A guide to bioidentical hormone replacement.

 

FAQ's

Becoming a Patient

 

 

The Treatment Program

 

 

Ask the Doctor

 

 

How do I begin? What does the program involve?

 

STEP 1: Contact Us

Provide your contact information here to indicate that you would like an appointment.  Someone will contact you within several days to schedule your appointment.  Alternately, you may contact our office on 877-888-3210 to schedule an appointment sooner.  We are typically booked up several months in advance.

 

STEP 2: Blood Test

You are required to get a blood test before your visit. We will send you a lab requisition that you can take to any Quest or Labcorp draw site. You can find the location of the nearest Quest Lab here. No appointment is necessary for your lab test. You must be fasting for 8-12 hours before the test is performed - nothing to eat or drink except water. Most labs open before 8AM. The results will be sent to our office 7-10 days later.   NOTE: If you have Oxford, United Healthcare or Horizon Blue Cross insurance, you will use Labcorp instead of Quest. 

 

STEP 3: Initial Consultation & Biomarker Testing

The final lab results must be available before your visit. Our technicians will conduct extensive biomarker testing on you here in our office to establish a baseline of your rate of aging.  Then your physician will spend 2 hours discussing the principles of bioidentical hormones, answering your questions, assessing your symptoms, and taking a detailed medical history and a physical exam.  Expect to spend at least 4 hours with us.

 

STEP 4: Treatment

At the end of your initial consultation, you and your physician will determine the course of treatment. Custom-compounded medications will be shipped to you the next day and every 28 days thereafter from our specialty compounding pharmacy partner.

 

STEP 5: Follow-Up

After 6 weeks of treatment, you will have your first follow-up consultation with your physician. You will need to get a follow-up blood test 10 days before your consultation. Your physician will discuss the effects of the program and adjust your dosages accordingly. You will repeat this process after 2-3 months and again every 6 months thereafter, depending on the situation.

 

 

What are the costs involved?

 

There are three areas of cost to consider:

Professional Fees: The fee for the 4-hour initial consultation and biomarker testing is $1,400.  Monthly Program Maintenance Fees are $75 for basic HRT (hormone replacement therapy), $100 for HCG therapy or $125 for HGH therapy.  See next question for more details on this fee.

 

Treatment: Medications will be shipped to your door every 28 days from our compounding pharmacy partner. Depending on your program, the cost of treatment ranges from $150 to $900 per month.

 

Lab tests: Initial lab tests cost approximately $660 (males) to $800 (females). Follow-up lab tests range from $260 (males) to $460 (females). Rates are higher for tests performed at Labcorp.  New patients will typically need 2-3 follow-up lab tests per year.

 

 

What does the Program Maintenance Fee cover?


The monthly Program Maintenance Fee is your physician's professional fee: $75 for HRT (basic hormone replacement), $100 for HCG therapy or $125 for HGH therapy.  This fee applies to every 28-day period as long as your physician is responsible for monitoring blood levels, managing your treatment program and treating symptoms. It does not correlate to office visits or shipments, but it is billed with your regular shipments for simplicity.

The $75 & $100 Program Maintenance Fees cover the following:

 

  • Follow-up consultations, e-mails, telephone calls, physical exams, analysis and review of laboratory tests. (You will consult with your physician 3-4 times in the first year at a value of $250 each)
  • Management of your lab follow-up requirements and treatment program
  • Ongoing PhysioAge Diagnostic Testing: arterial compliance, body composition, pulmonary function and skin elasticity
  • Complimentary blood draws in our office
  • Medicool pack in which to transport your refrigerated medications

The $125 Program Maintenance Fee covers all of the above, plus:

 

  • Annual DEXA bone densitometry scan
  • One complimentary nutritionist consultation (late cancellation fees are not covered)

 

 

Does your office accept health insurance?

 

Our office does not accept insurance for payment. However, this does not rule out the possibility of reimbursement by your insurance provider. We will be glad to provide you with properly coded invoices that you may submit for reimbursement. Many insurance plans will cover a portion the cost of office visits according to their out-of-network provider schedule. You may be subject to an annual deductible and a co-pay, depending on your coverage. Please contact your provider for more details on coverage.

 

 

Will my insurance cover the cost of prescriptions?

 

Most insurance companies do not cover the cost of compounded medications. For this reason, our pharmacy partner does not accept insurance for direct payment. However, we can arrange to provide you with properly coded invoices that you may submit to your insurance carrier for reimbursement.

 

 

 

Will my insurance cover the cost of lab tests?

 

Insurance plans will sometimes cover the cost of lab tests. Speak with your insurance carrier for more details. The list of tests we perform can be found here. 

 

 

Will my FSA cover your treatment?

 

Many employers offer a Flexible Spending Account (FSA) to their employees. These arrangements permit the employee to stow a portion of their pre-tax earnings in a special account for use on health-related expenses NOT covered by primary health insurance. Depending on the type of FSA, these arrangements may cover the portion of your treatment not covered by your primary health insurance, including medications, office visits, co-pays, program fees, vitamins & supplements. Ask your employer or visit the IRS FSA site.

 

 

Can I use my own pharmacy?

 

We are better able to manage your hormone levels with precise accuracy if all medications come from the same pharmacy. Bioidentical hormone modulation is very different from prescribing "one-size-fits-all" drugs like Premarin. Every treatment regimen is custom-tailored to the individual based on the results of blood tests, medical history, physical exam, and symptoms. With compounded medications, hormone powders are mixed with a cream or gel base or loaded into capsules. There are many variables such as the absorption level of the cream base and the size of hormone particles. By standardizing with one pharmacy (as with one diagnostic lab), we are better able to predict a patient's response to a certain dosage and properly adjust the dosage in response to symptoms. If a patient obtains their hormones or supplements elsewhere, we can never be sure exactly what they are taking.

 

 

Do I have to come to New York? How can I find a doctor in my area?

 

For your initial consultation, you will be required to come to our Manhattan office in person for a full physical examination. Subsequent consultations may be conducted over the telephone if distance presents a problem. If you prefer to consult with a physician experienced in bioidentical hormone replacement therapy in your immediate area, you may visit A4M (NOTE: This is the link to the physician search function at the Academy of Anti-Aging Medicine website.  Physicians who are trained in anti-aging medicine are also trained in treatment using bioidentical hormone replacement therapy. There is no relationship between PhysioAge Medical Group and the Academy of Anti-Aging Medicine.)

 

 

How are the hormones administered? How often?

 

Hormones are self-administered once or twice per day via transdermal creams (estrogen, progesterone, testosterone), oral capsules (progesterone, DHEA, pregnenolone, melatonin), or subcutaneous injections (HGH, HCG). Injections are relatively painless, using ultra-fine (#31 gauge, 5/16") insulin needles.

 

 

What are the hormones made from?

 

The bioidentical estradiol, progesterone and testosterone hormones we prescribe are derived from the wild Mexican yam.  These molecules are then modified to exact replicas of the hormones currently in your body.   HCG hormone is human-derived, and HGH is produced using recombinant DNA technology.  In every case, they fit the receptors in exactly the same way as the hormones in your body today.

 

 

What are the side-effects?

 

Side-effects are often minimal and manageable when restoring hormones to youthful levels. Some patients report breast tenderness or swollen joints when first starting bioidentical hormone replacement therapy; these and other adverse reactions can be remedied by reducing the dosage.  None of our patients have reported long-term side effects.

 

 

Do you test cortisol levels?

 

We do not test cortisol levels because currently there is no significant data on the value unless you are looking for the specific disease states of hypercortisolism (Cushing's syndrome) or hypocortisolism (Addison's disease). In between these two states of excess and deficiency, it is difficult to quantify the clinical effect of cortisol levels.

 

 

Do you do saliva testing?

 

Whereas saliva testing may be accurate for hormones that circulate in high concentrations, such as progesterone, not all hormones can be accurately assessed using saliva. For instance, estradiol is typically present in picograms (trillionths of a gram!) Since we require extensive blood testing for each consultation, there is no need to collect saliva samples as well. All the hormones we assess can be accurately measured using the blood samples that will be collected already.

 

 

What if I had a hysterectomy?

 

Bioidentical hormone replacement is perfectly safe after a hysterectomy. In fact, since the ovaries produce much of the testosterone in the female body, replacing this hormone is even more important.

 

 

How long do I need to stay on the program?

 

You should continue treatment as long as you wish to see results or resolution of symptoms. To help you assess the efficacy of the program on your health, we've developed a set of sophisticated biomarkers of aging called PhysioAge Diagnostics.  These tests measure the relative health of certain key body systems and metrics that typically decline with age.  Patients sometimes request to stop the program.  If they ever consider restarting, we can assess their relative health by taking new measurements to determine if they would benefit from additional treatment.  The majority of the more than 1,400 patients we have treated are still on the program. 

 

 

 

What happens if I stop the program? Will my body stop producing hormones on its own? Will my hormone levels decrease? Will I lose my gains?

 

In general, supplementation by exogenous (external) hormones will result in decreased endogenous (internal) production. However, the body tends to restore hormones to pre-treatment levels after cessation of treatment. If your own hormone production was low before treatment, it will most likely return to the same levels after treatment. As a result, most of the physical changes enabled by the program will gradually revert back to "normal".

 

 

Will my testes shrink on testosterone replacement therapy?

 

We currently restore testosterone using transdermal testosterone cream and HCG, human chorionic gonadotropin. Using the cream, the testes will likely slow production of testosterone in response to (perceived) high levels. This condition also may result in minor atrophy or shrinking of the testes. HCG emulates luteinizing hormone, which stimulates the testes to produce their own testosterone, thereby preserving their function and size. This product is injected each morning by the patient using an insulin syringe.  HCG can be prescribed in lieu of or in addition to transdermal testosterone cream.

 

 

Will I continue to get my period?

 

The answer to the question of whether to cycle or not to cycle when undergoing bioidentical HRT (bHRT) is complex and depends upon many factors specific to each woman. It also entails a long discussion of the evidence for and against it at this time. Briefly, our current interpretation of available data is that while cycling may turn out to have benefits with regard to breast cancer risk, there is not enough clinical trial data to mandate it for all patients, particularly those with a low risk of breast cancer and who have difficulty tolerating the fluctuation of hormones that cycling entails.

 

 

Have you had any success in treating fibromyalgia?

 

We are treating several patients with fibromyalgia and/or chronic fatigue, all with significant improvement in energy, level of pain, and frequency of exacerbation of symptoms. None have encountered a negative response. This does not assure similar response in all patients with fibromyalgia, but to date the response to therapy has been more effective than prior therapies. Although our program is not specifically designed to attack the underlying cause of fibromyalgia, it does restore function and strength of the immune system, restore efficiency of mitochondrial production of energy with cells, and improves the bodies natural anti-inflammatory capacity. If you are interested in pursuing treatment, contact the office to schedule a set of laboratory blood tests prior to coming in for consultation. With the test results we will be better able to discuss possible benefits of our treatment specific to your current condition.

 

 

When should I start thinking about bioidentical hormones? My doctor wants me to wait until I reach menopause.

 

The menopause is defined as a single day--12 months after your last period. Your physician's suggestion that you wait until you have passed this milestone reflects an antiquated view of a woman's transition from the premenopause to menopause. The majority of women experience their most severe symptoms in the months to years leading up to this milestone. To wait for this single day would be to subject women to a year or more of unnecessary hot flushes, night sweats, mental fogginess, and bone loss. Our approach is to start addressing these symptoms as soon as they appear. They often begin a year or two before the final menstrual period, a time called the perimenopause. By so doing, we can avoid all the havoc that fluctuating hormone levels can wreak on a woman. Our approach is to smooth the transition from normal cycling through the menopause rather than to wait for a somewhat arbitrarily defined date.

 

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