What is Concierge Medicine?
Concierge medicine is a patient-focused relationship between a doctor and patient where the patient pays an affordable fee for improved access and high-quality, individualized medical care. With concierge care the focus is shifted away from a disease maintenance approach toward a preventive, holistic one. This personalized approach is as affordable as a cell phone, cable TV, or monthly Starbucks' habit. The concierge fee enables you to receive personal attention, and Dr. Retzler to keep her patient load manageable to make sure your needs and goals remain top priority. Unlike other concierge practices, the HormoneSynergy® Concierge PLUS plan allows you to use your concierge fee as credit toward the purchase of nutraceuticals that support you in achieving your optimal aging goals.
What is Age Management and Functional Medicine?
"Anti-Aging" or "Age Management Medicine" is focused on the prevention, slowing, and reversal of age and lifestyle-related disease processes. This functional medicine approach to health focuses on finding and treating the underlying causes of chronic disease, rather than just treating symptoms or managing diseases after they're diagnosed.
This new paradigm of medicine better addresses the healthcare needs of the 21st century. By shifting the traditional disease or symptom-centered focus of conventional medicine to a more patient-centered approach, functional medicine addresses the whole person. Functional medicine doctors spend more time with patients, thoroughly assessing the way genetic, environmental, and lifestyle factors influence long-term health and complex, chronic diseases. In this way, functional medicine supports the unique expression of health and vitality for each individual.
The Goal of Age Management and Functional Medicine
How is HormoneSynergy® different from my “regular” doctor’s approach and treatment?
Many doctors ultimately work for the insurance and pharmaceutical industries, since their office visit times and diagnosis codes must meet insurance company definitions, and their treatments are limited to drugs that pharmaceutical companies market to them. Instead of simply managing symptoms, HormoneSynergy® focuses on prevention of age-related diseases or slowing disease processes if they've already occurred. HormoneSynergy® is committed to giving you tools to understand your current health, effective, natural options to slow or reverse aging, and research and information needed to make intelligent health decisions. This approach, combined with medication when necessary, offers a truly preventive and integrated approach to health care.
What testing is performed as part of my Optimal Aging Assessment?
- Blood work: complete hormone testing, a comprehensive metabolic panel, lipid panel with lipoprotein particle size/number and apolipoprotein concentrations, Lp(a), inflammation markers (Lp-PLA2 (PLAC), IL-6), fibrinogen, insulin, hemoglobin A1C, hsCRP, myeloperoxidase (MPO), cardiac dysfunction markers including cardiac troponin-I, NT-proBNP, cardiometabolic status markers (ferritin, leptin and adiponectin), genetic polymorphisms (Apo E genotype, MTHFR mutation, factor V Leiden, prothrombin mutation), homocysteine, CoQ10, vitamin D, B12, and an omega-3 fatty acid profile.
- HeartMath / Heart Rate Variability Testing: a unique training system that objectively monitors your heart rhythms and displays the physiological level of coherence — an optimal state in which the heart, mind and emotions are operating in sync and in balance, and the immune, hormonal and nervous systems function in a state of harmonious coordination.
- NeuroCognitive Testing - Computerized, validated brain function testing will be performed in our office or on your home computer to establish a baseline of memory and cognitive function.
In addition to lab testing, Dr. Retzler recommends yearly or every-other-year mammograms or other breast imaging for women. Digital rectal exams (prostate exam) may be recommended for men.
What additional testing is available if I want the most thorough assessment?
Telomere testing can be performed to assess the biological (rather than chronological) age of your cells. Dr. Retzler can also order DEXA (bone density) testing, a carotid artery ultrasound (to look for plaque and measure the thickness of arteries), and coronary artery scan or CT angiogram. Genetic markers that increase cancer risk can be performed, as well as testing for micronutrient deficiencies and antioxidant function. If indicated, comprehensive digestive stool testing can be ordered as well as food allergy testing.
What if I already have tests my doctor has performed?
You're welcome to bring all previous lab results or medical records to your appointment. The Optimal Aging Assessment does include thorough lab work; therefore, previous results may be helpful but may not be used as a substitute. This enables us to provide you thorough care in a streamlined, affordable fashion. It also ensures that Dr. Retzler will have all the labs she needs to properly assess your health and determine your treatment plan.
Does Dr. Retzler accept insurance or is she on any insurance panels?
Dr. Retzler’s office does not bill any insurance companies. Unfortunately, insurance companies determine the time allowed for patient visits and often the type of treatment. Dr. Retzler’s unique and successful approach to hormone balance and optimal aging falls outside the “standard of care” approach as put forth by the insurance industry to limit costs and increase profits. Insurance billing costs and restrictions would prevent her from providing you the thorough, individualized care that you deserve.
As a courtesy, our office provides insurance claim forms to attempt reimbursement on your own. Occasionally, patients do get reimbursed for some or all of their treatment depending on their insurance plan. Required lab tests are nearly always covered, and prescriptions may be covered by insurance companies. After the initial Optimal Aging Assessment, our office will provide insurance claim forms for you to attempt reimbursement. This is a courtesy for any appointments following your initial assessment. We will not provide any insurance forms or codes for the initial assessment, since we cannot give a diagnosis or procedure code before a patient is seen in the office, and since the initial assessment is designed as a package. You may request a letter for your health savings or flexible spending account for the initial assessment.
How can I afford this kind of care when my insurance doesn't cover it?
HormoneSynergy® and Dr. Retzler have designed your optimal aging care to be as affordable as possible. The information Dr. Retzler provides for you, combined with your translation of that knowledge into action, may save you thousands of dollars. Consider this: chronic diseases, such as heart disease and diabetes, affect nearly 1 in 2 Americans, and 75% of healthcare dollars are spent on managing these preventable illnesses. If you don’t embrace prevention and develop an optimal aging mindset, you will likely end up with an expensive chronic disease, eventually needing someone to take care of you. The current nationwide average for care is $206 per day for a private room in a nursing home, $183 per day for a semi-private room, $123 per day for an assisted living unit, and a minimum of $22 per hour for a home health aide. That’s $44,000 to $85,000 per year, which doesn’t include medical expenses. Can you afford to pay for this care? Can your family afford it?
Many people who seek optimal health and longevity consider the money they spend a smart investment. Some people set up flexible spending or health saving accounts through their employer or accountant--this enables the money spent on health care to be tax-exempt.
What if my primary care physician tells me that my lab results are normal?
Many times “normal” is not optimal. Sometimes physicians tell patients that health decline is inevitable with aging. Low hormone levels often get dismissed as “normal for your age”. Unless your physician is trained in ant-aging medicine, it is unlikely that he or she will be able to guide you in appropriate lab testing and interpretation, as well as treatment options. We recommend you treat all your health care providers as team members and consultants – gather information and advice before making your own decisions about your health.
What if my doctor tells me there is no research on bioidentical hormones?
He or she is wrong. There is a difference between “no research” and not knowing about or having read the research. It’s much easier for busy practitioners to dismiss patients, than it is to question their beliefs and read the research. Please refer to the Resources page for data on bioidentical hormones and feel free to share this information with your current physician.
Why doesn’t my doctor prescribe bioidentical hormones?
He or she may prescribe some bioidentical hormones since there are several pharmaceutical options. However, pharmaceutical companies only make money on patented drugs which they market directly to physicians. Since natural substances cannot be patented, synthetic hormones are often used, or the delivery method for bioidentical hormones is patented. These hormones are only available in a few dosages, and may or may not be the right dosage or mode of delivery for your body. No two people are alike when it comes to their hormone blueprint, so a one-size-fits-all pharmaceutical is often inadequate to meet your individual needs.
Your primary care doctor may also not know about all the options for bioidentical hormone replacement or s/he may not understand the research. In addition, testing and monitoring bioidentical hormones takes experience and education, something for which busy primary care doctors may not have time.
Will I have to take hormones for the rest of my life?
There are two main perspectives when it comes to hormone replacement – use the lowest dosage for the shortest time possible only to treat symptoms, or use individualized dosages for longer periods of time to treat symptoms, maintain youthfulness, and prevent diseases of aging. Both perspectives require proper evaluation of your specific risks, as well as appropriate follow-up. Dr. Retzler believes it is your choice whether or not to replace deficient hormones, and supports you in becoming informed about risks, benefits, and treatment options.
Where do I get my BHRT prescription filled?
If your BHRT prescription is not a pharmaceutical medication, we will fax it to a specialized pharmacy known as a compounding pharmacy. All compounding pharmacies are required by law to meet the requirements set by the resident state boards of pharmacy. Compounded medications are made from pure, FDA-approved hormones and are made into individualized dosages. Compounding options include sustained-release capsules, creams, gels, lozenges, or pellets.
Not all compounding pharmacies are equal — they can vary in terms of the expertise of the pharmacist making your medication, quality control, customer service, and price. Ideally, the compounding pharmacy you use should be accredited by the Pharmacy Compounding Accreditation Board (PCAB). The PCAB assures consumers that the compounding pharmacies it certifies have demonstrated superior quality and safety in compounding practices. Our office has extensive experience with several compounding pharmacies and will be happy to recommend one for you.
Will you prescribe human growth hormone (hGH) as part of my age management program?
Human growth hormone is not a miracle cure or the "fountain of youth"' as marketed by some anti-aging clinics. Improving diet, reducing stress and high cortisol production, getting adequate sleep, strength training, and optimizing DHEA and testosterone levels can help raise your own body's production of growth hormone.
What are subcutaneous hormone pellets?
Subcutaneous hormone pellets are one of several forms of bioidentical hormones available. Like other forms of BHRT, hormone pellets replenish hormones that are lost during the aging process. Pellets have been used since the 1940s and, unlike other forms of BHRT, they are very convenient. Pellets are painlessly inserted in fat tissue and deliver a steady amount of hormone into the bloodstream over 4 months. Hormone pellets dissolve completely and only need to be inserted 3-4 times a year. For more information about pellets, see Pellet FAQ.
How long before I see results?
That depends on your hormone imbalance and the treatment chosen. When bioidentical hormones are used, some symptoms resolve in days. Achieving complete hormone balance and resolution of hormone-related symptoms generally takes time. Usually, the more informed and committed you are, the quicker you will see results.
Do hormones cause breast cancer?
Currently every 50-year-old woman has about a 2.8% chance of developing breast cancer by age 60. This translates to an absolute risk of 2.8 breast cancer cases out of 100 women. When evaluating information regarding hormone use and breast cancer risk it’s imperative to determine what type of hormone is being discussed – such as synthetic estrogen, progestins, or methyl-testosterone versus bioidentical hormones – and what mode of delivery is used – such as oral, pellet, or vaginal. In addition, how many years a woman uses the hormone is important. For detailed information regarding estrogen, progesterone, and testosterone supplementation with regard to breast cancer, as well as risk factors for breast cancer, please read Dr. Retzler's “Hormones & Breast Cancer” handout.
Does testosterone cause prostate cancer?
Historically, testosterone was thought to cause prostate cancer. In fact, if your testosterone level is low, your doctor may still believe that giving you bioidentical testosterone will lead to cancer and he or she may caution you against it. Recently, several investigators published a meta-analysis, aimed at determining any link between hormones and prostate cancer. [Roddam AW, Allen NE, Appleby P, et al. Endogenous sex hormones and prostate cancer: a collaborative analysis of 18 prospective studies. J Natl Cancer Inst 2008;100:170-83.]
Overall, data from nearly 4,000 prostate cancer patients and more than 6,000 control subjects (men without prostate cancer) was pooled. No association was seen between the risk of prostate cancer and levels of testosterone, free testosterone, or dihydrotestestosterone (DHT).
Curiously, some studies have shown an association between low testosterone levels and prostate cancer. In addition, other studies have reported that a low testosterone level is associated with more aggressive prostate cancers (advanced pathological stage and higher Gleason score). A recent pivotal study strongly suggests that testosterone supplementation does not lead to prostate cancer. [Marks LS, Mazer NA, Mostaghel E, et al. Effect of testosterone replacement therapy on prostate tissue in men with late-onset hypogonadism: a randomized controlled trial. JAMA 2006;296:2351-61.]
For more information about prostate cancer, see "Prostate Cancer" handout on Resources page.
Can Dr. Retzler recommend hormones for me if I’m not a patient?
Dr. Retzler only prescribes hormones for established patients. Some hormone imbalance symptoms can be treated without hormone replacement. Information about products that can optimize hormone balance is available at our Online Store.
What if I live outside of Oregon?
We welcome you as a patient if you live out of state, and we currently help patients in nearly every state across the US, including some foreign countries. If you'd like to become a patient, all testing will be performed in advance to provide a thorough assessment and treatment recommendations at the time of your appointment. If you’d like to become a patient, we will arrange a phone consult to order lab work in advance so you can receive treatment recommendations at the time of your appointment.
Will Dr. Retzler recommend nutritional supplements as part of my treatment?
Our clinic has an extensive medicinary of pharmaceutical-quality supplements that are often recommended and/or prescribed. Dr. Retzler has compiled this medicinary over the years based on the quality and effectiveness of each item. Supplement recommendations are based solely on medical need. Please keep in mind that following your treatment plan as well as dietary and lifestyle recommendations (including supplements) as provided by Dr. Retzler will greatly affect your outcome.
What should I consider when purchasing supplements from HormoneSynergy® or anywhere else?
It’s important to keep in mind that not all products are alike, no matter what the label or packaging may claim. Make sure the supplements you take are manufactured in facilities that have pharmaceutical certification or are certified for good manufacturing practices (GMP) by the NPA (Natural Products Association), NSF (National Sanitation Foundation) International, or TGA (Therapeutic Goods Administration of Australia).
Note: there is a difference between GMP compliance and GMP certification. GMP compliance means the company monitors itself for adherence to GMP standards. GMP certification means an independent organization monitors the company for GMP standards.
It’s very expensive to become GMP certified; however, this certification ensures that the products you use are of exceptional quality. Besides coming from GMP-certified companies, ideally the supplements you take should be scientifically evaluated to verify the presence and concentration of active constituents. Very few supplement manufacturers conduct clinical trials on their formulas to document safety and effectiveness. This is because research is very expensive to perform. However, purchasing supplements with documented safety and effectiveness is a reliable investment in your health.
In addition to quality assurance and evaluation via clinical trials, look for optimal forms of nutrients and dosages. Consider the supplements you take to be as important as any medications prescribed by your doctor; in fact, you may consider them to be more important than medications since they can help you prevent the “polypharmacy” that is standard of care for aging Americans (remember, 25% of all Medicare patients use 6 or more drugs every day).
Will Dr. Retzler assume my medical care and act as my Primary Care Physician?
Although Dr. Retzler performs some primary care services, she is not available seven days a week and will not assume the role of your primary care physician