Bio-identical Hormone Replacement Therapy
Frequently Asked Questions
What is “bio-identical” Hormone Replacement Therapy?
The term “bio-identical” Hormone Replacement Therapy (or bio-identical HRT) refers to the use of chemically-identical (or “human-identical”) hormones to replace any diagnosed hormone imbalances. Examples include sex hormones like estradiol, estriol, progesterone and testosterone plus thyroid hormones like levothyroxine and liothyronine.
Non-bioidentical hormones refer to hormones with non-human chemical structures, like those that may be plant-like or animal-like in structure. Sometimes, bio-identical hormones are also referred to as “natural hormones” which may be confusing since not all “natural” hormones are bio-identical. Bio-identical hormones are made to resemble human hormones, while some ‘natural’ hormones may be from a source like equine (horse) urine—they are ‘natural’, but not bio-identical because many of its components are not identical to what humans make. Non-bioidentical hormones include CEE (conjugated equine estrogen) and progestins like medoxyprogesterone acetate (MPA) or norgestimate, commonly found in birth control pills.
What are the symptoms of hormone imbalance?
In both men and women, this may include symptoms like fatigue, poor sleep, “brain fog” or memory impairment, poor concentration, decreased sense of well-being, irritability, anxiety, low libido, poor sex drive, weight gain, hot flashes, menstrual irregularities (in women), erectile dysfunction (in men), and loss of muscle mass, to name a few.
I’m a middle-aged man with low energy, low libido, anxiety and have been battling my weight for a few years. Is bio-identical HRT right for me?
Medical research has shown that there is a gradual hormone decline in males with symptoms appearing mid-life, sometimes as early as age 30’s to 40’s. Towards the later decades in life, testosterone levels decrease further and lead to further worsening of symptoms or increased risk for degenerative diseases. Additional factors like being overweight/obese further worsens hormone deficiencies. Hormone imbalance in men is not limited to testosterone alone but includes others like estrogen, pregnenolone, DHEA, melatonin and/or thyroid. Discuss your symptoms with a physician trained in the use of bio-identical hormones to get a complete evaluation and recommendation. If hormone imbalances are present, bio-identical hormone therapy is a crucial part of your treatment regimen.
I’m a woman who is not yet in menopause but suffer from symptoms that may be those of hormone imbalance. Is it possible that I have hormone imbalance?
Yes, hormone imbalances can happen at any period in our lifetime. It may be aggravated by chronic illness, certain medications, stress, nutritional deficiencies or presence of any toxins in our body. A thorough evaluation will provide better information regarding the status of your hormones and any therapies that may be appropriate for you.
I feel that I may have hormone imbalance. What do I do?
We recommend a thorough evaluation with a physician who has expertise in the field of hormone therapy such as our providers at WFH. You should call our office to schedule your initial patient visit with our MD’s. If you have any lab work within the last 6 months, please inform our front desk when you call to book the appointment and make sure to send/bring copies to our office. We request that all female patients bring copies of their most recent PAP and/or mammogram if performed. You will be requested to fill out a comprehensive medical information form online that includes our office policies and questions regarding your medical history. In order to facilitate the flow of your visit, please have this completed at least 48 hours prior to your appointment time so that our providers have time to review the information.
What can I expect at my first visit?
Our medical doctor will do a thorough review of your medical history, current medications, supplements and perform a physical examination at your first visit. For females, please note that we do not perform internal exams/PAP test. Labs will then be requested as appropriate and an individualized plan will be made with you. This plan may include prescriptions, supplements/herbs, nutrition, detoxification and stress management. The initial hormone evaluation can be done by blood (serum) testing, blood spot, saliva or urine testing. Most of the initial hormone lab evaluation that is done at WFH is by blood/urine testing through a laboratory like Quest, LabCorp or Clinical Path Labs, which may be covered by most insurance plans. Additional specialized testing (like saliva, urine or other blood tests) may be requested if applicable. This will be discussed with you at your visit. Insurance coverage will vary based on your plan so you should find out from your respective insurance company with regards to coverage of tests. If it is determined that you are hormone deficient, then bio-identical HRT will be recommended as part of your overall treatment plan.
How often do I need to be seen if I am on HRT?
A patient is typically seen on follow-up 4-6 weeks after their initial visit in order to do a thorough review of laboratory results and further recommendations made as needed. This visit is shorter in duration that the initial evaluation. Subsequent visits will vary in frequency (every 2-4 months) depending on individual symptoms and progress. We usually monitor your lab work at least every 6 months, sooner if medically necessary when dose adjustments are made. We will continue to monitor you at least every 6 months and will provide the necessary prescriptions to last until your next visit.
Will you take over as my doctor?
Whole Family Healthcare will not take over the function of your primary care doctor. Any prescriptions that are provided by your primary care practice should be monitored and renewed by them if necessary. We advise that you keep a primary care doctor so that you have access to care after-hours and on weekends. We do not maintain admitting privileges at any hospitals. For our female patients, we also do not currently perform internal exams and/or PAP smears.
When do I start seeing results from bio-identical HRT?
There is no set time period but someone may already feel the effects of bio-identical HRT after 2-4 weeks, even if it may not be the optimal levels yet. We do not over-replace hormones, we strive to keep them in balance at the levels that your body needs in order to be optimal and have a good quality of life.
Can bio-identical hormones be used as contraceptives?
No, this is not a contraceptive. This is one limitation of bio-identical HRT. Its use will not prevent pregnancy. There are multiple other prescription medications specifically designed for contraception that patients may use with the advise of their physician. In men, testosterone replacement therapy may sometimes decrease fertility but is not an accepted method of contraception.
Where can I get bio-identical hormones?
In the United States, bio-identical hormone replacement therapy is available through prescription only after a thorough evaluation with a physician. They are available as FDA-approved formulations (such as branded or generic estradiol patches and gels or topical and injectable testosterone) from regular pharmacies. They are also available from compounding pharmacies. “Compounding” means the creation of a particular medication to fit the needs of a patient. Compounding pharmacies are typically not regulated by the FDA but adhere to strict guidelines by the state’s board of pharmacy.
What are the side effects of testosterone replacement therapy in men?
In general, hormone replacement therapy is safe but may have some side effects like: increased oiliness of skin, acne, decreased testicular size, decreased sperm count and fertility (especially in younger men), mild fluid retention, increase in red blood cell count, increase in estradiol production and breast tissue enlargement, cholesterol changes, or stimulation of prostate tissue and urinary symptoms. It is important to get baseline evaluation of prostate health before starting testosterone therapy. Studies have shown that testosterone treatment doesn’t cause prostate cancer, but it may ‘unmask’ prostate abnormalities. So, monitoring prostate health is part of ongoing treatment plans.
What is the difference in effects between bio-identical and “synthetic” hormones for women? How does it affect my risk for breast cancer?
Most doctors who prescribe hormones to women for its effects on the uterus (ie. for bleeding symptoms) are correct in its effects on the lining of the uterus—they are virtually indistinguishable. Non-bioidentical hormones will help control uterine bleeding. However, there is a lot of data available showing the difference in effects and advantage of using bioidentical hormones with regards to their other actions in the body: there is better overall symptom control, better physiologic effects and decreased risks of developing other medical conditions. Studies have demonstrated that women on progesterone report better sleep, less anxiety, less depression, less ‘brain fog’ and an improvement in sexual function compared to progestins.
In breast tissue, progesterone decreases breast cell growth and increases the breakdown of estrogens to less potent versions. These actions are not demonstrated by synthetic progestins. Large-scale trials have reported progesterone use as having a significant reduction in breast cancer risk compared with synthetic progestins. Studies on estriol (E3, a weaker bio-identical estrogen) show that it binds to the receptor that inhibits breast cancer cell development while CEE (Conjugated equine estrogen) binds to the receptor that promotes breast cell growth. Progesterones have also been shown to maintain and help the heart-protective effects of good estrogen.