New Patient Hormone Evaluation

I understand that a valid payment method (credit card) must be kept on file prior to my hormone optimization program consultation. If a valid payment method is not on file before the scheduled appointment time, Wellbeings Medical reserves the right to cancel the appointment and offer a rescheduled date and time.

Initial New Patient Consultation Fee, $299

Should I choose to enroll in the hormone optimization program following the consultation, the $299 consultation fee will be credited toward my first month's program fee. If I decide not to enroll in the program after the consultation, the $299 consultation fee remains non-refundable.

Hormone Optimization Membership: $299/month

The initial evaluation phase typically lasts 1–3 months, depending on the complexity of my symptoms, laboratory findings, treatment plan, and response to therapy.

The $299 monthly fee includes:

• Initial comprehensive hormone evaluation

• Review and interpretation of laboratory testing

• Development and adjustment of my individualized treatment plan

• Follow-up laboratory review

• Follow-up video visits, generally at a monthly cadence during the evaluation phase

• Medication management and prescribing, when appropriate

I understand that I will remain in the evaluation phase until my provider determines that my hormone treatment plan is sufficiently established and I am ready to transition to maintenance management.

If prescription hormone therapy is not needed, there is no ongoing hormone membership fee once the initial evaluation and workup are complete.

Hormone Optimization Maintenance Membership

$49/month

Patients who require ongoing prescription hormone therapy will transition to the Hormone Optimization Maintenance Membership once the initial evaluation phase is complete.

The maintenance membership provides ongoing medical oversight necessary for continued hormone prescribing and includes:

• Medical provider oversight

• Medication management, refills, and ordering

• Review of follow-up laboratory testing

• Video visits as medically appropriate or needed

• Ongoing treatment adjustments when indicated

• Access to eligible low-cost GLP-1 medications and peptide therapies when medically appropriate

The maintenance membership fee does not include the cost of medications, laboratory testing, specialty testing, or other third-party services unless specifically stated otherwise.

Current Weight Loss Program Members

If I am already enrolled in a Wellbeings Medical weight loss program, the following Hormone Optimization pricing applies:

Active Weight Loss Membership — $299/month
Hormone evaluation and management may be added for an additional $99/month.

Bridge Weight Loss Membership — $199/month
A new hormone evaluation may be added for an additional $99/month. Once the hormone evaluation is complete, ongoing hormone maintenance is $49/month.

Current GLP-1 Maintenance Members
If I am currently enrolled in GLP-1 maintenance and begin a new Hormone Optimization evaluation, the standard $299/month Hormone Evaluation fee will be added to my existing GLP-1 maintenance membership during the evaluation phase.

Once both my GLP-1 and Hormone Optimization programs have reached maintenance status, the memberships will be combined into a single:

GLP-1 + Hormone Optimization Maintenance Membership: $129/month

This lower monthly maintenance fee is designed to make continued provider oversight and expertise more affordable by distributing the cost of ongoing care throughout the year rather than requiring larger annual or quarterly payments.

Medication Costs

I understand that medications are not included in my monthly membership fee.

• Prescription medication costs vary depending on the medication, dose, formulation, and route of administration.

• Medications obtained through participating compounding pharmacies are provided at cost without an additional medication markup by the practice.

• FDA-approved medications, such as commercially available testosterone gel, may be eligible for insurance coverage when filled through a retail pharmacy.

• Compounded medications, including certain testosterone creams, injections, capsules, or other customized formulations, are generally not covered by insurance and require out-of-pocket payment.

• Insurance coverage for any medication is determined by my individual insurance plan and is not guaranteed by Wellbeings Medical.

Laboratory & Specialty Testing Costs

I understand that laboratory and specialty testing costs are separate from my monthly membership fee.

Routine laboratory testing may be completed using insurance or through available self-pay options. Insurance coverage is not guaranteed, and I am responsible for any deductible, copay, coinsurance, or non-covered charges assessed by the laboratory or my insurance company.

Specialty testing, including the DUTCH hormone test or multi-point salivary cortisol testing, is generally an out-of-pocket expense.

Typical Laboratory Monitoring

Laboratory monitoring is individualized based on my treatment plan, medications, clinical response, and health history.

• New patients: Initial follow-up laboratory testing is typically performed approximately 8–12 weeks after initiating or significantly changing therapy. Additional testing may be performed approximately every 3 months until a stable treatment plan has been established.

• Established maintenance patients: Laboratory testing is typically performed approximately every 6 months, although more frequent monitoring may be required based on medications, symptoms, laboratory abnormalities, or treatment changes.

Estimated Self-Pay Laboratory Fees

Initial Comprehensive Labs

• Male: approximately $200

• Female: approximately $170

Repeat Labs

• Male: approximately $110

• Female: approximately $85

These prices are estimates and may vary depending on the specific laboratory tests ordered.

I may alternatively choose to use insurance for laboratory testing through Quest Diagnostics. I understand that insurance coverage is not guaranteed and that I may be responsible for a copay, deductible, coinsurance, or the full cost of testing depending on my insurance benefits. Patient responsibility may be approximately $250 or more, depending on the tests ordered and my individual insurance plan.

When choosing the self-pay option, I will be informed of the applicable self-pay cost in advance. My provider may customize my laboratory panel based on my individual medical history, symptoms, medications, treatment plan, and clinical needs.

Hormone Therapy Options and Cost Reviewed

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
  $180 for a 2-month supply (400 mg daily) - starting dose and most stay here.
  $360 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: $60 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.

Updated Safety & Regulatory Information

• The FDA has removed the prior black box cardiovascular warning associated with testosterone therapy.

• Current evidence supports that testosterone therapy, when appropriately prescribed and monitored, does not increase cardiovascular risk in healthy men.

• Risk assessment remains individualized based on dose, formulation, route, and patient health.

• This update does not eliminate all risks, and ongoing monitoring is required.
  

Monitoring and Follow-Up Requirements

Patients agree to:

• Complete baseline labs prior to therapy

• Repeat labs 12 weeks after initiation or dose changes

• Continue monitoring every 3–6 months

• Report side effects promptly

• Attend required follow-up visits
  

Therapy may be adjusted, paused, or discontinued for safety reasons.

Potential Side Effects of Testosterone Replacement Therapy (TRT)

Testosterone therapy is generally well tolerated when appropriately prescribed and monitored, but side effects can occur. Not all patients experience these effects.

Common or Mild Side Effects

• Acne or oily skin

• Increased sweating

• Fluid retention or mild swelling

• Increased facial or body hair

• Mood changes, such as irritability or anxiety

• Changes in libido (increase or, less commonly, decrease)

• Injection site irritation (for injectable therapy)

• Skin irritation or rash (for topical gels)

Blood & Cardiovascular-Related Effects

• Increased red blood cell count (hematocrit), which can thicken the blood and increase clot risk if not monitored

• Changes in cholesterol levels, including possible lowering of HDL (“good cholesterol”)

• Fluid retention, which may worsen blood pressure or heart conditions in susceptible individuals

Current evidence shows no increased cardiovascular risk in healthy men when TRT is appropriately dosed and monitored, but individual risk factors must be considered.

Fertility & Testicular Effects

• Reduced sperm production

• Decreased fertility, which may be reversible after stopping therapy but is not guaranteed

• Testicular shrinkage, due to reduced natural testosterone production
  

Prostate-Related Effects

• Increase in PSA (prostate-specific antigen) levels

• Worsening of urinary symptoms in men with benign prostate enlargement

• Testosterone therapy does not cause prostate cancer, but may accelerate growth of existing prostate cancer
  

Sleep & Respiratory Effects

• Worsening of untreated sleep apnea

• Increased snoring in some individuals

Hormonal & Estrogen-Related Effects

• Breast tenderness or enlargement (gynecomastia) due to conversion of testosterone to estrogen

• Water retention or bloating

Rare or Serious Side Effects

• Blood clots (rare when monitored appropriately)

• Liver strain (primarily associated with certain oral formulations)

• Allergic reactions to medication components (rare)
  

When to Contact Your Provider Immediately

• Shortness of breath or chest pain

• Severe swelling in legs

• Sudden vision changes

• Severe headaches

• Signs of infection at injection sites
  

Individuals Who Should Use Caution

Careful evaluation is required for men with:

• History of prostate cancer

• Elevated PSA without evaluation

• Untreated sleep apnea

• Elevated hematocrit

• Significant cardiovascular disease

• Liver disease

Contraindications

Testosterone therapy is generally contraindicated in individuals with:

• Active prostate or breast cancer

• Uncontrolled polycythemia

• Severe untreated sleep apnea

• Hypersensitivity to medication components

• Use of supraphysiologic or non-prescribed dosing
  

Acknowledgment and Consent

I acknowledge that I have discussed the benefits, risks, alternatives, and limitations of men’s hormone optimization therapy. I understand that no hormone therapy is risk-free, fertility may be affected depending on treatment choice, and ongoing lab monitoring is required. I understand the program costs, insurance limitations, and that I may discontinue treatment at any time by notifying the clinic in writing. I consent to treatment as outlined above.