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What is the goal of bio-identical hormone therapy (BHRT)?

With BHRT most patients experience:

  • Increased Energy – mental and physical
  • Stronger metabolism – to build bones, to build muscle, to lose fat
  • Improved Body Functions – sleep, relaxation and mood
  • Improved Sexual Function –  enhanced libido, increased vaginal lubrication

Hormone Optimization also reduces risks of:  cardiovascular disease, osteoporosis, diabetes, lower cholesterol, Alzheimer’s disease, macular degeneration, cataracts, and improved immune function.

How is the BHRT administered in our practice?

We prescribe bioidentical hormones in the form of topical creams/patches or pellet therapy. Progesterone, when indicated, is given as an oral capsule or sublingual route. There are pros/cons to each method. We will discuss with each patient which option is best for their individual needs. However, our experience and the medical literature has shown that the subcutaneous pellet delivery system delivers consistent, physiologic levels of hormones, therefore maintaining a steady, constant and optimal level, and avoiding the fluctuation of hormone levels seen with other methods of delivery.  When pellets are used, testosterone and/or estradiol pellets are placed in a fatty area of the body, usually the buttocks.  They are extremely small, usually painless to insert, and provide a steady hormone level for 3-4 months for women.

Our experience has been that creams/ patches can be cumbersome, inconvenient and simply just don’t work as well. Topical creams can be transferred/spread to family members, which is particularly concerning if children are in the home as the cream can be spread by vapors in the air.  Estrogen pills create swings in blood hormone levels on a daily basis, as well as increasing the risk for developing blood clots. Patches can lead to skin irritation.


How long do I continue BHRT?

You can stop BHRT at any time, which will cause your hormones to drift back to your pre-treatment levels. Hormone deficiency symptoms and propensity to develop disease will return.  There is no age limit on treatment.  Though uncommon, patients as young as 25 (such as those with PCOS and severe PMS) as well as women in their 70’s or older have had wonderful benefits with this therapy.

If I balance my hormones, will all my symptoms resolve?

It’s not always that simple. There’s more to us than just estrogen, progesterone and testosterone.  There are several factors that are essential for a successful BHRT program.

Things to consider for optimal BHRT results are:

  • Sound Sleep (7-8 hours/night)
  • Regular exercise
  • Appropriate Supplementation, Micronutrient Evaluation
  • Stress Management and Treatment of Adrenal Dysfunction
  • Regular Bowel Movements (1-3 times/day)
  • Clean Eating
  • Food sensitivity testing, dietary changes
  • Periodic detoxification (2x/ year)
  • Optimal Thyroid function

If hormone optimization does not give you the results you desire, we have structured our practice and tailored our training to provide you with a comprehensive evaluation of health and wellness.  As a “one stop shop” for women’s healthcare needs, we will work with you to reach your desired goals.  From our wellness coaches who specialize in nutrition and weight loss, to our medical providers who integrate both traditional and functional medicine, our goal is to approach your health care from a holistic perspective.  Our goal is to give you the most complete care in whatever areas you may need.

Testosterone is vital to the health and well-being of BOTH men and women.  In women, testosterone is produced in both the ovaries and the adrenal glands.

Optimal levels of Testosterone in Women (from Pathgroup Lab):

  • Free Testosterone >6.75 pg/ml
  • Total Testosterone >100 ng/ml
Testosterone Benefits Include:
  • Contributes to muscle mass, strength
  • Decreases fat
  • Increases exercise tolerance
  • Enhances of the sense of well-being
  • Increases libido
  • Reduces risk of cardiovascular disease
  • Lowers cholesterol
  • Reduces blood sugar
  • Increases bone density

Essentially, testosterone enhances quality of life for and decreases the incidence of diseases associated with aging.  Testosterone is present and extremely important in both women and men, making adequate tissue levels very important for health in both sexes (it goes without saying that women require substantially less of it)!  There are hundreds of published articles on the health benefits of testosterone therapy in men and women- particularly for testosterone pellet therapy.  Potential side effects with testosterone include:  excess facial and body hair, oily skin, and acne.  If you have any of these symptoms, notify the office and we will discuss options to help, which may include lowering the testosterone dosage or using a water pill called Spironolactone that helps reduce these side effects.   Testosterone may also increase your red blood cell count, this is called erythrocytosis.  We will monitor your blood count and may recommend phlebotomy or a lower Testosterone dose if your blood counts are increasing.

Estrogen refers to a group of similar hormones in the body.  Estradiol is the main estrogen in the body that has been studied to prevent disease.

Optimal Levels of Estradiol:

  • Post-menopasal Women <100 pg/ml
  • Pre-menopausal Women
    • Estradiol level not accurate due to daily/ monthly fluctuations
Estrogen Benefits:
  • Protects against heart disease and stroke
  • Reduces osteoporosis
  • Reduces risk of Alzheimer’s disease
  • Protects against vaginal atrophy (vaginal dryness)
  • Helps with  urinary incontinence
  • Reduces hot flashes
  • Decreases skin wrinkles

Estrogens also help with fatigue, depression, mood swings and decreased libido.  Estrogen dominance/overload can lead to many symptoms including breast tenderness, uterine bleeding, weight gain and irritability.  It is imperative to balance estrogen therapy with progesterone.

Progesterone is primarily produced in the ovary just prior to and after ovulation. It is also produced in large quantities by the placenta during pregnancy and in small quantities by the adrenal glands.   Factors that can contribute to low Progesterone include:  excess dietary sugar and saturated fats, stress, anti-depressants, vitamin deficiencies (specifically vitamin A, B6, C and Zinc), low thyroid, birth control pills, and aging.

Optimal Levels of Progesterone:

  • Post-menopausal > 10 ng/ml
  • We dose Progesterone in pre and peri-menopausal women based on symptoms and side effects.
 Benefits of Progesterone:
  • Prevents Estrogen dominance
  • Promotes breast health (along with Testosterone)
  • Protects against breast cancer, fibrocystic disease, and ovarian cysts
  • Helps women relax and sleep better
  • Progesterone levels in premenopausal women are not accurate due to daily monthly variations.

Progesterone is given in capsule or sublingual form.  High doses of oral progesterone can cause drowsiness upon waking.  If morning drowsiness occurs, a sublingual form can be given. We want to dose high enough to get protective levels, but not so high that you feel woozy in the morning.  Some women are not affected by progesterone in this way, but others are very sensitive to it.  This is why we treat each person uniquely.  If you are on bio-identical estrogen, you will also be prescribed Progesterone to counteract the effects of estrogen. Unfortunately, most U.S. women are prescribed a synthetic progestin (i.e. Provera or medroxyprogesterone) which can cause side effects such as bloating, headaches, fatigue, weight gain, migraine headaches, and heart disease. Bio-identical progesterone does not have these side effects.  Other synthetic progestins are found in the Mirena IUD™, birth control pills, and Depo-Provera™. When these synthetic progestins are used in place of natural progesterone, women suffer from further hormone imbalances and do not receive the desired health benefits of natural progesterone. Natural progesterone is our calming hormone that relieves anxiety and allows us to sleep at night, while also protecting us from estrogen-dominant cancers.

DHEA is a hormone secreted by the adrenal glands. This hormone is a precursor to other sex hormones. In addition to having its own effect, it results in a shift to an anabolic or protein building state. DHEA reduces cardiovascular risk by increasing the breakdown of fat. This hormone also stimulates the immune system, restores sexual vitality, improves mood, decreases cholesterol and body fat.  Recent studies point to DHEA as an anti-stress hormone, reversing the effects of stress on the immune system.

DHEA is replaced with a sublingual tablet (it should be placed under the tongue and kept in place until it dissolves). Side effects of DHEA can be acne or unwanted hair growth, which can be treated by lowering the dose or using Spironolactone.

Optimal Levels of DHEA

  • Women > 200 ug/ml
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