Frequently Asked Questions

We are a cash-pay, membership-based practice, so we do not bill insurance for appointments, memberships, or treatments. The one exception is lab work, which many patients can run through their insurance, and we are happy to provide the codes you need. Working outside of insurance lets us give you real time and a plan built around what is right for you rather than what a plan will authorize. We keep pricing transparent and welcome HSA and FSA payments.

Your first step is Refine, our new-patient intake and comprehensive lab review designed to give you clarity and a plan. Labs must be completed before your appointment. Once you enroll, we help coordinate your lab draw, and we recommend scheduling Refine far enough out so your labs are drawn at least 48 hours beforehand. If you need help with timing, just call our office. Refine is intentionally thorough, this is where we connect the dots, answer the questions you've been carrying, and build a strategy that fits your body and your life. During your virtual Refine visit, Dr. Peoples reviews your goals, symptoms, health history, and labs, then recommends the right Flow or package based on your needs and priorities. A Flow is our longer-term care model, typically a 12-month package, designed for comprehensive hormone and longevity care, including prescriptions when appropriate, lifestyle guidance, and supplement support.

Your initial visit is comprehensive and unhurried. We begin with a detailed conversation about your symptoms, health history, lifestyle factors, and goals for treatment. We'll discuss what's been bothering you—whether it's low energy, weight gain, sleep problems, mood changes, or other concerns—and explore how long you've been experiencing these issues. We'll review any previous lab work or medical records you bring. Then we'll conduct a focused physical examination and discuss which advanced laboratory tests we recommend to get a complete picture of your hormonal and metabolic health. This appointment is designed to be thorough, educational, and personalized to your unique situation.

Most patients begin noticing improvements within 2-4 weeks of starting hormone replacement therapy, though the timeline varies by individual and which hormones are being optimized. Energy levels and sleep quality often improve first, followed by mood, mental clarity, and libido. Physical changes like body composition, muscle mass, and weight typically take 3-6 months to become noticeable. We emphasize that hormone optimization is a process, not an instant fix. We monitor your progress closely with follow-up appointments and lab work, making adjustments as needed to ensure you're moving in the right direction. Patience and consistency are key to achieving sustainable, long-term results.

When properly prescribed and monitored by a qualified physician, testosterone replacement therapy is safe and highly effective for men with clinically low testosterone levels. We conduct thorough baseline testing, review your complete medical history, and screen for contraindications before beginning treatment. Throughout your therapy, we monitor your testosterone levels, blood counts, PSA, lipids, and other key markers to ensure safety and efficacy. We adjust dosing as needed to keep you in optimal ranges and minimize side effects. Our goal is not just to raise your testosterone, but to restore healthy hormonal balance while protecting your long-term cardiovascular, prostate, and metabolic health.

Bioidentical hormones are chemically identical to the hormones your body naturally produces, whereas synthetic hormones have a different molecular structure. This distinction matters because bioidentical hormones fit perfectly into your body's hormone receptors, often resulting in better efficacy and fewer side effects. For women, bioidentical estradiol and progesterone more closely mimic natural hormonal patterns and have been shown in research to carry lower risks than older synthetic hormone formulations. We preferentially use bioidentical hormones in our practice because they align with our philosophy of working with your body's natural physiology rather than against it. We'll discuss the specific formulations that are right for you during your consultation.

Yes, we offer telemedicine appointments for established patients and for certain follow-up visits. However, your initial comprehensive evaluation must be conducted in person so we can perform a physical examination and establish a proper doctor-patient relationship. Once you're an established patient and on a treatment plan, many follow-up appointments can be conducted via secure video consultation, which is convenient for lab review, dosage adjustments, and progress monitoring. We'll discuss which appointments can be done remotely and which require in-person visits based on your specific treatment plan and medical needs.

Follow-up frequency depends on your individual treatment plan and where you are in your optimization journey. Initially, when starting hormone therapy, we typically see patients every 6-8 weeks to monitor progress, review labs, and make necessary adjustments. Once your hormones are optimized and stable, follow-ups often extend to every 3-6 months. We also conduct comprehensive annual evaluations with full lab panels to ensure your long-term health and catch any potential issues early. If you're experiencing any concerns or side effects between scheduled visits, we encourage you to reach out—we're always available to address questions and provide support throughout your treatment.

Our comprehensive lab panels go far beyond standard testing. For men, we measure total and free testosterone, estradiol, DHT, SHBG, LH, FSH, PSA, complete blood count, comprehensive metabolic panel, lipids, thyroid function, vitamin D, and other relevant markers. For women, we test estradiol, progesterone, testosterone, DHEA, thyroid hormones, metabolic markers, and depending on symptoms, additional hormones and nutrient levels. We also assess insulin resistance, inflammation markers, and nutrient deficiencies that may be impacting your health. These advanced tests give us a complete picture of what's happening in your body so we can create a truly personalized treatment plan based on data, not guesswork.

Hormone optimization can be a powerful tool for weight loss, but it's not a magic bullet. Hormonal imbalances—particularly low testosterone, estrogen dominance, thyroid dysfunction, and insulin resistance—can make it extremely difficult to lose weight no matter how much you diet and exercise. By restoring hormonal balance, we help normalize your metabolism, improve body composition, increase lean muscle mass, and reduce stubborn fat deposits. However, hormone therapy works best when combined with proper nutrition, regular physical activity, adequate sleep, and stress management. Our medical weight loss programs address all these factors together for sustainable, long-term results rather than quick fixes that don't last.

No referral is required to schedule an appointment with us. We welcome self-referred patients who are interested in optimizing their hormonal and metabolic health. Many of our patients come to us after hearing about our practice from friends, family members, or online research. That said, we're also happy to collaborate with referring physicians and keep them informed of your care if you wish. We believe that informed, proactive patients who take charge of their own health tend to get the best results, so we encourage you to reach out directly if you're interested in exploring whether our services are right for you.

We welcome patients who are already on hormone therapy but aren't getting the results they expected or want more comprehensive monitoring and support. During your initial consultation, we'll review your current treatment protocol, analyze your recent lab work, and assess whether adjustments are needed. Many patients come to us because their previous provider used a one-size-fits-all approach or didn't monitor them closely enough. We take the time to optimize every aspect of your treatment—dosing, delivery method, timing, and adjunctive therapies—to help you achieve the best possible outcomes. Transitioning your care to our practice is straightforward, and we'll coordinate with your previous provider if needed.

Not at all. While hormone levels naturally decline with age, hormonal imbalances can affect people at any stage of life. We treat men and women from their late 20s through their 80s, each with different concerns and goals. Younger patients may come to us for chronic fatigue, weight issues, fertility concerns, PCOS, or metabolic dysfunction. Middle-aged patients often seek treatment for perimenopause, menopause, or andropause symptoms. Older patients focus on longevity, vitality, and disease prevention. Our approach is personalized to your age, life stage, and health goals. If you're experiencing symptoms that are impacting your quality of life, age is not a barrier to seeking help.

We accept cash, checks, all major credit cards, and HSA/FSA cards. Payment is due at the time of service. For patients concerned about the cost of comprehensive care, we're happy to discuss payment plans and financing options that make treatment more accessible. Many patients use their Health Savings Account or Flexible Spending Account funds, which can provide significant tax advantages for medical expenses. We provide detailed invoices that clearly outline all services and costs. Our priority is ensuring that financial concerns don't prevent you from receiving the care you need to restore your health and vitality.

We understand that life happens and schedules change. We ask that you provide at least 24 hours notice if you need to cancel or reschedule your appointment. This allows us to offer that time slot to another patient who may be waiting for care. Cancellations made with less than 24 hours notice or missed appointments without notification may be subject to a cancellation fee. We make exceptions for emergencies and illness, of course. If you need to reschedule, simply call our office or send us a message, and we'll work with you to find a new time that fits your schedule.

Yes, as a board-certified physician, Dr. specializes in prescribing testosterone, bioidentical hormones, thyroid medications, and other prescription therapies when medically appropriate. Testosterone is a controlled substance, and we take our prescribing responsibilities seriously. We only prescribe testosterone to men with clinically documented low testosterone levels and appropriate medical indications. Our prescribing practices follow all state and federal regulations, and we monitor patients closely for safety and efficacy. We do not prescribe controlled substances for recreational use or performance enhancement. Our goal is legitimate medical treatment for patients with genuine hormonal deficiencies and metabolic dysfunction.

Absolutely. Thyroid dysfunction is extremely common and often overlooked or undertreated by conventional medicine. We perform comprehensive thyroid testing that goes beyond just TSH, measuring free T3, free T4, reverse T3, thyroid antibodies, and other markers that reveal the full picture of thyroid function. Many patients come to us already on thyroid medication but still experiencing symptoms because their treatment isn't optimized. We use bioidentical thyroid hormones when appropriate and adjust dosing based on symptoms and comprehensive lab work, not just TSH levels. Thyroid optimization is often a crucial piece of the puzzle for patients struggling with fatigue, weight gain, hair loss, and metabolic issues.

If you are experiencing a life-threatening medical emergency—such as chest pain, difficulty breathing, severe bleeding, stroke symptoms, or other acute emergencies—please call 911 or go to your nearest emergency room immediately. Our practice specializes in chronic hormone and metabolic conditions, not acute emergency care. For urgent but non-emergency concerns related to your treatment with us, please contact our office during business hours, and we'll make every effort to address your concerns promptly. For after-hours questions about your ongoing treatment, we have protocols in place to handle urgent matters. Your safety is our top priority, and we'll help direct you to appropriate care based on the nature of your concern.

Unlike many hormone clinics that use cookie-cutter protocols and minimal monitoring, we take a comprehensive, root-cause approach to hormonal and metabolic health. We're not just a prescription mill. We spend time understanding your complete health picture, order advanced laboratory testing, address nutritional deficiencies, optimize lifestyle factors, and monitor your progress closely. Dr. Nicole Peoples is a Board-Certified Internal Medicine physician with advanced training in integrative, lifestyle, and functional medicine, and a focus on hormone optimization and longevity. We don't just aim to get your numbers into "normal" ranges, we optimize them to help you feel your absolute best. We also address underlying metabolic dysfunction, not just hormone levels, for truly comprehensive care that produces lasting results.