Both men and women experience changes in their levels of hormones, affecting virtually all men and women by age 40. Symptoms of unbalanced hormones continue to worsen between the age of 45-55. Although these changes are a normal part of aging, the side effects can be disabling, affecting enjoyment of life, and the health of our relationships with friends, family, co-workers and spouses.
Bio-identical hormone replacement is the logical solution to the problem. Using hormones that are an exact match to what the bodies of men and women normally produce leads to relief of symptoms while minimizing the risks of hormone replacement therapy. BHRT stands for Bio-identical Hormone Replacement Therapy, and applies to both men and women.
Women – Estrogen, Progesterone and Testosterone
Estrogen, progesterone and testosterone are the three hormones that we need to consider when looking for answers to hormone imbalance that occurs in women between the ages of 40-55.
Estrogen – Symptoms of “Low Estrogen” include vaginal dryness and hot flashes. If these symptoms are present, then a trial of bio-identical estradiol is warranted. The concern with using supplemental estrogen is the proven link between Premarin (equine estrogen from horse urine) and a higher risk of developing breast cancer in women. The FDA warns women that all forms of estrogen therapy (including bio-identical) will increase the risk of breast cancer. I agree with that warning so if you need estrogen, stick with bio-identical estradiol pellets. If they help the vaginal dryness and/or hot flashes, then we will continue it for a couple of years, and then re-evaluate if it is still needed or not.
Progesterone – If you are having troubles sleeping at night, or not feeling rested in the morning, then there is a good chance that supplemental bio-identical progesterone will help. Dr. Abbott will give you the option of receiving progesterone by pellet or troche (oral dissolving). If you need to take bio-identical estradiol, and you still have your uterus, then you will also need to take bio-identical progesterone.
Testosterone – Testosterone is extremely important for the wellness of women who are age 40 and older. It is unfortunate that it is often overlooked by many primary care providers. Symptoms of low testosterone include fatigue, daytime drowsiness, sweating, anxiety, depressed mood, irritability, poor sleep, reduced libido (sex drive), reduced ability to orgasm and difficulty in losing mid-body weight. Testosterone is one of five treatments that Dr. Abbott uses to help people who participate in The OWL Diet plan. Bio-identical testosterone is offered by pellet therapy. Women and men can also choose testosterone injections, provided in the med spa, that are performed every 7-14 days.
Treatment Options for Women
Bio-identical Pellet Therapy – This is the number one option for women who want to receive guaranteed delivery of bio-identical hormones. Pellets are small sterile pellets containing pure bio-identical hormones. These are placed with expert care by Dr. Abbott during a “hormone pellet insertion”. The procedure is done at both Omaha Med Spa offices and takes approximately 15 minutes to perform. You will be pleasantly surprised how quick and comfortable your pellet insertion visit will be. Pellet therapy ensures even levels of hormones day and night for 3-4 months, providing symptom relief of all of your symptoms.
Pricing of female pellet therapy – includes the cost of hormone pellets (production of sterile pellets and delivery by courier to your home), the office visit to see Dr. Abbott, the procedure to insert the pellets, disposable costs (sterile tray). Pellet therapy is not covered by the cost of health insurance plans, but you are welcome to use your funds in your Health Savings Account (HSA) or Flexible Spending Accounts (FSA) to pay for your lab testing and all of the costs of pellet therapy.
Pellet therapy Pricing (each visit provides hormone replacement lasting for an average of 3-4 months)
Cost for one hormone pellet (estradiol, progesterone or testosterone) $300
Cost for two different hormone pellets (two of the following – estradiol, progesterone and/or testosterone) $350
Cost for three different hormone pellets (estradiol, progesterone and testosterone) $400
Testosterone Injections – Women now have the option of receiving injections of testosterone into the buttock muscle. These injections provide testosterone lasting for 7-14 days (most women do very well on injections performed every 2 weeks). We offer these injections in the office. The cost is $40 per injection, or you can buy a series of 10 injections for $350. After 10 injections, we will repeat a Hormone Panel of blood tests to monitor your response to treatment. When you buy a series of 10 injections, the cost of the Hormone Panel of blood tests is included in your charge of $350, making this the most affordable option for testosterone therapy for women.
For men we offer Two Options – Pellet Therapy or Injection Therapy.
Option One is Pellet Therapy
Pricing for Pellet Therapy for Men: $650
The pricing for men includes:
- Cost of testosterone pellets from the compound pharmacy
- Office visit for pellet insertion
- Procedure of pellet insertion
- Sterile tray and disposables
Option Two for Men is Injection Therapy
Dr. Abbott offers men the option of injectable testosterone. These shots are administered in the med spa, every 7-14 days. The dosing interval will depend on your response to treatments
The advantage of injection therapy is that it is generally less expensive than pellet therapy for men.
Pricing for Testosterone Injection Therapy:
Single Visit for Testosterone – $50
10 Injections of Testosterone, spaced 7-14 days apart (10-20 weeks of treatment) is $400. Pricing includes:
- Cost of testosterone from the pharmacy
- 10 visits to the med spa for buttock injections
- Full Hormone lab panel after every 10 injections
Frequently Asked Questions
What is “pellet therapy”?
Pellets are small and cylindrical. We use testosterone pellets that are produced in the USA by approved compounding pharmacies. Only pharmacies that provide quality assurance are used for our program. The pellets are produced from plant sources. Pellet therapy is not a new concept, or procedure – it has been used for decades! What is new and different is Dr. Abbott’s approach – come in for a free consultation and he will explain what sets him apart from other health care providers.
How do testosterone pellets work?
Once the pellets are placed under your skin, they will last an average of 3 to 4 months. The pellets slowly dissolve, providing excellent levels of testosterone day and night. After the pellets are totally dissolved, there is nothing to remove. If you benefit from pellet therapy, you will want to repeat the procedure every 3-4 months. If you only have the procedure one time, your body will go back to producing the lower levels of testosterone that were noted before treatment was begun. The pellet procedure is done in both Omaha Med Spa locations, by Dr. Abbott. This is performed as a sterile office procedure, and includes numbing to keep your procedure comfortable. Once the pellets are placed, they start working right away.
What does the FDA say about Testosterone Pellets?
The FDA has approved the use of testosterone pellets under the brand name Testopel™. The reason that I do not use Testopel™ is that it provides only one dose of testosterone. By using a compounding pharmacy, I am able to use a variety of strengths of pellets, and provide exact dosing of testosterone for each individual. The use of testosterone pellets produced by compounding pharmacies has not been submitted to the FDA, but their use is commonplace and well accepted by the medical community. Despite this, pellet therapy for men and women is not typically covered by insurance companies.
How and Where are the testosterone pellets inserted?
The pellet insertion procedure is performed at both Omaha Med Spa locations by Dr. Abbott. He uses the upper buttock area, just behind the hip. With a patient laying on their side, the skin is cleansed, and a local anesthetic (numbing) is used to make the procedure “pain-free”. After the area is numb, a small incision of the skin is made (about 1/4″ long). A small sterile instrument called a “trochar” is then placed through the incision and under the skin. This allows for insertion of the pellets. After the trochar is removed, the small incision is covered with a dressing. For several days after the pellets are placed, we ask you to moderate your activities. All of this information is covered in detail with our “Consent Form” and “Home Care Instructions”
Is Testosterone linked to a higher risk of Heart Disease, Stroke and blood clots?
There is some evidence of an association between use of supplemental testosterone and an increased risk of heart attacks, stroke and blood clots. It would be helpful to have more large clinical trials performed to learn more about this possible association. Many testosterone pellet providers claim that pellet therapy may actually reduce your risk of heart disease, and may improve your levels of cholesterol. I do not agree that there is adequate evidence to make these positive claims. The FDA only sanctions the use of testosterone in men without cardiovascular disease, and only when 2 fasting total testosterone levels are below 300. If a man or woman has any history of blood clots, heart disease or stroke, then they should avoid all forms of testosterone therapy. As with all medical treatments, there should always be a consideration of the Risk versus Benefit of testosterone treatment. Every patient needs to be evaluated based upon their medical history, risk factors, symptoms and response to treatment.
I am a women who also needs estrogen. Your focus seems to be more about testosterone for women. Why is that?
All women develop low levels of estrogen around the time of menopause, and this can cause symptoms of vaginal dryness, and hot flashes. (Night sweats, on the other hand, are related to low testosterone). Estrogen has been given to women for decades, but is unfortunately linked to a higher risk of breast cancer. I believe (and so does the FDA) that even bio-identical estrogen In women raises their risk of developing breast cancer. I prefer to start with testosterone therapy on it’s own, since there is no definitive proof that it is linked to causing cancer. I have also found that most of the “menopause” symptoms that women report are caused by testosterone, not estrogen! Testosterone in your body is broken down to form some estrogen, often helping treat the low estrogen symptoms. If a women has been on testosterone, and still has symptoms, then I will add bio-identical estrogen (and progesterone if they have a uterus). After several years of estrogen treatment, a trial off of it is warranted.
How long do I stay on BHRT?
If your health remains stable, and you are receiving benefit from BHRT, then it may be continued for life. The benefit and risks of hormone therapy must always be considered. If you develop breast cancer, I will stop prescribing all BHRT.