BHRT Consults – The Process:
Normally, a physician refers his/her patients to me for a hormone consult via phone or fax. However there are times when patients are referred by counselors, friends, family, etc. Once a patient contacts me wanting a consult, I find out who his/her physician is and first seek approval. Also, I ask the patient to complete a BHRT Info Packet, which gives me a detailed past medical history, previous & current prescriptions, and a symptom rating. Once I have a doctor’s approval for the consult & the patient returns the packet, I will schedule a one hour consult at the pharmacy. If distance is an issue, we can always schedule a phone consult instead. I MUST have a physician’s approval before meeting with a patient, since we’ll need the doctor to authorize the prescriptions. Once the consult is complete, I will send the doctor a 3 page fax with notes from the consult, an update on symptoms, any labs, and my recommendation. At that time, the doctor will fax back his/her signed approval and authorize the number of refills for the prescriptions.
BHRT Consults – The Hormones:
I use natural (yam) hormones that are USP grade and bio-identical. I use a ratio of estriol& estradiol (80/20) that resembles the ratio found naturally in women prior to menopause. I do not use estrone.
I will use transdermal BHRT cream to restore your patient’s hormone levels. Oral estrogens increase clotting risk. I prefer transdermal therapy to bypass first pass metabolism & get the hormones to the receptors before they’re metabolized or broken down. I may recommend giving a patient a portion of progesterone in a capsule to help with insomnia (great side effect of drowsiness/relaxation). The remaining portion will be applied transdermally to achieve better, more consistent levels.
I will never put a patient on estrogen without progesterone. All current data shows that that progesterone protects your patient from more than just uterine/endometrial cancer! Estrogen dominance promotes fluid retention, breast swelling & tenderness, mid-section weight gain, insomnia, anxiety/depression, and overall makes patients feel horrible! Estrogen alone causes the endometrium to proliferate, stimulates breast tissue, promotes clotting, results in fibroids, etc. Progesterone keeps estrogen “in check”. Why use antidepressants when natural progesterone can improve a patient’s mood, help them sleep, and reduce anxiety? I like to think of progesterone as the body’s natural antidepressant. When progesterone & estrogen levels are at an ideal ratio, a patient can feel like she’s in her 30’s again!
Testosterone is important for ladies as well as men. I use transdermal testosterone to reduce fatigue, improve libido, restore the ability to reach climax, reduce bladder symptoms, and help with memory retention.
I use low-dose estriol rather than estradiol to manage vaginal atrophy and dryness. Estriol has no associated risk with endometrial or uterine cancer, and is overall a more “passive” estrogen than the potent estradiol.
For men, I will determine a starting testosterone dosage using any blood from the doctor and a symptom review. After 8 weeks of transdermal testosterone replacement, I’ll check levels using a saliva test (ZRT Labs), which gives me a more reliable reading than blood. All sex hormones are fat soluble, meaning that the levels found in serum are more so representative of the hormones bound to protein. Hormones available to the body are stored in fat. Saliva tests are a great way to determine free levels of sex hormones.
BHRT Consults – The Pharmacist:
It’s important for you to know that I spend a lot of time with my hormone patients. Most of my time in the pharmacy is actually devoted to BHRT consults. Patients can text, call, or face-time my cell # if they have any issues or problems that need my attention. Managing hormone therapy requires a lot of time and energy, but I love what I do! I enjoy taking care of my patients! I continue to monitor his/her progress and make needed adjustments, keeping the physician updated every step of the way!
Thank you so much for the opportunity to work with you!
Anna Claire Heindl, Pharm.D.