YOU MAY NOT BE A CANDIDATE FOR BIO-IDENTICAL HORMONE REPLACEMENT THERAPY IF:

• You currently have, or were diagnosed with, cancer within the past 24 months.
• You have had a serious cardiovascular event (stroke, heart attack, pulmonary embolism, or cardiothoracic surgery) within the past 24 months.
• You have epilepsy or an uncontrolled seizure disorder (seizure within the past 12 months).
• You are currently pregnant or breastfeeding you are NOT a candidate for treatment.

INSTRUCTIONS FOR PRE-TREATMENT (EVALUATION) LAB WORK
Fasting for 8 hours prior to your blood draw is required. Please do not take any medication before the blood draw. Additionally, make sure to drink plenty of water beforehand.

FINANCIAL POLICY
You will be responsible for payment in full for the services provided, as these services are not covered by traditional health insurance. We accept the following forms of payment: HSA, FSA, MasterCard, Visa, Discover, American Express, Venmo, Zelle, Check, or Cash.

INITIAL EVALUATION
Comprehensive Lab Work & Hormone Consultation. This evaluation is conducted to assess your overall health and determine whether bio-identical testosterone replacement therapy is a viable treatment option for you.

$289 --- Comprehensive Lab Work & 4-week Follow-up Labs:

$ 350 --- Initial Consultation with Our BHRT Provider (via telemedicine/phone or in-office):
This is typically a 60-minute appointment to discuss your lab results, symptoms, and medical history to determine whether you are a candidate for bio-identical hormone replacement therapy.

 
TREATMENT COSTS
PELLETS (TESTOSTERONE W/ OR W/O ESTRADIOL) TREATMENTS:
$450 — Bio-identical Testosterone Pellets Treatment: Includes 6 months of testosterone pellet treatment.

• Office visit with a BHRT provider to discuss your individualized treatment plan immediately prior to the insertion of your pellets.
• Insertion of hormone pellets.
• $350 off if choose the first pellets insertion during the initial consultation.

BHRT CREAMS (ESTRADIOL AND/OR TESTOSTERONE) AND PROGESTERONE CAPSULES
Costs may vary from (about $100 monthly plus shipping) for compounding pharmacy customized doses.

Various Costs for Prescriptions (6-month supply) Sent to Pharmacy:
Costs may vary depending on your pharmacy, GoodRx coupon, or insurance coverage. Please check
with your pharmacy for the most accurate pricing options

STEPS FOR INITIAL EVALUATION:
Register your account on our website. (Check your email for 3 items)

BHRT Female New Patient Packet (Please complete it before your initial consultation).
Pre-evaluation lab work ($289) and instructions to schedule your blood draw at any Access Lab or Labcorp near you.
Instructions to schedule your initial consultation (7-10 days after your blood draw) with our BHRT provider on our website to review your lab results and medical history. This appointment can be either a telemedicine or office visit, whichever you prefer.

STEPS TO BEGIN TREATMENT:
If you choose to begin BHRT hormone replacement therapy after your consultation, the Testosterone w/ or w/o Estradiol Pellets Treatment (each female pellet treatment lasts about 3 months) will be $350 off the regular price of $450 when the initial insertion is done during the first visit.
Repeat consultation is required for every 6 months treatments.

Follow-up Lab Work and Symptom Assessment (Every 6 months):
Follow-up lab work (4 weeks after bio-identical hormone replacement therapy).
One consultation with a BHRT provider to review your lab results and assess your response to
treatment (30-minute phone call, 5-6 weeks after pellet insertion).

HOW TO MAINTAIN PELLET THERAPY:
When your initial symptoms begin to return, it’s time to have your pellets replaced. For most women, this typically occurs 3 months after insertion. Visit our website to schedule your BHRT Female Pellet Insertion. A payment of $450 will be collected when you reserve your appointment online, and you will receive a text message confirming your appointment time.

Bio-identical hormones treatment (BHRT) are concentrated hormones biologically identical to the hormones you make in your own body. Estrogen, progesterone, and testosterone are derived from the female ovaries (primarily) and adrenal glands (secondarily) prior to menopause.

Testosterone is a hormone produced by the ovaries and adrenal glands in women. In the medical research, testosterone supplementation in women has been shown to improve fatigue, exercise intolerance, muscle tone, libido, weight, depression, anxiety, and other conditions. 

Though laboratory assays can support a diagnosis of testosterone deficiency, they should not be used to exclude it as there are multiple problems in the measurement of testosterone (ex. dietary intake, sexual activity, sample storage variables, circadian variations). Greater reliance on the clinical features and consideration of symptoms is suggested as an appropriate tool in treating women with testosterone therapy. There is no generally accepted "normal" level of testosterone for women. It is reasonable to prescribe testosterone to a woman who has symptoms of low and to expect testosterone values that are supraphysiologic after treatment.

All testosterone use in women is considered "off-label.” Off-label use refers to the use of any medication for something other than its FDA (Food and Drug Administration) approval. Many medications prescribed in the US are prescribed for off-label use. The off-label use of testosterone therapy has not been evaluated by the FDA and any claims of benefit are purely educated opinions that come from consideration of various medical research studies.

Regarding hormone pellets, the production of the pellet is highly FDA regulated; however, the pellet insertion procedure is not an FDA approved procedure for hormone replacement.

Treatment goals will be discussed at each appointment. If goals are met, then maintenance doses will be discussed. If the treatment is not as effective as anticipated, it might be discontinued, and alternative therapies will be discussed. You are welcome to seek a second opinion or a specialist consultation.

The safety of hormone therapy during pregnancy cannot be guaranteed. Notify your provider if you are pregnant, suspect that you are pregnant or are planning to become pregnant during this therapy. Continuous exposure to testosterone during pregnancy may cause adverse effects in the fetus.

SIDE EFFECTS: Side effects of hormone therapy will be managed clinically and individually. There have been no reported irreversible side effects of hormone replacement therapy noted in the literature.

Potential side effects of pellet insertion procedure may include, but not limited to: Bleeding, bruising, swelling, and pain; extrusion of pellets; infection or abscess formation; seroma formation; scarring at insertion site; keloid scar. Surgical risks are the same as for any minor medical procedure.

Potential side effects of intramuscular injection may include, but not limited to: Pain or redness at the injection site.

Potential side effects of the hormones may include, but are not limited to: 

Estradiol Related: Dysfunctional uterine bleeding; growth of estrogen dependent tumors and breast tenderness. Oral formulations of estrogen have been shown to have a slight increased risk of blood clots, with a greater risk to smokers and overweight/obese persons. Non oral modalities of estradiol have not shown risk of blood clots.

Recent studies regarding risk of breast cancer in women taking menopausal hormones including estrogens have shown that estrogen and/or estradiol do not increase the risk of breast cancer or breast cancer recurrence. However, if a patient has an undiagnosed estrogen/hormone dependent cancer, a possible risk of accelerated growth may occur. For this reason, mammograms, according to current clinical guidelines, are recommended as a baseline prior to estradiol therapy.

Every patient has a right to refuse diagnostic mammogram. If refused, you will be required to sign a mammogram waiver before receiving hormone therapy. If you have a uterus and are on estradiol therapy, oral micronized progesterone (prescription) must be taken daily for protection against uterine cancer.

Testosterone Related: Hyper-sexuality (overactive libido), increased hemoglobin and hematocrit (erythrocytosis), acne, increase in body/facial hair growth, abnormal menstrual cycles, hair loss/thinning and virilization, voice changes or abnormal growth of the female genitals.

CONSENT FOR TREATMENT: I have been informed of all of options for hormone therapies and that I may experience any of the complications related to hormone replacement therapy and to the pellet procedure, should I proceed with that procedure. Periodic adjustments are required to fine tune the treatment with this type of medication. Periodic blood tests are necessary to determine if the dose needs to be adjusted. I understand that hormone therapies are available in many forms including creams, patches, injections, and oral medications. I understand that I am consenting to testosterone therapy for off label use of my symptoms. I understand the hormone pellet procedure is not FDA approved.

AFTERCARE: I agree to immediately report to my practitioner’s office any adverse reaction or problems that might be related to my therapy. Potential complications have been explained to me and I agree that I have received information regarding those risks, potential complications and benefits, and the nature of hormone and other treatments and have had all my questions answered. Furthermore, I have not been promised or guaranteed any specific benefits from the administration of hormone therapy. I accept these risks and benefits and if pursuing pellet therapy, I consent to the insertion of hormone pellets with a dosage regime discussed thoroughly by my hormone pellet provider.

I have read and understand this document in its entirety and have been given the opportunity to ask questions concerning my care. I consent to hormone replacement therapy and if pertinent to my agreed upon treatment plan, subcutaneous hormone pellet insertion. This consent is ongoing for this and all future management of hormone therapies and subcutaneous hormone pellet insertions.

References:

Glaser, R., Kalantaridou, S., & Dimitrakakis, C. (2013). Testosterone implants in women: pharmacological dosing for a physiologic effect. Maturitas, 74(2), 179-184.

Carruthers, M. (2008). The paradox dividing testosterone deficiency symptoms and androgen assays: a closer look at the cellular and molecular mechanisms of androgen action. The journal of sexual medicine, 5(4), 998-1012.

Bachmann, G., Bancroft, J., Braunstein, G., Burger, H., Davis, S., Dennerstein, L., ... & Traish, A. (2002). Female androgen insufficiency: the Princeton consensus statement on definition, classification, and assessment. Fertility and sterility, 77(4), 660-665.

Shufelt, C. L., & Braunstein, G. D. (2009). Safety of testosterone use in women. Maturitas, 63(1), 63-66.

Panay, N., & Fenton, A. (2009). The role of testosterone in women.

Maclaran, K., & Panay, N. (2012). The safety of postmenopausal testosterone therapy. Women’s Health, 8(3), 263-275.

Chlebowski, R. T., Anderson, G. L., Aragaki, A. K., Manson, J. E., Stefanick, M. L., … & Prentice, R. L. (2020) Association of Menopausal Hormone Therapy With Breast Cancer Incidence and Mortality During Long-term Follow-up of the Women’s Health Initiative Randomized Clinical Trials. Jama. 324 (4), 369-380.