BHRT Cream & Orals Aftercare

Estrogen is secreted by your ovaries up until menopause when levels become undetectable. Estradiol is the most biologically active form of estrogen. It protects against cardiovascular disease, osteoporosis, and Alzheimer’s disease. In menopause, low levels lead to vaginal dryness, hot flashes, night sweats, fatigue and decreased libido, just to name a few symptoms. Estradiol replacement treats these symptoms, as well as improves mood and overall well-being.

Treatment Preparations

ORAL: Oral estradiol is taken in the morning, as directed by your clinician. Because of the passage of oral estradiol through the liver upon digestion, there are unique benefits to oral estradiol versus other forms as it relates to potentially reversing coronary artery disease and improving cholesterol levels.

CAUTION: Oral estradiol is contraindicated in women with any clotting disorders.

TRANSDERMAL: Topical estradiol gel is applied to the inner arm, typically 1-2 pumps per day, as directed by your clinician. The gel should not be applied immediately before showering, swimming or using a sauna, all of which can reduce its effectiveness.

Estradiol patches are applied to the skin twice weekly, and it is important to alternate sites to reduce the risk of skin irritation.

Vaginal estrogen may be prescribed for persistent vaginal dryness, urinary symptoms or pain with intercourse. The Estring is inserted intravaginally every 3 months. Vagifem is an intravaginal tablet inserted at night, and Estrace is a vaginal cream applied at night, as well.

CAUTION: Children should avoid contact with topical estradiol due to risk of transference.

POSSIBLE SIDE EFFECTS: Occasionally, estradiol can cause nipple sensitivity which may improve with a GLA supplement of 800mg per day. Estradiol may also lead to uterine spotting or bleeding.
This is most common during the first year after starting BHRT. It may also occur if the progesterone isn’t being taken regularly or there are missed doses. If vaginal bleeding does occur, contact your clinician and we will typically recommend doubling the progesterone dose for 7-10 days, followed by a return to your usual dosage.

Progesterone is secreted by the ovaries and protects against uterine and breast cancers, osteoporosis, heart disease, and ovarian cysts. In menopause, low levels lead to insomnia and mood changes. Night time treatment with oral progesterone helps women sleep more soundly. Synthetic progestins are chemically manipulated and thus biologically different than natural, “bioidentical” progesterone. Progestins pose a cancer risk and can cause unwanted side effects such as bloating, headaches, fatigue and weight gain. To avoid these risks and adverse side effects, we only prescribe natural progesterone.

Treatment Preparation

Oral micronized progesterone is taken at nighttime, about 1-2 hours before bedtime.

POSSIBLE SIDE EFFECTS: Occasionally, daytime grogginess may occur, and please notify your clinician, who may recommend alternate time of dosing.

In women, testosterone is a hormone secreted by the adrenal glands and ovaries. It contributes to strength, decreased fat mass, increased exercise tolerance and improved libido. It improves energy, mood, cognitive function, lean muscle mass, bone density, and immune function. It also protects against cardiovascular disease, hypertension and possibly arthritis.

Treatment Preparation

Testosterone cream is applied to the external labia of your vagina once daily, as directed by your clinician. The initial dosage is typically ¼ gram of either 2% or 4% concentration. Avoid bathing, swimming, or showering for 4 hours after application.

CAUTION: To avoid the risk of transference, thoroughly wash your hands with soap immediately after application. Partners should avoid contact with unclothed and unwashed application sites. Avoid intercourse within 4 hours of application. Avoid any transference to pregnant or breastfeeding women to avoid the risk of virilization to the baby.

POSSIBLE SIDE EFFECTS: Some women experience transient water retention which can result in weight gain of 2-5 pounds, and/or swelling of the hands and feet. This usually resolves after 1-2 months of treatment, but if it persists, please contact your clinician for a possible diuretic. Testosterone may also stimulate hair growth on your face, chest or abdomen. If bothersome, please let your clinician know about a possible dosage change or additional medication to reduce this side effect. Depending on your sensitivities to testosterone, pimples may also occur but is usually short-lived, and can improve with a good cleansing routine.

In men, testosterone is secreted by the adrenal glands and testes. It contributes to muscle mass, strength, endurance, decreased fat mass, and enhancing well-being. It protects against cardiovascular disease, hypertension and arthritis. Properly delivered, it can improve healing capacity, cholesterol, libido, sexual performance and libido. It arguably prolongs quality of life and “health-span” by decreasing diseases associated with aging.

Treatment Preparation

Testosterone 10% lipoderm cream is typically applied to your scrotum twice daily- once in the morning and once in the late afternoon/early evening. Avoid bathing, swimming, or showering for 4 hours after application.

CAUTION: To avoid the risk of transference, thoroughly wash your hands with soap immediately after application. Partners should avoid contact with unclothed and unwashed application sites. Avoid intercourse within 4 hours of application. Avoid any transference to pregnant or breastfeeding women to avoid the risk of virilization to the baby.

POSSIBLE SIDE EFFECTS: Some men experience transient water retention which can result in weight gain of 2-5 pounds, and/or swelling of the hands and feet. This usually resolves after 1-2 months of treatment, but if it persists, please contact your clinician for a possible diuretic. Testosterone may also stimulate hair growth on your face, chest or abdomen. If bothersome, please let your clinician know for a possible dosage change, or additional medication to reduce this side effect.

Depending on your sensitivities to testosterone, pimples may also occur but is usually short-lived, and can improve with a good cleansing routine. While rare, testosterone may increase assertiveness or aggression. It may also cause some breast tenderness or nipple sensitivity due to a small amount converting to estrogen. Please contact your clinician for possible dose adjustments if you experience any of these side effects.

DHEA is an oral supplement that may be recommended by your clinician. It serves as a complement to optimal testosterone replacement. It helps to shift the body toward an anabolic or muscle-building state, reduces cardio-metabolic risk by increasing breakdown of fat, restores sexual vitality, and improves immune function and well-being. It is taken once orally in the morning.

Thyroid is the main metabolic hormone secreted by the thyroid gland. It regulates body temperature, metabolism, cerebral function and energy. Therapy is usually with bioidentical, desiccated porcine (pig) thyroid pills which have a combination of T3 and T4 hormones.

Thyroid medication should be taken first thing in the morning on an empty stomach with nothing to eat or drink but water for 30 minutes.

Melatonin controls sleep and circadian patterns. As we age, we tend to make less melatonin, thus impairing our ability to achieve a rejuvenating and restful night’s sleep. This can negatively impact our mood, energy, ability to concentrate, immune function, and well-being. We recommend taking an individually dosed, sustained-release melatonin capsule 1-2 hours before sleep, if needed. A shorter acting liposomal melatonin spray can also be used, if needed, for middle of the night awakening.