What is HRT and BHRT?
HRT stands for hormone replacement therapy, and BHRT is short for bio-identical hormone replacement therapy. All BHRT is HRT, but HRT is not necessarily BHRT.
Traditionally, women may have estrogen therapy for post-menopausal symptoms, and if women continue to have a uterus, progesterone therapy as well.
BHRT can include estrogen, progesterone, testosterone, DHEA, pregnenolone, melatonin and thyroid hormones.
What are some benefits of HRT?
Some benefits of optimizing hormone levels for menopause, perimenopause and andropause include:
Improved bone density
Improved brain health
Improved muscle and tendon health and recovery from wear and tear
Improved metabolic profile including less belly fat
Decreased atherosclerosis
Decrease cardiovascular morbidity and mortality
Improved quality of life
Improved sexual function
Improved urogenital symptoms such as lessened UTI’s, improved vaginal tissue integrity, less vaginal dryness
Improved libido
Improved sleep
Lessened anxiety, depression and fatigue
Improved quality of life
What are the risks of HRT?
Historically there has been a concern for increased clots and cardiovascular events relative to women’s HRT, estrogen and progestins. These risks were noted more frequently with women over 60 who newly initiated HRT (often 10 years after menopause), and studies that showed these risks used CEE (conjugated equine estrogens) and progestins (which is different from progesterone). There have been no increased incidence of cardiovascular disease in studies utilizing estradiol and progesterone, which are the primary estrogen and progesterone supplementation utilized by Melissa Young NP-C.
Is there anyone who cannot have HRT?
Anyone with an active breast cancer, ovarian, endometrial or prostate cancer is ineligible for estradiol or testosterone therapy.
Most other individuals can consider HRT and while some may not be eligible for HRT most traditionally considered such as estrogen or testosterone, there are other treatment options that can be discussed and considered.
Why do you recommend testosterone repletion for women?
Testosterone levels in women are noted to fall to approximately ½ the levels by age 45, relative to ages when younger.
Testosterone repletion for women has many documented benefits in optimizing women’s physical and emotional health.
Testosterone replacement benefits for women include:
Improved skin health
Reduced belly fat
Improved libido
Improved energy
Improved insulin sensitivity
Improved muscle mass
Improved exercise tolerance
Improved cholesterol profiles
Improved cardiovascular health
Improved memory and Alzheimers prevention
I’ve read that hormones are harmful and should be taken for the minimal amount of time necessary to treat menopausal symptoms.
This is true of synthetic hormones including Premarin and Provera, which are associated with increased breast cancer, stroke and heart attack risk, and this was published in the WHI trial. Premarin (or CEE, conjugated equine estrogen) and Provera (progestin) have been shown to be harmful.
Melissa Young NP-C does not prescribe Premarin or Provera for these reasons, but instead prescribes estradiol which does not increase risks of clotting, and progesterone, which is shown to decrease breast cancer incidence.
What are the benefits of testosterone replacement in men?
Improved quality of life
Protection against cardiovascular disease, diabetes, hypertension
Improved muscle mass, strength and endurance
Improved cholesterol profiles
Reduced muscle and joint aches and pains
Improved confidence
Decreased anxiety and depression
Improved libido
Decreased ED
Decreased Alzheimers and dementia
Decreased abdominal fat
Improved endothelial function
What are the risks of testosterone replacement in men?
Testosterone repletion is contraindicated in the presence of prostate cancer.
On must be very careful to avoid transferring testosterone to any family members –- especially to pregnant women, women and children. This can occur by sharing towels or through direct contact.
Testosterone as a standalone therapy is not advised in men who may wish to have children in the future.
Will I have to discuss embarrassing personal details at length in my consultation to get effective treatment?
A solid assessment of patient concerns is a critical part of effective care. However, some topics can be uncomfortable to talk about.
NP Melissa uses several standardized tools that are short and to-the-point, to assess women’s and men’s health symptoms that may be related to hormonal health. This involves looking at approximately 10 items and rating them using a numeric scale. Another tool is the GAIL breast cancer risk assessment tool. These standardized tools help ensure that the necessary information is understood to facilitate assessment and optimized treatment plans, in an efficient and relatively painless manner.
These scales help ensure that key symptoms are reviewed and addressed, and also are a great follow up tool to ensure efficacy of treatment in objective terms.
Why are people so enthusiastic about HRT?
Men and women in menopause and andropause frequently experience symptoms related to low levels of hormones.
Symptoms such as anxiety and depression can be addressed through pharmaceuticals and CBT.
Symptoms such as insomnia can also be addressed through medications.
BHRT involves repleting chemicals that already naturally exist in the body and are generally very well tolerated with few side effects. BHRT also is a type of preventative health care, and preventing cardiovascular disease and dementia, having improved cognition, wellbeing and sexual function can be side effects with BHRT that may initially be chosen for symptom resolution. These types of side effects are not generally found with various pharmaceutical products.
Some individuals have tried antidepressants for anxiety or depression and find they do not help much or are intolerable. Others feel frustrated when providers want to give them pharmaceutical products and treat their hormone related symptoms as being ‘all in their head”, and prefer a physiologic solution that addresses the root cause of the aging related symptoms, and for various reasons do not want to try conventional pills for symptom management.
Patients who have been treated with HRT often say, “I feel like myself again”.
Why do you offer thyroid supplementation?
Thyroid hormone is another supplement that can help with age related symptoms. Aging causes decreased thyroid receptor site sensitivity and sometimes lower thyroid levels. Many individuals are experiencing symptoms of low thyroid, and would like to trial thyroid supplementation. T3 or dessicated thyroid can be indicated for treatment resistant depression.
Thyroid supplementation can help with:
Hypothyroidism
Depression
Fatigue
Cold intolerance
Forgetfulness
Brain fog
Aches and pains
Excessively heavy periods
Side effects of thyroid supplementation may include:
Weight loss
Tachycardia
Anxiety
Insomnia
Many individuals can have improved TSH and T4 levels with synthroid but may feel better and report improved quality of life with whole thyroid, which directly repletes both T3 and T4.
What about DHEA?
DHEA is generally well tolerated with few side effects, and decreased with aging.
Benefits of DHEA supplementation include:
Improved cognition
Reduced stress
Improved immunity
Improved lipid profiles
Improved energy, decreased body fat, improved cholesterol
Decreased insulin resistance
In women, DHEA supplementation increases testosterone levels
DHEA can be beneficial with chronic fatigue syndrome and fibromyalgia
DHEA supplementation has been highly beneficial with lupus
NP Melissa Young does not personally prescribe DHEA but can provide more information on DHEA supplementation.
Why is progesterone important?
Progesterone is helpful with perimenopausal symptoms, anxiety, irritability, insomnia, sleep, brain and bone health, protects against cancers and osteoporosis. Progesterone can treat postpartum depression. An improved progesterone level can help with various problems related to estrogen dominance, including PMS symptoms.
Progesterone creams do not provide the same health benefits as oral progesterone, which is well tolerated by most. However, for individuals who do not tolerate oral progesterone, other routes of progesterone can still be helpful.
My friend had some estrogen cream prescribed by her naturopath and she didn’t notice any benefit from it. Why do you think that was?
Naturopaths in Ontario are currently not authorized to prescribe oral estrogens, oral progesterone or testosterone in any form. Estrogen and progesterone creams generally have fewer beneficial effects relative to oral therapy. Estriol cream is a popular naturopathic treatment, and while it can have significant benefits to skin, many of the more significant benefits of estrogen therapy are not associated with estriol (a weaker estrogen) use.
In addition, some naturopaths may recommend other treatments including botanicals with a philosophical preference to provide botanical products to improve health and hormone levels indirectly, as opposed to directly supplementing with bio-identical hormones.
Tell me something I might not know about HRT.
Declines in testosterone, estrogen and thyroid function with aging are associated with decreased skin thickness, elasticitiy, healing and tightness. A comprehensive BHRT program can optimize skin texture and appearance.
I’m interested in other weight-loss options, do you offer any?
NP Melissa offers ozempic prescriptions as a medical adjunct to a healthy diet and exercise program for qualified individuals. Melissa is able to provide information and recommendations on other natural and pharmacologic treatments for weight management.
Melissa will assess and treat binge eating disorder with pharmacologic products.
NP Melissa will also provide prescriptions and recommendations on supplementation to improve cardiometabolic health and decrease insulin resistance.
Will my insurance cover prescriptions by Melissa Young NP?
Please check with your insurance company with regards to whether a specific prescription is covered or not. In some cases medication insurance will cover medicines to treat a disease state, like blood pressure medications, antibiotics, and ozempic for diabetes, but may not cover some other items such as compounded testosterone cream. You can also check with your pharmacy to see if there may be any discounts you would be eligible for.
I would like a service not listed on this website, do you offer other services?
NP Melissa has other skills and services she may be able to offer. Please contact her directly with your questions. She is interested in offering timely, high quality care for individuals in Niagara. At this time Melissa is not offering narcotics or benzodiazepines at her Virgil practice. Melissa is able to prescribe medical cannabis.
[email protected]
Are NP services covered by OHIP?
At this time, NP services with Simpwell are not covered by OHIP, as NP’s in Ontario are compensated primarily through salaried positions such as in FHT’s, CHC’s and hospitals. Services are private pay unless otherwise specified. However, labs and diagnostic imaging when ordered for medically necessary reasons by an NP are covered, however, a fee would be charged to review results, as NPs cannot bill OHIP for this services as physicians in Ontario can. In addition, some labs are not covered by OHIP and require payment to Lifelabs.
I don’t want to take any HRT, but do want to optimize my health, weight, lean muscle mass and hormone levels. Can you help with this?
There are upstream functional medicine choices that include supplementation that can be helpful for all of these things. If you would like to go this route, Melissa can likely provide some helpful guidance, but please be aware that improvements can take 3 months before significant effects are noted, and when botanicals are used, often significant dosing of 3 different products can be needed for effects to be realized.
If you have already seen a naturopath who specializes in optimizing age related health concerns, and implemented significant diet, exercise and supplementation strategies, NP Melissa would likely not have significant additional non-hormonal treatment options to review.
I’m interested in optimizing my health and learning more. What resources can you point me to?
Optimal You. Christine Gingrich
Younger You: Reverse Your Bio Age and Live Longer, Better. Kara Fitzgerald
The End of Alzheimers. Dale Bredesen.
Bioidentical Hormone Replacement Therapy For Men and Women by Neal Rouzier, M.D.
I recommend a keto-flex diet with quality protein sources, plenty of minimally processed vegetables and fruits, fatty fish twice weekly.
Do you recommend any particular brands for supplementation?
I prefer Pure Encapsulations, Metagenics, Douglas Labs and Thorne. I also like NOW brand.
My preferred multivitamin for women is Metagenics Phyto-Multi and Thorne Athletic AM and PM.
I recommend Migrielief as an evidenced based migraine headache prevention supplement that includes riboflavin 400 mg and feverfew.
I like St. Francis herb farms supplements of valerian and passionflower, as well as their immune support drops.
I advise individuals to only supplement with iron if there is a clinical need to do so, as the risks of iron supplementation do not outweigh potential benefits if there is no clinical requirement.
Many individuals can benefit from zinc supplementation 2/4 weeks of the month, and zinc optimization is important for hormone health.
In summary
A comprehensive hormone replacement program can have significant health and quality of life improvements for men and women.
It is important to understand your personal health risk factors.
It is essential to continue with primary care follow up for routine labs, monitoring, and cancer care screening such as prostate, breast (mammograms), pap tests and colon cancer screening. It is essential to promptly follow up with any concerning symptoms such as lumps, bumps, skin changes, abnormal uterine bleeding, changes to bladder or bowel.
Hormone replacement does not substitute for a healthy diet, exercise, and appropriate supplementation.
What is the best multivitamin for me or what supplements should I be taking?
There is no substitute for a healthy, balanced, optimized diet and exercise. However, supplements can be helpful. Indivduals who have completed 23andme and Ancestry tests can look at genetic data that can help inform what types of supplements may be beneficial based on genetic data and survey. If you have this data and are interested, please ask if this is something you might be interested in.
Two other FAQs have been raised as being important.
What’s for supper?
What’s for dessert?
Regrettably, NP Melissa does not have fulsome answers to these questions at this time, but hopes to talk about these important questions in future posts. Here are a few points when it comes to optimized HRT levels.
Fatty fish twice a week is beneficial.
In general, lots of vegetables and fruits are important, as well as making choices that reduce insulin resistance -low or no added sugars. Zinc, magnesium, selenium and cholesterol are important building blocks in the steroidgenic pathway to help optimize one’s hormone levels.
HRT stands for hormone replacement therapy, and BHRT is short for bio-identical hormone replacement therapy. All BHRT is HRT, but HRT is not necessarily BHRT.
Traditionally, women may have estrogen therapy for post-menopausal symptoms, and if women continue to have a uterus, progesterone therapy as well.
BHRT can include estrogen, progesterone, testosterone, DHEA, pregnenolone, melatonin and thyroid hormones.
What are some benefits of HRT?
Some benefits of optimizing hormone levels for menopause, perimenopause and andropause include:
Improved bone density
Improved brain health
Improved muscle and tendon health and recovery from wear and tear
Improved metabolic profile including less belly fat
Decreased atherosclerosis
Decrease cardiovascular morbidity and mortality
Improved quality of life
Improved sexual function
Improved urogenital symptoms such as lessened UTI’s, improved vaginal tissue integrity, less vaginal dryness
Improved libido
Improved sleep
Lessened anxiety, depression and fatigue
Improved quality of life
What are the risks of HRT?
Historically there has been a concern for increased clots and cardiovascular events relative to women’s HRT, estrogen and progestins. These risks were noted more frequently with women over 60 who newly initiated HRT (often 10 years after menopause), and studies that showed these risks used CEE (conjugated equine estrogens) and progestins (which is different from progesterone). There have been no increased incidence of cardiovascular disease in studies utilizing estradiol and progesterone, which are the primary estrogen and progesterone supplementation utilized by Melissa Young NP-C.
Is there anyone who cannot have HRT?
Anyone with an active breast cancer, ovarian, endometrial or prostate cancer is ineligible for estradiol or testosterone therapy.
Most other individuals can consider HRT and while some may not be eligible for HRT most traditionally considered such as estrogen or testosterone, there are other treatment options that can be discussed and considered.
Why do you recommend testosterone repletion for women?
Testosterone levels in women are noted to fall to approximately ½ the levels by age 45, relative to ages when younger.
Testosterone repletion for women has many documented benefits in optimizing women’s physical and emotional health.
Testosterone replacement benefits for women include:
Improved skin health
Reduced belly fat
Improved libido
Improved energy
Improved insulin sensitivity
Improved muscle mass
Improved exercise tolerance
Improved cholesterol profiles
Improved cardiovascular health
Improved memory and Alzheimers prevention
I’ve read that hormones are harmful and should be taken for the minimal amount of time necessary to treat menopausal symptoms.
This is true of synthetic hormones including Premarin and Provera, which are associated with increased breast cancer, stroke and heart attack risk, and this was published in the WHI trial. Premarin (or CEE, conjugated equine estrogen) and Provera (progestin) have been shown to be harmful.
Melissa Young NP-C does not prescribe Premarin or Provera for these reasons, but instead prescribes estradiol which does not increase risks of clotting, and progesterone, which is shown to decrease breast cancer incidence.
What are the benefits of testosterone replacement in men?
Improved quality of life
Protection against cardiovascular disease, diabetes, hypertension
Improved muscle mass, strength and endurance
Improved cholesterol profiles
Reduced muscle and joint aches and pains
Improved confidence
Decreased anxiety and depression
Improved libido
Decreased ED
Decreased Alzheimers and dementia
Decreased abdominal fat
Improved endothelial function
What are the risks of testosterone replacement in men?
Testosterone repletion is contraindicated in the presence of prostate cancer.
On must be very careful to avoid transferring testosterone to any family members –- especially to pregnant women, women and children. This can occur by sharing towels or through direct contact.
Testosterone as a standalone therapy is not advised in men who may wish to have children in the future.
Will I have to discuss embarrassing personal details at length in my consultation to get effective treatment?
A solid assessment of patient concerns is a critical part of effective care. However, some topics can be uncomfortable to talk about.
NP Melissa uses several standardized tools that are short and to-the-point, to assess women’s and men’s health symptoms that may be related to hormonal health. This involves looking at approximately 10 items and rating them using a numeric scale. Another tool is the GAIL breast cancer risk assessment tool. These standardized tools help ensure that the necessary information is understood to facilitate assessment and optimized treatment plans, in an efficient and relatively painless manner.
These scales help ensure that key symptoms are reviewed and addressed, and also are a great follow up tool to ensure efficacy of treatment in objective terms.
Why are people so enthusiastic about HRT?
Men and women in menopause and andropause frequently experience symptoms related to low levels of hormones.
Symptoms such as anxiety and depression can be addressed through pharmaceuticals and CBT.
Symptoms such as insomnia can also be addressed through medications.
BHRT involves repleting chemicals that already naturally exist in the body and are generally very well tolerated with few side effects. BHRT also is a type of preventative health care, and preventing cardiovascular disease and dementia, having improved cognition, wellbeing and sexual function can be side effects with BHRT that may initially be chosen for symptom resolution. These types of side effects are not generally found with various pharmaceutical products.
Some individuals have tried antidepressants for anxiety or depression and find they do not help much or are intolerable. Others feel frustrated when providers want to give them pharmaceutical products and treat their hormone related symptoms as being ‘all in their head”, and prefer a physiologic solution that addresses the root cause of the aging related symptoms, and for various reasons do not want to try conventional pills for symptom management.
Patients who have been treated with HRT often say, “I feel like myself again”.
Why do you offer thyroid supplementation?
Thyroid hormone is another supplement that can help with age related symptoms. Aging causes decreased thyroid receptor site sensitivity and sometimes lower thyroid levels. Many individuals are experiencing symptoms of low thyroid, and would like to trial thyroid supplementation. T3 or dessicated thyroid can be indicated for treatment resistant depression.
Thyroid supplementation can help with:
Hypothyroidism
Depression
Fatigue
Cold intolerance
Forgetfulness
Brain fog
Aches and pains
Excessively heavy periods
Side effects of thyroid supplementation may include:
Weight loss
Tachycardia
Anxiety
Insomnia
Many individuals can have improved TSH and T4 levels with synthroid but may feel better and report improved quality of life with whole thyroid, which directly repletes both T3 and T4.
What about DHEA?
DHEA is generally well tolerated with few side effects, and decreased with aging.
Benefits of DHEA supplementation include:
Improved cognition
Reduced stress
Improved immunity
Improved lipid profiles
Improved energy, decreased body fat, improved cholesterol
Decreased insulin resistance
In women, DHEA supplementation increases testosterone levels
DHEA can be beneficial with chronic fatigue syndrome and fibromyalgia
DHEA supplementation has been highly beneficial with lupus
NP Melissa Young does not personally prescribe DHEA but can provide more information on DHEA supplementation.
Why is progesterone important?
Progesterone is helpful with perimenopausal symptoms, anxiety, irritability, insomnia, sleep, brain and bone health, protects against cancers and osteoporosis. Progesterone can treat postpartum depression. An improved progesterone level can help with various problems related to estrogen dominance, including PMS symptoms.
Progesterone creams do not provide the same health benefits as oral progesterone, which is well tolerated by most. However, for individuals who do not tolerate oral progesterone, other routes of progesterone can still be helpful.
My friend had some estrogen cream prescribed by her naturopath and she didn’t notice any benefit from it. Why do you think that was?
Naturopaths in Ontario are currently not authorized to prescribe oral estrogens, oral progesterone or testosterone in any form. Estrogen and progesterone creams generally have fewer beneficial effects relative to oral therapy. Estriol cream is a popular naturopathic treatment, and while it can have significant benefits to skin, many of the more significant benefits of estrogen therapy are not associated with estriol (a weaker estrogen) use.
In addition, some naturopaths may recommend other treatments including botanicals with a philosophical preference to provide botanical products to improve health and hormone levels indirectly, as opposed to directly supplementing with bio-identical hormones.
Tell me something I might not know about HRT.
Declines in testosterone, estrogen and thyroid function with aging are associated with decreased skin thickness, elasticitiy, healing and tightness. A comprehensive BHRT program can optimize skin texture and appearance.
I’m interested in other weight-loss options, do you offer any?
NP Melissa offers ozempic prescriptions as a medical adjunct to a healthy diet and exercise program for qualified individuals. Melissa is able to provide information and recommendations on other natural and pharmacologic treatments for weight management.
Melissa will assess and treat binge eating disorder with pharmacologic products.
NP Melissa will also provide prescriptions and recommendations on supplementation to improve cardiometabolic health and decrease insulin resistance.
Will my insurance cover prescriptions by Melissa Young NP?
Please check with your insurance company with regards to whether a specific prescription is covered or not. In some cases medication insurance will cover medicines to treat a disease state, like blood pressure medications, antibiotics, and ozempic for diabetes, but may not cover some other items such as compounded testosterone cream. You can also check with your pharmacy to see if there may be any discounts you would be eligible for.
I would like a service not listed on this website, do you offer other services?
NP Melissa has other skills and services she may be able to offer. Please contact her directly with your questions. She is interested in offering timely, high quality care for individuals in Niagara. At this time Melissa is not offering narcotics or benzodiazepines at her Virgil practice. Melissa is able to prescribe medical cannabis.
[email protected]
Are NP services covered by OHIP?
At this time, NP services with Simpwell are not covered by OHIP, as NP’s in Ontario are compensated primarily through salaried positions such as in FHT’s, CHC’s and hospitals. Services are private pay unless otherwise specified. However, labs and diagnostic imaging when ordered for medically necessary reasons by an NP are covered, however, a fee would be charged to review results, as NPs cannot bill OHIP for this services as physicians in Ontario can. In addition, some labs are not covered by OHIP and require payment to Lifelabs.
I don’t want to take any HRT, but do want to optimize my health, weight, lean muscle mass and hormone levels. Can you help with this?
There are upstream functional medicine choices that include supplementation that can be helpful for all of these things. If you would like to go this route, Melissa can likely provide some helpful guidance, but please be aware that improvements can take 3 months before significant effects are noted, and when botanicals are used, often significant dosing of 3 different products can be needed for effects to be realized.
If you have already seen a naturopath who specializes in optimizing age related health concerns, and implemented significant diet, exercise and supplementation strategies, NP Melissa would likely not have significant additional non-hormonal treatment options to review.
I’m interested in optimizing my health and learning more. What resources can you point me to?
Optimal You. Christine Gingrich
Younger You: Reverse Your Bio Age and Live Longer, Better. Kara Fitzgerald
The End of Alzheimers. Dale Bredesen.
Bioidentical Hormone Replacement Therapy For Men and Women by Neal Rouzier, M.D.
I recommend a keto-flex diet with quality protein sources, plenty of minimally processed vegetables and fruits, fatty fish twice weekly.
Do you recommend any particular brands for supplementation?
I prefer Pure Encapsulations, Metagenics, Douglas Labs and Thorne. I also like NOW brand.
My preferred multivitamin for women is Metagenics Phyto-Multi and Thorne Athletic AM and PM.
I recommend Migrielief as an evidenced based migraine headache prevention supplement that includes riboflavin 400 mg and feverfew.
I like St. Francis herb farms supplements of valerian and passionflower, as well as their immune support drops.
I advise individuals to only supplement with iron if there is a clinical need to do so, as the risks of iron supplementation do not outweigh potential benefits if there is no clinical requirement.
Many individuals can benefit from zinc supplementation 2/4 weeks of the month, and zinc optimization is important for hormone health.
In summary
A comprehensive hormone replacement program can have significant health and quality of life improvements for men and women.
It is important to understand your personal health risk factors.
It is essential to continue with primary care follow up for routine labs, monitoring, and cancer care screening such as prostate, breast (mammograms), pap tests and colon cancer screening. It is essential to promptly follow up with any concerning symptoms such as lumps, bumps, skin changes, abnormal uterine bleeding, changes to bladder or bowel.
Hormone replacement does not substitute for a healthy diet, exercise, and appropriate supplementation.
What is the best multivitamin for me or what supplements should I be taking?
There is no substitute for a healthy, balanced, optimized diet and exercise. However, supplements can be helpful. Indivduals who have completed 23andme and Ancestry tests can look at genetic data that can help inform what types of supplements may be beneficial based on genetic data and survey. If you have this data and are interested, please ask if this is something you might be interested in.
Two other FAQs have been raised as being important.
What’s for supper?
What’s for dessert?
Regrettably, NP Melissa does not have fulsome answers to these questions at this time, but hopes to talk about these important questions in future posts. Here are a few points when it comes to optimized HRT levels.
Fatty fish twice a week is beneficial.
In general, lots of vegetables and fruits are important, as well as making choices that reduce insulin resistance -low or no added sugars. Zinc, magnesium, selenium and cholesterol are important building blocks in the steroidgenic pathway to help optimize one’s hormone levels.
