Debbie Judd, a functional medicine provider, says The Metabolic Institute she operates in Spokane has grown in popularity, even though the hormone replacement therapy the institute offers for women undergoing menopause has been plagued with controversy for the past two decades. 

“It’s been (busy) for years,” says Judd who co-founded The Metabolic Institute, a trade name for Nutritional Wisdom Consulting Inc., with her husband, Dr. Michael Judd, a cardiovascular surgeon who is now retired. 

To open more appointment times, which are now booked through February, Judd has hired a new certified functional medicine provider with a doctorate in integrative medicine who will start this month. 

With emerging research and a push for awareness about women’s health in midlife, the demand for such services is expected to continue. 

Celebrities ranging from Halle Berry to Oprah Winfrey to Michelle Obama have begun to speak out about women and menopause. In March, the White House announced an initiative to advance research on women’s midlife health.

In May, a study in the medical journal JAMA concluded that the benefits of hormone therapy for the treatment of menopause symptoms outweigh the risks. The research was based on follow-up data from the Women’s Health Initiative study, which tracked thousands of women on hormone replacement therapy. The study was stopped in 2002 when it was discovered that women taking a combination of estrogen and progestin had higher risk of breast cancer and stroke, leading to a drop in women taking the replacement therapy.

The treatment, also known as menopausal hormone therapy, is a treatment that helps alleviate symptoms brought on by menopause, such as hot flashes, bone thinning, mood swings, and sleep problems, by replacing the body’s natural estrogen and progesterone levels. 

Judd says the Women’s Health Initiative study had an impact in the industry, yet more studies have emerged in the decades since that have clarified data and presented different interpretations of the data. Her own initial training and research in 2009 embraced the use of bioidentical hormone replacement therapy for menopause symptoms. As more pharmaceutical companies begin to offer bioidentical hormones, acceptance and awareness will continue to grow, she says. 

Founded in 2005, The Metabolic Institute is located on the second floor of the Quail Run office building, at 2204 E. 29th on Spokane's South Hill. Judd is an advanced practice registered nurse with 46 years of nursing experience who has continued her education in functional medicine since opening her practice. She has credentials in functional, nutritional, and regenerative medicine through The Metabolic Medicine Institute, an arm of the American Academy of Anti-Aging Medicine. She has advanced certification in endocrinology, and is certified in integrative oncology. 

With the new provider, the practice has a staff of eight, including, a licensed practical nurse, a nutritionist, an IV therapist, a business manager, and patient care coordinators. The practice doesn't accept insurance, and rates are charged by the hour, Judd says. An initial visit runs about 1 1/2 hours and costs $400. In the initial visit, Judd covers the patient’s history and determines the type of lab work needed.  Subsequent visits are usually about 30 minutes. 

The Metabolic Institute offers compounded bioidentical hormones derived from yams for hormone replacement therapy because the yams are more identical to human hormones than those synthesized from animal sources, she says. Compounded bioidentical hormones are custom made by a pharmacist according to a provider’s specifications and can be made in the form of oral capsules, lozenges that can be placed under the tongue, drops, or creams, she says. The prescriptions are made by First Pharma Associates LLC, doing business as Koru Pharmacy, at 1802 N. Monroe.

“It’s crucially important when women are on hormones to know the compounding pharmacy that you’re using,” Judd says. “A huge part of hormone replacement therapy is making sure you’re dealing with a good pharmacy.”

The U.S. Food and Drug Administration has approved bioidentical hormones, but the FDA doesn't regulate compounded bioidentical hormone therapies.

Judd says while there are commercially available bioidentical hormone therapies, such as estradiol patches, other ingredients in the treatment, like peanut oil, make it difficult for some patients to use.

“What’s nice about compounding is you can individualize their dosing,” Judd says. “When you use some of these commercial ones, you have to choose from what the pharmacies have available versus what the patient really needs. Some patients might be in between doses.”

Judd says she prefers to use saliva testing for hormones, as opposed to blood testing, because it provides a more accurate picture of the patient’s hormone levels. Hormones show up at lower levels in blood testing, often leading patients to be overprescribed, she explains.  

“I have a lot of patients that come to me on high levels of hormones that are not feeling well and are gaining weight,” Judd says. “When I do my testing, they are overdosed big time. It’s a challenge getting women’s hormones down, especially estrogen. Your body gets addicted to those hormones.”

Judd says that when patients come to her, she evaluates them holistically and considers other underlying factors, such as thyroid and adrenal gland conditions, stress levels, and exercise.

“We treat all hormones, the thyroid, the adrenal, gut health. We do a lot of autoimmune diseases,” Judd says. “We call functional medicine upstream medicine with the concept that long-term imbalances, if left untreated, end up becoming chronic illnesses.”