At the Florida Center for Hormones and Wellness, the waiting room has a therapeutic calm about it. The soothing atmosphere is the first impression John Carrozzella, MD, MSMS a hormone and metabolic wellness specialist, wants his patients to experience when they walk in his doors of his clinic nestled in the heart of the Dr. Phillips community. The Center is not a typical doctor’s office, offering nontraditional approaches to treating patients with hormonal deficiencies, sexual dysfunction, metabolic imbalances, auto-immune disorder and cosmetic needs. Carrozzella is passionate about his work and meeting the needs of his patients, many of whom have exhausted all other options and come to him looking for a solution to their health problems which are wreaking havoc on their lives.
For Carrozzella, his medical career began in a completely different field over 25 years ago. After graduating from Yale University with honors in molecular biophysics and bio-chemistry he headed to the University of Cincinnati for medical school where he graduated in the top 5% of his class with a Junior Year award of Alpha-Omega-Alpha. From there he pursued a career in orthopedics and practiced as an orthopedic surgeon for decades. But over those years, as the world of medicine and healthcare began to change he began looking for a change himself. However, he never expected how he would stumble across his new specialty.
“About 10 years ago my wife Sheryl went through dramatic and sudden menopause after neck surgery. Her life was miserable,” describes Carrozzella. “Here I was a doctor and there was nothing I could do to help her. Other doctors told us there was nothing they could do. So, we did our research and that’s when we found a physician who was doing hormone pellet therapy, it was an option that changed her life and mine.”
Burned out from a career in orthopedics and with his wife undergoing a therapy that improved her life dramatically, Carrozzella began looking down a new path of medicine and discovered the American Academy of Anti-Aging and Aesthetic Medicine.
“I found they offered exactly what I wanted to learn more about, anti-aging and wellness. And the best part about it was that everything they teach is evidence based medicine,” said Carrozzella. “Sheryl’s life turnaround was so dramatic it prompted me to change my whole career.”
And change it he did. Ever a scholar of medicine, Carrozzella began looking for options to become an expert in the fields of hormone therapy, wellness medicine and aesthetics. He became an Advanced Fellow of the American Academy of Anti-Aging and Aesthetic Medicine. From there, Dr. Carrozzella went on to earn a Master’s Degree in Metabolic and Nutritional Medicine from the University of South Florida School of Medicine. He earned a Certificate in Advanced Endocrinology, also from USF. In addition, he be-came a Diplomat of the American Board of Anti-Aging and Regenerative Medicine after passing both oral and written examinations. Dr. Carrozzella has always understood that the area of hormone therapy has been quite controversial in medicine, so to make sure that he was as familiar with the world’s literature on the subject as possible, he found a mentor in Dr. Neal Rouzier, an international lecturer and an expert in the field, who serves as Medical Director of The Preventative Medicine Clinics in Palm Springs, California.
“I believe in training and I set out to be as highly trained as anybody in this field and specialty,” said Carrozzella.
Bio-Identical Hormone Replacement Therapy (BHRT)
In August of 2015, Carrozzella opened his practice in the Dr. Phillips section of Orlando and dedicated his career full time to hormones, metabolic medicine and non-surgical aesthetics. He offers several literature-based yet nontraditional treatments, among them, bio-identical hormone replacement therapy (BHRT). According to Dr. Carrozzella, BHRT uses a safer and a more natural approach to hormone therapy when compared to the synthetic hormones Premarin® and Provera®. Even though they are manufactured in a lab, the bio-identical hormones estrogen, progesterone and testosterone have the exact same chemical structure as do the natural hormones. And, as he points out, when used propertly, these “near-natural” hormones are easily recognized by the body and they exert the same physiologic effects on the body as do the natural hormones.
For Carrozzella, it is important for patients and other physicians alike to fully understand the difference between bio-identical and traditional hormone therapy as well as the history behind both.
“Traditional hormone therapy, such as Premarin® (conjugated estrogens) and Provera® (medroxyprogesterone acetate, a synthetic progestin) was used for many years up until the early 2000s when a major landmark study, the Women’s Health Initiative, was published. That study pointed out that extra potent horse urine estrogens (Premarin®) tended to over stimulate breast tissue and when combined with the magnifying effects of Provera® breast cancer rates, in women taking these medications, increased. The resulting panic and fear about “hormones” overtook the country and the world. Unfortunately, all hormones were improperly judged by the results of this study and even ones with good literature behind them were shunned leaving millions of women to ‘suffer,’” explains Carrozzella. “When we look at bio-identical hormones there are no well-done studies that show that they cause any medical problem, disease or illness when used properly and in appropriate dosages. To the contrary, the medical literature is overwhelming supportive of the fact that when women and men use bio-identical hormones to restore their diminished endogenous hormones there are declines in many
diseases of aging such as a reduction in the incidence of cardiovascular disease, colon cancer, diabetes, osteoporosis, Alzheimer’s disease and even some cancers. When men and women are hormonally balanced mortality rates decline and they live longer and healthier lives. I’ve witnessed it first hand in my own family with my wife Sheryl and I witness it every day in my clinic.”
Carrozzella is trained in all modalities of BHRT, but is partial to pellet therapy. BHRT can be delivered via pellets, pills, creams, under the tongue sublingual pills and injection.
“Pellets are an ideal option for many patients because the hormone can be delivered at a nice constant level,” explains Carrozzella.
In pellet therapy, a pellet, the size of a grain of rice comprised of purified hormone, is implanted under the skin and slowly releases hormone therapy over four months.
Determining the right modality is about assessing each individual patient’s situation. For Carrozzella it’s about meeting the patient’s needs and adopting a treatment plan that is right for that specific patient.
The Patient Experience
At the Florida Center for Hormones and Wellness, women and men between 45 and 60 years old make up the core age group for bio-identical hormone therapy. And, while most hormone imbalances occur within this age range, there are many hormonal and metabolic conditions that exist both at younger and older age ranges, so there are many interventions that can be done for them as well.
“We see more women than men because the hormonal changes that women go through are more dramatic and less addressed by traditional medicine,” says Carrozzella.
Patients of the Center first undergo a detailed general medical history evaluation – a specific hormonal history and focused exam. Women are asked to describe their lifetime experiences with hormones from when they began their menstrual periods to present day. Then Carrozzella looks at the medicines they are on and does lab work. Specifically, he looks at a wide variety of hormone values including thyroid.
“I don’t think it is correct to treat without measuring and monitoring, but I don’t treat just numbers, I treat symptoms and outcomes of my patients,” says Carrozzella. “I am looking for symptomatic improvement, functional improvement and improvement in associated physiological parameters (like glucose and cholesterol metabolism).”
Carrozzella pays particular attention to the thyroid.
“The thyroid is the master hormone. It’s probably the most widely known metabolic hormone that there is. It can cause such profound abnormalities in the body,” he explains. “I find it interesting that a woman can say she has dry skin and thinning hair and she describes other symptoms that suggest hypothyroid; yet she is told by other doctors that her thyroid is fine. I have had many patients whose labs were on the lower end of normal; if they are symptomatic, they are functionally hypothyroid. Now, if they are treated by elevating their free T3 level from the lower quintile to the upper quintile the improvement in their symptoms, metabolism and their overall sense of well-being is dramatic. In my experience, female patients in particular, report that they feel better when their thyroid levels are in the higher end of the normal range.”
BHRT and nontraditional treatment myths
Carrozzella is very aware of the skeptics of bio-identical hormone replacement therapy.
“There are so many things that affect the cell function and physiology that are often overlooked in traditional medicine,” he explains. “This not only holds for the thyroid but all hormones. The cell receptor is waiting for the hormone to come along and plug into it like a key. The hormone then ignites a reaction that leads to a physiologic action that then leads to symptomatic improvement. Those receptors are so often damaged by factors such as inflammation, external radiation, chronic infections and toxicity that sometimes it takes more of the hormone to get the receptor to do what it is supposed to.”
He looks to his patient outcomes and research when defending his practice for hormone therapy replacement. He feels it is important to dispel many of the common myths associated with nontraditional hormone treatments and hormones in general.
Does BHRT cause cancer or blood clots?
“Many studies show that testosterone is breast cancer protective and progesterone is as well. Overall women with balanced hormones have cancer at lower rates,” says Carrozzella. “As for blood clots, there has been no incidence of blood clots with bio-identical hormones, but there are increased incidences with synthetic hormones.”
Do women need testosterone?
“Yes,” says Carrozzella. “Women do need testosterone and it leads to a better quality of life. Women have less disease and their relationships are better when the hormones are balanced. And, this includes testosterone.”
For men, a couple of prevalent myths out there are that testosterone can lead to higher risk of heart disease and that it also causes or worsens prostate cancer.
To the contrary. “There is an overwhelming abundance of literature that has shown that men who have low levels of testosterone have higher rates of heart disease. When they are then supplemented to higher testosterone levels, their cholesterol profiles improve and they develop less heart disease,” says Carrozzella. “There are recent articles that suggest otherwise but they were poorly done studies with flawed analysis. There is lots of historical evidence to show that testosterone is very heart beneficial. As for prostate cancer, the old saw that using testosterone in men is like “throwing gasoline on a smoldering fire” came from a very old “study” of just one patient. More recent studies have shown that older men with low levels of testosterone get more aggressive prostate cancer than men with higher levels. In fact, new research going on at Harvard University right now is looking at actually treating prostate cancer with testosterone. The research is in its early stages, but it is very promising.”
For Carrozzella, the passion for his career in hormones, wellness and metabolic medicine comes directly from his patients and from his wife who inspired him to pursue this path of medicine.
“I see women in pain, who have been given no hope for their condition. And to turn that around and give them hope is unbelievable,” he describes. “My patients say they never thought they would feel normal again. Men thank me for giving them their wives back and vice versa.”
Carrozzella knows that to get others in the medical community to understand the benefits of the therapy he offers is to help them see just how his treatments directly benefit a patient’s life and longevity.
“A typical male patient who I see experiences mental cloudiness, feels like he can’t keep up with his peers, his enjoyment in life is declining, he can’t stay in shape, he can’t perform sexually as he once could,” explains Carrozzella. “He has been prescribed pills and perhaps testosterone cream, but no one is really looking at these patients and seeing what their concerns are.”
Female patients experience some of the same symptoms, in addition to hot flashes, forgetfulness, irritability and depression.
“In traditional medicine, these symptoms are treated with over the counter remedies and often anti-depressants,” says Carrozzella. “Sadly enough these options aren’t meeting these women’s needs. They are band-aids, not solutions to their problems.”
Carrozzella encourages primary care physicians and gynecologists to consider BHRT, and the life changing effects it has on large numbers of patients.
“I can’t tell you how many times women break down in tears with the dramatic changes they’ve experienced because of BHRT,” describes Carrozzella. “Many times I hear that hot flashes and night flashes are gone within 72 hours of receiving BHRT. Typically, energy levels pick up in seven to 10 days, sex drives improve in 10 days to two weeks, within a month they report that they are thinking and acting clearer. We check blood levels in six weeks and usually by six to 12 weeks post BHRT they are feeling more normal, they are alert, sharp and active. They are seeing results in the gym. Their hair is thicker. Their sexual pain is gone. Their lives are better.”
But, Carrozzella points out that for this growing field the key is for referring physicians to find an appropriate and well trained specialist.
“Hormone and metabolic wellness is now becoming mainstream and is being taught at major medical schools such as USF, George Washington University and the University of Arizona,” he explains. “This is a specialized field that requires detailed and intimate knowledge. The key is to refer patients to a trained professional in this specialty who will evaluate the patient carefully and set out a treatment plan and monitor that plan accordingly.”
Once an orthopedic surgeon, Carrozzella is proud of the transition that his medical career has undergone. He considers his work as a hormone and metabolic wellness specialist a gift, one that makes a difference in his patients’ lives on a daily basis.
“I help people in some of the most tumultuous years of their lives. With the use of BHRT, metabolic medicine and a variety of aesthetic medicine options I can give them back their normalcy so they can have physical intimacy and togetherness and focus on important things in their lives,” he recounts. “I have been given a tremendous gift that I can then turn around and give to people. It is a life changing gift.”
SERVICES OFFERED AT Florida Center for Hormones and Wellness
- Women’s Hormone Replacement
- Men’s Hormone Replacement
- Low Testosterone
- Male and Female Sexual Dysfunction
- Erectile Dysfunction
- Advanced Endocrinology and Hormone Management
- Platelet Rich Plasma (PRP)
- O-Shot Procedure
- Priapus Shot Procedure
- Vampire Face Lift
- Vampire Facial
- Vampire Breast Lift
- Liquid Facelift
- Metabolic and Functional Medicine
- Auto-immune disorders
By Katie Dagenais