Bioidentical Hormone Replacement Therapy
BHRT, which is short for Bio-Identical Hormone Therapy, is a treatment that uses natural hormones to improve your health and wellbeing. It is a therapy used to restore your testosterone levels to the normal healthy levels you had in your 20's, but have declined as a result of aging and other reasons. BHRT testosterone pellets are made up of the same testosterone that's naturally occurring in your body, created from plant-based ingredients. Once the pellets are placed into the subcutaneous fat, then immediately begin releasing a continuous amount of testosterone into your bloodstream to restore balance. The procedure typically takes 10-15 minutes and you are able to go back to normal activities within a week.
What causes low testosterone in men?
Men experience a peak in testosterone levels in their early 30's and experience a gradual age-associated decline in their mid-30's that continues at a rate of 1-3% per year. Doctors will tell you that low testosterone is a normal part of aging, but this is a misleading statement. While aging is normal, hypogonadism or low testosterone is NOT and contributes to symptoms that negatively impact quality of life, as well as increase the risk of cardiovascular disease and cognitive disorders.
During aging, decreased functioning of the pituitary gland (which signals the testicles to produce testosterone) or decreased responsiveness of the cells in the testicles that produce testosterone result in decreased blood levels of testosterone. Other causes of low testosterone include:
- Unhealthy diet and obesity (increases estradiol, leptin, and adipokines)
- Inadequate sleep
- Undescended testis or injury to the testis
- Pituitary disorders such as Kallman’s syndrome
- Autoimmune diseases
- Chemotherapy and radiation therapy
- Alcohol, opioids, and prior anabolic steroid use
What are the symptoms of low testosterone?
- Decreased libido or sex drive
- Decreased strength and duration of erections
- Fatigue and decreased energy
- Decreased lean muscle mass
- Increased fat, especially in the abdomen
- Difficulty concentrating or mental fog
- Development of breast tissue (gynecomastia)
- Loss of bone mass (osteopenia or osteoporosis)
I had my blood testosterone levels checked, how do I know if I have low testosterone?
The decision to start testosterone supplementation in men is driven by symptoms, meaning that men should only be assessed for testosterone deficiency if they have some of the symptoms above. It is not based on serum testosterone levels. There are validated questionnaires that can be used to determine if a man has symptoms of low testosterone such as the Androgen Deficiency in Aging Males (ADAM) questionnaire:
- Do you have a decrease in libido (sex drive)?
- Do you have a lack of energy?
- Do you have a decrease in strength and/or endurance?
- Have you lost height?
- Have you noticed a decreased "enjoyment of life"
- Are you sad and/or grumpy?
- Are your erections less strong?
- Have you noted a recent deterioration in your ability to play sports?
- Are you falling asleep after dinner?
- Has there been a recent deterioration in your work performance?
If you answered "yes" to questions 1 or 7, OR "yes" to any 3 other questions, you may have low testosterone and could benefit from hormone supplementation. This is when we check and interpret lab values.
The major problem with defining low testosterone based on lab reference ranges is that we know that the reference ranges reported with your bloodwork are inaccurate. Each lab has its own reference ranges that are often determined by a small number of random patients, for example 20 random male patients of varying ages. If a male patient has the symptoms of low testosterone, we supplement testosterone based on the blood level and reassess the patient in 6 weeks. If his symptoms are improved, we know that he has low testosterone and will benefit from supplementation. We also make sure that we don’t go above a certain level because there are health consequences of high testosterone. The goal is always to return men to the healthy testosterone levels they had in their 20's.
Are there natural ways to increase testosterone levels?
The short answer is yes, but not enough to treat men with a diagnosis of hypogonadism or low testosterone. These are more relevant to men who do not have the symptoms of low testosterone but feel like they would benefit from slightly higher testosterone levels. The activities that have been shown to increase testosterone levels include:
- Exercise and lifting weights
- Reducing stress and cortisol levels
- Vitamin D supplementation if you are deficient
- Adequate sleep: sleeping only 5 hours a night was linked to a 10-15% reduction in testosterone levels
- Avoid exposure to chemicals that can affect testosterone levels such as bisphenol-A (BPA), parabens, and some chemicals found in plastic.
- Limit alcohol consumption: heavy alcohol use can lead to testicular atrophy
What are the side effects of testosterone supplementation with Bio-Identical Hormone pellets?
Since we are returning your testosterone to the normal healthy levels you had in your 20’s, there are no long term side effects, only benefits. When men with low testosterone initially start hormone supplementation, there is a 3-4 period while the levels are increasing that he may experience irritability or aggressiveness as a result of the change. This is normal and will subside when the patient reaches a steady level of testosterone in the blood. We check testosterone levels again 14-16 weeks after pellet placement and plan the next placement to ensure blood levels of testosterone do not drop below the level where a man becomes symptomatic and goes through the adjustment phase again.
Testosterone is converted into estrogen by aromatase in the body in both men and women. Some men have a relatively high level of estrogen in the body, defined as an estrogen to testosterone level greater than 3%. When this happens, men can experience symptoms of increased estrogen. We prescribe Letrozole, which is an aromatase blocker that is taken twice a month.
There are a number of health consequences related to high testosterone, including increased blood pressure, increased risk of cardiovascular events and stroke, prostatomegaly (enlargement of the prostate gland), mood swings, aggressive behavior, insomnia (difficulty sleeping), and excessive hair growth. These DO NOT happen with testosterone supplementation using Bio-Identical Hormone pellets because we supplement to normal healthy levels. Many men who present to our practice with low testosterone symptoms have a total serum testosterone level of 300-400 ng/dL, and our initial target for total serum testosterone after pellet placement is 1000 ng/dL.
What are the benefits of testosterone supplementation in men who have low testosterone?
- Improved libido and sexual satisfaction
- Alleviate symptoms of erectile dysfunction
- Increased energy and focus
- Increased lean muscle mass
- Decreased fat, especially in the abdomen
- Improved mood
- Better sleep
- Protective against depression and cognitive disorders such as Alzheimer’s disease
- Improved bone mineralization
- Decreased triglycerides, low-density lipoproteins (LDLs), and cholesterol
- Decreased risk of cardiovascular events like heart attack
What are Bio-Identical Hormone Pellets?
Bio-Identical Hormone pellets are the size of a grain of rice and are made of the same testosterone that occurs in your body, not the synthetic forms of estrogen and testosterone that are in other preparations. Injectable forms of testosterone can cause allergic reactions because of the additives and typically result in a higher level of aromatization and estrogen-related symptoms. Moreover, injectable forms are short-acting and result in peaks and troughs during weekly injections, whereas patients who use pellets experience slow, controlled release over months. The resulting blood level of hormone is also much more predictable with the pellets, peaking at 6 weeks after pellet placing and slowly decreasing over 4-5 months.
Should I do testosterone supplementation if we are planning on a pregnancy?
If you’re planning on pregnancy within 6-12 months, we recommend against testosterone supplementation. While testosterone is necessary for sperm production (spermatogenesis), exogenous testosterone (produced outside the body) suppresses the release of the gonadotropins from the hypothalamic-pituitary axis, which results in lower testosterone production within the testis. High testosterone levels within the testis is needed for sperm spermatogenesis. Because of this, testosterone supplementation can result in azoospermia (complete absence of spermatozoa in ejaculate) in 65% of men within 4 months of starting treatment.
For men who wish to preserve fertility, clomiphene and enclomiphene can be prescribed. These are medications that stimulate LH and FSH release from the pituitary gland, which stimulate the Leydig cells in the testicles to produce testosterone. The increased FSH increases sperm production and can improve fertility for men.
What is the process for undergoing hormone supplementation?
- Call us at (434) 260-1667 to schedule a consultation with on of our physicians or click on the Book Now link below
- Complete medical intake forms using our online portal
- Meet with one of our physicians to review your medical history, symptoms and health concerns, as well as discuss the benefits of hormone supplementation and treatment options.
- We use the SottPelle algorithm for dosing, which incorporates your symptoms and lab results to determine the optimal dose of hormones to bring you back to normal healthy levels
- Pellets are placed in the office; the procedure takes 10-15 minutes.
- You will start the feel the benefits of the hormones 3-4 weeks after pellet placement
- Labs are obtained 6 weeks after pellet placement to ensure optimal levels. If you continue to have symptoms despite increased hormone levels, our physicians can place additional pellets.
- Pellets typically last 3-4 months and repeat labs are obtained 14-16 weeks after the initial pellet placement to guide subsequent doses.
Men's Hormone Replacement
Starting At $700
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Dr. Itri discusses the symptoms of low testosterone
Dr. Itri discusses hormone supplementation with bio-identical hormone pellets
Dr. Itri describes 3 myths about testosterone supplementation
Listen to a patient testimonial about hormone replacement with BHRT
I recently received my first platinum hydrafacial done by Michelle and it was absolutely phenomenal! She took her time and really focused on making it an incredible experience, one of the most relaxing things I have ever done! Not to mention my skin looks and feels amazing!! I will be recommending this to everyone I know and I will absolutely be back for more!
Today was my first Hydrafacial done by Michelle! Studio R Aesthetics exceeded my expectations. The staff was extremely nice, the office was adorable and I was very comfortable. My facial was very relaxing. Michelle was terrific, Answered all of my questions and my skin felt amazing afterward. I already can’t wait for my next experience at Studio R Aesthetics. I can not recommend them enough.
I had a brow wax and tint. Not only did my brows look AMAZING but I never had someone rub the area around my brows! It was the most calming and relaxing experience! 10/10 recommend!
I had a awesome experience last week with Studio R Aesthetics, first thing was just how amazing the inside of the building was, it was gorgeous and full of light, so comfortable. I was shocked when I found out about all of the services that they provide, so many! Very impressive! I was also impressed by my doctor- Dr.Segura was a delight and very professional but down-to-earth , I felt very comfortable telling her my issue's she made me feel like I was being heard when I was speaking of my problem with my hair thinning, and falling out drastically, I got a bit emotional talking about my hair and she just made me feel like she really understood what I was going through, it was an amazing experience and I definitely will be going back for a long,long time. Thank you Dr. Segura for your kindness and your compassion for me, you are very special.
Brandy was great and knowledgeable!!
Had a great experience with Dr. Segura! She is very knowledgeable and reassuring. All of the staff were friendly and professional.
Amazing practice! Both doctors and staff are very knowledgeable and skilled at what they do! I look forward to every appointment!
Michelle did a wonderful job! Thank you Studio R!
I’ve been a patient of Dr. Segura for a year now, and I’ve had several procedures done by Brandi. Her calm and caring demeanor always brings me great comfort when she can sense my insecurities and difficulty in talking about the things I would like to improve or change. To her, I am the most important person in the world while I’m in her care, she goes into great detail of all procedures, and what they entail. She is very patient, kind and has my best interest in mind at every consultation. She is truly an artist and has given my beauty, and confidence back both inside and out. ❤️ Can’t wait for my next treatment!
Good experience! As a traditional medical person I was a little leery of the spa like setting for what I felt was more of a medical procedure (bioidentical hormone treatment). However, I was treated very professionally by Dr. Itri, who I found to be knowledgeable, competent, and very forthcoming and accommodating in responding to my questions & concerns.
I love coming here! I’ve been seeing Brandy & Michelle for about 3 years. They are so sweet and personable! The studio is GORGEOUS and the whole staff is talented! Highly recommend coming to see them for all of your aesthetic needs!!
They were able to get me in same day! Excellent customer service and beautiful office❤️
I started semaglutide in April and finished in August. I went from 171lbs to 133lbs and couldn’t be happier. Everything was so easy, everyone on staff was incredibly kind, and I am so glad I invested in myself. Well worth the money! Thank you, Studio R!
My name is Matt Street. I have been a client and patient with Studio R for well over a year. Over this time, I have used many of the services provided by Dr. Segura, and Dr. Itri. All of the services have been top-notch. Recently, I received a hydro-facial from Michelle. To say it was an amazing and invigorating experience would be an understatement. Michelle uses cutting edge technology to meticulously treat the face and neck area. I typically get about 3-4 facials a year and Michelle is, by far, the best to ever do it. Her expertise includes deep knowledge on how to maintain healthy skin. She provided me with many cost-effective options to continue to maintain a healthy skin routine. I highly recommend Michelle for all your facial needs. I will be exclusively using her services going forward. Thanks, Matt
Jason and Brandi are the experts in promoting optimal health. They understand bioidentical hormone replacement inside and out!! If you're showing the signs of aging: tired, achy, lack of libido, etc. call them right now! They can help you get your vitality back!
Dr. Segura is one of the kindest, most patient, and skilled physicians I have seen in all my years receiving fillers and Botox. I have not been happy in the past with the results of tox and fillers from others. Dr. Segura has made such a difference in how I feel. Definitely do not pay attention to the very few negative received as I can only assume they are from her competitors.
Dr. Segura exceeded all of my expectations from start to finish. I simply cannot recommend her enough for the most thorough, professional and impressive results.
Dr. Segura and the team are so thorough. She took her time explaining every option and providing a breakdown of cost, time, healing, etc. Will definitely come again.
I had a facial done by Michelle she done fantastic. And I had botex by Dr segura very informative and gentle. Definitely will be a repeat customer!!!
Outstanding service. It was my first time doing this and Michelle was great! She answered all my questions and I learned a lot during the sugaring!
My eyebrows have never looked as good as when Michelle does it! She listens and does exactly what you want!
I have been a client here for over a year now. I recall my first visit with Dr. Segura and how nervous and intimidated I was. Not for long though! Her quiet, calm and confident manner set me at ease and assured me that I was at the right place and in the right hands. The professional team at Studio R are so friendly and customer focused. I’m not even sure how I came to find them but I am certainly glad I did!!
Dr. Segura was so kind and informative. She took her time to explain everything to me and even made some recommendations based on my goals.
Michele is a very talented aesthetician who has taken a great deal of time educating me about all of the options that align with my skin care goals for aging and sensitive skin. She is incredibly skilled and adjusts the methods she uses based on what works. She’s top notch; can’t recommend enough.
Beautiful studio, lots of great services!
Love this place and there snacks! Michelle is absolutely the best waxer ever! She has been waxing me for years and always leaves me with amazing results. (:
I recently had the RHA filler procedure done by Dr Brandy Segura. I had my lips, corners of my mouth and chin area worked on. I was numbed up before the procedure, which made it very comfortable. The procedure went very well,and I was very pleased with the filler used. It’s been three weeks now and I am very pleased with the end results.
I love the space and the staff! Michelle does my facials lashes and brows. I absolutely enjoy my time with Studio R!
I decided to make a Brazilian waxing appointment at Studio R Aesthetics after a friend highly suggested them to me. I was not disappointed. The area is posh, welcoming, and luxurious. Michelle was patient with me as I asked questions and made sure I felt at ease during the wax. She was conversational enough to where I felt less tense, but not so much that I felt like I couldn’t enjoy the experience. I could tell she was very knowledgeable and she gave me a detailed 101 in sugaring vs. waxing. I’ve only dipped my toe into one small area of services here… they have so many more to offer! I’ll definitely be back!
What a tranquil environment! Walking into a very calm and clean reception area I was greeted almost immediately and taken back for my appointment fairly quickly. Michelle provided my services of a hydrofacial and waxing. Michelle was very professional and continued to educate me throughout the entire process. I learned so much about my skin and not only was rejuvenated but relaxed and at times, dozed off. I would highly recommend Studio R for any needs. All staff I came in contact with were friendly and beyond helpful.
I just recently moved (to Lynchburg) and was looking for an injector in a reasonable distance. I found Dr. Segura and loved the fact that she prefers to do the injecting work herself! I had Botox and fillers and when I asked about fillers she was very honest with me about what would help and make me happy. She didn’t try to sell me on more filler even when I thought it’s what I wanted! She was thorough, kind, and extremely gentle. And I’m obsessed with the results! Easily the best experience I’ve had! 10/10
Dr. Segura is fantastic. She has a wide range of minimally invasive options and during my initial consultation discussed the pros and cons of the treatments. I’ve had 2 of the 3 CoolPeel treatments that I purchased and I’m so happy with the results so far.
If I could give 10 stars I totally would! For starters this office is GORGEOUS with an amazing vibe and quality music if I might add. Most importantly, Dr. Segura is AMAZING. Not only is she super kind and walks you through every step, but she listens to you and what YOU want and that is super important. I am OBSESSED with my lips and I plan to return for filler and other services in the future. You can tell Dr. Segura knows what she's doing & I love that 👏 The front desk staff were also super kind and did I mention, the office is BEAUTIFUL 🤩 I 100% recommend. If you're on the fence, do it! You won't regret it.
Very thorough explanation of services and offerings, allowing the patient to come to an informed, personal decision as to their treatment. Excellent.
Dr Segura was extremely knowledgeable and helpful!
Every aspect of my experience at Studio R was amazing! The studio is incredibly clean and gorgeous - creating a relaxing, luxurious experience. All the staff are friendly, accommodating, and professional. My Botox and filler consultation with Dr. Segura was extremely informative and honest. This was my first time getting Botox/filler so she walked me through the basics, what to expect, pricing, areas of my face to prioritize over others, etc. She spelled everything out for me so there were no surprises! My Botox/filler combo appointment went extremely well. She made sure I was comfortable the entire time by checking in frequently. To her credit, it was a lot less painful than I anticipated due to the numbing cream and distraction device/methods she uses. It’s been a week since my appointment and I am SO happy with my results! She reduced my “gummy” smile with lip filler and also reduced TMJ related pain I was having with Botox. Studio R is a 1000 / 10!
I am 75 years old and never thought it's possible to have that younger look. With the pleasant attention and treatment, I have received from the qualified staff, at Studio. R Aesthetics, It is possible. I am a happier 75-year-old and younger looking than before.
My visit to studio R Aesthetics was great very clean environment and friendly staff. I went in for a chemical peel for my melasma and hyperpigmentation. Physician Michelle Morris took her time listening and explain me that it’s better if I wait not to get a chemical peel since I have rosacea. I like her honesty that she was worry about my skin rather than doing some procedure that I don’t need. So she recommended a facial which I really liked my skin felt much smoother and brighter main thing my rosacea did not flair up either after the procedure. All there products are great at the clinic she suggested to get some daily power defense moisturizer by zo which works great on my skin. I would Definitely recommend studio R.
I had my eyebrows tinted and shaped by Michelle. It was my first time having my eye brows professionally shaped and I was nervous. Michelle was wonderful and spend an hour and 20 minutes with me. I was so impressed and will make this a monthly part of my self care routine now.
I love how upscale and comforting this salon feels. Every team member I've worked with has been very happy to help me as well.
Fabulous relaxing and restorative facial tailored just for my needed.
The BEST in Charlottesville for lip filler and lash extensions! Dr. Segura and Michelle are so amazing to work with and my results are always perfection. I recommend Studio R to all of my friends and family.
I met with Dr. Segura to learn more about semglutide. The entire experience was lovely, their receptionist was super friendly and the office is beautiful. Dr. Segura was very informative and thorough.
I love coming here! I’ve been coming here for the past year for a variety of things and have always had a positive experience.
Always a great experience at Studio R. Aesthetics!
Dr. Segura is the best! She is very patient explaining all procedures to me carefully and thoroughly, and her results are terrific. I am often nervous before procedures and she is supportive of an incremental approach. Highly recommend.
Such an awesome staff!! So sweet and informative. I’ll definitely be coming back!
Had a great experience at Studio R. Received a facial from Michelle who is an incredible aesthetician, and the front desk staff, Cat and Emily, were extremely friendly and courteous as well. 10/10 highly recommend!
Studio R Aesthetics is amazing! Michelle has been my go to for my waxing needs for many years and I’m super happy to have found this wonderful place. It’s absolutely gorgeous and welcoming. And everyone is so sweet! I had a facial done today with Michelle and it was hands down the BEST facial ever. 5 stars isn’t enough, I would definitely recommend!!
Amazing salon and very personable staff. Will absolutely return! Michelle was great and the sugaring process was as painless as possible!