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about our clinic Dr. Michael Tyler

faqs

hormone modulation
Botox®

 

hormone modulation

What exactly is hormone modulation & how does it work?  Hormone modulation is the science of optimizing hormones that are no longer being adequately produced by the body. While genetic programming does many wonderful things, nature's plan brings us to the age of reproduction and nurturing, and then seems to have little use for us. At that point, we begin to fail. In fact, much of aging can be seen as deficiencies in many of the substances that our body once produced in abundance. Regaining and maintaining metabolic and endocrine functions at the upper end of the normal range for your age gives you the best opportunity for a healthy and vigorous life.  This optimal range is in the upper third of the normal range for age.

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 How long before you can actually see results? While this varies with each person, some people feel results within days. Just like beginning an exercise program, you can expect results within three to six months after beginning hormone management. Often the results of proper modulation are manifested by what you don't feel, i.e., sick, tired, moody, etc.

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 How long do I have to be on these therapies? You should give your program at least six months to see significant benefits. Most patients will experience benefits before three months and continue to see improvement beyond that point.  Your body needs that much time to heal and rebuild. You should remain on the program for as long as you want to optimize your health.  

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What happens if I stop the program? You will have gained time while you were on the program, but if you should elect to stop, you will experience no accelerated aging. Should you stop the program, your body will simply begin to age again at the normal rate.  The benefits will fade over time, however you still have benefited.

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 At what age should a person start such a program? Thirty-five is a good age for the initial baseline evaluation, because that is when deficiencies begin to appear.   Around thirty years of age, we lose hormones from 1%-3%.  It's never too early for any adult to begin the nutraceutical program. A person does not need to begin hormone modulation therapy, however, until such time as the body begins to lower its hormone production. Our thorough blood tests and assessments help us determine exactly where you may be most deficient and how we can best help you. Every person is different and will have different needs as far as hormone modulation goes.  

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Will the treatment interfere with my currently prescribed medications? Generally not. In some instances, medications may actually be reduced or no longer needed. Dr. Tyler will be able to advise you best on this and will be happy to work with your own doctor should you so desire.  

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Will Dr. Tyler be taking over as my doctor? Dr. Tyler is happy to communicate with your current health care team, and/or any specialists you may be seeing or he can take over your medical care it's your choice. 

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There's been a lot of negative press recently about HRT for women. What do you think about that? Most women over thirty-five years of age need some form of hormone supplementation, which can include testosterone, thyroid, and possibly others.  This applies to women that have reached menopause as well as premenopausal women.  Menopause is clearly a hormone deficiency condition. We believe it is absolutely crucial to the health and well being of every woman to replace these lost hormones with natural bioidentical hormones in order to maintain quality of life and prevent unnecessary suffering.  Synthetic means the molecule is not natural to the human body.  Bioidentical hormones are natural hormones whose molecules are identical to those made by humans.   

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Are you ever too old to start? Age is not a barrier.  Many of the older people, including those over 60 years, will ask this question thinking it is too late to begin a program. The answer is quite the opposite. Older people have greater deficiencies or partial deficiencies, therefore the response to hormone modulation and supplementation is excellent and almost immediate.  It is important to note that early intervention can reduce rapid advancement of diseases, such as osteoporosis and Alzheimer's.  Less progress is to be expected when conditions such as these are advanced.    

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Does your office accept health insurance? Our office does not accept insurance for payment. However, this does not rule out the possibility of reimbursement by your insurance provider. We will be glad to provide you with properly coded invoices that you may submit for reimbursement. Many insurance plans will cover a portion the cost of office visits according to their out-of-network provider schedule. You may be subject to an annual deductible and a co-pay, depending on your coverage. Please contact your provider for more details on coverage.

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Will my insurance cover the cost of prescriptions? Most insurance companies do not cover the cost of compounded medications. For this reason, our pharmacy partner does not accept insurance for direct payment. However, we can arrange to provide you with properly coded invoices that you may submit to your insurance carrier for reimbursement.

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Will my insurance cover the cost of lab tests? Insurance plans will sometimes cover the cost of lab tests. Speak with your insurance carrier for more details. The list of tests we perform can be found here

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Will my FSA cover your treatment? Many employers offer a Flexible Spending Account (FSA) to their employees. These arrangements permit the employee to stow a portion of their pre-tax earnings in a special account for use on health-related expenses NOT covered by primary health insurance. Depending on the type of FSA, these arrangements may cover the portion of your treatment not covered by your primary health insurance, including medications, office visits, co-pays, program fees, vitamins & supplements. Ask your employer or visit the IRS FSA site .

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How are the hormones administered? How often? Hormones are self-administered once or twice per day via transdermal creams (estrogen, progesterone, testosterone), oral capsules (progesterone, DHEA, pregnenolone, melatonin), or subcutaneous injections (HCG). Injections are relatively painless, using ultra-fine (#31 gauge, 5/16") insulin needles.

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What are the hormones made from? The bioidentical estradiol, progesterone and testosterone hormones we prescribe are derived from soy or yam.  In every case, they fit the receptors in exactly the same way as the hormones in your body today.

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What are the side-effects? Side-effects are often minimal and manageable when restoring hormones to youthful levels. Some patients report breast tenderness or swollen joints when first starting bioidentical hormone replacement therapy; these and other adverse reactions can be remedied by reducing the dosage.  None of our patients have reported long-term side effects.

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Do you do saliva testing? Whereas saliva testing may be accurate for hormones that circulate in high concentrations, such as progesterone, not all hormones can be accurately assessed using saliva. For instance, estradiol is typically present in picograms (trillionths of a gram!) Since we require extensive blood testing for each consultation, there is no need to collect saliva samples as well. All the hormones we assess can be accurately measured using the blood samples that will be collected already.

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What if I had a hysterectomy? Bioidentical hormone replacement is perfectly safe after a hysterectomy. In fact, since the ovaries produce much of the testosterone in the female body, replacing this hormone is even more important.

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How long do I need to stay on the program? You should continue treatment as long as you wish to see results or resolution of symptoms. 

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What happens if I stop the program? Will my body stop producing hormones on its own? Will my hormone levels decrease? Will I lose my gains? In general, supplementation by exogenous (external) hormones will result in decreased endogenous (internal) production. However, the body tends to restore hormones to pre-treatment levels after cessation of treatment. If your own hormone production was low before treatment, it will most likely return to the same levels after treatment. As a result, most of the physical changes enabled by the program will gradually revert back to "normal".

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Will my testes shrink on testosterone replacement therapy? We currently restore testosterone using transdermal testosterone cream and HCG, human chorionic gonadotropin. Using the cream, the testes will likely slow production of testosterone in response to (perceived) high levels. This condition also may result in minor atrophy or shrinking of the testes. HCG emulates luteinizing hormone, which stimulates the testes to produce their own testosterone, thereby preserving their function and size. This product is injected each morning by the patient using an insulin syringe.  HCG can be prescribed in lieu of or in addition to transdermal testosterone cream.

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Will I continue to get my period? The answer to the question of whether to cycle or not to cycle when undergoing bioidentical HRT (bHRT) is complex and depends upon many factors specific to each woman. It also entails a long discussion of the evidence for and against it at this time. Briefly, our current interpretation of available data is that while cycling may turn out to have benefits with regard to breast cancer risk, there is not enough clinical trial data to mandate it for all patients, particularly those with a low risk of breast cancer and who have difficulty tolerating the fluctuation of hormones that cycling entails.

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Have you had any success in treating fibromyalgia? We are treating several patients with fibromyalgia and/or chronic fatigue, all with significant improvement in energy, level of pain, and frequency of exacerbation of symptoms. None have encountered a negative response. This does not assure similar response in all patients with fibromyalgia, but to date the response to therapy has been more effective than prior therapies. Although our program is not specifically designed to attack the underlying cause of fibromyalgia, it does restore function and strength of the immune system, restore efficiency of mitochondrial production of energy with cells, and improves the bodies natural anti-inflammatory capacity. If you are interested in pursuing treatment, contact the office to schedule a set of laboratory blood tests prior to coming in for consultation. With the test results we will be better able to discuss possible benefits of our treatment specific to your current condition.

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When should I start thinking about bioidentical hormones? My doctor wants me to wait until I reach menopause. The menopause is defined as a single day--12 months after your last period. Your physician's suggestion that you wait until you have passed this milestone reflects an antiquated view of a woman's transition from the premenopause to menopause. The majority of women experience their most severe symptoms in the months to years leading up to this milestone. To wait for this single day would be to subject women to a year or more of unnecessary hot flushes, night sweats, mental fogginess, and bone loss. Our approach is to start addressing these symptoms as soon as they appear. They often begin a year or two before the final menstrual period, a time called the perimenopause. By so doing, we can avoid all the havoc that fluctuating hormone levels can wreak on a woman. Our approach is to smooth the transition from normal cycling through the menopause rather than to wait for a somewhat arbitrarily defined date.

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BOTOX®

What exactly is BOTOX ® Cosmetic? ?BOTOX ® Cosmetic is a purified protein produced by the Clostridium botulinum bacterium. It is a nonsurgical, physician-administered treatment that can temporarily reduce moderate to severe frown lines between the brows in people 18 to 65 years of age. During treatment, very low doses of BOTOX ® Cosmetic are administered via a few tiny injections directly into the muscles that cause those stubborn lines. The treatment is usually done in about 10 minutes, and no recovery time is needed. Within days, you may see an improvement that can last up to 4 months. Results may vary.

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How does BOTOX ® Cosmetic work? ?Those moderate to severe frown lines between your brows form over time as the result of muscle activity. BOTOX ® Cosmetic is injected directly into the muscles between your brows. It works by blocking the transmission of nerve impulses to the injected muscles; this reduces the activity of the muscles that cause those persistent lines to form.

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When will I see results from a BOTOX ® Cosmetic treatment? ?Within days, you may see a marked improvement in the moderate to severe frown lines between your brows. Lines continue to improve for up to a month, and results can last for up to 4 months. In clinical trials, nearly 90% of men and women rated the improvement in their appearance as moderate to better 1 month after treatment. Results may vary.

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How long does BOTOX ® Cosmetic last? ?Results from treatment with BOTOX ® Cosmetic can last for up to 4 months. If you discontinue treatment, the frown lines between your brows gradually will look like they did before treatment.

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Is treatment with BOTOX ® Cosmetic painful? ?Discomfort is usually minimal and brief. Prior to injecting, you may choose to numb the area with a cold pack or anesthetic cream. The entire procedure takes approximately 10 minutes. Many people are in and out of the office without downtime following BOTOX ® Cosmetic treatment.

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Who should not use BOTOX ® Cosmetic? ?BOTOX ® Cosmetic should not be used in the presence of infection at the proposed injection site(s) and in individuals with known hypersensitivity to any ingredient in the formulation. Patients with neuromuscular disorders such as ALS, myasthenia gravis or Lambert-Eaton syndrome may be at increased risk of serious side effects.

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Will I experience any side effects? ?The most common side effects following injection include temporary eyelid droop and nausea. Localized pain, infection, inflammation, tenderness, swelling, redness, and/or bleeding/bruising may be associated with the injection. Patients with certain neuromuscular disorders such as ALS, myasthenia gravis, or Lambert-Eaton syndrome may be at increased risk of serious side effects.

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Will my facial expressions continue to look natural? ?Although the results are visible, a treatment with BOTOX ® Cosmetic will not radically change your facial appearance or make you look as if you "had work done." The muscle activity that causes frown lines between the brows is simply reduced, so you can still frown or look surprised without the wrinkles and creases between your brows.

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Is BOTOX ® Cosmetic affordable? ?When considering your facial aesthetic options, BOTOX ® Cosmetic is quite affordable. According to an American Society for Aesthetic Plastic Surgery survey, BOTOX ® Cosmetic is one of the low-entry-cost facial aesthetic procedures in the United States . Like other appearance-related investments, such as hair coloring and cuts, teeth whitening, and chemical peels, the cost must be weighed relative to your expectations. Consult your doctor for further information.

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