Frequently Asked Questions

The human body is designed with an intricate network of chemical messengers (hormones) that communicate with one another in the body.  These messengers regulate our mood and cognition, skin integrity, body fat distribution, sexual health, gastrointestinal, urinary, and cardiovascular systems. Age, environmental toxins, stress, medications, and nutrition can alter these hormones leading to undesirable symptoms like mood swings, low energy, heavy or irregular periods, infertility and premature aging. Bioidentical Hormone Replacement Therapy (BHRT) seeks to restore and optimize these hormones (which are chemically identical to what your body makes). Synthetic hormones are derived from synthetic sources to act on the body’s receptors and although are well researched, often still safe for some, and effective at relieving symptoms, may confuse the body when the goal is optimal wellness.

Not all hormone replacement therapy is created equal. Historically, most of what has been available in terms of hormone replacement (including most common forms of birth control) is synthetic. More specifically, synthetic hormones are not derived from nature. Unfortunately, many synthetic hormones cannot be broken down by the body effectively. When the body is unable to break down synthetic hormones, the “build-up” effect can lead to adverse effects including breast and endometrial cancer in some cases. Bioidentical Hormones are different because they are plant-derived, and they are structurally identical to the hormones the body produces naturally. There is still much research to be done in comparing bioidentical and synthetic hormones.

Bioidentical sex hormones include Testosterone, Estrogen, Progesterone, and DHEA.  I treat with oral therapies, topical creams and gels, and commercial patches.

There are certainly risks and benefits to all treatments. Potential risks of hormones go up with age over 60 (specifically if not starting until that time), those who are more than 10 years from their menopausal transition, in smokers, and in those with extensive comorbid disease already (history of heart attack, stroke, blood clots, breast cancer, etc). 

The North American Menopause Society states that in most cases, actually the benefits of HRT (hormone replacement therapy) outweigh risks. 

There are numerous benefits to HRT: 

• Improved Quality of Life by improving sleep, energy, sexual function, depression, cognitive, vasomotor symptoms, vaginal dryness, and sense of wellbeing.

• Reduction in all - cause mortality

• Reduction in Alzheimer's, diabetes, cardiovascular disease, risk of heart attack, colon cancer, osteoporosis, and prevention of age related macular degeneration.

*Currently, the FDA has approved menopausal hormone therapy for relief of vasomotor symptoms, prevention of osteoporosis, and relief of moderate to severe menopausal vaginal symptoms. Uses beyond this are considered off-label.

It is much more complicated than that.

The Women’s Health Initiative study of 1991, which was released in 2002 caused massive confusion and panic. But it was flawed. This large study utilized synthetic estrogen (Premarin) and synthetic progestin in older postmenopausal women with multi-comorbidity.

Since then, this data has been further evaluated and findings were that in cases of estrogen only (because the women had a hysterectomy) breast cancer rates were not increased. In women who were on estrogen and synthetic progestin, it seems rates of breast cancer increased after 4-5 years of use.

Bioidentical progesterone does not seem to carry the same link with the available data to date.

Oral estrogens (synthetic or bioidentical) are processed through the liver (first pass metabolism). This process induces variability in estrogen levels and increased thrombogenic proteins, C-reactive protein (inflammation), and triglycerides, therefore activating the clotting cascade, specifically in those with other underlying risks. Transdermal estradiol options (patches and creams/gels) bypass the liver, therefore, bypass the detrimental impact on coagulation and risk of blood clotting.

Compounding pharmacies are pharmacies that specialize in patient specific medication preparations. These pharmacies use FDA approved medications to customize dosing and routes specific to the patients needs.

Compounding has been under scrutiny, but there are several highly regulated compounding pharmacies that produce quality options with rigorous testing to make sure that the medications are up to par. Such accreditations include Professional Compounding Centers of America (PCCA).

Most insurance companies do not cover compounded medications (some do), but usually the cost of these medications is much lower than their commercially available counterparts (if available).

The American insurance based world is dictating who, when, and how providers provide care. By lessening their coverage, practices are raising their rates to increase the payment received, which is the reason why the United States is one of the most expensive countries to receive healthcare in the world.

By not taking insurance, I can keep my prices lower, manage my practice solo, and practice in the way I feel is necessary and most beneficial to my patients. However, standard blood work may be covered by your insurance and I am always dedicated to giving you the most value for your hard earned dollar.

I will accept FSA account payments as well as provide superbills which can be submitted to commercial insurances for reimbursement.

An important note: Unfortunately Medicare has rules that I am not allowed to bill cash for services rendered regardless if you are willing to pay this. For this reason, I will not be able to see you if you have a Medicare based plan.