Hormone & Metabolic Health

Comprehensive hormonal evaluation and treatment for women and men, with a particular focus on perimenopause, menopause, andropause, and the complex relationship between hormonal health and musculoskeletal function.

When Standard Testing Does Not Tell the Complete Story

The most common presentation among new hormone patients at this practice is a straightforward one: symptoms that are clinically significant - disrupted sleep, changes in body composition, joint pain, cognitive changes, mood instability, reduced recovery — in the context of laboratory values that fall within a normal reference range.

This is not a contradiction. Reference ranges reflect population averages rather than individual adequacy. A woman in early perimenopause may have estrogen levels that are statistically unremarkable while experiencing meaningful changes in connective tissue integrity, sleep architecture, and cognitive function. The hormonal fluctuation of perimenopause, not only the eventual decline, is frequently responsible for symptoms, and standard testing often does not capture that picture accurately. Similarly, a man in andropause may have testosterone within range while losing muscle mass, recovering more slowly from physical activity, and experiencing changes in motivation and mental clarity that are not explained by other factors.

The purpose of a comprehensive screening labs and hormonal evaluation is to ask more complete questions than a standard panel does; to understand not just whether a value is within range, but whether it is sufficient for that individual, and what the full hormonal and metabolic context suggests about treatment.

“The most common thing I hear from new hormone patients is that their labs came back normal. My job is to determine what that actually means for them specifically, and what, if anything, has been missed.”

Who this care is designed for

Hormone medicine for women, men, or anyone who wants 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.

Treatment Approach

Treatment typically begins with a comprehensive evaluation, not just a screening panel review. That means understanding the full hormonal and metabolic context: how hormones are being produced and metabolized, what the adrenal and thyroid axes are contributing, how insulin sensitivity and body composition are influencing the hormonal environment, and what the clinical picture is communicating that the numbers may not.

Treatment protocols are constructed individually. They draw on the following tools in whatever combination is most appropriate for the patient.

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 Relationship Between Hormonal Health and Joint Function

“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.”
Learn more about regenerative injection therapies

Estrogen receptors are present 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 — increased susceptibility to tendinopathy and injury, slower tissue recovery, and joint pain that appears disproportionate to activity level — is one of the most consistently overlooked consequences of the menopausal transition.

Testosterone plays a parallel role in men, supporting muscle mass, tendon integrity, and the anabolic environment necessary for tissue repair. As andropause progresses, soft tissue and joints become progressively more vulnerable to injury and slower to recover.

This practice evaluates and treats the hormonal and the musculoskeletal together. For appropriate patients, hormone optimization is integrated with regenerative injection therapy — addressing both the tissue pathology and the biological environment that determines whether repair can occur. This is an approach that is not widely available from practices that treat hormones and orthopedics as separate clinical domains.

Conditions commonly treated

  • 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

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

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.

  • 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.

  • 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

  • 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.

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.

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