About Me

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Scottsdale, Arizona, United States
Angela M. DeRosa DO, MBA, CPE graduated from the Chicago College of Osteopathic Medicine in 1995. She went on to do an Internal Medicine Residency with a fast track emphasis in Women’s Health at Lutheran General Hospital. After her residency, she became the Director of Women’s Health Services and Education at Lutheran General Hospital. After two years of practice she started a full time career as the West Coast Senior Medical Director with Procter and Gamble Pharmaceuticals. There she worked on women's health product development, research and marketing. Seven years after starting this position, Dr. DeRosa decided to pursue other clinical endeavors. Dr. DeRosa is a nationally recognized internist and women’s health expert. Her clinical focus is on revitalizing the physician-patient relationship; striving to provide the highest quality of care to her patients in a warm compassionate environment.

Sunday, October 24, 2010

Sensational Media At It Again....Truth or Fiction?

Just because a family has one creepy drunk uncle, doesn’t mean the whole family is awful.

So goes it with Estrogens. The media is at it again…..scaring women about hormones and doing it in a fashion that I would consider negligent. Just this last week, there is yet again, another article in the New York Times about the negative effects of hormones and even Nancy Snyderman, MD from the Today show jumped on the bandwagon. While it appears from the headlines that “new” studies are being released, many people do not realize that these “new” publications are actually more data from the same Women’s Health Initiative study of women using Prempro (combination therapy with the synthetic hormones conjugated equine estrogen and medroxyprogesterone acetate, MPA, progestin) that was first reported in 2002. They are trying to make it sound like it is “hot off the presses”.

Since the Prempro part of the study was stopped, researchers are publishing only the data analysis from this group, not data from the women taking estrogen (Premarin) alone. Consumers do not realize is that it is common in academic medicine for the same study population data to be “mined” (or analyzed) for multiple publications on different topics. Rather than put all of the data analyses into one publication, a series of publications based on the same study group may be published over several years as the researchers consider different variables.

For women and physicians, it is confusing, because it seems another concern hits the news every other week. Unfortunately, the media headlines make it sound like this is yet another, different, study adding more fuel to the fire. In fact, it is simply more data from the same study, and the same combination of horse-derived estrogen and synthetic progestin (Prempro) being given to elderly women.

Most women’s health and hormonal experts would agree that Premarin and Prempro are poor choices for hormonal therapy. The estrogen is a synthetic estrogen made from horse’s urine (not the bio-identical estrogen made by a women’s ovary) and it is an oral delivery of estrogen which can increase a women’s risk for cardiovascular effects. Oral hormones have to process through the liver; called first pass liver metabolism. This type of processing allows for blood clotting factors to be released with can increase a person’s risk for blood clots, heart attack and stroke.

In addition, many physicians and researchers think that many of the adverse outcomes found in the PremPro arm of the study are more likely due to the particular progestin being used (Provera or medroxyprogesterone acetate), since earlier studies have shown that this progestin negates the beneficial effects of estrogen.

It is very important to ensure that women who have had a hysterectomy avoid taking progestin or progesterone unless there is a clear medical reason to do so. If a woman requires Progesterone they should only take one which is bio-identical such as Prometrium or compounded Progesterone like the one our body’s ovaries make.

These characteristics make Premarin and Prempro dangerous medications, but to say that all hormones are bad is just not true and is not based on scientific data.

Premarin and Prempro used in the WHI are not the same hormones made by our body, and the WHI study is not looking at the difference in the types and routes of delivery for the many other forms of hormone replacement therapy available. This study should not blanket over all estrogens. Non oral, bio-identical hormones have decades of data to support the positive effects especially when delivered via a subcutaneous method such as with bio-identical pellets. (I will be loading the site with many reference articles to support this claim)

Recent News also covers up the fact that the risk increases reported from the WHI were seen only with the Prempro group (combined daily progestin and estrogen). The Premarin (conjugated equine estrogen alone) group of women did not have these risks, and the women in that group who had had a hysterectomy and could take estrogen alone, ARE continuing the study. And early data suggests that the Premarin treatment group are deriving multiple benefits from a cardiovascular standpoint, decrease in breast cancer and osteoporosis etc. Even with the worst possible estrogen preparation on the market for women is showing benefit for women.. The media just doesn’t talk about this, because it “does not bleed so it can’t lead”.

To make matters worse, most physicians are as confused by this data as their patients. This is because they do not have the time to sort through all the data, and they often say “there is no data to support other forms of hormonal delivery”. If your health care provide say’s this……he or she is wrong. There is a big difference between “no data” and not having read the data. Lastly, there is a great fear of lawsuit in this country and many providers do not want to put themselves at risk and it is easier to not prescribe proper hormones than spend the time and energy to educate themselves and their patients on the “true data, risks and benefits and possible short and long term effects”. Lastly, time has become short in physician practices and they do not have the luxury to take the much needed time to have these discussions.

So before, “you throw the baby out with the bath water”……..educate yourself on the real data, talk to experts like myself and others who have dedicated their careers to understanding the data and effects on health, and question everything the media says about health and hormones in particular. You won’t be sorry.

Sunday, October 3, 2010

My doctor tells me my labs are normal........

So doctors don't always "get it".  Now that is not to say, they don't know what they are doing, but most physicians are not taught anything but the basics about women's health and especially the roles of hormones.  And most certainly nothing about the role of ttestosterone in women.  The United States, in particular, is light years behind when it comes to this. 

The advent of the Internet and more "baby boomers" getting to menopause is creating a higher demand for understanding and desire to feel better.  This is forcing more and more physicians to take notice.  With that said, there are only a handful of doctors who truly "get it" when it comes to hormones and know how to properly treat hormonal imbalances.

So what are the problems in getting diagnoses properly......

1) Doctors don't know all the signs and symptoms of testosterone deficiency.  The big ones are: mood swings, irritability, lack of patience, anxiety, depression, fatigue, loss of stamina, impaired memory and concentration, loss of libido, sleep disturbances, muscle weakness, inability to loss weight despite diet and exercise, increasing blood pressure, worsening cholesterol, impaired sugar metabolism and plain ole apathy.  You may ask yourself, "why do I hate my life or feel nothing, when I have everything I want".     Most doctors try to put you on an antidepressant, because this is easier than actually trying to figure out that you have a hormonal imbalance.

2) The  lab reference ranges are only reflecting true endogenous hormone production of testosterone....meaning what the ovaries and adrenals make every day.  This causes a perplexity to treatment and the ability to truly know what is "normal" for a particular women/patient.  Most lab reference ranges suggest that levels between 6-82 ng/.dl are normal.  However the labs are often inaccurate, not properly calibrated from women, do not capture the day to day variations in hormones and in peri-menopausal and menopausal women do not reflect the proper levels for treatment dosing.  There is no data to support that proper dosing for exogenous (or the testosterone we give you to take) should be based on establish ranges from endogenous production.  In fact, often good proper treatment levels can be 2-3time the "normal reference" range.  You MUST base treatment on the unique needs of each women to find the optimum dose to provide good effect without adverse side effects.  This take time and listening to each patient.

3) The media has scared the heck out of women when it comes to hormones.  There is so much misinformation out there and it takes time and scientific knowledge about studies to understand and sift through all the information.  This is not easy and a challenge even for the best of us.

More later......and I promise we will get to estrogen as well.  Just starting with this topic for now. We will address the perimenopause and what this transition means.. Sounds like fun huh!

Saturday, September 18, 2010

GOT TESTOSTERONE? : The role of testosterone in women and men.

So today will be a bit more technical.....providing you with some basic information on the effects of hormones particularly testosterone.  I hope you will find this information helpful and aid you in better understanding some of your own symptoms and feelings.  So here goes........
Hormone deficiencies currently affect over 55 million women and men in the United States; with the average American age on the rise, more research is being done on the effects of aging, hormone decline, and hormone therapy (HT). Commonly referred to as Menopause and Andropause (the “Male Menopause”), the decline in hormone production that results in a hormone deficiency often brings with it life altering changes. 
When we think of menopausal women, patients and physicians usually only think of Estrogen levels; and even then estrogen levels are inappropriately interpreted and treated.     However, a very important part of hormonal evaluation is measuring Testosterone levels and if low treating this deficiency.  Testosterone levels start to decline as early as the late 20’s in women and it takes a gradual course throughout a women’s life.  Usually women start to experience symptoms related to this deficiency in their late 30’s.  This can present much earlier if a women is on oral birth control pills or anti-depressants.  These along with other medications and disorders can cause free testosterone levels to become suppressed.
Testosterone gives women their mental clarity and mood stabilization, libido and sexual function, muscle tone and mass and ability to metabolize sugars into energy; giving them the ability to maintain a healthy weight.  A testosterone deficient woman will usually have symptoms of extreme fatigue, inability to lose weight despite working out and dieting, irritability and lack of sex drive even when in a healthy loving relationship.
Andropause, the male version of menopause, is also caused by testosterone deficiency. Surprisingly, every man begins a gradual decline in hormone production around the age of 30. Men can present earlier if they have medical disorder or medications which lower testosterone levels; such as opiate therapy for chronic pain, steroid use/abuse, antidepressant use and premature gonad failure.
When men have lowered testosterone levels they find themselves putting on weight, losing muscle mass, feeling sluggish, depressed, irritable, and having sexual dysfunctions which range from decreased orgasmic strength to overt impotence. 
The effect of hormone deficiency on the brain, muscle, bone, heart and metabolism can be significant without hormone therapy for women and men and dangerous to long term health. The brain needs a normal amount of testosterone in proper balance to produce serotonin which supports emotional balance.   When lacking in these hormones, men and women will experience emotional instability that often results in increased anxiety, irritability, sleep disturbances, anger, sadness and depression.  To make matters worse, physicians often diagnosis these patients with depression and put them on SSRI’s which only decrease the Testosterone levels further; exacerbating the problem.
The musculoskeletal system is also adversely affected by the loss of testosterone.  Testosterone deficiency can lead to muscle atrophy, osteopenia, osteoporosis, and high levels of pain in the muscles and joints.  Patients are often diagnosed with fibromyalgia when they really have a testosterone deficiency.
Glucose disorders and diabetes become more prevalent in patients with testosterone deficiency as testosterone must occupy its receptors on the muscle bed to properly intake sugar from the blood stream.  After a meal in a testosterone deficient patient, the glucose load will be inadequately processed into energy in the muscle and stay in the blood stream; this results in high glucose levels, insulin resistance, weight gain and ultimately pre-diabetes and diabetes.   This put patients at a much higher risk of developing metabolic syndromes and having adverse cardiac events.
Advances in understanding the function of hormones and the role of hormone replacement has made it possible to manage many of the negative side-effects associated with age-related hormone decline. One therapy that has gained popularity in recent years is biologically identical testosterone replacement therapy (TRT) for men and women.

TRT in men and women has been shown to enhance libido, decrease heart disease risk, increase lean body mass, and pre¬vent osteoporosis. Maintaining testosterone levels may also lower total cholesterol and LDL, and decrease insulin resistance. Additional research has shown a beneficial impact on cellular energy production, brain function, and oxygenation.

Testosterone therapy for men and women is based on personal hormone test results to determine the testosterone dosage that fits the needs of the person. No two people are alike, and hormone needs differ from person to person.

Biologically identical testosterone therapies include injections, topical creams and gels, sublingual tablets (dissolved under the tongue), and pellets. Injections are usually administered every two weeks. Topical gels are applied once per day and sublingual tablets are taken twice per day. Pellets are inserted by physicians subcutaneously and release a steady amount of testosterone over three to six months.  (Not all formulations are available to women).  

As with any prescription medication, the pros and cons of hormone therapy must be discussed with a knowledgeable healthcare provider who specializes in hormonal management.

So more again later......

Monday, September 13, 2010

Where to start?

I have been pondering all day as to were I should start.  There are so many topics to ponder.  So, I figured I would start with one of the most common reasons patients come to see me......

They state, " I have the perfect life....a great partner, a great job, wonderful kids and everything I could ever ask for....so why am I so unhappy?"

Well, let's just assume for a second that this is actually true....although I think we all live in a bit of the fantasy of perfection created in our minds so that we can compete with the jones.  Believe me....NOBODY has the perfect life and if they tell you this, they are lying.

So with that said....there are reasons to feel this way.  Many of us live with the Harried Women Syndrome...where we all try to be the perfect wife, perfect spouse, perfect employer, but all of this is next to impossible to maintain.  We all try to "have it all"....but maybe we just shouldn't have it all, all at the same time....and try to do it all perfect.  We need to pace ourselves.

But, from a BIOLOGIC standpoint.....we have an even better reason to feel this nagging feeling inside.

It is our decline in Testosterone that make us feel anxious, depressed, moody, and irritable.  Testosterone is mother natures serotonin.  It fires the receptors that give our brain the calming ability to handle daily life.  It also gives us the ability to experience joy, tolerate "stupid people" (well most of the time) and let simple troubles roll off our shoulders. 

As we lose our Testosterone......Yes WOMEN MAKE TESTOSTERONE AND LOTS OF IT.....we start to feel depressed, moody and anxious.  Can anyone say....anti-depressants?  That is why many women in their late 30's and 40's get put on these meds by physicians.

Why do doctors do this.....well they don't realize that Testosterone is driving this.  They are never taught about this in medical school or residency.  So, we need to teach them.

We will talk more about Testosterone and Ovarian decline tomorrow.........

Sunday, September 12, 2010

My Personal Story

Every day I see it time and time again.  Patients come to me and they say," I have seen many other physicians and they all told me I was too young to have hormonal issues".  They have been dismissed, told nothing is wrong or worse; made to feel crazy.  Women have largely been failed by the medical community.  It is this reason, I take this mission on every day.....that and I too have been there done that.

You see, when I was in my late 20's, I started having symptoms of ovarian failure (perimenopause) and nobody could help me understand what I was feeling.  I was already in the early years of my medical career, having just graduated from medical school and newly married.  I had everything I had ever dreamed of, but I was not happy, did not feel good and asked "is this all there is" every day.

I was alternating between anger and depression, mentally and physically drained (although residency can do that to you) and started having vague physical symptoms, like not sleeping well, feeling hot all the time, putting on weight, migraine headaches and overall fatigue.  Little did I know that it would take 15 years to fully understand what I was going through....but in the mean time I was told I was crazy, depressed and even put on anti-depressants.  Although many of my friends and my husband would argue that I still might be a bit crazy  (haha) that I was really experiencing the start of ovarian failure and having symptoms of perimenopause.  I went through menopause very early and I am now on hormonal replacment.  Mind you I am only 43 and went through menopause at 38. 

I was not too young.......and everyone is going to have ovarian failure.  This is biology.  However, this is a process that takes many years and does not just happen to us at the age of 52. (average age of menopause in the U.S. is 52).  What this means that depending on our genetics, our environmental exposure, medications, medical conditions and surgeries etc.....we are all going to start having symptoms in our 20, 30's or 40's. 

Although this is mother nature at her finest....it does not mean we have to suffer through it and get old before our time.  We have the medical knowledge to help women......we just need to get physicans and the medical community to get up to speed and it is up to us (women) to help them along.

This is why I do what I do.....and why I have started the blog today. 

I hope others will share there personal stories as well.

I plan to educate, provide the real data to help you better understand hormones and how they relate to our overall health. More importantly,I want to help you better understand the data around hormonal replacment so that you can make wise educationed decisions regarding your health care.....and not let the media, myths and misinformed medical professionals hinder your wellness.  It is too important.