We know you may have many questions about Bio-Identical Hormone Replacement Therapy, so we’ve developed this site to answer some of the more common questions. If you have additional questions or are interested in receiving services, please contact us.

About Your Visit
Hormone Imbalance
Bio-Identical Hormones
Conventional HRT
The Wiley Protocol ^TM
Additional Resources

About Your Visit

What will happen at my first visit?
As is standard practice at the Burick Center for Health and Wellness, upon arrival, you will be warmly welcomed and made to feel comfortable. Your waiting time to see Dr. Burick will be minimal if, it at all.

Dr. Burick will take a detailed health history, listen to your specific concerns, and answer any questions that you may have. You will then put on a comfortable robe and move to a private examination area. Dr. Burick will perform a focused physical exam and determine if any additional testing needs to be completed. Together, you and Dr. Burick will formulate a treatment plan and determine how and when to initiate therapy. Patients specifically wanting to begin BHRT may be given a prescription at the first visit if appropriate. Before you leave, Dr. Burick will give you ample time to ask any further questions and ensure your understanding of everything that has been discussed.

You may bring a loved one or friend with you to your first visit.

If you are not a current patient of Dr. Burick’s concierge practice, please bring all relevant medical records and test results for her review.

Can I do my consultation with Dr. Burick by phone instead of in person?
To ensure the highest level of care, all new patient visits must be done in person. Follow-up appointments may be via telephone provided the patient is seen in person at the Burick Center at least once a year. (Please see Services & Fees.) The patient is required to provide documentation of regular follow-up exams with their primary care provider or gynecologist. Follow-up phone consultations must be prearranged and will be billed by the half hour. Note: If you are not a concierge patient of the Burick Center for Health and Wellness, you must maintain a primary care physician. Presently, Dr. Burick is still accepting a limited number of patients to her primary care practice. If you are interested in joining the practice, please click here to learn more.

How often do I need follow-up appointments with Dr. Burick?
This will vary depending on your treatment plan. Women who invest in BHRT must be willing to take the time to monitor their physical and emotional response to the therapy. Dr. Burick insists that her patients agree to return to the office to asses their symptoms with the hopes that they are feeling better, stronger, and more energetic.

Patients who are initiating BHRT will require a follow-up visit within six to twelve weeks depending on the form of BHRT. This is scheduled to discuss the need for adjustments in the prescription. Once the prescription has been adjusted to the point that it is working well for you, it is important for us to properly monitor your progress and address any potential issues. We require that you return for follow up appointments at least every three to six months to continue receiving prescription refills. Follow-up lab testing ordered during or in anticipation of subsequent office visits are usually every three to six months depending on the patient’s hormone treatment plan.

How long might I need BHRT?
The answer to this question is quite variable. The average patient stays on hormonal supplementation for about five years, but some women may choose to use BHRT into their 70s. It’s about how the individual woman feels. We believe you are in charge of your own health. We will work with you to decide which treatment plan is the best for you.

How will I know the results of my test?
All patients are requested to complete an on line registration process to establish a chart on our secure clinical portal. This process is easily done through the Burick Center web site with no additional costs or fees. Once you have registered on the portal, and Dr. Burick has reviewed your test results, she will provide a copy of the labs with comments for you on the portal. We ask that you please contact the office directly if you did not receive a copy of your test results. Also, please notify our office of the date and location of your lab draw, so we may call for them if not automatically sent to our office.

Patients who have an HMO or elect to have their primary care physician order the requested labs are directly responsible for making certain that Dr. Burick receives a copy of the test results. For patients choosing to have Dr. Burick prescribe BHRT only, we ask that patients provide proof of test results for pap smears/mammograms/ultrasound etc. In doing so, we assure patients maintain basic health maintenance and standards of care.

Hormone Imbalance

Are menopausal women the only ones who have hormone imbalance problems?
No. Actually, symptoms related to hormone imbalance can be seen in all women and men, especially as they age. However, hormone imbalance is most pronounced in women entering menopause. This is related to a sudden, severe decline in ovarian hormone production. Most women begin to experience signs and symptoms of ovarian hormone decline beginning in their late thirties, and some even earlier. If women notice symptoms with consistent correlation to their menstrual cycle, the diagnosis of hormonal imbalance is likely. Beyond the decline of sex hormones, there may also be hormonal imbalances of other glands, such as thyroid (which is much more common in women than in men), pancreas (leading to diabetes), adrenal glands (leading to excess production of or reduced reserves of adrenal hormones), pituitary gland, etc. Since all hormones are interconnected, coexisting imbalances of multiple hormones may be the case in some patients. This diagnosis is made through a combination of laboratory studies and a list of subjective symptoms that are experienced by the patient.

Are saliva tests more accurate than traditional serum tests when evaluating hormone imbalance?
This is an area of great controversy in medicine. Right now, there is no agreement as to which is best, especially when evaluating sex hormones. Reproductive endocrinologists have traditionally relied on serum testing, and continue to do so. Proponents of saliva testing argue that only the free (unbound to protein) and therefore, biologically active fraction of a sex hormone is important and representative of what is actually in the tissues, which is what is measured in saliva testing. It appears that saliva testing may be superior when evaluating transdermal application of testosterone, due to more extensive metabolism by enzymes in the skin, which may not be picked up in the blood test. Saliva testing has also been found to be an accurate way of measuring adrenal cortisol levels. This is especially important when the diagnosis of adrenal fatigue is suspected. Dr. Burick uses both the clinical presentation of the patient and lab data to determine how to best treat the patient.

How extensive will my hormone testing be?
This will vary depending on your level of complexity. In general, Dr. Burick may recommend salvia testing as well as blood testing for sex hormones, thyroid, and adrenal precursor hormones, if indicated.

Does Dr. Burick also treat men with hormone imbalance issues?
Yes. Although men need to understand that the great body of literature studying HRT applies mostly to women, there is more information and studies being done with respect to men and the male equivalent of menopause, also known as andropause. Andropause is a relatively new topic of focus, especially by the anti-aging community and pharmaceutical industry. Many men may simply attribute their symptoms and reduced vitality to aging, when it could actually be related to testosterone decline. The symptoms that men experience are multiple and can include decreased libido, erectile dysfunction, decreased muscle bulk and strength, decreased energy and motivation and changes in sleep patterns. During andropause, men experience a documented decline in serum testosterone levels after age 40. Lab tests including blood as well as saliva tests can confirm and qualify this diagnosis. Currently, testosterone replacement is available in FDA-approved products of gels, patches, injections and pellets. Testosterone replacement can also be created by a compound pharmacist for men who are looking for an effective and natural alternative.

Bio-identical Hormones

What are bio-identical hormones?

First, let’s address hormones. Hormones are compounds derived from cholesterol which the body synthesizes. They are generally secreted by endocrine glands (such as pancreas, ovaries, and pituitary glands) or specialized cells of the body. Hormones are the chemical communicators for the body and have specific regulatory effects on activities of organs throughout the body. Bio-identical hormones are “ human-identical.“ That is, they fit into their designated receptor sites (like a key fitting into a lock) as specifically designed by nature. This is contrary to non-bio-identical hormones, which do not have an exact fit when bound to a receptor site. This accounts for their varying effects on different target organs and potentially more side effects.

Will BHRT work better for everyone?

Not necessarily. A comprehensive answer really depends on your individual situation. In general, bio-identical hormones may be better tolerated, since they are human-identical, and therefore, will fit into a receptor site as nature intended, thereby minimizing side-effects. However, certain situations may require more potent pharmaceutical drugs for adequate control, such as suppression of ovulation for birth control if desired, and for painful menstrual cycles, such as in endometriosis.

Will bio-identical hormones be covered by my insurance?

This depends on your specific type of insurance coverage. Most standard insurances will not cover non-FDA-approved medications. Compounded medications are generally not FDA-approved, although the active ingredient comes from pharmaceutical grade FDA-approved sources. Compounded medications are customized to the individual based on a physician’s specifications and are usually not made in large enough quantities to require FDA approval.

Conventional HRT

What are the current conventional methods of administering HRT?

There are several different methods of administering HRT. One method is the static dosing of hormones in the forms of pills, patches, gels, creams, troches (lozengers) or drops. These prescriptions offer the patient the same dose of hormone supplementation throughout the month.

Will I start menstruating again when I start HRT, even if I went through menopause several years ago?

Static dosing may also include using estrogen and testosterone daily with a cycle of consistent dosing of progesterone days 14-28. The progesterone in conventional HRT that is given to patients that have a uterus using this method will result in withdrawl bleeding. Patients lacking a uterus secondary to a hysterectomy will generally not receive progesterone with conventional HRT.

Will I be able to get pregnant on HRT, even if I went through menopause earlier?

No. Using HRT in menopausal women can certainly bring the return of menstrual cycles if used in cyclical manner, but ovulation (which is required for a woman to become pregnant) is extremely unlikely once a woman has gone through menopause.

Are all estrogens equivalent?

No. There are multiple types of estrogens, phyto-estrogens, synthetic estrogens (which can be found in birth control pills and menopausal HRT), and bio-identical estrogens.

What are phyto-estrogens?

Phyto-estrogens are plant-based estrogens and are commonly found in plants such as soy, red clover, vitex, and lignans such as flax. They are weak estrogens compared to the body’s own estrogens, but, when taken in large enough quantities, can either contribute to estrogenic effects in the body and/or compete for the body’s own ability to bind to its estrogen receptors. Responses are individual to the tissue site, based on whether the specific phyto-estrogen is binding more avidly at the alpha- or beta-estradiol receptor.

The Wiley Protocol^TM

Is Dr. Burick certified to use the Wiley Protocol^TM?

Yes, Dr. Burick has undergone training and is certified to use this protocol.

What is the Wiley Protocol^TM?

The Wiley Protocol, as described in the book Sex, Lies, and Menopause, by T. S. Wiley and Julie Taguchi, M.D., is a specific protocol of administering bio-identical hormones to women for those seeking a unique form of bio-identical hormone replacement therapy (BHRT). This protocol differs from conventional HRT in many ways. It uses only bio-identical estrogen (estradiol, specifically) and progesterone, made by compounding pharmacies in cream form. The hormones are applied on the skin. The dosage for each day varies so as to attempt to duplicate the 28-day menstrual cycle of a youthful reproductive woman, including hitting peri-ovulation peak serum levels of estradiol and progesterone (in the luteal phase).

How is the Wiley Protocol^TM different from other BHRT?

The Wiley Protocol largely differs from other BHRT in its recommendation of using much larger doses of hormones in HRT, as well a reinstituting rhythm (not static dosing), since the aim is youthful levels of hormones. Conventional methods can include lower doses of bio-identical hormones in static or cyclic dosing. Monitoring of hormone levels on this protocol can be done with serum blood tests or saliva tests. Many practitioners argue that saliva testing is more accurate specifically with regard to the application of progesterone topically through the skin, although this is currently controversial. It appears that levels of progesterone measured in the saliva versus venipuncture vary widely.

How is the Wiley Protocol^TM administered and what can I expect?

The protocol which is created in the form of a cream is topically applied to the arms or the thighs, in a consistent manner. Side effects are usually transient, and depend largely on a woman's hormone status prior to applying the protocol. For instance, a woman who is several years postmenopausal without HRT may require a longer period of adjustment to such youthful levels of hormones as compared to someone who is just entering menopause. Predictable monthly five-day menstrual bleeds are the rule on this protocol in women with intact uterus, although establishing such regularity may take up to one to three months depending on the woman’s individual situation. The protocol calls for administration of full complement of progesterone along with estrogen, even in women who have had hysterectomies, which is another point of difference from conventional HRT.
Detailed instructions on how to apply the hormones, potential drug interactions, and potential interfering factors such as exercise, are included on a pharmacy package insert with each batch of the creams. Common symptoms during the adjustment period as the body adapts to the protocol include and are not limited to: headache, nausea, dizziness, fluid retention, and breast tenderness. Patients should thoroughly review the FAQ section of T. S. Wiley’s official website at www.thewileyprotocol.com before actually initiating the protocol, as answers to commonly asked questions are reviewed.

What if I want to try the Wiley Protocol^TM?

The decision to initiate HRT (which includes the Wiley Protocol) is a very personal decision, and should be arrived at after thorough research of the literature and discussion with a knowledgeable physician. Dr Burick will help you work through a risk/benefit assessment based on genetics, risk factors, lifestyle, symptoms, and quality of life. Patients should also realize that the decision to initiate HRT need not be a permanent decision, and that repeat assessments at regular intervals may actually be beneficial. Once a woman has made the decision to initiate the Wiley Protocol, the prescription will be filled at a Wiley-registered pharmacy, who has agreed to compound the bio-identical creams to Wiley specifications. Wiley-registered pharmacies have also agreed to cap the monthly price of each hormones at a reasonable rate, as most insurances may opt to not provide coverage for this non-FDA-approved protocol. Wiley registration also allows standardization of the hormone creams. Patients wishing to initiate the Wiley Protocol are encouraged to read Ms. Wiley’s book before scheduling an in-person consultation with Dr. Burick to discuss the protocol in detail, including a detailed discussion of the controversy surrounding this protocol. By the third month of using the protocol, patients must have day 12 serum estradiol level checked, along with FSH and progesterone levels, and a day 21 serum estradiol and progesterone levels. These blood levels are helpful in assessing the peaking of both estradiol (day 12) and progesterone (day 21), and provide guidance in determining whether or not the protocol needs to be adjusted for each individual, although most adjustments are symptom-based. Patients should have repeat appointments with Dr. Burick shortly after the results of these levels are available to discuss any fine-tuning needed based on their lab results as well as tolerability of and response to the protocol. If adjustments in the protocol have been made, then follow-up lab testing should be obtained in another three months. Dr. Burick also requires patients to have regular follow-up pelvic ultrasounds in those who still possess their uterus, to monitor for potential side-effects, such as development of fibroids or endometrial (uterine lining) thickening. This is especially important given that monitoring progesterone effects via serum testing is not always reliable. This is Dr. Burick’s standard recommendation for any woman wishing to initiate any form of HRT and is not limited to those on the Wiley Protocol.

Additional Resources

One of Dr. Burick’s colleagues, Dr. Chen located in California, has created additional answers to some important questions as well as providing specific case studies based on her experiences. We have paraphrased the answers to some FAQs. You may also refer to Dr. Chen’s website at www.balancedapproaches.com for additional information.