A New Treatment Program to Improve Memory Loss

A New Treatment Program to Improve Memory Loss

Written by Kathy Lynch, PharmD – Women’s International Pharmacy

In spite of hundreds of clinical trials over the past ten years, Alzheimer’s disease (AD) has no effective treatment. AD affects 5.4 million Americans, predominately females. It is estimated that women have a greater chance of developing AD than breast cancer.

Research supports the theory that an imbalance in brain nerve cell signals causes this disorder. Specific signals make nerve connections to cement memories while others allow irrelevant memories to be lost. This signaling system becomes imbalanced so that new memory connections are inhibited while more information is forgotten. Reversible metabolic processes may be involved in the early stages of AD.

Dr. Bredeson and his colleagues at UCLA believe that a comprehensive, personalized approach is the best way to treat memory loss. They have developed a program that optimizes diet (no simple carbohydrates, gluten, or processed foods), utilizes meditation and yoga, and emphasizes the importance of sleep, hormones, good oral health, and exercise. Patients may use supplements as well as medium chain triglycerides like coconut oil or Axona.

The researchers believe that free T3 and T4, estradiol, testosterone, progesterone, pregnenolone, and cortisol need to be optimized. Nine out of ten patients in this pilot program had cognitive improvement.

Additional Resources:

For more resources from Women’s International Pharmacy, see our Mental Health Resources page.

A New Treatment Program to Improve Memory Loss2018-04-04T15:44:16-05:00

Testosterone and Heart Disease

Testosterone and Heart Disease

Written by Kathy Lynch, PharmD – Women’s International Pharmacy

Evidence continues to mount that there is no scientific basis for the assumption that testosterone supplementation causes heart problems. The European Medicines Agency (EMA) recently reviewed the risk of serious cardiac problems in men using testosterone replacement.

EMA’s Pharmacovigilance Risk Assessment Committee (PRAC) looked at major heart problems, particularly heart attacks. PRAC reviewed all recent negative studies plus data from positive studies and available safety data. They concluded that there is “no consistent evidence of an increased risk of heart problems with testosterone medicines.” PRAC also noted that there is evidence that low testosterone can increase the danger of heart problems.

This position has been adopted by the European Union. The EMA does support the conservative position that only men who are low in testosterone should receive replacement. They recommend periodic monitoring of hemoglobin, hematocrit, liver function and cholesterol. They caution that men with severe heart, kidney, or liver disease avoid testosterone altogether. Patients should talk to their doctor or pharmacist for further information.

Testosterone and Heart Disease2018-04-04T17:30:45-05:00

Sex Hormone Binding Globulin

Sex Hormone Binding Globulin

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy


Hormone levels in the blood must be just right. Steroid hormones, including testosterone, estrogens, DHEA, and progesterone, among others, are fat-soluble, but our blood is mostly water. Therefore, hormones and the blood do not mix very well. The body’s solution to this problem is sex hormone binding globulin (SHBG), a protein created by the liver which connects with the fat-loving hormones. The resulting complex becomes water-soluble and can move freely in the blood stream, carrying these hormones throughout the body. It also acts as a reservoir for the hormones it carries and protects the hormones from hyperactive liver metabolism and kidney excretion.

Hormones combine with SHBG to different degrees of affinity or attraction. The most strongly bound hormone is dihydrotestosterone (DHT), the active form of testosterone, followed by testosterone itself.

Although to a considerably less degree than DHT and testosterone, SHBG also shows affinity for estrogens, DHEA, and even progesterone. Estrogens increase SHBG production in the liver if the liver is functioning correctly. Adiponectin, a hormone released by the fat cells, is also involved.

Hormones related to testosterone decrease SHBG production by the liver. Insulin, hypothyroidism, and liver disease may also decrease SHBG. Low levels of SHBG are predictive of metabolic syndrome, diabetes, sleep apnea, PCOS, kidney disease, and obesity.

A useful test for checking hormone levels involves collecting urine for 24 hours and measuring the amount of hormone leaving the body that day. If a patient has low SHBG levels, testosterone will come out in the urine in greater amounts and may be interpreted as the patient having plenty of testosterone when their level is actually low. In order to accurately interpret the urine test results, the urine test should be accompanied by a blood test to measure SHBG.

An interesting scenario happens when testosterone is used as a supplement. As mentioned previously, testosterone decreases SHBG production by the liver. With less SHBG available over time, the supplemental doses of testosterone are more rapidly excreted by the body and don’t have an opportunity to build up in the blood and get to the tissues. It is important to test for SHBG especially if testosterone supplementation does not appear to be working.

Low SHBG causing low testosterone availability puts one at risk for sleep apnea. Poor sleep can, in turn, cause a decrease in testosterone, SHBG, and growth hormone production, creating a viscous circle. Regaining weight after weight loss can be predicted by low SHBG, and Polycystic Ovary Syndrome (PCOS) is also characterized by low SHBG.

If SHBG levels are too high, both testosterone and estrogens are bound. High levels of SHBG increase one’s risk for osteoporosis because the testosterone and estrogens needed to assist with bone formation are not available for use. Birth control pills can increase SHBG greatly, and high SHBG can be predictive of blood clot formation while on these drugs. High SHBG can also be predictive for cardiovascular disease.

Understanding SHBG is another tool to use in evaluating hormones. We are often tempted to label functions in our bodies as “good” or “bad” and some might apply this thinking to SHBG levels. There isn’t good or bad SHBG, just the levels that provide the best functioning for our bodies.

  • Fogle S. SHBG: What is it good for? Presented at the Age Management Medicine Group meeting, Las Vegas, NV: 2014 November.
Sex Hormone Binding Globulin2018-04-04T17:28:24-05:00

Testosterone: A Possible Treatment for Dry Eye Syndrome

Testosterone: A Possible Treatment for Dry Eye Syndrome

Written by Kathy Lynch, PharmD – Women’s International Pharmacy

An estimated 4- to 6-million older Americans suffer from mild to severe dry eyes. Dry eye syndrome (DES) has a wide variety of causes. This condition, while not life threatening, can be quite uncomfortable and distressing. (See our newsletter about Dry Eyes for more information.)

David Sullivan, a medical research scientist with the Schepens Eye Research Institute (a Harvard Medical School Affiliate), has spent the last 32 years studying the interrelationships between sex, sex steroids, and dry eye disease. His work has focused on the essential role that androgens play in the health and vital functioning of tear-producing glands.

Dr. Sullivan’s research suggests that testosterone deficiency contributes to tear instability and evaporation of the oil component of the tear layer. He supports the use of testosterone in the treatment of DES.

C.G. Connor studied the use of testosterone cream in DES. He found that testosterone cream, when applied to the eyelids, provided both symptom relief and an increase in overall tear production.
Additional Resources:
Testosterone: A Possible Treatment for Dry Eye Syndrome2017-12-13T16:44:00-05:00

Testosterone Replacement Therapy and Cardiovascular Disease

Testosterone Replacement Therapy and Cardiovascular Disease

Written by Kathy Lynch, PharmD – Women’s International Pharmacy

There have been few medical debates more contentious than the current controversy surrounding testosterone replacement therapy (TRT) and cardiovascular disease (CVD).

Two recent studies highlighted a possible, though far from probable, association between TRT and myocardial infarction (MI) or stroke. However, the Androgen Study Group (ASG), which was formed to respond to inaccurate attacks on TRT by the medical and public media, quickly discovered misreporting that resulted in two published corrections to one of the studies. With support from medical societies, researchers, and scientists around the world, ASG petitioned the Journal of American Medical Association (JAMA) to retract one of the misleading studies.

Dr. Neal Rouzier, a geriatric specialist who routinely prescribes testosterone to his male patients, has also been vocal in his criticism of the JAMA study. He reports that none of the 2,000 male patients he has treated with TRT experienced MI, and he maintains that 40 years of radiologic and laboratory studies demonstrate long-term protection against plaque buildup. Although low levels of testosterone have consistently been associated with an increase in CVD and mortality, Dr. Rouzier supports a cautious approach when prescribing TRT in older men with CVD or significant risk factors.

A new study, presented at the 2013 meeting of the European Association for the Study of Diabetes, found that low testosterone levels are associated with an increased number of acute MIs in diabetic men. Another recently published study found that older men who received testosterone injections did not appear to have an increased risk for MI. In fact, testosterone injections actually appear to be protective in men at high risk for MI. Clinical data compiled from 40 Low T Centers nationwide also found no association between TRT and MI or stroke.

Testosterone Replacement Therapy and Cardiovascular Disease2018-04-03T11:01:06-05:00

Book Review – The Secret Female Hormone by Kathy C. Maupin, MD, and Brett Newcomb, MA, LPC

Book Review – The Secret Female Hormone by Kathy C. Maupin, MD, and Brett Newcomb, MA, LPC

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

Dr. Kathy Maupin suffered greatly from the loss of testosterone when she had a hysterectomy and oophorectomy due to endometriosis. Replenishing with testosterone pellets has literally given her back her life. She writes passionately about what she and her patients have experienced when testosterone is restored. One of her goals is to enlighten other physicians about her practice model with the hope that more people get access to testosterone.

Dr. Maupin observed positive effects in many aspects after treating her patients for testosterone deficiency, including the following:

Loss of Libido

“Sex is science and not magic,” as Dr. Maupin asserts. Restoring testosterone relieves the loss of interest in sex, the loss of wanting to be touched, and the tendency to create grocery lists in your mind rather than enjoying intimacy. You can get it all back with testosterone restored.


Fatigue is at the top of the list of complaints that brings women in to see a physician. There are many causes for fatigue, including low testosterone. In addition, other complaints that contribute to fatigue (such as depression, hypothyroidism, hypoglycemia, and loss of interest in exercise) can be triggered by low testosterone as well.


Sleeplessness related to a testosterone deficiency occurs when there is a loss of deep sleep and dreaming, wakefulness in the early morning hours, and waking up feeling fatigued and not restored. Insomnia typically first occurs after the age of 35, just as testosterone levels start to drop.


Testosterone is responsible for the secretion of serotonin and norepinephrine, which helps mood, energy and focus. There are many other hormones involved in the manifestation of depression. Investigating hormone deficits, including testosterone, is essential for treating the problem at its core.

Migraine Headaches

Testosterone can cross the blood brain barrier and modulate the activity of the hypothalamus. Headaches may occur when the hypothalamus fails to produce its usual hormone stimulation. Often, other hormones deficiencies are also involved with migraine headaches.


When testosterone decreases, muscles shrink and less oxygen is delivered to the surrounding tissues. A “scarring” occurs in the connective tissue, leading to dimpling of the skin known as cellulite. Restoring testosterone can reduce cellulite.

Mental Acuity

Estrogen is well-known for improving memory, but testosterone also crosses the blood-brain barrier. Testosterone not only improves neurotransmitter production, it can also increase the number of brain synapses and brain cells.

Exercise Tolerance

As testosterone levels drop, exercise becomes more and more of a chore. The very thing that can increase testosterone production becomes more difficult. Testosterone increases blood flow to the muscles, increases uptake of the amino acid building blocks to restore tissue, and even helps clear out lactic acid, which is responsible for the pain in muscles experienced after overexertion.

Dry Eyes

A testosterone deficit may not be the only cause of dry eyes, but dry eyes become more prevalent as testosterone drops with aging, and this is especially common in women. Dr. Maupin found that systemic treatment with testosterone pellets often relieves age-related dry eye syndrome in her patients.


Although we most often think about estrogen deficiencies in relationship to loss of bone, Dr. Maupin writes that nothing helps restore bones as well as estrogen and testosterone used together. They are both powerful bone-building hormones.

Rheumatoid Arthritis

Testosterone can help reduce deterioration of the joints and balance overstimulation of the immune system, decreasing inflammation.

Systemic Lupus Erythematosus (SLE) or Lupus

This autoimmune disease is twelve times more prevalent in women than men. Dr. Maupin found that treating testosterone deficiency halted progression of the disease in her patients.


This autoimmune disease is also more prevalent in women. It is characterized by attacking the blood, and forming fibrotic and scar tissue. Testosterone helps relieve the scarring by reducing inflammation in the blood vessels.

Multiple Sclerosis

This autoimmune disease presents when the myelin sheath, which covers nervous system tissue, is attacked and damaged. Because testosterone can help modulate inflammation, it can help stop the progression of the disease or put it in remission.

Chronic Fatigue and Fibromyalgia

Both of these syndromes arise from a disordered immune system. Testosterone can help modulate both diminished and excessive immune system activity, and can be a key component in the treatment of either condition.

Dementia and Alzheimer’s Disease

Both estrogen and testosterone can have a dramatic impact on stopping the progression of these diseases. Early treatment seems to be a key factor of success.


This is the medical term for the muscle and tissue wasting and frailty that we associate with aging. The question facing Dr. Maupin was: Could intervention with hormones in the very elderly make a difference? Little is understood about first using hormones in the 80s but Dr. Maupin found, to her delight, that testosterone restoration could make an astounding difference in quality of life.

Insulin Resistance and Diabetes

Dr. Maupin writes that testosterone restoration can stop the progression of insulin resistance and forestall the development of diabetes.

Heart Disease

Both estrogen and testosterone restoration can help protect the vascular system against the damage that leads to plaque build-up and ultimately a stroke.

The Secret Female Hormone is a treasure about the very positive effects of identifying and treating testosterone deficiencies. Dr. Maupin is extremely excited about the results she sees in her patients in her clinical practice. Information is often presented in a theoretical fashion, but backed up with real life results. Unfortunately, many practitioners would not even consider that a testosterone deficiency could be involved in many of the diseases listed above. Perhaps after reading this book, they will.

In my opinion, the one thing this book falls short on is an emphasis on the importance of progesterone, especially in women who have had an oophorectomy. Progesterone has more than one target organ (the uterus); there are progesterone receptors throughout the body. Like testosterone, progesterone is a powerful neurosteroid and anti-inflammatory. Progesterone is a hormone that is usually produced abundantly in the adrenal glands and independently by nervous system tissue. Achieving a balance in hormones should always include the consideration of progesterone as well.

Book Review – The Secret Female Hormone by Kathy C. Maupin, MD, and Brett Newcomb, MA, LPC2018-04-04T17:40:39-05:00

Treating Multiple Sclerosis with Sex Hormones

Treating Multiple Sclerosis with Sex Hormones

Written by Kathy Lynch, PharmD – Women’s International Pharmacy


Multiple sclerosis (MS) is an autoimmune disorder characterized by inflammation and nervous system degeneration. Both estrogen and testosterone exhibit anti-inflammatory and neuro-protective effects when administered to MS patients in studies.

Male MS patients were treated with 100 mg of transdermal testosterone daily. At the end of the twelve month treatment period, cognitive performance improved while brain atrophy diminished. When female MS patients were treated with 8 mg of oral estriol daily for six months, evidence of lesions on MRIs decreased while brain function increased.

In addition, female MS patients are often plagued with chronic urinary tract infections (UTIs). Intravaginal estriol significantly decreases UTIs in postmenopausal women.

Further studies regarding hormones in the treatment of MS are ongoing.

  • Gold SM, Voskuhl RR. Estrogen and Testosterone Therapies in Multiple Sclerosis. Prog Brain Res. 2009; 175:239-251.
  • Raz R, Stamm WE. A Controlled Trial of Intravaginal Estriol in Postmenopausal Women with Recurrent Urinary Tract Infections. N Engl J Med. 329(11):753-756.
Treating Multiple Sclerosis with Sex Hormones2018-04-05T10:58:22-05:00

Hormones and Posture

Hormones and Posture

Written by Kathy Lynch, PharmD – Women’s International Pharmacy


Research conducted at the Harvard Business School by Professor Amy Cuddy indicates that body language affects hormone levels. When participants in a study deliberately positioned themselves in a power stance like Wonder Woman, wide open with arms raised, they had significantly increased levels of testosterone and decreased levels of cortisol, the stress hormone. When participants positioned themselves in a more submissive stance by crossing their arms and legs, appearing more closed and smaller in size, it produced the opposite effects on testosterone and cortisol. These changes in hormone levels could be produced by holding the posture for as little as two minutes. Cuddy believes that posture not only influences outcomes; it can also lead to long-term changes in our personalities.

Hormones and Posture2018-04-04T14:55:37-05:00

Book Review – The Hormone Cure by Sara Gottfried, MD

Book Review – The Hormone Cure by Sara Gottfried, MD

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy


Dr. Gottfried has a revolution in mind—one that may lead to better health for many women. In The Hormone Cure, she not only means to sort out the complexities of hormone balance and make it understandable, she offers solutions and numerous resources to help you attain it.

She covers so much ground that it is difficult to come up with something that Dr. Gottfried misses in this book. She begins by helping you sort out potential hormone imbalances with vivid questions such as:

  • “Increased abdominal circumference, greater than 35 inches (the dreaded abdominal fat, or muffin top—not bloating)?”
  • “Vaginal dryness, irritation, or loss of feeling (as if there were layers of blankets between you and the now-elusive toe curling orgasm)?”

She then walks you through the various hormone dysfunctions or irregularities, and describes the “Gottfried Protocol” specific to each.

Dr. Gottfried goes on to explain that each hormone issue is not independent of other hormone issues and (unlike how she was taught in medical school) combined hormone therapies addressing all of the hormone issues should be used together for the best result, rather than addressing one issue at a time. She further describes the common patterns or trends of hormone issues that she sees in her practice.

In addition, Dr. Gottfried explains how you should present symptoms and talk with practitioners to get the help you want, including treatments and/or prescriptions. She includes a glossary of the terms she uses, in case you are not familiar with the medical terminology, and also provides additional resources for getting tested (even at home) and for finding a practitioner who can help you.

Dr. Gottfried wants to help you create healthy habits, and to use journaling or technology to keep you on task. She offers diet suggestions, many of which tend toward an almost Paleolithic eating style. She discusses insulin and glucose levels at length, and covers many of the issues and health problems associated with insulin resistance. She also covers the problems associated with mercury toxicity in food and dental amalgams, and explains how hormone levels are affected. Questions surrounding environmental estrogen mimics (i.e., xenoestrogens) and eating soy are also covered.

Recognizing that non-medical approaches can also help achieve hormone balance, Dr. Gottfried recommends the HeartMath system for training yourself to reduce abnormally high cortisol levels due to stress, or using the alternate nose breathing from yoga traditions for the same result. (Dr. Gottfried embraces the practice of yoga and is a teacher herself.) She also suggests other tools that may help you along the journey, including Dr. Martin Seligman’s website authentichappiness.com, which contains questionnaires for assessing your own strengths and happiness.

Dr. Gottfried doesn’t intend to drop you once you have finished her book. She wants to continue to be your coach, and she has gathered up the power of social media: websites, webinars, blogs, emails, referrals, and references so you can continue your journey with her.

Her writing style is engaging and fun, which may lead some to think that Dr. Gottfried’s book is just a lot of fluff (her being a yoga teacher and all!). But, she is a scientist and medically trained at Harvard University, with over 20 years of medical practice and having treated more than 10,000 women. For inquiring minds, she has included a lengthy reference section that should convince even the most skeptical of her credibility.

Some practitioners have not been willing to address the complex problems of hormone dysregulation because they were not taught how to do so in medical school. Learning about balancing multiple hormones may seem daunting to them. However, this book is written in such an organized, simple, and yet scientific fashion, that Dr. Gottfried may well be knocking down some of the barriers preventing women from receiving the help they need to optimize their health. We say, bring on the revolution!

  • Gottfried S. The Hormone Cure: Reclaim Balance, Sleep and Sex Drive; Lose Weight; Feel Focused, Vital, and Energized Naturally with the Gottfried Protocol. New York, NY: Scribner; 2014.
  • Seligman MEP. Authentic Happiness. authentichappiness.com
Book Review – The Hormone Cure by Sara Gottfried, MD2018-04-10T14:37:51-05:00

Diabetes and Testosterone

Diabetes and Testosterone

Written by Kathy Lynch, PharmD – Women’s International Pharmacy


A testosterone deficiency has long been suspected in people with diabetes. A recent study concluded that males with sexual performance issues and/or abdominal obesity and metabolic diseases should be tested for low testosterone and treated accordingly.

A literature review examined the effects of testosterone therapy on patients with metabolic syndrome and found that they exhibited decreased fasting blood sugar, waist measurement, and triglyceride levels. In addition, insulin-dependent diabetic women with no menstrual cycle were found to have significantly lower levels of testosterone than cycling diabetic and non-diabetic women.

Diabetic men and women may want to have their testosterone level evaluated in light of the above findings.

Diabetes and Testosterone2018-04-04T13:17:39-05:00