do phlebotomies regularly as recommended, or to stop T and allow your blood count to decrease., and your symptoms will come back. I want you to read your post-pellet instructions, locate my book Got Testosterone? and read it especially the section on Erythrocytosis, and look at FAQs (frequently asked questions) on the www.biobalanacehealth website, read related episodes of my 677 blogs and or listen to my health casts for your answers.  You can imagine how I feel when my patients don't read what I provide to them in multiple forms to answer their questions. In the future you should read the information I have given you or come in for an appointment to discuss these matters.

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 (

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog If you are receiving testosterone or estradiol hormone pellet therapy, BioBalance Health wants to know if you have any of the following medical conditions that may require you to take antibiotics before any medical or dental procedure that breaks the skin, including pellet insertions and dental cleanings. BioBalance Health is dedicated to providing safe and effective hormone replacement with pellets for both men and women, and we want to ensure your health and safety throughout the process. We use sterile procedure guidelines, but certain conditions still require antibiotics to prevent local infections.   Conditions That May Require Pre-Procedure Antibiotics: If You Have Had a Joint Replacement.Some orthopedic surgeons recommend that patients take antibiotics before dental procedures to prevent infection in the joint that was replaced, while others may not. It is important that you follow the advice of YOUR orthopedic surgeon regarding antibiotics before any procedure. If your orthopedic surgeon has advised you to take antibiotics, please let us know. We can provide you with an antibiotic injection or a prescription to take the day of your pellet insertion that will prevent infection. If You Have Uncontrolled Type 1 or Type 2 Diabetes. If your blood sugar is not well-controlled, you may need antibiotics before your pellet insertion to prevent infection of the pellet insertion area. If you are treated and keep your sugars in good control you may not need antibiotics, however if your diabetes is in poor control, you are more likely to get an infection. It is important that you take antibiotics before your pellet insertion. The following blood sugar levels are considered indicators of poor diabetes control: HbA1c > 9.0 Fasting blood sugar > 150 mg/dL If your blood sugar exceeds these levels, or if your primary care doctor has recommended that you take antibiotics before dental cleanings or procedures, you should also take antibiotics before your pellet insertion to reduce the risk of infection.  If You Have an Autoimmune Disease and are on Immunosuppressive Treatment. If you are receiving treatment for an autoimmune condition that suppresses your immune system, you may be at higher risk for infection at the insertion site. In this case, you will need to take antibiotics before each pellet insertion. If your Rheumatologist does not believe antibiotics are necessary for you, you may proceed without them.  If You Are Receiving Cancer Treatment. Certain cancer treatments, especially those that suppress white blood cell production, can compromise your immune system. If you are undergoing such treatment, you should take antibiotics before or with your pellet insertion to prevent infection.   In Summary: If a doctor has advised you to take antibiotics for procedures, such as dental cleanings, you should also take antibiotics before your pellet insertion. Please inform us of any conditions or treatments that may require this precaution, and we will ensure you are properly prepared for your procedure.

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 During our interview I reviewed her path through recovering from years of no hormones and discussed how dramatic her recovery was.  Her symptoms included no libido and no orgasms, Painful intercourse from a dry vagina, fatigue, depression, troubles with memory, Insomnia, lack of motivation, dry wrinkled skin, alopecia, osteopenia, weight gain, loss of muscle mass and weakness, fibromyalgia, migraines, hot flashes, insomnia and poor of quality of life.  Her symptoms impaired her ability to have a quality life.  During the years after her hysterectomy, she developed hypertension and Rheumatoid Arthritis. After she was treated with Estradiol and Testosterone pellets, her recovery was dramatic and fast!  It amazed both of us, and she has continued to improve her health and now she is very healthy, without hypertension and she had almost a decade free of Rheumatoid Arthritis.   It turns out that the recovery of her energy, confidence and strength was well timed. She needed all the health and strength she could get to take care of her husband who finally succumbed to brain cancer in 2019.  The same year she had the strength to become VP of Paramount bank as her employment.  It seemed that the more life-disasters that she overcame, the stronger she got! As generally happens when people are overly stressed, even hormone replacement is overwhelmed.  In 2018 had a recurrence of rheumatoid arthritis, and she developed Hypothyroidism and Insulin resistance.  Grace, my NP at BioBalance Health, helped her treat her thyroid and weight gain and guide her to overcome these medical problems including losing the weight she gained with insulin resistance.   In 2022 she met, and married Mark Behlmann, who she served on the same charity boards with, but she had never met before.  She got her second chance with Mark at finding love and fulfillment in her partnership with him.  He encouraged her to compete in the. Ms. Missouri Senior, and she employed her energy, talent for singing, her own passion for success and service to become the 2024 Ms. Missouri Senior. In her role she encourages women to use their gifts to achieve everything that they can in life and to find a doctor to help them survive loss of hormones after menopause, so they can continue their service to family and society throughout their lives…she is the best example I can think of living your life to the fullest every day, no matter how old you are!

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.

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog In my Anti-Aging-Longevity practice, one of the complaints my new patients tell me about is the fact that their hair is thinning, falling out or changing to a brittle texture, as well as the fact that their hair is turning grey. Hair DOES get thinner, coarser, and greyer as we age!  That is a fact, and one I can't fully explain to you, except that it happens to everyone!  My philosophy is that each of us should work with what we have, and optimize it, as well as treat any condition that makes hair loss work instead of wishing and wishing we had the hair we did when we were 25! Accepting the fact that your hair gets thinner after 40 and working with the hair you have takes knowledge to determine what is normal and what is not. Some of the things that everyone should know before looking for the best path forward to healthy hair. Aging and Slower Hair Growth Low Growth Hormone Lack of Estradiol and T in women and lack of T in men Aging causes Growth Hormone (GH) to decrease, which slows the growth of hair, fingernails, bone.  Your hair falls out at the same rate as it did when you were young, but the growth slows which results in losing more hair than you replace which thins your hair! If you started your young life with fine, thin hair, then this difference between growth and loss of hair can make your hair very thin.  To get to the root of the problem (I apologize) increasing GH will make your hair grow a bit faster. Testosterone replacement and Estradiol replacement both increase the growth of GH. Both hormone replacements increase hair thickness. Testosterone has a second benefit.  Testosterone makes your scalp oiler, which in turn increases the longevity of your hair. At menopause the lack of these two hormones causes a big change in hair thickness. Loss of hair in specific areas—Balding Genetics Scarring alopecia Androgenic alopecia Extensions Dread-locks Balding and alopecia both cause a person to lose hair follicles, not just slow the rate of hair growth.  Balding usually is genetically determined, so look at the older members of your family to determine what is in your future.  This type of hair loss is very difficult to treat. 50% of men have some balding by age 50, and 1/3 of women experience it sometime in their lives.  Until recently there was nothing to stop this process or grow more hair in those areas, however both men and women can resurrect their hair follicles (if they haven't been gone too long) and make them grow with the TED hair restoration painless ultrasound treatment by Alma. Other options are Hans Weiman hair transplants or weaves, both of which are extremely expensive, don't necessarily look natural (President Biden and his son) and must be redone every couple of years. Women can just cover over the problem with a wig, but even that answer has drawbacks—they are hot and itchy until you get used to it. Women can also get extensions to make their hair look thicker, but it ruins the quality of the hair you have which in the long run causes even more hair loss from scarring of the scalp. Women of color have traditionally used tight braids, cornrowing or dreadlocks to control their hair.  This cultural process causes them to break their hair off at the scalp and damage the hair follicle from tension, which results in hair no longer growing in multiple areas of the scalp. Change in Hair Texture and Dryness At menopause for women and when men's testosterone gets very low, we notice a change in texture of our hair. The cuticle area that covers the hair shaft becomes fragile and stops protecting the hair shaft, so the texture becomes frizzy, and hair breaks causing a dull look similar to what my mother used to call a “birds nest”. Our scalps become dry, and the oil glands dry up with age and loss of sex hormones, so hair is dry and frizzy, making us look like we just stuck our fingers in a light switch.  You can read about many “natural remedies” but beyond taking collagen, Biotin and B vitamins most supplements don't work in a dramatic way that would be noticeable. The remedies for hair loss include all the following and you will have to do most of them to improve your aging hair! Hormone replacement of Estradiol and Testosterone Conditioners (which only work a little) Hair color which covers the shaft with pigment and strengthens hair Brazilian treatment that drives straightener into the hair shaft and seals it with heat. Take supplements of Collagen every morning Take methyl B12 and Biotin daily Stop bleaching your hair Eat a diet with healthy fats and protein Wash your hair every 2-3 days Take the fat soluble vitamins A.E.K,D If you are anemic take iron supplements Avoid statins if possible   Other medical causes of frizzy, broken hair can be found in low thyroid hormones which slows hair growth, decreases oil production, and results in brittle hair all over the head. Replacing your thyroid hormones and supplementing your iodine can overcome this obstacle. All medicine changes should be managed by your doctor. Many drugs cause hair loss, and you can't change some of them: Metoprolol or any Beta blocker Blood pressure medication Prednisone and all steroids Cancer treatments Anything that inhibits your B vitamins like some autoimmune diseases What can you do to fix what you can fix! Nutrition: Hair is protein; however hair requires oil (fat) to grow and be beautiful—a diet rich in protein, and healthy fats give you the building blocks to make healthy hair and skin. Add Vitamins of A/E/K/D, vitamin C, Multi Methyl B vitamins with methyl folate and Biotin because our diets aren't perfect!   Hair care: Get hair products without sulfides.  They break hair and make it weak!  Wash your hair as little as possible. Decrease the use of hot hair tools like flat irons.  Color your hair and or Brazilian it to make it stronger. Medications not to take are listed above. But the medications to take to help your hair are your sex hormones, Estradiol, Testosterone, and make sure your DHT doesn't get too high which can cause hair loss in the male pattern. You may need Finasteride or Minoxidil if you have male pattern hair loss. Sun damage is important to maintain your hair in sunny areas.  Wear a hat or scarf when outside and comb some conditioner through your hair at the pool to “cover your hair from sun damage”.   Summary: Now that you know the possible causes and treatments for hair loss, you can do everything possible up to seeking medical care, and then medical care may be necessary. Hair thinning is often familial and also due to our estradiol and testosterone hormones decreasing after 35-40 years of age. You may need a scalp biopsy from a Dermatologist if your hair loss is in patches or severe over a short period of time, which implies an autoimmune disease. When you see a doctor be prepared with a list of your hair products, your diet, a list of medicines and a timeline for your hair loss.  This preparation will get you the best treatment per doctor visit, and your doctor will appreciate not having to ask you all those questions!

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog Are you menopausal and have any of the following symptoms? Hot Flashes Night Sweats Dry Vagina Painful intercourse Dry skin Lack of sex drive Lack of motivation Fatigue Depression and or anxiety Change in body composition, with fat collection in the abdomen Loss of Muscle Mass and strength Irritability Inability to remember names and places Decreased ability to problem solve Insomnia Arthritis Body pain These are all symptoms we currently are aware of associated with menopause and low testosterone.  These symptoms can be treated and reversed with bioidentical estradiol and testosterone pellets. Menopause should be treated like an illness that is universal but more severe in some women compared with others.  If your symptoms affect your lifestyle, relationships and work then you should see a doctor who treats hormone deficiency and accept treatment! However, if you allow yourself to be manipulated by a male-dominated medical system that teaches all doctors to believe that menopause is normal as women age and don't seek out hormone replacement, then you just may be setting yourself up for years of symptoms that are treated with handfuls of medications, but never get you back to normal. Just think about this for a minute: Men develop erectile dysfunction and experience muscle loss as they age, but medicine doesn't consider ED or Sarcopenia a natural aging process for men, they advocate and endorse treatment with testosterone, ED medications, injections for ED and therapy for ED, and in most cases pay for it!  If the male mentality would include women we would all be treated with estrogen and testosterone when we got to age 50 (or menopause). It is not just about the symptoms that E-T replacement can cure, but the diseases that you can avoid by taking estrogen and testosterone after menopause.  These avoidable diseases of aging include: Osteoporosis leading to broken bones and spinal stenosis. Heart disease and stroke Diabetes Alzheimer's Dx and dementia Obesity Low muscle mass and inability to walk or move independently. Autoimmune diseases Loss of blood flow to Lower extremity, resulting in amputations and inhibiting walking and running Severe arthritis Gout Worsening depression and anxiety Frailty which is what causes most older people to be placed in a nursing home. Just think it is not fate that gives you these conditions.  It is genetics plus lifestyle plus whether you replace your sex hormones or not! This decision is in your control.  If you really want a life free of debilitating disease and symptoms that are require constant medical care, then you must buck the system (that was designed to keep us from maintaining our mind and body) and look for a doctor to replace your testosterone and estradiol in a non-oral delivery system and maintain it for life. By stopping ERT or Testosterone like the ACOG doctors tell you to, you will start the symptoms all over again.  My job is to offer you the right type of help to reverse the effects of menopause…both symptoms and diseases. Your job is to decide whether you want to get help and become healthy by taking non-oral estrogen and testosterone for the rest of your life. Think of menopause as a disease and you will be more prepared to fight for your right to be treated by the medical system.

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog The second set of myths about weight loss involve what we have been told by our federal government through the FDA and surgeon general, that is believed by most of us, but the motivation of the government is not generally for your well-being. Myth #7 Salt is bad for you, and you should limit your intake of salt to minimal amounts. A large study found that eating less than 3 grams of salt a day increases one's mortality by 25% when compared with moderate intake.  It is a fact that salt is vital to life, this contradicts the AHA who preaches that a low salt diet is what is required for health. Myth #8. Replacing hormones at menopause, estradiol and testosterone, will cause women to gain weight. The advent of menopause changes a woman's metabolism and makes every woman in industrialized nations insulin resistant which slows their metabolism and causes women to gain fat and lose muscle which lowers the metabolic rate even lower because muscle mass burns 90% of our calories, and as it shrinks the Basic metabolic rate drops. The only way to counteract this cataclysmic change is to replace estradiol and testosterone in a bio-identical and non-oral delivery system (pellets, patches, topical applications and vaginal tabs.  Even with sex hormone replacement, insulin resistance is Still a factor in weight gain, so a low carb, high protein diet and medical treatment with Metformin, or Wegovy or Mounjaro may be necessary to regain ideal weight after menopause. Myth #9 Milk products are bad for you, and you should take them out of your diet. Milk is not metabolized in the same way and does not have the same metabolic effects as milk products like yogurt, cottage cheese, ricotta cheese, and all cheeses. The majority of Americans can tolerate, and even need milk products as a valuable source of protein.  There is a small minority of people who cannot tolerate milk products, and even fewer who respond to milk products with inflammation. If you do not have GI symptoms, or joint aches when you eat milk products then you are not necessarily healthier to cut them out of your diet. Not only is milk good for most Americans, but it has been proven to decrease oxidative stress and inflammation….the very things it is accused of increasing! Myth #10 Skim milk is better for everyone than whole milk, and those people on a diet should opt for skim milk. This myth is born from the myth that we should eat low fat diets to lose weight. It is a fact that Whole milk has more fat than skim milk, but skim milk is higher in carbohydrate, is generally consumed in larger amounts and is not as satisfying as whole milk. Skim milk is 55% carbohydrate/43%protein/5% fat while whole milk is 50% fat/20% protein and 30% carbohydrate. Unfortunately, the processes we use to make milk safe to drink (Pasturization and Homogenation) remove the necessary enzymes (Lipases, and Lactase) that help humans tolerate lactose sugar in milk.  The process of skimming milk removes the Vitamin D and A that are in unprocessed milk. If you can drink milk, choose smaller volumes of whole milk, not skimmed, if you like milk products like listed above, then add them to your high protein diet.  A 64 million person- year study recently revealed that whole milk drinkers, milk product eater had a significant decrease in all-cause mortality. Skim milk drinkers did not have a decrease in all cause mortality. Myth #11 Cutting animal products in your diet will decrease your cholesterol and therefore prevent heart attacks. So why do we follow fads? I believe it is because we are human and we look for the easiest path to a goal, and easy diets appeal to most of us who want to lose weight, however losing weight is complex and involves a good medical based plan and a change in your lifestyle. Your plan should start with seeking the right kind of medical advice that fits the diet to your blood work, medical history and in some cases your genetics.

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog My medical practice, BioBalance® Health, allows me to hear all of the myths about how to lose weight, when I am in consultation with a new patient. All of my female patients and some of the men have at one time, or multiple times been fooled by the false promises of friends, doctors, and advertisers, about quick and easy ways to lose weight.  If you have bounced around trying every diet out there on the internet and failed to lose weight, then I can help you stop the pointless trial and error process, and help you embrace the difficult and time-consuming process of truly losing body fat and keeping it off! If you thought that all we do at BioBalance Health is replace women and men's testosterone with long-acting bioidentical pellets, you are partly right!  In addition to treating our patients' hormone deficiencies we also have the goal of attempting to guide them toward a healthy long life!  This involves treating “pre-diseases” like prediabetes that other doctors don't treat until damage has been done and guiding our patients as to the right way to achieve their ideal weight.  One of the important roles we have in assisting our patients with “fat-loss” is to disprove all the lies our patients have been told over the years by nearly everyone about how to lose weight.  Some of these myths are actually believable (unless you are a doctor and understand the physiology of weight loss), but still never work. Other diet plans work for some people with specific genetic qualifications, but not for the majority of the population.   Then, there are diet plans that are so bizarre and illogical, that they literally make me giggle when my patients describe the protocol (or advice) they have been following without results. Why are these myths so prevalent?  It is because we have been programed since childhood to eat in a way and in amounts that are inevitably going to cause us to be obese. It takes a lot of work to turn those lifestyles, habits and food choices around to lead my patients to lasting fat loss and long-lasting health. Hard work never “sells” and a time-consuming diet doesn't either so businesses make a lot of money keeping you fat! You may or may not have heard these! I will tell you why they   #1 Myth- If you eat fewer calories, you will lose weight, and all calories are the same. This is one of the myths that is spoken by doctors every day because they learned it 30 years ago in medical school, and it just isn't true!  To begin with calories in food are metabolized differently depending on whether they are Protein, Fat or Carbohydrate. It takes more calories to metabolize Protein, and more than fat and the food that burns the least calories to be metabolized are carbohydrates.  So, food calories are different depending on which food group they are from. Eg. There is a vast difference between the weight you might lose, or gain based on the food group your calories came from. For example:  If you eat a steak with 500 calories verses a slice of birthday cake/icing that contains 500 calories, it takes more calories to breakdown protein so you USE calories to make it into blood sugar, while the birthday cake takes almost no energy to make BS and readily makes fat if it is not used in exercise. Another factor that causes counting calories to be a losing proposition, is that every food stimulates insulin differently, and insulin that is over stimulated over time gives a person insulin resistance which causes them to be so efficient that they can go a day and not eat anything, and still fail to lose weight.  If you have tried a low-calorie diet and that happened, then you are not alone.   Going back to the steak and birthday cake example, steak does not stimulate insulin very much and birthday cake is likely to over stimulate your insulin making insulin resistance worse and doesn't make energy but is stored as fat! The third reason limiting calories cannot be the basis of a weight loss diet is that an individual human body has a vast number of factors that influence how you as a unique individual burns calories, therefore any one calorie limiting diet will not work for the majority of humans. We are all different with individual requirements for the types and amounts of food we need which is based on our genetics, our history of healthy or unhealthy diets, our daily exercise, and how obese we are when we start to lose weight. What that means simply is that there is no easy way to attain your ideal weight and stay there but limiting your calories.  Weight watchers tried this method for years and I never found a person who lost weight by eating a certain number of any type of calories (candy, dessert, or fruit and vegetables with the equivalent number of calories) in one day, who lost weight and kept it off.  If you eat 1200 calories of fruit, veggies, eggs, fish and or meat throughout the day and have an active lifestyle, you will lose fat that day. If you eat 1200 calories you save up all day to eat one dessert you will probably gain weight because it will overstimulate your insulin and make your calories into fat and not energy.  Weight Watchers changed their program several years ago when their clients realized their system didn't work. Counting calories to lose weight is a myth you should avoid.   Myth #2: The promise:  “If you just  eat _________ (one food like grapefruit/cabbage soup/ salad/juice take your pick)  for ____ weeks you will lose 20 lbs. The cabbage soup diet is an example of this failed “theory” which invaded the US female population in the early 2000s and my patients embraced it completely believing that they would lose 20 pounds in 4 weeks.  I objected and told them that eating only one food for 4 weeks was unhealthy, a baseless fad which was unlikely to work, but very few of them listened.   It turns out that Cabbage is a food that slows the metabolism of people with   A blood type, and the majority of citizens in my city, St. Louis, have A blood type!  At their next GYN visit my patients were all moaning over the fact that they had GAINED 20 pounds on the cabbage soup diet! Not eating a variety of foods is unhealthy and this proves that even an unhealthy diet doesn't promise weight loss for everyone. So please don't follow fads. they are baseless, and you might gain weight and not lose it!   Myth #3 You can exercise your way to fat loss,  eat whatever you like and still lose weight. I believe exercise should be part of every human's healthy lifestyle, and exercise is necessary to speed up the metabolism while you eat a low carb, high protein diet and refrain from bad habits like alcohol consumption. However, eating like you normally do and exercising hours daily will not bring about weight loss for 90% of the population of the US. Lasting weight loss doesn't occur unless you add eating a healthy diet, stopping bad habits and taking the required supplements necessary to decrease your fat mass, and exercise.  Yes, you have to do it all!    Increasing muscle increases our metabolic rate and exercising muscles increases the loss of fat, but both muscle building and muscle strength require high protein diets, with a moderate amount of fat, and without a lot of carbohydrate.  Eating carbohydrates unchecked can cause the weight loss promised by exercise-based weight loss programs to fail, over and over again. After the age of 45 your muscle will not be preserved while you lose weight if you do not replace your low testosterone and exercise too.  So it is not ONE factor that facilitates weight loss, it is complicated and there is a perfect fat-loss plan for everyone…you just have to find it!   Myth #4 Low fat diets are a good way to lose body fat and prevent heart disease! Every study has failed to support this idea!  Low fat diets don't lower cholesterol, but low carb diets do!  We were told by cardiologist for the past 30 years that low fat diets would lower the cholesterol and the atherosclerosis in your arteries…but they lied!  It is now accepted by most doctors that low fat diets leave people hungry which causes them to  eat too many carbs resulting in an increase in cholesterol and weight gain. Re-introducing fats into your diet should include healthy fats (fat from seafood, vegetables like olive oil, milk fat and other omega 3,6, and 9 ) are necessary for brain health and good body composition. The advice by the US FDA and Medical specialists to eat a low-fat diet has contributed to over 50% obesity, dementia, and diabetes in America. If your cardiologist tells you that a low fat diet is going to prevent heart disease, then look for a more up to date cardiologist.   Myth #5 High protein diets are not effective for weight loss. High Protein-Low Carb diets are the best diet for the majority of people in the US.  This diet is the most effective type of eating plan for your weight loss.  If you want to know what % of protein, fat and carbohydrates you should eat, then go to our website, BioBalancehealth.com and become a weight loss patient with genetic guidance and you will learn how to distribute your foods based on your unique genetic map.  High protein diets keep you “full” longer after a meal or snack, so your calorie intake is naturally lower. Reserve your intake of carbs to supply you with physical energy before and after exercise. Otherwise, your diet should consist of high protein and fat, and limited carbs, with plenty of fresh vegetables and fruit (these food are not considered carbohydrate).   Myth #6 Diet soda is a “free food” because there are no calories, so I can drink as much as I want to and lose weight!  Diet soda contains many chemicals, salt and includes a chemical sweetener called aspartame.  Salt causes swelling, and all chemical sweeteners stimulate insulin and act to make you hungrier than if you drank unsweetened iced tea, water or anything sweetened with stevia.  Stevia is a plant that does not contribute to insulin resistance and diabetes.  The majority of diet sodas stimulate insulin just like carbohydrates do and contribute to weight loss failure.  Every time you drink one you should consider it just like eating a carbohydrate!    Summary: Following the advice above will prevent so much frustration with future weight loss attempts, and will help you achieve your ideal weight through avoiding these myths about weight loss. Remember that weight loss fads have been around for a long time without a public refute of the obvious myths above.   Fads should be ignored if you want effective weight loss. Remember that Instagram and Facebook posts are only motivated by profit, even though they spread crazy diets as based on fact. There is no one monitoring the “fads” validity. Please don't listen to fads of people who are not doctors or nurses trained in weight loss! More Myths about weight loss next week!

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog Dave Glover, the most listened to talk radio voice in the Midwest, invited me on his show last week to talk about BioBalance Health Testosterone Pellets for men and women and BioBalance Skin my medical esthetic spa.  His show is on KMOX, the voice of the St. Louis Cardinals.  Dave Glover and I have worked together for 10 years, and he is unabashedly my patient who has experienced the superiority of our medical care that is unique, and preventive, in addition to being the best testosterone pellet therapy in the Midwest. We go far beyond to direct our patients to a healthier life. Dr. Maupin Radio Interview with Dave GloverWhen patients have their first appointment our doctors have already reviewed their lab amd medical history, and the first appointment is chocked full of information about the meaning of their laboratories, diagnosing medical problems such as insulin resistance and prediabetes to finding diseases they were unaware of.  At the same one-hour long appointment we work with our patients to develop an individualized diet and exercise program for their unique situations. The secret to our success in bringing 95% of our patients back to health is the foundation of replacing testosterone in the most effective and safest method with replacement non-micronized testosterone estradiol pellets.  We do much more in a short time to direct our patients to reversing the symptoms of aging (the symptoms of testosterone and estradiol loss) while we prevent future illnesses like diabetes and help our patients move to healthier lifestyles. Dave asked me what is new about BioBalance Heath.  We are always improving our knowledge, based on new medical research, and our newest offering is a simple genetic Diet and Metabolism Test called Nutrigen.  This test is done by simply doing a self-cheek swab and never has to be repeated!  Right now we are offering this test for $300 (a discount of $150).  If you have tried many diets and still don't know what type of food you should eat, our test is meant to be a ONE-TIME test to tell you everything you genetically need to lose weight.  Or if health is your goal and not weight loss and you want to know how to eat for the rest of your life, this diet is a necessity!  It comes with a 60-page report. What % of your diet should be fat, carbohydrates or protein? What times of day should you eat? Should you eat snacks? Does exercise help you lose weight or not? Is a low carb diet the best one for you? a low-fat diet? A low-calorie diet? Is a high fat diet the best for you to be healthy? What supplements do you genetically need? Everything you have ever asked about your individual path to ideal weight! Everyone who elects to take this test will get a 60-page report about every genetic factor that affects their diet, metabolism, exercise and weight loss.  It even includes what genetic factors are working against them and their ability to lose weight. When their test comes back, our Nurse Weight Loss Specialist, Sarah Hooper RN will be ready for them to make an appointment to go over the report and explain a healthy eating plan. We always have used the INBODY machine for following body composition and not just weight for ALL our patients, pellet, weight loss, and non-pellet patients. Dave then asked about what was new in our BioBalance® Skin Office? We are always looking for ways for our patients to look younger, and healthier as they age. Dr. Maupin and Sullivan's criteria to adding services is that they are TRULY EFFECTIVE, as well as painless, and the service is affordable compared to other pathways to the same outcome. This year we have added a painless hair growing ultrasound treatment called TED.  It can treat any form of hair loss, as long as there are some follicles left to stimulate. Women and men come in for 4 to 6 45-minute treatments, that feel like a scalp massage.  There are no necessary serums or vitamins to buy. You just have to keep the areas treated out of the sunlight for the month following the treatment.  This is a real breakthrough and compared to very costly hair transplants and painful PRP treatments this is a game anger! For women who have lost weight and ask us every time they come in for weight loss or pellets what they can do about sagging and crepey skin, now we have a variety of treatment s  to offer them: Opus treatments for the chin and jowls, Juvashape to tighten areas all over the body. EM Sculpt to build muscle, lose subcutaneous fat and tight skin, and EM Face to take the place of a Facelift!  Our patients are encouraged to come in for a free consultation to help them decide what they can do to “SHAPE UP” after successful weight loss! We offer episome treatments with our Aqua Gold treatments to rejuvenate tighten, smooth out and lift facial skin….It is a step up from  microneedling for more mature skin. We literally offer the MOST EFFECTIVE, MOST ECONOMICAL TREATMENTS with the least pain and best results anywhere!  BioBalance Skin Staff will guide you to the appropriate choice of treatments so you can be assured you have the best esthetic treatment for your individual problem. Our Goal is to help our patients look as good as they feel with their BioBalance Pellet treatments!

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog 2024 has been the hottest summer of the decade and it is causing many of you to go to the ER with heat related sickness. There are several risk factors that may put you at high risk for illness relating to the heat. I have been present several times when someone collapses from heat stroke which is the most severe heat related illness. The heat can kill you if it progresses this far.  It is interesting, athletes who won't back off from their outdoor activities, and will work out in the highest heat of the day. Heat stroke can cause a person to collapse, drop their blood pressure, act out, or pass out, or even seize, all of which are signs to call 911, and start emergency procedures: elevate their legs, if possible, place ice packs under the arm pits, around the sides of the neck, and on their groin. The highest risk patients: Babies and toddlers are over 65 On multiple medications Taking a diuretic Obese patients People with anemia and other blood conditions Patients with coronary heart disease Patients with atrial fib Those people who don't drink water, just caffeinated drinks-dehydrated people Who have just been flying (dehydrated) Who are hung over (dehydrated) Who have been nauseated and vomiting in the days before going out and working or playing in the heat. Ask the heat stroke victim to drink fluids if possible. Of course, make sure they stop the activity they are engaged in outside in the heat. Move them to a cool place while you are waiting for emergency help to arrive. Heat stroke can cause a vascular stroke or death, so emergency treatment is necessary. If possible, offer the victim water with electrolytes in them (NUUN-Sport) and some sugar in case they are also hypoglycemic as well. If they can't drink, which is a side effect of heat stroke, put a wet washcloth in your mouth to suck water from it slowly. My husband and I went on a trip to Cinque Terra, Italy with another couple last fall to hike the trails between the 5 towns that line the cliffs over the shores of Liguria.  The hike was supposed to start at 8 am so we could avoid the heat of the day….and it was in the 90s and humid…but as luck would have it the transportation we had arranged for wasn't able to take us to the starting point and we didn't get there until  10:30.  We packed several water bottles and a few snacks but we were not prepared for the  4  ½ hour trek high above the mediterranean on a trail that was 3 feet wide and involved thousands of steps up and down…we had drunk most of  our water in the first 2.5 hours and were very hot and sweaty the whole time….about 40 minutes from the town of Vernazza, my husband started stumbing, and talking nonsense…he had stopped sweating and couldn't walk….There was no place to lay him down without blocking the path and we found a shady spot for him to recline and put his feet up.  I had some Nuun-sport electrolytes which I had put in my water and had been drinking, so I put 2 electolye tablets in ½ bottle of water and tried to get him to drink it…..he was delirious and refused, and I had to force him to drink…he fell asleep and we received water and cold water bottles to put around his neck from passersby.  Ideally, we would have gotten ER help which he really needed, but there was no way to get emergency care to him and at 6-4 and 230 he was too heavy to carry/drag…and remember we were on the edge of a 200 ft cliff. When he had slept 20 minutes I kept my finger on his pulse and he was thready and fast…..Thankfully he rallied and we got to Vernazza and he walked into the ocean after drinking several glasses of water to cool off and fell asleep on the beach for an hour until he was ready to get on the train back to our hotel….This was one of the scariest times of my life because I knew what to do but didn't have the IVs, or water or ice or anything to help him.  Remember this and make sure you are always prepared for the worst scenario when you are active in the heat!   So how do you know when you are getting close to heat stroke?  You feel weak and out of breath. Your pulse rises, you stop urinating, and you STOP sweating.  You are getting close to heatstroke when you start to feel cold even though the ambient temperature is high.  When you feel dizzy and unstable on your feet…the next thing to happen is vascular collapse See the stages of Heat Related Illnesses below, which we are all at risk for! This is from the NEJM.   Heat-Related Illness Description Treatment Severe illness     Heat stroke A multisystem, life-threatening illness characterized by elevation of the core body temperature (to >40°C) and CNS dysfunction   Classic heat stroke: most often occurs among older persons with compromised behavioral and physiological compensatory responses to heat exposure Exertional heat stroke: most often occurs among healthy persons during extreme physical exertion, which results in excessive metabolic heat generation, often but not always with concomitant ambient heat exposure Move patient to cool environment; manage airway, breathing, and circulation; administer rapid cooling with cold-water or ice-water immersion or other means; administer intravenous rehydration; and evacuate to emergency department after on-site cooling is performed. ICU admission is warranted for management of end-organ sequelae. Moderate illness     Heat exhaustion Profound fatigue, weakness, nausea, headache, or dizziness (or a combination of these symptoms) resulting from a decrease in body water content or blood volume due to water or salt depletion from heat exposure; mild elevation (

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog In general, I spend my time defending women and the fact that our problems and sexual physiology is ignored, by the governmental powers and physician organizations in the US, so I try to do my part to bring information to women about their hormones and the aging process. Today I am changing my focus to men and the way men's normal sexual function is considered a “normal” and rarely discussed outside the men's locker room and or porn sites. So here goes…The fact is that men's sexuality isn't just the act of sex, but men spend a lot of their sexual energy on fantasies and just thinking about having sex.  Men's ability to have an orgasm is not just a wham- bam—thank you…well you know the phrase…and there are many physiologic factors that must work, in the background to bring a man from thinking about sex or desire, to an orgasm. Sadly, in the current environment couples don't talk about sex….they don't tell their partner what makes them excited or even what they want…. because none of us can read minds, too many of us don't get what we want when it comes to sex. With lack of communication between partners, leads couples to trial and error without a map.  Neither sex knows how the other sex “works”.  I decided to describe the normal series of what men go through on their way to orgasm to educate them and their partners.  In addition, the process is not always the same in each person and as men age the time between the first sexual thought to completion gets longer and longer…sometimes these detours include episodes of losing an erection, sometimes getting it back and sometimes not which leads to frustration of both partners. In youth when a man's free testosterone is high and his arteries are free of plaque, between puberty and age 35, erections may occur often, and they last a long time if the man is stimulated for a long period of time. At this point sex is automatic and easy to complete to orgasm and ejaculation. As time goes on, free Testosterone starts to decrease with age, as does the diameter of a man's arteries…blood flow doesn't rush to the pelvis to create an erection like it did in youth. The things that lower free testosterone.  What happens with age that cause erections and ejaculation to be less and less automatic and easy? T and free T drops after age 35 in most men and becomes critical by age 55, even in healthy men. Ejaculate decreases due to lowering of free T Vasectomies decrease the volume of ejaculate by 1/3 Stress causes free T to decrease. Hypertension causes arteries to contract and deliver less blood to the pelvis for an erection. High blood sugar and diabetes destroys the arteries in the pelvis making blood have a more difficult time getting to the penis. Stress causes Cortisol to rise and free T decreases, Obesity increases the estrogens in men and that decreases free T by binding it with sex hormone protein and inactivating it. Any medication the constricts blood vessels (ADD medicine, Phentermine, speed, etc) decreases blood flow to the pelvis. Some medications that lower blood pressure lower It in the pelvis too low so that men are impotent (e.g. Lisinopril). For men who don't know all these medical, aging changes that happen to most men, these changes cause fear and anxiety which of course makes it worse.  Men who have this issue (most men) are even reticent to talk to me about it and they haven't talked to their spouse either. So here is what I tell them:  You are aging like everyone else, and that fact can't be changed, however, your lifestyle and your medical health, or poor health is affecting your orgasms and your ability to have sex.  These factors CAN be changed.  You can change your BP medicine to one that doesn't impair erections.  You can get your diabetes or obesity under control, and you can improve your erections.  However, to get it all back you will need testosterone replacement if your free T is under 129 ng/dl. The safest way to accomplish this is with my practice BioBalance® Health…we do it better and know all the tricks to making you healthy productive and potent! What is in the ejaculate? mature sperm are mixed with whitish, protein-rich fluids with prostaglandins are produced by the prostate. These fluids nourish and support the sperm so they can live after ejaculation for a limited time to fertilize an egg.  This mixture of fluid and sperm, known as semen, and is what is moves through the urethra in the form of ejaculate. Sensory stimulation travels from the skin to the brain and stimulates dopamine and endorphins which are neurotransmitters that make a man fee happily ecstatic during and after an ejaculation.  These neurotransmitters also stimulate the Hypothalamus to make oxytocin, a bonding hormone that binds couples together. Many nerves, vessels and the brain are involved in a successful sexual encounter. The culmination of a sexual encounter is complex and involves the whole body. I find it interesting that the “medical view” of orgasm is still divided into 4 different steps when, if you are a male (or even a female who has had sex with a male) the divisions seem very arbitrary and is ALWAYS connected to ejaculation. It is a fact that men and women can have sexual intercourse and orgasm without ejaculation. The following is how the practice of medicine describes the male sexual act.   In contrast I have educated my patients by comparing sex to a on the fact that men can have orgasms which occur in the brain when endorphins flood the neurons, even without ejaculation.  So I will discuss, the male sexual experience to them, not with the “4 easy steps of male sexual response”, but as a “process” of achieving orgasm in men.  It is more like a recipe, that requires each ingredient to be added in order, but sometimes you can stop in the middle and start again.  It is not always a straight line from sexual desire to orgasm. In general, all men need testosterone to have sexual desire, and sexual desire to have sex, however both men and women can be physically or visually stimulated to be aroused without true sexual desire. If the man has a long history of having sex often, then the habit of having a sexual response can be achieved without enough testosterone, however the erection will not necessarily last long enough.   Continued physical stimulation can bypass desire, and therefore testosterone, and a man can be stimulated into having an erection of sorts and into having an orgasm with or without ejaculate An erection requires testosterone to become fully erect, however there is a “work around” now and men without testosterone can have an erection with Viagra, Cialis pills, or prostaglandin injections into the penis itself. Men can also have a penile implant placed so they can have sex without testosterone or Viagra/Cialis. However, let's talk about sex with testosterone in men who have good pelvic blood flow who don't require medication to become erect. The second necessary ingredient after testosterone is stimulation, which can be with touch, visual stimulation, auditory stimulation or even imagination that causes a man to be stimulated. The sexual response to any of these stimulations send messages through the nerves from the brain to the pelvis that dilates his veins and arteries. This sends blood to the penis from the arteries and blocks the veins from draining the blood out.  This creates an erection. Testosterone's role is to cause the arteries to dilate by stimulating the production of nitric oxide from the arterial walls. Remember the stimulation? The ongoing stimulation (mental, visual, auditory or imaginary) keeps the erection hard with vascular dilation. At this point stimulation can be changed or paused and other stimulation can prolong this part of the process.  Holding the base of the penis can keep it hard, or any tight encircling toy can keep the erection from proceeding to orgasm for some time or the erection can go away without continued stimulation. The third step is the preparation for orgasm which can last from as long as 30 minutes and as short as 2 minutes. A clear “pre-ejaculate” is produced that lubricates the penis for intercourse, and if ejaculation is to take place there is a “loading of semen” that takes place from the seminal vesicles readying the man for ejaculation.  At this point the penis contracts the muscles quickly in rapid repeating emissions that shoot the semen out of the urethra. This is the orgasm and ejaculation that occur together, which is typical of normal youthful ejaculation.  As men get older the force at which they ejaculate decreases. After ejaculation/orgasm the brain is flooded in endorphins, the feel-good neurotransmitters, that make a human feel happy and satisfied.  This is solely the result of the orgasm after a sexual encounter. The feeling of ejaculation does relieve pelvic pressure but is not needed to experience orgasm in most men. Medical science has been able supply an assist for desire (testosterone) and erectile function (vasodilation and release of nitric oxide but they have not discovered the “pill” to make ejaculations occur or to improve their volume.  It is important for an aging man to accept that orgasm doesn't require ejaculation since we don't have an answer to recreating the youthful ejaculation.  Besides age, vasectomy can also limit ejaculation.  dehydration, vasoconstrictors, anti-hypertensive drugs and diuretics can limit the volume of the ejaculate as well. After the “process of sexual orgasm” the penis loses tumescence, blood leaves the pelvis and overall relaxation occurs throughout the body. Then a period of time must pass before another erection can occur.  Over time some “twice a day men” can turn into once every week…..this can be changed by practicing…..having sex more often. The sexual response in both men and women is more like a symphony with several movements, than a recipe, but it is definitely not a series of steps that is followed in every human in every circumstance. It is the job of the physician to help patients both understand and live with any variations in the sexual process.  Much of what I do is act as a teacher to my patients who need to understand their own bodies and any dysfunctions thereof.  Understanding becomes treatment over time.

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog The medically accepted belief that testosterone is bad for men has finally now been superseded by a huge study from Australia that proves that men with healthy levels of Testosterone live longer and healthier than men with low Testosterone! All you men who have been told that testosterone is bad for you or will cause prostate cancer by your doctor, you can tell you provider that he or she is out of date!  At BioBalance Health® we have been treating men with testosterone pellets for years and our patients are our evidence that testosterone not only keeps men's sexuality healthy, but youthful testosterone blood levels keep men healthy in many ways, eg. strong muscles and bones, excellent immune systems, healthy heart and blood vessels, lean muscle mass and it prevents the diseases of aging too!   I have been treating men and women with Testosterone for over 20 years and I concur with how this study plays out in real life, in my own practice. When my patients replace men's low testosterone levels with testosterone pellets and they follow my recommendations for a low carbohydrate diet and weight training exercise, supplements and treatment of pre-diabetes and pre-cardiac disease, they live more productive, longer and more enjoyable lives. My goal for my medical practice is to keep both men and women healthy as they age, and testosterone replacement is the most important necessary element to that end.  My intent is to defeat the aging process with interventions that have the potential to delay the onset of age-related diseases and preserve your ability to live life to its fullest, no matter what age you are!  We have based our treatment on hundreds of other studies that literally studied one symptom of testosterone deficiency or disease of aging at a time in relation to testosterone levels and found bioidentical testosterone to be beneficial to the health and longevity of men. However, we treat all the symptoms of aging and low T with testosterone pellets. Australia's Men's Study found that men who continued to produce normal youthful levels of Testosterone or replace their Testosterone to achieve normal youthful levels lived longer, more active lives than men who let aging take its course and drain them of testosterone! We have known this for two decades and we have treated men and women with testosterone pellets, the most effective and safest way to prescribe T.  Many smaller studies have been done that prove the same thing, but none so dramatic as the latest study we are referencing. At this point I have two questions to answer for most of your inquiring minds: Why did all the experts tell you that testosterone replacement is dangerous? and, why are the experts in the field of men's medicine, Urologists, still advising men not to replace their low testosterone as they age? Let me explain that why everyone is so negative about testosterone and why most medical doctors still believe that prescribing testosterone to men is evil.  This all started in the 1950s based on the study of only 3 men, who had had prostate cancer. They said they were testing them to find out if testosterone caused prostate cancer recurrence in men after prostate cancer.  During the study one of the men had a recurrence of prostate cancer when he was given testosterone injections.  In the “olden days” that provided the basis for the belief that Testosterone CAUSED prostate cancer!  The doctor even got a Nobel prize.  Based on this minimal and falsely extrapolated information, 50 years of doctors have been taught that prostate cancer is caused by testosterone, when in reality testosterone is only dangerous if a man already has an aggressive cancer already, will testosterone replacement stimulate the growth of prostate cancer. This misinterpretation of a faulty medical study has prevented generations of men from being treated with testosterone to prevent diabetes, heart disease, loss of muscle mass and the ability to walk and lift, as well as the inability to have sex throughout their lives.  This has been a grave dis-service to American men, because the world follows us with all of our medical protocols, this misinterpretation and lack of preventive care with T has spread around the world. The second question you should ask is: Why are the experts in the field of men's medicine, Urologists, still advising men not to replace their low testosterone as they age? Well, this is not just your doctor's fault.  Other than being trained by generations of doctors who believed the inaccurate information about the danger of testosterone causing prostate cancer and passing it on, there is a problem with how we train the doctors who take care of men. Urologists are surgeons first and not particularly interested in anything that has to do with preventive medical care.  Their training is based on surgery: they go through a general surgery residency after medical school for 5 years and then do a specialty in urologic surgery which doesn't include treatment of anything medical or preventive.    More than that, their College of Urologic Surgery and their journal has been blinded by supporting the surgical treatment of prostate cancer, so their motivation to prevent prostate cancer is generally opposite their type of practice of medicine. They can only operate on prostate cancer when a man has it. Now if you have a penchant for conspiracy theories you may then jump to the conclusion that both the practice of medicine, the business of pharmaceuticals and the government have monetary benefit from keeping all of us sick, and limiting our longevity, since we are a drain on the system after we stop working and live off Social Security and Medicare.  In other words, old Americans don't provide value to the whole of society.  I contend it is only because we don't help aging Americans stay productive and healthy that they are a drain on the rest of the population…However, that conspiracy theory is just a theory I have heard from my patients. This study is big news because it is the most important study that has been allowed through the blockade of powers, to the public!  We at BioBalance Health® can now give you men what you need, and when other doctors criticize our treatment, we can defend our treatment plan with this Australian study and the other hundred studies that came before.  You have your ability to ask for what you need from your doctor, based on sound evidence! The second study is below and was in the Journal of Internal Medicine about the same time as the Australian men's study. Study links low testosterone to increased mortality A study published in the journal Annals of Internal Medicine found that men with low testosterone levels had a higher risk of all-cause mortality, and those with very low levels also faced an increased risk of cardiovascular mortality. The findings suggest potential links between testosterone concentrations and health outcomes, emphasizing the need for further investigation into underlying mechanisms and potential therapeutic implications.

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog On the last Heath cast #662 we talked about the choice of doing nothing when faced with symptoms of hormone deficiency and symptoms of aging, versus the choice to actively live a healthy life. I believe that concentrating on yourself as you age can save your lifestyle and or your life!  Preventing illness as you age is as important as paying your taxes! An unhealthy living plan without replacing deficient hormones can lead you on  a road to illness and early death.  If that doesn't motivate you, then consider yourself warned. Recently I saw a man in his late 70s who I had seen about 7 years before this.  He and his wife entered my office, and I could see that some of my medical predictions had come true.  This man had developed every disease I told him his blood work and physical self-predicted. Despite the treatment plan I gave him, he ignored me on diet, exercise, supplements, stopping smoking and drinking I gave him 7 years earlier.  He admitted that everything I told him would happen, did happen and now he is in constant pain, he is morbidly obese, and has trouble even walking.  He now has diabetes and has had a heart attack and 7 ER admissions for his heart since.  He did not do one thing I told him, except just recently he stopped drinking alcohol. He now is ready to live a healthy lifestyle however since he has so many diseases, he spends an enormous amount of money on medications and medical care.  The cost of care was his reason to ignore hormones, but he ignored my lifestyle advice as well.  Even though now a lifestyle change and testosterone pellets will improve his life, he still has done damage to his blood vessels and heart not to mention his joints and back.  These aging changes I cannot prevent, just stop the rapid progression. When you become our patient, we ask you a variety of questions that help us design a treatment plan, more accurately named a “longevity plan”. Symptoms of Testosterone, Estradiol and Thyroid deficiency: A combined list of symptoms of aging for men and women include: Loss of Testosterone Symptoms: ·      Loss of sex drive ·      Loss of erections, and morning erections ·      Loss of orgasms for women ·      Fatigue ·      Insomnia ·      Depression/anxiety attacks ·      Loss of strength and muscle mass ·      Frailty ·      Can't think clearly or remember names of things ·      Loss of motivation ·      Loss of efficiency at work ·      Weight gain ·      Belly fat increase ·      Sagging skin ·      Arthritis ·      Osteoporosis Loss of estradiol (women): ·      Hot flashes ·      Night sweats ·      Anxiety attacks ·      Irritability ·      Dry vagina ·      Painful intercourse ·      Sagging skin ·      Frontal balding ·      Urine loss ·      Dry skin ·      Shrinking vagina ·      Osteoporosis ·      Arthritis    Thyroid deficiency: ·      Hair loss ·      Fat gain ·      Fatigue ·      Depression ·      Feels cold all the time ·      Very dry skin ·      All body swelling ·      Constipation ·      High cholesterol ·      Low blood pressure and pulse These symptoms above can be treated and in treating them you will experience not only a lack of symptoms, but a longer healthier life. However, if you also change your lifestyle you can avoid the diseases of aging too! Through replacing your deficient hormones, add only individually chosen supplements and develop a healthy whole food eating plan, with 3-7 days a week of exercise (1 hour/ session).    What do I mean? What is a healthy Lifestyle? ·      If you smoke STOP! ·      If you Drink more than 15 alcoholic drinks a week, then stop, If you aren't addicted to alcohol, you should decrease your drinking to < or = 7 drinks a week. ·      Exercise 30-60 minutes a day (consecutively) ·      Throw out all the simple carbs in your kitchen: all cereals and granola, use olive oil to cook and no vegetable oils, Processed dry food in boxes or cans should be donated to charity. ·      Buy fresh fruit, fresh vegetables, cheese yogurt, fresh or frozen meat, fish chicken, turkey for meals at home. ·      Sourdough bread is the best choice in breads—it has no gluten but still has carbohydrates, so small amounts are advised. ·      Do something you love every day ·      Look for opportunities to have fun You CAN turn your bad genes off through a healthy lifestyle!  Now we know even your genes can be combatted through healthy living. The diseases of aging can be adjusted or avoided.  When thinking about what your risks might be, remember that Family history is a broad and faulty way to determine your risk, but genetic testing is a better way to determine your risk of disease that is found in in your chromosomes and genes. The combination of your genes are uniquely yours. Knowing what your genes are can guide you to an individual healthy lifestyle for avoiding disease and living a long life.   We offer this service for our patients who want to know what the perfect diet and lifestyle plan is.  It is called the   Nutrigen test is optional but a great idea if you are trying to renovate your life! This saliva test (no needles) can determine the genetics you inherited from your ancestors.  We then share the information with you and develop a lifestyle plan that includes lifetime changes in eating to decrease carbohydrates from grains and sugar, increase protein, and remove as many processed foods as possible. The Nutrigen test tells you what genes you inherited that impacts your health, but it doesn't tell me whether you have turn any of your bad genes off or your bad genes on! We offer that test to our patients who are trying to lose fat or just reframe their life so they can live more productively and as much without disease as possible, Now if you aren't convinced that you need to replace your hormones with testosterone plus estradiol if you are a postmenopausal woman, or if you figure you will   Does a future of having Alzheimer's disease strike your panic button enough to change what you eat and how much you exercise, and to replace your Testosterone with Pellets?  Or is it losing a limb from diabetes? Being unable to talk from a Stroke?  Would losing your ability to move around as you do today from a Stroke or heart attack make you scared enough to value your health and clean up your lifestyle?  Or would the prospect of never having sex again be the trigger that causes you to be as careful with you own health, body,  and mind, preserving it for the rest of your life? Medical care is not just about fixing the sick through medications or surgery anymore, although that is the paradigm we have all grown up in.  That dated belief may have dominated our  belief  about what medical care can do for us and how it works because until recently medical experts didn't understand how diseases sprouted from a bad lifestyle, or because we were taught that our genes determine our health and there is nothing we can do about it…..but we now know that leading a healthy lifestyle, using food as fuel and not entertainment, and being moderate in everything from food, to alcohol to exercise is the key to a long healthy life. New information in the last 20 years has come to light  revealing that an individual can turn off bad genes through a healthy lifestyle…. Your genetics do not  dictate your fate, but it is your behavior that dictates the diseases you will suffer fromwith through the last half of your life  and eventually die from. Let's talk about the most dangerous lifestyle choices that you can make. You must think about your body as a luxury car that requires a lot of maintenance, the best quality gas to fuel it, and loving care every day to maintain its value and performance.  Our bodies are a thousand times more complicated than the highest- performance car, and I contend that the most beneficial maintenance you can do is to think about your health every day especially when you are presented with behavioral choices.  For instance, when you wake up you should stretch and make sure your muscles are not spasmed.  YThe you should think about the two most important choices you will make all day, “When will I work out for an hour?” and “What shall I eat today?”. .  Exercise is key to managing your insulin sensitivity and blood sugar, protecting you from diabetes and heart disease.  Why would you avoid this inexpensive protection from these deadly diseases?   Planning what you will eat that day (or for the next week) should include  healthy, non-processed foods and drinks with plenty of water and protein and limited carbohydrates from grains especially from wheat. But you counter my suggestion ,” Wwhat should I do when everyone around me is overeating processed foods and drinking alcohol and sugared soda?”.  My answer is, “Stop and think! Do you drive over a cliff because the guy in front of you does? No!  Be brave and don't make a scene., just choose to eat and drink in a healthy manner…if that is not available, leave and find the food and drink your body needs!”  You are no longer a teenager when all the mistakes we make are “forgiven” by our bodies.  That stops working after age 20!   I think you should look at taking care of yourself like being engaged in working toward a goal, whether it be in sports, climbing the corporate ladder, getting a raise or getting your degree.  Health is a goal that will repay you throughout your life. I no longer work in OBGYN not because I didn't enjoy it, or it wasn't profitable enough, I stopped running around with my hair on fire, stressed out and exhausted without adequate sleep or nutrition because it was bad for me!  My medical practice literally made me sick!  I gained weight, felt terrible, looked old, was crabby and depressed, so I made a choice to make my health a priority and a priority for my patients. In terms of how  my medical practice changed…from doing insurance paid medicine which is paid for the patient by someone else I was daily faced with patients who didn't value my advice and didn't follow it!  I now have a medical practice where patients pay for their care themselves.  There is something about paying for something that makes you value it more! Instead of seeing patients yearly that I gave the same advice I give to my BioBalance patients today and repeating myself year after year without my patients making any progress, I now recommend lifestyle changes and treat my patients with replacement testosterone and estradiol pellets and they immediately feel better and follow my advice! I am blessed to watch my patients achieve health by changing their hormones, diet, exercise, changing medications and taking supplements to round out the nutrition offered by their food choices. The one most important health goal should be weight loss so you can achieve your ideal weight while you maintain your muscle mass. That change will take effort and sacrifice and if you are over 40 you will need testosterone to make this happen!    Here are the diseases that are caused by obesity: ·      CANCER! All kinds! ·      Diabetes-Type II ·      Heart disease, Myocardial infarction and stroke ·      Alzheimer's disease ·      Autoimmune diseases ·      Endometriosis ·      Arthritis and joint replacement ·      Hypertension and kidney disease ·      Immune deficiency Are you afraid of getting any of these diseases?  What is your most terrifying disease that keeps you awake at night?  Any of these in the list above?   I have always been fearful of Alzheimer's Disease and stroke because not being able to think and speak is my biggest fear!  I have gone so far as to have genetic tests for Alzheimer's Dx and I have 1 of the 2 genes that cause this devastating condition. However, because I have taken estradiol and Testosterone pellets since I was 47, my chance of getting this disease has been delayed 20 years.  Other factors that increase my risk for stroke and dementia are inflammation from being overweight, eating a high carb diet, lack of exercise, hypertension, poor neurotransmitters from a poor diet and bad gut bacteria.  One by one I have changed my lifestyle to decrease these risk factors. If I can do this, you can!  You don't have a harder work schedule than I have had or less time to choose foods to eat.  I choose to turn down more than one alcoholic beverage, to take my own healthy snacks when I travel and at my office. 

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog My goal for BioBalance Health® is to guide my patients to live a healthier life by offering them the newest preventive treatments, and safest hormone treatment available. My patients make an appointment with me and Dr. Sullivan for help with their current symptoms of aging and hormonal treatment to replace their missing hormones.  They also receive a plan for unique preventive lifestyle changes to assist them in continuing their lives in health. But first, I believe that treating the symptoms of aging is the first thing on the agenda, and those symptoms are treated by replacing the hormones that disappear with age, testosterone, estradiol and often thyroid hormone. These symptoms are classic and appear within a short period of time, together: This is a combined list of symptoms of Testosterone and Estradiol loss for women after age 38, combined with loss of Testosterone in men after age 50.   Symptoms of loss of Testosterone and Estradiol   ·      Loss of normal youthful body, muscle and shape ·      Loss of sex drive ·      Infrequent or absent orgasms ·      Fatigue ·      Depression   or Anxiety ·      Insomnia ·      Memory loss/ Difficulty thinking ·      Loss of motivation ·      New migraine headaches ·      Decreased muscle mass ·      Joint aches/ arthritis ·      Dry eyes   ·      Loss of balance ·      ED in men (men) ·      Poor or decreased ejaculation (men)   ·      Increased belly fat Loss of waistline ·      Weight gain   ·      Cellulite ·      Ringing in the ears   ·      Dry vagina (women) ·      Painful intercourse (women) My patients frequently tell me that they feel so good after getting their first testosterone pellets that they wish they would have come to see me years before because they have been suffering and now their symptoms are improved or gone. They also comment on how great their sex life is, their improved stamina to walk, play golf or run and how much younger they look! That is the enjoyable part of my practice. Replacing these hormones gives my patients their lives back and gives them their energy back so they can make changes in their lives to keep themselves healthy to avoid the diseases of aging. The Diseases of Aging are these: Cancer Type II Diabetes Arthritis Heart Attack Stroke Dementia, Alzheimer's Disease, Parkinson's disease Osteoporosis Frailty, inability to walk or climb stairs Immune deficiency Autoimmune diseases Depression and anxiety We find that we get great results with one or two hormones, but because we are preventive medicine doctors and hormone replacement doctors we are not just interested in your current condition and symptoms, but we are concerned about the diseases you are at risk to get when you get “old”.  We then go over your family history of diseases with you and use it to determine what you are at risk for. Let me say that family history is only ½ of your risk factor because each parent only carries 1/2 of the genes you own. This means that your risk is usually watered down by the relative who has the disease, and your risk usually goes up if two relatives on opposite sides of the family have the same disease. Even though we use family history as an estimate of your risk for diseases in the future it is not very specific or accurate.  The information your family tells you about their history may not be accurate for the real diseases your parents and grandparents had.  My family history is a good example of bad information in an individual's medical history: I thought I was at risk for Adult-Onset Diabetes because my grandfather on my father's side and my grandmother on my mother's side had Type II Diabetes. I was worried since medical school that I would eventually get AODM too. When I had my genetics done, I found that I had 4/5 genes that foretell obesity, but NO DIABETES genes! This changed my approach to my own health from avoiding carbs totally, to losing weight until I was at ideal weight.   In case you don't know it, almost all obese people develop Type II Diabetes eventually. If they don't change their lifestyle soon enough and lose weight as well as get the proper nutrition it is in their future. Diabetes is a disease that will follow them through their lives, putting them at risk for other diseases like cancer, heart disease, Alzheimer's disease, dementia of all kinds, arthritis, and joint deterioration needing joint replacements. This list includes the most common causes of death. So the moral of the story is, my family history didn't tell me what I was going to be at risk for!  You can plan your healthy living plan based on your family history, or you can get your own genetics done to tell you what you are at risk for based on your genes, OR you can just clean up your lifestyle, receive your hormone replacement using the safest delivery system (pellets) and begin a healthy lifestyle as soon as possible. Get real information based on your individual situation now with blood work and add your genetics or family history to help motivate you to get healthier. Changing your lifestyle is the hardest thing you can do so getting expert advice from a physician, and then follow it.  Look for a doctor who will help keep you motivated to follow your healthy living plan and do your half of the path to health and healthy aging without disease.   Please join me, Dr. Kathy Maupin, BioBalance Health® next time when we outline a plan for health and longevity to avoid the pain and disability of aging.

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog I bet you have heard the idiom, “There is no free lunch”, or  “There is no medication without a side effect”, but did you know that medications that are prescribed by your doctor can have negative effects on your health that are never even discussed with you….so you should protect yourself by replacing the nutrients that your medications  remove from your body, and that must be replaced for you to be healthy. Statins -→ COQ 10 DEFICIENCY= fatigue and depression Beta Blockers -→ COQ-10 DEFICIENCY= fatigue and depression Oral contraceptives and oral estrogen/progestins-→ COQ-10 DEFICIENCY= fatigue and depression Antidepressants called SSRIs-→ COQ-10 DEFICIENCY= fatigue and depression Dosage: If you take any of these medications you need to take COQ10 200-400 mg/day every day! Thiazide Diuretics=HCTZ -→ Magnesium and Zinc Deficiency muscle spasms, prostate issues, constipation Take 50 mg of Zinc and 400-600 mg of Magnesium Glycinate a day to replace what is lost. NSAIDS (Motrin, Advil, Aleve, Ibuprofen, Meloxicam, Naproxen, Indomethecin, Daypro, Mefenamic acid, Voltaren)-→ malabsorption, depression, anxiety, and the vitamin and mineral deficiencies listed: Folic Acid Deficiency- Take Methyl- Folate 500 mg Iron Deficiency—Take Iron Bisglycinate (Ferrabsorb) Vitamin C deficiency—Take Vitamin C 500-1000 mg/day Amino acid deficiency—take Arginine +/- Ornithine. OR change your medication to Celebrex 200-400 BID  PPIs=Proton Pump Inhibitors (Omeprazole, Prilosec, Pantoprazole, Lansoprazole, Protonix) are taken for stomach ulcers, H. Pylori infection and gastric reflux PPIs Increase Homocysteine which increases your risk of stroke, MI, and Pulmonary embolism.  PPIs decrease the absorption of many nutrients.  They actually cause malabsorption of essential nutrients.   Replace these nutrients with supplements, but much of what you take won't be absorbed unless you take daily Probiotics:  B12 – take methyl B12 1000 mcg/day Folate – take as methyl folate 5,000mcg/day Vitamin D – take 5,000 IU/day Note: PPIs can even cause the growth of dangerous gut bacteria causing chronic Hemophilus. If you have chronic vaginitis that smells fishy, it could be your PPIs! If you have this stop the PPI, take Pepcid instead (histamine receptor blocker) or nothing and take probiotics to repair the damage the PPIs have caused. These nutrients need to be replaced to keep you healthy, however it is better for most patients to only take PPIs for 2 weeks at a time or substitute a histamine receptor blocker like: Pepcid, Zofran. Surgery It is not just the medications doctors prescribe for their patients; sometimes surgical procedures can cause chronic diseases through preventing nutritional nutrients to enter your body.   Removal of the gall bladder must be done, yet patients are not told what they can do to be healthy after the surgery. The gall bladder provides enzymes that help you breakdown foods, primarily fats and absorb fatty vitamins from your food and supplements.  If you have had your gallbladder removed you can become nutritionally deficient in A, D, E fat soluble vitamins, and you will promote the growth of abnormal gut bacteria and are at risk for leaky gut, Celiac disease, autoimmune diseases and malnutrition. Everyone who has their gallbladder removed should take digestive enzymes with every meal and take Probiotics daily. Bariatric Surgery for Obesity The last iatrogenic nutritional deficiency that I will discuss is Bariatric surgeries, all kinds that remove part of the stomach, or band the stomach or in any way physically makes the stomach smaller is related to nutritional deficiencies caused by malabsorption of vitamins and minerals.  The way to combat these deficiencies include taking: a probiotic daily digestive enzymes with every meal and all vitamins should be chewable or sublingual to be absorbed from the mucosa of the mouth  In Conclusion: Remember I am a physician, and my job is to promote wellness in my patients.  It is sometimes more important and lifesaving to take the above medications or have these surgeries, than to prevent a nutritional deficiency in the future.  We must follow those medical decisions with trouble shooting addition of nutritional supplementation to replace what these necessary medications and surgeries remove.  That is preventive medicine and why supplementation is often needed for our health.  

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog You are what you eat, and you use what food and drink you eat based on your genetics. Weight loss requires professional advice, direction and oversight.  Combining receiving the best advice on what you should eat and drink as well as tailoring it to your metabolism and medical condition is what you should receive from your weight loss program.  Before you embark on a weight loss program you need to know the following lessons. Lesson #1: All Calories Do Not Create the Same Energy/Heat/Weight Loss in All People. You can put a gallon of gas into a Maserati and Ford Fusion and they do not provide the same performance (different acceleration or speed, pick up and ride) different MPG or speed because these two engines are not the same.  The Maserati burns fuel (calories) faster than the Fusion; it operates at a higher level of speed and performance, and it uses more gallons of gas per distance.  Just like the difference in cars, the difference in our bodies is VAST! I explain this truism every day in my office.  One of my female testosterone replacement patients returned for her first follow up consultation. The blood levels were ideal and all the symptoms relating to testosterone deficiency were gone!  However, the only thing she could think about was the fact that she did not lose weight (although she did gain muscle and lost fat) and her friend lost 15 lbs in the first 4 months!  Even though she and her friend were the same age their metabolisms were very different AND the fact that her friend did everything I told her to in regard to diet, limiting alcohol, taking supplements  and exercise, but she did not,  tipped the scales to cause her not to get the same result as her friend…in other words, her friend had a genetically faster metabolism, AND she put Premium “gas” into her metabolic car, changed the oil and took care of her car so it ran faster and better than the patient sitting in front of me who used regular gas, didn't care for her car and drove too fast and hard.  Two people the same age with different metabolisms, diet, exercise, supplementation, and stress level have widely different responses to weight loss.  Therefore, medical weight loss advice must be individualized to fit just you! The individual variables include: Genetic programing Current weight and diet Length of time you have been overweight Age Blood type (also genetic need for certain foods) Medical history/current diseases Medications you are on Supplements that you take or need to take Exercise and physical movement  Fad Weight Loss diets are a fraud to sell books or to get attention.  If it takes a 300-page book or a Social Media fad to sell a diet that is supposed to be good for everyone…it is a lie and may backfire! When the cabbage soup diet was a fad many of my GYN patients did it.  I had access to their blood types and knew that cabbage was bad for A blood types and slowed their metabolism. Despite my advice they still did the diet, and you know what happened?  They gained an average of 10 lbs!!!! Their blood type determined whether this particular diet would work for them. This is an example of how important your genetics are to weight loss.  What are the genetic variables that affect your approach to weight loss?  Inheritance how our body burns calories—are you a Fusion or a Maserati?: there are many genetic variables that make you as an individual require specific foods and exercise programs to get to your ideal weight and be healthy. It is the job of your medical advisor to determine what these are for you and tailor your diet accordingly. Your Blood type determines the best and worst foods for your metabolism and the number of days you should exercise. Do you burn calories at rest, or does it take active exercise for you to burn more than the baseline of calories? If you are warm while you sleep, then you burn calories at rest and therefore will burn more calories than someone who does not, even if you eat the same things and expend the same active calories a day. How much of each type of food do you eat? Protein/carbohydrates/fats. Protein takes more calories to metabolize than carbohydrates, and a lot more than fat, so the most calories are consumed by eating a high protein diet. Mood Determines your Mindless Eating: Genetically are you more apt to eat when you are anxious or worried? This is a behavior that can be changed by counselling, behavior modification, or even just making you aware of your inherited problem. Genetically do you always feel hungry? Genetically are you never full? These are genetically inherited qualities that affect the amount you eat and how often you go back for seconds.  There are medications and behavior modification that can counteract this genetic reality. Genetically does exercise or dieting result in the most weight loss? Believe it or not some people just have to diet without a lot of exercise to lose weight, others are programmed to exercise only for weight loss and then most of us have to use both methods to lose weight.  Let me say that exercise does use up more calories, whether you are built to burn more with dieting. Genetically how much lean muscle mass do you have? The more the better! Weight loss is aided by weight training three times a week, and the replacement of testosterone when you become deficient. Both of these muscle building methods increase muscle and decrease fat. Did you know that your muscle mass burns 80-90% of your calories.   More muscle means more weight loss, but your muscle metabolism must be turned on with testosterone, insulin sensitivity, good blood flow and more metabolic factors. The more fat you have the harder it is to lose weight because body fat doesn't burn many calories. High muscle mass burns a lot of calories even at rest! The more muscle you have compared to fat the faster your body will lose extra fat. Weight training is helpful to building muscle and losing fat. What percentage of food should you eat of each food type? That is genetically set. Your ideal % of Protein, Carbohydrates and fat are genetically determined. Many of us have discovered our ideal food chart through trial and error, but a weight loss genetic test can tell you as well! Your Age: The older you get the lower your sex hormone testosterone is. As you age testosterone, growth hormone decreases while estrone increases all of which cause and cause weight gain. Testosterone stops being produced from women's ovaries between 40-50 years of age. Men never lose all of their T but the level decreases from age 35 on to hit a clinically symptomatic level between 50-55 years of age. Estrone increases as Testosterone decreases and causes both sexes to gain belly fat. Do you have your sex hormones or not (particularly Testosterone)? Without T your muscles stop growing and burn fewer calories every day you go without T. This is why people tend to get old and fat as their T stops being produced (in women) or becomes clinically too low a level of free T at a certain age in a man's life. Growth Hormone decreases with age—adding nonoral T replacement increases Growth Hormone. Menopause immediately makes women who don't replace their estrogen and testosterone to gain up to 20 lbs without changing diet or lifestyle. Osteoporosis occurs and worsens with age because estrogen and testosterone in women decrease over time. Testosterone in men decreases in men which thins bones. Loss of bone causes loss of muscle and both cause weight gain.  More importantly, osteoporosis decreases the activity level of affected patients. Lifestyle impacts your ability to lose weight: How much water do you drink? You need sufficient water to lose fat. You should drink ½ your weight in pounds, in ounces of water to be able to lose weight.  That volume of water you should drink increases to ounces of water = weight in pounds if it is hot outside or you are doing work that makes you sweat. Do you eat cleanly- do you eat whole foods? Do you eat one salad a day? Do you turn down sugary foods and desserts. If the answer is yes, then keep it up because it is helping you lose weight! Do you eat fast food cereal, cookies desserts and or doughnuts? If so, stop! All of these foods are massive producers of blood sugar, metabolic syndrome and obesity!   These foods are literally bad for everyone! Do you eat a balanced diet? Humans are built to eat a varied diet with some fruit vegetables, meat, fish, eggs, butter, healthy fats (non-meat fats), with some grains and we were NOT built to eat sugar!  Do you eat a lot of carbs? A Low carb diet can allow you to improve IBS, prevent cancer, and Alzheimer's Disease, dementia, avoid bacterial and viral infections, high cholesterol and heart disease, diabetes, obesity….all the diseases that cause us to be sick and age are related to too much carbohydrate in your diet!  In Japan, Alzheimer's Disease is called Type 3 Diabetes! Do you sit all day or exercise and move your body –taking 10,000 steps actually helps you lose and maintain our weight as well as exercising your heart! Do you take vitamins and supplements to prevent deficiencies in your diet? If not then you need to write down everything you eat for a week and have your medical professional review it….My bet is that everyone in America needs supplements ! The minimum daily requirements on a vitamin bottle is the MINIMUM AMOUNT OF A VITAMIN THAT MERELY KEEPS YOU ALIVE!  These levels are not the amount of a nutrient you need to be healthy!  I bet you think alcohol is a food? It isn't!  Alcohol is a toxin, use it with care. Just because your friends drink a bottle of wine a night doesn't mean it is healthy…bad habits always want company! Diseases that you currently have affects your ability to lose weight. Are the glands that set your calorie burning rate healthy?   If your thyroid is low, you will have to work harder at exercise, and you will have to eat less calories to lose the same amount of weight a person your size who has a normal thyroid. If you have sick glands you are bound to be “over-fat” Diabetes and insulin resistance (abnormal your pancreatic gland) cause weight gain and an inability to lose weight if it is not treated. Metformin recreates insulin sensitivity, as does Mounjaro and Semaglutide medications. Liver and kidney disease your ability to get rid of the fat you are burning and you store up toxins that also slow your weight loss. Follow the directions of your doctor and get the healthiest liver and kidneys you can!  Fatty liver is secondary to Metabolic Syndrome, so treatment with Metformin, Semaglutide and Tirzapetide can cure this disease! Heart disease—high carbs not high protein diet causes arterial plaque! You have been lied to because statins make money!  Stop eating carbs and eat all the animal proteins you want! One of my patients has only eaten fruit, vegetables, grains, sugar and alcohol his whole life and he has severe atherosclerosis (hardening of the arteries) before he was 60! Avoiding animal products does not prevent heart disease. Endocrine disorders like overactive adrenal (high Cortisol) and hypoactive thyroid, pituitary adenomas can cause an imbalance of the metabolism and they can cause weight gain and fatigue that make it hard to lose weight. I will talk about Medications that cause weight gain—beta blockers, blood pressure medications, Statins, and others in a future blog.

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog If you have hypothyroidism (Low thyroid), fibrocystic breasts, fatigue, metabolic syndrome, diabetes, hair loss, obesity, or high cholesterol then taking supplemental Iodoral can improve these diseases.  These conditions have become an epidemic in the United States due to Iodine deficiency. My longevity medical practice is all about keeping my patients healthy so they can live not only a longer life but one with quality. In the last 20 years of my BioBalance® Health practice, I have seen a flood of new patients with conditions that are in part secondary to iodine deficiency.  Today in America, the majority of people need iodine and other supplements to their diet for many reasons: Food manufacturers don't supplement our foods as they did in the years from the 1940s to 2000. The food that we eat (even fresh food) contains less nutrition than they did 50 years ago. Fast food diets, processed foods and preservatives remove necessary vitamins and minerals that we need to be healthy. Alcohol leaches nutrients from our bodies and alcohol consumption is increasing. Chemical pollution has entered our food supply and now is stored in our bodies. We have added a chemical to our drinking water, fluoride, which displaces Iodine in our bodies leaving us Iodine deficient. Today I am going to address the symptoms and diseases of Iodine deficiency. This blog about Iodine is to inform you about the need for Iodine and what it does.  I hope to never have to remind my patients about taking this supplement again after listening to the associated podcast or reading this blog! Iodine is a micronutrient necessary for life. In a research article in the Journal, Frontiers of Nutrition, March 2024, a very succinct review of the illnesses that occur because of iodine deficiency and that can be treated (partially) with iodine supplementation. I recommend all of my patients who live in my area which has no iodine in the soil or ground water and where all the drinking water is fluorinated.  The Iodine supplement, Iodoral, is not a drug, but a nutritional supplement that is sold over the counter. The Iodoral 12.5 mg bottle of 90 is $14.50 for 3-6 months supply.  You can't afford NOT to take it! Why do we need this supplement at this time in America and many first world countries?  Governmental intervention in our basic need for water caused most of our deficiencies.  Iodine is produced naturally in the ocean by seaweed, and it is contained in the soil and ground water in areas of the country that are near the ocean and those areas that were covered by ocean water millions of years ago. So, if you think geographically, most of the US is in that “map”, except the Midwest.  However, man and government has intervened and caused our population to be iodine deprived by adding Fluoride to our water. The government and the FDA make decisions for us without looking at the subsequent damage that might be done by those decisions. In the 1949 the US government decided that EVERYONE needed to be protected from dental cavities so 75 years ago we fluorinated our water and that decision led to the epidemic of iodine deficiency. Fluoride in your drinking and cooking water literally replaces iodine, and takes its place molecularly, leading to generations of people with 25% fewer cavities and 100% increase in the list of diseases I have listed in the first paragraph!   Fluoride is the biggest cause of thyroid disease. Wouldn't it be better to use fluoride toothpaste once a day than drink it? In some areas of the country, called the “Goiter Belt”, we don't have any iodine in the natural ground water, so locally grown food does not contain Iodine.  These regions have had a history of high percentage of the population with low thyroid, and goiters, even before we added fluoride to drinking water.  This compounds the problem and the diseases from Iodine deficiency. I live in that area! Before the 1970s iodine was required to be added to bread, salt and a few other foods. Ever since I have been seeing more Eating designer salt has caused people to not even get iodine in the salt they eat,  Now we use all kinds of salt most of which don't have iodine in them,. So now you know what the problem is today as well as the answer, Iodine supplementation with Iodoral® every day! How do you know if you have low Iodine and or Hypothyroidism? Symptoms of low iodine mirror those of low thyroid: fatigue, swelling, Abdominal bloating and pain Constipation hair loss and broken frizzy hair, brittle nails, dry skin, cold body temperature BBT less than or equal to 98 degrees Fahrenheit, weight gain, depression, slow metabolism, slow pulse low BP fibrocystic breasts So what will taking Iodoral® do for you beyond reversing the symptoms above? Improved thyroid function which decreases fatigue, weight gain, hair loss, brittle nails, swelling, and slow metabolism…. The benefits to you and your thyroid gland are immense! Your thyroid hormones control your metabolism and control your thermostat. Every cell in your body requires thyroid, and therefore require Iodine.  If your body doesn't have enough heat, then your enzymes can't work and our cells can't do their jobs, heal themselves and skin, muscles and all our tissues suffer. How does that work? Thyroid hormones T1, T2, T3, and T4  are made from one amino acid, Tyrosine, an 1-4 Iodine molecules!  The molecular structure of Iodine calls for plenty of iodine nutrient in the blood stream to make thyroid hormones and  to attach to iodine receptors on each cell that uses thyroid in your body. Preserve the health and function of your thyroid gland. You will feel warmer, your pulse and blood pressure will normalize. You will lose weight. Your thyroid hormone keeps your body warm by stimulating mitochondria to burn calories.  In this way thyroid hormone controls your weight, how fast you burn calories, how energetic you are, how well you think, how your hair and nails grow just to name a few benefits of thyroid. You need to add iodine to your diet to produce thyroid hormones to maintain all these vital functions for you! Prevention of Fibrocystic Breast Disease. Women's breasts absorb a lot of iodine and need Iodine to be healthy. The absorption by the breasts of iodine steals I from the thyroid and accounts for women having a much higher incidence of Hypothyroidism.  The thyroid is starved without iodine and “dies”.  Hypothyroidism is a Woman's disease! Fibrocystic Breast Disease. Women's breasts are iodine sensitive and years of low Iodine can cause Fibrocystic Breast Disease. This is not a precancerous condition, but it makes it harder to find a cancer in a breast on a mammogram. Weight Loss/Avoid Metabolic Syndrome For both sexes Iodine is needed to maintain blood sugar control and the control of obesity.  It is one of the necessary nutrients when it comes to weight loss.  More importantly it can prevent Metabolic syndrome which is a combination of high blood sugar (diabetes/prediabetes), obesity, hypertension, and high cholesterol. If you have Metabolic Syndrome, you are at higher risk for Cancer, Heart Disease, Stroke, and early Death.  It doesn't take just iodine to treat this syndrome once you have it, but Iodine is key to making your medical treatments, diet, and exercise work to decrease your medical risks of disease and early death. Lower your LDL Cholesterol Hypothyroidism causes an increase in LDL Cholesterol; therefore it may increase the incidence of heart disease. Organ Systems Other than the Thyroid Need Iodoral: As you can see by the list above, vital organs other than the thyroid accumulate/store Iodine: salivary glands, stomach, pancreas, ovary and testes, which has led to the new realization that Iodine has effects outside of the thyroid. Other Results of Replacing Iodine to what is clinically considered a high level in the US. Blood sugar is lowered by adequate Iodine blood levels (199-299 mcg/L). Insulin resistance is improved by taking Iodoral Hypertension lowered to its lowest point when blood levels were between (300-499) Gout: the higher the iodine, the lower the uric acid in the blood, therefore fewer Gout attacks. Mortality rates increase to 33-75% higher in people with low iodine levels. Inflammation and inflammatory diseases improve with iodine supplementation Immune modulation is one of the benefits of iodine. If you have a poor immune system, it improves your resistance to communicable diseases. If you have autoimmune disease Iodine improves these diseases. How could supplementing Iodine, removing Fluoride, from our drinking water do for us individually and our country? Japan is an example of high Iodine levels that benefit health.  What happens in other countries with adequate iodine levels?  Japan has the highest level of iodine in the blood because they consume seaweed in their diet and most of their water and food has iodine in it. Of course, Japan is an island surrounded by iodized seawater! They consume 7 x the average amount of Iodine as Americans with healthy consequences. Japan has one of the lowest incidences of Metabolic syndrome and the diseases included in it.  A study on Iodine consumption revealed that obese women had a significant weight loss when eating food in Japan. Summary: We all need iodine in our food and water or if we can't get it, we must supplement it with an over the counter supplement, Iodoral ½-1 tablet a day (12.5 mg tablet). The “normal” reference ranges are skewed to the low iodine level, so many people stop taking iodine when they follow the reference ranges, however in this research paper the ideal blood levels were considered healthy up to 100- 399mcg/L while the Quest and Labcorps reference ranges are 52-109, much lower than what is considered healthy by research studies. Iodine does not cause hyperthyroidism, however if someone has hyperthyroidism there is controversy as to whether Iodine should be supplemented. Make your choice: Health with an inexpensive supplement (Iodoral) or illness with fluoride and without Iodine.

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog There is a lot of New Medical Information that is important for patients to make healthy decisions about their care or the care of their loved ones that you won't hear about on the news. For new research to reach you, the public, a researcher or a drug company has to spend a great deal of money for the public relations people to push information into the light.  I compiled the research I thought you might want to know about that has been discovered during the past 6 months. I always use these studies to educate my patients and to change my protocols for treatment, although many of them have been part of my practice for quite a while, because they just confirm what I have been seeing in my Integrative and preventive medical practice for years. The First Group of Discoveries Relate to Menopause,  and the Risks of Being Menopausal The most recent article in Lancet confirmed what has been obvious to me in my GYN practice for years. I am not sure why this actually required a study to prove that Menopause is tied to a higher rate of depression and anxiety, in conjunction with insomnia, higher stress perception, and hot flashes.  This study documented what the loss of estradiol, progesterone and testosterone can do to women in menopause.  The sad fact is that this article doesn't tell the reader what they need to know, how to treat these symptoms. However, I will let you in on a self-discovered fact:  The replacement of the hormones that disappear before and during menopause can be replaced in a non-oral delivery system to treat these symptoms.  I have 40 years of medical practice that proves my findings that agree with the problem, and my treatment with hormones. The Lancet: Menopause tied to mental health issues in certain women A study found that when certain women are menopausal, they increase their risk of Depression, anxiety, bipolar disorder who experienced stressful life events, had poor sleep related to hot flashes, or had previous depressive symptoms of depression were more likely to develop menopause-related mental health problems. Researchers wrote in the journal The Lancet that some women escape the mental health effects of menopause altogether. HealthDay News (3/6) Another recent study about menopause discovers that a lack of estradiol in the post menopause causes women to have trouble thinking. I agree with that revelation, but why doesn't the research take the next step and suggest a treatment to prevent this result of hormone loss?  Why doesn't the research tell us how to help women think by replacing their estradiol? Many other studies confirm that replacing estradiol will delay the onset of dementia by 10 years.  Another study reveals that the replacement of testosterone will delay dementia it 10 more years. These studies occurred over 20 years ago, but this study doesn't cite them. Poor and worsening cognitive function is one of the most frequent complaints of my new patients coming to BioBalance Health® for treatment of menopause and low testosterone with bioidentical hormone pellets. Dr Maupin: I am continually reminded of the importance of testosterone and estradiol replacement is to aging men and women when they come back for their second pellet insertion and review their list of the symptoms they complained of before they started E and T pellets The most frequent response I witness when I ask if a woman's ability to think, do her job and stay organized is completely better after 3 months of Estradiol and Testosterone pellets, is crying with relief!   Many patients are deeply worried that they are developing dementia, specifically Alzheimer's Disease when they first come to me, but are able to go back to work and or experience a renewed quality of life because their ability to think, they can now feel confident in their professions and careers. Dr M Estradiol associations with brain functional connectivity in postmenopausal women Testo, Abigail A. BS1; Makarewicz, Jenna BS1; McGee, Elizabeth MD2; Dumas, Julie A. PhD1 Author Information From the 1Department of Psychiatry 2Department of Obstetrics, Gynecology, and Reproductive Sciences, Larner College of Medicine, University of Vermont, Burlington, VT.  The results illustrate the relationship between estradiol level and functional connectivity in postmenopausal women. They have implications for understanding how the functioning of the brain changes for individuals after menopause that may eventually lead to changes in cognition and behavior in older ages. © 2024 by The Menopause Society I have another problem with studies that should be shared with patients is that they often imply that menopausal women are “crazy” instead of saying that women after menopause develop mental health issues that can be treated with hormone replacement. Women who are menopausal are not mentally ill they are hormone deprived! I view this as a “slam” and divisive attack on aging women. The fact that if we gave women what they need …hormonal replacement ….they would not suffer the symptoms of mental health disorders. Menopause tied to mental health issues in some women A study found that women who experienced stressful life events, who had poor sleep due to nighttime hot flashes, or who had previous depressive symptoms or depression were more likely to have menopause-related mental health problems. Researchers wrote in the journal The Lancet that some women escape the mental health effects of menopause altogether. Full Story: HealthDay News (3/6) The Second Group of Articles Is About The Loss Of Estrogen In Menopause Causes Heart Failure and Atrial Fibrillation.  This article from the European Society of Cardiology reveals that the longer women live without estrogen (e.g. is menopausal), the higher risk of developing heart failure and atrial fibrillation. Once again, there is no mention about how to prevent this disease!  Why can't they study the women who replaced their hormones and compare them to the women who didn't?                             Hormone Therapy May Boost Weight Loss for Postmenopausal Women Who are Overweight or Obese On Semaglutide, Study Finds My practice BioBalance Health® has a weight loss program that is very effective for weight loss using Semaglutides, and terzipatide.  For women who are menopausal we have found that they lose weight much more quickly if they are on E2 and T pellet hormone replacement.  This research article confirms the findings of this study. If you are menopausal and have gained weight after menopause that is hormonal and the faster, you can get on non-oral estradiol and testosterone replacement then you will be more likely to get to your ideal weight! March 18, 2024 Hormone therapy may boost weight loss for postmenopausal women on Semaglutides. Healio (3/18, Welsh) reports, “Hormone therapy was associated with an improved weight-loss response for postmenopausal women with overweight or obesity treated with Semaglutides, according to cohort study results published in Menopause.” In the study, “postmenopausal women on hormone therapy had a higher percentage of total body weight loss at 3 (7% vs. 5%; P = .01), 6 (13% vs. 9%; P = .01), 9 (15% vs. 10%; P = .02) and 12 (16% vs. 12%; P = .04) months of semaglutide treatment compared with no hormone therapy.” How and Why to Treat Metabolic Syndrome  Metabolic Syndrome is a combination of hypertension, high lipids, insulin resistance, obesity, prediabetes or diabetes, large abdominal measurement.  This combination puts patients at risk for heart disease and early death.  Many conditions and outcomes have been associated with metabolic syndrome, but now we have a treatment that can prevent one of the outcomes of this syndrome, the generic drug Metformin ER. Metformin, Cognitive Function, and Changes in the Gut Microbiome Endocrine Reviews, Volume 45, Issue 2, April 2024, Pages 210–226, Published: 21 August 2023 Article history Abstract The decline in cognitive function and the prevalence of neurodegenerative disorders are among the most serious threats to health in old age. Metformin can preserve cognitive function by treating metabolic syndrome and improving the gut biome that produces neurotransmitters. I am not naive enough to believe that the only thing that your brain needs to perform well is two sex hormones (E2 and T).  This new research from the Endocrine Society describes how the generic, inexpensive medication Metformin ER, can help preserve an aging patient's ability to think.  That is primarily because the brain has insulin receptors, and when a patient has insulin resistance brain cells don't receive enough blood-sugar to be able to think!  By taking metformin ER (extended release) plus replacing estradiol plus testosterone in pellet form, the brain gets what it needs (blood sugar) and patients can think again! The second factor the researchers found to be important to brain health and problem solving, is healthy gut bacteria in the intestines.  This requires eating whole foods, especially fruits and vegetables every day, and not eating fast food, alcohol, simple sugars, and preservatives that kill good bacteria. We recommend a daily probiotic by Mega + the lifestyle changes above. If you want to keep your ability to think for your whole life then you need E2 and T in pellet form if you are a woman and T if you are an aging male, plus Metformin ER daily and the above lifestyle changes. Metabolic Syndrome, Obesity, is the Biggest Risk for Cancer Metabolic syndrome may increase cancer risk by 30% People with metabolic syndrome had a 30% higher chance of developing cancer over the course of a decade after diagnosis, according to a study published in the journal Cancer. The researchers also studied inflammation by tracking C-reactive protein, concluding that elevated levels of the protein along with metabolic syndrome were “significantly associated with subsequent breast, endometrial, colorectal and liver cancers.” Full Story: National Public Radio (3/11) The struggle to stay young and healthy is a difficult fight but the most important battle that you will wage as an adult.  If people knew the whole truth, would they stop overeating, drinking, smoking, avoiding exercise, or stop taking illicit drugs?  I can only hope that if we convince people to take care of themselves better and replace the hormones that are missing as soon as they are clinically deficient, then they will also listen to the truth about the various ways to support their health and prevent disease.  I also hope that the doctors who write articles and do research stop treating women like crazy people instead of the gender that actually runs the world and not only nurtures the children but also organizes homes and businesses.  We are NOT crazy when we need hormones to be replaced (PMS, MENOPAUSE), we are experiencing symptoms of hormone-deprivation, and we just need to be treated with the hormones that are missing!

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog Last week one of my pellet patients asked me to see her daughter, even though I don't see young women anymore since I began BioBalance Health for people over 40.  I asked her why she couldn't see her gynecologist and she told me that she was told that she had PMS and that was a condition that was treated by a psychiatrist!  I have treated PMS successfully by replacing one hormone that is missing, Progesterone, two weeks a month, the same two weeks that women experience the symptoms of PMS.  I agreed to see her although I wish my fellow gynecologists would learn how easily this can be treated and not make young women feel like they are crazy, because they aren't! NOTE: Before I give you the impression that I treat PMS currently at BioBalance® Health, I want to clear that up: I only treat PMS in my younger cycling patients (36yo. to menopause) who take testosterone pellets for other symptoms.  My recommendation for finding a doctor who treats PMS in your area is to contact a local compounding pharmacy and ask the pharmacist which GYNs treat PMS, or contact one of the large compounding pharmacies, eg. College Pharmacy in Colorado Springs, or Belmar Pharmacy in Colorado as well to find a doctor in your area who can treat you.  There are many good compounding pharmacies who have pharmacists who can tell you which doctors prescribe progesterone for PMS. What is PMS? PMS symptoms are only present 2 weeks a month, the 2 weeks before menstruation. This condition causes patients to feel different, not like themselves in the ways listed below, and also caused menstrual changes in the menstrual periods that follow the PMS symptoms. The Emotional and physical Symptoms of PMS:  All occur monthly, for 14 days Depression Anxiety Anger and irritability Bloating, Migraine headaches, Water weight gain, Pelvic pain Fatigue Insomnia   The Menstrual Symptoms associated with PMS: The GYN Symptoms that can occur secondary to PMS (poor progesterone production) include: 1)irregular periods, spotting for a week before the period starts 2) heavy bleeding, sometimes uncontrollable bleeding, 3) infertility, 4) multiple miscarriages 5) lack of ovulation, and lack of periods for months at a time like with PCO Polycystic ovaries My History Treating PMS (skip if you already know this) I have been a gynecologist in private practice in St. Louis County since 1985 when I graduated from my OBGYN residency at Mercy Hospital. My training gave me an excellent knowledge of GYN Surgery and Obstetrics, but a very minimal understanding of the hormonal cycles of women, including Premenstrual Tension (PMS). Since the 1980s when PMS was recognized as a condition of women, OBGYNs have been taught that PMS is a psychiatric disease that must be treated with psychiatric medicines, primarily anti-depressants. Most OBGYNs today still believe that women who have PMS are “crazy”, and either give them an antidepressant which rarely work to treat the symptoms or refer their PMS patients to a psychiatrist.  In my case, I do not do either because PMS is a hormonal imbalance that causes emotional symptoms, and because psychiatric diseases are not cyclic every 28 days lasting 2 weeks, followed by 2 weeks of normalcy. The Cause of PMS Since 1988 I have studied the cause of PMS and with the help of a very intelligent compounding pharmacist, Pete Hueseman, I found the answer to the cause and treatment for PMS.  I began to treat PMS hormonally and now have successfully treated hundreds of PMS patients with bio-identical Progesterone.  It is a simple answer. PMS is caused by a deficiency of the hormone Progesterone during the two weeks after ovulation, from around days 14-28!  This is not a complicated diagnostic discovery, and the treatment should be obvious to all doctors who treat young, fertile women. More about that in a minute… From 1980- the present there has been no effective treatment for PMS approved by the FDA         (just ineffective anti-depressants) because it is still  categorized as a psychiatric disease.   When I took my second American Board of OBGYN test in 1999, a question on my test was: “Is PMS a Psychiatric Disease that should be treated with antidepressants?”  And the correct answer according to the American College of OBGYN was that that statement was TRUE, they believed and still do in 2024 that PMS is a psychiatric disease!  In 1999 I had been treating PMS successfully with bio-identical compounded progesterone for over a decade with bioidentical progesterone in non-oral form (suppositories, vaginal tablets, vaginal cream, and transdermal creams), given only during the second half of the menstrual cycle, from ovulation until the onset of the period. To understand PMS you have to understand how the three sex hormones work during a woman's 28 day cycle.  We count the days of a cycle starting at the first day of bleeding, which is day 1.  While we have a period our estradiol, progesterone and testosterone are all at their lowest level in the blood, but by the end of our period estradiol (estrogen) and testosterone start being produced by the ovary. They increase and both peak at ovulation, usually day 14, giving a woman a viable egg and a surge in her sex drive to motivate her to have sex and fertilize the egg. On day 14 the egg is released from the ovary and the corpus luteum (where the egg came from on the ovary) starts secreting progesterone.  This hormone increases and plateaus during the next 14 days, while estradiol and testosterone level out.  The day before bleeding, when the egg is not fertilized, all three hormones drop precipitously and that causes the uterine lining that was growing under the control of estrogen, to shed and bleed. PMS occurs during the second half of the menstrual cycle when the developing egg is not ovulated or is immature and ovulated but is not “ripe” enough to stimulate a decent progesterone blood level.  In the case of PCO, many eggs develop but are trapped and don't ovulate at all so no progesterone is produced.  In all these cases, women with PMS are symptomatic both in the symptoms above and the menstrual abnormalities listed earlier. All of the physiologic changes that take place in the PMS patient indicate an inability to conceive, or to conceive but have multiple miscarriages. The Treatment for PMS: The Treatment is bio-identical Progesterone, but the FDA didn't have a form of bioidentical Progesterone that worked until the last 10 years, when Prometrium was produced. Prometrium is an oral pill containing natural progesterone in peanut oil.  This works well for some women, but not for others. For those women we prescribe bio-identical compounded progesterone in sublingual, vaginal, transdermal and BLA Progesterone oral forms. The most important fact about diagnosing PMS is to remember that the symptoms of PMS only occur 2 weeks a “menstrual” month (28 days of the cycle).  The most important fact about treatment is that PMS should be treated with Progesterone the second two weeks of the menstrual cycle at bedtime. Now my patients ask me to treat their daughters who are cycling and whose OBGYN follow the guidelines of ACOG blindly even if the suggested treatment (anti-depressants don't work or make them worse).  I can only hope that the method of treating PMS as a hormone deficiency, instead of a psychiatric disease, will be accepted by American College of Gynecology and that you can find doctors you can be treated by, by finding a compounding pharmacy who will refer you. Compounding pharmacies in St. Louis: Neels's Pharmacy, and Medical Arts Pharmacy (ask for Brock) in Clayton MO, Jennifer's Pharmacy in Clayton, MO. neelspharmacy.com Phone number (314) 849-3123 Medical Arts Clayton Pharmacy https://www.medicalartsrx.com › compounding jenniferswholehealthpharmacy.c… (314) 862-7400

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog The Problem: I see women and men every day who are deficient in their own production of testosterone because of age, testicular trauma, removal of their ovaries, chemotherapy, chronic illness, and medications.  The cause of testosterone deficiency is as varied as the side effects and benefits of every different type of testosterone. This means that when you hear or read a headline like the one that came out last week: “Testosterone Treatment Fails to Offer Protection Against Fractures in Men with Hypogonadism, Research Indicates” You cannot take It at face value.   This headline should read Testosterone replacement in the form of testosterone cream given at a low dose given at a low dose to men who already had osteoporosis doesn't offer protection against osteoporosis. The headlines that read the way this one is an example of the reality that everyone loves to hate testosterone. This makes informed decision making by a patient very difficult because of the jaundiced view by physicians and drug companies about replacement of one to the hormones that men and women both make when they are young, but which becomes deficient in most of my patient population as they age. Why is there all this subterfuge and confusion about testosterone replacement? I believe it is the fact that allowing American's to age out of jobs and make room for the younger workers; many people cannot afford testosterone on their own so they are jealous of those people who can and do afford it; The insurance companies don't want to pay for anything they don't have to; keeping people youthful and healthy is not a priority for American medicine based on acute care in the ER and operating room; The group of naturalists who think aging is great, are people who either are out of touch or are very young; the use of testosterone by both sexes often makes the use of other medications unnecessary (anti-hypertensives, statins, autoimmune medications, etc, and also prevents patients from getting communicable diseases so the largest industry in the US, pharamaceutical companies cannot make more and more drugs to treat each symptom and disease individually; and lastly the government has made a very safe and natural hormone scheduled like amphetamines and pain killers by the DEA. Now why are these tests misleading?  All research studied are manipulated to have a desired outcome.  You can do a lot with statistics…you can make a blue sky look black! By given too little of a medication or vitamin, or by treating a disease for too short a time, or by picking the age group such that they won't respond you can make any drug look ineffective! So when you look at the studies on testosterone, you must look for the type of testosterone: is it a cream (which turns into estrogen as it passes through the skin? Or is it an injection of testosterone cyprionate which is not equivalent to natural testosterone and lasts 2 weeks because it keeps circulating through the liver and making more and more of the byproduct DHT than pellets or pure T injection? Simply if the type of T is not the type that you are taking or are contemplating taking then you should ignore the studies conclusions because each type of T and each delivery system of T has a variety of effects, each different from one another. “One testosterone is not equal to another form of testosterone. Therefore, a study that tests one type of testosterone does not apply to other forms of testosterone.” Dr Kathy Maupin MD The factors that matter as to how much improvement you will get when you choose a form of T replacement are: Testosterone chemical structure (the best is pure testosterone like in sub dermal T pellets) Testosterone delivery systems (subdermal pellet, cream, vaginal tablet, oral, patches) The dose/day or week or month Duration of use What tissue or organ system you are studying (e.g., bone takes many years to show improvement, while muscle increases relatively quickly with T pellets) The age and condition of the patients studied The starting blood level of testosterone Total and Free testosterone. The resultant blood level of free T The length of time a man or woman has been without testosterone before treatment I see research articles every day in the many journals I read that are shared with the public, that denigrate testosterone replacement in general, while in my practice, with the most effective form of T I have found, that T pellets literally transform  men and women who have T deficiency, most of whom are recently menopausal or over 55. The successful studies that recommend testosterone seem never to make the front of journals, but this recent study about bone density made all the title pages of the digital version of journals. The result will be that doctors and patients everywhere who should treat their osteoporosis with the safest treatment available, testosterone, will be the victims of VERY expensive drugs that have more side effects and less effectiveness. Research trials no longer look for the truth.  They look for “how do we get the answer we want to , so our drug that is not testosterone, will sell?”. These headlines deceive patients and scares them from asking for testosterone treatment, which can relieve their symptoms with one hormone, Testosterone, instead of many drugs. An even greater benefit of testosterone given at the dose that relieves testosterone deficiency symptoms, this one hormone gives my patients back their quality of life. In 2002 the WHI study scared menopausal women from taking their menopausal hormone therapy (ERT and HRT) which caused these women to develop anxiety, depression, frailty, osteoporosis, dementia, poor critical thinking, fatigue and many other symptoms that required treated multiple drugs to relieve just a portion of them. Women also developed marital problems because sex was so painful that they stopped having sex with their life partners.  An unproven fear of breast cancer led to the loss of these women's quality of life! An example of one of my most severely affected patients went off her ERT (estrogen only hormone replacement) that she had been on for decades since her hysterectomy because her doctor refused to prescribe it for her.  By the time she came to me she had developed depression, suicidal thoughts, agoraphobia, frailty and osteoporosis and she refused to leave her home.  It took her months for her son, a doctor friend of mine, was able to bring her to my office to restart her treatment. Today she is still traveling all over the globe and fully enjoying her well-deserved retirement! It has been estimated that in the 5 years after the WHI demonized estrogen replacement, more than 100,000 women died of diseases related to a lack of estrogen, and more experienced a loss of quality of life.   Even now over 20 years later, many doctors have not restarted giving estrogen to their women patients. Medical Thinking and rapidly changing standards of medical care when it comes to sex hormones has affected how we live, if we live, and how many drugs and diseases we get in our lifetime.  We have effective inexpensive treatments for loss of hormones, why are we always looking for expensive and non-hormonal answers to the symptoms of menopause.  In the last year pharmaceutical companies have developed a new drug with many side effects to treat hot flashes (fezolinetant/ Veozah, another new drug for osteoporosis (Tymlos 1pen, 1 injection/day = $2,134) and even a new drug for waning sex drive (Vylessi injection 2 times a week prn 1 month is $3,066/month) , also exorbitantly expensive!  Instead of recommending replacement of relatively inexpensive hormone replacement with estradiol and testosterone (with pellets for women approximately $140/month, and for men $200/month), the Big Pharma companies try to strike it rich with multiple piece meal treatments for the symptoms of menopause and low T.   I did not even mention medication for insomnia, migraine headaches, Viagra for men, lubricants for women and many other symptoms and treatments that T and E2 completely resolve. Back to the research article in question about testosterone for men, which employed testosterone as a transdermal gel, at a low dose, and determined testosterone (over-generalization) was not effective, for building bone in osteoporotic elderly men!  This was a defective study in every way, but the most important way was that it used T gel which turns most of the T into estrogen, so the effects are really from E2, E1 in men who do not respond well to E2.  The abstract is at the bottom of this page for your reading pleasure. I hope you are more selective in the future about what you believe and question the research that criticizes testosterone treatment, estradiol treatment especially the safest delivery system, pellets, when the research is short term, and generalizes the results from one form of Testosterone or estrogen to all forms. Testosterone Treatment Fails to Offer Protection Against Fractures In Men With Hypogonadism, Research Indicates MedPage Today (1/17, Monaco) reports “testosterone treatment didn't offer protection against fractures in men with hypogonadism, a” subtrial indicated. The research found that “compared with placebo, men who were on a testosterone gel actually had a significantly higher risk for fracture.” The findings were published in the New England Journal of Medicine. HCPlive (1/17, Iapoce) reports “the findings showed the 3-year cumulative incidence of all clinical fractures was nearly 4% among those treated with testosterone, compared with 2.8% in the placebo group.” Additional “data revealed the fracture incidence was also numerically greater in the testosterone group for all other fracture endpoints.”

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog T.E.D.  a NEW painless high intensity ultrasound treatment that actually regrows 65% or more of your hair.  It is the most effective treatment overall and really the most economic treatment with the least amount of time investment, no pain and best results.  Unlike hair implants, you can't tell you have had a treatment to make your “lost hair” grow again! The Problem of Hair Loss: Many of my patients (most of whom are over 40) complain that they have thinning or balding hair-loss before we even start our hormone treatment with hormone pellets. Testosterone treatments with Testosterone pellets rarely increase the DHT blood level enough to increase hair loss.  DHT is the metabolite of Testosterone which is responsible for “male pattern balding” also called hair loss associated with aging in men. Most of my patients have genetic hair thinning or balding, hypothyroid hair loss, or loss from a medication that they take.  We treat these metabolic causes, but we can't make hair grow back metabolically, we can just stop the loss!  NOW WE CAN MAKE LOST-HAIR GROW BACK with TED!   Features of Alma TED:                                 TED is a FOCUSED high intensity ultrasound that drives serums into the scalp to the level of the hair follicle. Alma has worked 17 years on a serum for hair loss and they have achieved their goal!  Only with TED will the serum get to the hair follicles that are “sleeping” and make them grown again!  This pairing of ultrasound and specific serums are key to the unique success of TED. Comparison OF TED with other treatments for hair loss: #1 TED is the only FDA approved treatment for regrowing hair! Six months ago, I was looking at various options to help my patients, and my husband, grow back their beautiful hair. After a comparison of multiple available treatment types for hair loss, I chose Alma Laser's high intensity ultrasound treatment, T.E.D. that combines a unique hair growth serum delivered deep in the scalp to awaken sleeping hair follicles, stimulating growth, even in follicles that are dormant. In 4 treatments that each last 45 minutes or less, TED brings hair follicles back to life without pain… I finally found the “holy grail” of hair restoration!  It is affordable and PAINLESS.  My medical skin care practice, BioBalance Skin®, offers free consultations to those men and women who want to have TED treatments to bring reverse hair thinning and balding. TED this works for men and women with all causes of hair loss! Total number of treatments: one a month for 4 months Time of each treatment =45 min Maintenance is at least one treatment/ year (average) Cost of treatment package: $3,400 Cost of each Maintenance treatment, after $450 1-2 times a year Pain= None! Effectiveness= 65% of hair lost regrows No down time! Who is a candidate for this treatment> Men and Women, all ages with hair loss of any kind (the younger you are the better) All patterns of hair loss up to Stage 3 hair loss (stage 4 has areas of balding without any follicles) Thinning hair all over the head Hair loss due to medications, genetic hair loss, and androgenic hair loss This treatment replaces the drug finasteride! (finasteride decreases libido and erectile function) without the side effects. This treatment can accompany thyroid treatment (but not replace it) for hypothyroid hair loss. Women with extensions can be treated and will eventually replace extensions.   Who is not a candidate/ or will have a less than optimal result: People with metal implants in their brain or skull or metal plates in the skull People with long term complete hair loss (their scalp has no hair and is shiny) > 5 years balding Patients currently on Chemotherapy but is OK after chemo is completed. Patients currently on immunotherapy Trichotillomania- Mental health condition where the patient pulls her own hair out. Patients with skin cancer of the scalp Infections, open wounds on the scalp   Information on Hair Loss: All these types of hair loss, except the most extreme will obtain a good result from TED Hair treatments.  Hair loss that occurs with age has typical patterns of loss. The examples shown below are examples of male and female age-related hair loss.  The same patterns occur from elevated androgens in some people. Some types of age-related genetic hair loss are merely thinning of the hair, where individual hairs are spaced out making hair look “see through”.         PATTERN OF HAIR LOSS                       NORMAL———– STAGE 1———STAGE 2————STAGE 3   TED HAIR GROWTH TREATMENT WILL WORK WELL WITH STAGE 1 AND 2 HAIRLOSS, IT  IS ONLY PARTIALLY EFFECTIVE  FOR STAGE 3 hair loss THE CONDITION OF THE SCALP IS IMPORTANT IN PREDICTING YOUR SUCCESS: SMOOTH, BALD LONGTERM LOSS OF THE SCALP RARELY RESPONDS THIN AND SPARSE AREAS DO RESPOND!   PROGRESSION OF FEMALE HAIRLOSS PATTERN                                   BOTH PATTERN AND CONDITION OF SCALP DETERMINES THE EFFECTIVENESS OF TED TREATMENTS WOMEN'S HAIR LOSS—In general women lose hair all over the head or at the temples and crown of the head. The stages of female hair loss above all respond to TED except the most severe-long term loss.   COMPARISON OF OTHER TREATMENTS TO TED I am asked by my patients, “How do I get thicker hair?”…or for the most common questions from those men who have been experiencing their hairline creeping backward every year, “How do I make this stop, I look like my dad!”.  Over the years my Medical Health Spa, BioBalance Skin® has attempted to help my aging  hormone replacement patients regain their thick and healthy hair and hairline with scalp injections with PRP and  Aqua gold injections of serum and PRP, however effective these treatments are in stopping the loss for a period of time, none of our patients were able to tolerate the pain of the injections in their head for an hour, even after topical pain relief. These invasive treatments really hurt not matter how we tried to remedy the pain.  It turned out that our patients couldn't tolerate one hour session, much less a series of treatments necessary to make a visible difference. Hair implants take so much time and money (>$15,000) that it is like taking on another job and is really only effective for receding hairlines, not thinning hair.  Patients have to have multiple treatments. There are other options that do not regrow hair but mask the process.  These all require ongoing treatment such as hair extensions, hair implants Hans Weiman hair restoration, all of which are prohibitively expensive, and are also painful and time-consuming. The one drug therapy to slow hair loss that is used by men, Propecia® finasteride is minimally effective at stopping the loss of hair, and it does not grow hair where it no longer grows. This drug also has significant side effects that many men can't tolerate including loss of muscle mass and erectile dysfunction.  Our patients who receive T pellets tell me that finasteride decreases all the sexual and muscle improvement they have gained from T pellets. Other new options for hair loss I investigated the required lifetime ongoing supplements (many of them) and ongoing treatment. The other option was significantly painful and not as successful as TED. When I find a new and unique treatment to solve the problems of my patients as they age, I am compelled to find an answer! For hair loss, TED is it! If you have thinning, receding, or balding hair don't wait, the sooner the better for bringing back hair follicles permanently! If you need visual documentation, please go to the Alma TED results page with this link to see picture proof of the results from TED treatments: Link to example pictures of the results from TED. https://almainc.com/products/almated

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog Last time I talked about the ways you can keep your skin healthy and the products I have found that medical grade products are effective to keep skin looking young and healthy.  My last Healthcast/Blog was about what you can do at home to improve your skin and look younger. This week we are going to talk about how to get the treatment you need to improve your skin if it is damaged and aging at the medical spa, and you may not have been able to be out of the sun or been able to follow the lifestyle changes I recommended that are necessary to avoid skin and sun damage.  The problem is bigger, and the treatments are more drastic, and expensive. When you have finally decided to do something to help your skin look younger, you must   do an introspective survey of your face and prioritize the problems that you see, placing what bothers you the most as your first priority.  I think writing this on a list and taking it to your consultation is the best way to proceed. When nothing is getting better with your own self-care, It is then time to get a consult from an expert who can tell you what you need to reverse your skin problems. Bring your list to the office consultation and decide on how much you can spend a month/or a year, on your own “renovation”. What to know when you have your consultation: When you have your consultation, you should be aware that there are at least 3 different treatments to treat any problem that you have. They have different levels of effectiveness and cost.  At our spa you will be able to choose between three levels of treatment, but often, the consultant will weigh in on what the best procedure is for you. The least expensive treatments take the longest time to reach your goal and are usually the least effective. There is generally a medium level treatment, which is a little more expensive and more effective than the least expensive but will take more time to get the results, and finally the most dramatic results and faster outcomes cost the most.  If you need fast results and can afford the procedures, then tell your consultant at the beginning of your interview.  On the other hand, if you have a limited budget but have an open time frame then tell her that too. This will help you get to the desired treatment fastest and make your consultation the most profitable for you. In case this doesn't make sense, here is an example:  The treatment of age spots or brown spots has three possible solutions. The least expensive treatment is achieved by the use of topical serums at home and a series of facials in the spa. The outcome takes time and is not as effective as the other two options.  The medium level of treatment (medium cost and effectiveness) is a VI or TCA Peel that has more immediate results and has some down time, but is less expensive than the most effective treatment, and more effective than the least expensive. The Laser IPL or Pixel treatments are the most expensive outside the operating room, they have some pain involved, but it takes only a couple treatments to rid yourself of the brown age spots that are on your face and decollate. In addition to the excellent results, these two treatments also tighten skin, and diminish wrinkles, while they remove the precancerous skin spots that make us look old.  This is the highest price treatment but is faster and more complete than other available treatments. Choosing the Treatment that is right for you: Your Goal, Time to get to Goal, Effectiveness of treatment, Downtime, Pain, and Cost. I think it is best to inform your Skin Consultant about how much time you have before you reach your skin goal, if you can have some downtime or not, and how much money do you want to invest in your skin “re-birth”. In terms of choice of treatments at a med spa, you will get what you pay for.  On our BiobalanceSkin.com website we have the three or four options for each skin problem (wrinkles, brown spots, sagging skin, eye lid droop, poor texture) that our patients present with.  I like that method of comparing treatments for each skin care problem. It should be transparent as to what your choices are, and what you get from a particular series of treatments. You should make your opinions known as to your priorities. That means what bothers you most about your skin. Think about it before your consultation and give her a list of priorities in writing which will keep her on track. BTW, none of these treatments work if you don't follow the instructions given to you for aftercare and follow-up treatments. Ask about before and after care at your consultation. For example, If a patient has chosen a pixel laser resurfacing to remove her brown spots, and after 2 weeks all of her brown spots have come to the surface and peeled off, and she doesn't use effective skin care products and doesn't wear sunscreen and stay out of the sun for the appropriate time, then there is no guarantee that her results will remain excellent. You must take control of your own self-care because it is 50% of the treatment, and 50% of the outcome of our treatment.  Please don't use products from Walgreens if we told you to use something else after or before the treatment! Price of each treatment series is usually critical to decision making…..each of us has a budget. However, you should understand that the least expensive treatments generally have a lower cost to the spa and are least expensive.  For example, what follows is a comparison between the three choices for improving texture and tone of facial skin are as follows: Least expensive: a series of Hydro-facials (30-45 minutes) one per month for three months, and three months of products, followed by a 3-month maintenance:  This is the least expensive and doesn't transform skin texture and tone as much, and doesn't last as long as other available methods of treatment.  If you have very little damage, are young and healthy, or you just want to maintain what you have, this is ideal for your needs. There is no downtime. Medium price: For example, Micro-needling treatments, are a medium cost and effectiveness treatment. This treatment uses a pen that contains a tiny needle that makes tiny “holes” in the skin's dermis all over the facial skin, neck and decollate, which then stimulates collagen production over the next 4-6 weeks, tightening and lifting the skin.  In general, this treatment is done in a series to achieve the results you are looking for.  2-4 treatments done every 4-6 weeks is the typical number of treatments needed.  Maintenance requires a few of these treatments a year. Down time is minimal, there is a redness that occurs for 24-36 hours and peeling of the superficial dead skin for up to a week, but it is not severe and can be covered with makeup. Micro needling is ideal for younger patients to prevent the sagging and loose skin that comes with aging.  It also makes the skin look fresh and glowing. Micro needling offers an Add-On of PRP to be applied and “injected” with the needles into facial skin to stimulate collagen production faster and more efficiently. Of course, this increases the price of the treatment. Highest price: The highest price treatments are generally appropriate for older patients, or impatient patients: those women who have a timeline for improving their skin ( a wedding or event), and those who have the most sun damage. You also get extra goodies when you get Laser Pixel treatments. The Pixel resurfacing not only improves texture and tightness of skin, nut it also removes brown spots and helps fill in wrinkles!  Lots of extras which makes the price worth it! There are several choices for the top-of-the-line procedures to improve texture and tightness and they are not all lasers. One non-laser treatment is called Aqua Gold treatment which has three choices for what is injected and three prices. It uses a small disposable applicator that has many short gold needles to deliver a serum by “stamping it into the skin”.  The injectables are hyaluronic acid injected below the epidermis and which combines the micro-needling technique with filler (very expensive) and Botox (very expensive) with an option to add activated platelets (a blood draw, spinning with an expensive activating compound). This treatment is expensive, but it is immediately effective, and the change is great.  There is no real downtime, and the changes are immediate. A series of these treatments can revolutionize the quality of your skin. The last component of getting the most out of your facial treatments includes buying the right products to help you maintain the beautiful results you have achieved through any of the above treatments.  It is a waste of your money to buy inferior products that may reverse the improvements you have paid for.   This is essential for preserving the improvements you have received from any of the esthetic treatments discussed in this blog. Now if you think you need a facelift, you should see an injector consultant to ask if she can help with a much less expensive injection of Botox, filler, or both.  Another treatment which is done without needles is the EmFace which uses magnetic energy to stimulate lift and muscle tone to literally do what a facelift does without a knife. Facelifts total cost is $75,000-$150,000 and has down time of months, and includes drains, and pain.  A series of EmFace series of treatments (4) is about $3500, without pain and without downtime.  When faced with surgery, always look for another way to do the same thing! Now you know what is ahead of you when you talk to a Skin Care Expert about how to achieve your beauty goals.

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog You may be like I am, and you took your “young skin” for granted, because it had always looked good, healthy, and glowing. Sadly, the damage that causes wrinkles brown spots, age spots, and sagging jowls occurs years before the damage shows on your face!  At age 40 I woke up, looked in the mirror and realized what I had been doing to my skin with baby oil and iodine plus 8 hours of sun a day, every summer, without sunscreen and moisturizer for the 30 years before and I realized I had to do something to reverse that process. I then began my study of skin, skin damage and how to heal it! I still and studying the new advances in skin care, nutrition for skin, and skin-care products. But why is our skin so important? I have two answers, one as a doctor and another as an esthetic specialist.   My “doctor answer” is that our skin is the largest organ in the human body, and it provides many benefits for us.  The skin not only protects the more delicate organs of the body, but the skin excretes toxins for us from sweat glands, it cools us with perspiration, and protects our muscles and internal organs from trauma and the sun's rays.  Our skin also protects us from cold with hair that grows on our head and body. The condition of the skin also acts as a reflection of our health.  It is possible to look in the mirror and determine if you are healthy or not.  The skin is also a window for others to judge our general health.  This is a double-edged sword.  It helps us self-diagnose medical problems or at least determine that something is wrong so we can make changes to our lifestyle or seek medical attention.  Our skin also reflects fatigue (dark circles under our eyes, sallow color and lack of glow or shine), BUT it also allows others to discover our age, health status and whether we have cared for our skin or not!  Our skin is a window to our internal health, so if you want to appear rested, healthy, and desirable, then you MUST take care of your skin! I am not saying that nonphysicians consciously look at you and say to themselves, “that person's skin looks sick”, but the condition of your skin determines unconscious judgements of the state of your health.   It is for this unconscious knowledge that we have about the appearance of our skin, that drives women to seek out ways to make their skin beautiful and young.   When we notice signs of aging, fatigue, and over-indulgence in our own skin we should take action if we want to reflect the impression of health and youth. Very perceptive people can tell what our age is by looking at our skin….that is why women spend time trying to fool them by improving the natural condition of our skin!  Our instinct to be and feel young motivates us to seek help.   No one wants to look their age!  Everyday Instagram and Facebook show ads that say…”Buy this and you will look #—- years younger” are barraging us. Those advertisers know our instinctive drive to turn back the clock and they use it to sell…but in general those “one answer ad campaigns” help the seller make money but won't do a thing for your skin….Don't be sucked into their sales job. If you are over 40 you will require a multipronged approach to get your youthful skin back. This process requires a change in your routine, your lifestyle….the very hardest thing for humans to achieve! As a doctor one of my observational skills that helps me diagnose patients before I even interview them Is my  first impression of their face and skin—if the color of their skin is dusky,  they probably don't have good blood flow (atherosclerosis, alcohol consumption or illnesses like Diabetes) and if the texture of their skin is thick and “piled up” I know they have poor skin care habits and often are not healthy.  I also look at the creases or wrinkles as well as brown spots that give away a patient's age and sun damage history.  There are many more signs of illness that I look for, but skin is like having Hercule Poirot (famous detective) sitting next to me whispering in my ear.” For non-doctors the appearance of your skin gives strangers an impression of your age, and how healthier you are.  Think of speed dating….you  are introduced to Mr. Right and he immediately is not interested.  He doesn't even care to talk to you.  His instincts say to him that you are not healthy and that you are older than you say you are, because of the condition of your skin.  The same thing can happen at job interviews….you don't want to look sick and old when you are going for a job.  No one even consciously knows they are judging you…they just know instinctively get the message that you aren't a candidate for whatever you are trying out for because of perceived old age and poor health….it is an unconscious reason for not choosing you! So why not consider the simple steps it will take to transform your skin, and yourself, from looking old and sick to young and healthy?  To get great skin, we must BE HEALTHY, in other words we must develop healthy habits as well as give our skin the attention and care it needs.  Here is a list of what is required to heal you skin and begin to look younger and healthier. DIET: whole foods, with a lot of water and fresh vegetables and fruit. No fast or processed food. SUPPLEMENTATION: Vitamin D, Vitamin E, Biotin, Methyl Vitamin B12 and methyl Folate DAILY EXERCISE: Gives your skin a glow with healthy oils and perspiration. REPLACE HORMONES THAT ARE MISSING: Whole body Testosterone (pellets), Estradiol, Thyroid if it is deficient CLEAN AND PROTECT YOUR SKIN: Treatment of the skin itself by washing and exfoliating dead skin off the surface twice daily, using serums specifically for the aging problem that bothers you most, and Moisturizers to keep the skin hydrated. Ok. so you think, you can do this, but here is the kicker—you also need to make harder lifestyle changes, and stop your bad habits: Stop Smoking Stop Drinking more than 4 oz of wine /night Stop fast food Get 7-8 hours of sleep every night. Now I hear the typical negative response coming through the computer…as if I am spoiling your party…I KNOW you don't want to change your habits….or stop excessive drinking, smoking, and staying out late, so you are already finding excuses why this obvious, simple answer  won't work for you!  If that is you, then stop worrying about your skin, because it won't be any better than it is today….and it will get WORSE with age! But if you will spend an extra 7-10 minutes a day on the health of your skin and you realize that it is time you clean up your act, then continue to listen to the things that you should do to have a beautiful body covered with glowing skin!  A little work and change of habits will get lots of compliments and people may ask you how you got beautiful skin!  The “happy” side-effect of taking care of your skin is that you are concurrently building a healthier body that will live longer without disease. The above changes are a start but protecting and feeding your skin is important too! In the list below I will share what products and   I use, but I have skin concerns that you might not have (I'm 69 and had a lot of sun damage as a teenager). These are examples, however if you are serious about having beautiful young and glowing skin, then using the medical grade skin products (those bought at your spa or dermatologist) are the most effective. Internal Nutrition for Your Skin (Diet)—Whole food diet (lean meat, eggs, fruit and vegetables every day!) + Supplements to give you what you are missing in your diet, in higher doses Stop Bad Habits (see above) and exercise every day Cleansing skin that is exposed to sun, lack of humidity, and air pollution requires daily cleansing and humectants. Cleaning off your makeup from your face, neck and decollate (Face Wash= e.g. Glycolic Renewal- Skinceuticals) twice a day Topical Nutrition (Serums) Skinceuticals e.g. CE Ferrulic, hyaluronic acid (Skinceuticals HA Intensifier) and other serums that feed your skin from the outside. Protect Your Skin from Dehydration (Moisturizers), and drink plenty of water especially in the winter when the heat is on to replenish the moisture to your skin from the inside. My moisturizer is usually Triple Lipid Moisturizer from Skinceuticals®, but AGE Interupter Moisturizer is my favorite during the winter or when I am vacationing in cold or dry climates, because it holds skin moisture in the best. Intermittently I use Defenage Serum and Moisturizer Professional products when I want to take a break and expose my skin to alternative treatment (this makes both types of products more effective). Protect your skin from damaging radiation from the sun (Sunscreen). You should wear sunscreen every day! In Missouri it is winter longer than summer (or so it seems), but until I found the ColorScience tinted sunscreen, I forgot my sunscreen all the time. This sunscreen is easier to remember because it is part of my makeup the I apply daily. It is a combination moisturizer, sunscreen, and foundation, I rarely wore sunscreen in the fall and winter before I found this product…not now! Daily exercise to bring blood flow to your skin, brings healthy oil and blood to the surface of the skin and releases toxins through sweating. Taking care of your skin at home is fairly simple and for the most part can be integrated into your daily routine.   Here are the basic skin care steps: Step #1 Cleansing your skin in the AM and before bed when you with a non-drying face wash. (Skinceuticals Gentle Face Wash or LHA face wash). Follow this with a serum specific to the needs of your skin to repair sun damage, to fade age spots, or to improve the texture of your skin. For example, Skinceuticals CE Ferulic— It lasts all day and assists in maintaining hydration and improving the condition of your skin. Step#2 Moisturize and Protect your skin from drying out during the day and while you are sleeping and not drinking water.  The 8 hours you sleep is the longest time you go without oral hydration, so your skin needs protection to hold the moisture in.  Moisturizers are generally a shield to prevent drying out.  The best of these moisturizers both feed your skin and protect it from drying, like Skinceutical's Triple Lipid Moisturizer before bed. Your morning routine is just like your bedtime steps, except after you moisturize, you should use a sunscreen that is equal to or greater than SPF 30, ideally with a tint instead of foundation. Hint: If you brush your teeth twice a day, then add 5 minutes to your morning and evening self-care you can clean and apply your skin care routine to your dental care.  Of course, there are many other types of topical products that preserve the beauty of your skin, but they are directed at specific problems such as acne, rosacea, deep wrinkles and discoloration, but it requires an expert in skin care to help you choose the most effective product for you. My patients ask me what skin care routine I follow, and I give them the following list of products and vitamins I use because I know that skin requires nutrition from my diet as well as topical products. Oral water intake: 80 oz of clear water a day for hydration Diet filled with daily raw vegetables/fruit, and a salad daily High protein and healthy fat in my diet (meat, fish, eggs, cheese, a variety of nuts, olive oil and yogurt) Products I use: Face Wash Skinceuticals: Replenishing Cleanser twice a day Serums: Skinceuticals CE Ferulic to improve skin tone and texture, HA Intensifier to increase Hyaluronic Acid for skin hydration, and Advanced Discoloration Corrector for brown (age) spots. Skinceuticals Triple Lipid Moisturizer, AGE Interrupter Moisturizer, or Defenage Serum and Moisturizer Tinted Sunscreen by Color Science   If you have taken excellent care of your skin with medical grade skin care products throughout your life, then all you have to do as you age is continue the care you already established and add some serums. Serums treat the skin with needed vitamins, minerals and peptides that are applied externally. medical grade products cost more because they actually penetrate the epidermis penetrate the epidermis and provide building blocks to repair and supply your dermis with needed “supplies” for healthy “daily reconstruction”.  So healthy diet with varied healthy and unprocessed foods, plenty of water, healthy fat and protein to “feed” your skin is a required step toward beautiful skin as you age. In the end most of us have not been aware of the needs of our skin until our skin starts to show aging and damage.  Because that is a common occurrence,  BioBalance Skin  offers a variety of treatments that you can receive at our Medical Spa that are all aimed at reversing the aging process by tightening sagging skin, removing age spots and wrinkles, elevating facial skin, fillers to inject to fill lost fat in our face as well as treating sagging upper arms and skin around our knees just to name a few.  Next week we will be talking about the more aggressive methods of improving aging and damaged skin available currently available in our Medical Skin Care Spa and other spas like it.

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog Every day in my office I hear horror stories about how my female patients are dismissed by the doctors they trusted to help them resolve their problems such as:   ·      Hot Flashes and night sweats ·      Loss of libido ·      Rapid weight gain ·      Brain Fog ·      Insomnia ·      Arthritis associated with lack of hormones ·      Anxiety/Depression starting in their late 30s ·      New irritability ·      New Migraine headaches ·      Lack of motivation ·      Fatigue   There doctors dismissed them, telling them they were just getting old, or they were “babies” because they can't stand a few hot flashes, the doctor changed the subject, or my most unfavorite response to a plea for help, “It is just in your head”. Many other demeaning responses have been recorded, but I am appalled at these responses.  For a patient it takes so much strength to ask these questions, and patients are literally at the doctor's mercy.  In case you didn't get it, the doctor who says these things is covering up for his/her own ignorance.  These are methods used by a person in charge who is challenged to answer a question he or she doesn't have an answer for.  In general, these doctors are men and women, however women have been trained by men and they taught women to do what they had been doing for years.  These “medical” responses are used to belittle the patient to hide their own lack of knowledge. If you are dismissed in this way you should not put up with it.  You can just never schedule with that doctor or practice again or you can find a new doctor who will hear your distress and treat you or tell you they don't know how to help and refer you to someone who does. You shouldn't put up with dismissive doctors.  Another dismissive phrase used by many doctors since the inaccurate WHI study is you're your doctor tells you that he doesn't BELIEVE in hormone replacement. You should respond that hormone replacement is not a religion, it is a medically necessary treatment for menopause! Board certified OBGYNs and Family Doctors should be trained in this treatment.  We women have not only been dismissed by doctors, but also by the Colleges (eg. American College of Obstetrics and Gynecology) that tell doctors how to practice.  In my OBGYN training I was taught that most of women's complaints were because they were depressed so they told us to put women on anti-depressants that just make them numb, but that did not treat our symptoms.   Misogyny is alive and well in the practice of medicine, even in the group of doctors who are supposed to dedicate their lives to the health of women, Obstetricians/Gynecologists. Discrimination CAN be taught, and I believe medical training still teaches these male oriented beliefs to new doctors who are almost 50% women. Medical schools allow women to become doctors because we are qualified, and they can't discriminate anymore.  When I was trained and for a few decades after I became a doctor, you would think I was a second-class citizen. I was left out of resident training run by the residents (almost all men).  Those older male doctors treated me like and. Interloper and some even told me I was not supposed to be a doctor because of my sex. …I was never treated as if I was an equal from the minute, I started medical training and women now practicing over the age of 50-something were all trail blazers and were told all women were hysterical and complainers.   I never accepted this view but now know that women complain because we are not believed and not treated with a treatment that really relieves our symptoms.  After my hysterectomy 2002 I was in private practice with like-minded women in Balanced Care for Women, and they tried to help me but admitted they didn't have the knowledge. I had terrible symptoms that I now know was from lack of testosterone.  The endocrinologists and primary doctors I sought help from belittled me and treated me like I was making the symptoms up!  The worst experience I had was with endocrinologists who were women just saying what their male counterparts had taught them without really thinking.  They “drank the Kool-Aid “from their male teachers and treated me like I was crazy because they were unwilling to admit they didn't know what was wrong with me!  I grew up in medicine (1977-now) under a cloud of sex discrimination and when I needed them most at the age of 47 my sister-doctors failed me…I know intimately how my patients feel when seeing doctors that demean them.   There has been a Federal Law to protect women since 1972, when the US government passed Title IX a Federal Civil Rights Law amendment, but in my experience the law was violated all the time.   Title IX 1972 (my interpretation is simplified and not the actual word for word amendment) Sex discrimination is unlawful in choosing an employee, a medical student, funding for sports at the collegiate level.   I am a champion for women and women's rights. We should require every medical student to be taught about this so the teaching from one generation to another doesn't contaminate young doctors.  Without this action the misogyny in medical care will continue. Recently The DEA required doctors to take an 8-hour course to help them learn to communicate with substance users in a more kind and sympathetic manner. The course's direction to be compassionate and supportive to substance users should be taken for treating women as well. That would be a giant step for all of us.  Wiping out discrimination takes generations but must start somewhere and that should be taught at the beginning of medical training. After we conquer the minds of physicians then we will have to work toward equity in drug development (all drugs are tested on men, but women were not tested on new drugs until 2014), the FDA, the DEA, and Pharmaceutical companies.  To make this happen patients will have to take part and not accept dismissive and discriminatory behavior by their treating doctors.

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog That is a strong statement, however I am confident in saying that belly fat can put you at risk for Alzheimer's disease, because it is a fact supported by medical research. These studies reveal that obesity, especially abdominal obesity (Beer belly, Gut, “Dunlap's disease”…..), increases the onset and rate of Alzheimer's dementia! Another reason to change your lifestyle to benefit your longevity. Abdominal obesity can come from fat accumulation right underneath your skin (the fat you can pinch between 2 fingers) OR the fat that grows inside your abdomen like an apron draped over the intestines. It is called “visceral fat”, and this type of fat is what places you in the crosshairs for several diseases of aging including Alzheimer's Disease, heart disease, stroke, diabetes, and rapid aging.  A large belly is more common in men, but it is still a risk for women if they develop an apple shaped body. Below is a picture of visceral fat, and a diagram of what it looks like in an artist's sketch of a normal weight person. When the yellow fat doubles and triples in thickness the abdomen pushes out to look like a “beer belly”.   Visceral fat extends from your stomach over the transverse colon and your small intestines like an apron.  This fat pad thickens with alcohol abuse (beer belly), high carbohydrate diet, overeating, junk food, under exercise and creates a large pad of fat that secretes inflammatory cells.  The resulting inflammation is the vehicle that damages your brain leading to Alzheimer's disease and damages your arteries leading to heart disease and stroke. In my office we use INBODY machines that measure your Visceral fat, BMI, and percent body fat.  Normal visceral fat is below #10 on our machine, BMI less than or equal to 25, and fat % for men < 19% and for women < 26%. The Research: A recent study correlated the size of patient's belly (visceral belly fat), and obesity with the amount of amyloid plaque (the cause of Alzheimer's disease) in their brain. This was measured by MRI in the study subjects' brains.  The age of the patients studied was between 40-60. The study found that the amount of visceral fat (fat inside your abdomen) is directly correlated with the amount of amyloid plaque and inflammation in the brain!  That causes Alzheimer's Disease. If that doesn't motivate you to lose your belly fat, then you are making a choice to eventually suffer from Alzheimer's disease, a heart attack, a stroke or arthritis.  If you are thinking that you will just wait for “something to happen”, then not making a decision to change your lifestyle is making a decision to take on illness in the future. We have new medications to help you lose that belly fat and they really work. You should ask your doctor to help you and if they don't understand the importance of arriving at ideal weight then look for a different doctor who will help you. Even with medication you will have to put in the work and self-control to turn down unhealthy foods when others are being unhealthy.  You will also have to add daily exercise to your schedule if you really want to avoid Alzheimer's Disease, heart attack, stroke and early death. The possible meds and habits that can help you lose your “belly”: ·     Limit calories and or carbohydrates ·     Increase daily exercise ·     Diet pills (amphetamines that older patients usually can't take) ·     Xenical (Orlistat)-Side effect is fatty diarrhea ·     Qsymia (topiramate/Phentermine) can increase BP ·     Contrave for craving (naltrexone/bupropion) can decrease sex-drive ·     Semelanotide (Imcivree-new), darkens the skin, expensive ·     Metformin ER an oral, effective medication to treat insulin resistance, and promote weight-loss ·     Victoza and Saxenda injections are diabetic treatments, that can cause GI reflux, however they work well for patients who have Type II Diabetes who need to lose weight. Even though many patients lost weight with these medications, many could not tolerate the drugs listed above because of the side effects.  These side effects limited our ability to help all patients lose weight…until now! Now, for the first time we have an effective way to help most people lose their dangerous visceral (belly fat). If you have a big belly you are at high risk for inflammatory diseases like Alzheimer's dementia, obesity, heart disease, diabetes, cancer and stroke. The new weight loss drug's generic name is Semaglutide, and has been marketed under several names: Wegovy, Ozempic, and Rybelsus. A second generic drug that is in the same family of drugs is called Tirzepetide, includes Mounjaro (for diabetics) and Zepbound (for weight loss). All of these drug's work for weight loss, pre-diabetes and Type 2 Diabetes.  Most insurance companies do not cover weight loss and they require a precertification for you to get the medication covered by insurance.  This precertification process is time consuming for the doctor and her staff, which costs the doctor an increase in her overhead to employ a nurse to provide this service for the patient. In general people with a BMI under 30 will not be covered for Semaglutide or Tirzapeptide, however if their BMI is over 30, there is a chance insurance will pay for one of these drugs for a period of time. The market price at the pharmacy is between $900/$1200 per month if you pay out of pocket to your pharmacy. Because of this fact and because we have so many patients whose pellets are not paid for by insurance, we provide access to the generic form of these drugs through a compounding pharmacy. The cost is a fraction of the normal out of pocket cost, about $560 for 3 months supply. In this way we have been able to treat many people who cannot afford to pay the exorbitant going rate for this medication. Because it is costly for a patient to receive the medication no matter how they are able to get it, It is very important for weight loss patients to be compliant and follow a low carbohydrate diet, exercise daily and to refrain from alcohol consumption while they are taking weight loss medications.  We require our patients who request these drugs to be seen at least every 2 months by one of our NPs or our weight loss specialist to help them get the best results possible. These drugs work for weight loss and diabetes by multitasking.  The ways the medication actually works are listed below: Semaglutide and Terzapeptide, ·      decrease hunger between meals   ·     you feel full faster than normal so you eat less ·     decrease sugar and alcohol-craving ·     decrease the release of sugar from the liver when you are fasting, which turns into fat ·     Prevent hypoglycemia which causes hunger and fat gain ·     Makes patients more insulin sensitive. Obesity is not just a lifestyle problem; it is a disease that should be treated with medicine PLUS lifestyle changes. These drug actions take place in the brain, stomach hormones, pancreas and liver, as well as in all the cells in your body. At Bio Balance Health® have years of experience in treating patients with bio-identical testosterone pellets and we have observed that weight loss plus testosterone pellets for patients over 40 allows patients to lose fat without losing muscle. Now we add these weight loss medications to T pellets, and we have the perfect combo for safe weight-loss (really fat loss). The biggest worry for patients is that they may not be able to get off this drug after they achieve ideal weight.  I have found that the longer you have been overweight and the more overweight you are, the higher the risk of needing maintenance medications to maintain your ideal weight. We try to wean our patients off injectable meds by switching them to Metformin ER, a drug that insurance will pay for. With these effective meds we finally, we have an effective preventive treatment to add to our testosterone and estradiol pellets for those people who view Alzheimer's as their worst nightmare, and for those patients who are worried about heart disease, diabetes and stroke  we can prevent the diseases that can ruin our “golden years”.   KCM Research: People with large amounts of visceral fat as they age may have higher risk of Alzheimer's disease. NBC News (11/20, Carroll) reports, “People who have large amounts of” visceral fat “as they age may be at higher risk of developing Alzheimer's disease, a new study suggests.” The findings were presented at the Radiological Society of North America's annual meeting. HealthDay (11/20, Thompson) reports that investigators “compared brain scans of 54 people between the ages of 40 and 60 with their levels of belly fat, BMI, obesity and insulin resistance.” The investigators “found that people who had more visceral fat compared with fat found just under their skin tended to have higher amyloid levels in the precuneus cortex.” The “relationship was worse in men than in women, and higher visceral fat measurements also were related to increased inflammation in the brain.”

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog At Bio Balance Health I order blood tests to evaluate my future patients before I even have my first appointment with them.  I use them to find a baseline for an individual patient, and to see if hormones will help them with their symptoms.  Blood tests work well for establishing a diagnosis but are not the only factor in determining an ideal dose of hormone that works for that patient.  Symptoms and medical history supply most of the information for determining dosage as well as help me find other medical problems to treat at the same visit. Many diseases in the early stages are not treated by primary care doctors because they are overwhelmed with their number of patients and the short-time they are allowed to see them.  Our goal is to prevent disease that have been missed or treat conditions at an early stage before they become severe.   Blood tests establish and confirm both hormone deficiencies and provide a baseline level before treatment and the optimal level for each individual patient.   That blood level may or may not be within the range that is expected for a treatment success (written on the lab report). You are an individual and it is my job to find the ideal blood level of hormones for you.   Why would the blood level not tell the whole story?   Your body is genetically programed to both PRODUCE hormones from your endocrine glands and ACCEPT those same hormones in each cell.  Every person is an individual and each person makes hormones based on their genetic map and environment. Everyone is programed genetically to accept hormones into their cells in an individual manner. This is the key to understanding the differences between patients' responses to an equivalent dose of hormones, either excreted from their own glands or absorbed through their chosen delivery system (oral, vaginal, transdermal or subdermal pellets) after their glands have aged and don't produce enough hormone, like estradiol and testosterone.   I was in Cambridge in 2014 for the release of my first book, The Secret Female Hormone, when I visited a medical bookstore.  I discovered a large red book that weighed no less than 10 lbs was titled Testosterone.  I looked through this book and found that there was information that I had not discovered in my research of the American medical journals and books, so I bought it and read some of it on the long flight home to St. Louis, MO. I found that this book had answers to questions I had uncovered in my then,13 years of hormone medical practice. My biggest question at that time was why 2 people of the same sex having the equivalent blood level of free testosterone often feel completely different. For example, I was trained that if a man had a blood level of free testosterone that was above 129 pg/ml and under 350 pg/ml (using Quest Diagnostics lab), then he should feel normal, like he did when he was in his thirties (barring any other illnesses interfering). However, I observed that some men felt great at 110 pg/ml while others at 130 continued to have the symptoms of low T. This puzzled me, but at that time I had no answer. Then I read the first chapter of Testosterone.   The answer is found in the individual differences in the receptors on each cell for that hormone, the receiving end of the hormone physiology.  It informed me that receptor sites are genetically created differently in each individual and that one-size-does-not-fit-all!   You can bathe a person's cells with what is considered an adequate blood concentration of testosterone for most people, let's say men since that was the subject of the first chapter, of the book Testsosterone, but some men would receive and use only a small portion of the circulating hormone. Their cells were “resistant”, therefore they required a higher concentration of hormone, to activate their cells. This very important fact in endocrinology has been ignored until recently when we began to use genetics to find the differences between individuals' receptor sites for all hormones and all peptide communicators. In the last 10 years we have found that receptor sites are the missing link in determining a person's required dose of a hormone, and they are genetically determined.   Here is an example from the book in a very simplified translation. Think of a key and lock. Each cell has “locks” or receptor sites all over it, and the keys are the testosterone molecules.  Some people's cells have locks that are easy to open and turn on a cell. They are “sensitive” to that hormone.  Some cells have difficult “locks” and they must be bombarded with a hormone “keys” to turn the cells on. This led the researchers to look for the snips of DNA that were responsible for the difference. They found them and then tested men from all over the world to see if there were regional groups, genetic groups, that contained more sensitive receptor sites or more resistant.   The results are quite telling and explain the differences between races and peoples in terms of how their bodies use the testosterone hormones available.  The men with the most sensitive receptor sites live closer to the equator: Mediterranean, African, Brazilian, and those men with more resistant receptors had DNA from ancestors who came from closer to both North and South poles: Scandinavia, Canada, Europe, South Africa, Southern Argentina etc.  The results mean that if you have a clear genetic line from one of these groups, we can predict whether you need a higher dose or lower dose to get the same resolution of symptoms. Most people in America are mixtures of genes so most patients don't give me any information from their ancestry.   However, there are two catches to this system of determining an individual's receptor site sensitivity; 1) In this century we are able to travel and find a mate on the other side of the globe and have been able to do so for generations, therefore we are “mutts”, or people who have multiple genetic sources in our DNA and therefore how we look or where we are from is not a good predictable factor for how we will accept our testosterone. 2) There is no commercially available test to evaluate the sensitivity of our receptors. Currently, the best science has found is to test DNA for the snips that predict sensitivity or resistance to testosterone!   This too will come to the practice of medicine, but “medicine” moves slowly and the government and people in control are always looking for a one-size-fits-all approach to illness and or aging, which makes me think this type of test will not be embraced by general American medicine.   At this point all I can tell you about dosing and blood levels is that you have an individual level that is good for you, so I try to figure out what that is, and “mark it” with your “perfect blood level”.  I proceed with is the knowledge that there are many other factors that affect the blood level of free-testosterone (active form) and the effect it has on individual patients.  This leads me to practice individualized medicine like a tailor makes a dress or suit that fits one person only. I have a lot of experience to recognize resistant or sensitive T receptor patients and I now know how to approach their care.  It is NOT by trying to adjust their hormones into the very inaccurate free T levels printed on the blood lab sheet, however I do look at those numbers to establish a baseline for that person, and I do listen to my patients when they tell me whether their symptoms are resolved or not. Resolving all SYMPTOMS is the real sign of a successful replacement of testosterone in both men and women.

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog When I tell my patients that they need a high protein diet, all they can think of is meat…but protein sources are found in many parts of our diet and eating a variety of protein sources is the key to health, we should find out what we should eat and why? Protein contains amino acids that are the major building blocks to make our muscles, skin, connective tissue, tendons, ligaments and bones.  It also supplies the components of our skin, hair and nails, and carries with it calcium (the major component of bones and connective tissue).  Protein is found in cheese, milk, all milk products, whey for protein shakes, pea protein, fish, all seafood, chicken, lamb, eggs, Quinoa and beans for building muscle. Pieces of proteins make up every fluid the body makes, including hormones, enzymes, peptide communicators, the immune globulins, semen, breast milk, and vaginal discharge….is it any wonder that I tell my patients to increase protein in their diets! Despite the need for amino acids and short chains of amino acids called peptides, we also need a variety of foods, all colors at every meal to provide the other building blocks of our body.  For example, fat is a very necessary food for every person, at every meal.  When I was pregnant, I wanted to feed my baby everything she needed to build a healthy beautiful brain, so I ate Braun Schweiger every day (made from liver) for lunch with a salad.  The Braun Schweiger provided Rachel, my daughter, with the building blocks for an amazing brain. Our brains are almost all fat.  That is the type of tissue that nerves are made of, but nerves also need B12 to work properly and B12 is primarily from animal products. It is relatively easy to include fat in our diets, but it is truly difficult to get enough protein to build muscle on a vegan diet. My vegan patients must be experts in obtaining protein from their diet and must be aware of the components in all the food they eat to get the proper nutrition. Carbohydrates are made for “action”.   Carbohydrates are required for exercise, walking and brains also burn carbohydrates when you are doing “brain work”. Carbohydrates are stored as fat if we eat them but don't exercise!  Think before you eat carbohydrates about your next 12 hours and whether you are going to exercise to burn the carbohydrates in your diet. So How Much Protein Do We Need? Growing teenagers, people who lift weights and try to gain muscle, pregnant women (need a minimum of 100 grams a day) and patients like mine on testosterone need more protein in their diet than the average sedentary, adult. To quantitate the number of grams of protein you need to sustain your body with a high percentage of muscle, a person needs more than ½ their weight in grams of protein. For example, a 125 lb. woman with average to high muscle mass will need more than 62.5 grams of protein a day. A person with higher muscle mass will need more than that. For athletes, weight lifters, patients trying to lose weight and sustain their current muscle mass, they need to eat the equivalent number of grams of protein to their weight, every day.  To do this a person will have to know how many grams are in each serving of their current foods and if they aren't eating enough, they should add high protein, low carb protein shakes times before or after they work out or exercise.  A typical protein shake will have 15 to 20 grams per serving and less than 5-10 grams of carbohydrate. An average size  hamburger has about 20 grams of protein.  Add beans, peas, cheese, yogurt, butter, ricotta cheese, milk, eggs, custard, chicken, fish fillets, shrimp, and protein bars.  Be careful not to overeat carbohydrate with your protein which can cause you to gain fat, while you make muscle. Why do we need more protein on the days we work out, especially with weights?  Weight training is a great muscle builder, in fact it is the best form of exercise for increasing your muscle mass.  But why do people who engage in this type of activity require more protein than those who walk?  The answer is in the physiology of human muscle when stressed by weight training exercises.  When you work out with weights you put specific stress on your muscles, and during the hour or hours you engage in this type of exercise your muscles are broken down. That's right, initially you LOSE MUSCLE! The act of physical labor on the human body that uses weights against gravity causes stress on the muscle fibers and they are broken down, their components (all made of protein) are then excreted from the body.  We don't recycle much of the broken-down muscle! Instead, we must provide new building blocks, or amino acids that are circulated to the muscles from our diet, tp build back the muscle and even build more than was there the day before your exercised! This is the reason weight-lifters work out the top half of their body one day and let it rest (to build muscle) the next day while they exercise the bottom half of their body! Now let's talk about protein necessary for aerobic exercise like running or fast walking.  Distance running does not build muscles in the legs (or anywhere else), because this type of aerobic activity breaks down muscles that are working hard, but they are not stressed against gravity enough to build muscle, unless the runner is obese. Obese people who do or do not exercise have huge calves not because they work out, but because their legs have to hold up more weight than it is designed to support so their lower legs lift a fat body every day!  Runners, however, are usually slender, and their calves, quads, and hamstrings are slender too.  They do not build muscles while running.  The purpose of running is the production of endorphins for enjoyment, and the aerobic benefit to the cardiovascular system.  Running also burns alot calories so carbohydrates are needed to give the current muscles energy to run.  If you have ever looked at runners' legs, they are not “cut” like lifters legs, that show the muscle bellies of the legs, but they are narrow long and smooth. These people don't need as much protein as a lifter even though they are running every day, because they don't require as much protein to build back what they already have plus more protein to make the muscles bigger! They just must sustain the muscle mass that is being used.  Their need is in carbohydrates that give them energy to feed the muscle fibers. As people age, they lose muscle mass unless they take testosterone and eat a high protein diet. Left to nature their muscle mass decreases by 3-8 % EVERY YEAR between the ages of 40 and 90, unless you take a healthy dose of testosterone.  Aging adults are advised to eat more protein to prevent this catabolism but truly it doesn't work if you don't replace the hormone that signals muscles to grow which is testosterone. Remember that protein comes primarily from animal products but can also be found in many kinds of beans and peas, but not in any fruit. Remember to grow muscle you need.   ·      Protein in grams per day equal to your weight ·      Varied colorful diet with enough fat and carbohydrates. ·      Testosterone ·      Weight bearing exercise Another reason supplements might not be necessary: “Protein is in every food group except fruit,” Dr Webb says. Every human was born to eat a variety of foods to satisfy all their daily nutritional needs. The benefits of variety include the types of protein sources. Meat is an obvious source of protein, but “thankfully we can find protein in a multitude of plant-based sources, including lentils, tempeh, tofu, and beans,” Corwin says. Barkoukis, a researcher on protein and nutrition, advises that "Variety in diet is the best plan,” she says. “Beans are an amazing powerhouse," however they do not have all the amino acids the body needs to sustain life. “Not all protein sources are alike, or equivalent. Animal proteins are “complete” in that they contain all nine essential amino acids, while most plant proteins often have some—but not all—of those aminos that we cannot make in our bodies, so we must get them from a food source.” Quinoa has all the essential proteins; beans are incomplete and should be combined with other sources. For those who always ask how food work, here it is taken from a book called Human How do the proteins from foods, denatured or not, get processed into amino acids that cells can use to make new proteins? When you eat food the body's digestive system breaks down the protein into the individual amino acids, which are absorbed and used by cells to build other proteins and a few other macromolecules, such as DNA. Nutrition. 1.    In the mouth your saliva begins the metabolism of proteins with amylase that is produced in your salivary glands. Your chewing breaks protein down into small pieces to help digestion. 2.    In the stomach acids (Hydrochloric acid from gastric juices and an enzyme pepsin to break down protein. Proteins take longer in the stomach to break- down so you feel full longer when you eat proteins. 3.    The small intestine is the major player in protein digestion. Here the Pancreas secretes trypsin and chymotrypsin These enzymes break food protein into amino acids. 4.    At the end of your small intestine there are specialized cells that transport protein into the bloodstream, and it circulates to where it is stored to make vital enzymes and building blocks for when you haven't been eating. 5.    Amino acids are recycled to make new proteins (muscle, enzymes, skin hair, etc. Amino acids to build other biological molecules containing nitrogen.   “It is critical to maintain amino acid levels by consuming high-quality proteins in the diet, or the amino acids needed for building new proteins will be obtained by increasing protein destruction from other tissues (stealing protein from your muscles) within the body, especially muscle. This amino acid pool is less than one percent of total body-protein content. Thus, the body does not store protein as it does with carbohydrates (as glycogen in the muscles and liver) and lipids (as triglycerides in adipose tissue). such as DNA, RNA, and to some extent to produce energy.”  Eating protein is vital to life!

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog There are almost as many different human metabolic variations as there are people in the world.  Our genetics make us all unique in ways that vary the way we can lose weight or even gain weight. On the other hand, we all had to descend from humans who survived famine, lack of water and lack of nutrition sources, so in one way we are all the same…we have genes that helped us survive times that required of us the ability to maintain our weight even without eating!  The people who genetically were unable to gain fat and keep it to hold them over during famine just didn't make it to an age they could procreate. The rest of us whose ancestors survived, have given the majority of us the genes to maintain body fat.   Unfortunately, we have been blindly unaware of what man's evolution and progress has led us to physically, and most of us are over-fat, and have trouble losing it!  The very genes that allowed us to survive the beginning of man's existence, are the same ones that make it hard to become slender. In addition, in our current societies in the western world, food is plentiful and inexpensive.  Our genes have not changed, but our environment has, and we are becoming sick because of our obesity…how do we survive this “new world”? You may hear a lot about insulin resistance, and I talk about it a lot on my Healthcasts, but it is insulin resistance that has allowed us to survive and has also led us to obesity today.  The humans who were insulin resistant who also held on to their fat in times of starvation are also the humans who have become obese in the face of plenty. We can't change our genes, but we can turn some of the obesity genes off through lifestyle and sometimes with the help of medication. Despite our basic sameness, we are also each individual, and genetically programed so that some of us lose weight if we restrict calories, others lose weight only if they exercise; Some of us don't lose weight with exercise; some people don't lose weight with carbohydrate restriction or fat restriction, and some do.  This is the ugly truth that lies behind the millions of books on diet, none of which work for more than a small number of us, and because it is a diet we can't maintain it...what we need is to determine is the best weight loss program for each of us, by using trial and error, or by using genetic testing that tells us what our best pathway to a normal weight looks like.   To begin we must take baby steps and learn about food and what the words mean that we use when referring to food.  Because there are many people who may have several hurdles to jump before they can live at their healthy weight, we need to all speak the same language of weight loss.   So let's start with a bit of education about food.   WHAT IS A SIMPLE SUGAR?   A simple sugar is a nutrient meant to give you energy for physical activity. Eating a small amount of a simple or a complex sugar before exercise is a good idea. However, if you sit most of your day, working with your brain instead of your body, simple sugars can increase your fat storage because you aren't physically working. This is true whether restricting sugar is your genetic method of weight loss or not. Too many simple sugars make you hungry and cause everyone to overeat.….causing weight gain and fat gain. So what are simple sugars?   Examples of simple sugars:   ·      Sugar, white, cane  and brown ·      Molasses ·      Regular Soda ·      Agave ·      Honey ·      Syrup-maple or any ·      Rice, white and brown ·      Cereals-all ·      Oatmeal ·      Donuts ·      White potatoes ·      Bread ·      Pancakes/waffles ·      Noodles ·      All Grains: wheat, oats, rice, corn and anything made from them including flour ·      Sweet tea ·      All Cakes, brownies, candy, chips, and many energy bars ·      All bagged snacks like pretzels, chips, cookies, and fruit with sugar added ·      Pies and most desserts, except fresh or frozen fruit. ·      Dried Fruit (has sugar added eat frozen fruit instead.) ·      All non-milk-based salad dressings except plain Olive oil and vinegar.   Note: All diet sodas have chemicals that stimulate insulin like sugar.  There are a few brands that use Stevia (an herb that is sweet, and not a chemical) and they are the exception so you can drink those without stimulating fat production.  Other options are unsweetened bubble water or plain water.     Eventually eating a diet filled with simple sugars leads to obesity, and diabetes no matter who you are, therefore if you are in not working physically with your body all day, every day ( machinists, farmers -in the summer, factory workers, outdoor laborers) you should not eat these foods except in small amounts with a protein to lengthen the time until you feel hungry again. The rest of us should rarely eat these foods. They should be considered foods for “special events”.     If you exercise aerobically and/or with weights for more than an hour at a time, then you may eat a small amount of simple sugars but eating small amount of complex sugars is healthier to help you maintain your muscle mass and your exercise stamina while losing fat.       COMPLEX CARBOHYDRATES: EAT INSTEAD OF SIMPLE SUGARS     SWEET POTATOES   Sweet potatoes taste sweet and have complex Carbohydrates so it takes longer for them to be digested which means they do not stimulate the secretion of insulin as fast or as high as white potatoes. They are a complex sugar.   Sweet Potatoes also have several health benefits including antioxidant healing role and anti-inflammatory properties.   CHICKPEAS (GARBANZO BEANS, BLACK BEANS AND LENTILS) Legumes like chickpeas, black beans, and lentils are not only complex carbohydrates buy are a great source of dietary fiber, making them wise choices for a filling you up and satisfying the pre-workout carbohydrate requirement.   QUINOA   Quinoa is a good source of plant protein. It can be a substitute for bread or pasta.   WHOLE GRAIN BREADS LIKE DAVE'S LOW CARB & HIGH PROTEIN BREAD   Whole grain bread like Dave's Bread has enough fiber and nut protein to prevent excessive stimulation of your insulin. Too much insulin leads to insulin resistance and causes fat gain instead of giving your cells energy. One piece of bread per meal is all you should eat if you are overweight and or have Type II diabetes in your family. Make sure you are not eating more than 25 grams of carb in any meal.   WILD RICE- is a seed and not a “rice”   You should eat wild rice instead of any other type of rice and only in small amounts.  All complex carbs should be eaten in small portions because in large portions they act just like simple carbs and increase weight gain.     NUTS: Cashews, Almonds, Walnuts, Chestnuts,   Nuts of all kinds can be a substitute for carbs in any form.  A handful of nuts should be enough to decrease your hunger and increase your protein as well as decrease insulin response to eating.   The Combination of foods that you eat is also important.  If you are going to eat any carbohydrate it should be paired with a protein and or a fat.   For example: If you are going to eat a piece of bread, then you can eat it with butter and or peanut butter or cheese or eggs.  This slows the absorption of the carbohydrate from the bread and prevents your blood sugar from surging and plummeting after you eat, leaving you fatigued and sleepy.   In The Dr. Maupin's Diet in my book the Secret Female Hormone, I recommend eating multiple times a day and controlling simple carbs and carbs from sugar and grains.  Scientifically it is a fact that if you eat 25 grams or less of carbohydrate foods from sugar or grains per meal then you can prevent Insulin resistance and the additional fat that follows insulin resistance.  It is also a good way to lose fat.  In my diet a person can eat as much fruit and veggies as they desire, except white potatoes and bananas.   WHAT YOU EAT, IS AS IMPORTANT AS HOW MUCH YOU EAT!   Other Strategies for weight loss include eating a protein with each carb which decreases the total volume of food you eat and increases satiety.   ·      Saving your carbs to be eaten before exercise.   ·      Portion Control of all food.   ·      Limit alcohol.  0- 4 drinks a week   ·      Daily exercise for over an hour/day.   ·      Drink a glass of water before you eat.   ·      Skip dessert   ·      Eat a salad daily   ·      Eat more than half your weight in grams of protein (Meat, cheese, eggs, milk products, whey protein and more)    The basic information was from my over 45 years of practice and Information provided by Inbody.  If you know by experience or you have had your genetics tested to reveal that limiting carbohydrates is needed for you to lose fat, then I hope this blog helped you understand what I mean when I tell you to limit your carbohydrate intake to less than 25 grams per meal.

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog This subject is for men who have had a high PSA and who have been advised that they need a prostate biopsy to determine if they have cancer. Many men go into the doctor for the biopsy necessary for diagnosis without expecting the “blind biopsy” procedure that is done through the rectum and is extremely painful when the doctor blindly takes pieces of the prostate…over and over again.   Blindly, means he is randomly picking a place to biopsy without a real target….with the urologist biopsying everywhere in the prostate 10 or more times. Finding a small cancer with this random or “blind” biopsy method is a less than effective way to find a small area of prostate cancer. Men who have had this procedure done rarely agree to a second round, under any circumstances and I agree with them. I always do a PSA test before I treat a man with testosterone so I often am faced with the question of what advice I should give him in this situation before I feel it is safe to give him testosterone. Of course, if he has prostate cancer, even a high PSA, I will not give a man testosterone until his urologist says he is safe to receive it.  Until recently there was no radiologic way to screen a for prostate cancer. Now urologists use Ultrasound or MRIs to find an abnormality in the prostate that they can biopsy.  This makes the procedure both more accurate and less painful. The way this procedure was done in the past, and is still done throughout the US, always caused me to wonder why urologists hadn't figured out a way to do it in a way that accurately biopsied a high risk area of the prostate, with one or two biopsies.  Now Urologists use rectal ultrasound or MRI, like Gynecologists use vaginal ultrasounds to find and drain or biopsy ovarian masses, or to harvest eggs in IVF. The urologists have even borrowed the idea to use numbing medicine as well to make it comfortable.  In the last 2 years I have found a few Urologists who have embraced the new, accurate biopsy procedure that used the MRI to find high risk areas and ultrasound to locate suspicious areas for biopsy, then used the same radiologic method to locate and  treat discrete focal areas of abnormality with cryotherapy (freezing) or focused ultrasound.  Finally in August of 2023,  a research article titled, “Focal Therapy for Localized Prostate Cancer in Older Men”, was published in the Journal of Urology. This article describes a much more accurate method of treating prostate cancer that resulted in the diagnosis and treatment of  low grade prostate cancer without recurrence and without complications, allowing men to have a conservative treatment for low grade prostate cancer, following a less painful and invasive diagnostic procedure. Compassion has finally come to diagnosis and  treatment of prostate cancer. We applaud the authors. August 22, 2023 Focal Therapy for Localized Prostate Cancer in Older Men Allan S. Brett, MD, reviewing Habashy D et al. J Urol 2023 Jul Lomas DJ and Frendl DM. J Urol 2023 Jul In an observational study, focal therapy was compared with radical treatment. At some centers, focal ablative therapy (generally with high-intensity focused ultrasound or cryotherapy) is a treatment option for selected patients with localized prostate cancer. This option could be attractive for some older patients with comorbidities who might be candidates for radical prostatectomy or radiotherapy (according to tumor grade) but who wish to avoid complications from radical intervention. Using data from national registries, U.K. researchers compared 262 patients (age, ≥70; median age, 74) who underwent focal ablative therapy with 262 propensity-score–matched patients who underwent radical treatment (mostly radiotherapy with androgen-deprivation therapy). At baseline, nearly all patients had intermediate- or high-risk disease. Estimated 5-year failure-free survival (the composite primary outcome, which included absence of salvage radical treatment, systemic treatment, distant metastases, or prostate cancer–specific death) was significantly higher in the radically treated group than in the focal-therapy group (96% vs. 82%). Estimated 5-year overall survival with focal therapy was 96%. COMMENT The better failure-free survival with radical treatment than with focal therapy (a 14 percentage-point difference) is not surprising. The challenge for individual decision making is to balance that difference against the higher rate of complications with radical treatment in older men — especially men with substantial comorbidities. We don't have long-term data from randomized trials to compare focal therapy versus radical treatment, active surveillance, or watchful waiting. But in the meantime, editorialists from Mayo Clinic conclude that focal therapy is “a reasonable strategy in older patients.” About 34,800,000 results (0.53 seconds)  Search Results Featured snippet from the web They insert a needle through the wall of your rectum and into the prostate to extract the cells for testing. This is a “transrectal biopsy.” Doctors usually take a dozen samples from various parts of the prostate. In some cases, they do the biopsy by inserting a needle through the skin between the scrotum and the anus.May 29, 2023

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog Are you menopausal and have any of the following symptoms? ·      Hot Flashes ·      Night Sweats ·      Dry Vagina ·      Painful intercourse ·      Dry skin ·      Lack of sex drive ·      Lack of motivation ·      Fatigue ·      Depression and or anxiety ·      Change in body composition, with fat collection in the abdomen ·      Loss of Muscle Mass and strength ·      Irritability ·      Inability to remember names and places ·      Decreased ability to problem solve ·      Insomnia ·      Arthritis ·      Body pain   These are all symptoms we currently are aware of associated with menopause and low testosterone.  These symptoms can be treated and reversed with bioidentical estradiol and testosterone pellets.   Menopause should be treated like an illness that is universal but more severe in some women compared with others.  If your symptoms affect your lifestyle, relationships and work then you should see a doctor who treats hormone deficiency and accept treatment!   However, if you allow yourself to be manipulated by a male-dominated medical system that teaches all doctors to believe that menopause is normal as women age and don't seek out hormone replacement, then you just may be setting yourself up for years of symptoms that are treated with handfuls of medications, but never get you back to normal.  Just think about this for a minute: Men develop erectile dysfunction and experience muscle loss as they age, but medicine doesn't consider ED or Sarcopenia a natural aging process for men, they advocate and endorse treatment with testosterone, ED medications, injections for ED and therapy for ED, and in most cases pay for it!  If the male mentality would include women we would all be treated with estrogen and testosterone when we got to age 50 (or menopause).   It is not just about the symptoms that E-T replacement can cure, but the diseases that you can avoid by taking estrogen and testosterone after menopause.  These avoidable diseases of aging include: ·      Osteoporosis leading to broken bones and spinal stenosis. ·      Heart disease and stroke ·      Diabetes ·      Alzheimer's Dx and dementia ·      Obesity ·      Low muscle mass and inability to walk or move independently. ·      Autoimmune diseases ·      Loss of blood flow to Lower extremity, resulting in amputations and inhibiting walking and running ·      Severe arthritis ·      Gout ·      Worsening depression and anxiety ·      Frailty which is what causes most older people to be placed in a nursing home. Just think it is not fate that gives you these conditions.  It is genetics plus lifestyle plus whether you replace your sex hormones or not! This decision is in your control.  If you really want a life free of debilitating disease and symptoms that are require constant medical care, then you must buck the system (that was designed to keep us from maintaining our mind and body) and look for a doctor to replace your testosterone and estradiol in a non-oral delivery system and maintain it for life. By stopping ERT or Testosterone like the ACOG doctors tell you to, you will start the symptoms all over again.  My job is to offer you the right type of help to reverse the effects of menopause…both symptoms and diseases. Your job is to decide whether you want to get help and become healthy by taking nonoral estrogen and testosterone for the rest of your life. Think of menopause as a disease and you will be more prepared to fight for your right to be treated by the medical system. 

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog Even though all women eventually stop having periods and stop making estrogen, testosterone, and progesterone we all have symptoms of menopause, even if you don't recognize them as symptoms relating to loss of estrogen, testosterone, and progesterone after menopause.  However, every woman experiences menopause differently. Some of us are devastated in every way by the multitude of symptoms that loss of our sex-hormones can create, on the other hand some women merely endure painful intercourse, hot flashes, headaches, and fatigue…or are told by their doctors that their symptoms are “getting older” and they have to live with it!  Aren't your symptoms enough for you to demand treatment? What I See: Every day in the office and even in my private life I run into women who complain about their symptoms of hormone loss. When I offer a solution for their symptoms of menopause and low T, I am often shot down by my patient's “fear” of hormones. For example, I was at a 70th birthday party recently and a flood of women came up to me and told me how young and heathy I looked.  When they asked me what I do to achieve that, and I explain that I have taken hormone pellets with T and E2 since I was 47 and they can get the same results, they immediately say, “I'm not doing that!  I don't want breast cancer!  Or “that will cause heart disease or gain weight! “. The media and their doctors who are not up to date in their reading of research have frightened them away from treatment for their symptoms!  The doctors should read more and not depend on 40-year-old information (med school and residency).  They just told me I was doing something right, but then the fear that society has instilled in them shuts the door on a chance to be healthy, mobile and at ideal weight forever.  The opposition to us is strong and this is really brainwashing women away from taking care of themselves!  The recent (last 10-15 years) research has revealed that medicine has been wrong about much of the advice that we give patients based on flawed research and the need for the media to scare women into dangerous action (not taking hormones).  These groups are literally making women suffer, take too many medications, and literally to be ill during the second half of their lives!  The power of the press causes women to comply.   Here are the “facts” doctors were taught over the last 4 decades: that are lies! Genetics hold your future. The new study of Epigenetics has revealed that we can turn off our “bad” genes with a healthy lifestyle. Diet—the Food pyramid lied to the American people to make money for America. They advised us to eat grains and sugar, and now we know that that caused Americans to be obese and diabetic. Exercise—Jogging long distances is healthy. Lie!  Exercise helps weight loss in a percentage of patients however most patients who exercise to extreme are less healthy than other people who are moderate in their exercise.  Moderation prevents the need for knee and hip replacements, the stress on the heart and kidneys causes early circulatory and renal disease. “Hormones” –cause Breast Cancer. Estrogen doesn't cause breast cancer however it can increase growth in estrogen receptor positive women. Not a cause, in fact women on ERT (without provera) had fewer breast cancers and less aggressive ones than women who took nothing! Testosterone is a MALE hormone, and we can't have any! Lie! We make three times as much testosterone in our ovaries as we do estradiol when we are fertile!  Do you see that we are manipulated into following false truths because our doctors are too busy to keep up and fear sells newspapers, magazines, and other news agencies. This is how we are discouraged from treatment by our gynecologists, our friends and society. Women are continually barraged with misleading information that makes us think that menopause is no big deal and we just have to live with it and get old gracefully, like our mothers did!  However, our mothers did get estrogen and other treatments for menopause!  Medicine has been completely revamped in the last 50 years, so we should be healthier, happier and have a better quality of life, yet we are prevented from achieving that through instilling fear in women. While we are dissuaded from treating the symptoms of menopause that take away our productivity and quality of life, we are put in an untenable position. We are discriminated against because we are menopausal.  The most recent example of this mission to cripple women's success was on national TV when Former Governor Nikki Hayley, the 52 yr. old female Senator who is running for president, was described as inadequate because she was  “past her Prime”, by a male politician who is in a party that touts the ability of an 81 year old man in that position to act as president of the US.   This is one example of millions of examples as to how we are denied treatment to give us powerful and productive lives while we are denied the medicines to make that possible! The powers that control us, Congress, Senate, the President, the FDA, and the NIH are for by our tax dollars, but they aren't working for us.  They perpetuate the myth that women are addled and inadequate because of our menopausal status, and then make it come true by lying to women about the risks of taking the hormone replacement that can make the second half of our lives productive.  The people who make decisions about this subject use fear to “manage” us. Headlines and Titles of articles are the weapons they use. The second hormone women need is testosterone, however testosterone is still claimed by men and they won't share!  Men have over 20 forms of FDA approved forms of testosterone while women have none!  Testosterone deficiency causes many of the symptoms women experience but don't associate with testosterone loss.  Fatigue, lack of sex drive, loss of muscle, weight gain, belly fat, arthritis, inability to think, depression and anxiety that begins before 40.  Doctors answer women's questions about these symptoms by saying, “You are just getting old”, and then refuse to treat or help except with an easy but ineffective treatment, anti-depressants!  That's how doctors are trained.  It's disgusting that doctors just ignore our symptoms.   The facts: Women make 3 times as much testosterone before menopause as we do estradiol, yet testosterone is still referred to by “experts”, including the American College of OBGYN who teaches doctors taking care of women's menopause. So women are “held down” and discriminated against by the majority of men, who still run everything :  the FDA  who won't approve Testosterone replacement for women; the government who won't pay for testosterone replacement or non-oral bioidentical hormone replacement (which is how we receive our T); and the group that I will discuss today—the journalists who title research articles to scare us, not  to educate us, and write them like we are children who need to be placated and brainwashed instead of  just treating  a uniquely female disease….MENOPAUSE!,,,with estradiol and testosterone. We have allowed ourselves to be manipulated and we repeat the rhetoric men have initiated. Why aren't we asking questions and making our doctors listen to us?  They should be helping us.  We are half the problem.  We find it easier to buy into the lies and do nothing rather than treat our symptoms.  We ignore the fact that doing nothing for ourselves is doing something negative for ourselves, one of their tactics used against us, is to scare us from seeking treatment for menopause with the current headlines (Like Hormone Replacement Therapy Causes Cancer and Heart Diseases). and messages barraging us to scare us away from treatment of our painful symptoms, while our decisions destroy our power to continue what we are still accomplishing after age 50. Here are the titles of the medical and public articles recently in the news that scare women into thinking that they are damaged after menopause and have no safe treatment. NEWS 7.2023 Ovarian cancer risk among women with PCOS doubles after menopause HealthDay (6/27, Murez) reports, __________________________ Women Who Undergo Bilateral Oophorectomy Before Menopause May Have Greater Risk Of Developing Parkinson's Disease Years Later, Study Suggests HealthDay (11/8 Norton) reports, Removal of both ovaries before menopause tied to risk of chronic health conditions MedPage Today (9/13, Robertson) reports   Gout risk higher for postmenopausal women Full Story: Healio (free registration) (8/14) ___________________________- The association between perimenopausal age and greater posttraumatic stress disorder and depression symptoms in trauma-exposed women Michopoulos, Vasiliki PhD; Huibregtse, Megan E. PhD; Chahine, E. Britton MD, NCMP; Smith, Alicia K. PhD; Fonkoue, Ida T. MD, PhD; Maples-Keller, Jessica PhD; Murphy, Amy BA; Taylor, Linzie BS; Powers, Abigail PhD; Stevens, Jennifer S. PhD You get the idea. The underlying message of all of these articles is “Menopause causes illness and death”, yet what it doesn't say is that treating menopause can treat and reverse everything about menopause except fertility. It is true that the symptoms of lack of estradiol and testosterone and the diseases that follow menopause can be treated with hormonal replacement, and risk of diseases of aging and the symptoms of estradiol and testosterone deficiency can be treated with Bioidentical E2 and T pellets!  I see it every day in my BioBalance® Practice! This describes the past, only you and other women can change the future!

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog Often in medicine, doctors discover a new use for an old treatment or a treatment that is approved for one use and serendipitously doctors find a new use for a drug or medical device. I have used a specific type of IUD in menopausal women on estradiol to prevent postmenopausal bleeding. The Mirena or Kyla IUD produces progesterone into the uterus to suppress the effects of estrogen on the endometrium, preventing post-menopausal bleeding and growth of fibroids. In the May 2023 Journal of OBG Management the experts have discovered that these special IUDs can be used for more than just birth control.  They don't contain any estrogen, but they deliver the progesterone (progestin) where it is needed to the lining of the uterus for 8 years! The cost of one IUD/8 years vs that of daily progesterone reveals a great cost savings by using a Mirena or Lyetta or Kyla (for uteruses that have not been pregnant) and a time savings for patients who are having difficulty with post-menopausal bleeding while on estradiol pellets, or any form of estrogen after menopause. The way these IUDs work is that the soft plastic material of the IUD has a packet of progestin attached to it that slowly dissolves over 8 years. In general, I don't advise the use of Progestins orally as it increases risk of breast cancer and heart disease ONLY when it is taken orally.  The small dose that circulates locally in the uterus is only beneficial and is not circulated throughout the bloodstream. The Mirena (I will use “Mirena” to represent all IUDs of the same genre because it was the first one FDA approved) is placed in the uterus in the GYN office, and a short string is left to stick out of the cervix to be palpable by the patient or the doctor to show that the IUD has not exited the uterus (which is rare in women not having periods, menopause). Generally the patient is given a week of progesterone to cause her to evacuate the remaining lining of the uterus before the IUD is placed. This will decrease the spotting and bleeding after the procedure. If it is a difficult insertion of the IUD, the GYN will often do a post insertion Ultrasound of the uterus to make sure the IUD is in place.  There are a few menopausal women who cannot have an IUD after menopause.  Those patients who have had an ablation of the lining of the uterus usually has scarring of the uterine lining so that an IUD would not be inserted easily or at all.  A patient with a uterine septum is not a cancidate for an IUD. Patients who have had a perforation of the uterus in the past are not a candidate for this treatment either. Patients with fibroids on the inside of the uterine cavity are not a candidate either, because the IUD may rub against the fibroid and cause it to bleed. However if you have a uterus and are on estradiol or oral estrogen and take progesterone or progestin with it to protect your uterus, and have trouble remembering the progestin or progesterone dose every night or you continue to bleed even on progesterone/progestin, then a Mirena would be a good solution for you! There is a novel treatment for those women who we have been unable to give estrogen to because of uterine bleeding, and the Mirena IUD or one of its sisters is the answer!

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog My medical practice at BioBalance® Health brings me many interesting issues that my patients have had to struggle with, before they finally come to me for T Pellets. The latest complaint that men bring to me on their first visit is their reticence to try T pellets because they already tried T cream, or T gel or T patches and they did not get the results that they expected and needed, so they believe T Pellets won't help them either.  Another problem the other forms of T can pose for men is that they try non-pellet forms of T and tell me that they felt a little bit better and they tell me that is all they thought they would get from any form of T replacement….they settle for feeling slightly better instead of feeling Completely Well! Compared to FDA approved Testosterone Creams, Gels, and Patches, Testosterone Pellets at BioBalance Health are superior in every way!  When deciding on a treatment or even when buying an important item for your home you should do your homework!  I am going to tell you today why men should switch to long-acting Bio-identical testosterone pellets instead of the other forms.   Deciding between various forms of Testosterone   #1 Effectiveness of each form of Testosterone When making a decision about which treatment to employ, you should look at whether the treatment will completely treat my symptoms, or just some of them/ and what are the side effects (what is the downside)? Below is a comparison from my book for men, “Got Testosterone?” that compares T pellets to other forms. Note that Creams/Gels/patches are all “Transdermal”, or delivered through the skin: The reasons for why the quality of the treatment is different for trans-dermals and pellets is because the up to 80% of testosterone converts into estrogen as it is absorbed by the skin. Men don't need or tolerate estrogens like women do, in fact estrogen binds up testosterone so it can't be used by the body.  So, gels, creams and patches give a man a small amount of T, but soon it inactivates the testosterone, and doctors think the dose is too low, so they raise the dose. The same thing happens over again and finally both doctor and patient give up and generalize the treatment failure and assume the man cannot take Testosterone (in any form). Pellet testosterone dissolves under the skin in a layer of fat and goes directly into the bloodstream where it goes to work and attached to Testosterone receptor sights. A small amount is converted into estrogen, but it is not enough to inactivate the testosterone from the pellet, so the effectiveness of Pellet Testosterone is quite different from transdermal forms of testosterone, and is greatly superior.   #2 Side Effects/Risks   The flipside of whether a medical treatment of any kind is right for you, is the risks of the treatment and the likelihood of side effects.  Knowing the effectiveness of a treatment and the risks, helps you decide whether it will work for you.  Knowing these two most important factors help a patient make a decision on which treatment he wants to try. There are risks that may not apply to you, however you should look to the side effects or risks that apply to you, to make your decision.  In the table the highest risk is noted with three Xs, and the lowest risk is one X. The side effects of T in Pellets are much lower than other forms of Testosterone. You must review whether these are risks for you individually or not. For example, if you are still of childbearing age or you still want more children than the lowest risk of infertility is offered by T Pellets, however there is still a risk. For those men who don't have hemochromatosis then this risk is not a risk at all. This really means that risks must be individualized for each man just like dosage.   #3 Ease of Complying with Dosage and #4 Cost   Whether you can actually continue treatment for a long period of time is pivotal to determine whether you should take a type of Testosterone replacement. You should look at these factors: ·      Can I realistically follow the dosing schedule? ·      How many times a year do I have to go to the doctor's office for this treatment? ·      How much time will I waste a month waiting in a doctor's office to get the treatment? ·      Is it administered at home or at the doctor's office? The next part of this equation is the cost of treatment.  Most testosterone medications are not paid for by insurance.  If they are paid for, they have a high copay for most insurance. If you get your testosterone from a pharmacy, then to compute your fee you should multiply the copay by 11 months. If you have to go to the doctor to get the script, you should add the doctor's fee as well. I have compiled the cost of each kind of treatment based on the initial dose, which might not be adequate for people who use trans-dermal testosterone and need to increase the dose multiple times. As for dosing, If you can't remember your vitamins, your medicine or to brush your teeth before you go to bed I can guarantee that you won't be able to remember your testosterone cream or gel, or pill.   In the End it is Your decision Everyone must make their own decision about what type of Testosterone to use.  Only you know whether you can be compliant with a daily regimen or would be better to come to an office to get your testosterone twice a year.  Only you know whether an effective form of T like pellets is worth the cost of treatment, however, to make a good decision you should compute the daily or monthly cost of the pellets to compare apples to apples. I see many men who have tried T shots, gels and patches, and come to me as a last chance to treat their low T symptoms with pellets.  98% of them are extremely happy and continue treatment, noting the difference between pellets and their previous T treatment.  If you continue to use gels and creams because the FDA approves of it, or because your PCP orders it, but you don't feel better, then you should try T pellets!

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog Your Consultations with Dr. Sullivan or Dr. Maupin last one hour! No other medical practices schedule an hour for consultations with each patient. You will see a doctor and have time to discuss your issues!!! Drs Maupin and Sullivan spend hours preparing for your first appointment.  They know what medical problems you have, your medications and allergies, and based on your medial history they determine your treatment plan.  This plan includes your pellet dose, treatment of other conditions or diseases that are out of control, a diet and eating plan, exercise advice, individualized supplement advice, and prescriptions for medications. Your health will benefit from the expert advice given by Dr. Sullivan and Dr Maupin and their team of Nurse Practitioners and Registered Nurses. BioBalance® Testosterone Pellets are the most effective, lowest risk Testosterone Replacement: We exclusively use Testosterone and Estradiol Pellets made from Non-Micronized Bio-identical Testosterone powder, from two compounding pharmacies who have been our providers for two decades. BioBalance® Health has the most experience in providing Testosterone and Estradiol Pellets in the Midwest We have been practicing anti-aging medicine and treating patients with bioidentical testosterone pellets longer than any other practice in the Midwest, over 20 years! BioBalance® Health doctors and NPs provide such a unique and successful level of care that patients fly from all over the world to see them. We are innovators and we have learned how to trouble shoot side effects and treat them before they happen. We have such a unique treatment method that we have doctors who request training with us, and patients who spread the word of our success to their doctors and their friends. BioBalance® Health Has the Highest Success Rate of any other provider of T and E2 pellets. We not only offer quality and service to the practice of Anti-Aging Medicine/ Functional Medicine, we also have the highest success rate of any other BI hormone practice anywhere.  We encounter the fewest side effects and complaints of any other hormone practice, and we are 95% effective at resolving the symptoms of hormone deficiency. We Treat Much More than Just Your Sex Hormone Deficiency! When replacing hormones and treating the symptoms of hormone deficiency is not enough, we treat our patients for other hormone deficiencies and diseases of aging: hypothyroidism, and Pre-diseases like pre-diabetes, obesity, fatty liver disease, and nutritional deficiencies. Our doctors and NPs often diagnose illnesses that your primary hasn't found yet! We apply cutting edge medical and nutritional treatments to keep you healthy as you age. Our goal for you is much more than giving you testosterone, it is lasting health. We combat the sickness and symptoms of aging with a foundation of bioidentical hormones (testosterone and estradiol pellets) plus nutrition, weight loss, exercise advice, esthetic procedures and genetic evaluations to determine your health risks and to diagnose cancer early.  We add new novel and effective ways to help our patients live healthier, longer, and more productive lives like the Gallery test for 99 types of cancer that finds cancer before traditional tests can (this test is for those patients who chose to have it and it is an additional fee). You are Not Just a Number! We are not a practice built on volume.  We learn your history and know who you are when you see us.  We make sure we keep your health history in mind when we make decisions for your treatment!  Our staff is family to the doctors and to each other.  When you enter our office, you will feel special and cared for! Our results are remarkable!  BioBalance Health receives most of our referrals from existing patients and doctors. Our Patients tell us that they have never had such a complete evaluation of their symptoms and that no other hormonal therapy has made them feel completely well as the treatment they receive in our office.  We are excellent Doctors and Nurse Practitioners who are determined to bring our patients back to health with the latest treatments and the most natural testosterone for both women and men.  We individualize your care because we know that one size medicine doesn't fit all!  Before you come to our office, we study your medical history and your blood lab results, to create a treatment plan that we adjust during your initial visit based on your needs. We offer the best Education for Patients available anywhere from Any Anti-aging, Integrative Practice in the US, and possibly the world. Dr Maupin has written 2 books for patients over age 36 that have been distributed in 6 countries, The Secret Female Hormone is for aging women and   Got Testosterone?  is for aging men.  The Secret Female Hormone is the first book about testosterone for women was the first book of its kind published anywhere!  Her book for men received the International Independent Publisher's Men's Health Award in 2019. Dr Maupin's biweekly Health casts and blogs has grown in number to over 650, 20-minute episodes.  found on You tube (www.youtube.com/@BioBalanceHealthcast) and our website, wwwBioBalancehealth.com. Dr Maupin is dedicated to educating her patients and the aging public with REAL information to help them make good decisions to keep them healthy and productive for a very long time. While traditional medicine has continued to concentrate only on the very sick, young, and fertile women and chronic diseases of the young, Dr Maupin fills in the gap providing advice for aging women and men with preventive medicine, hormone replacement, weight management and sexual dysfunction that mainstream medicine ignores! We offer the most effective weight loss program for our patients, that allows you to buy real food to eat with the help of prescription weight loss medications chosen for your situation! If our patients need help with weight loss after Testosterone Pellets, diet and exercise have been employed, we offer additional appointments with a Nurse Practioner (NP)/ RN team to help you lose the weight you have always wanted to lose.  Our NP/RNs chose the right medication for you and monitor your weight loss with our body composition machine, In Body® to help you see the fat you are losing. We combine “fat-loss” treatments with muscle preservation with testosterone pellets. Preserving Muscle mass is critical to stimulating the metabolism and to anti-aging progress. As you reach your weight loss goal, BioBalance® offers esthetic body sculpting treatments, when you have lost enough weight to shape your body without pain or lost time at work.  We acquired the most effective body sculpting EM Sculpt machine to sculpt your body with increased muscle, fat loss and tighter skin; EMsella for treating urinary incontinence and EM face for a non-surgical face lift. We review your Medical History, Symptoms and Lab before making an appointment for you, to determine if you need our treatment. We realize that you don't want to pay for something you don't need, so we review your medical history and blood work before you pay us anything or waste your time on an appointment that doesn't lead to treatment.  If we cannot treat your particular medical problem, we will give you your lab test results to take to your PCP and you will not have paid anything.  We only make an appointment for you if we believe we can help treat your symptoms, medical problems and/or help you lose weight if needed. Unlike any other practice we offer hour-long consultations with our doctors for your first, follow up, and problem consultations. Dr Maupin has created a medical practice dedicated to truly bringing her patients back to health: sexually, metabolically, nutritionally, and to help them look as good as they feel with her Esthetic practice, BioBalance® Skin. BioBalance Heath is the fourth medical practice Dr Maupin created/managed over more than 38 years of practicing medicine. Bio Balance Health® is the culmination of all she learned from organizing the three OBGYN practices. She decided that the only way to be the best doctor she could be was to surround herself with the most intelligent Doctors, Nurses and Nurse Practitioners, the most skilled staff possible and to treat them and pay them well, like family. Through her experience, combined with Dr Sullivan's business training and Family medicine background, she has created what she views as the finest type of preventive, hormonal medical practice. We want our patients to feel healthy, and to be productive as long as they live! Dr Maupin, Dr Sullivan, their husbands, and Dr Sullivans in-laws are all BioBalance® patients. Bio Balance® knows that the health we have as we age is primarily due to replacement and management of our hormones, nutrition, exercise and attaining ideal weight. Her plan behind the scenes is to create a medical practice that patients enjoy coming to, where staff is happy and well paid, and where doctors and NPs are encouraged to treat patients with cutting edge medical care for the benefit of their patients. Twenty-one years later, her dream is a reality and there is no other medical practice like it! You only pay for what you get! Your cost is based on what you receive, not on a large yearly fee that some other practices require. We are a cash practice because insurance companies don't pay for preventive medicine or bio-identical hormone replacement for women. They also generally won't pay for weight loss. For the services they do pay for we understand that many of our patients pay for insurance, and we try to use it when we can. Most of our prescriptions and labs we order are covered by health insurance directly. we will give you copies of your invoice to submit for your reimbursement from your insurance if your insurance allows. If you don't have insurance or have a high deductible, we will pass along the discount the lab companies give us, so your lab cost will be much lower than if you paid them directly! We live by the belief that we can offer medical treatment to our patients based on what we would want if we were the patient: To be treated individually, kindly, and efficiently To offer individualized treatment to each patient In a practice environment that is uplifting and happy From staff who feel like family In a lovely environment that is not clinical like other doctor's offices With individualized personal care over time To offer efficiency by stocking supplements and products on site for patients to buy on site To only offer quality goods and treatments we use personally To offer compassion that carries through everyone who works for BioBalance® Health and BioBalance® Skin.

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog BioBalance® Health uses other forms of measurement to determine body composition, and to diagnose healthy weight, versus overweight and obesity. BMI is a calculation of healthy weight, overweight, and obesity using just two parameters: Height and Weight. The US government endorses and uses this measurement in many ways to manage citizens, categorize them and even pay their salaries.  The AMA has been using this as a measurement of body health for decades. As of July 2023, the AMA is rejecting this measurement of health and illness. Calculate your BMI Go to https://www.calculator.net/bmi-calculator.html and you can calculate your own BMI. Below is a chart that many types of companies and people use as a reliable measurement to use for many purposes.  Below is the NIH explanation of BMI.  You can find your BMI and corollate it with how lean your body is. The Body Mass Index (BMI) Calculator can be used to calculate BMI value and corresponding weight status while taking age into consideration. Use the “Metric Units” tab for the International System of Units or the “Other Units” tab to convert units into either US or metric units. Note that the calculator also computes the Ponderal Index in addition to BMI, both of which are discussed below in detail. BMI introduction BMI is a measurement of a person's leanness or corpulence based on their height and weight and is intended to quantify tissue mass. It is widely used as a general indicator of whether a person has a healthy body weight for their height. Specifically, the value obtained from the calculation of BMI is used to categorize whether a person is underweight, normal weight, overweight, or obese depending on what range the value falls between. These ranges of BMI vary based on factors such as region and age and are sometimes further divided into subcategories such as severely underweight or very severely obese. Being overweight or underweight can have significant health effects, so while BMI is an imperfect measure of healthy body weight, it is a useful indicator of whether any additional testing or action is required. Refer to the table below to see the different categories based on BMI that are used by the calculator. Nurses have understood the fallacy of using BMI to judge whether a patient is overweight or not for decades, but the AMA and medical specialty societies have defended its use for as long as I have been in medical practice.  However, BMI is a crude way to evaluate patients for obesity and we use a more accurate measure, a true body composition from an InBody® machine to determine exactly how much fat, muscle, and water our patients are made of and if they need to lose fat for their health. This true measurement of body composition gives us an accurate measurement of your percent body fat, weight of your muscle and your visceral fat (belly fat) measurement. You may say, “so what?”, but I'll give you a few examples of how BMI is an INACCURATE measurement to follow for healthcare and for insurance, and other agencies that require employees to be a certain weight for their height. In my practice I take care of two men whose height is exactly the same, 5-10 (70 inches), both weigh 200 lbs., and they both have a BMI of 28.69 which is considered overweight (normal is < 25). However, the two men are very different in their body compositions and therefore their health risks:  Man number one has very little muscle and 30% body fat and is overweight and therefore is at risk for diseases that accompany obesity, high blood pressure, diabetes and heart disease.  Man number two has a very muscular build with heavy bones and has a body fat of 19% and looks lean and is healthy and is not at risk for hypertension, heart disease and diabetes. The BMI makes them the same, and therefore their doctors and employers consider them the same for insurance, treatment of their illnesses and categorization in medical studies that determine the qualities that put patients at risk for diseases.  Therefore, BMI is a very bad measurement to judge whether a person is at risk for diseases of obesity. The medical industry is big and slow, and this measurement will not be replaced with something else in the near future, however this gives you a basis for challenging the measurement as a basis for promotion, or a reason to deny you insurance or charge you more for insurance.  At Bio balance® Health we have used % body fat and abdominal visceral fat determined by a body composition machine (InBody) as our only measurements to determine future risk, and to determine whether someone requires weight loss treatment or not. BMI is very unfair to those people who are required to maintain a healthy weight for their jobs.  Those men and women who are in the armed forces cannot be promoted in rank unless they have a BMI of 25 or less, however the training that is required and the strength and stamina to be in the active military means that they must work out and exercise to build muscle, which then disqualifies them from promotion because it causes them to gain weight, but healthy weight. Using the BMI as a measurement, can cause a person to be disqualified for promotion because they are well muscled! Not only the US military discriminates against people with high BMI due to high percentage of muscle mass, the life insurance and health insurance industry does as well! A person is labeled obese and therefore “high risk” for illness and death just because they have a high percentage of muscle mass which is healthy, and not a risk. This makes some fit people uninsurable or increases what their life and health insurance costs. The worst discrimination by BMI discriminates against genetically highly muscled groups of people. The BMI was created using white males and white females making them the standard, however some genetic groups from African, Hispanics, Italians and other groups of people from Mediterranean and middle eastern heritage are discriminated against because they have a higher percentage of muscle and bone mass normally, compared with Caucasians, eastern Indians, and Asians, therefore using the BMI causes these groups to look “fatter” when they are really more muscled with thicker bones, which is healthier, not a higher risk for illness.   Obviously, people with high muscle mass can still be obese, but it should not be determined by height and weight alone. This decision by the AMA has been a long time coming, and the number of people who have been harmed by this method of determining obesity is incalculable. BMI is just a measurement based on height and weight.  For some average height and weight people, it is an accurate evaluation of normal body weight vs obesity. However, most people have various degrees of muscle mass, and it is the amount of muscle mass that skews the BMI measurement and judges some people as “obese” when they are at a healthy weight, and others are considered normal weight and composition even when they have a high body fat content and very little muscle.   AMA urges physicians to rethink use of BMI calculation The American Medical Association voted this week to recommend that physicians not rely solely on body mass index as a way to evaluate whether a person is at a healthy weight, as there may be biases and inaccuracies inherent in the method. The AMA recommended that physicians also take into account visceral fat, body adiposity index, metabolic and genetic factors, and fat, bone and muscle percentage. Dr. Scott Hagan of the University of Washington termed BMI “a very poor measure of general health,” adding, “Someone with an elevated BMI may be perfectly healthy.” Full Story: The New York Times (6/15)

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog Every physician and every overweight patient have struggled with achieving effective weight loss that was effective for most people, until now!  Almost simultaneously 6 weight loss drugs hit the market approved by the FDA for different uses.  The only drug approved for just weight loss is called Wegovy, a once-a-week injection that causes loss of appetite as well as a feeling of fullness when only a fraction of volume of an American meal is eaten.  It also works by limiting the hormone glucagon that dumps stored blood sugar into the blood when blood sugar levels get low, and it decreases the craving that many overweight patients complain of. The majority of overweight people have been eating a high carbohydrate diet filled with sugared soda, bread, pasta, cereals, candy, cake, cookies, chips, crackers etc.  This is the average American diet, and it is killing us! Years of eating this diet has made us fat and insulin resistant, as well as malnourished. Humans need food for fuel, and we have made it into entertainment! We need a varied diet of proteins, fats, and carbs. Our genetics dictates how much of each group we need; however, the one size fits all mentality of the FDA and the US government has led citizens to believe that cereal and bread is the basis for diet because America grows grain and sells it to our citizens…it is a diet based on GNP not our metabolism. Simply said this has left most children and adults obese and fatigued because they are not getting the right nutrition from their food intake.  Now we have to work backward, and the insurers of this country will not pay for the drugs we need to reverse the process. The drugs above are all variations of the generic name Semaglutide.  The only drug that is different is Mounjaro or Tirzepide. It is more effective for treatment of diabetes and obesity, however Ozempic and the only oral version, Rybelsus, are also effective for both Diabetes and weight loss.  We generally prescribe Wegovy for weight loss without diabetes, and we can try to get it approved by insurance for weight loss. However, this is generally not approved. The requirements for insurance to pay for these drugs for weight loss includes: BMI over 30 Two other illnesses that are associated with being overweight, eg hypertension, heart disease, prediabetes. Even with these requirements fulfilled they usually don't pay for it!  The price is $ 1,500 for one month!  Three months is around $4,500.  This is prohibitive for everyone. To solve this access problem, Dr Sullivan has contacted several compounding pharmacies who will make the drug for weekly self-injection at a much lower price!  The price is $540 for 3 months compared to $4,500. We have been recommending this avenue when we cannot get the drug paid for.  The only difference is that patients must draw up the small amount of semaglutide in an insulin syringe and inject themselves with a needle instead of a “pen”. This is the way we have been accessing this medication for our patients and we have seen unbelievable results!  People who could never lose weight are losing and very obese patients who did not have the staying power to continue dieting to get appreciable weight loss are now approaching ideal weight. The only people who cannot take this medication are those with a history of a specific type of thyroid cancer or a disease of the endocrine system called MEN II.  You know it if you have one of these rare problems. Others love to eat so much that limiting their intake is a problem for them. Special Cases: Those people who genetically are “never full”, or “always hungry”, this is the drug for them to make them feel full for the first time in their life…..  Obesity from never feeling full or always hungry is genetic.   Dr. Maupin: “I never understood those kids and adults who had to eat 24-seven or who could eat 2-3 plates of dinner. .I just had never walked in their shoes until I was pregnant…At that time in my life being 118 lbs and 5-3  when I got pregnant I never could catch up by eating enough calories to feed both of us. I felt full at the beginning of a meal but was always hungry, so I had to eat every 30 or 40 minutes.  I was hungry all the time!  It literally ruled my life, and it made me think about food all the time.  I felt like I was in a prison of low blood sugar restricting my activities. NOW I understand how terrible a genetic albatross having the “never full” or “always hungry” is! Except for pregnancy, I know that inherited genetics make some people always hungry, and others never feel full, and my heart goes out to them.  These GLP-1 drugs work well for people with these genes. PS.  I was thrilled to deliver my daughter, and it was both the happiest day of my life to see our beautiful baby, but I was also so relieved not to be hungry anymore!” If you have this genetic issue, then this classification of drug is for you! You will be able to get to ideal weight and you will have to stay on a maintenance dose to keep your weight at ta healthy level. How do you go off these meds when you have reached your ideal weight? We have our patients decrease their dose per week until they start to be able to eat reasonably. Sometimes we can't get our patients off the medication completely, but the cost is much lower because a 3-month dose will now last 3-6 months. We like to team up Testosterone pellets with semaglutide treatment for older women to make sure they don't lose muscle instead of fat. The T-pellets help patients become lean, and preferentially lose fat, not fat and muscle. What you can do with the medications to make them work faster, more effectively: Exercise daily for 45 minutes or more—normal life activity is not exercise!  Walking briskly means you can't talk and walk at the same time. Eat a low carbohydrate (know what that means), NO SUGAR, high protein diet with a lot of vegetables and fruits of every color 3 times a day. Snacks can be veggies, nuts, cheese, yogurt, eggs, and or fresh fruit. No baked goods, no crackers, bread, junk food or fast food. High protein diet means eating as many grams of protein as your weight in lbs if you are active.  Eat ½ of that in protein if you are not actively exercising that day. A delicious protein powder that actually tastes good is Phormula #1. I like the mint ice cream sandwich flavor….I can eat that as a meal substitute blended with fruit 3 meals a day. Drink filtered water and lots of it! At least 64 fl oz a day. No alcohol If you want to lose weight in certain spots like your waist or your thighs, I use the EmSculpt fat destroyer with skin tightening. For those of you who have had trouble with your weight or have had trouble losing it and keeping it off, then BioBalance Health Weight Loss program is for you!

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog Most women believe that the only reason to start taking estradiol when menopause begins is to decrease hot flashes and night sweats.  But Estradiol replacement is so much more effective and versatile than just stopping hot flashes!  When it comes to the replacement of testosterone for women, most still believe that T is just for men!  If a woman has been reading for the last ten years, she may have picked up the fact that T brings back a sex drive and energy to women over 40, but most of the important benefits of Estradiol and Testosterone replacement are hidden from the majority of women.  Journalists just aren't interested in us after we are no longer young and fertile, unless of course we are involved with a scandal!  The importance of replacing the hormones that are deficient after age 40, and the unpublished benefits that you can receive with E2, and T are the subject of this Blog. After the age of 40, after our childbearing years, we experience a multitude of symptoms and changes that when asked, OBGYN doctors shrug their shoulders and tell their patients that these terrible, quality of life “downers” are “just aging” and therefore the don't address them and won't treat them!  It seems medicine discriminates against women in mid-life by ignoring their pleas for help dealing with many symptoms of aging.  These common problems are listed below, and I will address each of them in regard to hormonal solutions for these problems. By the way, the replacement of the hormones estradiol and testosterone will treat all of these problems! Stress urinary incontinence—T increases the connective tissue that holds up your bladder, and estrogen supports the vaginal and bladder lining, assisting in working against gravity. Irritable Bladder—T and E2 send blood blow to the bladder and stimulate nerves that may be “short-circuited” causing the bladder to spasm and refer the feeling of needing to urinate all day and night. Recurrent Bladder infections-Testosterone and estradiol pellets thicken the lining of the bladder and the urethra, blocking an invasion of the bladder with bacteria which start a bladder infection. Interstitial Cystitis is a very difficult problem that comes from severe inflammation of the bladder and causes affected patients to feel like they have to pee every 5 minutes. These patients can think of little else—T and E2 pellets decrease the inflammation in the bladder and thicken the lining of the bladder to protect the bladder lining from irritants in the urine. Vulvodynia—a painful inflammation of the skin around the vaginal opening, the urethra and rectum. This condition has no effective treatment, however by taking systemic E2 and T pellets, women have gotten relief from this acutely painful problem by taking E & T hormone pellets. Anemia—Testosterone increases the ability of your stomach to absorb iron from your diet and increases you hemoglobin and oxygen carrying capacity. Painful intercourse from a dry vulva and vagina—E2 and T together thicken vaginal and vulvar skin, protecting the nerves in and around the vagina. The thickened skin and increased lubrication from these two hormones recreate the youthful stretchiness and moisture needed for painless intercourse. Osteo-Arthritis—Testosterone suppresses inflammation and T and E2 together increase synovial fluid that lubricates the joints, stopping pain. Hormonal Migraines —T and E2 in pellet form create a constant blood level of E2 and T which prevents hormonal migraines, which are stimulated by large fluctuations in E2 and T and from total lack of these hormones. As you can see many of the complaints that perimenopausal bring to their doctors can be treated with a single hormone complication! Instead, they are told that these terrible symptoms are just a normal part of aging and that they should just “suck it up”!  I believe that if the American College of OBGYN and the FDA would listen to women over 40 more, and “bless” the use of hormone replacement therapy in all forms, but especially Testosterone and Estradiol Pellets we would create a generation of women who were still productive, happy and without multiple doctors' visits!  How can the powers that are making the rules be so discriminatory against women! We are more than half of the public….we need help in this area of medicine.

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog A month or so ago I had a woman come to me for hormone replacement and one of the symptoms that bothered her the most was Lichen sclerosis on her vulva, the area around her vagina.  The symptoms are itching, burning, intolerance to putting creams and gels on the area, pain on intercourse, and the skin is fragile and breaks open and bleeds with intercourse. My patient did not come to me to treat this problem, because she had been told by many other doctors that it was not going to get better.  Lichen sclerosis (LS) is an autoimmune disease that affects the vulva and vagina.  I know from reading the research and my 20 years of experience that our treatment with T pellets has decreased the symptoms and sometimes reversed many different autoimmune diseases, however I had not had a patient with lichen sclerosis before so I told her that I was hopeful that her lichen sclerosis would resolve with Testosterone and estradiol pellets. After 3.5 months when she returned to the office she was grinning and said that she no longer had the LS…her gynecologist said it was a coincidence, because she had not been trained with the use of testosterone for treatment of post-menopausal symptoms, and autoimmune disease. I had another surprise when I treated a patient who had become agoraphobic when her doctor had told her she couldn't have any more post-menopausal hormones, even though she had had her ovaries removed 10 years before and before her hormones she had multiple severe symptoms of estradiol and testosterone deficiency. The ERT had resolved her problems but now they all came back more severely…she became depressed and anxious and afraid of leaving her house.  Her son is an Internal Medicine doctor and he called to ask for my help with his mother.  He had tried everything he knew of medically and nothing worked. Agoraphobia is thought to be a psychiatric condition, but in this patient's case it was merely a chemical reaction caused by a lack of estradiol and testosterone.  After 4 months of E+T pellets she was planning a trip to New Zealand and her agoraphobia was just a memory!  I had no idea that that condition could be due to menopause and lack of E2 and T. In the end it was clear that hormonal deprivation can cause agoraphobia and replacement can treat it! I have prescribed T and E2 pellets to treat a different group of diseases, autoimmune diseases, like Lupus, Rheumatoid arthritis, Sarcoidosis, and Grave's disease of the thyroid. The testosterone pellets are very effective at modulating the immune system and normalizing it, which decreases the severity and symptoms of these diseases.  Even though I know that every person with an autoimmune disease that I have treated with T pellets, has gotten much better the specialists who take care of them won't admit that it was testosterone pellets that improved their patient's quality of life.  There is plenty of research on the use of testosterone for autoimmune diseases, but it is not in the journals that Rheumatologists read.  The research is in the Journal of Metabolism and Endocrinology.   Worse yet, These doctors have learned that “hormones” worsen autoimmune diseases, however the information they are quoting really only refers to  oral estrogen replacement and not non-oral testosterone. This scares their patients from even seeking help for their hormone symptoms, and prevents them from improving their autoimmune diseases with a safer treatment, T and E pellets. Here are some examples of my patients who have had autoimmune (AI) diseases and have come to me for E and T pellet replacement. Women with autoimmune diseases improve drastically with testosterone pellets! Not only do their symptoms of low testosterone and menopause resolve, but their symptoms of their autoimmune diseases improve!  The old belief that hormones make AI diseases worse springs from the fact that oral estrogen (Premarin) that turns into estrone can decrease a woman's free T and make her autoimmune symptoms worsen. However. Educated hormone specialists like Dr. Sullivan and me, know how to prevent this and in fact make the symptoms of AI improve.  Here is the key to AI success: We give our patients with AI diseases a lower dose of estradiol in their E2 pellet, and a higher than average dose of T in their testosterone pellets, and we watch our patients get better! The Rheumatologists can't stop patting themselves on the back for the improvement in their patients after I treat them and tell their patients that the hormones should be stopped!  Patients are smart and they know why their symptoms disappeared!  They chuckle at the  arrogance of their rheumatologist.  The Rheumatologists just look ridiculous when they claim a patient's progress as from their own treatment, when it was really the addition of Estradiol and Testosterone pellets that improved their symptoms.  Some autoimmune diseases are progressive and very hard to treat in any way. I was quite surprised when T and E2 pellets  halted the progression of lupus blindness and the progression of MS (Multiple Sclerosis)!  It is remarkable and a “surprise result” that I was not told about in my training. One Rheumatologist, who is an acquaintance, told me that he stopped sending patients to me for hormones because they never went back to him!  I count that as success. There are many other diseases and symptoms that no one associates with Testosterone Deficiency or low Estradiol, that resolve or improve with the re-establishment of hormone balance. These include:   ·      Stress urinary incontinence ·      Irritable Bladder ·      Recurrent Bladder infections ·      Interstitial Cystitis ·      Anemia ·      Painful intercourse ·      Arthritis ·      Irritability associated with Menopause ·      Hormonal Migraines   We will discuss these other Unintended Benefits of T and E2 Pellets in Women in our next Healthcast and Blog.  Stay tuned!

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog There was  once a Saturday night live skit that featured one of their actors, Eddie Murphy,  teaching how to spell and say Py-ro-man-ia..and every time I see the word sarcopenia, I think of that skit…mostly because it is a word only researchers and doctors use to describe a condition where a person has lost a lot of  skeletal muscle, leaving her or him without enough muscle  to move around normally.   Sarcopenia is considered a side effect of aging….but it is really a condition of low testosterone level in the blood, that occurs with aging and results in disability.  For people over 70, this is what happens, you lose your muscles if you don't take testosterone replacement, and don't exercise and eat enough protein.  At any age your muscle is stimulated to grow by your resistance training, daily exercise, and it must be supplied with the building blocks of muscle which is protein from animal products in your diet. However, you can exercise daily and eat the right amount of animal protein and you will still become sarcopenic if you don't replace your testosterone to a level that is clinically needed as you age. Muscle is only made in people who have enough testosterone.   I am hoping that the next generation of women and men who are 70-year-old now will not be bent over, using walkers, and wheelchairs, and unable to get out of a chair as they age.  With long-acting testosterone pellets, in combination with daily exercise, active daily life and sufficient animal protein to make muscle I am working toward a world where humans aren't put on the shelf because they can't physically take care of themselves.   But muscle mass does more for you as you age than just get you from here to there without assistance.  Your muscle mass also is the primary organ in your body that burns 80% of your calories and turns them into energy.  The muscle cell itself is like a generator.  It takes in blood sugar and burns it to make energy for your cell. The trick here is to maintain enough muscle mass to make enough energy and burn your calories!  This takes the three elements above: 1) Young healthy free testosterone blood levels, 2) a diet including a large amount of the proteins needed by your body to make muscle which are found in animal proteins, and 3) exercise!  Every day, many times a day you must be active to keep your body healthy and muscled.   What happens when free testosterone does not stimulate your muscles to make more muscle? Here is how it works when you are young and have sufficient testosterone and when you replace your deficient testosterone. Every time you move or exercise you use your muscles.  Your muscles make heat and energy for you and for your cells. Testosterone sends blood flow to your muscles to stimulate your muscle cells to take in blood sugar and make energy and heat.  Testosterone does something more; it directs the muscles to regenerate after they are broken down the 24 hours after exercise and are discarded.  The day after exercise, your use your dietary protein to rebuild your muscles.  Without the stimulation of Testosterone to rebuild your muscle mass, your muscles break down as usual, but are not built up again! This leads to a never-ending loss of muscle, leading you to lose muscle mass, bone mass, and your best burner of calories!   The endpoint is a person who is 75, looks frail, can't walk fast, who has poor balance and falls and breaks bones. Older people who don't take testosterone also replace their muscle mass with fat, so their weight may go down (loss of muscle with fat replacement causes the waistline measurement to go up and clothing size to go up, but weight may in fact go down from the lack of testosterone stimulating muscle growth. All of this is well known to doctors yet it is hard to explain in a 15-minute office visit.    Now let's talk about what is new to our knowledge of muscle tissue and the diseases of aging.   In a research article from 2023, revealed the relationship between muscle mass and diabetes.  Those people who had a high % of muscle for their weight had a lower chance of having insulin resistance and diabetes.  Diabetes increases our risk for heart disease and death and requires many drugs and doctor's visits and increases the risk of an individual's early mortality. Think of it like this: Replacing T to a premenopausal level in women and to a young healthy youthful level in men increases muscle mass, which uses up blood sugar, which in turn decreases the risk of adult-onset diabetes, which decreases your risk of heart disease and early death!   Another study revealed the relationship between muscle mass and early death and found that the more muscle you have the lower your risk of mortality.  You and I know that you can't have great muscle mass as you age, without testosterone but that was not mentioned.  They just measured muscle mass and correlated it with the chance of death, and they found that the more muscle mass you have the lower your chance of death.   A study done on men only showed that the level of testosterone was associated with thicker cortical bones and estrogen in men decreased the cortical bone strength. Bone must have the tension of muscles to stay thick and healthy, so this indirectly gives us more information about how important weight training and resistance training is to your very life.   What Dr Sullivan and I do every day is assist men and women in curing their negative symptoms of testosterone deficiency as well as protecting them from becoming frail also called Sarcopenic as they age.  It is not enough to get older if you are not functioning well and are able to take care of yourself!

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog. At BioBalance Health we use the information from a vaginal probe ultrasound, combined with information from your medical history questionnaire, and an extensive fasting blood panel to determine whether an individual woman is a candidate for estradiol and testosterone bioidentical pellets. We also review the collated information to determine if we need more tests before we see a new patient.  The ultrasound of the pelvis gives us a visual picture of the ovaries and uterus of a woman. It is necessary to know if a patient is menopausal yet to interpret a new patient's ultrasound.  We obtain that information from your blood lab and medical history from the patient questionnaire.  All three pieces of information are essential to our treatment plan.  What can we discover from the vaginal ultrasound?   We are ruling out (making sure a woman doesn't have these pelvic problems): Several of these conditions preclude the use of estradiol in any form, some require a visit to your gynecologist for treatment before we add estradiol to your hormones and some of these conditions increase the risk of side effects.   1.    Endometrial Cancer 2.    Endometrial hyperplasia 3.    Endometrial polyps 4.    Fibroids 5.    Ovarian cancer 6.    Ovarian cysts 7.    PCO  **We use the vaginal ultrasound to determine the risk of bleeding on HRT.  ***For the first 3 uterine pathologies listed above we look at the measurement of  the Endometrial Thickness (ET), or finding an endometrial polyp necessitates  a visit to her GYN for evaluation, and most probably an endometrial biopsy or D&C. This pathologic test will rule in or out Endometrial cancer, endometrial hyperplasia.   The other diagnoses are determined by looking at the uterine size, contour, whether there are uterine fibroids, and looking at the ovaries for cysts or masses and the presence or absence of fluid in the cul-de-sac (area behind the uterus).  Why would we order a Vaginal Probe US for our hormone pellet patients after the first visit, while they are taking estradiol?  1.    Uterine bleeding is nonresponsive to treatment 2.    Uterine size is getting larger (patient complains of pain or pressure) 3.    High risk patients with recurrent uterine bleeding 4.    To follow the growth of fibroids 5.    To check the ovaries in patients who have a Family History of ovarian cancer (generally we have the patient's GYN follow this). 6.    To follow a benign looking cyst seen on the first US for growth.

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog At Biobalance® Health we often find cysts or masses on the ovaries of women who are menopausal quite by accident.  We order an ultrasound before we treat a menopausal woman with estradiol to see if there is a thickened lining that might cause bleeding under the influence of estrogen replacement, or to make sure there is no uterine cancer before we treat a new patient.  We also incidentally find ovarian masses or cysts when we are investigating pelvic pain or postmenopausal bleeding on our patients who are already on estrogen replacement.  In general, since BioBalance's female patients have their own GYN we don't do pelvic exams in the office, therefore we don't find a mass by palpating (feeling) the pelvic structures, however ovarian cysts and masses can be found by ultrasound as well as by physical exam.  We generally find ours by vaginal ultrasound. Why do we get ovarian cysts? Before menopause we make an egg every month (if we are not on birth control) that grows within a fluid filled sack. This egg will grow to about 18 mm, or 1.8 cm before it ruptures and releases the egg.  That is the miracle of ovulation.  It is normal to see one or two of these small cysts on the ovaries of ovulating, fertile women. These small sacks are not cysts because of their size.  Ovarian cysts are fluid filled sacks attached to the ovary that are over 2.5 cm. They often occur secondary to a trapped egg that won't ovulate for some reason, and the cyst will remain until the next period.  If the cyst doesn't dissolve before the next cycle, it can grow larger with the surges of hormones and it can prevent future ovulation, or it can cause pain from the stretching of the outer covering of the ovary. If a cyst is less than 2.5 mg. we don't re-ultrasound in cycling women.   If it is larger or continues to cause pain, we follow up an ultrasound in 6 weeks to see if it is growing.  If it is growing but is still clear, depending on the size and the pain involved, we might do a laparoscopy to remove the cyst from the ovary.  If it is growing and looks unusual in shape or density, we order 2 blood tumor markers for ovarian cancer.  If those are negative, we follow up with another ultrasound in 3 more months. In some patients, multiple ovarian cysts are the norm.  Those patients with polycystic ovaries create multiple cysts each month and rarely ovulate.  It helps to use the drug Metformin ER to improve ovulation in PCO patients (and the rupture of cysts).  Some patients require laparoscopy to punch holes in all the cysts especially if she is trying to get pregnant. What does a postmenopausal ovarian mass or cyst mean indicate? Now for postmenopausal patient's ovarian cysts and masses are much more worrisome but much rarer. Because the ovary is not metabolically active, and therefore not ovulating the menopausal ovary should look small without cystic structures, however there are some exceptions!  The menopausal ovary that has a fluid filled cyst 2.5 cm or less can have been there since the patient stopped ovulating and it never deflated, or ovulated.  This type of cyst doesn't grow and is not malignant. Ovarian cysts in postmenopausal women that are fluid filled and larger than 2.5 cm, or solid, or partially fluid filled and partially solid are suspicious for malignancy. In this case your doctor may order an MRI, a CT scan of the pelvis, and order cancer tumor markers.  In most cases these masses are benign, or early in a malignancy and can be treated with surgery.  Sometimes we find a suspicious mass that needs confirmatory ultrasound or MRI by a GYN Oncologist, tumor markers, and surgery would be scheduled to take the uterus tubes and ovaries and sometimes the omentum and lymph nodes. When will a patient know that her mass if not malignant and if she needs surgery? The surgeon may do a frozen section in the operating room to see if more than the ovary itself must be removed or your GYN may wait for the final pathology report to determine if it is malignant. That takes several days to a week. How common is ovarian cancer? Ovarian cancer is very rare and tends to run in families.  If you have not had a relative with ovarian cancer, then you are not likely to have ovarian cancer if you have a suspicious mass. That does not mean you won't' need surgery, it just means the outcome has a high chance of being benign. What can be mistaken for an ovarian mass on ultrasound? There are several pelvic structures that might be confused with an ovarian cyst/mass. The most common is a pedunculated fibroid that hangs down from the uterus and looks like it is coming from the ovary. These muscle masses from the ovary are generally benign, but they can grow under the influence of estrogens.  There are cysts called para-ovarian cysts that can originate from the fallopian tube.  They are fluid filled and can actually grow, looking like an ovarian mass, but they are benign, and most are sedentary and don't grow or become a problem. In my 25 years of operating on women I only had one of the next types of cysts that was thought to be a malignancy at first. It was a very large cyst, 12x 12 inches in diameter and I asked a general surgeon to come in and work with me to help with the surgery if it was a malignancy.  In the end, it was a cyst in the retroperitoneal space, called a peritoneal cyst, that was totally benign, and the patient did not require any further treatment after the surgery. Postmenopausal women who have had an ovarian cyst or ovarian mass you know that it can be an anxiety producing situation, however the great majority of the simple ovarian cysts in postmenopausal women are benign and surgery is not necessary.  Most ovarian cysts are likely to remain unchanged or disappear during the follow-up period. The malignancy rate of these cysts is about 1 in 10,000, so worry is usually unnecessary.  In my 25 years of private practice, I only operated on 5 patients with an ovarian cyst or mass that turned out to be malignant. As gynecologic surgeons we are trained to investigate any ovarian cysts that are suspicious through ultrasound, or surgically even if there is a very slight chance that they might be malignant. We are expected to remove any ovary that is suspected to be cancer, even if the chance is minimal that the cyst is malignant. In our practice we send all our patients with suspicious ovarian masses to their gynecologist for evaluation and treatment. American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Gynecology. Practice Bulletin No. 174: evaluation and management of adnexal masses. Obstet Gynecol 2016;128:e210–e226. doi: 10.1097/AOG.0000000000001768

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog. I learned about electrolytes in medical school as the substances Sodium, Chloride, Potassium, Calcium, Magnesium, and Phosphate we check on a metabolic panel. However, electrolytes are much more than values on a blood test. These minerals are some of the most vital substances needed to keep us alive.  Electrolytes can get out of balance in normal daily life and put us at risk of illness and death if we do not replenish them orally along with rehydration with water.   Our kidneys and hormones manage electrolyte concentrations as our intake of these substances in our food and drinks replenish electrolytes that are lost in urine, sweat, and bowel movements.  We are not conscious of the bodily mechanisms that manage our water balance, urination, keep our blood pressure normal and supply our brain with these vital nutrients to maintain consciousness, and we become symptomatic only when we are severely deprived of them. In my medical training, I also learned about how illnesses, and medications affect the amount of each electrolyte in our body however what I didn't learn was how important it is for healthy people who exercise in the heat to replace their electrolytes.  You don't have to be an NFL football player or play in the NBA to require electrolytes when you exercise. With inadequate electrolytes you can become weak, and confused, lose muscle strength, faint or completely lose consciousness when you are working or playing games in the heat, even if you are drinking water!  To make my point I'll relay a personal experience that you may have experienced as well, while playing a game outside in the heat.  I don't play much golf, but I do play in charity golf tournaments.  They are generally timed at the height of the summer heat, and they take almost twice as long as a usual round of golf.  This scenario sets all the players up for dehydration and a deficiency of electrolytes.  For several years in a row, I noticed that I was well hydrated for about 3 hours by drinking 3 or more bottles of water while I played the first 9 holes. By the 10th hole I was becoming physically weak and mentally slow. I felt I should be ok because I was drinking water and staying hydrated.  However, I felt like I was playing golf in Jell-O.  I continued to drink water because I thought I was dry, and that is what I thought was wrong with me.  Not so…instead of feeling refreshed by drinking endless water, I got worse.  Two years in a row I didn't finish the 18 holes.  What had I done wrong? I started using my diagnostic brain to figure out what I was missing.  Was I sick or was there something wrong with my metabolism?  While I was watching a pre-season football, I noticed the Gatorade that the players were guzzling. I had never tried Gatorade because of the amount of sugar in that drink.  I pulled up the contents of Gatorade and found that not only did it rehydrate the hot and sweaty players with water and sugar, but it contained all the electrolytes that players lose when they sweat and exercise in the heat!  Bingo!  I bet that was what I needed to finish the golf tournament….electrolytes!  It turns out that I had been half right by continuing to drink water, however the more water you drink while you are exercising the more your electrolytes are diluted!  It is not a reason to hold off drinking water, because dehydration can damage your kidneys and you can get heat stroke, however adding electrolytes is vital to surviving exercise in the heat.  The following year I armed myself with many bottles of water and plenty of electrolytes in the form of NUUN.  To every third bottle of water, I added NUUN electrolytes tablet…voila!  I could play 18 holes in hot weather and sweat for 5 hours without fainting, or losing muscle strength, and quitting! So how do you know when you are getting dehydrated and low on electrolytes?  You pay attention to your symptoms! Like everything else, the symptoms of electrolyte deficiency is somewhat individual.  The possible symptoms of electrolyte imbalance, either high or low electrolytes are listed below: ·      Dry mouth and thirsty ·      Restlessness ·      Mental Confusion ·      Weakness-overall ·      Inability to stand up ·      Muscle weakness ·      muscle spasms ·      Fatigue ·      Heart palpitations ·      Constipation ·      Nausea or vomiting ·      Diarrhea ·      Slow or irregular heart rate ·      Low blood pressure ·      Headache ·      Difficulty breathing ·      Low or high blood pressure ·      Fainting (Syncope) Remember I'm talking about electrolyte imbalance that is associated with sweating, exercise, diarrhea, drinking a lot of water without electrolytes while exercising, but the same symptoms can come from food poisoning and the severe fluid losses that accompany diarrhea and vomiting.  I am not talking about electrolyte imbalance that can be a specifically related to chronic medical illnesses, medical treatments and medications. These imbalances are specific to a particular  electrolyte loss and are not treated with global oral electrolyte replacement, and requires an ER or Urgent Care for rehydration. You may not think you need electrolytes but if you take diuretics, or if you go outside in the summer and perspire for long periods of time, you are at risk of losing your electrolytes no matter what your age, however, you become more likely to have this problem as you get older. By the way, one of the most dangerous factors in electrolyte deficiency is alcohol consumption!  Drinking alcohol uses up your magnesium and sodium, so if you drink while playing golf on a hot day, you are at high risk of having dangerous electrolyte deficiencies that can end in seizures and death! Treatment for severe dehydration, and or lack of electrolytes is IV fluids with electrolytes in the ER.  IVs with normal saline plus electrolytes will effectively treat dehydration from vomiting and diarrhea as well as from heat related dehydration, low electrolytes.  I don't own any stock in NUUN or Gatorade, and my go-to prevention would be to add electrolytes NUUN SPORT to every 3rd large bottle of water while actively exercising in the heat, or drink Gatorade instead of plain water every 3-4 bottles of water. Gatorade comes in G0 which is without sugar, or G2 has a much lower sugar content. People without diabetes who are actively exercising can drink some sugar while they are exercising, and it does help muscles to function when they are stressed. Those with Insulin resistance or diabetes should use Nuun, Gatorade zero or G2.   As I say all the time—prevention is the best treatment! Be prepared …. with an electrolyte containing treatment to take BEFORE you feel dizzy or weak! ·      Drink plenty of water while exercising, especially exercising in the heat, or spending hours in the sun ·      Every so often drink something with electrolytes in it (NUUN-Sport or Gatorade products) ·      When you start to feel weak, dizzy, muscle fatigue, Stop exercising, rehydrate, and consume salty products if you don't have electrolytes with you, and lie down in a cool place. ·      If you have symptoms of severe dehydration, muscle cramps, you stop sweating, and have changes in your ability to think, you should call an ambulance or go to the Urgent care or the ER for IV rehydration and balance electrolytes right away. Do Not drive yourself! ·      This condition can be life threatening! Just a little personal story: My husband (age 71 and I was 67) and our best friends (71 and 60) went to Cinqua Terra in northern Italy to take a famous hike between two of the towns perched high on the cliffs above the Mediterranean between Monterosa and Vernazza.  It is beautiful walk and we had been looking forward to it.  We were told it was 3.5 miles so we packed 2 large bottles of water each, I took NUUN electrolytes with me just in case, however we thought we would be hiking early in the morning. Then multiple roadblocks occurred to our plan—the ferry we were supposed to take was not running that day, and it took us 2.5 hours to get to the starting point of the hike. We started hiking at 10:30 am and the day was in the high 70s, and we were hiking in the hottest time of day.  We were already behind the 8 ball, but we didn't recognize it, and we had had a very early breakfast, so low blood sugar played a part as well. Our plan was to be finished well before lunch time.  You can imagine the rest…we are all great at sweating, especially my husband.  John is 6-4 and 240 so his body required more water and electrolytes than the rest of us with normal body indexes.  It took us more than 3.5 hours and it was hot and we were going up and down thousands of stairs made for donkeys..they were very high! You can imagine the rest…we'd finished almost all our water by the halfway mark, and there is no place to get off the trail, or to get help. My husband began to feel weak and developed a headache, and dizziness.  He was sweating profusely and couldn't continue after 2/3 of the trail. I had 1/3 of a bottle of water left and put a whole NUUN tablet in it (which he said tasted nasty)..but he drank it and laid down in the shade for 30 minutes.  He rallied enough to get him to Vernazza, but there is no ER there, so he got cool by soaking in the ocean and recovered with water and more NUUN.  I was monitoring him, checking his pulse that was thready, and his breathing.  I am not sure what would happen if We hadn't had water and NUUN. Protect yourself and your family with being prepared for summer exercise.

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog. BioBalance Health® pellets are very safe and not painful to have inserted. They are also the easiest form of hormone replacement a woman can have because the dose is adapted every 4 months and our patients only have to think about their hormones three times a year.   BioBalance Pellet therapy is associated with fewer side effects than any other hormone replacement, and we have a 95% success rate for resolving the symptoms of menopause and testosterone loss. Women's lives are drastically impaired at menopause.  BioBalance, and T pellets improve their quality of life to the level of quality they had before they were 40.   Dosage and pellet side effects are specific to the individual and it may take us a few pellet insertions and blood tests to get the ideal result. Finding your perfect fit is like having a custom suit made: hormone balance requires patience and several fittings, before we determine your maintenance dose, which will direct your dose of E/T for follow up pellet insertions.   We give a handout to each patient when she checks out after her first pellet insertion. We ask patients to follow the instructions given to them verbally and in writing in our office. Risks of pellet insertion procedure, risk of taking estradiol and risk of taking testosterone are rare, but patients are given this handout, so they know what to expect.  These same risks are on their consent that they read and sign before they even come to the office the first time.   Here are the most important instructions for immediate care of the insertion site:   ·      Take the pressure dressing off in 3 HOURS ·      Take the steri-strip off in 3 DAYS ·      Don't traumatize your incisional area ·      If you are allergic to tape please tell us ·      For three days don't submerge in water—hot tubs, bathtubs, the lake, a stream, or the ocean. ·      For three days don't exercise ·      Don't take oral or IV steroids if it is not life-threatening   Please tell us if you are on steroids or take blood thinners so we can alter our treatment plan.   The risks of the pellet insertion procedure include:   ·      Infection ·      Bleeding, ·      Bruising ·      Allergic reactions ·      Swelling ·      Pain ·      Reaction to the lidocaine with epinephrine :shakiness and anxiety, lasts a short period of time, and is not permanent.  Tell us if you have this side effect, and we will use lidocaine without epinephrine the next insertion. ·      Keloid scarring     As is usual for medicine , individual patients have a higher risk based on their medical history. Patients who are at higher risk for complications secondary to the pellet insertion procedure in patients who are:   ·      Diabetic ·      Have an autoimmune disease ·      Take steroids ·      Have a clotting/bleeding disorder ·      Keloid former ·      If you have many allergies ·      If you have orthopedic implants that require antibiotics at the dentist, then you should tell us so we can give you antibiotics.     Risks of taking testosterone pellets with BioBalance Health® in the first few weeks or months and are transient. These side effects usually resolve on their own without treatment.    The transient risks of testosterone treatment include:   ·      Over the top sex drive=Hypersexuality ·      Vaginal itching from increased blood flow—it is not an infection ·      Facial hair and acne (Prevented with Spironolactone preventive treatment) ·      Weight gain from muscle mass and sometimes from conversion of testosterone into estrone which is a genetic risk. ·      Increased muscle mass that is confused with weight gain. ·      Lowered voice is only a problem when you are a singer.  Generally, those who think they have a lowered voice really have reflux and it has nothing to do with testosterone pellets. ·      Clitoral enlargement—this is a reaction to a new testosterone exposure, and generally will go away in the following few months. ·      Thinning of hair at the temples and crown (Prevented with Spironolactone preventive treatment)   Women can take testosterone without estrogen before menopause, and after menopause if requested, however the symptoms of menopause will not be completely resolved with testosterone only pellets.   The risks of estradiol pellets are higher for patients with a uterus, than those women who have had a hysterectomy.   Those women with a uterus have the following risks:   • Uterine bleeding, growth of fibroids: Estradiol of any kind - pellets, pills, patches etc. - can stimulate the uterus to bleed. This can come from a thick lining, adenomyosis (spongy uterus), or fibroids. Prescribing progesterone, optimally sub-lingual progesterone or BLA progesterone from Belmar pharmacy, taken 1-2 times a day, counteracts this. Other treatments are surgical and offered by your Gyn. Your doctor will evaluate you for treatments: uterine wall ablation (80% effective), or a Mirena IUD. Sometimes bleeding will necessitate the choice between a hysterectomy and contin   Risks of estradiol pellets for women with and without a uterus: ·      Vaginal discharge: Estradiol increases the moisture in your vagina. This is a gift to some and a curse to others. This wetness is not an infection, but a normal response of the vagina to estradiol. It needs no treatment, but if it bothers you, then the choice might be that you might have to stop getting estradiol of any kind, or just put up with the wetness, or decrease the estradiol dose with the next insertion. ·       Bloating: This is sometimes caused by too high a dose of estradiol for a particular person, or the conversion of estradiol into estrone, which causes water weight gain. Some women need progesterone to balance the estradiol, to treat bloating. Others require a diuretic, or a low carb diet, thyroid medication, DIM supplementation or more exercise. Most of the time this symptom will resolve itself in a few weeks after it starts, as the body balances itself out. Bloating has many non-hormonal causes as well. ·      Anxiety/Depression: Most women's anxiety decreases as estradiol levels rise, but others feel irritable, and for this occurs only in a small subset of the population. For those patients we add progesterone SL (Sublingual tablets) to their regimen, and they improve. Think about whether you stopped your antidepressant when you started pellets. This is a premature move and can cause women to emotionally crash. Please continue your anti-anxiety medications, or your anti-depressants until 4-6 months has passed, and have the prescribing doctor help you wean off. ·       Breast tenderness: This symptom is usually from a hormone called estrone, and not estradiol, but breasts that have not been exposed to estradiol for years sometimes hurt as they “wake-up”. This is generally limited to a month during the first pellet cycle. The product DIM can alleviate this symptom. Remember that stimulation of the breast can also cause them to swell and hurt! In rare patients, progesterone can cause breast tenderness. ·      Weight Gain: Weight gain occurs for many reasons especially over the Holidays. Other times water weight gain can come from Estradiol. This water weight is self-limited and sometimes requires progesterone balancing, a diuretic, or thyroid replacement, increase of protein and decrease of carbohydrates and alcohol. • Migraine headaches: Estradiol in high levels that increase and decrease drastically destabilize the neurotransmitters and can instigate a migraine headache. Pellets increase very slowly, and decrease very slowly, so either your headache is a tension headache and not a migraine, or has a trigger other than estradiol, such as stress, weather change, or food allergies. Migraines generally improve on Estradiol and Testosterone pellets.    

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog The most common cause of hysterectomy in women are benign masses that grow within the uterine wall. They occur in 4 out of 5 women, and they can be small and asymptomatic, or they can grow large and cause pain, uterine bleeding, pelvic pressure, urinary incontinence and pregnancy complications. Uterine Fibroids are “the most common tumor in women world-wide”. Although benign, uterine fibroids are associated with significant morbidity; they are the primary indication for hysterectomy, and a major source of gynecologic and reproductive dysfunction, ranging from menorrhagia and pelvic pain to infertility, recurrent miscarriage, and preterm labor. Fibroids are also referred to as “leiomyomas”, “myomas”, “fibroid tumors”, and sometimes slangily referred to as “fireballs”.  They are in fact “ball-like” in shape and when we inspect them at hysterectomy, they are made up of swirling muscle cells that are laid down in concentric circles.  Gynecologists find fibroids when we examine a patient at their yearly visit by feeling an enlarged irregular uterus.  The fibroids are within the wall of the uterus and often cause heavy uterine bleeding.  Where the fibroids are, within the wall of the uterus, determines whether they are more likely to cause bleeding or not.  Placement up against the uterine cavity (“submucosal”) increases risk of bleeding, and placement in the middle and surface of the uterine wall (“subserosal”) decreases risk of severe bleeding. At BioBalance Health LLC we require every patient who comes to us who still has a uterus to have a formal abdominal and vaginal ultrasound to diagnose fibroids and other uterine abnormalities,  before we will give them estradiol pellets.  Testosterone doesn't have a negative effect on fibroids so we can still put a woman on testosterone with fibroids. Otherwise, we have the risk of fibroid growth in our consents, and we discuss this issue when a patient's ultrasound shows significant fibroids. What causes a woman to be more likely to have fibroids during her reproductive years? Triggers for Fibroid Development ·      Race ·      Genetics/ family history ·      Diet ·      Early Age at First Period ·      Toxins in the environment especially in early life ·      Obesity ·      Advancing age ·      Vitamin D deficiency ·      Hypertension ·      Pregnancy suppresses the growth of fibroids  Race: Both Black and Hispanic women are the most likely to develop fibroids and experience enough symptoms to cause the need for a hysterectomy. Black women are 3X as likely as white women to have fibroids, and they are more likely to have very large fibroids. In some circumstances fibroids can prevent pregnancy and cause recurrent miscarriages and preterm labor. 60% of African American women aged 35-49 years reported uterine fibroids, whereas 80% of those aged ≥ 50 have uterine fi-broids. Genetics/Family History: If a woman has a mother or sister with fibroids, then that woman has twice the risk compared to a woman without a family history of fibroids. “Uterine fibroid-linked mutations in MED12” are the most common mutation we have found, however a mutation in the COMP pathway is also found to be associated with fibroids. Diet: A diet with high intake of meat, fat and alcohol increases a woman's risk of developing fibroids.  A diet deficient in fresh fruit and vegetables also increases the risk of fibroid appearance and growth. Smoking is highly associated with fibroid growth. Early age of Menarche is a risk for developing fibroids, which increases the years a woman is exposed to estrogens. Toxins from the environment, and from alcohol increases the development of fibroids.  Cleanses might help rid your body of toxins that might methylate your genes and stimulate fibroid growth. Obesity and Being overweight: Body fat increases the estrone estrogens in the circulation, which stimulates fibroids to grow.  Advancing age until Menopause: When women enter their late 40s their ovaries decrease ovulation and the uterus is exposed to estrogen without progesterone, which causes fibroids to grow.  After menopause, some fibroids shrink while others stay the same. When women take HRT their fibroids may be stimulated again, however because it is not cyclic, it is less likely to stimulate fibroid growth. Hormone Replacement Therapy can increase the size of fibroids: HRT is only one of the factors that causes growth of fibroids in menopausal women.  If estrogen is balanced with progesterone (not progestins) growth is less likely.  Testosterone has no effect on fibroids so replacing testosterone is not a factor for Fibroid growth. At BioBalance we have medicated pellets that combine Testosterone with Anastrazole which suppress the growth of fibroids.  We use these on our patient who have known fibroids, if they are willing to undergo treatment with this Vitamin D deficiency The role of Vitamin D in development of fibroids is being researched at this time, however an adequate Vitamin D blood level is needed to help prevent Fibroid growth. “Approximately 80% of African American women have vitamin D deficiency, compared with only 20% of Caucasian women”. This is one of the factors in Race being a factor in the development of fibroids. Hypertension Increased diastolic blood pressure is associated with a higher risk of uterine fibroids, regardless of use of antihypertensive drugs. Women suffering from hypertension are 5 times more likely to develop uterine fibroids.  Not Having Babies (Low parity) Having had one or more babies (parity) is protective, and the more babies a woman has the less likely she is to have fibroids What are the Symptoms of Uterine Fibroids? Fibroids are benign uterine tumors, so patients are not at risk of dying of cancer, but women with fibroids often have quality of life issues, found in the symptoms listed above, that lead them to the final treatment for fibroids, a hysterectomy (removal of the uterus). So can we prevent these masses from occurring, growing and producing symptoms? How Do You Know You Have Fibroids? The growth of fibroids is generally slow and is accompanied by slowly worsening symptoms. When there are many fibroids, large fibroids or submucosal fibroids patients seek help for their symptoms which include: ·      Heavy uterine bleeding which can be severe leading to anemia ·      Pelvic pain and pressure ·      Large mass effect that puts pressure on the bladder and colon causing dysfunction of those organs like stress incontinence, and constipation. ·      Painful intercourse ·      Multiple Miscarriages ·      Preterm labor ·      Weight gain What is the Diagnostic Process that Confirms Fibroids When I was practicing OBGYN, and a women came into my office for a GYN exam and I felt. The uterus was enlarged and irregular, it triggered me to do three tests to see if it was a fibroid, ovarian mass, pregnancy or other abdominal tumor.  I would first order a rapid pregnancy test. Then I'd order blood work to see if my patient was anemic from heavy bleeding, and If the pregnancy test was negative, then I would order an abdominal and transvaginal ultrasound to get a picture of what I was feeling on exam. If I found a fibroid uterus, then I would have a discussion with my patient to see how severe her symptoms were.  I would also tell her how big the uterus.  The size of a fibroid uterus does matter.  If it is greater than 16 pregnancy week size, it is likely putting undue pressure on the other organs in the abdomen.  The speed of growth is also a factor because if the uterus grew quickly, then it has a tiny chance of being a malignant sarcoma.  The risk of this is < 1%, however fast growth of a fibroid uterus is an indication to do a hysterectomy. If the uterus is greater than 12 weeks size an ultrasound cannot adequately measure the uterus or reveal the inside of all of it so an MRI of the pelvis and abdomen is in order before surgery. What Type of Treatment Can Shrink or Remove Symptoms of Fibroids? The options for control of Fibroid Symptoms with Medications/Supplements include: ·      Progestins or Progesterone without cycling ·      Birth Control Pills ·      Lupron and other drugs in that class (this puts the patient into a temporary menopause). ·      Anastrazole (Arimidex®) which stops the conversion of testosterone into estrone and estradiol. ·      Stop Estrogen replacement, or. Lower the dose of estrogen if you are menopausal. ·      Treatment of inflammation (High CRP) ·      Vitamin D supplementation ·      Probiotics ·      Supplemental vitamins and minerals These are the first treatments doctors use to lessen the symptoms of fibroids unless bleeding is so severe that it becomes an emergency and then invasive treatments are used. ·      Uterine Artery Embolization is done by a radiologist and puts a “plug” in the fibroid's blood supply and then slowly the fibroid shrinks and dies. The only problem is that once you have had one fibroid, you can always make more.  This may be a delaying process to allow a patient to make more red blood cells before a definitive surgery. ·      Myomectomy is a procedure done under anesthesia, and it preserves the uterus while removing one or more fibroids.  This procedure makes the uterus more fragile and puts it at risk of uterine rupture if a woman gets pregnant and goes through labor.  Therefore, myomectomies are usually followed by a C-section for delivery to avoid the risks. This procedure cannot be done on all fibroid uteruses.  The doctor must determine if it is possible to preserve the uterus, since many fibroids invade the whole uterus. ·      Hysterectomy is the one procedure that guarantees that uterine fibroids will not return. After childbearing is complete a woman doesn't need her uterus for anything. It is simply there to bear children and does not secrete hormones or provide any other function. A Hysterectomy is done under anesthesia and removes the uterus that contains the fibroids.  If the cervix is not involved with fibroids and there is no history of cervical cancer, a supracervical hysterectomy can be done, preserving the cervix and the nerves that stimulate deep orgasms.   The Newest Research on Fibroids: Knowing this information should make it easier for you to understand your doctors' findings and what is ahead of you.  I hope you can understand the risk factors and the possible treatments available to you. References: “Comprehensive Review of Uterine Fibroids….”Endocrine Reviews,2021, Vol. 43, No. 4, 678-719 https://doi.org/10.1210/endrev/bnab039

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog If you are over 50 you have probably wished that you could have a face lift to bring you back to how you looked in your 20s or 30s. As an owner of a Medical Esthetic Spa named BioBalance Skin®, and because I am 68 myself, I have spent years looking for a facial treatment that would get the results of a surgical face lift, but without the pain, surgery and downtime. Because of the EmFace,  I have finally found what I was looking for so  I bought it!  It is called EM-Face, kin is the first medical spa to offer this treatment that makes facelifts a thing of the past. The EM Face is not only unique because the results of the EmFace are amazing, but it is also  unique because it isn't painful, it doesn't require many treatments (EMFace series is 4-6 treatments, one per week), and does not require anesthesia, there is no down time, no loss of time from work, and you are not at the mercy of a surgeon's skill to make you look like yourself at a younger age,  instead of a young stranger (think Sharon Stone). The EmFace treatment is done in our Medical Spa, and each treatment takes 30 minutes.  There is no operating room or anesthesia needed and it takes 4-6 sessions 30-minutes long , painless treatments that you don't even have to get undressed for!  After your treatment you can go right out in the world without bruising or any sign that you had a face lifting procedure. How does the EmFace work?  It uses electrical stimulation of the facial muscles to pull your facial skin up toward your temples, and it also tightens the facial skin so it literally makes your skin smooth and removes wrinkles!   Skin tone and muscle tone are improved and wrinkles disappear. …A face lift doesn't improve your skin tone and it only smooths deep wrinkles. Leaves no evidence of having a lifting procedure except that over the following 3 months you look progressively younger.   This is an advantage if you don't want your friends to know that you had anything done to make you look younger.  A face lift is obvious and it is hard to hide the fact that you had a major procedure to regain a youthful looking face. How long does it last? A Face Lift lasts about 10 years depending on the thickness and tone of your skin, as well as your age when you have the surgery.  EmFace generally requires one maintenance treatment a year to maintain the “lift” indefinitely. Cost comparison? EM-face 4 treatments costs around $2,800  and 6 treatments cost $3600 at BioBalance Skin®and that's it!. A facelift surgeon can charge t up to $100,000 for his or her services. Then  you have to add the additional costs of the operating room +  the cost of the surgical assistant + supplies and usually  you have to pay for one night in the surgery center. For a facelift, plan on paying over $150,000 total (assuming you have no complications) vs a total charge of $2,800-$3,600 for an EMSCULPT facelift.  Oh, I forgot to add the value of your time off from your job which can be 3 months after a facelift, before you want be seen  in public. Why does a face lift prevent you from showing your face right away? Facelift Surgery on the face involves dissecting the skin away from the muscle and bones of the face, pulling the skin up toward your temples, trimming off extra skin and then closing the incisions with suture. This massive dissection causes a large amount of swelling and bruising, requiring drains placed in your face, for weeks.  This damage lasts a long time and is PAINFUL! It generally causes patients to remain  housebound until they completely recover, which can be months. EMFace causes none of these side effects and complications,  so you can go out in public, or back to work right afterwards with a “glow”, and no sign that you had anything more than a facial. What are the comparable risks? The risks of a facial surgery of any kind are dramatic…damage to the facial nerve may not be recoverable, making you unable to smile or show expression on one side of your face.  Surgery risks are always numerous and most surgeries include the complications of anesthesia, even death, infection, bruising, non-healing, nerve damage scar formation and facial drooping. What should I do to prepare for either of these treatments for good results? Replace your testosterone (improves healing), and estradiol (improves texture and tone of your facial skin. Topical Skin Care, medical grade, (eg. Skinceuticals products) that stimulates the stem cells of your skin to grow and smooth the texture preparing for healing and tightening. Replace your estrogen and testosterone if you are over 45, 4- 6 months before the “lift”. Eat a high protein diet (more than half your weight in grams of protein/day) Stay hydrated with water and sometimes electrolytes. Lose as much weight as possible before the procedure. Get monthly hydra-facials and or micro-needling to prep your skin Take daily collagen supplementation in your coffee or tea Take healing vitamins: Vitamin D 5,000 u/day, Vitamin Methyl B12 and Methyl-folate, Vitamin A 10,000-25-000 u/day, Vitamin C 1000 mg/day at the very least. To help you make a decision, I have to tell you a little secret about what a facelift doesn't do.: a facelift doesn't take the place of getting  filler every 6-12 months; A facelift doesn't take the place of botox of other neurotoxin. After a face lift you will still need regular skin peels and hydrafacials, exfoliation, and rejuvenation of the face and neck with laser or micro-needling! A facelift JUST LIFTS! EmFace lifts sagging facial skin, smooths the skin on the face and forehead, and improves texture and tone of the facial skin while removing wrinkles and stimulating underlying facial muscles to become the same size and shape as when they were younger! You may notice that you don't need a neurotoxin as often as you did before the EmFace.  You may not need as much superficial filler to erase superficial wrinkles or dimpling.  EmFace also lifts the corners of your mouth so the downturn of the corners of your mouth are not as obvious, in fact the corners of your mouth actually turn up  like they did when you were younger. This is what you've been waiting for! I know it was what I was waiting for…the EmFace machine wasn't inexpensive, so the treatments using EmFace are not cheap….but they are drastically more affordable and less dangerous than a facelift!  I have finished my series and am happy that I no longer  dread the time and risk of having a facelift in the future.