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Confused About Hormones?

If you are confused about hormones, you’re not alone. There is a lot of misinformation, hype, and fear surrounding this topic—the indications for hormone replacement, whether to use or not, how to use it (topical, oral, vaginal, and even injected)… the list goes on.

Many women feel that they are alone in this struggle with no one to talk to.  Primary care doctors are too busy or disinterested and maybe have fallen prey to misinformation as well.

Common questions our team hears about hormone replacement therapy in Issaquah include what role blood work plays in perimenopause and menopause, how you can determine whether hormones are even the cause of symptoms, what hormones can or should be replaced and whether a woman should go on them simply for prevention.”

Evidence-Based Medicine with TLJ Aesthetics MD

At TLJ, our team doesn’t follow guidance set forth by drug companies who profit from their protocols.  As a member of the North America Menopause Society, we provide women only with scientific evidence and recommendations set forth by them and other academic and well-respected medical organizations.

Here the standard of care is working directly with physicians and surgeons who have developed the very techniques used to treat the issues we commonly see that hormones can help address and other treatments including feminine rejuvenation can augment.

Typical symptoms associated with perimenopause and menopause include:

  • Night Sweats
  • Hot Flashes Emotional Changes
  • Bladder Leakage
  • Vaginal Dryness
  • Vaginal and External Structure Laxity

Evidence-based medicine and treatments are of utmost importance. Our team feels strongly about the avoidance of over-treating or under-treating, unnecessary testing, and over-prescribing.

For women, balancing health and fitness, emotional health and cosmetic concerns is much easier with TLJ on your team.

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Hormone Treatment

Hormone Replacement Therapy at TLJ Aesthetics MD

Our Program

Dr Terry Jacobson discussing

Women’s Health and Wellness at TLJ is a program specifically designed for women over 40 and focuses on issues around the menopausal transition, health care issues and prevention specific to them.

Dr Jacobson saw the need to educate women about hormones and critical health care decisions to be made during this delicate period of a woman’s life.  Evidence based medicine and education are desperately needed by women, many of whom feel alone and lost to fend for themselves without the information they need to make decisions that impact their current and future wellbeing.

Here you will learn all you need to know about:

  • The transition through menopause
  • The risks, benefits, and alternatives to hormone replacement
  • How current symptoms can be treated
  • How decisions you make now impact prevention of disease

In this program, TLJ can serve as primary care or a supplement to your primary care.  But, always, it is concierge style.

Additional benefits of Women’s Health & Wellness at TLJ:

  • Plenty of time with your provider, never rushed
  • Timely appointment availability, typically within a few days
  • Access to your provider if you have an urgent problem.
  • Always, an evidence-based approach to managing your health.

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What hormones treat

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Many women begin experiencing changes in hormones around age 40. Some not until around 50.  Some transition right on through and past the official menopause and don’t even skip a beat.  Others of us struggle with this “new normal.” No matter where you are in this transition, it is important that women receive the proper education and evidence based medical advice.

Symptoms hormone replacement therapy can help to alleviate:

  • Hot flashes
  • Night and day sweats
  • “Brain fog” or lack of focus
  • Emotional lability, feeling a loss of wellbeing
  • Vaginal dryness and painful intercourse

The timing of initiation of therapy is critical in terms of risk/benefit profile of hormone therapy.

Did you know hormone therapy early can impact future heart health, bone health, longevity and maybe even cognition?  On the flip side, once a woman is 10 years past her last period or 60 years of age or older, the window of opportunity to initiate hormonal therapy is over.  Conversely, when started early, a woman in her 60s, 70s, and beyond can benefit from safe hormone replacement to enhance vitality and a healthy life.

It is important to discuss your heath, hormone benefits and risks with a clinician educated, interested and dedicated to your wellbeing today and for your future self.

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Evidence based approach to practicing medicine is of upmost importance. It is the use of the best research and evidence through high powered studies to determine the safest and most effective treatment strategies for patients that result in the best outcomes. It is not enough to have a “great idea” or “notion.” Rather, evidence must support the decision making between clinician and patient.

A study done over 20 years ago, the Women’s Health Initiative, changed the landscape of hormone replacement therapy forever. Or… well… for a while. Safety considerations were incompletely understood which prompted many clinicians to stop or decline starting hormones for women suffering with menopausal symptoms. In addition, initiation of hormonal therapy requires an in-depth conversation and assessment of patients. And time is not always something a busy provider has the luxury of in today’s healthcare environment, unfortunately. But today, with much more research, data, and knowledge, we can make safe and effective recommendations to our patients with confidence. You are not alone.

Hormone replacement therapy, otherwise known as menopausal hormone therapy, is an effective treatment for peri and post-menopausal vasomotor symptoms (hot flashes and day or night sweats), vaginal dryness, emotional changes associated with hormonal fluctuation, among other symptoms.  It has also been shown to reduce bone loss and prevent fractures.

In addition, symptoms sometimes assumed to be hormonal are not. Individuals should have a thorough assessment followed by a thoughtful treatment plan.

Hormone therapy can be considered during any phase of peri or post menopause.  The risks and benefits of hormone therapy are related to the timing of initiating hormones. An in-depth assessment must be done with a knowledgeable clinician to determine the best approach for each individual.

When it comes to assessing hormone status in pre, peri, and post menopause, many patients are surprised to hear that there is no role for blood work, saliva tests, or any other methods of measurement.  That is because symptoms are not associated with specific levels and those levels do not, therefore, prompt dose adjustments.  It is the patient and her symptoms that may prompt adjustments in therapy over time.

Lab work may be suggested to test for other problems that can masquerade as a menopausal symptom, however, such as anemia, thyroid disorder, diabetes, among others.

Bottom line: “I want to know where I’m at” with hormones, is not as easy as getting bloodwork.

The term bioidentical hormones is one that refers to the chemical structure of hormones naturally found in the human body.  It is not a scientific or medical term, otherwise.  Marketing efforts and lack of an evidence-based approach to hormone replacement can falsely reassure women that using bioidentical hormones is the best and safest approach.  However, studies are lacking to demonstrate superior efficacy and safety over a wide range of pharmaceuticals that have, by contrast, undergone approval for safety and efficacy by the FDA. 

Estradiol and progesterone are available in pharmaceutical products (as opposed to compounded products)  and have the same chemical structure as is found in the human body and have been approved by the FDA. The choice of which hormonal or non-hormonal treatment to alleviate menopausal symptoms should always be made between clinician and patient, taking many factors into account. 

Other estrogens found in the female human body include estriol and estrone and are not felt to play a role in hormone replacement, according to evidence and safety data currently available.

It is growing practice in some areas of the US to get bioidentical topical, buccal or injectable pellets (typically under the skin of the gluteus) compounded in pharmacies.  These products are not approved by the FDA for safety and efficacy.  In fact, there are concerns that compounded products are less safe than those manufactured by pharmaceutical companies who use good manufacturing practices (GMP), a system for ensuring that products are consistently produced and controlled according to quality standards designed to minimize risk to patients.  GMP is regulated by the FDA.

There are also concerns that hormone pellets that are injected under the skin may contain supraphysiological doses of hormones such as estrogen and testosterone which would be potentially harmful.

For additional information on compounded hormones, click in this short video:

Prescribed compounded products should be limited to cases where no good pharmaceutical option is available.

Topical estrogen in combination with any other “bioidentical” hormone that is compounded has not been shown to be more effective or safer than other hormone options, nor are they approved by the FDA for safety and efficacy.  Further, estrogen used topically in women with a uterus must be in combination with oral progesterone (or a progesterone IUD) to prevent uterine cancer.  The use of a topical progesterone cream has not been demonstrated to effectively accomplish this, potentially putting women at risk for developing uterine cancer.

Testosterone should not be used in most women for hormone replacement therapy. The exception to this is in women suffering from a mental health disorder known as Hypoactive Sexual Desire Disorder defined by “persistently or recurrently deficient (or absent) sexual fantasies and desire for sexual activity” that causes “marked distress or interpersonal difficulty.” Additional criteria also must be met for this diagnosis.

Otherwise, testosterone in women has not been demonstrated in clinical studies to have long term safety or efficacy for menopausal symptoms and can contribute to developing acne, hair loss, hair growth (where you don’t want it), clitoral enlargement, anxiety, deepening of the voice.

A position statement on the use of testosterone to treat women in pre, peri, or post menopause has been created to this point and endorsed by the following medical societies:

The International Menopause Society
The Endocrine Society
The European Menopause and Andropause Society
The International Society for Sexual Medicine
The International Society for the Study of Women’s Sexual Health
The North American Menopause Society
The Federacion Latinoamericana de Sociedades de Climaterio y Menopausia
The Royal College of Obstetricians and Gynecologists
The International Society of Endocrinology
The Endocrine Society of Australia
The Royal Australian and New Zealand College of Obstetricians and Gynecologists.

 Ask us for a copy of this position statement if you are interested.

There are multiple options to treat menopausal symptoms when a woman prefers this option or when hormonal therapy is contraindicated.  The choice of medication is dependent upon a number of factors unique to a woman’s health, risk factors and preferences.

Supplements that claim to improve menopausal symptoms lack evidence and the FDA does not regulate the supplements industry.  Therefore, precise ingredients are not known, claims can be misleading, and safety is not guaranteed. There are very few supplements that our practice recommends and none of them are for menopausal symptoms or to enhance hormone replacement for any reason. Caution should be used when supplements are recommended to the public and awareness of profit motive potentially associated with those recommendations.

Your journey with us begins with a complimentary meet and greet to determine if our goals are in alignment.  If so, you may join our program we call Women’s Health & Wellness at TLJ. We begin with a thorough health history, physical examination, and laboratory work, if indicated.  Risks and benefits of a variety of treatment options are discussed and, together, we embark on a path of better health, prevention, and optimal well-being.

Because we cannot separate you from your hormones, we take a holistic approach to your entire self and body.  The core of our practice is Internal Medicine., primary care.  We can either function as your primary care provider (preferably) or we can work together to compliment one you already see.

 At TLJ Aesthetics MD, we are caring for you, inside and out.

Women’s Health & Wellness at TLJ is a concierge model of primary care. Insurance is billed for your office visits.  A small monthly, semi-annual or annual fee is also charged for benefits not billed to your insurance including after hour availability to your provider for urgent matters, periodic news communications, as a few examples. This enables our team to provide ample time to our patients where they never feel rushed or unheard.

Of course, this would be our preference, as we’d like to take care of “all” of you now and in the future.  However, if you are a member of an HMO and cannot choose a primary provider outside that system, we are more than happy to supplement the primary care provider you already have.

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Beauty Secret

At TLJ Aesthetics MD, you are rewarded for making a commitment to YOU! TLJ’s Beauty Secrets Rewards program provides savings on Botox and Aesthetic treatments, Clinical Skin Care Products, among other perks!