Bioidentical Hormone Replacement Therapy
Physician-supervised hormone management based on your bloodwork, not guesswork
BHRT uses hormones that are molecularly identical to those your body naturally produces — distinct from synthetic conjugated equine estrogens used in conventional HRT. At RAAC Richmond, Dr. Charles Jiang (CPSBC) prescribes and monitors every BHRT plan. Compounded doses are individualized to your baseline hormone panel, then titrated over 3–6 months to find your optimal therapeutic range. This is prescription medical care, not a wellness supplement.
Physician-Supervised Hormone Management
BHRT at RAAC Richmond begins with a comprehensive hormone panel and symptom assessment. Dr. Jiang prescribes individualized compounded hormones sourced from Health Canada licensed compounding pharmacies. The initial titration phase runs 3–6 months; once stable, patients transition to quarterly monitoring visits with repeat bloodwork. Clinical evidence for BHRT varies by indication and hormone type — Dr. Jiang discusses realistic expectations, known risks, and the current evidence base at your consultation.
BHRT is designed to support hormone optimization through individualized assessment, prescription compounding, and physician-monitored treatment. The goal is meaningful symptom improvement within a framework of ongoing safety monitoring — not a cure for aging or a guarantee of any specific outcome.
Individualized Starting Dose
Your baseline estradiol, progesterone, testosterone, cortisol, DHEA-S, and thyroid panel determines the initial compounded dose. Clinical evidence varies — Dr. Jiang will discuss what is and is not supported for your specific presentation.
Health Canada Licensed Compounding
All compounded BHRT preparations are sourced exclusively from Health Canada licensed compounding pharmacies, ensuring pharmaceutical-grade purity, potency, and sterility standards.
Structured Titration Protocol
The 3–6 month titration phase identifies your lowest effective dose. Quarterly monitoring blood draws thereafter allow Dr. Jiang to adjust or discontinue treatment as clinical needs change.
Individually Compounded Bioidentical Hormones
Unlike mass-produced pharmaceutical HRT in fixed doses, BHRT is compounded to match your bloodwork-derived targets. Health Canada licensed compounding pharmacies produce each preparation under regulated quality controls. Dr. Jiang selects the delivery method that best fits your physiology and lifestyle — accounting for differences in absorption, first-pass metabolism, and VTE risk across routes.
Transdermal Cream
Topical estradiol and progesterone creams bypass hepatic first-pass metabolism, which may support a more favorable VTE risk profile compared to oral estrogen — particularly relevant for patients with cardiovascular risk factors.
Sublingual and Oral
Sublingual formulations offer rapid absorption and are useful for certain hormone types. Oral progesterone (micronized) has an established evidence base for perimenopausal symptom management.
Pellet Implants
Subcutaneous pellets provide sustained hormone release over 3–6 months. Dose cannot be easily adjusted once implanted — Dr. Jiang discusses this trade-off during consultation.
Quarterly Lab Monitoring
Regular serum hormone levels, lipid panels, and symptom reviews ensure that doses remain in the therapeutic range and are adjusted as your physiology changes over time.
Who May Benefit from BHRT
Suitability for BHRT depends on your symptom profile, medical history, and baseline lab results. Dr. Jiang reviews all of these at consultation — BHRT is not appropriate for everyone, and honest candidacy assessment is a core part of care at RAAC.
Patients Who May Be Appropriate Candidates
- +Women in perimenopause or menopause with significant hot flashes, night sweats, sleep disruption, or mood changes affecting quality of life
- +Men with confirmed low testosterone (andropause) by bloodwork, with symptoms including fatigue, loss of muscle mass, or reduced libido
- +Individuals with documented hormone deficiencies affecting daily function — confirmed on lab testing, not symptom alone
- +Women requiring pre-initiation screening: mammogram, Pap smear, and pelvic exam are recommended before starting estrogen therapy
- +Patients seeking an individualized, physician-monitored approach rather than mass-produced fixed-dose pharmaceutical HRT
Contraindications — BHRT Is Not Recommended If You Have
- –Personal history of hormone-sensitive cancer — breast, uterine, or prostate cancer — or current diagnosis under active oncology management
- –Active or history of venous thromboembolism (VTE), deep vein thrombosis, or pulmonary embolism (especially relevant with oral estrogen)
- –Undiagnosed abnormal vaginal bleeding — must be evaluated and explained before any estrogen therapy is initiated
- –Current pregnancy or breastfeeding
- –Severe or decompensated liver disease, or severe uncontrolled hypertension and active cardiovascular disease — these require a detailed risk-benefit discussion with Dr. Jiang before any hormone prescription can be considered
Physician-Led, Evidence-Informed Care
BHRT at RAAC Richmond is structured as medical management — not a wellness service. Dr. Jiang's approach combines comprehensive lab interpretation, individualized compounding prescriptions, and the ongoing physician relationship that safe hormone therapy requires.
Dr. Charles Jiang — CPSBC Prescribing Physician
Dr. Jiang is RAAC's Medical Director and the prescribing physician for all BHRT at the clinic. His role extends beyond ordering labs — he interprets hormone panels in clinical context, selects delivery routes appropriate to your risk profile, and remains your physician throughout the treatment relationship.
Comprehensive Initial Hormone Panel
Initial bloodwork includes estradiol, progesterone, total and free testosterone, DHEA-S, cortisol (AM), TSH, free T3, and free T4. This full picture allows Dr. Jiang to identify which hormones are clinically low, which are within range, and which require context before supplementation.
Health Canada Licensed Compounding Pharmacies
Compounded BHRT preparations are sourced from Health Canada licensed pharmacies, not unregulated supplement suppliers. Pharmaceutical-grade quality control governs potency, sterility, and consistency of every compounded formulation dispensed to RAAC patients.
Mandarin and Cantonese Services
RAAC Richmond serves the Richmond and greater Vancouver Chinese-speaking community. Dr. Jiang and the clinical team provide consultations and lab result explanations in English, Mandarin, and Cantonese — so language is not a barrier to understanding your care.
Conditions BHRT May Help Manage
BHRT may support symptom management across several hormonal conditions. Clinical evidence varies by indication — Dr. Jiang discusses the current evidence base and realistic expectations at your consultation. The following represent common indications, not guaranteed outcomes.
Perimenopausal and Menopausal Symptoms
Hot flashes, night sweats, sleep disruption, mood instability, and vaginal atrophy associated with declining estradiol and progesterone. The most evidence-supported indication for BHRT in women.
Andropause (Male Hormone Decline)
Confirmed low testosterone in men may contribute to fatigue, reduced muscle mass, mood changes, and decreased libido. BHRT with bioidentical testosterone requires baseline lab confirmation and ongoing PSA monitoring.
Bone Density Preservation
Estrogen plays a role in maintaining bone mineral density. BHRT may support bone health as part of a broader osteoporosis prevention strategy — alongside calcium, vitamin D, and resistance exercise.
Sleep and Cognitive Symptoms
Some patients report improved sleep quality and reduced brain fog during hormonal transitions. Clinical evidence for cognitive benefits is mixed — Dr. Jiang will discuss what the data does and does not support.
Adrenal and Thyroid Optimization
The initial panel includes cortisol and a full thyroid assessment (TSH, free T3, free T4). Sub-optimal thyroid function is a common contributor to fatigue and mood changes — and is managed separately from sex hormone supplementation when indicated.
Body Composition and Metabolic Health
Hormonal imbalances may contribute to weight changes and reduced muscle mass. BHRT may support metabolic function when hormone levels are confirmed to be below therapeutic range — results vary and are not guaranteed.
Your BHRT Treatment Journey
BHRT at RAAC follows a structured medical protocol: comprehensive baseline assessment, bloodwork-informed compounding, 3–6 month titration, and then quarterly monitoring. Every stage involves Dr. Jiang's clinical judgment — this is ongoing physician-patient care.
Step 1 — Baseline Assessment
Detailed medical history: symptom timeline, personal and family cancer history, cardiovascular history, current medications and supplements
Comprehensive hormone panel bloodwork: estradiol, progesterone, total and free testosterone, DHEA-S, cortisol (AM), TSH, free T3, free T4
Women initiating estrogen therapy: mammogram, Pap smear, and pelvic exam recommended before treatment start
Review of contraindications: history of hormone-sensitive cancer, VTE, undiagnosed vaginal bleeding, pregnancy, severe liver disease
Discussion of realistic expectations — what the clinical evidence supports and does not support for your specific presentation
Step 2 — Initiation and Titration
Panel Review with Dr. Jiang
Dr. Jiang reviews all bloodwork in clinical context — not just which values are below reference range, but which are clinically significant given your symptoms, age, and medical history.
Compounding Prescription
Dr. Jiang writes the compounding prescription specifying hormone type, dose, delivery route, and base. The preparation is compounded at a Health Canada licensed pharmacy to pharmaceutical-grade standards.
Start at Lowest Effective Dose
Treatment begins at the lowest dose expected to produce therapeutic benefit. Starting low and titrating gradually reduces the risk of supraphysiologic hormone levels and associated side effects.
3–6 Month Titration Phase
Follow-up bloodwork at 6–8 weeks assesses initial response. Dose is adjusted incrementally based on labs and symptom reporting until the optimal therapeutic window is identified.
Step 3 — Ongoing Monitoring
Quarterly bloodwork once stable: serum hormone levels, lipid panel, and other markers relevant to your risk profile
Annual women's health screening: mammogram and pelvic exam maintained throughout treatment
Symptom and quality-of-life tracking at each visit — dose is adjusted or therapy is reconsidered if clinical benefit is not maintained
Periodic reassessment of treatment rationale — BHRT duration is not open-ended; Dr. Jiang reviews whether continuation is appropriate at each annual visit
Lifestyle support: nutrition, resistance training, sleep hygiene, and stress management discussed as complementary contributors to hormonal health
*Individual results vary significantly. BHRT requires ongoing physician supervision and monitoring. Clinical evidence for specific outcomes varies by indication and hormone type — Dr. Jiang discusses realistic expectations at consultation.
Frequently Asked Questions
How long does it take to feel results from BHRT?+
Some patients notice improvements in sleep quality and hot flash frequency within 2–4 weeks of reaching therapeutic hormone levels. More comprehensive changes — mood stability, energy, cognitive clarity, body composition — typically develop over 3–6 months as the titration phase refines your dose. Individual response varies considerably, and no specific outcome is guaranteed. Dr. Jiang sets realistic expectations at your initial consultation based on your specific presentation.
Are bioidentical hormones safer than synthetic hormones?+
Bioidentical hormones share the molecular structure of endogenous hormones, which supports more physiologically congruent receptor binding and metabolism compared to synthetic alternatives like conjugated equine estrogens (Premarin). However, 'bioidentical' does not mean risk-free — BHRT carries real risks including VTE (particularly with oral estrogen), breast tissue changes with long-term estrogen use, and the general risks associated with any hormone supplementation. The safety profile depends on dose, delivery route, duration, and your individual medical history. Dr. Jiang discusses the evidence and your personal risk profile at consultation.
What does the initial hormone bloodwork include?+
The comprehensive baseline panel at RAAC includes: estradiol (E2), progesterone, total testosterone, free testosterone, DHEA-S, cortisol (AM), TSH, free T3, and free T4. Additional markers (LH, FSH, SHBG, CBC, metabolic panel) may be ordered depending on your clinical picture. This full panel allows Dr. Jiang to identify clinically relevant deficiencies and avoid supplementing hormones that are already within range.
Who should NOT start BHRT?+
BHRT is contraindicated or requires careful risk-benefit discussion if you have: a personal history of hormone-sensitive cancer (breast, uterine, or prostate), active or prior venous thromboembolism (DVT or pulmonary embolism), undiagnosed vaginal bleeding, current pregnancy or breastfeeding, or severe liver disease. These are not merely precautions — some represent absolute contraindications. Dr. Jiang will review your complete medical history before any prescription is written.
How often do I need blood tests during BHRT?+
Initial bloodwork is drawn before treatment starts. Follow-up labs are typically run at 6–8 weeks into titration to assess early response, then at 3–6 months to confirm stable therapeutic levels. Once stabilized, quarterly monitoring bloodwork is standard. Women also maintain annual mammograms and pelvic exams throughout treatment. Frequency may increase if dose adjustments are made or if any symptoms of concern arise.
How long do I need to stay on BHRT?+
There is no universal answer. Some patients use BHRT for 2–3 years to manage the most symptomatic phase of perimenopause, then taper off. Others continue longer-term under quarterly monitoring — particularly for bone density preservation and quality-of-life maintenance. Dr. Jiang reassesses the ongoing rationale for treatment at each annual visit. BHRT is not intended as a permanent open-ended prescription — continuation requires ongoing clinical justification.
Start with a Comprehensive Hormone Assessment
BHRT at RAAC Richmond begins with bloodwork, not assumptions. Book a consultation with Dr. Charles Jiang to review your hormone panel, discuss your symptoms in clinical context, and determine whether BHRT is appropriate for you. Mandarin and Cantonese consultations available.
Also offered at our Burnaby location
SkinArt MD offers the same treatment. If Burnaby is more convenient, our sister clinic can help.
#101 - 4378 Beresford St, Burnaby, BC V5H 0H6 · +1 (604) 639-2581