Certain side effects and risks have been associated with Hormone Replacement Therapy.

In women, these risks include, but are not limited to, an increased risk of:

  1. Developing endometrial cancer,
  2. Developing breast cancer,
  3. Developing blood clots, strokes, heart attacks, high blood pressure, or other cardiovascular problems,
  4. Causing tissue edema,
  5. Causing changes in lipids,
  6. Causing a permanent or long-term enlargement of the clitoris,
  7. Causing permanent hair growth on one’s face, chest, buttocks, or other areas of the body,
  8. Causing severe acne,
  9. Causing a woman’s voice to permanently deepen or deepen for an extended period of time,
  10. Causing menstrual or menstrual-like bleeding in a menopausal woman, and
  11. Developing psychological changes such as increased anger or aggressive behavior.
  12. There is currently no FDA Approved testosterone treatment for women.  Testosterone treatment for women is considered “off-label”.

The physicians and practitioners at Bella Vita are always available to discuss your individual medical situation and help you evaluate the risks and benefits of hormone replacement therapy.

Bella Vita Medical Center specializes in restoring lost hormones with natural (“bio identical”) hormones compounded in pellets of 17-beta estradiol and testosterone administered subcutaneously every 8 to 12 weeks.  (Please reference, “What are Pellets Made of?” and “Are Pellets FDA Approved?” in the Research Section of our Web Site). Administration frequency of the pellets varies according to subjective symptoms, objective blood levels and your progressive year of therapy, therefore,  the frequency of administration will be determined by the medical provider in consultation with you, the patient.  Natural progesterone is administered either sublingually or orally on a daily or cyclical basis.  Armour Thyroid, if medically indicated, is taken daily in oral form.


Estrogen /es•tro•gen/ (es´tro-jen): a generic term for estrus-producing compounds; the female sex hormones, including estradiol, estriol, and estrone. In humans, the estrogens are formed in the ovary, adrenal cortex, testis, and fetoplacental unit, and are responsible for female secondary sex characteristic development, and, during the menstrual cycle, act on the female genitalia to produce an environment suitable for fertilization, implantation, and nutrition of the early embryo.

Common signs and symptoms of estrogen deficiency:


  • Mental Fogginess. “I’ve lost my mind.”
  • Forgetfulness. “I can’t remember what I walked into this room for.”
  • Depression. “I feel blue.”
  • Minor anxiety. “I can’t seem to control my worries.”
  • Mood change. “Sometimes I wonder how I’m going to feel tomorrow.”
  • Difficulty falling asleep.  “My mind is racing and I can’t stop it.”
  • Hot flashes. “This wave of heat spreads through my body.”
  • Night Sweats. “I wake up soaking wet.”
  • Day long fatigue. “I can’t keep my head up.”
  • Decreased sense of sexuality and sensuality. “I have lost all pride in my body.”
  • Lessened self-image and attention to appearance.  “I could care less how I look.”
  • Dry eyes, skin, and vagina. “My body is like a dry summer.”
  • Loss of skin radiance. “I’ve lost my skin glow.”
  • Pain with sexual activity.
  • Increased back and joint pain.
  • Episodes of rapid heartbeat, with or without anxiety.  “Out of nowhere my heart starts beating out of my chest.”
  • Headaches and Migraines


Common signs of Excess Estrogen:


  • ·          Breast tenderness or pain
  • ·          Increase in breast size
  • ·          Water retention (as noticed in swollen fingers and legs).  “I can’t put on my rings.”
  • ·          Impatient, snappy behavior, but with a clear mind.
  • ·          Pelvic cramps, with or without uterine bleeding.


Benefits of Estrogen Replacement Include:

Protects Bones

Estrogen promotes the production of osteoblasts, or cells that produce bone.  When women have low estrogen levels, the risk of developing osteoporosis increases.  Statistics show that one of every two women and one of every four men over 50 will suffer an osteoporotic fracture. Estrogen replacement therapy may help prevent osteoporosis.

Protects the Heart and Brain

It has been suggested that estrogen benefits the heart by increasing high density lipoprotein, or good cholesterol, while also decreasing low density lipoprotein, or bad cholesterol. Accumulation of bad cholesterol in the arteries results in plaque buildup that leads to cardiovascular disease. Estrogen also aids in relaxing dilated blood vessels to promote increased blood flow.

Eases Symptoms of Menopause

During menopause, many women experience a feeling of occasional intense heat, known as hot flashes. They often experience other symptoms, such as sleep disturbance and mood swings. Estrogen replacement can help alleviate these symptoms.  Studies further note that vaginal dryness during menopause is problematic for some women, resulting in painful sex.  Estrogen replacement aids in alleviating dryness as well as preventing possible urinary tract infections associated with menopause, due to thinning of the urethra


  1. Breast Tenderness – Estrogen retains fluid.  Breasts may become sore or tender in a similar fashion to when you were in mid-cycle (when your estrogen was at peak).  Gradual restoration of estrogen (estradiol) may minimize this side effect.
  2. Thickening of the Uterine Wall – Estrogen acts to thicken and mature the endometrial lining as it did during your cycle to prepare the uterus for egg fertilization and pregnancy.  Gradual restoration of estrogen (estradiol) may minimize this side effect.
  3. Irregularities of the Menstrual Cycle – Estrogen’s effect on growth of the endometrial lining may create irregularities in cycling or may commence “spotting” after having been without cycles for some time.  Gradual restoration of estrogen (estradiol) may minimize this side effect.  In addition, maintaining a balance between estrogen and natural progesterone may also aid in minimizing this side effect.
  4. Risk of Cancer (Breast or Endometrial) – Estrogen has effect on the growth of tissue (cell proliferation) and can create an imbalance if left to become dominant.  Progesterone opposes estrogen’s cell proliferative actions and works to prevent dominance.  There are differing views, pro and con, on the effectiveness of progesterone in the “prevention” of estrogen dominance.  This may have basis in the fact that some medical providers consider natural progesterone and synthetic progestins to be of the same category in substance.  Others believe that natural progesterone has different and often opposite effects as synthetic progestins.  One point that is noteworthy is that natural progesterone is used by fertility specialists to support pregnancy, whereas synthetic progestins are used in the “morning after” pill to abort pregnancy.  Until further definitive studies are conducted, the potential BHRT patient should avail themselves to the literature, read all they can and if unable to arrive at an informed decision based on the literature, consult with your Primary Care Physician before starting estrogen replacement.

Clotting that may lead to stroke, heart attack or embolism – A study conducted in 2011 by the North American Menopausal Society entitled Increased Thrombin  Generation Among Postmenopausal Women Using Hormone Therapy: The Importance of the Route of Estrogen and Progestogens (Vol. 18 No. 8) states,   “Indeed, several randomized trials showed a substantial acquired APC resistance among postmenopausal women using oral estrogens but not in users of transdermal estrogens.”  What this means (in English) is that women who used oral estrogens were likely to have clotting issues, whereas those that used transdermal administration methods were not.  The paper attributes this difference to the fact that oral estrogens (or oral anything) goes to the liver before entering the blood.  Transdermal estrogens (through the skin) entered the blood first, before going to the liver.  Subcutaneous pellets also go to the blood first before going to the liver.  The problem apparently lies in a phenomenon called the “coagulation cascade” that results from the hepatic first-pass (meaning going to the liver first) of the oral estrogens.  This phenomenon was not found in use of transdermal estrogen (and would not be found in subcutaneous) administration.


Progesterone: A female hormone, the principal hormone that prepares the uterus to receive and sustain fertilized eggs.


In order to understand terminology, and avoid confusion, there are other terms used for progesterone that are often incorrectly considered interchangeable.  Such as:

  1. Progestin: A progestin is a synthetic progestogen that has some biological activity similar to progesterone.


  1. Progestagens: (also spelled progestogens or gestagens) are hormones that produce effects similar to those of progesterone, the only natural progestagen. All other progestogens are synthetic and are often referred to as progestins. http://progestogen.askdefine.com/



Helps the thymus gland
Helps immunological problems
Helps the thyroid gland
Helps use fat for energy
Improves memory
Is a mild diuretic
Is a natural antidepressant
Is a great skin moisturizer
Is necessary for fertility
Improves the efficiency of the heart
Maintains a healthy pregnancy
Maintains cell oxygen levels
Normalizes blood clotting
Promotes energy production
Protects brain cells/brain function
Relieves anxiety
Restores libido
Reverses aging in the skin
Sensitizes estrogen
Progesterone protects against
Breast fibrocysts
Breast cancer
Bulging veins
Cancer of the uterus
Cancer of the ovaries
Epileptic seizures
Facial hair
Fibrocystic breasts
Heart attacks
Hot flashes
Loss of hair
Mood swings (PMS)
Muscular aches and pains
Night sweats
Uterine fibroids
Vaginal dryness
Water retention
Doctors. Search the biochemical literature. This information is in there, it just isn’t being taught.


Note: this information is provided because of the failure of our medical system to teach about the real progesterone hormone and is not intended to diagnose, cure or treat any disease.



Common favorable side effects of Progesterone (natural) include:

  • Increased sex drive
  • Trim Waistline
  • Thicker Hair
  • Healthy even weight during the entire cycle
  • Healthy non tender breasts
  • Feel Happier
  • More regular period
  • Fertility MD’s use Natural Progesterone to prevent 1st Trimester Miscarriage

Common adverse side effects of Progesterone (natural) include:

  • · Bloating
  • · Cyclical breast tenderness
  • · Irregular period
  • · Increased headache
  • · Menstrual cramping
  • · Increased anxiety, irritability, mood swings, and depression
  • Increased Weight Gain


Testosterone is a steroid hormone from the androgen group and is found in mammals, reptiles, birds, and other vertebrates. In mammals, testosterone is primarily secreted in the testes of males and the ovaries of females, although small amounts are also secreted by the adrenal glands.  Considered a male hormone (androgen), but also produced in smaller quantities by the female body. Deficiency in women’s testosterone is associated with loss of bone density, loss of libido, and loss of the sense of wellbeing.

Testosterone For Women


– Clif Arrington M.D.


While testosterone is generally considered a male hormone, it is also produced in the female by the ovary. Although the level of testosterone in the female is only 10% of the level in men, it rapidly declines during menopause along with estrogen and progesterone. Some of the general effects of low testosterone in women are decreased sex drive (libido), decreased energy and decreased muscle mass.


In a study published in 1995 in the Australian journal Maturitas, thirty-two post- menopausal women were treated with either estrogen alone or estrogen plus testosterone. Both groups had increased libido. However the group taking the testosterone – estrogen combination experienced a significantly improved sex drive.


Additionally in other similar studies many women have reported that the addition of testosterone improved their memory, boosted energy, revived their interest in sex, and in general just increased their entire sense of well-being.


Additional benefits of testosterone replacement therapy in women are increased muscle and bone strength and increased self-assertiveness. Current research is showing benefits of reducing the risk factors for heart disease, Alzheimer’s, and diabetes.


Why Aging Women Need Testosterone
By Edward R. Rosick, DO, MPH, MS

Benefits for Women’s Sexuality
Although most mainstream physicians now believe that testosterone replacement in women who have had hysterectomies and/or oophorectomies can enhance their mood and well being, most still scoff at the idea that testosterone replacement is of any use to women who still have their uterus and ovaries intact.

Fortunately for women all over the world, Dr. Susan Davis is one of those rare researchers who are examining the ways in which testosterone supplementation can benefit women, whether or not they have had the aforementioned surgeries. At the Jean Hailes Foundation, a not-for-profit organization in Australia dedicated to women’s health issues, Dr. Davis and her colleagues have been studying testosterone’s importance in women’s overall health. In a 1999 article in the journal Clinical Endocrinology and Metabolism, Dr. Davis offered a detailed report on testosterone replacement therapy in both pre- and postmenopausal women.  In women who are post-menopausal or have had oophorectomies, judicious testosterone therapy has produced a direct and sustained improvement in sexual drive, arousal, and frequency of sexual fantasies. Dr. Davis acknowledged that treating women in their twenties and thirties with testosterone for low libido is controversial, but also stated that its use should not be discounted. According to Dr. Davis, testosterone supplementation can significantly benefit young and otherwise healthy women with low levels of testosterone who suffer from low libidos and sexual dysfunction.

In a more recent article published in 2001, Dr. Davis wrote that testosterone appears to be quite important in maintaining a woman’s energy level and sense of well being, regardless of her age.  Low testosterone levels in pre- and postmenopausal women can diminish motivation, induce fatigue, and contribute to low libido. Even women in their twenties who are taking birth control pills may suffer from low testosterone and its effects, as oral contraceptives are known to lower testosterone levels. While studies show that testosterone supplementation in postmenopausal women who have not undergone hysterectomies and/or oopherectomies can significantly improve sexual drive, arousal, and frequency of sexual fantasies, no such studies have been conducted on pre-menopausal women.  Dr. Davis states, however, that “it is the clinical experience of the author [Dr. Davis] that a subset of pre-menopausal women with sexual dysfunction and reduced circulating androgen [testosterone] levels significantly benefits from judicious parenteral testosterone replacement.”


 Androgen insufficiency in women

Glenn D. Braunstein *

Department of Medicine, Cedars-Sinai Medical Center, The David Geffen School of Medicine at UCLA, Room 2119 Plaza Level,

North Tower, 8700 Beverly Blvd, Los Angeles, CA 90048, USA

Available online 24 April 2006


Androgens are directly secreted by the ovaries and adrenals in women, and androgen recursors from these glands are converted in a variety of peripheral tissues into androgens. The major androgen in women is testosterone, and its action in target tissues can be mediated through the androgen receptor or through the estrogen receptor after aromatization to estradiol. Low sexual desire that causes personal distress (or hypoactive sexual desire disorder [HSDD]) is the most common form of female sexual dysfunction, and androgen insufficiency is one cause of this problem. In addition to a low libido, the clinical construct of the female androgen insufficiency syndrome includes the presence of persistent, unexplained fatigue and a decreased sense of well-being. Although there is conflicting information about the relationship between serum testosterone concentrations and sexual desire, multiple randomized,

double-blind, placebo-controlled treatment trials have demonstrated that testosterone improves libido significantly more than placebo.  Doses that provide physiologic to slightly supraphysiologic serum free or bioavailable testosterone concentrations are safe and

associated with only mild androgenic side effects of acne and hirsutism. Oral, but not parenteral or transdermal, testosterone may decrease high-density lipoprotein cholesterol. At present, no testosterone preparation has been approved by the FDA for the treatment of low sexual desire (HSDD), so all such therapy is considered to be off-label use at this time.




Increased acne – Testosterone creates natural oils in the skin. These oils in conjunction with oil based makeup (those that have emollients) may contribute to clogging pores and causing acne eruptions.  It is best to use oil-free makeup to help minimize this side effect.  Gradual restoration of testosterone can help minimize this side effect.
Increased facial hair – Testosterone is an androgen and can cause this side effect.  This side effect differs in severity from one individual to another.  Some women simply pluck the hairs as the do on their eyebrows.
Alopecia (balding) – Testosterone may cause some hair loss.  Gradual restoration of testosterone may help minimize this side effect.
Deepening of voice – Testosterone is an androgen and can cause this side effect.  It does so by thickening the vocal cords.  Gradual restoration of testosterone may help minimize this side effect.  Lowering levels or ceasing administration may reversethis side effect, should it occur.

Increase in Hematocrit and/or Hemoglobin  – Testosterone can increase the number of red blood cells (called erythrocytosis).  More red blood cells can mean increased oxygen (through the hemoglobin molecule) to the bloodstream, which may help if you are anemic.  However, too many red blood cells can raise the hematocrit (the percentage of red blood cells to liquid plasma) and “thicken” the blood that may lead to clotting.  This potential side effect is monitored with blood tests prior to any treatment.

Clitoromegaly (enlargement of clitoris) – Testosterone may cause an enlargement of the clitoris.  In some cases this is due to clitoral atrophy.

Muscle growth – Testosterone is known to build muscle.