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1 Optimize your life. LONGEVITY GUIDE TO w w w. o p t i m a l h e a l t h m d. c o m

2 Optimize your life. INTRODUCTION I DO YOU NEED THERAPY? HORMONE REPLACEMENT Q & A S GETTING STARTED HUMAN GROWTH HORMONE - HGH SECTION II INTRODUCTION TO HGH ANTI-AGING BENEFITS DYNAMICS OF HGH BENEFITS VS. RISKS STAYING YOUNG HEALTHY LIVING TESTOSTERONE SECTION III INTRODUCTION TO TESTOSTERONE DEFICIENCIES & BENEFITS DIAGNOSIS & TREATMENT TESTOSTERONE PROGRAMS ANCILLARY SUPPLEMENTS ORDER FORMS SECTION IV Call Optimal Health: w w w. o p t i m a l h e a l t h m d. c o m

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4 specialist Optimize your life. Welcome to Optimal Health & Rejuvenation Center, LLC. - We specialize in age management programs that focus on preventive medicine as a means to reduce the negative effects of aging. Our programs are a result of extensive medical research and advances in biotechnology, which have allowed us to combine both mainstream and alternative medical treatments in an effort to provide individuals with the benefits of a vibrant lifestyle and extended lifespan. Optimal Health combines several medical specialties that involve nutrition profiling, body chemistry, conditioning and hormone modulation, which deals with the endocrine system as key factor in optimal hormone balance.this guide will help you understand the importance of such hormones like: Human Growth Hormone, Estrogen, Testosterone, Melatonin and DHEA, that decline as we get older beyond 35 years of age. Right now you may already be experiencing many of chronic deficiencies that are a direct cause of premature aging, many are caused by a hormone deficiency or nutritional imbalance. Do you feel tired more often or forgetful, easily stressed or anxious, sudden weight gain, muscle loss and a diminish appearance or physique. All of the mentioned conditions have a direct impact in your lifestyle; they can lead to poor job performance, low self-esteem, lack of ambition and diminishing sex drive. Through our network of specialist and trained counselors, we can provide you with a safe and effective way to enter a medically supervised program that is specifically designed to deliver the optimal result you desire. We will be with you every step of the way, providing you with the guidance and advice to provide you with an exceptional outcome. After reading this guide you may have questions and we are here to provide you with answers. We know you will be eager to start on the path to a healthy and vibrant lifestyle, please call us with any questions you may have and one of our counselors will assist you. To get started, call us at:

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6 How do you know if you need therapy? What if we told you that Optimal Health has the power to reverse symptoms associated with the aging process and has the ability to make you feel, look, perform and live better, what would you think? Optimal Health has successfully treated thousands of patients with hormone replacement therapy, primarily focusing on medically supervised Human Growth Hormone (HGH) and Testosterone Replacement Programs. Right now, it is very likely your levels of Human Growth Hormone and Testosterone are not at their optimal level. Take this simple quiz to see if you are a candidate for Hormonal Replacement Therapy (HRT): Do you have a decrease in libido (sex drive)? Yes No Do you have a lack of energy and motivation? Yes No Do you have a decrease in strength and endurance? Yes No Have you developed love handles or a spare tire? Yes No Are you losing your figure and muscle tone? Yes No Have you noticed a decrease in enjoyment of life? Yes No Do you have a tendency to be sad and grouchy? Yes No Do you easily tire in the afternoon or after meals? Yes No Do you find yourself being forgetful? Yes No Do you have a lack of drive and ambition? Yes No If you have answered yes to at least half of these questions, chances are, you may already have low to moderately low levels of either Human Growth Hormone or Testosterone. Fortunately, there is something Optimal Health can do to help. Through one of our programs we can elevate your levels to the optimal ranges you may have enjoyed in your younger years. [ 1 ]

7 Hormone Replacement Therapy- Q&A What is HRT? Hormone Replacement Therapy (HRT) is a proven and effective process in which hormone levels are brought back to normal levels. Good levels will help maintain your energy levels, healthy mood, increased fertility and sexual desire. This therapy involves Human Growth Hormone (HGH) and Testosterone. HGH is the largest protein produced by the pituitary gland which is made up of 191 amino acids. HGH is genetically engineered of the same 191 amino acids. It is the same genetic engineering used for insulin. Cloning the identical sequence of the DNA for that of HGH makes it physically, chemically and biologically identical to the one made naturally by the pituitary gland. Testosterone is the Androgenic Hormone primarily responsible for normal growth and development of the male sex and reproductive organs. It facilitates the development of secondary male sex characteristics such as musculature, bone mass, fat distribution, hair patterns, and vocal chord thickening. How are the hormones replaced? Testosterone is replaced using either weekly subcutaneous (under the skin) injections or a specially formulated transdermal topical gel. The gel is typically applied to the surface of the skin in the morning and HGH is administered by daily injection. The Optimal Health Doctors and Medically Trained Counselors will explain the easy and painless process. Is it safe? Yes! There are numerous studies that have come out over the past years that have attested to the safety of natural hormone replacement. Does it work? Yes! This is not a fanciful search for the fountain of youth. It is medical science at its best. Over the years there have been thousands of case studies and medical trials that provide absolute, conclusive evidence that hormone therapy works and has many benefits that result in better health, energy and sexuality. Board Certified Physicians using sophisticated lab tests and treatment protocols make possible these favorable, life-altering results. When should I think about replacing hormones? The typical person s hormones start to decline by the mid to late 20 s. By age 35 declines are sufficient that symptoms may be evident. A great time to start replacing hormones is between the ages of 35 and 55. However, it is never too late. We have people in their 80's that have found a new life through HRT. Do you recommend replacing both HGH and Testosterone at the same time? Hormones may be replaced separately or in any combination. Better results are obtained from taking a combination of hormones. We like to say there is a 1+1=3 relationship - since the results are three times as high when taken in conjunction. How will I lose weight? HGH re-contours the body, changing your body composition to reduce the fat and increase lean muscle mass. It is like a metabolic liposuction, vacuuming out the fat from underneath, particularly throughout the abdominal area. Unfortunately, the more body fat you have in your mid-section, the less HGH your body releases. HGH accelerates the burning of fat by making it available as a fuel. By increasing free fatty acids, HGH makes the fat stored available for energy production. This is due to fat cells having HGH receptors that the HGH binds to. This triggers a series of enzymatic reactions in the cell to break down the fat. A process called lipolysis. With HGH you are changing the hormonal message telling your body to get rid of fat. HGH also increases your overall energy expenditures so that you actually burn calories faster, a great metabolic aftereffect. Unlike other fat-reducing methods which work against the body, HGH works with your body s natural order to lessen fat and increase muscle. [ 2 ]

8 How will I build solid muscle? HGH working thru IGF-1 increases the uptake of amino acids in the cell and enhances synthesis of DNA and RNA proteins, extra-cellular proteins, carbs, and sugars. The result is an increase in cell size, accelerating cell division and resulting in accelerated muscle growth. It also builds muscle by conserving the nitrogen needed for muscle tissue. Ordinarily when you loose weight you excrete nitrogen, but HGH keeps the body from losing nitrogen. It also increases protein synthesis without increasing the breakdown of proteins in the cell. Accelerated cell division also means speedy healing and repair after injury. Will Hormone Therapy help sexual dysfunction? Although sexual dysfunction can have many causes; replacing hormones is one of the best places to start treatment. We suggest raising your testosterone to a healthy level along with growth hormone, to boost your sex drive. There are many products that increase the amount of nitric oxide in the blood to aid sexual mechanics. Products like Viagra will not assist with the overall sexual function, they temporarily fix the mechanics of the problem. Our restorative Hormone Therapy Programs have been found to fix over 90% of problems of sexual dysfunction and will have you eagerly performing at optimum levels. Rarely will there be a need to supplement our effective programs, but you may safely take additional performance supplements along with one of our programs. Will hormone replacement cause my natural hormone production to decline? Cycling of hormones is designed to minimize the possibility of a decline in your natural hormone production. Cycling is taking time off from hormone replacement. When synthetic hormones are introduced into the body, the gland producing that hormone senses that the body has an adequate supply of the hormone and minimizes production. Cycling is mandatory for HGH and for men under 45 on testosterone. Are there side effects? If used under a doctor s care, there is absolutely no evidence suggesting any unfavorable long term side effects. If abused, you may develop carpel tunnel syndrome which is inflammation of wrist tendons, water retention, gynecomastia (testicle shrinkage) or acromegaly (enlargement of the bones). What about oral HGH or HGH stimulants? It has been medically proven that HGH cannot be absorbed through the digestive system. Advertisements that claim they have real HGH in a spray or pill may in fact only contain small amounts of HGH. There is some evidence that HGH can enter the blood stream if absorbed directly into the membranes of the mouth, but oral HGH therapy is not as effective as a medically supervised injectable program. Do I have to come to the Optimal Health Clinic in Miami Beach? No. We provide nationwide services through our network of affiliates. Within 48 hours of placing your order, one of our counselors will call you to arrange for a blood test and a physical exam at an affiliate in your area or in the privacy of your own home or office. How do I get started? It is easy. Call us at Our counselors will guide you through the various programs and help you fill out a confidential patient medical history form. This process usually takes no more than 15 minutes and can be completed over the telephone. Provided you qualify for treatment, your order will be shipped via FedEx. What if the doctor does not write a prescription? If your blood work or medical history results disqualify you from treatment, we will refund you 100% within 24 hours. [ 3 ]

9 What type of results can I expect? Although every case has its variations, generally you can expect: 1st Month: Increase in mental sharpness, enthusiasm for life and a reduction of mild to moderate depression. Higher levels of energy, better results from exercise and weight control efforts. Better sleep. 2nd Month: Improved muscle tone, enhanced sexual function, improvement in nail growth and skin tone, better digestion, increased strength and weight loss. Improved hair growth and thickening of the hair with shinier and healthier appearance. 3rd Month: Mental processes improve, including desire to do and complete projects, increased muscle size (particularly improved with exercise routine), hair re-growth, reduction in post menstrual symptoms in women, increased sexual desire, greater body flexibility. 4th Month: Similar to 3rd Month: Generally, improvements are heightened and are more consistent. 5th Month: Impressive weight loss, reduction of fat and muscle tissue is increased. Toned improvement to skin texture, reduced appearance of wrinkles, vast improvements to hair growth. 6th Month: This is a rather significant stage for women, since cellulite greatly diminishes, the body becomes more contoured, eyesight is improved, stronger resistance to colds, flu, and other illnesses, chronic pain diminishes, old wounds have a tendency to heal, excellent exercise tolerance, grayed hair begins to return to its natural color. Medical test show a reduction in LDL cholesterol and triglycerides, blood pressure normalizes, heart rate improves, some conditions due to disease vanish or are diminished and immune system improves. [ 4 ]

10 How do I get started? It is easy to get started on an Optimal Health Hormone Replacement Program. We have set-up a five step plan that is designed to save you time, effort and maximize results. Entering one of our medically supervised programs is a relaxed and carefree process. Step 1: Call Optimal Health toll free at Our Medically Trained Counselors will assess your goals, and guide you through the various programs we offer. If you choose, you may also complete the program order forms and fax it to Step 2: Once you have chosen a program designed to deliver your specific results, Optimal Health will set up your account and ask you a series of qualifying questions to complete your confidential medical history form. A process that usually takes no more than 15 minutes! Step 3: Within 48 hours of processing your information we will schedule a comprehensive physical examination and procure a blood specimen through our nationwide network of labs and medical affiliates. If preferred, this can be arranged to be done in the privacy of your own home or office. The results will be analyzed and sent directly to the Optimal Health medical center. Step 4: Based on the results of the examination, lab-work and medical history, one of Optimal Health s affiliate physicians will write your necessary prescriptions for your supplies, and offer any qualified advice. Step 5: That same day, your program supplies will be shipped via FedEx directly to you from one of our US- based, associate pharmacies. You will soon begin your physician-supervised Hormone Replacement Program. It is that easy! All of our programs are designed to offer you a quick, safe and effective way to self-administer a comprehensive anti-aging program. You are on your way to better health, energy and performance with Optimal Health. Optimize your life! For additional information please contact Optimal Health at [ 5 ]

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12 Optimize your life. HGH HUMAN GROW TH HORMONE [ 7 ]

13 Optimal Health & Rejuvenation Center, LLC 2006

14 INTRODUCTION TO HUMAN GROWTH HORMONE Optimal Health offers physician prescribed and medically supervised Human Growth Hormone (HGH) replacement programs helping patients enter a cost effective, comprehensive age management and physical development program. HGH is one of several endocrine hormones such as estrogen, testosterone, melatonin and DHEA that decline in production as we age. While many of these hormones can be replaced to deter some of the effects of aging, HGH goes far beyond suspending these effects. Not only does HGH retard biological aging but it significantly reverses the aging process. Researchers have proven that HGH therapy can reverse the effects of aging by as much as 20 years with less than one year of treatment. The benefits of HGH are seen more and more as new studies manifest its many rewards. HGH Replacement Therapy is the key to rejuvenation and added years of vitality to your life. Hormones can be thought of as "messengers" that are produced by the endocrine glands which are sent all over the body to stimulate specified activities. For example, growth, digestion, reproduction, and sexual functions. As its name suggests, HGH is a hormone that makes humans grow. HGH is a complex protein molecule made up of 191 amino acids, which is secreted in pulses by the pituitary gland. These pulses vary between 10 and 30 per day and can be strengthened by exercise. For years, doctors could only prescribe HGH for children who needed a growth boost; now HGH is prescribed to adults since it is integral for functions like: tissue repair, healing, muscle growth, bone strength, brain function, physical and mental health, and metabolism. HGH is produced at a rate that peaks during adolescence, at time when normal growth is accelerated, however, the production of HGH decreases with age. Humans normally produce about 500 micrograms (mcg) of HGH daily at age 20. By age 80, the daily production falls to 60 mcg (or less). Somatropin is the man-made version of HGH. Each manufacturer of somatropin assigns its own brand name, such as Genotropin, Humatrope, Norditropin, Saizen, and Serostim. They are available only by prescription and administered by subcutaneous injection. Once secreted by the pituitary gland, circulating levels of HGH stimulate production of Insulin-like Growth Factor 1 (IGF-1) from the liver. You can think of HGH as the hormone that gets the ball rolling, but IGF- 1, sometimes called Somatomedin-C, does most of the work. It is the IGF-1 that stimulates cells to divide, which causes growth. The amount of IGF-1 tends to mirror the amount of HGH that is produced by humans and because blood levels of IGF-1 are more stable, labs usually test for IGF-1 levels to read the HGH levels. For most people the pituitary gland produces sufficient HGH to retain a youthful appearance until age 35 or so. Then, somewhere between age 40 and 50, the body's ability to produce HGH declines to the point where the effects of aging are accelerated and begin to show. Simply put, HGH keeps humans young and attractive. Optimal Health offers HGH replacement therapy in the form of medically- supervised HGH programs that are designed to safely replenish and replace your body's own production of HGH. Whether your goals are antiaging or physical development, Optimal Health has a cost-effective and comprehensive HGH program that will deliver the results you want. Optimal Health & Rejuvenation Center, LLC 2006 [ 9 ]

15 ANTI-AGING HGH BENEFITS Signs of aging and hormone decline - THINNING SKIN AND INCREASED WRINKLING - DECREASED ENERGY AND STAMINA - EXCESS BODY FAT - LACK OF SEX DRIVE AND DESIRE - LOSS OF MEMORY & FOCUS - DECREASED KIDNEY FUNCTION - HIGHER LDL CHOLESTEROL LEVELS - WEAKENING HEART ND CIRCULATION - HAIR LOSS AND DISCOLORATION - INCREASED ANXIETY AND STRESS - DIMINISHED BONE DENSITY - REDUCTION IN THE REJUVENATION PROCESS - GENERAL FATIGUE Benefits of HGH replacement therapy + ENHANCED SEXUAL PERFORMANCE + IMPROVED EXERCISE CAPACITY + IMPROVED QUALITY OF DEEP SLEEP + BOOST IN ENERGY LEVELS + INCREASED LEAN BODY MASS + STRENGTHENED IMMUNE SYSTEM + SHARPER MEMORY AND CONCENTRATION + STRONGER BONES + REDUCTION IN CHRONIC FATIGUE + REDUCTION IN BODY FAT + NORMALIZING OF BLOOD PRESSURE + INCREASED HDL (GOOD CHOLESTEROL) + DECREASED LDL (BAD CHOLESTEROL) + ENHANCED FEELING OF WELL BEING + TIGHTER, MORE HYDRATED AND SMOOTHER SKIN + AND MANY OTHER ANTI-AGING AND PERFORMANCE ENHANCING BENEFITS [ 10]

16 DYNAMICS OF HGH REPLACEMENT THERAPY HGH - Our hormone system is best understood if you think of it as a cascade with the brain at the top followed by the pituitary gland, then the target organs, e.g. ovaries, thyroid, testicles; and finally physical and mental functions e.g., skin thickness, menstrual periods, sex characteristics, aggression, hair distribution, etc. Simply put, Human Growth Hormone (HGH) keeps humans young. For most people the pituitary gland produces sufficient HGH to retain a youthful appearance until age 35 or so. Then, somewhere between age 40 and 50, the body's ability to produce HGH declines and the signs of aging become more apparent. LH BRAIN HYPOTHALAMUS PITUITARY LH FSH GH HGH RELEASING FACTORS TSH Figure HGH - Human Growth Hormone decline (ng/ml) ADRENAL GLANDS TESTICLES OVARIES LIVER THYROID HGH Optimal range (ng/ml) TESTOSTERONE IGF HYDROCORTISONE ESTROGEN PROGESTERONE AGE Brain - The hypothalamus is part of the brain and is where hormone release originates, starting off the cascade by secreting "releasing hormones" which activate the pituitary glands. Pituitary - The pituitary gland is known as our "master gland." It sits at the base of our brain and communicates directly with the hypothalamus by special nerves and blood vessels. Releasing hormones travel from the hypothalamus to the pituitary and stimulate the formation and release of pituitary hormones into our circulatory system. The pituitary hormones exert their effects on many of our organs, such as the thyroid, adrenal glands, testicles, ovaries, and breasts. There are five basic pituitary hormones: Growth Hormone (GH) Adrenocorticotropic Hormone (ACTH) Thyroid stimulating Hormone (TSH) Follicle stimulating Hormone (FSH) Luteinizing Hormone (LH) The pituitary hormones are released into the general circulation and have effects on specific target organs, which then release hormones of their own. Thus, the pituitary hormones act like traffic controllers, they survey the scene, determine what is needed, and tell the organs when to release their hormones. Figure 2. HGH decline: general approximations Age: HGH IGF-1 ng/dl [ 11 ]

17 BENEFITS VS. RISKS HGH replacement therapy raises IGF-1 levels in the blood. It is the higher levels of IGF-1 that mediate all the effects attributed to HGH. Most studies about the use of HGH in adults and children fail to show any cancer related risks associated with the use of HGH or higher levels of IGF-1. A review article published in the New England Journal of Medicine on October 14, 1999, authored by Mary Lee Vance, M.D. and Nellie Mauras, M.D., concluded that there is "at present no evidence that Growth Hormone modulation affects the risk of cancer". All patients should be aware, however, that there are other reports that do indicate that there may be a risk. In 1998, two published studies claimed a higher incidence of prostate cancer among men who had higher IGF-1 levels years before the onset of the cancer. However, a number of experts agree that these studies are inconclusive and their methods may be flawed. Problems cited within these studies included: the method of statistical analysis, the interval between the blood sampling and the onset of cancer and the absence of any IGF-1 measurement at the time of cancer diagnosis. Several other studies show no difference in IGF-1 levels between normal healthy men and those with prostate cancer at the time of diagnosis and beyond. More recently, some studies point to a higher incidence of breast cancer in pre-menopausal women (but not post menopausal), who had higher IGF-1 levels one to five years prior to the onset of breast cancer. In this study, the blood specimens were also drawn prior to diagnosis and were not analyzed for several years, making these conclusions somewhat suspect and inconclusive. Although the majority of studies overwhelmingly point toward the safety of HGH, there is, as in virtually any area of medical science, some conflicting data among studies that may confuse the issue. This is true because of the complex nature of the human body and its physiology -- and the truism that medicine is not an exact science. As with any aspect of medical therapeutics, each of us must evaluate the information that is available, along with our needs and desires and measure these against any potential risk. Your Optimal Health team can help you understand and evaluate all the information available. Obviously we feel that for most patients the benefit of HGH therapy far outweighs the risk. Only you however, can make the final decision. To put it into context, similar controversy has surrounded the use of estrogen in post-menopausal women for the past 30 years. We are now aware that certain studies have shown that estrogen replacement in women may increase the risk of breast and endometrial cancer along with other risk factors. However, because of estrogen's proven protective effects against many other diseases (alzheimer's disease, heart disease, osteoporosis and colon cancer), the overall mortality is lower in women who take estrogen than it is in those who do not. It will be some time before there is as much data on HGH as there is on estrogen, yet we are convinced that for most people who have lower IGF-1 levels, the benefits of HGH replacement therapy outweigh the risks. [ 12 ] Optimal Health & Rejuvenation Center, LLC 2006

18 STAYING YOUNG WITH HGH There are many things one can do to "staying young." Being born with good genes, eating healthy foods, exercising regularly, watching your weight, avoiding stress, and getting enough quality sleep. Good habits we must all practice, yet these practices in fact, only delay and postpone the signs, symptoms and problems associated with aging. A medically supervised HGH program has many benefits that can improve life on many levels. All of the choices that you already have about healthy living are still true and should be practiced, whether you are starting HGH therapy or not. If you are serious about an anti-aging program, remember all good programs should consist of discipline and commitment in five major areas: HGH replacement, proper diet, nutrition, exercise, and restful sleep. 1. HGH REPLACEMENT 2. PROPER DIET 3. NUTRITION 4. EXERCISE 5. SLEEP For years, researchers have hunted for a more dramatic way to staying young. Now, after centuries of seeking the "Fountain of Youth" it appears that medical science has achieved the first major breakthrough, Human Growth Hormone therapy. The first major study showing the promise of HGH therapy was published in the New England Journal of Medicine (Rudman; 323: ). This study divided 21 men (between the ages of 60 and 80) with IGF- 1 levels less than 350 IU per liter into two groups: 12 test subjects and 9 control subjects. A 6-month period of data collection was followed by a 6-month period in which the test subjects received HGH injections. The results were promising: increases in lean muscle mass, decreases in adipose fat tissue, and increases in vertebral bone height. All test subjects had measurable increases in HGH levels, as measured by IGF-1 blood values. The control subject group on the other hand, had none of these results. The effects of six months of human growth hormone on body mass and adipose-tissue mass were equivalent in magnitude to the changes incurred during 10 to 20 years of aging. For a complete background on recent and past HGH studies and information on HGH therapy in general, we suggest the book entitled Grow Young With HGH by Dr. Ronald Klatz (ISBN ). [ 13]

19 HEALTHY LIVING AND HGH Important issues to consider with a HGH replacement therapy program. > Exercise If you do not have an exercise program, you should start one. It does not require membership at a gym. Find a program that fits your lifestyle---walking, swimming, sports---anything that provides a reasonable workout several times a week. Studies have shown that HGH replacement therapy is more effective for people who exercise regularly. > Nutrition Continue with a good nutrition supplement program that includes a good quality multi-vitamin and additional vitamin supplements containing vitamins A, C and E along with mineral supplementation. > Begin with small doses - like many hormones, HGH is potent and effective. More is not better! If you are just starting HGH replacement therapy, begin with small doses in the range of 0.1 to 0.8 mg per day. Remember that the goal of HGH replacement therapy is to restore your HGH production level to normal to upper normal ranges- --not to exceed normal production. > Morning injections - Your own production of HGH occurs mostly at night, during periods of deep sleep. By injecting HGH at bedtime, you have the potential of discouraging your normal HGH production. So, it is better to inject in the morning. Also, many physicians recommend giving your body 1 to 2 "days off" per week. > Watch for adverse side effects - Almost all adverse effects of HGH (water retention, sore muscles, Carpal Tunnel Syndrome) are related to doses that are too high. If you are retaining water, ask your Counselor and/or Physician at Optimal Health about correcting your dosage. Prolonged overproduction of HGH can cause serious side effects. This can occur in adults who have a hormonal disorder called acromegaly. This disorder is characterized by abnormal growth of the hands and feet. Soft tissue swelling of the hands and feet is often an early symptom, with patients noticing a change in ring or shoe size. If you notice any signs associated with acromegaly, consult your Optimal Health Counselor and/or Physician. > Sleep Sleep is important to good health and it appears that several anti-aging hormones, including HGH, are produced at higher levels during sleep than during waking hours. On average, 8 hours of sleep is sufficient rest for our bodies. > Proper diet The daily intake of high glucose carbohydrates, will retard the efforts you are putting into your antiaging program. You must keep processed foods to an absolute minimum. Focus on diets containing plenty of vegetables, fruits and plenty of water. Buying a book that gives the glucose ratings of various foods will help you avoid a high glucose intake. > Watch your weight HGH replacement therapy is not a weight loss program. While it does tend to build lean muscle and reduce fat, many users also find increased appetites. > Skin and sun When you are in the sun, use sun protection. Also use a good moisturizer morning and night to help balance out and maintain your skin. > Don't smoke If you have started HGH replacement therapy to look and feel better, smoking will only burden the process. Among other things, smoking makes your skin look older. > Water Drink plenty of water---every day! A hydrated body functions better and aids good health. [ 1 ]

20 Optimize your life. TE STOSTERONE REPLACEMENT THERAPY

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22 INTRODUCTION TO TESTOSTERONE THERAPY Testosterone is the androgenic hormone primarily responsible for normal growth and development of male sex and reproductive organs, including the penis, testicles, scrotum, prostate, and seminal vesicle. It facilitates the development of secondary male sex characteristics such as musculature, bone mass, fat distribution, hair patterns, laryngeal enlargement, and vocal chord thickening. Additionally, normal testosterone levels maintain energy levels, healthy mood, fertility, and sexual desire. The testes produce testosterone regulated by a complex chain of signals that begins in the brain. This chain is called the hypothalamic-pituitary-gonadal axis. The hypothalamus secretes gonadotropin-releasing hormone (GnRH) to the pituitary gland in carefully timed pulses (bursts), which triggers the secretion of the leutenizing hormone (LH) from the pituitary gland. Leutenizing hormones thus stimulate the Leydig cells of the testes to produce testosterone. Normally, the testes produce 4 7 milligrams (mg) of testosterone daily. Testosterone production increases rapidly at the onset of puberty and starts to decrease thereafter. It decreases rapidly after age 40 (from 20% to 70% of peak level by age 70). Approximately 50 million men in the United States experience testosterone deficiency and approximately 700,000 receive treatment. As men age, the decline in male sex hormones, called androgens, results in decreased muscular strength, decline in energy, decreased libido and an increased risk of erectile dysfunction resulting in poor sexual performance. Testosterone production declines naturally with age. Testosterone deficiency (TD) may result from disease or damage to the hypothalamus, pituitary gland, or testicles which inhibits hormone secretion and testosterone production, known as hypogonadism. Depending on age, insufficient testosterone production can lead to abnormalities in muscle and bone development, underdeveloped genitalia, and diminished virility. For men with a low level of free testosterone in the blood, testosterone or other Hormone Replacement Therapy (HRT) can be considered. HRT can help men with low testosterone levels, increase their libido and sexual arousal. Testosterone replacement also can improve muscle strength and bone mineral density in men and women with low levels of testosterone. Androgens such as testosterone, also promote an overall decrease in fat, an increase in muscle strength and lean body mass. Testosterone replacement therapy has been shown to lift mood and decrease anxiety. It may enhance orientation and memory and it may also have antidepressant effects. Whether your goals are anti-aging or physical development, Optimal Health has a cost-effective and comprehensive testosterone replacement therapy program designed to get the results you want. By contacting us, you have taken the first step toward better health, increased energy and improved sexuality. Optimal Health offers many testosterone programs that are designed to safely replenish and replace your body's own production of testosterone. Figure 3. Testosterone decline (general approximations): Age: Testosterone: ng/dl [ 17]

23 TESTOSTERONE DEFICIENCIES AND BENEFITS Testosterone deficiency signs - LOW ENERGY AND STAMINA - LACK OF SEX DRIVE AND DESIRE - LOSS OF MEMORY & FOCUS - MUSCLE WEAKNESS - HIGH LDL CHOLESTEROL LEVELS - MOOD DISORDERS - DEPRESSION - HAIR LOSS Testosterone replacement benefits + BUILDS LEAN MUSCLE + IMPROVES MEMORY + IMPROVES MOOD + IMPROVES ATHLETIC PERFORMANCE + ENHANCES SEX DRIVE + IMPROVES SEXUAL PERFORMANCE + LOWERS LDL CHOLESTEROL + INCREASES ENERGY + PROTECTS AGAINST HEART DISEASE [ 18 ]

24 TESTOSTERONE DEFICIENCY Types and Causes Hypogonadsim is classified by the location of its cause along the hypothalamic-pituitary-gonadal axis: Primary, disruption in the testicles Secondary, disruption in the pituitary Tertiary, disruption in the hypothalamus. Disease, injury, surgery, and drug side effects can cause hypogonadism and testosterone deficiency. Hypogonadism is congenital or acquired, depending on the nature of the underlying condition. Congenital causes include the following: Anorchia (vanishing testes syndrome; causing primary hypogonadism) Cryptorchidism (failure of testicles to descend into scrotum; causing primary hypogonadism) Hormonal deficiency (e.g., deficiency of leutenizing hormone (LH) releasing hormone; causing secondary or tertiary hypogonadism) Kallmann Syndrome (insufficient hypothalamic GnRH production; causing tertiary hypogonadism) Klinefelter Syndrome (underdeveloped testicles; causing primary hypogonadism Acquired causes include the following: Chemotherapy Damage procured during surgery to the pituitary gland, hypothalamus, or testes Glandular malformation Head trauma (affecting the hypothalamus) Infection (e.g., meningitis, syphilis, mumps) Isolated LH deficiency (e.g., Fertile Eunuch Syndrome) Radiation Testicular trauma Tumors (of the pituitary gland, hypothalamus, or testicles) -Continued [ 1 ]

25 TESTOSTERONE CONDITIONS & TREATMENT Signs and Symptoms Signs depend on the age of onset and the duration of hormonal deficiency. Congenital hypogonadism is generally characterized by underdeveloped genitalia (testes that do not descend into the scrotum) and, occasionally, undeterminable genitalia. The develop-ment of hypogonadism near puberty can result in gynecomastia (enlargement of breast tissue), sparse or absent pubic and body hair, an underdeveloped penis, testes, and muscle. Adult men may experience diminished libido, erectile dysfunction, muscle weakness, loss of body hair, depression, and other mood disorders. Complications Testosterone deficiency has been linked to muscle weakness and osteoporosis. Some studies show, proximal and distal muscle weakness detected in 68% of men with primary or secondary hypogonadism. Spinal, trabecular, and radial cortical bone density may also be significantly reduced in testosterone-deficient men. 30 % of men with spinal osteoporosis have long-standing testosterone deficiency, and one-third of these testosterone-deficient men have subnormal bone density that puts them at risk for fractures and/or injury. Diagnosis Serum and blood testing is done to determine the availability of testosterone and levels of LH and GnRH in the body. Men with low testosterone, in whom normal or high gonadotropin levels are found, typically have primary hypogonadism; which may stem from a problem in the testicles. Secondary and tertiary types, caused by problems of the hypothalamus or pituitary gland, often result in low testosterone and low gonadotropin levels. Other tests involve injecting GnRH or clomiphene citrate (an estrogen) to stimulate a diagnostic response within the hypothalamic-pituitary gonadal axis. Rarely, is there a need for a testicular biopsy, usually only in cases where sperm is absent from ejaculate despite normal testicle development is it necessary. A biopsy, which involves using a needle to collect a sample of testicular tissue, may detect a malfunction in sperm production. Treatment Treatment involves hormone replacement therapy. The method of delivery is determined by age and duration of deficiency. Optimal Health offers many testosterone replacement therapy programs, designed to deliver maximum results in the safest way possible. Who qualifies for testosterone therapy programs. Treatment for adults is aimed at maintaining secondary sex characteristics, improving energy, strength, mood, and feelings of well-being, and preventing bone degeneration. Modes of delivery include transdermal (gel), injection and oral forms of testosterone. Transdermal delivery (absorbed through the skin) is used to administer therapeutic agents for hormone replacement. Transdermal replacement therapy with a gel or cream is becoming the most common method of treatment for testosterone deficiency in adults. It establishes and maintains adequate serum levels without causing significant side effects. The most common side effects associated with transdermal testosterone therapy may include itching, discomfort, and irritation at the site of application. Some men may experience fluid retention, acne, and temporary gynecomastia. If necessary, Optimal Health can prescribe medications that help prevent these side effects. This method delivers testosterone for 24 hours when used properly. The gel must be allowed to dry on the skin before contact with clothing and must be applied at least 6 hours before showering or swimming. The gel should not be applied directly to the genitals. [ 20]

26 Kallmann Syndrome in adults may be treated with human chorionic gonadotropin, (HCG) which can cure cryptorchidism and infertility. Optimal Health has programs that include HCG and can answer any of your questions. Intramuscular (IM) injection is used less frequently because it is associated with erratic testosterone levels. Levels that shift abruptly between doses may cause fluctuating moods, disrupt energy levels, and interrupt your libido. Even as such, many athletes and sports people favor IM injections because of the quick results and concentrated method. Optimal Health has programs that include the most popular and safest forms of injectable testosterone such as Nandrolone Decanoate, Cypionate and Propionate. Possible side effects The goal of testosterone replacement therapy is to achieve normal to optimal levels of testosterone. For most patients, testosterone replacement therapy is safe. Possible side effects, however, include water retention, male pattern baldness, gynecomastia (enlarged breasts). The oral forms are also associated with some liver problems and the use of large doses of testosterone (in bodybuilding, for example) increases the risks of these side effects. Decreased normal testosterone production, prolonged or excessive testosterone therapy prompts the pituitary gland to stop producing the hormone gonadotropin. This, in turn, suppresses normal testosterone and sperm production, accompanied by shrinkage of the testicles and frequent or continuing (and sometimes painful) erections. Because of this, testosterone replacement therapy is usually prescribed in cycles. After a 2- or 3-month period, the patient takes a different drug (such as HCG) that stimulates the testicles to begin production again. Remember, the Optimal Health team will give qualified guidance through the various programs available and individually counsel each patient through the expected benefits and any potential risks. [ 21]

27 TESTOSTERONE PROGRAMS AVAILABLE TESTOSTERONE Testosterone Cypionate: Long acting oil-based injectable, which will keep testosterone levels sufficiently elevated for approximately two weeks. It is said to produce a slightly higher level of water retention, and slowing down the release of testosterone therefore, causing less production of estrogen build-up. However, since the testosterone is high in estrogen conversion, it can cause gynecomastia, this is why an accompanying drug like Nolvadex is added. Although active in the body for a much longer time period, Cypionate is injected on a weekly basis. Testosterone Propionate: Oil-based injectable containing ester which slows down the release for a few days. The Propionate is much faster acting and requires a much more frequent dosing schedule that can cause irritation at the site of injection. At the same time the buildup of estrogen and DHT will be pronounced, increasing the risk of gynecomastia. Users therefore need to add an antiestrogen such as Nolvadex to counteract this occurrence. Propionate is a powerful mass-building drug, capable of producing rapid gains in size and strength. Nandrolone - Decanoate (Deca): Extremely long acting compound, with a slow release time of up to three or four weeks. It exhibits much weaker androgenic properties than testosterone and is less likely to cause unwanted androgenic side effects. This can also show an extremely lower tendency for estrogen conversion, making water retention a nonissue. Deca has shown not only to be effective at safely bringing up the lean body weight, but is beneficial to the immune system and works to lubricate the joints. Deca is not known as a "fast" builder. The slow onset and its mild properties make this more suited for cycles with of a longer duration. With a cycle lasting 8 to 12 weeks, one can expect to elicit a slow even gain of quality mass. Testosterone Gel: A clear, colorless, alcohol based gel that gets applied once daily to the inner groin (being careful not to apply directly to genitals). Upon application, the gel dries within a few minutes and the skin absorbs the testosterone. This serves as a reservoir for the hormone, which slowly enters the bloodstream. Normal testosterone levels are usually achieved soon after the application. One can experience a significant increase in libido (sex drive) an increase in lean body mass, reduction of fatigue, increased bone density, improved energy levels, and muscle strength and endurance. (ng/ml) (ng/ml) (ng/ml) (ng/ml) Figure Figure Figure 4.3 Testosterone - Cypionate Injectable DAY 20 Testosterone - Propionte Injectable DAY 25 Testosterone - Nandrolone Decanoate Figure 4.4 DAY Testosterone - Gel DAY [ 22] Optimal Health & Rejuvenation Center, LLC 2006

28 TESTOSTERONE ANCILLARY SUPPLEMENTS ESTROGEN BLOCKERS Arimedex (Anastrozole): A non-steroidal agent, Arimidex is the aromatase inhibitor of choice. Especially appropriate when using substantial amounts of aromatizing steroids or when one is prone to gynecomastia while using moderate amounts of such steroids. Arimidex can achieve a high degree of estrogen blockage. However, it is possible to reduce estrogen too much with Arimidex---for this reason blood tests, or the less preferred salivary tests, should be done after the first week of use. This will determine if the dosing is correct. Arimidex's mechanism of action is in blocking conversion of aromatizable steroids to estrogen. Clomid ( Clomiphene Citrate): Not an anabolic steroid, but a synthetic estrogen with both agonist/antagonist properties, and is very similar to Nolvadex. It is used to block negative feedback of estrogens which can cause gynecomastia and enhances the release of LH and FSH causing natural testosterone production to increase. This is most beneficial at the conclusion of a testosterone cycle. If testosterone levels are not brought back to normal, a dramatic loss in size and strength can occur. Dosages range from mg daily over a four to six week period to bring testosterone production back to normal levels. Nolvadex (Tamoxifen Citrate): A non-steroidal agent that demonstrates potent antiestrogenic properties. This drug also shows the ability to increase production of FSH and LH in the male body. This is accomplished by blocking negative feedback inhibition caused by estrogen which can cause gynecomastia. Since a higher release of LH can stimulate the Leydig s cells in the testes to produce more testosterone, Nolvadex can have a positive impact on one s serum testosterone level and help restore a balance in hormone levels. It can also increase the rigidity and definition in the muscles. Nolvadex should be taken on the third week of a testosterone cycle until the point when natural testosterone levels are well under control. Dosages are typically in the range of 10 to 30mg daily. Teslac (Testalactone): Also an estrogen blocker, would be used with HGH instead of Nolvadex or Chlomid, which can suppress the effects of HGH. Teslac blocks negative feedback caused by estrogen and has the ability to increase production of FSH & LH. This stimulates the leydigs cell in the testes to produce more of your own natural testosterone. Also helps to harden and define muscles as well as help restore a balance in hormone levels. LH HORMONE RELEASER Novarel/HCG (Human Chorionic Gonadotropin): Used to stimulate the production of endogenous testosterone. It has the ability to mimic the LH, a pituitary hormone that stimulates the testes to manufacture testosterone. The excessive stimulation can likewise cause the testicles to rapidly return to their normal size and level of activity. Dosages range from mg for a duration usually no longer than 2 or 3 weeks. A combination of HCG and Nolvadex appears to be very synergistic, HCG providing an immediate effect on the testes (shocking them out of inactivity) while the antiestrogenic helps to block inhibition of gynecomastia. Figure 5 WEEK Sample Ancillary Supplement Cycle Testosterone Estrogen Blocker HCG TESTOSTERONE STROGEN BLOCKER Arimidex Nolvadex Clomid Teslac HCG Figure 5 is an estimated chart for an average 3 month testosterone cycle. Always consult your physician and follow the recommended prescribed dosage for each therapy and ancillary supplement program combination. These statements have not been evaluated by the Food and Drug Administration. Optimal Health & Rejuvenation Center, LLC 2003 Optimal Health & Rejuvenation Center, LLC 2006 [ 23]

29 Optimize your life. T H A N K Y O U Thank you for your interest in Optimal Health & Rejuvenation Center. By contacting us, you have made the first step in the right direction towards a vastly improved lifestyle on every level. For additional information please contact Optimal Health at Information listed in this document is provided for informational purposes and is not meant to substitute for the advice provided by your own physician or other medical professional. You should not use the information contained herein for diagnosing or treating a health problem or disease, or prescribing any medication. If you have or suspect that you have a medical problem, promptly contact your health care provider. 2 These statements have not been evaluated by the Food and Drug Administration.

30 Optimize your life. For additional information please contact Optimal Health & Rejuvematin at

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