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Hormones

Some people call it Anti-aging Medicine, Age-management, or Bio-identicals. Some call it holistic or environmental. Some people know “it” is what Suzanne Somers promotes. I find those titles too limiting to describe the full-spectrum of what I do as I help teens through seniors, men & women, thyroid & iodine, adrenal fatigue, Vitamin Levels, preconception & lactation; and weight-loss, fatigue, and hot flashes, dryness, and libido. I can test for micronutrient deficiency & food sensitivity. All this is in the context of family medicine. Some people that come to me, keep their own doctor and some decide to officially establish. I can check Iodine levels.

There are quite a few Back-to-Nature and “Palm Beach” practices offering this “specialty” type of care under different models.We all have different styles. 

If you suspect hormone insufficiency, I definitely encourage you to look beyond the traditional medical way-of-thinking. Most patients that come to me are educated and independent. They have researched “me” and “hormones” before they come in. Some have been to other medical specialists without results. Some have found me while on a desperate google search to find out what is wrong with them. More than likely, you were referred to me by someone who has been successfully treated. I am glad you found me. 

If you come to me for “hormones,” this is what you can expect: 

1) An initial visit which is covered by insurance (hCG weight-loss counseling an additional fee may apply). I like talking to you to get to know you and your symptoms. 

2) Fasting Blood work to be done at your lab include Chemistry, Blood Count, TSH, T4, T3, DHEA, Cortisol, Vit D, Testosterone, Progesterone, Estradiol. Other labs may include PSA, rheumatologic and arthritic profiles and anything else determined necessary. (Prolactin, MTHFR, FSH, LH, Food sensitivity, and intracellular vitamin analysisi). Most of these are covered by insurance. I offer intracellular micronutrient testing and food Sensitivity testing which is usually not covered by insurance. 

3) It takes a week for most labs to come back. 



If you have minimal symptoms, but blood testing suggests straight forward replacement I take care of things like Vitamins and thyroid. I DO NOT think every person needs hormones. 

If you have on-going symptoms suggestive of hormone overlapping with adrenals and thyroid imbalance--I will consult with a Pharmacist who specializes in your problems. 

Very Concerning Labs and symptoms--I will consult another physician, like an endocrinologist, or GYN if supplement support isn't the answer alone. 

4)If I consult a Pharmacist, you speak to the pharmacist by phone. I review and let you know that I approve final recommendations. You can get started on your plan without another immediate office visit. You are still medically supervised by me and we will determine when the next follow up is needed. Both the pharmacist and I are accessible to you and are both part of your team. We work with your insurance to reduce the out-of-pocket cost of the hormones and supplements we recommend. Veggie supplement options are available. 

(If you have been successfully working with another trusted pharmacist first, I can honor that.) 

5)For Food Sensitivity testing or micronutrient testing and extensive testing for baseline and information (but you are otherwise healthy) I like you to follow up with me. If you live a distance away or work long hours, I may be able to do that follow up by phone. Just ask me. 

6) If I transfer care to a specialist, you will be under the specialist care. Sometimes I will find the specialist is the best option, other times, I honor your request to seek another opinion. Let’s face it, not everything is going to get better with simple replacements. I am certainly willing to optimize your baseline hormone status and continue to work with another specialist. I need to warn you about one thing. I have been practicing in the community for over 20 years. I have built up rapport and trust from many specialists that respect my input. BUT there are also a few specialist who call bio-identicals, witch-craft, “whatever,” and even dangerous. It would be best if we were all healthy and didn't need anything. The supplements I prescribe are individualized and monitored by symptoms and follow-up labs; and monitored by me and pharmacy team. 

"Hormones" is a significant part of my practice. I like when my established patients come tome with their current concerns.

I refer out to compounding pharmacist often because I am willing to try cutting edge approaches to help balance non-specific hormone problems. Patients understand why they may need a referral to another physician, but don't understand the relationship I have with the Pharmacist. I decided to share my reasons with you. I refer you to the best resources for your circumstances. I recommend a PharmD, Doctor in Pharmacy, (the compounding pharmacist) as my clinical extender which means you are getting expert team approach care. The pharmacist is a part of your medical care team. I rely on him and his team to gather information about hormones and endocrine disorders not so always readily accepted by other MD's and drugstore pharmacists… even other compounding pharmacist. 

The PharmD attends continuing education and meetings when I can’t. I rely on him to make recommendations about dosage and delivery route (for example, SL, sublinguals are not available locally). The Pharmacist also is available to you for on-going opinions and adjustments in dosage often after hours. That may save you face-to-face visits with me. By getting the underlying problems balanced it often eliminates the need for ongoing pharmaceuticals and surgery. I find less mistakes when I consistently use one pharmacy team.

At the current time, I have been prescribing bio-identicals with this model for over seven years and I also want to keep up with my primary care skills. I can extend you the specialized hormone balance by keeping the pharmacist on the team. It is rare to find a physician who continues primary care AND extends services to hormones to the extent I do AND takes most insurance. By using the same pharmacy team, medial errors are reduced, as compared to having different pharmacies and different protocols for her to keep up with. 

I have no disclosures. I do not receive kick-back from the pharmacy. Nor are PharmD's employed by the practice. I simply refer you to the best resource for your circumstances at the time. In the meantime you are not paying high fees for anti-aging or weight loss clinics. The teamwork between the PharmD and the MD is a highly specialized one and patients come from all over seeking this kind of care. 

I am highly concerned for your safety. I do not think every person needs hormones. The most frequently asked question I get is about hormones causing cancer. While it would be best if we didn’t need any supplements, pharmaceuticals, or surgery sometimes we do. I will only prescribe for symptoms and problems. I try to get you back to your healthy baseline with as little intervention as possible for as short as possible. Most of the times I am simply replacing what your body doesn’t make or get enough of like vitamins or thyroid. If you need more than that, my opinion, prescription bio-identical hormones are effective when used properly and under the care of an expert physician trained specifically in bio-identical hormone replacement therapy. 

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