Biologically identical hormones such as estradiol, estriol, progesterone and testosterone are safer than synthetic hormones (Premarin and BCP’s) for hormone replacement therapy.
Compounded hormones are natural hormones that can be prescribed at a specific dosage and formulation that is best suited for your symptoms. The hormones can be prepared in a variety of forms for your specific needs such as creams, capsules, injection, liquid, or troches.
For men and women make sure any compounded cream or gel form of hormone replacement does not come in contact with anyone else.
If you are considering HRT then check with your insurance for possible coverage of the medications before your follow-up appointment for proper prescribing for you.
Lab is recommended every 3-6 months to ensure stability and safety.
Menopause Hormone Replacement Therapy
Estrogen Deficiency Symptoms
Hot flashes, night sweats, vaginal dryness, bladder problems, difficulty concentrating and moodiness are symptoms usually attributed to low estrogen levels during menopause. In addition, the incidence of disease processes such as cardiovascular disease, stroke, osteoporosis increase during menopause, while the basal metabolic rate declines causing abnormal weight gain.
Pellets, creams, vaginal rings, troches, oral preparations and transdermal patches are all available in natural hormone formulations.
Pellet- $350 (placed every 3 months)- Can contain both estrogen and testosterone.
Compounded cream 30 day supply- $35
Compounded cream 90 day supply- $85
Compounded oral or vaginal RDT/Troche- $45-$55 a month
Estradiol vaginal ring – insert vaginally per every 3 months.
Insurance coverage- $25 to $50 depending on insurance tier.
Estradiol Transdermal patches- Apply patch either weekly or 2 x’s a week- $95 to $135 per month. Insurance coverage – $25 to $50 depending on insurance tier.
Progesterone Deficiency Symptoms
Irritability, anxiety, insomnia, headaches, water retention is usually related to low progesterone levels.
Oral progesterone compounded in the sustained release capsule form or prometrium is the best option for insomnia described as not being able to stay asleep all night.
Progesterone in the sub-lingual or rapid dissolve tablet form is the best compound for insomnia described as not being able to fall asleep.
Prometrium- oral progesterone capsule
- Limitations: Contraindicated if you have a peanut allergy.
- Limitations: Only formulated in the 100mg and 200mg dose.
30 day supply- cash pay- $63 and with insurance coverage @$10.
Capsule SR release- 30-day supply – $45 and $90 day supply @ $105.
Liquid form 30 day supply – $55 and limited by a bitter taste.
Cream based form- $45.
Vaginal troche form- $55
Testosterone Deficiency Symptoms for Females
Low libido, decreased vitality, dry skin, loss of muscle mass are signs and symptoms of low testosterone.
Insurance will not cover testosterone treatment for females.
Pellet- $350 (placed every 3 months)- Can be just testosterone.
Cream 30 day supply – $45.
Cream 90 day supply – $105.
Rapid dissolve troche for vaginal or by mouth dosing -30 day supply – $45.
Note: Typically if estrogen and testosterone are combined in the cream form, then the price remains the same as the testosterone alone @ $55. The 90 supply of estrogen and testosterone in combination will be @ $100.
Peri-menopause or Pre-menstrual Syndrome (PMS)
Moodiness, headaches and emotional lability are symptoms usually related to estrogen dominance during the peri-menopause and PMS stages.
Treatment of Estrogen Dominance
DIM capsules – Recommend one po everyday and then two po when symptoms of breast tenderness or emotional lability are present.
Weight loss also helps to balance hormones by decreasing extra estrogen production, which is occurring in fat tissue.
Low progesterone is manifested symptomatically by increased anxiety, moodiness and inability to sleep starting 2 weeks before a period for PMS sufferers and the above symptoms could be present most or all the time for peri-menopause patients.
If symptoms are present throughout the typical 28 day cycle then take the progesterone every night before bed except the first two days of your period. Once your period starts then hold the nightly dose for two nights then resume back to the nightly dose and repeat above.
If symptoms are noticed a week or two before your period then start your first progesterone dose the night of ovulation ie. (Typically day 12 or 13 of your cycle). Continue the nightly dose until the first day of your period and then stop the nightly dose until ovulation occurs again and repeat the above.
Testosterone symptoms and options for treatment are the same as menopause.
Testosterone Treatment for males
Men who experience testosterone deficiencies usually complain of decreased libido, weight gain in the abdominal area, loss of muscle mass and fatigue with depression. Treating the deficiency will usually help all symptoms.
Side effects of testosterone treatment can be sterility so if you are considering having more children then testosterone treatment is contraindicated. Also with testosterone therapy there can be shrinkage of the testicals.
Lab must be performed at a minimum of every 3-6 months to monitor cholesterol, estrogen, prostate specific antigen and blood counts levels.
Some men will require Arimidex to prevent high levels of estrogen secondary to the conversion of testosterone to estrogen. Taking the estrogen blocker will help to prevent gynecomastia.
Blood donations may be required because testosterone therapy can increase the red blood cell count, which can increase the viscosity of the blood creating an increased risk for heart attack.
Prostate cancer is always a concern and monitoring the PSA is important as well as digital rectal exams.
Increase in aggressive personality tendencies needs to be monitored.
Compounded creams and gel forms must not get on anyone else. Wash hands thoroughly after rubbing the testosterone cream or gel on your body. Most men report applying the cream or gel after showering in the mornings.
Pellets are placed every 6 months and cost -$799.
Intramuscular injections are dosed once a week typically. Shots can be administered in the clinic or at home..
- Your medication stored at the clinic- $10 per shot
- Rogers Centers supplies medication- $20 per injection
IM Testosterone- @ $60 a month or @ $90 for a 3 month supply.
Compounded cream- @ $55 a month and @$105 for a 3 month supply.
Considerations for Hormone Replacement Therapy
Patient’s with a history of breast, uterine and/or ovarian cancer or high risk of getting breast, uterine or ovarian cancer should consider a consult with an oncologist to determine the risk/benefit ratio of HRT.
Persons with a history of blood clots or a family history of blood clots may need to be evaluated by a hematologist to determine the risk/benefit ratio of HRT.
Maintaining a normal weight, cholesterol and blood pressure during therapy will reduce the risk of blood clots, stroke and heart attacks while on HRT.
Side effects of estrogen can be bloating, headaches, breast tenderness, blood clots and ob/gyn cancers.
Side effects of progesterone can be morning sleepiness and increased risk of ob/gyn cancers.
Side effects of testosterone can be scalp hair loss, hair growth on the face, acne, enlargement of the clitoris and personality changes.