Recommendation 1
Evaluate adrenal function prior to starting testosterone, ideally with a circadian rhythm test (4 saliva samples). If patient is in Stage 3 adrenal fatigue, consider deferring testosterone until the adrenals have been corrected because of concerns about negative feedback.
Caution adrenal deficiency patients about the symptoms of adrenal shutdown – orthostatic lightheadedness and standing fatigue (caused by a drop in blood pressure), and excessive thirst (due to low aldosterone levels). Adrenal shutdown can be immediately corrected with oral or injectable corticosteroids.
Recommendation 2
Receive hands on training in pellet implantation, including patient volunteers (men and women). Training is available (with at least 1-month notice) in my San Diego office or with other colleagues (can call for referrals). We can be reached at (619) 419-2655 to schedule. Training is usually on Thursdays (all afternoon). Volunteer patients (usually 4-5 per training session) may receive free pellets and kits from the pharmacy if approved by pharmacy.
Recommendation 3
Implement TPI in your practice (and have it done on yourself if you have a need!). Within just 1-2 years you may be doing 10 or more procedures per week. TPI does not require nursing assistance. Suggested fees for this procedure can be discussed at training. Compounded pellets cost typically $20 or more per pellet and implantation kits vary in price – we use only disposable kits to avoid need for office sterilization and pass the cost of the kits (and pellets) to the patient. Insurance may not cover TPI, although some do. Most patients find the benefits and convenience outweigh the extra expense. Patients are always given the option of switching to another form of administration in the future. Many patients who are using other forms of treatment will switch to pellets if offered the option along with an appropriate description of benefits, and most continue with pellets if they respond well and it is affordable for them.
REFERENCES
1.Handelsman DJ, Conway AJ, Boylan LM. Pharmacokinetics and pharmacodynamics of testosterone pellets in man. J Clin Endocrinol Metab. 1990;71:216-222.
2.Jockenhövel F, Vogel E, Kreutzer M, Reinhardt W, Lederbogen S, Reinwein D. Pharmacokinetics and pharmacodynamics of subcutaneous testosterone implants in hypogonadal men. Clin Endocrinol (Oxf). 1996;45:61-71.
3.Greenblatt RB, Suran RR. Indications for hormonal pellets in the therapy of endocrine and gynecic disorders. Am J Obstet Gynecol. 1949;57:294-301.
4.Sands R, Studd J. Exogenous androgens in postmenopausal women. Am J Med. 1995;98(1A):76S-79S.
5.Glaser R, York AE, Dimitrakakis C. Beneficial effects of testosterone therapy in women measured by the validated Menopause Rating Scale (MRS). Maturitas. 2011;68:355-361.
6.Worboys S, Kotsopoulos D, Teede H, McGrath B, Davis SR. Evidence that parenteral testosterone therapy may improve endothelium-dependent and -independent vasodilation in postmenopausal women already receiving estrogen. J Clin Endocrinol Metab. 2001;86:158-161.
7.Dimitrakakis C, Zhou J, Wang J, et al. A physiologic role for testosterone in limiting estrogenic stimulation of the breast. Menopause. 2003;10:292-298.
8.Dimitrakakis C, Jones RA, Liu A, Bondy CA. Breast cancer incidence in postmenopausal women using testosterone in addition to usual hormone therapy. Menopause. 2004;11:531-535.
9.Dimitrakakis C. Androgens and breast cancer in men and women. Endocrinol Metab Clin North Am. 2011;40:533-547.
10.Dimitrakakis C, Glaser R. Subgroups of patients treated with an aromatase inhibitor (anastrozole) delivered subcutaneously in combination with testosterone. Poster presentation at: 9th European Congress on Menopause and Andropause; March 28-31, 2012; Athens, Greece.
FOR FURTHER INFOFRMATION
For more information, please contact the author at: [email protected]
ABOUT THE AUTHOR
Dr. Steve Center has practiced anti-aging and functional medicine in San Diego since 1998. A graduate of the University of Michigan and Albert Einstein College of Medicine, Dr. Center completed his internship and residency at University of California/San Diego Medical Center and Tulane University in general and orthopedic surgery. Dr. Center became Board Certified in Anti-Aging Medicine in 2003,and he completed the Fellowship in Anti-Aging Medicine in 2010.
Chapter 6
Iodine: Roles in Human Health and Toxicology
Alan Christianson, NMD
ABSTRACT
This paper offers a brief introduction to iodine. Topics discussed include biological functions of iodine, dietary iodine, iodine toxicity, the argument for/against pharmacologic iodine, and the relevance of iodine to the integrative physician.
INTRODUCTION
Iodine was discovered serendipitously by Bernard Courtois in 1811 in an attempt to more efficiently produce gun powder for Napoleon’s army.1 Its name is from the Greek ‘iodes’ for violet, the color of its vapor when burned. Iodine is a fascinating element, distinct in many ways from all other elements required for human nutrition. It is by far the heaviest of the required human elements with an atomic mass of 127. Iodine is essential for normal development and metabolism in all animals, including humans. Deficiencies can cause spontaneous abortion, increased infant mortality, hypothyroidism, cretinism, goiter, and mental defects.2
Goiter as a medical problem has been discussed in medical texts since 2700 BC. Chinese physicians documented that goiters could be reversed by ingesting burnt seaweed powder and eventually by orally ingesting animal thyroid tissue. Both treatments came to be generally accepted. Documented as early as 1600 BC, iodine’s use, in the form of seaweed as a treatment for goiter, is likely the earliest medical treatment still in use.3
Severe lack of iodine produces the morphological and cognitive impairments known as cretinism. As recently as the 1900’s, whole villages of cretins were found in rural mountainous areas of Europe. Some paleontologists have speculated that Neanderthals were not a distinct human species but rather remains of geographic pockets of cretins. Skeletal morphology between Neanderthals and cretins is quite similar and most Neanderthal remains have been found in regions known to have high rates of cretinism.4
The thyroid gland is chemically unique due to its dependence on iodine. In a severe deficiency of adequate iodine the gland cannot produce adequate amounts of hormone. This leads to severe hypothyroidism. If this occurs early in life, the brain never properly develops.5 To this day, its lack remains likely the most preventable cause of global neurodevelopmental morbidity.
Collectively, all adverse effects emerging from lack of iodine are currently called “iodine deficiency disorders” (IDD). The World Health Organization (WHO) estimates that roughly 2 billion humans suffer from or are at risk for IDD.6
Over the following years it became established that iodine was the active element of seaweed and that purified iodine was an effective treatment for goiter. This was one of the first cases where a nutritional lack was found to cause a disease that could be reversed by an isolated chemical.
IODINE AND HUMAN HEALTH
Biological Functions of Iodine
Biochemically, iodine’s main function is as an essential component of thyroid hormones. Thyroxine (T4) and triiodothyronine (T3) are comprised of approximately 65 and 59% iodine by weight, respectively.7 All mammals depend on thyroid hormones for regulation of enzymatic activity and protein synthesis. Once ingested, iodine is converted into elemental iodide, and taken up by the thyroid gland