Last month I was interviewed by Leslie Botha on the Holy Hormones, Honey! radio show at KRFC 88.9 FM, Ft. Collins, Colorado.

We discussed:

1. Why did I decide to become a menopause doctor?
2. Is menopause a chronic disease?
3. Is there really such a thing as post-menopause?
4. What is the best way to replace bio-identical hormones after menopause?
5. How do estrogen and progesterone deficiencies manifest in women's bodies after menopause?
6. Besides hot flashes and vaginal dryness, what are other common symptoms of menopause that most women don't know about?
7. What are bioidentical hormones?
8. What is the Wiley Protocol?
9. What is male menopause?

There are sections where I laugh after talking about serious issues. Aggh, it must be nervous laughter...because it's so sad I should be crying!

Click right arrow below to listen to the interview. And please leave your comments below.

Enjoy,

Dr. Miller 

Download MP3

I recently presented my seminar "How to Have a Luxurious Menopause & Postmenopause" to Wonderful Online Women (WOW).  What a wonderful audience they were!  The ladies were respectful, curious, and asked great questions.  Below, Ellen, the group's leader and host, gives her review.

"Another Thursday night, another wonderful Wow meeting.  Yummy food, good conversation, giggles, and lots of hugs were shared by the ladies.

And we were blessed by the company and wisdom of yet another great speaker.  Dr. Shira Miller is a "Concierge Holistic Menopause Physician" in Los Angeles who specializes in "luxurious menopause." She presented a fascinating slide show with the help of her handsome..." 
Click here to continue reading.

Enjoy,
Dr. Shira Miller
Follow the menopause conversations on www.facebook.com/menopausedoctor.  
To host a seminar, please email us. 

The short videos below are a collection of doctor, patient, and actor testimonials about the benefits of bioidentical hormone replacement therapies which mimic youthful hormone levels, rhythms, and menstrual periods.  They are available online and I have merely compiled them here for your convenience. As you know, I prescribe the Wiley Protocol in The Luxurious Menopause^TM treatment program. If you are one of my patients and are open to doing a video testimonial about any aspect of my practice, just let me know.  Warm regards, Dr. Miller

Endocrinologist Dr. Diana Schwarzbein explains how hormones should be replaced after menopause, and why a menstrual period needs to be restored. (1:59)

1960's iconic actress and author Celeste Yarnall on the Wiley Protocol.(2:11)

Click here to read her written testimonial from another source.

Julia Parker on Sex, Lies, and Menopause and the Wiley Protocol. (1:13)

Gynecologist Dr. Courtney Ridley on the Wiley Protocol. (1:03)


Thank you to Dr. Fred Bloem in Maryland for the three testimonials below.
55 year old A.R. on the Wiley Protocol. (8:43)

57 year old Neva W. on the Wiley Protocol. (5:11)


60 year old Kathy H. on the Wiley Protocol. (6:36)


Dr. Deborah Werenko on the Wiley Protocol. (0:59)


Suzanne Somers speaks to doctors about Bioidentical Hormones. (9:55)


T.S. Wiley on the Wiley Protocol. (1:50)

Click here to view videos of Dr. Shira Miller on her YouTube Channel. 

Dr. Shira Miller, Facebook's most popular menopause doctor, will be giving a lecture on menopause and postmenopause at the Pacific Athletic Club (PAC) in San Diego on October 1st.

A couple of weeks ago I started taking questions from my Facebook fans and then answering them on video. Below is the first Q&A video.

Please let me know what you think. My husband was my camera man, editor, voice over artist, and made sure I smiled (at least at the beginning) while discussing this very serious topic!

CLICK PICTURE BELOW TO VIEW

If you would like to be notified of new videos as soon as they are released, please subscribe to my YouTube Channel. The more subscribers I have the easier it will be for other menopausal and postmenopausal women and their partners to find this vital information on the internet.

-Dr. Shira Miller
www.shiramillermd.com
www.facebook.com/menopausedoctor

When, in the course of human evolution, women live past their reproductive years and survive past menopause, it becomes necessary for them to decide whether or not to get treated for the permanent estrogen and progesterone hormone deficiencies that result in their bodies because of menopause. Menopausal and "postmenopausal women" need to make this decision because estrogen and progesterone deficiencies have both short and long term consequences on women’s health, and most doctors don’t view these hormone deficiencies as a serious condition that needs to be treated but rather as a phase whose symptoms need to be subdued. A decent respect to the opinion of doctors and the fact that women need physicians to write their hormone prescriptions requires that menopausal and "postmenopausal" women should declare the causes which impel them to choose hormone replacement therapy (HRT) and declare independence from the permanent estrogen and progesterone hormone deficiencies which are caused by menopause. Here are some suggestions:

• Just because menopause is natural doesn’t mean its consequences shouldn’t be treated.

• Woman's bodies are in a state of estrogen and progesterone deficiency during both menopause and "postmenopause," so "postmenopause" is really a misnomer, even if a woman no longer has hot flashes.
  
  
• Just because aging women lose their supply of ovarian eggs (the natural source of female hormones) and ability to reproduce doesn’t mean menopausal and "postmenopausal" women need to live the rest of their lives in a state of estrogen and progesterone deficiency.

• Untreated estrogen and progesterone deficiency cause hot flashes, night sweats, weight gain, disturbed sleep, fatigue, joint aches, “brain fog”, memory problems, urinary leakage, vaginal dryness, painful intercourse, low libido, depression, anxiety, heart palpitations, accelerated skin wrinkling, accelerated osteoporosis, accelerated heart disease, and more.

• Recommendations to use antidepressants, sleeping pills, herbs or yoga for some menopausal and "postmenopausal" symptoms may help, but these treatments don’t address the primary estrogen and progesterone deficiencies which are the primary cause, and therefore don't provide optimal treatment and give women a false sense of security about their health.

• Just because patent hormones have been the most studied and prescribed form of HRT doesn’t mean they are the best choice for modern women who have access to bioidentical hormones. 

• Bioidentical hormones are man-made hormones which are identical in structure to hormones naturally produced by women’s ovaries and therefore cannot be patented.

• Not all forms of bioidentical HRT are alike and women's reproductive hormone levels and cycles have a particular nature which needs to be respected.

Happy Independence Day!

Shira Miller, M.D.
www.shiramillermd.com
www.facebook.com/menopausedoctor

My veterinarian is a friendly young woman, but this week she made me cry. I will admit that I'm not the average dog mom. As an integrative medicine physician I know the benefits of nutrition, lifestyle, and bioidentical hormone replacement therapy for humans and that old traditions die hard, so when I got my cocker spaniel puppy, Daphne, I did my due diligence to find the best diet, surgery, and vaccines for her. What I learned was drastically different from the recommendations of conventional veterinary medicine, similar in essence to when I started researching outside the box of conventional internal medicine.

One of the best E-books I read was "How to Protect Your Dog From a Vaccine Junkie," by holistic vet Dr. Paula Terifaj. I discovered that:

1. Dog vaccinations can have side-effects.
2. There is overwhelming evidence that vaccinations given after the age of six months protect dogs for up to seven years, and possibly for life.
3. Some vaccines are recommended, some are optional, and some are NOT recommended for any reason.
4. All vaccine recommendations need to be individualized.
5. There is NO evidence that dog vaccines need to be administered every year.

I was shocked to read that after your dog's one year booster shots, in most cases, the American Animal Hospital Association's 2006 Canine Vaccine Guidelines strongly recommend to revaccinate only every three years or longer, unless mandated by state statutes. What? This knowledge has been around since 2006? That's certainly not the impression we would get from the annual vaccine reminder postcards we get from our veterinary clinics.

When I received my postcard, I took my little pooch and drove almost an hour from home to see Dr. Terifaj. We did a blood titer test on Daphne to measure her antibody levels and determine if she had already mounted an immune response to her previous vaccines. She passed the test with flying colors and received a document stating she didn't need to be revaccinated for the time being. Yeah! I had this piece of paper placed in Daphne's chart and was very happy to be able to protect my dog from unnecessarily being shot with vaccines.

So what happened this week? Daphne had a mild ear infection and my husband took her to the veterinarian for some basic antibiotics. When the doctor told him she was also due for her vaccines, there was an unfortunate miscommunication, and she was shot in the back office with 5 unnecessary vaccines! All this from a DVM who knows we make alternative choices, has evidence of the dog's immunity in the chart, and has a sick dog in front of her (not a good time to administer vaccines anyway.) Luckily, Daphne hasn't suffered any side-effects, but since I have taken so many measures to protect my dog from unnecessary treatments the incident broke my heart. So much so that although I am not a veterinarian, I wanted to share my experience with all you dog lovers out there so that you may have the intellectual ammunition to be able to protect your dog...as much as possible.

To you and your dog's good health,

Dr. Shira Miller
www.shiramillermd.com

"Which vaccines and how often to vaccinate your dog are crucial questions requiring the acceptance of new medical findings, careful thought, and a departure from medical traditions. And don't think that your veterinarian should be trusted to make all your dog's healthcare decisions while you simply nod along. Your nodding is not the action of taking responsibility for your dog's health."  Dr. Paula Terifaj in "How to Protect Your Dog From A Vaccine Junkie"

Last month, I was interviewed by Kim McMillon on the Arts in the Valley radio show at 1480 KYOS AM, Merced, California.

We discussed:

1. The difference between perimenopause, menopause, and postmenopause
2. The short and longterm side-effects of menopause
3. Isn't menopause natural?
4. How are bio-identical hormones different from Premarin and Prempro?
5. Do hormones increase the risk of breast cancer and heart disease?
6. What's the best way to take bio-identical hormones?
7. What is male menopause?
8. Where can I find a doctor who prescribes bio-identical hormones?
9. What does Suzanne Somers have to do with it?

Enjoy and let me know if you have any questions.

Best,
Dr. Miller 

Click right arrow below to listen to the interview. 

Download MP3

Many women believe that if they just power through menopause, then everything will be okay. Contrary to popular belief, however, menopause is not a temporary phase, and postmenopause is a misnomer.

Menopause is the time during a woman’s life when her ovaries completely run out of eggs and she effectively ceases to produce two of her most potent hormones: estradiol (an estrogen) and progesterone. Whether you are 45 or 55 when it happens to you, the result is official infertility, loss of your monthly cycle, and a severe case of estrogen and progesterone deficiency. These hormone deficiencies are permanent and are a force to be reckoned with either right away…or eventually.

Some common problems caused by menopause are depression, anxiety, insomnia, irritability, lack of energy, low motivation, weight gain, hot flashes, night sweats, accelerated skin wrinkling, brain fog, vaginal dryness, painful intercourse, loss of libido, loss of femininity, urinary incontinence, heart disease, and/or osteoporosis. You may get “used to” your particular first symptoms, but just as is the case with any other hormone shortage, there are no long-term gains from a dearth of estrogen and progesterone, only further needless losses and an endless reduction in your body’s standard of living.

The necessary treatment for any permanent hormone deficiency is hormone replacement. The safest and most effective hormone replacement therapy (HRT) available for menopause is bioidentical hormone replacement therapy (BHRT). Bioidentical hormones are man-made hormones which have a molecular structure which is identical to hormones naturally produced by the human body. For example, as menopause causes an estradiol (estrogen) and progesterone deficiency, BHRT is a type of HRT which contains the exact ingredients "estradiol" and "progesterone."

Premarin, Provera, Prempro, and Ortho Tri Cyclen are hormones commonly given as HRT, but they are not bioidentical hormones. Similarly, Prozac, Ambien, Detrol, and Fosamax are frequently prescribed for menopausal symptoms, but they do not address the primary problem and create a false sense of security, not to mention their side-effects. Bioidentical estrogen and progesterone, like a key in a lock, fit precisely in women’s hormone receptors and are therefore the optimal treatment for menopause. That being said, not all BHRT is the same and the best methods mimic reproductive hormone cycles as much as possible.

Shira Miller, M.D.
Southern California's Concierge Menopause Physician
Facebook’s Most Popular Menopause Doctor

Come join me at www.facebook.com/menopausedoctor to help 
save the world from menopause. 

The ongoing mixed messages regarding the cardiovascular safety of hormone replacement therapy (HRT) in the treatment of menopause are despairing for both patients and doctors alike. It is important to think about the relationship between women’s hormones, heart disease, and menopause in broad principles--otherwise, we’d be a candle in the wind to the next press release or statistic.

Previously I have expressed why, I believe, menopausal women considering bioidentical HRT (BHRT) don’t need to worry as much about breast cancer. Now, I’d like to focus on whether or not BHRT is indicated in the prevention of heart disease.

Every year over 400,000 women die of cardiovascular heart disease (as compared to about 40,000 women who die annually of breast cancer) making it the leading cause of death in women. So, the impact of bioidentical HRT on heart disease, one way or the other, is of utmost importance. Notice, I write “BHRT” and not just “HRT.” This is an important difference.

Now, without knowing any statistics, what do we know about women and their hormone cycles, menopause, and risk of heart disease?

1.  Premenopausal, reproductive, women produce varying daily amounts of estradiol and progesterone which result in a menstrual period approximately every 28 days, unless they are pregnant or breast-feeding. The term “hormonal,” although unfortunately many times used in a derogatory way, is a good way to remember that reproductive women have different hormone levels at different times of the month. (Click here and press "play all" to interactively see how these hormone levels change over a normal menstrual cycle.)

2.  Women in menopause or postmenopause do not produce ANY significant amounts of estradiol or progesterone anymore, and therefore have an estrogen and progesterone deficiency. (Click here to view hormone levels before, during, and after menopause.)

3.  Heart disease is rare in premenopausal women, more common in prematurely menopausal, much more common in postmenopausal women, and very common in men.

From the above basic observations, scientists hypothesized that estrogen was the reason why women in general, and especially women before menopause, are protected from heart disease in comparison to men. Estrogen was thought so much to be protective against heart disease, particularly due to its positive effects on cholesterol, that in 1963 the oral unopposed estrogen Premarin (which is not bioidentical) was actually tested in men with heart disease. This counterintuitive use of estrogen (a primarily female hormone) on these men was attempted because men with a history of heart disease have the highest risk of recurrent cardiac events and so were therefore thought ideal candidates for a secondary prevention study of estrogen which could quickly discern its positive or negative outcomes. In 1966, however, a randomized trial using Premarin in men with heart disease was stopped early due an increased risk of blood clots and heart attacks. This negative result halted clinical trials on estrogens and cardiovascular disease for the next 20 years or so, although women still used Premarin for menopausal symptoms and classic animal experiments since the 1950’s continued to demonstrate that estrogens prevent hardening of the arteries (atherosclerosis) and significantly improve cholesterol.

In 1987, a pivotal follow-up report of the Lipids Research Clinics Program, which observed about 2200 postmenopausal women over 8.5 years, showed that estrogen (primarily Premarin) significantly reduced cardiac events in women. In 1991, a UCSD review of 24 observational studies showed around a 50% reduced risk of cardiac events in postmenopausal women ingesting Premarin. In 1992, a landmark UCSF meta-analysis of 32 observational studies showed that postmenopausal women taking Premarin (3 studies included a cyclic progestin) had about a 35% reduced risk of fatal heart disease. In 1998, at a time when Premarin was the most commonly prescribed drug in the US, a UCSD meta-analysis of 25 observational studies showed an estimated 30% reduced risk of heart disease in women using Premarin and a 34% reduced risk in 7 observational studies which used Premarin and cyclic progestin or cyclic progesterone. In 2001, the Nurses’ Health Study, which followed over 70,000 healthy postmenopausal women between 1976 and 1996, reported that nurses taking Premarin showed an approximately 40% reduced risk of cardiovascular disease.

So why the change of heart? With all of these observational studies showing a positive cardiovascular effect, why is there so much ongoing controversy about whether or not HRT is beneficial for heart disease? Well, observational studies are limited in that they may be biased by confounding factors, so the necessary randomized trials were initiated. The most famous of these randomized trials, the Women’s Health Initiative (WHI), was stopped prematurely and claimed in 2002 that HRT increases the risk of heart disease in healthy postmenopausal women. This was the biggest blow HRT has received in our lifetime and many women and physicians are still living in fear of its press releases.

Now, when new information contradicts more than 30 years of observational knowledge and basic science and animal experiments, it’s a good time to think twice and start asking questions before jumping to any conclusions.

These questions will be asked in Part 2 of this article. Some clues to the answers of the paradox are:  unopposed estrogen (estrogen administered without a progestin or progesterone) was found to increase the risk of uterine cancer, the type of hormones used in the Women’s Health Initiative matters, the method of hormone administration used in the WHI matters, and the difference between bioidentical hormone replacement therapy and conventional HRT matters.

Look for the continuation:
HRT During and After Menopause – A Total Eclipse of the Heart? Part 2
(coming soon)

Join Our Active Facebook Page
Subscribe to Dr. Miller's Email Newsletter (and receive Part 2 by email)

The greatest fear of women considering hormone replacement therapy (HRT) for the treatment of menopause is usually breast cancer. This is because, in July 2002, the widely publicized Women’s Health Initiative (WHI) study claimed that HRT increased the risk of breast cancer. More recently, in October 2010, the same study reported that HRT also increased the risk of death from breast cancer.

There is, however, the little-mentioned other side of the story, which everyone should know about:

1. The WHI findings on HRT and breast cancer are statistically insignificant, as Bluming and Tavris best explain in their thorough review.

2. The WHI study hormones were a daily, fixed-dose, oral combination (Prempro) of horse estrogens (Premarin) and a synthetic progestin (Provera).

3. Premarin attempts to mimic estradiol and Provera attempts to mimic progesterone, but neither is naturally found in humans, and thus they are not bioidentical hormones.

4. Real estradiol and progesterone are naturally secreted in varying daily amounts in healthy reproductive women, not in a fixed-dose; and progesterone is actually only produced for 14 days of a normal 28 day menstrual cycle. Click here and press "play all" to interactively see how these hormone levels change over a normal menstrual cycle.  Click here to view hormone levels during menopause.

5. Breast cancer is rare in young reproductive women who secrete both high and low levels of both estradiol and progesterone, depending on the day of their menstrual cycle.

6. In 1992 a small randomized 22 year trial showed that postmenopausal women taking high-dose Premarin daily, but Provera for only 7 days out of each month, did not have an increased risk of breast cancer.

7. In 2004 it was shown that women in the Premarin-only arm of the same WHI study actually had no increased risk of breast cancer, and the same study reported a slightly lower risk of breast cancer in 2006.

8. A pivotal 2008 study showed that postmenopausal women who carry the BRCA1 mutation, which predicts the highest lifetime risk of developing breast cancer in women, showed a surprising decreased risk of breast cancer in patients taking HRT.

9. Estrogens are paradoxically known to both stimulate and inhibit growth in many cell types, properties which are considered potentially pro and anti-cancer, respectively.

10. High-dose bioidentical estrogen is actually being used today to treat breast cancer.

I’d specifically like to focus on the last two points above, because I find them the most fascinating.  The use of estrogens to treat breast cancer is actually not new at all. Before the introduction of the “anti-estrogen” Tamoxifen for breast cancer in the 1980s, diethylstilbestrol (DES) and other high-dose synthetic estrogens were commonly used to treat breast cancer. DES was just as effective for breast cancer as Tamoxifen, but fell out of vogue due to its adverse effects.

The interesting part here is that while DES is an estrogen, Tamoxifen is considered an anti-estrogen, and yet they both have similar efficacy in treating breast cancer. This paradox unravels when one learns that estrogen naturally possesses both growth stimulating and growth inhibiting properties which likely depend on its dose, high-dose estrogens are growth inhibiting (apoptotic), Tamoxifen actually causes super high estradiol levels in premenopausal breast cancer patients, and Tamoxifen may be mimicking high-dose estrogen.

Sadly, the benefits of DES on breast cancer have long been lost in history, and nowadays most patients and physicians alike only know that an “anti-estrogen” is used in the treatment of breast cancer. They then erroneously infer that estrogens cause breast cancer and aren’t even aware that there is any paradox in what is known about the function of estrogen.

Now to the headline of this newsletter: In 2009 a small, phase 2, randomized study on postmenopausal women with breast cancer showed that oral estradiol was clinically beneficial against breast cancer. The lowest effective daily, fixed-dose, oral, estradiol used had the least adverse event rate and achieved estradiol blood levels similar to those found in pre-ovulatory reproductive women. Interestingly, this was the investigators’ goal. So, maybe, aiming to replicate the hormone levels of healthy reproductive women is productive.

An alternative approach to the above oral estradiol schedule (which is bioidentical, but still not physiological and increases inflammation and clotting) would be to prescribe transdermal/topical estradiol and progesterone in a rhythmic, cyclic, manner. The goal here being to achieve estradiol and progesterone levels similar to those found in healthy reproductive women. Such a regimen has actually already been invented, and is called the Wiley Protocol. The Wiley Protocol is currently being prescribed mostly by holistic physicians for the treatment of menopause and is undergoing formal research, but not yet for the treatment of breast cancer.

In conclusion, the WHI’s claim that HRT increases breast cancer risk is incorrect and alarmist and the fear of breast cancer should not prohibit physicians or their healthy postmenopausal women from initiating HRT. However, due to the reality of rhythmic hormone cycles in healthy reproductive women and evidence indicating the improved overall safety and efficacy of bioidentical hormones, I recommend bioidentical hormone replacement therapy (BHRT) and the Wiley Protocol instead of conventional HRT.

Shira Miller, M.D.
www.shiramillermd.com

Is there a woman you care about that may want to know the above information?
Please feel free to forward her this article.

The new menopause documentary Hot Flash Havoc has enjoyed special screenings and will be available on DVD in January of 2011.  Based on the trailer, seems like the movie will be quite entertaining and actually defending the use of bio-identical hormones.  I look forward to seeing it soon.

Check out the trailer here:  Hot Flash Havoc

- Dr. Shira Miller 

In men, the symptoms of low testosterone range from decreased sexual thoughts, erectile dysfunction, increased body fat, muscle aches and decreased muscle mass to anxiety, depression, lack of motivation, excessive sleepiness, and fatigue (especially in the afternoon.)

Many of the above complaints may be caused by other disease processes, but checking a testosterone level is prudent as men lose about 1% of their testosterone every year starting at the age of 30.  In addition, other chronic diseases may further lower testosterone levels.

If a man's level comes out "normal" please know that different doctors and different laboratories have different ideas about what "normal" testosterone levels actually are, and make sure a free testosterone level is also tested.¹

Best,

Dr. Miller 

1 Reference

The American College for Advancement in Medicine (ACAM - the voice of integrative medicine) is giving away 5 registrations to the 2 day workshop I helped design, Integrative Medicine 101, being held Nov. 3-4, 2010, in Las Vegas.

To win, participants must send a tweet to @acamstudents by this Friday, October 15th, 2010 at 2pm PST.  Tweets must indicate in 140 characters or less why you want to study integrative medicine.

5 winners will be selected this Friday.  $449 value

This course is most appropriate for medical students, residents, and physicians interested in learning about integrative medicine.  However, you don't need to be a doctor to participate.

Good luck.

- Dr. Shira Miller

If you haven’t already seen Sex and the City 2, the movie offers more than just fun, laughs, and woman-power--it provokes thought on an important medical issue.

In one of the wild storylines, Samantha Jones (played by Kim Cattrall) is going through menopause and using bioidentical hormones as her treatment: estradiol, progesterone, and testosterone. Most women don’t even know this natural hormone alternative exists since the last word from their doctor (and the news) was that synthetic hormone replacement therapy (HRT) significantly increases one’s risk of heart disease and breast cancer.

What is more, any breast cancer survivor in the audience who remembers Samantha’s history would consider her treatment as downright bad medicine.  But, is it?  Is Hollywood so irresponsible?  Should one take medical advice from a movie anyway?

Bioidentical hormones are completely different molecules from synthetic hormones. What is more, they are actually more effective and safer than synthetic hormones for the treatment of menopause.  In fact, Hollywood’s decision to raise awareness about bioidentical hormones in Sex and the City 2 is cutting-edge in comparison to Broadway’s choice to promote antidepressants and “welcome and celebrate” menopause in Menopause The Musical.

Sex and the City 2 offers new information about menopause therapy for women to think about and discuss with their doctor.

Dr. Shira Miller

If your answer is YES, then you'll soon be able to, if your doctor attends ACAM's upcoming integrative medicine workshop, co-chaired by Dr. Shira Miller.  Send the info below to your doctor or the office nurses and staff.

Workshop: Integrative Medicine 101
When: Nov 3-4, 2010 (Optimal Health Through Integrative Medicine Conference, Nov 3-7)
Where: Paris Las Vegas
How:  Click here to learn about all the courses, meet the physicians lecturing, and to register.
Discounts:  Available to medical students and residents 

Best, 

- Dr. Shira Miller 

Q -  I am a 31 year old man and losing the hair at my temples. I have tried using Rogaine for the past 4 years and my hair loss seems to be continuing. I am considering using Propecia but I wonder if there are any natural options I should be considering. I should also mention my work invokes a high amount of stress and I don't see that subsiding any time soon. Any advice would be appreciated.

Dear Brian, 

Male pattern baldness is a very common condition in men, and is typically identified by slow and progressive hair loss at the temples and crown of the head.  It is caused by genetic, hormonal, aging, inflammatory, and autoimmune factors, and has no known cure.  Although it is a cosmetic condition, it may cause much psychological distress, especially in men under the age of 50.

Rogaine (minoxidil) is an over-the-counter topical drug that is applied to the scalp, to help stimulate hair growth.  It works in some men, by an unclear mechanism, but only on hair at the crown of the head.  Propecia (finasteride) is a prescription oral tablet that works also only in some men, and only for hair at the crown or middle front of the head, not the receding hairline which most men easily see in the mirror.  
Propecia works by reducing the amount of the hormone DHT (dihydrotestosterone) at the hair follicle, which at least partially has been shown to be involved in scalp hair loss in male pattern baldness.  The problem is that DHT (dihydrotestosterone) is an active metabolite of testosterone, and is responsible for the development and maintenance of male secondary sex characteristics. And, Propecia reduces DHT levels not only in the scalp, but in the blood as well.  This explains why possible side-effects of Propecia are loss of libido, erectile dysfunction, and a decrease in semen production.  

Dr. Proctor has developed a natural shampoo and thinning treatment which address the multiple causes of male pattern baldness, and may be worth a try. Definitely this is something to discuss with your integrative medicine physician.

Please also know that hair loss caused by stress occurs rapidly over a few months, and then grows back, and that you should see a dermatologist to rule out other causes of hair loss if your doctor doubts the diagnosis of male pattern baldness.

- Dr. Miller

P.S. Let me know if anywhere on the Propecia website you see it mentioned that DHT means dihydrotestosterone.

Question - How can a woman in her late 40's minimize the symptoms of hormonal fluctuations, such as fatigue, forgetfulness, lower ability to handle stress, and hot flashes?

Dear Anne,

The first thing you must ask yourself is:  Why am I having these symptoms?  The diagnosis should direct your treatment.

Most likely, all else being normal, you may be suffering from perimenopause, which is the transition period to menopause, or frank menopause.  During this time, all women lose the production of the hormones estradiol and progesterone, as their last eggs die off and eventually they are no longer able to bear children.  

So, if the cause of your symptoms are the nose-diving reproductive hormones or you are already in menopause, I believe the treatment should consist of balancing or replacing your deficient hormones to youthful levels.  It's the same idea as replacing low thyroid with thyroid hormones.  

In conventional medicine, however, you will mostly be offered birth control (alien or foreign) hormones for a short period, antidepressants, or therapy.  If you think i am not serious, click here to read all about it on WebMD.  Please ignore their ads for foreign and alien reproductive hormones.  And click here to learn about the differences between foreign/alien hormones and bio-identical hormones.

In addition, for a traditionally-trained doctor, the main goal is only to make your menopausal symptoms go away, not address the primary problem of a reproductive hormones deficiency with all of its sequelae.  This is a huge misunderstanding because for many women in menopause, the hot flashes do eventually subside once they reach rock bottom hormone levels and they are no longer on the hormone roller coaster.  But, that doesn't mean they are all well and have nothing to worry about.  They are still at rock bottom, and they are still suffering from a reproductive hormones deficiency . . . which increases their risk of weight gain, brain fog, fatigue, muscle atrophy, low sex drive, vaginal dryness, painful intercourse, depression, anxiety, insomnia, heart disease, osteoporosis, and more.

I would recommend you see an Integrative Medicine physician for a comprehensive evaluation, preferably one who is able to prescribe you The Wiley Protocol  if appropriate and necessary.

I hope that helps.

- Dr. Shira Miller 

The single most important preventive medical therapy for aging men and women may be hormone replacement therapy. 

Below is my lecture, The Benefits of Hormone Therapy for Men & Women.  

Click here for POWERPOINT SLIDESHOW
Click here for PDF

You will learn the differences between bio-identical hormones and foreign/alien hormones, and understand why for most aging adults the benefits of bio-identical hormones outweigh the risks.  

Share with your parents or grandparents.  They surely don't want to be in the dark about this option.

Enjoy!

-Dr. Shira Miller 

If you have a question for your doctor that you've never had a chance to ask, or you're just not getting a good answer, ask your question here - Scroll down and ask your question in the "Post Comment" section below.  You may ask any question, and it will be answered by me personally, from an Integrative Medicine perspective.

- Dr. Shira Miller

P.S. To feel like you can really ask any question, without having to expose your identity, I recommend using a pen name.