Frequently Asked Questions

What are bio-identical hormones?

Bio-identical hormones are an exact replica of the hormones that are naturally produced by the body. The difference between bio-identical hormones and synthetic hormones is that, although both are created in labs, synthetic hormones are not identical to the hormones naturally created in your body and bio-identical hormones match your body’s hormones molecule by molecule.

Depending on what your symptoms are and which hormone(s) your body needs, Dr. Rohde may choose to prescribe bioidentical hormones such as estrogen, progesterone, testosterone, thyroid hormones, and supplements such as DHEA, melatonin or others as needed.

Why should I use bio-identical hormones?

You are probably already using some hormones – some not so good, and some good for your body. Birth Control Pills (not so good), Hydrocortisone (used for rashes), and Vitamin D in milk are all forms of hormones.

Over the last 100 years as we have doubled our life expectancy, the soft tissue glands which create our hormones are being forced to produce them longer than ever, and can’t keep up. As well, our increasingly stressful lives, poorer nutrition, and lack of proper fitness results in declining levels of hormones in our bodies.

Men and women have successfully used bio-identical hormones for decades. Men suffering from the symptoms of andropause or women suffering from menopause or peri-menopause, can turn to bio-identical hormones to replace the natural hormones that have declined as their bodies have aged.

In well known medical journals, researchers have reported that the bio-identical hormones, estrogen and testosterone, are not only safe but also have a positive impact on diseases like osteoporosis and prostate cancer.

Why do women need hormones before, during and after menopause?

No matter what your age, if your female hormones (estrogen, progesterone, and testosterone) are unbalanced, you may suffer ill effects such as hot flashes, night sweats, trouble sleeping, mood swings, depression, anxiety, memory loss, vaginal dryness, fatigue, hair loss, loss of your sex drive and especially weight gain. Women with balanced hormones integrated with proper nutrition and fitness can have a better quality of life as they age.

Why do men need testosterone replacement?

As men age, production of the hormone testosterone begins to decline and they experience symptoms of low testosterone. Testosterone is the hormone that is responsible for maintaining mental focus, energy, metabolism, muscle mass, fat levels, and sex drive. By balancing a man’s hormones with bioidentical hormone therapy, men can restore their vitality and reduce the symptoms of andropause.

When should I consider bio-identical hormone therapy?

In general, your body’s natural hormones begin to decline after your mid-20s and mild hormone imbalance symptoms are frequently present by your mid-30s. Men and women often start replacing hormones between the age of 35 and 40. If you are experiencing symptoms of hormone imbalance, it is best not to wait to be evaluated.

What are the side effects associated with bioidentical hormones?

Because bioidentical hormones have the same molecular structure of the hormones made naturally by your body, there are generally relatively few side effects. Side effects occur mainly when the dosage of hormone is too high or too low for the individual – it is all about balance, and any imbalance may cause symptoms. We monitor and evaluate each patient carefully to assure balanced and proper dosing.

How long until I see results using bioidentical hormones?

While it varies with each person, and depends on which hormone therapy you are using, most patients start to notice changes within the first month. Overall, you can expect to see results within three to six months. This amount of time is needed to allow for the proper balancing of your hormones.

What is the best age to consider bioidentical hormone therapy?

I believe that most people should have their hormones checked by the age of 40, or earlier, if they are experiencing symptoms of menopause or andropause. The way to prevent illness and to optimize one’s health is to take an active role in addressing health care risks before they become a problem. Getting tested when you still feel good gives you a benchmark for later comparison when the inevitable happens and your hormones begin to decline.

Are bioidentical hormones approved and regulated by the FDA?

The ingredients in bioidentical hormones such as estrogen, progesterone and testosterone are approved by the FDA. However, state and local pharmacy boards have jurisdiction over them, not the FDA. It is important to know you are using the highest quality compounding pharmacy and that they follow the most stringent guidelines and have excellent quality assurance.

Do I need to take these hormones forever?

Not necessarily, it depends on how well your body responds to bioidentical hormone therapy. Also important, it’s how well you manage your diet, sleep patterns, exercise, and stress levels that will assist you in regaining hormonal balance.

Some patients can wean off various hormones once they become balanced and have fewer symptoms of menopause or andropause. There are also patients who can wean off adrenal and thyroid support once their adrenals or thyroid glands have healed with appropriate lifestyle changes. There is no single answer for everyone, it depends on your individual hormone stability and how well your diet and lifestyle will support everything else. In the worst-case scenario, if you decided to stop bioidentical hormone therapy, your body would return to the state it was in before initiating your program.

Will this treatment interfere with my currently prescribed medications?

Generally no. You may need less medications, and you may even feel better off of some of your present medications. Medication changes are made gradually, and only with your consent.

Will you take over as my doctor?

Generally “NO”. Dr. Rohde works as a consultant. Also, it is not our plan to “steal” patients from other physicians as we frequently consult or work together to maximize patient care. We have had patients that wish to transfer their care to us, this is made on a case by case decision basis.

Can you use lab work I have already had done?

You may bring along any lab work, bone density, mammograms, PAP smears, or other diagnostic tests you have had done in the past year. We do not need the actual x-rays or ultrasounds, only the report. However, you will need to do a complete wellness panel which can include thyroid functions, adrenal function, female or male hormone panel, and others indicated by your history and examination. These tests can include both blood and saliva tests. This comprehensive test panel will tell us where your levels are today and assist us in starting you on your way to better health and hormonal balance.

Can I have my own doctor do the labs so that it will be covered under my insurance?

Yes, but we charge a $45.00 test management fee for labs done elsewhere as staff has to manually input these data into your chart. Labs done in our office flow directly from the lab into your chart eliminating staff time to update your chart. Further, each lab has its own normal values and using results from another lab may prevent us from doing our best for you.

What makes Dr. Rohde an "expert" in bioidentical hormone therapy?

In addition to being board certified in Family Medicine, Dr. Rohde is also board certified in Anti-Aging medicine through the American Academy of Anti-Aging Medicine. He also practiced obstetrics for over 15 years. He has managed female hormones, thyroid disease, and diabetes on a regular basis and has also undertaken many hours of extensive training in evaluation, testing, and treatment specifically for bioidentical hormones. He regularly attends CME courses and conferences on advancements and changes to remain on the “cutting edge”.

My doctor has prescribed me birth control pills, are they considered hormone therapy?

Yes, birth control pills are a synthetic hormone therapy. Synthetic hormones have differences in their chemical structure that are not a replica of the body’s natural hormones. Birth control pills carry several risks – they have a documented effect of increasing the risk for breast cancer for a period up to 4 years after you stop taking them. This may be a low risk when using them for short periods of time when planning a family in your 20’s or early 30’s, but an increasing risk with increasing age – consider non-hormonal contraception such as a vasectomy for your spouse or partner, especially if you are done having children!

Is the bio-identical hormone therapy program covered by my health insurance?

We will bill insurance companies with whom we have a contract for your consultation visit. Please be advised that we bill office visits within several days of your appointment. We will also bill for any lab testing or specialized testing at the same time as the office visit to ensure that the testing is “tied” to that office visit maximizing the likelihood that the insurance will pay for all your testing. Therefore you may receive an EOB from your insurer before you have had time to complete the home portion of your testing. These visits are time intensive due to the personal nature of our evaluation. If we do not have a contract with your carrier your visit will be Self Pay. Our policy is as follows:

Initial visit:

As a new consultation patient you will be billed an extended new patient visit charge, a 99204 or 99205, depending on the length of time we spend with you.
As an established patient you will be billed an extended office visit 99215, and if we spend more time with you we will also bill an extended office visit code for the extended length of time this initial interview and exam necessitates.

If you have no healthcare insurance or you are “out of network” because we do not have a contract with your insurance carrier we have reasonable cash pay prices. You will be asked to pay for your visit at the time of service. The initial new half hour visit will be $150.00, if additional time is required we will charge an additional $75.00 per 15 minute interval in addition. These charges are due the day of service. If you do not pay for your initial visit at the time of service we will bill you, but you will lose the cash pay discount and be responsible for the usual full visit price without the cash discount.

Second visit:

Treatment planning – this will also be an extended visit to allow us to review your lab studies and plan a personalized management program – we will charge an extended standard office visit (99215) due to the extra time and coordination this visit requires. If we require more than 40 minutes we will also bill an extended office visit charge (99354). Cash pay or out of network patients will be required to pay $150.00 at the time of the visit for a half hour appointment, and again an additional $75.00 for each 15 minutes over that time frame.

Third and Subsequent visits:

Generally these follow-up visits require less time and will be billed as a regular office visit (99214). Cash pay or out of network patients will be required to pay $75.00 at the time of the visit. Depending on your need to discuss and/or modify your treatment regimen, i.e. if you are having problems or require extra time to discuss your clinical situation, a higher visit code and additional time charges may be required.

Please be advised that if you have a high deductible policy and we are contracted with your insurer you will be personally liable for any and all charges up to and until your deductible has been met. Please come prepared to pay for these costs at your visit as you know you are liable for them. We will not bill these charges.

Similarly, if you have a high deductible insurance policy and we are contracted with your insurer we MUST bill your visit and labs. Billed lab prices will be much higher than our cash pay prices so you may decide to purchase your specialty testing through our companion pharmacy, Prairie Compounding Pharmacy, to avoid you having a huge bill against your deductible. Since the Pharmacy is not contracted with your insurer you may pay cash for the testing without violating your insurance contract. This would have to be paid at the time of service.

Testing

We will bill contracted insurance carriers for blood, urine, stool, and saliva testing. Some carriers will only cover a portion or not cover any of some specialty testing performed at specialized labs that we may feel is necessary to help diagnose your condition. They may state it is not warranted or that it is considered experimental as it is not considered “standard of care” or not every doctor would order these tests. In these instances we will discuss costs with you and ask you to sign an Advanced Beneficiary Notification (ABN) form which states that you want the test and lists the maximum out of pocket expense you will have if your insurance did not pay for any of the costs of testing. You will be responsible for paying that cost to us even if your insurance denies payment for the testing, which is the reason for the ABN form.

Will my weight change from bioidentical hormone therapy?

Hormones are like stop-lights. When they are balanced the light is green and you will get the optimum results from your nutrition and fitness programs. When they are imbalanced the light is red making it, in many cases, difficult to lose and easy to gain weight.

Hormones are chemical messengers that cause the body to make changes affecting weight gain or weight loss. Changes in hormone levels are also dependent on the lifestyle we lead and can affect our mood, metabolism, and energy levels.

For example, as women gain weight their estrogen levels rise and they become estrogen dominant which is an unbridled growth signal to the body – fueling weight gain and sabotaging any efforts at weight loss. Similarly, when males become less active there is often a gradual decline in testosterone. This hormone is known to boost metabolism and has the benefit of helping lower fat levels. Thus, when testosterone is balanced a man’s ideal weight is easier to achieve.

Why don’t traditional doctors prescribe bioidentical hormones?

Traditional doctors do not usually have the time or the resources to seek expertise in bioidentical hormones. Dr. Rohde has invested significant personal time and expense to undergo training in bioidentical hormone therapy and has specialized knowledge of anti-aging medicine learned through his extensive board certification training program in Anti-Aging medicine.

Do I need a prescription for bioidentical hormone therapy?

Yes. Bioidentical hormones are compounded prescription drugs that are produced in a specialized pharmacy. Each prescription is hand made from the highest quality ingredients and made by pharmacists that specialize in formulating drugs. Since every patient is unique, the strength or the dosage form needs to be specially made to fit the individual.

What is a compounding pharmacy?

A compounding pharmacy is a specialized pharmacy that hand makes individualized patient prescriptions. The quality of the ingredients used, the expertise of the pharmacist and the quality of customer service are all critical decisions on what pharmacy we use. Dr. Rohde works with several local compounding pharmacies as well as several larger national pharmacies.

Will hormone therapy help with stress?

High stress levels are very common in individuals with unbalanced hormones. Regulating hormones with bioidentical hormone therapy will certainly help to manage stress levels and increase general feelings of well-being, however the biggest component to improving stress levels are lifestyle changes. Generally you have two options – remove the stress, or change your response to the stress!

My sex drive is low, could it be my hormones?

Yes. A deficiency or imbalance of DHEA, testosterone, estrogen, progesterone, or other hormones can contribute to a lowered libido.

I have severe PMS, could it be my hormones?

Severe PMS symptoms can certainly be the result of a hormonal imbalance. Having your hormones tested by Dr. Rohde can help rule out other causes and get you on the road to healing.

Will you prescribe me vitamins and supplements?

If Dr. Rohde finds that your overall health and hormonal balance could be improved through vitamins and supplements, he will prescribe them to you. He recommends only pharmaceutical grade vitamins and supplements from a few respected companies.

I heard that estrogen might increase my risk for a heart attack or breast cancer. Is this true?

No, that is not true. Not all estrogens are created equal. Fears of increased risks of heart disease and breast cancer with estrogen therapy have mainly come from the WHI study that was stopped prematurely in the summer of 1992 because of an increased risk of breast cancer and heart disease that was seen in women taking Prempro. Prempro is extracted from pregnant mares urine. This is mostly estrone which is NOT a major portion of human estrogens! This study actually highlights the risks of estrogen therapy with non-bioidentical (synthetic) hormones, which is NOT the type used by Dr. Rohde.

I think the biggest risk of any hormone use is prescribing them and NOT PROPERLY MONITORING LEVELS! We NEVER monitored women’s hormone levels when using synthetic hormones, which in hindsight was wrong, and unfortunately most traditional physicians still practice in this blinded manner! Proper monitoring of levels is VITAL to Safe use and outstanding outcomes!

Hormones that are non-bioidentical use a one-size-fits-all approach to hormone therapy with hormones that are foreign to a woman’s body. We cannot generalize these study results to all estrogens. Conversely, bioidentical hormones, which are the same as what is in your body naturally, have been proven to be safe. We use bioidentical hormones and the two main estrogens that we replace are E2 – Estradiol and E3 – Estriol.

As far as heart disease, bioidentical hormone therapy has never been shown to increase the risk of heart disease and as a matter of fact, topical hormone replacement with bioidentical hormones has been shown to decrease the risk of heart disease and breast cancer.

In summary, we cannot use results of studies done on synthetic, non-bioidentical hormones to assess risks of bioidentical hormones. When an educated provider prescribes bioidentical hormones in the proper manner, with proper monitoring of hormone levels, there are no increased risks of the occurrence of breast cancer or heart disease.