Bioidentical Hormone Replacement Therapy | BHRT

Benefits & Frequenly Asked Questions

Pellets

Our pellets are “bioidentical” which means they are the same as the hormones naturally produced by the body when we were in our prime.  They are non-synthetic, using all-natural ingredients bio-engineered by our compounding pharmacy.  Because of this they are safer and do not create the side effects often associated with synthetic versions of these hormones.  


Testosterone

Both men and women produce testosterone.  Men produce most of their testosterone in their testicles and a lesser amount from the adrenal gland.  Women produce testosterone from their ovaries and a smaller amount from the adrenal gland. Natural testosterone in pellet form is less likely to cause problems such as acne, facial hair and baldness. In women, testosterone can cause a deepening of the voice.  


Common signs of testosterone deficiency:

· Loss of mental focus and concentration

· Muscle loss

· Joint pain

· Decreased strength

· Fatigue

· Less effective response to exercise

· Loss of libido (sex drive and arousal)

· Worsened menopausal symptoms

· Irritability

· Anxiety


In men, testosterone can convert to estrogen, which may cause side effects such as water retention, anxiety or irritability.  Men with high conversion levels of testosterone to estrogen will be given Anastrozole to reduce the levels of estrogen and make more of the testosterone bio-available.  


Estrogen:

Estrogen is the female hormone.  It makes you feel more sensual.  It brings a glow to the skin, helping with the turgor and moisture.  It keeps the vagina lubricated, fullness to the breasts, and clarity to the mind.  It uplifts and stabilizes your mood and will help protect the bones against osteoporosis.

Common signs of estrogen deficiency:

· Mental fogginess

· Forgetfulness

· Depression

· Anxiety

· Difficulty falling asleep

· Hot flashes

· Night sweats

· Fatigue

· Decreased sense of sexuality and sensuality

· Dry eyes, skin and vagina

· Loss of skin radiance

· Pain with sexual activity

· Increased back and joint pain


Progesterone:

Progesterone is a natural relaxer, it is vital to a woman’s well-being and helps balance the estrogen. If progesterone levels are too low in relation to estrogen a woman will experience sleep disturbances, irritability, anxiety, weight gain, breast swelling and tenderness, bloating, sweating, and loss of libido.  If you have a uterus, progesterone is also essential to protect against unopposed estrogen exposure which could put you at risk for uterine cancer.  If estrogen is taken without progesterone to balance it, a woman will experience bleeding.  It is essential to use progesterone any time you use estrogen if you have a uterus.  Even with a prior hysterectomy, progesterone will provide balance, and is recommended.

Benefits of progesterone:

· Acts as a natural diuretic to avoid water retention and bloating

· Relaxes, calms and protects your nervous system

· Decreases anxiety, depression, and mood swings

· Helps insomnia

· Improves breakdown of fat into energy

· Cuts the craving for sweets and carbohydrates

· Reduces breast tenderness 

· Increases HDL, the body’s “good cholesterol”

· Assists in lowering LDL, or “bad cholesterol”

· Helps maintain normal blood sugar levels


Pre-op Pellet Therapy Instructions:

Wear loose comfortable clothing the day of the procedure

Stop aspirin, ibuprofen, and fish oil 3 days prior to the procedure

Eat a small meal prior to pellet insertion


Post-op Pellet Therapy Instructions:

Avoid for 5 days: 

· submersion in water such as bathtub or swimming pool 

· strenuous/ high impact aerobic exercise

· avoid specific leg and glute exercises such as squats

Incision care:

· The incision site may be uncomfortable for 2-7 days.  

· You will be provided with an ice pack which will help reduce bruising and bleeding, leave this on for at least 10 minutes after the insertion. 

· If bleeding occurs after this, apply pressure and ice as needed.

· Avoid scrubbing the site until the incision is well healed (about 5 days).  

· You may remove the top layer (op site) in 1-2 days.  

· You may remove the steri-strips if they peel up, or after 5 days


Frequently asked questions:


I’m getting my first hormone implant, what should I expect?

· Wear comfortable clothing

· An area on the back of your hip will be numbed, a small puncture is made, and pellets are inserted into the subcutaneous tissue.  

· Steri-strips and an op-site (clear plastic bandage) is placed over the incision.

· You may experience a small pin prick at the start of the procedure from the needle to inject the anesthetic agent, or a slight “stinging” sensation as the anesthetic is introduced.

· Bruising and soreness lasting up to a week at puncture site are normal.

· Itchiness or mild redness at puncture site are also normal up to a week following implants.

· After your implant, please avoid exercise/heavy lifting/straining for 3-5 days 

· Avoid baths, hot tubs, swimming pools (submersion in water) for 5 days following your implant


When will I feel the hormones kick in?

· Some patients experience symptom relief within the first few days, others may notice a more gradual reduction in symptoms.  

· A patient who has had years of hormone depletion may take longer to optimize/get symptom relief.

· Peak effectiveness may take 4-6 weeks, but most people are feeling better after only 1-2 weeks.

· Don’t worry – they will kick in!


How often do I come in for hormones?

· On average, hormone replenishment is needed every 3-4 months

· Initially we will set up a repeat blood draw at 6 weeks to ensure you are getting a proper response and again at 4 months to be able to give you your next dose of hormones. 

· Blood levels of hormones must be drawn prior to EVERY implant.  We must know your levels before we give you hormones.

· If you find that you are becoming symptomatic again prior to the 4 months, we can adjust your dosing schedule.


Acne

· Due to skin types and testosterone’s oil producing effects, some patients may experience mild acne, others will not.  

· A pimple or two is your body responding to the testosterone, after you adjust to the elevated levels, it often clears up.  

· If acne persists, please let us know so we can work on strategies to treat.


Bleeding

· Women who receive estrogen may experience bleeding or spotting.  This is normal and nothing to be worried about.

· Taking oral progesterone not only balances the estrogen, but controls bleeding. Skipping a dose of progesterone or not taking enough will cause bleeding.  

· Progesterone is added to your estrogen replacement therapy to prevent overgrowth of endometrial tissue and lower your risk of uterine cancer.


If you have a uterus you must take progesterone every night before bed

· If you’ve had a hysterectomy, we still recommend the progesterone to balance the estrogen and help with sleep, mental clarity, mood, breast tenderness and bloating.

· If you experience bleeding which is heavy or for a prolonged time, please contact us.


DIM

DIM stands for 3,3'-Diindolylmethane, the indole found only in cruciferous vegetables, including broccoli, cabbage, brussels sprouts and cauliflowers. DIM improves estrogen metabolism and helps support healthy estrogen balance.

· Diindolylmethane is used for preventing breast, uterine, and colorectal cancer.

· DIM is an aromatase inhibitor, which means it prevents the conversion of testosterone into estrogen.  For this reason, it is used in both men and women.


Scheduling appointments?

· After your pellet insertion, you will be given a timeframe to return for repeat labs. Your next pellet insertion will be scheduled 1 week after your lab week.

· If you are becoming symptomatic prior to your next scheduled pellet insertion, please call and we will make a new appointment up to 3 weeks earlier.

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