Consent to Prescribe Hormonal Therapy

Bioidentical Hormone Replacement Therapy (BHRT) is the therapeutic use of hormones that are identical to the hormones made naturally by the body. There are many different types, but the ones used predominantly include: testosterone, progesterone, estradiol (E2), estriol (E3), DHEA, cortisol, and thyroid. These hormones are typically used to treat symptoms of perimenopause, menopause, andropause (male menopause), thyroid dysfunction and adrenal fatigue, although other symptoms may be treated as well.

Potential Risks
In medicine, there can be unforeseeable circumstances in which a patient may have an allergic reaction(s) or side effect(s) from treatment that involves (but is not limited to) supplements, medications, IV therapy ingredients, IM therapy ingredients, and more. Examples of side effects include:

● Syncope (fainting, vasovagal reactions, dizziness, lightheaded, weakness) when getting procedures such as IV, IM or lab draws and other therapies such as acupuncture.
● Scars (from hormone pellet therapy, acupuncture treatment, IM shots) and others
● Adverse reactions to hormone therapy such as:
● Skin & Body changes: acne, hair growth on face/body, voice changes, body changes (with hormone therapy)
● Hair loss
● Increased breast size and/or breast tenderness
● Vaginal bleeding (from hormone therapy treatments using Estradiol, progesterone, DHEA and testosterone)
● Increase/ changes in breast tissue density
● Increased red blood cell formation, hemoglobin and hematocrit
● Decreased sperm count (with testosterone therapy)
● Decreased testicle size
● Fluid retention
● Mood changes (ex. more aggressive)
● Organ puncture (acupuncture, IV therapy, IM therapy, hormone treatment)
● Organ failure
● Cancer

Estrogen Therapy: Bio-identical estrogens are available in various forms including oral capsules, troches, patches, pellets and topical creams. Adverse reactions may include bloating, breakthrough bleeding, breast swelling and tenderness, fluid retention, weight gain, liver cysts, death (e.g.-from blood clots or cancer) and mood swings. High potency conjugated estrogens (e.g. Premarin) have been associated with an increased risk of breast cancer and blood clots (the latter especially in smokers). Estriol may carry a lower risk of breast cancer and may even protect against breast cancer. Nonetheless, the whole area of estrogen replacement is undergoing further evaluation. Do not take estrogen if you have active breast cancer.

Progesterone Therapy: Bio-identical progesterone is available in various forms including oral capsules, troches, vaginal or rectal suppositories, and topical creams or gels. Progesterone therapy may be sedating, so it is recommended to coordinate dosing with sleep cycle. Adverse reactions may include bloating, breakthrough bleeding, missed menstrual cycles, breast swelling and tenderness, fluid retention, weight gain, sedation, and depression.

Testosterone Therapy: Bio-identical testosterone therapy is available in various forms including sublingual drops, troches, topical creams, pellets and injection. Side effects include acne, chronic priapism (persistent, abnormal erection of the penis), change in libido, angina or heart attacks, hirsutism (facial hair growth) and scalp hair loss, clitoral engorgement, voice changes, or water retention. Because it may improve insulin resistance in males, diabetics who use insulin should monitor glucose levels closely, as less insulin may be needed. Check with your physician before adjusting your dose of insulin. If using a formulation of testosterone that is applied to the skin, a local irritation may occur.

Synthetic hormones (such as Progestins) and bioidentical hormones (such as progesterone) have different effects on the body. Bioidentical hormones can be used and metabolized as our body was designed to do, thus potentially minimizing side effects. Compounded bioidentical hormone dosages can be fine tuned to your specific needs. Many European studies suggest that bioidentical hormones are safer than synthetic hormones. However, that doesn’t mean that bioidentical hormones are perfect.

We also do not have any large scale, double blinded, placebo controlled trials on bioidentical hormone replacement therapy. Although the use of bio-identical hormone replacement therapy has been shown in many studies to be safer than synthetic hormone replacement therapy, the risk of cancer-related side effects is still possible. In fact, there are physicians who do not agree with the use of bio- identical hormones.

Baseline hormone levels are ordered before any hormonal prescriptions are used. You will then be given an individualized prescription of BHRT based on your symptoms and test results. Symptom resolution is not immediate. It can take anywhere from 3-9 months until patients feel like they have the perfect fit. There are many different preparations of BHRT (topical creams, vaginal inserts, and pills). Some women respond to one form better than another. Saliva, blood, or dried urine tests are measured every 2-6 months until stable. When stable, hormone levels are then monitored every 6-12 months depending on the situation. Patient’s bodies and lifestyles change and so do their hormonal needs.

Hormones are usually measured via saliva, but some situations may require blood spots or dried urine. You are required to have pap smears (as frequently as indicated), mammograms, DEXA Scans (as indicated), and a pelvic ultrasound (as indicated). It is required that you supply us with a copy of these results for our records. Hormones are not prescribed or renewed unless these records are up to date. Men on testosterone therapy are required to have their testosterone levels checked at least every three months for the first year and then at least twice per year thereafter.

Dr. Linda Khoshaba is the Leading Integrative Health and Hormone Doctor in Scottsdale, Arizona. She has extensive experience working in the field as a Hormone Specialist and Natural Endocrinologist.

7500 E. Pinnacle Peak Rd. Suite A 109
Scottsdale, AZ 85255

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