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.

Saturday, December 15, 2012

Heart Attacks During the Holidays

Did you know cardiac deaths are highest on December 25th, second highest on December 26th and 3rd on January 1st. Does that make your heart race a little? It should. Please slow down, take some time for yourself and know the risks and symptoms.

Risk factors include the obvious including smoking, high blood pressure, high lipids, diabetes, lack of exercise and increased age. Not so obvious factors: cold weather, emotional stress and over-indulgence. Plus at the holidays, people drink more, eat more, exercise less.
A big problem during the holidays is that people delay getting treatment in order to not disrupt the holidays and women are particularly guilty of this.
Women also may not present the same as men. The symptoms may not be so obvious. Men tend to get the "elephant on the chest, jaw pain, radiation down the arm. Then drop to the floor, clutching their chest.  Women may not be so obvious. Although the most common in both is chest pain or pressure.
Women can also experience any of the following:.
a.      Pain or discomfort in one or both arms, the back, neck, jaw or stomach.
b.      Shortness of breath with or without chest discomfort.
c.      Other signs such as breaking out in a cold sweat, nausea or light-headedness.
d.      Flu-like symptoms
e.      Uncharacteristic fatigue
f.      As with men, women's most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting and back or jaw pain.

 What you can do:
a.      Pile on the layers. Try to avoid exposure to very cold temperatures. Dress warmly.
b.      Take a load off. Steer clear of heart stressors, including too much physical exertion (especially snow shoveling), anger, and emotional stress.
c.      Make good choices. Avoid excess salt and alcohol.
d.      Get help. If you feel chest pain or other symptoms, call 911 for emergency help.

The stakes are high. So give yourself and your family a gift this season. Don't postpone a doctor appointment or treatment because you don't want to spoil the holiday merrymaking.

Saturday, November 24, 2012

Birth Control Pills Over the Counter? NO WAY!


OB-GYNs are saying birth control pills should be over the counter. I disagree strongly and hope you and anyone you know who is on the pill or considering it will read this and share with others. 

The  ACOG is making this suggestion based on pregnancy rates.  However, what makes me crazy is that OB/GYNs are surgeons and deliver babies.  They usually do not fully understand the differences of oral contraceptive pills (OCPs) and just give them out without understanding the effects on the rest of the body. They only think about the vagina, ovaries and uterus.

Oral birth control is great at preventing pregnancy, yes, but they have metabolic consequences especially the low estrogen OCPs.  They can lower free testosterone (because the ovary makes this and you just shut it down) which increases your risk for depression, low libido, weight gain, sugar problems and even diabetes. They affect your thyroid function..slowing it down.  The low estrogen pills also have a relative high ratio of progesterone, which makes women crabby and gain weight, but also puts women into ametabolic syndrome which is high sugars, high lipids, increased weight and higher risk for heart attack and stroke.  OB-GYN’s don’t think about these things….they just want the contraceptive effect and to stop women from having heavy periods.  This is a good thing, but you need to know what you are doing first.

You can balance these effects by using OCPs with good Estrogen levels especially lowering the progesterone effect….unless you have Polycystic ovary syndrome (PCOS) which is a whole other topic.  You often need to provide or add back testosterone to these women.

There are other options to oral birth control, which are better including: ortho evra patches, nuva-ring and IUD’s.  These avoid processing through the liver and does not increase clotting risk. They also free up some of the testosterone made by the adrenal glands. (10%)  Less chance of the weight gain, low libido, depression etc.

 If OCPs go over the counter, doctors cannot advise women properly about which contraception is uniquely best for that patient. Also, the annual well women exam which is where most young women get their birth control refill would be lost….they would not be compelled to come in as often and we lose an opportunity to provide health education and the needed examinations to ensure they are and stay healthy.

Wednesday, October 24, 2012

Outrageous!


It is outrageous that we are still fighting the hormone fight on a badly designed study with flawed results. (WHI, 2002)
This “D” recommendation from another news story is coming from the organizations (USPTF) who gave a “D” recommendation about doing mammograms every other year after the age of 50.  
They are making a broad sweeping judgment based on only two medications (mind you I didn’t say bio-identical hormones which are NOT medications…they just replace what our bodies make. Meds treat illness)  Prempro and Premarin.  The 51 studies are largely based on follow up articles on the same WHI study being ruminated over. 
They are quoting inaccurate data because in 2009 even the WHI results were re-looked at with proper statistics and the Prempo arm showed neutral on breast cancer and a lowering of heart disease in women between the ages of 50-60. And the premarin arm showed a significant decrease in breast cancer by 23% and decrease in heart disease. 
Just last month the American College of Physicians (ACP) had an article in their journal about a large European study with over 1000 women at the appropriate age to start hormones (between 45-60) over 10 years a decrease of heart disease and heart failure/heart attack and NO increase in cancer. 
There are plenty of studies outside of the US that support using hormones for chronic illness protection.  However, this comes from hormones which are NON oral and bio-identical. 
Orals and synthetics DO cause increase clotting risk…..but even the worse of these DO NOT increase breast cancer. 
This study is OLD news and putting fuel on the fire to have women NEVER get hormones paid for by insurance companies.  It is complete gender bullsh*t! And it is hurting women.
Men get their erection drugs and hormones with NO questions asked…..what about women?  They have ZERO studies which are randomized placebo controlled studies and they get all preparations approved.  We have ONE BAD STUDY and millions of women on bio-identical now that have great data and we get NOTHING but terrible oral synthetic drugs approved or nothing at all.  We also have over 7000 women in placebo controlled randomized studies for our hormones and nothing!!

IT IS OUTRAGEOUS!

Sunday, September 9, 2012

VAGINA's 7000 vs PENIS' 0 ....and the vagina's are still losing

Now that I have your attention, let me bring some reality to this humor.  In 2012, did you know that we have over 7000 women in randomized placebo controlled studies to study new products/drugs for the treatments for sexual desire disorders in women (think low libido) as well as female pelvic dysfunction syndromes and to date the FDAhas not approved any of these in this country?  Testosterone helps with both of these medical problems and the only way we can get it for women is to compound it in a pharmacy or by using off label smaller amount of medications for men.  And to boot, many of the big pharma companies are trying to lobby the government to stop these pharmacies from doing so…..making these products unavailable to women.  This is outrageous!

Women in other countries have had access to approved products and we don’t.  Our country is light years behind other countries in women’s health issues and medications. And we are supposed to be the leaders in medicine. 
And what infuriates me even more…..did you know that men have numerous erectile dysfunction drugs (VIAGRA, CIALIS, LEVITRA) and tons of testosterone products in many forms (Testosterone cypionate injections, testim gel, androgel, testopel pellets…..to name a few) approved by the FDA.

And do you know how many randomized placebo controlled subjects in studies for these male products….Yup you guessed it ZERO.
So the reasoning behind the lack of female product approval.. .....They are worried the drugs will cause us adverse medical issues. Well none of the studies proved this.  The women showed only a small increase in acne and facial hair.  And most women did not discontinue the products due to this….as they felt much better. 

The male ED drugs can actually cause blindness, heart attacks and death.  Well at least they died blind and with an erection.
In a society where women are starting to outpace men in numbers in high leadership positions and having more with 6 figured salaries, we would think this would cause great alarm and a huge push to fix this.   The establishment has us off focus, because we still have to fight the fight on the birth control issue and who has the right to control our bodies……

Does anybody think we are in the 21st century?  It feels more like the middle ages.


Tuesday, August 21, 2012

STRIDES IN CANCER DETECTION - My thoughts on new gene biomarker

I came upon this video about a researcher from Mayo who discovered a gene biomarker for prostrate cancer detection and had to share this information with you!  This is very exciting news!  

I've known about the new marker Breast Test (BT test) that has identified a group of 5 inflammatory/tumor markers that can signal the presence of breast cancer...improving the detection of breast cancer in conjuntion with the usuall mammographic imaging, but men have not had any signficiant improvements in the detection of prostate cancer ...until now.  We have a glimmer of something to look forward to other than PSA levels.  PSA levels in the detection of prostate cancer in men has had its clinical challenges and most recently the US Preventive task force even stated that the PSA should not be used for routinue screening in men.

So, why has the PSA levels been challenging for doctors and patient?

To summarizie: 
The task force concluded from two large studies that over a period of 10 years, one prostate cancer death at most was saved from PSA screening for every 1,000 men screened.

The test finds many cancers that are not life-threatening, and treatment causes side effects from surgery and radiation such as impotence and urinary incontinence. The harms weighed against benefit aren't enough to justify the screen, the task force concluded.

But some doctors say the answer is to change the way that prostate cancer is handled in this country.

When a biopsy reveals cancer, 90% of men are treated -- even though most prostate cancers won’t threaten a man’s life.

However, the word CANCER evokes fear in even the most calm and reseasonable person.....no-one wants to know that they have a cancer brewing in their body.  But in fact, many of us die with cancers that are only found on autospy.  Not all cancers are going to kill us......or kill us quickly.

Which cancers to treat:  
Prostate cancer experts aren’t perfect about figuring out which cancers need treating and which can be carefully watched.
When a biopsy is taken, the cells are examined under the microscope and the cancer cells are given a so-called Gleason  score based on the shape of the cells. Gleasons of 8, 9 and 10 need to be treated, he says. Six or less, probably not.

Patients should do everything possible to get themselves to a center of excellence for treatment. Treatment side effects -- urinary incontinence, impotence and bowel problems -- are in the double digits across the U.S. but are “substantially” lower at centers of excellence,   There are good non surgical options that include high frequency ultrasound and proton therapy.

However, it is hopeful that with the advent of this new biomarker techology.....Mayo have found a way to better tell us which cancers we should aggressively pursue and which should we should.  However, I suspect this is a way off....this marker just may tell us if the cancer is present unlike PSA levels which cannot at this time.

Saturday, June 23, 2012

Testosterone is NOT the new Viagra......

"Doc, I need testosterone for my mojo." I hear this every day in my practice. Which in "guy speak" means erectile dysfunction. Although testosterone is great for libido and "mojo," people often mistake testosterone as a viagra-like substance to aid in "getting it up".

However, Testosterone and erectile dysfunction drugs work in totally different ways and one may not work without the other.  So here are the facts:

Testosterone is like the foundation of a home.  It is needed to prime all the organ systems to work properly including mental clarity, glucose metabolism, fat burning, mood and ability to deal with stupid, libido and, oh yeah, those erections! Testosterone primes the tissues in the penis to aid in engorgement of the blood in the penis, nervous system response to stimulation and ability and strength of the orgasm. 

Viagra, and other erectile disorder drugs on the other hand are a vasodilator....in other words it allows for the penis to be able to engorge with blood property so that an erection is possible.

If a man's libido is low or he has an inability to obtain an erection, one should start with testosterone first.   An erectile dysfunction drug should only be used if the testosterone did not fix the issue, as then blood flow is likely an issue.

Blood flow problems usually result from smoking, high cholesterol, high blood pressure, obesity and other things that cause damage to the arteries and veins.  And is usually occurs over years of damage.

In severe cases, even testosterone coupled with a drug like Viagra will not do the trick.  This is when penile injections (most men cringe at this thought but will do just about anything to "get it up") and pumps may be helpful.

Bottom line is......if you don't have your groove in the bedroom, talk to a doctor that specializes in testosterone replacement and has a good understanding that Viagra-like drugs are NOT the answer to everything.

Tuesday, June 5, 2012

Male MAN-opause

There’s no such thing as MAN-opause! Is there?!


With such an abundance of information in the media about menopause some might forget that men also undergo changes as they age, you might hear it described as “Man-opause” or more properly know as andropause. Since women are generally more vocal about medical issues there is more information available in the media about menopause and how to deal with the symptoms, however this is not a female exclusive problem…men’s bodies decline with aging also – shocking isn’t it?!

The term andropause refers to the testosterone decline men go through when their body gets to exceeding low levels of testosterone. It is called andropause because testosterone is an androgen, and androgens are male sex hormones. With decreasing amounts of circulating testosterone, the body responds by loosing energy, loosing muscle mass and sleep disturbances - in short a man feels worn down in every way.

The only way to truly replenish highly depleted levels of testosterone hormone is through hormone replacement therapy. Men have options when it comes to replacing testosterone such as testosterone cypionate injections, pellet insertions and testosterone cream (all of these treatments should be supervised by a physician). While these options may not permanently increase levels by maintaining long term treatment the old sense of well being will return.

So how can we help? All of you girlfriends, wives and friends need to take your male cohorts into a local clinic to have their hormone levels tested!! To learn more, please contact us or read more here.

Tuesday, May 22, 2012

World Thyroid Day

With World Thyroid Day here, we should all give homage to the wonderful little organ that sits in our neck and acts like the engine to our human automobile : “The Body”. However, approxiatley 1 in 3 women will have a thyroid disorder by the time they hit 50. Most doctors will miss the diagnosis if they just use the standard TSH screening test. As a medical profession we have lost the skill of history taking and physical exam in making the diagnosis of hypothyroidism.

 Many women come in with extreme fatigue, weight gain, sore muscles and joints as well as hair loss and cold intolerance. Their symptoms are screaming “hypothyroidism”.Then when you examine them, they have a slow heart rate, cold extremities, swollen neck which are clinical indicators of hypothyroidism. Then the doctors look at the TSH and if it is normal, they say” You don’t have a thyroid disorder” This is extrememly frustrating for patients and they have a reason to be so.

What happened to the good ole fashion skills of a doctor. They rely on this screening test and it is not the most reliable indicator especially if the women is also having Testosterone or Estrogen deficineny to boot. These hormones hang out together and get in trouble together. One must look at T3, T4 and reverse T3 levels to get a true indicator of the thyroid function and take it into consideration to their symptoms.

Hypothyroidism not only causing patients to feel terrible, but is a risk factor for cardiovascular disease, inflammatory conditions and cancers…including breast cancer. We should be taking a much careful look at the thyroid function in our patients not only to give them a better quality of life, but also to prevent the conditions that can cause it to stop short.


Patients should seek medical professionals who fully understand the role of thyroid and how to properly test and look for it. It is too important not to.

Monday, May 21, 2012

May is National Women's Health Month: Did you take care of your health?

Preventative health screenings are important but there is conflicting information about who needs them, when the right time is to get screened and how often certain tests should be done. May is National Women’s Health Month so it’s time to set the record straight and take health matters into your own hands.


Preventative health screenings are crucial but often confusing for female patients as there are many different guidelines that suggest different things. Many of these practice recommendations are based on large population statistics as well as monetary savings; none of which take into unique individual patients needs or risk. Routine tests are our best defense for early diagnosis of disease and in-turn higher successful treatment rates if something is detected. Women need to make their health a priority and National Women’s Health month is a great time to do that.”

Top 5 tests you should consider getting:

1. Heart disease is the number one killer of women throughout the world, six-times more likely to cause death than breast cancer. Based on these statistics, women over the age of 50 should have an electrocardiogram (EKG) yearly.

2. Skin cancer screenings must be conducted every year no matter what your age. The American Cancer Society anticipates Arizona will have 1,650 new cases of melanoma in 2012.

3. Pap smears should be done annually between the ages of 21 and 30 and then every 3 years in patients older than 30, providing they are in a monogamous relationship and have a history of normal pap smears.

4. Starting at age 40, mammograms need to be performed every other year and annually after age 50. To add increased detection of breast cancer, consider getting a BT test, which is a new blood test to detect the presence of inflammation markets which signal the possibility f breast cancer cells being present in the body.

5. A colonoscopy should be performed at age 50 to screen for colon cancer. After a baseline is established, follow up tests should be done every 5-10 years.

You can never be too careful when it comes to your health. Just this year I discovered a melanoma on a patient’s stomach during a routine skin cancer exam. She had been told by another physician that it was nothing to worry about. Trust your instincts….women know their bodies better than anyone else.



Saturday, May 19, 2012

Osteoporosis: It is not just your grandmothers disease.

With May being osteoporosis awareness month, it is important to remember that the skeletal system is the back bone (pun intended) of our body. Osteoporosis is a horrific disease that can be life threatening. Hip fractures, height loss, vertebrae fractures and other painful symptoms can result from osteoporosis. While this is not an easily detectable disease early in one’s life, there is knowledge available for protecting your health.
Simple aging is one of the biggest factors for the onset of osteoporosis in both men and women, women lose up to 10% of their bone in the first few years after menopause and most women are also Vitamin D deficient, therefore unable to properly absorb calcium. Hormone replacement therapy is critical during this point of a women’s life. Replacing estrogen and testosterone or beginning treatment with bone loss prevention drugs can stop the occurrence or lessen the severity of the disease.

Getting a DEXA scan while important is not the only way to diagnosis osteoporosis. Clinical risk factors such as family history, fracturing after the age of 50 (even wrist/ankle), vitamin D deficiency and BMI less than 20 can be other ways for a physician to diagnose osteoporosis.

One of the main myths about the disease is that it strictly affects women however osteoporosis threatens both men and women. Men have more bone density than women, due to their size, and therefore osteoporosis is usually later onset for them, but still occurs. Having an abundance of information is the key to understanding what how to take preventative measures against the disease. There are ways to stop osteoporosis or revert it back into osteopenia by undergoing hormone replacement therapy.

I urge you to seek an expert in osteoporosis and begin testing and seeking treatment if you are above the age of 50 (that’s you too men). Seek help from someone who understands the importance of each medication because not all osteoporosis medications are safe.
Every time I see an older person walking down the street, humped over with vertebral fractures, it make my heart break….as I know this could have been prevented.











Saturday, April 14, 2012

The Magic Pill of Depression

With the increase in social media and onslaught of television commercials telling us how to live our lives better every day, we are also told that many of us are depressed and require treatment for depression. Unfortunately many of us are looking for that magic pill to take away the stressors of life and doctors are willing co-conspirators. It is much easier to swallow our sadness away then learn coping skills or get to the bottom of what may be worsening our ability to cope with the day to day hurdles life throws at us.
However, we have been condition to believe that life should be “happy” all the time and sadness or anger is not acceptable and definitely not attractive. Medicate and this all goes away.

So how do you know if you are really depressed or are just having a normal grief reaction to life stressors? Symptoms include but are not limited to a feeling of unease, constant worry, lack of energy, sleeping too much or too little, desire to isolate ones’ self from others or having a feeling of hopelessness or inadequacy. This also needs to go one for a period of 3 months or more.

Most people encounters stressors that cause many of the above symptoms for short periods of time, but when this affects are abilities to cope with life we are in need of medical attention.

Unfortunately, the body will always deal with stressor one way or another. If we block the emotional release, it will come out physically.

Under increased stress our bodies adapt to the stress by increasing or decreasing the release of certain hormones which can cause these symptoms. After the stressor is gone, these hormones go back down to normal and our bodies relax. If a stressor has not been properly dealt with, these hormones stay elevated un-naturally and cause physical harm to the body. It is as if the body believes it is constantly being attacked by an intruder.
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 at the very least slap them.
Hormone deficiencies can make all this worse. Any underlying mood disorder gets exacerbated.

So before you take that “magic pills”, you need to ask yourself; “am I having an normal reaction to a life stressor and need to learn coping mechanisms”, “have I had my hormones evaluated to ensure that hormonally deficiencies are not contributing to my lack of emotional well-being” and “are my doctors too willing to prescribe anti-depressants because it is easier to do this rather than listen to my concerns”.

Anti-depressants are appropriate and very helpful for patients with true depression….but this magic bullet is not the cure all for everyone and in fact can make things worse in the long run.
If you'd like to learn more, give us a call and make an appointment for a well woman check.

Saturday, February 11, 2012

INTIMACY: What's love got to do with it?

Wouldn’t it be nice if life’s little intimate moments were accompanied by music – like a movie, each emotion perfectly depicted by a melody. Sounds nice, but it’s not really intimacy it provides, it’s simply a warm fuzzy feeling. Those feelings are short lived but the intimate long lasting relationships made with family, friends and partners are the relationships that provide the love we need in our lives.

Understanding all of the elements involved in intimacy is the best way to re-discover the ways in which two people must connect for the longest and healthiest relationship possible. The definition of intimacy includes familiarity, closeness and coziness. If this is not what you think of when you are with your partner it doesn’t mean you are devoid of intimacy but it may be an indicator that you and your partner have room for improvement.

First and foremost, do you love yourself? No truly, do you feel confident in your skin? Are you happy and proud to be YOU every day? This may sound cliché but until you are satisfied with who you are, how can someone else feel comfortable to confide their most intimate thoughts and feelings with you?

Often times we see men and women in their 40’s and beyond beginning to experience a disjunction between how great they used to feel and how they feel now. This has an effect on how we carry ourselves around our intimate partners. Experiencing weight gain, decreased libido and overall sluggishness is a reality of aging. This isn’t an equation for doom but it certainly warrants reason for change. Keeping yourself healthy by finding a new routine (exercise, new type of work, hobbies etc) and regaining optimal hormone levels may be what it takes to get you back to feeling your best.

Increasing a diminished libido is one of the key ingredients to regaining interest and intimacy with a partner. Our good friend testosterone is the hormone that provides, amongst other things, our libido. Women have a smaller amount of testosterone to begin with and during menopause testosterone decreases to very minimal levels. By replacing testosterone libido increases, sex drive is restored and connections between partners are reestablished. Intimacy elevates more easily when desire returns.

Don’t be afraid this February to rekindle the intimacy with your loved one and embark on a journey. Whether that be a local adventure, a trip or something as simple as a candlelit dinner, communicate and open up with each other. If there are aspects of yourself that need improvement, confide in your partner so they can help you. But most significantly express the importance of having them in your life.

I have seen couples regain and exceed the intimacy they had when they were first together. By relinquishing love and confidence for themselves they intern found each other again. What more could a doctor ask for other than health and happiness for her patient’s!

Give those you love what they deserve…attention – yourself included!

I wish a Happy Valentine’s Day to all of you