Hormone Imbalances

Men can experience hormone imbalance at any time in life. Although it is common for older men to experience a gradual decline in their testosterone levels, younger men can also experience symptoms of low testosterone for many reasons. We are seeing an increase in the number of younger men with symptoms of low testosterone with correspondingly low levels of the hormone. Reasons for low testosterone in men include:

  1. Sleep apnea
  2. Chronic use of prescription or illicit opioids - hydrocodone, oxycodone, fentanyl, methadone, buprenorphine (Suboxone) and heroin
  3. Overweight/obesity
  4. Use of substances including alcohol, stimulants, and cannabis as well as tobacco
  5. Trauma
  6. Stress and anxiety

Men who experience symptoms of low testosterone may also experience symptoms of cortisol dysfunction and thyroid hormone imbalance. It is critically important for men to receive testing and treatment addressing all of these systems, cortisol, thyroid, and testosterone, in order to restore function and vitality.

Hormone optimization is not something providers are often taught during conventional, allopathic training and something that is often left out of Western medical treatment. Testosterone therapy in particular can cause significant medical complications and testosterone can be misused by men and women. My training and clinical experience in addressing hormone imbalance, including testosterone allows me to treat men effectively and safely.

My approach to hormone optimization includes the following:

  1. Detailed medical and behavioral health history that allows me to elucidate risk factors that may preclude a man from receiving testosterone, or other, hormone therapy.
  2. Detailed, personalized laboratory evaluation that is tailored to age and symptomatology. I utilize evidence-based serum lab testing only. I use saliva testing ONLY for evaluation of the hypothalamic-pituitary axis (cortisol).
  3. Referral to resources that allow men to fully understand the literature, risks, and benefits of hormone therapy.
  4. A detailed discussion of the risks and benefits of hormone therapy for each man based on their history, symptoms, and reasons for wanting to engage in treatment.
  5. Discussion regarding realistic expectations for symptom improvement using hormones.
  6. Discussion regarding commitment to engaging in lifestyle behavior modification if needed to maximize outcome.
  7. Continuing hormone therapy only if there are measurable benefits, minimal risks, and compliance with follow-up laboratory testing and office visits, and preventative screening according to guidelines.

This approach, along with ongoing continuing education about the risks and benefits of therapy on my part, allows me to provide treatment to men that improves function and vitality while minimizing risk and continually re-evaluating treatment protocols and outcomes.

Types of Hormone Therapy

Bio-identical Versus Compounded

Not all bio-identical hormones are compounded. There are pharmaceutical-grade, FDA-approved bio-identical testosterone preparations available for men. Thyroid hormones are another example of FDA-approved pharmaceutical-grade bio-identical hormones. 


There is considerable misinformation provided to consumers about bio-identical hormone therapy. Bio-identical means that the compound being used is molecularly the SAME as the testosterone a man produces biologically.  Testosterone products that are FDA-approved and pharmaceutically produced include injections, topical gels, nasal gels, patches, pellets, and oral formulations. These formulations are all produced as molecular compounds that are quickly transformed in the body to become bio-identical testosterone. The formulations of delivery are designed so that testosterone can be absorbed into the bloodstream, so in that sense, they may not be biologically identical initially, but through the transformation process become molecularly identical to a man's hormone. The exception to this is the testosterone pellet available as a pharmaceutical product (estoppel). This product is inserted under the skin and is delivered to the bloodstream as a bio-identical molecule. 


Bio-identical hormones can be formulated as a compounded product. Compounded means that the product is created by a compounding pharmacy rather than as a pharmaceutical-grade product. These products can be formulated as one of the following:

  1. Topical cream - testosterone creams can be applied to the skin or scrotum
  2. Testosterone cypionate injections - similar to pharmaceutical grade but can be created with personalized dosing
  3. Pellet - testosterone pellet placed just under the skin during an in-office procedure. Pellets must be replaced every 4-6 months. There are studies showing that Testopel and compounded pellet therapy are equally effective at raising testosterone levels and improving symptoms. 

Compounded hormones are not FDA-approved. There can be risks associated with using compounded products including drug quality problems, either too much or too little active ingredients, or contamination. Working with a reputable compounding pharmacy and following laboratory values during treatment is critical to ensuring safe and effective compounded hormone therapy. 

I typically prescribe pharmaceutically available testosterone cypionate injections compounded testosterone pellet therapy or topical compounded cream, depending on history, presentation, and patient preference. 

How Do I Know If I Have a Testosterone Deficiency?

Simple laboratory testing which is often covered by insurance can elucidate testosterone deficiency. 

Low testosterone is defined as symptoms of low testosterone accompanied by a total testosterone level of less than 300 ng/dL. There is evidence that men with low free testosterone, in addition to symptoms, may also benefit from testosterone therapy. Additional laboratory testing to rule out medical causes of low testosterone, and evaluate blood counts and prostate health are also necessary prior to determining if a man qualifies for testosterone therapy. 

I do not use salivary or urine testing to evaluate testosterone in men. 

What Are the Symptoms of Testosterone Deficiency?

  • Reduced libido
  • Erectile dysfunction
  • Fatigue
  • Depressed mood
  • Loss of muscle mass and reduced exercise tolerance
  • Loss of facial and body hair
  • Weight gain
  • Sleep changes
  • Insulin and blood sugar imbalance - Borderline or Type 2 Diabetes
  • Elevated cholesterol
  • Overall loss of vitality and reduced quality of life

Hormone Optimization 

Hormone Optimization for men is much more than achieving higher testosterone levels. Some men have low testosterone simply due to aging, but for most men, low testosterone is the result of more complex systemic dysfunction. Substance use, trauma, chronic stress, anxiety and depression, and lifestyle behaviors related to nutrition, sleep, movement, and stress management can all affect testosterone levels.

It is important to evaluate and address imbalances in the cortisol, thyroid blood sugar, and insulin systems. The root cause(s) of testosterone deficiency must be evaluated and a treatment plan to restore balance throughout the system.

Not all men want testosterone optimization with exogenous hormones, some men are not good candidates due to cardiovascular disease or prostate concerns, and many men with low testosterone desire to treat testosterone while preserving fertility. An integrative approach to low testosterone levels, with or without exogenous testosterone therapy, is required to restore function and vitality.

Integrative health is the approach I am striving to provide for individuals who come to see me. My clinical training and experience in primary care, addiction medicine, and functional medicine have allowed me to look at physical and behavioral health conditions, including hormone imbalance,  with a much wider lens.

Medications may be utilized, but do not form the foundation of care. Exploring the root cause of your symptoms, physical and emotional, and empowering patients to heal themselves forms the foundation of care with Heron Wellness.

What is Integrative Health? I have been working on this definition for a long time, and after finding a definition of Integrative Health from the California Institute for Integral Studies I have been able to develop my approach to care.  The components of the treatment process I have developed are based on my training and clinical experiences with patients over the years.

Patient-centered, coordinated, whole-person care with a focus on healing and wellness of body, mind, and spirit.

Therapeutic Components

Allopathic Medicine – Medications as needed for physical and behavioral health conditions. Coordination with specialists as needed.

Evidence-Based Behavioral Health Interventions – Referral and coordination of care with therapists and psychologists to support their emotional wellness.

Functional Medicine – Conventional and specialized laboratory testing and evaluation and education and support for implementing positive behavioral changes related to the 5 MODIFIABLE LIFESTYLE FACTORS - NUTRITION, MOVEMENT, SLEEP, STRESS MANAGEMENT, SOCIAL CONNECTIVITY

Hormone Optimization – Focusing on addressing imbalances in cortisol (fight or flight), thyroid, and sex hormones

Complementary Modalities – 5- Needle-Protocol (ear acupuncture), mindfulness, nutraceuticals and botanicals. Coordination with physical therapy, acupuncture, massage, therapeutic yoga, energy work

Traditional Healing Practices – Referral and coordination of care with healers in the community

Integrative health care applied to physical and emotional symptoms, including those of hormone imbalance, allows us to develop a treatment plan based on your unique presentation, life circumstances, and priorities for healing.

Integrative  Health is a treatment approach that is guided by me as a provider, but executed by the individual who is in need of healing. This is not a passive approach to care. This is your journey, and you alone have the power to make the change.

We will create a treatment plan guided by your needs, your current ability, and life circumstances, knowing that this will be a dynamic process, changing with time as you improve, have a setback, or see a new vision for yourself.

This is your work, and I am here to provide you with resources and guidance to improve your functionality, your resilience, and ultimately your best self.

If you are interested in approaching Hormonal changes, Behavioral Issues, and Wellness with an Integrative Approach, please reach out to Schedule a Discovery Call

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Areas Served

Heron Wellness is located in Salt Lake City, Utah and serves patients throughout the Greater Salt Lake City Area and Eastern Utah including Provo, Highland, Cedar Hills, Summit, Park City and Ogden. These areas include but are not limited to the counties of Salt Lake City, Davis, Weber, Morgan, Summit, Wasatch, Utah and Tooele.

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