Hormone optimization using Bioidentical Pellets!

New Service Alert!  We now offer hormone replacement therapy to optimize your wellness as we age using Biote Hormone Pellet therapy! 

What is BHRT (Bioidentical Hormone Replacement Therapy)

Unless you are living under a rock, I suspect you have heard of “bioidentical” hormones—particularly if you are in the peri-or post-menopausal decades (believe it or not, that can start in your 40’s, and continue through your 7th decade!) But just what is the difference between traditional prescribed, FDA approved hormone replacement therapies and “bioidentical” and why might it matter?

What Exactly is a Bioidentical Hormone?

The term “bioidentical” means that a substance is chemically and structurally identical to the material the body naturally produces. Bioidentical hormone therapy used to treat female menopausal symptoms typically contains estradiol but can also include testosterone (yes, it’s well documented that your ovaries make far more testosterone than estrogen!).  Unfortunately, despite this scientific awareness there are no FDA products available for female testosterone replacement in women.

Some prescribed FDA approved estrogen conjugates include estradiol and some utilize other variations of that base product (where they come from is a whole other lecture)!

Now don’t get me wrong.  I do understand why we have an FDA approval process here in the US.  It was originally designed to provide safety and efficacy of new products, and to provide purity guidance in manufacturing. BUT: The pharmaceutical industry cannot patent a structurally identical structure without adding something to it so almost all have some other binder. A single strain bioidentical product has no dollar value to them, and as thus, is neither studied or offered in its simplicity on the mass market.  In addition, there can be up to a 30 margin of error in potency of any prescribed medication from batch to batch that is deemed “acceptable” by FDA standards?  Seems like a fairly significant variance between recipes don’t you think? 

But let’s be fair:  the counter argument is that compounded drugs (such as bioidenticals) can also have a margin of error.  Originally independent compounding pharmacies did not all monitor for variance—but the process is much more defined and reputable compounders are monitoring, testing, and more aware of variance now.  While we discuss the bioidentical hormone arena it’s a good place to tell you that one reason I elected to partner with Biote as my source is that each batch (lot number) of pellets is piston pressed and tested for potency.  The deviation standard is 3-10%--which is quite impressive, and nearly guarantees you’re getting an equal dose with EVERY VISIT!

I think it’s also important to keep in mind that compounding pharmacies are expected to comply with USP Standards for the preparation of these hormone therapies.  Biote independently tests each lot of products for strength variability.  And while compounded pharmacies may not be required to collect information on adverse events, Biote does gather information and has a robust community page in which certified practitioners can collaborate with one another on specific situations for best patient outcomes.  

Compounded bioidentical hormone therapies are prepared by a compounding pharmacy according to a provider’s specifications with each person’s combination being unique to them. Using Biote pellets I’ll have the ability to do that as well.  Your customized dose would be just what you need of each individual hormone (Estradiol and testosterone specifically).  And since lot variance is so much lower, we should get much greater consistency. To date, there have been no well known randomized, controlled trials comparing compounded bioidentical hormone therapy with placebo or FDA-approved hormone therapies for menopausal symptoms. But we are gathering data every year and the future, your future, should be hopeful!

Is Bioidentical Hormone Therapy Safer or More Effective?

While some take home a message that bioidentical hormones are safer and more effective than synthetic hormones, we just don’t know.  Why?  Well, no pharmaceutical company is going to spend millions of dollars in a head-to-head trial for many reasons.  But there is certainly data to support why it may be a good idea to optimize your levels for the very best life.

There is a tendency to think of bioidentical hormones as “all-natural”, they, like the hormones used in traditional hormone therapies, are manufactured in the laboratory (though they come from sweet potatoes and yams). Bioidentical hormone therapy may carry the same risks as traditional replacement therapy however when you go through the data, it certainly appears the benefit exceeds the challenges.  The large studies that we have in the US which identified potential increased risk of blood clots, stroke, endometrial cancer and breast cancer (such as the Women’s Health Initiative and the Million Women Study) were in studies stopped early, with conclusive data that was poorly extrapolated, and later recanted. Those studies were also recanted (by one of the lead investigators no less!) as being so flawed in their design that conclusions should not be drawn from the original data.  So where does that leave us? Well, it leaves us with medical providers who may or may not consider short term replacement therapy for their patients, but few who understand the long-term positive benefits found in many published studies (protective in heart disease, diabetes, Alzheimer’s disease, breast cancer and osteoporosis, just to name a few).

How are they delivered?

The method I will implore includes delivery of either estradiol and or testosterone via pellet (a small incision is placed in your precious derriere where it is slowly absorbed over time and re”filled” in 3-6 months (roughly a 15 minute procedure with lab results done about once a year once we have you dialed in). That means you don’t have to worry about daily pills, creams or shots, or application of patches.  It eliminates the highs and lows of product delivery to your blood stream, and your body gets a more “normal” delivery of the good stuff.  It does require time outside of the bath/hot tub/sauna/soaking or buttock exercise for a few days (3 days women/ 7 days men)—but you can get pelleted and go right back to work. No real down time.  

If you know me, you know I’m conservative in my practice—but my goal is to optimize your hormones, including thyroid, if need be, as well as impart a healthy dose of education on how you can help yourself with only the most appropriate supplements as well as lifestyle changes to maximize the pleasure you have in day-to-day living for as many days as we have left.  

Stay tuned to learn more about why you might consider BHRT for yourself and your partner, or why you may not be a candidate. 

EZGel PRF: natural enhancement

What is EZ Gel Plasma Filler?

EZ Gel plasma filler is a 100% natural, temporary re-volumizing filler felt to be regenerative.   It contains both serum albumin and growth factors obtained through your own blood source—ALL NATURAL! We use YOUR body’s own powerful proteins to rejuvenate skin, instead of relying on artificial components—this plasma filler is a prime treatment for skin rejuvenation. In addition, the extended release of growth factors and bio-stimulation may further enhance beautiful, natural results.

Where Can EZ Gel Be Used?

It can be used for volume enhancement and symmetry adjustment, as well as skin rejuvenation. It stimulates collagen production, reducing the signs of aging (wrinkles, fine lines, loose skin) and acne scars.

Common treatment areas in the face include: under eye hollows (most common)nasolabial folds (common)*cheeks*marionette lines*smoker lines*jawline

Benefits:

The PRF utilizes the patient’s own natural healing mechanism to promote improved bodily repair. Promotes the growth of new cells that are robust and healthy. Increases the body’s natural desire to repair proteins collagen and elastin. The benefits of the treatment may continue for many weeks or even months after the first treatment has been done.

Recommended Treatment

2 treatments, 6-8 weeks apart.

Repeat treatment may be needed every 4-6 months, depending on your initial condition and your goals.

Who Is a Candidate for EZGel Plasma Filler?

Everyone! Unless you have known active cancer or a hematologic issue (if you did, you'd know). However, there is no data to support EZ Gel if you are pregnant or breastfeeding. Also, we don’t know if you should add EZ Gel Plasma Filler if you are currently taking antibiotics, or have recent or upcoming dental procedures—that’s a personal decision.

Pre-Treatment

Come WELL HYDRATED! Consider drinking alkaline water for 2 days prior to treatment and avoiding fatty meals to give us the best sample possible. Discontinue blood thinning products such as ASA, ibuprofen, and certain supplements 1 week prior to treatment if agreeable with your prescriber. Skin should be completely clean prior to treatment (please come with no makeup, moisturizer, etc). Numbing cream may be applied to treatment area prior to procedure or numbing at the injection entry site may be performed.

Post-Treatment

Expect tenderness, redness, swelling (can be significant for a few days), and potentially bruising post treatment. The duration of these expectations is totally dependent on your healing capacity—I’ll do my best to reduce any avoidable side effects, but I can’t promise anything!

Personally, I feel swelling is the most common side effect, mine lasted a full 3 days after tear trough correction.  So please plan accordingly!  Don’t come in for treatment if you have a big event that weekend unless you’re good with telling everyone what amazing treatment you just had! Apply cool compresses if any discomfort is noted post- treatment (on for 10 minutes, then off for 1 hour) during the first 24 hours.  Avoid strenuous activity for 24 hours to reduce elevated blood pressure and acceleration of swelling.

The volumization dissipates over the next several weeks, but FEAR NOT; “that is when the magic of your own tissue regeneration is happening!”  Your result will be evident about 3-6 months post, and recommendations are to have 2 treatments about 6-8 weeks apart then pause and watch for improvement.   More treatments are totally doable if your goals exceed your immediate results.  This is a PROCESS—be patient with your body!  

Daxxify-- the nuts and bolts of something new

Have you heard about Daxxify(daxibotulinumtoxinA-Ianm)? Heck yes, we’ve got it! If you are curious and want to know more, read on and stay tuned for the next series of informative (and professionally yet slightly opinionated) posts!

What is Daxxify? This is the latest FDA approved neurotoxin available for use in the United States. It launched late last year with a select number of large clinics picked to unveil it and work out the kinks on how to use, and talk about it. With initial fussing done, 15 additional clinics were added in Washington, and we have now joined the team! I’m a big proponent of not being the first, but not the last to try something new—and then, only if it has robust studies behind it. I love the philosophy of the product, and know it will be well received by a good portion of my clients, though I don’t expect to convert all patients to it. Keep reading to understand why.

US tox market: lets back up because it’s important to remember that we have enjoyed the benefits of cosmetic muscle relaxation for decades now. Our agents of anti-aging come from a variety of manufacturers starting with the notorious Botox, followed by Dysport, Xeomin and Jeuveau. All of these brands utilize botulinumtoxin type A (though there are 7 serologically distinct types from A-G). Each of the type A toxins on the market as noted above are on-label approved for various cosmetic indications, and a couple of them have therapeutic indications as well. If you’re a science nerd like me and want to break it down further, many have different molecular weights from one another, and different stabilizing particles which make them unique. There are even some studies that talk about the activity or bioavailability of each particular brand—of course, all of them having their sales “pitch” as to why their better than the rest. It’s unfortunate that we have to describe them as a toxin because it makes them sound sinister, but it is indeed an exotoxin produced by a bacterium (Clostridium botulinum) which can be found in soil both on land and in the sea. That being said, we have over 20 years of objective data to support their safe use.

What makes this one different? It has been produced with a peptide complement that is touted as the “magic” ingredient that allows it to last up to twice as long as the other neuromodulators on the market, when given in appropriate doses. That may mean that instead of coming in 4 times a year, you only have to come twice to keep your frown neutralized. Data supports it, but I want to see it with my own two eyes…so my calendar is set to analyze my n=2 durability study in Sept/Oct 2023. That’s when I hit our 6 month mark….

Daxxify and unit conversion confusion

The benefit of muscle relaxation that lasts roughly twice as long likely sounds pretty good to you. Only having to come in two (ish) times a year would be a dream, because no one in their right mind wants to voluntarily succumb to a needle in their face more often than necessary. What will it cost you? That’s the next burning question. Before we can answer that we should chat a bit about units.

When it comes to medication units are a measurement of ingredient, not volume. Each of these products comes in a film or powder state and we add sterile fluid to that to allow it to be deliverable through a tiny needle. All pharmaceutical and over-the-counter medication in the US is identified by a dose such as grains, milligrams, units, or some such thing so that there can be uniform delivery. But Botox units do not equal Dysport units, and they do not equal Daxxify units either. Botox and Xeomin units are more closely related, but the bioavailability and activity is different. So, one does not equal one outright, your medical provider should be looked to for guidance on relative equivalents. Let me just say it’s complicated enough to understand how the product is packaged and delivered, then throw on top bioavailability variation and it’s a nightmare to explain even to a mathematical mind.

You will not see RediscoverdU post Daxxify as a cost per unit for several reasons: #1) it’s complicated (as noted above) and the last thing we want to do is muddy the waters of understanding. #2) different muscle groups require different dosing based on the intensity of the muscle’s activity, frequency of dosing, and FDA recommendations. #3) dose equals duration for this product just as it does for the others, but there are some limitations to that as well. If we’re suggesting it will last twice as long as your usual neurotoxin but we underdose you for financial considerations, you won’t appreciate the effects that you dream of—then both of us are disappointed. Here, you just have to trust your provider. It will likely cost you just over half again as much as your usual treatment…as us and we’re happy to give you a ballpark based on your last session, or on your treatment areas that will do good by you, but not go unnecessarily overboard.

Daxxify onset and durability details

If you know me you know that I’m pretty insistent on trying the things I offer (if they are reasonable for me to do). After all, how can I possibly tell you what to expect if I haven’t gone through it on my own? So, on March 10th my brilliant side kick and RN extraordinaire helped me with my plunge and I received my first Daxxify dose. So, this is what we know as of now, and what we’re hoping for in the end.

This product is injected very similar to other neurotoxins. The same tiny needle in roughly the same places as you might have enjoyed it before. Current on-label indications are for the frown lines between your eyebrows, but it is already used for areas such as the forehead, and crow’s feet around the eyes as well as other industry standard locations off-label. I personally thought it stung ever so slightly more than the others, but that didn’t last. My little depots of product were pink for about 10 minutes longer than usual, then they disappeared as expected. At 36 hours after injection, I could see it starting to work: that’s about a week and a half earlier than I usually appreciate it. It “feels”, how should I say it, stronger? than the others, but maybe that’s because I’m scrutinizing a ton more than I normally would.

At 2 weeks after initial injection I am confident I’m at maximal “freeze”, and I expect it to very gradually begin to soften just as the others do. The peptide which is unique to Daxxify is reported as the reason it “stick” to the synapse longer, allowing for longer effectiveness. For study purposes the area between the brow lasted the longest, then crow’s feet then forehead—which incidentally corresponds to our usual dose range. Makes perfect sense to me!

I know what my usual dose behaves like durability wise, so I’ll be curious to see how it compares—won’t know that til Sept/Oct. I based my treatment dosing on an equivalent that I think is reasonable per data points during Daxxify’s studies. Let’s hope I calculated well!

Daxxify side effects & contraindications

What about Side Effects—how does that compare to other neuromodulators already on the market? Makes sense that with something new, you want to be sure you know what you’re getting into. And while the efficacy and safety of botulinumtoxinA has been well studied by all manufacturers, how does this compare? Well….pretty darn similar for the lot!

The most common adverse side effects from administration of daxibotulinumtoxinA-Ianm include headache (6%) and eyelid droopiness (2%) during the drug trial. These side effects were also identified in the other toxins on the market during their trials. Keep in mind, EVERY oddity that is noted by a subject during a drug trial must be reported on the report. If you read the potential side effects from taking acetaminophen (Tylenol) your mind would be blown too! Other ASE include injection site pain, redness, bruising, edema or asymmetry. If you’re a total nerd, check out the full prescribing insert found in your product box, or online with the FDA.

None of neurotoxins are deemed okay to use during pregnancy or breastfeeding, we just don’t study this protected group and we go with a better-safe-than-sorry stance. It stands to reason that if you have a skin infection (also known as cellulitis) in the area being treated, you should postpone care. For those with difficulty in swallowing or breathing issues, you should talk to your provider before considering treatment. And if you have an uncontrolled auto immune disease, speaking with your specialist to get their okay is a respectful and smart thing to do.

If you’re allergic to other neurotoxins, avoid this one too. And if you’re a non-responder to the other formulations of botulinumtoxinA, you’re likely going to be a non-responder to this one as well. We have seen a little more immunogenicity over the years—another reason to get a real dose less often, rather than a little bit frequently to limit your exposure to both the toxin as well as the other ingredients.

Considering Daxxify? Candidates with calendar limitations vs budget limitations

In my first post on Daxxify I mentioned that I think this will have strong appeal to part of my client base, but I don’t expect to convert everyone. Why is that? Well, if you love your current tox and are satisfied with its effects, why would you change? I can’t think of one reason! But if you are hoping for longer lasting, solid results; or have one of those social/life/work calendars that make getting in for an appointment challenging, then you just might want to check this out! For those who really want to try it but are on a tight budget, plan ahead to save a few extra buckaroo’s—maybe not get it this dose, but mark your calendar for next treatment. Sure, it is going to cost you a few more pennies on treatment day, but overall requiring fewer treatments per year will neutralize that cost… and you get back your time as well (there’s nothing more precious than that!).

For those who only treat one area on the regular (most commonly, that’s the scowl between your eyebrows—scientifically known as the glabellar complex). If that’s the case I say check out Daxxify. That will run you somewhere around $500 (give or take fifty bucks). If you’re sitting on the fence of whether or not to convert, you might consider going Daxxifyâ for your most stubborn treatment area, or your highest priority for correction. We refuse to low ball treatment with this product because it would be counter intuitive. As with all neurotoxins we provide there is a minimum per session, but we will work with you, your anatomy, and your goals to customize your care plan just for you! Want more time with less lines? This may just be your look that lasts!

* Prices based on time of writing and are subject to change. All sales final, no guarantees of any specific response or durability. Heck-- you're different...embrace it!