Hormone Replacement Therapy


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Winter 2017 Go Beyond Medicine® Hormone Replacement Special - $39 initial visit (medication, labs, procedure extra)

How much is it worth to you?

At Go Beyond Medicine® we understand how anyone can get in a rut with their health and there seems to be no positive outcome. The first step to understanding if hormones are the cause of your changes is when you’re still young and yet you feel older. Is it harder to get through the day and maybe you feel different, sluggish, older or fatigued?

Ask yourself: How much a medication would be worth that …

  • Increases Bone Density;
  • Increases Muscle Mass;
  • Reduces Fatty Tissue;
  • Increases Energy;
  • Relieves Anxiety;
  • Relieves Depression;
  • Relieves Pain;
  • Relieves Inflammation;
  • Restores Sleep Patterns;
  • Increases Libido & Sexual Performance;
  • Lowers the Incidence of Breast Cancer;
  • Lowers Blood Sugar;
  • Reverses Incontinence;
  • Thickens Skin as it Reduces Wrinkles;
  • Has No Adverse Effect on Liver Function or Clotting Factors;
  • Only Requires 3 – 5 Doses a Year; and
  • Has Mild Side Effects That May Include: Facial Hair Growth, Acne &/or Polycythemia?

What are hormones?

Hormones are chemical messengers secreted into the bloodstream by gland. These substances play a significant role in your overall health and well-being.Collectively hormones allow the endocrine system to regulate all body functions.

One example is insulin, secreted by the pancreas. Every cell’s glucose metabolism and thus energy production is dependent on insulin’s activity. All hormones work in concert as metabolism and energy are also affected by thyroid hormone, and cortisol as well as the sex hormones testosterone, estrogen and progesterone.

A balanced endocrine system allows for optimal cell function and subsequently optimal health and well-being.

What is hormone replacement therapy?

Most are familiar that diabetics receive insulin treatment, or those with low hypothyroidism / low thyroid receive thyroid hormone replacement. So what about sex hormone replacement for menopause or andropause (Low T)? Both conditions are related to the gradual decline in the production of testosterone, progesterone and estrogen. When deficiencies or imbalances develop, replacement restores youthful levels improving health and well-being. In both menopause (women) and andropause (men), hormone declines are gradual and progressive over a period of years, ultimately resulting in physiological and psychological changes. Symptoms vary in each individual and each symptom may vary from mild to severe.

What is testosterone?

Known as the male hormone it is also present in and critical to health and well-being of women. In both men and women Testosterone is part of many physiologic processes, including muscle and bone growth and health, red blood cell production, libido and sexual response, energy levels, mental function including concentration, focus, irritability, memory and sleep. In addition, testosterone plays a key role in inflammation, metabolism and digestion helping to maintain blood sugar, cholesterol and triglyceride levels and utilization affecting weight. Testosterone replacement enhances weight loss and in doing so decreases the risk of diabetes, heart disease and stroke. Recent studies seem to indicate that testosterone therapy may protect against breast and endometrial cancer and have no effect on prostate cancer.

What are some benefits of bio-identical hormone and testosterone therapy?

Natural Hormone Therapy May Offer These Unique Life Changing Benefits:

  • Reduces Hormone Related Weight Gain
  • Relieves Hot Flashes
  • Increases Energy
  • Boosts Libido
  • Improves Sleep
  • Reduces the Risk of Breast Cancer
  • Reduces Osteoporosis
  • Increases Sexual Interest
  • …And Much More!

What treatment solutions are available?

Go Beyond Medicine® is committed to regulating your body and providing you with healthy alternatives. Research dating back to the 1930’s and 1940’s clearly demonstrates the health benefits of restoring balance to these hormones in women and men.

Most patients respond best to testosterone therapy alone. Some will need to supplement with estrogen and/or progesterone. Others do well with natural alternatives like DHEA, herbal supplementation, gels or creams. Our medical team evaluates every option, including your lifestyle and your budget, to develop a treatment plan that makes you feel your very best!

Why are pellet implants used?

Pellet implants are used because scientific data supports this form as the most effective and bio-identical method to deliver hormones for women and men. Pellet therapy avoids the fluctuations of hormone levels seen with every other therapy by delivering consistent healthy levels of hormones for 3-5 months in women and 4-6 months in men.

Why haven't I heard about pellets?

You may wonder why you haven’t heard of pellets. Pellets are not patented and have not been marketed in the United States. They are, however, frequently used in Europe and Australia where pharmaceutical companies produce pellets. Most of the research on pellets is out of Europe and Australia. Pellets were frequently used in the United States from about 1940 through the late 1970’s before oral-patented estrogens began being marketed to the public.

What if my Primary Care Physician or my Gynecologist says there is no data to support use of pellet implants?

He or she is wrong. There is a big difference between "no data" and the doctor not having read the data. It is much easier for busy practitioners to dismiss the patient than it is to question their beliefs and do the research. It’s about a patient making an informed choice.

After pellets are inserted, patients may notice that they have more energy, sleep better and feel happier. Muscle mass and bone density will increase while fatty tissue decreases. Patients may notice increased strength, co-ordination and physical performance. They may see an improvement in skin tone and hair texture. Concentration and memory may improve as well as overall physical and sexual health.

These are obvious benefits that the patient experiences. There is also data that supports the long term safety of hormones delivered by pellet implants.

How long until a patient feels better after pellets are inserted?

Most female patients begin to "feel better" within 48-72 hours while others may take a week or two to notice a difference. Men usually take 2-4 weeks before they start to notice the benefits of the pellets. Diet and lifestyle, along with hormone balance, are critical for optimal health. Stress is also a major contributor to hormone imbalances and illness.

How long do pellets last?

Pellets usually last between 3-5 months in women and 4-6 months in men. The pellets do not need to be removed. They completely dissolve on their own and are absorbed into the body.

TAKE THE TEST!

Complete our online questionnaire to find out if you're a candidate for hormone therapy.

TAKE THE TEST!

What is Andropause (Low T)?

Andropause, also known as "Low T", refers to a decline in testosterone levels. As men age, the ratio of estrogen to testosterone increases. Testosterone is converted to estradiol by an enzyme called aromatase. Estradiol can then convert to estrone, another strong estrogen.

It is not only the decline of testosterone but the increase of estradiol and estrone that cause the symptoms of Andropause. High levels of the estrogens increase the carrier protein called SHBG, which binds testosterone, making it inactive or unavailable to the cells, further increasing the symptoms of Andropause.

Do men need bio-identical hormone therapy?

Testosterone levels begin to decline in men beginning in their early 30s and is routinely referred to as Andropause. While most men maintain adequate levels of testosterone into their mid 40s to mid 50s, some men maintain it into their late 70s to early 80s.

Unlike women, who may experience rapid changes in hormone levels, men experience a gradual decrease in hormones. As testosterone levels decline, there is deterioration of both mental and physical health.

Men should be tested when they begin to show signs of testosterone deficiency. Even men in their 30s can be testosterone deficient and show signs of bone loss, fatigue, depression, erectile dysfunction, difficulty sleeping and mental decline. Most men need to be tested around 50 years of age. It is never too late to benefit from hormone therapy.

Does testosterone cause prostate cancer?

Testosterone does not cause prostate cancer. In fact, low levels of testosterone are associated with more aggressive disease and worse outcomes (even in dogs). Normal testosterone levels may actually protect against prostate cancer. However, testosterone can stimulate an active cancer.

An elevated estrogen-to-testosterone ratio is a risk factor for both BPH and prostate cancer. Some authors feel that changing the ratio in favor of testosterone may offer protection to the prostate gland.

Does testosterone cause liver failure or increase the risk of heart disease?

Testosterone therapy does not cause liver failure. High doses of synthetic, chemical anabolic steroids, like methyl testosterone are toxic to the liver. These anabolic steroids can lead to jaundice, liver cysts, and liver tumors.

It is the synthetic hormones that increase LDL, suppress HDL, and increase the risk of heart disease, not testosterone.

TAKE THE TEST!

Complete our online questionnaire to find out if you're a candidate for hormone therapy.

TAKE THE TEST!

Is there a role for testosterone implants (pellets) in a pre-menopausal female?

Testosterone pellets may be used in pre-menopausal females (women who have not stopped menstruating). Testosterone has been shown to relieve migraine or menstrual headaches, help with symptoms of PMS (pre menstrual syndrome), relieve anxiety and depression, increase energy, help with sleep and improve sex drive and libido. If a pre-menopausal female has a testosterone pellet inserted, she must use birth control. There is a theoretical risk of ‘masculinizing’ a female fetus (giving male traits to a female fetus).

Why isn’t estrogen therapy or Estradiol pellet therapy recommended?

We have shown that symptoms, including hot flashes, are relieved with continuous testosterone alone. Testosterone delivered by pellet implant is extremely effective therapy. In addition, it does not have the unwanted side effects of estrogen therapy.

Over half of women treated with estrogen (especially the pellet implant) will experience uterine bleeding. If a menopausal patient has bleeding, she must notify her physician and have an evaluation, which may include a vaginal ultrasound and endometrial biopsy. Estrogen also stimulates the breast tissue can cause breast pain and cysts. It also increases the risk of breast cancer. Higher levels of estrogen (in the second half of the menstrual cycle) are needed for pregnancy. Most women feel better with lower levels of estrogen.

Almost all symptoms, including hot flashes, are relieved with testosterone pellets alone. A study by Sherwin in 1985 looked at testosterone, testosterone with estradiol, estradiol alone and placebo. The group of women who responded best (somatic, psychological and total score)…testosterone alone! The groups that did the worst…estrogen alone and placebo. Higher levels of testosterone were associated with a better response. These results are expected. Testosterone is the major ‘substrate’ for estrogen production in the brain, bones, vascular system, breast and adipose tissue. Some physicians do not understand this and may insist that estrogen therapy is needed.

Excess estrogen can cause anxiety, weight gain, belly fat, tender breasts, emotional lability, symptoms of PMS, and mood swings. Long-term exposure to stronger estrogens like estradiol and Premarin can increase the risk of breast cancer. In addition, there is exposure to many estrogen-like chemicals.

Some women (and men) "aromatize" or convert too much testosterone to estradiol, which can interfere with the beneficial effects of testosterone. An "aromatase inhibitor" (i.e. anastrozole) may be prescribed to prevent this. Patients, including breast cancer survivors and men with elevated estrogens, may be treated with the combination testosterone-anastrozole implants.

Do pellets have the same danger of breast cancer as other forms or hormone replacement therapy?

Pellets do not carry with them the same risk of breast cancer as high doses of oral estrogens. Oral prescriptive estrogens do not maintain the correct estrogen ratio or safe hormone metabolites. Pellets do not increase the risk of breast cancer like the synthetic, chemical progestins used in the Women’s Health Initiative Trial.

Data supports that balanced, bio-identical hormones are breast protective. Testosterone, delivered by pellet implantation, has been shown to decrease breast proliferation and lower the risk of breast cancer, even in patients on conventional hormone replacement therapy. Clinical studies show that bioidentical testosterone balances estrogen and is breast protective.

This is not true of oral, synthetic methyltestosterone found in Estratestâ, which gets converted to a potent synthetic estrogen, which can stimulate breast tissue.

In the past, testosterone implants were used to treat patients with advanced breast cancer. In 1940, it was theorized that treating patients with testosterone implants earlier, at the time of diagnosis, would have an even greater benefit, preventing recurrence. Androgens have also been shown to enhance the effect of Tamoxifen® therapy in breast cancer patients.

Are there side effects to estrogen delivered by pellet implantation?

When a patient first starts on hormone therapy there may be mild, temporary breast tenderness, which resolves on its own. Hormone receptors may be very sensitive and take time to adjust. There may be a temporary water weight gain, which will also resolve on its own. Women, especially those who have not had a hysterectomy, may choose a different method of delivery of estrogen, as the risk of bleeding is significant. Balancing the progesterone to estrogen ratio can effectively curtail vaginal bleeding. Further diagnostic testing may be ordered to determine the cause of bleeding.

Will hormone therapy with estradiol and testosterone pellets help with hair loss?

Hormone deficiency is a common cause of hair loss and treatment with estradiol and testosterone implants can help re-grow hair. Hair becomes thicker and less dry with pellet therapy.

Do patients need progesterone when they use the pellets?

Progesterone helps thicken the lining of the uterus each month in preparation for receiving and nourishing a fertilized egg. It is used during hormone replacement therapy to stimulate menstrual periods in women who haven't yet reached menopause but aren't having periods because of a deficiency of progesterone in the body.

Most of the time, when estradiol is prescribed, progesterone is also prescribed, even if the patient has had a hysterectomy. Progesterone is prescribed in an alternate delivery system as it dissolves too quickly to include in the pellet. It usually is delivered in an oral troche (like a throat lozenge) or cream.

The main indication for the use of synthetic progestins, like Provera®, is to prevent the proliferation (stimulation) of the uterine lining caused by estrogen. However, there are progesterone (not progestin) receptors in the bone, brain, heart, bladder, breast and uterus where progesterone has been shown to have beneficial effects. Progesterone can be used as a topical cream, vaginal cream, oral capsule (Prometrium®), sublingual (under-the-tongue) troche or drops. Only oral progesterone (100-200mg) and vaginal progesterone (45-90mg) have been studied and shown to protect the uterine lining from estrogen stimulation.

Women at any age may experience hormone imbalance. Levels decline or fluctuate contributing to debilitating symptoms. Hormone therapy with pellets is not just used for menopause. If a patient is pre-menopausal, she uses the progesterone the last two weeks of the menstrual cycle (Day 1 being the first day of bleeding). Pellets are useful in severe PMS, post partum depression, menstrual or migraine headaches, and sleeping disorders. Pellets may also be used to treat hormone deficiencies (testosterone) caused by the birth control pill.

What can I expect at my initial visit?

We will have you complete new patient information, which includes an initial evaluation of your symptoms. We also will want to have some bloodwork done to test your hormone levels and help isolate symptoms of lack of focus, sexual desire, depression, anxiety, or less energy. The medical evaluation along with your lab readings will enable our medical team individualize your treatment.

Are there any side effects or complications from the insertion of the pellets?

Complications from the insertion of pellets include; minor bleeding or bruising, discoloration of the skin, infection and the possible extrusion of the pellet. Other than slight bruising or discoloration of the skin, these complications are very rare. Testosterone may cause a slight increase in facial hair in some women. Testosterone stimulates the bone marrow and increases the production of red blood cells. A low testosterone level in older men is a cause of anemia. Testosterone, delivered by implants or other methods, can cause an elevation in the red blood cells. If the hemoglobin and hematocrit (blood count) get too high, a unit of blood may be donated.

After the pellet implant procedure, we recommend avoiding vigorous physical activity 72 hours (3 days) for women and 5-7 days for men. Early vigorous physical activity may cause pellet extrusion, i.e., a pellet working its way out. Antibiotics may be prescribed if a patient is diabetic or has had a joint replaced. However, this is a "clean procedure," and antibiotics are most often not needed.

Can a patient be allergic to the implants?

Very rarely, a patient will develop local zone of redness (3-8 cm) and itching at the site of the testosterone implant. There is minimal or no tenderness and no other sign of infection. Pellets are made of up testosterone, stearic acid and PVP (povidone). Patients may react to the PVP. Implants can be compounded or made without PVP. Many patients who develop a local reaction to the implant have low cortisol levels and upon further questioning, have symptoms of adrenal insufficiency. Cortisol testing may be recommended. If needed, 25-50 mg of benedryl works well for the itching

How are hormone levels monitored during therapy?

Hormone levels may be drawn and evaluated before therapy is started. This may include an FSH, estradiol, and testosterone (free and total) for women. Men need a PSA (prostate specific antigen), sensitive estradiol, testosterone, LH, liver profile and blood count prior to starting therapy. Thyroid hormone levels (TSH) may also be evaluated.

In men, follow up levels, including a PSA, blood count and estradiol, may be obtained prior to subsequent testosterone implantation. Men must notify their primary care physician and obtain a digital rectal exam each year. Women are advised to continue their monthly self-breast exam and obtain a mammogram and/or pap smear as advised by their gynecologist or primary care physician.

How much does this cost?

The cost for the insertion and the pellets is between $345 and $600, depending on the dose of the hormone and the number of pellets needed. Men need a much larger dose of testosterone than women, and the cost is higher.

When compared to the cost of drugs to treat the individual symptoms of hormone decline, pellets are very cost-effective. There is better, "unbiased" data on pellets and bone density than any pharmaceutical drug on the market, and it is beyond the scope of our website to examine the cost of drugs used for insomnia, depression, sexual dysfunction, obesity, diabetes, hypertension and other conditions related to hormone imbalance.

Will insurance cover the procedure?

We believe prevention is much more cost-effective than disease, and we hope you do as well.

As a private, direct care medical practice, Go Beyond Medicine® requires up front payment for services. Contact your insurance company to see if your costs will be reimbursed.

In addition, we accept HSA and FSA health care card payments, along with CareCredit.

Is HRT out of reach if I lack insurance or my policy doesn’t cover it?

NO! Go Beyond Medicine® has several options which will make the cost of hormone therapy affordable for you. Prevention is much more cost effective than disease. Furthermore, the money you’re saving from having more energy, focus and drive and a refreshed outlook on life often outweighs the cost of managing the cost of managing symptoms and stress from hormone imbalance. In fact, you’ll probably save money in the long run … You tell us.

CareCredit may also be an option.


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Michael J Grogan, M.D. © 2018 | Go Beyond Medicine ® | Designed by Randall Perkins and Daniel Johnson Jr