Mandy Cotten, Institute for Hormonal Balance and BioTE

Hormone Replacement Therapy

About the Expert

Dr. Mandy Cotten, FNP-C has performed over 15,000 pellet procedures, averaging 300 per month. As clinic coordinator at BioTE, she helps train others in the importance of hormone optimization to assist patients in achieving the highest quality of life. She was named a Top Family Nurse Practitioner by the International Nurses Association. She’s on the clinical advisory board of BioTE and is currently involved in research to investigate the long-term benefits of hormones and the BioTE method.


What are Bioidentical hormones?

Bioidentical hormones look exactly like your naturally occurring hormones. So, when they can enter your body, they go directly to the receptor site, and achieve the desired results. Conversely, synthetic hormones must be metabolized through the liver first where they must convert to a different structure and sometimes can cause the opposite effect than what’s desired. Where conventional hormone therapy is often only available in one or two set doses, bioidentical hormone therapy (BHRT) dosage can be tailored to the individual patient’s needs. BHRT can be administered through creams, patches, pills, or pellets. Patients can contact the Institute for Hormonal Balance at (817) 467-7474 or to schedule a consultation and determine which is best for them.

Why don’t more doctors utilize bioidentical hormones?

Unfortunately, there was a—now discredited—study in 2002 called the Women’s Health Initiative which incorrectly indicated that hormones were dangerous for women. Due to the media’s exacerbation of this study, many providers and patients were scared away from hormone therapy—conventional or bioidentical. The primary investigators in this study have walked back their findings realizing they didn’t actually show bioidentical hormones to be dangerous for women. (However, synthetic progestins did increase risk for breast cancer and cardiovascular issues.) One of the primary investigators, Dr. Robert Langer has since said, “Over-generalizing the results from the women who were on average 12 years past menopause to all post-menopausal women, has led to needless suffering and lost opportunities for many.” Many women have unduly suffered due to the overgeneralization of these findings.

What are the benefits of BHRT?

Balanced mood, improved sleep, reduced brain fog, decreased hot flashes, decreased vaginal dryness, increased stamina and energy, increased muscle mass, decreased fat mass, increased libido, heart protection, bone protection, brain protection, and enhanced sexual response and desire.

How soon can I expect results from BHRT?

This depends on the type of hormone therapy you’re using. Typically, you should start to notice a difference within seven to 10 days of starting a new therapy. With pellet therapy, you should notice a larger difference around the four-to-six-week mark. Sometimes adjustments to the treatment plan are needed. I ask new patients to commit to two rounds of pellets since dosage adjustments are sometimes
needed to get patients feeling optimal.

How often will I need to follow up during my therapy?

Hormone therapy is not black and white. We obtain initial lab testing, then test again four to six weeks after initiating therapy. The patient shouldn’t require labs again for another year, unless we’re adjusting their dose. Most male patients need pellet therapy every four to six months. Most female patients need pellet therapy every three to five months.

How much should I expect to pay?

Pellet therapy for women is $350 every three to five months. For men it ranges between $650 and $750 every four to six months.
(817) 467-7474

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