dr. nelson: hello everyone, it’s nice to be back with you ... · as you can see there in red, the...

RONDA NELSON PHD ND MH 1

SUPPORTING MALE HORMONES & COMMON DYSFUNCTIONS (PART 2)

Dr. Nelson: Hello everyone, it’s nice to be back with you for our part two of Evaluating

Male Hormones webinar series. And I really love talking about this because I think not

very people are chatting up about male hormones.

So last week we covered a lot, we went in depth about the adrenal glands, and talking

about how that is such a key factor for really dealing with males and what might be going

on with their sex hormones, what might be going on with their version of the endocrine

system.

We are very familiar with females, we all kind of know how to do that, but sometimes

these male issues can get a little bit tricky to deal with. But until you deal with that

underlying issue, and that is that adrenal gland – we are going to review that in a minute

– that can really make a big difference with how well, or what kind of outcome you are

getting with these men.

So before we get started, I want to throw this in here: if you want to get more information

and watch me, if you don’t have Periscope as doctors, you need to. And if you want to

know how to do it just watch me on Periscope. This is a great way for you to market you

as a professional in your arena with what you do. If you want more information, you can

email me and I’ll help you be able to navigate through this. But I’ve just had so many

practices and doctors be able to use this tool to be able to get their message out, be

perceived as the expert in their field, it’s just one more thing you can add and it’s not

social media, which makes me really happy because I really have an aversion to social

media – it’s necessary, we got to do it, but anyway – so I just wanted to throw this in. So

let’s just jump right in.

@slide 5: Testing Options for Adrenal Dysfunction

We’re going to talk now about how do we test these adrenal glands. There’s several

different ways we can do it and we are briefly going to cover in-office testing, some of

them are using either serum or saliva, saliva being my favorite. So here are some of the

things, let’s just jump through these:



One of the things we know is that conventionally the testing used for any adrenal

dysfunction is going to be focused on either Addison’s or Cushing’s disease and it

is going to involve using serum.

It’s always just that single sample test. There is some variety in the way that those

are tested but the key thing I want you to know is that there is no consideration of

that dysfunction in that circadian pattern that we looked at, and we’ll look at some

more here.

Many years ago, back in 2006/7/8 the American Endocrine Society said serum

testing is really inadequate for evaluating and assessing steroid hormones. That’s

all those hormones in that sex hormone pathway all the way down, starting with

cortisol and progesterone, 17-hydroxyprogesterone and then all of the sex

hormones and the androgens in men.

So we know that saliva testing is a much more valid way and reliable way of looking

at the tissue exposure to these hormones rather than just what is floating around

in the blood stream. However, medicine doesn’t yet really recognize that.

@slide 6: Ragland’s Test

One of the tests that you can do for adrenals, and I know most of you know this so I

won’t spend a lot of time here, but that’s Ragland’s test. So that is just with the systolic

pressure, have them lying down, use a manual cuff so you are going to be doing this

manually, not with an electric one. But just do that normal regular cuff pressure test,

don’t take the cuff off but have them stand up, and then take it quickly.

What we want to see if there’s a good adrenal function, we want to see a 6-10 point

change. It should rise in the systolic pressure. That is great, that is optimal.

If it is 10 points or less or it even drops more than that, you can see there, if the

pressure drops 20 points or more then we know that the patient is in trouble. Their

adrenal glands are in trouble.

And again, they may not have Addison’s or Cushing’s, both of those diseases are

relatively uncommon. They are actually very uncommon. I’ve had one Addison’s patient



and one Cushing’s patient in the last 12 years, and I’ve seen 1000s of people. You are

just not going to see them. This is just dysfunction in the gland, it is just not performing

the way it needs to perform.

@slide 7: Pupillary Reflex Test

One of the other ones that I like doing this test with the patients because I can send them

home with this test. I do it and then I do it again and let them see. So the pupillary reflex

test is a fabulous way of seeing how the body is responding to a stressor.

So you are going to get a little pen light and basically shine it in the eye like you’d be

looking if you went to the optometrist, they are going to look in your eye with a light. What

we are looking for though is not at the retina, we are looking at the way that the pupillary

reflex:

is it going to constrict and hold

is it going to start to pulse

or is it going to enlarge or is it going to fail to constrict at all on exposure to that

light

So the light is the stressor. So when we have the patient in a normal room with normal

light, we can see where their pupil is at. Give them a little flash of that pen light and watch

the pupil. And here you can see, I don’t need to go over it, you can read here, but you

can see what will happen. The point is if the body is unable, if those adrenal glands are

unable to hold that pupil and:

Constrict it and hold it for 20 seconds or it starts to pulse that’s ok.

But immediately if it doesn’t constrict but it is like trying to, it starts to pulse then it

loses its tone and it gradually enlarges, then we know there’s some fatigue.

What happens in severe exhaustion is that stress, the light stress on the pupil, just

blows that pupil right out - I mean it just blows out, it gets large, it doesn’t constrict

at all.

So that is a great in-office test. As I said, I do this on them and then I will turn them around

and do it again on their other eye. And they love this is because they go home and they



are checking it, their eye, and they are checking their husband, their spouse, their kids

and their friends and everybody learns how to do this and I’ve had a number of new

patients come in over the years by just teaching the patient how to do this easy test at

home.

@slide 8: Foundational Evaluation of Sugar Handling

This is a handout I give out when I teach seminars around the country and this is from the

international IFNH, you can order this if you want to but you don’t really need to. All this

is giving us is information on the body about where we might also see some issues with

the adrenals.

As you can see there in red, the medial knee, there is medial knee tenderness at

that insertion point.

We’ve got that adrenal inguinal ligament tenderness that we can see right there in

the groin.

And then there’s also the posterior interior ilium, the PI, where we are going to get

that chronic short leg.

So those are 3 other in-office tests that are really quick to do.

@slide 9: Hair Mineral Analysis

Another one I like to do is the hair-mineral analysis. I’m not going to talk about this

too much but you can see there the sodium and the potassium, those are the two

markers on the larger chart there, that will give us indication of adrenal health.

Hair mineral analysis is just looking at soft tissue. The hair is just soft tissue. So

we are looking at mineral accumulation in the hair.

This one is a little bit harder to understand and interpret, you have to spend some

time learning this test. But it is a great indicator. It is not a full diagnostic tool – that

is not what we are using it for, what we are using this for is a way to be able to

assess and see what kind of stress is the body under based on what these minerals

are that we see in the hair.



@slides 10-11: Serum vs Saliva

And then the last thing, my favorite, is going to be using saliva:

We’ve already discussed this, serum has been found insufficient and impractical.

So think about the patient who is already – maybe they have some anxiety, they

are exhausted, and we are going to send them in for a phlebotomy 4 times in one

day. That is not going to be a good plan for them, talk about inducing stress. That

is really going to be a stressor for them.

The serum, because it only measures that protein bound hormone, which is greater

than 95% in circulation, it is what is in circulation, it’s what’s floating around in the

bloodstream, it is not what is in the local tissue, and that is what I want to see. I

want to see what is happening with cortisol at the site of the receptor. What is

happening in the tissue? How much is getting there? How much we have in the

blood stream is one thing, that tells me about the health of the adrenal glands and

the other cortisol producing glands and sites in the body, that’s fine what is in the

blood stream, but I want to see what is in the tissue, what is actually working on or

at and around those receptor sites.

So we know that there is a correlation between the free and the salivary testing,

because salivary testing measures that free fraction.

The government uses it on astronauts, military personnel, it is paid for by insurance

as even Medicare will pay for salivary testing, cortisol testing.

We know since 2007, the paper that was released by the American Endocrine

Society said saliva is a much better way to go.



@slide 12: Testing Options Saliva

So this this is what I do, this the test that I use, a particular lab I like. There are a number

of them you can use, so please feel free to use whatever you like. The one I use does a

4 sample test:

that is from 6-8am

at noon

around 4-5pm

and then at bedtime.

And it kind of follows the natural circadian pattern of the adrenal glands.

@slide 13: Adrenal Test

The test that I use is called an ASI from Diagnos-Techs. I like them because I like the

other markers that are included in the panel. So I like the ranges, I’m very happy with this

test, I’ve been to the lab, seen what they do and I’m very happy with this test.

Not only does it give us that daily cortisol rhythm, those four markers, four points

throughout the day.

It also gives us DHEA pool, so DHEA and DHEAs.

We’re going to get a look at 17-hydroxyprogesterone which is the antecendent to

cortisol.

Fasting and post-prandial insulins.

The gliadin marker, just as a kind of an indication that maybe this patient has

something going on.

And then we are going to be able to look at the total secretory IgA in the body, but

it is a real good indicator of gut health because we know 80% of the secretory

immunoglobulin A produced along those mucosal linings, 80% of that is in the gut.

So if we are looking at any kind of male or female hormone assessment, we want

to include these, the ASI along with that.



@slide 14: Normal Cortisol example 1

So this is a normal cortisol, you can see this patient has got a nice robust cortisol first

thing in the morning, at noon, at 4pm, and then it is dropping appropriately at midnight.

@Slide 15: Circadian Cortisol Profile example 2

But if we look right here, this particular test, this patient is not feeling so hot. This is the

patient that maybe has lost some of that hypothalamus pituitary input to the adrenal

glands, because it is not in that natural curve. So that green shaded area is where we

want to see that, and that is based on – remember these glands, I call them kind of stupid

sometimes because they can’t produce the hormone without the instruction. They need

the instruction from upstairs. They need that pituitary ACTH to signal the adrenal gland

so that we know we are getting those pulses when they are supposed to be happening.

This poor patient is flat out tired, and not only that, I suspect HP axis dysregulation.

@slide 16: Circadian Cortisol Profile example 3

Here’s another example. This patient is not feeling so great in the morning, ok, but not

great; does a little bit better throughout the day, but then look at what happens at midnight.

Now there’s two scenarios that could be here, I’ll give you the two scenarios and then I’ll

tell you which this was on one of my patients.

So two scenarios would be that: she gets home from work, this was a female. She is met

with the kids, the dog, spouse, homework, dinner, soccer game, has to run to the store

because doesn’t have enough, parents that are needing help, or she’s got teenagers –

that is enough to push you over the edge, right.

So she really encounters some serious stress when she gets home from work and her

cortisol just jacks up in the evening. Having elevated night time cortisol is one of the

first patterns of dysregulation that you will see with patients that are in any state of

adrenal dysfunction. Just those adrenals glands are not working well. So that is what

we see here at midnight, that is one possibility.



The other possibility is she used a progesterone cream before she collected the

sample.

And that was actually the case with this particular patient, she did use a progesterone

cream. She put it on, and it doesn’t take much and the saliva is going to pick that up and

now we are seeing it on the saliva test with the cortisol. It is transferring through 17 OH

progesterone and then dropping down into cortisol. We’ll look at that chart again in a little

bit if you don’t remember from last week.

@slide 17 Circadian Cortisol Profile example 4

This patient, again, this is an executive at a very high, publically traded company. She is

the administrative assistant, to the CSO of the organization, so lots of stress, lots of

meetings, lots of responsibilities. She had 3 small kids at home and when she got up and

she hit the freeway, and probably taken the kids to daycare school, whatever, her stress

started and it lasted all day long.

The nice thing about this is we do see the elevated cortisol, that tells us that we have got

a stress response and you could just as easily see this in a man. But she is just burning

up that cortisol during the day and then she is exhausted when she is waking up in the

morning. And so you can see lots of different ways.

@slide 18: Circadian Cortisol Profile example 5

Here is another one. This one is a progesterone – woman didn’t tell me she was using a

progesterone cream and you can find this with men. The reason I put these in here is

because if a woman is using a progesterone cream and she has been in contact with her

husband for some time, you can start seeing dysregulation in the cortisol profiles because

of that cross contamination in the skin. This is well referenced, well researched in the

literature. This particular one is a woman, but we are going to look at some male cases

here in a minute. But this is the same thing, the same thing with testosterone like we

talked about last week.

With testosterone, when you’ve got a man who is using oral or topical, the topicals are

worse for this, but you will see that when he is under the cover snuggling up with his girl



– this is not sex, but skin to skin contact – that skin to skin contact can transfer those

hormones back and forth. So I have a colleague who is an MD in Texas and he said to

me not long ago, I had my first case, first husband and wife came in. He said it was funny

because I tested the salivary hormones for both of them, sex hormones, he had more

estradiol than she did, and she had more testosterone than he did. And she was using a

compounded estrogen cream and he was using a testosterone. They were clear that they

were getting it from one another.

@slide 19: Adrenal Gland Support

So how are we going to support those adrenal glands, I promised you we’d get into this

and this is what I want to spend the first part of the webinar talking about.

First thing, how do we help these patients modify or eliminate their stressors? That

stress is not going to go away at all, but one of the things we can do is maybe

coach them through a little bit of lifestyle modification. Maybe say no when you

can, or if you can get somebody to come in and clean your house for you so you

don’t have that responsibility, anything you can do to modify those stressors.

Stabilize their blood sugar, this is super important because the adrenal glands are

very involved in blood sugar regulation.

Get them to exercise if they can tolerate it, sometimes they are too tired and the

thoughts of doing an exercise program is enough to make the want to cry. But even

if they can just start – walk to the mail box and back, walk to the end of the block

and back, just something, some kind of movement, or even stretching, any kind of

stretching. Anything you do to just work those muscles, stay fit. You can use lots

of things, you can use a household chair, just gentle pushup, squats or lunges

holding on to a chair.

Then I love to use herbs, and other nutritional support to provide the support that

we need for those adrenal glands.



@slide 20: Nutritional and Herbal Support

So if I can put the nutrient with the herb, I like that synergy of that combination.

That is just how I do it. You all may have a very different way of doing it so please

don’t feel like, I’m not asking you to do what I do, I’m just telling you what I do.

- We know that the adrenal glands take vitamin B and those cofactors.

- We need vitamin C and those cofactors.

- We need trace minerals.

- And we’ve got to have adequate fat, that is crucial.

- And I will pair those foods, minerals, fats, with the adrenal trophorestorative

herbs which we will talk about in a minute.

So any time you’ve got this situation, where you’ve got a man that’s in adrenal

stress, you’ve got to be able to evaluate the adrenals alongside any male hormone

evaluation, you’ve got to put them together.

@slide 21: HP Axis Support

So HP axis support might be part of your adrenal protocol and I’ll talk about how

to do that in a minute.

I typically will focus more on the hypothalamic support rather than the pituitary and

the reason that I do that is because of the involvement of the adrenal glands in the

emotional component of stress.

So I don’t know of very many people who would say they don’t have any emotions

that are involved in that stress response. It is almost always emotionally driven,

especially for women, but men the same way. They are emotionally charged. That

emotion is going to be part of that limbic system, right. The limbic system and the

hypothalamus are so connected. So because stress has such a strong emotional

component, I’m tending to think about hypothalamic support rather than the



pituitary, but I may need some pituitary support and I’ll talk about how to do that

with herbs.

Desiccated products I recommend using them only short term to provide relief to

the gland. Only.

But this is where I see a lot of practitioners get into trouble with these desiccated

products, granted the patient feels amazing when you give them the desiccated

product, they feel fabulous, they are on the top of their game. And it is wonderful.

But the desiccated product, just like providing desiccated or synthetic thyroid

hormones, or any other glandular, over time the gland, the endogenous gland, the

patient’s own adrenal gland, will down-regulate and become lazy and just become

a little more atrophied over time when you are providing these desiccated products.

There is a time and a place to use them, and that is while you are providing

nutritional and herbal support at the same time you are giving the desiccated

product. So allow the desiccated product to be the crutch. You are giving the gland

a temporary relief, a break, so to speak. But you better be coming in behind with

some good support for the adrenal glands so you can pull that desiccated out after

a couple of months and then the gland is working much better.

So liquid herbs are what I like to use but again you can use whatever you want.

@slide 22: Liquid Adrenal Support

So I’m going to tell you that the two herbs that I love are Rehmmania, along with an

adaptogen that I love and my favorite one is Ashwaganda, or Withania, that is another

name for it. Licorice is also great for helping the adrenal restoration process, and we’ll

talk about in a few minutes about the concerns with hypertension. But I love using the

herb in multiple herbs together.



@slide 23: Key Adrenal Protocol

So here is how I do this, this is what I do:

I use these 4 liquids and I blend them together and put them together in a tonic.

Sometimes I’ll just give the 4 bottles to the patient and let them do it.

- Rehmannia, Ashwaganda

- I give them an Echinacea because of the role of the adrenal glands with the

immune system and as well Echinacea has a very strong HP axis regulating

property.

Now remember with these herbs, I will tell you for those of you that are going oh I can’t

believe she is using herbs, herbs never work – I’m going to tell you US herbs rarely work.

There are a few companies where the herb will actually confer a therapeutic effect but

very few of them do. And I have a master’s degree in herbology and extensive advanced

study in herbology and use of herbs and I’m telling you Western Herbs do not have the

phytochemical potency that some of the herbs do that are from overseas. So these herbs

come in from Australia, I use a company called Mediherb and they are through Standard

Process and they are the reason that I use Standard Process only because I love the

quality of these herbs, and I know that I’m going to have the same therapeutic outcome

every time. They have never failed me yet. So I cannot tell you how many times this

adrenal tonic - and I always say it kind of raises people from the dead.

And I’ll go to - when I teach seminars and I’m telling these docs if you’ve got fatigued

patients and you suspect adrenal - any kind of adrenal dysfunction, you use this tonic and

in two months they feel like they have come back to life. And they say no, I’m going to

use – whatever, and it doesn’t work. And then they’ll come back and use this and sure

enough it works every time.

Here are some of the other supplements I use:

I use one from Standard Process, it is called Drenamin, it’s just got those Bs and

Cs and cofactors I told you about, combining the food.



In and of itself it is not altogether therapeutic in repairing the adrenals, but when you pair

it with the herbs it really works.

You can give some hypothalamic support here or there is one called Withania

complex and that just really helps to calm them down.

@slides 24-25: Herbs

So here is a chart of some of the properties of these herbs that I like to use. And we’ll just

stick with the first 4 here just so you can have an idea. This is why I love using these

herbs, because they have so many different effects in the body.

So if you look, Rehmannia, Ashwaganda, Echinacea, Licorice – those first four are the

four I put together in that combination. All 4 of them are anti-inflammatory, and how many

of our patients have got strong inflammation happening in their body whether it is gut

inflammation, brain inflammation, joint inflammation, wherever it is, all four of these are

anti-inflammatory.

- Echinacea has adaptogenic properties just like the Ashwaganda does. Echinacea

stimulate lymphatic. I don’t even have all them listed on here. It supports the HP

axis. It has strong effects with the Hypothalamus pituitary.

- Rehmnannia acts as a mild laxative. It is the key adrenal restorative herb.

So I love using these herbs because I can get so much more bang for my buck, so to

speak, when I put them together.

You don’t ever have to worry about hypertension with licorice. The amount in this

tonic is insignificant, will not have an effect. I’ve used this liquid combination for

over 10 years, I have never yet had one problem with hypertensive patients. Only

when you use the licorice at a really high dose for an extended period of time, that

is when you are going to get into trouble, but it is only after maybe 3 or 4 months.

You’d have to use a really high dose of licorice for a really long period of time.

So I love using these liquids and it is one of the fastest ways that I can get those adrenals

to repair.



@slide 26: Rehmannia

So here’s, and we are going to slide through these really well, here’s the Rehmannia:

- And here is the individual dose, so 4.0-8.5mls per day, I recommend that you

divide them.

- But it just supports and nourishes the adrenal glands, supports the HP axis.

- You can read here, I don’t need to read all this to you – safe for children, safe for

pregnant women, also safe during lactation.

- There are no contraindications with this herb for any medication. This is safe all

the way around.

- It does help make bowel function work a little bit better.

- And it works well when it is combined with Ashwaganda.

@slide 28: Ashwaganda

So Ashwaganda here again. 3.5-6mls a day.

It is also known as Withania.

This one is probably one of the best adaptogenic herbs that I have, to use, that I

love because it just gives them a real sense of ah I can do it, I don’t feel as

overwhelmed as I did, I’m good, I can do this.

It also enhances immune function. So when I’ve got a patient that has depressed

white blood cell count, for whatever reason, the first herb that I’m thinking of is

Ashwaganda.

So this combines extremely well with Rehmannia, those two go well together.

@slide 28: Echinacea

This is a blend of Echinacea purpurea and Echinacea angustifolia.

This is very, very, excellent to use with any autoimmune condition, it does not

stimulate or amp up the autoimmune response but instead what it does is it



modulates it, so it will calm down an overactive immune and also enhance an

underactive immune function.

This promotes healthy white blood cells and blood cell production is regulated by

the endocrine system, so supporting the endocrine system plays a huge role in

how your CBC looks.

So Echinacea, great, this is a blend again, 3-6mls per day.

@slide 29: Withania Complex

And then there’s Withania complex, this is the 4 herbs that are in it: Skullcap, Licorice,

Ashwaganda, and a little bit of Korean Ginseng.

You would think that it would be very stimulating but it is not. Withania complex just calms

them down. I need it for that wired and tired patient, they’re super amped up but they are

exhausted, it’s like they are stuck in that sympathetic mode. They are just wired and they

can’t calm down, they are anxious, and worried about stuff, they are agitated, they ae

moody, they are just not happy in their own skin. And we have so much of this walk out

the door.

9 tablets is a pretty high dose, usually I’ll start them around 3-6. And this product works

incredibly well, super great for A-type personalities. You want to start them high, right

about 6, and then they can titrate down as – I would say it is going to take your rpms down

– you are going to go from like having a vehicle moving at 8000rpms, way over in the red

zone, it is going to pull you down to 1500-2000 rpms which is functional. That is what this

is like, I always call it Disneyland in a bottle, it just makes everybody happy.

@slide 30 : Licorice

Now here is the licorice one. 1:1, 1.5-4.5 mls a day. Pretty potent, but again this one

works super well on the adrenal glands and it is also excellent for the digestive system to

just soothe and heal and rebuild that.



@slide 32: Eleuthero

This is another adaptogenic herb that some of you may be familiar with. This one has

more of a role in modulating blood glucose, so I use this sometimes. If I have a patient

that has got more of a blood sugar handling problem. It is also known as Siberian

Ginseng, for those of you who are not familiar with this.

@slide 33: Using Desiccated Adrenal

So the desiccated adrenal we talked about this, just use for up to 12 weeks for immediate

help, but only use it in conjunction with the other herbal, nutritional, adrenal support. So

use your herbs, use diet, support their blood sugar, etc.

I’ve had this product, the desiccated adrenal product work well for a gentleman who lost

his wife very suddenly. He took her into the hospital for something they thought was minor

and he didn’t bring her home and they’d been married for 55 years. And I needed to give

him some support because his adrenals just took a tank. And this really helped him. But

I also gave him that liquid tonic and I gave him a few other things and it brought him, he

was able, didn’t change the situation obviously, but it helped him be able to adapt, to

grieve, and to get through the process without feeling completely worn out.

@slide 34: Adrenal Complex

So this is another one that, another simple combination of just Rehmannia and just

Licorice. Tiny bit of licorice with more Rehmannia. And this is a tablet if you didn’t want to

use the liquid this is a tablet form that helps support adrenal glands.

@slide 35: Rhodiola and Ginseng

And then two other ones, these are two of my other favorite ones that I use often for

adrenal glands. This one right here and the next one are probably my two favorites for

men that won’t do a liquid but they really need to do something.



I will use this one because this is great for workaholics, it is great for chronic fatigue, it

helps with mental clarity, sharpness, memory, concentration. If you are used to

accomplishing x during the day, x amount of work, you take the Rhodiola Ginseng

together and it increases that productivity by about 20% and they love it.

@slide 36: Rhodiola Schisandra

The other one is Rhodiola Schisandra. This one is more for the under 45 patient and is

very good for physical stamina, strength, endurance. Helps with, like if you work out, when

I go to the gym I take 2 Rhodiola Schisandra before I go and I take 2 when I’m done and

it makes an unbelievable difference in my workout at the gym.

And also helps with liver detoxification, is anti-inflammatory, so this one is a great one as

well.

@slide 37: Chronic High Cortisol

So if you have a patient that ends up with that chronically high cortisol like the one that

we saw, the lady that was working in the publically traded company and she was the

assistant to the CSO, this is where you want to get in and get that high cortisol pushed

down, because as we talked about last week cortisol is catabolic, it will break down body

tissue. We don’t want accelerated aging. So we want to get that cortisol back in the normal

range where it confers more of a beneficial and protective effect.

So two of my favorite herbs are Ashwaganda and California poppy. Those are two

that I use often for support when their cortisol is high.

The dose on both is just one teaspoon just 1-2 times a day. I prefer that you do it

beforehand. And if the high cortisol is keeping them from sleep, taking California

poppy, you could do both, before bed does really help with sleep, it just helps to

calm them down and get that cortisol to come down.



@slide 38: For Extreme Fatigue

If the fatigue is extreme and you’ve got a patient that you suspect might be even in more

of an Addison’s type situation, you may want to consider combining a little bit higher dose

of licorice with some Eleuthero and then take that throughout the day at those cortisol

pulses, don’t have them take it too late in the evening because it will keep them up. That

licorice is pretty nice, it works well but it is quite stimulating and it might keep them up.

@slides 39-40: Starting Point

So where do we start. I flew through those but you guys will be getting the notes so please

feel free to print and download.

We want to stabilize blood sugar.

We want to make sure that we’ve got dietary changes because if you get their

dietary changes in place you get their blood sugar stable, you will improve their

energy by as much as 50% or more. So I always start with the diet first. When

these men come in I say ok I want to see what you are eating because you know

what it is – they are living on coffee, living on fast food, or they are skipping

breakfast, or they are eating out, or not eating until late, or not eating at all, higher

amounts of alcohol – you’ve got to get their diet right first. That improves their

energy when you can stabilize that blood sugar, they’ve got that nice steady

release of glucose, that availability of glucose throughout the day.

I have a cd, I’ll show you a picture of it in a minute, that I recorded to give to my

patients, for them, and I have one for doctors as well, you can get it on my website

if you want. I give them this dietary makeover cd to educate them about how to eat

and it is basically a simplified protein, fat, carb, more like a paleo diet, I’m not a big

fan of the paleo diet per se as a starting point because so many patients just can’t

do it so this just makes it super simple.

But if I can get their blood sugar stable, that is going to make a big difference in

how those adrenal glands respond.

This is what the cd looks like, it is available on our website if you are interested.



@slides 41-42: Dietary Makeover

So I recommend that they get these 5 foods out:

- I want every man off of the grain, especially the gluten containing grains, but

grains, grains, get them off the grains, they are so inflammatory.

- Processed dairy products, I say ok to raw dairy if you want, but processed dairy

products I try to get them off them right away.

- Non-fermented soy products are a no-no so that would be like soy burgers or tofu

or that kind of thing.

- Any caffeinated products like the coffee because of the hit they are putting on the

adrenal glands. Green tea is fine though, I’m fine with that.

- And then any processed or refined sugar, we know that that is highly inflammatory

as well.

So I tell them:

Don’t skip meals, don’t skip breakfast, lunch, dinner.

I want you to eat a protein, a fat and a carb with every meal and every snack

So you are going to eat every 2-3 hours, and what that translates to for these men

is I want them eating a breakfast, a lunch, a snack in the afternoon and dinner.

And then twice as many veggies as fruit because fruits are easy, right, we can just

grab and go. But what I want to do is get them so they have that steady blood

sugar release throughout the course of the day.

This just provides them a good framework.

Allows them a lot of flexibility and freedom as far as what they eat.

But it keeps that blood sugar steady.



@slide 43: What Are They?

Protein: So here’s what I tell them, here’s your protein. I really want them to focus on

animal protein. I have found over the years that the patients that have vegetable protein

or abstain from all the animal protein, that they do tend to be sicker patients and they

don’t tend to do as well. Most people don’t know how to eat correctly a vegetarian or

vegan diet. I am a big fan of animal protein.

Fats: The fat always really good saturated fats and I know that in the functional world we

know that these saturated fats are where it is. But again make sure that the fats are

organic or that you are at least getting from a good source. So I would never recommend

for example eating the chicken skin on an animal that has been fed incorrectly or

inappropriately because the fat cells are where those toxins are stored. So it is very

important to educate them. If you are going to use lard or bacon make sure you get it from

a pig that is sustainably raised. Butter obviously organic, all those fats really important

that they are good sources.

Carbs: And then fruits, veggies, beans, legumes, things that are going to get them good

amount of fib and some carbohydrates, that is what we want in that column. Notice the

absence of the grains.

@slide 44: Adrenal Case Studies

So lets’ jump in and look at a couple of case studies to tie all this together before really

getting into the male physiology.

@slide 45: 84 Year Old Male

This was a funny case because this 84 year old guy comes in and he is just the funniest

guy, but he was really wirey and very hyperactive, he talks really fast, he was always very

active but he says I’m tired. So I’m automatically thinking he’s got to be that A-type

personality, exhausted but always amped up. He said he had some digestive issues, he

had a little bit of bloating, some reflux, indigestion, but his loss of libido was his greatest

concern, which cracked me up. Here’s this 84 year old guy, right, and he says I don’t have

as much muscle tone any more, I just can’t do what I used to do and I look like a saggy



old man – I really want to make sure that I have libido, I got to have libido, my wife really

wants me to have libido. And I’m thinking, I don’t know, maybe I should ask her if she

wants you to have libido because you are making me crazy. He is just dadadada talking

really fast and at the end he tells me oh by the way, I’m using a testosterone cream.

@slide 46: 84 Year Old Male - Tests

So I ordered the adrenal test which is the ASI

And the male hormone test which is called the eMHP and you are going to know

this panel really well by the time we’re done

And I ordered a thorough blood panel, really got a good work up on him

I did a Ragland’s test on him and he had a 15 point drop in the systolic pressure

so I knew his adrenals were in a little trouble

But he kept saying don’t take me off my testosterone cream, I want to stay active,

I want my libido, don’t take my testosterone cream away. I mean he just would not

let go of it.

@slide 47: 84 Year Old Male - Protocol

So I started him on – you can see exactly what I gave him – so I gave him:

- the tonics

- the Drenamin

- the Drenamin and the Symplex both of those are Standard Process products but

you may have something that you like just as well to stick in there.

- And then I gave him an herbal formula called Digest and it is basically a bitter

herb. And so I have him dissolve the bitter taste and then swallow, I want him to

taste those bitter herbs to really activate that so that he can get that nervous

system engaged in the digestive process really actively.



@slide 48: 84 Year Old Male – ASI

So here was his test. So you can see that he is not ok in the morning, but he is a

little high, he is running a little bit high, not that bad, like he is ok but he does not

have a nice curve – you see that lazy boy curve in that green shaded area. He is

sort of like a not great curve, he is just not there. I need that morning cortisol to go

up nicely.

So remember we talked about last week how important DHEA is to be able to see

if we have got a diversion of cholesterol down to cortisol at the expense of the sex

hormones. And his DHEA is a little lower than I’d like to have it.

His insulin fasting and postprandial are both low so I know he has got some blood

sugar stuff going on.

His 17-hydroxyprogesterone looks good.

His SIgA just a little bit low.

And look at that gluten antibody and he was eating a ton of white bread and

crackers and dips and all sort of stuff, so I knew his diet wasn’t great. He wasn’t

willing to talk about much of anything with me except you know what, he just

wanted to make sure his parts were still working.

@slide 49: 84 Year Old Male – Comments

- So he might have a pancreatic issue because of all the sugar intake and the carb

intake.

- His gut health looks to be compromised because of the gliadin.

So these are just some of the comments I made.



@slide 50: 84 Year Old Male – Follow Up Appointment

So I gave him the stuff and 3 weeks later:

- I’m giving him tonics, Drenamin, after I get the test results I’m still going with the

same protocol.

- I said I want you to get off of gluten.

- I wanted to talk to him about his diet again.

And then you’ll see after we get into the male stuff what happens with this 84 year old guy

and his testosterone. So when I put here ‘to be continued’, note that right now I’m just

dealing with his adrenals and his digestion. And the Simplex for those of you who do not

know that one, that was kind of an overall endocrine support – just a little bit of pituitary,

adrenal, testicular support and thyroid. So that one is a good all over endocrine reset

supplement. So we’ll remember this 84 year old guy because we are going to continue

him later. Let’s look at our next case

@slide 51: 37 Year Old Male – History and Symptoms

This one is a 37 year old male, this one is actually very recent for me in the last 9 months

or so.

- Super stressful job, worked in the coffee industry, actually is a Starbucks

manager.

- He was on two medications, one for anxiety and one for sleep, and neither one of

them were working very well. He always looked pretty frazzled.

- And when he came into the office just discontented with his life, not happy with

his job, he wants to do something different.

- He is noticing a greater loss of muscle tone.

- Decreased morning erections.

- He says I’m in a blue funk and I don’t know why, I can’t snap out of it. I should

have a really great life but I just can’t snap out of it.



- His diet was really high in refined carbs and grains. At Starbucks, he told me, they

let all of the associates have free food. So all the Starbucks employees eat at

Starbucks, because you can eat a bagel for free. And if you look at Starbucks

there is nothing in there but bread, every single thing is bread, maybe a yogurt.

@slide 52: 37 Year Old Male – Initial Recommendations

So again I did the same thing:

- I ordered salivary work up

- I got a blood panel on him

- And I said start by at least doing something that will help reduce your stress – he

really did have a lot of stress – whether it is walking or yoga, or working outside,

whatever it is.

- I gave him the dietary makeover, my little spiel on how to change your diet, and

he had already listened to it at that point.

@slide 53: 37 Year Old Male – Initial Protocol

So I started same thing:

- gave him that tonic – same kind of deal, see a lot of times it is the same

- and then gave him some Withania complex, that was the anti-anxiety type of

herbal preparation, it is not addictive, you can start and stop it at any time.

And then I talked to him about going back to his doctor about weaning off the medications

that he was on because I knew that nothing I was going to give him was going to be

contraindicated with what he was taking.



@slide 54: 37 Year Old Male – ASI

So here is his saliva test, you can see he is high in the morning and he works the

morning, so he went in in the morning about 9am and when he took this test this

was his wake up test which was about 7.30am, so he has already woken up feeling

amped up and then he is high cortisol while he is working then he got off about

3pm so then you can see that when he tested that cortisol again about 4pm it

bottomed out and then he was just exhausted the rest of the day.

Look how low that DHEA is. So remember when we are diverting that

pregnenolone steal, as we call it, when we are diverting those precursors from

down the cortisol pathway, that’s at the expense of the sex hormones. So I see

this and I know this guy is in trouble with his sex hormones, I already know it.

His insulin both with blood sugar problems here but I wasn’t surprised because of

all the stuff he’s been eating at Starbucks.

And his 17-OH Progesterone was a little normal but a little higher than I usually

see it.

I knew his SIgA was in trouble, less than 5 which basically means zero, not

testable.

But the good thing was that he didn’t seem to be mounting a response to the gluten.

That didn’t mean that I wanted him to keep it, but it did tell me that at least we didn’t

have that going on.

@slide 55: 37 Year Old Male – Comments

So these are just my comments and again these you will see in your notes for your

reference which we just discussed.



@slide 56: 37 Year Old Male – Follow Up Appointment

So when he came in we went over his test results:

- And he said after being on the tonic for 3 weeks he did feel better.

- He was making dietary changes.

- He wanted to do a cleanse, so I said ok we are going to work on like 3 weeks -

we are just going to get in and do some clean up.

- He started to wean off with his MD off the antidepressant.

- And he was super happy with the Withania, it just really helped the anxiety.

- He just stopped the sleeping pills, he just opted to stop them. He wanted

something to help with that and we did work on that.

- But he was very encouraged with his overall progress.

@slide 57: 37 Year Old Male – Revised Protocol

So based on that adrenal test I got back:

- I started him on the 3 week cleanse, I put my own little twist on it and if you want

that information you are welcome to email me, I will give that to you.

- Kept him on the adrenal tonic, there you can see that, 1 tsp x3 daily when he was

done with that liver cleanse, and again, for many of you, you will have something

you can do that just really helps jump start that Phase 1, Phase 2 and get those

detoxification pathways working, kidneys, skin, etc.

See here again a lot of my core stuff is the same.

- I did give him Valerian before bed, that really helped him to sleep.

And then again this guy we are going to look at a little bit later when we start talking about

how well we are able to evaluate his male hormones. I just gave you the adrenal side, so

hold tight on this guy we will look at the rest later – and I will review it, you don’t have to

worry about remembering.



@ slides 58-59: 56 Year Old Male – History and Symptoms

And this is the last one: 56 year old guy

- Libido gone

- Super high stress

- He was a couple of hours away from home, his commute was Monday morning

and then Friday evening.

- He had classic low testosterone, low androgen, lots of androgen dominance

symptoms.

- Decreased morning erections.

- Loss of muscle tone.

- Apathy, fatigue, irritability, blah – didn’t care.

- Diet – he is eating out because he is on the road, living in a hotel.

- He has tried multiple supplements, been to multiple practitioners.

- Libido horrible – he really wanted help with that, he said I could look at the absolute

sexiest woman and it wouldn’t do a thing for me. He said nothing, it’s like the lights

are on but nobody’s home.

He was on a testosterone patch but it made him feel awful.

He was using a protein powder on the weekends that was supposed to enhance

muscle strength and you can guess from what we talked about last week – guess

what that protein powder had in it, it was a hormone.

He says he is trying to exercise but it is so difficult, he is actually beyond

exhausted.

@slides 60-61: 56 Year Old Male – Initial Recommendations

So I tested him.

I talked about his diet.

I talked to him about the endocrine triangle that we talked about and how important

it is to support the adrenal glands.

And look here, I did much the same thing.



This time I gave him some Kava, and that was before bed if he needed it for sleep

and that did help him a lot.

And I also gave him something to support his digestion.

@slides 62-63: 56 Year Old Male - ASI

So here’s his adrenal test:

Now this actually looks pretty good. Now this guy is tired all the time, no libido, all

those androgen dominance symptoms, lots of androgen dominance, so he is

looking like he is turning into a girl, so to speak, he is losing that testosterone. We

will look at his male hormones when we get to those, but I am not seeing it right

here, I looked at this and went – this all looks pretty good.

The DHEA is a little bit high, so I wondered what was going on there, why was that

DHEA high.

His fasting insulin was less than 3 but it is close.

Non-fasting a little bit high, so I’m thinking we got some blood sugar issues here

as well.

His gut looks like it might be a little compromised, we may have a little inflammation

in there. That IgA is a little low.

And his gluten antibody looks fine.

So I was not sure if the DHEA was because of maybe exogenous exposure or maybe

increased ACTH or HP axis, I was not sure but I questioned him about that.

@slide 64: 56 Year Old Male – 4 Week Follow Up Appointment

So in 4 weeks he came back, I gave him the same old stuff and he says he feels better,

his energy is better, his mental clarity improved, and I really just supported his adrenal

glands and his digestion. The Kava helped with sleep. The libido isn’t back but he said he

has started to feel more like himself again.



@slide 65: 56 Year Old Male – Revised Protocol

So I revised his protocol a little bit, started him on a little bit of a cleanse, kept him on the

tonics and then just kept going with him.

So this guy, before we go any further let me just tell you about this guy:

With the DHEA, we need to go back here – do you remember that it was high at 14

[@slide 62], optimal where we want it is 7-10. Remember when I told you last week that

the protein powders, I think we talked about this last week that the protein powders can

be high and spiked with DHEA. And indeed we found out from him that the one he was

using was, and that was what this DHEA here was happening. When you have high

DHEA, remember that is at the top of our androgen pathway, that pro-hormone or that

hormone precursor is DHEA, down to andro, testosterone and then the rest of the way

through the pathway and when that DHEA is high you run the risk of elevated other

androgens and loss of receptor sensitivity. So keynote here that you want to remember.

So these are going to be our 3 guys, we’ve got the old guy; we’ve got the medium guy,

the 37 year old; and we have the 56 year old. We are going to look at these guys later

when we get through the male hormones and we’ll find out what happened to them.

@slide 66: Male Sex Hormones

@slide 67: Steroid Hormone Pathways

So now, what everybody’s waiting for, let’s jump into the men. We are going to finish off

the rest of tonight and the next few weeks with a really in depth look at male hormones.

We’ve laid the foundation, we know that we’ve got to be able to look at the steroid

hormone pathway:

all these hormones are made from cholesterol, pregnenolone, to 17-

hydroxypregnenolone down to 17-hydroxyprogesterone and into cortisol.

When that man is under stress he is going to divert that cholesterol, or the

pregnenolone really, down into cortisol at the expense of those male sex

hormones.



@slide 68: Hypothalamus-Pituitary-Testicular Axis

So here’s that HP axis, so we’ve got the hypothalamus to the pituitary to the testes.

Now instead of looking at CRH and ACTH as being the respective HP hormones,

now the hypothalamus, when we are talking about the sex hormones, now we are

looking at Gonadotropin Releasing Hormone from the hypothalamus to the

pituitary, which signals FSH or LH, men have both, to the testes, and then the

testes release their respective hormones and that feeds back to that HP axis.

@slide 69 Male Hormone Pathway

So now if we get into this we can break this down a little bit more specifically. It looks a

little confusing but let’s just start at the top:

So here we’ve got the hypothalamus with GnRH, gonadotropin releasing hormone.

This is what we just looked at but this is now expanded a bit.

The GnRH signals to the pituitary and it basically is saying, hey listen, we need

some GnRH, we need some testicular, ovarian, whatever it is, we need some

hormone, some sex hormone.

So the pituitary in men, just like women, releases FSH and LH. But in men,

obviously, the results of those hormones and what they stimulate is a little different

than in women.

FSH is going to act upon the Sertoli cells. The Sertoli cells are located in the testes

and they are going to contribute to the development of the sperm.

The LH, or Luteinizing hormone, is the other hormone and that is stimulating the

Leydig cells in the testes, the Leydig cells produce testosterone, which also has a

role in the development of sperm.

So the FSH and the LH have to work synergistically, we need the Sertoli cells and the

testosterone from the Leydig cells to be able to produce and mature the sperm.



@slide 70: Follicle Stimulating Hormone (FSH) in Men

So let’s look at FSH in men:

What it does is it enhances those androgen binding proteins from the Sertoli cells.

So it helps those Sertoli cells as well to produce inhibin, that is the negative

feedback hormone to the anterior pituitary and that basically shuts down the FSH

when we need it to stop, otherwise we have a man that is overproducing,

overproducing, overproducing, or over stimulating the production of the sperm, and

we don’t want that.

So if we’ve got elevated FSH, it might be that we don’t have enough sperm

production, the sperm quality is insufficient, or we could just have bad feedback.

And the HP axis is messed up.

@slide 71: Luteinizing Hormone (LH) in Men

LH in men is also produced in the anterior pituitary.

And that as I said stimulates testosterone production from the Leydig cells.

When you’ve got low LH, so think about this with this HP axis, low LH could indicate

the need for less testosterone, in other words we have got enough, the LH is quiet

because we don’t need it. [speaker indicates the slide is a typo, this is correct.]

We’ve got elevated LH, that’s that typical HP axis feedback where the LH the

pituitary is saying hello we need more testosterone, but we also could have this

issue of cell receptor down regulation as well. We are going to get into that a little

bit later.

@slide 72: Sex Hormone Pathway

So here’s the sex hormone pathway, I made it nice and bright and colorful so you got your

red, orange, pink whatever color that is.

There we go, pass through 17-hydroxypregnenolone over to DHEA and all the way

down into the production of testosterone, aromatized down into the estrogens and

then 5 alpha reductase into DHT.



@slide 73: Stress vs Reproduction

So as you know, those sex hormones do have that very delicate balance with the

stress handling hormone.

The body is going to always prioritize survival over libido. And that’s the way I

explain it, look, is your body going to say I have decreased morning erections or

I’m so stressed out I want to go jump off a bridge. It is really going to prioritize the

survival instinct and the production of cortisol and the ability to manage stress over

libido.

So when the patient is under stress, you’ve got this guy and he is just absolutely

jacked up stressed out, his sex hormones are going to become dysregulated

because we are going to move all of that down that pathway to those sex

hormones.

@slide 74: Adrenaline – Cortisol Graph

So this is the same example we talked about last week, you can see that these men –

and it is the same for women but we are talking about men here – so we get this

adrenaline spike, an adrenaline surge. So this guy gets up and his wife is already ragging

on him and she is yap yap yapping at him and he says I’m outta here, I got to go to work.

So he gets out of work and he is in the car and he is calm, then he pulls into the parking

lot and his phone starts ringing and he is walking into the office and there goes the

adrenaline surge again, he has a meeting, then he has a problem with an employee, you

can see all day long this adrenaline – he is just pushing, pushing, pushing on his adrenal

glands and what happens is, as we just talked about, cortisol then comes in to try and

stabilize that adrenaline surge, but the adrenaline surges just keep on and keep on and

pretty soon that baseline cortisol just goes up and up and up and up. Eventually resulting

in the loss of production of these sex hormones and then this poor guy is just a mess

because his poor little adrenal glands are just shut down.



@slides 75-76: Sex Hormone Pathway – Androgen Hormones

Now we’ve got all this stress that’s gone down that cortisol pathway and now we do not

have enough of these sex hormones to be able to keep him in the game, keep his libido

up, keep his sperm production up, if he is in reproductive years, and make him feel so

much better.

@slide 77: Primary Precursor – DHEA

So let’s look at these hormones individually. Let’s take a look at this primary sex hormone

precursor DHEA:

We know that it comes from pregnenolone.

It is produced in the adrenal glands, in the ovaries in women, but the testes and

also the brain.

It is called the mother or the prohormone for andro and testosterone for the other

androgen hormones.

It’s the most abundant hormone based in the body.

And about age 25 you’re going to start to see some reduction of DHEA.

@slide 78: Use Caution with DHEA

If the patient has got an elevated intake of DHEA we are going to see that elevate on a

test just like our last guy, the 56 year old. I tell you I see it so commonly in bodybuilding

supplements, muscleman powders. These guys go to the supplement shop where they

have – I always laugh when I go, there’s like 55 gallon drums of this protein powder, you

need a dolly to get the protein powder the jar is so big, and they wheel it out to the car,

and they have Mr. Studmuffin on there and he’s got ripples on ripples on ripples on

muscles – and this is the poor guy with no libido, he is unhappy with his marriage or his

girlfriend, he wants to be a studmuffin so he goes to the store and he gets the DHEA

powder – that’s how I think about it, it is true, a protein powder that he doesn’t realize has

got DHEA and then he is going to end up having excess testosterone, too many

estrogens, too much DHT, he is just going to screw up the whole thing. And the problem



is the DHEA when it gets high, it causes irritability and acne. Not to mention the increase

potentially of testosterone and estradiol downstream.

And I cannot tell you how many times I see this, I see this all the time. But unless you

know what to look for, you are going to miss this one and it is really important for these

men.

@slide 79: Functions of DHEA

So DHEA is great, we need to enhance DHEA. But DHEA is produced primarily in the

adrenal glands, for men and women, and secondarily in the testes. Where I’m going to

go if his DHEA is low, and I’m on those adrenal glands, I am supporting those adrenal

glands. Don’t give DHEA. Anytime you give a hormone you are going to down-regulate

the receptors for that particular hormone in as short a time as 2-3 months. So giving

DHEA is never going to be the right idea. What we want to do is fix the underlying problem,

isn’t that what we are trying to do, we are trying to look at this from a functional approach.

We are trying to look at this from a holistic perspective and say how do we fix the body

so the body works right.

So DHEA is important:

It plays a role in libido.

It helps to offset the effects of high cortisol.

It increases insulin sensitivity.

It keeps the lipids normal.

It reduces fat.

It increases muscle.

Helps the immune system.

Improves sleep.

Etc.



@slide 80: Causes and Symptoms of Excess DHEA

We need DHEA, these guys need this DHEA. But when we’ve got too much DHEA now

we are going to have problems, now we’ve got:

Acne.

Aggression, irritability.

Down-stream hormones start to elevate.

The guy starts not sleeping well.

He could even have increased body or facial hair

And it could be just from an exogenous intake or exposure unknowingly. You can get

50mg doses of DHEA over the counter. It makes me crazy, that should never happen.

@slide 81: Muscle Milk

Here is what I’m talking about: Mr. Muscle, there were some that were even more stud

than this one, this one you can’t see his whole body. But look at the flavor – cookies and

cream – can you imagine how much junk is in this stuff, oh my gosh. And these guys are

just going after this muscle milk, they all want to build it up. The reason it will have good

results is because I know this has got DHEA in it because I tested pre and post use in

men. It wasn’t the cookies and cream one, I just had to get that picture because it made

me laugh. But here’s the problem.

@slide 82: Photo of 16 Year Old

So this young man right here, at the time this picture was taken he was 16, almost 17 and

you can see the acne on his face. And it actually, this particular picture is really, really,

good. This is his acne almost completely resolved. So this young man had such bad acne,

and you can see, and I apologize for the redness it is just the way the photo was taken,

and you can see right below his lips he’s got a little bit of a whitehead right there, but you

can see how inflamed his face is and you can see some of the scarring. He had cystic



acne. Some of the pustules were the size of his thumb. They were up underneath his

eyes, around the sides of the nose, over on the side of the face, down on the neck. And

he is the happiest young man, very well adjusted young man. And this young man came

to me with this horrible acne because his mom made him come. And he is a great kid, but

he really didn’t even care about his face, didn’t care. He says my friends like me for who

I am, and I don’t care. And I’m thinking, oh my gosh, this is not ok for a 16 year old kid.

And he didn’t care. This was actually after it was resolved. The first time I saw him he was

14, when it was really bad, but he’s almost 17 and now it is mostly resolved.

@slide 83: AXE Deodorants

And this right here was the problem. Now I know if I could hear you, you would be saying

no way. And I would say, yes way. These AXE products are just destroying the hormones

in our men, especially these young boys. So they are loaded, loaded, with pheromone

compounds, with hormone-like compounds. And the aggression, the irritability, not in

every guy, but in some guys, and for this young man that I just showed you the picture of,

his acne started 3 months after he began using the AXE deodorant, AXE something on

his skin, and there was a body spray, he also was using the shampoo. And when mom

and he agreed to pull these out, his face began to clear up.

And I went in and worked on the other stuff, and his hormones, male hormones, were off

the hook – DHEA I think was probably almost 10 times higher than it was supposed to

be; his testosterone was off the chart high; his andro was off the chart, everything was

high, downstream of the DHEA and this was the culprit.

And I know if you don’t believe me, I’m sorry, but I’m telling you I’ve seen this in countless

other men, and young men especially, that are using these products – getting these high

doses of what I suspect to be DHEA or those precursors and it is affecting them

downstream.



@slide 84: Causes and Symptoms of DHEA Deficiency

When we have men with low DHEA, deficiency, we are going to see:

Lower levels of cholesterol.

Inability to handle stress.

Immune function starts to get compromised.

Fatigue

They lose stamina and muscle tone because they are really losing that ability to

produce those androgen hormones when that DHEA is low.

Lose memory

Reduced libido

So we think, oh your DHEA is low, let’s just give you some – no, no, no, don’t do that

because then you’re going to end up messing up that hormone, down-regulating those

cell receptors. Better to address the problem and go after the adrenal glands.

@slides 85-87: Androgen Pathway - Androgens

So now the next one down is andro.

Androstendione is part of the androgen family, so these are defined as male sex

hormones, although women have them we don’t refer to them in women as that

because they are minor hormones.

In men obviously they are the major hormones. And we look at andro, testosterone

and then dihydrotestosterone or DHT.

So these are produced in the testes in men, ovaries in the women.

And also in the adrenal glands in both sexes.

So all of these androgens are needed for overall health, energy, vitality, sense of wellness

and wellbeing, they are responsible for red blood cell development, healthy mood,

emotions, they are very, very, important. These group of hormones play a significant

protective role in the body.



@slide 88: Androstenedione

So androstenedione specifically is an anabolic hormone, similar to testosterone.

And the adrenals the testes are where we are going to see this.

It is regulated by ACTH which is talking to the adrenal glands and the FSH / LH in

the testes.

So it is a direct precursor for testosterone and then also estrone.

Shares receptors with testosterone and DHT.

So if a man, for instance a bodybuilding dude, is taking andro, we might see that his

testosterone and E1 could elevate. But we know that andro also will bind with testosterone

and DHT receptors, so if a guy is taking a lot of andro he might see a decreased amount

of testosterone and DHT because the androstendione is binding up all of those receptors.

It is less potent than testosterone, has about a tenth of the strength.

And if they are taking it orally it can affect that downstream estrogen level.

@ slide 89 : Androgen Hormones

This is kind of a blown up chart of these hormones and how they interconvert. And look

at all these arrows going every which way. So now I’m going to look at testosterone. So

what I want you to see about testosterone is this:

See testosterone there in the middle, it converts to DHT through the 5 alpha

reductase enzyme.

It also can aromatize into estradiol.

And it also will interconvert, notice that, with E1.

And andro also will go to E1.

So we’ve got this little triangle between andro and testosterone and E1.

- Now E1 is a hormone that is not incredibly potent, but men do need this hormone.

So the only two female hormones, as we call them, are E1 and E2.



- E3 is not really a player for men, we don’t see it that is why I put an x through it.

But I wanted to leave it on there so you know there is an E3, but it is not in the

conversation we are going to have.

- So when you’re looking at testosterone we know if you give DHEA, let’s say the

guy is taking muscle body product and or the AXE product, or whatever – he is

getting andro, which is converting into E1 and testosterone.

- The testosterone is going to go one of three places – we are going to see it in DHT

elevated, we are going to see estradiol elevated, or we are going to see E1 even

more elevated. These really work in combination with one another.

@slide 90: Testosterone

So testosterone, as you would expect shares the receptors with andro and DHT.

It is 10 times stronger than andro yet one tenth as strong as DHT. So DHT is the

downstream hormone that has the biggest bite or the highest amount of potency.

So testosterone is absolutely fabulous for men, women don’t seem to have benefit from

getting testosterone and I see lots of women that come in with compounded – somebody

who does not just know hormones has given them a cocktail of all these hormones and

testosterone I’ve never seen not one bit of difference with testosterone in women. So I

don’t know why it is given. But in men very important, not that we give it but what we want

to do is improve testicular production of testosterone and that pituitary signaling.

@ slide 91: Functions of Testosterone

What we know about testosterone:

Super for memory.

If there is too much we might have a guy that is more aggressive, more angry.

Even women that are getting that overspill of testosterone through passive transfer skin

to skin, you’ve men that are on testosterone and they are married, and I’m not talking



sexual intercourse, sex isn’t what is doing it, it is the sweat that’s doing it. And the sweat,

the skin to skin or passive transfer can make that woman aggressive and mean and she’s

not going to know why she’s having personality changes, and it is because of the

husband. I’m telling you, these bioidentical hormones, we have not yet seen the disaster

that is going to happen because of the rampant use of these bioidentical hormones. It’s

starting to happen, we’re starting to see it but it is going to get so much worse, I’m telling

you. So we don’t want to use the bioidenticals, we don’t want to give it, we want to improve

the body’s ability to produce it.

It is important for muscle development.

Very important for maintaining normal blood pressure.

Improved insulin sensitivity, decreases resistance.

Maintains good lipids and body fat.

And protects the body against age related mental decline.

So testosterone super important.

@slides 92-94: Androgen Hormones – DHT

Now look at the role of DHT:

This one, same thing, we’ve got all these androgens are sharing those same

receptors.

That comes from that 5 alpha reductase, testosterone down into DHT.

This particular hormone is controlled by progesterone, so there is a strong

correlation between the production of the 5 alpha reductase enzyme with

progesterone.

- So if we’ve got higher levels of progesterone we are going to down-regulate that

5 alpha reductase enzyme which is going to give us low DHT and a loss of

androgen dominance. Now why would a man have high levels of progesterone? I

know you would talk to me if you could. The reason that he is going to have high

levels of progesterone is he is getting it from his wife or he is getting it from a body

care product, I’m telling you that’s what I’ve seen.



- If we have low levels of progesterone they will upregulate the enzyme and that’s

going to give us chronically high levels of DHT. So progesterone is a really

important player with this 5 alpha reductase enzyme and that’s how we get the

testosterone down to DHT.

So it’s 10 times stronger and it really sucks on to that receptor.

90% of DHT is produced in the skin and the liver.

So when we’ve got elevated levels we see high DHT, in women leading to female

pattern balding - we can see this, that it does affect those hair follicles to shrink,

At least it doesn’t have a role with estrogen which we are going to see in a minute

here.

But it has been associated with male pattern baldness, increased body hair, BPH

and prostate cancer at elevated levels.

@slide 95: Androgen Hormones Pathways Chart

So look there DHT on the bottom left:

Testosterone straight into DHT, DHT doesn’t go anywhere else, there is no arrow.

It doesn’t go back to testosterone, it just sits there. So see why you’ve got it by

factors of 10 all the way down: Andro to testosterone to DHT.

So now let’s look at these estrogens, these two estrogens.

Now if you kind of take an eyeball and make a triangle between testosterone and

estrone and estradiol.

- You can see that the 3 of them are going to kind of work back and forth.

- We’ve got testosterone and E1 that are going to go back and forth, those two

hormones are going to interconvert.

- And then we’ve got E2 and E1 that are going to interconvert.

- So E2 could end up becoming a problem as E1 can.



@slides 96-98: Estrogens – Estrone

So peripheral tissues are what are giving us this estrone from these androgens, the

DHEA, testosterone, etc. So what we’re finding is that with estrone, let’s take a look at

that one first:

It is made in very small amounts in the testes, there is not a lot made because the

man does not need a lot, but we do need some because it is very protective.

It is produced in the fat cells by the conversion of the androgens to estrogen

through that aromatase enzyme.

So if we have a guy that has a higher amount of fat, he is going to produce more

estrone.

And the estrone will eventually keep dropping downstream and it will convert to

estradiol.

I have seen the E1 in bodycare products for men.

@slides 99-100: Men’s Body Care Products - Estrogen Pathways

Here is one of the ones that I personally know – this is a 46 year old male and he used

this product 3 years. His wife had him come in to see me because she said he is not

himself. He doesn’t want to do anything, he doesn’t want to engage in life, he is just

boring. He used to love to go out and do things, he doesn’t do that anymore and I thought

well that sounds like something is going on with his sex hormones because he should be

a manly man kind of guy.

When I tested him his estradiol was ten times higher than it should have been. And I knew

he wasn’t taking estrogen, estradiol. And I asked his wife and she said she wasn’t taking

any kind of hormone, so I thought the only place it can be is exogenous.

So she was into health and making sure all her face products were clean. I actually

cleared her, she didn’t have any contamination and I could see, but he kept saying no,

no, no, I don’t know what it is. We finally figured out that this top branded product from

The Body Shop was what he was taking. And it is just an aftershave lotion. He only was



using it when it travelled. The problem was he travelled 40 weeks out of the year. So this

little tube stayed in his bag of toiletries that he would take with him when he travelled and

this tube right here he only used it on his face when he travelled. Well why didn’t he use

it at home? Well when he was at home he would prefer to shave with an actual razor.

While he travelled he didn’t want the mess with it so he used an electric razor and the

electric razor made his skin dry and just a little bit rough and chaffed. So he found this

while cruising through the airport one day, frustrated that his skin always felt bad and he

couldn’t make it feel better. So this one, the person at the store said, oh you’ll love this, it

makes your skin soft and smooth after you shave. And he thought, well that’s my answer

right there. So he started using the product and by golly it had E1 in it and it jumped his

E1 and his E2 were way up but his testosterone was completely normal, it stayed right

there in that estradiol E1-E2 pathway. All those upstream hormones for him were normal.

So don’t rule out – you’ve got to keep uncovering rocks until you find the source of the

product was, it took us a while to figure that one out.

@slide 101: Estradiol

Estradiol is the female hormone needed in men, predominantly in women, but it is the

one that I always say it has got some wicked teeth. And it and it can cause some damage.

It is very self-stimulating.

It is 12 times as potent as E1.

And testosterone under a stress response will convert to estradiol very, very, very

easily.

But men need estradiol because it helps to sensitize their androgen receptors, so

we need a little bit of estradiol in them, but you put them under stress and all of a

sudden they are doing nothing but making estradiol out of testosterone.

So the aromatase enzyme – let’s look back for a minute [@slide 100] – that

aromatase enzyme is the testosterone to E2 converter. Insulin resistance, unstable

blood sugar, or cortisol elevation will upregulate the aromatase enzyme leading to

an increase in estradiol, this is the key and this is why I bolded it here because if



the patient has any kind of insulin resistance, their blood sugar is off, they are

eating infrequently, they are skipping meals, they are eating crappy food, or they’ve

got high stress and high cortisol like one of the cases that we saw earlier, they will

upregulate those aromatase enzymes and they will become an estradiol making

machine.

@slide 102: Photo – result

And this is what ends up happening. They end up getting that belly fat, they end up getting

that testosterone converting it down through that aromatase enzyme into the estrogen

and that belly starts sticking out, sticking out, sticking out, this you will see all the time in

that aging male population, as they get a little bit older they start increasing that

conversion down into estrogen.

@slide 103: Estradiol

So if we’ve got elevated DHEA, whether that is from a bodycare product, an AXE

product, a muscle milk protein or other kind of protein powder, it will eventually if

given long enough at a high enough dose, it will eventually increase that estradiol

downstream.

When estradiol gets elevated, it signals the growth and enlargement of prostate

cells .

So whenever you’ve got a man who comes in, and we’ll talk about this when we get in to

the common things that we see with men, whenever you’ve got a man that has

enlargement of the prostate, you’ve got inflammation in there, enlargement, he’s got BPH,

his PSA might be up a little bit, you want to look for estradiol. It won’t always be the culprit

but don’t negate looking for this using saliva testing.

High estradiol also very, very, involved in gynecomastea in men.

If it is really elevated it will start messing with that HP axis, it will suppress LH and

subsequent testosterone levels due to that negative feedback.

So this estradiol in men is a bad guy, we do not want a lot of estradiol.



@slide 104: Role of the Liver

Now the liver is really important here because:

The liver is going to conjugate and release these get these estrogens out through

the bile, bound to fiber, through the bile out in the stool primarily.

The estrogens that are released in the bile, that bile can get thick and sticky if the

estrogens are high. So I’ve seen this with men when I’ve done a saliva test – they

are coming in with gallbladder type symptoms and one of the first places I’m going

to look is for estrogen. Because that estrogen causes that bile to get thick and

sticky.

If their liver function is impaired, and what I mean by that is that those Phase 1,

Phase 2, the P450 family of enzymes, if they are not working in the liver that is

going to allow those estrogens to just remain in the tissue, they are going to just

keep circulating and circulating and circulating and creating all kinds of problems.

So if you have a man that you think has loss of androgen dominance, aside from

adrenal support get that foundation piece put in place because remember that’s

the bottom of that triangle, you’ve got the adrenals and the testes in that endocrine

triangle and you’ve got to get in and get working on the liver.

@slide 105: Sex Hormone Pathway – Progesterone

So now let’s take a peek at progesterone:

This is the secondary pathway for men, that is why it is in pink.

But pregnenolone through 17 hydroxy over to DHEA and then down into those

androgens is the primary preferred pathway.

However, progesterone is the secondary pathway, this is why women that are

using progesterone and sleeping with their husbands can cause the man to have

elevated andro and testosterone and on downstream.

You can see progesterone is not going to have the same effect on DHEA, the

pathway doesn’t work that way.



@Slide 106: Progesterone

So progesterone primarily produced in the adrenal glands in men.

So we know where it is synthesized and how it comes.

Very little is needed. On a saliva test we are looking at progesterone being

anywhere from 50-100 so very low compared to what we would see in women.

@slide 107: Her Progesterone

But her progesterone could be the problem:

So this rampant use of this progesterone can cause that sweat to transfer, as we’ve

been talking about, that passive transfer.

And it will not show up on a serum test. And this is where I think we get it wrong

conventionally because the serum test isn’t going to show – the serum gives us an

idea of how well the gland is functioning, what’s going on with the gland itself, not

so much what’s happening in the local tissue, but what the gland is doing that is

what the serum is telling us because the glands are releasing their hormones

directly into the bloodstream and binding to that binding protein.

So when she’s doing her progesterone, especially the cream, it will just accumulate

in the fatty tissue in the area she is putting it on.

And let’s say she is putting it on her arm, all she has to do is wrap her arm around

her dude and start sweating. And then she’s just given him a nice little hormone

bath.



@slide 108: Progesterone vs Progestins

Now progesterone ‘bioidentical’ vs the progestins, they are two different animals.

Research has been with the synthetic progestins but the bioidentical progesterone

there has been a real resistance to do a lot of testing with that. So much of the

research is based on progestins.

Now these have been shown to cause cancer.

But many men regardless of that, in spite of that, are given progesterone or

progestins to offset their high levels of estrogen. But this is where I just go whoah,

stop, put on the brakes, flashers on, I’m not going anywhere. Why would we give

progesterone to offset a higher level of estrogen, why don’t we just clean it up and

make it normal. How about we just give the liver a little bit of love. We could use a

herb like Schisandra, greens are great for men, we could use foods that are going

to feed and nourish and stimulate and help that Phase 1, Phase 2 – cruciferous

help that Phase 1, Phase 2 work better. Why would we give progesterone to offset

high levels of estrogen, that seems crazy.

@slide 109: Maintaining Androgen Dominance

We want men to maintain that really healthy balance of their male hormones from puberty

on. And when we’ve got a healthy relationship between their adrenal hormones, the

testicular hormones, like testosterone, and how they are being regulated by the

hypothalamus and pituitary, our guys are going to feel awesome, they are going to feel

great.

But it is when we start throwing stress into the mix, diet and blood sugar regulation -

remember I said it upregulates that aromatase enzyme, now all of a sudden they are

coming in to you or I and they are saying, I don’t feel good, I have decreased morning

erections, I have no libido, I can’t maintain an erection, I can’t have an orgasm, the

orgasms can even be painful because of the inflammation in the prostate, that might be

due to the estradiol, they might have loss of muscle tone, they might have memory issues,

fatigue issues, you name it – we just went through a whole bunch of symptoms that it

could be.



@slide 110: Not Just Testosterone

So when we’re looking at loss of androgen dominance you can’t just look at

testosterone. So the guy goes in and says, hey, I’m not feeling real hot.

What is his doctor going to do? You have low T, we are going to give you some

testosterone.

But that testosterone isn’t the problem, the problem is –

- I’m going to ask the question, why is testosterone low, where is it going?

- Does he not have enough precursor upstream?

- Do we have cell receptor down-regulation so that the testosterone can’t get to the

cell?

- Do we have a loss of testosterone down to E2 or E1?

- What is happening, what is going on with his adrenal glands?

- How am I going to get in and really support this guy?

@slides 111-112: Loss of Androgen Dominance

So here’s some of the symptoms of loss of androgen dominance. We talked about these

last week and we are actually wrapping up, which is nice, we’ll get you guys off pretty

quick. So if you have questions be sure you enter them now. But this loss of androgen

dominance is kind of a big deal for these men, look:

Increased risk of cardiovascular disease

Insomnia

Body fat problems

You see that testosterone to aromatase conversion, that starts to happen

Muscle mass goes away

Start having ED

Fat distribution, they start getting that belly fat, could even be hip fat, rolls on the

side or flank fat on the back

Prostate and urinary problems



They get apathetic, they don’t really care, they get like – oh, I don’t really care

about anything, no big deal

Pessimism, that was one of the things that the woman who brought the man in that

was using that aftershave cream, she said that all of a sudden he was just negative

about everything. You want to go to the movies? No, don’t want to find parking. Do

you want to go out of town this weekend? No, I don’t want to have to go look for a

hotel. Just being negative, pessimism, that’s one of the things

Loss of interest in job, I see that a lot. They’ve been in a job and just don’t care,

passive, don’t really care

Thinning skin, sometimes I’ll see that

Muscle weakness

Blood pressure can elevate

Bone issues. Moreso osteoporosis in women because of our more greatly

fluctuating different types of hormones.

Central weight gain

etc.

So these are some of the issues that we see with men that have lost their androgen

dominance.

@slide 113: Initial Considerations

So when you have guys that come in and this is what they got, there’s two places

you want to go:

- Always, always, look at the entire endocrine system, meaning those steroid

hormones.

- You have to assess the adrenal glands along with those male hormones. If you

don’t assess both of those together, you’re going to miss something.

And if the guy is on testosterone, you can’t do the saliva test because all you’re going to

see is the testosterone on the saliva test. So they have to be off of that testosterone for

as long as possible before you do the test. I prefer week or longer, but sometimes if you

pull them off of the testosterone their energy will tank and their mental clarity will tank



because they’ve become dependent on it and we want to get the supporting gland

corrected, we want to get the gland that’s producing it i.e. in men it will be the testes, get

that HP axis signaling happening so that they can then produce those hormones the way

that they are supposed to.

So always evaluate all the steroid hormones.

The serum testing is fine if we want to look at what the health or capability or

capacity of the testes are to produce testosterone, but not for what is actually in

the tissue.

- So when the testosterone is released from the gland, it goes directly into the

bloodstream and binds to a protein.

- So if we see low serum testosterone, that is going to tell us that the testes are not

producing testosterone, that’s all.

- It could also be because they’ve got decreased binding protein, that could be an

issue as well.

Sometimes you may want to evaluate that. But saliva testing is really where we want to

go, look at what is happening with those cell receptors.

@slide 114: Liver and Adrenal Support

So start with adrenal support always. I’m giving you here is what you can take

back to the office tomorrow morning and say alright, this is what I’m going to do,

even if you don’t have any tests, if you don’t have the saliva test that you need,

you can still start by giving them something, give them something to help support

adrenal glands.

And I use this it’s called the 21-Day Purification, but it’s basically the liver cleanse.

Whatever you’ve got that you like, whatever nutrients, herbs, you can do it

however you want, I’m just telling you how I do it. But a lot of them will have you

change dietary, or take out protein, or take out fats, I leave all of that in.

- But while I’m working on their liver, I’m going to support their adrenals.

- I like using Spanish black radish.

- And then some kind of omega or fatty acid of some kind.



And then any kind of support for male sex hormones which we’ll talk about more

as we get on into the male physiology.

Student Q&A

So Ron if you’re there. I am going to have to give you guys more content next week

because two weeks in a row we have finished early. So I’m ready for some Q&A, I’m

hoping that Ron is listening and can hear me.

Dr. Grisanti: I’m here! I’ve been very attentive. Ok, let’s see here, let me just expand my

questions here / opening the box with the questions.

Question 1: Adrenal tonic and fluid retention, if someone has edema can tonic be used?

Answer 1: Yes, I’ve never found a problem with it causing fluid retention or being the

problem if the patient has a little bit of fluid retention. I actually find that because it does

have an anti-hypertensive effect, a couple of those herbs, that it is really great for that.

But you have to ask the question why they are retaining fluid, but there is no problem with

either causing it or being a problem if the patient does have a little bit of fluid retention.

Question 2: How long do you keep them on these herbs, do you stop them when they

start feeling better?

Answer 2: I don’t very often retest the adrenal glands because I go by how the patient is

feeling. Most of the time when I combine the herbs with the nutrients that they need, the

Bs the Cs, etc., when I can get those two put together, very typically it’s 2-3 months and

the patient is absolutely feeling like a rock star. And most of the time they will reduce, they

will take themselves off of the tonic all by themselves. Instead of taking it 3 times a day

they’ll do it twice a day, and they’ll do that for a few weeks and then they’ll forget and then

they’ll do it once a day. And I tell them that anything I give you supplement wise, like an

herb or otherwise, my goal is to get you off of it as quickly as I can, I want to get in, get

the problem fixed and then get out. When you take your car to a car repair place, you



don’t have to go in every day to get your tyre fixed, you go in you get your tyre fixed and

you get out. And that is the goal here, get in, get it fixed, and get out. I tell them, when

you’re done, when your adrenal glands are nice and healthy and robust and when you

stop that adrenal tonic you should feel fabulous.

But if they continue to have a real high stress go, go, go, type of life then they may opt to

stay on it maybe once a day. Just because it keeps those adrenals kind of playing in the

game, they don’t get burned out quickly. I take it twice a day because my stress level is

pretty high. And I’m very busy, I run a few clinics, I travel all over the country, I was in

Orlando last w/e, and the next 4 weeks I’ve got West to East coast trips 4 weeks in a row

– that is a stressor. So if I don’t support my adrenal glands I’m going to be in trouble and

it is the same for these men. So it really depends on the man, but I will tell you, once you

start them on it often they don’t want to get off because they feel so much better, but they

can.

Question 3: Do you have a webstore for products you are recommending?

Answer 3: I don’t sell Standard Process products, I can’t, they don’t allow online sales, it

is prohibited. But you can find someone that sells them or you can contact Standard

Process and order them yourself. I do have a website, my website is restorationhealth.net

You can go there if you like, but we don’t have anything really to sell per se on our website

because I really deal with the patients on a one to one basis.

Question 4: Have you seen irregular heart rates from high DHEA consumption?

Answer 4: You can get irregular heart rate. I’m not going to think DHEA first thing if I get

someone with an irregular heart rate, I’m not going to think oh that is a DHEA problem,

but I have seen that happen. It doesn’t happen every time, but I’ve seen that happen. But

I’m telling you the DHEA and the hormone thing, it is rampant out there, it is just really a



problem, you’ve got to rule that out and the only way you are going to know is with a saliva

test.

Question 5: What is your experience with Anna’s Wild Yam?

Answer 5: Well I don’t know that brand, but I will tell you that the Wild Yam, there is no

plant in nature that contains hormones. Plants don’t make hormones. Only people make

hormones and animals have hormones, they are endogenously produced. So you can’t

take Wild Yam and call that a hormone.

Now, what the plant does have are certain steroidal compounds that are precursors for

hormones that the body can use. It is like going to Hometown Buffet or one of these

smorgasboard places where they have every kind of bad food in the whole world and you

get to go pick and choose what it is that you want to eat. So when we provide these

steroidal precursors, the body can go oh I need this and this and this and I need to make

this hormone today or this one later today or tomorrow. It is going to use those precursors

as building blocks to be able to produce the hormone. When you take ‘Wild Yam’ and you

turn it into ‘bioidentical progesterone’ that is really kind of a lie because the Wild Yam, in

order for that to be turned into progesterone there are 17 biochemical steps that the Wild

Yam has to go through in order to be bioidentical progesterone. So what about

‘bioidentical’ progesterone sounds ‘bioidentical’ to you?

What I’d rather do is use the herb, i.e. the Wild Yam and allow the body to make the

hormone, then my job is to strengthen the gland. So that the gland can use those nutrients

to produce the hormone. It is not a ‘low T’ issue. It is a glandular deficiency.

Question 6: In the one case you recommended Valerian for sleep, and in another case

Kava for sleep, why the difference?

Answer 6: Good catch, whoever got that one, good job, A+. it just was really based

probably on some intuition maybe, I don’t know, I think sometimes I ask them – like the



Valerian, I use the Valerian more when they are having difficulty falling asleep and they

lay in bed and they can’t fall asleep and stay asleep, and you don’t get that sustained

deep sleep for a number of hours.

The Kava, I use that more when I’ve got some who tends to be feeling a little overwhelmed

during the day, maybe not a lot of anxiety per se, but just overwhelmed with life,

responsibilities, and that overwhelm kind of carries with them through the night and they

tend to be kind of in and out during the night, that is the Kava. That is how I use them.

If I take two Valerian, me, it gives me 6 hours of, and I call it comatose sleep. You go out

and you’re done, a train could come through the middle of the house and I don’t think I’d

wake up. But if I take 3, it puts me out for maybe 7-8 hours but it takes me about 20

minutes to wake up in the morning. The Valerian that I get from Mediherb works really,

really, well.

So I guess that’s kind of the difference, and some of it is just in practice, I know how the

herbs work so I just think I probably intuitively know which one to give. But that is how I

would best describe it, Valerian for the person who is not sleeping and Kava for the person

who is overwhelmed and the overwhelmed feeling doesn’t let their brain stop at night.

Question 7: I’m on Cortef 10mg am, 5mg noon, 5mg 4pm for adrenal dysfunction, very

low cortisol, severe chronic fatigue, any comment on the Cortef, concerned about being

on it for so long?

Answer 7: Yes, well, that is kind of bad. Because the Cortef is just cortisol and when

we’re giving cortisol, you are suppressing and basically causing the adrenal glands to

atrophy. So what you now have to do, is you have to get in and you have to start feeding,

and feeding, and feeding those adrenal glands. And the best way to do that, I would never

use Licorice initially, I would use that tonic that you saw. At least, if you didn’t want to mix

all those herbs and do all that, at least use Rehmannia. That Rehmannia 1:2 liquid

preparation is fabulous for this, and you want to start feeding and nourishing those adrenal

glands. I have probably had a dozen, maybe a dozen and a half, patients that have come



in on long term Cortef before and it is about a 2 year process to be able to get you off the

Cortef and get those adrenal glands back up and running again. They will recover, if you

feed them they will return. But it just takes a while. It is a long process, and I use a little

desiccated in the middle when pull the patient – work with a doctor, get them off the Cortef,

substitute out to desiccated, at least it is a little bit more gentle and we’re giving some

precursors that I’m feeding, feeding, feeding from behind. Lots of herbs, lots of

adaptogenic support, it can be done but it does take a while.

Question 8: Will any pharmaceuticals not mix with recommended herbs – if a patient is

on a heart medication, medication for diabetes, I guess looking for any contraindications?

Answer 8: There are a number of contraindications with the herbs and what I

recommend, there are several websites that you can go to that will give you those, but

because the quality of the herbs that come out of Australia is so high, they have to come

under their manufacturing standards. They are regulated in Australia like our FDA would

regulate the pharmaceutical industry. And many of us know that maybe that regulation

needs some help, but my point is when you get say an Ibuprofen, you know that every

time if this says 200mg of active ingredient, you are going to get that in that every time

because it’s regulated, quality control tested, it is very stringent. That’s how the herbs are

manufactured and controlled in Australia. So when I use these herbs here, they also have

to have a backbone of research and that research, they know which drug will interact with

these herbs and what I do is I refer to this frequently when I have a patient come in and

they are on medication, I just have couple of resources and they are both produced from

Mediherb or the company that makes these herbs and it tells me – I look up the herb and

it will tell me exactly which medications this herb is contraindicated with. So it is foolproof

for me. It is really easy, I don’t have to be an expert at it, I just have to do due diligence,

and go look up the herb that I want to give, say Rehmannia, and if I look it up and it says

contraindicated with xyz, then there is my answer. I don’t know all that off the top of my

head, I only read the resources that they provide. And I’ve never had a problem.



Question 9: Should all soy be eliminated in your recommended diet?

Answer 9: Yes, unless it is fermented soy like miso, natto, tempeh, shoyu – like

fermented soy sauce with soy beans. I don’t recommend soy per se, because not only

does it have a very strong hormone-like effect in the body, but most of the soy in this

country, at least in food products – they are doing it genetically modified anyway, and it’s

got all that junk fertilizer and stuff on it. I’m not a fan at all of soy, unless it’s fermented, in

that case I think it’s great.

Question 10: I’m not sure how this question is phrased, whoever wrote this question, I’m

going to read it: low DHEA and high cortisol in a 5 year old, how to about? I assume they

want to know how to approach a 5 year old with low DHEA and high cortisol.

Answer 10: So DHEA low and high cortisol in a 5 year old. So this is a kid that is under

stress. The question you’d want to ask first is, why in the world, what is going on in this

kiddo, either in life, lifestyle, environment, or internally that is causing this elevation of

cortisol. You can have cortisol elevate not from exogenous stress or external stress, it

could be an internal stressor too. So you got to figure out, why high? That is your number

one question.

We get why the DHEA is low because all of that pregnenolone is just dropping straight

down to cortisol, of course the DHEA is going to low. But I’m not too worried about the

DHEA as much as the high cortisol.

So again what I mentioned, those two herbs that are great for high cortisol, and I’m

assuming that you’re talking about salivary cortisol, so I’m going to base my response on

the fact that you’ve worked that salivary, not serum. For high salivary cortisol the two

herbs that work very well for bringing that down are Ashwaganda and Califronia Poppy.

Both of those herbs are safe in children. The way that I would give that child, if that was

my patient, I would give that child that tonic that I recommended with the 4 herbs. Because

with the high cortisol we are going to have immune suppression, we are going to have

immune compromise, so I think the Echinacea will be important. The Licorice is very



calming. And you also don’t know what is going on in that kid’s gut, so I might look at diet

as well. But I would use that tonic, those 4 herbs. At an absolute minimum use the

Rehmannia and Ashwaganda.

In order to dose those herbs for a child, there’s a rule that we call Young’s Rule. And if I

give it to you, it will just confuse you, but if you look it up you can find it. Young’s Rule.

And that is how you calculate the dose appropriate for children. As well, if you do need to

give liquid herbs to children, they are in an alcohol preparation, I’m not worried about the

small amount of alcohol for them but this is how I do it – I use jello ice cube trays and

basically make jello shots. So I put the appropriate dose of herb for each dose into each

of the little cubes of the ice cube tray, and then I make gelatin and I’ll use their favorite

fruit juice with some good quality gelatin and I basically make jello for them out of fruit

juice and you pour the jello into each of the cubes of the ice cube tray and the herbs will

disperse wonderfully inside the jello and then keep the ice cube tray in the refridgerator,

this doesn’t need to go in the freezer just because it is an ice cube tray, but just keep

them in the refridgerator and then you just give them one of these little gelatin cubes and

that is how you dose the herb and it will cover almost any herb, and that is how you get

them down.

Question 11: Are there any men’s deodorants that contain DHEA other than AXE, is it

found on the label of these products?

Answer 11: Great question. This is just my clinical experience, I see problems with Old

Spice, I’ve seen problems with Mitchum, and the AXE. I’d say AXE first and then Old

Spice, those seem to be the two that I’m finding; AXE I know for sure and I’m finding a lot

of strong correlation with Old Spice as well.

I don’t know what to tell you about deodorant except when you have a man tested and

his DHEA is high and you suspect the deodorant, the easiest way to do is to get him off

the deodorant, clean the liver out, so you will pull out that DHEA out of the tissue, and

then retest him to see if the DHEA is normalized and then put him back on these

deodorants and test him again. I’ve done that, and sometimes I’ll do that and pay for the



test because I just want to know. But those are the ones that I’ve seen have been the

most problematic.

Question 12: If a woman is taking bioidentical progesterone in capsule form, can she

transfer the progesterone to the significant other in the same manner as the cream?

Answer 12: Yes, it does take a little bit longer to build up in the tissue when you are

taking it orally because it moves through the liver. But yes, she can absolutely do that.

I’ve seen the creams are worse, but over time the oral preparations are going to do the

same thing.

Question 13: Is Maca ever beneficial for males?

Answer 13: Yes, Maca is a great herb, you can use it for males. It doesn’t have as much

of that adrenal, you know I’m really looking at how I restore the adrenals and the testes

together. I don’t use that herb very often because of the quality control issues with it, I

don’t find that it is consistent. And that is what bothers me, I want to be able to give an

herb, use an herb and know I’m going to get a consistent outcome every time. I don’t want

to get an herb and have it work maybe one time and maybe the next time it doesn’t work.

I don’t like that. That tells me that the phytochemicals aren’t right in it. Something is wrong.

Somebody didn’t test or check it. So I just don’t use that herb as well, you could use it. It

is an aphrodisiac. But I’ve had it exacerbate some conditions, but it is a quality control

issue for me, so I don’t use it very often.

Question 14: How would you proceed taking a patient off DHEA if they’ve been on it for

a few years?

Answer 14: Well first you want to go after the liver, but at the same time you want to

support the adrenal glands because where is DHEA made – in the adrenal glands

primarily, in men. So support the adrenal glands, give those adrenals some support and



they will produce DHEA and then you can slowly titrate them off or you can just take them

off cold turkey. I would say most of the time when patients decide they want to stop it cold

turkey, they don’t really have too much trouble. It is not like they get fatigued or tired, or

can’t think or anything like that. They seem to do ok as long as that adrenal support is in

place.

Question 15: Is the adrenal tonic you recommend from Mediherb?

Answer 15: All 4 of those are from Mediherb, absolutely.

Question 16: When you see a patient with cholesterol 160 or lower and they are on a

statin, is that going to be an issue with hormone production?

Answer 16: You bet. I really think anything below 180 is going to affect hormone

production. I’m not a fan of statin drugs, I’m not a fan of red yeast rice as an ‘alternative’

to a statin drug because it acts on the same mechanism as the steroid drug, just not with

as heavy a hand. I don’t have a problem with cholesterol being up around 200/230/240,

there’s plenty of research, I’m standing very confidently on that research that is out there

for higher levels of cholesterol being very protective and beneficial. So again, depending

on your license, your scope of practice, you’d have to refer the patient back to their

prescribing doctor to work on getting off, or the patient always has the option to go off

themselves. But I just educate them about their options, tell them what the drug is doing.

I have a handout that I give them that lists all the side effects of a statin drug – patients

don’t often look that up and when they see that on a piece of paper, these are the most

common side effects, they will always look at that and go oh my gosh, almost all of that

is me. And that is usually enough for them to say I’m done. But be careful, if they choose

to go off a statin there is a rebound effect that happens with cholesterol, they go off the

statin and cholesterol shoots up real high, it’s like they’ve had a pillow over the mouth and

as soon as you take the pillow off then starts the screaming help, help. So a rebound

effect and it takes a couple of months for that to calm down. So don’t panic, that is normal,



the tissues have been starved of cholesterol because the medication forced the

suppression of the production of cholesterol. Once you take the medication away, the

cholesterol will go up and it will start to heal and repair the tissue as needed.

Question 17: Do you have an opinion or thoughts on some other supplements, like

Tribulus?

Answer 17: Yes, I love Tribulus and I was thinking as I was doing the webinar that I forgot

to mention Tribulus – which we’ll get to it in subsequent webinars, but it would have been

a great one to put in this one. Tribulus is fabulous. Everyone thinks of Tribulus as raising

testosterone, which it does, but that is not its primary action. Tribulus acts on the adrenal

glands to enhance production of DHEA. So Tribulus is a great herb for the production of

DHEA. When DHEA is nice then you’ll end up with very nice levels of the androgens

further on downstream.

The wonderful thing about using herbs is that you are never going to stimulate the body

to over produce any hormone endogenously. It will only normalize production. And that is

what I love about them, it is not like giving a hormone. You can screw everything up by

giving the hormone, why don’t we just give the herb, in this case Tribulus, that enhances

that major prohormone which is only then going to increase and normalize those hormone

levels downstream.

Dr. Grisanti: There have been a lot of questions and I appreciate everyone’s participation

in providing the questions.

Dr. Nelson, thank you for your time, I really appreciate it. And we’re looking forward to -

we have two more series, part 3 and part 4 and that will be posted very soon.

Doc, thank you for your time, have a wonderful evening, and I’ll talk to everyone real soon.

Dr. Nelson: Goodnight.

Dr. Grisanti: Goodnight everyone, take care.

dr. nelson: hello everyone, it’s nice to be back with you ... · as you can see there in red, the...

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