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Restore Balance and Revitalize Your Health With Female Hormone Therapy in San Diego

Hormones play a vital role in nearly every aspect of a woman’s health—from mood, metabolism, and energy levels to sexual function, bone health, and mental clarity. When hormone levels decline or fluctuate due to age, stress, or lifestyle factors, it can lead to symptoms that impact both physical and emotional well-being.

At Coastal Plastic Surgeons’ Medspa, our personalized female hormone therapy in San Diego helps restore balance and optimize wellness through precise, evidence-based care tailored to your individual needs. Schedule your consultation today to take the first step toward renewed energy and lasting hormonal harmony.

What Is Female Hormone Therapy?

Female hormone therapy, also known as hormone replacement therapy (HRT) or bioidentical hormone replacement therapy (BHRT), is a medical treatment designed to replenish the body’s natural hormones when levels decline.

For women, this typically includes estrogen, progesterone, and sometimes testosterone—key hormones that regulate reproductive health, metabolism, and emotional balance.

At Coastal Plastic Surgeons’ Medspa, we specialize in individualized hormone restoration programs that use bioidentical hormones—compounds molecularly identical to those naturally produced by your body. This approach allows for precise customization and better compatibility, minimizing side effects and optimizing results. Our goal isn’t just symptom relief—it’s helping women thrive at every stage of life, whether they’re approaching menopause, managing perimenopausal changes, or seeking preventive wellness care.

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Addressing Hormonal Imbalances That Affect Mood, Metabolism, and Vitality

Hormonal changes can subtly influence how women feel, function, and age. Fluctuations in estrogen, progesterone, and testosterone can lead to mood swings, slower metabolism, fatigue, and a noticeable loss of motivation or vitality. At Coastal Plastic Surgeons’ Medspa, female hormone therapy is designed to correct these imbalances through precise testing and customized treatment. By restoring hormonal harmony, patients often experience steadier moods, renewed energy, and a metabolism that supports sustainable wellness and weight management.

Signs of Hormonal Imbalance

Hormonal fluctuations can begin years before menopause and may intensify as estrogen and progesterone levels drop. Many women experience symptoms that go far beyond hot flashes or mood swings.

Common signs of hormonal imbalance include:

  • Low Energy and Fatigue: Feeling tired even after adequate rest.
  • Weight Gain or Difficulty Losing Weight: Particularly around the abdomen or hips.
  • Mood Swings and Irritability: Anxiety, depression, or sudden emotional changes.
  • Sleep Disturbances: Trouble falling or staying asleep.
  • Low Libido: Reduced sexual drive or arousal.
  • Brain Fog and Memory Issues: Difficulty concentrating or recalling information.
  • Hot Flashes and Night Sweats: Sudden temperature fluctuations.
  • Vaginal Dryness or Discomfort: Leading to pain during intercourse.
  • Thinning Hair or Dry Skin: Signs of reduced collagen and hormonal support.

Benefits of Female Hormone Therapy

Balancing your hormones can have a profound effect on your overall health and vitality. With a treatment plan designed around your unique needs, hormone therapy can provide meaningful and lasting benefits, including:

  • Restored Energy: Feel more alert, motivated, and physically active throughout the day.
  • Improved Mood Stability: Alleviates anxiety, depression, and irritability for greater emotional well-being.
  • Enhanced Sleep Quality: Promotes deeper, more restorative rest.
  • Balanced Weight and Metabolism: Supports healthy fat distribution and improved metabolic function.
  • Renewed Sexual Health: Increases libido and comfort during intimacy.
  • Sharper Focus and Memory: Enhances mental clarity and cognitive function.
  • Stronger Bones and Muscles: Protects against osteoporosis and age-related weakness.
  • Healthier Skin and Hair: Encourages elasticity, hydration, and a youthful glow.

When balanced correctly, hormone therapy doesn’t just help you feel younger—it helps your body function at its best.

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Personalized Approach to Hormone Therapy

Every woman’s hormonal profile is unique, and so should her treatment plan. At Coastal Plastic Surgeons’ Medspa, we begin with a comprehensive consultation that includes:

  • Detailed Medical History Review – Understanding your health background, symptoms, and lifestyle.
  • Comprehensive Lab Testing – Evaluating hormone levels such as estrogen, progesterone, testosterone, DHEA, and thyroid function.
  • Personalized Treatment Planning – Developing a program tailored to your specific needs, using bioidentical hormone formulations.

Your treatment may include a combination of hormone creams, injections, pellets, or oral supplements, depending on your preferences and health goals. Our providers monitor your progress closely, adjusting dosages as needed to ensure safe, optimal results.

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“After researching at least a hundred different plastic surgeons from here in San Diego all the way up to Beverly Hills, I decided to go with Dr. Batra based on his level of skill and expertise. The before and after pictures of his patients spoke for themselves—there was just no comparison. It has been almost a year since my breast augmentation, and I could not be happier with what a great job Dr. Batra has done.”

Haley G.

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Types of Female Hormone Therapy

There are several delivery methods for hormone therapy, each designed to provide consistent absorption and reliable results.

Bioidentical Hormone Pellets

Tiny implants placed under the skin that release hormones gradually for up to four months.

Topical Creams and Gels

Applied to the skin for steady daily absorption.

Oral Capsules or Tablets

Convenient for daily use and easily adjustable.

Injections

Provide a controlled, direct method for restoring hormone balance.

Your provider will recommend the best option based on your lifestyle, comfort level, and how your body responds to treatment.

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What to Expect During Treatment

The process begins with a private consultation and lab work to measure your baseline hormone levels.

Once your personalized treatment plan is developed, therapy begins with low, physiologic doses that mimic the body’s natural hormone production.

You may start noticing improvement within a few weeks, with full benefits typically achieved after two to three months as your hormone levels stabilize.

Your provider will schedule follow-up appointments and lab tests to fine-tune your dosage and ensure that your results remain consistent.

Safety and Monitoring

At Coastal Plastic Surgeons’ Medspa, your safety and long-term wellness are our top priorities. Bioidentical hormone therapy has been extensively studied and is considered safe when properly prescribed and monitored by trained professionals.

We maintain ongoing communication with each patient, tracking progress through follow-up evaluations and lab work. This ensures balanced hormone levels, optimal effectiveness, and minimized side effects.

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Complementary Treatments for Holistic Wellness

Many women choose to combine hormone therapy with other Medspa and wellness treatments for a more comprehensive rejuvenation plan. Popular options include:

  • IV Vitamin Therapy – Replenishes nutrients and boosts energy.
  • Microneedling and Skin Rejuvenation – Improves skin elasticity and glow as hormones rebalance.
  • Medical Weight Management – Supports healthy weight loss alongside metabolic balance.
  • Stress Management and Sleep Optimization – Addresses lifestyle factors that impact hormone health.

How Much Does Female Hormone Therapy Cost?

The cost of female hormone therapy in San Diego depends on your customized treatment plan, including the type of hormones prescribed, dosage, and frequency of follow-up care. During your consultation, you’ll receive a personalized cost estimate and information about our flexible financing options through PatientFi, CareCredit, and ALPHAEON Credit.

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Meet Your Provider: Dr. Munish Batra

Dr. Munish Batra, MD, FACS, is a board-certified plastic and reconstructive surgeon and founder of Coastal Plastic Surgeons. With a focus on advanced wellness and aesthetic medicine, Dr. Batra leads a team of medical professionals who specialize in personalized treatments such as female hormone therapy. Under his direction, patients receive attentive, evidence-based care designed to optimize health, confidence, and longevity.

Why Choose Coastal Plastic Surgeons?

At Coastal Plastic Surgeons’ Medspa, we believe that true beauty begins with balance—both inside and out. Our team combines advanced medical knowledge with compassionate care to help women restore hormonal harmony and rediscover their best selves. From comprehensive testing to ongoing support, we take a whole-person approach that prioritizes your safety, well-being, and quality of life. Schedule your consultation today to learn how female hormone therapy can help you feel renewed, revitalized, and empowered.

Here What Our Clients Say

I went to Dr. Batra because he was a recommended by my friend and seeing the results he had with her I was impressed! So I decided to do my tummy tuck. In my second week post op I ...

I went to Dr. Batra because he was a recommended by my friend and seeing the results he had with her I was impressed! So I decided to do my tummy tuck. In my second week post op I cried because I was so amazed how my belly looks. I’m going on 4 weeks now and I couldn’t be more proud and Dr. Batra did amazing job on my tummy tuck. I highly recommend him! Speaking about perfectionists, he is and you want that as a surgeon. I’m just so excited and looking forward for full recovery! Thank you Dr. Batra, you’re awesome!

—Q.T.

I’m so pleased with my tummy tuck, everything went super well, and he is the best San Diego. I’m recommending him to my family & friend's. Every follow up appointme...

I’m so pleased with my tummy tuck, everything went super well, and he is the best San Diego. I’m recommending him to my family & friend's. Every follow up appointment he would listen to my questions or concerns and answer everything with honesty. Thank you Dr. Batra.

—L.K.

The most professional, caring and competent staff led by the amazing Dr. Batra! From the first appointment, I was made to feel comfortable and cared for! I highly recommend this pl...

The most professional, caring and competent staff led by the amazing Dr. Batra! From the first appointment, I was made to feel comfortable and cared for! I highly recommend this place! Dr. Batra is not only an outstanding surgeon, but a very kind and caring person with a great personality and sense of humor. I also can’t say enough great things about the staff!

—L.H.

I am in my 6 weeks recovery from breast reduction. I am very pleased with the results. Dr Batra as well as his staff were very comforting before and after the surgery. They schedul...

I am in my 6 weeks recovery from breast reduction. I am very pleased with the results. Dr Batra as well as his staff were very comforting before and after the surgery. They scheduled me for the surgery in less than a month after my first visit and the procedure went by much easier than I expected. My neck and back pain disappeared, the shape and size of my breast is just what I expected. I truly feel that I was lucky to have the surgery done with this amazing surgery group.

—N.T.

I underwent a breast augmentation and lift procedure with Dr. Batra at Coastal Plastic Surgeon’s 10 weeks ago, and I couldn't be more thrilled with the results. From the init...

I underwent a breast augmentation and lift procedure with Dr. Batra at Coastal Plastic Surgeon’s 10 weeks ago, and I couldn't be more thrilled with the results. From the initial consultation with staff to post-operative care, the entire experience was nothing short of wonderful. I was so nervous about having the procedure done but my old implants were encapsulated and needed to come out.

Not only did Dr. Batra deliver outstanding results that exceeded my expectations, but his bedside manner was truly exceptional. He took the time to listen to my concerns, answer all my questions, and ensure that I felt comfortable and informed throughout the entire process.

I highly recommend Dr. Batra to anyone considering a breast augmentation or lift. His skill, attention to detail, and compassionate approach set him apart as a top-tier plastic surgeon. Thank you, Dr. Batra, for your exceptional care and for helping me achieve the confidence I've always desired.

—K.R.

I had an explant and lift on May 9th 2025…the experience was top rate. I felt heard, safe, and comfortable the entire time and the results were just what I hoped for.

—C.T.

My breast reduction experience with Dr. Jindal was exceptional. The entire team is welcoming, helpful, and respectful, especially Gabriela, who helped me so much and was an absolut...

My breast reduction experience with Dr. Jindal was exceptional. The entire team is welcoming, helpful, and respectful, especially Gabriela, who helped me so much and was an absolute pleasure to be around. Dr. Jindal listened to what I wanted and delivered beyond my expectations. He was incredibly kind and attentive during the entire process. If you are considering getting a breast reduction, I highly recommend choosing Dr. Jindal. I am so happy with my results and grateful to the entire team at Coastal Plastic Surgeons.

—P.S.

As a mother of two it was time for...."a little work." After considering multiple surgeons in deferent areas I had consultations with two. After my consultation it was clear....Dr....

As a mother of two it was time for...."a little work." After considering multiple surgeons in deferent areas I had consultations with two. After my consultation it was clear....Dr. Batra was the most knowledgeable, professional and attentive to my concerns. He felt very trust worthy and not creepy at all. The procedure went great and recovery went well. Dr. Betra and his team especially Alexa were the best. Im so happy with my results! I would highly recommend Coastal Plastic Surgery to anyone. Don't put it off ladies it's sooo worth it.

—A.D.

I'm the type of person who doesn't typically write reviews or even have the time, but my recent experience with Coastal Plastic Surgeons is definitely worth my time! I am a mommy o...

I'm the type of person who doesn't typically write reviews or even have the time, but my recent experience with Coastal Plastic Surgeons is definitely worth my time! I am a mommy of three, with my youngest being 2 years of age. After each baby I'd bounce back to my original weight but as you know the beauty of having children can leave devastating damage to the appearance of our bodies. After three breastfed big babies I was left with an unrecognizable belly button, hanging excess tissue and droopy breasts I knew NO workout or diet could remedy! I made the best decision in having a full tummy tuck and breast implants done by Dr. Batra! I never thought I'd be able to wear a two piece ever again! I felt very confident with his knowledge and experience. Trust them when they express their opinions because they were absolutely right! I wanted to go very natural and at first I was afraid with the size preference of the implants chosen for me, but in the end the results were perfect so I'm happy I listened. I would highly recommend this place to anyone who is in doubt!

—A.T.

Is it weird that I'm excited to write this review?! I can't say enough great things about Dr. Batra and his staff! I decided to schedule a BA consultation with Dr Batra after seein...

Is it weird that I'm excited to write this review?! I can't say enough great things about Dr. Batra and his staff! I decided to schedule a BA consultation with Dr Batra after seeing the amazing pictures on his website. Dr. Batra was super warm, honest, and professional from day one. He took time to really listen, offered an honest opinion, and made me feel so comfortable. It has only been 7 weeks since my surgery and I'm already beyond thrilled with my results. Dr. Batra is truly talented yet is so humble. Nicole was so encouraging and genuine through the whole process. Rachel was really sweet and informative. Kelsey is always so pleasant on the phone and makes scheduling a breeze. I was also really impressed by the surgery center. The nurses went above and beyond and seriously spoiled me. I never thought surgery could actually be enjoyable! I was anticipating the worst with the recovery process due to friends experiences, but was blown away by how little pain I experienced. I feel incredibly blessed that I was in such great care and picked such an awesome surgeon! I would do it all over again in a heartbeat and wouldn't change a thing! Thank you Dr. Batra and staff for taking such wonderful care of me and making me feel so special!

—C.M.

I had my first surgery (breast augmentation) in January with Dr. Batra. He is an amazing person besides doctor. He did a great job and has followed me constantly on my recovery. If...

I had my first surgery (breast augmentation) in January with Dr. Batra. He is an amazing person besides doctor. He did a great job and has followed me constantly on my recovery. If you want someone safe and who will contact you or answer you immediately when you have a concern pick him! My last follow up I told him about my legs I’ve been going to the gym for over a decade almost two decades actually and have not been able to shape them. Dr. Batra doesn’t make me feel like anything is wrong with me. He makes me feel so comfortable and it’s so easy to tell him my concerns he told me it was such a common thing and that meant everything to me. He eases my concerns and most importantly makes me feel safe. I had consultants in the past that made me uncomfortable and never went past a consultation. Being a nurse I am a little picky with my health. His staff is amazing I wish I remembered everyone’s name but specifically Miriam is amazing! Not that anyone else is any less it’s just when you go she will be your contact person for almost everything. She answers my questions. She gets back to me immediately even off the clock. You are awesome thank you for answering me. Just today I sent her a message thinking she would get back to me tomorrow morning when she was back at work and she called me after her dinner!!! Thank you for easing my experience. You guys are amazing I can’t wait till next week my second surgery with you and definitely not my last!

—M.C.

My experience with Dr. Batra has been AMAZING! I had multiple consults that left me feeling doubtful. The day I met Dr.Batra he was very knowledgeable and reassuring. I am now comi...

My experience with Dr. Batra has been AMAZING! I had multiple consults that left me feeling doubtful. The day I met Dr.Batra he was very knowledgeable and reassuring. I am now coming up on my third week post-op, and so happy with my results! If you have any desire to do something for yourself book a consultation with Dr.Batra because you won’t regret it.

—X. J.

I just want to say Courtney from Dr. Batras office is so patient and understanding! I could talk to her about anything, I have surgery comming up and have been so nervous about the...

I just want to say Courtney from Dr. Batras office is so patient and understanding! I could talk to her about anything, I have surgery comming up and have been so nervous about the whole process but she has been a huge help! So far im very pleased ill be back to let you know how surgery goes.

—C.F.

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—RF

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—SO

I have never met a nicer Doctor/Surgeon. He is not your typical cold, no talk Doctor. He is a very nice and caring person who completely makes you feel comfortable. I had a wonderf...

I have never met a nicer Doctor/Surgeon. He is not your typical cold, no talk Doctor. He is a very nice and caring person who completely makes you feel comfortable. I had a wonderful surgery experience with Dr. Batra. I had to have a hysterectomy and an umbilical hernia repair/tummy tuck. This typically means two separate surgeries. Dr. Batra helped me tremendously because he did my hernia repair/tummy tuck at the same time as my O.B. did the hysterectomy. He is so easy going and kind. I did not have to do two surgeries because he was so workable with my situation and needs. The office ladies are a pleasure to talk to and are very personable. I had a great experience with Dr. Batra and the entire staff. I feel 100% better and my tummy is hernia free and beautiful again! I have recommended him to my friends and family because my experience was truly amazing. Thank You Dr. Batra!!

—AF

I was referred to Dr. Batra by a friend. From the moment I met Dr. Batra I knew he would be my plastic surgeon. I felt so comfortable with him that I booked my surgery the same day...

I was referred to Dr. Batra by a friend. From the moment I met Dr. Batra I knew he would be my plastic surgeon. I felt so comfortable with him that I booked my surgery the same day of the consultation. I had a tummy tuck done with Liposuction. Not only did he do an amazing work but he was so caring and attentive that he put my mind at ease. I highly recommend Dr. Batra to anyone that is interested in plastic surgery.

—RF

I have been getting surgeries since i was 3 years old. I was in a kitchen fire at age 3 and suffered from burn scars on my face and arms. After 18 years of getting surgeries done o...

I have been getting surgeries since i was 3 years old. I was in a kitchen fire at age 3 and suffered from burn scars on my face and arms. After 18 years of getting surgeries done on my face all over southern california I have never met such a talented and generous surgeon! He did a PRO BONO surgery on me without me asking. I have never felt so warm and welcomed in a surgeons office. Him and his staff are amazing. After several consultations with plenty of doctors i automatically knew I wanted Dr. Batra to do my surgery, and i am so happy I did. I recommend him to all of my clients, Family & friends especially for any work on the face. He is the only one i trust. I am forever Grateful of him!

—YI

I would recommend Dr Batra to friends and family. He was very professional in the last year at all visits and during my surgery. I trusted that he would do a good job and my result...

I would recommend Dr Batra to friends and family. He was very professional in the last year at all visits and during my surgery. I trusted that he would do a good job and my results were better than I expected.

—SO

I am currently 3 months post op after having both a tummy tuck and an arm lift. Dr. Batra is a true artist. He, Dr. Rod, Miriam, and the rest of his team were all fantastic. I love...

I am currently 3 months post op after having both a tummy tuck and an arm lift.

Dr. Batra is a true artist. He, Dr. Rod, Miriam, and the rest of his team were all fantastic.

I love my new silhouette. The end results are way better than I ever imagined they could be!

—AL

I had a Tummy Tuck six months ago and i couldn’t be happier. Dr. Batra’s staff, surgical team and staff were amazing. Dr. Batra is confident, caring and gave me a phenomenal new tu...

I had a Tummy Tuck six months ago and i couldn’t be happier. Dr. Batra’s staff, surgical team and staff were amazing. Dr. Batra is confident, caring and gave me a phenomenal new tummy. I would encourage everyone who’s considering plastic surgery to make an appointment with him for your free consultation and you’ll see what I mean. Good Luck.

—JK

My surgery was a HUGE success. More important than how wonderful my surgery and surgeon was, I felt completely cared for and even pampered throughout my care leading up to surgery ...

My surgery was a HUGE success. More important than how wonderful my surgery and surgeon was, I felt completely cared for and even pampered throughout my care leading up to surgery and after. Today was a huge day for me. For the first time in over 10 years I went to the beach confidently wearing a bikini. The only reason I was able to do this was because of Dr. Batra and his staff. And the excellent customer service and care just keeps going. I will never go to another surgeon if I ever need plastic surgery again. I am 5 weeks out of surgery, my true results are not even there yet, and I feel like a new person. Thank you just doesn’t seem to cover it. If you are considering plastic surgery go see Dr. Batra. I cannot say enough. And I still love you, Maryam!!

—JF

I couldn’t ask for a better surgeon and I love my outcome!!! I get compliments all the time on how perfect my breasts are and would recommend him to anyone! Including my good frien...

I couldn’t ask for a better surgeon and I love my outcome!!! I get compliments all the time on how perfect my breasts are and would recommend him to anyone! Including my good friend who also got a breast augmentation from Dr. Batra and can’t stop talking about them! Thanks Dr. Batra, you and your staff are amazing!

—KC

After multiple consultations with plastic surgeons in and out of the area, I decided on Dr. Batra. I had 2 breast surgeries from another p.s. both ending with capsular contracture ...

After multiple consultations with plastic surgeons in and out of the area, I decided on Dr. Batra. I had 2 breast surgeries from another p.s. both ending with capsular contracture and a lot of miscommunication, so finding a surgeon who is humble, confident, and attentive was very important to me. Dr. Batra has the hands of an angel and I hardly felt any pain after surgery, and what little pain I did feel Tylenol took care of. I am 10 weeks post op and my results are beautiful and I can finally be confident about my breasts thanks to Dr. Batra. I would definitely recommend him to anyone, especially those who are needing a revision.

*Update- I am 16 months post op and have healed beautifully! Just wanted to update this because I know how difficult it is finding a really good surgeon, and I’m just so happy and grateful everything turned out well thanks to Dr. Batra.

—CB

Dr. Batra is a true Artist. I’m six months out from my surgery. I couldn’t be happier with my outcome. My breasts are PERFECT and so is my liposuction. After having a baby and brea...

Dr. Batra is a true Artist. I’m six months out from my surgery. I couldn’t be happier with my outcome. My breasts are PERFECT and so is my liposuction. After having a baby and breast feeding, I was very self conscious about wearing a bikini or strapless dresses. After Dr. Batra did my surgery, I can wear anything I want. I love the implant size that Dr. Batra recommended for me. They look and feel very natural. Thank you Dr. Batra for giving me my body back.

—MG

I had an amazing experience with Dr Batra and his staff at Coastal Plastic Surgeons over the last year while having a tummy tuck post twins. From my initial visit, to pre op, the a...

I had an amazing experience with Dr Batra and his staff at Coastal Plastic Surgeons over the last year while having a tummy tuck post twins. From my initial visit, to pre op, the actual surgery and many follow up appointments, he remained professional and the staff was very helpful. I would recommend him and his team to friends and family.

—SO

I have been seeing Dr. Batra for several years. He originally repaired a botched breast reduction and lip enhancement messed up by a well known Del Mar plastic surgeon. Since that ...

I have been seeing Dr. Batra for several years. He originally repaired a botched breast reduction and lip enhancement messed up by a well known Del Mar plastic surgeon. Since that time, I have continued to see Dr. Batra for way less serious problems and overall “fun” improvements. He is the best botox and filler doctor out there. I rarely even bruise after the injections. I have been to other doctors in the past for this and experienced severe bruising.

I went to see Dr. Batra today and after I left his office, I felt compelled to let you all know again how great he and his staff are. I just love those guys and the great work that they do.

—CT

My breasts were left physically deformed after nursing 3 boys, but Dr. Batra revived my breasts and made them perfect!! I could not be happier with the customer service, cost, and ...

My breasts were left physically deformed after nursing 3 boys, but Dr. Batra revived my breasts and made them perfect!! I could not be happier with the customer service, cost, and work that was done to me. I had a breast augmentation (no lift) and got 440cc silicone implants. It has been only a month since surgery but I am MORE than satisfied with the results!

Thank you Dr. Batra and team! You have rejuvenated my spirit!!!

—AD

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FAQ Female Hormone Therapy

How long does it take to see results from hormone therapy?

Most women begin to feel noticeable improvements in mood, energy, and sleep within two to six weeks, with full benefits appearing after several months of consistent treatment.

Is bioidentical hormone therapy safe?

Yes. Bioidentical hormones are structurally identical to those naturally produced by the body and are well-tolerated when prescribed and monitored by experienced providers.

Will hormone therapy cause weight gain?

When properly balanced, hormone therapy can actually help regulate metabolism, making it easier to maintain a healthy weight.

Can I combine hormone therapy with other treatments?

Absolutely. Many patients combine hormone therapy with Medspa treatments, nutrition programs, and wellness therapies to achieve optimal overall health.

How long do I need to continue hormone therapy?

The duration varies for each patient. Some women choose to continue therapy long-term for sustained benefits, while others use it for a specific period under medical supervision.

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