Should you use Telehealth for HRT?

Currently, options for telehealth abound if you do a quick online search. Examples include My Alloy, By Winona, Thrive Lab and MidiHealth.

My search for a knowledgeable provider that was licensed in my state, took me to a lot of places on the internet. It was very challenging to find someone who was up to date on current best practices for perimenopause and menopause, were open minded to a variety of options (not just married to one delivery method of hormones) and a practice that had reasonable response times for questions and was not overly expensive.

I share my experience with finding a provider and starting HRT in this article . TL/DR is that it was a very bumpy road! And if me, the hormone expert, had such a hard time getting the right prescriber, I know how hard it is for the average woman.

I’ve had a telehealth practice since long before the pandemic so I’m not a stranger to this style of visit, at least from the doctor’s side of the desk (or rather the camera) and I can say it may not be for everyone. That said, there are a lot of advantages and I’ll cover both sides of that here as you may very well like me be coming up short for someone local to get you what you need.

I will also say that getting a prescriber for HRT is merely one part of the battle. Getting the right dose, optimizing metabolism of these hormones to both decrease risk and minimize side effects and playing with the myriad of ways you can cycle and fuss with HRT to get it just right for you is a much bigger game to play. Not to mention that diet, blood sugar, inflammation, gut health, exercise and nervous system regulation are all important parts of this puzzle.

HRT is merely only one variable in the equation.

All of this is what I do in my practice so please reach out to talk about becoming a patient.

Why Women Are Turning to Telehealth Options & Online HRT Experts

If your symptoms are raging, you don’t feel like yourself, you’re barely surviving let alone thriving and/or you are simply concerned about future risk of heart disease, osteoporosis and dementia likely you’ve been Googling “HRT options near me” or posting in a Facebook group to crowd source how everyone else is surviving.

Or you may have reached out to your local doc as most women feel the logical place to start as this is a fundamental issue for women’s health is their OBGYN.

Or maybe you’ve assumed an endocrinologist is the best first stop – they are experts in hormones, right?

The truth is OBGYN’s admittedly do not get a lot of training in menopausal medicine. As well, endocrinologists are great at diagnosing and treating overt hormone pathologies like low thyroid or low growth hormone for example, but less so in perimenopause and menopause.

I believe this is changing, especially with OBGYNs but in the 2020s, most of you are getting your HRT info from social media and books written by experts.  Women are demanding more info and better care, so things are changing.

 

However, if you have asked for advice on HRT from your primary doc or your OBGYN you may have been met with the following:

• Sounds like you need an anti-anxiety med or a sleep med for that insomnia.
• Perhaps a low dose birth control pill will help.
• HRT is dangerous and causes cancer, you shouldn’t do it.
• This is all just part of aging and women have to just put up with things like a low sex drive and weight gain.
• You just need an SSRI and you’ll feel like you can handle life again.
• Just stop drinking wine (ok there’s some truth to that one).
• We can’t test your hormones in perimenopause they are all over the place.
• We can’t give you estrogen because your lab test showed estrogen is normal.

**Those last two are quite confusing, no?

If you’ve had any of these responses, see these other posts I’ve written on HRT for a better understanding of risks and your options:

Does HRT Cause Cancer?

What Women Need To Know About HRT

Understanding Bioidential vs. Synthetic Hormone Replacement

 

Why Are Women Turning To Telehealth

If your concerns were dismissed by your local doc or you don’t feel you’re getting the best HRT info from the OBGYN that has been caring for you up until midlife, you’re still in need of care and/or you want to know you’re in safe and capable hands with a provider that is an expert in HRT, telehealth seems like a great option since all of that is what these companies advertise.

There are pros and cons to using telehealth for your HRT but know that they are certainly not all created equal.

 

Pros

• It’s often easier to find a provider online vs. locally that specializes in HRT for women in midlife and beyond. Your local family practice doc or your OBGYN may have many other things they do well but menopause medicine might just not be one of them.
• It can be much faster to get an appointment. Many OBGYN offices have wait lists that are months long.
• Virtual appointments take less of your precious time as there is no commuting, no sitting in the waiting room. It’s often a much more efficient doctor appointment experience.
• Like traditional visits, most telehealth companies accept insurance.

 

Cons

• There is something about a face to face interaction that is missing and it can be hard to put your finger on it. It may simply be Zoom or it may be missing that interaction with the receptionist you’ve seen face to face for years at your doc’s office. There can be a bit of a disconnect for some women, though not all.
• You can’t have a physical exam or a mammogram over telehealth. There is simply a limit to what you can do via this medium and there is still absolutely a need for a relationship with a physician that is local for various screenings, check ups, etc.
• Not all telehealth providers are licensed in your state or accept your insurance. There is often an additional issue with testosterone prescriptions as some providers are licensed to prescribe other hormones but not testosterone in your state because of how it is regulated.

 

 

My Experience With Telehealth

I share my journey with HRT and the long winding path to finding a provider that I trusted and was able to help me in this article. For me, locally it was a total bust to find anyone even remotely open to a bigger conversation about HRT that included anything outside of FDA regulated estrogen patches or a reasonable dose of hormones that offered some protection and alleviation of symptoms. And I felt scared to even mention anything deemed “alternative” or complementary.

As I turned to the internet, the slick marketing of HRT clinics in my area that focused on anti-aging turned my stomach.

And as far as looking for a functional medicine doctor to help, so many of them were all purpose, one stop shop functional medicine and not experts in women’s hormones.

Basically I needed me!

Like all of my patients using HRT, I  needed a combo of my expertise and high touch care along with someone to give me the right prescriptions. Luckily I finally found the right prescriber and I’m taking care of all of the functional medicine support myself, at least currently.

It took many, many tries so hang in there and get the answers you need. Reach out to me if you need help.

 

It is important to note that while I love my provider and I love my HRT regimen, it is not the only thing we need to address.

There is still:

• Hormone metabolism support that I monitor with DUTCH testing.
• Inflammation and gut health that I monitor with bloodwork and GI Map stool testing.
• Lifting weights and walking
• Eating plenty of veggies for fiber and hormone support.
• Watching my blood sugar
• Doing all the inner work that now feels so pressing during this challenging life change I talk about on the Dr Brooke Show and in this FREE guide: Midlife Is More Than HRT

While HRT is merely one aspect to thriving in midlife, it is an important one for many women. We have many more options these days which is great but it can be hard to sift through online providers to know you’re working with someone you can trust and who will help you get what you need. I guide women in my practice through this every day whether we’re working with a telehealth provider or their local doc, together we cover all the bases.

 

If you are going it alone to find an HRT telehealth provider keep an eye out for these things:

If it seems like a standard “protocol” that all women they work with get, you aren’t getting customized advice.

If they put several hormones into one compounded cream, it may seem easy since it’s one application only, however, this is at always a total mess as you can’t change the dose of one hormone without getting a new prescription and that can be wasteful and expensive as often a 3 month supply is sent.

I also advise against starting all hormones at once. I generlaly suggest estrogem and progesterone first, then layering in testosterone and/or DHEA. Of course, this approahc is not right for every woman and must be individuallized. However, starting mutliple hormones at one time is often tricky when you’re having side effects or symptoms and you aren’t sure which one is causing it. Testosterone and estrogen in partiuclar get very confusing as testosterone converts to estrogen, so generally best to start one then the other.

If they only provide one option: alwasy compounded or always only FDA regulated formulas. The truth is you need a provider that will roll with it and figure out what will work best for you. See this article on my experience to see why.  And see this post on compounding pharmacies.

 

There is simply so much nuance to this and that’s what I do best! So reach out if you need help guiding your HRT regimen – and of course, doing all those other things! Email me to get started at drbrooke@betterbydrbrooke.com.