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Referring Doctors and Colleagues

After nearly 20 years of plastic surgery practice, the last 10 of which have been devoted to aesthetic surgery of the face and body, I have become aware of a significant unmet need present in most all of my patients. I have been surgically rejuvenating my clients’ appearance to better reflect externally how they desire to feel internally. Still, the aging process causes inevitable evolutionarily programmed decay of body structure and function. Like many of you, I have read with interest articles of varying quality that have been published on “anti-aging” treatments. Aging and death are inevitable (fortunately). However, the undesired decrease in quality of life that occurs as a result of “aging” includes as its causes: decreased bone density, increased fat, decreased muscle mass, increased fasting blood sugars and cholesterol leading to many medical problems, decreased libido, decreased energy, poor erectile function, anxiety and depressive symptoms, sleep disturbances, etc. Stress certainly seems to accelerate this process. The percent of the population in our high stress metropolitan area taking anti-depressants for many of these symptoms staggering.

 

Many believe (as I have now come to believe) that a significant part of this decline in quality of life as we age has to do with a decreasing levels of circulating hormones, in particular testosterone, estradiol, and progesterone. The wide spread use of statins (which block cholesterol synthesis) also leads to a marked decline in circulating sex hormones since cholesterol serves as the building block for all hormone synthesis. No, I am not starting an Internal Medicine, Endocrinology, or OB-Gyn practice! But, I am offering a service to your patients and mine of inserting bio-identical estradiol and/or testosterone time release pellets into those that would benefit. The hormones in the pellets are molecularly identical to our endogenous human hormones, and are synthesized from an oil derived from yams. In my exploration of this topic, I have found this manner of supplementation to be far superior to injections, pills, creams and patches as regards to both steady state human hormone levels and patient compliance and convenience. I have enclosed a Dear Patient letter that describes this process from a patient point of view. (I would also be happy to provide you, upon request, a summary of the history and politics of bio-identical hormones.)

While there is comparatively scant research in bio-identical hormones due to the lack of pharmaceutical company funding (drug companies cannot profit from non-patentable bio-identical hormones), the studies that have been done have dramatic findings. There have never been any findings of health risks when using physiologic doses of bio-identical hormones, nor logically should there be any. In fact, the opposite seems to be true. A 10 year study by Dr. Tutera from 1992 to 2002 (screening out only those women with diagnosed cancer at the time of study initiation) of 976 women receiving Bio-identical hormone pellet insertions found: only one patient developed breast cancer (at less than one year into the study), no patient developed ovarian cancer, and one patient (at 6 months) had stage 3 grade 1 endometrial cancer and was cured by therapy. Statistically, there should have been approximately 70 women who developed breast cancer during the study. The only two cancers in 976 women occured so early in the study that the cancers could be described as pre-existing. The Mayo Clinic surveyed 176 women who switched from synthetic animal progestins to micronized bio-identical progesterone and found that 50% reported a decrease in hot flashes, 42% reported improvement in depression, and 47% reported an improvement in anxiety. Wake Forest University School of Medicine reported that bio-identical progesterone protected against artrial vaso-spasm making it preferable when compared to the negative cardiovascular effects (which included a lowering of HDL)of horse derived progestin. The clinic I visited in Tennessee reports up to an 8.3% increase in bone density one year from the testosterone implants in men and women.

What is abundantly clear is the fact that men and women are very unhappy with the state of their sex hormones for more than just sexual related reasons. The multibillion dollar sales of erectile dysfunction drugs and OTC "herbal remedies" of varying quality for men and women speak directly to this fact. The huge use of anti-depressants in the over 35 female age group also speaks loudly. The fact Oprah aired two different shows devoted to bio-identical hormones in January of 2009 speaks to the current interest and unmet need in treating important quality of life issues. The confusing Women’s Health Initiative Study points to the obvious: that pregnant mare urine derived hormones are not molecularly nor physiologically the same as human hormones, and cause health issues due to differences in their mechanism of action. Most all of the symptomatic "side effects" of non-human hormone treatment are absent when treating with bio-identical hormones. When I was training at one of the largest pellet insertion clinics in the U.S., the self reported patient satisfaction with quality of life improvements was astounding. Contrary to my initial thoughts, male BPH symptoms seemed improved with testosterone supplementation, and no cases of prostate cancer have been found in those with prescreened normal PSA levels receiving the testosterone pellets. (Perhaps it is the absence of a sufficient levels of hormones that cause our receptor cells to be over stimulated due to a lack of feedback, thereby causing the development of cancers.) Academic studies on the cancer prevention aspects of bio-identical hormone therapy are underway. As my medical school dean told me on graduation, "Half of what we taught you is wrong. Your job over the next 40 years is to figure out which half."

I look forward to providing this wonderful service that has helped so many elsewhere regain a better quality of life both personally and within their marriage and family. I am always willing to discuss this therapy in general or concerning a specific patient with you. The pellet insertions I perform should have nothing but beneficial effects on your patient’s health, and make your job of attending to their medical needs easier. I expect you to take on no additional work or precautions except that type II diabetics will experience a lowering of their blood sugar, and the need for anti-depressants, anti-hypertensives, and statins may be lessened.

Sincerely,
Mark Richards MD

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"My experience with Dr. Mark Richards, has been absolutely wonderful. What I really appreciated most was the personalized services I received from him and his staff. In addition, I have a wonderful body."

Ms. B is a 45 year old female who had body disproportion. Even after losing 30 pounds through diet and exercise, her body disproportion persisted. She selected Dr. Richards to perform Vaser LipoSelection of the abdomen, flanks, back, and inner thighs to provide contour and proportion to her body. What a success! She was snug in a size 14 when she began her mission to "get into shape" and now comfortably wears size 9-10 pants. Ms. B is extremely pleased with her "new body", can see the results of her exercise regime, and gets compliments every day.