Frequently Asked Questions: Hormone Tx

Many people have questions about the safety and efficacy of hormone treatments. I provide individualized hormone treatment programs. Every patient undergoes our complete metabolic bloodwork panel; a physical exam including breast exam, and a full 90-minute initial intake to make sure that hormone treatment is safe and recommended for you.

Here are some common questions, asked in our free 30 minute screening consults.

Will I need to stay on hormone treatment forever?

Current evidence shows that estrogen and progesterone bioidentical replacement therapy is safe for up to 15 years. After 15 years the risk of hormonal cancers increases very slightly. I encourage our patients to follow their own instincts around the duration of bHRT. Many women reach a point where they want to try coming off the hormones, to see how they feel. (Many then come back on the hormones for the feelings of well being they provide!) There is no “right answer” for the duration of hormones treatment; instead, your ongoing health and feelings of wellness may be the most important indicator to measure this.

What is a Bioidentical hormone?

Bio –meaning, of the body and Identical meaning, exactly like = hormones that are exactly like those your body naturally produces.

Why use Bioidentical hormones?

Generic and brand name hormones made by pharmaceutical companies all have biochemical additions to the basic hormone structures like pharma-signatures that make the drug patented (and profitable.) Bioidentical hormones are made as liquids, creams, troches, rapid dissolve tablets, injections or suppositories by a compounding pharmacy laboratory like Apothecary by Design to make them exactly like the hormones your body would naturally be producing. Drug companies cannot make money off of this form of hormone because they are universal; therefore their use is discouraged by big pharma. We know that bioidentical hormones are the safest, most effective way to replace hormones in your body. We only use compounded, bioidentical estrogen, progesterone, and testosterone at Age Management Center.

Do hormones cause cancer?

The Women’s Health Initiative study in 2001 did show an increased risk of not only breast cancer, but also heart disease in women taking the medications in the study. What is KEY here is that the hormone medications used in the study were the horse-based estrogen Premarin and a synthetic version of progesterone called progestin, brand name Provera. The study was separated into just Premarin users and Premarin + Provera “Prem-Pro” users. The Provera Rx was clearly indicated as the causative factor for the increased risk of breast cancer in clinical data. In further studies on bioidentical progesterone it has been evidenced that 200 mg of bioidentical progesterone is actually protective against the development of breast cancer.

It was the synthetic pharmaceutical analogue Progestin that is linked to cancer development, not either bioidentical estrogen or progesterone. Having said that, if you already have an estrogen positive cancer growing in your body, additional hormone replacement therapy can feed the tumor growth. We encourage all of our patients to get screening mammograms yearly during menopausal hormone replacement therapy, and actively support anti-cancer nutrition and antioxidant supplementation as part of our treatment protocols.

What about heart disease in women and estrogen use?

One of the most surprising results of the Women’s Heath Initiative was the increased risk of cardiovascular health issues like blood clots resulting from plaque rupture in women using Premarin. Estrogen is in fact protective for the cardiovascular system as it increases elasticity in all systems including the blood vessels. More elastic, flexible arteries means healthier blood flow. However, when combined with risk factors for atherosclerosis (plaques in the arteries) like elevated cholesterol, high blood sugar, smoking and being overweight the benefits and the risks need to be weighed to assess what is best for each woman.

At Age Management Center our complete metabolic blood work panel and 90 minute initial consult is in part to ensure that your body is metabolically able to handle additional bioidentical estrogen, and that you are a good candidate for hormone treatment. Some women need to do additional metabolic and cardiovascular work to reduce risk factors before estrogen-based therapy is indicated. Oral estrogen (taken by mouth) was associated with more risk for plaque rupture than topical estrogen. We start all women on a topical mix of bioidentical estradiol and estriol plus additional progesterone to manage symptoms while navigating risk, ultimately improving metabolic and cardiovascular health for effective anti-aging.

I thought testosterone was only for men?

Want to know a secret? Testosterone is like magic for womens health. It is actually the most abundant hormone across our entire lifetime because our body continues to produce it after menopause (if all goes well.) Testosterone is extremely valuable for women’s health because it is the “vitality” hormone that leads to physical and mental strength, bone health, leadership qualities, sexual appetite, sexual satisfaction, mood stability and more. Testosterone levels naturally start to get lower around 40, but the adrenal glands take over testosterone production when periods stop completely. We see low testosterone in women of all ages; we use testosterone supplementation in most of our menopausal treatments, because it helps you feel great! This hormone has been part of menopausal treatments since 1937. There is not much excitement generated about it in traditional medicine because who wants strong, sexual, healthy, happy, active, passionate postmenopausal women? I do!

Will taking testosterone make me look manly? (Facial hair, lower voice etc)

My job is to replace and optimize hormones to their natural levels. When testosterone levels are optimized for your body, it is unlikely you will have complications like black facial hairs, voice lowering, acne, or other classic side effects. However, this of course depends on your genetics and sensitivity to hormones. We start with the lowest possible dose after our thorough initial exam, an adjust dosages based on your personal experience plus laboratory testing. If you happen to be someone who does have side effects like facial hair or pimples, these are immediately reversible by lowering your dose.

At Age Management Center I also provide transition support for transgender and transsexual individuals. These dosages of hormones are significantly higher than doses used for hormone replacement, and do have permanent and reversible side effects that are usually considered desirable by the people using them.

Do you accept insurance?

Age Management Center is a concierge medical practice. We offer the best of modern regenerative medicine, guided by cutting edge evidence based research, in a relaxed, comprehensive manner. Our hormone programs are simple. Once a month fees include all doctor visits, emails, and phone calls, as well as your administrative support and foundational hormones. We operate outside the insurance system so that we can offer the high touch personalized medicine that our patients have come to rely on. We do not bill insurance companies for our services; however we can give you an itemized “superbill” for your services that you can submit on your own for reimbursement. We invite you to come in for our free 30-minute consultation to learn more about our concierge medical programs and how these might work for you.

Can I use my insurance for the comprehensive metabolic bloodwork?

We prefer that our patients use our cash-based in house laboratory services as it allows for consistent lab results and lab values, speedy results, streamlined workflow and improved coordinated care. We thoroughly research the best prices for lab work, and pass those savings on to our patients. For example, our complete metabolic blood work is priced at $1800 through insurance billing. We offer it at $395, passing on our physician pricing to you. Many of our patients have tried to use their insurance to run the blood work, and with deductibles and co-pays have ended up paying at least $600-800 for the same work.

Furthermore, many insurance companies and PCP’s will not cover some of the hormonal blood work evaluations we consider crucial to accurately understanding your metabolic and hormonal health. By having all of your blood work arrive in time for your initial visit, we are better able to serve you in a timely and effective manner. Laboratory, physician and clinical services can all be claimed as health expenses on your taxes, and can be part of your deductible.th

Can I use my Health Savings Account or Flex Spending Account?

Yes. Age Management Center services are billable through HSA and FSA’s.

Share

Fertility is the New Holy Grail

Resolve to know more about the underling factors affecting conception and alternative family possibilities. * This article was originally written for the February 2015 Digital Issue of Essential Living Maine*

I had two stepmothers who were infertile for various reasons, and have an adopted baby brother. Several of my close friends and family member have used IVF to conceive, and I have my eggs cryopreserved. A few of my good friends have fostered and adopted, and others have intentionally chosen childfree lives. As lesbian and gay marriage has normalized, and divorce rates have climbed, more and more alternative families are being created using sperm banks, surrogates, egg donors, known sperm donors and more. The quest for fertility is all around us, and has been for the past 30 years in ever-increasing numbers.

The Internet has an enormous amount of information available on this topic, as the World Wide Web offers an enormous cross cultural support network for women trying to conceive (#TTC.) Infertility is usually a silent disease without any visible disability associated; however, it draws deeply on the mind/body and soul in underground ways that cannot be explained to those who do not have to undergo its trails and tribulations. Thus, the web is a great way to connect, share information, and do research while maintaining public anonymity.

220px-Sangreal-1Integrative Medicine is key to enhancing fertility. Integrative Medicine combines the best of modern medicine (reproductive technology) with time-honored complementary and alternative medicines (botanical therapies, clinical nutrition, homeopathy, acupuncture, and stress management support.) The quest to get pregnant (and stay pregnant!) has been a calling of doctors and midwives since the beginning of time and across all cultures.

After ten years of fertility specialization, here are my Top Ten Integrative Medicine Fertility Fundamentals to know about when mapping your journey:

  1. First, while on oral contraceptive pills, rings, or IUD’s and for at least 6 months coming off them, it is important to supplement with a good quality multivitamin that contains at least 10-20mg of all of the B vitamins, magnesium, vitamin C, and 800mg folic acid. These are depleted by synthetic estrogens, and a deficiency can cause long term fertility issues down the road.
  1. If you have a family hx of miscarriage, have had a miscarriage yourself, or have any anemia or high homocysteine on lab work, you may want to test for a genetic defect called MTHFR that leads to a folic acid absorption issue. http://www.apothecarybydesign.com/blog/archives/332
  1. DHEA is a fat-soluble antioxidant and hormone precursor produced by the adrenal glands. DHEA is also a key player in egg health, showing improved embryo quality and higher live birth rates than controls. Studies have used 75 mg of DHEA daily. 1 DHEA supplementation also evidenced higher rates of spontaneous pregnancies in long-term poor responders to IVF in another study using 25 mg three times per day. 2 DHEA supplementation slows the aging process by preventing lipid oxidation while improving energy and metabolism.
  1. CoQ10 is imperative to egg health. Egg division from 46 to 23 chromosomes requires effective mitochondrial function. 3. It has been suggested that mitochondrial DNA defects that effect metabolic capacity may be a cause of failure in egg maturation, fertilization, or early embryonic development. 4. Aged eggs have decreased mitochondrial energy which can result in deficient energy to divide properly resulting in Downs’s syndrome and other genetic anomalies. All women over 30 who are still considering pregnancy should be on 100mg of ubiquinol daily to maintain efficient mitochondrial activity.
  1. Test your hormones early, and keep testing every few years for an objective measurement of fertility reserves. Follicle Stimulating Hormone (FSH) levels must be tested on day 3 of the menstrual cycle with Anti Mullerian Levels (AMH) levels before beginning fertility protocols. FSH reflects the relationship between the ovaries and pituitary and higher levels indicate perimenopause and poor ovarian function. Therefore, levels of FSH under 10 are best. AMH is also called the “egg timer” as it gives an accurate level of the follicular reserves of the ovaries. AMH levels do not fluctuate throughout a cycle and can be tested at any time. Serum AMH levels decline throughout ones reproductive life cycle, and are undetectable after menopause; therefore, higher levels are more desirable.
  1. Don’t wait too long to consider IVF. If you have been #TTC for more than 9 months and have not become pregnant with regular, timed inseminations, IUI’s or intercourse, make appointments with a fertility clinic and an Integrative fertility specialist. Having a Plan B will decrease stress, and it takes time to consider the financial and medical burdens associated with reproductive technology. However, it is worth it to have that baby in your arms! If IVF is needed, committing to the process earlier in your fertility journey can increase your chances for that #BFP (Big Fat Positive) on your first attempt.
  1. Don’t forget the men! At least 30% of infertility is male factor. Too often one half of the couple is doing everything possible (yoga, clean eating, no caffeine, no alcohol, meditation, support group, acupuncture, etc) while the other half is the root cause of the issue. Getting a sperm analysis is one of the first steps in a fertility evaluation, and can bypass months of angst from non-conception.
  1. Sperm need fertility enhancing supplements too! Omega 3 fats, 15 mg zinc, and stress busting herbs like Maca or Ashwaganda will improve sperm health, tonify libido and boost fertility.
  1. Have your thyroid hormones including TSH, Free T3 and Free T4 and your progesterone levels tested. Low thyroid function leads to low progesterone, which leads to frequent miscarriage in a classic vicious cycle. Some Endocrinologists and Family Docs may have conservative opinions on these levels and may use outdated reference ranges or be unwilling to test for Free T3. Consulting an Integrative Medicine Doc, Naturopathic Doctor or anti-aging Hormone Doctor may give you more information about optimizing your hormone levels rather than operating at a subclinical deficiency.
  1. Consider alternatives to the traditional nuclear family. There are many beautiful babies who want safe, stable, loving homes and need fostering and adoption. I know three amazing families of beautiful fostered babies! There are also women able and willing to carry babies to create families that are not their own. While a biological birth is what we are taught to dream for, this is not the answer for some. Infertility is tragic and real for people who have always assumed they would be able to birth when they are ready. Allow your self to grieve as a couple, but do not close the door on other options even if they seem inconceivable at first.

On another note, childfree living also has many blessings. Our culture is slowly shifting away from the definition of having a (nuclear) family as the ultimate success. Childfree living allows for a more relaxed and abundant lifestyle with more freedom, ability to travel, and heightened romance for a couple. We are an overpopulated planet, and I know from my life, having an auntie that is invested and involved in my life is incredibly valuable. Here are many ways to be a part of a family, and each version needs to be recognized as equally valuable and important!

I could keep typing another ten set of treatments supports, and probably another ten after that,  I am so passionate about fertility! However, as I said earlier the Internet is a rich resource. Some other articles I have written on the topic include:

I wish each of you success on your Holy Grail of Fertility. May your journey connect you to your own Divine nature as you experience one of the great, uncontrollable mysteries of life: Conception!

References

  1. Addition of Dehydroepiandrosterone (DHEA) for poor-responder patients before and during IVF treatment improves the pregnancy rate: a randomized prospective study. Hum Reprod.  2010; 25(10): 2496-500Accessed September 13 2013
  1. Leonidas mamas, Eudoxia Mamas. Dehydroepiandrosterone supplementation in assisted reproduction: rationale and results. Current Opinion in Obstetrics and Gynecology 2009, 21:306-308.
  1. David Meldrum, MD. Aging gonads, glands, and gametes: immutable or partially reversible changes? Fertility and Sterility 2013; 99:1-4.
  1. The use of mitochondrial nutrients to improve the outcome of infertility treatment in older patients. Fertility and Sterility 2010; 93:272-5.

To book an appointment:

http://www.agemanagementcenter.com/contact-amc/  or call 207-774-1356

Clinical Practice:

www.agemanagementcenter.com

www.facebook.com/AgeManagementCenter

For more information about Infertility see:

Share

Women need Testosterone

When I say Testosterone, what do you think?

Most people think: men, male. Some people think trans,*  transgender, or FTM. Very few people will think “the most abundant sex hormone across a women’s lifespan and an important sex hormone for all genders.”

All of the above is the correct answer.

Estrogen and Testosterone have been sequestered into gendered boxes, but both are equally important sex hormones for human health. Functional and biologically active androgenic receptors are located throughout the body in both sexes. Testosterone receptors are found in the breasts, heart, blood vessels, digestive tract, lung, brain, spinal cord, nerves, bladder, uterus, ovaries, skin, bone, bone marrow, muscles and fat cells of all women. This wide diversity of receptor locations illustrates the panorama of body systems that rely on adequate levels of testosterone for optimal female  function.

And yet, this important hormone is routinely ignored in women of all ages and especially those in their 30’s and 40’s who are exhibiting signs of testosterone deficiency including: dysphoric mood, muscle loss, cognitive decline, insomnia, breast pain, rheumatic and other pain, incontinence and sexual dysfunction.

Think you might be T deficient? Take our Eve test now! http://www.agemanagementcenter.com/eve-scale/

Around menopause, testosterone and other pro-androgens like DHEA, DHEA-S, and androstenedione become the primary hormones available as estrogen and progesterone levels decline. The ovaries stop becoming the major source of hormonal production, and the adrenal glands take over. As early as 1937, testosterone was used as a successful and important bioidentical hormone replacement option for menopausal women.  Seventy-seven years later, doctors still do not routinely address testosterone deficiency in this population, nor do they even test for it!

Symptoms are not enough to assess hormonal balance. Accurate bloodwork including Total Testosterone, Free Testosterone, Sex Hormone Binding Globulin, Estradiol, Total Estrogen, Progesterone and DHEA-S must be assessed to have a clear picture of hormone health for all genders.

Many endogenous hormones can be converted into other hormones, like Testosterone being aromatized to Estradiol and DHEA-S into Testosterone or Estrogen. Understanding these pathways and monitoring the blood levels over time is the best way to achieve optimized hormone status. No hormone should be ignored based on presenting gender or sex, as it is the delicate interplay of hormones that creates vibrant wellness.

For more information on women and testosterone make an appointment to consult with Dr. Wright now. To schedule bloodwork to assess your testosterone and other hormone levels, call Kristen at 207 774-1356. Free initial consults are available.  www.agemanagementcenter.com

References:

Transdermal testosterone therapy improves wellbeing, mood, and sexual function in premenopausal women. Goldstat, Rebecca MPH1; Briganti, Esther MD2; Tran, Jane MD1;
Wolfe, Rory PhD2; Davis, Susan R. MD, PhD1 Menopause. September 2003 – Volume 10 – Issue 5 – pp 390-398

Testosterone therapy in women: Myths and misconceptions Rebecca Glasera,b,∗, Constantine Dimitrakakisc, Maturitas 74 (2013) 230– 234

Current perspectives on testosterone therapy for women. Susan Davis MB, Bs, FRAC-P, PhD., Sonia Davidson MB, Bs, FRAC-P, PhD.  Menopausal Medicine. Volume 2 0 , No. 2 — Ma y 2 0 1 2

Share

September 2013

IMG_1626Apples are in season again, so it must be time to go back to school. This year, I will be the one in front of the classroom! This is completely new for me, and I have been anxiously preparing mentally (and literally) for most of the summer. Academics are an important part of a doctors CV, and an area that I have studiously avoided in my career thus far. But when Corinne Martin at University of Southern Maine Nursing School contacted me about the program she has been developing as a holistic health minor for USM the fear was less than the excitement. I am honored to be teaching CON 284 Botanical Therapies for the fall semester. The course is an introductory level exploration some of the issues that surround medicinal plant use including historical dynamics, ecological effects and cultural perceptions of herbs. I will also be teaching practical clinical use of commonly used botanicals. We have guest speakers coming in, a practical how-to workshop on medicinal preparations, and a diverse reading list. Plant medicine has been foundational to my practice, and I am grateful for the opportunity to expand my own understanding and become more of a community resource!

I work primarily at the Age Management Center these days, with a strong focus on hormone health. I work with Dr. Michael Bedecs who is a Men’s Health expert, and is extremely experienced in hormone replacement. I am grateful to say he has taken me under his wing, and I have found a permanent place for my private practice here in Maine (and beyond.) It took almost two years to find the right work environment and business associate after owning my own clinic for 11 years in Toronto. Stay tuned for new articles on fertility,  perimenopause and transgender/transsexual health care. When working with hormones, it is impossible not to consider trans* health care, as this is a population often dependent on hormone use. Dr. Bedecs and I will continue to merge his extensive knowledge of hormone use with my specific integrative medicine training, community commitment, and health care activism to create a concierge style medical practice to serve all genders equally with cutting edge comprehensive treatment plans.

The other work I have been doing is more personal, learning how to trust my gut. Who is good at this? Tips? Strategies? It is so hard in this mixed modern world for me to be able to sift through the messages that come from outside vs. those that come from inside. What I have learned, is that if the inner messages are not heeded, outside havoc will soon result. Or, an event will occur with a big “I Told You So” tag on it. This is part of my process as a human – what is your process? We all have evolutionary issues that we work though, each as unique as stars. Having good guides – as partners, therapists, teachers, doctors, friends – is key to actually learning from our process and not repeating the same mistakes. I am lucky to have all of the above right now – except a good Dr. That is next on my list!

Thank you for reading through, for listening. My health story is mirrored in my life, and I know all of yours are too. It is the details of life that illustrate the pathways of disease and also those of health. Find yourself a Dr that will listen for the details, and trace paths. Take a new course. Call someone you miss. Step outside your comfort zone and do something professionally that scares you! It is September 2013, the time is ripe!

Share

Nutrition, Herbal Medicine, Homeopathy

Naturopathic medicine is not a single kind of healing, but is an array of healing practices. I think of Naturopathic Medicine as a wheel, and what we do as the different spokes that make up the whole. These “spokes” are called modalities, and include acupuncture, counseling, herbal medicine, functional medicine, homeopathy, massage, minor surgery, nutrition and in some states/provinces, prescription medications and/or IV therapies. Naturopathic Medicine is diverse – each doctor chooses what areas to focus on.  Many N.D.’s choose one specific modality, like acupuncture, functional medicine, or homeopathy. Others, like myself, are eclectic and utilize many of the modalities, depending on the individual case.

Acupuncture, counseling and massage are not as applicable for self care; however, nutrition, herbal medicine, and homeopathy are very important ways that people can take care of themselves. There is only so much help that Dr. Google can offer. If general information basics are not resolving the issue, or you have complex health concerns with multiple medications involved, having a licensed ND assist you in recovery is going to be the most effective and safest utilization of natural medicines.

NUTRITION is the philosophy of using food as medicine. Nutrition can be used therapeutically to treat specific conditions – such as eating beets and dandelion leaves for liver cleansing, or cabbage juice for ulcers. The foods that we eat in 2013 are very different from what our grandparents were eating. The soils are stripped of minerals (or toxic like on Munjoy Hill, ) many foods are genetically modified, and the preparation and processing of foods radically alters nutritional values. Supplementation is generally included with nutrition as it is often necessary, given today’s food choices, to supplement some nutrients that are no longer found in food.

HERBAL MEDICINE is an excellent way to treat the whole family. In theory, it is similar to using pharmaceuticals – specific components within each herb cause specific actions in the mind, body and spirit. Herbs can have a powerful action or a gentle action. Generally, the best herbs for self care are simple, common and safe for everyone in the family. If there are any specific contraindications such as interactions with medication, I would be sure to mention those.  The general dose for herbal medicine for an adult is 1 teaspoon of tincture (alcohol extract) in a small amount of water, 3 times a day. Teas are drank hot 2-3 times a day or as needed. Children’s dosage can be determined as follows:

Patients weight in lb divided by 150 = percent of dose

ie) 70 lb child / 150 = 0.46 so child gets slightly less that ½ adult dose.

If is 1 tsp 3 x a day for adult, give ½ tsp 3 times a day to child.

Herbs are generally best taken on an empty stomach, to maximize absorption.

HOMEOPATHY is a very complex system of medicine that gently supports the body’s ability to heal itself through the use of “remedies” and the philosophy that “like treats (or cures) like.”  The specific remedy chosen is one, which, if given to a healthy person, would elicit the very symptoms of an illness. Therefore, the remedy is known to cure that illness. Homeopathic treatment can be a profound journey of self-discovery as old wounds are healed and our true potential is illuminated. Explaining the mechanism of homeopathic medicine is difficult as it operates on the quantum level rather than the commonly understood Newtonian mechanism of action.  Symptoms are seen as effective reflections of compensation on the  mental, physical, and emotional levels. For example, when a warning light comes on in your car,  we investigate what was wrong with the engine, not just disconnect the light! Seen as warning lights, symptoms are the body’s way of showing the outside world that something is wrong or not working properly. The constellation of symptoms points the Homeopathic Doctor to understand the bigger picture overall, and which remedy is indicated to effectively treat the underlying condition. A Naturopath practicing Homeopathy gives a homeopathic remedy to stimulate the body’s defense systems to complete the healing process. This is the concept of the vital force: the body is always trying to move towards health.  This medicine is an extremely safe and effective method of eliminating disease.

 

Share