Z Medi Clinics and Z Medi Spa
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General:

Bio-identical hormone pellets are comprised of naturally derived concentrated hormones. These hormones are designed to be biologically identical to the hormones a woman makes in her own body, including estrogen and testosterone, which are made in the ovaries and adrenal glands.Bio-identical hormones have the same effects on the body as one’s own estrogen and testosterone did when the woman was younger, without the monthly fluctuations of menstrual cycles.

Benefits:

The bioavailability of hormones from the pellets is virtually complete. There is no first pass hepatic inactivation and no change in clotting factors. Current pellets are well standardized and release hormones at a consistent rate which minimizes swings in plasma levels seen with injections and other forms of hormone therapy. It is also suitable for patients who do not absorb the topical creams and gels and who do not like the frequent dosing and fluctuations of sublingual lozenges (troches).

The potential benefits of testosterone include a possible increase in bone density, short term memory, energy, muscle mass, libido, and sense of well-being.

The potential benefits of estradiol pellet(s) include possible elimination of mood swings, anxiety, irritability, cardiovascular protection, sleep disturbance, and protection from developing colon cancer, improvement of bone density and brain dysfunction. Additionally, it may decrease the frequency and severity of headaches.

Pre pellet insertion:

Laboratory evaluation including the measurement of various hormone levels will be obtained prior to consultation with the provider. During the consultation, the medical provider will review the medical history to determine if the patient is a candidate for hormone pellet therapy. If appropriate, the dose of testosterone hormone will be determined by the medical provider based on several factors including symptoms, laboratory evaluation and body weight. Laboratory evaluation will be required periodically and at various intervals determined by the provider. You must notify the medical provider of any of the following prior to scheduling the procedure:

• allergy to latex

• allergy to epinephrine

• allergy to anesthetic medications such as Lidocaine

• congenital or acquired conditions associated with increased bleeding

• use of blood thinning/anti-coagulant (Coumadin, Plavix) or aspirin therapy

(These medications may need to be stopped a few days prior to your procedure. Never discontinue use of these medications without first consulting your medical provider.

Antibiotics (Keflex or Doxycycline) may be given prior to the procedure if you are diabetic or have had a joint replacement. Additional antibiotics may be given following the procedure if deemed necessary by the medical provider.

Pellet insertion:

You may drive yourself to and from the procedure. This is performed by a medical provider as an outpatient office procedure using sterile technique. An injection of a local anesthetic consisting of 1% lidocaine with or without epinephrine is used to numb the area. Once the area has been sufficiently numbed, a small incision is made in the skin most commonly in the upper buttock region or the lower abdomen wall. A small pellet or pellets, approximately the size of a grain of rice are inserted beneath the skin, into the fatty tissue. The procedure takes

approximately 10 minutes and is associated with minimal discomfort. There may be minimal discomfort following the procedure.

Post pellet insertion:

Instructions on the post pellet insertion sheet must be followed to avoid possible risks and/or minimize discomfort.

Tylenol can be used for minor pain alleviation. Sitting in any standing water such as in a pool, bathtub, hot tub, jacuzzi or sauna and all vigorous physical activity (especially lunges, squats, walking or running at an incline) should be avoided for 7 days following the insertion of the pellets.

All anti-inflammatory medications including ibuprofen (Advil, Motrin), Aspirin, Naprosyn (Aleve) and any other prescription anti-inflammatories should be avoided for 2 -3 days due to increased risk of bleeding.

A ‘booster’ insertion of hormone pellets may be recommended after the initial pellet insertion based on lab results and symptoms.

Risks and Contraindications:

Testosterone replacement therapy is contraindicated and should not be given to pregnant women (can lead to birth defects) or nursing mothers. Patients who are pre-menopausal and capable of childbearing will need to maintain a reliable form of birth control while receiving pellet hormone replacement therapy.

In some cases, the body will convert a higher percentage of testosterone to Dihydrotestosterone (DHT). DHT can cause acne or hair loss. Both can be corrected by adjusting the testosterone dose in the subsequent visit and/or prescribing medication that blocks the conversion to DHT.

Estrogen can aggravate uterine fibroids or polyps, if they exist, and cause vaginal bleeding. I understand that if I have a uterus and receive estrogen, I will likely need to use the hormone progesterone to offset estrogen’s effect on the uterus lining. I understand that it is not unusual to have breakthrough vaginal bleeding or spotting. I am to call my provider at ZMED CLINIC if breakthrough bleeding or spotting occurs.

Possible side effects/reactions:

• brief stinging or burning sensation for a few seconds following administration of lidocaine local prior to pellet insertion

• brief shakiness, jitteriness, and heart racing due to use of epinephrine

• Slight, temporary discoloration or bruising of the skin may be normal

• minor swelling and/or soreness at insertion site, common for 2 – 3 days, may perisist for up to 2 weeks

• infection, abscess or bleeding

• irritation of skin due to post insertion dressing

• lack of effect (from lack of absorption)

• transient fluid retention

• extrusion of pellet

• breast tenderness and swelling especially in the first three weeks (estrogen e-fect)

• increase in hair growth on the face

• change in voice

• clitoral enlargement Potential side effects that are to be aware of include:

• increased growth of estrogen dependent tumors

• birth defects in babies exposed to testosterone during their gestation

• growth of liver tumors, if they are already present

• Infection, abscess and bleeding

Medications:

Daily use of the supplement DIM (Diindolylmethane) is recommended for many reasons including but not limited to the following: promotes beneficial estrogen metabolism increasing preferred form of estrogen, provide protection against hormone-dependent cancers, decrease acne and improve mood.

Progesterone may be prescribed in women with a uterus to prevent thickening of the uterine lining.

Labs and Appointments:

I understand that lab work will be required prior to my first procedure and are necessary for management of my hormone pellet therapy at various intervals for the duration of my treatment with hormone pellet therapy. Additional labs may be drawn when deemed necessary by the treating provider or when requested by you, the patient.

Charges: Office visit charges include a provider consultation fee, pellet insertion procedure feeand cost of the required hormone pellets. The pellet fee varies and depends on the number of pellets I may receive. The precise amount is to be

determined by the treating medical provider. I understand that I am responsible for any lab charges that may not be covered by my insurance company.

Payments: I understand payment is due in full at the time of services. I understand that the clinic does not accept insurance.

CONTRAINDICATIONS FOR HORMOME REPLACEMNT THERAPY ARE LISTED ON

THE HORMONE REPLACEMENT THERAPY CONSENT FORM WHICH I HAVE READ

AND SIGNED.

I have read and understand the above consent form. I have been encouraged and had the opportunity to ask any questions I have regarding pellet therapy. All of my questions have been answered to my satisfaction. I further acknowledge that the risks and benefits of this treatment have been explained to me, and I have been informed that I may experience complications, including one or more of those listed above. I accept these risks and benefits and I consent to the insertion of hormone pellets under my skin. I understand that no guarantee or assurance has been made as to the results of the procedure and that it may not cure any condition that I may have.