Hormone Replacement Therapy- What To Expect At An Initial Visit With A Licensed Naturopathic Doctor Versus A Conventional MD By Dr. Patti Haebe, NMD

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Hormone Replacement Therapy- What To Expect At An Initial Visit With A Licensed Naturopathic Doctor Versus A Conventional MD



By Dr. Patti Haebe, NMD

October 4, 2018



Hormone replacement therapy, while around for years, has been growing in popularity due to accessibility and efficacy and it’s not just for women anymore! Hormone replacement therapy has grown enormously in importance for males starting as young as 35 years old. Naturopathic Doctors are known for detailed medical intakes lasting 45-90 minutes in duration that include in-depth medical history while a visit with a conventional medical doctor spans a quick 10-20 minutes.



Your first visit with either provider will include a personal history, blood work as well as a physical examination. Lab tests that should be routinely run for males by a Naturopathic Physician include:

  • CBC
  • CMP
  • Total Testosterone
  • Free Testosterone
  • DHEA-S
  • SHBG
  • Estradiol
  • Progesterone
  • DHT
  • PSA


Your MD/DO may order all the above labs or a slimmed down list usually including Total Testosterone, PSA, CBC, and CMP.



Your physician will also be listening for symptoms of hormonal imbalances from low testosterone or DHEA that you may be experiencing such as:

  • Poor stress response
  • Poor memory
  • Low Libido
  • Brain Fog
  • Fatigue
  • Depression
  • Diminished Motivation
  • Inability to Climax
  • Muscle Weakness
  • Increased abdominal fat


After receiving lab results, values on the low end of the range may warrant either testosterone and/or DHEA supplementation. Naturopathic Doctors may sometimes utilize herbs such as maca, tribulus or supplement oral DHEA to jump start sex hormone synthesis. However, significant deficiencies may require a prescription for testosterone. If a testosterone prescription is warranted, it is a controlled substance and the provider will do a search with the local board of pharmacy to ensure the patient does not have a history of controlled substance abuse and/or is not obtaining multiple testosterone prescriptions through other doctors.



Testosterone prescriptions are available in many different forms, the most commonly prescribed by conventional docs seems to be Androgel due to the ease of application under the armpits and is readily available in most commercial pharmacies. Just like in any profession, each Naturopathic Doctor prescribes slightly differently, there is no consensus on any one specific treatment methodology.



Because Naturopathic Doctors often run additional lab work, as mentioned above, additional hormonal imbalances may be identified and must be addressed. The most common being low progesterone or high estrogen. Elevated estrogen levels are common with the over conversion of testosterone to estrogen, these levels are even higher in men who have recently lost or are losing weight as estrogens can be sequestered within fat cells and released with the fat loss. A natural aromatase inhibitor that prevents this is called chrysin, a natural compound that has proven to be quite effective at dropping estrogen levels and increasing the physiologic effects of present testosterone.



This leads to more complex prescribing by NMDs that includes custom-compounded creams that may include Testosterone, DHEA, Progesterone and sometimes chrysin. Injectable testosterone cypionate is another alternative, injected abdominally or in the thighs once or twice weekly. These prescriptions are made specifically for each patient at a compounding pharmacy and may or may not be covered by insurance.



Lab testing should be repeated 4-6 weeks after starting a hormone replacement therapy regimen to make sure that your prescriptions are the correct strength. Everyone responds slightly differently to hormone replacement so expect a little bit of fine-tuning!



MDs, DOs, and NMDs all practice with the patients healing in mind, the goal is always to reestablish homeostasis and do no harm. As you can see, the deeper you look into hormonal pathways, the more targeted you can be in your approach which is why seeing a licensed naturopathic doctor with a hormonal specialty can be advantageous, especially if previous hormone replacement has only been marginally effective. Treating the root cause is essential and ensuring hormones are well balanced and playing together create the best patient outcomes.



If you are suffering from the symptoms listed above, consider seeking out care from your primary care physician or a licensed Naturopathic Doctor. Advocate for yourself and make sure all of your concerns are being addressed adequately.





Dr.Patti Haebe is a licensed naturopathic doctor in the state of Arizona. She sees patients via a telemedicine based practice called Ocotillo Integrative medicine and specializes in hormone optimization, pre-conception planning and general wellness.

Ocotillo Integrative Medicine

Ocotillointegrativemedicine.com

@Dr.Patti_Haebe

 
Brilliant article!

Very logical progression.

And, most importantly, it outlines the proper steps that *should* be followed via an Integrative Medicine approach!
 
My wife went to a Naturopath because she had postmenopausal symptoms that affected her life tremendously. I see the author is from the states so I don't know if requirements are that much different between the two countries but my wifes was a lot more involved.

After establishing what her diet and lifestyle was like the Naturopath literally put her on a diet/vitamin program for a year to "prepare the body for hormone therapy". The blood panel was so extensive that when my wife went to get a script for DHEA from her MD the Naturopath had to explain to her what some of it meant. After the year was up she was put on the lowest possible dosage of Estrogen and Progesterone that can be had from a pharmacist. Within three weeks she was responding to the treatment.

My wife went to her doctor for an unrelated issue and they talked about her HRT, the doctor asked what her dosages were and was very surprised, she said that had she gone through a MD the lowest dosage would have been double what she is on now and the whole "preparing the body" just wouldn't have happened.

The point I'm trying to make here is not that long ago I would have turned up my nose at a Naturopath, I have a newfound respect for them.
 
My wife went to a Naturopath because she had postmenopausal symptoms that affected her life tremendously. I see the author is from the states so I don't know if requirements are that much different between the two countries but my wifes was a lot more involved.

After establishing what her diet and lifestyle was like the Naturopath literally put her on a diet/vitamin program for a year to "prepare the body for hormone therapy". The blood panel was so extensive that when my wife went to get a script for DHEA from her MD the Naturopath had to explain to her what some of it meant. After the year was up she was put on the lowest possible dosage of Estrogen and Progesterone that can be had from a pharmacist. Within three weeks she was responding to the treatment.

My wife went to her doctor for an unrelated issue and they talked about her HRT, the doctor asked what her dosages were and was very surprised, she said that had she gone through a MD the lowest dosage would have been double what she is on now and the whole "preparing the body" just wouldn't have happened.

The point I'm trying to make here is not that long ago I would have turned up my nose at a Naturopath, I have a newfound respect for them.

I would be great if you or your wife could provide more details (without getting too personal) of her experience with this. Maybe in the women's forum?

I know it would help my wife with her current situation
 
I would be great if you or your wife could provide more details (without getting too personal) of her experience with this. Maybe in the women's forum?

I know it would help my wife with her current situation
I’ll talk to my wife tonight and see if she’ll be willing to give more details.

It was life changing for her and more importantly the sex has gotten much much better for her.

I mentioned this thread to her this morning and she thinks that not all naturopaths are born equal, this one seems to be exceptional so it’s a crap shoot finding THE one. My wife can now at least give advice on asking the right questions in your search.
 
I'll talk to my wife and compose a few questions.

Tell your wife thanks, we appreciate it
 
My wife just started TRT today for a one month trial - will be doing a log first privately and then posting details as it happens. Appreciate the article.
 
When I switched my specialist, they were stunned at the amounts my previous specialist had given me. They chopped my doses and I nearly immediately started seeing results, compared with over a year with the previous. So definitely take your time and interview any specialist, naturopath, or MD you see.
 
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