As pioneers in HRT since 1999, we have watched with interest as the hormone therapy landscape has shifted over the years. Thankfully, there are many qualified providers in the marketplace who follow best practice when treating their patients. We consider ourselves to be among them.
However, there continue to be far too many providers engaging in highly questionable practices. Broadly speaking, we find the following to be deeply concerning:
- Practitioners prescribing HRT without the expertise necessary to do so safely and effectively.
- Practitioners who jeopardize safety and effectiveness by cutting corners during the execution of treatment (generally in an effort to reduce costs).
- Practitioners not following best practice because doing so requires too much time, patience, and attention to detail.
Within the past year or two in particular, there are new players within the national marketplace who are especially guilty of cutting corners. Following are just a few of the widespread issues we hear about from new clients who come to us after trying one of these providers:
- In many cases, these providers are prescribing HRT to their patients without doing any lab testing.
- Intake procedures are often inadequate or non-existent.
- Medications are often prescribed on a one-size-fits-all basis.
- There are frequent logistical issues with everything from credit card transactions to medication orders because customer service infrastructure is often lacking.
- Clinical staffing is limited, making it difficult for patients to get help if they need it.
- Many of these providers communicate with their patients primarily via messaging. It can take days to get a response (if a response is provided at all), and we understand it’s virtually impossible to speak with a competent human in real time.
- Clinical and customer service staff often lack the training and expertise necessary for proper execution of treatment. Turnover is rapid, and patients are unlikely to develop ongoing relationships with the people providing their care.
- Patient education related to how HRT works, what to expect, and how medications should be taken is frequently lacking.
- Patients often have little to no interaction with a physician. Turnover can be an issue here, as well, and there may not be an ongoing relationship with any particular physician.
- Record-keeping is often inadequate.
- Monitoring progress on an ongoing basis via routine lab testing and regular interaction with clinical staff is often inadequate or non-existent.
Now…Let’s Pay Some Special Attention to Testosterone for Women
Many of these providers will not prescribe testosterone to their patients at all. To be clear, this is not because their patients don’t need testosterone. Most of them likely do. Rather, these providers will not prescribe testosterone because testosterone is a controlled substance. As such, it cannot be prescribed without a DEA license, routine lab work, and adequate oversight. In other words, prescribing testosterone requires time, effort, documentation, and special licensing.
Also, testosterone cannot be properly dispensed to women using a conventional pharmacy. Rather, custom compounding (using a compounding pharmacy) is a necessity. In the absence of compounded medication, dosing will not be precise or individualized. Once again, the issue here is time, effort, and expertise…because writing prescriptions that are customized to each patient’s needs requires all three.
Our understanding is that some of the providers described above are prescribing DHEA to their patients, claiming that DHEA is a suitable substitution for testosterone. But it absolutely is not. DHEA is definitely easier to prescribe than testosterone (because DHEA is not a controlled substance). And…DHEA is an important hormone in its own right. But DHEA is not a substitute for testosterone.
The rationale provided by practitioners who prescribe DHEA to women in lieu of testosterone is that if a woman supplements DHEA, some of that DHEA will convert to testosterone. While it is true that some DHEA in a woman’s body might convert to testosterone, that amount will almost never be enough to optimize her levels and positively impact how she feels (if it converts at all).
Certainly, if a woman is DHEA deficient, it will generally make sense for her to supplement DHEA for the benefits that DHEA itself provides. But the only way to effectively increase testosterone levels in a woman’s body is via testosterone replacement.
We’re Talking About Your Health—Don’t Settle for Less Than You Deserve
There are areas in life where bargain shopping makes sense. Our strong feeling is that your health and your HRT shouldn’t be among them.
Following are some important considerations when looking for an HRT provider:
- Insist upon having lab work done before you start treatment, and every 6 months thereafter (at a minimum). Without lab testing, a provider will be guessing at what your body needs, which is not only unsafe but also does not bode well in terms of results. There is no room guesswork when it comes to prescribing HRT.
- Pay attention to your provider’s intake procedures. Apart from ordering lab tests, your provider should know a lot about you before any prescriptions are written. A detailed health history should be taken (and updated at regular intervals); a complete inventory of symptoms should be taken (and tracked over time); and patient goals, objectives, and areas of concern should be discussed. Patient education is also important. Your provider should review your lab results with you and explain to you what they mean each time your lab test; they should talk with you about how HRT works and about what you can expect from treatment; and they should review with you how your medications should be taken.
- Insist that your medications and dosing be individualized and finetuned to your body’s unique needs. One size does not fit all when it comes to hormone therapy. If your provider is prescribing the same thing to all of their patients (which is usually the case among providers who don’t do any lab testing), this should be a red flag. Likewise, your dosing should be tweaked and adjusted over time as your physiology and your lab levels shift. If your provider does not take the time to make sure your levels remain optimized over time, this is another red flag.
- Ask about your provider’s approach to customer service and inquire as to what their structure is in this regard. Ensure that you will be able to reach someone in real time within a reasonable amount of time if you have a question or need help. If your provider communicates primarily by message with long periods of time passing between a question being asked and answered, consider whether this will be tolerable for you in the long run.
- Make sure your provider’s staff are knowledgeable. Ask a lot of questions. If your provider’s clinical and customer service staff cannot answer your questions or won’t take the time to do so thoroughly, look elsewhere. It also doesn’t hurt to ask if there are specific staff members you will communicate with on a regular basis. You want to build relationships over time with the people who will be overseeing your care.
- Make sure you will have an appointment with a physician at least one time per year, and that there will be regular physician oversight in between those appointments as needed. Anything less is bad medicine. Also, continuity of care is important. While there can be instances where the physician overseeing your care may legitimately need to change, such changes should be the exception as opposed to the rule.
- If you are testosterone deficient, make sure your provider can and will prescribe testosterone to you. Ensure your dosing will be customized to your body’s physiological needs.
As a woman-owned and family-operated business, Renew Youth has been providing best-in-class hormone therapy to our clients for more than 26 years. Call us. Ask us questions. Get to know us and allow us to get to know you. We think you’ll be glad you did. You can reach us at 800-859-7511. Or fill out our easy contact form.