Hawaii Wellness MD

Bioidentical Hormones Your hormones play an important role in how you feel each day. These so-called “messengers” of the body regulate many different functions and processes, including those related to sleep, metabolism and reproduction. As you age, or as a result of certain health conditions, hormone levels decrease. Especially important are the levels of testosterone, estrogen and progesterone. They have a big impact on how you feel. The right balance of hormones keeps you feeling energetic and active. Hormonal decline leads to a wide array of undesirable outcomes: sleeplessness, fatigue, foggy thinking, low energy, weight gain and loss of lean muscle. Hormone replacement therapy (HRT) restores the levels in order to improve the way you feel and to reduce the negative effects of hormone decline. What are Bioidentical Hormones? Regenerative medicine practitioners most often utilize bioidentical hormones in their treatment protocols, as differentiated from other synthetic hormones. The differences come down to how they are made, what they are made with and their molecular structure. Bioidentical hormones are manufactured in a lab to be identical to naturally occurring hormones, which is why they are favored by regenerative medicine practitioners. When examining the chemical structure of bioidentical hormones, they are exactly identical to the structure produced naturally by the human body. For this reason, it is expected to perform no different than your naturally occurring hormones. The same claim cannot be made of synthetic hormones. The differing and “additional” structures seen in synthetic hormones may have additional undesired physiological effects within the body and should be avoided whenever possible. We specialize in Bioidentical Hormone replacement therapy whenever possible. What do Bioidentical Hormones do? Bioidentical Hormones are used to replace the low and continually decreasing levels of hormones witnessed in the natural aging process. The appropriate replacement of your hormones to a balanced state can help alleviate many common aging symptoms. Your doctor may recommend hormone replacement therapy as a way to alleviate: Lack of energy Poor sleep Decreased libido Lack of interest in sex Lack of interest in your favorite activities Weight gain or weight fluctuations Loss of muscle mass Difficulty concentrating Vaginal dryness Hot flashes High cholesterol High risk of heart disease Loss of bone density Thinning hair Once your baseline has been established through blood, urine, or saliva testing, we will be able to determine whether you can benefit from hormonal replenishment. Hormones may be administered in pill form, as a gel or cream, an injectable, or as an implanted bioidentical pellet. The dose is based on the symptoms you are seeking to alleviate, as well as your age and health history. Follow-up discussions and periodic lab testing are very important to monitor how the dose is working or not working for you. Bioidentical Hormone replacement therapy is a highly customized and individualized treatment program. Our access to the nation’s best pharmacies allow us to provide the highest quality customized bioidentical replacement hormones. Will I Have to Stop Hormone Replacement Therapy at a Certain Age? Not necessarily. There is not a predetermined age at which it is no longer safe. Instead, your health will need to be carefully evaluated to make sure you are still a good candidate. As a person ages, they are likely to need reduced dosing of their hormones. As with all aspects of modern medicine, an evaluation of the risk-benefit ratio of all therapies is the best way to determine when a therapy should be initiated and when therapies should be stopped. Our highly trained and experienced physicians continually monitor your safety and risk-benefit ratio to make essential changes to your therapy as needed. Are Bioidentical Hormones Only for Women? Absolutely not. Men and women alike can benefit from HRT because both men and women experience hormonal imbalance and hormone decline. The term used to describe the decline of hormones with age in males is Andropause. Bioidentical hormone replacement therapy is offered as a remedy for the symptoms of Menopause in females and Andropause in males. Get Started on the HRT Process In some situations, Peptide or versions of stem cell therapy can be combined with bioidentical hormone replacement therapy. But it also often makes sense to perform HRT as a standalone treatment. Schedule a consultation to find out what’s right for you.

Low testosterone, a form of hypogonadism, occurs when the body fails to produce an adequate supply of this hormone. This condition is more prevalent as men age, occurring in about 20 percent of men over 60 years of age and increasing to as much as 50 percent in men over 80 years of age. While testosterone is thought of as the male hormone, it is necessary for female functioning as well, and women may also suffer from low testosterone. Following an evaluation, both men and women may benefit from testosterone replacement therapy. Testosterone is a sex hormone naturally produced within the body. In men, this hormone helps to maintain sperm production, control sex drive, and regulate muscle mass and bone health. The pituitary gland and the brain control the production of testosterone which is secreted through the testicles. Symptoms of Low Testosterone Symptoms of low testosterone in men may include increased body fat, enlarged breasts, reduced muscle mass, diminished bone density and decreased energy. Sexual symptoms may include: Low libido (sex drive) Inability to reach orgasm Erectile dysfunction Low sperm count Diminished volume of seminal fluid Smaller or softer testicles Men with low testosterone may also experience sadness, irritability, or depression. Causes of Low Testosterone The causes of low testosterone in men can vary and may include: The natural aging process, Andropause (male menopause) Alcohol intake and opioid drugs Injury or infection of the testicles Treatment for testicular cancer Hormonal disorders, including cortisol imbalance Infections or chronic diseases Nutritional deficiencies and poor diet Some medications and certain genetic conditions can also lower a man's testosterone reading. Men who are hypertensive, obese, or who have elevated cholesterol levels may also suffer from low testosterone levels. Diagnosis of Low Testosterone To diagnose low testosterone, the doctor will perform a physical examination and review all of the patient's symptoms. Testosterone levels are measured with a blood test, but other diagnostic tests may be administered as well, including: Urinalysis Sperm count PSA test for prostate cancer Hematocrit (red blood cell count) Cortisol levels Complications of Low Testosterone In addition to negatively affecting quality of life and intimate relationships, low testosterone can be a factor in several disease conditions. Recent research suggests that men with low testosterone are at increased risk of developing diabetes, osteoporosis, and cardiovascular disease. Treatment of Low Testosterone Treatments for low testosterone involve replacing the hormone in the body. Often referred to as testosterone replacement therapy, these methods include administering the hormone through: Gel, cream, or patches applied to the skin Injections Subcutaneous bioidentical pellets This treatment is effective in restoring normal testosterone levels in the male body and reducing symptoms. Testosterone replacement therapy is considered a lifelong treatment option. It is important that men taking testosterone be carefully monitored by their doctors. Risks of Testosterone Treatment Our highly trained physicians can determine if you are a good candidate for Testosterone replacement therapy. Once established as a good candidate, your physician will discuss any risks that pertain to your therapy. There are many public misconceptions regarding the risks of testosterone replacement therapy. Most commonly, these involve cancer and cardiovascular disease. Most recently, the two highly publicized articles by JAMA which indicated increased risk of cardiovascular disease with Testosterone replacement therapy were completely debunked. Though used as a fertility treatment in the short term, the long-term use of testosterone may interfere with fertility. More studies are needed in this area, but our physician has successfully used techniques to preserve fertility in younger patients within our clinic. Testosterone treatments are not usually recommended for men who have been treated for prostate or breast cancer. Low Testosterone in Women While testosterone is thought of as the male hormone, it is necessary for female functioning as well. Testosterone can be prescribed for women on an off-label basis as therapy for symptoms of menopause, such as hot flashes or vaginal dryness and low libido. Low libido is amongst the most common complaints of female menopausal and peri-menopausal females. Research has shown that women after menopause may also benefit from testosterone therapy which can: Increase mental clarity Help maintain mood balance Relieve fatigue Increase bone density Decrease body fat Restore libido Testosterone does not increase the risk of cancer in women and has been shown to offer protection against Type 2 diabetes and cardiovascular disease.

The aging process is one of those things in life that is truly inevitable. Although nothing can stop you from getting older, you can take certain steps to age gracefully and age well. Taking good care of your body is a great way to encourage youthful vitality from the inside, out. While we offer treatments like BOTOX® Cosmetic and Fillers to effectively soften the signs of aging at a skin-deep level, a healthy lifestyle combined with regenerative therapy address aging at a cellular level. The Best Anti-Aging: Eating Well and Exercise! Sometimes the most basic measures are the ones we don’t want to take. Lifestyle modification is the most difficult “pill” for any patient to accept. Eating well, staying active, limiting the unhealthy habits in your life – all of these basics are a good way to age well. In advanced age, it’s also important to stay socially connected. All too often our senior citizens become isolated. Stay in touch with old friends and seek out new friendships. It’s an important part of overall wellness. Directed Supplementation Based on comprehensive lab testing, family history, and clinical findings, our physician will make recommendations for “directed” pharmaceutical grade supplementation. Many patients take a bowl full of supplements on a daily basis, but when asked why they take each pill they will have no reasonable answer. Furthermore, the quality and absorption level of generic supplements are highly questionable. Taking every supplement you’ve heard “is good for you” is neither cost-effective or safe. Physcian-directed supplementation is a customized approach based on your body’s individual deficits and requirements. This targeted approach is effective to fight inflammation associated with the natural aging process, support metabolic functions of longevity, improve common health conditions, and counter or limit many undesirable effects of prescribed medications. Hormone Therapy Hormones – particularly estrogen, progesterone and testosterone – naturally decline as we age. These hormonal imbalances are in part responsible for some of the less desirable effects of aging: weight gain, sleeplessness, loss of lean muscle, fatigue, impaired concentration. By introducing specific hormones into the body, we can level out some of these imbalances. First, blood work must be completed to get accurate levels and to see which hormones could use a boost. Hormones may be administered via implantable pellet, a pill or a topical cream. We specialize in all forms of bioidentical hormones. Over time, you should start feeling a reduction in the undesirable symptoms listed above as your hormones are replenished. Peptides One of the hottest topics in age-management is Peptides. Peptides (as referred to in the anti-aging world) are short amino acid chains that directly or indirectly regulate body function and metabolism. Many Peptides can mimic particular benefits of Growth Hormone- and that is probably a major reason behind their popularity. Most Peptides are delivered by injection with a tiny needle several times per week. Depending on the Peptide, the desired effect may be weight loss, muscle or strength gain, reduced inflammation, rapid repair from injury, increased energy, improved sleep… and the list goes on. Some peptides are recognized to improve specific medical conditions. Peptides can be further broken down in to “secretogues.” These peptides can enhance the release or effect of natural Growth hormone within the body. Although the popular Peptide GEREF (Sermorelin) was FDA approved, most Peptides are not FDA approved and their use remains off-label. Regardless, the use of Peptides is commonplace in modern age-management medicine. Assessing Your Goals and Treatment Options Arrange a consultation if you are ready to learn more about anti-aging treatments using regenerative medicine techniques. Hormonal therapy and other methods may be the right way to restore youthfulness from the inside out!

Menopause Menopause is the time in a woman's life when her menstrual period has stopped. Menopause is caused by a decrease in the ovaries' production of the hormones estrogen and progesterone, which eventually results in the ovaries' ceasing to produce eggs, and the end of menstruation. A woman has reached menopause when she has not had a menstrual period for at least 12 months. Menopause is a natural process that takes several years. During this time, fertility decreases, and periods often change in duration, frequency, and amount of blood flow. This stage is known as perimenopause, and it is often when symptoms of menopause begin. The average age that menopause occurs is 51, although it may occur prematurely in women who have had total hysterectomies or have received chemotherapy or radiation treatments. Symptoms of Menopause The symptoms of menopause can vary, with some women experiencing no symptoms at all and others experiencing multiple severe symptoms. The first phase of menopause often begins with irregular periods, and can include the following symptoms: Insomnia Hot flashes Night sweats Fatigue Discomfort during intercourse Vaginal dryness or itchiness Urinary tract infection Bladder control issues Weight gain Thinning hair Dry skin Menopause can also have mental and emotional effects, causing mood swings, depression and irritability. Diagnosis of Menopause Menopause is usually diagnosed based on symptoms. In some cases, blood tests are used to make an accurate diagnosis, and rule out any underlying conditions. Two tests are typically used. Follicle-Stimulating-Hormone Test A follicle-stimulating-hormone (FSH) test measures the level of follicle-stimulating hormone in the blood. When a woman's estrogen levels begin to decrease, the pituitary gland in the brain causes FSH to be released, stimulating estrogen production by the ovaries. If a woman's levels of FSH are rising, menopause is often the most likely cause. Thyroid-Stimulating-Hormone Test A thyroid-stimulating-hormone (TSH) test measures levels of thyroid-stimulating hormone in the blood. It helps to determine whether hypothyroidism is responsible for symptoms; an underactive thyroid can cause symptoms similar to those of menopause. Vaginal pH testing is also used to help diagnose menopause; pH levels increase to about 6 from the reproductive years' average of 4.5. Treatment of Menopause Treatment for menopause varies depending on the individual. One treatment is hormone-replacement therapy (HRT), in which medication containing estrogen or progesterone is prescribed to replace the hormones that are deficient within the ovaries. These synthetic forms of hormones are delivered through pills, patches or creams. However, there are risks associated with HRT, including heart disease, stroke and breast cancer. Risks may vary depending on a woman's health history and lifestyle. Before deciding if HRT is appropriate, a woman should discuss its risks and benefits with her doctor. Women suffering from depression or mood changes due to menopause may benefit from taking antidepressants or anti-anxiety medications. Low-dose vaginal estrogen, which is available in a pill or cream form, can be prescribed to help reduce dryness within the vagina. Medication is also available to treat the osteoporosis often caused by menopause. Women who maintain a healthy and active lifestyle may experience less discomfort during menopause. Complications of Menopause In addition to temporary discomfort and symptoms, menopause can cause long-term health complications for women. The bone disease osteoporosis is a common concern for women who have been through menopause. During menopause, production of estrogen, which supports bone mass, decreases. The drop in estrogen causes bones to become less dense, and prone to fracture and injury. Additional complications of menopause may include the following: Cardiovascular disease Urinary incontinence Sexual dysfunction Women experiencing menopause should consult with their physicians for effective treatment of symptoms, and recommendations for reducing the chances of complications.

The inevitability of age is that cells and systems in the body degenerate. This degenerative process leads to a variety of ailments, most often causing persistent pain, stiffness and limited range of motion. By regenerating and in some cases replacing damaged cells, organs and tissues, pain and injury can be reversed to a degree. Regenerative medicine encompasses those efforts to rescue or replace damaged, diseased or dead tissue in the body. Aside from the changes that accompany aging, regenerative medicine can also be applied to the treatment of sports injuries, chronic pain, joint pain, hormonal imbalance and many other issues. An experienced regenerative medicine professional works with you to develop an effective plan to restore well-being using your body’s natural ability to stimulate healing. Types of Regenerative Medicine Regenerative medicine is a broad term covering a range of treatments. Hallmark therapies include: Stem Cell Therapy Platelet-Rich Plasma (PRP) Injections Hormone Replacement Therapy (HRT) IV Therapy Tissue Engineering Prolotherapy Exosomes Anti-Aging Treatments These treatments meet a wide range of needs and alleviate various symptoms. You can live a pain-free, more active life in most cases. While the use of stem cells is what most people associate with this field, there are actually many areas of study and clinical application. Other aspects of regenerative medicine involve organ and tissue transplants, scaffolding, devices and biomaterials. Regenerative Medicine Questions You deserve clear answers about your treatment options. Contact us to get the full details on our services. What does regenerative medicine mean? Regenerative medicine focuses on obtaining, developing and delivering cells in order to restore or repair the normal functioning of body systems. What can regenerative medicine be used for? This branch of medicine has many applications, including the treatment of: Knee pain Back pain Neck pain Shoulder pain Sports injuries Arthritis Elbow pain Ankle pain Wrist and hand pain Hip pain Foot pain Toe pain and numbness This list is not exhaustive. During a consultation, you can find out whether the ailment, injury or illness can be addressed with these types of interventions How effective is regenerative medicine? Regenerative medicine is effective for certain people experiencing certain ailments or diseases. Because there are so many therapies within regenerative medicine, the effectiveness of each branch has its own factors. Your regenerative medicine provider will discuss the studied effectiveness, risks and benefits with you as part of your consultation. Are stem cells used in regenerative medicine? Yes, stem cells are an important part of regenerative medicine. Many people use the phrases interchangeably, and stem cells are the most common association with the term “regenerative medicine.” In fact, stem cells are just one of the very exciting areas in this field of research and clinical practice. What are the benefits of regenerative medicine? This branch of medicine has many promising benefits as well as observed benefits: Reduces pain Enhances healing Jumpstarts the process of regeneration Increases collagen production, which in turn strengthens tissues May make it possible to avoid surgery and/or pharmaceutical drugs Harnesses the power of your body’s ability to heal and repair itself Focuses on the root cause of an ailment, not the symptoms alone May provide relief that you have not been able to achieve with other treatments Consulting an experienced provider is the only way to know if it will be beneficial for you specifically. Who is a good candidate? You may be a good candidate for regenerative medicine if any of the following apply: Seeking an alternative to joint surgery or joint replacement Tendon or ligament injuries Joint pain Arthritis Pain in the hips, knees, shoulders, wrists, elbows, fingers, toes, neck or back Spinal pain ACL/MCL tears Rotator cuff injury Meniscus tear Temporomandibular joint disorder Headaches caused by neck pain Limited range of motion in any of your joints In a consultation or over the phone, we can better determine your candidacy. Regenerative medicine can be a great way to address pain or degenerative diseases. Schedule a Regenerative Medicine Consultation The next step in the process is scheduling your consultation with an experienced regenerative medicine provider. After listening to your concerns and reviewing your medical history, all therapeutic options will be reviewed with you.

BOTOX® Cosmetic FAQs BOTOX® Cosmetic is a prescription drug that, when injected, temporarily paralyzes muscles. BOTOX Cosmetic injections treat moderate-to-severe facial lines and wrinkles that are formed by continual muscle contraction. Treatment with BOTOX Cosmetic is the most popular physician-performed nonsurgical cosmetic procedure in the United States. What does BOTOX Cosmetic do? According to its manufacturer, Allergan, Inc., "BOTOX Cosmetic is the first and only FDA-approved prescription product that temporarily improves the appearance of both moderate-to-severe frown lines between the brows and moderate-to-severe crow's feet in adults." How does BOTOX Cosmetic work? Properly placed injections of BOTOX Cosmetic, which contains a purified and safe form of botulinum toxin A, block nerve impulses sent to muscles, weakening them to the point where they cannot contract. When will I see results from BOTOX Cosmetic? How long does it last? Results from BOTOX injections are apparent within 24 to 48 hours, and are maximized by 30 days. Results often last between 3 and 4 months. Does BOTOX Cosmetic have medical applications? Yes; it is used to treat a number of medical problems, including excessive sweating, overactive bladder, neck spasms, crossed eyes, chronic back and jaw pain, and migraines. Who is qualified to give BOTOX Cosmetic injections? The manufacturer of BOTOX Cosmetic recommends that injections only be given by a doctor who has experience with BOTOX Cosmetic, and has a "medical practice that focuses on facial aesthetics and offers other facial aesthetic treatments." What are the possible side effects of BOTOX Cosmetic? Side effects of BOTOX Cosmetic are usually mild and temporary. Possible injection-site side effects include pain, infection, inflammation, tenderness, swelling, redness, bleeding and bruising. What are the possible cosmetic side effects of BOTOX Cosmetic? Depending on where they are given, cosmetic side effects of BOTOX injections include eyelid drooping and swelling.

RADIESSE® Volumizing Filler RADIESSE® volumizing filler is a synthetic injectable filler that has been U.S. Food and Drug Administration (FDA)-approved for reducing moderate-to-severe wrinkles, folds and creases around the nose and mouth by augmenting the skin's natural collagen supply. It is a safe, effective and long-lasting alternative to injectable collagen and other dermal fillers for smoothing wrinkles and adding facial volume and contour. RADIESSE filler is composed of microspheres in a water-based gel; the microspheres are made of a substance called calcium hydroxylapatite, which stimulates the production of collagen. When injected into lines and wrinkles, the additional collagen that is produced smooths out the lines and wrinkles, and adds volume to the skin. RADIESSE Volumizing Filler Applications RADIESSE volumizing filler can be used on various areas of the face and body. In addition to correcting scars that leave depressions, it is effective in improving the look of the following: Nasolabial folds (run from corners of nose to corners of mouth) Marionette lines (run downward from corners of mouth) Downturned corners of the mouth Jowl pre-sagging Chin wrinkles RADIESSE filler has also been approved by the FDA to restore and correct the signs of lipoatrophy (loss of fat beneath the skin) in patients with the human immunodeficiency virus (HIV). RADIESSE Volumizing Filler Procedure Before a patient is given RADIESSE filler, the treatment area is cleaned. RADIESSE injections are then made with a fine needle, and typically take only 15 minutes to perform. There is little-to-no downtime; many patients return to their normal activities right away. RADIESSE volumizing filler is also FDA-approved for mixing with the anesthetic lidocaine, which makes the injections less painful. Typically, only 1 or 2 treatments are needed to achieve the full benefits of RADIESSE volumizing filler. RADIESSE Volumizing Filler Results Results are visible immediately after injection, and sometimes last up to a year. Because results are temporary, treatments must be repeated to sustain them. Touch-up treatments may prolong the effects of RADIESSE filler. RADIESSE Volumizing Filler Side Effects Side effects of RADIESSE filler are usually not serious, and go away on their own. They occur at the injection site, and include the following: Mild irritation Swelling Itching Redness Bruising Tenderness Allergy testing is not necessary before treatment because the calcium hydroxylapatite microspheres in RADIESSE filler are similar to minerals that occur naturally in the body.