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Part IV: Complexities of Hormone Replacement Therapy:

An Evidence Based Protocol Review


June 2nd-4th, 2017 — Chicago, IL

December 1st-3rd, 2017 — Salt Lake City, UT


All Course Details, Fee’s & Registration : http://worldlinkmedical.com/live-cme-courses/part...


Course Description:

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.



COURSE OBJECTIVES:

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 cancer growth.

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 dysfunction.

19) Review the historical perspective that pieces together the studies to understand the complexities in the NAMS recommendation for HRT.

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, and compliance.

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 estrogen intolerance.

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 pendulum swings.

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.