Bioidentical Hormone Treatment
Your hormones are responsible for controlling and maintaining most of your bodily functions including your moods, digestion, immune system, etc.
If you would explore the possibility that you may be experiencing an imbalance with your hormones, Dr. Michelle Parsons is well versed in evaluating, diagnosing and treating many hormone-related issues of women and men and may be able to help you. Please note that while there is no fee for an initial consultation, the office does not accept medical insurance for the evaluation, diagnosis, and treatment of hormone replacement therapy. Dr. Parsons utilizes bio-identical hormone replacement therapy and does not utilize pellets for treatment of hormone imbalance related symptoms.
In addition to evaluating estrogen, testosterone and progesterone issues, Dr. Parsons also treats thyroid and adrenal function and as well as evaluating for MTHFR variants. Initial evaluation and diagnosis are $500. Ongoing evaluation and management can often be managed by phone consultation with a pharmacy technician without additional charge, however, evaluations with Dr. Parsons are $500. There is an annual fee of $500 for ongoing re-evaluation and management.
Dr. Parsons will compare your hormone lab values with your symptoms and treat accordingly. Dr. Parsons feels it is important to not just treat numbers but to treat the whole person, and each person is an individual with their own needs. There is no one size fits all when it comes to hormones. It is for this reason that Dr. Parsons does not utilize hormone pellets, as once the pellet is injected into your body, the dose can not be changed for the duration of the pellet time of action, which is usually 3 - 4 months. We have seen patients who have been treated with hormone pellets who present with abnormal chest hair and increase in acne who must wait until the dose has expired. Also pellet insertions over time cause permanent scarring at the insertion sites. Dr. Parsons prescribed creams or tablets so that doses can be adjusted easily as needed and are bio-identical, meaning the same hormones that your body would normally produce, instead of synthetic hormones not normally produced by the body.
Dr. Parsons will have your labs drawn to see what your baseline hormone labs are. Renove Med Spa is a LabCorp drawing facility and we can draw your labs in office and send lab specimens direct to LabCorp. We can either submit your insurance information or request a cash price if you do not have insurance. We can also give you a lab slip to have your labs drawn at the facility of your choice.
Hormones We Will Test
Luteinizing Hormone (LH) - this is a hormone released by your brain to tell your ovaries to release hormones. With normal hormone levels, the LH level will be less than 6 mIU/ml typically. After menopause the LH will increase as the brain will release more LH to stimulate the ovaries to produces more sex hormones, estrogen, progesterone and testosterone. There can also by an LH surge during ovulation and may spike to around 15 mIU/ml.
Follicle Stimulating Hormone (FSH) - this hormone is similar to LH in that it is also released by the brain to stimulate the ovaries to produce sex hormones and should also be below 10 mIU/ml in premenstrual women and will increase after menopause.
Note: if the LH and FSH are found to be abnormally low, then there could be a primary reason for low hormone levels, meaning the brain is not producing LH and FSH. If this is the case, then a brain MRI is usually ordered.
Estriol (E3)- this form of estrogen is typically only present during pregnancy, therefore estriol is not routinely tested.
Estradiol (E2) - is the main estrogen in men and women with beneficial effects and is routinely tested with a BHRT panel. Typical premenstrual levels can be the the 100 - 300 pg/ml range and will drop significantly post menopause. In men the level should be less than 50 pg/ml. Symptoms of deficiency of this hormone can be cravings, sugar and/or salt cravings, chemical sensitivity, arthritis, headaches, bladder symptoms, thinning skin, incontinence, frequent urinary tract infections, bloating, heart palpitations, sleep disruptions, vaginal dryness, painful intercourse, hot flashes, night sweats, difficulty with reaching climax.
Estrone (E1) - is another estrogen hormone than can be released by the fat cells in our body and is not as beneficial as estriol and estradiol. We can see an elevated estrone level compared to estradiol with certain disease patterns such as polycystic ovary disease and certain genetic traits such at MTHFR.
When Dr. Parsons prescribes estrogen BHRT, it will be in the form of a topical cream. Dr. Parsons, as stated does not insert pellets and does not prescribe oral estrogens as oral estrogen must make a first pass through the liver which can be associated with liver toxicity and also increases the dose and the risk of blood clotting. Topical estrogen does not have these risks and the dose can be altered as needed, which cannot be done with pellets. The topical estrogen cream will come in the form of a combination of Estriol and Estrone and is called BiEst, meaning 2 estrogens. The ratio of these 2 estrogens will vary depending on symptoms and the values of your baseline hormone testing. BHRT is complex and all of our treatment plans are highly specified for each person. BHRT should not be attempted by someone who does not have the knowledge and experience to manage hormone replacement therapy.
Progesterone - estrogen can be stimulating and energizing, think of the surge of energy you may get sometimes just prior to your menses or with PMS, or with the nesting instinct seen frequently in pregnant women who have an overabundance of motivation to clean and organize prior to the baby's arrival. Progesterone does the opposite, and is a calming hormone. Progesterone works on the GABA receptors in the brain, which are the same receptors that alcohol and benzodiazepines like Valium act on. Therefore it is important to evaluate the total estrogen levels in comparison to progesterone levels as these 2 hormones work intimately together. There is an outdated though that if a woman no longer has a uterus than hormone supplementation with progesterone is not needed. This is false. Progesterone is very important as a balance to estrogen and is a potent mood stabilizer as it acts directly on the brain. Progesterone works so powerfully on the brain that it is used in some setting of traumatic brain injury to help the brain heal. We will also evaluate the progesterone level in our male patients as well. Usually we will choose to supplement Progesterone in the oral form as there are receptors for progesterone in the stomach that are not activated if progesterone is administered topically only. Symptoms of low progesterone include menstrual irregularities, heavy menses, break through bleeding, anxiety, irritability and frequent awakening typically at 3am. Many of our patients who begin BHRT therapy with oral progesterone are able to wean off their anti-anxiety prescription medications. We also recommend that while taking progesterone to not drink alcohol as the alcohol will block the receptors for progesterone, diminishing the effect of the progesterone. The dose of progesterone will typically range from 100 - 400mg before bedtime. The dose of progesterone can be increased during stressful periods as progesterone is a precursor of cortisol and the demand for cortisol increases during stressful periods.
Testosterone - we check the total testosterone and the free testosterone in both men and women. It is the free testosterone that is very important to check, not just the total testosterone, as it is the free testosterone that is the active form in the body. In men the free testosterone should be around 20 to 30 ng/dl. Testosterone levels can be decreased in men for a variety of reasons. We will also check the LH and FSH levels to rule out a primary reason for low testosterone levels, or primary hypogonadism. Low testosterone levels in women can cause symptoms of vaginal dryness and painful intercourse, urinary frequency and urgency, as testosterone is important in women to maintain vaginal and urethral health, bone loss, fatigue, depression, fuzzy thinking, loss of recent memory, and decreased sex drive. Decreased testosterone in men can cause, fatigue, loss of AM erection, decreased ejaculate, loss of muscle mass and strength, as well as decreased libido and sexual function.
Testosterone HRT can be in the form of a weekly injection or daily cream application. Both forms are effective and follow up hormone levels will be drawn to ensure improvement in symptoms and blood hormone levels.
Note: whenever testosterone supplementation is started in men, it is vitally important to check the estrogen levels and to prescribe an estrogen blocker such as anastrazole, specifically an aromatase inhibiter. Without utilizing anastrazole, the exogenous testosterone supplement can convert to estrogen and cause gynecomastia or enlargement of the breasts in men. Human chorionic gonadotropin or HCG will also be offered to men who begin HRT with testosterone as exogenous testosterone supplementation will cause the testicles to produce less testosterone on their own and can shrink in size. We will also check an annual prostate specific antigen or PSA level. If the PSA is abnormal we will refer you to a urologist.
Complete blood count (CBC) and Chemistry panel (Chem-12) - once a year while on BHRT, Dr. Parsons will check a CBC and Chem-12 as sometimes hormones, testosterone in particular, can have an effect on the hematocrit level. The Chem-12 will also check kidney and liver function, electrolytes and blood sugar level.
Vitamin D - though we call vitamin D a vitamin, it is more appropriate to call it a hormone, as Vitamin D is a pro-hormone as our hormones are made from Vitamin D. Therefore it is essential to have a normal vitamin D level when contemplating starting BHRT. Despite the fact that vitamin D is stimulated in our skin by the sun, most of us in the northern hemisphere just don't get enough natural sun exposure to adequately create enough Vitamin D to reach optimal levels. If your vitamin D level is low, Dr. Parsons will recommend regular supplementation with vitamin D, in the form of D3.
Vitamin B12 and Folate - Vitamin B12 and folate are essential for many many reasons, but for BHRT purposes, both of these vitamins are essential cofactors to ensure adequate enzyme functions that are essential in hormone production. If enzymes are the machinery in a factory, cofactors are the foreman, directing production and efficiency of production. Therefore we will test B12 and folate levels and supplement as needed. There can be many reasons for B12 deficiency as the proper absorption of B12 is complex, but one common cause of B12 and folate deficiency is a genetic variant or mutation known as methylene-tetra-hydrofolate-reductase or MTHFR for short.
Ferritin - to be complete, Dr. Parsons will add a ferritin level to screen for iron deficiency and a potential cause of fatigue, which is a common symptom of hormone imbalance.
Anti-gliadin Antibody - as one of the symptoms for estrogen deficiency is bloating, in order to be clear on the etiology of this symptom, we will check for this antibody. If the presence of this antibody is detected it is indicative of a gluten sensitivity, and if present can cause bloating with the ingestion of gluten, which is present in foods that contain wheat flour.
Cortisol - cortisol is important for normal functioning of the entire body, metabolism, immune function and the ability of the body to meet the demands of stressful events, such as physical stress, immunologic stress and emotional stress. When the body cannot meet the demands of a stressful episode and is unable to produce adequate cortisol, the body collapses, literally, with low blood pressure, lightheadedness and extreme fatigue. This can be called adrenal fatigue and at the extreme, Addison's disease. If the cortisol level is low we will recommend adrenal support, such as getting adequate rest, nutrition, sleep and even brain rest. Supplementation with cortisol is rarely needed, but can be provided on a case per case basis.
DHEAs - dehydroepiandrosterone sulfate is produces by the adrenal glands and goes hand in hand with checking a cortisol level to determine the functioning of the adrenal glands. If supplementation is indicated, it is usually in the form of 7-keto DHEA which has the added benefit of converting into testosterone.
TSH - thyroid stimulating hormone. Just as the LH and FSH are released by the brain to stimulate the ovaries and testicles to produce and release sex hormones, TSH is also released by the pituitary gland in the brain to stimulate the thyroid gland to release free T4, a thyroid hormone. It is vital to check TSH to properly evaluate for primary or secondary causes of hypothyroidism though it is also not an adequate thyroid hormone screen to just check the TSH level. Thyroid hormones are complex and cannot be evaluated properly when checked in isolation from one another. In general a normal range for TSH will be between 0.5 and 1 uIU/ml. An elevated TSH usually indicates hypothyroidism and a low TSH can indicate hyperthyroidism or over medication with thyroid hormone medications.
Thyroxine or Free T4- the thyroid gland primarily produces thyroxine or free T4 as the main thyroid hormone. However thyroxine is not the thyroid hormone that has the most effect on the body. Thyroxine needs to be converted to triiodothyronine or free T3, which is the active form of the thyroid and acts on all the cells of the body to regulate metabolism. So although a TSH and FT4 levels may be normal, if the FT4 does not convert to FT3, then the body will be hypothyroid. Therefore it is essential to always check the FT3 level when evaluation for thyroid function. And just as testosterone can convert to estrogen, FT4 can convert not to FT3 but to its opposite, Reverse T3. This can happen with certain nutrient deficiencies and certain genetic conditions, such as MTHFR. When FT4 does not convert appropriately to FT3 we call this a conversion drag.
Reverse T3 - it is important to always check a Reverse T3 level especially for patients who take thyroid hormone medication such as Synthroid, also known as levothyroxine, as some people will convert the levothyroxine into Reverse T3 instead of FT3. Reverse T3 does exactly what it sounds like, it is the reverse of thyroid hormone and works to slow down thyroid function. Some people who take Synthroid or levothyroxine will have normal levels of TSH and FT3 but will have all the symptoms of hypothyroidism and we will discover that their Synthroid is converting and building up at Reverse T3. Unfortunately there is no Reverse T3 blocker like anastrazole for estrogen, so it will be important to monitor this hormone level with thyroid hormone replacement therapy. If this is the case, Dr. Parsons can prescribe Cytomel or liothyronine.
Iodine - it is also vitally important to check an iodine level when evaluating thyroid function. Thyroid hormone, FT4 and FT3 is approximately 85% iodine, so if you don't have enough iodine you cannot adequately make thyroid hormones. FT4 has 4 iodine molecules and FT3 has, you guessed it, 3 iodine molecules.
Thyroid Peroxidase (TPO) Antibodies - these will be checked to determine if you have an autoantibody issue against your thyroid. The presence of TPO antibodies block the thyroid hormone receptor sites and an adjustment will need to be made to the dosing of thyroid hormone replacement medications.
MTFHR - if you are presenting to us with a hormonal imbalance with symptoms, we will need to check for this particular genetic mutation has a possible confounding factor.