Posted on April - 29 - 2012

Letter regarding hormones to fellow physician

I was recently requested to write to a patient’s internist to offer my ideas regarding testosterone treatments for males. The letter is informative about the various parameters regarding prescribing testosterone.

Hello Dr. ____,

 Your patient asked me to forward to you the hormone regimen that I had him on. It was as follows:

 Testosterone cyprionate — 80 mg (200 mg per ml) IM (intramusclular), which would be 0.4 mg once a week. I suggested Sunday.

 Arimidex — 1 mg twice a week PO to prevent the excessive elevation of estrogen. This would have to be balanced with lab work to keep it around 20 to 40 mg. Some require only 1/2 mg (half of a tablet) twice a week.

 Proscar or Avodart if the DHT (dihydrotestosterone) becomes too elevated.

 Human chorionic gonadotropin (HCG) — 1,000 mg twice a week SC or IM. This is to prevent atrophy of the testes and also boost the testosterone toward the end of the week, so this is given Thursday or Friday and Saturday, if the testosterone is given on Sunday.

 If he wants to take HGH, I would suggest 0.4 mg SQ to start with to keep the IGF1 level at around 200 mg or so.

 The lab values suggested by Cenergenic when I took their course was:

    testosterone total – 700 – 900 mg

    testosterone free – 130 – 160 mg

    estradiol – 20 – 40 mg

    DHT – 25 – 75 mg

    DHEA – 350 – 500 mg

Thanks.

 Best

 Ron

 

 

 

I was recently requested to write to a patient’s internist to offer my ideas regarding testosterone treatments for males. The letter is informative about the various parameters regarding prescribing testosterone.

Hello Dr. ____,

 

Your patient asked me to forward to you the hormone regimen that I had him on. It was as follows:

 

Testosterone cyprionate — 80 mg (200 mg per ml) IM (intramusclular), which would be 0.4 mg once a week. I suggested Sunday.

 

Arimidex — 1 mg twice a week PO to prevent the excessive elevation of estrogen. This would have to be balanced with lab work to keep it around 20 to 40 mg. Some require only 1/2 mg (half of a tablet) twice a week.

 

Proscar or Avodart if the DHT (dihydrotestosterone) becomes too elevated.

 

Human chorionic gonadotropin (HCG) — 1,000 mg twice a week SC or IM. This is to prevent atrophy of the testes and also boost the testosterone toward the end of the week, so this is given Thursday or Friday and Saturday, if the testosterone is given on Sunday.

 

If he wants to take HGH, I would suggest 0.4 mg SQ to start with to keep the IGF1 level at around 200 mg or so.

 

The lab values suggested by Cenergenic when I took their course was:

    testosterone total – 700 – 900 mg

    testosterone free – 130 – 160 mg

    estradiol – 20 – 40 mg

    DHT – 25 – 75 mg

    DHEA – 350 – 500 mg

Thanks.

 

Best

 

Ron

 

 

 

 

 

 

 


Website: Finger & Associates
Phone: 912-354-4411

Posted on October - 30 - 2011

Bioidentical Hormone vs. Non-bioidentical Hormone Replacement Therapy

Why is it Controversial?

 

A bit of history is in order to explain this confusing mystery. My involvement in hormonal therapy as a plastic surgeon began when I needed to learn more about the subject for chapters on hormones for my book “Why Grow Old,” which was published in 2010. In addition, I was curious about the subject and have always had an interest in hormones since medical college. The powerful effect of hormones on the human body continues to amaze me.

 

A flawed study

 

I was once at a dinner with other couples and the lady next to me, about 50 years old, was fanning herself continuously. She was miserable with her menopausal symptoms of hot flashes and sweating. We began talking and she related to me that her doctor took her off hormones because of a recent study that revealed how hormonal replacement therapy (HRT) caused an increase in cancer and heart disease. The study her doctor was referring to was the Woman’s Health Initiative, a large clinical trial of 16.000 women that was cut short in 2004 because of the substantial increase in heart attacks, strokes, and breast cancer by using the synthetic non-bioidentical hormones, estrogen and progestin. The interpretation of the study was flawed resulting in mistreating thousands of women with menopause.

 

After reviewing the literature, the study simply proves that synthetic non-bioidentical hormones are harmful. These are quite different from bioidentical hormones. Bioidentical hormones are identical to those our body naturally makes, whereas non-bioidentical hormones are compounds foreign to our bodies.

 

Statistics relating to unnatural hormones vs. bioidentical hormones:

 

Unnatural (non-bioidentical) estrogen replacement therapy can cause an increase in blood clotting, especially when given by mouth. In one study, there was an increase in blood clotting by a startling 290% in patients treated with non-bioidentical progestin with estrogen. However, those who were given natural bioidentical progestin in combination with estrogen had a 30% reduction in blood clotting.

 

In a study of monkeys fed an unhealthy diet, supplemental estrogen decreased the formation of plaques in their arteries (atherosclerosis) by 72% compared to the control group, protecting them from atherosclerosis. The favorable statistics remained the same when the monkeys were given bioidentical progesterone, but when fed non-bioidentical progestin, the protective effects of estrogen was eliminated.

 

Numerous studies have demonstrated that there is an increase risk of breast cancer with the use of non-bioidentical hormones. One study demonstrated a 40% increase with non-bioidentical progestin and estrogen.  Very worrisome, indeed. However, it appears that bioidentical hormones are associated with a reduction in breast cancer.

 

The question may arise as to whether one should take either synthetic or natural progesterone at all. A trial study in the International Journal of Cancer in 2004 revealed that premenopausal women with the highest levels of their natural progesterone had an amazing 88% reduction in breast cancer compared to those women with the lowest levels of progesterone. The villain is not progesterone itself, but non-bioidentical progestin. It makes perfect sense and it is backed by a host of studies that supplemental progesterone should be bioidentical, identical to that produced in our bodies, and not unnatural non-bioidentical progestin.

 

Back to the question, why is it controversial?

 

The short answer is that doctors and studies, such as the WHI, failed to recognize the difference in bioidentical and non-bioidentical hormones, and the difference is vast. There was a knee-jerk reaction to the flawed study and the results were misinterpreted. The body of scientific evidence indicates that the natural progesterone and estrogen actually helps to protect people from the very diseases caused by unnatural estrogen and progestin.

E. Ronald Finger, MD, FACS

Plastic Surgeon

Savannah, GA

www.fingerandassociates.com

www.hairtransplantsavannah.com


Website: Finger & Associates
Phone: 912-354-4411

Posted on August - 25 - 2011

Men have menopause, too! It’s called Andropause.

Men have menopause, too! It’s called Andropause. 

An instant moment of recognition happens when you mention the word menopause to women – or men. It’s synonymous with hot flashes, moodiness and depression and ‘unpleasant’ changes in the female body’s shape. But did you know that men go through a menopause of their own and it’s called andropause.  

We know that menopause happens when women stop producing the necessary sex hormones –namely, estrogen and progesterone. When this happens around the ages between 45 to 55, it’s not fun. Thankfully, these symptoms can be treated with replacement hormones, preferably bioidentical hormones. 

Back to men — or andropause. When does it happen? Usually, it’s about 10 years after menopause strikes in women. The symptoms are: loss of libido, poor sexual performance, less muscle mass, more weight in the mid-section, and mood changes. The most common misconception is that it should be treated with testosterone. Far too often I see testosterone prescribed for men in the cream form or weekly shots as a cure-all for andropause. The problem is, like most things, it’s not that simple. 

To be sure, testosterone builds muscle, enhances sex performance, etc., but it often doesn’t function as testosterone in the body. Some of it is aromatized into estrogen and some of it converted into DHT (hihydrotestosterone). In fact, men at age 50 often have more estrogen than women of the same age. Let me clarify, just like women men have a combination of testosterone and estrogen, but the ratios are different. 

Understanding and Treating Andropause

Blood tests are necessary when treating men with testosterone to quantify how much of the hormone is aromatized into estrogen. If estrogen is elevated, and it usually is, a medication should be given to prevent this conversion into estrogen. One such medication is Arimidex (anastrozole), which is taken once or twice a week. If this medication isn’t taken, the man may develop breasts like a woman, which is called gynecomastia. Additionally, it is the belief by some doctors that prostate cancer may be related to elevated estrogen. 

If too much testosterone is converted to DHT, this could cause BPH, benign prostate hypertrophy, or permanent hair loss. Another common symptom is acne. The treatment to reduce this conversion is either Proscar (finasteride) or Avodart (dutasteride). But blood tests must be performed to know the whole story of how the additional testosterone is being utilized. 

Testosterone can be given in many ways from creams to injections to surgically inserted pellets. The pellet is a good method of delivery, but it does leave a small scar. The creams are converted into DHT more rapidly by the various appendages of the skin, causing the mentioned hair loss and BPH. If one prefers using the creams, Avodart or Proscar should be taken also. 

If injections are preferred, a patient can self-injected once a week, but as with other treatments, blood tests should only be performed until the levels are stabilized and there is better understanding of the body’s response. In addition, blood levels of testosterone should be kept at reasonable levels, as seen in a person of about 35 years old.

Of course, a thorough physical exam should be performed (especially a prostate exam) on anyone before being treated with testosterone.

Men who have had andropause properly treated may find the regimen bothersome at first, but virtually all of them think the benefits are well worth the trouble and expense. In fact, most men rave about it.

E. Ronald Finger, MD, FACS

Finger and Associates Plastic Surgery Center

Savannah, GA

www.hairtransplantsavannah.com

www.newyouthskincare.com

www.newyouthmedicalspa.com

 

 


Website: Finger & Associates
Phone: 912-354-4411

Posted on April - 04 - 2010

My new book, “Why Grow Old,” now available!

I have finally placed my experience, research and knowledge of both plastic surgery and anti-aging between two covers, a six year effort.  The name of the book is Why Grow Old, published in 2010.  So far, it can be purchased at the New Youth Medical Spa in Savannah, GA.

New Youth Medical Spa
5356 Reynolds Street
Savannah, GA 31405.

Email:  info@fingerandassociates.com or complete this form.
Phone: 800-868-9301 or 912-354-4411

Price:  $24.95.

Why should you read this book?
This is a scientific health book for the non-scientist, non-physician.  This is not a diet book, but is a comprehensive book on why we grow old from our cells to our bodies as a whole, and how we can thwart and even reverse the aging process. It is a guide to nutrition, supplements, hormones, skin care, exercise and plastic surgery toward feeling and looking your best. Discussed are many important aging processes that are related to how we live and our habits that most people have never read about or heard of.

Subjects discussed in this book:

  • Causes of aging on a molecular level
  • How to turn back the clock
  • Effects of poor nutrition and bad habits on health and appearance
  • Anti-aging supplements and foods
  • How to grocery shop for health
  • Skin and how to keep it youthful forever
  • A hormone guide for both men and women
  • Exercise—how and why
  • Plastic surgery—a thorough discussion of all procedures, both surgical and non-surgical and information to help assure your best results.

Chapter Titles

  1. Causes of Aging
  2. Nutrition and Supplements
  3. Hormones and Aging
  4. Aging and Your skin
  5. Exercise—How and Why
  6. Plastic Surgery: a comprehensive review of both surgical and non-surgical procedures

Appendix 1: Choosing effective nutrient supplements
Appendix 2: Whole for sources for each nutrient and the nutrient’s function
Appendix 3: Now to grocery shop for optimum health

Who is Dr. Finger?
Dr. E. Ronald Finger is a plastic surgeon in Savannah, GA.  He was born in Marion, South Carolina and is a graduate of Emory University, Atlanta, GA. and Medical College of South Carolina in Charleston. After an internship at Grady Memorial Hospital, he completed his general surgery residence at Tampa General Hospital and his plastic surgery residency at Wilford Hall Medical Center, Lackland AFB while in the USAF. In 1973 he was discharged as a Lt. Colonel, became certified by the American board of Plastic Surgery, married his present wife, Cheryl, and moved to Savannah, GA. Shortly thereafter, he opened the first outpatient plastic surgery center in Georgia and became well known, nationally and internationally, for his plastic surgery. Dr. Finger then opened the first medical spa in the coastal area in 1998 and developed the New Youth Skin Treatment System, a cosmeceutical line designed to make your skin look like a child’s.  New Youth products are sold nationally and abroad.

E. Ronald Finger, MD

www.fingerandassociates.com

www.newyouthmedicalspa.com

912-354-4411/ 800-868-9301

Savannah, GA

What are people saying?

I picked up your book, Why Grow Old,” over the weekend and could not put it down as I am totally of the belief that we can age without growing old. I have been practicing ant-aging for many years. I find it fascinating to learn about and read all that I can to stay up on the latest findings. I found your book very enlightening and comprehensive. It covers all areas and in great detail. This an invaluable tool for anyone on the path to slowing down the aging process and getting and staying healthy. I found it easy to read and understandable, I finished it today. Thank you so much for taking the time and energy you invested in this magnificent book.

Sherry

Educational, informative and as Dr. Finger says, “Good health is beautiful.” A must read for everyone concerned with their health and well being.

Barbara A.

I found Dr. Finger’s book interesting and understandable from a lay persons view. With his book as my guide, I have developed a health improvement plan I am confident will help me maintain a high quality of life for many years to come.

Henry H., Retired VP
Age 77

It is so informative and interesting. I especially enjoyed reading about how to eat right and to execise and how to protect yourself from sun damage and how to take care of your skin. It is always important to get a reminder of how to do things right. We may know how, but we become lazy or forget. There is so much information in the book that you can’t remember it all, but it is a great book to keep coming back to for looking things up. I know I will.

Kerstin Clark
Savannah, GA


Website: Finger & Associates
Phone: 912-354-4411

Posted on November - 22 - 2009

Hormone deficiency: menopause, andropause, somatopause and Bio-Identical Hormones

 In women menopause is the cessation of hormone production (estrogen, progesterone and even testosterone) that occurs at about age 45 to 50 years old.  In men, it is called andropause and is a cessation of testosterone production.  It occurs at a much wider range between 40 and 60 years old.  Somatopause relates to decrease production of growth hormone, which starts at about 30 years old and continues throughout life.  It occurs in females and males.

 The most common symptoms of menopause are night sweats, depression, and hot flashes.  Additional signs are weight gain, earlier death and dementia.  Andropause results in loss of muscle mass, weight gain, loss of the youthful shape of mass in the shoulders, larger abdomen and trunk size, moodiness, depression, loss of energy and sex drive.  Both andropause and menopause contribute to mental decline, increased body fat, cardiovascular disease and cancer mortality.

 A well documented study was the WHI, Woman’s Health Initiative published in April, 2004 in the Journal of American Medical Association.  The problem with the study was they only used synthetic hormones, and not bio-identical hormones.  This resulted in increase in breast cancer and cardiovascular disease.  Numerous studies show just the opposite using bio-identical hormones, namely decreased cardiovascular disease, breast cancer and dementia. 

 Bio-identical hormones are plant derived but the chemical compounds are identical to those of humans.  An example of synthetic hormone is Premarin, which is derived from pregnant mare urine, thus pre-mar-in.  There are about 30 compounds that are unnatural to the human being.  Provera is a synthetic progesterone and has been linked to increased cardiovascular disease and breast cancer.  Unfortunately, many doctors stopped prescribing HRT (hormone replacement therapy) because of this study.

 The hormones we are concerned with in women are estrogen and testosterone and in men only testosterone.  While we find more estrogen in women and more testosterone in men, the difference is the amounts.  Women have more estrogen and men more testosterone.  However, at age 50, men may have more estrogen than women.  Women have a reduction in estrogen production and in men, testosterone is converted into estrogen.  Both sexes have a decline in testosterone.

 These problems of hormone deficiency can be treated with HRT, hormone replacement therapy, and only bio-identical hormones should be used.  For women estrogen and testosterone can be replaced with compounded creams, tailoring the doses individually to the patient.  An even better solution is the estrogen/testosterone pellets.  These are inserted into the lower abdomen or upper buttocks through a very small incision and will last 4-5 months in the female.  Women also need bio-identical progesterone replacement, which is given by oral capsule.  In the male, only testosterone is replaced, and it lasts 5-6 months. 

 Testosterone creams are not advocated for the male because of the increase in DHT (dihydrotestosterone), which causes prostate enlargement and hair loss.  If this occurs, it can be treated with Avodart, if necessary.  Oral testosterone may cause liver damage.  The pellets do not have these problems.

 Prior to treatment, lab tests must be done to determine the patient’s hormone levels.  Additionally, men must have a PSA drawn to determine prostate health.  These lab tests will be repeated prior to the next treatment, then thereafter about once a year. 

 Hormonal balance is one of the primary factors in age control, and it is impossible to feel or look as good following menopause or andropause unless HRT with bio-identical hormones is used.

 E. Ronald Finger, MD, FACS

Finger and Associates Plastic Surgery Center

Savannah, GA

www.fingerandassociates.com

www.newyouthmedicalspa.com

912-354-4411/ 800-868-9301

800-868-9301

912-354-4411


Website: Finger & Associates
Phone: 912-354-4411