Chantel Unseld, APRN                502.275.1683                                  Facial Expressions, LLC​​

Men & Women Are You Experiencing Any of These Symptoms

Hot Flashes/Night Sweats
Decrease Libido
PMS/Menstrual Migraines
Difficulty Sleeping at night
Low Testosterone
Loss of Muscle Mass or Increase Abdominal Fat
Brain Fog or Not Feeling Yourself

    How To Get Started?

    1. Congratulate yourself for taking the first step in the process of changing your life.

    2. Fill out the appropriate forms below and return them to our office prior to your appt or email them directly to me at [email protected]  Having these forms prior to your visit allows me time to review your syptoms more thoroughly. 

    3. Call our office at 502.348.0992 to receive an order for the lab work that you will need based on your symptoms.  We would prefer to  use LabCorp but if you provide us a Fax number you are welcome to get your labs done at another facility.  

    4.  Once your lab work has been completed your first visit with Chantel Unseld, APRN can be scheduled.  

    5. As we understand schedules can change we would appreciate you taking every step to keep your appt time that we have given you.   


    Female Initial Forms

    Male Initial Forms


    Follow Up Forms

    Follow Up Forms

    Appointment Fees
    Initial consult for new patient 55-60 min, plus 30 min consult w/ our dietician/lifestyle coach $300

    Follow-Up Appointment 10-15 min  $75
    Follow-Up Appointment 25-30min $150
    Follow-Up Appointment 40-45min $189
    Follow-Up Appointment 50-60min $250

    An additional 3 appointments with the dietician are included with any 30-60 minute F/U appt with Chantel Unseld, APRN

    Vit B12 injections are included monthly between each appointment with Chantel Unseld, APRN
    Vit B12 levels less than 500 need weekly injections for a month and are priced at $10 each injection    

    *Please note these fees will not include the cost of labs or prescriptions that you may be required to obtain in order to make the most appropriate plan for you.

    *You are welcome to run blood tests through your insurance OR if you feel your coverage is poor we can provide you a self pay price through our office that must be paid in full before lab order is given. At this point we will provide you insurance codes that you can attempt to file with your insurance for reimbursement.

    *Approximate yearly fees for OV may estimate at $1,300/yr and vary depending on how many health issues we are needing to discuss. Once you have established your medication regimen and stability of levels these costs will decrease.  

    *Labs fees through ZRT will need to be performed if you are using creams due to this is the only appropriate way to determine if your dose is safe for you.
    *Approximate costs can add $700/year

    **Payment is required at the time of service. We do not participate with any insurance plans. 
    **As we understand schedules can change we would appreciate you taking every step to keep your appointment time that we have reserved for you.  

    Your lab results will be reviewed with you in detail at the time of your next appointment. The return of your lab results do not allow us to make determinations about changes in the treatment plan as they are an isolated fact. We make decisions based on a comprehensive review of your current clinical symptoms coupled with your current lifestyle, your medications and supplement in conjunction with the labs. Integrating all of these pieces of information allows us to make the most accurate and helpful recommendations.
    A copy of your lab results is always available for you. We encourage you to share these results with your primary care physician or any health care providers involved in your care. If your doctor is unfamiliar with the labs drawn, we would be happy to speak with them regarding their interpretation.

    FAQ’s About Hormones
    What is the difference between synthetic hormones and bio-identical hormones?

    In our bodies, our hormones work on a lock and key mechanism. Our own hormones fit the lock exactly allowing the proper message in the amount needed by the body to get through. Bio-identical hormones, when carefully and appropriately compounded, also fit the lock almost like our own hormones, allowing them to mimic the actions of our own hormones and keep things in balance. Synthetic hormones do not usually fit the lock well and must “force” their way in. These hormones are often made from pregnant horse urine (thus the name “Premarin”) and because they don’t sit on the hormone receptor exactly as the body likes, they may block out other hormones from also reaching that receptor.

    Can I get bio-identical hormones from a regular pharmacy, such as CVS, or do they need to be compounded?

    Some bio-identical types of hormones have been released by the pharmaceutical companies. One example of this is Elestrin or Divigel, which are bio-identical types of estradiol. They have an altered patented system owned by the pharmaceutical company. Prometrium is another example of a bio-identical type of progesterone that is available at any pharmacy. The disadvantage of these hormones is they only come in 1 or 2 doses and can’t be changed if those doses do not work for you. Also the slow release progesterone form the compounded pharmacist is superior in aiding deep restful sleep all night. The major advantage is that compounded bio-identical hormones can come in whatever dose the patient needs because the pharmacy can “compound” that hormone into whatever is needed. The one size ts all method does not always work when addressing hormone imbalances.

    I have heard that compounded bio-identical hormones are not FDA approved. Why is that?

    In order for the FDA to approve a drug, they must test that drug in the proper dosage and combination. Because a compounded hormone can come in any dose that the physician determines is needed by the patient, it is not possible to test each of these doses. Bio-identical hormones that are not compounded and only come in one or two doses (like the Prometrium example above) are FDA approved. However, this does not mean they are safer than the compounded versions of these hormones.

    How soon can I expect to feel better after I start my hormone therapy?

    The amount of time needed to see a positive change in symptoms after starting therapy is different for everyone. Bio-identical hormones sit on the hormone receptor site for about 3 months. This means that it takes about 3 months for a change in hormones to saturate that receptor site. It is usually best to wait about 3 months before changing doses (up or down) because that is about how long it will take for the current dose to actually take effect.
    Common complaints from our patients as to why they initiate hormone therapy include insomnia, hot ashes, night sweats, depression and irritability. While these symptoms de nitely can arise from hormonal imbalance, diet, exercise, stress and other life factors can also play a huge part. In our hormone programs, we educate and empower you on lifestyle changes that can be made to enhance the effects of hormone therapy. Our patients that make these changes, as well as take their prescribed hormone regime, tend to feel better more quickly.

    What kind of testing do you do to track my hormone levels?

    In most cases serum blood testing will be recommended. Your hormone levels uctuate greatly throughout the course of your monthly cycle. Even if you are no longer having monthly cycles, your hormones levels will vary daily . Checking hormone levels in blood looks at your levels on that speci c day and can be a place to start when evaluating hormones produced by your own body

    Does insurance cover bio-identical hormone therapy or any of the testing?
    Some of the testing is covered depending on your insurance carrier. There are no insurance billing codes for bio-identical hormone counseling in regards to office consultations. 

    What Hormones are We Talking About

    Breast cancer risk is the greatest fear for women considering hormone replacement.  If done at physiologic amounts and in balance, BHRT does not increase the risk of breast cancer.  Large studies using physiologic estrogen with physiologic progesterone have repeatedly shown no increase in risk, and even a possible decrease in risk.  Physiologic amounts of testosterone have also been shown to be protective against breast cancer.  Nutritional support and lifestyle modifications can have a dramatic effect on the risk of developing breast cancer.  

    Estrogen-  There are 3 forms of Estrogen . Estradiol, Estriol and Estrone.  Estrogen is a female hormone that is produced in the ovaries.  Your body has receptor sites everywhere: in your brain, muscles, bone, bladder, gut, breasts, eyes, heart, lungs.  Estrogen has over 400 crucial functions in your body.  It regulated body temperature, helps prevent alzheimer's disease, maintains muscle, helps regulate blood pressure, enhances your energy, improves your mood, and increases your sexual interst.  Other functions include: increasing your metabolic rate, which helps your body run at a youthful level, decreases wrinkles,  maintains the amount of collagen in your skin, decreases risk of colon cancer, helps maintain your memory, maintains bone density and the list goes on.  The Estrogen you will be given will be a combination of Estradiol and Estriol . These natural hormones mimic the body's receptors for estrogen in the body.  Commercially available or synthetic hormones contain many forms of estrogen that do not fit into the estrogen receptors in your body and therefore float around in your blood stream forcing the body to figure out how to metabolize them.  

    Progesterone- is a sex hormone and it plays a role in menstruation, pregnancy, and the formation of embryos.  Progesterone is made in the ovaries up until menopause and then it is made in the adrenal glands.  Progesterone functions to balance estrogen in your body.  It has a positive effect on your sleeping pattern, helps build bone, prevents anxiety, irritability, and mood swings.  It also helps the bladder function and helps relax the smooth muscle in the gut so that your body can break down food into nutrients. Synthetic progesterone that is commercial available do the very opposite in your body. 

    Testosterone falls into the class of hormones called androgens.  Androgens are found in both women and men and made in the adrenal glands and ovaries (in women). Testosterone functions in the body to help decrease bone deterioration, decrease excess body fat because testosterone metabolizes fat, elevates norepinephrine in the brain (which is the same effect as taking an antidepressant), helps maintain memory, increases muscle mass and strength, increases sense of emotional well-being, self-confidence, and motivation, and increases sexual interest.  
    Causes of testosterone deficiency include adrenal stress or burnout, birth control pills, depression, menopuase,
    Ways to increase testosterone are to exercise, decrease stress, get 7-8 hrs sleep a night, and loose weight. 

    DHEA is another one of your sex hormones.  It is also made by your adrenal glands and in small amounts by your brain and skin. DHEA production declines with age, starting in the late twenties. DHEA also makes your estrogen and testosterone.  DHEA functions in the body to help you deal with stress, increase brain function, increase lean body mass, increase sense of well-being, promote weight loss, support your immune system and reduce insulin resistance.  So therefore replacing DHEA can help improve sleep, increase muscle strength, increase feelings of well-being and quality of life because you will have more energy, less infections, an improved mood, etc.  

    Thyroid- your thyroid gland is your body's regulator.  Therefore, an imbalance of your thyroid homone can affect every metabolic function in your body.  Functions include tissue repair and development, aides in the function of mitochondria (energy makers of your cells), assists in the digestion process, modulates carbs, protein, and fat metabolism, modulates sexual function, regulates energy and heat production. Watch the video below for more information on how the thyroid functions in your body. 

    Cortisol- is made by the adrenal gland also and is commonly known as the stress hormone due to its involvment in your response to stress.  Cortisol functions to help you sleep, improve mood and thoughts, influence DHEA, Estrogen and Testosterone, control weight, balance blood sugar, affect stress reaction and is an anti-inflammatory.    When you stress your cortisol levels raise and if they stay high for long periods of time the adrenal gland will weaken and "burn out".   When this happens your cortisol and DHEA levels will drop and this is called adrenal fatigue.  This can cause other conditions in your body such as depression, diabetes, memory loss, heart disease, impotence, panic disorders, rheumatoid arthritis and sleep disorders to name a few.  

    Melatonin- is also a hormone in your body that is made in the brain, eye and GI tract.  Melatonin causes drowsiness and lowers your body temperature when it's time for you to sleep, and it also helps you wake up by resetting your daily biological time clock.  Melatonin also acts as a reparative agent to every organ in the body. So if production of melatonin is not made with a good amount of sleep at night you leave your body vulnerable to many medical conditions.  These can include prevention of cancer by increasing anti-oxidative activity , balancing the stress response, stimulating the production of growth hormone to keep us youthful.  

    There are pros and cons to too much or too little hormone so just as goldilocks said we need it just right. 
    How Our Thyroid Works