About Me

My photo
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.

Monday, December 5, 2011

The Holiday Blues: Not on the top 40 list of songs.

With the arrival of the Holiday season the majority of us experience Christmas music, festive lights, delicious food, anxiety and depression. Wait, anxiety and depression? Unfortunately yes. During this time of year there is an elevated incidence of anxiety and depression. The causes may vary from changes in weather, stress from family to lack of adequate sunlight. It is an overwhelmingly emotional time of the year for many people.

How do you know if you are one of these people? Common symptoms include but are not limited to a feeling of unease, worry, lack of energy, or having a feeling of hopelessness or inadequacy. Under increased stress our bodies adapt to the stress by increasing or decreasing the release of certain hormones which can cause these symptoms.

As you may have guessed the fluctuation of hormones play a role with this conundrum. Common physiological factors that contribute to symptoms of anxiety and depression often include excess or minimum levels of cortisol. Cortisol is a tricky hormone. Unless it is perfectly balanced it can be the origin for many systemic inadequacies. When stress levels are high, cortisol is released at an increased rate. Having uncommonly high cortisol is often the cause of the weight gain and fatigue. When cortisol levels are too low you may experience the feeling of hopelessness and fatigue.   Commonly correlated symptoms of low estrogen and depression include fatigue, unexplained weight gain or brain fogginess. Put this together with testosterone deficiencies you are just about doomed to feel at least irrigated, anxious or have mood swings.  As I tell all my patients, the very least you will have the "stupid people syndrome".  When people act stupid you can't cope with it anymore.....you want to bite their heads off or a the very least slap them.

Hormone deficiencies can make all this worse.  Any underlying mood disorder gets exacerbated.

Also, Seasonal Affective Disorder which correlates lack of sunlight and shorter days with depression. Since getting away to Mexico for increased sunshine is not an option for everyone, try alternatives like bundling up to enjoy a nice walk on a sunny day or find activities that increase sunlight exposure during those vital hours during the day.

However, even the most mentally adjusted, with good hormone balance and dare I say a happy family, can have mood disorders during the holidays. Remembrance of past times, high expectations of what the holidays can bring and being disappointed and shear madness of having to do everything perfect can really increase stress. 

Remember to take time for yourself, recognize when you need some extra TLC and find comfort in that you are not alone.  Holidays are crazy for most folks and you do not need to pretend that they are perfect.....they are a time to take thanks in the things that bring you joy and love.....and recognize that our health is very important.  Give yourself the gift of TLC and a good medical evaluation.  Make sure your hormones are balanced and this will help with the coping of the holiday crazies.

Sunday, November 6, 2011

HOLIDAYS: A time for joy and diabetes.

Wouldn’t you love to sit back this holiday season and enjoy treats, wine and endless mashed potatoes with gravy? Unfortunately the holiday season only rolls around once a year and we decide this is our time to indulge without consequences. Well, maybe we should re-think this attitude... or at least think about moderation of attitude.

Millions of people struggle with a condition known as diabetes mellitus. More than 5 million people have pre-diabetes mellitus (Pre- DM or insulin resistance) in this country and don’t even know it.

As a healthcare provider I am frequently screening my patients in order to catch this disease before it has developed or stop it from occurring all together. This is not a disease that discriminates; both men and women alike are targets.

Most patients and also many providers are not aware of the keen role hormones play in preventing insulin resistance which starts the ball rolling toward full blown diabetes. Testosterone is a key hormone in both men and women that helps our body process and move sugars so that they can burn off easily. If we are deficient in testosterone (yes, both men and women have this hormone) the sugar can’t move into the muscles so the pancreas has to deal with the sugar with insulin. This causes the sugar to store as fat, makes the liver make sugars and we gain weight particularly in the mid section. The subsequent ups and downs of sugars and insulin wrecks havoc in our bodies and it gets harder and harder to maintain our weight let alone lose it.

Hormone deficiencies by themselves are usually not enough to cause diabetes. However, if coupled with decrease in activity, improper eating habits or other metabolic issues such as low thyroid, our bodies don’t stand a chance. Insulin resistance will occur and diabetes will follow if we are not careful.

So how can you enjoy your holiday season and still feel good about your body and your body feel good about you. How about some of the following ideas:

 Get some physical activity – Get a hot trainer or participate in an active sport or exercise with your spouse/partner. How about just going for a walk. Find a way to get active and stay active. This will also improve your High Density Lipoproteins (HDL’s), the good cholesterol, which when low are another risk factor for Pre-DM.

 Use a low glycemic index protein powder to help you control sugar cravings and swings through out the day.  Gluten Free, Brown Rice Glycemic Foundation is my personal favorite. http://www.orthomolecularproducts.com/ProductDetails.aspx?id=20421241-c7d1-49ee-b5e4-e5e9de00f272

 If you are going to drink during the festivities, try lower calorie drinks without all the sugary mixers or even better stick to wine. Red wine in particular contains reseveratrol which has anti-oxidant heart healthy effects. And size does matter. Typical serving size is 6-8 oz. Most drinks today contain twice that. Limit the numbers of glasses you drink as well. A typical glass of wine contains 150 calories and these can add up quickly.

 Eat smaller meals throughout the day and if going to a holiday meal, try eating some raw vegetables or a protein bar prior to leaving. You don’t want to be starving when you arrive. You will only eat and drink more………packing on more calories.

 Get your hormones and thyroid levels checked by a provider who knows how to properly interpret the results. Lab references ranges are often misinterpreted by providers who are not properly trained in hormonal health. Symptoms of hormonal deficiency as well as clinical indications on exam are equally important in making a diagnosis. Make sure your provider is listening to you and taking the time to look at all three: symptoms, physical exam and labs.

I don’t want to be a total killjoy; everyone should indulge occasionally and certainly enjoy the holiday season and all of the goodies it has to offer. But let’s do our part to avoid this terrible and ever growing disease from affecting us! Small things can make a difference.

Happy Holidays

Saturday, October 15, 2011

October: Breast Cancer Awareness Month

Given the fact that October was breast cancer awareness month, I found the irony troubling of having to tell a patient that she has invasive breast cancer. It is never easy to tell a patient this news, but it always makes me take pause on the science behind these diagnoses. 

This women had lived a very healthy life, never drank, never smoked, did not have a bad family history for breast cancer or any other major illnesses. She always was going through menopause and was looking for me to help her feel better and was considering hormone replacement.  You see, her estrogen  levels were very very low and she was starting to have the menopausal symptoms we have come to recognize easily.

Even though she had not yet started hormones, one of her first questions when I gave her the diagnosis was about hormones and can they cause breast cancer.

I answer this question on a daily basis with patients and it is the one that has the most amount of misinformation surrounding it.

Let me give you the unadulterated facts (without pharmaceutical bias or politics).

1) The studies have shown that estradiol alone does not cause breast cancer.

2) Our bodies have the highest levels of estrogen in them when our breast cancer risk is almost zero.  It is not until we hit menopause (when our levels are at their lowest) that the risk goes up.

3) The study that showed a small increase in breast cancer was majorly flawed. Also, the the women in the arm of the study that showed this small increase in breast cancer were also on Medroxyprogesterone Acetate ( a very bad progesterone loaded with negative side effects for the body). It is this hormones which can cause breast cancer; not bio-identical progesterone or estrogens.

4) Testosterone ( a major hormone for health and well being) will LOWER breast cancer risk.

5) NOT ALL HORMONES ARE CREATED EQUAL! Our bodies were designed to be perfect. Estrogen was placed in our bodies for a major reason.  It is when molecules which are not exactly the same as our original hormones are introduced issues may arise.

This patient had done everything right in her life and still developed breast cancer.  Sometimes it is just sheer bad luck.  The good news is that it was caught early. This will give her a great chance of a cure. It is through proper medical care and surveillance that allowed this to happen.

We can do everything right and sometimes things just go wrong. Mother nature has an evil twin.........and she is a real bitch.

Saturday, September 3, 2011


Hormonal contraceptive methods are designed to regulate your cycle and prevent ovulation. Oral birth control pills if not chosen wisely or without regard to their affect on other hormones or proteins in the body can cause weight gain and other side effects. There are different forms of hormones available for perimemopausal and menopausal women that actually HELP women lose weight, improve mood and feel like themselves again.
Often the problem with oral hormonal contraceptives is that it can lower the amount of free testosterone in the body. It does this by releasing a protein that bind free testosterone when the oral hormone is metabolized in the liver ( first pass liver effect.).
Testosterone is responsible for enhancing libido, restoring energy, strengthening bone, and relieving depression. It also helps with mental clarity and utilization of glucose.
Oral contraceptives also contain progesterone. Progesterone is the hormone that primarily in premenopausal women prepares the body for pregnancy which makes women have food cravings, hold water weight and feel sleepy. This protective mechanism is ideal for keeping mom and baby safe, but isn’t ideal for women who are not intending to become pregnant. Too high of a progesterone ratio in some pills exacerbate this even further.
For menopausal women, low doses of progesterone may be necessary, but not at the levels found in oral birth control pills that cause undesirable side effects.

Saturday, January 15, 2011

Tuscon Tragedy: How medicine failed us.

As an Arizona healthcare professional, I have watched the Tucson tragedy unfold in absolute horror and disgust; knowing in my heart that the medical profession and government have largely failed in this situation. The terrible loss and injury of our fellow citizens saddens me beyond words. May our prayers comfort those in need at this time.

As the politically motivated continue to look to blame one another, I find their blame misplaced and only aimed at political gain. There is a much larger issue and one closer to the actual cause.

If we look at the underlying pathology that affected the perpetrator of this senseless event, it is evident that he had a significant mental disorder which became fueled by substance abuse. In addition, there were many opportunities by multiple folks and institutions to intervene. This didn’t need to happen……..

I have clinically witnessed numerous times, young males who engaged in substance abuse (especially depressants and hallucinogens such as marijuana and Salvia Divinorum) who lose their “natural” serotonin which can cause mood disorders or worsen one that is already present. These substances lower testosterone and ultimately cause gonadal failure resulting in lowered libido, infertility, weight gain, cardiovascular events and muscle atrophy. The less known affects of testosterone include mood stability and coping mechanism which are all augmented by serotonin receptors which require testosterone to properly fire. Both males and females, through normal aging, lose testosterone which causes a decrease in mood and coping. If one abuses marijuana or other illegal substances, the body slows it natural production of testosterone even further. And it the abuse is in a younger person, the mind never develops properly and these deficiencies can be further exaggerated.

No matter what side a person sits on the marijuana debate, I believe, we can all agree that these types of substances, are unhealthy for the developing mind.

Simple medical blood tests or intervention could have prevented such a decline. Unfortunately, there are so many stigmas associated with mental decline or suffering and a lack of funding to help support people with such difficulties. The avenues made affordable are when the crisis has reached an extreme, requiring involuntary lockdown, or tragic conclusions such as this.

Mood disorders are often exempt from insurance policies or the actual cause of denial of insurance in the first place. People are afraid to admit they need help or when they do find the resources, they are minimal or they are treated with disrespect at the best or as “crazy”.

So few clinicians are willing to look deeper or take the time to listen to patient. This takes time and effort. Also, most providers do not understand the role of hormones such as testosterone and other underlying treatable conditions exacerbating the mood disorders. To make matters worse, their attempts to “fix” the problem through anti-depressants may only make matters worse. Selective Serotonins Re-uptake Inhibitors (SSRI’s) are known to cause sexual dysfunction but most clinicians and patients are unaware of the underlying mechanism. This side effect comes from an increase in Serum Hormone Binding Globulin (SHBG) which causes a lowering in free testosterone. This decrease’s a patient libido and sexual function. But, as I stated above, there is more to testosterone than libido. It also causes a decline in serotonin which makes mood and coping worse.

These drugs may temporarily make the patient feel better, but over time, the decline in testosterone results in worsening of mood and an exacerbation of the underlying mental condition. It becomes a vicious cycle which often results in the providers increase the doses or adding other medication further making matters worse. If they were aware of this effect, they could work to avoid this and help their patients.

In this case, this young man had an underlying mental condition which presented with paranoia, depression, anger and psychotic breaks. Then he likely tried to self medicate these delusions with mind altering substances.

On many occasions, the people he encounter during his primary and secondary education, failed to make a proper assessment and only passed him onto others hoping that “it would just go away”. He was not only showing mood instability but also evoked fear in others. This should have been report to agencies or at the very least prompted a psychological evaluation. The college he attended wanted him to have an evaluation in order to be accepted back but what about other institutions unaware of this or the unsuspecting public. We have mechanisms in place to attempt to stop people from drinking and driving. You would think that threatening violence such as this in a public forum would require some consequences. We can find away to balance civil liberties while protecting the public from “high risk” individuals who appear to be crying out for help.

These miss-steps led to a deadly cocktail of delusions, with no place to seek help, lack of authority to intervene and opportunity. This ultimately caused this tragic event. I only can hope we can learn from this. “The immediate future is going to be tragic for all of us unless we find a way of making the vast educational resources of this country serve the true purpose of education, truth and justice. “
(Anne Sullivan Macy)

Saturday, January 8, 2011

"Why Can't I Lose Weight"

Everyday I hear this from my patients.......both men and women. They work out, they eat right and all their efforts seem to be in vain. This becomes very frustrating and depressing.

So what is going on? Why do our best efforts go unrewarded?

This gets back to hormonal balance; particularly Testosterone and Thyroid.

In order to understand how this work, you need to understand how calories are burned. When you eat a meal, all food converts to glucose (sugars). In order to eliminate and use this glucose cleanly and effectively it needs to enter the muscles, provide energy and then burn off. 

Testosterone is required for glucose to enter the muscles. If you have inadequate testosterone levels (see blog entry below about testosterone in men and women), you can not move glucose into muscles. This then puts the pressure on the pancreas to handle it.  The pancreas uses insulin to deal with glucose. This causes wide swings in sugars causing sugar cravings and weight gain.   The liver then gets involved and  converts glucose to fat.   All this can leads to pre-diabetes (insulin resistance), diabetes and other cardiovascular complications.

Testosterone is the KEY!!!!!!! 

This is why men tend to lose weight faster and easier than women.  They have more testosterone and more muscle mass.  Women you are not imaging this; we are biologically set up to keep weight on compared to men.

To make matters worse, testosterone is thyroids best friend. They hang out together and get in trouble together. Thyroid drives mother nature's metabolic engine of the body. Imagine when your thyroid is perfectly balanced your body is humming along like a Lexus hybrid coupe; running and burning fuel efficiently. If your thyroid gets going too much (Hyperthyroidism) it is like putting your body in  Formula One Race car mode; burning off fuel fast.  If your thyroid gets sluggish or starts to fail (Hypothyroidism), you become like a Pruis: burning fuel very slowly. If your testosterone is low, your thyroid will not function properly. This affects your metabolism and your ability to lose weight.

In clinical practice, we check your thyroid function through blood tests. Often times, the thyroid levels appear to be normal when it is not.  If your testosterone level is low, your thyroid blood values will not be accurately portrayed. You need proper testosterone levels before you can truly know the thyroid function. Unfortunately, most physicians, are not aware of this relationship and misinterpret the values.  This leads to them telling patients "your thyroid is normal" and in fact it may not be.  You need to listen to the patients' symptoms and watch the thyroid levels as the testosterone levels are replaced. Many times, we "unmask" a low thyroid state once the testosterone levels are normal. The patient was suffering from low thyroid for years and physicians didn't catch it; because they saw "normal" thyroid levels.

As you can see, you need to have proper testosterone and thyroid levels to lose weight and keep it off. If you haven't had your levels properly interpreted, you need to have your levels checked and PROPERLY evaluated.

Start 2011 with this gift to yourself...........your body will thank you for it!

Monday, January 3, 2011

Sexual Response Cycle in Women and Men

So let's talk about sex.......

There is so much myth and mystery surrounding sex and intimacy that the real truth gets buried.  This often leaves men and women feeling inadequate or abnormal. 

Every time I see a movie which shows a women having an orgasm within 10 seconds of stimulation I want to scream. (and not in that good way :0)  Really......most women are NOT wired this way. Men get the idea that they are doing something wrong and women feel pressured to feel something they are not in order to "feel normal".

So let's start with some basics:

1) Sexual expression if a normal and healthy part of human behavior.
2) Health Care Providers are not effective in speaking with their patients about sexuality.
3) Men and Women have different sexual response cycles.
4) Arousal and Desire are NOT the same thing.

Now that we have the bullet points, let me explain some biologic basics.

Men usually progress through progressive and sequential phases of sexual response. (as described by Masters and Johnson's, Human Sexual Response).  This means that first they feel desire, which stimulates excitement (arousal) which results in plateau of good feelings and then ultimately orgasm and resolution.  Seems pretty simple. 

Women, on the other hand, are much more complex (DUH).

Women exhibit a circular response which can either start with desire, sexual neutrality or arousal.  Early in a relationship it is more likely that a women will experience the desire for sex and may often initiate sex.  However, as the women proceeds into a long term relationship,  she moves into sexual neutrality: where a women is receptive to being sexual but does not initiate activity.  The desire for intimacy prompts her to seek ways to become sexually aroused via other stimuli, such as music, candles, erotic materials etc.
Once she is aroused, then the desire kicks in, leading to intimacy and/or orgasm.  This assumes that the goal for sexual activity is not necessarily orgasm but rather personal satisfaction which can either be physical and/or emotional connection.  WOW.....

So the bottom line is men start with desire which proceeds to arousal and women need arousal to proceed to desire.  What a Heterosexual Dilemma.

So men....those massages and flowers do work. Women need to feel sexy before they become sexy.

More info about this topic can be accessed via www.arhp.org

On the next post, I will review the so called norms in sexual excitement and orgasm.