Hormonal Replacement and weight loss options 

1. Compounded Bioidentical Combined or Individual Hormones

     Estradiol/ Biest/Triest and  Progesterone and DHEA and Testosterone in creams or troches

2.Combined Estrogen/Progestins (not bioidentical) - Retail Pharmacy

   Bijuva Tabs  - Estrogen 0.5 mg/ Progesterone 100 mg (bio-indentical) -1-dose daily for 90 days - #90

   Combipatch - Estrogen/ Norethindrone acetate patch - only 2 strengths- twice weekly

   Climara - Estrogen/ Levonorgestrel patch - only 1 strengths- once weekly

3. Estrogen -Retail Pharmacy

    Evamist spray - 1-3 doses daily for 90 days - #1

    Climara Estradiol patch - weekly - 5 doses -# 4

    Minivelle/Vivelle-dot - twice weekly - 5 doses - #8

    Estadiol tablets - 1 or more daily 

4.  Non -Estrogen -retail pharmacy

Vezoah 45 mg tabs - 1 pill daily - (need multiple blood tests- liver problems) #30

Osphena 60 mg pill - 1 pill daily - (need progesterone if uterus) -#30

Prometrium (progesterone) 100 or 200 mg pill at night

SSRI's-paroxetine (Paxil) Fluoxetine(Prozac)

SNI's- Venlafaxine (Effexor) and Citalopram(Celexa)

Clonidine -

Gabapentin low dose

Oxybutin

5. Non -Estrogen -retail pharmacy- over the counter

Herbal Meds - 

Phytoestrogens , Red Clover, Black Cohosh , Flaxseed, Sage, Dong Quai , Maca Root, Pine Bark Extract , Rhaponti Rhubarb Extract

Can try but most studies suggest minmal or no improvement 

Progestrone creams - low dose

Oral Medications:

Minoxidal Oral- low dose off label - better response than topical - safest FDA approved

Spironolactone Oral - anti androgen - up to 50% improvement

Finestreride Oral - off label in women - 70% response dose dependent

Dutasteride Oral - off label - potentially higher response than finasteride

Combined Minoxidil /Spironolactone or finesteride Oral - better than oral Minoxidil alone - more side effects 

Topical Medications:

Minoxidil Topical - OTC - 2- 5 % - 2 x better than placebo - 40-60 % show moderate regrowth

Finasteride Topical - off label in women - 

Combined Minoxidil/Finasteride - compounded if oral side effects 

Combined Minoxidil/Finasteride/Spironolactone- compounded if oral side effects 

A. Titzepatide (Zepbound) - GLP-1 + GIP agonist- reduces appettite , slows digestion - 15-21 % wt loss -72 wk

• Side effects = Nausea,Vomiting, Diarrhea, constipation , gallbladder issues , rare panceatitis

• Shots dosing monthly - 2.5, 5.7.5,10,12.5,and 15

• Foundayo Pill dosing - 0.8 , 2.5 ,5.5, 9, 14.5 and 17.2 - no restrictions - smaller molecule more easily absorbed

B. Semiglutide (Wegovy) - GLP-1 agonist- reduces appettite , slows digestion - 15-17 % wt loss -64 wk

• Side effects = Nausea,Vomiting, Diarrhea, constipation,gall bladder issues, rare pancreatitis

• Shots dosing monthly - 0.25, 0.5, 1 ,1.7 , and 2.4

• Pills dosing monthly - 1.5, 4 , 9, and 25 - must take first thing in AM with water on empty stomach =wait 30 minutes before food

C. Phentermine/Topiramate (Qsymia) - appettite suppression,neuro modulator - 8-10 % wt loss -64 wk

• Side effects = dry mouth, constipation,tingling , insomnia, anxiety, inc heart rate

• Pills dosing monthly - 3.75/23 for 2 weeks , 7.5/46 for 12 weeks (3%), 11.25/69 for 2 weeks , 15/92 for 15- 27 wks - if not lost (5%) -discontinue - wean off every other day for 1-2 weeks

D. Naltrexone /Bupropion (Contrave) - Brain appettite/reward modulation - 5-9 % wt loss -64 wk

• Side effects = nausea, headache, insomnia, inc blood pressure

• Pills dosing weekly - 8/90 -one (wk #1), 8/90 -one twice a day (wk #2) , 8/90 -2 in AM + 1 PM (wk #3)- 8/90 -2 in AM + 2 PM (wk #4)- - if not lost (5%) by 16 wks -discontinue - wean off every other day for 1-2 weeks

E. Phentermine (Adipex-P, Lomaira)- stimulant appettite suppression,- 3-7 % wt loss -12 wk

• Side effects = dry mouth, constipation,tingling , insomnia, anxiety, inc heart rate

• Adipex/Phentermine Tabs = 37.5 QD -may cut in half

• Lomaria tabs - 8 mg -3 x day - may cut in half

• Adipex/Phentermine capsules = 15, 30, 37.5 daily

• Phentermine OTD = 15, 30, 37.5 QD -if not lost (5%) -discontinue - wean off every other day for 1-2 weeks

F. Orlistat (Xenical, Alli) - blocks fat absorption - 3-5 % wt loss -6 months

• Side effects = Oily stools , gas, fecal urgency , abdominal pain , fecal spotting, and fat soluble vitamin deficiencies A,D,E,K

• Pills dosing monthly - 120 mg TID with fatty meals - can decrease to 60 mg TID if side effects

G. Lifestyle modifications

• Diet - fruits,vegatables, and whole grains

• Exercise - Regular activity-walking and yoga

• Stress Reduction - Yoga, meditation, and Deep Breathing

• Avoid Triggers - Caffeine, alcohol and spicy foods

• Sleep optimization - regular schedule with relaxing bedtime routine

• Quit smoking and Limit Alcohol