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BHRT stands for Bio-Identical Hormone Replacement Therapy. The “B” stands for Bio-Identical, not biosimilar. During the development of a therapeutic project, any modification in the manufacturing process can create slight changes in the structure of the resulting drug, thus creating a “biosimilar.” The term “Bio-Identical,” as defined by experts from The Endocrine Society, is a compound that has exactly the same chemical and molecular structure as the hormones that are produced in the human body.
Testosterone pellets can provide sustained normal testosterone levels for 3 to 4 months, but they are not available in all countries. Subcutaneous implantation is a minor surgical procedure; risks associated with pellets include POME (which stands for pulmonary oil microembolism), infection and extrusion of the pellet.
A formulation that has been used for many years is injectable testosterone esters, such as enanthate and cypionate. These are inexpensive but require frequent administration (every 1–3 weeks) because of their relatively short lifespan in the body. In addition, injectable formulations may result in transient levels above the physiologic range and can cause fluctuations in libido, mood, and energy, as serum testosterone concentrations vary over the injection intervals.
Transdermal testosterone formulations (such as gels, creams, and solutions) are preferred by some patients and physicians as an alternative to injections. Stable physiological testosterone levels are
achievable using these preparations but require daily application and may cause skin irritation. Men who use these topical (or transdermal) formulations must be careful not to transfer the drug to women or children by direct contact.
Currently, all topical preparations contain a warning for risk of transference. [ Other testosterone formulations that are used less frequently include testosterone patches, buccal tablets, and intranasal gel.
The desired effects of testosterone therapy in men include the following:
+ Increased lean body mass
+ Decreased fat mass
+ Increased bone mineral density
+ Increased sexual functioning
Several studies have reported on the use of testosterone replacement therapy in men with low testosterone levels. The treatments were administered either by injections or using a scrotal patch. Most studies have shown increases in lean body mass and bone mineral density and decreases in fat mass. Accompanying the increase in muscle mass has been an increase in either upper- or lower-extremity strength.
Initial Visit $100
Lab Review Follow-Up ($200)
Pellet Treatment ($700)
Follow-Up Labs ($100)