Hormone Replacement Therapy Doctor Joseph Edward Kaye

How many male patients do you estimate that you have treated with testosterone therapy?

Approximately 750 over the past 2 years

What are your preferred delivery methods for prescription testosterone?

Subcutaneous implants or "pellets" are, in my opinion, the best method for testosterone replacement as they closely mimic normal secretion patterns in the young male with diurnal variation and optimal levels. Implants avoid the peaks and valleys that are experienced with injections or creams. They last up to 5 months and restore libido, sexual function, muscle mass, bone density, glucose tolerance, energy levels, mental fogginess, and depressed mood better than the alternatives. The alternatives are injections of testosterone or HCG, pills such as Clomid or Anastrozole, testosterone creams, or a patch system. I usually prescribe compounded creams as I can get a higher concentration, better absorption, and smaller volume than the brand name product Androgel.

Doctors sometimes develop different areas of expertise. Do you feel that HRT (Hormone Replacement Therapy) is one of these areas for you and your office?

I consider myself the expert in BHRT for both men and women in the Boston metropolitan area. I have over 600 active current patients and specialize in this area of medicine. In addition, I am currently board-certified in Internal Medicine, Integrative and Holistic Medicine, Emergency Medicine, and Anti-Aging Medicine. I provide not only BHRT, but a complete holistic approach that addresses all a patients concerns with respect to management of chronic illness, slowing/reversing symptoms of ageing, detoxification, diet/fitness, sports medicine, treatment of sports injuries, intravenous therapies. Patients can learn more about my practice at www.optimalwellnessmd.com or www.BodyLogicMD.com

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What do you monitor on a routine basis when a man goes on HRT?

We monitor many hormones and their metabolites as well as nutrients and toxins: For example, total and free testosterone, bioavailable testosterone, shbg, dht, estradiol, albumin, cbc. We also look at approximately 20 other hormones in conjunction with testosterone therapy. Keep in mind that no hormone works in isolation: there are complex interactions between thyroid, adrenal, growth hormone, blood sugar, insulin, diet, exercise, and testosterone. All of these areas must be monitored and optimized for good effect.

How do you handle men who clearly could benefit from HRT but do not have insurance? What options are available through your office?

We do not accept any form of insurance as payment at the office, so having or not having insurance is not an issue for us. We operate a fee for service practice. We keep our fees reasonable, but this type of practice takes a great deal of time and attention and typical insurance plans make it impossible to provide the level of service our clients require. Our initial visits are 90 minutes and followup appointments are 45 minutes. I keep the practice size small so I can personally attend to each patient's needs in a timely manner. This would not be possible in a high-volume, insurance based practice. We do offer a billing service that will submit the paid invoice to the insurer. Many of our clients are reimbursed for their visit fees after the claim is submitted. We do not participate with Medicare or Medicaid. Often blood tests are covered by insurance even if the visits are not. Again, the prospective patient should consult their insurer to determine what their plan covers or does not cover.

Do most insurance plans cover standard treatments in your office? (Feel free to explain some of the exceptions.)

PPOs that permit "out of network" physician visits usually cover 80% of charges. HMOs may cover lab fees but usually do not reimburse for visit fees as we are out of network. Patients who plan to submit insurance claims should confirm their benefits or restrictions with their insurer. We highly recommend that patients open a healthcare savings account (HSA) so they can pay for nutritional supplements, medical care, medicines with "pre-tax" money. Usually if one looks at the total cost per year, the most economical healthcare plan is a high-deductible catastrophic insurance plan coupled with an HSA.

How do you monitor prostate issues and screening for men on HRT?

I do digital prostate exams as indicated and closely monitor the PSA level. If the PSA rises and remains high, I refer to urology for a further workup. Keep in mind that testosterone does NOT cause prostate cancer to develop and there is no correlation between using testosterone and the development of prostate cancer. However, if a cancer already exists, the PSA may rise if testosterone treatment is begun. In that case, we refer for a biopsy/ultrasound. Many things besides prostate cancer can elevate PSA: infection, benign prostate enlargement, having more sex, even constipation. So, a rise in PSA is no reason to become overly alarmed; it is something that must be further evaluated.

How does your office go beyond simple subscribing of PDE5 Inhibitor for Erectile Dysfunction? Do you have any other treatment strategies for men who are experiencing a loss of erectile strength?

PDE5 inhibitors, such as viagra or cialis, are very effective. However, we use compounded versions that are rapid acting and more effective than the brand named products. We do not do injection therapy for ED in this office. I have found that attending to the vascular health of the patient by correcting a variety of metabolic abnormalities, chelation therapy, nutritional therapy, and of course BHRT with testosterone will greatly enhance erectile function in most men. In men who require injection therapy, I refer to a specialist in that area.

Are there aspects of your practice or treatment strategies that you’d like to share that feel may make your practice "stand out from the crowd?"

My practice is holistic. This means that I treat the whole person-not just prescribe testosterone therapy. I address all hormonal imbalances, not just testosterone which leads to a much better outcome. I combine natural and traditional medicine, with a focus on weight loss, bioidentical hormone replacement, sports nutrition, mood and neurological disorders, reversal of chronic disease, anti-aging medicine, preconception medicine, and detoxification. I dedicate my practice to guiding my patients through the process of healthy aging and helping them to alleviate or reverse chronic illness.

I have affiliated this practice with BodyLogicMD,(www.bodylogicmd.com) the nation's largest group of physicians dedicated to bioidentical hormone replacement and functional medicine. In this role, I help women and men find relief from symptoms of hormonal imbalance such as low libido, weight gain, irritability, depression, hot flashes and loss of muscle mass. I offer my patients bioidentical hormone replacement therapy (BHRT) and customized nutrition, supplement, and fitness programs as well as standard and complementary medical treatment.

Using advanced laboratory, genomic, and physical testing that is not available to most physicians, we attempt to identify unsuspected causes of chronic conditions, which can then be corrected, returning patients to a state of wellness and vitality.

I have trained in Mind-Body Medicine through Harvard and use Meditation, Biofeedback, and Stress Management in my practice. I practices what I advocate to my patients and I can discuss my programs from personal experience. I exercise daily, follow a prudent low-stress/nontoxic lifestyle, eat a healthy diet with appropriate supplementation and have been treated with BHRT since 2005. I have perfect blood pressure, heartrate, laboratory and cholesterol numbers, optimal hormones, a low bodyfat, excellent muscle development, and a biological age measured in my early 20s (measured by Telomere length, and Sphygmocore testing). I offer myself as an example as to what can be achieved with this type of medicine.

Can you give a brief description of your medical certifications and licensing?

Licensed in MA since 1997, no malpractice history. Quadruple Board-Certified: Internal Medicine, Emergency Medicine, Integrative/Holistic Medicine, Anti-Aging Medicine with additional training in Functional Medicine.

Can you please list any contact information for men interested in reaching your office?

• www.optimalwellnessmd.com Phone: 781-933-4200
• www.BodyLogicMD.com