Many patients wait until they begin experiencing the symptoms of menopause, but having hormone levels checked before the onset of hormonal decline is important in establishing a baseline. Knowing the baseline allows the patient and Dr. Monaco to closely monitor hormone levels and intervene at the right time.

Having hormone levels checked early can also help patients identify perimenopause early; it occurs gradually over many years and may not be apparent immediately following onset.

What are the symptoms of perimenopause?

Perimenopause is the time period before menopause (one year after the last menstrual period), which can last 1 – 10 years. The symptoms of perimenopause include:

• Hot flashes
• Mood swings; irritability
• Night sweats
• Pain during intercourse
• Vaginal dryness
• Anxiety

How long does it take to notice a change?

When symptoms are resolved depends on the length of time it takes to achieve true hormone balance. Women in the throes of perimenopause generally notice an improvement in night sweats and hot flashes in just a few days, while it may take a few months to notice cognitive and memory benefits.

Does BHRT cause weight gain?

A decline in natural hormone production causes weight gain. As a matter of fact, many women over age 35 find that regardless of their diet and exercise regimen, they struggle to manage their weight. By balancing hormone levels, the patient allows her body to work the way it did when she was younger, improving her metabolism and ability to maintain a healthy weight, during both perimenopause and post menopause.

Does BHRT work without any lifestyle change?

BHRT is most effective when combined with a healthy diet, exercise routine, and stress management in place to address the health and well-being of the whole patient. Each of these is an important part of postmenopause health and wellness.

Does BHRT require a prescription?

In some cases, bioidentical hormones can be purchased without a prescription, but the strength is approximately 1/10th of the same prescription-grade hormone. In order to receive maximum benefit, patients must work closely with a regenerative medicine doctor who can prescribe full-strength bioidentical hormones and monitor their efficacy in the body.

Patients suffering from declining testosterone levels may experience:

• Lack of desire for intimacy
• Inability to achieve erection for men
• Decreased semen production for men
• Hair loss
• A decrease in energy levels
• Lost muscle mass
• Increased body fat
• Decreased bone mass
• Problems with mood and mental capacity

Scheduling an appointment is an important first step.

When should men see a doctor?

Because the goal is to maintain hormone levels most men have at ages 21-49, men can see a doctor in anticipation of the decline to ensure they’re able to treat it proactively. This allows the doctor to get a baseline and potentially detect decline in hormone levels before they cause noticeable symptoms.

Why is it important to see a doctor?

It’s critical that patients undergo comprehensive medical testing before embarking on a hormone modulation program. First, a baseline blood PSA must be taken to rule out existing prostate cancer. Then free and total testosterone and estradiol tests are required to ensure that too much testosterone isn’t being converted into estrogen. Follow-up testing for estrogen, testosterone, and PSA are needed to rule out prostate cancer and fine-tune the program. A qualified and experienced integrative medicine doctor can use the results of these tests to design a program tailored to each patient’s unique situation.

What can cause high testosterone levels?

There are 5 basic reasons free testosterone levels may be low:

• Too much testosterone is being converted to estrogen through the activity of aromatase, and/or the liver is failing to remove excess estrogen, possibly because of heavy alcohol intake.
• Too much free testosterone is being bound by SHBG. This would be especially apparent if a man’s total testosterone level is in the high normal range but his free testosterone level is low.
• Not enough LH (which controls the production of testosterone) is being secreted by the pituitary gland, resulting in low total testosterone.
• Not enough testosterone is being produced by the testes, which causes low testosterone and high LH.
• DHEA level is abnormally low

How is low testosterone treated?

Treatment depends on the underlying cause of the hormonal imbalance and typically includes supplements, bioidentical hormones, and lifestyle changes like weight loss or exercise. Dr. Monaco ensures every patient receives a treatment plan customized to his unique lab results and goals.

The symptoms are much the same for both men and women:

A decrease in sex drive

Weak orgasm

Lack of energy

A decrease in strength, endurance

Lost height

Reduced enjoyment of life

Feeling sad or irritable

Declining sports ability

Falling asleep after dinner

Decreased work performance

//// Seeking treatment as soon as these signs and symptoms are detected can ensure early diagnosis and intervention. ////

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Why is testosterone so important?

Testosterone plays a key role in health and wellness for men and women…

Offers mental clarity

Maintains muscle mass

Protects bone density with age

Increases energy

Provides cardiovascular protection

Regulates libido

Decreases fatigue

Protects the brain

While sex drive is often the most noticeable or undesirable side effect, driving patients to see a regenerative medicine doctor, the risks of low testosterone extend beyond libido to include cardiovascular, brain, and bone risks as well.

How is declining libido treated?

The first step in treatment is a comprehensive patient screening, including patient interview, review of signs and symptoms, medical history, physical examination, and blood tests. Once this is complete, Dr. Monaco can determine the underlying cause of the decline in libido. In some cases, the cause isn’t insufficient testosterone so much as it’s an overproduction of a competing hormone. Once the cause is known, a custom treatment plan is created with the goal of improving the patient’s libido and overall health and wellness.

Treatment may include dietary or lifestyle changes, the addition of natural supplements, or bioidentical hormone replacement therapy. In most cases, ongoing monitoring of hormone levels is important in ensuring the condition is well managed and maintained.

How can sexual problems impact a patient’s life?

Sexual problems can dramatically impact a patient’s life. Declining testosterone levels can put a strain on intimate relationships, cause feelings of embarrassment and inadequacy, and deeply impact self-confidence. Dr. Monaco understands the deep impact hormone insufficiency can have on a patient’s life, as well as how difficult it can feel to share these intimate details with a doctor. He provides compassionate and empathetic treatment to patients suffering from problems with intimacy with one goal: to improve the patient’s quality of life in a safe and effective way.

What is adrenal fatigue?

Adrenal fatigue is a term used to describe the state a person is in when their adrenal glands decrease hormone production in response to a stressful lifestyle.

What are the signs and symptoms of adrenal fatigue?

Those experiencing adrenal fatigue may struggle just to get out of bed in the morning, suffering from chronic fatigue, feel tired after waking in the morning, or have trouble thinking with clarity or completing tasks. Adrenal fatigue can make it difficult to fully function.

Why is it important to schedule an appointment?

There are 2 important reasons to see a doctor as soon as possible:

• These symptoms can indicate a serious underlying condition like arthritis, anemia, heart failure, or diabetes and adequate screening is crucial
• The sooner adrenal fatigue is detected the sooner the therapy will improve how the patient feels

What treatment is available for adrenal fatigue?

Treatment depends on the severity of the problem. When adrenal fatigue is caught early, in stages 1 or 2, dietary changes and herbal supplements can sometimes naturally balance hormone levels and increase adrenal gland production. However, patients who are in stage 3-4 adrenal fatigue typically require bioidentical hormone replacement therapy.

What kind of doctor treats adrenal fatigue?

Most traditional doctors will not treat adrenal fatigue; they’ll test for underlying conditions and if none are detected, they’ll prescribe medication to improve sleep or wakefulness. While these solutions may help temporarily, they don’t address the real problem: decreased hormone production of the adrenal glands.

A regenerative or integrative medicine doctor understands the dramatic impact adrenal fatigue can have on the patient’s life and knows how to screen for and treat the decline. Finding a doctor who is Fellowship trained and board-certified in regenerative medicine, like Dr. Monaco at Nashville Hormone & Integrative Medicine, is imperative in ensuring treatment is both safe and effective. An integrative medicine doctor will not rule out underlying causes but screen for those as well before making a determination.

Why is DHEA important?

DHEA is the most common steroid hormone in the body. It’s produced mainly by the adrenal glands, and to a lesser extent, elsewhere in the body. DHEA can be metabolized into other sex hormones including testosterone and estrogens and up to 150 individual metabolites. Because it’s metabolized into other hormones, DHEA may allow the body to choose which hormone is needed, then synthesize that hormone from the available DHEA.

The thyroid gland is a butterfly-shaped organ located at the front of the neck. Its main function is to produce thyroid hormones, which control the body’s metabolic rate. The thyroid gland uses iodine to produce thyroid hormones. Two primary hormones produced by the thyroid are T3 and T4.

What happens when thyroid hormones are imbalanced?

The thyroid directly impacts metabolism. An excess of thyroid hormones (hyperthyroidism) overstimulates the body, resulting in a slew of undesirable symptoms, including racing heart, anxiousness, and weight loss, while hypothyroidism, or a lack of thyroid hormone, can cause symptoms like fatigue/sluggishness, heart failure, mood problems or depression, and weight gain. Hyperthyroidism is rare, while hypothyroidism is common.

Low levels of thyroid hormone may result in a host of medical problems ranging from weight gain, poor energy, cardiac insufficiency, high blood pressure, high cholesterol, impaired glucose metabolism, depression and psychiatric disorders, musculoskeletal pain, infertility and reproductive disorders, pregnancy complications, and in severe cases, death. Thyroid regulation is critical.

What are the signs and symptoms of thyroid disease?

The signs of thyroid disease depend on the type of thyroid disease (hypothyroidism or hyperthyroidism). Symptoms of hypothyroidism include:

Fatigue, sluggishness, weakness

Constipation

Sensitivity to cold

Weight gain

Hair loss; thinning hair

Depression

Stiff, swollen joints

Irregular menstrual cycles

High cholesterol

Puffy face

Dry Skin

Signs and symptoms of hyperthyroidism include:

Weight loss

Rapid heart rate

Heart palpitations

Anxiety

Trembling hands

Sweating

Irregular periods

Sensitivity to heat

Hair that is brittle and fine

Trouble sleeping

Muscle weakness

Frequent bowel movements

Because thyroid disease can affect many systems of the body, it’s important that patients seek medical attention and thyroid regulation as soon as they suspect something is wrong.

How does bioidentical hormone replacement therapy improve the symptoms of thyroid disease?

The most common treatment for low thyroid hormone levels consists of thyroid hormone drug replacement therapy. The primary purpose of thyroid hormone drug replacement therapy is to alleviate symptoms. Most commonly, clinicians give a drug only containing T4 expecting the body to convert the T4 to the active hormone T3. This conversion requires many nutrients and is inhibited by stress. Clinical trials report patients feel better when a combination of T3 and T4 are given. Additionally, iodine, zinc, selenium, Vitamin C, copper, and Vitamin E may be deficient and could result in incomplete relief of symptoms as well.

Regenerative medicine doctors focus on the health and well-being of the whole patient, combining natural and comprehensive hormone therapy with diet and exercise to ensure the best possible outcome for the patient.