Bio-identical Hormone Replacement Therapy (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 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.