Ask Dr. Rob: What is Hormone Replacement Therapy
By Rob Hamilton, M.D. BC Emergency Medicine, Regenerative Medicine
What is hormone replacement therapy and does it really work?
Done properly, bioidentical hormone replacement therapy restores a person’s hormones back to healthy physiologic levels that they had when they were in their 20s and early 30s. Although this doesn’t reverse aging or "make you 18 again,” it can alleviate many of the symptoms mentioned above in men and women, and also helps to prevent or slow the development of many of the degenerative diseases that are so common as we age: osteoporosis, cardiovascular disease, cognitive decline, arthritis, etc. Hormones are important messenger molecules in the body that signal the body to heal and repair itself, and losing them keeps the body from repairing itself over time.
What are the "natural" changes of aging?
As men and women age we experience a natural decline in our hormones. Women already know about this — they call it menopause, also known as the “change of life.” And that is truly what it is — life changes — and usually not for the better. Women have three important hormones (testosterone, progesterone, and estradiol) that progressively start to decline, usually in the late thirties to late forties. As these hormone levels drop, many women experience significant changes in their mental and physical well-being that can negatively impact their daily lives. Ultimately these hormones levels almost complete disappear and a woman enters menopause. Her reproductive years come to an end — usually her menstrual periods stop. However, a number of other bothersome symptoms and changes can occur in a women’s body both before and after menopause, including things like night sweats, hot flashes, poor sleep, moodiness, irritability, fatigue, lack of energy, weight gain, loss of muscle mass, difficulty recovering after exercise, loss of mental clarity / foggy thinking, depression, anxiety, decreased libido, vaginal dryness, and bothersome hair and skin changes. Although men’s hormones don’t “suddenly” decline causing a menopause like women’s do, men’s testosterone levels decline as they age. And while the changes aren’t as immediately apparent or dramatic, they add up over time to causing significant worsening of quality of life. As a man’s testosterone declines, he experiences many symptoms but ofttimes so gradually he doesn’t even realize they are occurring. These symptoms may include fatigue, loss of energy, poor sleep, moodiness, irritability, weight gain, loss of muscle mass, depression, anxiety, difficulty recovering from workouts, decreased libido, and erectile dysfunction. Although these changes are “natural” and occur to all of us as we age, modern medicine has given us convenient, safe, and effective ways to replace these critical hormones as we age. Much like any medical intervention, hormone replacement therapy must be correctly prescribed and carefully monitored, but done well, the effects can be life changing. While some argue that we should just “age naturally,” it’s worth pointing out what we do in medicine is to prevent “nature from taking it’s course’ When I was practicing Emergency Medicine and a patient came into the ER with a heart attack we didn’t just tell them “don’t worry, it’s normal aging.” We would intervene and do something. Although the decline in hormones is much less acute than a heart attack, the life changing effects of hormone loss with age can be similarly detrimental, and so why wouldn’t we want to intervene if we can do so safely?
Are there side effects?
Like any medical therapy, there can be side effects or issues with hormone replacement therapy, but done properly, it is nearly free of such side effects. Usually side effects are related to the delivery method. Remember, these hormones are not foreign substances — they are exactly the same molecule that your own body makes and expects to see, so mostly side effects occur if they are dosed incorrectly (commonly, dosages are too high). That is where it is important to have someone who specializes in hormone replacement and has the expertise that our clinicians at PRM do to direct your care.
Once I start, do I have to stay on it forever?
No… but… many of our patients have such an improvement in the quality of their lives that they don’t want to stop. One of my mentors in the field, the first physician to start using bioidentical hormone replacement in the United States, told me that many of his patients ask him, “When should I stop taking my hormones?” His answer: “When you no longer want to be healthy.” That having been said, you can discontinue therapy at any time. Your hormone levels will return to where they were before starting the treatment. Hormone replacement therapy is NOT addictive, and there is no “withdrawal” from stopping, other than returning to the way you previously felt.
Will my insurance cover hormone replacement therapy?
Because of our unique model and the type of services we provide, we are unable to bill insurance for your care. However, the hormones we prescribe in our Hormone Replacement Co-Insurance Membership for men and women are available at your local pharmacy and will likely be partially or completely covered by your prescription drug insurance program. If they are not covered, there are excellent online prescription drugs coupon programs (for example, goodrx.com) that will minimize your out of pocket costs. For the ultimate in convenience and the best quality bioidentical hormone replacement therapy, we suggest our Concierge Memberships, which are NOT covered by insurance. The hormones we prescribe in our Concierge program are specially prepared for you in a nationally recognized compounding pharmacy and shipped directly to your door. Insurance companies generally don’t pay for compounded prescriptions, but our relationships and purchasing power have allowed us to get you easy access to the best quality hormone replacement therapy.
How do I know if I need hormones or if I will benefit from therapy?
Determining whether or not you are a candidate for hormone replacement therapy is an easy process. All of our patients start with an Introductory Consult. We run specialized lab testing to check hormone levels in women (estradiol, progesterone, total/free/bioavailable testosterone, CBC, FSH and LH) and men (total/free/bioavailable testosterone, CBC, and PSA levels). These results tell your provider whether or not your hormones are imbalanced. At the Introductory Consult, your provider will go over these lab results with you and make recommendations based on your current hormone levels. The best part is that at Prestige Regenerative Medicine, we cover the costs of these labs (which usually run about $500) and you will not receive an unexpected lab bill. If you would like to schedule an Introductory Consult with a provider, call us at 530-395-0505 or schedule a call with our Program Director.
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