December 2013 Newsletter
December 2013 Newsletter
GOODHORMONEHEALTH NEWS VOLUME 3-December 2013 www.goodhormonehealth.com The purpose of GOODHORMONEHEALTH NEWS is to disseminate new information to Dr. Friedman’s patients and others who signed up to receive his newsletter before posting on his website. We encourage you to visit www.goodhormonehealth.com and to make an appointment to see Dr. Friedman to discuss your medical condition. Please contact his office at [email protected] to suggest a future topic for GOODHORMONEHEALTH NEWS or to schedule an appointment. Be sure to schedule a follow-up appointment. Follow-up appointments are available in person, by telephone (20 min.), drive by (15 min.), email or FaceTime. We are running a special on email appointments at $130. Order your “I’ve been to see the Cushing’s Wizard” car magnets and sweatshirts and other Cushing’s gift items at http://www.cafepress.com/sk/zebraesque. Dr. Friedman will be hosting “meet-ups” in which patients meet with Dr. Friedman to obtain information about endocrine conditions. Live meet-ups will be in Los Angeles and audioconferenced meet-ups can be arranged throughout the country. Dr. Friedman talked on Hypothyroidism and hair loss in women on HER Radio on November 28, 2013. Listen to the broadcast at http://radiomd.com/show/her-radio/item/16359-tired-weak-ordepressed-you-may-have-hypothyroidism AND http://radiomd.com/show/her-radio/item/16368thinning-hair-the-reasons-for-your-hair-loss ______________________________________________________________________________ Replacement for Trans-D-tropin Dr. Friedman prescribed Trans-D-tropin for patients with a low IGF-1 (marker for growth hormone), who did not meet criteria for growth hormone deficiency. Trans-D-tropin was composed of amino acids that stimulated growth hormone secretion, but was removed from the marker by the FDA. Dr. Friedman found a replacement product called TdttropinPlus that seems similar to Trans-D-tropin. It costs about $175/month, doesn't need a prescription and can be obtained at http://www.collegepharmacystore.com/product_p/amp_tdttropin.htm or http://tdttropinplus.com/ ______________________________________________________________________________ Earn $$ for Adult Growth Hormone Deficiency The purpose of this research is to obtain your feedback on the design of a new pen-injector and the instructional materials. No injections or medication will be given during the research session; this is strictly an observational research project, and all responses will be kept confidential. Qualified participants will receive a total stipend of $250. This study will take place over 2 days, 1 hour each day. If you or someone you know fits this description and lives in the San Francisco, Los Angeles, Dallas, Philadelphia or the San Diego area, please call: Trotta Associates (San Francisco/Los Angeles)- Michelle @ 310-306-6866 x65 Dallas by Definition (Dallas)- Jessie @ 1-800-336-1417 Group Dynamics (Philadelphia)- Alice @ 610-822-1010 Taylor Research (San Diego)- Ben @ 858-810-8400 x203 ______________________________________________________________________________ Dr. Friedman congratulates R.M., a patient whom Dr. Friedman diagnosed with Cushing’s disease in 2012. She underwent successful pituitary surgery in NY in March 2012. Since surgery, she feels great, lost 795 pounds and was able to fit into a beautiful wedding dress. R.M. said “With the help of Cardio every day and eating right and phentermine as well and more importantly feeling great, I am now healthy!” Here are her pre-op (September 2011) and wedding pictures (October 2013). Way to go R.M. __________________________________________________________________________ Power of Juicing Dr. Friedman believes healthy eating can complement hormonal optimization to achieve good hormone health. has advocated a vegetable-based diet for many years, but was recently inspired to personally take up and advocate juicing for his patients after watching Fat, Sick and Almost Dead, a documentary about the power of juicing. In this newsletter, he highlights L.H and his wife N.H. who have improved their health by juicing. L.H. has hypopituitarism and has been seeing Dr. Friedman for about 10 years. With pituitary hormone treatment, his health improved, but he still wasn’t able to turn the corner and become truly healthy until he changed his diet and started juicing. Here is their juicing recipe: 3 cups water, 1 bunch romaine hearts, two handfuls of kale, two handfuls of deep green blends (kale, chard, spinach), 1 big cucumber with skin, 1 cup yogurt, 1.5 cups mixed frozen fruit (mango, papaya, strawberries, pineapple). It completely fills their Vitamix container which is at least 68 oz. They divide equally and drink within 15 minutes of making it. Below is L.H. with his grandson and their juicing ingredients. Dr. Friedman’s juicing recipe is kale, shredded carrots, one tomato, fresh ginger, frozen blueberries and frozen mango. ______________________________________________________________________________ The 15% Rule of Who Should Get T4/T3 Combination The thyroid makes two hormones, T4 which has a long half life meaning it can be given once a day. T4 gets converted to T3 which is the active form of the hormone and has a short-half life, meaning it has to be given frequently. Most patient with hypothyroidism are treated with levothyroxine, which is T4. There are many brands of levothyroxine that include Synthroid, Unithroid, and Levoxyl. However, two very important recent articles suggested that about 15% of patients with hypothyroidism do not convert T4 to T3 properly and should be on a T4/T3 combination or on desiccated thyroid that contains T4 and T3. I wish to highlight both of these papers as they are very interesting and important studies. One study came from the United Kingdom that looked at the prevalence of the gene that converts the T4 to T3. This is called the type 2 deiodinase. In this study, 15% of the population had an alteration in the gene that converts T4 to T3, the alteration is called a polymorphism. This polymorphism means the DNA is changed so that this enzyme works less effectively. The patients with this polymorphism required higher T4 dosing and had more psychological problems than those that did not have the deiodinase polymorphism. They did not examine whether these patient would benefit from T4/T3 combination and also did not actually measure the enzyme, they only looked at the gene coding for this enzyme. Another very intriguing article came out in Italy that initially examined patients that had a thyroid nodule but were not on a thyroid medicine and did not have any other problems with their thyroid. Examining several thousand of these healthy patients, they were able to establish normal values for free T4, free T3, and TSH in this Italian population. Once these normal values were obtained, the researchers then took patients that had their thyroid completely removed for thyroid cancer, but did not get any other procedures done to the thyroid such as radioactive iodine. The patients with the thyroid cancer who had the thyroid removed were then placed on T4 or levothyroxine therapy and their free T4, free T3, and TSH were measured. All the patients had a normal TSH and that was the criteria for being in the study. However, approximately 15% of the people had a low serum free T3 that was below the range previously established. An additional 5% of the patients had a free T4 above the range that was established. This shows that about 15% of the people do not convert the T4 to T3 properly. This was based on serum T3 levels and is a very good indication that these 15% of the people would need T3 in addition to T4 to get both levels in a normal range. This study suggested that measuring serum free T3 is quite helpful in patients that are treated with T4 for hypothyroidism, an evaluation that is not normally done. This paper did not measure reverse T3, which some alternative doctors use to determine that the T4 to T3 conversion does not occur and actually this paper suggested that the measurement of serum free T3 itself can be used to determine which patients need T4/T3 combination treatment. These 2 intriguing papers challenge the idea that all patients with hypothyroidism should be treated with T4. Dr. Friedman uses different thyroid medicines to treat patients with hypothyroidism including T4/T3 combinations, and desiccated thyroid that contains T4 and T3. Dr. Friedman interprets this data that the majority of hypothyroid patients do fine on T4 alone including himself, who takes only T4. Approximately 15% of the population does need T4/T3 combination to have an optimal effect on the thyroid. Dr. Friedman feels these patients are the vocal minority who are not doing well on T4 treatment and would benefit from seeing a thyroid specialist like Dr. Friedman. For more information about Dr. Friedman’s practice or to schedule an appointment, go to www.goodhormonehealth.com. ______________________________________________________________________________ Mild Growth Hormone Deficiency Versus Mild Cortisol Deficiency - Which One Should You Treat? The pituitary makes several hormones, and if the pituitary is damaged, such as in cases of surgery, radiation, a pituitary tumor, or if the pituitary is small from conditions like Sheehan's syndrome and empty sella syndrome, hormone deficiencies occur. There is a set order of these hormone deficiencies, and growth hormone is the first hormone deficiency to occur in cases of hypopituitarism. The second one is usually LH and FSH, which leads to low estrogen and testosterone. The third hormone to be affected is TSH, which leads to low thyroid hormones (central hypothyroidism), and the last hormone to become deficient, which requires extensive damage to the pituitary, is ACTH, and when that is affected, low cortisol occurs. Dr. Friedman is very interested in optimizing hormone replacements in hypopituitarism and is surprised at the recent guidelines and articles that state that only severe cases of growth hormone deficiency should be treated. There was an article in the Journal of Clinical Endocrinology and Metabolism in June 2013 that suggested that idiopathic (without a clear cut cause) growth hormone deficiency does not exist. This article suggested that growth hormone deficiency should only be treated if it is severe and if the patient has other pituitary hormone deficiencies. In fact, many insurance companies require that the patient has at least 2 to 3 other pituitary hormone deficiencies before treatment. To me, this makes no sense because the growth hormone deficiency is the first pituitary deficiency to occur. So the question is why is it recommended that mild growth hormone deficiency not be treated. On the other hand, almost everybody treats mild cortisol deficiency. In medicine, we looks at the benefits and risks of treatment, and the treatment for cortisol deficiency is giving hydrocortisone or Cortef. Certainly, if hydrocortisone is needed it should be given, but in many borderline cases it is unclear whether hydrocortisone needs to be given. Giving exogenous cortisol shuts down the adrenal glands from making its own cortisol and therefore, once you start cortisol, it is may be very hard to stop it. Additionally excess cortisol, and it can be very hard to give the right amount of cortisol, leads to weight gain, diabetes, infections, and osteoporosis (thin bones). Many endocrinologists erroneously feel that patients can die suddenly from cortisol deficiency. This is based on old literature and occurred only in patients with severe cortisol deficiency. More recent literature suggests that patients with mild cortisol deficiency do not die suddenly, do not necessarily need to be treated with hydrocortisone, and the benefits of treating with exogenous hydrocortisone most likely outweigh the risk unless the cortisol deficiency is severe. Additionally, hormonal replacement should be guided by symptoms. Patients with low cortisol have nauseousness, vomiting, diarrhea, abdominal pain, joint pains, and weight loss. Most patients with fail their cortisol stimulation test and are told they have mild cortisol deficiency do not have those symptoms. In fact, many patients with hypopituitarism have more symptoms of excess cortisol such as weight gain, than cortisol deficiency. In contrast, patients with growth hormone deficiency do have weight gain. They have trouble sleeping. They have psychological and psychiatric problems including depression, mood swings and irritability. Their quality of life and functionality is much lower. All these symptoms are improved with growth hormone replacement. Growth hormone replacement has very few side effects. The main side effects are joint pain and edema. Some patients on growth hormone replacement can get worsening glucose control, but in general the patients feel so much better on growth hormone replacement, they exercise more and feel better and their blood sugar improves. Dr. Friedman has found that patients with mild growth hormone deficiency do just as well on growth hormone replacement as those with severe. He is in the process of trying to study this, but he has found that growth hormone deficiency in patients that have a growth hormone stimulation test such as a glucagon stimulation test that peaked between 3 and 8 benefit from growth hormone replacement, just as the ones that would have severe growth hormone insufficiency such as those that have a growth hormone peak after a stimulation test of less than 3. Dr. Friedman suspects that the real reason why mild growth hormone deficiency is not treated while mild cortisol deficiency is treated has to do with cost and insurances. Growth hormone replacement is quite expensive and can cost over $1000 a month while cortisol replacement is quite inexpensive. Because of the cost of growth hormone replacement , most people need their insurances to pay for it, and insurance companies are getting more and more reluctant to cover growth hormone replacement, possibly because of the cost. Because Dr. Friedman is very interested in improving the patients' quality of life, especially those with hypopituitarism, he tries to fight to have patients with mild growth hormone deficiency covered by their insurance and so those patients could benefit from growth hormone replacement. For more information about Dr. Friedman’s practice or to schedule an appointment, go to www.goodhormonehealth.com. If you wish to be removed from this newsletter email list, please email us at [email protected]
Growth Hormone Deficiency Treatment Market : Global Industry Analysis and Forecast, 2016 - 2022
The primary factor contributing to the growth of global growth hormone deficiency treatment market is increasing incidence of growth hormone deficiency syndrome. Several other factors which may cause the global growth hormone deficiency market to grow include changing lifestyle, prevalence of other genetic disorders and incidence of GHD in adults. However, high cost of treatment will always remain the major restraint for global growth hormone deficiency treatment market.More information
A. Jostel, C. Lissett, S.M. Shalet (2005) Hypopituitarism. In: Endocrinology... DeGroot), W. B. Saunders, New York.