Hormone Balance (HRT + TRT)
Symptoms aren't "just aging."
Hot flashes, night sweats, mood shifts, brain fog, fragmented sleep, loss of libido, low motivation, slow recovery, recurring fatigue — most of these trace to declining estradiol, progesterone, DHEA, or testosterone, sometimes alongside thyroid or cortisol drift. The diagnostic mistake is to read symptoms without a panel, or to read a panel without symptoms. We do both. Women: a follicular-phase panel (estradiol, progesterone, FSH, LH, free T4, TSH, DHEA-S, cortisol, SHBG, free testosterone) read against menstrual cycle and symptom diary. Men: two morning total-testosterone draws on separate days, plus free T, SHBG, LH/FSH, prolactin, and estradiol — read together so that a low total T is interpreted alongside SHBG status rather than treated as a single number.
Compounded to your physiology, not a one-size capsule.
We use only bioidentical — molecularly identical to your body's native hormones — formulations. Estradiol (transdermal cream, patch, or pellet), micronized progesterone (oral or vaginal), testosterone (cream, troche, pellet, or weekly injection), and DHEA where indicated. The compounding pharmacy doses to your labs, your symptom response, and your route preference. Women in perimenopause often start with low-dose transdermal estradiol plus oral progesterone; postmenopausal women may move to higher transdermal estradiol or estradiol/testosterone combinations. Men typically choose between weekly subcutaneous testosterone cypionate, daily transdermal gel, or 3-4 month testosterone pellets. Fertility-preserving men start with hCG or clomiphene rather than exogenous testosterone, to preserve endogenous LH/FSH signaling and testicular function.
First year close-watched, then a sustainable cadence.
Hormones are not set-and-forget. We rebuild the signaling environment over months and watch carefully: quarterly lab work in the first year (hormone trough levels timed to your dosing window, plus hematocrit for men on TRT, PSA in men over 40, lipid panel, fasting glucose / HbA1c, liver enzymes, full thyroid axis), then semi-annual once your numbers and symptoms are stable. Pellet patients receive an additional check at 6-8 weeks post-insertion to confirm absorption curve. We add bone densitometry (DEXA) every 2 years for women on long-term HRT. Adjustments are guided by symptom diary and lab trends together — never by lab alone. The objective is sustained physiology, not a peak number.
- 01
Comprehensive Baseline
30+ markers including sex steroids, thyroid axis, adrenal status, metabolic and cardiovascular risk.
- 02
Bioidentical Only
Estradiol, progesterone, testosterone, DHEA — molecularly identical to native hormones, never synthetic equivalents.
- 03
Multiple Routes
Transdermal cream, patch, troche, pellet, subcutaneous injection, vaginal — chosen to fit your physiology and lifestyle.
- 04
Cycle-Aware for Women
Perimenopausal protocols respect remaining cycle; menopausal protocols adapt to postmenopausal physiology.
- 05
Continuous Monitoring
Quarterly bloodwork in year one, then semi-annual; HCT, PSA, lipid, glucose, thyroid as appropriate.
- 06
Bone & Cardiovascular Surveillance
DEXA every 2 years for long-term HRT; lipid and cardiovascular markers tracked throughout.
- 07
Fertility-Preserving Options
hCG, clomiphene, or low-dose enclomiphene for men still planning to conceive — preserves endogenous testicular function.
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Symptom-Diary Driven
We adjust to symptom response, not just lab number — sustainable physiology, not chasing peaks.
- 09
Club Coordination
A health steward handles scheduling, labs, formulation changes, and cross-clinic records.
Frequently Asked
Is HRT safe?
Modern bioidentical HRT, started within roughly 10 years of menopause and properly monitored, has a favorable benefit-risk profile per the 2022 NAMS Position Statement. We screen at intake for contraindications including active breast or uterine cancer, unexplained venous thromboembolism, severe liver disease, and known cardiovascular risk. The Women's Health Initiative findings that scared a generation off HRT were largely about conjugated equine estrogens plus synthetic progestin started a decade post-menopause; modern transdermal bioidentical protocols do not replicate that risk profile.
Does TRT cause prostate cancer?
Multi-year data, including the landmark 2023 NEJM TRAVERSE trial of nearly 5,200 men, show no increased prostate-cancer risk at physiologic testosterone replacement doses over 33 months. Pre-existing high-risk prostate cancer is a contraindication, and we monitor PSA throughout treatment in men over 40.
How long until I feel different?
Most patients begin to feel changes within 4-8 weeks of reaching their therapeutic dose, with continuing improvement over 3-6 months. Sleep, mood, and energy usually move first; libido and body composition follow over months. We adjust dose at the quarterly review based on both symptoms and labs.
Can I stop later if I want to?
Yes — there is no commitment. Most patients prefer to continue because symptoms return when the signaling environment is removed, but you can taper off under physician guidance at any point.
Is it covered by insurance?
The Longevity Club's private-membership coordination is not covered by MSP. Specific drug prescriptions follow BC PharmaCare and your private extended-health insurance — many compounded bioidentical preparations qualify for partial reimbursement. We provide itemized physician receipts for submission.
What if my levels are 'normal' but I feel terrible?
Conventional lab reference ranges are wide and population-based; they capture pathology, not optimal function. A 35-year-old man with total testosterone of 280 ng/dL is technically 'normal' but functionally deficient. We read your numbers against your age, symptom profile, and ratios (free T, SHBG, estradiol) rather than against a single cutoff.