Hormone Replacement Therapy (HRT) is implemented to optimize hormone levels in the blood, helping to reduce symptoms associated with low levels of these hormones.
Many individuals have inadequate hormone levels despite technically normal blood tests. Some individuals suffering symptoms related to menopause or andropause or inability to lose weight may also benefit from these therapies. Hormone replacement therapy can be used to augment hormone levels in a number of conditions where diminished hormone levels are evident.
I acknowledge that testosterone, thyroid and other hormones may be prescribed off label to treat a variety of signs and symptoms.
I acknowledge that there are no guarantees or assurances made with respect to the benefit of the hormone therapy prescribed for me.
I understand that I will be in charge of administering these hormones and supplements prescribed to me.
I will conform and comply with the recommended doses and methods of administration.
I understand that initial blood tests will be performed to establish my baseline hormone levels.
I agree to comply with requests for ongoing testing to assure proper monitoring of my hormone levels.
I agree to report to the medical provider any adverse reaction or problems that might be related to my hormone therapy.
I understand that with hormone supplementation there are possible risks and complications:
Testosterone Replacement Therapy can suppress natural testosterone production, leading to potential dependency on therapy. Elevated hematocrit levels due to increased red blood cell production can raise the risk of stroke or heart attack, necessitating regular blood monitoring. Patients with pre-existing heart disease, prostate issues, or untreated sleep apnea should exercise caution when considering TRT. Furthermore, improper dosing or lack of follow-up care can lead to undesirable side effects such as severe acne, mood swings, or significant changes in cholesterol levels, which may contribute to cardiovascular complications. Close medical supervision and adherence to prescribed protocols are essential to minimizing these risks and optimizing health outcomes.
Testosterone replacement therapy can significantly impact male fertility by suppressing natural testosterone production in the testes, leading to reduced or even halted sperm production. This suppression occurs because exogenous testosterone inhibits the release of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), both of which are critical for sperm production. In some cases, this effect may be reversible upon discontinuation of TRT, but prolonged use increases the risk of permanent infertility. I have been made aware of alternative options, such as the use of human chorionic gonadotropin (hCG) or selective estrogen receptor modulators (SERMs), which may help preserve testicular function.
Thyroid hormone replacement therapy is used to treat hypothyroidism, a condition in which the thyroid gland does not produce enough hormones. While thyroid hormones play a crucial role in metabolism, energy production, and overall cellular function, their use requires careful management. Over-replacement or excessive dosing of thyroid hormones can lead to symptoms such as heart palpitations, increased heart rate, anxiety, unintended weight loss, osteoporosis, and muscle weakness. On the other hand, inadequate dosing may fail to alleviate symptoms of hypothyroidism, such as fatigue, depression, and weight gain. Patients with pre-existing heart conditions must exercise caution, as excessive thyroid hormone levels can increase the risk of arrhythmias and cardiovascular complications. Regular monitoring of thyroid hormone levels, including TSH, Free T3, and Free T4, is necessary to ensure proper dosing and minimize potential side effects.
Alternatives to bioidentical testosterone include but are not limited to nutraceutical supplementation, acupuncture and non-treatment.
After consideration of these risks I consent to treatment with hormones.
I have not been promised or guaranteed any specific benefit from the administration of this therapy.
I understand that the role of the medical provider is for hormone replacement only.
I agree that I am and will be under the care of another physician for all other medical conditions. Revv Health does not accept insurance for hormone therapy services and any associated lab work.
I, therefore, agree to pay for all services including laboratory, membership and/or medication charges myself, with the understanding that I will not be reimbursed by my insurance company. There are no exceptions.
I have read and understand all of the above consent and I fully understand what I am signing and hereby request and consent to treatment using hormone supplementation therapy.
