Dr. Joseph M. Perlman Advanced Plastic Surgery Centre

At Advanced Plastic Surgery Centre, we’re always looking for better ways to help our patients. We now offer consultation and management of hormone dysfunction using BHRT. Hormones regulate many bodily functions including growth, reproduction, and metabolism.

Peak levels for most of the hormones occur in our 20s and early 30s. Hormone levels decrease over the next 20 years both in men and women. Estrogen and progesterone levels decrease markedly at the time of menopause and testosterone levels decrease in men at about the same time. These lead to a number of symptoms including lack of energy and sex drive in both men and women and women in particular, hot flashes, thyroid dysfunction, mood swings, and weight gain, among other problems.

The key to understanding and managing hormone dysfunction requires individualizing the right hormone replacement, based on a patient’s symptoms and lab tests. During the initial consultation, not only do we have the patient’s fill out a questionnaire in which they check off their symptoms but we also want to know things such as their sleeping habits, tobacco and alcohol use, height and weight, type of exercise they regularly do, the medications they are taking and most importantly, their eating habits. A proper diet is key to maintaining good hormone balance. Avoiding a lot of sugar and eating proper portions of proteins, carbohydrates, and fats is essential. Many patients don’t realize that starvation diets actually work against the metabolism, by breaking muscle down in addition to losing fat.

During the initial consultation, we determine what lab work is necessary. All testing is done through an accredited facility and the results are sent back within five days. We then meet again with the patient to discuss the results and plan the proper BHRT. The hormones are compounded at a certified local pharmacy. The most common BHRT for women includes estrogens, progesterone, testosterone, and occasionally thyroid supplement and cortisol supplements.

We also have the patient monitor their symptoms, once they start therapy, to make sure that they are improving. We always start with the lowest dose that we think will be effective. Patients who are already on synthetic hormone replacement at the time of their initial consultation, are usually tapered off those hormones and gradually replaced with BHRT.

Frequently Asked Question

What is BHRT (Bioidentical Hormone Replacement Therapy) and how does it differ from traditional HRT?

Bioidentical Hormone Replacement Therapy (BHRT) involves the use of hormones that are chemically identical to those the human body produces naturally. These hormones are derived from plant sources and are modified in a lab to match the molecular structure of human hormones. BHRT is used to treat hormonal imbalances, typically in menopausal women but also in men and younger women with specific conditions.

Traditional Hormone Replacement Therapy (HRT), on the other hand, uses synthetic hormones or animal-derived hormones. These hormones are similar but not identical to human hormones. Traditional HRT often includes medications like Premarin (derived from pregnant mares’ urine) and synthetic progestins.

Who can benefit from BHRT?

Individuals who might benefit from BHRT include:

  • Menopausal and perimenopausal women: To alleviate symptoms such as hot flashes, night sweats, mood swings, and vaginal dryness.
  • Men with low testosterone levels: To improve symptoms like fatigue, loss of muscle mass, and decreased libido.
  • Individuals with hormonal imbalances: Conditions like thyroid disorders, adrenal fatigue, or estrogen dominance.
  • People seeking a more “natural” approach: Those who prefer bioidentical hormones over synthetic or animal-derived options.
What are the potential risks and side effects of BHRT?

Potential risks and side effects of BHRT include:

  • Increased risk of certain cancers: Like breast and ovarian cancer, particularly with long-term use.
  • Cardiovascular issues: Including blood clots, stroke, and heart disease.
  • Hormonal side effects: Such as acne, weight gain, mood swings, and bloating.
  • Other risks: Including gallbladder disease, liver issues, and breast tenderness.
What are some things to consider before starting BHRT?

Things to consider before starting BHRT:

  • Medical history: Including a personal and family history of cancer, cardiovascular disease, and other conditions.
  • Current health status: Hormonal levels, overall health, and existing medical conditions.
  • Goals and expectations: Understanding what symptoms you want to manage and the realistic outcomes of BHRT.
  • Risks vs. benefits: Weighing the potential benefits of symptom relief against the risks of side effects and complications.
  • Professional guidance: Seeking advice from a healthcare provider experienced in hormone therapy to get personalized recommendations and monitoring.
How is BHRT administered?

BHRT can be administered in various forms, including:

  • Creams and gels: Applied to the skin, allowing hormones to be absorbed through the bloodstream.
  • Patches: Worn on the skin, providing a controlled release of hormones.
  • Pills: Taken orally, though they may have higher risks of side effects due to first-pass metabolism in the liver.
  • Injections: Administered directly into the bloodstream or muscle, offering precise dosage control.
  • Pellets: Implanted under the skin, releasing hormones over a period of months for long-term treatment.