FAQ: Weight Loss, Hormone Replacement Therapy and More

No, you do not need a referral to receive treatment at Peak Performance Health & Wellness. However, we do work closely with other healthcare providers to ensure that our patients receive the best possible care.

Peak Performance Health & Wellness offers a variety of health services including chiropractic care, hormone replacement therapy, weight loss, antiaging, myofascial release, manual therapy, joint injections, KT-taping, peptide support, and nutritional supplement counseling.

No, we do not accept insurance. As many wellness services are not covered by insurance such as Bio-identical hormone replacement. However,  we will provide you with billing information if you would like to file a claim individually with your insurance. Some patients have been successfully reimbursed for exams. Please notify us prior to the visit if you are planning to file on your own. 

Bioidentical hormones, such as the ones used by Biote, work with the body’s chemistry because they closely replicate the molecular structure of the hormones that normally occur within the body.. 

There are several symptoms that hormone replacement therapy can improve. Labs are drawn and reviewed by your provider to ensure a deficiency exists and replacement would be beneficial. 

In no particular order. Patients often experience a combination of these symptoms:

Physical Exhaustion (fatigue, lack of energy, stamina or motivation)

Sleep Problems (difficulty falling asleep or sleeping through the night)

Irritability (mood swings, feeling aggressive, angers easily)

Anxiety (feeling overwhelmed, feeling panicky, or feeling nervous) Decline in drive or interest (loss of “zest for life,” feeling down or sad)

Joint and muscular symptoms (poor recovery after workout, inability to add muscle, joint pain, muscle weakness)

Difficulties with memory (concentration, finding the right word, or retaining information)

Sexual Desire or Performance (reduced or diminished)

Erectile changes (weaker erections, loss of morning erections)

Ejaculations (infrequent or absent)

Sweating (night sweats or increased episodes of sweating)

Hair loss, rapid or thinning

Feeling cold all the time, having cold hands or feet

Headaches or migraines (increase in frequency or intensity)

Weight (difficulty losing weight despite diet/exercise)

Bladder problems (difficulty in urinating, increased need to urinate)

In no particular order. Patients often experience a combination of these symptoms:

Difficulties with memory (concentration, finding the right word, or retaining information)

Vaginal dryness or difficulty with sexual intercourse

Sexual Problems (change in desire, activity, orgasm and/or satisfaction)

Sweating (night sweats or increased episodes of sweating)

Hot Flashes (burst that starts in the chest and lasts or short duration)

Hair loss, thinning or change in texture of hair

Feeling cold all the time, having cold hands or feet

Headaches or migraines (increase in frequency or intensity)

Weight (difficulty losing weight despite diet/exercise)

Bladder problems (difficulty in urinating, increased need to urinate, incontinence)

Physical Exhaustion (fatigue, lack of energy, stamina or motivation)

Sleep Problems (difficulty falling asleep or sleeping

through the night)

Irritability (mood swings, feeling aggressive, angers easily)

Anxiety (feeling overwhelmed, feeling panicky, or feeling nervous)

Declined in drive or interest (loss of “zest for life, ”feeling down or sad)

Joint and muscular symptoms (joint pain, muscle weakness, poor recovery after exercise)

A significant hormonal transition will occur in the first four weeks after the insertion of your hormone pellets. Therefore, certain changes might develop that can be bothersome.

• INFECTION:

Infection is a possibility with any type of procedure. Infection is uncommon with pellet insertion and occurs in <0.5 to 1%. If redness appears and seems to worsen (rather than improve), is associated with severe heat and/or pus, please contact

the office. Warm compresses are helpful, but a prescription antibiotic may also be needed.

• PELLET EXTRUSION:

Pellet extrusion is uncommon and occurs in < 5% of procedures. If the wound becomes sore again after it has healed, begins to ooze or bleed or has a blister-type appearance, please contact the office. Warm compresses may help soothe discomfort.

• ITCHING OR REDNESS:

Itching or redness in the area of the incision and pellet placement is common. Some patients may also have a reaction to the tape or glue. If this occurs, apply hydrocortisone to the area 2-3 times daily. If the redness becomes firm or starts to

spread, please contact the office.

• FLUID RETENTION/WEIGHT GAIN:

Testosterone stimulates the muscle to grow and retain water which may result in a weight change of two to five pounds. This is only temporary. This happens frequently with the first insertion, and especially during hot, humid weather conditions.

• SWELLING OF THE HANDS & FEET:

This is common in hot and humid weather. It may be treated by drinking lots of water, reducing your salt intake, or by taking a mild diuretic, which the office can prescribe.

• BREAST TENDERNESS OR NIPPLE SENSITIVITY:

These may develop with the first pellet insertion. The increase in estrogen sends more blood to the breast tissue. Increased blood supply is a good thing, as it nourishes the tissue. Taking 2 capsules of DIM daily helps prevent excess estrogen

formation. In males, this may indicate that you are a person who is an aromatizer (changes testosterone into estrogen). This is usually prevented if DIM is taken regularly but can be easily treated and will be addressed further when your labs

are done, if needed.

• MOOD SWINGS/IRRITABILITY:

These may occur if you were quite deficient in hormones. These symptoms usually improve when enough hormones are in your system. 5HTP can be helpful for this temporary symptom and can be purchased at many health food stores.

• ELEVATED RED BLOOD CELL COUNT:

Testosterone may stimulate growth in the bone marrow of the red blood cells. This condition may also occur in some patients independent of any treatments or medications. If your blood count goes too high, you may be asked to see a blood

specialist called a hematologist to make sure there is nothing worrisome found. If there is no cause, the testosterone dose may have to be decreased. Routine blood donation may be helpful in preventing this.

• HAIR LOSS OR ANXIETY:

Is rare and usually occurs in patients who convert testosterone to DHT. Dosage adjustment generally reduces or eliminates the problem. Prescription medications may be necessary in rare cases. 5HTP may be helpful for anxiety and is available

over-the-counter.

• FACIAL/BODY BREAKOUT:

Acne may occur when testosterone levels are either very low or high. This lasts a short period of time and can be handled with a good face cleansing routine, astringents and toner. If these solutions do not help, please call the office for suggestions and

possibly prescriptions.

• AROMATIZATION:

Some men will form higher-than-expected levels of estrogen from the testosterone. Using DIM 2 capsules daily as directed may prevent this. Symptoms such as nipple tenderness or feeling emotional may be observed. These will usually resolve

by taking DIM, but a prescription may be needed.

• HIGH OR LOW HORMONE LEVELS:

The majority of times, we administer the hormone dosage that is best for each patient, however, every patient breaks down and uses hormones differently. Most patients will have the correct dosage the first insertion, but some patients may

require dosage changes and blood testing. If your blood levels are low, results are not optimal and it is not too far from the original insertion, we may suggest you return so we can administer additional pellets or a “boost” (at no charge). This would require blood work to confirm. On the other hand, if your levels are high, we can treat the symptoms (if you are having any) by supplements and/or prescription medications.

The dosage will be adjusted at your next insertion.

• TESTICULAR SHRINKAGE:

Testicular shrinkage is expected with any type of testosterone treatment.

• LOW SPERM COUNT:

Any testosterone replacement will cause significant decrease in sperm count during use. Pellet therapy may affect sperm count up to one year. If you are planning to start or expand your family, please talk to your provider about other options.

A significant hormonal transition will occur in the first four weeks after the insertion of your hormone pellets. Therefore, certain changes might develop that can be

bothersome.

• INFECTION:

Is possible with any type of procedure. Infection is uncommon with pellet insertion and occurs in <0.5 to 1%. If redness appears and seems to worsen (rather than improve), is associated with severe heat and/or pus, please contact the office. Warm compresses are helpful, but a prescription antibiotic may also be needed.

• PELLET EXTRUSION:

Pellet extrusion is uncommon and occurs in <5% of procedures. If the wound becomes sore again after it has healed, begins to ooze or bleed or has a blister-type

appearance, please contact the office. Warm compresses may help soothe discomfort.

• ITCHING or REDNESS:

Itching or redness in the area of the incision and pellet placement is common. If you have a reaction to the tape, please apply hydrocortisone 2-3 times per day to the rash.

If redness becomes firm or starts to spread after the first few days, you will need to contact the office.

• FLUID RETENTION/WEIGHT GAIN:

Testosterone stimulates the muscle to grow and retain water which may result in a weight change of two to five pounds. This is only temporary. This happens frequently

with the first insertion, and especially during hot, humid weather conditions.

• SWELLING of the HANDS & FEET:

This is common in hot and humid weather. It may be treated by drinking lots of water, reducing your salt intake, or by taking a mild diuretic, which the office can prescribe.

• BREAST TENDERNESS or SWELLING:

This usually occurs most commonly in the first round of pellets but does not usually continue thereafter. DIM 1 capsule daily is helpful in preventing this, but the dose may be increased to 2-3 daily, if needed. Evening primrose oil is helpful as is Iodine+ if this occurs.

• MOOD SWINGS/IRRITABILITY/ANXIETY:

These may occur if you were quite deficient in hormones. These symptoms usually improve as hormone levels improve. 5HTP can be helpful for this temporary symptom

and can be purchased at many health food stores.

• ELEVATED RED CELL COUNT

(most common in men): Testosterone may stimulate growth in the bone

marrow of the red blood cells. This condition is called erythrocytosis. Erythrocytosis may also occur in some patients independent of any treatments or medications.

If your blood count goes too high, you may be asked to see a blood specialist called a hematologist to make sure there is nothing worrisome found. If there is no cause, the

testosterone dose may have to be decreased.

• HAIR LOSS:

Is rarely due to pellets but can occur in some patients who convert testosterone to DHT. Dosage adjustment generally reduces or eliminates the problem. Prescription medications may be necessary in rare cases. Workup for other causes may also be needed.

• FACIAL BREAKOUT:

Some pimples may arise if the testosterone levels are either too low or rise rapidly. This lasts a short period of time and can be handled with a good face cleansing routine, astringents and toner. If these solutions do not help, please call the office for suggestions and possibly prescriptions.

• UTERINE SPOTTING/BLEEDING/IRREGULAR PERIODS:

This may occur in the first few months after an insertion, especially if you have been prescribed progesterone and are not taking properly: i.e. missing doses, or not taking a high enough dose. Please notify the office if this occurs. Bleeding is not necessarily an indication of a significant uterine problem.

• HAIR GROWTH:

Testosterone may stimulate some growth of hair on your chin, chest, nipples and/or lower abdomen. This tends to be hereditary. Fine, vellous hairs or “peach fuzz”

often occurs but is not thick nor coarse. You may also have to shave your legs and arms more often. Dosage adjustment generally reduces or eliminates the problem.

POST-INSERTION INSTRUCTIONS FOR MEN

• Your insertion site has been covered with two layers of bandages. The inner layer is a steri-strip, and the outer layer is a waterproof dressing.

• Do not take tub baths or get into a hot tub or swimming pool for 7 days. You may shower, but do not remove the bandage or steri-strips for 7 days.

• No major exercises for the incision area. No heavy lifting using the legs for 7 days. This includes running, elliptical, squats, lunges, etc. You can do moderate upper body work and normal walking on a flat surface.

• The sodium bicarbonate in the anesthetic may cause the site to swell for 1-3 days.

• The insertion site may be uncomfortable for up to 2 to 3 weeks. If there is itching or redness you may take Benadryl for relief (50 mg orally every 6 hours). Caution: this can cause drowsiness!

• You may experience bruising, swelling, and/or redness of the insertion site which may last from a few days up to 2 to 3 weeks. If the redness worsens after the first 2-3 days, please contact the office.

• You may notice some pinkish or bloody discoloration of the outer bandage. This is normal.

• If you experience bleeding from the incision, apply firm pressure for 5 minutes.

• Please call if you have any bleeding (not oozing) not relieved with pressure, as this is NOT normal.

• Please call if you have any pus coming out of the insertion site, as this is NOT normal.

• We recommend putting an ice pack on the area where the pellets are located a couple of times for about 20 minutes each time over the next 4 to 5 hours. You can continue this for swelling, if needed. Be sure to place something between the ice pack and your bandages/skin. Do not place ice packs directly on bare skin.

REMINDERS:

• Remember to have your post-insertion blood work done 4 weeks after your FIRST insertion.

• Most men will need re-insertion of their pellets 4-5 months after their initial insertion. If you experience symptoms prior to this, please call the office.

• Please call as soon as symptoms that were relieved from the pellets start to return to make an appointment for your next insertion.

POST-INSERTION INSTRUCTIONS FOR WOMEN

• Your insertion site has been covered with two layers of bandages. Remove the outer pressure bandage any time after 24 hours. It must be removed as soonas it gets wet. The inner layer (usually a steri strip) should be removed in 3 days.

• Do not take tub baths or get into a hot tub or swimming pool for 4 days. You may shower, but do not remove the bandage or steri-strips for 3 days.

• No heavy lifting or major exercises for the incision area for the next 3-4 days, which includes running, elliptical, squats, lunges, etc.

• The sodium bicarbonate in the anesthetic may cause the site to swell for 1-3 days.

• The insertion site may be uncomfortable for up to 2 to 3 weeks. If there is itching or redness you may take Benadryl for relief (25 to 50 mg orally every 6 hours). Caution: this can cause drowsiness!

• You may experience bruising, swelling, and/or redness of the insertion site which may last from a few days up to 2 to 3 weeks. If the redness worsens after the first 2-3 days, please contact the office.

• You may notice some pinkish or bloody discoloration of the outer bandage. This is normal.

• If you experience bleeding from the incision, apply firm pressure for 5 minutes.

• Please call if you have any bleeding not relieved with pressure (not oozing), as this is NOT normal.

• Please call if you have any pus coming out of the insertion site, as this is NOT normal.

• We recommend putting an ice pack on the area where the pellets are located a couple of times for about 20 minutes each time over the next 4 to 5 hours. You can continue this for swelling, if needed. Be sure to place something between the ice pack and your bandages/skin. Do not place ice packs directly on bare skin.

REMINDERS:

• Remember to have your post-insertion blood work done 6 weeks after your FIRST insertion. If you are not feeling any better by 4 weeks, however, please call the office to have your labs drawn early.

• Most women will need re-insertion of their pellets 3-4 months after their initial insertion. If you experience symptoms prior to this, please call the office.

• Please call as soon as symptoms that were relieved from the pellets start to return to make an appointment for your next insertion.

We have three local and reputable compound pharmacies depending on supply, shipping times, and concentrations may vary. All of our compound pharmacies follow the rules and regulations set by local and federal law. These pharmacies also send a product sample to a 3rd party verification vendor to ensure the purity of the product. 

Anytime someone goes on a calorie deficit it's easy for the body to break down muscle tissue to be used for energy first because it's harder to break down fat. Best practice for prevention is to maintain regular physical exercise which includes resistance strength training and cardiovascular endurance training.  (Recommend CDC guidelines for physical activity https://www.cdc.gov/physical-activity-basics/guidelines/adults.html).

GLP-1  should be avoided if you have a family history of medullary thyroid cancer or multiple endocrine neoplasia syndrome type 2 (MEN2). If you develop a lump on your throat contact your provider promptly as further diagnostic testing is recommended. 

GLP-1 can increase your risk for pancreatitis, bowel obstruction, and gastroparesis which are rare but do occur.

Common injection site reactions include rash, itching, or erythema which are generally short lived. 

Nausea can occur and often occurs more when we are not listening to our body. Eating too much or drinking a rapid bolus of fluid can frequently be the cause of  nausea and vomiting.  

Lowest most effective dose. Best outcomes arrive with a conscious decision to improve and eat right.  Medication doses that are lower tend to wean off 1-2 days before the next injection. This is an imperative time to make an effort to continue eating portions like the start of the week. This improves your chances of coming off the medication without rebound weight gain once weight loss goals have been achieved. If unable to tolerate this method you can move up on the dosing schedule to prevent it. 

GLP-1 can reduce the risk of heart disease, heart failure, and hospital admissions for major cardiac events. They can also reduce the number of atherothrombotic events. It can slow kidney damage by lowering blood sugar, blood pressure, and LDL cholesterol. As well as improve glucose metabolism. It has also been known to decrease stroke risk in Type 2 Diabetics. 

If you miss your regularly scheduled dose, take the missed dose as soon as possible within 5 days of the missed dose. You shouldn’t take two doses of Semaglutide within 48 hours of each other. If it’s been more than 5 days since the missed dose, skip the missed dose altogether, and take your next dose on your regularly scheduled day or adjust your scheduled day accordingly. Taking two doses in the same week can cause additional side effects. 

Regular exercise is important for maintaining your health and achieving your goals. Currently, the CDC recommends 8- 10,000 steps per day. That's a total of 5 miles. Average individuals achieve 3-4,000 steps per day. For individuals over 65 recommend 6-8000 steps per day for the same benefits. Interestingly walking so much did not increase the risk of osteoarthritis in the knees.