Hormone Therapy - Integrative Family Medicine of Asheville

Hormone Therapy

There’s a lot of ‘buzz’ around hormones and it can be hard to know what to believe. Our practitioners have undergone extensive training to help you understand:

  • Is hormone therapy appropriate for you?
  • Are there underlying causes to address before treating hormones?
  • What is the safest approach for you?

Hormones function in a complex system. Literally, everything affects everything. By considering your whole picture, we can detect hidden imbalances that can have dramatic effects. For instance, we have seen many patients correct their hormone imbalances by adjusting their nutrition, sleep, and stress levels. We only recommend hormones as part of a comprehensive treatment plan.

We do not treat hormones in isolation. We consider your lifestyle, risk factors, and health goals. We look at the Big Picture.
bio-identical hormone therapy
Is Bio-identical Hormone Therapy safe?

The Women’s Health Initiative (WHI) Study demonstrated that taking Unopposed Equine Estrogen can increase the risk of endometrial and breast cancer. Some practitioners propose that using bio-identical hormones are safer than pharmaceutical ones. Currently, there is not enough evidence to support this claim. We do use bio-identical hormones, though we want to be clear that they are not risk free. We can minimize the risks by:

  • Emphasizing healthy lifestyle to promote hormone balance
  • Assessing your cancer risk with a thorough history
  • Using the lowest possible dosage
  • Balancing the estrogen/progesterone ratio
  • Using weaker estrogens when warranted
  • Applying the hormone at the site of symptoms
  • Monitoring your hormone metabolites

There is not a ‘one size fits all’ solution, and your safety is our priority. We will always ‘start low and move slow’ to see how your body responds to treatment.  Our goal is to use hormones only when needed and at the lowest possible dosage to address your symptoms.

How do we test hormones?

There is heated discussion about the best ways to test hormones. Blood (serum) testing has the most research, however there may be a lag time between dosage changes of topical hormones and blood levels. While saliva testing may track dosage changes of topical hormones promptly, there can be problems with contamination and oral hormones not reflecting oral accurately. Newer tests looking at urine hormone metabolites provide a comprehensive picture of your hormone cascade; however, these test may not reflect the hormones stored in your tissues. Your provider will help you determine the best testing for you based on your history, dosage changes, and route of hormone delivery.

What do we require for hormone treatment?
  1. We require that all patients sign an informed consent before receiving hormone therapy. We will work with you to minimize risk of treatment. Cumulative estrogen exposure is considered a risk factor for estrogen related cancers, and we want to manage your symptoms with the lowest possible estrogen exposure. We do not recommend hormone therapy for women who have first degree relatives with breast or endometrial cancer. In these situations, we may refer to local Chinese Medicine practitioners who are skilled in an herbal approach. There is some evidence supporting topical estriol for vaginal dryness, vaginal atrophy, or urinary incontinence in this population.
  2. Questions regarding hormone therapy must be answered in an office visit or a tele-visit (Phone/Skype.) Lab results are best discussed in-person. Our patient portal messaging system is only for brief, simple physician messages. The complexity of hormone-related questions requires a conversation.
  3. To provide therapy, we require screening. Due to the potential increased risk of hormone-related cancers, we require that our female patients follow the screening guidelines as outlined by the US Preventive Services Task Force (USPSTF.) For men, we require that you have a prostate specific antigen (PSA) every 6 months and a digital prostate exam every year. These are the recommendations as outlined by The Institute for Functional Medicine to prioritize your safety.
  4. We test hormone levels every 6 months. Many lifestyle factors can affect your production of hormones and your hormone metabolism.
How much does treatment cost?

While we believe that not everyone needs hormone therapy, we find it useful for some patients. We use the lowest dose necessary to manage your symptoms, test every 6 months, and require the recommended screening exams. Our approach emphasizes safety. This approach may require more frequent testing than some offices.

We have designed our pricing to make this service accessible to our members. The cost of treatment will depend on the degree of workup that you require.

Here are three examples:

 

  1. An uncomplicated situation would involve an initial hormone panel that includes an analysis of your hormone metabolites. This gives us information about your cancer risk and whether other hormonal systems are influencing your sex hormone levels. If everything appears normal, we will proceed with treatment. If you respond well to the initial dosage, we would recheck your levels in 6 months. We would require the yearly recommended screening exams as well. 
  2. While most clients experience initial improvement, your body will adjust to hormones over a period of months. In some clients, the initial hormone dosage is not enough or may need other adjustments. We start with a low dosage and gradually increase until your symptoms are controlled. There is not a ‘one size fits all dosage’ since everyone will respond to treatment a little differently—your body is a dynamic, living system. This situation may require more frequent testing to help guide treatment.
  3. A more complicated situation might involve someone who also has adrenal, thyroid, or metabolic imbalances that require deeper testing. The body is a complex, interdependent system— everything affects everything. We may need to address the other imbalances before we are able to find a stable or safe hormone dosage. This might involve a more complex functional medicine work up. You can read about this in our Specialty Services section.