Anyone who has symptoms related to hormonal deficiencies, such as low estrogen causing sleep disturbance, flushes and flashes, or low testosterone which causes low libido, fatigue and loss of strength and endurance, will benefit from hormone replacement therapy.
People without symptoms but who have medical conditions such as high cholesterol, diabetes or osteoporosis can successfully reverse their effects with the hormone replacement therapy process as well. A strong family history of heart disease, stroke and dementia should interest anyone who wants to proactively protect themselves from these conditions.
The process for hormone replacement therapy starts with an initial telephone inquiry. On average that will be about ten minutes of the doctor directly answering patient’s questions and providing an overview of the consultative process including an explanation of fees and insurance.
The initial meeting determines the patient’s needs, understanding of hormone replacement therapy and relative concerns and why they are interested. These typically include symptom relief, disease prevention, or both. A thorough personal and family medical history are obtained, dietary, exercise and sleep patterns are discussed, and a mental status and stress management evaluation are undertaken.
This is followed by an explanation of hormone replacement therapy, noting the practice is based on controlled medical trials that demonstrate cause and effect of positive outcomes. The concept of optimization of all hormone levels is emphasized. Finally, a discussion of the role of the laboratory and the compounding pharmacy rounds out the consultation. The patient is given specific literature in advance of the follow-up consultation.
The second meeting is scheduled after all laboratory findings become available. There is a brief recap of the patient’s motivations, followed by a review of all laboratory results, with specific emphasis on those hormones to be replaced. Patients are told initial dosing is intentionally low to determine if there is a sensitivity or side effects to the medications, such as fluid retention or bloating, followed by scheduled increases determined by how one feels and the rise of hormones towards their optimal levels. The endpoint is achieved when the patient’s physical goals and optimal replacement values have been met. At that point, monitoring and modifications take place every three to four months.
When to start the hormone replacement therapy process can be determined by a patient’s symptoms such as low energy, brain fog, lack of estrogen, fatigue, low libido, etc. Stress reduction with supplements can weigh in with other forms of relief like meditation, yoga, spirituality or massage therapy. Or the patient may be motivated to do something to avoid repeating a family medical event like heart disease or dementia.
Progesterone is the second dominant female hormone. During the reproductive years, it is made in the ovary during the second half of the menstrual cycle. One of its many functions is to protect against estrogen-related cancer. In menopause, if progesterone is not given, breast and uterine lining cells constantly in an estrogen environment are able to undergo precancerous and cancerous changes. The addition of progesterone to the treatment regimen very clearly prevents that from happening. Protective hormone levels are required, again proving the necessity to periodically monitor patients.
There are many regimens used in physician’s practices: ten days a month, five to ten days every two to three months or continuously. I ascribe to the continuous approach: if one is trying to prevent cancer why leave time for cells to be unprotected.
There is a delicate orchestration of bioidentical hormones that ultimately provide complete symptom relief, protection against heart disease, cognitive defects and degenerative disease and ideal hormone levels. This doesn’t happen overnight and patients need to have some degree of delayed gratification. Some aspects become ideal in a matter of one to two months, others may take the better part of a year to reach the multiple goals above.
Once a patient feels great and the hormone replacement levels are reached, the long-term benefits based on scientific evidence are irrefutable. Discontinuation at any time results in the reoccurrence of symptoms, loss of protection against the major killer heart disease and stroke, increased risk of dementia, and so forth.
The recommendation is to continue indefinitely on hormone replacement therapy.
Patients initially view HRT with many concerns and misconceptions which must be addressed rationally and coherently. Unfortunately, the medical media, friends, and even physicians who misunderstand the medical literature provoke fear that hormones will cause breast cancer, heart attack, stroke, and dementia.
In actuality, this could not be farther from the truth. Randomized controlled studies have repeatedly proven that HRT actually does the opposite: reduces the risk of heart disease by 50%, Alzheimer’s disease 50-83%, not only does it not cause breast cancer but reduces the incidence, it decreases colon cancer and reverses osteoporosis. No increased incidence of blood clots either.
Many of these preconceptions arise from studies which cite associations but fail to demonstrate cause and effect, the use of synthetic hormones, not natural hormones, and inherent bias.
There are three aspects to the cost of therapy: the professional fee for the expertise of the physician planning and guiding the therapy, the laboratory, and the compounding pharmacy.
If a simple replacement plan is undertaken, such as an estrogen patch or creams and a progesterone pill, there is little expense to the physician and laboratory. Commercially manufactured bioidentical estrogen and progesterone are available in limited doses but are usually covered by insurance.
A more comprehensive approach requires greater time and monitoring, more extensive use of the laboratory, and the need to individualize hormone therapy provided by the compounding pharmacist. In our in-office laboratory, 100% of all tests are covered by your insurance, no matter who your carrier is, your copay, or deductible. This is a major advantage.