Your hormones have numbers. Not guesses. Not symptoms.
Fatigue, low libido, weight gain, brain fog. These symptoms have a dozen possible causes. We run a full hormone panel, work through a set of lifestyle factors first, and only consider hormone replacement when lab data confirms it's necessary. Your care team, including your physician, plays a coordinated role throughout the protocol.
How this protocol works
This isn't just testing. It's a coached cycle designed to get you where you want to be.
What we measure
Total and free testosterone
Your baseline hormone status
Drawn before 10 AM on an empty stomach, because testosterone peaks in the morning. An afternoon draw can read 30% lower and send you down the wrong path. We measure both total and free, since SHBG determines how much your body can actually use.
Estradiol and progesterone
The hormones most doctors under-test
Critical for both men and women. In women, progesterone must be drawn at the right point in the cycle or the result is meaningless. We time it correctly. In men, estradiol matters because too much or too little creates its own set of problems.
SHBG
How much hormone your body can access
Sex hormone-binding globulin acts like a sponge. High SHBG means less free testosterone reaches your tissues, even if total testosterone looks normal. Insulin resistance, thyroid problems, and liver function all move this number.
LH and FSH
Where the problem starts
These pituitary hormones tell us whether low testosterone is a production problem (testes or ovaries) or a signaling problem (brain). That distinction changes the entire treatment approach. Most hormone clinics skip this step.
Full thyroid panel
Not just TSH
Most doctors check TSH alone. We run TSH, free T4, free T3, reverse T3, and TPO antibodies. TSH can sit in the 'normal' range while your body struggles to convert T4 to the active form. Reverse T3 shows whether conversion is being blocked. The full picture catches what a single number misses.
DHEA-S and cortisol
Adrenal function and stress load
DHEA-S declines steadily with age and is a precursor to both testosterone and estrogen. AM cortisol gives a baseline snapshot. When symptoms suggest chronic stress is suppressing the whole hormonal axis, the DUTCH panel maps the full daily cortisol curve.
IGF-1
Your growth hormone signal
Growth hormone is pulsatile and useless to measure directly. IGF-1 is the stable downstream marker. It reflects your body's recovery capacity, muscle-building potential, and aging trajectory. Relevant to every member in this protocol, not just those on HRT.
DUTCH Complete (when indicated)
Estrogen metabolism mapping for women considering HRT
Before starting estrogen therapy, we want to know how your body processes it. The 4-hydroxy pathway produces metabolites linked to DNA damage. If that pathway is dominant, we support detoxification first. We run it when it will change a decision, not as a default.
What’s different after this protocol
You know what your hormones are actually doing. Not a guess based on symptoms. Not a single testosterone number drawn at 3 PM on a random Tuesday. A full picture, drawn correctly, interpreted by a clinical team that knows the difference between “in range” and “good.”
If lifestyle changes were enough, your follow-up labs show it. You have the data showing your hormones responded to better sleep, less alcohol, more resistance training, or whatever the plan called for. That’s a result most people never get because most doctors never retest.
If HRT was indicated, you’re on an evidence-based protocol with follow-up labs to check whether it’s working and safe. Not a pellet from a med spa. Not a cookie-cutter approach. A plan built around your specific results, with monitoring built in.
What this protocol delivers
- A full hormone panel with expert review that goes beyond “normal” or “low”
- Verification that lifestyle factors (sleep, body composition, stress, alcohol, exercise, medications) are addressed first
- Results from a second lab draw showing whether lifestyle changes moved the needle
- If on HRT: an evidence-based protocol with follow-up labs confirming safety and efficacy
- If lifestyle-only: confirmation that the plan worked, with a monitoring schedule going forward
- A clear understanding of what your hormones are doing and why, with numbers you can track over time
Hormone clinics skip the homework. We don’t.
The testosterone clinic model is simple. You feel tired. They test your testosterone. It’s “low-ish.” You start TRT. Nobody checked your sleep. Nobody checked your body composition. Nobody asked about your stress, your alcohol intake, or whether you’ve touched a barbell in three years.
The problem: all of those things affect your hormones directly. A man sleeping five hours a night with high stress and no resistance training doesn’t have a testosterone problem. He has a lifestyle problem. Starting TRT masks it.
For women, the situation is worse in a different way. Perimenopause symptoms get dismissed as “just aging.” Hormone testing is inconsistent or incomplete. The decision to start HRT is based on symptoms alone, without testing estradiol, progesterone, testosterone, thyroid, and metabolic status together.
We do the homework. We test broadly, verify that prerequisites are met, and only consider HRT when the data says lifestyle work isn’t enough.
The lifestyle factors we verify before considering HRT
These aren’t arbitrary hurdles. Sleep, body composition, alcohol, exercise, stress, and medication interactions each have a documented effect on hormone levels, symptom severity, or treatment outcomes.
See what we check for each
- Sleep. 7+ hours for at least four consecutive weeks, confirmed by wearable data. Sleep deprivation alone can drop testosterone by 10-15%.
- Body composition. Excess body fat aromatizes testosterone into estrogen. If body composition is a factor, we address it first.
- Alcohol. Heavy drinking suppresses the HPG axis and raises estrogen in men. We verify intake is within limits for four or more weeks.
- Exercise. Resistance training raises testosterone more reliably than any supplement. We confirm you’re meeting minimum movement standards.
- Stress. Chronic cortisol elevation suppresses sex hormones downstream. We screen with validated tools and add cortisol testing when symptoms warrant it.
- Medication review. Opioids, glucocorticoids, SSRIs, and other drugs affect hormone levels. We document what you’re taking and coordinate with your prescribing provider.
Measure, verify, coach.
Your team follows a structured path. Baseline labs drawn correctly, lifestyle prerequisites verified with real data, a second lab draw to confirm what changed, and a physician-led conversation about HRT if the data calls for it. Every step is tracked. Nothing is assumed.
Common questions
Is this protocol right for me?
A few patterns fit. You're tired, your libido has disappeared, and you want to know if hormones are the cause before jumping to TRT or HRT. You've been offered testosterone replacement, but nobody checked your sleep, body composition, or stress levels first, and something about that felt wrong. You want the data to decide, not the symptoms. Not a clinic that makes money selling you injections. If you're in perimenopause, see the next question.
I'm a woman in perimenopause. Is this the right protocol?
Yes. A complete female panel is timed to your cycle, including estradiol, progesterone, FSH, LH, AMH, and thyroid. If HRT is indicated, your physician coordinates an evidence-based protocol. The DUTCH Complete panel maps your estrogen metabolism before anything is added.
Will I need to go on HRT?
Maybe not. Many members see hormone levels improve once sleep, exercise, body composition, and stress are addressed. Lifestyle prerequisites are verified first. HRT is considered only when lifestyle changes aren't enough. It's not a starting point.
How is this different from a testosterone clinic?
A testosterone clinic tests your T, sees it's low-ish, and starts you on TRT. Nobody checks whether you're sleeping five hours a night or drinking fourteen beers a week. We check. Lifestyle prerequisites must be verified before HRT enters the conversation. If the real problem is sleep deprivation and stress, TRT masks it.
How does this work?
If your lifestyle prerequisites are already met and lab data confirms suboptimal hormones, your team moves quickly. If lifestyle work is needed first, that work is what makes the retest meaningful.
What comes after this protocol?
Your data feeds into other protocols. Low testosterone in men often tracks with poor sleep, which points to Sleep Health. Insulin resistance drives SHBG down and free androgens up, which connects to Metabolic Health. Hormone changes affect body composition and training response, which feeds Muscle & Body Composition and Physical Capacity. Your team recommends based on your actual results.
What does this cost?
Included in Protocol membership: $695/mo, or $7,500/yr prepaid (save $840). New members start with the Foundation Assessment, which runs your baseline labs and determines which protocols to prioritize. The Foundation is $1,500 standalone, included with annual membership.
From the Protocol blog
Tired, foggy, low drive. Is it hormones or something else?
Full testing, lifestyle verification, and decisions driven by your data. Book a discovery call and we'll tell you if Hormonal Health is the right place to start.
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