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What Your Doctor May Not Tell You About Premenopause

By Virginia Hopkins John R. Lee Jesse Hanley

Warner Books

Copyright © 1998 John R. Lee, M.D. and Virginia Hopkins
All right reserved.
ISBN: 0-446-67380-3

Chapter One

Premenopause as a Life Cycle

You’re only in your mid-thirties and you absolutely do not want to hear the word “menopause” applied to you, even if it is “pre” menopause. You’re not there yet. You’re still young, you haven’t even had kids yet for heaven’s sake, or your kids aren’t even out of grade school. And yet you know something in your body isn’t quite right. You haven’t changed your eating or exercise habits, but you’re gaining weight. Your breasts are sore and lumpy, especially premenstrually, and you’ve started to have irregular periods. Maybe you’ve lost some of your sex drive or your skin is dry or isn’t as smooth as it used to be. You used to think of yourself as very even-tempered, but lately you’re irritable and snappish, and you can’t seem to get out of bed in the morning. You have friends your age who are struggling with infertility, uterine fibroids, and premenstrual syndrome (PMS) when they’ve never had it before. What’s going on? It’s premenopause syndrome, which is not a natural or inevitable part of life but rather one created by our culture, lifestyles, and environment.

Premenopause syndrome is a phenomenon that all women know about, but very few have a name for. Some fifty million women are going through premenopause right now, and most of them have experienced some form of this syndrome, which is a collection of symptoms experienced by women for ten to twenty years before menopause.

We call this pre-menopause rather than using the medical term perimenopause, because premenopause syndrome can begin as early as the mid-thirties whereas perimenopause technically means “right around menopause,” meaning the year or two before, during, and after menstrual cycles end.

If you’re a woman between the ages of thirty and fifty, you know a woman, maybe yourself, who has fibroids, tender or lumpy breasts, endometriosis, PMS, difficulty conceiving or carrying a pregnancy to term, sudden weight gain, fatigue, irritability and depression, foggy thinking, memory loss, migraine headaches, very heavy or light periods, bleeding between periods, or cold hands and feet. These symptoms are part of premenopause for a majority of today’s women, and are the result of hormone imbalances, most of them caused by an excess of the hormone estrogen and a deficiency of the hormone progesterone. As you’ll discover as you read on, natural progesterone is essential for maintaining hormone balance, and yet it has been largely overlooked by conventional medicine because of medical politics and pharmaceutical company profits.

However, premenopause symptoms are not just about biochemistry. They are also about women who are out of touch with the cycles and rhythms of their bodies, their feelings, and their souls. These are women who struggle to balance families and work, women who forget to take care of themselves, and women who aren’t getting the help they need from their health maintenance organization (HMO).

There was a time when a woman’s mother, grandmother, and aunts would quietly let her know what to expect during each phase of her life and help her through the rough patches with herbs and homespun, time-tested wisdom. These days the medical profession has taken over the role of a woman’s extended family, but sadly, the advice they have to give out has more to do with dispensing drugs and scheduling surgery than with solutions that are healing-or that even work!

When women have premenopausal symptoms, estrogen is commonly prescribed. When that causes irregular bleeding or cervical dysplasia, or doesn’t help their symptoms, their doctors often then resort to surgically induced menopause in the form of a hysterectomy, or they try personality-altering drugs such as Prozac and Zoloft to medicate them until they get through this particular phase of their lives. Or they are given more synthetic hormones-and the wrong hormones at that. None of these approaches really improves the quality of a woman’s life, and they all have grave potential to cause illness and even to be life-threatening. In spite of what a conventional doctor will tell you, you can do something about the symptoms of premenopause besides antidepressant drugs, synthetic hormones, and surgery. We’re not trying to say you will never have any symptoms as your hormones wind down or that you can live forever or that your skin will stay smooth and unwrinkled until you’re ninety. But you definitely do not have to suffer from lumpy breasts, fibroids, and many of the other symptoms that show up anywhere from five to twenty years before menopause.

SO LOOKING FORWARD TO MENOPAUSE

One of the reasons that premenopausal women don’t want to talk about menopause is that they dread this hallmark of aging. This attitude is sad and contributes heavily to the emotional causes of premenopause symptoms. This attitude is particularly true of the many women who have postponed having children and who wonder if they’re going to be able to have children before their biological alarm clock goes off.

Women have been taught in countless ways that their value lies in their ability to be sexually attractive to and unconditionally supportive of men, as well as being unselfishly maternal and unconditionally loving of their children. While these are truly positive feminine traits, they are also one-sided. A woman who has only developed these traits without developing her sense of self will be terrified at the prospect of aging. When her children have left the house, her breasts are sagging, and her skin is wrinkling, what does she have left?

Women who only develop this side of themselves also tend not to have good boundaries. They have spent so many years making themselves totally and selflessly available to their husbands and children that they don’t know where their families end and they begin. They have trouble saying no and would be hard pressed to tell you when they last had an hour to themselves-or what they’d most like to do with an hour if they had one. It’s no wonder that the process of becoming a more individualized and free woman can be a frightening one. These women are craving self-definition: Who am I? What’s important to me? What really matters? What am I teaching my kids? What values do I stand for in my work? What are my personal creative gifts? They have to relearn their right to say, “No, I won’t do that”; “No, I don’t have time”; and “No, I’m not available right now.”

Once a woman passes over the threshold of menopause and begins to redefine herself, she has the potential to discover the richest time of her life. She can look back on the energy and enthusiasm of youth as a thrilling and exciting time. Childbirth and parenting were magical and rewarding. A career was creative and empowering. Now her first fifty years of life are digested and integrated into wisdom and freedom. If you talk to menopausal women you will find that once a woman comes across the fifty threshold and gets a year or two over it, very few would go back for anything other than a tight butt and fewer wrinkles. Menopause was once called the “dangerous age” because so many women begin speaking their minds at that time of life. What the world needs more than anything is for a woman to have the courage to speak her mind.

Menopause is a life cycle to be respected and looked forward to. In the future, menopausal women will once again be cherished and appreciated for the experience they bring to the rest of us and looked upon as role models by younger women for their sense of individuality.

CREATING A POSITIVE PREMENOPAUSE CYCLE

Before puberty, you had the freedom of living without hormonal cycles and the relatively steady physical and emotional balance of that freedom. During puberty, you rode the ups and downs of a body getting used to the surges of sex hormones and menstrual cycles as well as the growth of pubic hair, breasts, and a libido. In your twenties and early thirties, if you were lucky, you experienced a remarkable period of high energy, clear thinking and all the excitement, privileges, and challenges of being an adult and building your adult life. This is also a time when your hormones reach their maximum hum. There’s a rhythm working that is so genetically empowered that it’s harder for all the spiritual, psychological, and environmental challenges you have to knock it off balance.

Sometime between your mid-thirties and mid-forties this strong, vibrant cycle becomes more easily influenced by outside factors and lifestyle choices. You notice things are changing again. Your periods aren’t as regular as they once were, and your breasts get painfully lumpy when you’re premenstrual. Sometimes your periods are heavier or lighter than usual. You’re at least a little moodier than you used to be, and you tire more easily. You don’t recover as quickly from a long trip or a late night out. You need more sleep, or you aren’t sleeping as well. You strain your muscles more easily when you exercise and find yourself grunting a little when you stand up. If you eat poorly or miss a meal, you notice it. Those onion rings you used to scarf down without consequences now give you heartburn, and just one too many glasses of wine gives you a headache. You aren’t quite the sexual tigress you used to be, and sometimes you notice you’re not as lubricated during intercourse. You used to have mild PMS, but now it’s distracting and unpleasant. Even though your diet and exercise are the same, you’ve gained a little weight, and no matter what you do it doesn’t come off and stay off. You’re sprouting more than a few gray hairs, and if you’re over forty, chances are good that you need reading glasses, at least for the fine print.

* * *

These are the signs of a midcycle of life when everything is changing again. It’s not as short, intense, and dramatic as puberty for most women, but once again your hormones are fluctuating up and down, with a gradual and overall direction of winding down (see figure 1.1).

The premenopause life cycle is an extremely potent and empowering time of life. A balanced premenopausal woman is confident, knows herself, and has enough experience to be moving around in the world with self-assurance. She realizes that Prince Charming is not going to gallop up and rescue her, so she is no longer looking outside of herself for security. She has achieved a level of competence in the home and the workplace, as well as familiarity with her own strengths and weaknesses. One of the keys to a healthy premenopause cycle is to make it not just okay but wonderful to be moving into a time of life when we’re becoming less physically powerful but more emotionally and spiritually powerful.

Anne

Anne is a forty-four-year-old schoolteacher who went to her doctor a year ago complaining of weight gain, depression, and headaches She had also been having irregular periods for about six months. The depression and headaches were very difficult for her to cope with while teaching a class of energetic junior high schoolers. On many occasions she had found herself uncharacteristically snapping at her students or on the verge of tears.

She and her husband didn’t have any children, but they were avid weekend hikers and loved to travel the world to beautiful hiking spots. Anne’s weight gain had made it difficult for her to keep up on the hikes, and her depression made it hard just to get out of bed on weekends. Anne was nearly thirty pounds overweight, and her face was flushed, as if she had a permanent blush.

When Anne went to her HMO’s doctor, he told her she was going into menopause, and gave her a prescription for Premarin, a synthetic estrogen and Provera, a synthetic progesterone. She dutifully took them, and for about two weeks she felt better. Then her symptoms started to become worse than before she had begun taking the synthetic hormones, and every time she took the Provera in the middle of her cycle her depression became dramatically worse. When she called her doctor to tell him, he called in a stronger dose of estrogen to the pharmacy, which Anne began taking. Within two weeks of the new regimen she had gained six pounds and was almost constantly weepy. She was calling in sick to work because her headaches had become so severe.

After six months of enduring these symptoms and on the verge of losing her job, Anne returned to her doctor for a pap smear and it came back positive for cervical dysplasia, a potentially precancerous condition. He told her that although they could take a wait-and-see approach for six months, he recommended a hysterectomy. He promised her that after the hysterectomy all her symptoms would disappear and she would be a much happier woman.

At this point Anne went to see Dr. Hanley, weeping through most of the appointment. She confessed that she thought some of her depression was caused by the realization that at this late stage of her life she wanted a child, even though her husband was adamantly against it, to the point of not wanting to have sex for fear of pregnancy. Anne said with a sad laugh that her sex drive had disappeared since she had started taking the synthetic hormones, so she didn’t really mind that her husband didn’t want to have sex.

Dr. Hanley suggested to Anne that she keep a daily journal of her feelings, including her feelings about not having a baby. She explained that while Anne’s symptoms were no doubt partly related to her conflict over having a baby, the severity of her headaches, depression, and weight gain, as well as her cervical dysplasia, had probably been caused by the high doses of estrogen she had been taking, as well as the synthetic progestins. Dr. Hanley did hormone tests, which revealed that Anne’s level of follicle-stimulating hormone (FSH) was still normal, but her estrogen level was way too high, an indication that she was not in menopause yet. She suggested that they gradually ease her off the synthetic hormones, replacing them with natural progesterone. Dr. Hanley asked Anne to take the vitamin Colic acid along with sublingual vitamin B12 and vitamin A to help heal the cervical dysplasia. She was asked to return in eight weeks for another pap smear.

Dr. Hanley also asked Anne to take up a gentle but regular weight-lifting program at the gym to bring her metabolism back to normal and help her reduce weight. Anne added twenty minutes on the treadmill and said the workout immediately picked up her energy and she felt more hopeful and cheerful.]

Six months later, Anne had lost twenty pounds, and her last pap smear came back normal. She said that within days of beginning on the natural progesterone it felt as if her body was giving a huge sigh of relief, and her symptoms began to get better. She was bubbling over with energy and enthusiasm for a hike in the Peruvian Andes she and her husband were going on in a few weeks. She still felt sad about not having a child, but after many months of writing in her journal, she decided that her marriage was more important.
Continues…

Excerpted from What Your Doctor May Not Tell You About Premenopause by Virginia Hopkins John R. Lee Jesse Hanley Copyright © 1998 by John R. Lee, M.D. and Virginia Hopkins . Excerpted by permission.

Best Selling Books – by John R. Lee, M.D.

Dr. John Lee’s Hormone Balance Made Simple

by John R. Lee, M.D. and Virginia Hopkins

A user-friendly guide by the authors of the classic bestsellers What Your Doctor May Not Tell You About Menopause and What Your Doctor May Not Tell You About Premenopause, Dr. John Lee and Virginia Hopkins.

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What Your Doctor May Not Tell You About Menopause

NEWLY REVISED AND UPDATED!

The breakthrough book on natural progesterone.
by John R. Lee, M.D. and Virginia Hopkins
Warner Books 2004 (372 Pages)

The original book on progesterone cream by John R. Lee M.D., the pioneer in the use of natural hormones, on using natural hormones, diet and exercise to treat menopause symptoms such as hot flashes, night sweats and osteoporosis. Extensively revised and updated in 2004.

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What Your Doctor May Not Tell You About PREmenopause

Balance Your Hormones and Your Life from Thirty to Fifty.
by John R. Lee, M.D., Jesse Hanley M.D. and Virginia Hopkins
Warner Books 1999 (395 pages)

Real solutions from John R. Lee, M.D. for PMS, fibroids, fibrocystic breasts, weight gain, fatigue, endometriosis, irregular or heavy periods, infertility, miscarriage, and other premenopausal hormone imbalance symptoms, in detail. He also covers the topics of stress, birth control pills, hysterectomy and cancer. Many case histories are included, and Dr. Hanley adds a new dimension to this book by addressing the emotional issues of premenopause symptoms as well as the use of herbs and nutritional supplements to treat symptoms.

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What Your Doctor May Not Tell You About Breast Cancer

Another pioneering book by John R. Lee, M.D. that really gets to the bottom of why women get breast cancer and how to prevent it. It covers a wide array of topics including how HRT may trigger breast cancer, why doctors use chemo and radiation even though they don’t work very well, what causes breast cancer, how to prevent it, and the remarkably preventive benefits of natural hormones– when used properly.

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Hormone Balance for Men

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What your doctor may not tell you about prostate health and natural hormone supplementation.
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Hormones Etc 2003 (28 Pages)

The long-awaited work by John R. Lee, M.D. that sheds light on how men’s hormones really work, what really causes prostate cancer, and how to supplement with natural hormones safely. It’s a short book but it’s packed with provocative insights and useful information.

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Natural Progesterone

by John R. Lee, M.D.

Written especially for doctors and other health care professionals who want the scientific details and biochemistry behind the use of natural hormones. A gift every woman should give her doctor!

BLL Publishing 1993 (104 pages)

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What Your Doctor May Not Tell You About Menopause

$14.95

NEWLY REVISED AND UPDATED!

The breakthrough book on natural progesterone.
by John R. Lee, M.D. and Virginia Hopkins
Warner Books 2004 (439 Pages)

Here’s where to find the Table of Contents for this original and classic book (extensively updated and revised in 2004), on natural progesterone by John R. Lee M.D., the pioneer in the use of natural hormones. Includes detailed and current information on using natural hormones, as well as diet and exercise, to treat menopause symptoms such as hot flashes, night sweats, loss of libido, and osteoporosis.

TABLE OF CONTENTS

Foreword
Introduction

PART I: THE INNER WORKINGS OF HORMONE BALANCE

Chapter 1 The Crux of the Matter: Menopausal Politics and Women’s Hormone Cycles

Menopausal Politics
What Is Menopause?
The Rise and Fall of Hormones During the Menstrual Cycle
Premenopause

Chapter 2 The Dance of the Steroids

The Cast of Major Players
Choreographing the Dance
The Journey Along the Steroid Hormone Pathway
The Dance of the Steroids
Four Movements: The Flow of Steroids in Our Bodies

Chapter 3 The History of Hormone Replacement Therapy and the Estrogen Myth

Menopause Becomes a Disease
The Truth Behind the Hoopla
Perpetuating the Estrogen Myth
The HRT Chickens Come Home to Roost

Chapter 4 What Is Estrogen?

How and Where Estrogens Are Made and Used in the Body
Estrogen and Cell Division
How Estrogen Affects a Woman’s Body
The Estrogen Dominance Syndrome
The Myth of Estrogen in Hormone Replacement Therapy
What Are Normal Estrogen Levels?

Chapter 5 Hormone Balance, Xenobiotics, and Future Generations

Turning on the Hormone Switch
The Canary in the Coal Mine?
The Impact on Future Generations
Safe Living in a Sea of Estrogens
Pesticides and Plastics
Solvents
Cleaning Up Your House
Cleaning Up Your Office
Xenoestrogens and Future Generations
If You Want to Know More

Chapter 6 What Is Natural Progesterone?

The Discovery and Use of Progesterone
Exactly What Is Progesterone?
Comparing the Synergistic Effects of Estrogen and Progesterone
The Cycle of Progesterone Production
Progesterone and Procreation
How Progesterone Affects the Body
Progesterone and Steroid Synthesis
Progesterone and the Brain
Progesterone and Sex Drive
Progesterone in Men

Chapter 7 The Dramatic Difference between Progesterone and Progestins

The Difference between Synthetic Drugs and Natural Compounds
What Is a Progestin?
Progesterone and Progestins: What’s the Difference?
Progestins Gave Birth to the Sexual Revolution

Chapter 8 Sex Hormones and the Brain

The Basics of Brain Communication
How the Inner and Outer Brains Regulate the Body
Estrogen and the Brain
Progesterone and the Brain
Progesterone and Fetal Brain Development
Progesterone and Brain Injuries
Progesterone and the Elderly
Progesterone and Libido
Postpartum Blues
Progesterone and Sleep Patterns

Chapter 9 What are Androgens?

DHEA
Testosterone
Androstenedione

Chapter 10 Hormone Balance and the Menstrual Cycle

The Rise and Fall of Hormone Levels
Anovulatory Cycles

PART II: HORMONE BALANCE AND ILLNESS

Chapter 11 Progesterone and Menopause Symptoms

The Mystery of Menopause
A Brief Look at Premenopause
Falling Estrogen and Progesterone, Rising GnRH, and Hot Flashes
Progesterone Deficiency
Menopause and Estrogen
Androgens and Menopause
What Can Be Done for Menopausal Symptoms?

Chapter 12 Hormone Balance and the Adrenal and Thyroid Glands

Premenopause and Stress
Follicle Burnout
Estrogen Excess
Possible Symptoms in Premenopausal Women with Estrogen Dominance
The Adrenal Glands
The Adrenal Cortex
The Role of DHEA
Nutritional Adrenal Support
How Cortisol Levels Affect Thyroid Function
Hormone Balance and Aging
Progesterone and Thyroid Hormone

Chapter 13 Hormone Balance, Nutrition and Osteoporosis

Debunking the Osteoporosis Myths
What Is Osteoporosis?
A Bit About How Bones Are Built
Osteoporosis and Estrogen
Osteoporosis and Progesterone
A Progesterone Cream and Bone Density Study
Other Osteoporosis Treatments
The Phosphonates (Fosamax, etc.)
SERMS (Evista)
Keeping Your Bones Strong
Testosterone, Minerals, Vitamins, Exercise
How Bones Are Depleted
Excess Protein, Diuretics, Antibiotics, Fluoride, Metabolic Acidosis, Alcohol, Hyperthyroidism, Cortisone, Asthma inhalers, Depo Provera
What Your Doctor May Not Know About Bone Density Measurement
What Does Bone Density Really Mean
Use Height as a Baseline
Techniques for Measuring Bone Mineral Density

Chapter 14 Women and Cardiovascular Disease

Estrogen and Heart Disease
Progesterone and Heart Disease
Only Half of Heart Attack Deaths in Women are Caused by Blocked Arteries
Insulin and Heart Disease
Food Basics
Slowing the Glucose Train
What about Cholesterol?
High Blood Pressure
Iron Overload
Homocysteine
C-Reactive Protein (CRP)
Nutrition and Lifestyle
What About Aspirin?
Strokes and Hormone Balance
Preventing Strokes
What Increases Stroke Risk
What Decreases Stroke Risk

Chapter 15 Hormone Balance and Cancer

Reestablishing Cellular Communication
How Cancer Develops
Estrogen Stimulates Cell Growth
The Cancer-Protective Benefits of Progesterone
Breast Cancer
Hormone Receptors in Breast Cancer
What About Mammograms?
Tamoxifen and Aromatase Inhibitors Endometrial Cancer
Why Your Doctor May Be Poorly Informed
Transcultural Factors in Breast and Uterine Cancer

Chapter 16 Getting Off Conventional HRT and Onto Natural Hormones

Questions and Answers About Natural Hormone Replacement Therapy

Chapter 17 Natural Hormone Balance and Pelvic Disorders

Vaginitis
Pelvic Inflammatory Disease (PID)
Ovarian Cysts and Mittelschmerz
Endometriosis
Fibroids
Endometrial Cancer
Hysterectomy
Staying Naturally Healthy

Chapter 18 Hormone Balance and Other Common Health Problems

Premenstrual Syndrome (PMS)
Hypothyroidism (Low Thyroid)
Fibrocystic Breasts
Migraine Headaches
Skin Problems (Acne, Seborrhea, Rosacea, Psoriasis, and Keratoses)
High Blood Pressure
Candida
Allergies
Arthritis
Autoimmune Disorders
Urinary Tract Problems
Gallbladder Disease and Bile Flow

PART III: CREATING AND MAINTAINING HORMONE BALANCE

Chapter 19 How to Use Progesterone Supplementation

Types of Progesterone Supplementation
Testing Your Hormone Levels
Not All Wild Yam Extract Is Progesterone
How and When to Use Natural Progesterone
Possible Side Effects of Progesterone
Dosage Recommendations for Natural Progesterone
How to Get the Most Out of Your Progesterone Cream
When During the Month to Use Progesterone Cream
Guidelines for Menopause, Premenopause, Hysterectomy, etc.
Using Progesterone If You Have Migraines
If I’m Menopausal and Take Progesterone, Will My Periods Start Again?
Where to Find Natural Progesterone Cream

Chapter 20 How to Use Estrogen, DHEA, Pregnenolone, the Corticosteroids, Testosterone and Androstenedione

Estrogen
DHEA
Pregnenolone
The Corticosteroids
Testosterone
Androstenedione

Chapter 21 Nutrition for Healthy Hormones

Refined Carbohydrates
Excess Calories, Not Just Excess Fat
Good Fats and Bad Fats
Whole Foods are Best
Eat Organic Foods Whenever Possible
Is Vegetarianism Protective?
Opt for Free Range Meat, Eggs and Poultry
Are Dairy Foods Right for You?
Eat Your Phytochemicals
Drink Plenty of Clean Water
Take Your Multivitamins/Minerals
Get Some Exercise
How Are Your Adrenal Glands Working?
Digestion
Preventing Heartburn
Taking Care of the Large Intestine: Probiotics
Special Foods for Hormone Balance
Herbs for Hormone Balance

Chapter 22 Commonly Asked Questions about Using Natural Progesterone

Glossary Recommended Reading

RESOURCES
Sources of Natural Progesterone Supplements
Sources of Salivary Hormone Tests
Recommended Alternative Health Newsletters
Appendix: The Structure of Steroid Hormones

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Convicted WikiLeaks source Bradley Manning says he wants to undergo hormone therapy while in prison.

For Bradley Manning, a military prison may be a next-to-impossible place to begin his transition to a woman. The Army says it doesn’t provide hormone therapy or sexual reassignment surgery to inmates.

But even outside of prison walls, getting this kind of medical help is often a struggle.

In the corporate world, only 42% of employers have insurance plans that cover short-term leave, mental health counseling, hormone therapy and surgical procedures for transgender employees, according to a survey by the Human Rights Campaign.

That’s up from 19% in 2008, but it still means the majority of employers don’t offer this coverage.

And paying out of pocket can be a heavy burden.

Related: Transgender job seekers face uphill battle

The cost to transition from one gender to another varies greatly.

Hormone replacement therapy can cost around $30 per month and therapist visits can cost more than $100 each. Undergoing surgery is less common but typically rings up at anywhere between $5,000 and $30,000 depending on the kind of operation, estimates Masen Davis, executive director of the Transgender Law Center.

Transgender and unemployed for 4 years

“It can be difficult for transgender individuals — especially the lower income and unemployed — to pay for the medical care they need to be themselves,” said Davis.

Tim Chevalier, a 32-year-old transsexual man from California, said he ended up with $50,000 in medical bills because his health insurance plan didn’t cover his transition-related costs — including an emergency visit to the hospital after the procedure.

Transgender financial struggles: ‘How we get by’

Some people are even unable to complete their transitions because of financial constraints.

Another man said he hasn’t been hired for a full-time job since he started his transition from female to male. He went through hormone therapy, but hasn’t been able to afford chest reconstruction surgery — which would cost $6,000.

Convicted WikiLeaks source Manning, who said he wants to be called Chelsea, may need to press his case by arguing that he isn’t getting the medical treatment he needs, said Jillian Weiss, a professor of law and society at Ramapo College.

“It is likely to be a very long road for Chelsea Manning,” she said.

CNNMoney (New York) First published August 22, 2013: 5:30 PM ET

Gender Reassignment Surgery: $30,000-Plus

Nearly two years after beginning my therapy and hormone replacement therapy, I was ready for my gender reassignment surgery at 18. In order to have this surgery, most doctors will require proof of at least two years of therapy, as this is not a reversible procedure. They also need to be certain that you’re fully aware of the decision that you’re making and all of its consequences. For me, it was one of the happiest moments in my life. There are really no words to describe the excitement and anticipation I felt leading up to surgery. I will say, however, that I cannot stress enough enough how important it is to do your research before choosing a GRS surgeon. Only a handful of doctors in the world are truly experts in this field, and choosing the wrong one can lead to catastrophic results. This step in the transition is very expensive, and the average cost is upwards of $30,000. In addition to the actual procedure, you also have to pay for travel costs and hotel accommodations if a good physician does not live in your neighborhood. But in my opinion, this is a small price to pay for a lifetime of completion. I feel incredibly blessed that I had the opportunity at such a young age, and the opportunity to live my life in a way that feels true to me, in part, because of this surgery.

Facial Feminization Surgery: $25,000-$60,000

A year after having gender reassignment surgery, I went back under the knife for facial feminization surgery — a set of reconstructive procedures that alter typically male facial features to bring them closer in shape and size to typical female facial features. In my personal experience, this is the most life changing surgery of them all. As a young transgender woman, nothing was more important to me than being able to “blend” into society seamlessly. It’s not only crucial for vanity reasons (what girl wants to look like a boy?), but also for safety reasons. Being trans often subjects you to discrimination, bullying, and physical aggression.

It’s so important to members of the trans community that our outward appearance and inner self are in complete harmony. Speaking from personal experience, although not often, I did occasionally come across some level of bullying prior to having FFS. It’s simply a lot easier to be singled out and targeted when the aggressor can identify you as being trans. But again, there’s a price to pay for the procedure. Board certified surgeons that are qualified to do these procedures will charge anywhere from $25,000 to $60,000 depending on the amount of work you get. Mine cost about $30,000, as I only opted for the procedures that I thought would benefit me the most at the time, which were forehead and jawline contouring.

Breast Augmentation: $5,000-$10,000

Having a breast augmentation as a transgender woman is an entirely personal choice. I know many who have chosen not to, and instead let their hormones do all the work when it comes to breast development. I chose to have surgery because I wanted a fuller bosom, and my hormones didn’t help completely on that front. This surgery will cost between $5,000 and $10,000, and it all depends on the surgeon you choose, where that person is located, and what type of implant you want. Breast augmentation was by far the most painful of all the surgeries. In fact, after all the other procedures, I usually only felt some level of discomfort. When I woke up from this one, it was like an elephant was sitting on my chest.

10 Things Your Doctor Won’t Tell You About Hormone Therapy

2. Hormone therapy may help stabilize your mood swings. Women who’ve used hormone therapy say it has helped them cope with the irritability and dramatic mood shifts that can accompany perimenopause and menopause. Barbara Younger had already gone through menopause without too much trouble. But after she had her uterus and ovaries removed to treat endometrial cancer, her normally upbeat mood plummeted. She suspected her ovaries had been making just enough estrogen that losing them made her feel “PMS and menopausal stuff times three.”

Her gynecologist prescribed a low-dose hormone patch. “Within 24 hours my mood lifted, and I’ve been basically fine ever since,” she says.

Younger, who blogs about menopause and endometrial cancer at Friend For The Ride, says she’s a bit worried about taking hormones given her cancer history. She is planning to begin tapering off hormone therapy soon. For now, she adds, she’s staying in close touch with her gynecologist and oncologist.

3. Bioidentical hormones are not better for you, and could be worse. Hormone preparations specially tailored to patients by compounding pharmacies, known as bioidentical hormones, are widely touted as being safer and more natural than Food and Drug Administration (FDA) approved versions of hormones. But this simply isn’t true, says Margery Gass, MD, the executive director of the North American Menopause Society (NAMS) and a NAMS-certified menopause practitioner at the Cleveland Clinic in Ohio.

“There is no hormone out there that women can use that can be harvested from the field, or the trees, or anyplace else,” Dr. Gass says. “All go through laboratories and have to be processed with multiple chemical steps to be in the form that humans can use.”

Still, many women who take bioidenticals swear by them. “Bioidenticals work, and it’s a great option,” says Candice Storms, 45, of Puyallup, Washington, who suffered severe menopausal symptoms after surgery to treat uterine cancer in which her ovaries were also removed.

4. Compounded hormone drugs are not FDA-tested for safety. Custom-compounded formulations of hormones are not made with FDA oversight, Gass warns. They are also not regulated by the FDA, not tested for safety, nor for quality or effectiveness, notes NAMS. Custom-made compounded drugs could have less, or more, of the hormone than a woman needs, and can also have added ingredients that may affect your safety. Unlike a prescription drug, a compounded preparation is not necessarily the same each time you pick up a new supply, and can vary among pharmacists and pharmacies.

5. You don’t need blood or saliva tests of your hormone levels before starting hormone therapy. No physician organization recommends testing hormone levels before prescribing hormone therapy. Since symptoms of thyroid problems can mimic menopausal symptoms, however, doctors will typically test your thyroid function before prescribing hormone therapy. Also, Montgomery says, testing for levels of follicle-stimulating hormone (FSH, a hormone that helps regulate your menstrual cycle) can determine whether a woman’s ovaries are still functioning. But testing hormone levels in saliva is “nonscientific and almost useless,” he adds, and what’s more, insurers don’t cover it.

6. Hormone therapy means having a new conversation with your doctor every year. Timing matters, when it comes to hormone therapy risks. The biggest misconception among his patients considering hormone therapy, according to Montgomery, is that it causes cancer, stroke, and heart disease in anyone who takes it. In fact, a large research review of studies, published in March 2015, found a slightly decreased risk of heart disease with hormone therapy for women who were younger than 60. However, hormone therapy was associated with a greater risk of stroke in older women.

A study reported in 2015, called the ELITE trial, found that women who took hormone therapy within six years of the onset of menopause saw heart-related benefits. They had slower progression of plaque buildup in their arteries (known as atherosclerosis, this buildup increases the risk of stroke and heart attack) than women who took placebo. But taking hormones later, 10 years or more after menopause onset, did not affect atherosclerosis progression.

Risks and benefits for an individual woman change as she ages, Montgomery says, and women who choose to take hormone therapy should not continue indefinitely. “It needs to be a conversation with your doctor every year.”

7. Hormone therapy can be tailored to your symptoms and needs. These days, hormone treatment comes in many forms. Systemic estrogen, in which the hormone is delivered to the entire body, can be taken via pills, patches, creams, gels, even sprays. You can also use creams, tablets, or rings to deliver low-dose estrogen directly to the vagina.

“For example, if a woman’s only problem is vaginal dryness and painful experiences with sexual activity, we can use a very low dose vaginal product that just treats the vagina and has for the most part a local effect,” says Gass.

8. Vaginal hormone therapy may help when you have overactive bladder symptoms. Many women begin to experience frequent urination and even incontinence as menopause nears. Hormone therapy delivered locally to the vagina may help ease these symptoms, according to a research review of 34 studies published in 2012.

On the other hand, the same review found evidence that so-called systemic hormone therapy — pills and patches that deliver the hormone to your entire body — could actually make urinary symptoms worse.

RELATED: 10 Things Your Doctor Won’t Tell You About Hysterectomy

9. You can take hormone therapy while you are in perimenopause. You’re considered to have gone through menopause if you haven’t had your period for a full year. But women often experience symptoms for years before menopause actually happens. This time in a woman’s life, when she’s still menstruating but her body has begun to phase out of childbearing mode, is known as perimenopause.

And perimenopause may last a lot longer than previously thought. The Study of Women’s Health Across the Nation, which is following 3,302 women as they transition to menopause, found more than half had hot flashes and night sweats for longer than seven years.

Women in perimenopause can take hormone therapy to address their symptoms, Montgomery says, although he may prescribe a lower dose for these women than for those who have already reached menopause.

10. If you are going through menopause you don’t necessarily need to have your hormones replaced. Menopause isn’t much fun, to say the least, but it’s a normal part of life. In fact, while treating menopausal symptoms with hormones used to be called “hormone replacement therapy,” Montgomery says, experts now prefer the term “hormone therapy.” While hormone therapy is great for menopausal symptoms, it won’t keep you young forever, no matter what bioidentical hormone advocate Suzanne Somers says.

“We take the position that menopause is a normal and natural occurrence in a woman’s life, no more pathological than puberty,” says Gass. “It’s a little bit like puberty, in reverse.”

Bioidentical Hormone Therapy in Orange, CA

What is bio-identical hormone therapy?

Bio-identical hormone replacement therapy (BHRT), is used to balance your hormones, improving and alleviating symptoms resulting from hormone deficiency as a result of aging or a medical condition.

The bio-identical hormone replacement therapy is targeted at increasing or balancing hormones that are tied to reproduction, sex, and youth.

What are bio-identical hormones?

A hormone is a regulatory substance naturally produced by the body in order to stimulate specific cells or tissues into action.

They are part of the endocrine system and serve as the body’s chemical messengers. The most common hormones are estrogen, progesterone, and testosterone and when these hormones begin to fade or reduce, it can lead to unpleasant symptoms, especially in menopausal women.

Some symptoms of a hormone imbalance may include:

  • Mood swings
  • Night sweats
  • Hot flashes
  • Vaginal dryness
  • Fatigue
  • Loss of muscle
  • Insomnia
  • Pain during sex
  • Lack of energy
  • Loss of or low libido
  • Forgetfulness
  • Weight gain

Low Testosterone Therapy

Men begin losing testosterone at the rate of 1-3% per year beginning at age 30. Current medical research now defines it as a male equivalent to menopause: Andropause. Symptoms of Andropause, or testosterone deficiency, in men include fatigue, lack of mental acuity, loss of libido, and difficulty achieving or sustaining an erection.

Weight gain can also be an unpleasant side effect of Andropause. Having low testosterone levels, or “Low T,” increases cortisol and insulin levels, which then increases fat and the risk of type 2 diabetes. Studies show that men over 55 with Low T demonstrated a significant increase in coronary artery disease, high cholesterol, and heart attacks.

Additionally, men with Low T are 3 times more likely to get Alzheimer’s. They are also at risk for bone ailments; testosterone builds bone by up to 8.3% per year, preventing and reversing osteopenia and osteoporosis.

If you feel “off,” pay attention to how you feel. What is “normal” for the average population in your age group may not be normal or optimal for you. At Veritas Medical Center, we offer bio-identical hormone therapy options to treat Low T and reverse its negative side effects. Give us a call today to schedule your consultation to start feeling like yourself again.

What is the treatment like?

Bio-identical hormones come in many forms. They can be administered as pills, topical creams, transdermal gels and patches, shots, or implanted pellets. We also offer vaginal gels, rings, and tablets for our female clients.

After a consultation, our experienced physicians will perform routine medical tests such as saliva, urine, or blood tests to measure your hormone levels. That way we can determine the best possible method of treatment to prescribe for you.

Menopause & Hormone Replacement Therapy

For even the healthiest women, peri-menopause and menopause can bring with them a variety of symptoms such as hot flashes, sleep disruption, heart palpitations and other challenges. Should these or other symptoms begin to affect your enjoyment of daily living, Desert West OB/GYN encourages you to discuss options with your provider.

We are committed to providing a personalized treatment plan to help you through this time of transition. Hormone Replacement Therapy, or HRT, is successfully used by millions of women to replace the hormones that their ovaries no longer produce (typically estrogen and progesterone). Use of HRT can substantially reduce or eliminate symptoms and, in addition to other benefits, has been proven to protect against osteoporosis and improve mood.

Your provider will work with you to determine the proper level of hormones that’s right for you. We believe in using the lowest dose for the shortest amount of time.

There are several options when it comes to HRT. Conventional hormone replacement uses estrogens derived from the urine from pregnant mares and the progestin is a synthetic hormone. The FDA approved drugs, which can be taken orally or via a skin patch, can be purchased at any pharmacy with a prescription.

Bioidentical hormone replacement uses hormones that are chemically identical to human hormones. These are taken orally and are available with prescription through special compounding pharmacies.

BHRT Pellet Therapy — Desert West OB/GYN now offers a quick and easy way of delivering bioidentical hormones. Following lab work to test your hormone levels, BHRT pellets derived from soybean and Mexican yam plant sterols are painlessly inserted under the skin of the hip using a local anesthetic. A new pellet is re-inserted approximately every four months. Pellet therapy addresses symptoms without the inconvenience of daily pills. There is a $250 per insertion fee (cash only) as most insurance companies do not cover this therapy.

Learn more about BHRT Pellet Therapy “

Small budget impact

Disproportionate views on the prevalence of transgender persons and the cost of their care also extends into the general population, Dr Hopwood said. While empirical data on the demographics of transgender persons in the United States is generally unavailable due to difficulties stemming from discrimination, estimates from various surveys suggest 1% to 3% of the population has ever experienced a form of gender dysphoria, and only 0.5% has sought dysphoria treatment.

“They get a lot of attention because it’s kind of sensationalistic, and that’s how our society thrives,” he said. “It’s a skewed view of the very tiny population.”

The primary additional needs of gender-affirming care are hormone therapy, psychological care and surgical procedures, First Report Managed Care Editorial Advisory Board member Larry Hsu, MD, Medical Director of the Hawaii Medical Service Association, said in an interview. Although each of these treatments come with their own costs, he said that their impact is still minimal when considering the size of this population.

“I can reasonably state that the cost per unit per patient is not that significant,” he said. “It pales by multiple factors compared to other disorders. This is not a budget breaker.”

Approximately 75% to 78% of individuals seeking gender dysphoria care will pursue hormone treatments, which are generally continued for the duration of a transgender patient’s life, Dr Hopwood said. The prices for these will vary by delivery method, he continued, with oral estrogen costing $20 monthly, injectable estrogen roughly $150 to $200 monthly, and accompanying spironolactone $10 to $20 monthly. For transgender men’s hormone therapies, testosterone injections typically cost $80 monthly (but may vary based on state supply regulations), testosterone patches more than $300 monthly, and testosterone gels between $300 to $350 monthly.

“As far as medications go … those are super cheap,” Dr Hopwood said. “But you do have a lifetime of them, so people starting them in their 20s and 30s … are going to be using them for a long, extended time period.”

Surgeries, on the other hand, are characterized by a larger one-time cost. These procedures are most often sought by transgender males, Dr Hopwood said, with the most common being chest reconstructions costing between $9000 and $10,000. Whereas survey data cited by Dr Hopwood suggest that 40% of transgender males have already had this procedure, only 3% reported undergoing a metoidioplasty ($50,000-$60,000) and 2% reported having a phalloplasty ($50,000-$300,000). Hysterectomies ($10,000) were also reported by 20% of transgender men, although Dr Hopwood said that many of those seeking the procedure do so out of medical concern.

Although some may view certain gender-affirming surgeries for transgender women as cosmetic, Hopwood said that many of these procedures are especially necessary for women as they are much more likely to face discrimination or violence based on their presentation. Breast augmentation surgeries can cost anywhere from $5000 to $10,000 and are sought by more than half of transgender women, he said. Facial feminization surgeries could be as expensive as $40,000 or as little as $3000 depending on the patient’s preexisting facial bone structure. For sexual organ surgeries, vaginoplasties ($30,000 to $50,000) were reported among approximately one-fifth of transgender women, while labioplasties ($4,000 to $5,000; sometimes included with vaginoplasty) and orchiectomies ($4000 to $6000) alone were less common. Dr Hopwood noted that some transgender women will also seek hair removal, non-breast implants, tracheal shaves or liposuction to better fit in with the general population, although these surgeries are much less likely to be covered by insurance policies.

Nearly all of these considerations must be considered alongside psychological care for depression, anxiety, suicide risk, and other mental health issues that more frequently affect transgendered persons, Dr Hsu said. In addition, these patients are required to visit a psychological health expert prior to starting hormone therapy or gender-affirming surgeries, Dr Hopwood explained, with sign-offs from two experts often required for sexual genital surgery.

Attention to comorbidities will also become more imperative as a transgender patient ages, Barney Spivack, MD, national medical director of Medicare case and condition management at OptumHealth, and First Report Managed Care Editorial Advisory Board member said. Along with the typical gamut of chronic diseases, he noted that prostate, breast, cervical, and anal cancers could require special attention, alongside side effects of and reactions to hormone therapy.

But in spite of these additional costs, Drs Hsu and Hopwood both stressed that their impact pales in comparison to the expensive routine therapies necessary for other large patient subpopulations

“The cost overall is pretty negligible,” Dr Hopwood said. “In single sections it’s going to be kind of high, but certainly less expensive than HIV and cancer treatment, and we treat that routinely. It’s got to be put into perspective, and the sensational part about who is being treated has to be removed from the equation for people to think clearly and really look at things without all of the kneejerk visceral reactions that come into play.”

Barriers to basic care

Hormones, surgery, and counseling may be the first issues raised when discussing transgender care, but oftentimes it is the lack standard care that most greatly affects this population and, as a result, drains resources from health care systems down the road.

“We’ve still got humans that need preventative primary and the same care as absolutely every other person—the basic care is absolutely required,” Dr Hopwood said. “The problem is that the basic care is often what is being denied, and treated as part of this ‘you’re costing me money.’ But we don’t treat anybody else that way with basic preventative care.”

Under the Affordable Care Act’s non-discrimination provision (Section 1557)—which received a final ruling on May 13, 2016 but as of now is partially enjoined by a US District Court—any health program, insurer or other activity that receives support from HHS may not discriminate on the basis of a race, color, sex and other patient characteristics. While the provision ensures care for transgender persons, Dr Spivack said, it is not a sure bet that providers or insurers will support every treatment.

“The main point is that coverage for health services has to be appropriately provided regardless of sex assigned at birth, gender identity, or recorded gender,” he said. “But just because there’s a nondiscrimination mandate, that does not mean that everything is covered.”

Hopwood said that depending on the state, most if not all care related to gender dysphoria will be denied by insurers. The result, he said, is that cervical cancer, breast cancer screenings, or other care tangentially related to sex may be routinely denied for many transgender patients. In addition, infrequent coverage of mental health care for gender identity or dysphoria forces many patients to either hide their orientation, or to forego care and grow into a more substantial burden.

“The number one cost and drag on health care, on systems, is major depression and the cost of disability for people who cannot get up and go to work,” Dr Hopwood said. “The effect (of transition care) is that you take people who are otherwise going to be living off of disability and public services and you get them back into productive adult participation in a society.”

Lack of treatment or coverage could lead these patients to seek their own care from less reputable sources, warned Dr Hopwood and Caitlin Leach, PharmD, clinical pharmacist at Park Pharmacy, Maryland, and lecturer on transgender topics at the School of Pharmacy at University of Maryland.

“There’s a lot happening that forces patients to turn to silicone ‘pumping parties,’ where needles may be shared,” Dr Leach said in an interview. “People are pumping silicone, which is incredibly dangerous, or there are hormones that they might acquire from non-pharmacy sources. That’s going to put them at a huge risk for complications and potentially ED visits, which we already know are very expensive and a burden to the health care system.”

“It’s just horrible for people, and they don’t have any other options for healthy care,” Dr Hopwood said. “But they sure do show up with the infections, with the loose stuff floating through their hearts and lungs. The care catastrophic care, and it costs way more than it would have just cost to do the implants.”

Increased awareness could change care

Growing awareness of transgender persons in mainstream culture could have a modest effect on the future of care, as those experiencing gender dysphoria increasingly step forward. Dr Hsu explained that his health system had recently noticed a small bump in the number of transgender cases—a change that he labeled the “Bruce Jenner effect.” Dr Leach said that she hoped more providers would gain experience and become more comfortable treating transgender patients over time, with the eventual goals of reducing discrimination from providers and convincing insurers of the importance of transition care coverage.

“I know a lot of physicians will disagree with me that it’s not their job to become activists, but I do think… we need to get involved with discussions on insurance coverage and advocating to other care providers,” she said.

While Dr Hopwood said that he did not believe the total number of patients experiencing gender dysphoria would change, he anticipated that growing awareness could lead these patients to seek care at a much younger age. Such a trend, he explained, could lead to greater costs for health care systems due to the many additional years that a patient would be seeking regular hormone treatment.

Even if these numbers were to see a slight increase, however, the experts said that their stance on the overall impact of providing transgender care would remain the same.

“While there are some larger costs in the 3 to 5 year time period, the long-term cost… is not a budget-buster,” Hsu said. “CFOs should not be losing sleep about this cost.”

Is Bioidentical Hormone Therapy Covered By Insurance?

If so, much of the cost will be out-of-pocket. A looming question is this, “Is bioidentical hormone therapy covered by insurance?” The short answer is, yes, sometimes. Read on to find out more.

What is Bioidentical Hormone Replacement Therapy?

A hormone is a medication prescribed by a doctor. You can take hormone medications as a pill, injection, or applied to the skin using a patch or gel.

Doctors prescribe Hormone Replacement Therapy (HRT) to treat hormone imbalances, such as menopause and thyroid. Men also can also receive hormone therapy for andropause (more about that later).

Bioidentical Hormones

Bioidentical hormones have hormones that are chemically identical to the hormones in your body. Many bioidentical hormones sold by non-FDA approved companies have natural and organic products.

They also differ from mainstream hormone drugs in that you may be able to get a custom dose made for you.

Though, many FDA-approved, traditional hormone therapies contain natural hormones as well. Your healthcare provider most likely prescribes these routinely.

Some of the products you may have heard of are Climara, Estrace, and Vivelle-Dot. Those three contain estrogens. Another is Prometrium, which is natural progesterone. These are all natural hormones derived from plants.

Natural Does Not Mean Bioidentical

If a hormone replacement is “Natural,” it means the hormones come from plant or animal sources. They aren’t synthetic and created in a lab.

Understand, though, that these natural products still need processing to become bioidentical hormones. This includes any organic products as well.

The answer varies depending on your health insurance. Some policies cover more than others. Insurance covers certain prescription hormone therapy costs. Many of these are bioidentical.

If you are a candidate for hormone replacement therapy, check with your insurance provider. Even if HRT is a medical necessity, your plan may not cover the medications.

Many times, insurance does not cover holistic or progressive treatment plans. It doesn’t cover bioidentical hormone replacement therapy in these cases.

Does Insurance Pay for Bioidentical Hormone Replacement for Men?

As men age, they have a gradual loss of hormones, especially testosterone. While not as well-known as female menopause, there is such a thing as andropause for men. Andropause interferes with a man’s health and lifestyle.

Symptoms in men include weight gain, muscle loss, and fatigue. Other troubling symptoms include hair loss, urinary problems, and erectile dysfunction. Bioidentical hormone replacement therapy can help restore balance.

Here again, check with your insurance provider to see if it covers HRT. If you are looking for bioidentical hormone treatment, in particular, verify which hormones your policy covers.

Likewise, check to see what types of practitioners the plan includes and excludes.

Are Bioidentical Hormones Covered by Insurance for Women?

Menopause begins after a woman has her last menstrual cycle. The average age for women entering menopause is 51. Even before that last cycle, menopause changes the hormone balance in a woman’s body.

Progesterone, estrogen, and even testosterone levels begin to drop. The result is symptoms like mood swings, hot flashes, and thinning of the vaginal lining.

A doctor may prescribe hormone therapy to relieve these symptoms. Hormone therapy also treats some of the long-term effects of menopause like bone loss.

The same coverage guidelines apply here as they do for men. Your policy may cover traditional hormone therapy but not bioidentical hormones. Also, most insurance carriers don’t cover testosterone when prescribed for women.

Are Bioidentical Hormones Covered by Medicare?

Original Medicare (Part A and Part B) has limited prescription drug coverage. It doesn’t cover hormone therapy medications at all, even those for menopause.

If you need coverage for HRT, you’ll need a Medicare Part D Prescription Drug Plan. You can opt for a private insurance company. Or, you can add a stand-alone Part D Prescription Drug Plan to your original Medicare.

Another avenue is a Medicare Advantage (Medicare Part C) Prescription Drug. This plan covers prescription drugs, including those for hormone therapy.

For a list of covered medications, see the plan’s formulary. A formulary is a list of covered medications. If your doctor prescribes a drug that’s not on the formulary, you can request a substitute.

How Much Does Bioidentical Hormone Replacement Therapy Cost?

How much bioidentical hormones cost depends on your insurance coverage. If your insurance covers the prescriptions, you’ll pay the set copay. Likewise, if your practitioner is a preferred provider, you’ll pay your regular copay.

If your insurance doesn’t cover your prescriptions, you will pay out-of-pocket for them. If your healthcare provider is not in your insurance network, then you will pay per the plan rules.

Hormones Available Over-the-counter

Some hormones are available without a prescription. Examples are DEA, micronized progesterone, and pregnenolone. You buy these over-the-counter.

Insurance does not cover them even with a prescription. The costs for these vary by brand and can become a bit costly.

Ways to Lower Costs

If you choose a private HRT clinic, you’ll pay out-of-pocket for their services. Though, there are ways to reduce some of the cost.

You may be able to file a claim for the tests ordered by the HRT clinic. You can also check to see if you can go to a provider site to have those tests done. Your insurance may cover that in this case.

Also, ask your HRT provider if they offer payment plans or interest-free financing.

Finally, inquire about discounts from your HRT provider. For example, you may be able to receive a discount on orders in larger quantities, such as a six-month supply.

Begin Feeling Better

Is bioidentical hormone therapy covered by insurance? If it is, don’t waste any time getting yourself to a health care provider who can help you. Please contact us with questions or if you wish to find a practitioner near you.

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