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14/Oct/2021

Everyone who comes into our office has asked this question at least once, “How much does Hormone Replacement Therapy cost?”.  Well, the answer here is that it can vary.

There are some variables in whether or not you have health insurance, what type of therapy you elect to use, and of course, your budget.  The following details apply for women seeking hormone replacement therapy, before or after menopause.

First, let’s look at using your health insurance.  In our Hormones by Design offices, we do not accept health insurance for the office visit but will gladly use your health insurance for lab work once you are established as a patient.  Therefore, the cost for the office visit is usually around $100.

Labs can be sent to your health insurance if you like, or you may pay for them yourself.  We have exceptionally low lab prices.  You can see all of them at https://hormonesbydesign.com/hbd-labwork-waco/.

Second, you must consider the type of therapy that you choose.  The overwhelming majority of our patients choose monthly injection therapy.  This is where the patient comes into our office for a lab draw about 3 days before their scheduled appointment, the labs are sent off, and results come back by appointment time.

These lab results are then used to craft a combination of hormones into an injection solely for that patient.  For patients that choose injection therapy, the cost per month is included in the office visit, so it is generally only the $100 per month.  No matter what therapy you choose, progesterone is almost universally needed for every patient.

This is given orally via a prescription.  The cost of a progesterone prescription varies according to each patient’s insurance.  Typically, the cost ranges from $20 per month and up.

Lastly, you need to consider your budget.  Here at Hormones by Design we will always take your budget into consideration.  We don’t ever want a patient to feel that regaining a more youthful quality of life is not attainable due to cost.

There are many ways with which to do hormone replacement.  We want to work with you to find the therapy and the price that is sustainable for you.  We strive for amazing care at affordable prices.


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10/Feb/2021

Thyroid hormone replacement therapy is used to treat which of the following conditions?

A lack of thyroid hormone can cause a whole list of uncomfortable symptoms including:

  • weight gain/loss
  • hair loss
  • acne
  • drop in energy in the morning or evening (or both)
  • body aches
  • depression
  • and much more

At Hormones by Design, our licensed providers not only specialize in bio-identical hormones, but they also specialize in the diagnosis and treatment of thyroid-related issues.

Thyroid hormone can be replaced in several different ways.  Patients can choose from custom-compounded formulas or commercially available prescriptions.  Either way, replacing thyroid hormone can help eliminate the list of symptoms above and get your energy back!

Call and schedule your new patient appointment with us today and let’s get started making you…a more optimal you.

 


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24/Jan/2021

One common question we get is, “What is Hormone Replacement Therapy?” (HRT) Our reply is simply that it is what the name says. Your doctor is using prescription drugs to replace your body’s hormones.

What is in hormone replacement therapy?

This is the truly important question.  HRT can be accomplished with a variety of prescriptions.  Most physicians use synthetic hormones like those found in Premarin.  Premarin is actually made of pregnant horse (mare) urine.  So, it is not the same as what the human body requires.  Our physicians use bio-identical hormones.  This ensures that the hormones are the same molecular structure as the hormones your body makes.

How is hormone replacement therapy accomplished?

In other words, the patient wants to know how this therapy is administered.  Well, that is the choice of the patient.  Most of our patients chose our unique monthly hormone injections.  These are customized to the patient based on current lab results and patient symptoms.  Patients report feeling better faster and enjoy being able to change their dose if needed at their next appointment.

What hormones are used in HRT?

In general, female patients can receive Estrogen, Progesterone, and Testosterone.  While male patients receive only Testosterone.

When do I need HRT?

HRT can start as early as necessary.  Symptoms can start in your 30’s and 40’s with what is called perimenopause.  This goes all the way up to your 50’s when menopause typically starts. Symptoms are generally the biggest indicator of your need for HRT.

Where can I get HRT?

A qualified doctor/healthcare provider must prescribe HRT.  Hormones by Design has a highly trained and qualified provider in each of its locations to serve your HRT needs.

Who needs HRT?

Both women and men can benefit from HRT.

Hormones by Design treats women and men with bio-identical hormone replacement.  We have locations in San Antonio, Boerne, and Waco, Texas.  Visit our website at www.hormonesbydesign.com.

 

 

 


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24/Jan/2021

You have finally reached menopause.  Your first thought is “Yeah!  No more periods!”, and then the symptoms of menopause hit.  You begin experiencing one or more of the following:

  • Hot flashes
  • Night sweats
  • Trouble sleeping
  • Anxiety
  • Lack of sex drive
  • Lack of energy
  • Vaginal dryness
  • Foggy thinking
  • Mood swings
  • Weight gain

These symptoms, along with lab work showing that your hormone levels are low, indicate that you are a candidate for starting Hormone Replacement Therapy.

Menopause does not have to be a miserable time in your life.  You could get back the vitality that you had in your 20s and 30s with Hormone Replacement Therapy.

At Hormones by Design, we recommend and utilize Bio-identical Hormone Replacement (BHRT).  BHRT uses hormones that are the exact same molecular structure as the hormones that your own body produced when you were younger.  Most of our patients opt for our unique monthly hormone injections.  This allows for a customized dose to address lab values and symptoms that the patient is experiencing.

Hormones by Design treats women experiencing the symptoms of menopause and even perimenopause (that comes before menopausal age).  We have locations in San Antonio, Boerne, and Waco, Texas.  Visit our website at www.hormonesbydesign.com.


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24/Jan/2021

Many people ask, “What kind of doctor prescribes Hormone Replacement Therapy (HRT)?” The answer is somewhat general in that almost any kind of doctor can prescribe HRT.  There are Gynecologists, Urologists, Internists, and even Family Practice doctors that prescribe HRT.  However, that is not the most important thing that a patient should consider when choosing a doctor for HRT.

The most important thing is that the doctor specializes in HRT and has built their practice around it.  In other words, you want a doctor that does HRT all day, every day.  You want your doctor to have plenty of experience with HRT.  Some doctors have HRT “added” to their practice in the form of pellet therapy. Pellet therapy is not a fit for all patients.

The second most important thing is that the doctor uses Bio-Identical hormones in their replacement therapy.  Most doctors are trained to use synthetic hormones like Premarin that is made from pregnant horse (mare) urine.  You want to make sure that your doctor is using hormones that are the same molecular structure as the hormones your body made when you were younger (Bio-Identical).

Hormones by Design treats women and men with bio-identical hormone replacement.  We have locations in San Antonio, Boerne, and Waco, Texas.  Visit our website at www.hormonesbydesign.com.


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For those that are needing more information about Telemedicine, we have put together a Q&A to answer common questions. If there is a question you still have that is not listed here, please do not hesitate to give us a call!

  1. What is Telemedicine?  Telemedicine is like a Skype or Face Time call.  It is a two-way, face-to-face video conference.
  2. Why are you not just using Skype or Face Time then? Skype and Face Time are not HIPAA compliant/secure.  Our program that we use is
  3. Do I have to download something? Nope. The link that we send to you automatically connects you to the secure video conference.
  4. Do I have to do it on my phone? Nope.  You can do it on your computer but your computer MUST HAVE speakers and a video camera.
  5. So how does this work then? Suzi will send you a text if you want to use your phone, or an email if you want to use your computer.  You click on the link in the text or email and that connects you to the call.  You will see Suzi on the screen.
  6. Can I not just wait a few months to go over my results? We recommend that you continue your care just like normal with this face-to-face video visit.  This allows us to make sure your medications are working correctly and give you plenty of refills just like normal.


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We have all heard of it and many of us suffer from it…PMS or Pre-Menstrual Syndrome.  Symptoms such as bloating, hunger, headaches, and moodiness can begin anywhere from 5 to 11 days before menstruation.  Most women (about 90%) get some sort of PMS symptoms each month and this is especially true for women in their 30s.

What are the symptoms of PMS?

Physical symptoms of PMS can include:

  • Swollen or tender breasts
  • Bloating or a gassy feeling
  • Cramping
  • Headache or backache
  • Constipation or diarrhea

Emotional symptoms of PMS can include:

  • Mood swings
  • Irritability
  • Increased appetite or food cravings
  • Feeling tired
  • Sleeping too much or too little
  • Trouble with concentration or memory
  • Tension or anxiety
  • Depression, feelings of sadness, or crying spells
  • Less interest in sex

How/why does PMS occur?

After ovulation, progesterone and estrogen increase to prepare the uterus for pregnancy.  If pregnancy does not occur, these levels begin to decline quickly.  It is the decrease in progesterone that triggers symptoms such as the increased craving for chocolate and the mood swings.

How do I test for PMS?

A qualified bio-identical hormone replacement center can do a simple blood draw to test your hormone levels (preferably on days 19-21 of your cycle).  This test and your symptoms will let your doctor know how to treat you.

How can I treat PMS?

Once your labs results have come back, your doctor may want to prescribe you supplemental progesterone for all or part of your monthly cycle.  This increase in progesterone can combat many of the physical and emotional symptoms of PMS.

What can I do at home to help control PMS?

  • Exercise—this helps your body deal with stress and releases endorphins that help create a positive mood.
  • Get enough sleep—sleep is critical to your body’s ability to deal with stress and succeed in repairing any cellular damage that occurs during the day.
  • Eat healthy—make good food choices (at least most of the time).  Meat, veggies, and fruits should makeup the bulk of your diet.

Dr. Melissa Miskell is the Medical Director of Hormones by Design, a bio-identical hormone replacement center in Waco and Boerne, Texas.  Her highly trained Nurse Practitioners have been treating hormone patients for more than 10 years and are accepting new patients.  In San Antonio, call (210 305-5077. In Waco call (254) 230-4225 to schedule with Women’s Health Nurse Practitioner, Suzy Hancock.  In Boerne call (830) 981-9540 to schedule with our Family Nurse Practitioner, Nancy Beebe.


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Time flies the older we get.

It feels like one day we are chasing toddlers and the next we are nearing menopause. Two common symptoms that usher in this phase of life are hot flashes and night sweats.  For most women, establishing care with a qualified bio-identical hormone center makes these symptoms more manageable.

However, there are patients that cannot take bio-identical hormones (or simply do not want to).  What can those patients do? Here are some natural options for alleviating the frequency and severity of hot flashes and night sweats.

  1. Exercise Many scientific researchers have proven that exercise stimulates the release of feel-good hormones called endorphins. Brisk walking, jogging, and swimming are good aerobic activities that can help release tension in the body and mind.
  2. Relax and Mediate Practice deep abdominal breathing. Sit in a quiet spot to inhale and exhale slowly for just 15 minutes. Controlled breathing (characterized by slow and deep breaths) can calm and relax the body.  Waking up in the middle of the night because of night sweats?  Using this technique may help calm you.
  3. Keep a Diary – Keep track of the time of episodes, the stress level or emotional state when it occurs, food and drinks consumed prior to occurrence, clothing worn, sleeping conditions (if it’s a night sweat), activities done and other elements that might have triggered the episode.  This can help you avoid those triggers.
  4. Supplements – There are pharmaceutical grade supplements available that will help you through these symptoms.  For example, I recommend Xymogen’s Femquil.  This supplement helps your body deal with xenoestrogens (hormone disrupting compounds found in the environment) and promotes healthy hormone balance.  (More on Xymogen below).

You can try one or all these options.  They are all safe and do not involve the use of hormones.  Need more information on what you can do to help with your hormonal symptoms?  You can still see a qualified bio-identical hormone center.  On occasion, problems with your thyroid can cause symptoms like hot flashes or night sweats.  A simple blood test can help your doctor determine what you need (whether vitamin or prescription) and how much.

Interested in ordering the Femquil mentioned here?  Xymogen provides our pharmaceutical grade supplements we use in the office.  Simply go to Xymogen.com, Patients, Xymogen Xpress, and register.  Call or email our offices to get your Referral Code.  Physician Code is always: Miskell.

Dr. Melissa Miskell is the Medical Director of Hormones by Design, a bio-identical hormone replacement center in Waco and Boerne, Texas.  Her highly trained Nurse Practitioners have been treating hormone patients for more than 10 years and are accepting new patients.  In Waco call (254) 230-4225 to schedule with Women’s Health Nurse Practitioner, Suzy Hancock.  In Boerne call (830) 981-9540 to schedule with Family Nurse Practitioner, Nancy Beebe.


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4 Common Activities that Trigger Hot Flashes

Yep, you know you are having a hot flash when you feel like you are going to spontaneously combust.  Nothing sounds better than standing in front of the open freezer door (and even then, that is not cool enough).  Well, there are some things in life that promote hot flashes.  If at all possible, you should try to minimize doing these things…

  • Drinking alcohol—I know, that glass of wine at the end of the day is one of the ways you relax.  I understand!  However, alcohol can trigger a histamine response in many women (you can see this when your cheeks start to get flushed after drinking).  This histamine response can also trigger a hot flash.  Try to limit your alcohol consumption and take a supplement like Xymogen’s Hist DAO before drinking.  (More on Xymogen below)
  • Eating spicy foods—Mexican, Thai, or Chinese…all these foods tend to be spicy.  Consumption of spicy foods tends to make you flush and sweat, leading to increased hot flashes.  Limit your consumption of spicy foods when possible.
  • Smoking—If you needed one more reason to quit, here it is.  Smoking increases hot flashes.  However, if you have a genetic predisposition to poor estrogen metabolism and increased sensitivity to environmental toxins smoking can make menopause in general more severe.  Consider kicking the habit.
  • Getting overheated—By this I mean getting overheated with no real way to cool down effectively.  Painting in a hot room with no air conditioning, or just being outside during a summer day in Texas.  Once you start the sweating and flushing, a full-blown hot flash can follow.  Try to plan these activities when the temperatures are not soaring.

avoid spicy foods to avoid hot flashes

One thing to always consider when dealing with hot flashes is when to see a hormone specialist.  Remember you don’t have to suffer.  Bio-Identical hormones can help replenish your levels to where you feel good again!  A simple blood test can tell your hormone doctor what you need to be taking and how much.Dr. Melissa Miskell is the Medical Director of Hormones by Design, a bio-identical hormone replacement center in Waco and Boerne, Texas.  Her highly trained Nurse Practitioners have been treating hormone patients for more than 10 years and are accepting new patients.  In Waco call (254) 230-4225 to schedule with Women’s Health Nurse Practitioner, Suzy Hancock.  In Boerne call (830) 981-9540 to schedule with Family Nurse Practitioner, Nancy Beebe.

Want to order some of the Hist DAO mentioned above? You can order pharmaceutical grade supplements through Xymogen Xpress.  Simply go to Xymogen.com, Patients, Xymogen Xpress, and register.  Call or email our offices to get your Referral Code.  Physician Code is always: Miskell.


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By now most people have at least heard about hormone replacement.  But how do you know if you need it?  Well, here are five distinct signs that hormone replacement could benefit you.

  1. Hot Flashes – If you have ever had one, you KNOW what I am talking about.  When it feels like your entire body is going to ignite and you need to stand in front of the open freezer, you are experiencing a hot flash.  This is a sure sign that your hormones are changing, and you need to investigate hormone replacement.  You don’t have to put up with this…it can be fixed.
  2. Night Sweats – Can sometimes go hand-in-hand with hot flashes but waking up with your nightgown soaking wet doesn’t have to be tolerated.  Not only is this a huge nuisance, it will inevitably interfere with your sleep, causing all the health issues that correspond with sleep deprivation as well.
  3. Weight gain – Yes, getting “thicker around the middle” can be related to hormone imbalance.  Particularly for women, weight gain is usually in the abdominal area.  Thyroid can also play a role in weight gain and should be checked along with hormone labs.
  4. Fatigue – Remember how much more energy you had when you were in your 20s?  Well, part of that energy was due to your increased hormone levels during that time.  Hormone replacement (in particular Bio-Identical Hormone Replacement) can help to replenish these hormone levels and get back the “pep in your step!”
  5. Lack of Sex Drive – Don’t be afraid to admit it…you may be apathetic about sex.  Not really wanting or caring if you have sex is a sign that your hormones levels are declining.  Women need testosterone too (in much smaller doses than men) in order to help keep their sex drive active.  If you find yourself just not in the mood, you need to see a qualified hormone replacement doctor.  Believe me, your significant other will thank you.

There are multiple other signs and symptoms that hormone replacement can help alleviate.  However, if you currently have any one of these five, you should see a doctor.  A simple blood test can show the levels of all your hormones and thyroid.

Dr. Melissa Miskell is a bio-identical hormone replacement expert who has been practicing for 18 years, and is the Medical Director of Hormones by Design in Waco, Texas. Suzi Hancock is a Women’s Health Nurse Practitioner that will love to see you in our Waco office! Hormones by Design is currently accepting new patients at (254) 230-4225.


There are hundreds of clinics attempting to treat hormone imbalance. What makes us different? We listen, then we take action. Our business model makes it possible for us to start your treatment on day one. Faster treatment = feel better faster.
Hormone Replacement Therapy in San Antonio, Waco, and Boerne

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