Dr. Chad: This is Dr. Chad Edwards and you are listening to Podcast number 32 of Against the Grain. Are you tired and fatigued? Are you frustrated with doctors because they just don’t seem to listen? Do you want to fix your pain without surgery? If you answered yes to any of these questions, then we are the clinic for you. We offer Tulsa prolotherapy, PRP or platelet rich plasma therapy and stem cell injections, IV nutritional therapies, bioidentical hormone replacement therapy, and functional medicine to help you get back on track to optimal health. Call our clinic at 9-1-8-9-3-5-3-6-3-6 or visit our website at www.revolutionhealth.org to schedule your appointment today.
Male: Welcome to Against the Grain podcast, with Dr. Chad Edwards, where he challenges the status quo when it comes to medicine. We get into hot topics in the medical field with real stories from real patients to help you on your way to a healthy lifestyle. Get ready, because we are about to go Against the Grain.
Marshall: Hello, this is the super tall, Marshall Morris and I’m joined today by Dr. Chad Edwards who believes that 80% of medical recommendations are crap, technically speaking here. He’s the author of Revolutionize Your Health with Customized Supplements, he is a board certified family physician, he served the US Army for 23 years and he is the founder of revolutionhealth.org and the Against the Grain podcast. Dr. Edwards what is up?
Chad: It’s a good day.
Marshall: It is a good day and I just got to see the hot topic here for today and I’m pretty excited about it, I don’t know anything about it, so you’re going to have to educate me on it but–
Chad: That’s what I’m here to do, so I’m pretty excited too.
Marshall: So what are we getting into, what is the hot topic?
Chad: We talk a lot about hormones, we talked about testosterone replacement, last time we talked about testosterone and prostate cancer, all this talk about hormones and all– that kind of stuff for a long time. Today, short story, we’re going to talk about hormone replacement using bio identical hormone pellets, so it’s a different form, it’s a different way to give patients hormones so that their levels are optimal and why is this beneficial, why would it not be a good idea, why is it a good idea, those kinds of things. So I’m excited about it, I think a lot of people would really benefit from using pellets and one of my big cautions is going to be, be careful where you get them because there’s a lot of crap out there for how it’s being done, the quality of the pellets, we’re going to talk about that Tulsa prolotherapy.
Marshall: Okay, so we’re getting into it and why is this a hot topic, why is this a controversial issue and against the grain issue for everyone?
Chad: Well the first thing is because we’re using bio identical hormones and if you talk to my colleagues– in fact, I got to tell you a story. So one of my nurses at my clinic was at her Obgyn’s office O-B-G-Y-N, was at her office dropping something off or something. She looked down and saw a prescription to the compounding pharmacy that we were using and it was a bio identical hormone cream and she asked the nurse that was standing there, she was like, “So, I didn’t know Dr. Snuffy did bio identical hormones and what’s the deal with that?”, the nurse rolled her eyes and she’s like, “The patient was insisting on this and Dr. Snuffy feels like it’s a scam”, it was a scam and so using the same kinds of hormones that are in your body naturally is a scam, yet it’s okay if I give you horse piss, because– I don’t know if we talked about this before but, have we talked about Premarin?
Marshall: Yes, we talked about it in one of the previous episodes.
Chad: Okay, so for those of you that haven’t listened to that previous episode, Premarin stands for pregnant mare’s urine and it is derived from the urine of pregnant horses. There was the first time that estrogen was commercially available in a cost effective manner because they could actually pull them out. The problem is, I treat human beings and conjugated equine estrogens are very good for horses not so good for humans. So the structure of those hormones are different in women and men than they are in horses, so why would we give you a horse estrogen. It’s very important to understand I won’t go down this rabbit trail too deep but there are three estrogens in the human body: there’s estrone, estradiol and estriol. Estradiol is the dominant estrogen during menstruating years, it’s the one created by the ovaries and it’s the dominant hormone. After menopause estrone becomes the dominant hormone. Now part of the problem is, with estradiol you have a balancing of the effects of the estrogen. There’s two different estrogen receptors one is an alpha one is a beta. Those receptors, the alphas cause growth the betas cause degradation of growth kind of thing, where the estradiol binds to each of them like 50-50 and so there’s a null effect. One effect offsets the other as far as risk. Estrone however, binds to the alpha receptor with high affinity and 80% to the alpha receptor 20% to the beta, so you don’t have the offset of the risk. I would argue that estrone is the real problem, the dominant estrogen in conjugated equine estrogens, estrone, so when we look at the risk that we see with hormones, period. The studies that have been done have almost exclusively been done on Premarin which was commercially available for years and years. Women’s health study released in 2002 stopped early because of the risk of cardiovascular disease strokes and there was some concern about breast cancer– I don’t remember if that was in the study or not, but it was stopped because of the risk of stroke. But the other piece of that was using medroxyprogesterone acetate which is a progestin. So we’ve got estrogens and you have progesterones, those are normal, progestins are abnormal, they’re not natural human hormones and we’ll have more pod again, we’ve had some but we’ll talk more about progestins in the future, but there’s estrogen and there’s oestrogen, the one we want are bio identical hormones. So the reason this is a hot topic is because we’re using bio identical hormones and many of my colleagues are not, so that would be reason number one, reason number two– that took me a long time to answer that Tulsa prolotherapy.
Marshall: Wow, that was–
Chad: Apparently I had a lot to say.
Marshall: Yes, you’re passionate about it.
Chad: Well its– again when you look at this is, why on earth would we think that it’s a scam to give you something that’s normally naturally in your body but by golly we’re going to give you that horse piss. Have you lost your mind, what is wrong with these doctors that are doing this and thinking that this is the way to go and that’s a scam, shame on you. That’s what I think about them.
Marshall: What is the second reason that this is a hot topic?
Chad: So we’re using pellets to use this and for years, what I’ve done is creams, recently I’ve jumped over into the pellets and so the reason that this is a hot topic, and we’ll lead off with this, is why I was against pellets for a long time. Obviously I’m a fan of bio identical hormones in appropriate patients, but using pellets I had– in my practice, I’ve got patients that are coming to see me and what I was seeing from a lot of these patients that were getting pellets somewhere else, were just nightmare stories. And I was sitting here thinking, their hormone levels are off the charts and they’re all over the place, they feel awful, it took months to get their hormones regulated and I was like, “My God, these pellets are awful”, but the problem is that, it wasn’t the pellet, the pellets have been around for a long time, in fact the first hormone pellets were discovered, if you will, in 1939, so they’ve been around for a long time and they’ve sort of increased in popularity so to speak recently, but the patients that were coming in and having had hormone pellets were messed up and so I was thinking these pellets are– that’s a bad idea. And the problem is that it wasn’t the pellet that was bad, it was the way it was done. The dosing wasn’t right and the quality of the pellets was crap, so the first component– so I would argue that that’s the other reason why this is a hot topic. Am I okay to dive down the next piece?
Marshall: Yes, dive down the next piece and then I’m going to have you explain for the listeners what the pellet actually is, what it physically is.
Chad: Yes, great point, so basically there’s two ingredients, it’s pretty simple, you have the hormone and then you have a filler or a binder, I should say, called stearic acid and this isn’t the pellets that I use, The pellets that we use, I would argue, are the highest quality, they are made by compounding pharmacy, but the compounding pharmacy falls under a 503B which is kind of a manufacturer in the compounding world. So they are held to a very high FDA standard, this is not the compounding pharmacy on the corner Tulsa prolotherapy. There was some big issues with compounding from NECC, New England compounding center in Northeast, where they were making steroids compounded and then sending out all over the place and some of these patients got fungal infections and some of them died.
Chad: Died so it was big media stuff and when they went in and inspected the facility, there was fungus and– they probably had mold growing all over the place and there may have been growing all kinds of crazy stuff as a side experiment or something, who knows. But it really gave compounding pharmacies a bad name and the issue is getting good quality compounding. The pharmacy that we used for the manufacture of our pellets is A5 or 3B held a very high standard by the FDA and every– they have a very good number one quality controls, but number two, they actually test their pellets consistently to make sure that they give us the highest quality.
Marshal: How big is the pellet?
Chad: Depends on how much hormone is in it, so you’re looking at, I don’t know, that big. [crosstalk] That’s helpful for the listeners.
Marshal: Okay, so like a size of a dime?
Chad: Yes well, it’s not a circular thing, it’s a like a pencil lead but a little bit bigger in diameter. It’s probably about a centimeter long so little under a half an inch. For male testosterone pellets, yes, the diameter’s probably ten millimeters or so.
No, I’m sorry, not that, it got to be a centimeter. It’s probably, I’m sorry, a couple of millimeters.
Marshal: Pencil lead?
Chad: It’s a little bit bigger than pencil lead, but its — they’re not big. And you make a little incision in the skin in the buttocks. And you put a little troche in there, the trocar in there and put the pellets in there, cram them in there and there you go. We use a numbing medicine for it; it’s a really simple procedure, very easy, very well tolerated.
Marshal: What’s this next part of hormone, is it hormone replacement or hormone supplement using pellets. What’s the next piece to this?
Chad: Yes so, the first piece is the quality of the pellet itself. The second thing I would argue is the dosing, making sure that there dosed right. Going back to the quality piece, when I had patients that were coming in and we had doctors that were giving these pellets but they would get one that was a branded pellet. It was high quality manufactured and all those kinds of things, but then they would put in– and you got to understand like for men you might use eight to 12 pallets. So they would put in one branded pellet and then they would put in nine generic pellets that they got from the compounding pharmacy in Mexico or some– I don’t know, but not the branded pellet. What I saw was patients coming in and they got these levels that are off the charts and then they wouldn’t last very long when that pellet broke up, it crushed or disintegrated. It wasn’t made to that high standards and the high quality under really high pressure that the pharmacies are specialized in this or able to manufacture. They got messed up results, they got jacked up results so the quality of that pellet is essential Tulsa prolotherapy.
The second piece is the dosing of this pellet. You got– everybody’s a little bit different, everybody needs a little bit different hormone levels. One of the benefits to using hormone pellets is the consistent levels that are released. When we give testosterone as an injection, testosterone cypionate, that is number one, not a bio identical hormone even though I’ve been using testosterone sypionate for years. I’ve actually used it myself for testosterone replacement therapy. I don’t generally see problems but it is not bio identical testosterone. The hormone pellets, the testosterone in the pellets is bio identical. Testosterone cypionate is time released. It is broken down– can fairly consistently and the half life is about eight days. It’s broken down consistently over a few weeks. The hormone pellets are released based on your need so you if you got guys that work out hard, you may say you need a level ten of testosterone and we give you testosterone cypionate and that delivers a level eight, well you still have a little bit of a deficiency there. The hormone pellets if you need a ten they’re going to deliver a ten. Their absorption is based on cardiac output. How much blood your heart’s pumping, how do you work out. The more you need, the more it’s going to give you. At the same time it may not last as long because there’s only so much in the bank so to speak.
Chad: Those are some of the benefits to the pellets, but that’s why I think that these patients had such a problem with pellets, the quality the pellet and the dosing. You want customized dosing specifically for you. You don’t want Billy Bob’s dose, you want Marshall’s dose. How much do you need? Let’s give you that amount.
Marshal: Cool, let’s take a quick break real quick and we will be back with more on hormone pellets.
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Marshal: Okay we are back with Dr. Chad Edwards and we’re talking about hormone pellets and Dr. Edwards, I got something special for us.
Chad: I like special.
Marshal: Okay, this topic is actually from one of our listeners who wanted to know about it and so we actually put out on the website an opportunity for people to ask questions about the topic. Okay and so I’m going to read some of these questions for us and maybe you can dive in and answer him for all the other listeners.
Chad: Let’s do it.
Marshal: Okay so the first question is and you briefly touched on this but how often do you have to get hormone pellets. You mentioned that your body uses it as needed? But how often is that?
Chad: Yes, so it’s going to vary, but there’s a little bit of a range. For women, most women are going to need pellets between three and four months. What we do is we put the pellets in; we’re going to check your levels in about six weeks. If you’re not doing well we may check in a little bit sooner because we want to get you a boost and get you where you should be. if you’re doing well then most of the time between three and four months, women start to know, I’m start to drop off a little bit I need to go get re-pelleted. Three to four months is how I would say for a woman.
For men, I would say between four and five months. Some people would say up to six. I think that’s a little bit long, four to five months is generally what we see but again it depends on, for men and women, how much are you working out, how are you metabolizing the hormones and chewing them up, how much do you really need. Short answer, three to four months for women, four to five months for men.
Marshal: Is being re-pelleted a clinical term or as a–
Dr. Edward: Sure I’m a doctor I’m a doctor and I’ve just said it, that must make it right [laughs]
Marshal: I was just giving you a hard time. One of our listeners also had asked– They’re thinking about getting testosterone replacement in the form of pellets. Should I be concerned about prostate cancer going up with my testosterone replacement?
Chad: That is a great question and my short answer is listen to episode 36 of the podcast. Because we spent a whole podcast going over that. Short answer or the slightly expanded answer is there is no association between testosterone and prostate cancer as far as testosterone replacement and prostate cancer. Go into all the details in episode 36.
Marshal: Okay, cool. The next one is another testosterone replacement question. Are my testicles going to shrink with these hormone pellets?
Chad: That’s a great question and the short answer is yes. They are, basically your testicles are stimulated to produce testosterone. When we give you testosterone the testicles don’t have to do it, so you’re going to see about a 15% shrinkage in the size of your testicles and sometimes we can get — we can help a lot with that with using an additional hormone called HCG. We use that as an injection usually couple times a week and we often see that come right back and then it might– we’d stay on hormone replacement on testosterone will see him go back down and so we just kind of fill them back up so to speak. You could take a hormone holiday, I don’t necessarily recommend that. But let your body kind of re stimulate the production.
Marshal: Okay, the next question being is in terms of the actual hormone replacement itself. Why pellets verse a cream? Okay so what are the advantages or the pros and cons between the two?
Chad: The first thing is the creams have a really very variable absorption through the skin. I’ve — for years I’ve recommended that women actually use a mucosal applications so they apply it to the labia and the outer vaginal area so just inside the vagina. Some women don’t like doing that so they use it on their skins, a little bit more convenient but again it gets back to that variable absorption rate Tulsa prolotherapy.
The second reason is because most of the time, you need to use those creams twice a day in order to maintain consistent results. I’ve often dosed them at once a day. Part of that is for compliance. The second thing is cost but just trying to get those optimum levels and a lot of women do pretty well on once a day but to get optimum, we probably need to do twice a day. And so who wants to use a cream twice a day? And when you use a cream, you have to wash your hands; you can’t let anything get into contact with the skin. If you’re using it on your inner forearms, then you can have what we called transference where we actually transfer the hormones to someone else and then you have the mess and all that stuff. Plus you have to go to the pharmacy and get refills, we need to call them in, pharmacy loses their refill and they say they didn’t get it. Then you’re without your hormones and so you go into this menopause and really nobody likes that at all because, you just kind of become a bear and then you call and yell at our clinic and you know it’s just– we don’t like doing that. So, with the pellets you get them and you forget about it for three to four months.
Marshall: That sounds almost like a no-brainer.
Chad: I would agree with that, it’s much more convenient, the procedure is very easy, it’s extremely well tolerated, we get excellent levels and excellent results with this male and female and then with men you don’t have to worry about the injections, you don’t have to worry about refills all of those kinds of things. You get your pellets you forget about it for five months.
Marshall: What am I missing here about hormone pellets and kind of like some closing thoughts here with all this.
Chad: So, the pellets are going to be a little bit more expensive than most of the other forms of therapy, but the added benefit is a very physiologic we want to replicate nature. So, very physiologic release mechanism that gives you the hormones that you should have when you should have them for a consistent period of time at a very reasonable cost and patients feel amazing when they get them done.
Marshall: Boom, I love hormone pellets just– I told you I was excited about it and I feel so much more educated.
Chad: Our patients are really– once we made that switch our patients are really, really excited about it.
Marshall: Cool. Well, thank you so much Dr. Edwards I appreciate you sharing with us today.
Chad: Man have a great day and happy pellets.
Marshall: Happy pellets. Thanks for listening to this week’s podcast with Dr. Chad Edwards. Tune in next week when we’ll be going Against the Grain.
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