The Mac Female Bio-identical Hormone Program

The Mac Female Bio-identical Hormone Program The Four Tiers INTRODUCTION THE MAC BIOIDENTICAL HORMONE PROGRAM 1

Many years ago, Vicky and I began hormone replacement therapy. We took the doses recommended by the top hormone physician on the planet. We eventually swelled up like sponges and the pain became so horrible. I literally could not get myself out of bed in the morning. We decided, forget this! Then years later, we, me being a board certified anti-aging physician, and Vicky a certified anti-aging health coach, decided that something must have went wrong with our first attempt because too many people we knew were having great success. We decided to research it and experiment on ourselves and our friends. We found that low doses gave us the gains we sought. That is how The Mac Bioidentical Hormone Protocol began. As we researched and participated with Medical Doctors as members of the American Academy of Anti-Aging Medicine, we found that it made only good sense to start patients on very low doses and slowly raise the doses until the gains they sought were achieved. It worked! We began using our protocol and quickly opened seven clinics throughout Northern California. We use a team approach. Dr. Larry Abel is the behind the curtain objective physician guiding the process, in a sense he is the pilot. I am the tour guide and Vicky is the head attendant. Dr. Abel writes the scripts and monitors all objective data, I work as the researcher, developer and teacher of all the anti-aging protocols and Vicky is the anti-aging concierge for The Mac Institute, Inc. We learn and we teach. We teach doctors and patients how to use hormones utilizing our slow and steady approach to achieve optimum hormone levels and its youthful results. For more than three decades, we have done nothing but research, learn and teach anti-aging medicine. We love it! It is our passion. As partners that are passionate about anti-aging medicine and health optimization, we spend every day reading, developing, communicating and coaching our protocols. Our protocol is basically common sense. Start on a low dose, a very low dose and if your symptoms go away that is all you need. If the symptoms of hormonal deficiency do not go away, we reevaluate and increase in small quantities the hormone that still seems deficient. We use both subjective and objective indicators to make that decision with subjectivity being the trump card. If there is one thing that we have learned about hormones, lab tests can only tell you where to start but not where to go. The Mac Bioidentical Hormone Protocol is a protocol that builds a foundation and allows you to build upon that in a slow and steady manner until you have a house that no one can blow down. We begin with gonadotropins for the take off, and then the sex hormones of Estrogen, Progesterone and Testosterone to keep it all flying smoothly. Then we add the third tier of precursors such as Pregnenolone, DHEA, Melatonin and Thyroid to reinforce and stabilize the flight. In our fourth Tier, we take you into space, by using hormones such as Human Growth Hormone and other hormones that increase pleasure and provide a more youthful appearance and vitality. 2

We welcome you on your journey to being young again. This is our success story: One day as we sat on the couch, a remote in one hand and a beer in the other, it all seemed so foreign, I turned and asked Vicky, when was the last time we were home? She pulled out the calendar and it had been 27 weekends, 27 WEEKENDS! Not working but playing. Hiking, camping, biking, fishing, attending the theatre, concerts, and everything we loved to do. 27 weekends! All pleasure no business. We realized that we had begun our low dose protocol, 30 weeks before. Before hormones, we usually spent our weekends sitting on the couch, but since we began using our protocol, we had become young again. We had begun to enjoy life like we had decades before. Just last week we climbed to the top of Yosemite Valley, over 8000 feet. That s what hormones do; they put the spark back into your life. As for our sex lives? We don t want to embarrass you or make you feel less. It is what many would considerextraordinary. Our motto is to make every patient feel great, look great and sexual again. We have hundreds of success stories. That is our job, and it is a wonderful job. The Mac Anti-Aging Protocol consists of five steps. Achieve the correct waist to height ratio Maintain the waist loss and optimize your health through great nutrition Optimize your hormones utilizing our four tier protocol Remove the environmental toxins and replace them with anti-aging nutrients Become Strong, Flexible and Cardiovascular-ly Optimal. Because You only live as long as your waist is small, You are what you eat, Our hormones do not decrease because we age; we age because our hormones decrease, Genetics may be the gun, but the environment pulls the trigger, What makes you feel old when you re old, your joints, your weakness and your stamina, be flexible, be strong, and be fit! The Mac s 3

Where do you start? Bioidentical Hormone Replacement Therapy is more subjective than objective. Lab test tells us where to start but a subjective test as this hormone symptom self test tells you where you need to go. Check yes or no if you experience the symptoms listed below each hormone Estrogen Symptom Yes No Are you experiencing hot flashes? Do you feel exhausted on a daily basis? Do you suffer from headaches/migraines Do you suffer from night sweats? Are you experiencing vaginal dryness? Have you noticed mild losses of bladder control? Are you noticing bouts of mild to severe depression? Have you had a history of urinary tract infections? Has there been an increase in forgetfulness Are you having trouble concentrating? Have you noticed a decrease in your ability to explain things? Do you suffer from occasional bouts of rapid heartbeat? Are you more moody? Do you cry easily? A score of 0-4 A score of 5-8 A score of 8+ Most likely no need of estrogen bio-identical hormone replacement therapy Most likely a need of estrogen bio-identical hormone replacement therapy No doubt there is a need of estrogen bio-identical hormone replacement therapy Progesterone Symptom Yes No Are you noticing lumpiness in your breasts? Are you experiencing anxiety? Do you have a problem with bloating? Do you become easily stressed? Are you increasingly with age becoming moody? Are you experiencing breakthrough bleeding? Do you suffer from menstrual cramps or PMS? Do you suffer from Low body temperature? Do you have or have a family history of endometriosis? Do you suffer from sleep disorders? Do you have heavy periods? Do you snore? Are you experiencing pain in multiple areas of your body? Have you had an increase in weight? A score of 0-4 A score of 5-8 Most likely no need of progesterone bio-identical hormone replacement therapy Most likely a need of progesterone bio-identical hormone replacement therapy 4

A score of 8+ No doubt there is a need of progesterone bio-identical hormone replacement therapy Testosterone Symptom Yes No Has your sex drive decreased? Have you noticed increased belly fat? Have you noticed an increase in the size of your breasts? Are you developing cellulite? Have you had a decrease in self esteem? Do you feel like flopping onto the couch after work? Are your eyelids drooping? Have you noticed that your hair is thinning? Do you feel hypersensitive? Are you gaining weight? Are your muscles turning to flab? Do you have high triglycerides, high LDL & low HDL? Do you suffer from ED or decrease in hardness? Do you have diminished Physical Performance? A score of 0-4 A score of 5-8 A score of 8+ Most likely no need of testosterone bio-identical hormone replacement therapy Most likely a need of testosterone bio-identical hormone replacement therapy No doubt there is a need of testosterone bio-identical hormone replacement therapy Thyroid Symptom Yes No Are you sensitive to cold? Do you suffer from cold hands and feet? When you wake, do you have a puffy face and swollen eyelids? Do you put weight on easily? Do you have dry skin? Do you have trouble getting up in the morning? Do you suffer from constipation? Do you wake with morning stiffness? Do you feel like you re walking through mud? Have you have fibromyalgia? Are you forgetful? Are you nervous? Are your muscles cramping? Do you feel weak? A score of 0-4 A score of 5-8 A score of 8+ Most likely no need of thyroid bio-identical hormone replacement therapy Most likely a need of thyroid bio-identical hormone replacement therapy No doubt there is a need of thyroid bio-identical hormone replacement therapy 5

Estrogen Makes a Woman a Woman ESTROGEN REPLACEMENT PROTOCOL Natural, bio-identical estrogens are available and may be compounded into a variety of dosage forms. There are three main estrogens, estrone (E1), estradiol (E2), and estriol (E3). These are normally present in the body in fairly fixed ratios. However, it is not always necessary to supplement them in any specific ratio. For example, a combination product of E3 and E2 is commonly prepared with amounts ranging from a 50/50 mixture to 80/20 or even 90/10. The important factor is using the correct estrogens for you. Estrogens may be compounded into oral capsules, oral liquids (never taste good), sublingual drops, vaginal suppositories, lozenges or topical creams. In our opinion, the creams offer the best of the many choices. They are easy to use; they're well absorbed; and the doses are easy to adjust. You may hear the words, TriEst and BiEst. These refer to a triple estrogen and a double estrogen combinations, respectively. The TriEst formulas are not often used these days because of a concern for their estrone (E1) content. The BiEst formulas contain estriol (E3) and estradiol (E2). Women may need estrogen supplementation for a variety of reasons (menopause, hysterectomy, etc.). Regardless of the reason, we believe using natural, bio-identical hormones 6

makes much more sense than any of the synthetic drug products or "natural" products derived from other animals. Doses vary for each woman - and usually change over time. While it is difficult to recommend a specific dose, we can offer a suggestion for a starting dose. We believe it is important to look at the actual hormone levels indicated in your blood or saliva but more importantly your symptoms related to hormone deficiencies. Half of the practitioners we know use saliva tests to determine hormone levels and the other half use blood tests. We may choose either depending on the individual. Whatever testing is used, we suggest it be performed periodically to verify that the hormone supplements are being absorbed and balanced. Because we recommend the creams the total amounts can be adjusted when needed. A common starting point is BiEst 1 mg per day. The ratio of E3 to E2 can range from 50/50 to 80/20. A BiEst 2mg, 50/50 mixture would provide 1 mg E3 and 1 mg E2 per dose. We commonly order a transdermal cream that provides 1mg of BiEst in 0.2ml of cream base. This corresponds with one small line on a 10 ml cream syringe. A BiEst 1 mg, 80/20 mixture would provide.8 mg E3 and 0.2mg E2 per dose. 0.2 ml of cream is equal to one small line on a 10 ml applicator. This is a relatively small amount - about the size of a small pea. While it is possible to combine estrogens with progesterone and testosterone into a single compound, it is no longer recommended - particularly when starting out. There is no way to adjust any particular hormone if they're all mixed into a single cream. One particular advantage of our protocol is that you can adjust the dose by using a little more or a little less per dose. If your doctor starts with 1 mg per dose and you find it is not relieving you of your symptoms, you can adjust the dose by adding 0.1ml to the original 0.2. The markings on the syringe barrel make this easy. 7

ESTRADIOL (E2) Estradiol, the principal estrogen found in a woman's body during her reproductive years. It is primarily produced by the ovaries. Estradiol is very effective for the symptomatic relief of hot flashes, night sweats, and facial aging. We look at E2 as the Pretty hormone. It makes the hair thick, the skin youthful and the heart healthy. When you see actresses look better in their forties than they did in their twenties, think E2. Estrogen dominance occurs to both men and women. This occurs when estradiol is too high in comparison to the other sex hormones, testosterone and progesterone. Estradiol is a fat storing hormone and fat makes estradiol and estradiol makes fat, etc. This the cause of weight loss resistance. ESTRIOL (E3) E3 works on a woman s plumbing. It helps with vaginal dryness and increases the thickness of the vaginal wall. A deficiency in E3 causes a thinning of the epithelial lining of women s vagina and urethra. This will cause painful intercourse, an increase in urinary tract infections and incontinence upon coughing or sneezing. Where E1 and E2 have associations with cancer, E3 has been shown to have anti-cancer effects. It has been shown that women with breast cancer had reduced urinary excretion of estriol (E3). It has also been observed that women without breast cancer have naturally higher estriol (E3) levels, compared with estrone and estradiol levels. ESTRONE (E1) Estrone is the estrogen most commonly found in increased amounts in post menopausal women. The body derives it from the hormones that are stored in body fat. Estrone does the same work that estradiol does, but it is considered weaker in its effects. Estrone is very rarely used any longer because of its association with cancer. How to apply: Estrogen (Bi-Est) Apply after bathing. Cream: Areas to apply: Inner upper/lower arms Inner thighs Where the skin is thin and can easily absorb the cream. Skin should be clean and dry. Spread a thin layer on a large surface to increase absorption. Rub the cream in thoroughly (approx. 10 times back and forth). Rotate the areas for application of the cream so that individual sites don't become saturated. Cream will dry in 5 to 10 minutes and should not be washed off for approximately 2 hours. Therefore activities such as bathing, swimming, exercising (inducing sweat) can wash the medication off your skin and should be avoided for 2 hours following application. 8

Cycling Women with monthly menstrual cycles should take Estrogen cream on days 1-14 of their cycle unless otherwise directed by our medical staff. (Day 1 is the beginning of your menstrual cycle and may fall on any calendar date). There are three protocols for Post menopausal women and to our observance we have not seen much difference between the three, making not one of them better or worse than the other. Protocol 1: utilize the recommended dose for 25 days continuously and discontinue for 3 days. Protocol 2: utilize the recommended dose for 28 days continuously and discontinue for 3 days. Protocol 3: utilize the recommended dose daily. You choose the protocol that makes more sense to you. 9

Progesterone Progesterone is the Happy Hormone: The feel-good/romantic hormone for men & women! Progesterone is a hormone made primarily by the ovaries at ovulation. From the point of ovulation to the first day of your period (the luteal phase), is when progesterone levels are usually at their highest. When the ovaries are not producing progesterone, the adrenal glands are the primary producers. Progesterone is used by the body to make other hormones such as estrogen and testosterone. Cortisol, the stress hormone, is also formed from progesterone. Dr. Mac states that progesterone is the one and true Chill Pill. Progesterone supplementation helps with sleep, anxiety, depression, aging, uterine and prostate problems. Progesterone is also known to help with being in present time and increasing attentiveness. It is the candlelight and music hormone, the hormone for romance, the compassionate hormone. Estrogen Dominance Progesterone is needed in hormone replacement therapy for men and women for many reasons, but one of its most important roles is to balance or oppose the effects caused by estrogen dominance. Women who have suffered from PMS and menopausal symptoms will recognize the hallmark symptoms of estrogen dominance: weight gain, bloating, mood swings, irritability, tender breasts, headaches, fatigue, depression, hypoglycemia, uterine fibroids, endometriosis, and fibrocystic breasts. Estrogen dominance is known to cause six different types of cancers including breast, ovary, cervical, uterine and prostate cancers. Estrogen dominance occurs because of menopause, stress and the environment. After menopause, 10

estrogen levels may drop 60% but progesterone levels drop to near zero. The drop in estrogen usually gets the blame for menopause and the stop of menses, but it s the combined drop of all the sex hormones that causes the symptoms of menopause. Stress causes progesterone levels to be affected. People under stress find progesterone to be very effective in their ability to handle stress. Xeno-estrogens found in the environment are also affecting society. They cause men to be estrogen dominant as they age. They also are being blamed for early puberty now being seen in eight year old girls. Xeno-estrogens are found in plastic bottles, pesticides and fertilizers. Remember, fat makes estrogen and estrogen makes fat. Dr. Mac once gave a lecture, where he had the highest estrogen level in the room. There were twenty-seven women in attendance. Bio-identical Progesterone vs. Provera Many patients ask us why they should use bio-identical progesterone instead of the progestin Provera which is what most conventional physicians prescribe. Bio-identical Progesterone is preferable to the synthetic progestins such as Provera, because it is natural to the body and has no undesirable side effects when used as directed. If you have any doubts about how different progesterone is from the progestins, remember that the placenta produces 300-400 mg of progesterone daily during the last few months of pregnancy, so we know that such levels are safe for the developing baby. But progestins, even at fractions of this dose, can cause birth defects. The progestins also cause many other side effects, including partial loss of vision, breast cancer in test dogs, an increased risk of strokes, fluid retention, migraine headaches, asthma, cardiac irregularities and depression. Synthetic progesterone has been found to be a major reason of so many cancer cases during the Women s Health Initiative that caused the study to be shut down. Premenopausal Woman and Progesterone In the ten to fifteen years before menopause, many women regularly make enough estrogen to create menstruation, but do not ovulate not making any progesterone, thus setting the stage for estrogen dominance. Using progesterone cream during this time can help prevent the symptoms of PMS. We now know that PMS can occur despite normal progesterone levels when stress is present. Stress increases cortisol production; cortisol blocks (or competes for) progesterone receptors. Additional progesterone is required to overcome this blockade, and enable the body to better handle stress. Bio-identical Progesterone is made from plants Progesterone used for hormone replacement comes from plant fats and oils, usually a substance called diosgenin which is extracted from a very specific type of wild yam that grows in Mexico, or from soybeans. In the laboratory diosgenin is chemically synthesized into the identical progesterone made by humans. Some companies sell diosgenin, which they label "wild yam extract" as a medicine or supplement, claiming that the body will then convert it into 11

hormones as needed. While we know this can be done in the laboratory, there is no evidence that this conversion takes place in the human body. Progesterone cream application Progesterone is easily absorbed through the skin and into the capillary blood. Thus absorption is best where skin is thin: face, neck, chest, breasts, and inner arms. Women with fibrocystic breasts should apply progesterone directly to the breast this will help reduce and in many cases eliminate lumpy breasts. The Mac Protocol usually begins by applying Progesterone cream to the chest and breasts at night. Progesterone will help you sleep. It is always best to use creams after a shower or bath, but in progesterone s case always use it at night, especially in the beginning. Do not apply on fatty areas of skin. Skin should be clean and dry. Spread a thin layer on a large surface to increase absorption. Rub the cream in thoroughly (approx. 10 times back and forth). As time passes, after a few months we will have you rotate the areas for application of the cream so that individual sites do not become saturated. Cream will dry in 5 to 10 minutes and should not be washed off for approximately 2 hours. Therefore activities such as bathing, swimming, exercising (inducing sweat) can wash the medication off your skin and should be avoided for 2 hours following application. Cycling The Mac Protocol utilizes a unique and easy cycling method. Since we utilize small doses of bhrt, it is very safe and side effects rarely occur. As for cycling, our unique approach utilizes a woman s natural cycle. Women with monthly menstrual cycles should apply a minimal dose on days 1-14 and then increase the dose during the days 15-28. (Day 1 is the beginning of your menstrual cycle and may fall on any calendar date). For postmenopausal women, apply cream for the first 28 days of the calendar month than take three days off. But just like estrogen many women prefer to use it on a daily basis. If you experience any skin irritation or allergic reaction, 12

discontinue use and call our office. If you have any questions about this or any other medications recommended by our office, please do not hesitate to call us at 800-788-7454. The Mac Protocol s Recommended Progesterone Dosage For premenopausal women the usual beginning dose is 20 mg/day for days 1-14 and 40-100 mg/day during days 15-28. Progesterone cream will come in 10 ml applicators. 1 ml will usually contain 100 mg of progesterone. Women will usually start with 1/5 of a ml which would be equal to 20 mgs. For postmenopausal women, we recommend beginning with 40 mg/day than revisiting the dosage monthly and increasing the dosage if necessary until progesterone deficiency symptoms have diminished. There are three protocols for Post menopausal women and to our observance we have not seen much difference between the three, making not one of them better or worse than the other. Protocol 1: utilize the recommended dose for 25 days continuously and discontinue for 3 days. Protocol 2: utilize the recommended dose for 28 days continuously and discontinue for 3 days. Protocol 3: utilize the recommended dose daily. You choose the protocol that you feels make more sense to you. Progesterone cream risks During the third trimester of pregnancy, the placenta produces about 300 mg of progesterone daily, so we know that a one-time overdose of the cream is virtually impossible. If you use an entire syringe of cream at once it might make you sleepy. However, we recommend that women avoid using higher than the recommended dosage to avoid hormone imbalances. More is not better when it comes to hormone optimization. Progesterone pills? We recommend transdermal cream rather than oral progesterone, because some 80% to 90% of the oral dose is lost through the liver. But if you are suffering from a sleeping disorder, we have found that oral works better. Many times, we will recommend both. When using oral doses, we will start you at 100 to 200 mgs. The reason oral works better is because the metabolite that the liver makes from digesting the progesterone aids tremendously in sleep. Oral when combined with the cream induces a better night sleep. Our protocol will include a combination of both when sleeping disorders are a symptom. 13

Testosterone High Testosterone High Sex Drive Low Testosterone No Sex Drive TESTOSTERONE REPLACEMENT PROTOCOL Testosterone is best known for its libido enhancing actions. Without sufficient testosterone neither men nor women have a desire for sexual activity. Testosterone deficiency, which becomes more common with age, is linked not only to decreased libido but also to a number of other medical problems. One of these is Metabolic Syndrome, factors that increase the chances of developing heart disease, stroke and type II diabetes. Nonalcoholic fatty liver disease, also called a fatty liver, commonly co-occurs with people whom have metabolic syndrome. To receive a diagnosis of the metabolic syndrome, patients must have three of the following five risk factors: abdominal obesity (a large waist line), low HDL ("the good") cholesterol, high triglycerides (fats in the blood), high blood pressure and high blood sugar. Do Women need Testosterone? The symptoms women experience from low levels of testosterone are loss of sex drive, dry and thin skin, lower self esteem, lower self confidence, inflammation of the vagina, increased body weight and belly fat. The only side effects we have ever seen is mild hair loss. The good news 14

the hair appears to grow back after this process with better thickness. Women who use testosterone often state that they feel more alive and active. Many doctors ignore testosterone for their female patients. If a woman complains of lack of energy, lack of sex drive, or weight gain especially around the belly, many doctors just dismiss these complaints as a result of aging and do not concern themselves with these symptoms. Postmenopausal females nearly always benefit from small doses of testosterone. This can be applied to the inner thighs or arms. The dose must be individualized for each person. The goal is to reproduce the hormone levels experienced in younger years so that the effects of aging are lessened. This treatment will increase the energy level, the enjoyment of sex, and the figure of those who are taking the therapy. Muscle tone and bone mass will also increase. Testosterone for women may be one of the greatest weight loss factors for menopausal patients. It is theorized that one reason females have difficulty losing weight compared to men is the lesser concentrations of testosterone. And when they do lose weight, they do not gain muscle mass like men do. Male hormones help mobilize fat and build muscle. Simple blood or saliva tests can determine if there is a testosterone deficiency. Finding natural ways of replacing these hormonal balances is essential. Just taking doses of estrogen or progesterone will no longer rectify the symptoms caused by sex hormone deficiencies. TESTOSTERONE TRANSDERMAL CREAM Testosterone requires a prescription. It is useful to begin at a low dose and gradually increase the amount until the proper personal response is achieved. Every person is different so each person will need to find his or her dose. For women, it is good to start with 1 mg per day applied to the wrists, chest, neck, inner thighs or arms. Men s doses are usually much higher ranging from 20 mg to 100 mg per day. Testosterone is a naturally occurring hormone and is basically non-toxic. However, a person can experience some discomfort if the dose is too high. The most notable signs of excess testosterone are oily skin, increased acne, and hair growth. All of these are reversed when the dose is reduced. Testosterone cream is dispensed in a syringelike device that holds 10 ml. For women, we start between 2.5 and 5 mg in each ml. The dispensing device is marked off in 0.2ml increments. Each increment provides.5 to 1 mg. Depending on your doctor's order, you may need to increase the daily amount by 0.1ml (0.5mg), after one to two months. There is no absolute upper amount that you can use it is determined by your individual response and your doctor's orders. Women usually find their best dose is approximately 2.5mg per day. Let us know what dosage is working best for you because we can customize a compound that provides your dose in the most convenient volume of cream excess cream is not harmful, just messy. 15

How to apply: Testosterone Apply after bathing. Cream: Areas to apply: Inner thighs is where we start then rotate to Inner upper/lower arms (Hairless Areas Only) Upper chest and neck (avoiding the breasts) Where the skin is thin and can easily absorb the cream. TESTOSTERONE MUST NOT BE APPLIED TO AREAS WITH HAIR The one problem with testosterone is that it will change into DHT by an enzyme in the hair follicle. This enzyme will change testosterone into Dihydrotestosterone (DHT). DHT will turn into estrogen. We do not want this to happen. Skin should be clean and dry. Spread a thin layer on a large surface to increase absorption. Rub the cream in thoroughly (approx. 10 times back and forth). Rotate the areas for application of the cream so that individual sites don't become saturated. Cream will dry in 5 to 10 minutes and should not be washed off for approximately 2 hours. Therefore activities such as bathing, swimming, exercising (inducing sweat) can wash the medication off your skin and should be avoided for 2 hours following application. Cycling Women with monthly menstrual cycles should take Testosterone cream on days 1-25 of their cycle unless otherwise directed by our medical staff. (Day 1 is the beginning of your menstrual cycle and may fall on any calendar date). There are three protocols for women no longer menstruating and to our observance we have not seen much difference between the three, making not one of them better or worse than the other. Protocol 1: utilize the recommended dose for 25 days continuously and discontinue for 3 days. Protocol 2: utilize the recommended dose for 28 days continuously and discontinue for 3 days. Protocol 3: utilize the recommended dose daily. You will help choose the protocol that you makes more sense to you. Be sure that you correlate all the sex hormones together, Estrogen, Progesterone and Testosterone. The Macs 1-800-788-7454 www.30lbsin30days.com 16

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