Organic Medicine

A PATIENT’S MANUAL Organic HELPING PEOPLE LIVE LONGER & HEALTHIER LIVES Medicine THE LEE CLINIC, LLC WILLIAM M. LEE, M.D. MEGAN H. LEE, D.O. │ VALERIE H. LEE, P.T., C.H.T.

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Organic Medicine Introduction: Overview.........................................................................5 Chapter 1: Adrenal Dysfunction................................................ 18 Chapter 2: Women’s Hormones & Menopause ����������������� 21 Chapter 3: Men’s Hormones & Andropause ����������������������� 24 Chapter 4: Natural Thyroid Replacement ����������������������������25 Chapter 5: Vitamins & Minerals..................................................28 Chapter 6: Autoimmune Disease & Leaky Gut ������������������30 Chapter 7: Lyme Disease & Coinfections ����������������������������� 33 Chapter 8: Neurotransmitter Testing...................................... 36 Chapter 9: Gastrointestinal Studies.......................................... 37 Chapter 10: Environmental Toxins & Heavy Metals............ 38 TheLeeClinic.com Organic Medicine • 3

About the Author WILLIAM M. LEE, M.D., F.A., C.E.P Dr. William Lee founded The Lee Clinic in 1993. After graduating from Creighton Medical School in 1971, Dr. Lee worked as an ER physician and then began a family practice in 1987. During his years in family practice, Dr. Lee became interested in anti-aging or “organic” medicine and has been specializing in natural hormone replacement for men and women and treatment of chronic diseases such as Lyme disease and fibromyalagia since 1993. Member, American College for the Advancement of Medicine Member, American Academy of Anti-Aging Medicine MEDICAL DIRECTORSHIPS 1971 - 1972: Flight Surgeon, USA7 Southeast Asia 1972 - 1987: Phoenix Memorial Hospital Emergency Department 1987-2000: Desert Foothills Medical Center. Scottsdale, AZ 2000-2005: Phoenix Fire Department Wellness Center 2005-Present: The Lee Clinic, Northern Virginia 4 • Organic Medicine TheLeeClinic.com

About the Author MEGAN H. LEE, D.O. After seeing the impact her father made on the lives of others with his practice, Dr. Megan Lee realized that this organic view on healthcare was also the way she wanted to practice medicine, and her life. Attending an osteopathic medical school allowed her to approach healing with holistic perspective, making joining The Lee Clinic the right choice. After graduating from Bucknell University, where she played Division 1 tennis, she received her Doctor of Osteopathy at West Virginia School of Osteopathic Medicine. She completed her internship in Internal Medicine at Georgetown University in Washington, D.C. and is a member of the American Academy of Anti-Aging Medicine. Like her father, she is an avid equestrian and continues to play tennis in her free time. TheLeeClinic.com Organic Medicine • 5

We want to change how “ ”you think about your health. Introduction We will explain, in layman’s terms, how you can live DR. WILLIAM LEE’S BACKGROUND a longer, healthier, more productive life. This is an opportunity for you to become more involved in and more My father was a general practitioner in rural Iowa informed about your medical care and your health. during the 1940s and ‘50s. There was no pre-hospital care (paramedics or EMTs), and there were no There are other thyroid and hormone books on the ambulances. Instead, the local funeral hearse would go market, but our goal is to present an overview of how it all to the scene of an accident and, depending on what comes together. Humans are complex, and with the way they found there, either head to my dad’s office or the we bombard our bodies with toxins, stress, and a myriad of hospital or return to the funeral home. other “bad guys”, we wonder how we survive at all. But in My father made house calls and my mother was his our experience, our bodies are resilient. If we can build up nurse. His patients often bartered for his services and balance what your body is naturally missing, we can by offering chickens or some type of food. At the give our bodies the best chance of returning to health. beginning of his practice, neither Medicare nor any other third-party payer existed. He was in full charge of The purpose of this manual is to share our experiences the care he gave his patients, and he was not limited to and our thoughts as physicians, especially Dr. William 15-minute visits. Lee, who has been in active practice since 1971. We want Today, as we all know, the practice of medicine has to share how he changed his practice from emergency changed. Pre-hospital care and emergency rooms are medicine to preventative medicine. In our practice and everywhere; third-party payers and managed care this manual, we stress the importance of prevention, dictate care. Physicians often do not have the luxury of patient education, and patient involvement. truly getting to know their patients. I went to Creighton Medical School, which had a Many call what we practice Anti-Aging, Functional, reputation for a very hands-on approach to medicine. It Integrative, or Preventative Medicine. We prefer the term followed a “see one, do one, teach one” method Organic Medicine: we focus on how our bodies work During the first two years of medical school, all medical to best heal our patients. Many disease processes can students were taught how the body works. During the be linked to poor diet, hormonal imbalances, vitamin next two years, we learned what drugs to prescribe and deficiencies, infections, toxicities, and allergies. If not how to perform surgeries. diagnosed and addressed early, these issues can increase the risk for cancer and other serious conditions. We listen to our patients to find the root cause of the issue–to help them feel like themselves again. 6 • Organic Medicine TheLeeClinic.com

“Listen to your patient. He is telling you the diagnosis.” —William Osler, MD Noted medical educator In that era, there was no discussion of preventive THE ADVENT OF A NEW medicine. APPROACH TO MEDICINE After graduating from medical school in 1970, I interned at Good Samaritan Hospital in Phoenix. At As a response to this realization, I attended the first the end of my internship, my entire class was drafted. I American Academy of Anti-Aging Medicine (A4M) was drafted into the Air Force as a Captain and served meeting in Las Vegas in 1993. There were only 12 as a flight surgeon in Southeast Asia. After my tour of physicians, and the meeting was held in a tent. duty, I returned to Phoenix and joined a medical group Today, more than 6,000 physicians attend the annual that contracted out Emergency Room physicians to five meetings, and the Academy has more than 26,000 area hospitals. In 1972, I became the Emergency Room members worldwide. Dr. Megan Lee and I still attend Director at Phoenix Memorial, an inner-city hospital. these meetings twice a year. Every physician did 24-hour shifts. The lecturers at this first meeting addressed the notion Trauma teams or pre-hospital care did not yet exist. that there must be biomarkers for aging, which was an Most of the time, we were the only physicians in the eye-opening experience for me. As soon as I returned hospital. We would run the codes in the ICU, deliver from the conference, I began applying what I learned babies, and run back down to a busy emergency room. there in my private practice. I worked with many other ER physicians at that time I set aside one day a week to see patients using this to help make emergency medicine a specialty. In the anti-aging approach and I was able to generate great 1980s, the first board exam in emergency medicine results. My patients embraced the concept! Women became a reality. I hope that the type of medicine we came in with symptoms like PMS, insomnia, fatigue, describe in this manual—and that I have practiced weight gain, or hot flashes. As I listened to, tested, and since 1993—will someday soon become a recognized treated patients, they improved and were very happy specialty. with the results. I became convinced that this was the After 18 years as the Medical Director in the ER, medicine I wanted to practice, since I was addressing I changed tracks and began a private practice in the underlying issue. I attended as many conferences family medicine. In 1988, Marty Chattman, MD as I could and read all the articles published about this and I opened the Desert Foothills Medical Center approach. in northern Scottsdale. It was a 17,000-square-foot As I described previously, the specialty of medicine building with a free-standing outpatient urgent care I now practice has been referred to as Anti-Aging, facility. We were open 24 hours a day, 365 days a year. Complementary, Alternative, Functional, Integrative, We provided family practice, specialists, radiology, and or Preventive Medicine. Each of these terms refers to lab services. a slightly different emphasis within the field. I prefer Now that I was providing primary care, many of my the term “organic medicine” to describe the type of patients were women who had been seen by many medicine that examines how the body works and how physicians prior to coming to me. Most had been told we can prevent illnesses and maintain optimal health. that the symptoms they were experiencing (insomnia, Organic medicine is, in a sense, medicine without man- anxiety, irritability, and fatigue) were all in their head. made chemicals. They were simply prescribed anti-depressants and/or Even though our practice is not just conventional sleeping pills and given a dismissive pat on the head. medicine, we are fully licensed physicians and believe in These women knew intuitively that something was “regular” medicine. We always advise patients to keep amiss. I believed them and explained that the medicines their regular physicians for routine health issues. We tell they were being prescribed were not treating the cause them to continue to get regular physical exams and to but simply masking their symptoms. In 1993, I was use patented medicines when needed. beginning to realize that something was missing in the “regular MD” world. TheLeeClinic.com Organic Medicine • 7

CASE STUDY The goal in our practice is to prevent future health problems by building up our patients’ immune system PHOENIX and their general health. This type of medicine has FIREFIGHTERS made our practice more fulfilling for us. And it has excellent patient compliance and outcomes. We get Alan Brunacini, the chief of the Phoenix Fire more “thank yous” from our patients now, than we did Department, followed me as a patient when in all our previous practices combined. This manual I moved into private practice. A leader in describes the methods and testing that have evolved in the industry, he felt all firefighters needed to our practice, to help our patients get to the root of the receive the same level of care and detailed issue. attention that the companies gave their What we do is detective work. How did the patient get fire trucks. Together with Rudy Dragone here? What is really going on? For us, it is going back RHP (a compounding pharmacist at Clarks full circle to the first two years of medical school when Pharmacy), we developed a program of we learned how the body works. It seems logical to us. prevention and education for firefighters Since we physicians are all subject to our experiences, and their wives. We provided testing and training, and our images in the communities, we need treatment as needed. to be logical. Our care for patients involves treatments based on After 9/11, others began to acknowledge objective testing and educating patients on how to take the unique stresses and toxin exposure charge of their own health. Sometimes, patients come to which firefighters are exposed. Stress to us with zero information and they feel out of control. is a constant, as the job demands that Our job is to provide patients with a road map to good professionals stay in a constant state of health and the information they need to make the right “fight or flight.” In 2012, firefighting was decisions along the way. This manual is intended as a listed as the second most stressful job in guide for patients just starting this journey. the country. This results in many negative biological and mental effects—not the least THE CHALLENGES OF of which is high levels of cortisol, which CONVENTIONAL MEDICINE has many detrimental effects. Medicine is similar to other sciences; there is often Our innovative wellness program gave disagreement over theory and practice. firefighters and their wives a support One of our favorite quotes from a patient is, “Why can’t system that had been lacking. We gave you doctors get it together and be on the same page?” lectures once a month and tested for This is an interesting question, but there is a large a range of issues (see chart below) and divide between doctors who rely on patented medicines treated as indicated. We did IV treatments (“conventional” medicine) and those who are willing to as needed. I remained the physician for prescribe non-patented ones (“organic” medicine). this program until I moved from Phoenix to Virginia in 2000. It was a very rewarding experience. Thyroid TheLeeClinic.com Cortisol Sex hormones Vitamins Heavy metals Environmental toxins GI balance Inherited heart disease 8 • Organic Medicine

Studies have documented that a doctor interrupts patients on average every 23 seconds. Peer Pressure. In the medical community, there is well as vitamins and dietary supplements is that they substantial pressure on physicians to fit in with their could be counterfeit, or worse yet, toxic. Every year, colleagues. Some doctors will use non-conventional thousands of drugs are recalled because they are either medicines themselves, but peer pressure may push them ineffective or may cause serious, even life-threatening, to stick with accepted, conventional treatments. side effects. In 2014, there were a staggering 2,061 drug We are conventional, fully licensed physicians (MD recalls in the United States! That was as many recalls as & DO) and certainly not opposed to conventional we saw in the previous 9 years combined (2,217). As treatments. We use patented drugs when necessary. the FDA steps up its regulations, more and more drugs Over time, we have found the need to use patented may be recalled. medicines in only 10% to 20% of the cases. We have The only way to be sure of the content of vitamins and seen that the best approach to health is a proactive one supplements is to buy pharmaceutical-grade products. and one that uses as many organic interventions as If you see the letters “NSF GMP” on the label, you possible. know the product is safe. The National Science Limited Time. The pressure to see more and more Foundation is an independent, third-party inspection, patients in a day has led to the advent of the 15-minute testing and certification company committed to appointment and one consistent complaint: doctors public health and safety (GMP stands for Good can spend very little time getting to actually know Manufacturing Practices). their patients. And they certainly do not have time to Nonetheless, when you have a complaint, your educate their patients on vitamins, diet, thyroid, and conventional doctor is thinking, “Is there a pill I can hormones. give you?” It is much easier for a provider to say, “Here The result is frustrated physicians and patients. is some Prozac®—come back in a couple of months and Listening. When our patients come to us, they are often tell me how you feel” than to dig into the root cause of discouraged with the medical care they have received. the issue. Their primary complaint is that the doctors do not At the Desert Foothills Medical Center, where Dr. listen to them and tend to interrupt them. William Lee worked, they had 16 feet of cabinets just Studies have documented that a doctor interrupts their for samples pharmaceutical representatives brought the patients on average, every 23 seconds. No wonder clinic. Yet, the physicians found that about half their patients complain that doctors do not listen! patients had some kind of a problem with patented Integrative, holistic medicine is great because these medicines. practitioners avoid a knee-jerk response and evaluate This situation is discouraging for patients; they feel— a patient’s health as a whole. We like to think that rightfully so—that they are being dismissed. the patient will tell us the diagnosis, if we pay close Reactive Protocols. Medicare assumes people will live attention. The doctor and patient act as a cooperative for about 65 years. These programs were designed team using multiple therapies to fix the health problem. decades ago when people rarely lived longer. Insurance A Reliance on Prescription Drugs. Another common companies figure you will change insurance in two to complaint is that doctors just treat symptoms and are three years. So why spend money on you? If you do not that interested in determining the root cause of the live beyond 65, Medicare will decide whether you will problem. Patients also come to us because they watch receive care for certain diagnoses. the TV ads that list all of the serious side effects of With conventional medicine, we start to look for many drugs. problems around the age of 50. We check cholesterol, Another fear concerning patented medications as the colon and prostate, send the patient for a mammogram, and so on. But there is no digging into nutritional status, diet, lifestyle or hormones. TheLeeClinic.com Organic Medicine • 9

Under the current model, patients often wait until they of life. We don’t think we will live forever, but the real have symptoms to consult with a doctor, but sometimes issue is the quality and independence of the life lived. the physician only addresses immediate symptoms. The best way to practice medicine is to listen to patients Prevention is not discussed. and treat everyone as an individual. Physicians need to This is a completely reactive approach to medicine. go back to using what they learned in the first two years Proactive health care begins much, much earlier—as of medical school — how the body works and what can early as the 20s. we do to restore it to optimal health. The total picture of the patient (history, clinical exam, ORGANIC MEDICINE: and tests) tells us how to choose the right tests so that we THE LOGICAL ALTERNATIVE can identify and treat the root cause. Educating patients so they are involved in their health can take time, but the Patients today prefer a preventative approach. They are rewards are great. This approach is logical not just to us, learning how to take care of themselves and are feeling but to our patients. Organic medicine also has a much more in control of their health. They are asking their wider safety range that protects patients. physicians, “Is there anything else I can do?” A Simple Example. So let’s say that you have a blood Consider preventive health care your “real” insurance test to check your thyroid, your vitamin D levels, and policy. Instead of spending all your money at the end of RBC magnesium. Oftentimes, the results will come life, you should be spending smaller amounts throughout back in the “normal” or “low normal” range. Doctors your life for an ongoing program that focuses on quality are taught to tell their patients that such results are CONVENTIONAL VS. ORGANIC MEDICINE Health Issue Typical Prescription Organic Solutions Insomnia in a woman Ambien®, Lunesta® Progesterone, Magnesium, Melatonin, Cortisol Evaluation High blood pressure A hypertensive drug Weight loss, Magnesium, Sleep apnea test, Thyroid Balancing Fibromyalgia, lupus, etc. Lyrica®, Prozac® Removing Food Allergens, DHEA, Thyroid Balance, Addressing Leaky Gut Irritable Bowel Syndrome/ Steroid, Lomotil® Removing Food Allergens, Correcting Vitamin Deficiencies, C olitis Addressing Leaky Gut Weight problems More exercise Balancing Hormone & Thyroid, Diet, Sleep & Micronutrient Evaluation Depression Prozac® Balancing Hormones & Thyroid, Evaluating for Low Vitamin D, B6, B12, Addressing Leaky Gut & Neurotransmitter Levels Physicians need to go back to using what they learned in the first two years of medical school—how the body works and what can we do to restore it to optimal health. 10 • Organic Medicine TheLeeClinic.com

THREE PERSPECTIVES ON ORGANIC MEDICINE #1: EVOLUTION The theory of evolution is that we are given enough hormones, thyroid, and vitamins to procreate and once we pass our child-bearing years, we weren’t meant to live much longer since our job was done. By understanding the fundamental biology underlying our anatomy, we can alter this course by replacing the “good guys” as they are depleted. We can maintain our health so that we can stay out of the nursing home, see our grandkids, and have a good quality of life. #2: YOUR BODY AS A GARDEN If you had a garden and the plants were dying, the gardener would first examine and work with the soil. If you think of your body as a garden, and disease as a weed, the question becomes, “What is the soil like?” To prevent unwanted guests in your garden, such as weeds and insects, you must be proactive. Your garden must be fortified with the correct soil and nutrients to maintain its strength and vitality. In the same way, you must keep your body healthy to prevent disease and to deal with illness or stress. Instead of just “spraying the weeds,” we must take care of our bodies and immune systems because they are the soil of our garden. We need to have a strong immune system to fight off illness. We all have mutations going on in our bodies, but we have such a dynamic tendency for health, we don’t even know it. But at some critical point, the systems tip away from health. The resulting cascade can be slow (chronic diseases) or fast (a heart attack). “acceptable.” We are pretty sure that, if you check you are suffering from insomnia, we will immediately your oil and find you have only 2 quarts when you are consider the possibility of low levels of progesterone (in supposed to have 4, you wouldn’t be satisfied with just women), magnesium, melatonin, or high stress. 2 quarts. The pathways in the human body are amazing. The So let’s look at those results again. If your Free T3 body has a strong desire to be in balance. But when thyroid levels are low, that could explain why you are things go awry, the only way to make the patient better feeling fatigued. You want your levels to be at the top of is to address the root cause. We use patient history, normal. Concerning the vitamin levels: The Required clinical examination, and extensive testing to evaluate Daily Amount (RDA) is a very low bar—the level that what is the real root cause of the patient’s symptoms prevents serious heath consequences. So, once again, and then work to help the body rebalance. you don’t want to be low; you want to be in the high An old adage tells us that “the eye sees what the mind normal. For Vitamin D, that means at least 40 to 60 knows.” This simple quote aptly explains the need for nanograms/ml. We find nearly every one of our patients us to have an open mind and listen to what the patient is low in vitamin D. describes. Ask the patients. They will tell us the answer. It is important to “connect the dots”-how various ORGANIC MEDICINE IN PRACTICE symptoms interrelate. Many times, the diagnosis can be almost confirmed based on the signs and symptoms At our clinic, we like to think about the components reported by the patients. We should also have the that make up the human body. So you will tell us knowledge about the symptoms so that we ask exactly about your symptoms. Then, we begin to think about what is related to the present disorder and obtain the nutrient or hormone that might, either in excess relevant information from the patients. or deficiency, cause your symptoms. For example, if TheLeeClinic.com Organic Medicine • 11

THREE PERSPECTIVES ON ORGANIC MEDICINE #3: YOUR BODY AS A CAR For another analogy, let’s compare your body to an automobile. If you wait too long to take your new car to the shop for routine maintenance, you are going to expect some major repairs. While some repairs might have been unavoidable, many could have been prevented or mitigated by preventive care. It’s no different with your body. Now, just as there are different makes and models of cars, requiring different parts and/or maintenance, men and women cannot be treated the same way when it comes to hormone replacement. So, for discussion purposes, let’s say a woman’s body is a Chevy SUV and a man’s body is a Ford diesel truck. Just as an SUV and a diesel truck have different components and run on different fuel, women have a system based on progesterone and estrogen, and men have a testosterone-based system. These are two very different systems that require different fuels, i.e., hormones. But the thyroid, vitamins, and cortisol are basically the same for men and women. The car computer system is similar to the brain since it too has a feedback and sensor loop to monitor activity and health. Your brain is the central control system. It controls the function of your organs and tissues through the secretion of chemicals. The secretions of these chemicals are dependent on the positive and negative feedback mechanisms present in the body. Positive feedback generally increases the action of a gland, organ, tissue, or at a receptor site, while negative feedback decreases or entirely blocks the action. Our bodies are like a 4-cylinder engine. One cylinder is thyroid, one is hormones, one is vitamins, and one is cortisol. If the first three are low because of aging or nutritional depletion, your body has to run on cortisol. From a biological perspective, survival is the overriding goal for your body. Most of us are not in a true survival situation, but the body doesn’t always know that. If we stay in that state too long, we “burn out” (adrenal exhaustion). That’s why it is critical to monitor your thyroid, hormone, and vitamin levels — so we can support the adrenals until the other cylinders are back up. Some health care practitioners only do adrenal support, which does not make sense. Back to the car analogy: before you start to make repairs, you need to look at all of the parts and diagnose the problem. And it’s much easier to fix a car using original parts. We tell patients they are a Chevy, and we are going to replace what is needed with Chevy parts, not Ford parts (patented medicines). To add, women are not horses, so Premarin® (pregnant mares urine) is not a safe and effective choice. Women also are not plants, so we avoid using soy, dong quai, evening primrose, for example, to merely cover up symptoms. We are all unique. When we see a patient, we can tell them the most likely deficiencies. But the actual numbers and levels will vary because we are all unique. When a patient’s name is at the top of the lab report, showing true deficiencies or imbalances, we find that compliance is much better. The test result is all about that person, they no longer have to guess and go by what their neighbor says is good take, we show them what they are actually lacking and treat accordingly. 12 • Organic Medicine TheLeeClinic.com

LEE’S THYROID LAW The biggest indicator of energy and health, in our experience, is your free T3 level. Our rule of thumb (“Lee’s Law”) is that free T3 x 2 = Energy. Remember, free T3 is the active thyroid hormone, indicative of true function, not TSH, which just measures the “phone call” from the brain to the thyroid (what most conventional doctors check). If we ask a patient to rate on a scale of 1 to 10 their energy level, it is surprising how accurately that relates to the Free T3 level. If they say 8 (nobody says 10), then their T3 level will be near 4. The normal T3 range is from 2.0 to 4.4. So if a patient rates their energy level a 5, and their T3 is high normal (above 3.5). We then start to consider sleep issues, Lyme, or Mono as potential sources of their fatigue as opposed to being completely thyroid-related. As a general rule, hormones give us energy, as do vitamins and general nutrition, but thyroid levels and energy are the most closely related and Free T3 is not commonly tested. In this type of medicine, the physician is a teacher, a consultant, and a coach. We believe that patients must want to be educated so they can be active participants in their care. Part of our job, as their physician, is to provide them with information so that they understand the science behind their treatment and that we are literally “on the same page.” The patient has to be informed, in control, and motivated for this treatment approach to work. DO NOT REINVENT THE WHEEL Our body is, to put it simply, constantly striving to be in balance. “Homeostasis” is the striving of the body to regulate such properties as temperature, pH, concentrations of sodium, and so on. The body can take care of itself. It is a wonderfully complex system. But it does require a lot of nutrients to run properly. Many people from around the world are changing their views about modern medicine because of the strong and alarming side effects from today’s “wonder drugs.” Organic medicine works with the natural body systems to work with it—not against it. And it does not have a litany of adverse effects. There is no need to reinvent the wheel. The human body is smarter than we are! We do not need to do anything fancy; we just need to work with the body to be healthy. TheLeeClinic.com Organic Medicine • 13

Let’s respect our bodies and the amazing way they were The purpose of this manual is to give you the tools to designed. stay in not just good health, but optimal health. As Scientists are always discovering new pathways and stress and disease are an inevitable part of our lives, we publishing their research. These pathways have always would like to share our insights into how best to keep been there. We just need to provide the right tested your body and immune system in optimal condition. A “supplies” to the body and let the body do the work. strong immune system is critical to fighting off disease. The body already knew the pathways. Healthy immunity is having normal levels of cortisol, thyroid, hormones, iodine, DHEA, and zinc, as well IS YOUR GENERAL HEALTH as the correct pH and oxygen levels. A good immune GOING UP OR DOWN? system also depends on avoiding foods we are sensitive to, avoiding environmental toxins (heavy metals and Our bodies are in a continual dynamic process of chemicals) and mold, and avoiding chronic infections tearing down and building up. We rebuild every 7 (lyme, candida, parasites, and molds). years. If we take care of ourselves, our health will We have found that patients who get a disease typically improve. Conversely, if we abuse our health, we will reported they were under a lot of stress during the begin the downward decline. In biological terms, we previous year or two. When Dr. William Lee was a must maintain our health by continuing to accept flight surgeon in the Air Force, an autopsy on a pilot healthy nutrients. When these healthy nutrients revealed he had an acute myocardial infarction just decline, we experience “the dwindles.” before the crash. Similarly, after treating a man in the ER for a heart attack, his wife said he had been fine IT IS ALL ABOUT BALANCE and was “just yelling on the phone”. Loss of control, whether a bad marriage or a bad job or both, can cause Estrogen/Progesterone stress, either acute or chronic, affecting our health Magnesium/Calcium greatly. Zinc/Copper The medical field needs to give much more weight to Testosterone/Estrogen this cascade from loss of control to health issues when Good Bacteria/Bad Bacteria evaluating and treating patients. STRESS CAN OVERRIDE EVERY PATIENT IS UNIQUE ALL SYSTEMS In our practice, we see every patient as a unique It is well established that chronic stress is known to individual. Before patients come to see us, they fill out reduce immunity, create disease, and lower overall an extensive questionnaire. We need to know about health. Many of our patients will tell us they have been their chief complaint, of course, but we also want to see under a lot of stress the previous year and just feel “run the pertinent medical history and lifestyle habits. Do down”. A study conducted by the San Francisco VA they exercise? Do they get good restorative sleep? Are Hospital Center and the University of California found they anxious or stressed? The answers to these questions that the more traumatic stress a patient was exposed tell us a lot. After reading their questionnaire and to throughout a lifetime, the greater the chances the then discussing their symptoms and history, we order patient would have of elevated levels of inflammatory appropriate testing and devise a treatment plan. markers in the bloodstream. Studies have also shown It is not just about the main complaint; it is about how that the one thing that people who live past 100 have in well they have taken care of themselves. Do they look common, is very low levels of inflammation. younger or older than their stated age? Do they look There are some aspects of our health that are out tired or stressed? What diseases run in their family? We of our control, like our genetics and parts of our try to get an idea of any outside factors (stress, toxins, environmental exposure. and pathogens) that might be affecting their health. 14 • Organic Medicine TheLeeClinic.com

TEST. DON’T GUESS. After deciding what tests will best give us a good picture of what is going on, we go over them in detail during the follow up visit. If there are hormone imbalances or vitamin deficiencies, we replace; but always start with the minimum effective dose. We retest every 6 months to ensure proper levels. For hormone replacement, if symptoms persist, we would titrate upwards until symptoms were controlled, within reason. For instance, for a woman with headaches induced by low progesterone levels, we would start supplementing with low levels of natural progesterone and slowly increase until symptoms were controlled. If a patient is low in thyroid, for most, prescribe natural desiccated thyroid and increase dosage slowly over months. We always check labs at one to two months and work to get the free T3 in the upper half of the lab reference range. In a later chapter we will discuss thyroid replacement in more detail. Patients who have yeast overgrowth, lyme disease, adrenal dysfunction or toxins are the slowest to heal, as it takes a longer time to get the “bad guys” out. On the other hand, patients who have a “disease diagnosis” have different tests results. When tested, these patients will show a decline of the “good guys” (i.e., adequate levels of vitamins and normal neuronal transmitter balance) and an increase in the “bad guys” (i.e., food allergies, Lyme disease, heavy metals, environmental toxins, parasites, or neurotransmitter imbalance) to cause their symptoms. It can take more time to heal because it takes more time to get the “bad guys” out. CONCLUSION Today, we don’t want to just live longer; we want to increase healthspan and stay healthy during our lifetimes. Not only do we expect to watch over our children, but we want to be here for our grandchildren as well. We want to stay out of the nursing home, enjoy an active lifestyle, and be involved with our families. Use this manual to take control of your health and feel like yourself again. The issue is no longer just lifespan, but healthspan. TheLeeClinic.com Organic Medicine • 15

DR. WilliamM. Lee’s Thoughts in 1997 Our practice has evolved over the past 30 years, and we are convinced that there is much we can do to increase not just our lifespan but our healthspan. Dr. William put together this infographic in 1997 while in family practice. 16 • Organic Medicine TheLeeClinic.com

Chapter 1: Adrenal Dysfunction 45-Year-Old Female “Completely Played Out” Cortisol is the “fight or flight” hormone and when someone is under chronic stress (including overtraining), adrenal dysfunction can occur. During an acute stressor, cortisol and adrenaline go up, but then usually comes down. However, if under chronic stress, cortisol fails to come down properly. It can cause cortisol to rise in the morning or at night and become unbalanced. Elevated cortisol leads to fatigue, weight gain, sugar cravings, osteoporosis and high blood pressure. Over time, the brain either shuts off production of cortisol due to high levels or the adrenals simply stop producing the normal amounts, shown below. Low cortisol is compensated with elevated adrenaline, leading to caffeine cravings, sugar cravings, extreme fatigue, weight gain, dizziness on rising and low emotional reserve. It’s that “wired and tired” feeling. If cortisol is shown to be low all day through a saliva test, hormone replacement may be warranted. If so, we use the safest bio-identical hormones only at the time of day needed and for a short period of time. If a patient’s cortisol is found to be high, certain adaptogenic herbs may be used for recovery, to prevent total burnout. TheLeeClinic.com Organic Medicine • 17

Different Patterns of Cortisol These graphs demonstrate four different patterns of cortisol. We use saliva testing over a 12-hour period to give us insight into how to treat effectively. Normal Adrenal Exhaustion Two Ladies with Different Patterns of Cortisol Cortisol should be high upon wakening and taper down This patient is adrenally exhausted and is putting out + during the day. no cortisol. Two Ladies with Different Patterns of Cortisol High Stress at 3pm High Stress Insomnia This patient has difficulty sleeping when cortisol is + We often see cortisol spike when stress is high. high at night. 18 • Organic Medicine TheLeeClinic.com

Chapter 2: Women’s Hormones and Menopause The comment we hear from most of our patients is “I am not myself.” After testing, we use bio-identical hormones and use follow-up testing to monitor levels. We treat conservatively and adjust dosage as indicated by the patient’s symptoms and monitor regular testing. Low estrogen can manifest in women as hot flashes, night sweats, depression, fatigue, weight gain, incontinence, low libido and recurrent UTI’s. Low progesterone symptoms manifest as anxiety, irritability, insomnia, headaches and migraines. Low hormones can start as early as your twenties. In our practice, we use bioidentical hormones to replace deficiencies, and never use oral estrogens. Estriol is the weakest and safest estrogen and is prescribed as a topical cream, in combination with estradiol. Bioidentical progesterone can be either a pill or a cream. If replacement is needed, we will decide together which modality to use. Our goal is to bring the hormone levels back to the levels of natural hormones. We test hormones every 6 months to ensure proper levels for health. We have included a copy of the NIH study that was conducted in 2002 and was stopped before completion because of negative results. It is very important to note that this study used conjugated horse estrogens (Premarin) combined with progestin. These are chemicals, with hormone like effects, causing side effects and health consequences, which are very different from bioidentical hormones that alleviate symptoms and prevent disease. TheLeeClinic.com Organic Medicine • 19

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Chapter 3: Men’s Hormones and Andropause Testosterone declines roughly 2% a year in men, after the age of 30. And as testosterone falls, it is more likely to covert to estrogen, pushing their testosterone even farther down. Xenoestrogens in the environment (pesticides, hormones in animal products, phthalates, parabens, etc.) are worsening the situation, making testosterone levels in men lower each year, on average. Testosterone is important for linear thinking, a can-do attitude, muscle tone, hand-eye coordination, and sexual performance. Low testosterone and high estrogen can cause moodiness, gynecomastia, heart disease, osteoporosis, dementia and muscle weakness. One in every five patients we see in our office has high levels of estrogen, and low testosterone. Below are two examples of saliva tests that demonstrate low testosterone (first one) and high estrogen (second one). We utilize saliva testing (as with female patients) due to its accuracy. It allows us to see the free, unbound testosterone that is available to the body to use. Salivary testing is done every 6 months to ensure proper levels. 22 • Organic Medicine TheLeeClinic.com

Chapter 4: Natural Thyroid Replacement Thyroid issues are one of the most common problems we see in our practice. The diagram below is a depiction of some of the issues that can be seen with low thyroid and high thyroid. We test for thyroid function in nearly every patient, as it relates to so many functions in the body, and is very often not working correctly. What is your thyroid? It is a butterfly shaped organ located in the low and front of your neck that is in charge of your energy, cardiac output, blood pressure, skin turn over, hair growth, nail growth, mental function and metabolism. It receives input from your brain via the hormone TSH (thyroid stimulating hormone) to make T4 (thyroxine) which needs to be converted to T3 (triiodothyronine) which is what your body actually uses at the mitochondrial level. As we have explained before, conventional physicians just check the TSH (the phone call) and make sure that you are not “calling down too loudly”, but do not evaluate the actual energy output (free T3). If it is elevated, you are given levothyroxine or Synthroid, which is synthetic T4. Many medications, diseases, heavy metals, microbiome imbalances, stress and nutritional deficiencies inhibit the conversion of T4 to T3, resulting in continued fatigue, constipation, depression, hair loss, etc. We replace thyroid, if low, with natural desiccated thyroid, which contains T3 and T4, and have had much better results. With replacement, it can take 2 to 4 months to see improvements. And once they do, their motivation and energy returns, so they feel like themselves again. Along with those tests, we also evaluate for Hashimoto’s thyroiditis and Grave’s disease, two autoimmune disorders of the thyroid. Genetic and environmental factors influence both disease processes, therefore we focus on what we can fix, the environment. Avoidance of food allergens (which we can test for), fixing gut imbalances through stool testing and restoring normal flora with probiotics can improve symptoms. We will dive into autoimmune diseases later in this book. TheLeeClinic.com Organic Medicine • 23

Hypothyroid Example Lab Results This patient is a young women with low T3, “normal” TSH, no energy and low zinc levels. T3, FREE 2.2 pg/mL (2.9-4.6) <LOW T3 WITH NORMAL TSH> T4, FREE, Non-Dialysis 1.0 ng/dL (0.9-1.4) TSH 1.72 mIU/L (0.5-4.30) Deficiency < 10 ng/mL Insufficiency 10-30 ng/mL Sufficiency 30-100 ng/mL Toxicity > 100 ng/mL Selenium 103 ng/mL 70-150 Zinc L0.64 mcg/mL 0.66-1.10 <Zinc helps the conversion of T3 to T4 Vitamin B6 27 mcg/L 5-50 24 • Organic Medicine TheLeeClinic.com

Clinical Signs of Hypothyroidism HHaAiIrRLLoOsSsS LOLSoSssOoFfLlAaTtEerRaAlLeEyYeEbBrRoOwWs S OvHitvaaemriarilnll,so,hshasiirgihlnosstswreinsosw,moormehneenaivisys lcmoauewtsaeldTtob3xy,iclloiotwyw.theyrsotirdo, gesetrno,gepnr, oprgoegsestteerroonnee(i,nlorewlatiBonVtoitealemvatiendsm. Ianle hroergmuolnaers) B medicine we say- Rogaine, hair transplants and steroid injections into the scalp. I see more goiters in children because of low Iodine. We put Floride in toothepaste, chlorine in the watGerO, aInTdERbrSomCAinNe iRnEbSrUeaLdT. TFhReOseMdiLspOlaWceIIOodDinINe.E We see goiters due to low iodine levels. We put fluoride in toothpaste, chlorine in water, and bromide in bread. These chemicals displace iodine and can result in iodine deficiency. Goiters TTHYhRyOroIDidTRTErAeTaMtmENeTnBtEBFOefRoErAeNaDndAFATEfRter TheLeeClinic.com Organic Medicine • 25

Chapter 5: Vitamins and Minerals We test vitamin levels that are important for thyroid function, general health, cancer prevention, mental function, and longevity. If a patient is found to be low, we replace conservatively, and recheck every six months. It is very rare that any patient that comes to us is fully replete in vitamins. Even those eating a “good diet” have deficiencies. Our soil is depleted of nutrients, so the broccoli of today is not the broccoli of the 1950s. We strongly recommend that any vitamin supplementation is done with pharmaceutical-grade vitamins, to ensure potency and purity. 26 • Organic Medicine TheLeeClinic.com

The MTHFR Gene’s Importance The methylenetetrahydrofolate reductase (MTHFR) is a gene that is used to make an enzyme that is involved in methylation, which affects neurotransmitter and protein production, normal homocysteine and cholesterol levels and detoxification throughout the body. Those with this mutation have an increased risk for thrombotic events (heart attacks, strokes, pulmonary embolisms, deep vein thrombosis), fatigue, insomnia, miscarriages, severe treatment resistant depression or anxiety, cancer, diabetes, IBS, autoimmune diseases and cognitive decline. For those with a family history of any of the issues above, or have a history of those diseases, are evaluated for the mutation. It is done through a blood test which is usually covered by insurance. TheLeeClinic.com Organic Medicine • 27

Chapter 6: Autoimmune Disease and Increased Intestinal Permeability In an autoimmune disease, the body produces antibodies that attack its own tissues. Autoimmune diseases are one of the top 10 leading causes of death in girls and women of all ages up to 64 years of age. The National Institutes of Health (NIH) estimates that more than 53 million people can be suffering from an autoimmune disorder. These patients can be passed from one doctor to another as communications from one specialist to another can be less than perfect. There is emerging research that genetics, diet, increased cleanliness of the environment and toxins may play a role in the increase of autoimmune diseases. The majority of autoimmune diseases start with increased intestinal permeability or “leaky gut”. Some stressor (food allergy, gut bacteria imbalance, medications, stress, environmental toxins, infection, etc.) causes inflammation in the gut lining. Inflammation creates openings in the cell linings to allow for the immune cells to get to the area of infection or irritant. In the gut, when this happens, undigested food particles cross the gut lining where 70% of our immune system lies. Antibodies are created towards these food particles, which then cross react to attack certain tissues, shown below. So, instead of giving a steroid or injection, finding the direct cause of the autoimmune disease does best. There are many components to an autoimmune disease, but if a food allergy or gut imbalance is playing a large role, fixing that and avoiding the allergen can be a much better solution. TISSUES OF THE BODY AFFECTED BY AUTOIMMUNE DISEASE 28 • Organic Medicine TheLeeClinic.com

Examples of Autoimmune Disease RROoSsAacCeEaA LLuUpPuIsS FIBRFiObMroYmLyAlGagIAia Psoriasis on elbowPs SbeOfoRrIeAaSnIdSafter food allergy testing Hair LosBsefore After food Laollsesrogfylateral eyebrows testing and adjustment of diet TheLeeClinic.com Organic Medicine • 29 Hair loss in women is low T3, low estrogen, progesterone, low B Vitamins. In regular

Food Sensitivity Testing with ALCAT Food allergies are one of the most common causes and amplifiers of autoimmune disease. While avoiding gluten and dairy can provide some relief, those two are not always the only culprits. For most, a blood test looking at foods, chemicals, herbs or even molds, is needed. We use a blood test through ALCAT testing due to its higher accuracy that standard IGG testing. Food sensitivities will show up, whether or not you’ve ever eaten the food. The image below is a sample report for a patient. Patients are recommended to stay in the green for 6 months to a year, and then should slowly reintroduce foods once their gut heals. We will go into more in depth gut testing later on in the book, that can also be very beneficial for autoimmune diseases. 30 • Organic Medicine TheLeeClinic.com

Chapter 7: Lyme Disease and Coinfections Lyme disease and its coinfections can have a myriad of symptoms. The most common are fatigue, migratory joint pains, headaches, fevers, night sweats, and tremors. Recovery can be long, but we can help during the process. We usually start with antibiotics, a protocol to remove the biofilm and possibly IV vitamin C and low-dose naltrexone, if needed. Treatment is highly individualized and varies from patient to patient. Normalized thyroid, hormones, gut, and vitamins help with the immune system and support them along the way. TheLeeClinic.com Organic Medicine • 31

Biofilm Protocol for Chronic Infections The biofilm protocol is useful for lyme disease, candida overgrowth, mold, chronic viral infections, and cancer. We are a history of infections, both acute and chronic. These infections are bacterial, viral, fungal (yeast), and para- sitic. These microbes have adapted and been around since the beginning. They communicate and develop protective defenses. The most protective of them is called the biofilm. The situation has been made worse by heavy metals, drug resistant microbes, and environmental toxins that we acquire, even in utero. The biofilm that is formed by these microbes make it 100 to 1,000 times harder to treat an infection. It blocks the transfer of oxygen through the capillaries, which can make patients tired. To add, researchers have found that antibi- otics don’t work as well in the presence of biofilm. The biofilm protocol must be individually based and is used with antibiotics over a 3 to 4 month period. Below are the components of the protocol, dosing will change with each patient. • ACS – A colloidal silver spray that kills lyme, yeast, and the viruses that live in the biofilm. Activated Silver safely reduces the total body burden of all pathogens, bacterial, viral, spirochetes and fungi. • Nattokinase – A proteolytic enzyme that breaks up the biofilm, allowing antibiotics to work. • Grape Seed Extract – Studies have shown that GSE is effective against killing lyme without antibiotics. • Fiber – Lyme is excreted in the bile duct, as are mold and many toxins. The fiber aids in removing them, by stopping it from being reabsorbed in the GI tract. • Vitamin C– Overall, vitamin C helps protect against cellular damage, stimulates production of collagen, aids iron absorption and supports heart and immune system function, which is important. In respect to pathogens, the effect on the immune system is important for fighting pathogens. If oral antibiotics are effective in treating the infection, we usually recommend IV vitamin C for treatment. • Iodine – Iodine supports your thyroid (which improves your immune system), makes you more alkaline, and also works like an antibiotic. 32 • Organic Medicine TheLeeClinic.com

Chapter 8: Neurotransmitter Testing Our neurotransmitters rule our mood, energy, focus, sleep, and motivation. If there is any imbalance, it can cause a variety of psychological disorders, such as ADHD, ADD, anxiety, depression, insomnia and extreme fatigue. Knowing which neurotransmitters are in excess or which ones are lacking, can help guide a more constructive treat- ment. Supplementation, to help create a balance, would depend on the results and are highly individualized. Serotonin, GABA, glycine, glutamate, histamine, dopamine, norepinephrine, epinephrine are all measured through an at home urine test. Depending on levels, you are given a personalized supplement plan to help naturally balance your own natural neurotransmitter production. TheLeeClinic.com Organic Medicine • 33

Chapter 9: Gastrointestinal Studies Incredible research in the past 5 to 10 years has shown us the importance of gut health. More than 80% of our immune system resides in the gut, and we find the GI-MAP test is important for a variety of symptoms. Patients with abdominal pain, IBS, Crohn’s, constipation, gas, bloating, food allergies, SIBO, autoimmune diseases, autism, or diarrhea find this test very helpful. The GI-MAP test is a stool DNA/PCR analysis of viruses, bacteria, parasites, enzymes, microbiome balance (with sensitivities and resistances), H. Pylori & worms. This means, we can see if there are imbalances in the gut microbiome, which can direct our probiotics treatment, as well as see if there are any infections pathogens causing the issue. Enzyme levels show pancreatic health and guide supplementation. Testing also evaluates inflammatory markers and blood in the stool, which can help us understand the underlying disease process. Those with an autoimmune disease, food allergy or suspected “leaky gut”, zonulin levels can be measured to see if increased intestinal permeability is occurring. 34 • Organic Medicine TheLeeClinic.com

Chapter 10: Environmental Toxins & Heavy Metals 50-Year-Old Georgetown Lawyer with Exposure to Environmental Toxins There are no known “safe” levels of any heavy metal in the body. Heavy metal toxicity is damaging to DNA and proteins, accelerates aging and is very neurotoxic. By far, the most common heavy metals we see in our patients are lead and mercury. Lead is not just seen in the inner city, but in many people who live or have lived in an older city or home as a child. Older patients can have lead in their system due to leaded gasoline. High levels of mercury can be seen due to excessive consumption of tuna and may also be related to mercury dental fillings. We prefer chelation therapy using DMSA (a pill), since it can be done at home and does not disrupt daily life. Proper levels of zinc, glutathione, and adequate methylation are also monitored. TheLeeClinic.com Organic Medicine • 35

5-Year-Old Boy with Leukemia How does a 5-year-old boy test positive for toxins typically found in cosmetics? The answer is exposure to environmental toxins passed down from mother to child, in utero. These xenoestrogens in petrochemicals have also been implicated in breast, ovarian, uterine, prostate, and blood cancers. Once we know the toxins, we have protocols for helping the body detox from the burden. 36 • Organic Medicine TheLeeClinic.com

23-Year-Old Hairdresser These environmental toxins can also act like estrogens, which is why they are called xenoestrogens, and can be an occupational hazard for both men and women. Anyone who uses cosmetics can be affected. The majority of cosmetics contain parabens, benzenes, and a multitude of other toxins. Skincare, hair care, commercial meat & dairy, plastics, tampons, and fertilizers on fruits and veggies are all carrying different endocrine disruptors, making us unbalanced. These xenoestrogens are pushing down our natural protective & calming progesterone and our testosterone in men. The Lee Clinic has developed skin creams without parabens or petrochemicals, called Doctor + Daughter. They are available on our website. TheLeeClinic.com Organic Medicine • 37

36-Year-Old Golfer Here is another example of where environmental toxins can wreak havoc. Golf courses are filled with pesticides and fertilizers that can disrupt hormones and cause cancer. So, this is just another reason why we test for environmental toxins, detox those toxins, monitor hormone levels and recommend that patients read labels, eat organic when they can, don’t microwave in plastics & avoid hormones in meat. 38 • Organic Medicine TheLeeClinic.com

References TheLeeClinic.com Organic Medicine • 39

References Journal of the American Medical Association, Jan. 20 doi:10.1210/jcem.83.6.4843. 1999. Sapolsky R. Glucocorticoids, stress, and their adverse Regulatory Affairs Professional Society 8/11/2014 neurological effects: relevance to aging. Experimental Gerontology. 1999;34(6):721-732. doi:10.1016/s0531- Cortisol 5565(99)00047-9. Schoorlemmer R, Peeters G, van Schoor N, Lips Aardal-Eriksson E, Karlberg BE, Holm AC. Salivary P. Relationships between cortisol level, mortality Cortisol - an Alternative to Serum Cortisol and chronic diseases in older persons. Clinical Determinations in Dynamic Function Tests. Clinical Endocrinology. 2009;71(6):779-786. doi:10.1111/ Chemistry and Laboratory Medicine. 1998;36(4). j.1365-2265.2009.03552.x. doi:10.1515/cclm.1998.037. Scott L, Dinan T. The Neuroendocrinology of Chronic Baelestreri, R, Jacopino, GE , Foppiani, E , Elicio, N. Fatigue Syndrome: Focus on the Hypothalamic Aspects of Cortisol Metabolism in Obesity. Archives of Pituitary Adrenal Axi. Functional Neurology. 1999; 14: the Maragliano Pathology Clinic. 1968, 24(4):431-41 3-11. Bjorntorp, P.,and R. Rosmond. Obesity and Cortisol. Tilders F, Schmidt E, Hoogedijk W, Swaab D. Delayed Nutrition. 2000; 16(10): 924-936. effects of stress and immune activation. Best Practice & Chrousos G. The role of stress and the hypothalamic– Research Clinical Endocrinology & Metabolism. pituitary–adrenal axis in the pathogenesis of the 1999;13(4):523-540. doi:10.1053/beem.1999.0040. metabolic syndrome: neuro-endocrine and target tissue-related causes. Int J Obes Relat Metab Disord. Hormones 2000;24:S50-S55. doi:10.1038/sj.ijo.0801278. Doane L, Adam E. Loneliness and cortisol: Chmouliovsky L, Habicht F, James R, Lehmann T, Momentary, day-to-day, and trait associations. Campana A, Golay A. Beneficial effect of hormone Psychoneuroendocrinology. 2010;35(3):430-441. replacement therapy on weight loss in obese doi:10.1016/j.psyneuen.2009.08.005. menopausal women. Maturitas 1999;32(3):147–153. Epel E, Lapidus R, McEwen B, Brownell K. Stress doi:10.1016/s0378-5122(99)00037-7. may add bite to appetite in women: a laboratory Mosconi P, Donati S, Colombo C, Mele A, Liberati study of stress-induced cortisol and eating behavior. A, Satolli R. Informing women about hormone Psychoneuroendocrinology. 2001;26(1):37-49. replacement therapy: the consensus conference doi:10.1016/s0306-4530(00)00035-4. statement. BMC Women’s Health. 2009;9(1). de Kloet E, Oitzl M, Joëls M. Stress and cognition: doi:10.1186/1472-6874-9-14. are corticosteroids good or bad guys?. Trends in Rouzier, N. How to Achieve Healthy Aging:Why Neurosciences. 1999;22(10):422-426. doi:10.1016/ Everyone Should Replace Hormones, A Review of the s0166-2236(99)01438-1. Medical Literature. 2007; 213- 250. Jefferies, WM. Cortisol and immunity. Medical Wright J. Bio-Identical Steroid Hormone Replacement: Hypotheses. 1991; 34(3):198-208. Selected Observations from 23 Years of Clinical and Mills, EJ. The Endocrinology of Stress. Aviation and Laboratory Practice. Annals of the New York Academy Space Environmental Medicine. 1985; 56(7):642-50 of Sciences. 2005;1057(1):506-524. doi:10.1196 O’Connor T, et al.. The stress response and the annals.1356.039. hypothalamic-pituitary-adrenal axis: from molecule to melancholia. QJM. 2000;93(6):323-333. doi:10.1093/ Estriol: Why Estriol (E3) qjmed/93.6.323. Rosmond R, Dallman M, Björntorp P. Stress-Related Follingstad A. H. Estriol: the forgotten estrogen? JAMA Cortisol Secretion in Men: Relationships with 1978; 239: 29-30. Abdominal Obesity and Endocrine, Metabolic and Head, KA. Estriol: Safety and Efficacy. Altern Med Rev Hemodynamic Abnormalities1. The Journal of Clinical 1998; 3: 101-113. Endocrinology & Metabolism. 1998;83(6):1853-1859. Holtorf K. The Bioidentical Hormone Debate: Are Bioidentical Hormones (Estradiol, Estriol, 40 • Organic Medicine TheLeeClinic.com

and Progesterone) Safer or More Efficacious Than doi:10.1016/0303-7207(94)90096-5. Commonly Used Synthetic Versions in Hormone Kano H, Hayashi T, Sumi D et al. Estriol retards and Replacement Therapy?. Postgraduate Medicine. stabilizes atherosclerosis through an NO-mediated 2009;121(1):73-85. doi:10.3810/pgm.2009.01.1949. system. Life Sciences. 2002;71(1):31-42. doi:10.1016/ Antonijevic I, Stalla G, Steiger A. Modulation of the s0024-3205(02)01564-3. sleep electroencephalogram by estrogen replacement Kim S, Liva SM, Dalal MA, Verity MA, Voskuhl RR. in postmenopausal women. American Journal of Estriol ameliorates autoimmune demyelinating disease: Obstetrics and Gynecology. 2000;182(2):277-282. Implications for multiple sclerosis. Neurology 1999; doi:10.1016/s0002-9378(00)70211-0. 52(6):1230–1230. doi:10.1212/wnl.52.6.1230. Barnes R, et al.. Pharmacology of Estrogens. In: Lobo Lauritzen, C., and S. Velibese. Clinical Investigations of R, editor. Treatment of the Postmenopausal Woman: a Long acting Oestriol (Polyoestriol Phosphate). Acta Basic and Clinical Aspects. New York: Raven Press, Endocrinologica 38 1961; 38: 73-87. Ltd.; 1994. pp. 57–68. Legros S, et al. Endocrine prophylaxis of breast cancer Castelo-Branco C, Duran M, González-Merlo J. with cyclic estrogen and progesterone. International Skin collagen changes related to age and hormone Surgery. 1966; 45(5): 496-503. replacement therapy. Maturitas. 1992;15(2):113-119. Lemon H. Antimammary carcinogenic doi:10.1016/0378-5122(92)90245-y. activity of 17-alpha-ethinyl estriol. Cancer. Cavalieri E, Rogan E. Catechol Quinones of Estrogens 1987;60(12):2873-2881. doi:10.1002/1097- in the Initiation of Breast, Prostate, and Other 0142(19871215)60:12<2873::aid- Human Cancers: Keynote Lecture. Annals of the New cncr2820601204>3.0.co;2-b. York Academy of Sciences. 2006;1089(1):286-301. Lemon HM. Clinical and experimental aspects of the doi:10.1196/annals.1386.042. anti-mammary carcinogenic activity of estriol. Frontier Colditz G, Rosner B. Use of estrogen plus progestin Horm Research. 1977; (5): 155-73. in associated with greater increase in breast cancer risk Maheux R, Naud F, Rioux M et al. A randomized, than estrogen alone. Am J Epidemiol. 1998; 147: S45. double-blind, placebo-controlled study on the effect of Effects of estrogen or estrogen/progestin regimens on conjugated estrogens on skin thickness. International heart disease risk factors in postmenopausal women. Journal of Gynecology & Obstetrics. 1994;47(2):198. The Postmenopausal Estrogen/Progestin Interventions doi:10.1016/0020-7292(94)90388-3. (PEPI) Trial. The Writing Group for the PEPI Melamed M, Castaño E, Notides AC, Sasson Trial. JAMA: The Journal of the American Medical S. Molecular and Kinetic Basis for the Mixed Association. 1995;273(3):199-208. doi:10.1001/ Agonist/Antagonist Activity of Estriol. Molecular jama.273.3.199. Endocrinology 1997;11(12):1868–1878. doi:10.1210/ Hayashi T, Ito I, Kano H, Endo H, Iguchi A. Estriol mend.11.12.0025. (E3) Replacement Improves Endothelial Function and Olsson H, Ingvar C, Bladström A. Hormone Bone Mineral Density in Very Elderly Women. The replacement therapy containing progestins and given Journals of Gerontology Series A: Biological Sciences continuously increases breast carcinoma risk in and Medical Sciences. 2000;55(4):B183-B190. Sweden. Cancer. 2003;97(6):1387-1392. doi:10.1002/ doi:10.1093/gerona/55.4.b183. cncr.11205. Pathophysiologic consideration in the Head KA. Estriol: safety and efficacy. Alt MEd Rec. treatment of menopausal patients with estrogens: 1998; 3(2): 101-113. the role of estriol in the prevention of mammary Jeng MH, Parker CJ, Jordan VC. Estrogenic potential carcinoma. Acta Enocrinol Suppl (Copenhagen). 1980; of progestins in oral contraceptives to stimulate human 233: 155-73. breast cancer cell proliferation. Cancer Res. 1992; Peterson M, Holbrook J, Hales D, Smith N, Staker L. 52(23): 6539-6546. Contributions of the History, Physical Examination, Kalkhoven E, Kwakkenbos-Isbrücker L, de Laat S, and Laboratory Investigation in Making Medical van der Saag P, der Burg B. Synthetic progestins Diagnoses. Obstetrical & Gynecological Survey. induce proliferation of breast tumor cell lines via 1992;47(10):711-712. doi:10.1097/00006254- the progesterone or estrogen receptor. Molecular 199210000-00013. and Cellular Endocrinology. 1994;102(1-2):45-52. Organic Medicine • 41 TheLeeClinic.com

Pompili A, Arnone B, D’Amico M, Federico P, Gasbarri Taylor, M. Unconventional estrogens: Estriol, biest, and A. Evidence of estrogen modulation on memory triest. Clin Obstet Gynecol 2001; 44: 864-879. processes for emotional content in healthy young Tzingounis VA, Aksu MF , and Greenblatt RB. The women. Psychoneuroendocrinology. 2016;65:94-101. Significance of Oestriol in the Management of the Post- doi:10.1016/j.psyneuen.2015.12.013. menopause. Acta Endocrinologica 1980; 235: 45-50. Punnonen R, Vaajalahti P, Teisala K. Local oestriol Utian WH. The Place of Oestriol Therapy after treatment improves the structure of elastic fibers in the Menopause. Acta Endocrinologica 1980; 235: 51-56. skin of postmenopausal women. Ann Chir Gynaecol Vooijs Geurts T. Review of the endometrial safety Suppl. 1987; 202: 39-41. during intravaginal treatment with estriol. European Raz R, Stamm WE. A Controlled Trial of Intravaginal Journal of Obstetrics & Gynecology and Reproductive Estriol in Postmenopausal Women with Recurrent Biology. 1995;62(1):101-106. doi:10.1016/0301- Urinary Tract Infections. N Eng J Med 1993; 329(11): 2115(95)02170-c. 753-756. Wise P, Dubal D, Wilson M, Rau S, Liu Y. Estrogens: Santen R, Pinkerton J, McCartney C, Petroni G. Risk Trophic and Protective Factors in the Adult Brain. of Breast Cancer with Progestins in Combination Frontiers in Neuroendocrinology. 2001;22(1):33-66. with Estrogen as Hormone Replacement Therapy. The doi:10.1006/frne.2000.0207. Journal of Clinical Endocrinology & Metabolism. Rossouw JE, Anderson GL, et al. Writing Group for 2001;86(1):16-23. doi:10.1210/jcem.86.1.7269. the Women’s Health Initiative Investigators. Risks Schiff I, Wentworth B, Kroos B, Ryan KJ, and Benefits of Estrogen Plus Progestin in Healthy Tulchinsky D. Effect of Estriol Administration on the Postmenopausal Women: Principal Results From the Hypogonadal Woman. Fertil Steril. 1978; 30(3): 278- Women’s Health Initiative Randomized Controlled 282. Trial. JAMA: The Journal of the American Medical Shaywitz S, et al. Effect of Estrogen on Brain Association. 2002;288(3):321-333. doi:10.1001/ Activation Patterns in Postmenopausal Women During jama.288.3.321. Working Memory Tasks. JAMA. 1999;281(13):1197. Yang TS, Tsan SH, Chang SP, Ng HT. Efficacy and doi:10.1001/jama.281.13.1197. safety of estriol replacement therapy for climacteric Shen L, Qiu S, Chen Y et al. Alkylation of women. Chin Med J (Taipei) 1995; 55: 386-391. 2‘-Deoxynucleosides and DNA by the Premarin Metabolite 4-Hydroxyequilenin Semiquinone Radical. Estrogen in Men Chem Res Toxicol. 1998;11(2):94-101. doi:10.1021/ tx970181r. Faloon W. Dangers of Excess Estrogen in the Sicotte N, Liva S, Klutch R et al. Treatment of multiple Aging Male - Life Extension. LifeExtensioncom. sclerosis with the pregnancy hormone estriol. Annals 2016. Available at: http://www.lifeextension.com/ of Neurology. 2002;52(4):421-428. doi:10.1002/ magazine/2008/11/dangers-of-excess-estrogen-in-the- ana.10301. aging-male/page-01. Accessed August 2, 2016. Stephens MB. Estrogen-progestin increases breast Hoffman M, DeWolf W, Morgentaler A. Is low cancer risk. J Fam Pract. 2000; 49(4): 301-302. serum free testosterone a marker for high grade Takahashi K, et al. Safety and efficacy of oestriol for prostate cancer?. The Journal of Urology. 2000:824. symptoms of natural or surgically induced menopause. doi:10.1097/00005392-200003000-00027. Human Reproduction. 2000;15(5):1028-1036. Ho C, Nanda J, Chapman K, Habib F. Oestrogen doi:10.1093/humrep/15.5.1028. and benign prostatic hyperplasia: effects on stromal Takahashi K, Manabe A, Okada M, Kurioka H, cell proliferation and local formation from androgen. Kanasaki H, Miyazaki K. Efficacy and safety of oral Journal of Endocrinology. 2008;197(3):483-491. estriol for managing postmenopausal symptoms. doi:10.1677/joe-07-0470. Maturitas. 2000;34(2):169-177. doi:10.1016/s0378- Singh P, Matanhelia S, Martin F. A potential paradox 5122(99)00108-5. in prostate adenocarcinoma progression: Oestrogen as the initiating driver. European Journal of Cancer. 2008;44(7):928-936. doi:10.1016/j.ejca.2008.02.051. 42 • Organic Medicine TheLeeClinic.com

Tivesten Å, Hulthe J, Wallenfeldt K, Wikstrand J, doi:10.1016/s0140-6736(88)92837-1. Ohlsson C, Fagerberg B. Circulating Estradiol Is an Bolaji I, Grimes H, Mortimer G, Tallon D, Fottrell Independent Predictor of Progression of Carotid Artery P, O’Dwyer E. Low-dose progesterone therapy Intima-Media Thickness in Middle-Aged Men. The in oestrogenised postmenopausal women: effects Journal of Clinical Endocrinology & Metabolism. on plasma lipids, lipoproteins and liver function 2006;91(11):4433-4437. doi:10.1210/jc.2006-0932. parameters. European Journal of Obstetrics & Tivesten Å, Mellström D, Jutberger H et al. Low Serum Gynecology and Reproductive Biology. 1993;48(1):61- Testosterone and High Serum Estradiol Associate 68. doi:10.1016/0028-2243(93)90054-g. With Lower Extremity Peripheral Arterial Disease Bowman BMiller S. Elevated progesterone during in Elderly Men. Journal of the American College of pseudopregnancy may prevent bone loss associated with Cardiology. 2007;50(11):1070-1076. doi:10.1016/j. low estrogen. J Bone Miner Res. 2009;11(1):15-21. jacc.2007.04.088. doi:10.1002/jbmr.5650110104. Burnett C, Reddi A. Influence of estrogen and Progesterone progesterone on matrix-induced endochondral bone formation. Calcified Tissue International. Anasti J, Leonetti H, Wilson K. Topical Progesterone 1983;35(1):609-614. doi:10.1007/bf02405102. Cream Has Antiproliferative Effect on Estrogen- Cicinelli E, Petruzzi D, Scorcia P, Resta L. Effects Stimulated Endometrium. Obstetrics & Gynecology. of progesterone administered by nasal spray on the 2001;97(Supplement):10S. doi:10.1097/00006250- human postmenopausal endometrium. Maturitas. 200104001-00022. 1993;18(1):65-72. doi:10.1016/0378- 5122(93)90030- Arafat E, Hargrove J, Maxson W, Desiderio D, Wentz l. A, Andersen R. Sedative and hypnotic effects of oral Collaborative Group on Hormonal Factors in Breast administration of micronized progesterone may be Cancer. Breast cancer and hormone replacement mediated through its metabolites. American Journal of therapy: collaborative reanalysis of data from 51 Obstetrics and Gynecology. 1989;159(5):1203-1209. epidemiological studies of 52 705 women with breast doi:10.1016/0002-9378(88)90448-6. cancer and 108 411 women without breast cancer. The Attia G. Progesterone Receptor Isoform A But Not Lancet. 1997;350(9084):1047-1059. doi:10.1016/ B Is Expressed in Endometriosis. Journal of Clinical s0140-6736(97)08233-0. Endocrinology & Metabolism. 2000;85(8):2897-2902. Cooper A, Spencer C, Whitehead M, Ross D, Barnard doi:10.1210/jc.85.8.2897. G, Collins W. Systemic absorption of progesterone Formby B, Wiley TS. Bcl-2, survivin and variant CD44 from Progest cream in postmenopausal women. The v7-v10 are downregulated and p53 is upregulated in Lancet. 1998;351(9111):1255-1256. doi:10.1016/ breast cancer cells by progesterone: inhibition of cell s0140-6736(05)79323-5. growth and induction of apoptosis. Mol Cell Biochem. Cowan LD, et al. Breast cancer incidence in women 1999; 202(1-2): 53-61. with a history of progesterone deficiency. American Formby B, Wiley TS. Progesterone Inhibits Growth Journal of Epidemiology. 1981; 114(2): 209-217. and Induces Apoptosis in Breast Cancer Cells: Inverse Cromer B. Effects of Hormonal Contraceptives on Effect on Expression of p53 and Bcl-2. Annals of Bone Mineral Density. Drug Safety. 1999;20(3):213- Clinical Laboratory Sci. 1998; 28(6): 360-9. 222. doi:10.2165/00002018-199920030-00002. Bäckström T. Epileptic Seizures in Women Related Cummings SR, et al. Risk Factors for Hip Fracture to Plasma Estrogen And Progesterone During the in White Women. New England Journal of Medicine Menstrual Cycle. Acta Neurologica Scandinavica. 1995; 332: 767-773. 1976;54(4):321-347. doi:10.1111/j.1600-0404.1976. Dalton K. Progesterone Suppositories And Pessaries tb04363.x.Barengolts E, Gajardo H, Rosol T et al. In The Treatment Of Menstrual Migraine. Headache. Effects of progesterone on postovariectomy bone loss in 1973;12(4):151-159. doi:10.1111/j.1526-4610.1973. aged rats. J Bone Miner Res. 2009;5(11):1143-1147. hed1204151.x. doi:10.1002/jbmr.5650051109. Beynon H, Garbett N, Barnes P. Severe Premenstrual Dalton K. The premenstrual syndrome and Exacerbations of Asthma: Effect of Intramuscular Progesterone. The Lancet. 1988;332(8607):370-372. TheLeeClinic.com Organic Medicine • 43

progesterone therapy. London. 2d ed. 1984. menstrual disorders. Neurology. 1986;36(12):1607- Darj E, Axelsson O, Carlstrom K, Nilsson S, Schoultz 1607. doi:10.1212/wnl.36.12.1607. B. Liver Metabolism During Treatment with Estradiol Herzog A. Progesterone therapy in women with and Natural Progesterone. complex partial and secondary generalized seizures. Gynecological Endocrinology. 1993;7(2):111-114. Neurology. 1995;45(9):1660-1662. doi:10.1212/ doi:10.3109/09513599309152489. wnl.45.9.1660. Dennerstein L, Spencer-Gardner C, Gotts G, Brown Koenig H, Schumacher M, Ferzaz B et al. Progesterone J, Smith M, Burrows G. Progesterone and the synthesis and myelin formation by Schwann cells. premenstrual syndrome: a double blind crossover Science. 1995;268(5216):1500-1503. doi:10.1126/ trial. BMJ. 1985;290(6482):1617-1621. doi:10.1136/ science.7770777. bmj.290.6482.1617. Lancel M, Faulhaber J, Holsboer F, Rupprecht R. The Desai H. Natural Progesterone Therapy in the GABA A receptor antagonist picrotoxin attenuates most Treatment of Preeclampsia. sleep changes induced by progesterone. Ellison P. Measurements of Salivary Progesterone. Ann Psychopharmacology. 1999;141(2):213-219. NY Acad Sci. 1993;694 (1 Saliva as a D):161-175. doi:10.1007/s002130050827. doi:10.1111/j.1749-6632.1993.tb18350.x. Lane G, Siddle N, Ryder T, Pryse-Davies J, King Fitzpatrick L, Good A. Micronized progesterone: R, Whitehead M. Dose dependent effects of oral clinical indications and comparison with current progesterone on the oestrogenised postmenopausal treatments. Fertility and Sterility. 1999;72(3):389-397. endometrium. BMJ. 1983;287(6401):1241-1245. doi:10.1016/s0015-0282(99)00272-1. doi:10.1136/bmj.287.6401.1241. Freeman E, Purdy R, Coutifaris C, Rickels K, Paul S. Landau Rlugibihl K. Inhibition Of The Sodium- Anxiolytic Metabolites of Progesterone: Correlation Retaining Influence Of Aldosterone By Progesterone *†. with Mood and Performance Measures following The Journal of Clinical Endocrinology & Metabolism. Oral Progesterone Administration to Healthy Female 1958;18(11):1237-1245. doi:10.1210/jcem-18-11- Volunteers. Neuroendocrinology. 1993;58(4):478-484. 1237. doi:10.1159/000126579. Laidlaw J, Ruse J, Gornall A. The Influence of estrogen Gambrell, RD. Use of Progestogens in Post- and progesterone on aldosterone excretion. The Menopausal Women. International Journal of Fertility Journal of Clinical Endocrinology & Metabolism. 1989; 34: 315-321. 1962;22(2):161-171. doi:10.1210/jcem-22-2-161. Greene R, Dalton K. The Premenstrual Syndrome. Lee J. Is natural progesterone the missing link in British Medical Journal 1 1953: 1004. osteoporosis prevention and treatment?. Medical Grünewald R, Aliberti V, Panayiotopoulos C. Hypotheses. 1991;36(2):178. doi:10.1016/0306- Exacerbation of typical absence seizures by 9877(91)90267-3. progesterone. Seizure. 1992;1(2):137-138. Lee J, John R. Natural Progesterone: The Multiple doi:10.1016/1059-1311(92)90012-p. Roles of a Remarkable Hormone. Rev. ed. Phoenix: Hanley S. Asthma variation with menstruation. British BLL Publishing, 2000. Journal of Diseases of the Chest. 1981;75(3):306-308. Leonetti H. Transdermal progesterone cream for doi:10.1016/0007-0971(81)90010-3. vasomotor symptoms and postmenopausal bone Harden C, Pulver M, Ravdin L, Jacobs A. The Effect loss. Obstetrics & Gynecology. 1999;94(2):225- of Menopause and Perimenopause on the Course 228. doi:10.1016/s0029-7844(99)00266-5. de of Epilepsy. Epilepsia. 1999;40(10):1402-1407. Lignières B. Oral micronized progesterone. Clinical doi:10.1111/j.1528-1157.1999.tb02012.x. Therapeutics. 1999;21(1):41-60. doi:10.1016/s0149- Herzog A. Intermittent progesterone therapy and 2918(00)88267-3. frequency of complex partial seizures in women with Mauvais-Jarvis P, Sitruk-Ware R, Kuttenn F. Luteal phase defect and breast cancer genesis. Breast Cancer 44 • Organic Medicine TheLeeClinic.com

Res Tr. 1982;2(2):139-150. doi:10.1007/bf01806450. growth in human breast carcinoma cells. Cancer Res. Martorano JT. Differentiating between Natural 1990; 50(24): 7858-7862. Progesterone and Synthetic Progestins: Clinical Prior J. Progesterone as a Bone-Trophic Hormone. Implications of Premenstrual Syndrome and Endocrine Reviews. 1990;11(2):386-398. doi:10.1210/ Perimenopause Management. Comprehensive Therapy. edrv-11-2-386. 1998; 24(6-7): 336-9. Richards-Kustan CJ, Kase NG. Diagnosis and Maxson WS, et al. Bioavailability of Oral Micronized Management of Perimenopausal and Postmenopausal Progesterone. Fertil Steril. 1985; 44(5): 622-6. Bleeding. Obstet Gynecol Clin North Am. 1987; Miyagawa K, Rosch J, Stanczyk F, Hermsmeyer K. 14(1): 169-89. Medroxyprogesterone Interferes With Ovarian Steroid Roof R, Duvdevani R, Stein D. Gender influences Protection Against Coronary Vasospasm. Obstetrical outcome of brain injury: progesterone plays a protective & Gynecological Survey. 1997;52(9):561-562. role. Brain Research. 1993;607(1-2):333-336. doi:10.1097/00006254-199709000-00020. doi:10.1016/0006-8993(93)91526-x. Miles R, Paulson R, Lobo R, Press M, Dahmoush Rupprecht R, Holsboer F. Neuroactive steroids: L, Sauer M. Pharmacokinetics and endometrial mechanisms of action and neuropsychopharmacological tissue levels of progesterone after administration perspectives. Trends in Neurosciences. 1999;22(9):410- by intramuscular and vaginal routes: a comparative 416. doi:10.1016/s0166-2236(99)01399-5. study**Presented at the 40th Annual Meeting of Rylance P, Brincat M, Lafferty K et al. Natural the Pacific Coast Fertility Society, Indian Wells, progesterone and antihypertensive action. BMJ. California, April 8 to 12, 1992. Fertility and 1985;290(6461):13-14. doi:10.1136/bmj.290.6461.13. Sterility. 1994;62(3):485-490. doi:10.1016/s0015- Sampson G. Premenstrual syndrome: a double-blind 0282(16)56935-0. controlled trial of progesterone and placebo. The British Journal of Psychiatry. 1979;135(3):209-215. Mohr P, Wang D, Gregory W, Richards M, Fentiman doi:10.1192/bjp.135.3.209. I. Serum progesterone and prognosis in operable Segaloff A. Inhibition by progesterone of radiation- breast cancer. Br J Cancer. 1996;73(12):1552-1555. estrogen induced mammary cancer in the rat. Cancer doi:10.1038/bjc.1996.292. Res. 1973; 33(5): 1136-1137. Moyer D, Lignieres B, Driguez P, Pez J. Prevention Shaywitz S, et al. Effect of Estrogen on Brain of endometrial hyperplasia by progesterone during Activation Patterns in Postmenopausal Women During long-term estradiol replacement: influence of bleeding Working Memory Tasks. JAMA. 1999;281(13):1197. pattern and secretory changes**Supported in part by doi:10.1001/jama.281.13.1197. Besins-Iscovesco Laboratories, Paris, France. Fertility Shi-Zhong Bu, De-Ling Yin, Xiu-Hai Ren, Li-Zhen and Sterility. 1993;59(5):992-997. doi:10.1016/s0015- Jiang, et al. Progesterone Induces Apoptosis and 0282(16)55916-0. Up-regulation of p53 Expression in Human Ovarian Norman T, Morse C, Dennerstein L. Comparative Carcinoma Cell Lines. Am Cancer Soc 1997; 1944- bioavailability of orally and vaginally administered 1950. progesterone**Supported by Hoechst, Hounslow, Simon J. Micronized Progesterone. Clinical United Kingdom. Fertility and Sterility. Obstetrics and Gynecology. 1995;38(4):902-914. 1991;56(6):1034-1039. doi:10.1016/s0015- doi:10.1097/00003081-199538040-00024. 0282(16)54713-x. Sitruk-Ware R, et al. Oral Micronized Progesterone. O’leary P, Feddema P, Chan K, Taranto M, Smith M, Contraception 1987; 36: 373. Evans S. Salivary, but not serum or urinary levels of Snow-Harter C. Bone health and prevention of progesterone are elevated after topical application of osteoporosis in active and athletic women. Maturitas. progesterone cream to pre-and postmenopausal women. 1995;21(2):159. doi:10.1016/0378-5122(95)90001-2. Clin Endocrinol. 2000;53(5):615-620. doi:10.1046/ j.1365-2265.2000.01130.x. Papa V, Reese CC, Brunetti A, et al. Progestins increase insulin receptor content and insulin stimulation of TheLeeClinic.com Organic Medicine • 45

Stephenson K, et al. Topical progesterone cream does dysfunction. Clin Endocrinol. 2003;58(5):632-638. not increase thrombotic and inflammatory factors in doi:10.1046/j.1365-2265.2003.01764.x. postmenopausal women. Blood. 2004; 104: Abstract Bancroft J, Wu, F. Changes in erectile responsiveness 5317. during androgen replacement therapy. Arch Sex Behav. Tavaniotou A. Comparison between different routes of 1983;12(1):59-66. doi:10.1007/bf01542116. progesterone administration as luteal phase support in Bardin CW, et al. Androgens: risks and benefits. Journal infertility treatments. Human Reproduction Update. of Clinical Endocrinology and Metabolism, 1991; 2000;6(2):139-148. doi:10.1093/humupd/6.2.139. 73(1): 4-7. van der Burg B, Kalkhoven E, Isbrücker L, de Laat S. Baroiller J, D’Cotta H, Saillant E. Environmental Effects of progestins on the proliferation of estrogen- Effects on Fish Sex Determination and Differentiation. dependent human breast cancer cells under growth Sexual Development. 2009;3(2-3):118-135. factor-defined conditions. The Journal of Steroid doi:10.1159/000223077. Biochemistry and Molecular Biology. 1992;42(5):457- Basaria S. Anabolic-Androgenic Steroid Therapy in 465. doi:10.1016/0960-0760(92)90257-j. the Treatment of Chronic Diseases. Journal of Clinical Vuorento T, Lahti A, Hovatta O, Huhtaniemi Endocrinology & Metabolism. 2001;86(11):5108- I. Daily measurements of salivary progesterone 5117. doi:10.1210/jc.86.11.5108. reveal a high rate of anovulation in healthy Bhasin S, Bremner WJ. Emerging issues in androgen students. Scandinavian Journal of Clinical and replacement therapy. Journal of Clinical Endocrinology Laboratory Investigation. 1989;49(4):395-401. and Metabolism 1997; 82(1): 3-8. doi:10.3109/00365518909089113. Callewaert F, Boonen S, Vanderschueren D. Sex steroids Ward D. Natural Progesterone: The ‘Feel-Good’ and the male skeleton: a tale of two hormones. Trends Hormone. 2015. in Endocrinology & Metabolism. 2010;21(2):89-95. Wren B, McFarland K, Edwards L, et al. Effect doi:10.1016/j.tem.2009.09.002. of sequential transdermal progesterone cream Chamnes SL, et al. The effect of Androgen on nitric on endometrium, bleeding pattern, and plasma oxide synthase in the male reproductive tract of the rat. progesterone and salivary progesterone levels Fertility and Sterility. 1995; 62(5): 1101-1107. inpostmenopausal women. Climacteric. 2000;3(3):155- Channer K. Cardiovascular effects of testosterone: 160. doi:10.1080/13697130008500109. implications of the “male menopause”?. Heart. 2003;89(2):121-122. doi:10.1136/heart.89.2.121. Testosterone/DHEA Chen C, et al. Endogenous sex hormones and prostate cancer risk: a case control study nested with the Anderson J, May H, Lappé D et al. Impact of carotene and retinol efficacy trial. Cancer Epidemiol Testosterone Replacement Therapy on Myocardial Biomarkers Prev. 2003; 12(12): 1410-6. Infarction, Stroke, and Death in Men With Low Cherrier M, Asthana S, Plymate S et al. Testosterone Testosterone Concentrations in an Integrated supplementation improves spatial and verbal memory Health Care System. The American Journal of in healthy older men. Neurology. 2001;57(1):80-88. Cardiology. 2016;117(5):794-799. doi:10.1016/j. doi:10.1212/wnl.57.1.80. amjcard.2015.11.063. Coffey D. Similarities of prostate and breast cancer: Arlt W, et al. Dehydroepiandrosterone replacement Evolution, diet, and estrogens. Urology. 2001;57(4):31- in women with adrenal insufficiency. New England 38. doi:10.1016/s0090-4295(00)00938-9. Journal of Medicine. 1999; 341(14): 1013-1020. Edwards EA, Hamilton JB, Duntley SQ. Testosterone Arver S, Dobs A, Meikle A, Allen R, Sanders S, Propionate as a Therapeutic Agent in Patients with Mazer N. Improvement of Sexual Function in Organic Disease of the Peripheral Vessels. New England Testosterone Deficient Men Treated for 1 Year with Journal of Medicine N Engl J Med 1939;220(21):865– a Permeation Enhanced Testosterone Transdermal 865. doi:10.1056/nejm193905252202103. System. The Journal of Urology. 1996:1604-1608. Ellem S, Wang H, Poutanen M, Risbridger G. doi:10.1097/00005392-199605000-00020. Aversa A, Isidori A, Spera G, Lenzi A, Fabbri A. Androgens improve cavernous vasodilation and response to sildenafil in patients with erectile 46 • Organic Medicine TheLeeClinic.com

Increased Endogenous Estrogen Synthesis Leads to Hogervorst E, Bandelow S, Combrinck M, Smith A. the Sequential Induction of Prostatic Inflammation Low free testosterone is an independent risk factor (Prostatitis) and Prostatic Pre-Malignancy. The for Alzheimer’s disease. Experimental Gerontology. American Journal of Pathology. 2009;175(3):1187- 2004;39(11-12):1633-1639. doi:10.1016/j. 1199. doi:10.2353/ajpath.2009.081107. exger.2004.06.019. Elmlinger M, Dengler T, Weinstock C, Kuehnel W. Jackson JA, Riggs MW, Spiekerman AM. Testosterone Endocrine Alterations in the Aging Male. Clinical Deficiency As a Risk Factor for Hip Fractures Chemistry and Laboratory Medicine. 2003;41(7). in Men: A Case-Control Study. The American doi:10.1515/cclm.2003.142. Journal of the Medical Sciences 1992;304(1):4–8. English K. Men with coronary artery disease have lower doi:10.1097/00000441-199207000-00003. levels of androgens than men with normal coronary Jankowska E, Biel B, Majda J et al. Anabolic angiograms. European Heart Journal. 2000;21(11):890- Deficiency in Men With Chronic Heart Failure: 894. doi:10.1053/euhj.1999.1873. Prevalence and Detrimental Impact on Survival. Erfurth EMT, Hagmar LE. Decreased serum Circulation. 2006;114(17):1829-1837. doi:10.1161/ testosterone and free triiodothyronine levels in circulationaha.106.649426. healthy middle-aged men indicate an age effect at the Jones R, Nettleship J, Kapoor D, Jones H, Channer pituitary level. European Journal of Endocrinology K. Testosterone and Atherosclerosis in Aging 1995;132(6):663–667. doi:10.1530/eje.0.1320663. Men. American Journal of Cardiovascular Drugs. Feldman HA. Low Dehydroepiandrosterone and 2005;5(3):141-154. doi:10.2165/00129784- ischemic heart disease in middle-aged men: prospective 200505030-00001. results from the Massachusetts Male Aging Study. Kaiser FE, Viosca SP, Morley JE, Mooradian AD, American Journal of Epidemiology 2001;153(1):79–89. Davis SS, Korenman SG. Impotence and Aging: doi:10.1093/aje/153.1.79. Clinical and Hormonal Factors. Journal of the Findlay J, Place V, Snyder P. Treatment of Primary American Geriatrics Society 1988;36(6):511–519. Hypogonadism in Men by the Transdermal doi:10.1111/j.1532-5415.1988.tb04021.x. Administration of Testosterone*. The Journal of Clinical Kay-Tee K, et al. Lower Endogenous Androgens Predict Endocrinology & Metabolism. 1989;68(2):369-373. Central Adiposity in Men. Annals of Epidemiology doi:10.1210/jcem-68-2-369. 1992. 2(5): 675-682. Gann PH, Hennekens CH, Grodstein F, Stampfer Lichtenstein MJ, et al. Plasma Testosterone and Serum MJ, Longcope C, Verhoek-Oftedahl W. A prospective Lipids in Male Survivors of Myocardial Infarction. study of plasma hormone levels, nonhormonal factors, American Journal of Epidemiology 1987; 126(4): 647- and development of benign prostatic hyperplasia. The 657. Prostate Prostate 1995;26(1):40–49. doi:10.1002/ Marin, P, et al. Androgen Treatment of Middle Aged pros.2990260109. Obese Men: Effects on Metabolism, Muscle and Gouras G, Xu H, Gross R et al. Testosterone reduces Adipose Tissues. European Journal of Medicine 1992; neuronal secretion of Alzheimer’s beta -amyloid 329-336. peptides. Proceedings of the National Academy of Mårin, P., et al.The Effects of Testosterone Treatment Sciences. 2000;97(3):1202-1205. doi:10.1073/ on Body Composition and Metabolism of Middle pnas.97.3.1202. Aged Obese Men. J obes & Rel Metab Dis. 1992; Harman S, Blackman M. Male menopause, myth or 16(12):991-997 menace? Maturitas 1995;21(2):161. doi:10.1016/0378- Mårin P. Testosterone and Regional Fat Distribution. 5122(95)90009-8. Obesity Research. 1995;3(S4):609S-612S. Hill A. The Testosterone Solution. Rocklin, CA: Prima doi:10.1002/j.1550-8528.1995.tb00233.x. Pub.; 1997. Marques-Vidal P, Sie P, Cambou JP, Chap H, Perret Ho C, Nanda J, Chapman K, Habib F. Oestrogen B. Relationships of plasminogen activator inhibitor and benign prostatic hyperplasia: effects on stromal activity and lipoprotein(a) with insulin, testosterone, cell proliferation and local formation from androgen. 17 beta-estradiol, and testosterone binding globulin Journal of Endocrinology. 2008;197(3):483-491. doi:10.1677/joe-07-0470. Organic Medicine • 47 TheLeeClinic.com

in myocardial infarction patients and healthy Biology 1996;16(11):701-706, 1383–1387. controls. The Journal of Clinical Endocrinology & doi:10.1161/01.atv.16.11.1383. Metabolism 1995;80(6):1794–1798. doi:10.1210/ Prins G, Birch L, Tang W, Ho S. Developmental jcem.80.6.7775625. estrogen exposures predispose to prostate carcinogenesis Meikle A. Enhanced transdermal delivery of with aging. Reproductive Toxicology. 2007;23(3):374- testosterone across non-scrotal skin produces 382. doi:10.1016/j.reprotox.2006.10.001. physiological concentrations of testosterone and its Prins G, Huang L, Birch L, Pu Y. The Role of Estrogens metabolites in hypogonadal men. Journal of Clinical in Normal and Abnormal Development of the Prostate Endocrinology & Metabolism. 1992;74(3):623-628. Gland. Annals of the New York Academy of Sciences. doi:10.1210/jc.74.3.623. 2006;1089(1):1-13. doi:10.1196/annals.1386.009. Monda JM, Myers RP, Bostwick DG, Oesterling JE. Publications. Testosterone — What It Does And The correlation between serum prostate-specific antigen Doesn’t Do - Harvard Health. Harvard Health. 2015. and prostate cancer is not influenced by the serum Available at: http://www.health.harvard.edu/drugs-and- testosterone concentration. Urology 1995;46(1):62–64. medications/testosterone--what-it-does-and-doesnt-do. doi:10.1016/s0090-4295(99)80160-5. Accessed July 29, 2016. Mooradian AD, et al. Biological actions of androgens. Rosano G, Leonardo F, Pagnotta P et al. Acute Anti- Endocrine Reviews 1987; 8(1): 1-28. Ischemic Effect of Testosterone in Men With Coronary Morales A. Androgen Replacement Therapy and Artery Disease. Circulation. 1999;99(13):1666-1670. Prostate Safety. European Urology. 2002;41(2):113- doi:10.1161/01.cir.99.13.1666. 120. doi:10.1016/s0302-2838(01)00039-2. Savvas M, Studd J, Norman S, Leather A, Garnett T, Morgentaler A. Occult prostate cancer in men with low Fogelman I. Increase in bone mass after one year of serum testosterone levels. JAMA: The Journal of the percutaneous oestradiol and testosterone implants in American Medical Association 1996;276(23):1904– post-menopausal women who have previously received 1906. doi:10.1001/jama.276.23.1904. long-term oral oestrogens. BJOG: An Morley JE. Testosterone replacement and International Journal of Obstetrics and Gynaecology. the physiologic aspects of aging in men. 1992;99(9):757-760. doi:10.1111/j.1471-0528.1992. The Aging Male. 2000;3(4):215-215. tb13879.x. doi:10.1080/13685530008500361. Seidman S, Walsh B. Testosterone and Depression in Murphy S, Khaw K-T, Cassidy A, Compston JE. Sex Aging Men. American Journal of Geriatric Psychiatry. hormones and bone mineral density in elderly men. 1999;7(1):18-33. doi:10.1097/00019442-199924710- Bone and Mineral 1993;20(2):133–140. doi:10.1016/ 00004. s0169-6009(08)80022-0. Schwartz E, Holtorf K. Hormones in Wellness and Møller J, Einfeldt H. Effectiveness of Testosterone Disease Prevention: Common Practices, Current State Treatment. Testosterone Treatment of Cardiovascular of the Evidence, and Questions for the Future. Primary Diseases 1984:7–9. doi:10.1007/978-3-642-61744- Care: Clinics in Office Practice. 2008;35(4):669-705. 7_4. doi:10.1016/j.pop.2008.07.015. Ozata M, Yildirimkaya M, Bulur M et al. Effects Simon D. Association between Plasma Total of gonadotropin and testosterone treatments on Testosterone and Cardiovascular Risk Factors in Lipoprotein(a), high density lipoprotein particles, Healthy Adult Men: The Telecom Study. and other lipoprotein levels in male hypogonadism. Journal of Clinical Endocrinology & Metabolism The Journal of Clinical Endocrinology & 1997;82(2):682–685. doi:10.1210/jc.82.2.682. Metabolism. 1996;81(9):3372-3378. doi:10.1210/ Stanley HL, Schmitt BP, Poses RM, Deiss WP. Does jcem.81.9.8784099. Hypogonadism Contribute to the Occurrence of a Phillips GB, Pinkernell BH, Jing T-Y. The Association Minimal Trauma Hip Fracture in Elderly Men? Journal of Hyperestrogenemia With Coronary Thrombosis of the American Geriatrics Society 1991;39(8):766– in Men. Arteriosclerosis, Thrombosis, and Vascular 48 • Organic Medicine TheLeeClinic.com

771. doi:10.1111/j.1532-5415.1991.tb02698.x. al. Effect of testosterone replacement therapy on lipids Stattin P, Lumme S, Tenkanen L et al. High levels and lipoproteins in hypogonadal and elderly men. of circulating testosterone are not associated Atherosclerosis 1996;121(1):35–43. doi:10.1016/0021- with increased prostate cancer risk: A pooled 9150(95)05673-4. prospective study. International Journal of Cancer. Zvaram J, et al. Nitric Oxide Mediated Erectile Activity 2003;108(3):418-424. doi:10.1002/ijc.11572. in a Testosterone Dependent Event: a Rat Erection Swerdloff RS, Wang C. Androgen deficiency and aging Model: a Rat Erection Model. International Journal of in men. Western Journal of Medicine 1993; 159(5): Impotence Research 1995; 7(4): 209-219. 579-585. Tan R, Pu S. A pilot study on the effects of Testosterone in Women testosterone in hypogonadal aging male patients with Alzheimer’s disease. The Aging Male. 2003;6(1):13-17. Goldstat R, Briganti E, Tran J, Wolfe R, Davis S. doi:10.1080/tam.6.1.13.17. Transdermal testosterone therapy improves well-being, Tenover J. Androgen administration to aging men. mood, and sexual function in premenopausal women. Clinical Andrology 1994; 23(4): 877-892. Menopause. 2003;10(5):390-398. doi:10.1097/01. Tenover JS. Effects of testosterone supplementation in gme.0000060256.03945.20. the aging male. Journal of Clinical Endocrinology and Metabolism 1992; 74(4): 1092-1098. Thyroid Testosterone: The Test. Labtestsonlineorg. 2016. Available at: https://labtestsonline.org/understanding/ Escobar-Morreale H, del Rey F, Obregón M, analytes/testosterone/tab/test. Accessed July 29, 2016. de Escobar G. Only the combined treatment Theodoraki A, Bouloux P. Testosterone therapy in with thyroxine and triiodothyronine ensures men. Menopause International. 2009;15(2):87-92. euthyroidism in all tissues of the thyroidectomized rat. doi:10.1258/mi.2009.009025. Endocrinology. 1996;137(6):2490-2502. doi:10.1210/ Vermuelen A. Androgens in the aging male. Journal of endo.137.6.8641203. Clinical Endocrinology and Metabolism 1991; 73(2): Hertoghe T, Klatz RM, Goldman B, et al. Thyroid 221-224. Diagnosis and Treatment. Poor Reliability of the sing Villareal D, Holloszy J. Effect of DHEA on Abdominal plasma TSH-test for diagnosis of thyroid dysfunction Fat and Insulin Action in Elderly Women and and follow up. Anti-Aging Medical Therapeutics, eds. Men. JAMA. 2004;292(18):2243. doi:10.1001/ 2000; 127-37. jama.292.18.2243. Hertoghe T. Thyroid Diagnosis and Treatment. Many Wang C. Transdermal Testosterone Gel Improves conditions related to aging reduce the conversion Sexual Function, Mood, Muscle Strength, and Body of thyroxine to triidothyronine – a rationale for Composition Parameters in Hypogonadal Men. prescribing preferentially a combined T3 + T4 Journal of Clinical Endocrinology & Metabolism. preparation in hypothyroid adults. Anti-Aging Medical 2000;85(8):2839-2853. doi:10.1210/jc.85.8.2839. Therapeutics 2000; 138-53. Weksler ME. Hormone replacement for men: has the Lichten EM. Synthetic Thyroxine vs Dessicated time come?. Geriatrics 1995; 50(10): 52-55. Thyroid. JAMA 2004;291(12):1445. doi:10.1001/ Wisse, Brent. Testosterone: MedlinePlus Medical jama.291.12.1445-a. Encyclopedia. Medlineplusgov. 2016. Available at: Appelhof B, Fliers E, Wekking E et al. Combined https://medlineplus.gov/ency/article/003707.htm. Therapy with Levothyroxine and Liothyronine Accessed July 29, 2016. in Two Ratios, Compared with Levothyroxine Zgliczynski S, Ossowski M, Slowinska-Srzednicka J, et Monotherapy in Primary Hypothyroidism: a Double- Blind, Randomized, Controlled Clinical Trial. The Journal of Clinical Endocrinology & Metabolism. 2005;90(5):2666-2674. doi:10.1210/jc.2004-2111. Baisier W, Hertoghe J, Eeckhaut W. Thyroid Insufficiency. Is Thyroxine the Only Valuable Drug?. Journal of Nutritional & TheLeeClinic.com Organic Medicine • 49

Environmental Medicine. 2001;11(3):159-166. between deposition in adipose tissue and oxidation doi:10.1080/13590840120083376. to [14C]CO2 in ad libitum-fed or food-restricted Bermudez F, Surks MI, Oppenheimer JH. High rats. Biochimica et Biophysica Acta (BBA) - Lipids Incidence of Decreased Serum Triiodothyronine and Lipid Metabolism 1993;1168(2):205–212. Concentration in Patients with Nonthyroidal Disease. doi:10.1016/0005-2760(93)90126-t. The Journal of Clinical Endocrinology & Metabolism DeGroot LJ. Dangerous Dogmas in Medicine. 1975;41(1):27–40. doi:10.1210/jcem-41-1-27. The Endocrinologist. 1999;9(3):248. Bowen R. Mechanism of action and physiologic effects doi:10.1097/00019616-199905000-00020. of thyroid hormones. Colostate. 2005. Available at: Dommisse JV. T3 is at least as important as T4 in all http://vivo.colostate.edu/hbooks/pathphys/endocrine/ cases of hypothyroidism. J Clin Psychi. 1993; 54(7): thyroid/physio.html. Accessed July 29, 2009. 2770278. Bowen R. Synthesis and secretion of thyroid hormones. Dullaart R, van Doormaal JJ, Hoogenberg K, Sluiter Colostate. 1999. Available at: http://vivo.colostate. WJ. T3 rapidly lowers plasma lipoprotein-A, apo-B edu/hbooks/pathphys/endocrine/thyroid/physio.html. and LDL-cholesterol in hypothyroid subjects. The Accessed July 29, 2009. Netherlands Journal of Medicine. 1995;46(4):179-184. Brownstein D. Overcoming Thyroid Disorders. West doi:10.1016/0300-2977(94)00116-q. Bloomfield, Mich.: Medical Alternatives Press; 2008. Eaton CD. Co-existence of Hypothyroidism with Bunevičius R, Kažanavičius G, Žalinkevičius R, Diabetes Mellitus. Journal Michigan Medical Society. Prange AJ. Effects of Thyroxine as Compared with 1973;21(8): 355. Thyroxine plus Triiodothyronine in Patients with Eggertsen R, Petersen K, Lundberg P, Nystrom E, Hypothyroidism. New England Journal of Medicine Lindstedt G. Screening for thyroid disease in a primary N Engl J Med 1999;340(6):424–429. doi:10.1056/ care unit with a thyroid stimulating hormone assay with nejm199902113400603. a low detection limit. BMJ. 1988;297(6663):1586- Cakir M, Samanci N, Balci N, Balci M. 1592. doi:10.1136/bmj.297.6663.1586. Musculoskeletal manifestations in patients with Felicetta J. Effects of illness on thyroid function tests. thyroid disease. Clin Endocrinol. 2003;59(2):162-167. Postgraduate Medicine. 1989;85(8):213-220. doi:10.10 doi:10.1046/j.1365-2265.2003.01786.x. 80/00325481.1989.11700751. Chopra I. A Study of Extrathyroidal Conversion of Ford E, Giles W, Dietz W. Prevalence of the Metabolic Thyroxine (T 4 ) to 3,3,5-Triiodothyronine (T 3 ) Syndrome Among US Adults: Findings From the Third in Vitro*. Endocrinology. 1977;101(2):453-463. National Health and Nutrition Examination Survey. doi:10.1210/endo-101-2-453. Obstetrical & Gynecological Survey. 2002;57(9):576- Christ-Crain M, Meier C, Guglielmetti M et al. 577. doi:10.1097/00006254-200209000-00017. Elevated C-reactive protein and homocysteine values: Foster R, Thornton M. Thyroid in the treatment cardiovascular risk factors in hypothyroidism? A cross- of menstrual irregularities. Endocrinology. sectional and a double-blind, placebo-controlled trial. 1939;24(3):383-388. doi:10.1210/endo-24-3-383. Atherosclerosis. 2003;166(2):379-386. doi:10.1016/ Fujimoto S, Indo Y, Higashi A, Matsuda I, Kashiwabara s0021-9150(02)00372-6. N, Nakashima I. Conversion of Thyroxine into Clyde PW, Harari AE, Getka EJ, Shakir KMM. Tri-iodothyronine in Zinc Deficient Rat Liver. Combined Levothyroxine Plus Liothyronine Compared Journal of Pediatric Gastroenterology and Nutrition. With Levothyroxine Alone in Primary Hypothyroidism. 1986;5(5):799–805. doi:10.1097/00005176- JAMA. 2003;290(22):2952. doi:10.1001/ 198609000-00023. jama.290.22.2952. Gelenberg AJ. T3 + T4 = success. Biological Therapies Cooke RG, Joffe RT, Levitt AJ. T3 augmentation in Psychi. Nsltr. 1992; 15(4): 14. of antidepressant treatment in T4-replaced thyroid Hershman J. Getting the most from thyroid tests. patients. J Clin Psychi. 1992; 53: 16-18. Patient Care. 1989. Cruz ML, Williamson DH. Effects of triiodothyronine Hertoghe T, et al. Considerable improvement of administration on dietary [14C]triolein partitioning 50 • Organic Medicine TheLeeClinic.com