To Pellet or Not to Pellet

vigorhealthandbeauty • September 18, 2023

There seems to be a giant influx of all kinds of information on social media, online and, well, everywhere in regards to hormone replacement therapy lately. As a matter of fact, in my 20 years as a PA and with 10 years in hormone replacement alone, I’ve never seen such an amount of information on the topic. Or is it misinformation?

I try to avoid the active (inactive?) scroll of social media. In the past I could waste HOURS with just going through posts, videos, etc. Obviously being a clinic owner and interacting with patients, I hear the info that's out there and will go look up what my patients ask about and holy shit… there is so much, just, stuff out there. The supplement industry alone is a multi billion dollar industry, that is before any actual medical prescription products. It’s very easy to blur the line between what is medical and what is framed as medical but in reality is slick marketing. This is where I get a little pissed. Or maybe a lot sometimes. 
I’m going to talk about HRT or BHRT pellets. I'm not railing against them. I’m not bashing them. My issue is how they seem to be frequently marketed. I’ll start by breaking down some of the terminology. “Bio-identical” is a common phrase used in marketing for pellets and it sounds great right? Identical to what your body makes is the implication. It can’t be unsafe if it’s identical, right? Know what else is “bioidentical”? Any hormone given to a patient that engages that hormone receptor and replicates the action that your body's natural hormone does. 

As you can see in the picture above, upper Left is your body's testosterone molecule. The other images are the various synthetic testosterone molecules. Are any of those “identical”? None. But they exert the same influence in the body in varying degrees of length of action. The next term that is used (and over-used) frequently in the marketing of pellets among other things is “natural”. Natural meaning from nature or not man made/synthetic. Pellets are frequently called natural as they are usually derived from a so-called natural source. The one that comes readily to mind is made from yams. Sounds great! How can it be bad for me if it's from yams? Who doesn't love yams (well, me. Is it a potato? A fruit? A vegetable? Why is it made sweet then sometimes not? Plus I think they taste gross). But is the implication that they just squeeze the living shit out of a yam and testosterone just drips out? Not unlike prescription testosterone, it’s MADE IN A LAB. 


“Yams are natural substances that are put through a chemical synthesis in a laboratory setting to derive the end product of testosterone”. It is also important to note that many of the pharmaceutical forms of hormones are BIOIDENTICAL. For example micronized progesterone, and a variety of estrogen formulations (Billingsly, 2022). Therefore, at Vigor we too are offering bioidentical therapy in the form of FDA approved medication. We do not market it as such, but we provide what is the best option for each individual person.  The only natural form of testosterone is made within the body itself. These phrases are used frequently as they inspire a level of trust in the marketer. If it’s natural and identical to my body's products, there is no way it’s bad for me. Therefore it’s safer and preferable than other forms of HRT offered. 

 FALSE


As with any medical treatment, there are risks. From Tylenol all the way to open heart surgery. This isn’t lessened because the product is labeled “natural” or “bioidentical”. A growing body of research is revealing that pellets can carry MORE risk for a few reasons. They are not regulated in production. In essence many of them are supplements therefore the dosing per pellet SHOULD be consistent, but is not always. 


While they can be compounded and at Vigor, we love our compound pharmacists and truly stand behind their products, this isn’t the case for all compound pharmacies. 


Once a pellet is in, if a patient were to experience side effects, there's no digging them out. Unfortunately, I’ve seen this in action And have been on the receiving end of the very upset patient with unintended side effects having to explain that while the effect will lessen as the pellets absorb and levels drop, it can be a long road of 3-6 months. 


So why am I so “anti-pellet”? Actually, I’m not. I have done pellet BHRT in a previous practice and for some patients, it’s a Godsend.  If a practice or provider offers HRT and they will ONLY offer pellet therapy or if they strongly recommend them over other types of HRT for “safety reasons” or because they are the best because they are natural, my opinion is they are likely worried more about their bottom line and less concerned with addressing the patients complaints that they came for in the first place. Let me clarify that, A round of pellets for a female patient runs from $350-$500 every 3-4 months, BEFORE any blood work costs to start the process or to check lab values as therapy proceeds or before any costs to “boost” the dose if needed due to poor response. For a male patient, think $750 to over a thousand per placement every 4-6 months. See how that could add up? Now I am not faulting anyone for offering this service. Like I said above, it can be a great treatment for some patients. But so are many other great options that cost so much less and provide the exact same (in some cases better) response the patient is seeking.


At Vigor, I tailor treatment to each individual patient's desired effects, medical history and goals. I have several treatments at my disposal to meet individual needs. I have purposefully chosen to not offer pellets at this time… again, at this time. As the bugs get worked out and more oversight is added to their production, that could change. And as with all of our services, if I decide to add that product, they will fall within our affordable pricing guidelines. We believe in being very up front and honest with our patients. We hope to under promise and over deliver. And while this is a business and we are the owners, we are also patients and want our services to be available and safe to our patients of all income levels. If pellets ever meet our standards and we can offer them at a good price, we will. Until that time, we will get you the results you’re looking for through many other treatment options. All of which are as bio identical as the next.  @Mr.T_Indy


 I couldn’t let this topic go without my two cents. I without a doubt was a pellet lover, at first. I say at first because, there is nothing better than having an improved self. I stood tall on my soapbox, testosterone makes women feel better, it does and it will continue to do so. I love data and I check my labs maybe more than I should. After time, I recognized that my testosterone level was getting very high for part of the 3 to 4 month cycle, and then as that level would decline I would start feeling like crap again. According to many of the promises offered by bioidentical companies, my body should have maintained an acceptable level for an extended period of time, but that is not what occurred. I would go way up and then way down, and the majority of the time I was most likely dosed way too high for a woman. I was still on a roller coaster that I had intended on getting off of. Since switching to subcutaneous testosterone injection, which I control weekly, my symptoms don’t return, my ass is not sore and or building up scar tissue, and I do not spend 1 month at a man's level and 2 more months on the dive downward. I also prefer to have control of my dosing so if issues arise, I can just change my next dose. What I do agree with is that subcutaneous is the best route for testosterone replacement. What I do not agree with is people going without a service that can improve quality of life due to cost or lack of access. My hope is that Vigor can continue to provide cost effective hormone replacement services for ALL people. 

@Mrs.T_Indy


Reference Billingsley, A. (2022, May 27). Bioidentical Hormone Replacement Therapy for Menopause: Safety, Uses, and Cost. GoodRX Health. Retrieved September 17, 2023, from: https://www.goodrx.com/healthcare-access/medication-education/bioidentical-hormone-therapy

Your Body is a Lamborghini

By Kristen Mattox • February 12, 2024
Your Body is a Lamborghini

NAD+

September 11, 2023
Looking for the fountain of youth? I know at our house, we are always learning about things we can do to continue to age well. In all reality, recovery is harder, fat loss is harder, and our musculoskeletal system is yelling at us frequently. NAD+ is a supplement we both use to help reduce some of the effects we have due to our active lifestyle and the effects of aging. “NAD+ can directly and indirectly influence many key cellular functions, including metabolic pathways, DNA repair, chromatin remodeling, cellular senescence and immune cell function. These cellular processes and functions are critical for maintaining tissue and metabolic homeostasis and for healthy aging” (Covarrubias, et al., 2021).

The Importance of Your Metabolic Health

By vigorhealthandbeauty • July 17, 2023
Metabolic health is defined as having optimal blood sugar, triglycerides, high-density lipoprotein (HDL) cholesterol, blood pressure, and waist circumference, the key is without using medication. Many of these numbers can be modified using lifestyle changes that stay implemented. Metabolic numbers can be corrected in some cases with interventions such as diet and exercise alone, but the moment you stop those interventions the numbers will revert back to being out of range and dangerous for your health. Understanding the importance of metabolic health, your genetics, your family history of chronic disease and where your levels presently are can save and extend your life. Cardiovascular disease is the LEADING cause of death. Per the CDC: One person dies every 33 seconds in the United States from cardiovascular disease. About 695,000 people in the United States died from heart disease in 2021—that’s 1 in every 5 deaths. What is sad about these statistics is that all people can implement interventions to lower their risk of deaths caused by cardiovascular disease. The interventions start with lifestyle changes, however for a large portion of individuals especially those with familial history and or decades or metabolic dysfunction, medications are necessary. I will use myself as an example as I have a strong family history of cardiovascular disease. My father and both of his parents had to have open heart surgery. Knowing this fact made me focus heavily on prevention all of my adult life, maybe to extremes at times. I say maybe a little extreme because there have been times that I cried over reviewing my LDL results which were only slightly above 100. LDL is considered the bad cholesterol, commonly referred to as lethal. My family doctor actually would never treat my level just above 100 (the high end of normal, I generally ran 118) no matter how much I requested it. I also obsessively tracked these levels for as long as I can remember. Each time I would get this same result, I would try new interventions because in my mind that number needed to be lower. @Mr.T_Indy can attest to my breakdowns over this. None of the interventions I tried lowered that number, it remained consistently the same. I can finally say that my LDL is now below 100, but I am an example of a person who needs medication to do this. My family history tells me this, along with my years and years of interventions that didn’t work. Understand though, the interventions I tried are still maintained along with the medication. I exercise almost every day with cardio and weight training. I eat a low fat diet. I monitor my food pairings. I rarely drink alcohol, and I don’t smoke. Do I sometimes eat what I want? Yes I do, but 80% of the time I am following the above because I know that is what’s best for my metabolic health. And mainly, I know that is what will help me as I age and hopefully will keep my heart beating long enough to watch my grandchildren grow up. An important thing to think about is that metabolic health is not merely about a person’s size. It is a part of the equation, but you can be within a normal weight range and have metabolic dysfunction. Weight and size are not the only indications for determining metabolic health. All people need lab work to determine metabolic health regardless of weight and or size. The majority of people have some form of metabolic dysfunction that needs to be corrected. At Vigor, we spend a lot of time discussing hormones and yes this is part of your metabolic health, but we also check all the other levels that are part of determining your metabolic health. Paul and I both are driven by helping people recognize and correct any metabolic dysfunction to promote longevity. Metabolic health not only helps with preventing cardiovascular disease, it also helps to prevent type 2 diabetes, stroke, alzheimer’s, obesity, and nonalcoholic fatty liver disease, just to name a few. I always say yes wellness has a price, but the price of chronic disease far outweighs the price of wellness. At Vigor we will check the labs for your metabolic health once per year. If you are unsure where your numbers fall or have questions about things you can do to improve your metabolic health, be sure to discuss with Mr. T and or schedule a consultation. Your body and your life is priceless, don’t forget that! Live Well, @Mrs.T_Indy and @Mr.T_Indy

Meet Ashley Compton, Social Media Manger

By vigorhealthandbeauty • July 11, 2023
Ashley Compton is Vigor Health and Beauty's social media manager. Ashley runs Vigor's website, blog Invigorating Thoughts, and social media accounts. Ashley is a wife, mom, and big sister. She is a graduate of the University of Kentucky and has a master's degree from Indiana University in Educational Leadership and administration. Ashley's day job is in public education administration. However, in her spare time, Ashley enjoys creating and sharing health and wellness content on behalf of Vigor Health and Beauty. For brand and athletic sponsorships, email us today at vigorhealthandbeauty@gmail.com or reach out to us via Instagram!

Meet Shelby, Medical Office Manager

By vigorhealthandbeauty • July 6, 2023
Meet Shelby Hosmer, B.S., CCA, Medical Office Manager Shelby Hosmer is our Medical Office Manager. She graduated from Indiana University, Bloomington in 2017 with a degree in Healthcare Administration and a minor in Law and Public Policy. She is a recent graduate of the Luddy School of Informatics, Computing, and Engineering’s Medical Coding Certification program at Indiana University, Indianapolis. Shelby is a Certified Coding Associate through the American Health Information Management Association (AHIMA). Shelby is here to answer any questions or concerns you have regarding appointment scheduling, billing, lab work/results, prescription refills, and electronic health record information.

Peptides

By vigorhealthandbeauty • June 28, 2023
What are peptides? A compound containing two or more amino acids in which the carboxyl group of one acid is linked to the amino group of the other (Dictionary.com). Amino acids are proteins. The difference between a peptide and a protein is size. Proteins have more amino acids than do peptides. At Vigor, we do use many peptides for our patients. To name a few: Sermorelin- increases GH Melanotan- libido, tanning BPC-157-wound repair, regeneration, inflammation SeMAX- neurocognitive (focus) PT 141- libido, sexual dysfunction CJC1295/Ipamorelin- increase growth hormone/weight loss The above are some of the most commonly requested and used. We also prescribe semaglutide and tirzepatide both for weight loss. These are currently being lumped into the term “peptides” because GLP-1 stands for glucagon-like peptide. Both of these medications are GLP-1 agonists and are the third most commonly prescribed medications at our office after testosterone and neurotoxins. If you are currently a patient and are interested in peptides please feel free to send us a message in the thryv portal for more information and pricing. If you want to become a patient you can schedule on our website for your blood work and consult. Be Well, Paul and Kristen Mattox @mr.T_Indy and @mrs.T_Indy

Why Alastin?

June 5, 2023
One of the most frequent questions I get asked as an aesthetic injector is “what products should I use?” I always have the same two responses, Alastin medical grade skin care and Tretinoin, AKA retin A, which is a prescription strength cream. The rationale to my response is guided by the literature and the miracles I see with consistent patient use. As people, we spend a lot of time thinking about prevention but the majority of us wait until a problem exists before trying to reverse or treat it. Our skin is our largest organ and spending time thinking about how to best take care of it, is key to preventing age related changes. Why Alastin? The company behind Alastin is Galderma, there are currently over 40 studies that demonstrate the effectiveness of the products and the before and after photos alone demonstrate how well they work. I use the post injection serum on all my clients to help improve the appearance of the skin post injection, support the production of collagen and elastin, improves hydration and plumpness(Alastin Skincare). The Alastin website has some amazing before and after photos with some of their most popular products on their website . https://alastin.com/pages/before-and-after If you have questions about products let me know, order your Alastin here . Be Well, Kristen Mattox

Just Get Started

By vigorhealthandbeauty • May 15, 2023
A journey of a thousand miles begins with a single step - Chinese Proverb Weight loss is hard. Getting back in shape is hard. Resisting our favorite foods because we know they don't meet our goals or are healthy for us is hard. But in all honesty, how many things in life are truly “easy”. And if they are easy, what's the value in them? You don’t learn much. And even “easy money” doesn't always feel great because it’s rarely earned. So what the hell do we do with all this hard shit we want to do. Just get started. That's it. Wanna know how much easier finishing is when you have started? On the contrary, finishing anything is impossible unless you get started. Whatever your goals, that first step may just be downright awful. But you know what comes easier after that first one? The next ones. I feel like we, as humans, are programmed to be achievers. I also feel like that with the ease of so many tasks now due to technology, we tend to overlook the value of “doing” something. We start the days pretty early at the T household, usually between 3:30 and 4am. Even after having this as a lifestyle for most of my adult life, many mornings still start with eyes opening, then an immediate “just hit snooze” said to myself. As much as I get a huge kick out of working out (I often say that's my free time, a fun activity), I don’t leap out of bed, ready to rock. I have to digest the snooze comment, then tell myself “take the first step” and head to the kitchen for my 40 oz water jug and celsius powder. Once I’m up (that first step), for me it’s a waste to be up, caffeinated and dressed, and then not go. Cardio days… Mrs. T will attest that I don’t care for it. It’s boring, tedious and just bleh. But I know that I need a certain amount of zone 2 cardio each week to be healthy. It’s hard to push myself to get on that elliptical each time, but I take the first steps… and before I know it, an hour has passed. Sometimes that first 5-10 minutes just sucks. No way around it. But it gets easier, I get more awake and I feel it makes a difference in my mood. We all have a choice every day, every morning, every meal or whatever it is that's in the arena of your goals. As daunting as any task may seem, as insurmountable any mountain may appear, as absolutely discouraging it can be to get on a scale or look in a mirror, don't let any of that take away from you taking that first step. You’ll be shocked at how quickly you’ll look back and realize not only that you’ve done it (it being whatever it is for you), but that first step wasn’t as bad as you thought and just maybe there are some other first steps you’ve been putting off that maybe won’t be so bad. So whatever that goal is or challenge may be, take one step… Just one step towards it. Look back, realize you’ve started and how it feels, then keep stepping. That first step can turn into a thousand miles before you even realize it. Be Well, Paul and Kristen Mattox Mr.T_Indy Mrs.T_Indy

Skin Cancer is Preventable

By vigorhealthandbeauty • May 3, 2023
There are over 5 million cases of skin cancer diagnosed every year and according to the Skin Cancer Foundation, skin cancer is the most common type of cancer in the United States (Skin Cancer Foundation, n.d.). In this week's blog, we want to provide you with things you should be doing to prevent and screen for skin cancer. Skin cancer can be seen, and the easiest way to get this checked is by scheduling an appointment with a dermatologist to do a skin check. I did a little searching and I also found that there are two offices in Indiana that offer free skin cancer screenings. Free Skin Cancer Screening. Additionally, The AIM At Melanoma foundation provides a step by step how to do a self-examination with a video. Skin Self Exam. Signs and symptoms to look for include the following: Common skin cancer symptoms may include: Skin growths, scabs or sores that don't resolve Changes in existing skin spots Pale or waxy skin patches Scaly patches on the skin Red or flesh-colored moles (City of Hope, n.d.). A few prevention tips include to wear sunscreen daily. At Vigor we recommend Alastin products, my favorite being the tinted SPF sunscreen. I actually wear this as foundation as it is non-greasy, light and protects my skin. You can purchase this product and other Alastin skin care at this link . Other important things to remember is with prolonged exposure to sun wearing clothing, hats and sunglasses can also be preventive. Another important fact is that taking nicotinamide 500mg twice a day, can be preventative of many common types of skin cancer (Starr, 2015). I started this regimen 1 year ago after it was recommended by my dermatologist, it is proven effective and is very low cost. It is important to make sure you buy the nicotinamide without other ingredients per the study cited. If I were given a wish to go back 20 years and change something, it would be that I had taken better care of my skin. I have unfortunately had numerous procedures to remove multiple locations of basal cell carcinomas and the sad truth is, I could have prevented all of them. Basal cell carcinomas, while generally non cancerous, if left untreated can be dangerous and require extensive treatment including radiation. Live Well, Kristen Mattox @Mrs.T_Indy References AIM At Melanoma Foundation (n.d.). How To Do a Skin Self-Examination. https://www.aimatmelanoma.org/melanoma-101/early-detection-of-melanoma/how-to-do-a-skin-self-examination/ American Academy Of Dermatology Association (n.d.). Find a Free Skin Cancer Screening. American Academy of Dermatology Association. https://www.aad.org/public/public-health/skin-cancer-screenings/find-a-screening City of Hope (n.d.). Skin Cancer Symptoms. https://www.cancercenter.com/cancer-types/skin-cancer/symptoms Skin Cancer Foundation (n.d.). May is Skin Cancer Awareness Month. https://www.skincancer.org/get-involved/skin-cancer-awareness-month/?gclid=Cj0KCQjw6cKiBhD5ARIsAKXUdybmzdAF4TYJF811Hthzgibgv36z3SNZ16A-tIurZkUmCVepGxttIRMaAnUTEALw_wcB Starr P. Oral Nicotinamide Prevents Common Skin Cancers in High-Risk Patients, Reduces Costs. Am Health Drug Benefits. 2015 Aug;8(Spec Issue):13-4. PMID: 26380604; PMCID: PMC4570055.

Productivity Anxiety

By vigorhealthandbeauty • April 26, 2023
Ever had one of those days when you felt anxious the entire day no matter what you were accomplishing? I was having one of those days yesterday, and let’s be fair, I am an anxious person on most days. But yesterday felt like I was walking in quicksand going nowhere fast. In actuality, I probably accomplished more by 0800 than most do all day. I have done this my entire adult life… pushing myself to extremes, setting the hardest goals for myself etc. But, there comes a point for all of us that such levels of anxiety can impact our mental and physical health. When thinking about what to share with you all this week, I figured why not use myself as an example. Every person has different levels of anxiety and different things they are anxious about. I have spent many years studying anxiety in nursing students. I suppose my empathy for their anxious behavior stems from the fact that I suffer from anxiety myself. I use cognitive behavioral therapy (CBT) and exercise to assist me. A great example from @thebraincoach is included in the photos above. CBT essentially uses the power of positive self-talk to guide you through something you are feeling anxious about. I first started using this technique in 2016 after I was attacked by a dog while running. As you might imagine, I stopped running outside for a while and still to this day when I am running, I am also looking for dogs. To overcome this fear I had to defeat it and I did so by continuing to run even though I was scared. I did this by turning the negative event into a positive one. In fact, I completed my first full marathon as a result. Bad things happen, anxiety happens, what we choose to do after is ultimately up to us. Prolonged anxiety is well documented to be detrimental to your physical and mental health. There are a wealth of tools online to help with coping. Establishing healthy interventions can help prevent using poor coping methods such as over eating and excessive alcohol consumption. If you suffer from anxiety, please know that there are options, you are not alone and if you need help with it you can message me anytime. Be Well, Kristen Mattox @Mrs.T_Indy  References Mustafa, N. (n.d.). Cognitive Reappraisal to Reduce Productivity Anxiety. Instagram. Mustafa, N. (n.d.). This is Productivity Anxiety. Instagram.
More Posts