ConquerConquer DIABETESDIABETES with with Gender-Specific Gender-Specific

Bio-Identical Bio-Identical TESTOSTERONETESTOSTERONE

Edward Lichten, M.D.FACS, FACOG, FABAAM

American Academy of Anti-Aging Medicine

December 14-15, 2007

The Worst Diabetic MaleThe Worst Diabetic Male

50 years old, dark skinned man on insulinNo regular source of work, food, healthcareJunk food and history of homelessnessConfused and disoriented

If you were faced with

What Would You Do?

What Would You Do?What Would You Do?

Send him to the hospital?Refer him to an endocrinologist, who

handle 75% of all diabetics?Treat him?

Even if you were a Board Certified Gynecologist?

Hemoglobin A1c= 18: Hemoglobin A1c= 18: Uncontrolled DiabeticUncontrolled Diabetic

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There is There is a new way of a new way of thinking about thinking about

staying staying healthy..healthy..

And it is And it is called called

““Anti-Aging” Anti-Aging” MedicineMedicine

“Ageless” 75 year old Mary won the Alcatraz swim by going directly across San

Francisco Bay

Ten Years Ago the Future of Ten Years Ago the Future of Anti-Aging Medicine wasAnti-Aging Medicine was

Using Bio-Identical Hormones that identically match the hormones produced in the body– Sustained release

T4 and T3 thyroid

– DHEA– Pregnenolone

Ten Years Ago the Future of Ten Years Ago the Future of Anti-Aging Medicine wasAnti-Aging Medicine was

Using Gender-Specific Hormones– Estradiol and Estriol for women– Progesterone for women– Testosterone for women– Testosterone for men

Because a man and a woman are different, their body respond differently. Medical therapy must be based on matching their innate ratio of natural sex hormones.

And that was good and the A4M increased in members

Because of the Ground Breaking Exposure toBecause of the Ground Breaking Exposure to B-HRT B-HRT from from

thethe A4M and the Life Extension Foundation A4M and the Life Extension Foundation

A4M LOFTY GOALS: “Anti-Aging medicine seeks to identify the root cause of one’s symptoms...We age because our hormones decline, our hormones don’t decline because we age.” Michael Galitzer, M.D.

There is a Greater There is a Greater Awareness that Staying Awareness that Staying

Healthy can be assisted byHealthy can be assisted byReplacing and Maintaining, Replacing and Maintaining,

thesethese Natural, Natural, Bio-Identical Bio-Identical HormonesHormonesBut we must remember 1991:

The problem with The problem with Anti-Aging MedicineAnti-Aging Medicine

Is that our Antidotal Reports

do not have a

Scientific Methodology:

Therefore, our detractors say we are ‘snake-oil’ salesmen

And why not?And why not?Our products—vs– their productsOur products—vs– their products

Compounded thyroid Estradiol topical cream Progesterone micronized Testosterone cream

Armour thyroid Estrasorb©

Prometrium© capsule Androgel©

Not much different!

There are 6 There are 6 Endocrine GlandsEndocrine Glandsin the human bodyin the human body

that release that release biologic hormonesbiologic hormones

HypothalamusPineal

Pituitary

Thyroid

AdrenalPancreas

Ovaries-Testes

Scientifically,

When in BalanceWhen in Balance

12 MAJOR HORMONES

Released by these six endocrine glands

work together,

‘Exciting’ your body to

Energy and Health

Growth Hormone

Thyroxin & T3

DHEA & Cortisol

Insulin & Glucagon

TestosteroneEstradiol &

Progesterone

Calciferol

Suggested that proper replacement of bio-identical hormones holds great promise in the future in slowing the aging process, and as aTreatment

for age-related diseases

In Suzanne Somer’s book it is

When you have a DiseaseWhen you have a Diseaselike Diabeteslike Diabetes

You have

no Balance,

No Energy,

And Inadequate levels of

Bio-identical Hormones

When you have DiabetesWhen you have Diabetes

may shorten life expectancy 10 years and be the cause of multiple end-organ failures

This imbalance

2121stst Century Century Diabetic EpidemicDiabetic Epidemic

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Millions ofAmericans withDiabetes

With twice as many MORE still to be diagnosed!

The Future of The Future of Anti-Aging MedicineAnti-Aging Medicine

is here!is here!

Treating Diabetes

With

Bio-identical

Testosterone In Men

Diabetes MellitusDiabetes Mellitus

Today, we will re-teach the physiology of diabetes. Diabetes Mellitus is the leading cause of morbidity, mortality and 80% of non-cancer medical office visits: it is the primary cause of

heart disease high blood pressure Cholesterol elevation cerebral vascular stokes and obesity.

Diabetes MellitusDiabetes Mellitus

What do we really know about

1. The cause of diabetes?

2. The diagnostic tests for diabetes?

3. Best medication to control diabetes?

4. The mechanism of action of the medications available for diabetes?

5. The future for treating diabetes?

TheThe

DefinitionDefinition of Diabetes Mellitusof Diabetes Mellitus

The Webster’s Deluxe Unabridged Dictionary Second Edition defines diabetes mellitus as:

Diabetes mellitus is a chronic form of disease characterized by excess of sugar in the blood and urine, hunger, thirst, and gradual loss of weight: also called sugar diabetes.

Wikipedia incorporates a more scientific description Diabetes mellitus is a disorder of carbohydrate metabolism. It is a disease

characterized by persistent hyperglycemia (high blood sugar levels). It is a metabolic disease that requires medical diagnosis, treatment and lifestyle changes.

Medical PracticeMedical Practice The presence of abnormally elevated glycogenated hemoglobin is diagnostic of

diabetes mellitus

The World Publishing Company- William Collins Publishers, Inc. 1979

TheThe

CauseCause of Diabetes Mellitus:of Diabetes Mellitus:

The ancient Egyptians, Chinese, Macedonians (Hippocrates) and Romans (Aretaeus of Cappadocian) recognized this disease to be one of excessive urine (polyuria), leading to wasting and death. Today, we scientifically characterize this disease by its specific anomaly of carbohydrate metabolism

Type I: Inability to make insulinType II: Resistance to the insulin made

TheThe CauseCause

of Diabetes Mellitus:of Diabetes Mellitus:Type I: Insulin Deficiency

characterized by

– Destruction of the pancreatic islet cells by some infection or autoimmune reaction

– Typically occurring in a child or adolescentType II: Resistance to the Action of Insulin

characterized by

– Resistance to insulin at the cellular level with the initial excessive insulin production being unable to clear glucose from the blood stream

Pre-Diabetes: Metabolic Syndrome is a pre-diabetic condition with excessive insulin production effectively keeping the glycogenated hemoglobin in normal range.

What are theWhat are the Diagnostic TestsDiagnostic Tests

for Diabetes Mellitus? for Diabetes Mellitus? Screening tests

– Urine: presence of glucose– Blood: elevated glucose level

Diagnostic tests– Blood: elevated fasting serum glucose– Insulin: elevated fasting insulin level– Red Cell: elevated glycogenated hemoglobin measured directly

or as Hemoglobin A1c Comprehensive testing

– Glucose Tolerance Test with Insulin levels

Glucose Tolerance TestGlucose Tolerance Test with Insulin Levelswith Insulin Levels

The GTT shows the dynamic response of glucose being cleared from the blood after the stress of a glucose load.

GTT-I was described by Kraft in 1976; any glucose >145 or insulin >50 is strongly suggestive of obesity and/or the metabolic syndrome.

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RL Kraft, M.D. Chairman, Dept. Of Pathology, St. Joseph’s Hospital, Chicago, Ill. In Radio-assay: Clinical Concepts. Proceedings from a Symposium On Radioimmunoassay Held in Washington, DC January 28-29, 1974;91-106.

Glucose Levels

Fact- 1: GTT-I needed to classify type of diabetes

The Glucose Tolerance Test The Glucose Tolerance Test with Insulin Levelswith Insulin Levels

The GTT-I shows the dynamic response of insulin in presence of the stress of a glucose load.

Normal 4 fold increase at first hour; 50% drop at 2hr

Type II diabetes is a progressive disease characterized by increasing demands for insulin.

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Type IIearly

Hollenbeck C, Reaven GM. Variations in Insulin-Stimulated Glucose Uptake in Healthy Individuals with Normal Glucose Tolerance. JCEM 1987;64: 1169-73

Normal Insulin Levels

Type-I and Type-II late AODM lack Type-I and Type-II late AODM lack an an insulin insulin dynamic responsedynamic response

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Type II early

Type II late

Type I: SumI <70 Normal: SumI 70-130

Type II-late SumI <70 Type II-early SumI >130

Fact-2: Type I and Type II late have inadequate, flat insulins < 70

The Standard of Care protocol The Standard of Care protocol for treating diabetes mellitus is for treating diabetes mellitus is

Type I: add subcutaneous insulin Type II: add oral hypoglycemic agents, insulin-

sensitizers and newer oral and injectable agents Type II-late: add insulin injections if all else fails

Based on the hospital approved Evidence Based Protocols

With the goal is to control hyperglycemia

But since Type I and Type II But since Type I and Type II late are practically identical!late are practically identical!

Type I diabetes Normal screened group

– Obese, aging population

Type II diabetes– Early

Type II diabetes– Late

GTT-I: no Insulin changes GTT-I: normal or metabolic

syndrome based on normal GTT-I: hyperglycemia and

higher insulin release GTT-I: No or poor insulin

response

Why would you treat Type-I or Type-II late differently?!

Scientific Method: Scientific Method: Lab Tests must dictate treatmentLab Tests must dictate treatment

Scientific Methodology

1. Cannot treat NIDDM without a GTT-I

2. Type I and Type II-late are virtually identical

3. Stop oral hypoglycemic agents Type I & II late.

4. Ask “why would a U.S. Doctor start oral agents to temporarily treat hyperglycemia while accelerating the transition from Type II early to Type II late?” Especially when we now know that better bio-identical treatments exist?

Fact-3: Hypoglycemic agents are not indicated for Type I or late Type II

The Failure of The Failure of Evidence Based Evidence Based

MedicineMedicineAmerican physicians have been taught to treat

by protocol the diseases like heart, diabetes, obesity and high blood pressure.

DIABETES MELLITUS GIVES US A CHANCE TO THROW AWAY THE PROTOCOLS AND

TREAT THE ‘CAUSE’.

But You Already Know the But You Already Know the Cause and Treatments? Right?!Cause and Treatments? Right?!

Type I is an autoimmune disease that destroys the Beta islet cells that produce insulin. Treat with insulin.

Type II is caused by insulin resistance. Treat with oral hypoglycemic agents.

NORMAL PHYSIOLOGY is NORMAL PHYSIOLOGY is FacilitatedFacilitated Transport TransportPromotes glucose storagePromotes glucose storage

CELLOnly in the presence

of INSULIN is GLUCOSE taken into

the cell.

INSULIN (Big Cheese)

GLUCOSE (Sugar Bag)

Is the Cause of Poor Type I Is the Cause of Poor Type I diabetic control unavailability of diabetic control unavailability of physician supervised Insulin?physician supervised Insulin?

No

Type I Diabetes MellitusType I Diabetes MellitusTreatment: Injectable InsulinTreatment: Injectable Insulin

FACT: Ideal control of Diabetes, “lowest possible Hemoglobin-A1c” is the single, most important predictor of a long-life and freedom from complications. M Rizzo, ADA

FACT: Adding insulin alone brought less than 40% of volunteers to HgB-A1c of 8.1-2

1. Mathew Riddle, M.D. Letter to the Editor: JAMA. 1997; 297(19): 1523.

2. Hayward RA. Maning WG, Kaplan SH, Wagner EH. Greenfield S. Starting insulin therapy in patients with type 2 diabetes: effectiveness, complications and resource utilization. JAMA 1997; 278:1663-69.

3. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. New England J Medicine 11993; 329977-986.

Insulin Therapy is Insulin Therapy is Not Enough for Not Enough for Type I Diabetics!Type I Diabetics!

UNDERSTANDING

the Role of Testosterone Therapy for Men with Insulin Requiring Diabetes Mellitus

Oral Therapy is Oral Therapy is Not Enough for Not Enough for

Type II Diabetics!Type II Diabetics!UNDERSTANDING the Role of

Testosterone Therapy for Men with Non-Insulin Requiring

Diabetes Mellitus

““All Diabetic Men are All Diabetic Men are Testosterone Deficient!”Testosterone Deficient!”

A4M: 1998 Lichten keynote speakerJAMA: 2006 Ding EL. Harvard Medical group

“Higher levels of testosterone are protective”A4M: 1998 Lichten: Add-back testosteroneJAMA: 2006 Ding: Higher bio-testosterone

Cross-sectional studies indicated that testosterone level was significantly lower in men with type 2 diabetes ....Similarly, prospective studies showed that men with higher testosterone levels (range, 449.6-605.2 ng/dL) had a 42% lower risk of type 2 diabetes

Fact-4: A4M attendees heard it first!

Eric L. Ding, BA; Y. Song MD et al. Sex Differences of Endogenous Sex Hormones and Risk of Type 2 Diabetes. JAMA. 206; 295: 1288-99.

Physiology of Diabetes-Physiology of Diabetes-Cells Need Energy Cells Need Energy as well asas well as Insulin Insulin Glucose must be cleared from the blood stream to

minimize AGEs, accumulated glycogen end-products, that ‘clog’ the cell.

Energy is needed for facilitative transportation to move glucose across the cell membrane.

The ATP Cycle that produces Energy is activated by bio-available sex hormones.

In the male, the key bio-available sex hormone is TESTOSTERONE.

Fact-5: Need energy Why Testosterone?

Low levels of testosterone predict death. Shores MM. Low Serum Testosterone and mortality in male veterans. Arch Inter. Med 2006 Aug 14; 166(15): 1660-5. After adjusting for age, medical morbidity, and other clinical covariates, low testosterone levels continued to be associated with increased

mortality (hazard ratio, 1.88; 95% CI, 1.34-2.63; P<.001)

There are two keys to opening There are two keys to opening the cell wall to transport glucosethe cell wall to transport glucose

1. INSULIN: discovered by Banting and Best in 1922

2. Sex Hormone Binding-Sex Hormone ligand discovered in 1955 but not recognized for its role in glucose transport until today

Fact-6: Two keys to cell wall dynamics: insulin and testosterone in men

Understanding SHBGUnderstanding SHBG Sex Hormone Binding Globulin (SHBG) when bound to the sex hormone of

TESTOSTERONE or ESTRADIOL is the ligand that affixes to and changes the 3-dimensional cellular wall characteristics to facilitate entry of not only hormones but glucose and nutrients.

Examples of better glycemic Examples of better glycemic control in Type I diabeticscontrol in Type I diabetics

““Since Harvard now agrees with the A4M’s lecturer Dr. LichtenSince Harvard now agrees with the A4M’s lecturer Dr. Lichten that all diabetic men are testosterone deficient” that all diabetic men are testosterone deficient”

First, and Foremost ADD-BACK BIO-IDENTICAL

TESTOSTERONETESTOSTERONETo all diabetic men

Insulin Dependent Insulin Dependent Diabetes MellitusDiabetes Mellitus

Testosterone IM Reduces Insulin RequirementsTestosterone IM Reduces Insulin Requirements

72 yo. White male in year 1997. Testosterone reduced hyperglycemia and almost all of the 40 units/day of insulin required in 2 months!

T-2 protocol: Testosterone injections 100mg IM twice a week.

Gangrene unresolved- amputation necessary.

Dropping Insulin Requirements with Testosterone Injections

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Insulin Use in case of Gangrene

Insulin Dependent Insulin Dependent Diabetes MellitusDiabetes Mellitus

Testosterone IM Improved Glycemic ControlTestosterone IM Improved Glycemic Control A.M. 50 year old Black Male

presented on 16units/insulin/day– HgB-A1c >18% – Glucose fasting: 488mg/ml

T1-protocol: increased insulin while starting add-back Testosterone weekly IM

20 weeks later:– HgB-A1c = 7.4%– Glucose fasting: 47 mg/ml in AM

asymptomatic

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Insulin Dependent Diabetic MenInsulin Dependent Diabetic Men 12 IDDM patients have

completed Testopel© for first 3 months, then none.

All individuals required 80+ units of insulin per day and were able to reduce their insulin required by HALF!

All maintained or improved their glycemic control

After three month wash-out their need for insulin returned to baseline.

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Fact-7: Testosterone improves glycemic control in IDDM men

http://www.usdoctor.com/SUMI1.htm

IRB Study 907 –96 Providence Hospital, Southfield, MI

Hypoglycemia and impending coma in brittle, insulin-requiring diabetics is the reason doctors err on keeping the blood sugar high.

Testosterone allows tighter control by preventing symptomatic hypoglycemia and coma.

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The Key to Tight Glycemic Control is The Key to Tight Glycemic Control is that men on Testosterone rarely that men on Testosterone rarely

experience HYPOGLYCEMIC Crash!experience HYPOGLYCEMIC Crash!

The Key toThe Key to IDDMIDDM ControlControl is thatis that

Testosterone Prevents HypoglycemiaTestosterone Prevents Hypoglycemia

Fact-8: Testosterone prevents hypoglycemia

Stored Tissue Glycogen

Blood Stream Glucose

Insulin Glucagon

Testosterone ATP Energy Cycle

As effectively as Testosterone improves clearance of glucose from the blood stream, it reconverts glycogen to glucose preventing hypoglycemia.

Protecting Men Diabetics Protecting Men Diabetics from Hypoglycemiafrom Hypoglycemia

Is Unique to TestosteroneMakes addition of Testosterone

MANDATORY for OPTIMAL DIABETIC CONTROL!!

This may well be one of the most important healthcare discovery in the last 100 years!

How Do We Now Treat Insulin How Do We Now Treat Insulin Requiring Diabetic Men?Requiring Diabetic Men?

Insulin and injected Testosterone

The reason we do not use the Androgel© or compounded bio-creams or the Androderm© patch is that (1) absorption from the skin is poor in older individuals and (2) the skin aromatizes testosterone to estrogen, negating the positive effect of testosterone replacement.

K.S. Nair MD PhD et al. DHEA in Elderly Women and DHEA or Testosterone in Elderly Men. NEJM. 2006; 355: 1647-91. “Serum levels of testosterone increased only 20% of expected based on FDA submitted data”

Fact-9: Only Injectables are Effective

How Do We Now Treat Insulin How Do We Now Treat Insulin Requiring Diabetic Men?Requiring Diabetic Men?

Testosterone Enanthate $ 25/mo

Deca-Durabolin $ 50/mo

Testopel© $100/mo

NO! Androgel©or Testoderm© $330/mo

EXCEPTIONS: All need CBC, comprehensive, lipids, PSA and prostate examination before starting testosterone replacement.

EXCEPTIONS: Prostate or testicular cancer cases or Prostate Specific Antigen greater than 2.5 needs urologist’s clearance.

Insulin Requiring Diabetic Men

(Type I and Type II late)

Need Testosterone to improve their glycemic control and reduce

their requirements for insulin.

What about Type II diabetic men?

Conclusion: Type I and II-late need testosterone and insulin

Adult Onset Diabetes MellitusAdult Onset Diabetes Mellitus: : has the same complications as Type Ihas the same complications as Type I

Hyperglycemia and Hyperinsulinemia precede

DIABETES:– OBESITY– HEART DISEASE– RETINOPATHY– GANGRENE and

Shortened life expectancy by up to 10 years!

Adult Onset Diabetic Men Adult Onset Diabetic Men need Testosterone!!need Testosterone!!

Before and 1-year after testosterone

replacement: year 1997-8

Abnormal GTT-ILow Testosterone

Normal GTT-I ‘Normalized’ Testosterone

Non-insulin Dependent Diabetes Non-insulin Dependent Diabetes Testosterone Improves HyperglycemiaTestosterone Improves Hyperglycemia

Discontinues 20mg of micronase and lowers fasting glucose on T-2 protocol with twice weekly testosterone injections

Fact-4: All Diabetic Men are Testosterone Deficient

Fact-10: All NIDDM, Diabetic men may benefit from Testosterone

Dropping Micronase Requirements with Testosterone Injection

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Testosterone improves Testosterone improves Hemoglobin A1cHemoglobin A1c

Without meds, change in diet, exercise, or weight loss, DB was able to drop his HgBA1c from 11 to 6.5 in 4 months without oral agents.

Fact-11: Testosterone improves glycemic control with/out weight loss

JULY AUG SEPT OCT 2001

Hemoglobin A1c !!

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http://www.usdoctor.com

Screen Everyone for Diabetes and Screen Everyone for Diabetes and pre-diabetes (pre-diabetes (metabolic syndrome)metabolic syndrome) Fasting:

– Glucose normal < 105 mg/dl– Insulin normal < 10 uIU/ml– Hemoglobin A1c normal < 6 percent– Triglycerides normal < 130 mg/dl

Testosterone:– Total Testosterone normal > 450 ng/dl– Sex Hormone Binding normal < 15 nmol/L– Estradiol normal < 25 pg/ml

Fact-12: Screen everyone for diabetes with fasting glucose, HgB-A1c, lipids-- and for men, bio-available testosterone

Perform the GTT-Insulin Test: Perform the GTT-Insulin Test: with hourly insulin levelswith hourly insulin levels

CR 66 year old AA male with HgB-A1c=9.0

GTT- abnormal– Sum Insulin = 62

Testopel© protocol– effective.

Based on GTT-I, he might need insulin in the future, but not now since the testosterone has sensitized his cells to insulin and increased his ATP energy.

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Add-Back TestosteroneAdd-Back Testosteroneand follow the improved HgB-A1cand follow the improved HgB-A1c

Hemoglobin A1c9

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6July Aug Sept Oct Nov 2006

Same 66 year old dentist. Treatment with Testopel© every month resulted in normalization to HgB-A1c of 6.0 in 12 weeks. Testosterone therapy appropriate even in presence of minor cerebral vascular accident before T.

U.K. Treats Diabetic Men with U.K. Treats Diabetic Men with IM TestosteroneIM Testosterone

D. Kapoor in 2006 published double-blind cross-over study confirming that “testosterone replacement therapy reduces insulin resistance and improves glycaemic control in hypo-gonadal men with type 2 diabetes.”

Statistical findings– Reduce insulin resistance– Reduced insulin required– Reduced fasting glucose– Reduced HgB-A1c– Reduced waist measure– Reduced total cholesterol

10 men on insulin pre-study 14 men not on insulin

Kapoor D, Goodwin E, Channer KS, Jones TH.  Testosterone replacement therapy improves insulin resistance, glycaemic control, visceral adiposity and hypercholesterolaemia in hypogonadal men with type 2 diabetes. Eur J Endocrinol, 154(6): 899-906   2006

Adult Onset Diabetes Mellitus:Adult Onset Diabetes Mellitus:

When treating a 35+ years old male, with sexual complaints or medical conditions…

Demand a measurement of Bio-available Testosterone!

Because Testosterone affects every cell in a man’s body

Brain: libido, mood

Muscle/ Bone: strength

Liver: synthesis proteins

Sex Organs: penile growth, reproduction

Measurement of Bio-Available Measurement of Bio-Available TestosteroneTestosterone

Serum Testosterone Levels– Total Testosterone– Free Testosterone FAI=

Sex Hormone binding globulin

Free Androgen Index (FAI)– Ratio of Testosterone/SHBG

– Ideal: 0.7 to 1.0

__[Testosterone total]__

30x [SHBG]

Diabetic Men are Diabetic Men are Testosterone Deficient!Testosterone Deficient!

(also Obese, Heart, Lipid, Hypertensive)(also Obese, Heart, Lipid, Hypertensive) The Europeans measure ‘unbound’ testosterone as

the FREE ANDROGEN INDEX [TT]/[SHBG]Normal: Ratio greater than .7Male Normal Metabolic Syndrome

Total Testosterone 450 ng/dl 250 ng/dl

Sex Hormone BG 15 nmol/L 50 nmol/L

Free Androgen Index >1.0 - 0.7 0.1 to 0.4

Avoid treating Type II-early Avoid treating Type II-early diabetes with oral agents diabetes with oral agents

(sulfonylureas, insulin sensitizers)(sulfonylureas, insulin sensitizers)

It is bad practice to treat the symptom

(of hyperglycemia) while ignoring the scientific proof that these ‘protocol’

medications may accelerate destruction of the pancreatic islet cells…

FACTS to REMEMBERFACTS to REMEMBER

1: GTT-I needed to classify type of diabetes

2: Type I (autoimmune) and Type II late (burn out) are similar: insulin requiring

3: Oral hypoglycemic agents are rarely indicated

4: All diabetic men are testosterone deficient

5: Glucose movement takes energy: energy takes testosterone

6: Insulin and Sex Hormone+SHBG ligand are keys to cell wall permeability

7: Testosterone improves glycemia for IDDM: Insulin dependent diabetic men

8: Testosterone may help prevent hypoglycemia, crisis and coma

9: Only Injectable forms of Testosterone are Effective for Diabetes

10: All NIDDM men may benefit from Testosterone

11: Testosterone may improve glycemic control with or without weight loss

12: Screen everyone for diabetes with fasting glucose, HgB-A1c, lipids --and for men, testosterone measurements

Putting it all togetherPutting it all togetherINSULIN is still involved in facilitated (glucose)

transport but transport takes ENERGY!TESTOSTERONE is the source of ATP energy

from the Kreb’s (citric acid) cycle that facilitates the action of insulin!

INSULIN & GLUCOSE

Hippocratic Oath:Hippocratic Oath:Above all, Above all, physician,physician,

Do No Harm!Do No Harm!Practicing the Standard Medical Treatment

Protocols for Adult Diabetic Men

1. Ignores the appropriate treatment of one scientifically recognized cause of Diabetes in men: testosterone deficiency

2. Exposes the patients to unnecessary drugs, side-effects and expense. The annual cost of diabetic outpatient medications are

Health Care is in FluxHealth Care is in Flux

Paradigm Shift from ‘prescription Pharma’ to prevention is being fueled by 50 million paying ‘baby-boomers’ who are taking an active role in maintaining and improving their physical and mental health. This is called “Anti-Aging!”– Exercise and diet– Vitamins and supplements– Reading, researching and exploring new and

alternative medical avenues for prevention.

We have learned today that We have learned today that Gender-Specific hormones Gender-Specific hormones

are the key to living wellare the key to living well “I don’t buy the Pharma story”

“I’ll do what is best for me!” Nutrition, exercise, avoid toxic

smoke, food and environments..– But most importantly

Take Bio-Identical Hormones!

Pharma is flooding U.S. with Pharma is flooding U.S. with more useless Diabetic Drugsmore useless Diabetic Drugs

FDA approving drugs of questionable value– Byetta© : gila monster saliva at $600/month– Rezulin© : Removed from market causing deaths $300/mo

and now Avandia© leaving Actos© against dissenters Pharmaceutical Companies continue to bring to

market unproven and barely helpful ‘wonder drugs’– Novartis: Astra-Zenica Bristol-Myers Squibb– Merck: Pfizer: a new insulin nose spray

No New Cures or Breakthroughs expected from Stem Cell Research for diabetes

Testosterone AloneTestosterone Alone

End of the Pharmaceutical

Stranglehold on

Diabetic and Medical Practice

So we are offering our patients FDA approved injected testosterone at a cost of $15 per month and, an ‘entirely new concept’ that

may herald in the

Are you an Evidence Based Are you an Evidence Based ‘protocol’ puppet of Big Pharma?‘protocol’ puppet of Big Pharma?

Writing for oral agents for ‘burned out’ diabetics?– Micronase©, Gliberide©

– Glipizide©, Glucotrol©

– Amaryl©, Starlyx ©

Writing for expensive and ineffective insulin- sensitizing agents?

Thiazolidinediones– Actos

– Rezolin© and Avandia©

removed by FDA

Incretin mimics– Amylin and Lilly -Byetta ©

Gliptins– Merck - Januvia©

– Novartis - Glavus© (on hold)

PPAR gamma insulin sensitizers– AstraZeneca; tesaglitazar ©

– Bristo-Myers Squibb -muraglitazar ©

Inhaled insulin– Pfizer© -Exubera©

Or a U.S. DOCTOR Or a U.S. DOCTOR who puts his patients’ first?who puts his patients’ first?

Diabetes Education:

Screen, test, treat: low testosterone and diabetes

Men with diabetes have a 2x greater risk of having total testosterone less than 300 ng/dl.

Endocrine Today: October 2006

American Association of Diabetic Educators, Donna Rice MBA, RN, CDE president

You need to decideYou need to decide

Testosterone Injections and Pellets can be dispensed in your office practice

Along with better medical care

TESTOSTERONE is the key TESTOSTERONE is the key to life for men…period.to life for men…period.

Testosterone has been studied and used since 1939; before there was an F.D.A.

Higher levels of testosterone are associated with living longer and is

truly, “Anti-aging” medicine

You, Doctors, You, Doctors, are the Masters of Medicineare the Masters of Medicine

Staying Healthy and Treating Staying Healthy and Treating Disease is by keeping us all Disease is by keeping us all

Anabolic! Anabolic! Say Yes to TestosteroneSay Yes to Testosterone!!

If you learn only one thing today, remember

For you and your patients,

The purpose of science is not to cure The purpose of science is not to cure us of our sense of mystery...us of our sense of mystery...but to constantly reinvent but to constantly reinvent and reinvigorate it. and reinvigorate it.

Robert M Sapolsky, M.D., professor of biology and neurosciences, Stanford University and author of The Trouble with Testosterone. Simon and Schuster. NY. 1997

So Become the Anti-Aging So Become the Anti-Aging Doctor of the futureDoctor of the future

Be the doctor that knows the science behind the causes of diabetes

Be the doctor in your area with the knowledge to truly treat the disease, naturally

Be the doctor that shows your patients they can discontinue the synthetic, Pharmaceutical

expensive oral agents and reduce their insulin and have less complications and feel better and have

better sex!

The Future of MedicineThe Future of Medicine

Is in your hands

Edward M. Lichten, M.D., Edward M. Lichten, M.D., FACS, FACOGFACS, FACOG

WEBSITE: www.USDOCTOR.comOffice: (248) 593.9999

Lichten Wellness Center– 180 East Brown Street– Birmingham, MI 48009

Email: drlichten@yahoo.comFor copies of this lecture or study course,

http://www.USDOCTOR.com/A4M.ppt

I hope I have done that for you today.

Insulin Resistance predictsInsulin Resistance predicts Age- Related Disease including Cancer Age- Related Disease including Cancer

Metabolic Syndrome (Increased Fasting Insulin, Exaggerated Insulin Response, or Reduced Insulin Response to glucose load) predicts Heart Disease, Obesity, Dyslipidemia, Hypertension, and Diabetes

GM Reaven MD shocked the medical establishment by following 208 apparently healthy men and women for 4 to 11 years. Those in the upper 1/3 of steady-state plasma glucose (or area under 2hr-OGTT insulin curve) had 28 of 40 clinical events including cancers. Middle 1/3 had 12. Lower 1/3 had none!

FS Facchini, GM Reaven. Insulin Resistance as a Predictor of Age-Related Diseases. Journal Clinical Endocrinology Metab 2001:86;3574-3578

Hypothesis:Hypothesis:Add Back Testosterone is Anti-AgingAdd Back Testosterone is Anti-Aging

Men who are testosterone deficient by FAI will live longer and better because they will have less METABOLIC SYNDROME

Measured as lower fasting insulin, normalized GTT-I are associated with reduced risk factors: obesity, heart disease, hyperlipidemia and hypertension

Personal and Medical ExperiencePersonal and Medical Experience

50

My own andropause at 45 trigger my interest and I knew that without finding that natural treatment, I would not have been here with you today!