December 31, 2012

Abel and I are planning a new  journey together.  This began last week when I went to get the lab results back from Dr. Greg Brannon.  Seems as if my testosterone is a 4 which is very low and explains my mood swings, hot flashes and memory loss among other things.  These 3 things however have a direct effect on my life and my interactions with others, especially family and co-workers.  Dr. Brannon suggested that Abel and I change the way we eat and work on losing weight.  We have decided that this is something that we want to do together, so we will begin this journey January 2.  (We have to have our traditional New Year's Day dinner of Gnocchi, Milenesa, Collards and Black Eyed Peas!).    I will go back the middle of January and Dr. Brannon will then place a Bioequivalent Hormone Implant that will balance out my hormone levels and hopefully I  will be able to come off my PMS medicine.  The weight loss will maximize the benefit of the hormone pellet.  Below is an article from https://www.anewyouwellnessclinics.com/,  If after you read this and are interested in the Pellets, give A New You a call at:  919) 322-1931 and schedule an appointment.

BHRT Pellet Therapy FAQs & Understanding Hormone Pellet Implants

What are pellets?

Pellets are made up of hormones, most commonly either Estradiol or Testosterone. The hormones are pressed or fused into very small solid cylinders. These pellets are larger than a grain of rice and smaller than a ‘Tic Tac’. In the United States, the majority of pellets are made by compounding pharmacists and delivered in sterile glass vials. There is an FDA approved 75
mg testosterone pellet.

Why pellets?

Pellets deliver consistent, healthy levels of hormones for 3-4 months in women and 4-5 months in men. They avoid the fluctuations, or ups and downs, of hormone levels seen with every other method of delivery. Estrogen delivered by subcutaneous pellets, maintains the normal ratio of estradiol to estrone. This is important for optimal health and disease prevention. Pellets do not increase the risk of blood clots like conventional or synthetic hormone replacement therapy. In studies, when compared to conventional hormone replacement therapy, pellets have been shown to be superior for relief of menopausal symptoms, maintenance of bone density, restoration of sleep patterns, and improvement in sex drive, libido, sexual response and performance.

Testosterone delivered by a pellet implant, has been used to treat migraine and menstrual headaches. It also helps with vaginal dryness, incontinence, urinary urgency and frequency. In both men and women, testosterone has been shown to increase energy, relieve depression, increase sense of well being, relieve anxiety and improve memory and concentration. Testosterone, delivered by pellet implant, increases lean body mass (muscle strength, bone density) and decreases fat mass. Men and women need adequate levels of testosterone for optimal mental and physical health and for the prevention of chronic illnesses like Alzheimer’s and Parkinson’s disease, which are associated with low testosterone levels. Even patients who have failed other types of hormone therapy have a very high success rate with pellets. There is no other ‘method of hormone delivery’ that is as convenient for the patient as the implants. Pellets have been used in both men and women since the late 1930’s. There is more data to support the use of pellets than any other method of delivery of hormones. In addition, there is significant data that supports the use of testosterone implants in both women and men.

How and where are pellets inserted?

The insertion of pellets is a simple, relatively painless procedure done under local anesthesia. The pellets are usually inserted in the lower abdominal wall or upper buttocks through a small incision, which is then closed with a skin tape (steri-strip). The experience of the health care professional matters a great deal, not only in placing the pellets, but also in determining the correct dosage of hormones to be used.

Are there any side effects or complications from the insertion of the pellets?

Complications from the insertion of pellets include; minor bleeding or bruising, discoloration of the skin, infection, and the possible extrusion of the pellet. Other than slight bruising, or discoloration of the skin, these complications are very rare. Testosterone may cause a slight increase in facial hair in some women. Testosterone stimulates the bone marrow and increases the production of red blood cells. A low testosterone level in older men is a cause of anemia. Testosterone, delivered by implants or other methods, can cause an elevation in the red blood cells. If the hemoglobin and hematocrit (blood count) get too high, a unit of blood may be donated.

After the insertion of the implants, vigorous physical activity is avoided for 48 hours in women and up to 5 to 7 days in men. Early physical activity is a cause of ‘extrusion’, which is a pellet working it’s way out. Antibiotics may be prescribed if a patient is diabetic or has had a joint replaced. However, this is a ‘clean procedure’ and antibiotics may not be needed.

Why haven’t I heard about pellets?

You may wonder why you haven’t heard of pellets. Pellets are not patented and have not been marketed in the United States. They are frequently used in Europe and Australia where pharmaceutical companies produce pellets. Most of the research on pellets is out of Europe and Australia. Pellets were frequently used in the United States from about 1940 through the late 70’s when oral patented estrogens were marketed to the public. In fact, some of the most exciting data on hormone implants in breast cancer patients is out of the United States.

Do men need hormone therapy?

Testosterone levels begin to decline in men beginning in their early 30’s. Most men maintain adequate levels of testosterone into their mid 40’s to mid 50’s, some into their late 70’s to early 80’s. Men should be tested when they begin to show signs of testosterone deficiency. Even men in their 30’s can be testosterone deficient and show signs of bone loss, fatigue, depression, erectile dysfunction, difficulty sleeping and mental decline. Most men need to be tested around 50 years of age. It is never too late to benefit from hormone therapy.

What if my primary care physician or my gynecologist says that there is ‘no data’ to support the use of pellet implants?

He or she is wrong. There is a big difference between ‘no data’ and not having read the data. It is much easier for busy practitioners to dismiss the patient, than it is to question their beliefs and do the research. It’s about a patient making an informed choice. After pellets are inserted, patients may notice that they have more energy, sleep better and feel happier. Muscle mass and bone density will increase while fatty tissue decreases. Patients may notice increased strength, co-ordination and physical performance. They may see an improvement in skin tone and hair texture. Concentration and memory may improve as will overall physical and sexual health. There is data to support the ‘long term’ safety of hormones delivered by pellet implants.

Do pellets have the same danger of breast cancer as other forms of hormone replacement therapy?

Pellets do not carry with them the same risk of breast cancer as high doses of oral estrogens that do not maintain the correct estrogen ratio or hormone metabolites. Nor, do they increase the risk of breast cancer like the synthetic, chemical progestins used in the Women’s Health Initiative Trial. Data supports that balanced, bio-identical hormones are breast protective.

Testosterone, delivered by pellet implantation, has been shown to decrease breast proliferation and lower the risk of breast cancer, even in patients on conventional hormone replacement therapy. Clinical studies show that bio-identical testosterone balances estrogen and is breast protective. This is not true of oral, synthetic methyl- testosterone found in Estratestâ, which gets converted to a potent synthetic estrogen, which can stimulate breast tissue. In the past, testosterone implants have been used to treat patients with advanced breast cancer. In 1940, it was theorized that treating patients with testosterone implants earlier, at the time of diagnosis, would have an even greater benefit, preventing recurrence. Androgens have also been shown to enhance the effect of Tamoxifen® therapy in breast cancer patients. References supporting these statements can be found in the data section of www.hormonebalance.org in the ‘Breast Cancer Folder’.

How long until a patient feels better after pellets are inserted?

Some patients begin to ‘feel better’ within 24-48 hours while others may take a week or two to notice a difference. Diet and lifestyle, along with hormone balance are critical for optimal health. Stress is a major contributor to hormone imbalance and illness. Side effects and adverse drug events from prescription medications can interfere with the beneficial effects of testosterone implants.

How long do pellets last?

The pellets usually last between 3-4 months in women and 4-5 months in men. The pellets do not need to be removed. They completely dissolve on their own.

Do patients need progesterone when they use the pellets?

Women who are treated with testosterone implants alone (no estrogen therapy) do not require progestin therapy. However, if estradiol, or other estrogen therapy is prescribed, progesterone is also needed. The main indication for the use of progesterone, is to prevent the proliferation (stimulation) of the uterine lining caused by estrogen. There are progesterone (not progestin) receptors in the bone, brain, heart, bladder, breast and uterus where progesterone has been shown to have beneficial effects. Most of the time, when estradiol is prescribed, progesterone is also prescribed even if the patient has had a hysterectomy.

Progesterone can be used as a topical cream, a vaginal cream, an oral capsule (Prometrium®), or sublingual drops. Only oral progesterone (100-200 mg) and vaginal progesterone (45-90 mg) have been studied and shown to protect the uterine lining from estrogen stimulation. If a patient is pre-menopausal, she uses the progesterone the last two weeks of the menstrual cycle (day 1, the first day of bleeding). Hormone therapy with pellets is not just used for menopause. Women at any age may experience hormone imbalance. Levels decline or fluctuate contributing to debilitating symptoms. Pellets are useful in severe PMS, post partum depression, menstrual or migraine headaches, and sleeping disorders. Pellets may also be used to treat hormone deficiencies (testosterone) caused by the birth control pill.

Is there a role for testosterone implants (pellets) in a pre-menopausal female?

Testosterone pellets may be used in pre-menopausal females (women who have not stopped menstruating). Testosterone has been shown to relieve migraine or menstrual headaches, help with symptoms of PMS (pre menstrual syndrome), relieve anxiety and depression, increase energy, help with sleep and improve sex drive and libido. If a pre-menopausal female has a testosterone pellet inserted, she must use birth control. There is a theoretical risk of ‘masculinizing’ a female fetus (giving male traits to a female fetus).

Can a patient be allergic to the implants?

Very rarely, a patient will develop local zone of redness (3-8 cm) and itching at the site of the testosterone implant. There is minimal or no tenderness and no other sign of infection. Pellets are made of up testosterone, stearic acid and PVP (povidone). Patients may react to the PVP. Implants can be compounded or made without PVP. Many patients who develop a local reaction to the implant have low cortisol levels and upon further questioning, have symptoms of adrenal insufficiency. Cortisol testing may be recommended. If needed, 25-50 mg of benedryl works well for the itching.

How are hormones monitored during therapy?

Levels will be reevaluated during hormone therapy, usually prior to insertion of the next set of pellets. After the first year of therapy, hormones levels may be followed less frequently. Men must notify their primary care physician and obtain a digital rectal exam each year. Women are advised to continue their monthly self-breast exam and obtain a mammogram and/or pap smear as advised by their gynecologist or primary care physician.

How much does this cost?

The cost for the insertion of pellets will vary depending on the dose of the hormone and the number of pellets needed. Men need a much larger dose of testosterone than women and the cost is higher. Pellets need to be inserted 2 to 4 times a year depending on how rapidly a patient metabolizes hormones. When compared to the cost of drugs to treat the individual symptoms of hormone decline, pellets are very cost effective. Prevention is much more cost effective than disease. Long, continuous administration of hormones by pellets is convenient and economical for the patient. Pellet implantation has consistently proven more effective than oral, intramuscular, and topical hormone therapy with regard to bone density, sexual function, mood and cognitive function, urinary and vaginal complaints, breast health, lipid profiles, hormone ratios and metabolites.

“Understanding Hormone Pellet Implants”
Provided By: Rebecca Glaser, MD, FACS
www.hormonebalance.org

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January 2:  Abel and I started our new way of eating.  We went to Trader Joe's in Cary to seek out organic foods and were a little disappointed at the selections, but bought some meat and a few vegetables.  One of the meats was organic ground beef and I used that to make some burgers and put them on 2 leaves of Romaine lettuce, topped them with a slice of bacon and organic broccoli slaw. (I will have the recipes for things that we make on this website).  I had made some ginger garlic soup the day before and we had a couple of cups of that. 

Abel says he felt better yesterday by eathing healthier, but I was just hungry all day.  I am diabetic and felt like my sugar was falling, but I kept a constant check on it and it never got below 145, so I knew it wasn't falling.  My sugar levels are something that I will have to constantly moniter as I go along this journey.

We also decided that we are going to join Rex Wellness.  I know we can exercise at home and walk in our neighborhood, but for me water aerobics is what I prefer and Abel likes the machines and steam room.  So Thursday we will go and join Rex.

I survived day 1 !!  I only had 1 cup of cofffee and water the rest of they day, so cutting out my diet drinks is a little stressful!  But I keep telling myself: 

Philippians 4:13
I can do all things through Christ who strengthens me.

Until tomorrow!

Kim