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
- HIV/AIDS
- 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
- Irritability
- Decreased lean muscle mass
- Increased fat, especially in the abdomen
- Depression
- Infertility
- 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 specialists or click on the Book Now link below
- Complete medical intake forms using our online portal
- Meet with one of our specialists 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 specialists 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.
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BHRT
Frequently Asked Questions
BHRT is a safe and effective medical therapy that corrects hormone imbalances that frequently lead to age-related symptoms.
In a few weeks, you can anticipate noticing a reduction in your symptoms and enhanced general well-being after treatment has begun. The average time to obtain complete results is three to six months.
Some redness, bruising, and swelling are possible for a few days after pellet placement. Tenderness can last up to two weeks following implantation.
Once you begin treatment, you should notice an improvement in your mood, and your symptoms should decrease within two to four weeks. As your body adjusts to more hormones, your symptoms should diminish, and you will begin to experience the benefits of a balanced hormone level. It generally takes your body a few months to achieve balance.
Most patients report symptom alleviation within 2-4 weeks, although hormone restoration may take up to six months.
Hormone replacement therapy with pellets generally lasts four months at a time. Symptoms of menopause and andropause could gradually begin to reappear after four months.
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(434) 260-1667
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Wednesday 09:30AM - 06:30PM
Saturday: 10:00 AM to 04:00 PM
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