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Hormone Replacement Therapy Doctor Forrest Smith

LOCATION: Roswell, GA (12/8/2011)

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

Thank you for the opportunity to tell you a bit about my practice. I am an integrative MD who switched from conventional Internal Medicine more than 7 years ago. I specialize in bioidentical hormone therapy for reproductive, adrenal, thyroid, and growth hormone. I treat both men and women. I average 2 to 5 new male patients weekly for testosterone and related therapies.

What are your preferred delivery methods for prescription testosterone?

My preferred route of delivery is self injections of testosterone enanthate or cypionate given twice weekly which are compounded for dose adustments. A minority will prefer the daily compounded topical gels.

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?

BHRT is a major portion of my practice, however, it is balanced by the attention to the rest of the endocrine system (i.e. the adrenal, thyroid, etc.). I also continue a traditional medical practice. I have over 170 patients successful on my HCG Weight Loss protocol. I see several patients with chronic fatigueing illnesses commonly called CFS, Fibromyalgia, Lyme, Environmental diseases (mold exposure illness), and Heavy metal toxicity. As a Functional Medicine physician I do specialty testing of blood, urine and stool to customize nutrition supplements. We have IV nutritional and chelation therapies as well as accupuncture. I am pursuing my credentialing through the American Academy of Anti-Aging Medicine (A4M). I have anti-aging skin care with a complete medical spa for light/laser therapies, injectible fillers and Botox, and chemical peels. I have a protocol for hair restoration based on pharmaceuticals, nutrtionals, hormones and microelectric current treatments.

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

My initial testing is always individualized to the patient but normally includes: total and free testosterone, estradiol., DHEA-S, CBC with diff, Lipid, Comp Met Panel, fT3, LH, Prolactin, Vit D 25 (OH), and PSA. Follow-up testing is usually a salivary male hormone panel (inclusive of Test, E1,E2, P1, DHEA, Androstendione, DHT), PSA, fT3 and CBC at 6 weeks. Prescriptions are adjusted according to labs via a phone consult or office visit (whichever is preferred). After the 6 week recheck, hormones are continued on a 6 month or annual basis, depending on complexity.

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How do you handle men who clearly could benefit from HRT but do not have insurance? What options are available through your office? Do most insurance plans cover standard treatments in your office? (Feel free to explain some of the exceptions.)

My office is entirely off insurance, so my fee structure is designed to be more affordable than many on-line companies. Insurance forms along with CPT and ICD-9 codes are provided for patients to file to their insurance, if they have one.

How do you monitor prostate issues and screening for men on HRT? Or do you let other physicians handle that?

PSA is tested before starting and at 6 weeks. Beyond that, it is tested once a year and a DRE is done annually. As you are aware, men with optimal testosterone levels are less likely to develope high grade prostate cancer, but may, speed growth of pre-existing cancer.

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?

I prescribe PDE5 inhibitors.

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?”

In my testosterone replacement protocols, I monitor and treat with various aromatase inhibitors (Anastrozole or chrysin with piperine and herbals), Clomiphen to stimulate the testicles, compounded pharmaceutical-grade HCG at doses to either stimulate testicular function and/or for weight loss, DHEA and dessicated natural thyroid. It is never a simple prescription for testosterone.

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

I am board-certified Internal Medicine for over 30 years. I am trained by the Institute of Functional Medicine and American Academy of Anti-Aging Medicine. I am licensed in Georgia.

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

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