Informed Consent for Hormone Replacement Therapy

Because of the rapidly changing research about the safety and efficacy of hormone therapy for anything other than birth control, we feel that it is important that you have information about the risks and benefits of hormone therapy before you undergo the therapy we have discussed. HRT (Hormone Replacement Therapy) is approved by the FDA only for prescribed deficiencies. Using it for other symptoms or problems is considered “off-label” use, and the liability is on the patient, not the provider. When hormone levels are brought back to the “normal range” for your age, there is mounting evidence that your overall health benefits. HRT is the most effective treatment for hormone deficiencies. There may be other long-term beneficial effects of treatment. The current medical thinking is always changing, so it is important to discuss HRT with your provider each year at your annual exam to find out what the latest thinking is.

Please read the following: By checking the box you are agreeing that you have discussed the reason for taking female/male sex hormones with your provider and understand why he/she is prescribing them and the risks associated with taking hormones, including but not limited to the possibility of an increased risk of breast cancer, endometrial cancer, blood clotting, stroke, or heart attack. You understand that your provider will do everything he/she knows to do to decrease and minimize the risks of HRT but that there are no guarantees that these measures will be effective at preventing the negative side effects mentioned above or others that we do not know about yet. You accept the risks and unknowns of taking hormone therapy and wish to have your provider prescribe them for you.