Testosterone Replacement Therapy in Palm Beach

Aging is difficult enough for women without having to deal with declining hormones. Women of Palm Beach often complain of a diminished sense of wellbeing, chronic fatigue, and a loss of libido just to mention a few symptoms of hormone imbalance.

For many women there is a tremendous void in treatment of menopausal symptoms. Hot flashes, mood swings and low or no sex drive are just the tip of the iceberg. Some earlier hormone imbalance symptoms of estrogen deficiency are frequent waking at night. Many others are present, including “mental fogginess.” A woman’s short-term memory retention may be dwindling and her concentration and focus isn’t as good as it used to be. Frequently, women may experience some loss of energy to the point that they actually slide into symptoms of chronic fatigue.

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In addition, women may experience some mood swings and irritability, and at the extreme may actually develop feelings of depression. With the loss of energy and chronic fatigue, females find themselves unable to exercise as much as in the past, or to recover as quickly when exercising. Women often find themselves increasing weight gain in spite of attempts at exercising. One hormone imbalance symptom that is not frequently discussed is the loss of sex drive and diminished libido. Not only is energy level and sense of wellbeing diminished, but anticipation and enjoyment of sexual activity is waning as well.

Ten Common Myths About Testosterone Treatment For Women

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Breast Cancer is the cancer that develops in the breast tissues mostly in the inner lining of milk ducts or in the lobules which supply milk to the ducts. Depending on the place of origination, they are known as ductal carcinoma, if originated in the milk ducts or lobular carcinoma when originated in the lobules. Breast cancers are also classified as hormone-positive or a hormone-negative cancer which is decided based on their sensitivity to hormones like progesterone and estrogen.

The options available for breast cancer treatment depend on the type of breast cancer and the staging results. Staging is the process in which the disease spread and its progressive extend is determined. Though it is the most common non-skin type of cancer in women and is considered one of the fatal types of cancer, there are many advanced breast cancer treatment options which can help cure this disease if detected early.

Breast Cancer Treatment Plan

Once the cancer has been diagnosed, the doctors evaluate the pathology report and form a plan that would suit the type of cancer and the stage to which the disease has progressed. Treatment modes aim at reducing the spread of the disease, destruction of the diseased cells and reduction of chances for re-occurrence in future. The doctors would choose a single or a set of treatment options based on the patient's medical conditions which they may evaluate periodically.

Types of Breast cancer treatment methods

The treatments available are in general classified as standard methods and clinical trial methods. Standard methods are those that are currently practised for the cure of breast cancer while clinical trials are those that are currently being tested for more efficient results. The standard methods of breast cancer treatment include surgery, hormone therapy, chemotherapy, radiation treatments and targeted therapy.

Surgical method of Breast Cancer Treatment

Surgery is one potential option for removing the cancerous cells from the body. The entire breast or a partial portion of the breast is removed depending on the level of spread and the stage to which the disease has progressed. Based on the level of operation that is required to remove the cancerous cells, the surgeries are differentiated into three types as below.

* Breast-conserving Surgery - This is an operation where only the portion of the breast that contains the cancer is removed and not the breast itself. If the surgery requires removal of just the tumor in the breast and a little amount of tissue, it is known as Lumpectomy or is known as Partial mastectomy if it includes removal of partial amount of the breast along with a considerable amount of normal tissues. These kinds of surgeries may also include removal of lymph nodes under the arm which are used for the purpose of biopsy. Such dissection done either along with the surgery or after it is known as lymph node dissection.
* Total Mastectomy - This kind of surgery targets on removing the whole breast which is infected with the cancerous cells. This also requires removal of lymph nodes for the purpose of biopsy.
* Modified radical Mastectomy - This is the surgery that removes extensive portions to get rid of the cancerous cells. The complete breast affected by cancer along with certain lymph nodes under the arm and the chest muscle lining is removed by this process of surgery. In certain cases, even part of the chest wall muscles that are affected are removed by this surgery.
* Radical Mastectomy - This surgery removes the complete breast, chest wall muscles and all the lymph nodes under the arm. This kind of surgery for breast cancer treatment is also known as Halsted radical mastectomy.

These surgeries can also be followed by other modes of breast cancer treatment methods like chemotherapy, hormone therapy or radiation therapy to kill any presence of cancer cells. Such kinds of treatment that helps in prevention of cancer re-occurrence is known as adjuvant therapy. Some patients can also consider the option of breast implants to rebuild the removed breast shape after a mastectomy.

Chemotherapy

This kind of treatment helps in killing the cancerous cells or prevents them from growing by means of internal administration of drugs. The way of drug administration can be either through the blood stream that spreads throughout the body which is known as systematic chemotherapy or is placed directly in the cerebrospinal fluid or any specific organ which is known as regional chemotherapy.

Hormone Therapy

This kind of breast cancer treatment includes the introduction of substances that negate the effect of hormones which induce cancerous growth. Estrogen has been known to induce the growth of breast cancer in certain cases. One of the treatment methods includes prevention of ovaries from secreting the hormone estrogen and such a method is known as ovarian ablation. The hormonal therapy includes the usage of aromatase inhibitor which decreases the estrogen secretion in the body. Aromatase inhibitors are given for hormone-dependent breast cancer patients who are in postmenopausal stage while tamoxifen is used in cases of metastatic breast cancer. Aromatase inhibitors are also in general used as a means of adjuvant therapy after continued use of tamoxifen for two years or more.

Radiation Therapy

High energy x-rays are in general used as an alternative for drugs to kill the cancer cells and prevent them from growing.

Targeted Therapy

Another type of treatment that helps in destroying the cancer cells without any harm to the normal cells is called targeted therapy. The targeted therapies used in breast cancer treatment are in general of two types, Monoclonal antibodies and Tyrosine kinase inhibitors.

* Monoclonal Antibodies - These kinds of substances are antibodies that are made from a single type of immune system cell which has the potential to identify and destroy cancer cells. They are also sometimes used to carry toxins or drugs to the cancer cells to bring in effective destruction of the cells. Trastuzumab is a monoclonal antibody that is used in treating patients of breast cancer. This method can be clubbed along with chemotherapy as a means of adjuvant therapy.
* Tyrosine Kinase inhibitors - These drugs block signals that are needed for tumor growth and are in general used in combination with other anti-cancer drugs. Lapatjnib is one such inhibitor which helps block the HER2 protein inside the tumor cells and is used effectively for treatment of HER2- positive breast cancer patients.

How to Raise Your Testosterone Levels With Testosterone Cream

hormone replacement therapy pellets

There's a growing interest in testosterone hormone replacement for treating symptoms related to aging. You've probably seen advertisements of virile, muscle bound men in their 60's and 70's.

Along with the growing interest there's also a growing amount of information. But much of it is anecdotal stories, misleading data and flat out, unproven myths. Especially as it relates to testosterone replacement therapy for women.

The fact is that medically administered, testosterone therapy is also used to successfully treat symptoms of hormone deficiency in pre and postmenopausal women. And two physicians-Dr. Rebecca Glaser and Dr. Constantine Dimitrakakis-are dispelling the misinformation about it through scientific research.

Dr. Glaser and Dr. Dimitrakakis focus on subcutaneously implanted, bio-identical hormones (human identical molecule) and not oral, synthetic androgens or anabolic steroids.

With that in mind, here are the 10 myths of testosterone replacement therapy for women.

Myth #1: Testosterone is a "male" hormone

Although men have a higher circulating level of testosterone than women, from a biological perspective, men and women are genetically similar. Both sexes include functional estrogen and androgen (testosterone) receptors. And while estrogen is popularly considered the primary female hormone, throughout a woman's lifespan, testosterone is actually the most abundant, biologically active hormone with significantly higher levels than estradiol. And as early as 1937, testosterone therapy was reported to effectively treat symptoms of the menopause.

Myth #2: Its only role in women is sex drive and libido

There's a lot of hype about testosterone's role in sexual function. But in reality, it's a fraction of the overall physiologic effect testosterone plays in women. That's because testosterone governs the health of almost all tissues including the breast, heart, blood vessels, gastrointestinal tract, lung, brain, spinal cord, peripheral nerves, bladder, uterus, ovaries, endocrine glands, vaginal tissue, skin, bone, bone marrow, synovium, muscle and adipose tissue.

The function of these tissues declines as testosterone declines. The result of this deficiency in both men and women includes dysphoric mood (anxiety, irritability, depression), lack of well-being, physical fatigue, bone loss, muscle loss, changes in cognition, memory loss, insomnia, hot flashes, rheumatoid complaints, pain, breast pain, urinary complaints, incontinence as well as sexual dysfunction. And just like for men, these symptoms are successfully treated in women through testosterone therapy.

Myth #3: It masculinizes females

Testosterone therapy has been safely and successfully administered in women for over 76 years. Rather than decrease a woman's femininity it increases it. Testosterone stimulates ovulation, increases fertility and safely treats the nausea of early pregnancy without adverse effects.

Sure, large doses of supra-pharmacological synthetic testosterone are used to treat female to male transgender patients to increase male traits like body hair. But this requires high doses over an extended period of time. Even then, true masculinization is still not possible. And these effects are reversible by simply lowering the dosage.

Myth #4: It causes hoarseness and voice changes

Hoarseness is most commonly caused by inflammation due to allergies, infectious or chemical laryngitis, reflux esophagitis, voice over-use, mucosal tears, medications and vocal cord polyps. Testosterone possesses anti-inflammatory properties. There is no evidence that testosterone causes hoarseness and there is no physiological mechanism that allows testosterone to do so.

Although a few anecdotal case reports and small questionnaire studies have reported an association between 400 and 800 mg/d of danazol and self-reported, subjective voice 'changes' an objective study demonstrated the opposite.

Twenty-four patients received 600 mg of danazol (synthetic testosterone) therapy daily and were studied for 3 and 6 months. There were no vocal changes that could be attributed to the androgenic properties of danazol. These conclusions are consistent with a one year study examining voice changes on pharmaco-logic doses of subcutaneous testosterone implant therapy in women by Glaser and Dimitrakakis.

Myth #5: It causes hair loss

Hair loss is a complicated, genetically determined process and there is no evidence that either testosterone or testosterone therapy cause it. In fact, from a medical perspective, dihy-drotestosterone (DHT), not testosterone, is considered the active androgen in male pattern balding.

There are many factors associated with hair loss. For example, it's common in both women and men with insulin resistance. Insulin resistance increases 5-alpha reductase, which increases conversion of testosterone to dihy-drotestosterone in the hair follicle.

In addition, obesity, age, alcohol, medications and sedentary lifestyle increase aromatase activity, which lowers testosterone and raises estradiol. Increased DHT, lowered testosterone, and elevated estradiol levels can contribute to hair loss in genetically predisposed men and women. But so can medications, stress and nutritional deficiencies.

In studies conducted by Glaser and Dimitrakakis, two thirds of women treated with subcutaneous testosterone implants have scalp hair re-growth on therapy. Women who did not re-grow hair were more likely to be hypo or hyperthyroid, iron deficient or have elevated body mass index. And none of the 285 patients treated for up to 56 months with subcutaneous T therapy complained of hair loss.

Myth #6: It has adverse effects on the heart

On the contrary, there is overwhelming biological and clinical evidence that testosterone promotes a healthy heart. Testosterone has a beneficial effect on lean body mass, glucose metabolism and lipid profiles in men and women. It is successfully used to treat and prevent cardiovascular disease and diabetes.

Testosterone also widens blood vessels in both sexes, has immune-modulating properties that inhibit plaque and strengthens the cardiac muscle. It improves functional capacity, insulin resistance and muscle strength in both men and women with congestive heart failure.

Myth #7: It causes liver damage

High doses of oral, synthetic androgens (e.g., methyl-testosterone) pass through the digestive system, are absorbed into the entero-hepatic circulation and can adversely affect the liver. But subcutaneous implants and topical patches avoid the entero-hepatic circulation and bypass the liver. So there is no adverse effect on the liver, liver enzymes or clotting factors.

Furthermore, non-oral testosterone does not increase the risk of deep venous thrombosis or pulmonary embolism like oral estrogens, androgens and synthetic progestins. And despite the concern over liver toxicities with anabolic steroids and oral synthetic androgens, there are only 3 reports of hepa-tocellular carcinoma in men treated with high doses of oral synthetic methyl testosterone. Even the report of benign tumors (adenomas) with oral androgen therapy is exceedingly rare.

Myth #8: It causes aggression

Although anabolic steroids can increase aggression and rage, this does not occur with testosterone therapy. Even supra-pharmacologic doses of intramuscular testosterone undecanoate do not increase aggressive behavior. But as stated before, testosterone can aromatize to estradiol. And there is considerable evidence among species, that estrogens, not testosterone, play a major role in aggression and hostility.

However, in studies conducted by Glaser and Dimitrakakis, over 90% of women treated with subcutaneous testosterone therapy have documented decreased aggression, irritability and anxiety. And this is not a new finding. Androgen therapy has been used to treat PMS for over 60 years.

Myth #9: It may increase the risk of breast cancer

It was recognized as early as 1937 that breast cancer was an estrogen sensitive cancer and that testosterone acted as a counter balance to estrogen. Clinical trials in primates and humans have confirmed that testosterone has a beneficial effect on breast tissue by decreasing breast proliferation and preventing stimulation from estradiol.

However, some epidemiological studies have reported an association between elevated androgens and breast cancer. But these studies suffer from methodological limitations, and more importantly, do not account for associated elevated estradiol levels and increased body mass index. And the cause and effect interpretation of these studies conflicts with the known biological effect of testosterone.

Although testosterone is breast protective, it can aromatize to estradiol and have a secondary, stimulatory effect on the estrogen receptor. But when testosterone is combined with an aromatase inhibitor in a subcutaneous implant, it blocks testosterone from aromatizing.

This form of treatment has been shown to effectively treat androgen deficiency symptoms in breast cancer survivors and is currently being evaluated in a U.S. national cancer study. In addition, Dimitrakakis and Glaser see a reduced incidence of breast cancer in women treated with testosterone or testosterone with anastrozole implants.

Myth #10: The safety of testosterone use in women has not been established

Testosterone implants have been used safely in women since 1938. Any real concerns would be well established by now.

Long-term data exists on the successful and safe use of testosterone in doses of up to 225 mg in up to 40 years of therapy. In addition, long term follow up studies on supra-pharmacologic doses used to 'female to male' transgender patients report no increase in mortality, breast cancer, vascular disease or other major health problems.

Many of the side effects and safety concerns attributed to testosterone are from oral formulations, or are secondary to increased aromatase activity due to elevated estradiol. This effect increases with age, obesity, alcohol intake, insulin resistance, breast cancer, medications, drugs, processed diet and sedentary lifestyle. Although often overlooked or not addressed in clinical studies, monitoring aromatase activity and symptoms of elevated estradiol is critical to the safe use of testosterone in both sexes.

Adequate testosterone is essential for physical, mental and emotional health in both sexes. Abandoning myths, misconceptions and unfounded concerns about testosterone and testosterone therapy in women allows physicians to provide evidence based recommendations and appropriate therapy

Does Testosterone Replacement Therapy Help Improve Sperm Production?

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The good news for men that suffer from low testosterone levels is that there are treatment methods available to help them get their levels back up to normal as well as get rid of the symptoms that are associated with this condition. Testosterone replacement therapy is one of the first methods of treatment that doctors choose for their patients. This type of treatment is created for the purpose of introducing more testosterone into the body, which will raise the levels. Men can receive this replacement therapy through injections, having pellets implanted underneath the skin, by applying a topical gel or taking a pill.

While these methods have both advantages and disadvantages, there is a newer product on the market that is quickly becoming popular. Similar to gel, testosterone cream is an effective form of treatment for raising testosterone levels in a way that is convenient and easy to use. Many men favor testosterone cream over the patch or gel because there is less chance of skin irritation. In order to use this product, all you have to do is apply a generous amount to your stomach, upper arms, thighs and shoulders once a day for up to eight weeks in order to maintain normal levels of testosterone.

It is important to note that there are side effects that come with using the cream that include problems with indigestion, headache or dizziness and high blood pressure in relation to fluid retention. Because this product can cause prostate problems, men that are currently suffering from issues with their prostate will not be able to use this cream.


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Bioidentical Hormone Replacement Therapy in Palm Beach

Are you one of the many people in Palm Beach who are burning the candle at both ends and maybe only getting 4 or 5 hours of sleep a night? Are you also one of those guys having problems with his sex drive and feeling out of sorts? Well, recent studies done in Palm Beach in the last 3 years show that these symptoms could all be due to the effect of sleep on testosterone – just how, though, may be a chicken and egg question!

While it’s true that lower testosterone levels can be the cause of a sluggish sex drive and irritability it seems to be a matter of research opinion whether low sleep levels cause low testosterone or low testosterone causes lack of sleep.

Does Testosterone Replacement Therapy Help Improve Sperm Production?

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All women will experience the effects of menopause at some point in their lives, usually somewhere between the ages of 30 to 65. These effects are caused by hormone imbalances as the body tries to adjust to its new "normal self". There are different remedies available to relieve the symptoms that occur. Natural hormone replacement therapy is one that has helped many women.

I'm sure you've heard it before. Friends and family members have stories of how they have been tormented with hot flashes, mood swings, energy loss, weight gain and other terrible symptoms.

Many of these people went through numerous tests to determine what's wrong. Some found relief while others went on in their uncomfortable state. Unfortunately, these types of stories are common. You may be one of these people that are still suffering and hoping to find an end to this cycle of reoccurring symptoms.

When you reach this stage of your life, your body's hormone balance changes. Specifically, a depletion of the hormones estrogen, progesterone and testosterone occurs. The amount of hormonal change will be different for every woman. The traditional method of treatment is known as Hormonal Replacement Therapy. This is referred to as HRT. Chances are someone you know has taken this approach to help menopausal symptoms.

Many women will search for safe treatments. Studies have shown that using synthetic hormones as a treatment increases the risk of cancer and cardiovascular disease. HRT should be prescribed by your doctor after a thorough risk evaluation and potential benefits review have been completed. The prescription should be specific to you to ensure effectiveness and safety.

Natural hormone replacement therapy should be a strong consideration to reduce or eliminate the effects of menopause. Many women feel more comfortable taking a natural remedy rather than using drugs.

The goal of natural hormone replacement therapy is simple. Its purpose is to bring your hormonal balance back to the state prior to beginning menopausal. Once this is achieved, you will start to gain relief from the symptoms of menopause.

There are a number of safe, natural, effective treatments you can use. It is worth your time to go this route. I believe if more women knew of these solutions, all would try them first before going the HRT path.

Medifast Recipes - Ways to Shake Up Your Medifast Shakes

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Theoretically,  menopause is not a disease.  Therefore, there is no cure.  Many women opt to forgo any treatment at all, and simply tolerate many of the symptoms associated with this normal transition.  However, for those women whose symptoms are so severe as to interfere with their quality of life, there are many options at their disposal.

Remedies may be implemented by the woman herself for the conditions associated with menopause.  For example,

Hot flashes: Several nonprescription treatments are available, and lifestyle choices can help.

  • Many women feel that regular aerobic exercise can help reduce hot flashes
  • Foods that may trigger hot flashes, such as spicy foods, caffeine, and alcohol, should be avoided.
Heart disease: A low-fat, low-cholesterol diet helps to reduce the risk of heart disease.

Weight gain: Regular exercise is helpful in controlling weight.

Osteoporosis: Adequate calcium intake and weight-bearing exercise are important. Strength training (lifting weights or using exercise bands in resistance training) can strengthen bones.

Certain medications are beneficial in reducing many of the signs and symptoms of menopause.

Hormone Replacement Therapy

  • estrogen or a combination of estrogen and progestin
  • treats hot flashes
  • reduce fracture risk by building bone mass
  • improve cholesterol levels
  • decrease vaginal dryness
  • estrogen and progestin combination associated with increased risk of heart attack, stroke, and breast cancer
  • estrogen alone associated with increased risk of endometrial cancer
  • increased risk of gallstones and blood clots
Selective Serotonin Reuptake Inhibitors (SSRIs)
  • normally used for depression and anxiety
  • effective in reducing hot flashes
Clonidine (Catapres)
  • used to lower blood pressure
  • effective in reducing hot flashes
Gabapentin (Neurontin)
  • primarily used for treating seizures
  • used to treat hot flashes
Megestrol (Megace)
  • short-term relief of hot flashes
  • not recommended as first-line drug
Medroxyprogesterone (Depo-Provera)
  • injectable
  • sometimes effective in treating hot flashes
  • may cause weight gain and bone loss
Several medication options are available for the treatment of osteoporosis during menopause.  They include:
  • Aldenodrate (Fosamax)
  • Raloxifene (Evista)
  • Calcitonin (Calcimar or Miacalcin)
There are natural remedies on the market which report to reduce hot flashes.  However, for many, the clinical studies are conflicting and inconclusive.  These include:

Black Cohosh

  • herbal supplement
  • German studies recommend limiting its use to six months or less
  • not regulated by the Food and Drug Administration
  • side effects include nausea, vomiting,  dizziness, visual problems, slow heart beat, and excessive sweating
Plant Estrogens (Phytoestrogens)
  • soy is an example
  • safety of soy in women with breast cancer not established
Other Herbal Preparations - avoid or take under supervision of health care provider
  • dong quai
  • red clover
  • chaste-berry
  • yam cream
  • Chinese medicinal herbs
  • evening primrose oil
There are several treatment options available to help alleviate the symptoms of menopause.  These treatments should be individualized for each patient.  As many of these methods are not without risk, they should be implemented and monitored under the guidance of a physician.

Treatment for Menopause

bioidentical hormone therapy cost

Many people have found that one of the easiest ways to lose weight is with the Medifast weight loss program. The program is set up so easy that anyone can lose weight by following the steps. Unlike other weight loss plans, medifast has meal plans and delivered meals so you do not let your diet fall by the way side. One aspect of this meal plan is the Medifast shakes. If you want to change up your shakes, though, you have to get a little creative. There are different medifast recipes you can use to alter the taste of your shakes without compromising the nutrients.

The Medifast shakes are a great addition to your diet plan because they can take the place of your high calorie snack foods. Snacking is one of the most common diet killers, so it is important to be able to prevent the urge. If you have been getting bored with your shakes, you can try different medifast recipes to alter the taste. One way to do this is by making a milkshake out of them. Instead of mixing the recipe in the plastic bottle, add a little ice and pop it into a blender. Your shake will have the same quality to it, but it will taste like a rich treat.

Other medifast recipes include adding their flavor infusers, which are sugar free. These are meant to be drunk with water but could be added for flavor to your medifast shakes. You should try adding them to the vanilla shakes for the best results. This also is a great way to change up the flavor infusers if you get bored with them from time to time. There only are so many flavors Medifast can create for your shakes that sometimes you have to leave it to yourself to create your own.

Another great way to change the taste of your medifast shakes includes using sugar free syrups that you can buy at the supermarket. These are syrups that you would add to your coffee for different flavors. With these, your Medifast recipes are virtually endless. All you have to do is make sure the syrup you are using is sugar free otherwise it is defeating the purpose of drinking the shakes. You have the option of using fruity flavors such as raspberry or you can stick with the nutty flavors of hazelnut. By changing the flavors, you are making it easier to stick with your diet plan.

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West Palm Beach, Florida

West Palm Beach is a city in and the county seat of Palm Beach County, Florida, United States.[6] It is located immediately to the west of the adjacent Palm Beach, and is one of the three main cities in South Florida. The population was 100,343 (revised) at the 2010 census. The University of Florida Bureau of Economic and Business Research (BEBR) estimates a 2016 population of 108,896, a 7.9% increase from 2010. It is the oldest municipality in the Miami metropolitan area, having been incorporated as a city two years before Miami in November 1894. Although West Palm Beach is located approximately 68 miles (109 km) north of Downtown Miami, it is still considered a principal city within the Miami metropolitan area, due to the solid urbanization between both cities. The estimated population of the Miami metropolitan area, which includes all of Palm Beach County, was 6,012,331 people at the 2015 census.

The beginning of the historic period in south Florida is marked by Juan Ponce de León's first contact with native people in 1513. Europeans found a thriving native population, which they categorized into separate tribes: the Mayaimi in the Lake Okeechobee Basin and the Jaega and Ais people in the East Okeechobee area and on the east coast north of the Tequesta. When the Spanish arrived, there were perhaps about 20,000 Native Americans in south Florida. By 1763, when the English gained control of Florida, the native peoples had all but been wiped out through war, enslavement, or European diseases.[7]

Other native peoples from Alabama and Georgia moved into Florida in the early 18th century. They were of varied ancestry, but Europeans called them all "Creeks." In Florida, they were known as the Seminole and Miccosukee Indians. The Seminoles clashed with American settlers over land and over escaped slaves who found refuge among them. They resisted the government's efforts to move them to the Indian Territory west of the Mississippi. Between 1818 and 1858, three wars were fought between Seminoles and the United States government. By 1858, there were very few Seminoles remaining in Florida.[8]


Testosterone Replacement Therapy in Palm Beach