Complexities of Hormone Replacement Therapy:
Based Protocol Review
2nd-4th, 2017 — Chicago, IL
1st-3rd, 2017 — Salt Lake City, UT
Details, Fee’s & Registration :
For years Part III attendees have
lamented, “So is that all there is? Can’t there be more? Although there are new
articles, research, updates, literature critiques, and sarcasm (of course), the
majority of this course will be problem solving, case management, mistakes to
avoid, and tricks of the trade. The audience will consist of those with
significant experience, questions, and issues which make for an excellent
experience for both me and participants, as we all learn from patients and
ourselves. Extensive literature review in Parts I, II, & III have not
allowed me to present all the interesting and complicated cases and situations
that I have encountered in the last 15 years of practice. So bring your tough
cases, comments, thoughts, and ideas and have another fun weekend with your
talented peers. This will be a collection of the most talented and experienced
physicians in this industry. Enjoy.
1) Understand the benefit of
MR-guided trans-rectal prostate biopsy and subsequent state of the art focal
laser ablation of prostate cancer in comparison with other more problematic
standard treatment modalities.
2) Integrate into your practice the
Dynamic contrast Enhanced MRI with real time temperature mapping and tracer washout
for accurate diagnosis and location of prostate CA.
3) Review prognosis and complications
for radical prostatectomy, proton gun radiation therapy, brachytherapy, cryotherapy,
HIFU, laser ablation, as well as costs.
4) Review management strategies and
importance of testosterone utilization in prostate cancer survivors as well as literature
support. How to be your patient’s advocate as no one else where explain all the
ins and outs of the various available treatments.
5) Evaluate the association of
testosterone and estradiol levels and the risk of developing prostate cancer.
Should be raise, block, or administer estrogen based on the literature?
6) Based on the recent medical
literature, physicians should be freed of any antiquated and unscientific restrictions
that inhibit optimal treatment of their patients with testosterone, whether it
is before or after prostate cancer diagnosis.
7) Appreciate that optimal thyroid
levels are best as recent studies determine that high TSH levels are associated
with increased arterial stiffness and plaque thereby increasing CVD risk.
8) Review the recent NAMS position
statements that further distinguish the emerging differences in the therapeutic
benefit-risk ratio between ERT & HRT at various ages and time intervals
from onset of menopause.
9) Understand that high testosterone
levels in women are associated with an increased risk of breast cancer. Also understand
that studies show testosterone administration is protective against breast
cancer and is apoptotic to cancer cells. This demonstrates that association
does not prove causation and one should not extrapolate them to be the same.
10) High estrogen levels in men are
associated with increased cardiovascular risk. However estrogen administration in
men protects against heart disease and prostate cancer. This demonstrates
another example where association does not imply causation.
11) Evaluate and discuss my 50 most
difficult management cases involving HRT.
12) Learn current approaches to
manage vaginal bleeding, DUB, and endometrial hyperplasia.
13) Recent medical evidence seems to
counter everything that you have learned in regards to preventing prostate cancer.
14) Review medical studies
demonstrating the various mechanisms of estrogen’s ability to stop prostate
15) Androgen deprivation therapy in
men results in higher cardiovascular mortality and metabolic complications and this
can be prevented by simply administering estrogen.
16) Traumatic Brain Injury affects
quality of life by pituitary dysfunction: When and how to test and not miss it.
17) Evaluate recent literature
demonstrating the mechanism by which synthetic progestins increase breast
cancer development through the production of the RANKL protein.
18) Utilize dual intravaginal therapy
to maximize the effect on atrophic vaginitis, chronic UTI, incontinence, and sexual
19) Review the historical perspective
that pieces together the studies to understand the complexities in the NAMS recommendation
20) Review a fun and entertaining
article that puts in perspective the often distorted, oversimplified, over-exaggerated,
and simply wrong conclusions from the WHI investigators.
21) Evaluate abnormal lab tests and
various symptoms in complex and confusing cases.
22) Evaluate exactly when to use
estrogen in premenopausal women and when not to use it: Anovulation vs. amenorrhea.
23) Identify different types of
estrogen and progesterone and when to prescribe each.
24) Review various scenarios that
dictate when to switch to alternate forms of HRT, based on history, BMI, risks,
25) Hair loss in women: Current
approach to reverse hair loss.
26) Understand various alternatives
in testosterone administration in women.
27) Review when to switch from oral
to transdermal estrogen; when to switch from transdermal to oral estrogen
28) Current approach to preventing
CVD in women with Syndrome W (X).
29) How to treat the vagina with
pills, patches, rings, and things.
30) Review of management strategies
for progesterone intolerance.
31) HRT review, myths, updates,
alternatives when the usual routine doesn’t work.
32) Update on diagnosis, treatment,
and prevention of prostate cancer. Should we be prescribing estrogen to men instead
of blocking it
33) Review management strategies for
34) Evaluate the best prevention and
treatment for incontinence and UTI, from wet to dry and dry to wet. Prevention is
the key before use of drugs or surgery.
35) Current recommendations from NAMS
for HRT and ERT and how they differ from past recommendations. Oh how the
36) Review the history as to why the
world believes testosterone causes prostate cancer.
37) Further review the data
demonstrating that E2 is the best estrogen but not the safest.
38) Review the work up for elevated
PSA and that doesn’t mean biopsy and what to do when the biopsy is negative.
39) How to design a study of T3 to
make sure that it fails.
40) A literature review of spironolactone
and its BBW.
41) Discuss the most recent FDA BBW
for testosterone as it pertains to MI, CVA, and DVT.
42)Review dosing and administration
of tranexamic acid to stop your patients from bleeding.