TREATMENT STRATEGIES FOR TRAUMATIC BRAIN INJURIES

“He’s my cousin,” George said.  “I told his old lady I’d take care of him. He got kicked in the head by a horse when he was a kid.  He’s awright.  Just ain’t bright.  But he’ll do anything you tell him.” 1

TRAUMATIC BRAIN INJURY (TBI) DEFINED

In simpler times, this classic line from John Steinbeck’s, Of Mice and Men, depicting a head trauma and any subsequent bizarre behaviors was thought of as a quirk of nature, nothing to see here.  With improved diagnosis and treatment modalities, the notion that “It’s God’s will” or “It is what it is,” gave way to the recognition that the over 1.7 million head injuries per year resulting in 52,000 deaths, 275,000 hospitalizations, and 1.365 million ER visits,2 is a modern-day medical epidemic.

The bad news—the number of reported head injuries and emergency visits has skyrocketed since 2007, and the number of hospitalizations has remained unchanged.  Upwards of ten million Americans suffer from the consequence of undiagnosed traumatic brain injury.3  The good news—better recognition of the effects of TBI has led to a dramatic drop in deaths.

Traumatic brain injuryis an induced structural injury, with or without intracranial lesions or physiologic disruption of brain function,caused by an external force.  Additionally, there needs to be a new onset or worsening of consciousness level, amnesia of the event immediately before or after the injury, and an altered mental state at the time of the injury.  Symptoms include confusion, disorientation, slow thinking, and an altered mental state; neurologic deficits including weakness, loss of balance, change in vision, praxis, paresis/plegia, sensory deprivation, and aphasia that may or may not be transient.

Symptoms of Traumatic Brain Injuries

Traumatic brain injuries disrupt normal hormonal homeostasis, leading to peripheral hormone insufficiencies and comorbid affective disorders.  Traumatic brain injuries also alter behavior related to employment, maintaining social relationships and social roles, all of which are a primary factor leading to long-term disability.  Traumatic brain injuries lead to psychiatric issues including depression, suicide ideation, anxiety, agitation, anger, paranoia, sexual dysfunction, and drug-and-alcohol abuse, all of which are common sequelae in TBI survivors.4

THE HORMONE CONNECTION TO TBI

TBI vs. Hypothalamic Failure vs. Panhypopituitarism

  • Symptoms of hypothalamic failure include fatigue, temperature dysregulation, weight gain, insatiable appetite, sugar cravings, sleep disturbances, pain, especially in trigger points, mood and libido disorders.
  • Symptoms of panhypopituitarism are fatigue, lethargy, depression with or without panic, difficulty concentrating, memory Impairment, decreased libido, sexual dysfunction, insomnia, faulty judgment, emotional outbursts, and new onset or worsening substance abuse.
  • Long-term signs and symptoms of TBI sequelae match hypopituitarism and overlap those of hypothalamic dysfunction.
S/S TBI5Hypothalamic Dx6S/S Hypopituitarism7
Fatigue (100%)

Depression w anxiety/panic

Difficulty concentrating

Memory impairment

Decreased libido; sexual dysfunction

Insomnia

Faulty judgment, slow thinking

Irritability w/emotional outburst

Substance abuse

Fatigue

Depression

Concentration difficulties  

Memory impairment

Diminished libido

Sleep disturbance

Flawedjudgement

Mood disorders

Substance abuse

Fatigue, lethargy

Depression w panic

Difficulty concentrating

Memory impairment

Decreased libido, sexual dysfunction

Insomnia

Faultyjudgement

Emotional outbursts

Substance abuse

The Six Primary Hormones

  1. Testosterone
  2. Estrogen
  3. Progesterone
  4. Growth Hormone
  5. Thyroid Hormone
  6. Cortisol

The Three Secondary Hormones

  1. DHEA
  2. Pregnenolone
  3. Prolactin

Supplements: My Magnificent Seven

  1. Omega-3s (EPA/DHA)
  2. MCT Oil
  3. Vitamin D3
  4. Probiotics/Prebiotics
  5. Glutathione
  6. L Threonine
  7. Branch Chain Amino Acids

THE SIX PRIMARY HORMONES

Testosterone

  • Testosterone acts as an antidepressant and anti-anxiety agent, improves mental clarity, strength, energy, mood, motivation, a sense of well-being, muscle tone, sexual energy, and sexual desire. Androgen receptors, present throughout the brain, positively impact cognitive function and exhibit ongoing effects in the mature brain.8
  • Testosterone attenuates inflammatory cytokines, increasing IL-10, an inhibitor of pro-inflammatory cytokines IFN-gamma, IL3, TNF alpha, and GM-CSF; protects against mitochondrial dysfunction; controls neuronal excitability, and improves seizure control. 9 Testosterone alleviates pain, particularly in the lower back and knees, and moderates anorexia nervosa.
  • Testosterone deficiency results in depression, fatigue, and suicide ideation. Testosterone levels are inversely proportional to depressive symptoms.  Free testosterone levels in the lowest quartile presage the highest incidences of depression.
Signs/Symptoms of Testosterone DeficiencySigns/Symptoms of Testosterone Excess
Weak, flabby muscles

Low self-esteem

Loss of muscle mass

Lack of energy/stamina

Loss of coordination and balance

Loss of confidence

Mental fatigue

Decreased libido

Lack of sex drive/orgasm

Weight gain

Depression

Thinned hair

Fatigue

Dry skin,-poor elasticity

Aggressiveness

Agitated/Irritable

Oily skin/oily hair

Overconfidence

Acne

Increased facial hair

Decreased HDL

 

Estrogen

  • Estrogen maintains cerebral blood flow, glucose, oxygen, lactic acid production, modulates pain, prevents apoptosis (cell death), and inhibits the progression of neurologic deterioration and neuronal loss in the central nervous system. Estrogen lowers the risk of PTSD after trauma and aids in recovering from a stroke or TBI. 10
  • Elevated estrogen levels result from increases in aromatase activity, the testosterone metabolizing enzyme. Estrogen excess is a byproduct of obesity, alcohol excess, environmental estrogens, estrogen-containing foods, zinc deficiency, liver dysfunction, supraphysiologic testosterone therapy, calcium deficiency, and diabetes.  An excess of estrogen leads to headaches, insomnia, bloating, mood swings, anxiety, depression, panic attacks, fibrocystic breast disease, breast tenderness, vaginal spotting, uterine fibroids, endometriosis, ovarian cysts, and gallstones.
  • Symptoms of estrogen deficiency include hot flashes, night sweats, brain fog, an increase in belly fat, generalized pain, PTSD, and depression.
Signs/Symptomsof Estrogen DeficiencySigns/Symptomsof Estrogen Excess
Poor /non-existent libido

Drooping breasts

Vaginal dryness

Urinary incontinence/Infections

Hot flashes

Night sweats

Brain fog

Memory issues

Irregular menstrual cycles

Amenorrhea

Thinning skin

Wrinkles especially around the mouth

Increased insulin resistance

Osteoporosis

Diabetes

Elevated lipids

Heart disease

 

Fluid retention

Cervical dysplasia/fibroids

Hypothyroidism

Fatigue

Insomnia/poor sleep

Bloating

Anxiety/fear

Breast swelling/tenderness

Severe headaches

Excess menstrual bleeding

Weight gain

Increased breast cancer incidence

 

In Men

Breast enlargement

Prostate enlargement

Difficulty urinating

Increased emotional lability

Tearfulness

Progesterone

  • Progesterone dominates the second half of the female menstrual cycle. It cleans up estrogens messes, the equivalent of a behind-the-scenes political operative.  Progesterone relieves estrogen-dominant headaches; breast, uterine and ovarian cysts; moodiness, abdominal cramps, andProgesterone is calming, regulates fluid balance, increases blood sugar, and improves thyroid function and mineral balance.  It relieves menopausal symptoms and decreases the risk of endometrial cancer, fibrocystic breast disease, osteoporosis, and heart disease.
Signs/Symptoms of Progesterone DeficiencySigns/Symptoms of Progesterone Excess
PMS

Depression/mood swings

Anxiety/irritability/nervousness

Breast swelling

Bloating/water retention

Bone loss/osteoporosis

Uterine fibroids

Excessive menstrual bleeding

Decreased HDL

Insomnia

Worsening hot flashes

Increased cortisol

Decreasedglucose tolerance

Increased fat storage

Increased appetite/carb cravings

Depression

Feeling “drunk” or “hungover.”

Water retention

Drowsiness

◆  Progesterone improves mood and sleep, acts as a neutral diuretic, maintains estrogen-induced arterial dilation, and reduces estrogenic stimulation of the breasts.  Progesterone, allo-progesterone, and DHEA protect neurons from oxidative stress, aidsin neuroregeneration, and myelin regeneration; reduce the inflammatory cytokines, interleukins IL-1B, and TNF alpha.  The result is anti-anxiety, antidepressant, anti-aggressive, anti-inflammatory, anti-stress, and anti-convulsant behavior.

Growth Hormone

  • Growth hormone preserves memory, improves concentration and mental clarity. Untreated GH deficiency results in rapid weight gain, anxiety, depression, poor cognition, loss of memory, obsessive-compulsive activity, brain fog, dark moods, paranoia, and outlandish, destructive, and criminal behavior. 11
  • Growth hormone (GH) deficiency is the first and most common hormone deficiency post-traumatic brain injury. Acutely, three months post-injury, 20% of TBI victims exhibit growth hormone deficiency.   Untreated, rates increase to 35-40% of survivors one-year post incident.12-14
Signs/Symptoms of Growth Hormone DeficiencySigns/Symptoms of Growth Hormone Excess
Anxiety and depression

Baldness

Decrease in sexual function and libido

Decreased muscle mass and strength

Difficult to concentration and lack of memory

Dry, thin skin

Elevated triglyceride levels

Fatigue

High levels of LDL (the “bad”) cholesterol

Insulin resistance

Lower tolerance to exercise

Reduced bone density

Sensitivity to heat and cold

Deficient energy levels

Weight gain especially increased abdominal waist circumference

Decreased quality of life

Sarcopenia

Loss of exercise capacity

Osteopenia

Loss of strength

Increased total and intra-abdominal fat

Glucose intolerance

Dyslipidemia

Increased fragility of skin and blood vessels

Decreased skin thickness

Decreased muscle tone, increased droopiness

Reduced confidence and optimism

Reduced immune function

Thyroid

  • Thyroid hormones act as the body’s gas pedal, providing fuel for every organ in the body. It is a Goldilocks hormone; we need “not too much, nor too little.”
  • The thyroid influences the neurotransmitters dopamine, serotonin, glutamine and GABA, acting as a fine-tuning mechanism in the functioning of neural networks, tempering psychotic ideation. 15The thyroid manages the patient’s energy and mental clarity.
  • Ninety-eight percent of patients with thyroid issues are hypothyroid. Thyroid deficits lead to fatigue, depression, poor cognition, and psychosis.Signs and symptoms include dry skin, dry hair, nails that crack and break easily, constipation, an inability to lose weight, cold intolerance, constantall day fatigue, and thinning of the outer third of the eyebrow.
Signs/Symptoms of Thyroid DeficiencySigns/Symptoms of Thyroid Excess
Weight gain

Fatigue

Lack of endurance

Dizziness

Joint stiffness

Depression

Anxiety

Decreased concentration

Muscle weakness

Headaches

Mood swings

Brittle nails

Irritability

Word salad

Joint aches/pains

Swollen fingers

Brain fog

Memory loss

Body temperature <97.5

Weight gain or loss

Fatigue

Shakiness

Heat intolerance

Restlessness

Increased thirst

Hair Loss

Anemia

Increased sweating

Hives/itching

Soft nails

Rapid heartbeat

Chest pain

Shortness of breath

Weakness

Decreased muscle mass

Anxiety/panic attacks

Depression/irritability

Emotional swings/aggression

Cortisol

  • Cortisol regulates electrolyte balance, blood sugar cravings, the immune response, and the effects of stress. In an ideal world, tensions arise, pass quickly, and the adrenal glands resume business as usual.  In the real world, stress A begets stress B, which generates stress C, ad infinitum.  The adrenals flood the body with cortisol,resulting in a syndrome marked by an intermittent, peculiar “burnout” type of fatigue.(Fatigue attributed to hypothyroidism is steady in nature.)
  • Cortisol levels and symptom severity are due to the augmenting effects of cortisol on dopamine activity. High cortisol levels lead to elevated dopamine levels, which in turn, decrease prolactin production, resulting in treatment-resistant anxiety and depression.16
  • Patients with cortisol excess crave salt and foods high in sodium, often become hypoglycemic under stress, experience increased PMS, perimenopausal, and menopausal symptoms. Depression and fatigue are common, and the ability to handle stressful situations diminishes.  The patient complains of muscle weakness, histamine-like allergic reactions, lightheadedness when rising from lying down or sitting, diminished libido and apathy.
Signs/Symptoms of Cortisol DeficiencySigns/Symptoms of Cortisol Excess
Insomnia

Fatigue on awakening, intermittent daily Fatigue

Digestive Issues

Emotional Imbalances

Loss of sexual interest

Low blood pressure

Low blood sugar

Slow heartbeat

Sugar cravings

Feelings of stress

Lightheadedness when sitting or standing

Chemical sensitivities

Irritability

Symptoms of hypothyroidism

Allergies

 

Sleep disorders

Sugar cravings

Decreased efficiency

Fat deposits

Osteoporosis

Fatigue

Increase inblood pressure

Increase incholesterol and triglycerides

Water retention

Increase inblood sugar

High blood pressure

Thinning skin

Loss of muscle mass

Anxiety

Feeling of stress

Abdominal weight gain

Arthritis and muscle pain

Hair loss

THE THREE SECONDARY HORMONES

Dehydroepiandrosterone (DHEA)

  • Dehydroepiandrosterone acts as an antidepressant and mood regulator; builds energy and confidence, and improves one’s sense of wellbeing. It decreases visceral and subcutaneous fat; reduces serum low-density lipoprotein and triglyceride levels; improves bone density, insulin resistance, insulin sensitivity, myelin sheath production, the immune system, and allergy symptoms; raises growth hormone levels in the evening; promotes wound healing; lessens fatigue, and alleviates dry eye syndromes.17-18
  • Low levels of DHEA manifest as dry hair, skin, and eyes; flabby muscles, especially in the abdomen; scant hair under the arms and pubic area; atrophic tissue in the pubic area; noise intolerance; and deficient libido.
  • Symptoms of DHEA excess mimic those of excess testosterone: fatigue, anger, deepening of the voice, insomnia, mood changes, weight gain, excess facial hair, acne, sugar cravings, restless sleep, and irritability.
  • Patients with cortisol excess crave salt and foods high in sodium, often become hypoglycemic under stress, experience increased PMS, perimenopausal, and menopausal symptoms. Depression and fatigue are common, and the ability to handle stressful situations diminishes.  The patient complains of muscle weakness, histamine-like allergic reactions, lightheadedness when rising from lying down or sitting, and apathy.
  • High DHEA-S concentrations are protective;low DHEA-S levels, due to stress and aging, lead to cognitive decline.
Signs/Symptoms of DHEA DeficiencySigns/Symptoms of DHEA Excess
Depression

Poor stress management

Lack of Stamina

Moodiness

Osteoporosis

Memory Loss

Bone, joint, muscle pain

Facial hair

Oily skin

Acne

Bossiness

Impatience/anger

Irritability/mood changes

Deepening voice

 Pregnenolone

  • Pregnenolone blocks the effects of cortisol and is a GABA-A receptor antagonist. It stimulates excitation and inhibition of the nervous system, increases stress resistance,and acts as an anti-inflammatory agent by decreasing sensitivity to pain following peripheral nerve injury.
  • Pregnenolone sulfate regulates neurotransmission in the hippocampus, the site of memory and learning. 19 It improves both physical and mental energy, myelination, synaptic transmission; and stimulates NMDA receptors.Pregnenolone repairs nerve damage; blocks the production of acid-forming compounds; and enhances alertness, learning, and sleep.
  • Pregnenolone deficiency results in a 100-fold drop in inhibiting presynaptic GABAergic synaptic mechanisms versus GABA-A receptors. Neurotransmission is reduced, manifesting as anxiety, panic attacks, agitation, aggression, insomnia, and social phobias.  Peripheral manifestations of lack of pregnenolone include arthritis, insomnia, poor focus, memory loss, fatigue, depression and an inability to handle stress.
  • Pregnenolone excess results in anger, anxiety, drowsiness, muscle aches,fluid retention, headaches, palpitations, irritability, and insomnia. 20
Signs and Symptoms of  Pregnenolone DeficiencySigns and Symptoms of Pregnenolone Excess
Loss of short-term memory

Forgetfulness

Brain fog

Depression

Reduced perception of bright   colors

Pessimism

Arthritis

Insomnia

Autoimmune diseases

Estrogen dominance

Mood disorders

Social phobias

 

Edginess

Feels “uptight”

Frequent worries

Acne

Drowsiness

Muscle aches

Fluid retention

Headache

Rapid Heart rate

Irritability

Anger

Anxiety

 Prolactin

  • Prolactin, produced in the anterior pituitary gland, is the hormone responsible for promoting milk production, along with over 300 other functions in the human body. Prolactin stimulates breast development, inhibits gonadotropin-releasing hormone (GnRH) synthesis, inhibits ovulation in females, spermatogenesis in males, and increases dopamine secretion.
  • Prolactin deficiency manifests as edginess, agitation, aggressiveness, anxiousness, fidgetiness, panic attacks, restlessness, and “treatment resistant” depression.Effects in men are impotence, loss of libido, and hypospermatogenesis.
  • Elevated prolactin levels negatively affect testosterone, progesterone and sex hormone binding globulin (SHBG).Significant effects of hyperprolactinemia in women are amenorrhea, cessation of normal cyclic ovarian function, loss of libido, occasional hirsutism, and increased long-term risk of osteoporosis. Breast cancer, ovarian cancer, chronic renal failure, hypopituitarism, autism, schizophrenia, restless leg syndrome, insomnia, polycystic ovary syndrome, herpes, epilepsy, surgery, and stressful conditions are the result of hormonal failure.
Signs/Symptoms of Prolactin DeficiencySigns/Symptoms of Prolactin Excess
Femalies:

     Treatment-resistantdepression/anxiety

     Panic attacks

     Restlessness

     Fidgetiness

     Edginess

     Agitation

     Aggressiveness

Men:

     Erectile dysfunction

     Premature ejaculation

     Low sperm count, low sperm motility

 

 

 

 

Females:

        Amenorrhea, Polycystic Ovaries

        Cessation of normal cyclic ovarian   function

        Loss of libido

        Hirsutism

         Increased long-term risk of osteoporosis

        Breast, ovarian cancer

        Migraineheadache

Men:

        Impotence

        Loss of libido

        Hypospermatogenesis.

        Hormones Negatively Affected:

Testosterone

Progesterone

  Sex hormone binding globulin (SHBG).

Other psychiatric signs and symptoms:

Schizophrenia

Autism

Stress

Restless leg syndrome

  Insomnia

SYMPTOM QUIZ FOR THE SIX PRIMARY HORMONES(21)

 1. Testosterone

NeverAlways
1.        My face has gotten slack and more wrinkled01234
2.        I’ve lost muscle tone.01234
3.        My belly tends to get fat01234
4.        I’m constantly tired.01234
5.        I feel like making love less often than I used to01234
6.        I forget things and less mentally sharp01234
7.        I feel less self-confident and more hesitant.01234
8.        My sexual performance is weaker than it used to be01234
9.        My muscle tone is poor01234
10.     I tire easily with physical activity01234

Add up your overall score ____________.Women: 5 or less: satisfactory level;between 6 and 10: possible testosterone deficiency; 11 or more: probable testosterone deficiency.   Men: 10 or less: satisfactory level; between 11 and 20: possible testosterone deficiency; 21 or more: probable testosterone deficiency.

2. Estrogen

NeverAlways
1.        I am losing hair on top of my head.01234
2.        I have hot flashes.01234
3.        I have night sweats.01234
4.        My breasts are droopy.01234
5.        I feel tired constantly.01234
6.        I am depressed.01234
7.        I have vaginal dryness.01234
8.        My thinking is foggy.01234
9.        I have wrinkles around my lips.01234
10.     I have less interest in sex.01234

Add up your overall score ____________. 10 or less: satisfactory level; between 11 and 20: possible estrogen deficiency; 21 or greater: probable estrogen deficiency

3. Progesterone

NeverAlways
1.        My breasts are swollen01234
2.        My friends claim I am nervous and agitated.01234
3.        I am anxious and/or depressed.01234
4.        I am a light sleeper or sleep poorly.01234
For premenopausal and menopausal women on hormone replacement therapy
5.        My breasts are swollen and painful before period01234
6.        My lower belly is swollen01234
7.        I am irritable and aggressive01234
8.        I lose self-control01234
9.        I have heavy periods01234
10.     My periods are painful

Add up your overall score ____________.Post-menopausalwomen without hormone replacement therapy: 4 or less: satisfactory level; between 5 and 8: possible progesterone deficiency; 9 or more: probable progesterone deficiency.  Menstrual women and women taking hormone replacement therapy: 10 or less: satisfactory level;between 11 and 20: possible progesterone deficiency; 21 or more: probable progesterone deficiency.

 4. Growth Hormone

NeverAlways
1.        My hair is thinning01234
2.        My cheeks are sagging.01234
3.        My gums are receding.01234
4.        My abdomen is flabby.01234
5.        My muscles are slack.01234
6.        My skin is thin and dry.01234
7.        It is hard to recover from physical activity.01234
8.        I am exhausted.01234
9.        I don’t like the world.  I tend to isolate myself.01234
10.     I am continuously anxious and worried.

Add up your overall score ____________.10 or less:satisfactory level;between 11 and 20:possible growth hormone deficiency; 21 or greater:probable growth hormone deficiency

5. Thyroid

NeverAlways
1.        The outer third of my eyebrows are thinning.01234
2.        My hands and feet are always cold.01234
3.        I am tired all the time.01234
4.        I put on weight easily.01234
5.        I have dry skin .01234
6.        I have trouble getting up in the morning.01234
7.        I am more tired at rest than when active.01234
8.        I am constipated.01234
9.        My joints are stiff in the morning01234
10.     I feel like I live in slow motion.

Add up your overall score ____________. 10 or less: satisfactory level; between 11 and 20:possible thyroid deficiency; 21 or more: probable thyroid deficiency.

6. Cortisol

NeverAlways
1.        I wake up tired in the morning.01234
2.        I need an energy drink mid-morning (coffee/tea, etc.).01234
3.        I crave sugar or salt (especially midafternoon)01234
4.        I have difficulty concentrating..01234
5.        I have needed a nap midafternoon01234
6.        By 8 p.m., I’m ready for bed.01234
7.        If awake after 9 p.m., I am most alert.01234
8.        I have psoriasis, eczema, or skin allergies01234
9.        I often nod off reading or watching TV.01234
10.     I have low blood pressure.

 Add up your overall score: ________. 10 or less: satisfactory level;between 11 and 20: possible cortisol deficiency.;21 or greater:probable cortisol deficiency

 SYMPTOM QUIZ FOR THE THREE SECONDARY HORMONES

1. DHEA

NeverAlways
1.        My hair is dry.01234
2.        My skin and eyes are dry.01234
3.        My muscles are flabby.01234
4.        My abdomen is getting fat…01234
5.        I have little hair under my arms.01234
6.        I have little hair in my pubic area (0 = plenty; 4 = none).01234
7.        I have little fatty tissue in the pubic area (0 = padded; 4 = flat).01234
8.        I don’t tolerate noise.01234
9.        I have low libido..01234
10.     I lack my unique scent during sexual encounters.

Add up your overall score:____________.  10 or less: satisfactory level; between 11 and 20:possible DHEA deficiency; 21 or greater: probable DHEA deficiency

  1. Pregnenolone

NeverAlways
1.        My short-term memory is poor01234
2.        I am apathetic and directionless01234
3.        I suffer from more than one autoimmune disease01234
4.        My memory worsens in stressful situations.01234
5.        I have reduced perception of bright colors.01234
6.        I have little-to-no artistic abilities.01234
7.        I have little fatty tissue in the pubic area (0 = padded; 4 = flat).01234
8.        I am aging faster than my peers (0 = no; 4 = yes).01234
9.        My genitalia are underdeveloped (0 = no; 4 = yes).01234
10.     I have a poor attention span.01234

Add up your overall score:____________. 10 or less: satisfactory level; between 11 and 20: possible pregnenolone deficiency; 21 or greater:probable pregnenolone deficiency

  1. Prolactin

NeverAlways
1.        I am restless for no apparent reason (0 = no; 4 = yes),01234
2.        I have difficulty sleeping; Sleep aids do not work (0 = no; 4 = yes).01234
3.        I suffer/have experienced infertility (0 = no; 4 = yes).01234
4.        I have long standing libido/sexual performance issues (0 = no; 4 = yes).01234
5.        I react to stressful situations inappropriately.01234
6.        Itake antipsychotic medications with minimal improvement.01234
7.        I have early (< 45 y/o) onset heart or vascular disease (0 = no; 4 = yes).01234
8.        I have  difficulty relaxing.01234
9.        I have an autoimmune disease (0 = no; 4 = yes).01234
10.     I get frequent coughs, colds, infections  (0 = no; 4 = yes)..01234

Add up and about your overall score ____________: 10 or less: satisfactory level; between 11 and 20: possible prolactin deficiency; 21 or greater:probable prolactin deficiency

DOSAGE SUMMARY SCHEDULE

The Six Primary Hormones

Testosterone

  • Males
    1. Transdermal cream: 1-20%, ½ to 1 gm daily to the inner thigh or inner arm
    2. Intramuscular (injections): 40-100 mg IM weekly or split dose twice weekly
    3. Pellets: 500-1400 mg/Rx. (Lasts 4-6 mo.)
    4. Under 40 or to preserve fertility:
      1. Clomiphene citrate: 25-50 mg 2-5 times weekly.
      2. HCG: 3000 IU subcutaneously weekly x 2; then 1000 IU twice weekly. Change off every third month to avoid antibodies
  • Females
    1. Transdermal: 5-20 mg/gram, ½ to 1 gram daily to inner thigh or inner arm
    2. Intramuscular: 5-20 Mg every 7 to 14 days
    3. Pellets: 80-150 mg/Rx
  • Notes
  1. Elevated estrogen levels in men result from aromatase activity.
    1. Zinc citrate (30-90 mg/d)
    2. Quercetin (250 -500 mg/d)
    3. Glycyrrhiza – licorice
    4. Grape seed extracts composed mainly of proanthocyanins
    5. Resveratrol
    6. DIM (1-3 gm/d p.o.}
    7. Chrysin (250 mg bid p.o., topical 50 mg/d)
    8. Progesterone Cream 2-5%, caps 10-15 mg/d
    9. Myomin
    10. Berberine
    11. Vitamin K
    12. Anastrozole (0.5-1.0 mg 1-3x/wk.)
  2. Transdermal preparations for women often contain multiple hormones. See chart after progesterone dose discussion for combination estrogen/progesterone/testosterone transdermal formulas.
  3. Testosterone excess remedy
    1. Saw Palmetto:240-260 mg. twice daily
    2. Metformin: 250-1000 mg/d
    3. Spironolactone:100 mg 1-2x/d
    4. Spearmint tea
  1. Hair loss due to elevated testosterone
    1. Reduce the testosterone dose by 50%
    2. Increase doses of the female hormones’ estradiol and progesterone
    3. Finasteride 2.5 mg/d
    4. Platelet-rich plasma (Increases hair count 30%, on average
    5. Injection or dermabrasion pen increases hair count by up to 30%
    6. 1% melatonin compounded cream applied nightly to scalp for six months
    7. Laser cap

Estrogen

  • Females
    1. Bi-est gel, (80/20) dosed at 0.5-5.0 mg/gm
    2. Estriol 5 mg/gm @ 1 gm intravaginal suppository @ bedtime for vaginal dryness.
    3. Pellet insertion
    4. Estrogen target blood level is 75-100 pg/ml
    5. Estradiol 6-15 mg pellet
  • Notes
  1. Estrogen excess
    1. Progesterone offset-nights 14-25 pre-menopause
    2. Elagolix: 150-200 mg
    3. Weight loss
    4. Liver detox
    5. Ultrasound of pelvis Re: fibroids, tumor
    6. If estrone excess: 7 Keto DHEA (25-50 mg.)
    7. Breast Cysts
      1. Progesterone cream 50 mg/gm apply @ bedtime x 6-week minimum
    8. For vaginal bleeding, breast tenderness
      1. Lower Dose
      2. Double progesterone until symptoms disappear

Progesterone

  • Females
1.     Menopausal:
a.       Capsule (daily)100-200 mg @ bedtime
b.      Cream50-200 mg/gm @ bedtime
2.     Perimenopause:50-100 mg two times per day to four times a day
3.     PMS (14 or 30 days)100 mg q/d to four times a day until relief
4.     Vaginal bleeding (stop Estrogen)100-200 mg two times a day until no bleeding

(typically, 5-10 days

5.     Endometrial Hyperplasia200 mg bid

Notes

    1. Progesterone excess
      1. Chasteberry
      2. Swedish pollen extract
    2. Combinations

Estrogen/Progesterone/Testosterone Combinations(21)

EstradiolEstriolProgesteroneTestosteroneApplication
Starter0.2mg2.0 mg100 mg1 mgVaginal
Breast Tender0.1 mg2.0 mg100 mg.1 mgVaginal
Breast Tender0.1 mg2.0 mg100 mg.NoVaginal
Fatigue0.2 mg2.0 mg50 mg.1 mgVaginal
Libido0.2 mg2.0 mg100 mg.2 mgTransdermal
Basic0.2 mg2.0 mg100 mg.NoTransdermal
CancerNone2.0 mg100 mg.1-2 mg.Vaginal

Growth Hormone Injectables

  1. HGH 0.8-1.2 IU/day SQ5-7 IU day/wk
  2. Sermorelin w or w/o GnRH 2 or 6 (2 causes nausea, 6 causes hunger)
  3. Peptide CJC 1295 with DAC 0.5-2.0 mg q. week (can cause hot flash for 5-15 minutes)
  4. Oral spray:
  1. HGH spray (homeopathic) (3 sprays under tongue @ bedtime-let absorb)
  2. Secretropin, Dynotropin-(3 sprays under tongue @ bedtime-let absorb

Thyroid

  1. Medications
    1. T4 only (synthetic): Synthroid, Levothroid, Levoxyl, Levothyroxine
    2. T3 only: Cytomel, Liothyronine
    3. T3/T4 combo (synthetic): Thyrolar, Euthroid, Liotrix
    4. T3/T4 combo (bioidentical): Armour, Nature-Throid, Westhroid, desiccated thyroid
  2. Diet
    1. Gluten free
    2. Allergen 4 Rs elimination
  3. Autoimmune protocol
    1. Gluten-free diet
    2. Plant sterolins: Moducare, Wobezyme N
    3. Low-dose Naltrexone

Cortisol

  1. Stress reduction techniques-reading, running, walking, Tai chi, yoga, etc.
  2. Adaptogenic herbs: Rhodiola, ginseng, ashwagandha, and cordyceps based supplements
  3. Adrenal glandulars
  4. Low-dose hydrocortisone-7.5 mg in am, 5 mg at noon, 2.5 mg between 4 pmand 6 pm

The Three Secondary Hormones

DHEA

  1. Men: 25-50 mg daily at bedtime
  2. Females: 10-25 mg at bedtime

Pregnenolone

  1. Maintenance: 30-60 mg
  2. Memory loss: 100-150 mg am and pm

 Prolactin

  1. Hyperprolactinemia (Pituitary Adenoma)
    1. Bromocriptine: 2.5 mg 2-3 x/d.
    2. Dostinex: 5 mg twice weekly
    3. Vitamin B 6-100 mg/d
    4. Chasteberry-lowers prolactin
    5. Ashwagandha-lowers prolactin
  2. Hypoprolactinemia (manifesting as treatment-resistant anxiety/depression)
    1. Acupuncture
    2. Metoclopramide-10 mg twice daily
    3. H2 Blockers
    4. Estrogen
    5. Pituitary evaluation
    6. Neurotransmitters-GABA, serotonin

MY MAGNIFICENT SEVEN

Omega-3’s (EPA/DHA)

Attribute: Cognition

Dose: 1000-4000 mg/d

 

Medium Chain Triglyceride (MCT) Oil

Attribute: Energy, neuroprotection

Dose:

Titrate:

Days 1-3: 5-7g (1 teaspoonful)

Days 3-7: Up to 10g (2 tsp.)

Day 8: 14 g dose of MCTs.  1 Tbsp of MCT Oil

Vitamin D3

Attribute: Neurotransmitter production, memory storage, synapse density

Dose:

Typical: 5000-10,000 IU @ bedtime or 50,000 IU Vitamin D2 once weekly

Calculated dose For every 1000 IU supplementation raises 25 hydroxy D increase serum value eight ng/dl in approximately three months. Exposure to the sun for 20 minutes without sunscreen is equivalent to 20,000 IU/d

Example: 25 OH Vit D = 30 ng/dl; goal 50-80 ng/dl

Supplement with Vitamin D3 4000 IU (4×8=32) +30=62 ng/dl expected

Probiotics/Prebiotics

Attribute: Cognition, learning, memory

Dose: Probiotics

25-100 billion units daily

Administer with prebiotics and fiber

Spore-based probiotics: ½ cap daily x 7 days, then one cap daily x 7 days, then 2 caps daily

Attribute: Insulin sensitivity, bone preservation, weight control

Dose: Prebiotics (22)

Dietary fiber: 25-38g

Prebiotic fiber: 5g-20g

Resistant starch: 20g

Glutathione

Attributes: Liver detoxification, tremors, weight control

Dose:

50-100 mg 1-2 times/day in a liposomal base or

IV push (diluted in 3 ml. NSS) over 5 minutes

Magnesium L-Threonine

Attribute: Sleep, focus

Dose:

Magnesium 144 mg

L-Threonine 2000 mg

Branch Chain Amino Acids (BCAAs)

Attribute: Enzyme and hormone production

Dose:

5-7 grams pre, during, or post-exertion

SUMMARY OF HORMONES AND BRAIN FUNCTION

HormoneFunctionsS/S Deficiency
TestosteroneMood, motivation, strengthFatigue, depression, suicide
EstrogenBlood Flow to BrainPTSD, pain, depression
ProgesteroneAnti-inflammatory, Calming Depression, anxiety, aggression
Growth hormoneMemory, concentration, mental clarityParanoia, poor concentration, dark moods
ThyroidEnergy, mental clarityPoor cognition, depression, psychosis
CortisolEnergy, coping with stressSugar cravings, morning fatigue, allergies
DHEARegenerates myelin, protects brain cells Aging, poor memory, infections
PregnenoloneMemory, cognitionAnger, anxiety, apathy
ProlactinThe sense of well-being, calmnessTreatment-resistant depression

SUMMARY OF MYMAGNIFICENT SEVEN

Seven Supplements Essential for Recovery from Traumatic Brain Injury

SupplementFunctionsDose
Omega 3 Fatty AcidsCognition1000-4000 mg./day
MCT OilEnergy, neuroprotectionDays 1-3: 5-7 gm (1 tsp)

Days 3-7: 10 gm (2 tsp)

Day 8 and up: 14 gm (1 Tbsp)

Vitamin D3Neurotransmitter production, memory storage5-10,000 IU @ bedtime or

50,000 IU/wk

See text for exact calculation

ProbioticsCognition, Learning, Memory25-100 billion/d
GlutathioneLiver detox, tremors, weight control50-100 mg in a liposomal base

IVpush 600-1200 mg in 3 cc NSS

Magnesium L-ThreonineSleep, focusMagnesium 144 mg

L-Threonine 2000 mg/d

Branch Chain Amino AcidsEnzyme and hormone production5-7 gmspre, during or post-exertion

RESOURCES

  1. Steinbeck J. Of Mice and Men. London, England: Penguin; 2006.
  2. Rates of TBI-related Emergency Department Visits, Hospitalizations, and Deaths — United States, 2001–2010 | Concussion | Traumatic Brain Injury | CDC Injury Center https://www.cdc.gov/traumaticbraininjury/data/rates.html.
  3. Rates of TBI-related Emergency Department Visits, Hospitalizations, and Deaths — United States, 2001–2010 | Concussion | Traumatic Brain Injury | CDC Injury Center https://www.cdc.gov/traumaticbraininjury/data/rates.html.
  4. Fork, M, Bartels C, Ebert, AD, et al.; Neuropsychological sequelae of diffuse traumatic brain injury; Brain Injury. 2005 Feb;19(2):101-8.
  5. About Traumatic Brainhttp://www.bcftbi.org/about-tbi/behavior.asp
  6. Hypothalamus Disorders: Causes, Symptoms, Treatment, Prognosis. com.https://www.epainassist.com/brain/hypothalamus-disorder
  7. Pituitary Injuries from Trauma. pituitaryinjuryfoundation.org https://www.pituitaryinjuryfoundation.org/about
  8. Craft S, et. al. Androgen Effects on Cognitive Function.Seattle, Washington, WA: William Brenner Geriatric Research, Education and Clinical Center, VA Puget Sound Health Care System; 2007
  9. Reddy DS. Testosterone modulation of seizure susceptibility is mediated by neurosteroids 3 alpha androstanediol and 17 beta-estradiol. Neuroscience. 2004.
  10. Nauert R. Estrogen levels influence susceptibility to PTSD. Psych Central.August 8, 2018. https://psychcentral.com/news/2017/01/20/estrogen-levels-influence-susceptibility-to-ptsd/115390.html
  11. Leon-Carrion J, Leal-Cerro A, Cabezas FM, et al. Cognitive deterioration due to GH deficiency in patients with traumatic brain injury: A preliminary report. Brain Injury. Jul21, 2007;(8):871-5.
  12. Aimaretti, G,Ambrosio MR, Benvenga S, et al., Hypopituitarism and growth hormone deficiency after TBI. Growth Hormone IGF Res. 2004 June 14; Suppl A:S114-7.
  13. Agha A, Phillips J, Thompson CJ. Hypopituitarism following traumatic brain injury (TBI) Br. J. Neurosurg. 2007;21:210–216.
  14. Kelly DF, McArthur DL, Levin H, et al. Neurobehavioral and quality of life changes associated with growth hormone insufficiency after complicated mild, moderate, or severe traumatic brain injury. J Neurotrauma. 2006 Jun;23(6):928-42.
  15. Santos, NC, Coseta, C, Ruano, D, et al.Revisiting thyroid hormones in schizophrenia. Journal of Thyroid Research.2012:Article ID 569147.
  16. Yamada H, Yoshino M, Matsumoto T, et al. Effects of phytosterols on anti-complementary activity. Chem Pharm Bull 1987; 35:4851-4855.
  17. Nestler JE, Barlascini CO, Clore JN, Blackard WG. Dehydroepiandrosterone reduces serum low-density lipoprotein levels and body fat but does not alter insulin sensitivity in normal men. J Clin Endocrinol Metab. 1988;66(1):57-61
  18. Jankowski CM, Gozansky WS, Kittelson JM, et al. Increases in bone mineral density in response to oral dehydroepiandrosterone replacement in older adults appear to be mediated by serum estrogens. J Clin Endocrinol Metab. 2008 Dec;93(12):4767-7.
  19. Schumacher M. Neurosteroids in the hippocampus: Neuronal Plasticity and Memory Stress. 1997 Oct;2(1):65-78.
  20. Guth L, Zhang, Z, Roberts, E. Key Role for pregnenolone in combination therapy that promotes recovery after spinal cord injury; Proc Natl Acad Sci. 1994 Dec 6;91(25):12308-12.
  21. Gordon, M.Traumatic Brain Injury., San Diego, CA: Millennium Health Centers; 016.
  22. Hertogue, T, et al. A4M Lecture Series, BHRT Symposium Notebook, Los Angeles, C. February 25-28, 2015;page 6-7.

 

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