Dr.
Frank Shallenberger’s
Vol. 7, No. 10
Why You Probably Need
Hormone Therapy — And Your
Doctor Doesn’t Know It
What’s the difference between you at
age 65, and you at age 35? Well, there are
many differences, but the two most impor-
tant are that your wisdom is up and your
hormones are down.
In this Issue
Q Why women over 50 are more likely
to suffer from arthritis … and what
they can do to ease the pain ...... p. 4
Q If you retain fluid and your doctor
can’t figure out why, here are 5
possible causes — and how to
fix them ...................................... p. 6
Q Most bioflavonoids are great for your
health, but this one can be dangerous.
Here’s what you need to know.... p. 7
Q 3 reasons you should never get a
CT scan if you’re healthy .......... p. 8
Coming Next Month
• Why you might have sleep apnea and
not even know it. This test will tell you —
and there’s a simple way to treat it.
• Most people think the male hormone
testosterone is the cause of prostate
cancer. But the real cause might be
a hormone that’s great for women —
but deadly for men.
October 2008
However, I’m finding more and more of
my new patients aren’t taking hormones.
Some are afraid that it might cause cancer.
But many of them aren’t taking them for
another reason – their doctor told them they
don’t need hormones.
But neither of these reasons is true.
I’ve explained in the past that hor-
mones don’t cause cancer. The media hyste-
ria over hormonal replacement therapy has
confused a lot people, including doctors. Let
me make this perfectly clear – there has
never been one published study that indi-
cates that replacing your deficient hormone
levels does anything but prevent disease.
They only improve the quality and length of
your life.
None of those headlines that claimed:
“Studies show an increase risk of cancer,
strokes, and heart disease from hormonal
replacement,” were studies of hormones.
Every single one of those studies referred to
patented drugs that are routinely used by
conventional doctors in place of hormones.
These drugs are not hormones. They are
chemicals that have some similar actions to
hormones. The most common examples are
the drugs Premarin and Provera. But
they’re chemicals, not hormones. So it
shouldn’t be too surprising that these drugs
are dangerous. Common sense dictates that
taking a drug to replace a deficient hormone
instead of taking the hormone itself is
bound to be risky.
Real hormones are identical to the ones
that your body makes. They are known as
bio-identical hormones because they’re bio-
logically the same as what’s already in your
body. That’s why you shouldn’t fear taking
bio-identical hormones. They are quite safe
if you use them properly.
In fact, you should be more afraid of
not using real hormones. If your hormone
levels are low and you don’t fix the deficien-
cy, you significantly increase your risk of
osteoporosis, heart disease, diabetes, arthri-
tis, dementia, and cancer.
And that brings us to the real point of
this article. You might be deficient and your
doctor could still tell you that there’s no rea-
son to take hormones. Why? Because most
doctors don’t know how to test for hor-
mones properly. This is especially true for
men.
How to Determine Your
Hormone Levels
Most people assume that the best way
to diagnose a hormone deficiency is to get
laboratory tests. But, there are three ways
to determine hormone deficiencies. And lab-
oratory tests are the least important. I’ll
explain why in a moment.
The most important way to diagnose a
hormone deficiency is to consider symptoms
and physical signs. When a particular hor-
mone is deficient, there are certain symp-
toms and physical findings that are obvious.
For example, dry, flaky skin is an indicator
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—2—
of low thyroid hormones. A decrease of hair
growth on the legs is a sign of testosterone
deficiency. Doctors well versed in bio-identi-
cal hormone replacement (BHR) are aware
of these clues. They can usually prescribe
the right hormones simply by talking with
and examining the patient.
The next most important way to diag-
nose a deficiency is by using a “clinical
trial.” This means, giving the patient the
hormone and seeing what happens. Let me
give you an example of a clinical trial.
One of the classic symptoms of testos-
terone deficiency is apathy, or a decreased
interest in the things of life. But there are
also plenty of other reasons why a person
might be apathetic. Depression, nutritional
imbalances, sleep disorders, or a deficiency
of the thyroid hormones can all cause apathy.
If a doctor thinks that the reason for apathy
is a testosterone deficiency, he can verify it
with a clinical trial. All he has to do is pre-
scribe a two-to-three month course of testos-
terone replacement therapy. If the apathy
disappears, then it proves the diagnosis. If
it doesn’t, then it’s back to the drawing
board. This is perfectly safe even if there’s
not a deficiency. The body will adjust back
to normal levels after the trial is finished.
The third most effective way to diag-
nose a deficiency is by using laboratory test-
ing. I use laboratory testing more as a way
of monitoring the hormones I’m prescribing
than to actually diagnose deficiencies. The
reason is that the normal ranges for hor-
mones are too large. It’s quite common for a
patient to have a hormonal deficiency and
yet still have laboratory values in the nor-
mal range.
Take the thyroid hormone T4, for
instance. The normal laboratory range for
T4 is between 4-12 ug/dl (micrograms/deciliter).
But that’s a huge range. If your body has
always had T4 levels of 10 ug/dl, and now it
can come up with only half as much (5
ug/dl), then you’re clearly deficient. But
you’ll still be within the normal range. What
is a normal level of a hormone for one per-
son is not a normal level for another.
 Clearly, doctors should check all hor-
mone levels before prescribing. But when
signs and symptoms of deficiency are pres-
ent, they should not withhold treatment
simply because the laboratory test falls
within the normal range.
Check Them All
When most people think of “hor-
mones,” they automatically think of the sex
hormones estrogen, progesterone, and
testosterone. But other hormones can
become deficient and need to be replaced
besides the sex hormones. These include
thyroid hormones, adrenal hormones, and
growth hormone.
Hormones do not function in a vacu-
um. They are interdependent and synergis-
tic. That means they need each other to
work effectively, and they work together.
This means that any hormone, even though
it’s present in its optimal amount, won’t
function completely unless all of the other
hormones are also present in their optimal
amounts.
So for the best possible results, you
have to replace all the deficient hormones. If
you take only one hormone and others are
deficient, then you can cause problems. For
example, if you have hot flashes and take
only estrogen to treat it, then it will take a
much larger dose to be effective. This can
create an imbalance, and greatly increase
the chance of side effects.
When I treat hot flashes, I typically
prescribe a dose of estrogen that’s about
one-eighth of the dose that most doctors
use. I can get the same protective effects
that estrogen offers with a much smaller
dose because I prescribe it along with every
other hormone that’s needed.
So when you have your hormones
checked, be sure to check them all. Here’s a
list of hormones your doctor should test for:
• estradiol
• estriol (women only)
• estrone (women only)
• progesterone
—3—
• DHEA
• testosterone
• TSH
• free T3
• free T4
• insulin
• cortisol
• somatomedin-c
Different Hormones —
Different Tests
Most people and doctors alike think
that the best way to test hormone levels is
by using a fasting blood specimen. This test
works for thyroid hormones, insulin, and
somatomedin-c. The blood levels of these
hormones on a fasting specimen are steady.
They don’t change from minute to minute.
But this is not true of the other hormones.
The blood levels of the sex hormones
(estradiol, estriol, estrone, progesterone, and
testosterone) and the adrenal hormones
(cortisol and DHEA) do change from minute
to minute. There’s only one way to get
around this with blood tests. Your doctor has
to draw three different blood specimens 15-
20 minutes apart. And then he has to mix
the specimens together. At that point, the
lab can analyze the mixed specimen to get
an accurate picture of your hormone levels.
The only problem is I have never heard
of one doctor ever doing the test this way.
And no wonder. He would have to charge
the patient for three draws instead of one.
And the patient would need to spend up to
an hour in the lab to get the specimens.
So instead of doing it by the book, doc-
tors keep on ordering blood tests that are
inaccurate.
But there’s a really great way to get
around all of that. All your doctor has to do
is analyze the hormone levels in a sample of
saliva. While this may sound a little unusu-
al, salivary testing has many advantages
over the now obsolete blood testing.
First, blood consists almost entirely of
non-bioavailable hormones. These are hor-
mones that are bound up by binding pro-

Why Arthritis Is a Disease of
Aging — And How to Stop It
Have you ever noticed that arthritis hits
most people after they reach age 50? There’s a
simple reason for this. And, believe it or not, it’s
fairly easy to treat.
You just read that hormone deficiencies
can cause a host of problems as you age. And
osteoarthritis is one of these problems. Did you
know that the incidence of osteoarthritis in
women dramatically increases over that of men
once women reach menopause? That’s because
sex-hormone levels drop rapidly and significant-
ly during menopause. Although the levels of
sex hormones decrease in men, they do so at a
much slower rate than they do in women.
Research has shown that both estrogen
and testosterone have receptors in cartilage.
This means that these hormones will react with
cartilage cells and cause metabolic effects.
In particular, researchers have identified
two estrogen receptors in normal and
osteoarthritic cartilage. This indicates that
cartilage can respond to estrogens.
And, a recently published study in Joint,
Bone, and Spine confirmed this. The authors
state that hormone replacement therapy for
menopause can decrease the symptoms of
osteoarthritis. It can also reduce the damage
to the hip and knee.
Other studies suggest that estrogen
teins, such as sex hormone binding globulin
(SHBG), cortisol binding globulin (CBG),
and albumin. Measuring these bound
up hormones gives a very inaccurate idea
of what is effectively going on at the tissue
levels.
Saliva on the other hand contains only
bio-available, unbound hormones. So analyz-
ing the hormone content of a saliva speci-
men gives a far more accurate result.
Another advantage to saliva testing is
the ease and simplicity of collecting the
specimen. No need to go to the lab. No need
for blood draws. And for those of you who
—4—
Clinical
replacement therapy slows down and even stops
the long-term progression of osteoarthritis. This
is particularly true in the knees and ankles.
Still other studies show that women who
take estrogen replacement therapy consistently
have a lower rate of osteoarthritis than women
not taking estrogen. I’ve seen this in my own
practice.
In fact, when a woman walks into my
office with osteoarthritis, the first thing I want
to know is if her body has an adequate amount
of hormones. And I explain that if she wants to
heal the damage that has already occurred, as
well as prevent any more damage, hormonal
replacement therapy is essential.
Of course, I’m not talking about replacing
their deficient levels with synthetic drugs, such
as Premarin or Provera. Studies have clearly
shown that these therapies are associated with
an increased risk of heart disease, cancer,
strokes, Alzheimer’s, and osteoporosis.
No, I am talking about replacing their defi-
cient hormones with bio-identical hormones.
Researchers have never shown natural hor-
mone replacement to have any of the risks iden-
tified with synthetic treatment.
Men Are at Risk Too
Earlier, I mentioned another important
hormone to prevent osteoarthritis. Testosterone
deficiency is also a major cause of arthritis, par-
have less than perfect veins, saliva testing is
much less stressful.
And steroid hormones are exceptionally
stable in saliva. Much more so than with
blood specimens. This means that the levels
of the hormones in saliva are much less like-
ly to change while they sit in the test tube
than the levels of hormones in blood.
And saliva hormone tests are much less
expensive. Because of the specimen stability,
your doctor can send saliva specimens to the
laboratory by inexpensive couriers.
Blood, on the other hand, requires
l Pearls
ticularly in men. Very few men make it to their
60s without developing a deficiency of this hor-
mone. Men with diabetes develop the problem
at an even younger age.
When we correct testosterone deficiency,
you can bet that within several months their
symptoms improve significantly. I’ve seen this in
my practice. And many scientific studies prove
that men lose on average about 3% of their joint
cartilage each year because of falling testos-
terone levels.
The Most Important Hormone
for Arthritis
Finally, I should mention what may be the
single most important hormone of all regarding
osteoarthritis. It has the hard-to-remember
name of IGF-1, which stands for insulin growth
factor-1. And if that’s not hard enough to
remember, try this — it also goes by the name of
somatomedin-c. No matter which name you
choose to use, this hormone is made in the liver
in response to another hormone called growth
hormone.
Researchers have shown that cartilage
repair is absolutely contingent on there being
enough IGF-1 around. Not surprisingly, other
researchers have demonstrated that the lower
your blood levels of IGF-1, the more likely you
are to have osteoarthritis.
So how can you keep your IGF-1 levels
qualified personnel (phlebotomist), special
procedures (needles and serum collection
tubes) and equipment (centrifuge and lab
space to house it), specialized shipping ves-
sels (ice pack), and express delivery
(overnight). A typical complete saliva hor-
mone panel costs $180. The same panel
done on blood would cost between $500-600.
Remember, if you’re over 50, there’s a
good chance you need hormone replacement
therapy (not drug therapy). So it’s impor-
tant you see a doctor soon. If you can’t find
a doctor who will test and treat you for hor-
mone deficiency, you can find one at
www.acam.org.
high? It’s quite simple. While estrogen and
testosterone deficiency always requires pills,
shots, or creams, you can often increase your
IGF-1 levels with exercise and diet.
Appropriate exercise for even only 30 min-
utes, can often immediately double your growth
hormone levels. And the higher level of growth
hormone will stimulate your liver to produce
more IGF-1.
To form a dietary perspective, you will
need to keep a lid on how many carbohydrates
you eat. The more carbohydrates you eat, the
higher your insulin levels will be, and the lower
your IGF-1 levels will be. This is because insulin
blocks the ability of growth hormone to stimu-
late the production of IGF-1 in your liver. This is
yet another reason to keep those carbohydrates
out of your diet and focus more on high protein
foods, such as nuts, seeds, meats, eggs, and dairy.
Cicuttini FM, Wluka A, Bailey M, O’Sullivan R, Poon C, Yeung S,
Ebeling PR. Factors affecting knee cartilage volume in healthy
men. Rheumatology (Oxford). 2003 Feb;42(2):258-62.
Denko CW, Boja B, Moskowitz RW. Growth promoting peptides
in osteoarthritis: insulin, insulin-like growth factor-1, growth
hormone. J Rheumatol. 1990 Sep;17(9):1217-21.
Reginster JY, Kvasz A, Bruyere O, Henrotin Y. Is there any
rationale for prescribing hormone replacement therapy (HRT) to
prevent or to treat osteoarthritis? Osteoarthritis Cartilage. 2003
Feb;11(2):87-91.
Richette P, Corvol M, Bardin T. Estrogens, cartilage, and
osteoarthritis. Joint Bone Spine. 2003 Aug;70(4):257-62.
Tsai CL, Liu TK. Osteoarthritis in women: its relationship to
estrogen and current trends. Life Sci. 1992;50(23):1737-44.
One final note: If your doctor is hesi-
tant to use the saliva test, show him this
article and have him read an excellent
review article on salivary testing. David
Zava published the article in the January
2004 edition of the Townsend Letter for
Doctors and Patients. It contains some of
the technicalities that will appeal to your
doctor. He can find it at:
http://findarticles.com/p/articles/mi_m0ISW/i
s_246/ai_112728019. Q
REF: Bernard, H, editor. “Clinical diagnosis and management
by laboratory measurements.” Seventeenth edition (1984), W. B.
Saunders. West Washington Square, Philadelphia, PA 19105.
—5—
Why Your Doctor Can’t Find the Cause
(and Cure) of Your Fluid Retention
Do your feet and legs begin to swell
after you’ve been standing for long periods
of time? Do your socks leave a depression in
your legs where the elastic top compresses
the tissue? If so, you have a classical case of
edema. Edema is simply fluid retention.
Edema is an important indicator of a
significant imbalance in the body. And, as
such, you need to discover the cause and
properly treated it.
When you first consult your doctor
about edema, the two primary causes that
he’s been trained to discover are heart fail-
ure and kidney disease. If the edema is just
in your legs, you can rule out kidney dis-
ease. The edema caused by kidney disorders
is typically present not only in the legs but
also in the face and arms and hands.
Your doctor can quickly determine if
the cause is heart failure. He just has to do
a clinical examination, and perhaps a chest
X-ray.
The problem is that about 90% of the
time, the cause of edema, even severe
edema, is not one of these conditions. Once
he rules out these two causes, all too often
doctors will just stop looking for the real
cause. Instead, they might prescribe a
diuretic drug to “pull the water off.” This
approach however introduces a drug into
the system while at the same time failing to
determine what the actual cause of the dis-
order is.
So, if you have edema, but don’t have
kidney disease or heart failure, it’s time to
find the real cause. Here are some of the
most common causes and what you can do
about them.
Obesity — Frequently the develop-
ment of edema is simply secondary to exces-
sive weight. Lose the weight and the edema
goes away. This is particularly true if hot
weather aggravates the edema.
Low thyroid function (hypothy-
—6—
roidism) — Hypothyroidism is extremely
common. I often diagnose it in young per-
sons. And I find it in over 80% of all patients
over the age of 50. Most doctors will miss
the diagnosis, however, because their med-
ical school taught them that hypothyroidism
can’t be present unless a blood test called
“TSH” is abnormal. This is very unfortu-
nate because several studies published in
medical journals have pointed out that the
TSH test can be normal in patients with
obvious hypothyroidism. And edema is cer-
tainly a very common symptom of hypothy-
roidism. Hypothyroidism will often respond
to iodine supplements, which you can buy at
many health food stores and on the
Internet. My favorite brand is Iodoral.
A protein-deficient diet — If edema
exists in a patient that’s a vegetarian, I
always first think of this as being the cause.
The best way to determine this is to get a
blood test called a serum albumin. In
healthy patients, the serum albumin is over
4 grams/dl. If the value is lower than this,
the odds are pretty good that either the
patient is not eating enough protein, or they
have a digestive disorder that interferes
with the proper digestion and assimilation
of protein. Correct the disorder and the
edema will go away.
Excessive use of salt — This is prob-
ably the most common cause of fluid reten-
tion. Even if you don’t add extra salt to your
food, many foods, especially processed and
restaurant foods, are high in sodium. If you
suspect this to be the cause, then simply go
on a very low sodium diet for three weeks,
and take some additional magnesium sup-
plementation (500 mg). The edema will go
away if excessive salt is the cause.
Excess estrogen (in women) —
During hormone replacement therapy,
edema can occur either as a result of the
excessive use of estrogen or an insufficient
dose of progesterone. Keep in mind that the
drug Provera, which doctors commonly use
as a substitute for progesterone, is a very
poor substitute. In fact, it often causes fluid
retention. The other cause, one that’s com-
mon in menstruating women, is when the
body doesn’t produce enough progesterone.
In these cases, the woman will often notice
the edema in the two weeks before she has
her menstrual period. The treatment for
Why You Might Need to Take This
Dangerous Bioflavonoid
Did you know there’s a bioflavonoid
that’s actually a drug? Or that it can cause
serious immune problems? Bioflavonoids are
largely responsible for the various colors in
vegetables. They also have many important
health benefits. And most bioflavonoids are
completely nontoxic and free of drug interac-
tions. I have never seen a side effect from
these valuable nutrients. Ipriflavone, howev-
er, is another matter.
Ipriflavone is not a natural bioflavonoid.
It’s a synthetic isoflavone (plant estrogen). Dr.
Laszlo Feuer first synthesized it in Hungary.
Thus, in my mind, even though it’s available
over the counter, ipriflavone is a drug. Various
countries have it registered as a prescription
medication for osteoporosis. These include
Japan and Argentina.
While researching ipriflavone, health sci-
entists discovered that it led to increases in
the skeletal calcium of various animals.
Numerous studies have shown that ipri-
flavone increases bone density. It also reduces
the risk of osteoporotic fractures. One study,
however, suggests that the benefits of ipri-
flavone might come with a dangerous price tag.
In October 2000, Dr. Alexandersen from
Denmark reported on a three-year study on
ipriflavone. According to the study, ipriflavone
had a rather dramatic effect on certain
immune cells called lymphocytes.
Compared to the control group, patients
treated with ipriflavone had an overall reduc-
tion in their lymphocytes. On average, their
lymphocyte levels fell 30%. Worse yet, 29
patients, that’s over 10% of all those treated,
developed an excessive lowering of lympho-
—7—
both of these conditions is to use over-the-
counter progesterone cream. The problem
will typically disappear after one to two
months of therapy.
If your doctor rules out kidney disease
and heart failure, don’t let him put you on a
diuretic. First, look for one of these causes.
Then fix the cause and your edema will go
away. It really is that simple. Q
cytes called lymphopenia. Their levels were so
low that they withdrew from the study.
So does this study mean that you should
never use ipriflavone? Not necessarily. One
important thing to note was that even with
the decreased levels, there were no signs of
immune weakness, such as infections, etc. In
fact, to be fair, there were no side effects at all
for the ipriflavone treated group.
But there’s more to this story.
Osteoporosis is a disease caused by hormone
deficiency. My favorite treatment for osteo-
porosis is to replace sagging hormone levels.
Unfortunately, not everyone wants to
take hormones. And the use of hormones in
women with a history of breast cancer is
often contraindicated. So in these cases, I will
use ipriflavone. And I find that ipriflavone,
combined with vitamin D, vitamin K, and
daily exercise can often result in significant
increases in bone density. Yes, it’s a drug. But
it works.
In my patients who take ipriflavone, I
insist that they check their lymphocyte levels
every six months for the first two years. This
tells us whether they are in the 10% who, for
unknown reasons, have a decrease in their
count. So far I have not found a case of lym-
phopenia.
So if you’re taking ipriflavone, don’t get
excited. Just have your lymphocyte levels
checked regularly. This will tell you if there’s
any danger in continuing the treatment. In
most cases, you’ll be fine.
REF: Alexandersen, P., A. Toussaint, et al. “Ipriflavone in the
treatment of postmenopausal osteoporosis: a randomized con-
trolled trial.” JAMA. 2001 Mar 21;285(11):1482-8.
 LETTERS
Q. I’m a 48-year-old male in good
health. My doctor suggested I get a
whole body CT scan to make sure
there aren’t any cancers or artery
blockages. Is this a good idea? — Marty
M., St. Louis, MO
Dear Marty,
This is a bad idea. I think all you are
asking for is trouble. There are three prob-
lems with this approach.
First, whole body scans frequently miss
what they are supposed to find. In fact,
before you get the scan you will be required
to sign an informed consent form that says
exactly that.
Second, more often than not, the report
will come back inconclusive in one or more
ways. This problem is then “solved” by
ordering even more studies, including more
X-rays, and maybe even biopsies that all too
often come back normal anyway. But along
the way, you’re subjected to significant, but
unnecessary radiation, pain, and risk.
Third, they use levels of radiation in
these studies that are high enough to
increase your risk of developing cancer. As
you might already know, ionizing radiation,
the kind that is used in CT scans, causes
cancer. The Environmental Protection
Agency (EPA) agrees. It says that in people
under the age of 50, the radiation risk from
whole body CT scans exceeds the potential
benefit. In fact, the EPA insists that “the
procedure is inappropriate for general diag-
nosis of healthy individuals.”
REF: www.epa.nsw.gov.au/radiation/ctbodyscans.htm.
Q. My doctor recently surprised me.
He said my vitamin D levels are low. It
was a surprise because I spend a lot of
time outdoors in the sun. Is there
something wrong with me? — Dorothy
H., Orlando, FL
Dear Dorothy,
Years ago, we might have assumed
TO THE EDITOR
something was wrong. But today, we know
that low vitamin D levels are very common
— even in people who spend a lot of time in
the sun. In fact, unless you’re taking a vita-
min D supplement, the chances are good
that your levels are going to be unacceptably
low. The consensus is that for optimal
health, vitamin D levels should be greater
than 80 ng/ml.
I began to routinely examine the vita-
min D (25-hydroxyvitamin D) levels of every
one of my patients over the age of 30. What
I found was astounding. Not one of them
had blood levels anywhere close to 80 ng/ml.
In fact, 30% of them had levels below the
deficiency mark of 30 ng/ml. And it has been
rare to find anyone with a level over 40
ng/ml.
For most people, the only way you can
reach a level greater than 80 ng/ml is by
taking vitamin D capsules. The starting
dose is 5,000 units of vitamin D3. Advanced
Bionutritionals has an excellent product
(call 800-728-2288). I am so impressed with
how poorly sunlight is able to increase vita-
min D levels that I no longer check vitamin
D levels in my patients unless they are
already taking vitamin D. What’s the point?
I know they’re going to be low. And I can
save them the expense of an unnecessary
test.
REFS: Binkley, N., et al. “Vitamin D Level May Be Low Despite
Adequate Sun Exposure,” J Clin Endocrinol Metab.
2007;92:2130-2135.
Got a Question?
Do you have a question for Dr.
Shallenberger? If so, please send it (typed
only) to him c/o Soundview Publications,
P.O. Box 8051, Norcross, GA 30091-8051 or
feedback@RealCuresLetter.com. While he
won’t be able to respond personally, he’ll try
to answer as many questions as he can in
these pages.
—8—