Hormone Optimization

• Women in their 30-50s experiencing symptoms related to hormonal fluctuations despite “normal” lab values ordered by primary care or OBGYN

• Menopausal women with symptoms related to low or absent hormone production

• Men experiencing symptoms of low or imbalanced hormones

If you do not fall into these categories but feel that your hormones may be contributing to symptoms, a Functional Medicine consultation may be a better starting point. This is particularly helpful for women experiencing high stress, anxiety, depression, or cyclical symptoms during the luteal phase. Hormonal evaluation and treatment planning can be performed, and if prescription therapy is indicated, you may then transition into the Hormone Optimization membership.

Hormone Optimization Membership: $49/month

Current Active Weight Loss Members: $25/month add-on

Maintenance Plan GLP-1 + Hormone Optimization Membership: $99/month

This low monthly fee is designed to make ongoing provider expertise more affordable by distributing costs over time rather than requiring large annual or quarterly payments.

Monthly Fee Covers:

• Medical Provider Oversight

• Medication Management and Ordering

• Lab Review

• Video visits scheduled on as needed basis

• Access to GLP-1 and peptides

Medication Costs are in addition:

• Prescription medications are not included in the monthly fee and vary based on medication and route of administration

• FDA-approved medications (e.g., estradiol patch, oral progesterone, testosterone gel for men) may be covered by insurance at retail pharmacies

• Compounded medications (e.g., specialty creams, injections, oral testosterone) are out-of-pocket expenses

Lab Tests are in addition:

• Labs may be completed using insurance or self-pay (insurance coverage is not guaranteed but often covers a portion).

• Other labs, such as DUTCH test or 4 point cortisol saliva testing are out of pocket expenses.

• New patients: initial recheck at 8-12 weeks, then typically every 3 months until steady state is reached 

• Established patients: typically every 6 months

Self-Pay Lab Fees:

Initial Comprehensive Labs

• Males: $200

• Females: $170

Repeat Labs

• Males: $110

• Females: $85

• Concierge-level care with ongoing secure email/text support

• Video visits as clinically indicated (generally no more than once every 3-6 months)

• Prescription management when medically appropriate

• Lifestyle guidance addressing nutrition, sleep, stress, movement, and other contributors to hormonal imbalance

• Comprehensive hormone symptom questionnaire

• Sexual Health evaluation and treatment

• Laboratory testing using:

  • Initial labs may be performed via blood testing (often insurance-covered) or DUTCH testing, selected based on patient needs and preference

  • At-home DUTCH Complete Hormone Panel commonly used for 6-month follow-up testing, ~$300

  • Ongoing lab monitoring is required for men receiving testosterone therapy

Treatment options are individualized based on symptoms, lab results, fertility goals, medical history, cost, and patient preference.

Option 1: Enclomiphene (Fertility-Preserving Therapy)

• What it is: An oral medication that stimulates the body to produce its own testosterone while preserving sperm production and testicular size.

• Dosing: Take one capsule orally daily.

• Cost: Dispensed through a compounding pharmacy, $60–$70/month.

• Why it may be chosen: Men wishing to maintain fertility, younger patients, or those with secondary (brain-signaling) low testosterone.

• Potential benefits: Increased natural testosterone production, preserved fertility and testicular size, oral dosing without injections. It usually moderately raises testosterone, but not as high as direct testosterone.

• Risks and side effects: Headaches, mood changes, rare visual disturbances, and possible reduced effectiveness in primary testicular failure. Titrating the dose slowly may avoid side effects.

• Can also be used in combination with injectable testosterone to help preserve testicular size instead of taking gonadorelin or hCG

Option 2: new Oral Testosterone (Kyzatrex)

• What it is: New to market FDA-approved oral testosterone absorbed through the lymphatic system rather than traditional liver metabolism.

• Dosing: Twice a day with fat-containing food

• Cost: Dispensed through a compounding pharmacy and is not covered by insurance
  $250 for a 2-month supply (400 mg daily) - starting dose and most stay here.
  $450 for a 2-month supply (800 mg daily). Price subject to change.

• Why it may be chosen: Preference for oral therapy and avoidance of injections or skin transfer risks with topical.

• Potential benefits: Raises testosterone levels consistently, avoiding the peaks and troughs associated with twice-weekly injections.

• Risks and side effects: Suppression of sperm production, increased red blood cell count, strict dosing requirements with meals, and lack of insurance coverage. Not showing same sperm production as injections in trials, though there is still a risk.

Option 3: Injectable Testosterone (Subcutaneous Route)

• What it is: Testosterone injected under the skin using small needles. It has the same effectiveness as old-school intramuscular injections.

• Dosing: Typically injected twice weekly. Does not require refrigeration.

• Cost: $200 for 20 weeks of medication. Dispensed through a compounding pharmacy and is not covered by insurance. 

• Why it may be chosen: Most reliable and consistent absorption, lower cost compared to oral options, and improved symptom control for many patients.

• Potential benefits: Stable testosterone levels, less daily management, and good tolerability when dosed appropriately.

• Risks and side effects: Suppression of sperm production, increased red blood cell count, acne or oily skin, and the need for self-injection. If used alone, testicular atrophy/shrinkage may occur. If this is a major concern, we could add gondarelin or hCG injections or oral enclomiphene to keep endogenous testosterone production.

Option 4: Topical Testosterone Gel

• What it is: Daily applied testosterone gel absorbed through the skin.

• Why it may be chosen: Preference for non-injectable therapy and potential insurance coverage if criteria are met.

• Cost: may be covered by insurance only if strict lab criteria for hypogonadism are met; otherwise, retail cost is approximately $50/month.

• Potential benefits: Easy daily application and no injections.

• Risks and side effects: Risk of transferring testosterone to partners or children, skin irritation, variable absorption, and suppression of sperm production.

• Most patients do not choose this as it requires a daily topical application.

Patients are encouraged to request medication cost estimates prior to starting therapy.

As you could guess, optimizing women’s hormones proves a bit more challenging than optimizing mens (go figure…)

Together we will decide which option or combination of options is best for you based on symptoms, lifestyle/convenience factor, lab results, genetics etc. As a rough estimate, see below for different options and estimated pricing.

• Estrogen Replacement: patch, cream, vaginal cream, and less likely to be prescribed oral.

• Progesterone: oral, cream, and less likely vaginal suppository.

• Testosterone: cream, oral troche.

• Creams can be custom compounded to include all 3.

• Estrogen patch and oral progesterone can be typically be covered by insurance at your retail pharmacy.

• All creams and custom oral formulations, and testosterone creams are out of pocket expenses, usually < $100/month.