Answers to Common Questions
Unfortunately, we are unable to accommodate spontaneous onsite visits due to our commitment to previously scheduled appointments.
Please follow the steps to Getting Started.
Before you start the online hormone health assessment, we must correspond with you by telephone to collect personal information to enhance safeguarding of confidentiality. To initiate this call, you must complete the Patient Consent Form. On this call, we will also discuss eligibility for hormone restoration therapy (HRT).
If you are eligible for HRT, we will provide you with a WellNurtureMD Client ID that is required to advance to the online hormone health assessment form.
If there are contraindications for HRT, we schedule an appointment prior to you completing the online hormone health assessment form to determine whether to advance.
You do not require a referral. Our physicians provide care in the area of midlife health and other health issues that result from hormone imbalance. We are a private care not a primary care facility, thus we are not government funded or affiliated. However, we do encourage you to inform your family physician of your care with us. Our physicians are open to communications required with them. General health issues should be directed to your family physician.
Following initial consultation and commencement of any treatment, to promote maximum benefit of your follow up appointment times with the MD, we ask that you communicate any concerns through email then a decision will be made regarding intervention. Please note that forms such as disability, unemployment (stress leave) etc., should be directed to your family physician.
Hormones are proteins that behave like powerful chemical messengers that are delivered to the body tissues through the blood. Once hormones enter tissues they turn on genetic switches that regulate general health and wellbeing that includes emotional response. Different glands and organs in the body produce hormones.
Estrogen hormones help maintain the health of reproductive tissues, breasts, skin and brain. High estrogen levels can cause fluid retention, weight gain, migraines and over stimulation of the breasts, ovaries and uterus. Insufficient estrogen levels can lead to hot flashes, vaginal dryness, rapid skin aging, urinary problems, excessive bone loss and changes in memory/cognition.
Progesterone is a hormone balancer, particularly of estrogens and other steroid hormones. It enhances the beneficial effect of estrogens while preventing problems associated with excessive estrogen. It also supports adrenal function, which regulates stress, and has a calming influence that helps improve sleep, mood, and the ability to stay focused mentally.
The thyroid gland produces thyroid hormones, which regulate body temperature, oxygen use, and metabolism. The two most important thyroid hormones, thyroxine (T4) and triiodothyronine (T3) require selenium, iodine and tyrosine as building blocks and for proper functioning.
Hypothyroidism – when the thyroid gland is under-active and hormones are depleted – this can cause appetite loss, chronic fatigue, constipation, depression, dry skin or other skin conditions, hair loss, infections, sensitivity to cold or low body temperature, muscle weakness, weight gain, painful and heavy menstrual periods.
Hyperthyroidism – when the thyroid gland is overactive can result in heart palpitations, weight loss, sweating, anxiety, insomnia, trembling hands, muscle weakness, increased bowel movements, changes in menstrual flow, hair loss, breathlessness, heat intolerance, and osteoporosis (in severe cases).
The adrenal glands control the hormones released during stress. If the adrenal glands are already compromised, then the hormonal imbalance that occurs during peri-menopause and menopause will further inhibit their ability to function properly. Symptoms may include fatigue, inability to sleep through the night, anxiety, depression, increased susceptibility to infections, reduced tolerance for stress, craving for sweets and salty foods, allergies to things you were never allergic to before, chemical sensitivities, and a tendency to feel cold.
Cortisol is one of several hormones produced by the adrenal glands. It plays a pivotal role in the hormonal and immune system and is secreted in response to stress in the body, whether real or imagined. Normal healthy levels of cortisol are needed for the body to function optimally, but chronic or repeated stress will cause the body to continually produce higher levels of cortisol. This can cause depletion of reserves and eventually cause adrenal fatigue or “burnout”.
DHEA, an important hormone for wellbeing and vitality, is one of the markers of aging. It is also the source of many sex and steroid hormones in the body. After it is secreted from the adrenal glands it remains as DHEA or is converted into certain hormones the body needs, such as estrogen and testosterone. Our DHEA levels peak between the ages of 20 and 25, and then start to decline. Low levels of DHEA have been associated with immune dysfunction, heart disease, obesity, low libido, mental disturbances, and blood sugar instability.
Testosterone plays an important role in women and men. It improves mood and assertiveness, reduces depression and anxiety, improves bone and muscle, maintains muscle size, and enhances sex drive and sexual sensitivity. The decrease of testosterone occurs earlier and initially at a greater rate for women than for men. Special attention is needed for women who have had early menopause or surgical removal of their ovaries.
Hormonal decline can begin as early as the mid-thirties. Today’s fast-paced lifestyle, stress, poor nutrition, as well as environmental toxins can all influence the optimal production and function of our hormones potentially having significant impact on acceleration of the aging process. Therefore, making changes in lifestyle and restoring depleted hormone levels can help slow down the aging process and improve the body’s function. Listening to your body by way of paying attention to the symptoms it presents is an important step to being proactive in seeking optimal health now and in the future.
Read more on common symptoms of hormonal imbalance at ZRT Laboratory – Hormone Imbalance.
Hormones commonly tested. At “WellnurtureMD” we carefully select the profile that best meets your needs based on assessment. Upon re-testing we only select components which offer valuable information for adjustments and further fine-tuning of symptoms in an attempt to keep service fees as minimal as possible.
Our most common initial profiles are: Female profile 1 and Male profile 1 in capillary blood. Blood allows us the opportunity to add on other components if required. This add-on option is available by contacting the lab thus eliminating the need to collect an additional blood sample. Saliva does not offer as much flexibility for additional testing. However, it is another convenient option for assessing sex hormones.
ZRT, our lab of preference, was founded in 1997 and they are located in Oregon, USA. They are a CLIA (meets federal regulations) certified diagnostic laboratory and as a leader in the industry they have tested over 2 million people world-wide.
Hormones commonly restored are:
– Progesterone in peri-menopause when cycles may be irregular and symptom fluctuation is more prevalent
– Progesterone and / or Estrogen in menopause when cycles have stopped
– Estrogen is only prescribed when ovarian failure has been determined either by 12 consecutive months without a menstrual cycle or blood values that confirm it (FSH, LH).
– Testosterone at any phase if restoration is determined to be necessary. Women require much smaller amounts of testosterone than men and it is vital for many primary body functions. Thus, testosterone is often prescribed in a compounded topical cream at very different ratios for women and men
– DHEA if prescribed is a compounded slow release tablet known to restore testosterone (and more minimally estrogen) levels in women.
– Herbal adaptogens and other nutraceuticals of appropriate choice may be recommended to support adrenal function and overall health
Benefits of hormone restoration:
– Restores mental function and memory
– Enhances emotional well- being
– Changes fat to lean muscle mass
– Promotes healthy sleep patterns
– Reduces wrinkles by increasing collagen and elastin
– Reverses thinning, sparse hair and dry skin
– Boosts immune function, improving healing capacity
– Decreases bad cholesterol and increases good cholesterol
– Increases bone density and bone mass, decreasing risk of osteoporosis
– Increase the desire and endurance for exercise
Based on the results of our assessment and the suggested appropriate medical testing selected, determined by symptoms, an individualized treatment program is created. We address all aspects of your health: physical, emotional, mental, as well as lifestyle to alleviate uncomfortable unwanted symptoms. Correction of hormone imbalances to restore vitality and prevent more serious health problems moving forward is a key component of preventative medicine.
Our approach to providing bio-identical hormone replacement therapy includes compounded and pharmaceutical products. By choice, we don’t use any synthetic hormones as there are many bio-identical pharmaceutical products on the market.
Compounding provides more flexibility in dosing, allowing our prescribing personnel to utilize the least amount necessary to alleviate symptoms. For women or men where hormones are contraindicated due to pre-existing risk factors, identified through screening assessment, the use of non-hormonal intervention can be implemented as well.
We incorporate natural supplements, stress management and promotion of healthy dietary habits. When identification of the benefit of referral to other trusted professionals who will facilitate optimal well-being arises we seek additional expertise.
Hormone restoration can provide symptom relief within weeks after initiation of therapy. Because of hormone fluctuations and lifestyle changes necessary to achieve and sustain balance the process can take several months to critique. Once balance is achieved we recommend an annual evaluation ongoing as long as hormone replacement therapy is continued. The physicians will counsel each individual on the optimal duration of hormone replacement therapy based on guidelines provided by the North American Menopause Society.
Clients who adhere to their treatment plans see the most improved results.
We typically see men who experience a gradual decline in testosterone due to the aging process. It can begin a rapid decent around age 40-45 and onward. Our process can be expensive as we are a private clinic, thus we try to be informative upfront about fees and potential outcome.
If you are younger than 35 years of age, we might ask:
- Do you have a family physician?
- Have you asked them to do a testosterone level through Medicare?
This testing is an option free of fee with presenting symptoms and if it is low often they will run a bioavailable testosterone (which is more definitive).
If testosterone levels are pre-determined to be low then you would qualify as a potential candidate to start testosterone replacement and our experienced team would be happy to assist then follow your progress ongoing.
First, one is “whole” blood drawn from the end of the finger. This is mostly capillary blood as opposed to blood drawn from the arm, which is venous blood. The former contains nutrients, hormones, and oxygen to feed the tissues. The latter is partially spent of these life-giving components and is returning to the heart, lungs, and gastrointestinal tract to pick up another load.
Second, dried blood spots are comprised of whole blood complete with blood cells, whereas serum is the watery component that remains after lab technicians separate blood cells from venipuncture blood (ex, blood drawn from veins using a syringe). Therefore, any hormones bound to any removed blood cells during the separation process are lost. Consequently, test results from blood spots reflect a more accurate assessment of your correct capillary blood hormone levels than test results from serum. Since capillary blood is what feeds the cells of your body, hormones detected in capillary blood reflect a more accurate assessment of hormone levels that affect your body’s tissues (information sourced from zrtlab.com).
Benefits of treatment can often be experienced within the first few weeks. Every individual presents with different variables requiring a unique to them approach. Reassessment (diagnostics) to evaluate clinical response after treatment is necessary at three-six months at the discretion of your MD. The first prescription is written for three-six months to assure the best clinical response has been achieved. If further intervention (raising or lowering dose) or the introduction of an additional hormone by prescription is required a scheduled retesting at six months would be necessary to assure adequate clinical review of each intervention.
The standard is one to two revisits to fine tune your regime and determine ongoing personalized hormone replacement therapy dosages. The diagnostics for retesting only look at the hormones that have been prescribed as well as the ones directly influenced. Our efforts focus to keep the fee associated with further lab testing of a lesser amount than initial assessment. It is of vital importance that we determine your levels to be within the recommended therapeutic parameters and the physician requires this confirmation before providing ongoing lengthy prescribing. This is crucial to avoid poor management.
We have provided a preauthorization / reimbursement inquiry form on our website (under Fees and Forms) to print and provide to your private health insurance. Insurance companies do not allow direct billing in New Brunswick under Naturopathy, therefore, invoices need to be submitted independently.
The laboratory work required is accompanied by a prescription as previously mentioned the doctor prefers numerical values in conjunction with symptoms to determine appropriate dosages. The physician’s fee is private pay and may or may not be eligible for reimbursement. Invoices are provided for each service with the provider’s designation and licence numbers.
It varies greatly whether prescriptions such as estrogen, progesterone and testosterone are covered by your insurance. In certain cases, a special authorization is requested by the insurance company to provide them with more information regarding the specifics of the prescription. The doctor will address these requests by way of a special authorization form (at a minimal administration fee). Any estimate inquiry regarding the cost of each hormone can be forwarded to “Mapleton Pharmacy” by calling 1-506-855-2210.
Please note, dosages are individualized and clients can require restoration of one or more hormones therefore, exact pricing is difficult to quote. In addition, the dosage and duration can fluctuate. Supplements (non-prescription) are rarely covered by health care plans.
Testing is done through ZRT Laboratories a certified CLIA (follows federal regulatory standards) facility, they are a leader in the industry providing qualified expert advice on specimen collection and testing.
“WellNurtureMD” has an integrative working relationship with a compounding pharmacist who has been part of our team since opening day. His valued expertise, as well as his colleagues, is frequently sought by the team as we orchestrate the best individualized approach for each client. He chose to extend his education in pharmacy to include a specialized certification in compounded products and his passion in promoting this niche market is demonstrated by his personable approach.
If you have an existing professional relationship with a pharmacist capable of providing the compounded prescriptions suggested we encourage you to source he/she whom you are confident with.
We as physicians realize that women (and men) have very specific health concerns as they age that require extra time, and often a multifaceted or holistic approach. We have developed an integrative health model that encompasses and addresses hormones, physical health, emotional and mental health which implements action wherever a need is identified. Our physicians manage other family medical service commitments in addition to their passion to provide specialized care around many of the conditions that result from or worsen with hormone depletion. They are clinician certified by the North American Menopause Society and have attended other symposiums across North America that address the variety of medical issues surrounding hormone decline and aging.
In addition to the physician’s credentials all other staff have attended educational conferences and received certification in addressing hormone restoration (Toronto, Ontario & Miami, Florida).
“WellNurtureMD” opened in May of 2012. We have experienced accelerated growth providing services to clients from all over the province of N.B., as well as the rest of the Maritimes.
Yes, we welcome clients from other areas but do require completion of the online assessment with required testing. Your initial consultation with one of our physicians can be “in person” or “virtual” as the treatment we provide does not require physical assessment. Subsequent follow-up is necessary every 12 months for safe medical review to continue receiving our services.
After establishing an integrative approach to achieving wellness, that you are very much a part of, we will make every effort to accommodate your difficulties in accessing us. We are able to prepare and mail test kits, email forms and arrange booked correspondence by telephone.
For your medical safety, we ask that patients refrain from communicating medical concerns through our clinic email. It is for general clinic communications only and may not be time sensitive based on the volume of daily emails received.
We ask that clients call the office if they require medical assistance to book an appointment. This is done for your own medical safety.