Bioidentical Hormone Replacement Therapy

#1 Because there’s a heck of a lot more to HRT than prescribing bioidentical hormones and, as a Certified Menopause Practitioner, I have the knowledge base and experience to get it right the first time. There are a number of problems with HRT as it is often prescribed and managed:

• Women are too often prescribed HRT without being properly informed about the potential benefits and risks of HRT.
• Suboptimal hormonal preparations, including non-bioidentical preparations, are too often employed.
• A suboptimal method of administration is too often employed (oral versus transdermal estrogen).
• Insufficient attention is paid to individualizing the dosage, with many women being prescribed dosages that are unnecessarily high.
• HRT is often prematurely discontinued under the guise that HRT should always be used for the shortest time possible.
• Hormones are often prescribed where none are required. For example, many perimenopausal women require only progesterone for symptom management and yet end up on combined HRT for unclear reasons.
• Little to no attention is paid to identifying and addressing other hormone imbalances that may be contributing to a patient’s symptoms.
• Little to no attention is paid to ensuring that the administered hormones are being metabolized in an optimal fashion.
• Insufficient attention is paid to mitigating the potential risks of HRT through lifestyle modification.
• There is insufficient acknowledgment that lifestyle factors alone can precipitate or contribute to hormone imbalances.

#2 Although there is considerable uncertainty regarding to extent to which bioidentical HRT increases the risk of breast cancer, with studies suggesting no or very little increased risk, it is safest to proceed under the assumption that it does confer a small increased risk of breast cancer and to proceed accordingly. I therefore include an integrative treatment plan for breast cancer prevention as part of every private-pay HRT consultation.

#3 I am comfortable prescribing transdermal testosterone and other medications to address sexual dysfunction as an add-on to HRT. 

Patients interested in pursuing HRT with have 2 options:

1) Private pay (recommended). This service includes a more comprehensive assessment of hormonal status and integrative treatment recommendations. Note that the total cost of private-pay HRT is $400 (special, limited-time rate for a 2-appointment initial consultation). This means that if you’re on HRT for 1 year, 3 years, 5 years, or longer, you’ll only pay $400. This is because follow-up appointments to tweak your HRT regimen are OHIP-covered. However, this requires that the first appointment takes place in person. In addition, at least one appointment must be conducted in person every 24 months. Follow-up appointments to address issues other than your hormone replacement regimen are not free of charge/included in this $400 fee.

2) OHIP-covered (starting summer 2024). This service includes straight HRT without a more detailed assessment of hormonal status or integrative treatment recommendations. In order to qualify, the first appointment must take place in person. Subsequent appointments may take place by videoconference but at least one appointment must be conducted in person every 24 months. Note that due to payment restrictions  put in place by the Ministry of Health, I am only able to see a certain number of patients for OHIP-covered HRT per year. If you are interested in OHIP-covered HRT, please contact us at [email protected].