Expert Hormone Care Designed to

Support Whole Body Function

Tired woman sitting on gray sofa

Hormonal Imbalance in Modern Life

Lifestyle in the United States has become increasingly sedentary, and more technologically driven. These behaviors create an unnatural environment, incongruent to our genetic needs, leading to physiological imbalances in key hormones such as estrogen, serotonin, and cortisol, which can perpetuate the stress response and disrupt overall health. Human suffering is not necessary.

At HD Health, our approach to hormonal enhancement is to maximize quality of life and optimize function. We use evidence-based research to guide our approach. We use bioidentical hormones to avoid side effects while maximizing absorption and efficacy.  We also listen to our patient's needs, so they are a part of the healing process.

Who Should Consider Hormone Optimization

Hormone replacement therapy may be beneficial for individuals experiencing:

  • Perimenopausal, menopausal, or postmenopausal symptoms.
  • Depression, anxiety, or other mental health challenges.
  • Overweight or obesity with decreased muscle mass.
  • Elevated blood sugar or diabetes.
  • High blood pressure.
  • Low energy levels.
  • Slowed recovery or joint pain and arthritis.
  • Women of any age.
  • Men of any age.

Hormonal Enhancement for Women

Goal: Promotes the best qualities in women by regulating moods and emotions, providing calmness and balance, reducing stress, and reducing the negative effects of estrogen, thereby decreasing the risk of disease and dis-ease. Let’s stop ignoring women!

Three main hormones to balance: progesterone, estradiol, testosterone.

Premenopause (ages teens through 40s): Typically treated with contraceptives and SSRIs; most common hormone deficiencies: 1) progesterone, 2) thyroid, 3) testosterone, 4) DHEA.

Perimenopause (mid 30s–40s): Lasts 2–8 years; severe fluctuations of estrogen (E2) and a steady decline of P4. Estrogen increases while progesterone decreases.

Signs and symptoms:
Hot flashes/night sweats, anxiety, depression, irritability, insomnia, brain fog, weight gain, fatigue, breast tenderness, joint pain, vaginal dryness, and decreased libido.

Irregular periods (lighter or heavier than normal, skipped cycles), shorter or longer cycles, breakthrough bleeding, or spotting between periods.

No “gold standard” for diagnosis: Diagnosis is based on a combination of symptoms and lab findings (mild elevation of FSH, slight lowering of progesterone, increased estradiol), though labs may appear normal due to fluctuations. We treat the patient, not the numbers.

Early Perimenopause: Beginning of cycle variability and symptoms; cycles may vary by 7+ days, but menses generally still occurs. FSH begins to fluctuate with occasional elevations above 25 IU/L; estradiol is often normal to high. Estrogen fluctuations and progesterone deficiencies drive symptoms such as breast tenderness, mood instability, irritability, anxiety, migraines, fluid retention, and bloating.

Late Perimenopause: Transition period approaching menopause with more severe symptoms; amenorrhea of 60 days or more, with up to 12 months between periods. FSH is persistently elevated above 30 to 40 IU/L, with estradiol trending low. Estrogen deficiency symptoms predominate, including hot flashes, vaginal dryness, fatigue, insomnia, and low libido.

Menopause (between ages 45–55): When a woman has not had a menstrual period in 12 consecutive months, along with an FSH of 50. This signifies the cessation of ovarian function, resulting in decreased estrogen and progesterone levels.

Signs and symptoms:
Same as perimenopause, plus worsening bone health and increased cognitive decline (memory).

The adrenal glands still produce progesterone post-menopause, but to a much lesser degree than the ovaries. Estrogen is also produced by fatty tissue.

Sex hormone levels remain consistently low. Some menopause symptoms diminish while others increase, including insomnia, vaginal dryness (frequent UTIs and pain with intercourse), urinary incontinence, weight gain, increased body fat/decreased muscle mass, increased cancer risk, and increased inflammation.

Key Hormones to Regulate in Women

Progesterone (oral preferred route of administration)

If deficient

  • Hot flashes/night sweats
  • Anxiety
  • Depression
  • Irritability
  • Insomnia
  • Brain fog
  • Weight gain
  • Fatigue
  • Breast tenderness
  • Joint pain
  • Vaginal dryness
  • Decreased libido

Benefits

  • Pro-metabolic: enhanced glucose metabolism and mitochondrial function in the cell
  • Anti-estrogenic
  • Anti-inflammatory: reduces cytokines
  • Anti-cancer: breast and uterine
  • Anti-stress
  • Pro-mood
  • Neuroprotective: protects brain cells, enhances memory, cognition, myelination
  • Improves hypertension
  • Lowers stroke risk
  • Improves bone health
  • Enhanced collagen production
  • Blocks DHT and supports mitochondrial health to prevent hair loss
  • Improves sleep, mood, anxiety, depression, and emotional well-being
  • Enhances GABA in the CNS (glutamate is excitatory, GABA is sedative in CNS)
  • Pro-thyroid: balances thyroid and increases sensitivity to thyroid hormone

Side Effects of Progesterone Therapy:
If at a therapeutic dose, women generally feel great. If underdosed: anxiety, nervousness, muscle tension, insomnia, early/heavy menses, or little to no effect. If overdosed: grogginess, depression, lethargy, low libido, and delayed bleeding.

Contraindications for P4:
Active or recent history of breast cancer or hormone-sensitive cancers; undiagnosed abnormal vaginal bleeding.

Timing (all stages):
Premenopause, early perimenopause, late perimenopause, menopause, and post-menopause.

Estradiol (oral preferred route of administration)

When balanced with progesterone:
Supports feminine body characteristics, enlargement of breast tissue and pelvis, vaginal lubrication, ovulation, and female voice characteristics. Pro-metabolic: enhances energy production and glucose metabolism; supports vascular health; neuroprotective: improves memory, reduces plaque formation, enhances neurons/synapses, and enhances serotonin. When combined with P4, it has been shown to decrease the risk of dementia. Enhances mood, cardiovascular protection, and lipid improvement. Improves nitric oxide production, increases vasodilation, improves HDL, decreases APO B, and increases APO A, helping decrease vascular plaque formation. Improves bone density, insulin sensitivity, glucose absorption, and reduces visceral fat. Improves vaginal dryness, decreases UTIs, increases libido/orgasm, improves tissue health and blood flow, and enhances skin elasticity through improved hydration and collagen production. Supports breast tissue health, eye health, tear film production, mucous membranes, and reduces inflammation and cancer risk.

Estradiol Deficiency:
Decreased memory, focus, brain fog, motivation, libido, increased depression, joint pain, dry mouth, dry eyes, dry mucosal membranes, hot flashes, night sweats, vaginal irritation, burning mouth syndrome, increased cardiovascular disease risk, osteoporosis, cognitive decline/Alzheimer’s, insulin resistance, skin aging, and poor wound healing.

Side Effects of Estradiol Therapy:
If overdosed: weight gain/fluid retention, bleeding/spotting (typically resolves after 3–5 days), migraines, and breast tenderness/swelling.

Contraindications:
Current breast, uterine, or endometrial cancers. Patients with triple-negative breast cancer (TNBC) or ER-/PR- breast cancer may be candidates for BHRT after successful treatment. Thrombophilia (Factor V Leiden, Protein S deficiency), DVTs, and pulmonary embolisms. Pregnancy: allowable.

Timing:
Late perimenopause, menopause, and post-menopause.

Testosterone (injection or intravaginal preferred route of administration)

Benefits in women:
Supports bone health, sexual and genitourinary function, mood and mental health stabilization, metabolism, and body composition.

If deficient:
Women may experience fatigue, weight gain, decreased libido, poor sleep, brain fog, poor muscle recovery, atrophied vaginal/clitoral tissue, painful intercourse, osteoporosis, anxiety, irritability, lack of motivation/depression, poor concentration/memory, increased dementia risk, indecisiveness, emotional outbursts, tearfulness, and low energy.

Side Effects:
Acne, oily skin, increased libido, painful clitoris, and increased sensitivity.

Contraindications:
Active or history of hormone-sensitive cancers; pregnancy (teratogenic); thrombophilia (Factor V Leiden, Protein S deficiency), history of DVTs, and pulmonary embolisms.

Timing:
Late perimenopause, menopause, and post-menopause.

Female Labs:
LH, total testosterone, free testosterone, estradiol, progesterone, TSH, Free T3, T4-direct, ferritin, fasting insulin, DHEA, and SHBG.

When/how to draw blood:

Premenopause: Ideally around cycle day 21 (best time to evaluate progesterone), assuming cycles are regular and during the peak luteal phase; however, this is not absolutely necessary, especially if symptomatic.

Perimenopause: Any day, morning preferred.

Post-menopause: Any day, morning preferred.

8-hour fast recommended, ideally collected between 7–10 a.m. Drink two glasses of water beforehand.

If on HRT, blood should be drawn on injection day before injection (trough level). Hold all HRT creams and injections before labs.

Hormonal Enhancement for Men

Key Hormones to Regulate in Men

Testosterone (injections and creams preferred route of administration)

If deficient:
Men may experience fatigue, weight gain, decreased libido, decreased morning erections, poor sleep, brain fog, and poor muscle recovery. Emotional symptoms may include anxiety/irritability, lack of motivation/depression, poor concentration/memory, indecisiveness (lack of mental firmness, submissiveness), excessive emotions (outbursts, tearfulness), and low energy.

Benefits of Testosterone Therapy

  • Cardiac:
    Helps improve dyslipidemia, hypertension, stroke risk, and peripheral vascular disease (claudication, gangrene). Supports vasodilation and blood velocity, provides antiarrhythmic effects, improves diabetes management, and decreases vascular inflammation. Testosterone cream, in particular, may increase HDL and decrease LDL.
  • Metabolic:
    Overall, testosterone is anti-inflammatory. Helps support Type 2 diabetes management by improving insulin sensitivity and glucose utilization by cells. Decreases visceral and subcutaneous fat while improving lean muscle mass.
  • Musculoskeletal:
    Increases anabolic activity (muscle growth) and decreases catabolic/cortisol activity (tissue breakdown).
  • Immunity:
    Acts as an immune booster, may help prevent autoimmune disease, and may decrease mortality.
  • Sex:
    Improves ED and erection quality (DHT-driven), improves libido (estradiol E2-driven), supports prostate health, and improves fertility and sperm production (endogenous or via HCG/FSH).
  • Mental Health:
    Decreases depression, lack of motivation, anxiety, and irritability. Improves brain fog, well-being, quality of life, and may support Alzheimer’s/dementia prevention.

Side Effects of Testosterone Therapy:

Minimal when done properly. Manageable side effects may include acne, water retention, allergies, infection, insomnia, anxiety, hair loss, gynecomastia, nipple sensitivity, and sleep apnea.

Male Blood Panels:

When/how to draw blood:

CBC, CMP, LH & FSH, total testosterone, free or calculated free testosterone, PSA-total with reflex to free, SHBG, prolactin (optional), DHEA, TSH, Free T3, and T4-Direct.

8-hour fast recommended. Drink 2–3 glasses of water before labs to help HCT levels. Morning labs should be completed between 7 a.m.–10 a.m. If already on TRT, blood should be drawn on injection day before injection (trough, the lowest point of testosterone levels).

Additional Information About Hormones

Myths:
Unfamiliarity bias is the automatic prejudice and suspicion of something new or unknown. Several randomized controlled studies have been performed and included on this website to support the evidence-based practice of HD Health.

Hormones Cause Cancer

Did you know that cancer cells are present in the human body every day? The body’s immune system works daily to find and destroy these cells before they can grow, spread, and cause disease. Gene mutations that cause cancer cells are inevitable.

Naturally occurring hormones like progesterone, estrogen, and testosterone are meant to stimulate growth and may actually enhance the immune system. When these hormones become unbalanced (particularly estrogen), the immune system becomes more prone to dysfunction, making the body more susceptible to cancer.

The primary contraindication for hormone therapy is someone with a new, active cancer.

Hormones Are a Cardiovascular Disease Risk

The Food and Drug Administration (FDA) has removed the black box warning regarding thrombotic and cardiac events. In fact, low testosterone is associated with coronary artery disease, stroke, and increased mortality. Testosterone increases blood velocity, which may help decrease thrombosis.

Types of Hormones:

Bioidentical:
Compounded, micronized, grape seed oil-based hormones that act more naturally in the body, with fewer side effects and better absorption.

Synthetic:
Conjugated Equine Estrogens (Premarin), Ethinyl Estradiol (oral contraceptives – associated with increased strokes and breast cancer), Medroxyprogesterone Acetate (Provera/Progestin – cancer-related), and Norethindrone. These are not structurally similar to human hormones (they look and act somewhat differently), resulting in more side effects and reduced effectiveness.

Both types are plant- or animal-derived.

Route of Administration:

  • Oral:
    Effective, well-tolerated, and the preferred route for progesterone and estradiol.
  • Intramuscular (IM):
    Effective, well-tolerated, and the preferred route for testosterone.
  • Transdermal:
    Effective and potent for DHT (improved sexual function) while allowing more free testosterone.
  • Subcutaneous:
    An acceptable route for testosterone; however, shallow IM is preferred.
  • Pellets:
    Effective but invasive, with less autonomy and difficult titration; not considered ideal.

Androgens to Consider:

  • DHT (dihydrotestosterone)
  • DHEA (dehydroepiandrosterone)

Other Aspects Affecting Balance:

  • SHBG (sex hormone-binding globulin)
  • HCG:
    A peptide used to help keep the testicles functioning.

Benefit of Testosterone Therapy for Men and Women

Cardiac

  • Helps dyslipidemia
  • Helps hypertension
  • Helps stroke prevention
  • Helps peripheral vascular disease (claudication, gangrene)
  • Improves vasodilation and blood velocity
  • Antiarrhythmic effects
  • Improves diabetes
  • Decreases vascular inflammation-estradiol
  • Testosterone cream in particular increases HDL and decreases LDL

Metabolic

  • Overall testosterone is anti-inflammatory
  • Helps DM2
  • Improves insulin sensitivity
  • Improves use of glucose by the cell
  • Decreases visceral and subcutaneous fat
  • Improves lean muscle

Musculoskeletal

  • Increases anabolic activity
  • Decreases catabolic/cortisol effects

Immunity

  • Acts as an immunosuppressant
  • Helps prevent autoimmune disease
  • Decreases mortality

Sex

  • Improves ED and erection quality (DHT driven)
  • Improves libido (estradiol E2 driven)
  • Supports prostate health
  • Improves fertility and sperm production (endogenous or via HCG/FSH)

Mental Health

  • Decreases depression
  • Decreases lack of motivation
  • Decreases anxiety and irritability
  • Improves brain fog
  • Improves well-being and quality of life
  • Helps Alzheimer’s/dementia

Additional Information about Hormones

Myths:
Unfamiliarity bias is the automatic prejudice and suspicion of something new or unknown. Several randomized controlled studies have been performed and included on this website to support the evidence-based practice of HD Health.

Hormones Cause Cancer

Did you know that cancer cells are present in the human body every day? The body’s immune system works daily to find and destroy these cells before they can grow, spread, and cause disease. Gene mutations that cause cancer cells are inevitable.

Naturally occurring hormones like progesterone, estrogen, and testosterone are meant to stimulate growth and may actually enhance the immune system. When these hormones become unbalanced (particularly estrogen), the immune system becomes more prone to dysfunction, making the body more susceptible to cancer.

The primary contraindication for hormone therapy is someone with a new, active cancer.

Hormones Are a Cardiovascular Disease Risk

The Food and Drug Administration (FDA) has removed the black box warning regarding thrombotic and cardiac events. In fact, low testosterone is associated with coronary artery disease, stroke, and increased mortality. Testosterone increases blood velocity, which may help decrease thrombosis.

Types of Hormones:

Bioidentical:
Compounded, micronized, grape seed oil-based hormones that act more naturally in the body, with fewer side effects and better absorption.

Synthetic:
Conjugated Equine Estrogens (Premarin), Ethinyl Estradiol (oral contraceptives – associated with increased strokes and breast cancer), Medroxyprogesterone Acetate (Provera/Progestin – cancer-related), and Norethindrone. These are not structurally similar to human hormones (they look and act somewhat differently), resulting in more side effects and reduced effectiveness.

Both types are plant- or animal-derived.

Route of Administration:

  • Oral:
    Effective, well-tolerated, and the preferred route for progesterone and estradiol.
  • Intramuscular (IM):
    Effective, well-tolerated, and the preferred route for testosterone.
  • Transdermal:
    Effective and potent for DHT (improved sexual function) while allowing more free testosterone.
  • Subcutaneous:
    An acceptable route for testosterone; however, shallow IM is preferred.
  • Pellets:
    Effective but invasive, with less autonomy and difficult titration; not considered ideal.

Androgens to Consider:

  • DHT (dihydrotestosterone)
  • DHEA (dehydroepiandrosterone)

Other Aspects Affecting Balance:

  • SHBG (sex hormone-binding globulin)
  • HCG:
    A peptide used to help keep the testicles functioning.

 

Hormonal Disruptors 

PUFA (polyunsaturated fatty acids) - Avoid!

  • Weak chemical structure (susceptible to oxidation)
  • Makes cells more permeable
  • Disrupts thyroid (T4 to T3)
  • Increases cortisol and prolactin
  • Seed oils (flax seed, canola oil, peanut oil, vegetable oil) – originally used for lubrication

Versus stable/healthy fatty acids (saturated): 

  • Butter
  • Coconut oil
  • Beef tallow

Increase 

  • Magnesium
  • Vitamin E
  • Selenium

Endotoxin (LPS – LipoPolySaccharide) 

Eat whole foods!

  • Endotoxins are pro-inflammatory
  • Suppresses metabolism
  • Disrupts hormone regulation
  • Causes neurological and vasculature damage
  • Toxic metabolite of gram-negative bacteria
  • Related to leaky gut when it gets into the body
  • Happens with inflamed or unhealthy people (usually contained in GI)
  • Related to PCOS and endometriosis

Glucose 

  • Glucose is not bad
  • Primary fuel source
  • Depends on cell health (mitochondrial integrity and cellular processing)
  • Affected by the above factors

Hormones 

  • Hormones are vital for maintaining cellular metabolism
  • Helps process energy efficiently
  • Helps prevent disease processes

Foods 

Foods now are high in fats and sugar, not typically found in nature.

  • Sugars aren’t bad
  • Fats aren’t bad
  • But high sugar foods with high fat (high calorie) are bad and disrupt physiology
  • Coupled with preservatives and PUFAs further causing stress

HRT Goal 

  • The goal with HRT is not to replace, but to restore balance

5 Metabolic Hormone Disruptors

These components interfere with hormone regulation.

Estrogen, Serotonin, Cortisol, PUFA, Endotoxin

Decrease metabolic rates, increase inflammation; HRT and TRT bring balance.

Estrogen 

  • When unbalanced: pro-inflammatory, proliferative (cancer), pro-stress, pro-glycolysis (inefficient energy production rather than oxidative phosphorylation)
  • Beneficial but has to be regulated and balanced
  • If dominant, can mimic stress hormones
  • Can damage function (limits mitochondria) and structure (stress/inflammation) of the cell
  • Xeno estrogens (environmental)

Serotonin 

  • Causes fibrosis (metabolic build up), coagulation (clotting), lowers metabolic rate, GI distress, glycolysis
  • Not a happy hormone, but a signal of stress
  • Disruptive when dominant
  • Neurodegenerative

Cortisol 

  • In excess: catabolic
  • Glucose metabolism disruption
  • Increases fat storage
  • Intestinal permeability (elevated endotoxin)
  • Neurodegenerative
  • Impairs immunity
  • Cardiovascular risk
  • We balance by increasing testosterone for men, progesterone for women
  • Increases gluconeogenesis
  • Decreases insulin sensitivity

What Does the Research Say?

The Impact of Hormone Health on the Body

Balanced hormones play a critical role in overall well-being, including:

  • Reduced fat accumulation
  • Improved mood and decreased depression
  • Enhanced wound healing
  • Increased energy levels
  • Improved strength and muscle development
Girl looking at skin blemishes

A Decline in Modern Hormonal Health

Testosterone levels have decreased by 30%–40% since 1970. At the same time, approximately 74% of Americans are overweight or obese, significantly increasing disease risk and mortality. Early-onset cancers have surged by 79% in recent years, and it is estimated that 1 in 2 Americans will develop cancer in their lifetime. Additionally, 20%–25% of women in the U.S. are currently taking antidepressant medications.

Restoring Balance Through Hormone Therapy

At HD Health, hormone optimization is designed to restore balance, improve physical performance, enhance mental well-being, and support long-term vitality through a personalized, medically guided approach.