Come to grips with your health – Cheah Ui-Hoon ”Business Times, Executive Lifestyle”

This is a very interesting excerpt from a longer article published in ‘’The Business Times’’ in 2002.

In those days Singapore was supporting compounded hormones. Many people, male and female, have benefitted since then. Why is there now a witch hunt against them in Singapore?

Marion Gluck, who was spreading the word in Singapore at the time this article was published, has blazed the trail with bioidentical hormones and now works from her clinic in London. (See

Come to grips with your health

Cheah Ui-Hoon Business Times, Executive Lifestyle
Friday, 06 December 2002 Page: 18
Singapore Press Holdings Ltd.

. . .

THE recent Women’s Health Initiative (WHI) study on the dangers of hormone replacement therapy (HRT) in the United States has decisively dunked HRT as the miracle treatment for ageing and menopausal women. This might come as news to most, but not to holistic medical practitioners.

In fact, the findings made on synthetic hormones like Premarine Provera now throws the spotlight on natural, or bio-identical, remedies that have been around for 50 years, but which are less well-known.

Dr Marion Gluck, a women’s health specialist, points out that there is a safe, natural alternative for women, and men, who are suffering from symptoms of menopause and andropause such as hot flashes, night sweats, mood swings, and depression.

The German-trained doctor, currently based in an integrative medical centre in Australia, is spreading the word about Natural HRT (NHRT) in Singapore. She’s been to Singapore four times already, giving talks on NHRT at Shambhala Yoga School. ‘Women have been given a raw deal, because they’ve been exposed to synthetic hormones which have higher risks of side effects, not knowing that the safer alternative has been available,’ says Dr Gluck. Also, synthetic hormones have been given to women as a one-size-fits-all solution, and isn’t customised to individual needs.

‘It’s really important for doctors and patients to know that there’s an alternative on offer,’ says Dr Gluck. One of the reasons for this lack of information is that natural hormones – referring not to the source of hormone but to the actual hormonal structure – aren’t commercially viable for drug companies to produce since they can’t patent it.

Natural, also called bio-identical, hormones are derived from wild yam and soy, and unlike mass-produced hormones, they are custom-made to match the exact needs of the individual. The delivery systems are also safer and less taxing on the liver, as bio-identical hormones come in the form of creams and troches, which are like lozenges. In NHRT, the hormones estrogen, progesterone and testosterone have identical chemical structures of the hormones they replace, not being artificial or synthetic.

‘We would prescribe physiological doses, which are usually quite low, and that is effective enough,’ says Dr Gluck, who’s been in medical practice for 24 years. Practising integrative medicine, Dr Gluck would also prescribe or refer patients to other forms of treatment such as acupuncture or traditional chinese medicine if those are necessary or better-suited for the patient. ‘Instead of disease-based healthcare, as is now practised in the West, we have to turn around and concentrate more on prevention. It’s not just to keep a healthy constituency, but also to curb rising health costs,’ she says.

In the future, it’ll be easier for Singaporeans to get NHRT next year when a local company sets up the region’s first compounding pharmacy. Specialist Compounding Centre will operate from Camden Medical Centre, specifically for NHRT prescriptions.

Thomas Khoo, the head pharmacist, explains that a compounding pharmacy is basically like how the pharmacies of old used to be, compounding different formulas to meet individual needs.

One reason why the compounding pharmacy hasn’t existed here is because of lack of demand, but Mr Khoo thinks that it’s a matter of awareness. ‘We’re focusing first on NHRT prescriptions, and will venture into other areas once we’ve established the pharmacy,’ he says.

Dr Marion Gluck can be reached at Other NHRT practitioners include Shirin Jacob Clinic for Women, tel: 6733-7716 and Dr Ian Lee, tel: 6734-3831.

Why we must have foreign patients

Jeremy Lim, a partner in the Health & Life Sciences practice of Oliver Wyman, a management consulting firm.

A version of this article appeared in the print edition of The Straits Times on 22 July  2015.

Doctors need more patients to hone their skills, and Singapore patients benefit when a large pool of patients fuels biomedical innovation.

Medical tourism has been characterised as being about economic benefits and about attracting rich foreigners. Not any more – it’s not about them, it’s about us.

In 2003, then Acting Health Minister Khaw Boon Wan launched SingaporeMedicine, a national initiative to establish and enhance Singapore’s position as the medical hub of Asia. The ambitions were bold: one million foreign patients a year by 2012, the creation of 13,000 jobs and a contribution of $3 billion to the economy, or roughly 1 per cent of gross domestic product (GDP).

Since then, SingaporeMedicine has disappeared from policy discussions, becoming an agenda policymakers appear ready to excise from the collective memory. The SingaporeMedicine website has even been taken down, and once bold signage in at least one public hospital proclaiming “International Medical Services” has now quietly shortened to an ambiguous “IMS”.

What happened?

In launching SingaporeMedicine, Mr Khaw took pains to assert that “the dream of becoming a regional medical hub and containing healthcare costs are not mutually exclusive”, to allay fears that such moves would raise healthcare costs for all Singaporeans. He also pre-emptively explained using the analogy of Toyota Corollas, Lexus cars and Formula 1 racing that Singapore had to offer different types of healthcare to different target segments – Corolla-type care for the “bulk of our patients” with “maximum reliability, zero defects and lowest possible cost”, Lexus-type healthcare for those who can afford and want more, and Formula-1 cases to “show the world that we can hold our own against the best in the world and win”.

Fellow parliamentarians were not easily persuaded though. For example, Madam Halimah Yacob voiced concerns about distracting or diluting the public hospital core mission of serving Singaporeans. She said: “Foreign patients who come here do so because they want better and faster treatment and will have to be given priority… if we want to establish a reputation and continue attracting them. As it is, we are already suffering from a shortage of doctors, nurses and other allied professionals.”

By 2009, the Health Ministry’s tone had subtly shifted to arguing that SingaporeMedicine was only a secondary objective and that “our primary objective is to serve Singaporean patients, rendering good medical care at competitive prices”.

Despite the public concerns, Singapore has to soldier on. Foreign patients are vital to our healthcare system’s continued ability to provide quality healthcare for Singaporeans. In healthcare, high volumes deepen clinical acumen, sharpen surgical skills and enable higher quality for all patients, foreign and local.

I fear attracting foreign patients is no longer a “nice-to-have” but a “must-have”.

We may not have enough patient volumes in some specialities to even maintain competence and safety. Malaysia’s Institut Jantung Negara (National Heart Institute) aggressively markets itself internationally and performs almost 3,000 open-heart operations annually.

The National Heart Centre in Singapore? Fewer than 300 bypass operations in the last 12 months. What about the National University Hospital? Only 75 operations. “We have excellent outcomes despite the small numbers,” you might say. “How long more?” would be my response. Many of our heart surgeons cut their teeth in an era of plentiful patients and we continue reaping the fruits now.

Do we have enough patients today to train and build up the next generation of cardiac surgeons? Singapore has 43 cardiac surgeons island-wide: The latest numbers work out to only about a dozen operations per year per surgeon.

Is this enough?

The American Board of Thoracic Surgery stipulates that for surgeons in training, “operative experience requirements include an annual average of 125 major operations”.

Let’s be unequivocal – we need more patients.

The second reason we need more foreign patients is for biomedical innovation. For our biomedical research and innovation ambitions to be realised, Singapore needs medical scientists and clinicians to sub-specialise and focus on specific diseases or even sub-types of specific diseases.

And for this, we need patients, far more patients with certain selected diseases than Singapore’s modest domestic population could ever provide.

When I trained in Johns Hopkins Hospital, my supervisor was Dr Patrick Walsh, a world-renowned expert in prostate cancer. He had performed personally thousands of prostate cancer operations and this intimate knowledge of the disease had enabled him to pioneer innovative surgical techniques and contribute immensely to the foundational understanding of prostate diseases. His patients come from all over the world, not just America.

This call to reignite SingaporeMedicine is not a blunderbuss, clumsy and unbridled pursuit of all manner of foreign patients. Similar to labour policy, SingaporeMedicine needs a scalpel-like precision:

•Where are Singapore’s strategic priorities in healthcare and where are the gaps?

•Which types of foreign patients with diseases of interest and value to Singapore do we need to help plug these gaps?

• How do we encourage, for our own interests, foreign patients with these conditions to choose Singapore and help us maintain our pole position as a regional medical hub and as an increasingly successful biomedical powerhouse? Better coordination between public and private healthcare sectors? Special visa arrangements? Subsidies for expensive technologies?

I don’t have the answers, but I do know we need to have that conversation.

Forget the one about foreign patients crowding out locals; it’s a red herring and hurts Singaporeans.

Let’s discuss how some types of foreign patients can benefit from the excellent care Singapore is able to offer today, and help us to help ourselves.

HCS: And don’t let’s drive away the foreign patients who come here for bioidentical hormone replacement therapy by making it unavailable in Singapore.

Evidence based medicine vs personalised medicine

Some interesting comments on evidence based medicine from this Malaysian doctor. And isn’t the BHRT we get from compounding pharmacies is something like the ‘personalised medicine’ described here?

(Bolding by HCS)

Dr Rizin H Kusop. MBBS, MSc (Anti-Aging, Regenerative and Aesthetic Med), Dip. Family Med

From the website of  Society for Advancement of Hormone & Healthy Aging Medicine Malaysia (SAHAMM)

You may have heard what ‘evidence based medicine’ is all about. This is especially true if you are very inquisitive about your illness and health. Some doctors will also spell this out (including me) in trying to explain certain treatments for your illnesses.

Evidence based medicine is a concept where only practices which has been proven beneficial in majority of patients in the past are chosen to be practiced on you, the patient. It means a treatment is now being given to you because it has been proven to work in the past on majority of patients. If you are behaving like ‘majority of the patients’ then the treatment should work on you too.

Unfortunately there is no single treatment or practice which is considered working effectively on all patients at all time. The key concept of evidence base medicine is, if it works on some ‘statistically significant’ percentage of people then it may work on all people too. Another way looking at it is, if it works on most people, it should works on you too! Now both you and me know that those concepts are at best, oversimplified and at worst, simply not true. We are unique individual.

Then comes the personalised medicine which you may never heard before. Personalised medicine is a concept which treatments or practices are tailored only for you and no one else. This is where your doctor tries to work out the best treatment and management for you which may not be applicable to others. Unfortunately, this concept is still in its infancy. The doctor trained in this field would have to get to know you better than you know about yourself. One of the key concepts in this practice is for the doctor to do a genetic profile on you and work from there to see what medications, diets, exercise regimens and supplements optimise your health.

For example, if you have high blood pressure, the genetic profiling will reveal if one class of drug is effective to lower your blood pressure and the other class may be absolutely useless. Similarly, genetic profiling will tell if weight lifting exercise or aerobic exercise makes you lose weight. Genetic profiling also will tell if you need Statin or only vitamin B12 and folate to lower your cholesterol.

These variations are due to defects in our genes which can be detected by reading the sequences of DNAs. Often the variation is caused by a single change in the long series of DNA sequences. The variation is named as ‘Single Nucleotide Polymorphism’ or SNP (pronounced as snip). There are just too many SNPs in human body that there are probably no two similar human beings exist at the same time.

Of course, the genetic profiling test comes with its own cost and knowledge to interpret. It will be quite a while before personalised medicines makes it way to main stream medicine. Meanwhile, it make sense for you to take your health personally and understand that some conventional treatments may not work for you.

Bio-identical hormones

Dr. Karla Dionne, writing about Bioidentical hormones, says:

“I am optimistic that as patients become more informed and continue to ask for bio-identical hormones, the medical community will respond by recognizing and acknowledging the benefits of a natural hormone over a synthetic one.”

. . .

HCS: If only . . .

Why is BHRT available in Hong Kong, India, Japan, Australia, Thailand, Malaysia, Switzerland, Germany, Canada, South Africa . . . but under threat in Singapore?

Hormone Choice Singapore has been thinking about the possibilities for us and other people in the region to get access to our therapy overseas. The centres below are just a few that we came across.

However, we keep coming back to the question, why are these supposedly non-evidence based treatments freely available in all these other extremely well-regulated countries but under threat here?

If Singapore refuses to help us, and other patients in the region, we do have other places to go to but we say that with great frustration – and sadness. Singapore is supposed to be “a state of the art” medical centre.

  • Dr Susan Jamieson – Hong Kong – in the 90s, she pioneered the use of bio-identical hormones in women in Hong Kong.   “. . . unwanted side effects were the most common cause of women stopping HRT, however the newer “natural” bio-identical progesterones used in natural or bioidentical hormone replacement therapy (BHRT) fortunately appear to cause none of these symptoms!”

  • Dr. Deepak Anjana Chaturvedi – Mumbai, India – a Physician Endocrinologist, Diabetologist, Antiaging Specialist and Bariatrician based in Mumbai with clientele from all over the globe. “It’s not about one’s calendar age. It’s all about the productive and active age. Bio Identical hormone replacement therapy improves the productive age and hence is an important tool in the field of antiaging.”

  • Dr. Chiaki Kawashima – Tokyo“we use hormones which have identical chemical structures to indigenous hormones and therefore potential side-effects are greatly reduced or entirely absent.”

  • Dr Cabot Clinics – across Australia“The doctors and naturopaths at our clinic have been pioneers in the use of natural bio-identical hormones – we have used them for over 20 years. These natural hormones are wonderful for your skin, energy levels and your sex life. They can also help to overcome fibromyalgia and mood disorders.”

  • Dr Don MacGeachy – Queensland – has been using bio-Identical hormones since 1998. He is considered a leader in this field and has a wealth of experience relating to this topic. “It has always made sense that if we could tailor the hormonal dose to each individual woman by performing blood tests and prescribing the exact bio-identical molecule in correct dosage this would be the most appropriate way to treat menopause and pre-menopause.”

  • Dr Graeme Williams – Sunshine Coast“The art of clinical medicine including detailed history and careful examination, together with lots of communication and compassion is necessary.”

  • Your Health, Leaders in Integrative Medicine – across Australia“Natural Hormone Replacement uses various doses of natural oestrogens (oestriol, oestradiol, oestrone), progesterone, DHEA and testosterone as determined by prior testing for blood levels of the relevant hormones. Often progesterone is indicated in many cases due to oestrogen dominant symptoms and conditions. The aim is to achieve normal physiological levels of these hormones in the right balance for optimum health.”

  • Bumrungrad Hospital – Bangkok, Thailand“Hormone replacement refers to the use of bio-identical hormones that are chemically identical to those produced in a woman’s body. Replacement of estrogen is always done in combination with progesterone, and both have the same effect as natural ones.”

  • Bangkok Hospital – Phuket, Thailand – Royal Hormone Programme The hormone replacement therapies (HRT) at Bangkok Royal Life Anti-Aging Center use only bioidentical hormones, which are synthesized to be identical to the indigenous hormones of the human body. With close follow-up examinations and individualized hormone control, our hormone replacement therapies are of the highest standards of safety and effectiveness.”

  •  Dr Wan Julia Sham Ariffin MD – Allied Healthcare group – Malaysia“She specializes in Bio-Identical Hormones Replacement Therapy, Cell Therapy, Obesity and Fitness. Her main interest is Hormone Modulations, Wellness and Age Management.”

  • Society for Advancement of Hormone & Healthy Aging Medicine Malaysia  – “Conventional medicine treats diseases with patented medicines which is actually a downstream medicine. Healthy Aging Medicine is an upstream medicine where the focus is on prevention, early detection and treatment of age related dysfunction which adds ‘LIFE TO YEARS AND YEARS TO LIFE’.”

  • Society of Anti-Aging, Aesthetic and Regenerative Medicine Malaysia – affiliated with A4M to “Maintain a position stand on Anti-Aging Regenerative Medicine in Ministry of Health in the usage of bioidentical hormones to be allowed only to registered medical practitioners and to be listed under the medical speciality and not to be classified under Traditional and Complementary Medicine.”

  • Dr Jean-Pierre Naim – Geneva – one of the most celebrated international experts in the field of anti-aging “has published numerous works dealing with anti-aging medicine and more particularly on the protocols allowing for the boosting of longevity, on hormone replacement therapy, on the use of bio-identical hormones for aging men and women and on the protocols of telomerase.”


  • Dr. med. Rudolph Weber – Wiesbaden, Germany“We are one of the first gynecological offices in Germany to offer individualized management of perimenopause and menopause symptoms and other hormonal disorders by natural / bioidentical hormones.”

  •  Bioidentical Hormone Replacement Doctors – Clinics Across Canada “Bio identical hormones are extracted from plant sources like soy and wild yams. They possess a molecular structure that is identical or “bio identical” to the hormones produced by our bodies. This is why they will not produce the unwanted side effects caused by synthetic hormones, nor do they increase the risk of any kind of cancer. On the contrary, they are extremely beneficial to the female body undergoing menopause because they provide relief from the uncomfortable symptoms experienced at this stage.”

  • The Compounding Pharmacy of SA – “It’s important that hormone replacement therapy is overseen by a doctor specialising in individual hormone restoration, as each person’s response to hormone treatment is unique. Hormone replacement therapy should follow a customised approach, based on each particular patient’s needs and health concerns. Individual hormone levels can be balanced safely and effectively by using bioidentical hormones customised to each person’s particular requirements.”



Hormone optimisation therapy for you?

Dr Amir Farid Isahak

This article taken from The Star online 13 April 2013

The acronym, HOT, which stands for hormone optimisation therapy, is about increasing levels of hormones which are within the ‘normal’ but low range, especially if accompanied by symptoms.

In my previous four articles, I explained the roles of one dozen hormones that are evaluated and corrected by wellness and anti-ageing doctors.

I have mentioned that when you go for your “executive profile” blood tests, only one hormone (TSH or T4) is tested. And when this is normal, you are told that you are okay.

Well, in fact, many other systems may be going haywire inside you. For example, for the sex hormones, most men past 50 don’t have a clue that they are andropausal (male menopause), unlike their female (menopausal) counterparts who know their status because their once regular menses have ceased.

In fact, many men in their 40’s already have low testosterone, some low enough to be defined as andropause.

How can you know that your body is healthy and working well if you don’t have a clue about the levels of all the important hormones in your body? For example, many of my patients were shocked to learn of their low HGH (growth/youth hormone) or testosterone levels. Without testing, they would not have a clue.

Many unhealthy men are also walking around with excess oestrogens, with some having more oestrogen (oestrodial) than their menopausal wives!

An anti-ageing hormone assessment would include at least 10 of the hormones mentioned in the last four articles. In future, when we understand more about the other hormones (and when testing becomes cheaper), many more will be included. The more of these hormones are corrected or optimised (if necessary), the better your health.

HRT – Hormone Replacement Therapy

I will not discuss the details of hormone therapy, but only the concepts. You should always get the advice of your doctor, and never self-medicate with hormones as the subject requires much understanding, and the wrong treatment can cause more problems for you.

In general, therapy should only be carried out by doctors who understand the subject well, after careful evaluation, and with regular reviews/follow-up.

Most of you are familiar with the term HRT, which means hormone replacement therapy. It should mean the replacement of any hormone (eg thyroid for hypothyroidism, insulin for diabetes), but the term has been hijacked by gynaecologists to become synonymous with female sex hormone HRT or simply female HRT.

Female HRT is further divided into ET/ERT (oestrogen therapy/replacement therapy), PT/PRT (progestogen therapy/replacement therapy, usually only in younger women with “oestrogen dominance”), and EPT/EPRT (combined oestrogen+progestogen therapy/replacement therapy, which is most common for menopause).

“Replacement” implies using something to replace what is deficient or absent. For women who undergo natural menopause, the decline is gradual and HRT is “optional” after weighing the pros and cons (made very confusing since even the experts disagree).

However, women who have their ovaries removed for whatever reason before natural menopause (ie surgically-induced menopause) should go on HRT because the oestrogen deprivation is sudden and drastic, and the residual oestrogen production by other tissues (eg fat) can be extremely low.

There is little controversy in the replacement/replenishment of thyroid hormones, insulin, cortisol and other hormones when these are deficient.

The controversy arises in female HRT because of unexpected adverse results after long-term studies; in the use of natural or “bio-identical” hormones as a solution to this; and in replenishing other hormones in patients who have “low normal” levels who want to improve their health.

Synthetic and horse oestrogens

All the studies, including the WHI (Women’s Health Initiative, US) and The Million Women Study (UK), which alerted the world that female HRT was not safe, only studied women who were on synthetic and/or horse hormones.

Although their conclusions are still being debated now, these studies virtually halted HRT.

It is a pity, because menopause carries many health risks, and women were deprived of the right solution.

Two to three decades ago, when I was a full-time gynaecologist, we did not have much choice of female HRT drugs. And the ones most promoted, and therefore the ones we were most familiar with, used CEE or conjugated equine oestrogens (ie oestrogens obtained from pregnant mare urine) as the oestrogen component.

The drug insert and reference books listed the active ingredient as CEE. However, since all this controversy, I notice that it is not listed as CEE anymore, but as “natural oestrogens”, which hides the fact that it comes from the horse, although it is indeed from nature!

It does provide some benefits, and is still widely used by doctors after 70 years in the market.

When female HRT was first introduced, doctors only used synthetic and/or horse oestrogens. Soon, they realised that the women were getting uterine cancers. So they added progestins (synthetic progestogens) in combination with the oestrogens. This combination reduced the womb cancers but increased the number of breast cancers instead.

Nobody of course bothered to study the bio-identical oestrogens and progesterone (natural human progestogen) because the drug companies cannot patent them.

Now we have other choices (apart from conventional synthetic/horse hormones) to treat menopausal problems, including herbal medicines, selective oestrogen receptor modulators (SERMs), selective tissue oestrogenic activity regulator (STEAR), and natural bio-identical hormones (for more on the subject, please refer to Hormones for health, Fit4life, Feb 17, 2013).

BHRT/ BIHRT – Bioidentical HRT

The controversy over BIH (bio-identical hormones) and their use in HRT (BIHRT or BHRT) continues unabated. The Malaysian Menopause Society (MMS) is bringing down Dr Tobias Johannes de Villers, the President of the International Menopause Society (IMS), to explain its stand against BIH, while the Society for Anti-Aging, Aesthetic & Regenerative Medicine Malaysia (SAAARMM) will also bring international experts to explain the benefits of BIH at their respective congresses in KL within the next few weeks.

Ironically, while MMS officially rejects BIH, its latest newsletter (April 2013) carries advertisements of both bio-identical and horse-derived hormones side by side.

Here I quote the position statement of the A4M (American Academy of Anti-Aging and Regenerative Medicine), the world’s largest medical anti-ageing organisation, which is adopted by our own SAAARMM: “It is the position of the A4M that the use of hormones in ageing patients to replenish these levels to a youthful physiologic state, when conducted by qualified physicians trained in the practice of treating age-related hormonal decline, constitutes a legitimate and important life-enhancing, life-extending medical application.

“Bio-Identical Hormones have the same chemical structure as hormones that are made in the human body. The term ‘bio-identical’ indicates that the chemical structure of the replacement hormone is identical to that of the hormone naturally found in the human body. In order for a replacement hormone to fully replicate the function of hormones, which were originally naturally produced, and present in the human body, the chemical structure must exactly match the original.

“Thus, BIHRT is a method by which replaced hormones follow normal metabolic pathways so that the essential active metabolites are formed in response to the treatment. It is the molecular differences between bio-identical and non-bio-identical that may prove to be the defining aspect in terms of their safety and failure to make this differentiation could be misconstrued.

“Regrettably, a number of articles recently appearing in various newspapers and magazines have falsely suggested that BIHRT is unsafe and ineffective.

“The goal of BIHRT is to optimise function and prevent morbidity with ageing and to enhance quality of life. With proper modification, adjustment and titration by an experienced anti-ageing physician, the benefits of BIHRT far outweigh the risks.” (Extracted from

I fully endorse the above statements and have found BIHRT most useful in my own practice. There are many other doctors who have achieved better results with BIHRT compared to synthetic or horse HRT.

HOT – Hormone Optimisation Therapy

Now I would like to introduce a new acronym, HOT, which stands for hormone optimisation therapy. While the term hormone optimisation therapy is not new, I would like to stress that HRT was meant to replace/replenish severely deficient hormones (as in andropause, menopause and hypothyroidism) while HOT is about increasing levels of hormones which are within the “normal” but in the “low normal” range, especially if accompanied by symptoms.

What about those with “low normal” levels but who do not have symptoms? Well, actually, many don’t complain because they don’t realise or don’t know what they are missing.

Often, the deterioration in health occurs gradually, and there is a large overlap of symptoms attributed to other problems such that the patients may not complain about it, and doctors may not know if the “low normal” hormone levels are causing or contributing to sub-optimal health.

Many patients with “low normal” hormone levels (eg testosterone) report improved health and wellbeing after hormone optimisation (ie therapy to increase levels from low-normal to average or higher levels).

Anti-ageing doctors may be accused of over-treating if this concept is not understood by other doctors who just go by the lab results. Many people don’t realise that they should and could be much healthier than they are, if only they get their hormones checked and optimised.

Even if you live a healthy lifestyle, have adequate sleep, manage stress well, eat a healthy diet (plus supplements as necessary), exercise regularly (including building muscles and of course doing some qigong) and maintain your ideal weight, you should still check and optimise your hormones to achieve the best of health.






Bioidentical Testosterone: The best male anti-aging tool the experts don’t want you to have – Dr Jonathan Wright

A useful and interesting article by this Harvard graduate, one of the fathers of bioidentical hormone therapy, in which the author claims:

For over 30 years, I’ve worked with men ages 45 and up whose symptoms and tests indicated a need for bio-identical testosterone. The results have been gratifying for everyone involved. Most notably, bio-identical testosterone therapy helps improve mood, attitude, cognitive ability, and general outlook on life. Many wives and families have observed that “Grandpa is a lot less grumpy,” remembers things better, and laughs and smiles a lot more often.

Plus, bio-identical testosterone improves muscle mass and strength, rebuilds bone, strengthens the heart and blood vessels, lowers total cholesterol and blood sugar, raises HDL (“good”) cholesterol, lowers blood pressure, lessens the chances of blood clots, improves tissue oxygenation, improves the health of a non-cancerous prostate gland-and that’s all before we get to testosterone’s positive effects on libido and your sex life.

Revising guidelines for testosterone testing could more accurately diagnose deficiency

One of the issues under discussion among patients and doctors in Singapore is how to determine when there is a need to treat men with supplemental testosterone therapy.  This new study shows that levels of free testosterone are more informative than total testosterone levels

European Society of Endocrinology     16 May 2015

A new study presented at the European Congress of Endocrinology in Dublin suggests that some men suffering from testosterone deficiency may be missed under current clinical guidelines while others are misdiagnosed with testosterone deficiency. The researchers call for a revision of the clinical guidelines to ensure that men are receiving the best possible care.

Testosterone deficiency, also known as male hypogonadism, can lead to decreased libido and infertility, but it has also been associated with a higher risk of developing metabolic syndrome, diabetes and osteoporosis. In men, testosterone levels gradually decline with age. In recent years, an increasing number of ageing men are presenting with symptoms suggestive of hypogonadism and testosterone levels that are around or below the lower limit for young men. To date, the diagnosis of hypogonadism in these middle-aged and elderly men and their management remains controversial.

Researchers at the University of Manchester, UK and the University of Leuven, Belgium (represented by Dr Leen Antonio) used data from the European Male Aging Study (EMAS) to determine the relative importance of total and free testosterone measurements in diagnosing testosterone deficiency in aging men.

Testosterone exists in the body in two states; bound to proteins (98 % of total testosterone) and non-protein bound or free (2% of total testosterone), the latter being the biologically active fraction. Current clinical guidelines suggest that testosterone deficiency is diagnosed by measuring total testosterone levels. However Dr Antonio’s study shows that levels of free testosterone are more informative.

Only free testosterone can enter cells and is responsible for testosterone action. When men get older, total testosterone levels decrease while the levels of the protein that binds it increases. This means that the level of free testosterone decreases more than the total testosterone with age.

Dr Antonio, “We show that middle-aged and elderly men with normal total testosterone levels but low free testosterone levels have more symptoms of hypogonadism compared to normal men than those with normal free but low total testosterone – these men currently miss out on treatment because they are not diagnosed with testosterone deficiency.”

“On the other hand, men with low total testosterone but normal levels of free testosterone do not suffer from testosterone deficiency, yet are misdiagnosed with the condition and can be treated with testosterone inappropriately.”

Dr Antonio and colleagues propose that new guidelines should recommend measuring free testosterone, in addition to total testosterone, in the evaluation of men with hypogonadal symptoms.


Curing hearing loss with hormone therapy

By Dr Nor Ashikin Mokhtar        5 April 2013

Several physicians and researchers have attempted to treat hearing loss with a hormone called aldosterone, which is produced in the cortex of the adrenal glands.

Who would have thought that a hormone could help reverse hearing loss? I certainly would not have made the connection if not for one of my patients who came to see me after having visited several ear, nose and throat (ENT) specialists, who could not help her with her hearing problems.

As I have an interest in the use of bio-identical hormones, I did some research of my own in this area. I was pleasantly surprised to find that several physicians and researchers have already done some work in treating hearing loss with a hormone called aldosterone.

It was gratifying for both me and my patient when we found that bio-identical replacement of aldosterone helped to reverse her hearing loss.

This can give hope to many other people, especially the elderly, who face poor quality of life issues due to progressive loss of their hearing.

Hearing loss

It has always been thought that one of the inevitable consequences of getting older is losing your hearing.

Many elderly (or just slightly older) people find it increasingly difficult to hear conversations around them. They keep having to ask people to repeat what they’re saying, they turn up the volume of the television and radio, and they can’t even hear themselves speak sometimes.

Hearing loss can have significant consequences on a person’s quality of life. When you can’t hear, your communication with family and friends suffers, as everything has to be repeated or shouted.

You also find that there is less enjoyment in the things that you used to love, such as music or movies. This can leave you feeling frustrated or helpless.

Hearing loss is most commonly caused by injury to the hair cells lining the middle ear. These tiny hairs are responsible for transmitting sound to the brain. These hair cells can be damaged by exposure to excessive noise or decreased blood flow due to atherosclerosis, hypertension or diabetes.

If, like my patient, you are at your wits’ end because you have already seen numerous ENT specialists who were unable to help you, you may want to consider bio-identical hormones. This may be the solution to help you stop or even reverse your hearing loss.

What is aldosterone?

Aldosterone is a steroid hormone from the mineralocorticoid family and is produced in the cortex of the adrenal glands.

This hormone plays a role in regulating kidney function and in controlling levels of two signalling chemicals – potassium and sodium – in the nervous system.

This is the first clue that aldosterone is important for hearing: potassium is needed in the inner ear, where a potassium-rich fluid converts sounds into signals that the nervous system can identify.

Therefore, aldosterone helps to maintain a healthy level of potassium in the body, which in turn, helps to maintain hearing.

However, as people age, the amount of aldosterone produced in the body decreases, because the adrenal glands do not work as well as they should.

At the same time, potassium levels fall as well. This may explain why age-related hearing loss develops, because low aldosterone could affect hearing both in the inner ear and in the part of the brain that processes sounds.

There is some scientific evidence to back this up. A study in mice several years ago found that aldosterone added to the drinking water of the mice had the same effect as glucocorticoid drugs for reversing hearing loss.

Research has also been carried out in humans. Scientists from the International Center for Hearing and Speech in the US measured levels of aldosterone in people with severe hearing loss and found that they have half the amount of aldosterone compared to people with normal hearing.

However, too much aldosterone in the body is not healthy either. Large amounts of aldosterone, caused when a benign tumour grows on the adrenal cortex, can lead to high blood pressure and low serum potassium values.

Bio-identical replacement

If low aldosterone is thought to contribute to hearing loss, then a logical intervention would be to replace the hormone in the body.

Dr Jonathan V. Wright is one of the physicians in the US who uses bio-identical replacement of aldosterone to treat hearing loss in his patients, and he claims to have had success with this therapy.

Bio-identical hormone therapy is also known as “natural hormone therapy”. Bio-identical hormones are not synthetic hormones, but they are made in a laboratory using a plant chemical extracted from yam and soy.

The difference between bio-identical hormones and synthetic ones are that the former behave exactly like the hormones our body produces.

Dr Wright prescribes bio-identical aldosterone to his patients in “physiologic” quantities, meaning amounts that are normally present in the body (no more than that). He found that this therapy had success in more than half of his patients suffering from hearing loss.

Aldosterone therapy is believed to not only restore hearing significantly within rapid time (from a couple of weeks to a couple of months), but is also effective in patients who had lost their hearing many years ago.

Other physicians are looking at different supplement-based interventions to help with hearing loss. Vitamin B12 and folic acid, as well as vitamin D, are among the micronutrients that are believed to boost hearing.

Gingko biloba and vinpocetine supplements are also believed to increase blood flow, which helps improve hearing. More research will have to be carried out to investigate the safety and efficacy of these supplements.

Meanwhile, bio-identical aldosterone therapy may be helpful for people with hearing loss who have not found success with other treatments.

When using bio-identical aldosterone therapy, it is important to monitor the levels of aldosterone, potassium and sodium in the body to ensure that they remain within normal levels.

Not just anyone can prescribe bio-identical hormones, so be sure to speak to a qualified physician or pharmacist, particularly one specialising in anti-ageing medicine or bio-identical hormone therapy. –