Dr. Dagstani utilizes only bio-identical hormone replacement therapy (BHRT) in treating patients with hormonal deficiencies. These hormones are safe and more effective than synthetic forms. BHRT hormones are fully recognized by the brain and they allow the body to restore itself to its previous normal and vital state.

Why Hormones Decline as we Grow Older

• Hormones decline as we age every year after the age of 40, often even earlier.
• Advances in healthcare, vaccinations, sanitation, food preservation techniques and others have drastically increased life span. However, the glands that produce our hormones do not regenerate but continue to decline, producing fewer hormones with each passing year.
• As we age, it becomes increasingly important for both men and women to keep their hormones balanced. Balanced hormones help to protect against fatigue, mood swings, obesity, other diseases and to enjoy an overall healthier sense of well being.

What does “Bio-Identical” mean?

“Bio-identical” hormones are compounds which are manufactured in the lab to have exactly the same chemical and molecular structure as the hormones that are produced by the human body. Although any hormone can be made to be “bio-identical”,  the term is most often used to describe formulations containing estrogens, progesterone, dhea, and/or testosterone.

Drug companies cannot patent a bio-identical hormone.

By contrast, synthetic hormones are intentionally different. Drug companies cannot patent a bio-identical structure, so they most often invent synthetic hormones that are patentable (Premarin, Prempro, and Provera being the most widely used examples).  Though bio-identical hormones have been in existence since the late 1930’s.

Are bio-identical hormones better than synthetic hormones such as Premarin and Prempro?

We firmly believe the answer is YES. However, that doesn’t mean bio-identical hormones are perfect.  The great appeal of bio-identical hormones is that they are natural and our bodies can metabolize them as it was designed to do, thus minimizing side effects. Synthetic hormones are quite strong, often producing intolerable side effects. Moreover, the compounded bio-identical hormones can be dosed to each individual’s need, which is impossible with limited doses, mass-produced synthetic products.

Are bio-identical hormones safer than synthetics?

European medical studies suggest that yes, bio-identical hormones are safer than synthetic versions. However, we must be cautious because bio-identicals have not been heavily studied, especially for long-term use. In any case, we recommend that no drug ever be viewed as completely safe.

What are the four primary types of bio-identical hormone therapy and the differences between them?

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.