Women’s General Questions

Medical Aesthetics & Laser Spa Serving Sherwood Park, Spruce Grove, St. Albert & Nearby Edmonton, Alberta

Why was told to apply my cream vaginally?
Our skin acts as a great barrier, even when we might not want it to. When we apply cream we want as much of it as possible to be absorbed by your body so that you can feel relief from your symptoms. We have found that when to the vulva (pv) 2-3 times more of the hormone gets absorbed. Additionally, when applying testosterone to the skin we find it can cause a darkening of the hair in the region of application, to avoid this we recommend applying the cream vaginally where there are no hair follicles and so this becomes less of a concern.

I seem to be getting a yeast infection or burning sensation since starting the BHRT when I apply it vaginally? What should I do?
These sensations are generally caused by intolerance to the base cream and not the medications themselves. You CAN apply the cream to the part of the inner forearms, until your next refill. When you are refilling these prescriptions, please discuss these symptoms with your pharmacist and they can use a different base cream that may eliminate these symptoms.  If we can not find a base cream that works for you with the per vulva application we may need to adjust dosing for application to the skin.

After starting Testosterone treatment I’ve noticed unwanted facial hair-growth, oily skin &/or acne. What should I do?
In order to work together to optimize your testosterone levels it is important for you to be able to identify symptoms of excess Testosterone including the above. Some other symptoms may include increased body hair, oily hair and aggressive behavior. If these symptoms occur we recommend you discontinue the cream until the symptoms resolve and contact the BHRT department to discuss the best options for you to proceed. It is important to note that irreversible symptoms associated with testosterone treatment such as deepening of the voice and clitoral enlargement are seen only with extremely high-dose therapy that is unmonitored. Keep in mind that DHEA can cause the same side-effect profile as testosterone.

I thought Prometrium was supposed to help with sleep, why do I feel wide awake after taking it?
When taken orally progesterone goes to the liver for first-pass metabolism, where in most individuals it is converted into a deactivating metabolite that makes us feel drowsy and can help with sleep. In a small percentage of people it is instead converted into an activating metabolite which makes them feel wide awake. To still allow the benefits of progesterone we recommend inserting the pearl vaginally. Here it can be easily dissolved, allowing you to receive the same benefits of progesterone but by-passing this conversion by the liver.

I was told Prometrium would help me with sleep but I am waking in the morning feeling very drowsy. What should I do?
We recommend starting with 100mg (1 capsule) before increasing dose to avoid taking too much. When taken orally progesterone goes to the liver for first-pass metabolism, where it is converted into a deactivating metabolite that makes us feel drowsy and can help with sleep. To still allow the benefits of progesterone we recommend inserting the pearl vaginally. Here it can be easily dissolved, allowing you to receive the same benefits of progesterone but avoiding the drowsy feeling.

After I started taking DHEA or when my dose was increased I started to notice unwanted facial hair-growth, oily skin &/or acne, what should I do?
In order to work together to optimize your DHEA levels it is important for you to be able to identify symptoms of excess DHEA. If these symptoms occur we recommend you discontinue the cream until the symptoms resolve. Once resolved you may resume taking the DHEA every other day, this in effect cuts your daily dose in half. If symptoms reoccur the dose may either be further decreased or you can be switched to 7-keto DHEA a metabolite of DHEA. 7-keto DHEA is unable to convert into testosterone meaning while receiving many of the same benefits it does not produce the same side effects as standard DHEA. Although, it comes with a trade-off as it also means we are unable to measure these levels within the blood as with regular DHEA.

I have been applying the cream for 2weeks but haven’t noticed any changes, in fact I feel worse. Should I stop?
It is not unusual for BHRT to take several months to correct hormone imbalances and relieve symptoms. Indeed, after a change in hormone dose, we wait 6-8 weeks before a new blood test is done to check levels. Hormones are powerful but in the short term their effects are subtle. This patient should persevere till his/her next visit. A review of blood work and symptoms at that time will often show a person how far they have come.

I buy vitamins and omega 3’s from Costco as they are less costly. What is the difference in the vitamins sold at True Balance?
All of the vitamins and supplements sold at True Balance are of high quality and are made by reputable companies that hold quality of their products first and foremost. These supplements and vitamins are pure and subject to third party testing for potency and contamination. In the supplement world the old saying ‘You get what you pay for’ truly applies. True Balance our omegas 3’s are certified to be mercury and dioxin free and are of guaranteed potency. They have achieved the ‘5 star’ rating by the International Fish Oil Society. This rating applies to only a handful of omega 3 products. Our multivitamin rated in the top two vitamins available in North America, as decided by Comparative Guide to Nutritional Supplements.

I take anti-depressants/cholesterol pills/diabetes meds prescribed by my physician. Should I stop taking them? Will the BHRT affect their function?
The products prescribed by your BHRT practitioner will not interfere with your conventional medications. Over time, you may be able to taper some of these medications as your health improves. This should only be in conjunction with your family physician.

My family doctor has called and said that according to my bloodwork results I am taking too much thyroid medication?    1) Did you remember not to take your medications the morning of the bloodwork? It is common for patients to remember the bloodwork instructions when they are doing our bloodwork, but not think about it when they are doing bloodwork for their family doctor. Taking your medication that morning will result in blood levels being above normal range. 2) Is your family doctor just looking at TSH? We do not put much value in the TSH level and focus on the Free hormones and Basal Body Temperature (BBT). We also know that to optimize those levels your TSH will be suppressed. 3) Do you have any high thyroid symptoms; heart palpitations, shakiness, or anxiety? If any of these symptoms exist, then you should decrease your dose by 30mg of Desiccated thyroid per day.

Why are you not using saliva to test my hormone levels? There is no scientific evidence or basis for using saliva levels over blood levels to test hormone levels. There is some value when evaluating baseline levels, but not true when monitoring a patient on treatment. We acquire accurate results with the Alberta Healthcare (free) blood testing that allows us to monitor “on treatment” levels. This in conjunction with the symptom form that we have you fill out at every appt has allowed us to successfully treat 100’s of patients. Saliva is used to test adrenal function, as well as urine testing.

How long is it safe to stay on the hormone treatment? Most people seek BHRT to reduce the troublesome symptoms of the menopause or andropause (male menopause). BHRT is very effective at relieving symptoms; however, this relief often lasts only as long as the hormones are used. Conventional HRT in women uses agents that have been shown to increase the risk of breast cancer after 5 years of use. This has led to the concept of 5 years of HRT and then stop. The exciting aspect of BHRT is the suggestion that it can relieve symptoms and reduce the risk of breast cancer. True Balance will be instrumental over the next 5 years in proving this through an ethics approved study.

While patients seek BHRT for symptom relief, BHRT practitioners have additional targets for their therapy. BHRT reduces inflammation, increases muscle mass and bone density. As well, BHRT improves mental function and memory. BHRT appears to give all these benefits and reduce the chance of breast cancer while it also very effectively treats the symptoms that drove the patient to our office in the first place. It is the old ‘win-win’ situation and the reason that we do not place a time limit on the use of BHRT at this time.