FREQUENTLY ASKED QUESTIONS

Sex hormones regulate melatonin (a hormone that controls your circadian rhythms and sleep-wake cycle).  When your sex hormone levels drop, the melatonin production increases to throw off your sleep rhythms and encourage depression.  Estrogen also has an impact on your body's temperature regulation; a sudden fluctuation can trigger a hot flash. With mood swings, the culprit here is once again imbalanced estrogen levels.  Estrogen receptors inside the brain, increase neurotransmitter and synapse connectivity.  Fluctuations of estrogen can cause neurotransmitters to ignite unpredictably, creating seemingly unexplainable mood swings.  Imbalanced hormone levels can become increasingly complex, because sometimes the level of a hormone is not as important as its ratio to the other hormones.  This is why we talk of "balancing" hormones rather than merely increasing them.

Losing chemical substances that were once natural and common throughout your body, which regulated and assisted with daily body functioning throws your body out of alignment.  The hormonal shifts, imbalances, and fluctuations in menopause may cause all the following:

• weight gain

• night sweats

• insomnia

• thinning hair brittle nails

• hot flashes

• mood swings

• lack of energy

• forgetfulness

• vaginal dryness

• loss of sex drive

There exists a significant difference between physiologic optimization and abuse.  Generally athletes are young and vigorous and already performing at a very high level.  These athletes do not have any partial hormonal deficiencies, so they take hormones to go way beyond the optimal physiologic range. Whether athletes take a testosterone derivative or growth hormone, there is a short-term benefit for performance, but the long-term detriment to their body exceeds the benefits.  It is illegal to use HGH for body builders, sports enhancement or anti-aging.  It is legal to treat natural deficiencies of hormones in one's body proven by medical, physical and laboratory investigation and extensive screening with natural bio-identical hormone replacement.

Andropause is the male equivalent to menopause.  Some men actually go through a sudden change in testosterone levels; this correlates to the hormonal changes experienced by women during menopause. Most men, however, have a more subtle hormonal decline.  On the average, a man’s testosterone levels begin to decline at a rate of about 1% per year after age 30-40. Blood or saliva testing is necessary to determine testosterone levels and to establish the need for testosterone replacement therapy (blood tests require an order from the patient's physician).  Andropause has a wide variety of symptoms, including:

• Physical symptoms ( muscle weakness, heart disease, atherosclerosis)

• Mental/Emotional changes (depression, irritability, anxiety, panic, dementia, loss of joie de vivre)

• Increase in prostate size leading to benign prostatic hypertrophy

• Sexual dysfunction ( low libido, erectile dysfunction, poor/less satisfying orgasms)

• Abdominal fat often takes the place of formally hard muscle, even with regular physical exercise

• Eight hours of uninterrupted sleep are less frequent as nocturnal visits to the bathroom to urinate increase in frequency

• The thick head of hair that once covered the head becomes gray and thinner.

Many physicians state that these changes in men are an inevitable part of “normal” aging.  The idea that there is such a thing as andropause is still thought of as a myth by most mainstream medical doctors. They state that since men don’t have a physical signpost (such as the cessation of menstruation seen in women), andropause does not exist.  Even though women have a clear-cut physical demarcation in their lives, other changes of menopause take place over several years.  In the case of andropause, it is thought that the majority of physical, mental and emotional changes take place over 10 to 15 years. It has been estimated by some researchers that today; as many as 25 million American men between 40 and 55 are experiencing signs and symptoms of andropause.

Testosterone is the therapeutic agent used for Andropause.  Transdermal testosterone gel or cream applied to the skin is used to treat Andropause.   It does not irritate the skin and it can be applied as little or as often as your body requires.

Absolute Contraindications to testosterone therapy include the presence of prostate or breast cancer woman or men.

Transdermal testosterone replacement should help achieve optimal results for the man impacted by Andropause especially when combined with a healthy lifestyle composed of appropriate exercise, good eating habits and vitamin-mineral supplementation.

Hormone Modulation is the science of optimizing hormones that are no longer being adequately produced by the body.  While genetic programming does many wonderful things, nature's plan brings us to the age of reproduction and nurturing, and when completed, seems to have little use.  At that point, we begin to fail.  In fact, much of aging can be seen as deficiencies in many of the substances (Hormones) that our body once produced in abundance.  Regaining and maintaining metabolic and hormonal functions at the upper end of the normal range for your age gives you the best opportunity for a healthy and vigorous life.  This optimal range is in the upper third of the normal range for age.

While this varies with each person, some people feel results within days.  Just like beginning an exercise program you can expect results within three to six months after beginning hormone management.  Often the results of proper modulation are manifested by what you don't feel (sick, tired, moody, etc.).

Most women over thirty-five years of age need some form of hormone supplementation which can include testosterone, thyroid, and possibly others.  This applies to women that have reached menopause as well as pre-menopausal women.  Menopause is clearly a hormone deficiency condition. We believe it is absolutely crucial to the health and well-being of every woman to replace these lost hormones with natural bio-identical hormones in order to maintain quality of life and prevent unnecessary suffering.  Synthetic means the molecule is not natural to the human body. Human hormones are natural hormones whose molecules are identical to those made by humans.

You should give your program at least four to six months to see significant benefits.  Most patients will experience benefits before three months and continue to see improvement beyond that point.  Your body needs that much time to heal and rebuild.  You should remain on the program for as long as you want to optimize your health.

You will have gained time while you were on the program, but if you should elect to stop you will experience no accelerated aging.  If you stop the program your body will begin to age again at its normal rate.  The benefits will fade over time, however you will have still benefited.

Thirty-five is a good age for the initial baseline evaluation because that is when deficiencies begin to appear.  Around thirty years of age, men lose hormones from 1%-3%.  It's never too early for any adult to begin the nutraceutical program.  A person does not need to begin hormone modulation therapy however, until such time as the body begins to lower its hormone production.  Blood tests and physical assessments help our certified staff determine exactly where you may be most deficient and how we can best help you.  Every person is different and will have different needs as far as hormone modulation is concerned.

Will Hormone Replacement Treatment interfere with my currently prescribed medications?

Typically no.  In some instances medications may actually be reduced or no longer needed.

Age is not an obstacle.  Many of the older people (including those over 60 years) will ask this question thinking it is too late to begin a program.  The answer is quite the opposite.  Older people have greater deficiencies/partial deficiencies, therefore the response to hormone modulation and supplementation is excellent and almost immediate.  It is important to note that early intervention can reduce rapid advancement of diseases, such as osteoporosis and Alzheimer’s.  Less progress is to be expected when conditions such as these are advanced.

Yes, you are getting older, but age is not a barrier to the enjoyment and continuing quality of life, the maintenance of energy, mind, mood, weight, muscle, and sexual activity.  Men frequently complain of mood changes, depressive feelings, fatigue, and not being as decisive in their home and business as they were in the past.  They might work out, but become tired more quickly, have difficulty building muscle and so become discouraged easily.  Erectile problems may not even be the first sign of the onset of andropause and so one may think that if he can function sexually his hormonal status must be fine.  But mental issues are close behind erectile complaints and are equally bothersome.  However, most men won’t seek medical advice for fatigue and mood disorder, but once they have a few erectile difficulties they will quickly decide to seek medical advice.

The prevalence of obesity has doubled since the year 1980.  Overlooked are research findings indicating substantial fat-loss effects in response to the proper use of bio-identical hormones, certain prescription drugs and nutrients, along with lifestyle changes.

Overeating is associated with bloating of the gastrointestinal tract (stomach and intestines) with excess fats and sugars leaving the digestive tract and entering our bloodstreams.  This results in our bloodstreams bloated with fats and sugars.  Constant exposure to excess fats and sugars in our blood results in insulin resistance, oxidative stress, vascular inflammation, and platelet activation, all of which sharply increase heart attack, stroke and diabetes risks.  Chronically bloated bloodstreams also contribute to weight gain and surplus fat pounds.  Post prandial (PP) refers to after eating so this means PP lipemia [fat in blood and glycaemia (sugars in blood) after eating].

One might think that dieting (food restriction) alone would resolve postprandial metabolic disorders.  The problem is that there are fundamental age-related problems that often require medical intervention.

1. Imbalance between energy (food) intake and energy expenditure

2. Hormone imbalance

3. Genetic factors

4. Multiple physiological and molecular mechanisms influencing body fat regulation.

Adipocytes (fat cells) function to store calories in the body.  When energy is needed, specific command signals mobilize adipocytes to release their stored fat.  They are the primary site for fat storage and are bloated with triglycerides, which is the form that most fat exists in the body.  Age-related weight gain occurs when these fat cells accumulate large amounts of triglycerides and swell due to overeating, lack of exercise, hormonal imbalance and genetic/physiologic mechanisms.

The answer is the aging process adversely affects the adipocyte (fat cell) in regards to proliferations (more fat cells) and to storage and release of triglycerides which helps explain the difficulty maturing individuals have in controlling their weight.  The fat cell produces Leptin which signals satiety in the brain and increases fat metabolism for energy, adiponectin, which improves insulin sensitivity, (high is good) and glycerol-3-phosphate dehydrogenase (G3PD) causing triglyceride fat storage.  Therefore if we could increase leptin and adiponectin and decrease G3PD, you could have an ideal mechanism to assist in fat loss.  However overweight individuals have high leptin because they have leptin resistance since it is bound to C reactive protein, the same as mature diabetics have insulin resistance and high insulin levels.  Implementing a treatment regimen to reduce the postprandial burden of high fats and sugars in the bloodstream will improve metabolic pathways that help reduce body fat, while lowering markers of vascular disease risk.

Weight loss can greatly reduce triglycerides lipids, postprandial lipids and lipoproteins particularly when it is accomplished with a diet that is low in fiber-poor, refined carbohydrates, saturated and omega-6 fats, high in complex whole- food carbohydrates, soluble and insoluble fibers, lean protein, and mono-unsaturated fats( omega -3).  Cutting out processed carbohydrates (such as breads, crackers, breakfast cereals, bagels, and pretzels made with refined, processed white flour) alone can yield a 30% reduction in postprandial lipoproteins.  Omega-3 fatty acids in fish oil exert powerful effects in reducing postprandial lipoproteins.  Ingesting just 1,200 mg of EPA/DHA from fish oil can easily lower postprandial fat remnants by 50%.

1. Reduce calorie intake, especially saturated fats, omega-6 fats, and simple sugars

2. Block acute glucose absorption to reduce excess insulin response

3. Inhibit enzymes to reduce amount of absorbed fat and carbohydrate calories

4. Modulate hormones and enzyme in the liver, blood, and fat tissues for healthy metabolism to remove excess fats-glucose from the bloodstream (PP) and stored triglycerides from fat cells

Any patient with high fasting triglyceride blood level should be suspected as suffering some degree of postprandial lipemia.  Inhibiting carbohydrate absorption will help reduce triglyceride and glucose blood levels.   As we age people no longer have the metabolic capacity to eat the same number of calories they did in their youth because of an increasing inability to rapidly utilize and then purge dietary fats from their bloodstream.

Excess calories manifest outwardly as unwanted fat.  Orlistat reduces dietary fat absorption by 30% and has been around for about 10 years; it functions by blocking an enzyme (lipase) that is needed to absorb fat in the intestinal tract, thus decreasing its absorption into the bloodstream. Extra fat soluble vitamins are needed if one uses this agent.  Metformin has been used by anti-aging enthusiasts for its ability to reduce glucose and insulin levels reducing PP blood and fat burden, and so metformin seems to mimic some of the beneficial effects of caloric restriction.

1. Reduce their intake of simple carbohydrates, saturated fats, omega-6 fats, and trans fats.

2. Impede glucose absorption by inhibiting the absorbing enzymes

3. Suppress insulin spike by slowing carbohydrate absorption

4. Decrease fat absorption by taking a lipase inhibitor i.e. Orlistat

What is Dr. Pugen’s long-term objective to restore a more youthful metabolic pattern that will last a lifetime?

Hormonal balancing and enzymatic modulation.  For men, replacing free testosterone lost to normal aging is usually required.  Women deficient in estrogen are encouraged to restore estrogen to more desirable ranges.  Both men and women should maintain TSH (thyroid-stimulating hormone) and T3 (triiodothyronine) thyroid hormone levels in optimal ranges.

Sex hormones are involved in the metabolism, accumulation, and distribution of body fat.   Adipocytes (fat cells) are sensitive to testosterone, estrogen, and progesterone, thus enabling these sex hormones to exert a direct action. In the presence of an imbalance of certain sex hormones (as occurs with aging), there is a tendency towards an increase in abdominal obesity.  Sex hormones regulate the amount and distribution of fatty tissues; so they are key elements of a comprehensive program to eliminate obesity. When properly prescribed, bio-identical hormone replacement therapy in post-menopausal women and older men often reduces the degree of abdominal obesity.

Carboxytherapy is the new, simple and proven technique that can dramatically improve the appearance of cellulite, reduce fat, and reduce/remove the appearance of stretch marks by increasing the metabolism of adipose tissue (fat).   Treatments are quick, comfortable and effective for a high percentage of patients.  It is also used to improve hair growth on the scalp.

Carboxytherapy is a non-surgical technique where by CO2 is infiltrated into the subcutaneous fat via the smallest needle available (30G X ½ in).  From one injection point the carbon dioxide diffuses easily into adjacent tissues so you won't feel like a pin cushion. Treatments take 15-20 minutes.

Carboxytherapy works in three complimentary ways.  First, when injected into the subcutaneous fat CO2 mechanically breaks down the fat (lysis).  Secondly, it produces a strong vasodilatory effect increasing blood flow to the area, which stimulates the metabolism of fat.  Finally, improved circulation means more oxygen and nutrients delivered to the skin stimulating the production of collagen which revitalizes the skin's texture and firmness, thus reducing the appearance of cellulite and the "orange peel" effect.  For hair rejuvenation this vasodilatory effect leads to increased nutrition and circulation of the scalp which allows for in an increase in the anagen stage of hair growth, resulting in hair growth.

No, not when injected.  Carbon dioxide is a non-embolic gas produced by each cell in our bodies as a by-product of cellular metabolism.  During a standard laparoscopic procedure up to 20 liters are injected into the abdomen with no ill effects; during a Carboxytherapy treatment no more than 1 liter is injected.

No.  Often described as uncomfortable, yet 95% of patients find it tolerable enough to complete the required 10 sessions.  As a result of the increased circulation the treated area will be red and feel warmer for up to 20 minutes.

No.  Do not to eat for one hour before or after treatments to optimize your results and avoid rigorous exercise, sweating and the bathing for 4 hours to keep the injection sites clean.

Between 10 and 20 sessions are necessary to dramatically reduce cellulite.  Fewer treatments are required when combined with a weight loss program or with the other technologies.  Carboxytherapy can be given every other day however 1-2 sessions per week is the standard protocol.  Reaching your final goal depends on the extent of your cellulite, stretch marks, skin, age and lifestyle. Monthly treatments will be required to maintain your result.   Carboxytherapy is usually used in combination with low level laser for hair re-growth.  Normally treatments are performed on a weekly basis based on a 6 month or 1 year program.

For cellulite usually after the 3rd or 4th session you will see that your skin looks noticeably healthier tighter and smoother.  After 8-10 sessions you will be able to see a dramatic improvement.  For hair rejuvenation, some improvement is usually apparent between 3 to 6 months.

For cellulite, with monthly maintenance treatments, eating healthy and regular exercise, result will last indefinitely.  If you are unable to keep up the maintenance sessions or healthy eating and exercise then the cellulite will begin to creep back on average in 5 to 6 months.  It's like going to the gym…the more you go the better you will look…the longer it will last.  If you stay on top of it, 3 to 4 sessions will get you back to smoother firmer skin.  For stretch marks the results are long lasting however multiple treatments are required.  For hair loss bi-weekly or monthly treatments may be required depending on your results.