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BHRT Hormonal Acne

Acne is a common skin condition that affects people of all ages and can have multiple etiologies.It is characterized by pimples, blackheads, whiteheads, and cysts that can appear on the face, neck, chest, and back. Acne is caused by an overproduction of oil in the skin, combined with the buildup of dead skin cells and bacteria. Treatment options include topical and oral medications, as well as lifestyle changes such as a healthy diet and stress reduction.

Androgen Receptor Blockers

  • Spironolactone 100 mg oral tablet (Dispense: 30)

Topicals (retinoids) Speed up cell turnover making blockage of the pores less frequent

  • Clindamycin 2%/Benzoyl Peroxide 5%/ Niacinamide 3%

  • Clindamycin 2% Tretinoin 0.05% Niacinamide 3%

  • Clindamycin 1.2%/ Benzoyl Peroxide 3.75%

Mix with CeraVE PM moisturizer over the counter if too drying

Androgen Receptor Inhibitor: Reserve for patients in whom initial topical therapies fail; for moderate to severe acne, may be used as part of an appropriate combination regimen.Clascoterone is an androgen receptor inhibitor that decreases sebum production and inflammation.

  • Clascoterone (Winlevi) cream-Apply thin layer to affected areas of skin twice daily 

Oral Abx: Tetracycline

  • Seysara

Sunscreen:  Use mineral/physical sunscreen daily with titanium and zinc oxide

We love Alastin’s sunscreen


Zinc Oxide - 19.95%Mineral UVA/UVB protectant.

TriHex Technology®Works with the skin to clear out damaged elastin and collagen and support the skin’s natural ability to produce new, healthy elastin and collagen.

EctoinHelps provide protection from blue light and can repair existing sun damage within the skin.

• OTC washes include ingredients with salicylic acid, benzoyl peroxide, ZO skin care line is a home run for your acne prone patients on pellets


  • Watch high glycemic index foods like rice, white bread, potatoes, chips- Consider IR nutraceuticals to help with PCOS type symptoms 2/2 high Testosterone

Skin Care:

  • Hydrafacials (Given testosterone effects of increasing pore size)

  • Dermaplaning (For Hirsutism) 

  • Chemical Peels


EstroDIM® is a targeted supplement that combines the synergistic benefits of the cruciferous vegetable metabolites indole-3-carbinol (I3C) and 3-3’-diindolylmethane (DIM) to support balanced estrogen metabolism.

Clinical Applications

  • Supports Estrogen Balance

  • Supports Proper Estrogen Metabolism for Women and Men

  • Improves Estrogen Detoxification Pathways

  • Provides Cellular Antioxidant Support for DNA Stability

Hormones (especially estrogen) are critically important in human development and tissue repair. However, estrogen’s proliferative effects must be balanced and controlled for optimal health. Therefore, to ensure proper hormonal balance, estrogen synthesis and detoxification should be supported. Estrogen has several downstream metabolites, of which some are beneficial while others possess potentially harmful biological activity. By keeping hormones in balance and ensuring the body can process estrogen properly, cruciferous vegetable metabolites (i.e., I3C and DIM) work together to maintain cellular health.

EstroDIM® is a targeted supplement that combines the synergistic benefits of the cruciferous vegetable metabolites indole-3-carbinol (I3C) and 3-3’-diindolylmethane (DIM) to support balanced estrogen metabolism. Formulating I3C and DIM together creates the ideal combination of beneficial metabolites that work together to support estrogen balance, breast and prostate health.


Cosmedix provides vitamins, minerals and phytonutrients to help maintain healthy hair and nails.

Clinical Applications

  • Provides Key Nutrients For Skin, Hair and Nails

  • Enhances Collagen Formation

  • Thickens and Strengthens Hair and Nails

  • Promotes Hormone

BalanceHealthy skin, hair and nails result from a variety of biological factors, including balanced nutrition and a healthy lifestyle. Collagen, the body’s main structural protein, makes up 70% of the skin and is vital in helping to maintain the skin’s firmness, suppleness and elasticity, as well as the constant renewal of skin cells. Research has shown collagen production begins to decrease around the age of 18 and continues to decline at a rate of about 1% per year after age 40. After menopause, skin thickness may decrease at a rate of about 1-2% annually.

Cosmedix provides several essential vitamins, minerals and phytonutrients needed to support healthy skin, hair and nails. Cosmedix provides betaine HCl, which helps to promote efficient digestion and assimilation of proteins and minerals necessary for hair and nail health. It includes MSM, which provides a bioavailable source of sulfur, for connective tissue integrity. Saw palmetto is added to support normal levels of DHT, known to play a role in the thickness and health of hair. In addition, silica (from horsetail grass extract) is included for its collagen-enhancing properties. Each serving of Cosmedix contains 100 mg betaine HCl, 320 mg of saw palmetto and 325 mg MSM. Added support from vitamin A, vitamin D3, folic acid, vitamin B12, biotin and selenium provide a full spectrum of skin, hair and nail support.


Ortho Biotic® includes a carefully assembled cast of probiotic organisms to support microflora balance and maintain a healthy environment for vitamin uptake and optimal immune function.

Clinical Applications

  • Helps Maintain Gastrointestinal Balance

  • Increases Secretory IgA for Enhanced Gut Immunity

  • Supports Bowel Regularity

  • Supports Digestion and Micronutrient Absorption

The GI tract is a finely balanced environment where roughly 500 different strains of bacteria compete for space and nutrients. When there is a healthy balance (eubiosis), few symptoms exist. However, dysbiosis can occur when an overabundance of potentially harmful organisms prevail. The natural microflora balance can be upset by medications (such as antibiotics, oral contraceptives, etc.), excessive alcohol consumption, or poor dietary intake.

Because probiotics are live organisms, there are many challenges associated with manufacturing and distributing probiotic supplements. For a probiotic to be effective, it must be shelf-stable through the expiration date and precisely delivered to the intestinal tract, where it can have maximum benefit. BioShield® technology is an innovative manufacturing process developed to ensure consistent and reliable results. The microorganisms in Ortho Biotic are protected, sealed and freeze dried away from moisture, heat, light and oxygen. This allows the bacteria to remain dormant until they are exposed to moisture in the GI tract. By utilizing advanced encapsulation technology, the probiotic organisms are preserved and released on-target for maximum benefit.

Ortho Biotic® is a unique probiotic formula designed to deliver active organisms shown to promote healthy gut microflora, protect intestinal integrity and boost immune function. Included in this formula is Saccharomyces boulardii, an extensively researched microorganism shown to help restore microflora balance by enhancing commensal organism function. Each Ortho Biotic® capsule provides seven proven probiotic strains chosen for their ability to withstand the harsh gastrointestinal environment and adhere to the intestinal tract to deliver superior results.

Orthomega 820:

  • Maintains Normal Inflammatory Balance

  • High-Intensity Support for Establishing a Positive Mental Outlook

  • Targeted Support for Joint Comfort and Musculoskeletal Integrity

  • Maintains Healthy Cardiovascular Function and Blood Sugar Balance Already Within Normal Levels

Orthomega® 820 is a powerful omega-3 concentrate that supports positive mental outlook, inflammatory balance, cardiovascular health and blood sugar balance already within normal levels. It also provides high-intensity support for joint comfort and musculoskeletal integrity.

Clinical Applications

  • Maintains Normal Inflammatory Balance

  • High-Intensity Support for Establishing a Positive Mental Outlook

  • Targeted Support for Joint Comfort and Musculoskeletal Integrity

  • Maintains Healthy Cardiovascular Function and Blood Sugar Balance Already Within Normal Levels

Orthomega® Select EPA is a high-concentration eicosapentaenoic acid (EPA) fish oil designed for those needing intensive nutritional support of this essential fat. Research shows that EPA promotes a positive mental outlook and has a significant calming effect on the brain. In addition, EPA has been shown to improve joint mobility and support cardiovascular health. Orthomega® Select EPA is sourced from off the Chilean coast, where cold, fresh waters provide the cleanest, most sustainable source of fish in the world. Each soft gel delivers 660 mg EPA in the natural triglyceride form for superior absorption.

While EPA/DHA combination formulas remain the backbone of any fish oil regimen, as research on fish oil continues to accumulate, new evidence has emerged supporting the value of unique formulations of high-intensity EPA for more targeted uses. Fatty acids in the n-3 family are considered essential to humans because our bodies are unable to make them; in humans, conversion of alpha linolenic acid to EPA is slow, making supplementation necessary. EPA also boosts cognitive health and is an essential part of the structural integrity of the central nervous system making it a key component of neurological wellness. With over 10,000 published studies on fish oil in the last three decades, EPA and DHA from fish oil is among the most researched natural ingredients available and has a long history of safety and efficacy.

Vitamin D3 50,000 IU:

In addition to supporting bone health, vitamin D plays an important role maintaining cardiovascular health and immune function, and promoting an overall sense of well-being.

Clinical Applications

  • Maintains Bone and Dental Health

  • Increases Calcium Absorption and Balance

  • Boosts Immune Activity

  • Supports Cardiometabolic Health, Blood Sugar Balance Already Within Normal Levels, and Weight Loss

  • Helps Increase Musculoskeletal Strength and Comfort

Vitamin D is a steroid hormone that is part of a group of fat-soluble pro-hormones best known for the role they play in supporting bone health and aiding in the absorption of calcium and phosphate from the gastrointestinal tract. A growing body of research highlights vitamin D's important role in supporting other body systems, including cardiovascular and blood sugar balance, musculoskeletal strength, and neurological and immune function, enabled by vitamin D's ability to target over 200 different genes throughout the body.

Vitamin D3 50,000 IU is ideal for those who have difficulty achieving and maintaining peak vitamin D levels. For those who require an immediate boost in their vitamin D status, the vitamin D3 50,000 IU formulation is a convenient, effective way to get the substantial support they need.


Treatment 101:

Topical retinoid/tretinoin: which is a type of vitamin A derivative that can help unclog pores and reduce inflammation. 

*Tretinoin can increase sun sensitivity, it is important to use proper sun protection. 

Benzoyl peroxide cream or gel to help kill bacteria and reduce inflammation. It can bleach clothes/pillow cases!

Antibiotics to improve any associated bacterial infection. 

Topical Moisturizer: We recommend using a non-comedogenic, oil-free moisturizer to prevent dryness and irritation caused by the use of topical acne medications.

Gentle Cleanser: We recommend a gentle, non-comedogenic cleanser to be used twice daily to help remove excess oil and debris from the skin.

Avoid Picking or Squeezing Lesions: It is very important to avoiding picking or squeezing acne lesions, which can worsen inflammation and lead to scarring.

Sun Protection: It is important to use sun protection; we recommend a broad-spectrum sunscreen with an SPF of at least 30 to be applied daily.

Lifestyle modifications: Avoid touching your face, picking at acne, avoid using oily cosmetics, and  cleanse your face twice daily with a gentle cleanser.

Follow-up: Schedule a follow-up appointment as needed to evaluate the response to treatment and to make any necessary adjustments.


Effect of the lipidic lipidosterolic extract of Serenoa repens (Permixon) on the ionophore A23187-stimulated production of leukotriene B4 (LTB4) from human polymorphonuclear neutrophils

Saw Palmetto† Saw palmetto (Serenoa repens or Sabal serrulata) has been used historically to support hormone health, as it provides essential fatty acids and phytosterols. Studies have shown saw palmetto promotes hormonal balance via several mechanisms. An in vitro study found saw palmetto inhibits 5-α-reductase, an enzyme that converts testosterone to 5α-dihydrotestosterone (DHT).6 Excessive levels of DHT have been implicated in hair loss issues. A randomized, doubleblind, placebo-controlled trial in adult men with mild to moderate androgenic alopecia (N = 26, 23 -64 years), found oral supplementation with 200 mg saw palmetto plus an CLINICAL APPLICATIONS WOMEN’S HEALTH † These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. extra 50 mg β-sitosterol (a constituent fatty acid of saw palmetto), twice daily, over 25 weeks improved investigator assessed hair density in 60% of subjects versus 11% with placebo.7 Saw palmetto also helps maintain hormonal balance by inhibiting the binding of androgens to receptors8 and promotes inflammatory balance by antagonizing the cyclooxygenase and lipoxygenase inflammatory pathways in vitro. 9,10 Both of these factors are crucial for maintaining healthy skin.

Aromatase and regulation of the estrogen-to-androgen ratio in synovial tissue inflammation: common pathway in both sexes

A hormone involved in aromatase activity is vitamin D, which downregulates aromatase in human RA macrophages. Collectively, evidence suggests a key role of aromatase in sex hormone balance during chronic inflammation and points to the importance of vitamin D as a possible new tool for aromatase modulation.

Butawan M, Benjamin RL, Bloomer RJ. Methylsulfonylmethane: Applications and Safety of a Novel Dietary Supplement. Nutrients. 2017;9(3).

Omega-3 Fatty Acids for Major Depressive Disorder With High Inflammation: A Randomized Dose-Finding Clinical Trial

Conclusions: EPA 4 g/d demonstrated a medium effect size for response rates versus placebo. This dose may alleviate MDD in overweight individuals with elevated inflammatory markers, and change in hs-CRP may be correlated with clinical response.

Effect of estrogens on skin aging and the potential role of SERMs

Estrogens have significant effects on skin physiology and modulate epidermal keratinocytes, dermal fibroblasts and melanocytes, in addition to skin appendages including the hair follicle and the sebaceous gland. Importantly, skin aging can be significantly delayed by the administration of estrogen. This paper reviews the effects of estrogens on skin and the mechanisms by which estrogens can alleviate the changes due to aging that occur in human skin. The relevance of estrogen replacement therapy (HRT) in post-menopausal women and the potential value of selective estrogen receptor modulators (SERMs) as a therapy for diminishing skin aging are also highlighted.

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