Oral Pills: Orally delivered hormones (pills) will pass through the liver prior to entering the bloodstream. This is called “first pass” metabolism. This has been shown to increase the risk of blood clotting and increased risk of heart attack and stroke, even if the hormone is bio-identical. In addition, when the liver metabolizes hormones it increases a protein called SHBG (sex hormone binding globulin) which binds up free testosterone and estrogen. This essentially makes the hormones given ineffective.
Injectables: ‘Depot’ drug formulations are created by mixing a substance with the drug that slows its release and prolongs the action of the drug. The two most frequently used forms in the US are the testosterone esters, testosterone cypionate and testosterone enanthate which are almost interchangeable. These are only used in men as the doses would be too high for women.
The adverse side effects of injected testosterone esters are generally associated with high peak levels in the first few days after an injection followed by lows after the injection starts to wear off. Some side effects may be lessened by using a shorter dosing interval (weekly or every ten days instead of twice monthly with enanthate or cypionate.) 100 mg weekly gives a much lower peak level of testosterone than does 200 mg every two weeks while still maintaining the same total dose of androgen. This benefit must be weighed against the discomfort and inconvenience of doubling the number of injections. Having “peaks and valleys” never allows the body to have sustained levels which would reset all the testosterone receptors causing the most positive effects on the body.
Transdermal Therapy: The term “transdermal” refers to topical delivery through the skin, by the use of a gel, cream or patch. Transdermal hormones are usually applied to the skin in small daily doses in an effort to keep a steady level of hormones in the system at all times. This approach lessens the extreme “peaks and valleys” in hormone levels sometimes associated with injectable forms. With injectables, hormone levels rise dramatically initially and can reach a low-point a few days before the next shot is due, which can cause irritability, hot flashes, and low energy in some users. Transdermal application tends to be attractive to those individuals who are not comfortable with needles and injections. Even with once-daily use of gels and creams, you can also experience significant peaks and valleys which can cause adverse events. Some forms of daily transdermal application, particularly the patch, are substantially more expensive than injectable forms of hormones. Patches often cause skin irritation and/or allergic reactions to users. Patches can fall off with excessive sweating and they must be fully protected with plastic when swimming. Creams and gels can be transferred by direct skin contact so special care must be taken to avoid contact with partners, children and pets. In the United States, testosterone patches are not available for women, only estradiol patches.
Pellet Therapy: Pellet therapy has been available in the United States since 1939. It is a sustainable delivery method for bio-identical hormone therapy. Pellet therapy is an ideal hormone treatment that helps balance body chemistry and restores health and vitality in both women and men. The long-lasting pellets (typically 3-5 months) make this hormone therapy treatment option the easiest, most convenient and typically most effective method available. Instead of dealing with a daily, weekly or every other week hormone pill, cream, patch or shot schedule you meet with a provider every three to five months for an easy pellet insertion. During the simple in-office procedure, the tiny pellets are inserted into the buttock area. The small incision site requires just a small bandage. The pellets which separately contain estradiol or testosterone (used individually or in combination), react to the needs of your body by secreting additional amounts of the hormones just as your body naturally would during periods of stress or exercise. Fortunately, the pellet therapy is consistently maintained, the body does not experience extreme highs and lows. Although many patients notice a difference within a few days, in particular estrogen effects, it can take up to four weeks or longer for the full effects to be felt.
Which Is The Best Method Of Bio-Identical Hormone Therapy For Me?
Today, bio-identical therapy is becoming mainstream and part of the age management movement. Many are looking to it not only for a way to help slow down aging and to deal with hormone imbalances. Ultimately, it is your decision to choose. Please make this important decision with the help of Dr. Dagstani. He will discuss your medical history and lifestyle needs then work with you to choose the bio-identical hormone therapy that is best suited for you.
For additional information or to schedule an appointment with Dr. Dagstani, please call us directly at 480.861.3916. We look forward to working with you and restoring you to optimum health.
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