Thank you for your interest in Innovative Aesthetic's Bio-Identical Hormone Replacement Therapy (BHRT) services. Dr. Levitt is available for consultations on Tuesdays and by appointment. Contact the Innovative Primary Care Office today at 480.776.0626 to schedule an appointment to determine whether BHRT might improve your quality of life.

Why Hormone Replacement Therapy?

Hormone Replacement Therapy (HRT) helps men and women combat a variety of issues that low levels of hormones due to normal aging or other causes can bring – fatigue, low stamina, depression, loss of memory, decreased motivation, challenges with sex drive, loss of muscle tone, atherosclerosis, low bone density and many other issues. First we need to understand what hormones do for us throughout our lifetimes.

Hormones regulate many bodily functions. Throughout their youth, women experience the impact of hormones. First during puberty estrogen and progesterone allow for the development of breast tissue, maturation of the eggs (follicles) in the ovaries, and regulate the menstrual cycle. Imbalance of these hormones can lead to moodiness, irritability, heavy periods, irregular cycles and breast tenderness. Usually by the time women head into their late 40s, the levels of hormones can begin to fluctuate and there may be a relative dominance of estrogen and normal to decreased levels of progesterone. This can impact the way she feels, her interest in sex, the silkiness of her hair, her energy, mood and sharpness of thinking. As women progress to menopause, which is defined as absence of a menstrual period for one year, related to the natural decrease in estrogen and progesterone hormone levels, women may see a change in a number of normal functions like sleep, a healthy sex life, mood changes and vaginal dryness, which could lead to pain on intercourse. Hormonal imbalance can also upset the normal functioning of many organs and systems, paving the way for many aging-related diseases.

Men face challenges from low DHEA and Testosterone that could include loss of libido, decrease in mental sharpness, decreased motivation, mood changes, and slower recovery after physical exercise among other issues. Men can also start seeing weight gain due to increased fat accumulation as muscle mass declines.

Dr. Levitt developed Innovative Primary Care with the distinct idea of incorporating new thinking and new solutions to support a patient’s overall health and wellness. She believes hormone replacement is as a vital part of supporting wellness for the aging population.

What are the Issues that HRT can help with?

Hormone Replacement Therapy (HRT), also now being called Hormone Therapy (HT), refers to the supplementation of hormones to address the symptoms that can occur to due low hormone levels.

There are a variety of issues that can be related to hormone deficiencies, and they can worsen over time. You might experience some of the following symptoms:

• Anxiety
• Irritability
• Fatigue
• Depression
• Loss of Muscle Tone
• Decreased Exercise Tolerance
• Loss of Memory/Fuzzy or Slower Thinking
• Difficulty Sleeping
• Weight Gain
• Difficulty in achieving and maintaining an erection
• Prostate Enlargement
• Cardiovascular Disease/Atherosclerosis
• Bone loss or decrease in bone density/Osteoporosis
• Elevated blood sugar levels
• Vaginal Dryness/pain with intercourse
• Dementia
• Hot flashes, night sweats

What are the specific challenges Women face that can be helped by HRT?

Bio-identical hormone replacement (BHRT) provides positive health effects for a women and her well-being as she ages. It supports cardiovascular and bone health, and can help in cutting the risk of diabetes and dementia. In addition, BHRT consistently relieves symptoms of perimenopause and post-menopause. It can help with your sex life, stave off the effects of age-related ailments, and provide you with renewed energy.

About Menopause

Menopause is a time of hormone deficiency and imbalance. The body stops creating estradiol—a woman’s most important estrogen. At the same time, testosterone production slows to a trickle. During the slowdown/shut down process, the level of follicle stimulating hormone (FSH) generated by the pituitary gland steadily increases. This is an attempt to stimulate the ovaries into production. But healthy follicles (eggs in the ovaries) are in short supply, if any remain at all. It’s at this stage that the follicles proceed to atrophy and die. This halts the body’s ability to ovulate. The lining of the uterus thins in response to the sharp decline in estrogen. The monthly bleeding finally stops. This is when FSH levels usually soar.

• Menopause usually occurs in women in their 40s or 50s, and on rare occasion impacts women in their late 30s, or as late as early 60s.
• Other types of menopause include: premature ovary failure (POF), premature menopause and surgical menopause (when ovaries are removed).
• Signs or symptoms may vary by individual.

Women of any age who have symptoms should consult a physician. A proper physician’s evaluation will help determine the diagnosis or if the symptoms could be due to causes other than hormonal imbalance or menopause.

About Perimenopause

Perimenopause is a transitional phase in the aging cycle for women. It usually begins 2-8 years before menopause and continues through the first 12 months after the last menstrual period. A woman’s ovaries stop producing normal levels of estrogen and progesterone, and secrete only small amounts of testosterone. While the ovaries stop making hormones, there are small amounts of hormones that are continued to be made by the adrenal glands. They never again reach the levels that they were prior to menopause and overall hormone levels remain low through the remainder of a woman’s life. 

Symptoms of perimenopause may include:

• Wide fluctuations in estrogen levels
• Irregular periods
• Unusually heavy periods
• Mood swings
• Hot flashes
• Night sweats
• Depression
• Fuzzy or impaired thinking
• Headaches
• Weight gain
• Lowering of sex drive

While many women go through menopause or perimenopause without symptoms, in others, this can be an unsettling, disruptive and stressful time. In some instances, it may include challenges to their quality of life.

How does Hormone Replacement Therapy help Men?

Testosterone is indeed a man’s most vital hormone. It defines him as a man, just as estrogen defines a woman. Testosterone is also central to good health. It provides the foundation for many of important body functions.

About Andropause

Every man experiences a gradual decline in hormone production as he gets older, just like women. HRT can help men similarly to the therapy’s impact on women. Men, at around age 30, start to manufacture less and less testosterone, losing roughly one to three percent of the hormone per year. Then, sometime between 40 and 55, testosterone levels drop dramatically and signal the onset of Andropause or Low Testosterone, often called Low T. After this happens, a man may find himself deficient in sexual desire, gaining weight, losing muscle mass and feeling unmotivated, depressed and moody.

• Andropause is the male version of menopause and can be treated with hormone replacement therapy.
• It is caused by a decline in hormone production which usually starts around age 30.
• Men lose approximately one to two percent of their testosterone per year until sometime between 40 and 55 years of age when levels can fall more sharply and signify the beginning of andropause.

Symptoms of andropause may include:

• Loss or decrease of sexual drive
• Decreased sexual function and/or sensitivity
• Weight gain
• Loss of muscle mass
• Feeling sluggish, depressed and irritable
• Sleep disturbances
• Chronic fatigue
• Decreased energy, strength and endurance
• Anxiety
• Depression
• Mood swings
• Decreased mental quickness and sharpness
• Loss of mental focus
• Prolonged recovery from exercise
• Decreased muscle response to exercise
• Less desire for activity and exercise
• Loss of eagerness and enthusiasm for daily life

About Low T

Low testosterone in men (hypogonadism) is the decreased production of hormone by the testes. This normally happens as a man ages. Andropause occurs when testosterone levels take a dramatic dip. This usually takes place somewhere between the ages of 40 and 55.

Researchers estimate that 1 in 4 men past the age of 30 have low testosterone. That amounts to millions of men yet not every man shows symptoms of deficiency. In fact, low testosterone is perhaps one of the most under-diagnosed conditions in men.

At healthy levels, whether natural or accomplished through hormone supplementation, testosterone supports:

• Sex drive & function
• Muscle mass and strength
• Optimal fat distribution
• Production of red blood cells
• Sperm production
• Healthy bone mass
• Cardiovascular health
• Prostate health
• Cognitive function
• Mood stability
• Energy levels
• Motivation & drive
• Healthy skin
• Fluid balance

The best way to determine if you have low testosterone levels is to go through proper testing and analysis guided by a health care provider. Some men show no signs of having Low T levels, yet may have diminished levels.

What are the Methods of Treatment?

Bio-identical hormone replacement therapy is typically administered in one of several ways: pellets, intramuscular injection, oral (pills or a lozenge like pill), or by creams/gels.

Pellets

Pellets containing estrogen and/or testosterone for women and testosterone for men are inserted through a small incision in the upper buttock area and deposited into the fat layer. The incision is closed by steristrips and covered by a band aide that is worn for six days. Pellets deliver consistent levels of hormones for 3-6 months in women and 4-6 months in men. They avoid the fluctuations, or ups and downs, of hormone levels seen with every other method of delivery. Pellets do not increase the risk of blood clots that can be seen with oral or synthetic hormone replacement therapy.

Some patients begin to feel better within 24-48 hours of having a pellet inserted while others may take a week or two to notice a difference.

Studies show that when compared to conventional hormone replacement therapy, pellets provide superior relief for menopausal symptoms, maintenance of bone density, restoration of sleep patterns, and improvement in sex drive, libido, sexual response and performance.

Even patients who have failed other types of hormone therapy have a very high success rate with pellets and prove to be the most convenient method for the patient. There is more data to support the use of pellets than any other method of delivery of hormones.

In the United States, the majority of pellets are made by compounding pharmacists and delivered in sterile glass vials. There is an ‘FDA approved’ 75 mg testosterone pellet made for men. Pellets purchased through compounding pharmacies are not considered to be FDA approved. Clinicians trained in anti-aging medicine and pellet therapy have been using this modality for many years. In fact, pellets were originally developed in the 1930s both in Italy and the United States.

The side effects or complications from the insertion of a pellet is relatively rare. Complications could include minor bleeding or bruising, discoloration of the skin, infection, and the possible extrusion of the pellet. After the insertion of the pellet implant, vigorous physical activity is avoided for 3-4 days to help prevent an extrusion of the pellet.

In women who have a uterus, it is necessary to supplement progesterone anytime they receive estrogen in any form. Bio-identical progesterone can be supplemented as a cream or orally. Some compounding pharmacies do make progesterone pellets which can be used in women who have had their uterus removed, but because their blood levels are less reliable, it is probably not a preferred method for women who still have their uterus.

Estrogen and testosterone therapy by implantation of pellets is a safe and effective method of hormone therapy for both men and women. Administration of hormones by pellets is often a more convenient and economical method by which to improve hormone levels.

Where do you get pellets and how much does it cost?

IPC obtains pellets from either Wells Pharmacy or Solutions Pharmacy, both compounding pharmacies located in Tennessee. The cost of each pellet is between $15 and $30. Men need anywhere from 2-6 200 mg pellets, depending on their testosterone level and response to therapy. Women will need one pellet of testosterone and one pellet of estrogen at varying doses, depending on their deficiencies and desire for supplementation. The cost for insertion for one or more pellets at a singular visit is $250. Invoices will be provided to be submitted to your insurance company. In some instances, some insurance companies will reimburse for some of the cost. If you have an Health Savings Account, they also may be used for HRT costs.

What about hormone creams?

Testosterone, estrogen, progesterone and pregnenolone can all be compounded into hormone creams. They can be prescribed for both men and women. Doses can be adjusted based on symptoms and blood levels of low or excess hormone levels.

The creams are purchased through one of many compounding pharmacies that are located throughout the Valley. In some instances, health insurance may pay for these creams, but in many instances, they do not. Based on what is prescribed, costs will vary from around $40-$80 or more per month.

Contact the Innovative Primary Care Office today to schedule an appointment to determine whether Bio-Identical Hormone Replacement Therapy might improve your quality of life.