(Pete Hueseman, R.Ph., P.D.'s 21st visit)

Dearest: My guest tonight is Pete, Hueseman, R.Ph., P.D. Pete has been a Registered Pharmacist for 30 years. Although Pete is a registered pharmacist and dispenses all sorts of prescription medications, he's focused his area of expertise on women's health care, and naturally compounded, BHRT, bio-identical hormone replacement or HIH - human-identical hormones, such as estradiol, estriol, estrone, tri-estrogen, micronized progesterone, DHEA, testosterone, pregnenolone.

Pete specializes in counseling patients and physicians on the use of natural hormones. He advises patients and physicians, nationwide, and is an acknowledged expert on the use of *natural* hormones or NHRT (natural hormone replacement therapy)

Pete is professionally associated with NAMS, the Academy of Alternative Medicine, Alternative and Complementary Medicine Association, and is registered with more than one professional Pharmacist's Association. Pete also is co-owner of Bellevue Pharmacy Solutions.

Pete, thank you for returning to continue our discussion about menopause and bio-identical hormones :)

Pete Hueseman, R.Ph, PD: Thanks for the kind introduction, and it is always good to be here! I am ready to answer any questions.

Dearest: It's always good to have you here :)

Dearest: Pete, is there a simple explanation as to how supplemental bio-identical hormones work to prevent so many menopausal symptoms?

Pete Hueseman, R.Ph, PD: They are chemically identical to what the ovaries used to produce, so when one uses them, they fill in where the lack of hormones is needed and usually do this with less side effects, and good safety too.

Dearest: Pete, what physical conditions, illnesses, or a history of or predisposition to physical conditions would contraindicate the use of bio-identical hormone therapy?

Pete Hueseman, R.Ph, PD: Recent breast cancer patients must be very careful, and maybe not use right away; recent blood clots from anything, or a recent stroke. These things don't mean you can't use them, but must be very careful, and probably have recovered from the event for a while.

Dearest: What about someone who has gallstones or gall bladder disease?

Pete Hueseman, R.Ph, PD: Hormones can also aggravate a bad gall bladder. I have had a few patients who, after using them awhile, had to have the gall bladder removed, and then went back on the hormones for symptom relief once the gall bladder was removed.

ElegantEl: What over the counter meds will help with my severe Hot flashes and night sweats?

Pete Hueseman, R.Ph, PD: Possibly Revival soy, Black Cohosh or Promensil (red clover from Australia), or some brand of phyto estrogens.

ElegantEl: I was on bioidenticals for 5 years and felt it was time for a break.

Dearest: ElegantEl, you'll find lots of information on Power Surge's Recommendations page at www.power-surge.com/recommend.htm including many OTC products that Pete can provide via his pharmacy - they're not all prescription.

Pete Hueseman, R.Ph, PD: Well, then try one of these for awhile, and see how it goes, you can always go back on the natural HRT.

Hot: Hello Pete. I'm 59 and post menopausal for about 15 years now. I started to take bio-identical compounded progesterone about 4 months ago. I seem to be sleeping better, however my sex drive is zero. As for extreme hair loss - would I need to take a saliva test? I thought progesterone would help, but not yet. Thanks from Canada

Pete Hueseman, R.Ph, PD: Yes, we could send you a saliva test kit, but it sounds like you need some natural testosterone or DHEA, and maybe a stronger estrogen, or to also have a full thyroid panel test, but this is only accurate in blood. Progesterone needs to be balanced with the other 3 hormones. A saliva test is not mandatory, but a good idea.

Dearest: FYI -- You can call Pete at 1-800-728-0288 or E.mail him directly at consultph@bpharmacysolutions.com

Cate: My doctor says my testosterone is low. I'm dragging my feet on taking natural replacement because of fears of my hair falling out (happened to a friend who sees a different doctor). Am I being reasonable in my concern over my hair? Am taking KetoDHEA, Progesterone, Revival soy, and Chinese herbals now.

Pete Hueseman, R.Ph, PD: If your hair is not falling out now, then I would recommend to try it. You can always use a different dose form later on, if it becomes a problem. It usually is not as big a problem as most women think it is. Hair falling out is usually a lack of estrogen, and thyroid imbalance.

Dearest: Also, in 11 years, and communicating with tens of thousands of women - I've only heard a very few mention hair loss as a side effect of using hormone replacement - especially bio-identicals.

Cate: OK, with trepidation. I'm a chicken over my hair. My friend does have thin hair anyway and has thyroid issues. This is very reassuring. Thanks.

IAmPixie: Doctor, are there safe medications that you can take for menopause when you have a hypo-thyroid?

Pete Hueseman, R.Ph, PD: Yes. You need to get a prescription to get the thyroid set straight, then we can talk about some Biest, with progesterone (and the Progest enhances the thyroid function), and then to balance with DHEA and Testosterone if they are also low. This can all be found out with a saliva test.

The safest thyroid medication is the Armour thyroid.

IAmPixie: My thyroid is under control now. I have no uterus either.

Pete Hueseman, R.Ph, PD: Then we need to discuss some Biest, and get it all balanced. My phone is 1-800-728-0288 for a consultation

Edelweiss: What if you are in a high risk bracket due to family history - breast cancer and stroke in immediate family. Do bio-identicals have any 'risk' factors I should know about?

Pete Hueseman, R.Ph, PD: We do a consultation based on the Gale model, and one of our consultant Pharmacists, Paul, Janna, or Vicki would go over this with you in depth.

There are still risk factors, and on the Gale model, we can figure out just what they are for any one person.

Dearest: Pete, what about the nay sayers who say, "hormones are hormones" - are the risks associated with synthetic hormones really worse than naturally compounded, plant-derived bio-identicals?

Pete Hueseman, R.Ph, PD: I disagree with them. However you still must be careful, and always use the lowest dose to get rid of the symptoms. There are articles out there that show how the natural HRT does not increase breast cancer reoccurrence when used after treating the breast cancer, so the quality of life is better for the patient.

Kdobnc21: I have been experiencing a variety of premenopausal symptoms for the past year. I recently ordered a non-prescription progesterone cream via an internet site but I am not sure if I should start using it or try to find a Dr. in my area who can prescribe bioidentical hormones via prescription after doing hormone testing. Also, is saliva testing more accurate than blood testing?

Pete Hueseman, R.Ph, PD: Blood and saliva testing are equally accurate if done properly.

You can try the OTC cream, see if it helps. If it doesn't, then please call me to do an oral consultation, and with that can come a doctor referral, if your doctor will not cooperate.

We also will give you a suggestion to have your doctor order at that time.

Dearest: Also, Pete, there are so many OTC progesterone creams out there - many of which are pretty useless - wouldn't you recommend using a reputable brand?

Pete Hueseman, R.Ph, PD: Yes, I always recommend the Progest body cream (we do sell it) by Emerita, a division of Women' Group Formula Company, the first and best OTC progesterone cream. A 4 oz. tube sells for $39.99.

Dearest: Again, Power Surge recommends Emerita - which is Progest at www.power-surge.com/recommend.htm - Pete can send it to you.

MyJourney: My last period was in October and before that it was about 6 months. I have hot flashes, muscle and joint pain, irritable, and NO libido now! Am I STILL perimenopausal? I'm 54 years old. My doctor doesn't think you are MENOPAUSAL until you have not had a period for 1 year.

Pete Hueseman, R.Ph, PD: I think we could now classify you as post menopausal, and if you call tomorrow or next week and ask for me (Pete), I can do a consultation, and get you started to feeling better in a safe fashion. By the way, we do ship everywhere and accept hundreds of insurance plans for payment of prescriptions.

MyJourney: Thanks, I hope my insurance covers bio-identicals.

Pete Hueseman, R.Ph, PD: Most insurance plans do pay now, at least from our Pharmacy.

IAmOK2000: My wife takes Premarin. She is 49 and had total hysterectomy. She has no energy, no libido etc. What do you recommend for bio-identical levels?

Pete Hueseman, R.Ph, PD: The correct balance of Biest with some testosterone and probably some DHEA. Call me, or have her call me for a specific dose recommendation, 1-800-728-0288.

Hot: How does a Canadian get saliva test done for thyroid or for low estrogen and testosterone, for hair falling out. Do I need a prescription from my Doctor?

Pete Hueseman, R.Ph, PD: You do NOT need a prescription for the saliva test, and we mail it to you via 1st Class mail from our Pharmacy.

You can not do thyroid in a saliva test, and have it be accurate or correct.

The hormones would require a prescription, yes.

Dearest: And you then provide the results to the patient, Pete? Or to their doctor?

Pete Hueseman, R.Ph, PD: The results get sent to me and to the patient directly from the laboratory, then we do a consultation, make a recommendation, and then the doctor will officially make the prescription order from there.

Dearest: Ahhh.. thanks.

MaryO: A question I was going to ask at the last chat. About that Pituitary Plus again - what if a person has a real issue with high cortisol? Would this product mask that in blood, urine or saliva testing? Thanks!

Pete Hueseman, R.Ph, PD: It would not mask it, but could help it come back in line, if indeed this was the problem. Then a blood, saliva or urine test could be done as a follow up to see if more was needed or not.

Dearest: I want to ask one other thing about the Pituitary Plus. Where do the ingredients come from? And, are there any side effects to using it?

Pete Hueseman, R.Ph, PD: The ingredients are from thyroid extracts, and I have not seen anyone have any side effects from using it yet; and I sell many bottles each month. I don't have the bottle right in front of me to look at the exact ingredients in it right now.

Edelweiss: Any idea if and when these compounds will be covered by our medical plans? They will cover synthetic HRT - but scoff at alternatives. At least that's the case in the Detroit area. Only the blood work is covered?

Pete Hueseman, R.Ph, PD: If one has Blue Cross, United Healthcare or Medicare, then I can get the saliva test covered for only a co pay. Most insurance companies, if you use our Pharmacy, do have prescription coverage right now. However, the co pays do fall into the 3rd tier column, so the co pays are $20.00 or 25.00 or 35.00 or up to $50.00 each, not just the generic $5.00 co pay.

Meg2820370: What kind of testing has been done with bio-identical hormones for long term side effects and how long should one remain on them?

Pete Hueseman, R.Ph, PD: Meg, the rule is probably the same as the synthetics, about 5 years, and some just lower the dose and take for 10 to 20 years, if they need to stay on it to feel well.

There have been no long term studies for the bioidenticals to date.

SundarKoyal: I have recently been reading about DHEA, but would like a little more first hand information on it, such as .... Who can or should be taking it?

Pete Hueseman, R.Ph, PD: Most men and women have reduced levels once they reach 40 years old, so anyone over that age is a candidate, if it tests in the low to low-normal range.

MyJourney: Do you have doctors who refuse to use bio-identical hormones? I don't know if my doctor would or not. Would bio-identicals affect my weight? I am having a hard time losing weight.

Pete Hueseman, R.Ph, PD: To balance your hormones naturally can also help you get your weight back under control. There are a few doctors who will still not use the bioidenticals that we recommend. If that is the case, then I say call me, and I will try to find you someone near to you who I have worked with before, and who will write the prescription for you, and then you become that doctors patient for the future.

Dearest: I must have asked you this a dozen times, but why would a doctor feel free to prescribe Premarin and Provera, but not natural, bioidenticals?

Pete Hueseman, R.Ph, PD: Sometimes it is political. If they are affiliated with a teaching institute, the big drug companies have those doctors on the payroll. And since the bioidenticals are generic right away, and not patentable to make lots of money, therefore no one does the actual trial studies to promote and show how well they will work.

FlyFisher: How can one tell if they are getting real bioidentical hormones in their creme (Biest)? A local compound pharmacist swears that that is what he uses, but it is significantly cheaper. So I question it.

Dearest: That's where "reputation" comes in. It's like coming to Power Surge which is endorsed by most of the largest women's health organizations or going to some shlock menopause site.

Pete Hueseman, R.Ph, PD: Well, most Pharmacists are honest, and can make a cream, but since I don't work there, I can't say for sure. I would assume he or she knows what they are doing.

I would have to know the strength and quantity, and the price charged to decide whether it was too cheap or not. There is lots of time involved in making something from scratch. I also assume he has good and accurate equipment.

Dearest: How many of us can get behind counters to see pharmacists' equipment? :)

Gee, that doesn't sound quite right. LOL

Pete, how long have you been a pharmacist? And how long have you been working with bioidenticals?

Pete Hueseman, R.Ph, PD: I have been a registered Pharmacist for 32 years next summer, 5 years of professional schooling, many continued education courses and conventions. Now the course is a 6 year course. I have been working in this specific field for 14 years now, since June 1991.

Dearest: That's great!

Edelweiss: How often do you need to have hormone levels checked? Is there a preference between blood testing vs saliva?

Pete Hueseman, R.Ph, PD: I would do the tests that you can get covered by your insurance. I stated the ones covering saliva earlier. We usually do the test for a baseline in the beginning, then a recheck in 3 to 4 months, and then once a year thereafter.

MyJourney: Is yam cream the same as bio-identical hormones?

Pete Hueseman, R.Ph, PD: Yam cream is not necessarily a bioidentical progesterone cream. If it says dioscorea , then no, it is then a Mexican Yam extract, and that doesn't work the same way at all.

Meg2820370: In the 14 years you've been doing the bioidenticals, have you ever heard of any side effects such as those that happen with synthetic HRT?

Pete Hueseman, R.Ph, PD: Oh yes, they can happen and do happen. The key is getting them balanced correctly, and we at Bellevue Pharmacy Solutions are the best at doing that in the U.S.A.

Many Pharmacist can make cream and capsules, but can't make very good fine tuning recommendations for the bioidenticals.

Dearest: That's also one of the best advantages to the bioidenticals - that they can be tweaked in dosage so you're not stuck with the one or two doses the commercial/synthetic manufacturers provide.

Pete Hueseman, R.Ph, PD: I take great pride in solving the hard cases all across the country, as does Paul, Janna, Brock, Vicki, Marlene and Jim.

Dearest: Those names Pete gave you are all pharmacists at Bellevue Pharmacy Solutions.

Pete Hueseman, R.Ph, PD: There are so many women out there needing help, I have trained all of the above on how to do it, so I can get some help for all of the patients, and they all do a very fine job now. By the way, Paul Hueseman, Pharm.D. is my son and one of my partners.

Dearest: Yes, and he was a wonderful guest in Power Surge, too!

Edelweiss: Are bio-identicals used on a daily basis or measured out as birth control - so many days of estrogen - so many days of progesterone, etc?

Pete Hueseman, R.Ph, PD: Usually the estrogen part is taken daily. The progesterone can be cycled or taken daily depending on each individual situation. The Testosterone and DHEA are usually used daily.

Dearest: Pete, when a woman has a uterus and is taking estrogen, must she take progesterone as well to protect the lining of the uterus?

Pete Hueseman, R.Ph, PD: This is an absolutely correct statement!

SturdyWoman: Do you ever keep someone on estrogen (low dose) if they cannot tolerate taking any form of progesterone?

Pete Hueseman, R.Ph, PD: Sturdy, yes we do that fairly often, then you must have an ultra sound done every 6 months to measure the thickness of the lining, to see if a D + C is necessary, or maybe use some progesterone every 3.5 months in order to shed the lining.

RollerCoaster: Hi, Pete. Do you have any suggestions for menstrual migraines? Mine usually begin on day two or three, and are severe (lasting two to three days). I am currently using a 5% progesterone cream, .2ml twice a day days 12 - 26.

Pete Hueseman, R.Ph, PD: It sounds like you have a slow estrogen rebound production, and maybe need a low dose estrogen from day 25 to day 5 of the new cycle. That is what I would try first.

RollerCoaster: Thank you!

HRTFan: I am on an estrogen patch. Is that considered bioidentical? The estrogen listed is estradiol, I think.

Pete Hueseman, R.Ph, PD: Yes, that is one of the natural bioidentical estrogens in the patch.

HRTFan: Thank you for the reassurance.

Dearest: Pete, of the various modalities of delivering bio-identicals, which is your favorite - or is one more effective than others? You know, pills, creams, gels, etc.

Pete Hueseman, R.Ph, PD: My favorite, and it seems to work quite well is the sublingual tablets, then the duragel, oil capsules, creams and suppositories, pellets, and injectables.

FlyFisher: Any opinion on Estrace .01 mg. creme? My doctor recommended that I use it for vaginal dryness. (a dab nightly). I'm on Biest creme and Prometrium. Is that ok or not as far as bio identical goes?

Pete Hueseman, R.Ph, PD: It sounds like a good thing to try to me, but it is probably 0.01% in strength. Use a small amount. A small green pea size will be the amount.

ElegantEl: Pete, since November, I've been off the bio-identicals (Biest and testosterone) that you have prescribed for me for the last 5 years. Since there are no studies done, how long should I take a break from them if I decide to start up again? And what can I do about my total lack of libido in the meantime?

Pete Hueseman, R.Ph, PD: In the meantime for libido, I just got into stock a new item Perfusia S.R. I believe it is an amino acid of l-arginine to increase circulation to the private parts for men and women. Of course, there is the old stand by, we sell called Alura, and it does work very well.

You could go back on the Biest / Testosterone at any time now, and it would still be safe for you.

Kdobnc21: Is progesterone cream effective by itself or should I also look into using a natural form of estrogen along with the progesterone? I have not had any hormone testing done.

Pete Hueseman, R.Ph, PD: Call me tomorrow or next week, let's go over your total symptom profile, and then I can advise you, sometimes we can give a recommendation without testing, and oftentimes I do just that. it sounds like you do need some natural bioidentical estrogen to go along with the progesterone.

Edelweiss: Is there any further research on whether there is a link between Alzheimer's disease and estrogen?

Pete Hueseman, R.Ph, PD: No new news. I believe the lack of estrogen can exacerbate the Alzheimer's condition though.

MyJourney: Will it cost me about $75 per month to do bio identicals?

Pete Hueseman, R.Ph, PD: It depends on what you need, and if you have insurance or not. $50.00 to $75.00 per month is a fair estimate.

Thanks for all the good questions, and all of you new people did great, as did the oldtimers.

Dearest: Pete, thank you once again for educating women about our hormones and menopause. You can ask Pete your questions at www.power-surge.com/asktheexperts.htm, or you can call him at 1-800-728-0288 or E.mail him directly at consultph@bpharmacysolutions.com