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Bioidentical Hormone Replacement Therapy (BHRT)

What are bioidentical hormones?  How are bioidentical hormones different?

Bioidentical hormones are identical in structure to the hormones humans naturally produce but are produced in a lab from plant matter.  Bioidentical hormone replacement therapy (BHRT) differs from synthetic hormone replacement therapy because synthetic hormones are produced from animals and are not molecules which are found in nature.  Since the hormones that are naturally produced in humans differ from those which are synthetically produced, your body often views these animal hormones as foreign bodies, sometimes leading to an immune-related response, creating potentially serious and certainly unwanted side effects.  However, since your body views bioidentical hormones to be the same as those it produces itself, they are often a safer and more effective alternative to traditional hormone replacement therapy.  In other words, bioidentical hormone therapy refers to the use of hormones that exactly mimic the structure and function of the hormones inside your body.

What are the symptoms of menopause?  Why should I get tested?

  • Mood Swings
  • Anxiety
  • Depression
  • Irritability
  • Hot Flashes
  • Insomnia
  • Vaginal Dryness
  • Poor Sex Drive
  • Leaking Urine
  • Weight Gain
  • Weak Bones
  • High Cholesterol
  • Low Energy
  • Fatigue
  • Thin Skin

Why should I start bioidentical hormones?

If you are suffering from any of the symptoms listed above, you should consider starting bioidentical hormone therapy.  Bioidentical hormones help with mental clarity, feeling energetic, strengthening bones, and proper weight distribution.  Menopause changes where women store their fat.  When estrogen and progesterone levels fall, the body begins moving fat deposits to different areas.  Women tend to move fat from their thighs and buttocks to upper back and abdomen.  Although your total weight may not be changing, you may notice your clothes do not fit the same.  This is because your body’s fat stores are shifting.   One of the major benefits of bioidentical hormones is the cessation of hot flashes.  Since hot flashes are caused by estrogen deficiency, bioidentical hormone replacement quickly resolves hot flashes and night sweats.   Cosmetically, estrogen is extremely important.  It helps maintain a vibrant skin tone by allowing a healthy amount of subcutaneous fat.  Without small amounts of fat beneath the skin, it becomes thin and transparent.   Maintaining healthy amounts of subcutaneous fat allows for plump skin with a youthful texture.

Perimenopause can be an equally frustrating time of life for women since hormone levels can fluctuate wildly and unpredictably.  By using bioidentical hormones, the hormone fluctuations can be blunted and improve hormonal stability which helps with mood swings and irritability as well as sexual interest.

Younger women can also have their hormone levels evaluated and replaced with bioidentical hormones if needed.

How do I get evaluated for hormone replacement?

Hormonal evaluation is easy to do and can be done by a simple blood draw in our office.  If you are menopausal, your hormones can be drawn at any time.  If you are perimenopausal, your healthcare provider will suggest the best time to get your hormone levels checked in regards to your menstrual cycle (or period).  For menstruating women, hormone levels are checked 3 weeks after the first day of your menstrual cycle.  Hormone blood levels are covered by most insurance plans, but you should call your insurance company if you are concerned about coverage.

Hormone testing from saliva is available at our office.  It is not covered by insurance, so most people prefer blood testing.

Which hormones levels are evaluated?

Different hormone levels are checked depending on the reason or medical problem being evaluated.  Our lab has the capability to check all hormone levels, including estrogen, progesterone, total testosterone, free testosterone, DHEA, SHBG (Sex Hormone Binding Globulin), cortisol, FSH, LH, Prolactin, and any other hormones needed.  After  your evaluation, you can get your hormone levels checked.

Do I need progesterone even if I do not have a uterus?  I had a hysterectomy, and my gynecologist told me that I did not need progesterone.

We believe that progesterone is a necessity for women on bioidentical hormone therapy because it is a vital hormone that balances estrogen and testosterone.  The goal for hormone replacement is balancing your hormones to a natural level.  All women in their young, fertile years have progesterone, so why would we stop replacing it after menopause?  Progesterone has many positive effects, including balancing estrogen dominance, improving sleep quality, strengthening bone, preventing mood swings, reducing bladder leakage, reducing bowel irritation, and many more benefits.  If your gynecologist told you that you do not need progesterone, they were correct.  Progesterone replacement is not an absolute necessity after a hysterectomy, but we believe that it is beneficial for all women, so we include it in hormone replacement therapy unless the patient declines.  However, if you still have your uterus, then progesterone therapy is a must with hormone replacement therapy.

Why do women need testosterone?

Women need testosterone just like men need estrogen.  Testosterone is needed at much lower dosages in women than for men, but it is used to provide bone strength, decrease body fat, increase muscle mass, maintain memory, improve self-confidence, and increase sexual desire.

Dr. Sneed wrote an excellent blog about this:  http://www.ausfp.com/testosterone-women

How much do bioidentical hormones cost?  What will my insurance cover?

Bioidentical hormones must be compounded by a pharmacy, and these hormones cannot be branded by a pharmaceutical company.  Each pharmacy has different prices, so it is important to shop around for the price that suits you the best.  Keep in mind that sometimes you will pay extra for high quality compounding, fast turnaround times, and excellent customer service.  Since these hormones are compounded specifically for you, it is cheaper to buy a 90 day supply rather than a 30 day supply.  A reasonable cost is around $1 per day per hormone; therefore, a 90 day supply of Biest and Progesterone should cost around $180 or less.

Note:  Your insurance may or may not cover compounded medications.  You can call your insurance company and ask if compounded medications are covered.  Also, the pharmacy will be able to tell you if your insurance company will help cover your hormone prescriptions.

All of your hormone laboratory tests and office visits will be covered under your insurance plan.  Similar to most office visits, you will be expected to pay co‑pays and any deductible payments that your insurance company requires.

Where can I get my bioidentical hormone prescriptions filled?  What is a compounding pharmacy?

There are multiple compounding pharmacies in Austin, Texas.  A quick Google search can identify many of them.  You should find one that is close, friendly, and makes high quality compounds.  If you need assistance, we can help suggest pharmacies.  A few of the pharmacies our patients frequently use are:

Stonegate Pharmacy

www.stonegaterx.com

512-707-2300

Lamar Plaza Drug Store

www.lamarplazadrug.com

512-442-6777

Peoples Pharmacy

www.peoplesrx.com

512-444-8866

NuCara Pharmacy

www.nucara.com

512-454-9923

Tarrytown Pharmacy

www.tarrytownpharmacy.com

512-478-6419

 

How does hormone therapy work at Austin Family Medicine Associates?

We use an individualized approach to hormone replacement therapy by testing your hormone levels and creating a plan based on your body’s specific needs.   After an initial consultation using your medical insurance, we will create a comprehensive treatment program using bioidentical hormone replacement therapy (BHRT).  Additionally, we can evaluate your health status and signs of disease or aging in order to maximize your chances of staying off of medicine and maintaining your health.  We can also care for all of your gynecological concerns, including PAP smear and well woman exams.  We always have female providers available if you prefer a female healthcare provider.  This comprehensive medical and lifestyle approach to your health helps alleviate the pain and suffering caused by conditions such as menopause, perimenopause, PMS, and other female hormonal conditions.

We also insert bio-identical hormone pellets for women who do not want to use cream every day.

The pellets are inserted in either hip just beneath the skin.  New dissolving pellets are inserted every 4 months.  The procedure is done in our office within 30 minutes.  There is minimal pain associated with the insertion.  Read more about this procedure and its cost on our website.