Hormone replacement therapy treats symptoms of hormonal decline, such as fatigue, poor sleep, low libido or hot flashes, once blood tests confirm an imbalance.
Hormonal decline is not a disease — it's a natural part of aging. But "natural" doesn't mean you have to suffer through it. Fatigue, brain fog, weight gain, low libido, poor sleep, mood swings, and muscle loss are not inevitable consequences of getting older. They're symptoms of hormonal imbalance — and they're treatable.
What happens to hormones as you age?
In women, estrogen, progesterone, testosterone and DHEA change through perimenopause and menopause, while in men testosterone gradually declines after its peak; these shifts can contribute to symptoms such as hot flashes, poor sleep, low energy and reduced libido.
For Women: Perimenopause and Menopause
Hormonal changes begin years before menopause (the "perimenopause" transition, typically ages 40-55):
- Estrogen fluctuates wildly before declining — causing hot flashes, night sweats, mood changes, vaginal dryness, and bone density loss
- Progesterone drops first, often causing anxiety, insomnia, and irregular cycles
- Testosterone (yes, women have it too) decreases gradually — affecting energy, libido, and muscle tone
- DHEA declines steadily from the late 20s onward — impacting immune function and vitality
For Men: Andropause ("Male Menopause")
Testosterone levels in men peak in the late 20s and decline approximately 1-2% per year after age 30. By 50, many men are significantly below optimal levels:
- Total and free testosterone drop — causing fatigue, reduced motivation, erectile dysfunction, and muscle loss
- SHBG (sex hormone-binding globulin) increases — further reducing bioavailable testosterone
- Estrogen may rise relative to testosterone — contributing to weight gain (especially abdominal) and mood changes
- DHEA and pregnenolone decline — affecting cognitive function and stress resilience
What Is Bioidentical Hormone Replacement Therapy (BHRT)?
Bioidentical hormones are molecularly identical to the hormones your body naturally produces. Unlike synthetic hormones (used in older HRT protocols), bioidentical hormones fit your body's receptors precisely, resulting in:
- Fewer side effects than synthetic alternatives
- More predictable metabolism — your body processes them through natural pathways
Which hormones does BHRT for women address?
BHRT for women usually focuses on estradiol, progesterone, low-dose testosterone and sometimes DHEA, chosen and dosed according to symptoms and bloodwork, with topical forms often preferred for estrogen.
Core Hormones We Optimize
Estradiol (E2) The primary estrogen.
Progesterone It's fundamentally different from synthetic progestins like medroxyprogesterone.
Testosterone It's an often-overlooked but critically important hormone for women's wellbeing.
DHEA The "mother hormone" — a precursor to both estrogen and testosterone. Supplementation can support immune function, bone density, and skin health.
Benefits Women Typically Experience
- Resolution of hot flashes and night sweats (often within 2-4 weeks)
- Improved sleep quality and duration
- Restored libido and sexual comfort
- Better mood stability and reduced anxiety
- Enhanced cognitive clarity ("brain fog" lifts)
- Improved bone density (reducing osteoporosis risk)
- Better skin elasticity and hydration
- Easier weight management
When is testosterone replacement therapy appropriate for men?
TRT is considered only when a man has both symptoms of low testosterone and repeated blood tests confirming low levels, and other causes such as thyroid problems, sleep apnea, stress or medications are checked first.
When Is TRT Appropriate?
TRT is considered when a man has both:
- Symptoms of low testosterone (fatigue, low libido, erectile dysfunction, cognitive decline, depression, muscle loss, increased body fat)
- Laboratory confirmation — total testosterone consistently below 10-12 nmol/L, or free testosterone below the age-adjusted reference range
TRT Delivery Methods
| Method | Pros | Cons |
|---|---|---|
| Topical gel/cream | Steady daily levels, easy to adjust | Daily application, transfer risk |
At RAAC, Dr. Jiang selects the delivery method based on patient preference, lifestyle, and how their body metabolizes testosterone (monitored through regular bloodwork).
Benefits Men Typically Experience on TRT
- Increased energy and reduced fatigue (often within 2-3 weeks)
- Improved libido and sexual function (4-8 weeks)
- Better mood, motivation, and cognitive clarity
- Increased lean muscle mass and strength (with exercise)
- Reduced abdominal fat over time
- Improved bone density
- Better sleep quality
- Enhanced cardiovascular markers (when properly monitored)
TRT Safety and Monitoring
Responsible TRT requires ongoing monitoring. At RAAC, we check:
- Total and free testosterone — ensuring therapeutic but not supraphysiological levels
- Estradiol — testosterone can convert to estrogen via aromatase; we manage this
- Hematocrit/hemoglobin — testosterone stimulates red blood cell production; too-high levels need management
- PSA — prostate-specific antigen monitoring for prostate health
- Lipid panel — cardiovascular risk management
- Liver and kidney function — general health markers
Blood work is typically done at 6-8 weeks after starting, then every 3-6 months ongoing.
How does RAAC approach hormone therapy?
The process starts with a detailed history and an extensive blood panel, looks for root causes such as sleep, stress and nutritional gaps before prescribing, and then adjusts an individual protocol with ongoing monitoring.
Dr. Jiang's philosophy goes beyond simply prescribing hormones:
1. Comprehensive Assessment
- Detailed symptom questionnaire and medical history
- Extensive blood panel (not just testosterone or estrogen — we test 30+ markers)
- Assessment of thyroid function, adrenal health, metabolic markers, and inflammation
2. Root-Cause Investigation
Before prescribing hormones, we look at:
- Sleep quality and potential sleep apnea
- Stress and cortisol patterns
- Nutritional deficiencies (vitamin D, B12, iron, zinc, magnesium)
- Gut health and inflammation markers
- Medication effects
3. Individualized Protocol
- Nutritional support guided by your bloodwork
- Lifestyle optimization guidance (exercise, nutrition, sleep hygiene, stress management)
4. Ongoing Optimization
- Regular follow-up bloodwork and symptom check-ins
- Dose adjustments based on how YOU respond (not textbook averages)
- Long-term health monitoring and prevention
Is hormone replacement therapy safe?
Risk depends on the hormones, dose, delivery route and your health history; this section explains how modern transdermal bioidentical protocols differ from the older WHI regimen and why monitoring, such as PSA testing for men, is standard.
"Isn't HRT dangerous? What about the WHI study?" The Women's Health Initiative (2002) used synthetic hormones (conjugated equine estrogens plus a synthetic progestin) in older women. Modern BHRT uses bioidentical hormones, started earlier, with transdermal delivery — a fundamentally different risk profile. Multiple subsequent studies support the safety of properly managed BHRT.
"Will TRT cause prostate cancer?" Current evidence does NOT support the outdated belief that TRT causes prostate cancer. However, TRT is contraindicated in men with active prostate cancer. PSA monitoring is standard practice.
"Will I become dependent on hormones?" Your body is already "dependent" on hormones — that's biology. If you stop HRT, your symptoms will return because your body's natural production has declined. This isn't addiction; it's supplementing what your body no longer adequately produces.
"Can't I just use supplements instead?" Some supplements support hormonal health (vitamin D, zinc, ashwagandha), but they cannot replace hormones when levels are clinically low. Think of it like insulin for a diabetic — lifestyle helps, but sometimes you need the actual hormone.
How much does hormone therapy cost in Richmond?
Costs for the initial bloodwork, consultation and ongoing prescriptions are discussed at your consultation rather than published, and follow-up blood tests are usually recommended every few months to adjust treatment.
The cost of initial bloodwork, the consultation and any ongoing prescription is explained at your consultation. Follow-up bloodwork is recommended every 3-6 months.
How do you get started with hormone therapy?
- Book a consultation with Dr. Jiang at RAAC Richmond
- Complete our detailed health intake questionnaire
- Get comprehensive bloodwork (we'll provide the requisition)
- Review results together and design your personalized protocol
- Begin treatment with close follow-up monitoring
The entire process from first visit to starting treatment typically takes 2-3 weeks, allowing time for thorough lab work and thoughtful protocol design.
Book Your Hormone Assessment
Tired of feeling tired? Book your consultation with Dr. Charles Jiang at RAAC Richmond. Let's find out what your hormones are actually doing — and optimize them for how you want to feel.
Dr. Charles Jiang, MD — 29+ years of medical expertise. RAAC Richmond Anti-Aging Clinic: 5580 No. 3 Rd Unit 110, Richmond BC V6X 0R8. Serving Richmond, Vancouver, Burnaby, Surrey, and Metro Vancouver.
