Hormone & Metabolic Health

"My labs are normal. But I feel terrible."

This is the most common thing I hear from new patients. And it is almost always the beginning of a more complete conversation than they have been able to have anywhere else. Hormonal decline and imbalance rarely show up cleanly on a standard panel, but they show up reliably in the body — in sleep quality, joint health, mood, body composition, energy, and cognitive clarity. If you have been dismissed or told to wait and see, there is usually more going on than what has been evaluated so far.

What standard testing misses

Standard hormone panels were designed to detect deficiency. They were not designed to detect you.

Reference ranges on a hormone panel reflect the average across a broad population. They identify extremes. What they do not capture is whether your levels are adequate for your individual physiology, your life stage, and the way your body specifically metabolizes and responds to hormonal shifts.

A woman in early perimenopause can have estrogen levels that fall within the normal range on paper while experiencing real and significant changes in sleep architecture, joint integrity, mood regulation, and cognitive sharpness. The fluctuation during this transition, not just the eventual decline, is often what drives symptoms, and standard testing rarely captures that picture accurately.

A man in andropause can have testosterone within the reference range while losing muscle mass, experiencing slower recovery, and noticing changes in motivation and resilience that are not explained by lifestyle factors alone. The question is not just whether a number is within range, but whether it is sufficient for that person.

A younger woman with PCOS, estrogen dominance, or PMDD can have labs that look unremarkable while her body is providing clear clinical signals every month. Root-cause hormonal evaluation asks different questions than a standard panel, and it often produces different answers.

The conversation this practice is interested in having is not about whether your labs are normal. It is about what your body is telling us and what a more complete evaluation might reveal.

Who this care is designed for

Hormone medicine for women and men who want a more complete picture.

Women in Perimenopause and Menopause

Perimenopause can begin a full decade before the last menstrual period, and the hormonal fluctuations of this transition affect far more than the reproductive system. Estrogen receptors are present throughout connective tissue, the brain, the cardiovascular system, and bone. When estrogen begins to shift, patients frequently notice changes in joint health, sleep quality, body composition, mood stability, and cognitive function well before any standard lab panel reflects a problem.

Many women in this window are told their results are normal and their symptoms are stress, age, or anxiety. In my experience, this is rarely the full story. Perimenopause is a legitimate physiological transition that deserves a thorough clinical response, not reassurance and a waiting period.

For women who have reached menopause, the evidence supporting bioidentical hormone replacement therapy is substantial and continues to grow. The risks and benefits are individual, and treatment is always calibrated to your specific history, values, and goals.

Men Navigating Andropause

Testosterone declines gradually in men beginning in the mid-thirties, and the changes are easy to attribute to stress, overwork, or the natural process of aging. Decreased motivation, slower recovery from physical activity, changes in body composition, reduced libido, joint stiffness, and shifts in mood and mental clarity are all clinically relevant signs of hormonal change in men.

Andropause is significantly underdiagnosed in conventional medicine, in part because the decline is gradual rather than abrupt, and in part because men are not routinely screened for it. This practice applies the same depth of hormonal evaluation and individualized treatment approach to male patients that it does to women. Testosterone and related androgens matter for men's health, performance, and quality of life, and they deserve the same clinical attention.

Younger Women with Hormonal Imbalance

PCOS, estrogen dominance, PMDD, endometriosis, and the hormonal disruption that frequently follows discontinuation of oral contraceptives are conditions that significantly affect quality of life and are often undertreated or managed with oral contraceptives as the primary and only tool.

If you have been told that the pill is your best option or that your symptoms are something to manage rather than resolve, a root-cause hormonal evaluation can offer a more complete picture. The goal is to identify what is actually driving the pattern and to build a treatment strategy that works with your underlying biology rather than simply suppressing the cycle.

How this practice approaches hormone care

A comprehensive evaluation before any treatment is recommended.

Before any treatment is discussed, we spend time understanding the full hormonal and metabolic picture. That means reviewing not just hormone levels, but how hormones are being metabolized, what cortisol and thyroid function look like, how insulin sensitivity and body composition may be influencing the hormonal environment, and what the clinical picture — meaning your actual symptoms and history — is telling us that the numbers may not.

Hormone optimization at this practice is not a protocol applied uniformly. It is an individualized clinical strategy built around your specific biology, your life stage, and what you are trying to achieve.

Bioidentical Hormone Replacement Therapy (BHRT)

Bioidentical hormones are structurally identical to the hormones the human body produces naturally. Unlike synthetic or animal-derived hormone preparations, they are metabolized through the same biological pathways and recognized by the same receptors as endogenous hormones. BHRT is used for perimenopause, menopause, and andropause, and is calibrated to your individual lab values, symptom presentation, and goals rather than a one-size protocol.

Herbal and Botanical Endocrine Support

Evidence-based botanical medicine has a meaningful role in hormonal health, particularly for cycle regulation, stress-related hormonal disruption, thyroid support, and as an adjunct to hormone replacement therapy. These are not alternatives to clinical care but tools within it, applied where the evidence and the clinical picture support their use.

Nutritional and Metabolic Optimization

Hormones do not operate in isolation. Insulin resistance, specific nutrient deficiencies, inflammatory burden, and gut health all directly influence how hormones are produced, metabolized, and signaled throughout the body. Treatment planning at this practice includes evaluation of the metabolic environment that hormones live in, not just the hormone levels themselves.

Stress Physiology and Lifestyle

Cortisol has a direct and well-documented effect on every other hormonal axis in the body. Sleep quality, stress physiology, movement, and recovery are treated here as clinical variables that require honest evaluation and specific intervention, not general lifestyle advice.

“The goal is not to chase a number. It is to understand your specific physiology well enough to know what it actually needs.”

Something most hormone providers are not looking for

The connection between your hormones and your joint pain is real, and it is frequently missed.

Estrogen, progesterone and testosterone receptors are distributed throughout connective tissue, including tendons, ligaments, articular cartilage, and the synovial lining of joints. When estrogen declines during perimenopause and menopause, connective tissue loses both structural integrity and healing capacity. The clinical result is an increased susceptibility to injury, slower tissue recovery, more pain with less provocation, and joint changes that feel disproportionate to activity level or age.

This is one of the most consistently overlooked aspects of the menopausal transition. It is why a significant number of women in their mid-forties to mid-fifties develop frozen shoulder, Achilles tendinopathy, or progressive joint pain that their physician cannot account for using standard imaging or injury history. The answer is often hormonal, and it is treatable.

Testosterone plays a parallel role in men. It supports muscle mass, tendon strength, and the anabolic environment that enables tissue repair. As testosterone declines during andropause, soft tissue and joints become progressively more vulnerable, and recovery from both exercise and injury slows in ways that are often attributed to aging but are frequently addressable.

This practice evaluates and treats the hormonal and the musculoskeletal together. For appropriate patients, hormone optimization is combined with regenerative injection therapy so that both the tissue damage and the biological environment that determines whether that tissue can heal are addressed in the same treatment plan. This integrated approach is not available at practices that treat hormones and orthopedics as separate clinical domains.

Learn more about regenerative injection therapies.

“One of the first signs of perimenopause is often joint pain, not a hot flash. This is something I make a point of telling patients early.”

Conditions commonly treated

If you have been dealing with any of the following, there is usually more that can be done.

— Perimenopause

— Menopause

— Andropause and low testosterone in men

— Polycystic ovary syndrome (PCOS)

— Estrogen dominance

— PMS and PMDD

— Endometriosis

— Stress-induced hormonal decline

— Post-oral contraceptive hormonal disruption

— Thyroid dysfunction

— Adrenal dysregulation and HPA axis imbalance

— Insulin resistance and metabolic syndrome

— Pre-pregnancy planning and fertility support

— Low libido in women and men

What working together looks like

Your path to treatment.

Step 1 — Initial Consultation

We begin with a thorough intake covering your complete symptom history, any prior lab work, your current life stage, and what you are hoping to achieve. This is an extended appointment by design. You will leave with a clear sense of what may be driving your symptoms and what the evaluation and treatment options look like.

Step 2 — Comprehensive Lab Evaluation

Where indicated, we order a complete hormonal and metabolic panel that goes beyond standard testing. This typically includes a detailed assessment of sex hormones and their metabolites, thyroid function, adrenal markers, metabolic indicators, and nutritional status relevant to hormonal health.

Step 3 — Personalized Treatment Plan

Your treatment protocol is built around your specific lab findings, symptom picture, health history, and goals. It will draw on whichever combination of tools is most appropriate for your situation, calibrated to your individual biology rather than a standard protocol.

Step 4 — Ongoing Monitoring and Refinement

Hormone optimization is an ongoing clinical relationship, not a single prescription. Labs and symptoms are monitored over time, and treatment is adjusted as your biology evolves and your goals develop.

Frequently Asked Questions

Bioidentical hormone replacement therapy has a substantial and growing evidence base supporting its safety and efficacy when appropriately prescribed and monitored. The relevant risks and benefits are specific to the individual, including their personal and family health history, the type and delivery method of hormones used, and the dose. These factors are reviewed in full at your consultation so that you can make a genuinely informed decision.
Conventional hormone replacement therapy typically uses synthetic or animal-derived hormones that are not structurally identical to human hormones. Bioidentical hormones are molecularly identical to the hormones your body produces and are metabolized through the same biological pathways. Many patients report that bioidentical hormones feel more physiologically natural and produce fewer side effects, though individual responses vary and the evidence base continues to develop
In most cases, yes. "Normal" means within a population reference range. It does not mean optimal for your specific physiology, adequate for your life stage, or sufficient to explain the absence of symptoms. Hormone-related symptoms frequently occur in the context of levels that are technically within range but not appropriate for that individual patient. A more comprehensive evaluation often tells a meaningfully different clinical story.
Yes. Andropause is a legitimate and significantly underdiagnosed clinical condition. Male patients receive the same depth of hormonal evaluation and the same commitment to individualized treatment as female patients at this practice.
Dr. Krake is in network with PacificSource and Regence Blue Cross Blue Shield for office visits and consultations through FoRM Health. Laboratory work coverage depends on your specific plan, as well as collaborative decision making on standard vs. functional testing methods. BHRT and certain other treatments vary by coverage and are discussed at your consultation.
No referral is required. New patients can book directly through FoRM Health.

Take the first step

You deserve a clinical evaluation that takes your symptoms as seriously as you do.

If you have been told your labs are normal while your body is telling you something different, that discrepancy is worth investigating. The first step is a consultation where we review what you have been experiencing, what has already been evaluated, and what a more complete picture might look like for you specifically.

Book a Consultation