FAQ's
General FAQs
Do you accept insurance? No, many of our services are not covered by insurance, so we are a cash-based practice. We accept cash, debit or credit cards. We will however provide a super-bill upon request that you may submit to your HSA/FSA for reimbursement.
I do not have a primary care provider (PCP), will you be my PCP? Unfortunately, No! We are not a primary care provider office. I am not a primary care provider. We offer services which include acute care visits, and we offer management of specific chronic complex conditions such as obesity, metabolic dysfunction and male hormonal replacement therapy. It is very important to have a primary care provider who can complement our treatment services.
What are your office hours? Currently, since we are brand new we are scheduling by appointment only. I have a wide variety of available hours and appointment times for telehealth and in-office visits. These can be scheduled on the client portal. Currently My IN OFFICE/IN PERSON availability is Tuesdays and Thursdays. As the office becomes more established, we will update our office hours accordingly. My goal is to be as accommodating to my patient's schedules as possible.
What is a compounding pharmacy? A compounding pharmacy is a type of pharmacy that specializes in creating customized medications to meet the specific needs of individual patients. Unlike standard pharmacies that typically dispense mass-produced medications, compounding pharmacies can mix ingredients in various forms (such as creams, gels, or liquids) and adjust dosages to suit a patient's unique requirements. This can include: Personalized Medications: Tailoring medications for patients with specific ailments, allergies, or preferences. Alternative Dosage Forms: Creating forms of medication that may not be commercially available, such as flavored liquids for children or topical treatments for skin conditions. Medication Shortages: Compounding can provide alternatives when certain medications are in short supply. Compounding practices are regulated by state pharmacy boards and must adhere to specific guidelines to ensure safety and efficacy. We utilize multiple different compounding pharmacies, each of them are accredited compounding pharmacies, FDA registered, and Current Good Manufacturing Practices (CGMP) certified.
I am interested in some services... but I am unsure if they are right for me. What can I do? Send us an email! Or submit a request on the contact form. we will get back to you and see if we can help you decide if you are a good candidate or not. If you would like to just see what your hormone levels or blood work looks like before committing to an evaluation, please feel free to purchase some blood work on our labs page!
What is your cancellation and refund policy? Appointment fees are due at time of booking. With that said, if you must cancel or reschedule, please do so before 24 hours. If less than 24 hours notice is provided, 50% of booking fee will be refunded. NO SHOWS: If you are a no show, you forfeit 100% of the booking fee. No refunds. Sorry. Medications CAN NOT be returned. Even if they are unopened. No refunds on prescribed medications. If you purchase a 3, 6 or 12 month testosterone package: Participants are committed to the full 3 month, 6-month or 12-month term of the Testosterone Prepay Program. Cancellation requests must be submitted in writing at least 30 days prior to the end of the term. Participants will remain responsible for fulfilling all payment obligations for the entire 3-month, 6-month or 12-month term, even if they cancel mid-term. There are no pro-rata refunds for unused months. However, participants who are unable to continue the program due to a health-related issue, as determined by a healthcare provider, may be eligible for cancellation without further charges, provided that they submit documentation to support their claim. During the period between the cancellation request and the end of the commitment term, participants will retain full access to the program's services.
Do you see kids? Nope. Sorry, we do not see anyone under the age of 18 years old and that includes the online acute care telehealth visits.
TRT FAQs
What are symptoms of Low T? Gynecomastia/Infertility (most likely in those with primary hypogonadism.) Decreased vigor and libido Decreased energy Depressed mood Lack of motivation Poor sleep Difficulty concentrating Mood swings Reduced physical performance Fatigue Decreased muscle mass and body hair (less common but a sign of long-standing low T)
If it is determined I have low-suboptimal T levels, how will you help? 1. Comprehensive Testing: The center will provide thorough hormonal testing to diagnose low-suboptimal testosterone levels accurately. 2. Personalized Treatment Plans: Each patient will receive a tailored treatment plan based on their needs and health goals. 3. Testosterone Replacement Therapy: The center will offer various forms of testosterone replacement therapy (excluding pellets per our malpractice insurance rules.) 4. Lifestyle and Nutritional Guidance: we will recommend general diet, exercise, and lifestyle changes that can help improve testosterone levels naturally. 5. Ongoing Monitoring: Regular follow-up appointments will ensure treatment is effective and adjusted as necessary. (Don’t forget sick visits are included for you as a courtesy.) 6. Additional Health Screenings: The center may conduct screenings for related health issues like diabetes and cardiovascular health. 7. Referral to specialists: For moderate to severe cases, referral to an endocrinologist and other specialists for comprehensive care may be warranted.
What kind of long term things should I consider if I want to try TRT? Current FDA TRAVERSE trials from 2023 concluded that there was no increase in the risks of adverse cardiovascular outcomes in men using TRT for hypogonadism; however, they did confirm an increase in blood pressure. This risk is more prominent with oral T undecanoate or subcutaneous T enanthate. Our skilled practitioner understands these risks, so we have developed the systems we have in place. Additionally, T undecanoate IM carries a risk of Pulmonary oil microembolism. Topical gels and transdermal solutions carry a risk of secondary exposure, so it is increasingly important to understand their safety. Hepatotoxicity has been limited to oral T formulations. However, we monitor and observe this risk for all formulations. Our standard go-to T formulation is cypionate injectable due to the additional side effects of other formulations. Blood pressure increases may be potentially secondary to fluid retention and peripheral edema. Cypionate is contraindicated in those with liver impairment due to this fluid retention. Our plan: Monitor blood pressure and peripheral edema, complete a metabolic panel, and adjust treatment as indicated. Polycythemia/erythrocytosis, exact mechanism unknown, hypothetical thoughts include the role of hepcidin, iron sequestration and turnover, erythropoietin production, bone marrow stimulation, and genetic factors. Our plan: monitor hematocrit and hemoglobin levels and adjust treatment as indicated, as well as therapeutic phlebotomy with HCT levels equal to or above 54% Prostate cancer and benign prostatic hypertrophy risks. Evidence is conflicting. With BPH, if you have a severe AUA/International Prostate Symptom Score greater than 19 and lower urinary tract symptoms, unfortunately, you are excluded from enrolling in the TRT program. If you have known prostate cancer, you will need a urology clearance before proceeding. Our plan: We monitor your PSA levels closely and refer you to urology if necessary. It is important to note that PSA levels do tend to rise directly after initiation of TRT. However, this is most often transient. Worsening of sleep apnea. Our plan: If you have untreated sleep apnea or suspect you have undiagnosed sleep apnea, we will refer you back to your PCP for sleep study and treatment. Infertility and testicular atrophy. Our plan: We recommend that if this is important to our men, they should also utilize HCG or Gonadorelin to help decrease the effects of testicular atrophy and infertility. This is a common side effect of testosterone replacement therapy. Gonadorelin may help with testicular atrophy but is inferior to HCG for fertility. HCG, due to FDA regulations, is unfortunately quite expensive. Gonadorelin, to be truly optimal, should be injected multiple times daily. However, it is rarely prescribed as such due to the high probability of noncompliance and inconvenience; therefore, providers are still prescribing gonadorelin as they would HCG. There is also the option to add HCG during times you are trying to conceive only. Every man is unique, and we are here to help you navigate your individual needs and maintain what is important to you while also balancing your hormones. HCG is utilized in our weaning protocol if you decide to discontinue TRT.
I had my testosterone checked with my PCP, it was deemed "normal", can I still be considered for treatment? Absolutely! Even if you fall within the lab range as “normal” you still may have complaints of symptoms associated with testosterone deficiencies. This is because there isn’t an established consensus on where someone should be. Each person is so different. Ultimately the goal is to improve your quality of life as well as improve your symptoms. The current medical guidelines state that Testosterone levels >300 are "normal" and thus insurance will not cover TRT. We look beyond the standard outdated medical guidelines and treat the patient and symptoms and to a lesser degree worry about the number.
Will my natural ability to produce testosterone decrease on TRT? It is imperative to note that TRT is considered a lifelong treatment. Once you begin and reap the benefits, you will have to continuously take the medication to keep your T levels up, as the treatment does not work only once to increase your levels and then sustain them. There is no definitive proof that your body stops producing testosterone to the point where it can’t recover after ceasing testosterone replacement therapy (TRT). Research indicates that the longer you are on TRT, the longer it may take for your body to return to “your” normal levels, and sudden drops can cause mood changes and hormone fluctuations. Our plan: If you decide to stop TRT, we will initiate a weaning protocol to help mitigate the withdrawal effects of discontinuing TRT. It is crucial to understand these potential effects and decide what is right for you. For men with significant symptoms, TRT can be a life-changing intervention that can be utilized throughout their lives.
What are potential side effects of TRT? TRT, when administered at therapeutic doses, rarely causes side effects. However, some potential side effects include acne and water retention (more common in the first 1-3 months), gynecomastia (related to genetics), and decreased fertility. Fertility is the most concerning side effect, especially for men who want to have children in the future. Options like semen analysis, sperm preservation, HCG, and FSH can be considered to mitigate this risk. Other less common side effects include injection site reactions, increased red blood cell production, testicular atrophy, insomnia, and anxiety (often due to high doses).
How often do I need to get blood work done? Roughly every 8 to 12 weeks in the beginning. Very often it takes a little while to get dialed in. We will check at the 8-12 week mark, and depending on what blood work reveals and how you are feeling. If there are any adjustment in dosing there will need to be repeat labs 8-12 weeks after the change. Once you are "dialed in" on the dose that works for you, twice yearly appointments are all that are required to stay complaint with the DEA and federal laws concerning controlled substances.
Why do I have to sign a Controlled Substance Agreement? testosterone is classified as a controlled substance in many countries, including the United States, where it is listed as a Schedule III controlled substance under the Controlled Substances Act. This designation means that while testosterone has accepted medical uses, it also has the potential for abuse and dependency. As a result, its distribution and use are regulated, and it typically requires a prescription from a licensed healthcare provider for legal use. This also means that all testosterone shipped by mail will require a signature.
Can I just get my testosterone through a retail pharmacy? Well, maybe. If your PCP prescribes it and it is approved by your insurance... sure... However our program utilizes compounding pharmacies for multiple reasons, including: Customization: Compounding pharmacies can tailor hormone formulations to meet individual patient needs, adjusting dosages, delivery methods (such as creams, gels, or pellets), and specific hormone combinations based on hormone levels and symptoms. Personalized Treatment: Every patient has unique hormonal profiles and symptoms, and compounding pharmacies can create personalized treatments that may not be available in standard commercial products. Quality Control: Compounding pharmacies often focus on high-quality ingredients and can carefully select raw materials to ensure the bioidentical hormones meet specific standards for purity and potency. Access to Specific Hormones: Some hormones may not be available in commercially manufactured forms, especially for certain combinations or routes of administration. Compounding pharmacies can provide these specialized formulations. Adjustment Over Time: As patients' hormonal needs change, compounding pharmacies can easily reformulate the medication to adjust dosages or switch hormones as necessary. Management of Side Effects: By customizing the formulation, compounding pharmacies can help minimize side effects that patients may experience with standard hormone replacement therapies. Overall, compounding pharmacies play a crucial role in providing tailored and effective bioidentical hormone replacement therapies to meet individual patient needs.
Weight Loss FAQs
Do you offer GLP-1 RA medications? Yes! But in recent months it has become more complicated with FDA regulations. If you have medical insurance and you have a qualifying condition (BMI >27, and one comorbidity [High blood pressure, diabetes, sleep apnea] you may qualify for insurance coverage of Weygovy (semaglutide) or Mounjaro/Zepbound (Tirzepatide). We ask that you verify with your insurance company if you have coverage for these medications. If you DO, we will prescribe and complete the prior authorization for you. You will be required to have monthly visits via telehealth with us in order to receive your monthly prescription refills. This service is offered at $99/month.
What if I do not have insurance or my insurance will not cover GLP-1 RA medications? Good question! There are a couple of options here... First option is if you have a qualifying condition (BMI>27, and one comorbidity) we can access Lilly-Direct services to obtain Zepbound (Tirzepatide) We can also access Weygovy (Semaglutide) through Novo-Nordisk Direct cash payment as well. The clinic will see you monthly via telehealth for a fee of $99 and this visit will include your new prescription for your medications. Currently the cost of Lilly-Direct Tirzepatide is as follows: $349 for 2.5mg (for first month) $499 for 5 mg/7.5mg/10mg monthly thereafter (must be re-re-ordered within 45 days or price increases. Novo-Direct is $499/month all dosages. I prescribe to the company, and you will pay the corporation direct, and they will send you the medications directly.
Wow, those options are good... but this still seems very expensive for my budget, are there other options? Yes... there is one more way to obtain GLP-1 RA medications. We can discuss the risks and benefits of obtain compounded medications through our TRUSTED and SAFE compounding pharmacies. There is currently a lot of debate about the use of compounding pharmacies due to patent laws now that these medications are off of the "shortage" list. However this is one way to access these medications for cheaper monthly costs, safely. Pricing will be provided on a case by case basis, but monthly pricing will ultimately include your monthly visit/medication/supplies and quarterly lab follow ups. Pricing subject to change due to availability in the current climate. ALTERNATIVELY; aside from GLP medications we also offer: Phentermine Contrave Lipo-Mino Injections MICC injections Metformin Sermorelin NAD+
I have a lot of side effects on normal dosing of the commercial GLP-1 RA products, what can I do? If you require special dosing not available with commercial products then you are the perfect patient to receive compounded medications which can by tailored to specific dosing. The medication can also be compounded with other additives to help with tolerance such as B6 for nausea, or L-carnitine to prevent muscle wasting.
Wellness & Cannabis Certification FAQs
What are the benefits of IV hydration therapy? IV hydration therapy offers several benefits, including: Rapid Rehydration: It quickly replenishes fluids and electrolytes, making it effective for dehydration caused by illness, exercise, or heat exposure. Nutrient Delivery: IV therapy can deliver vitamins, minerals, and other nutrients directly into the bloodstream, enhancing absorption and effectiveness. Improved Recovery: Athletes use IV hydration to recover faster after intense workouts or competitions by reducing muscle soreness and fatigue. Increased Energy Levels: Many people report increased energy and alertness after receiving IV hydration, which can be beneficial during periods of fatigue. Enhanced Skin Health: Hydration can improve skin elasticity and moisture, leading to a healthier appearance. Treatment for Migraines: IV fluids can help alleviate migraine symptoms by rehydrating the body and addressing potential electrolyte imbalances. Hangover Relief: IV hydration is often sought for hangover relief, as it can combat dehydration and replenish lost nutrients. Support for Medical Conditions: Conditions like gastrointestinal disorders, where oral intake is not feasible, can benefit from IV hydration to maintain necessary fluid and nutrient levels.
Do I pick my own IV treatments? Yes and no... IV therapy is often times over looked as a simple process, but the reality is it is actually a complex medical treatment requiring expert evaluation for appropriate treatment. Generally if you have a desire to manage a particular symptom, and there is a treatment you would prefer, our provider will consider your preferences after an evaluation of your symptoms and medical history determines treatment choice would be appropriate.
Who should not receive IV and vitamin treatment? Patients with: Heart Conditions: Individuals with heart failure or other cardiac issues may be at risk of fluid overload. Kidney Problems: Those with kidney disease or compromised renal function may struggle to process excess fluids. Electrolyte Imbalances: Patients with specific electrolyte disorders could exacerbate their condition with unmonitored hydration. Allergies: Individuals with known allergies to any components of the IV solution should avoid this treatment. Certain Medications: People taking certain medications that affect fluid balance or electrolyte levels should discuss IV hydration with the provider. Infection Risks: Those with active infections or compromised immune systems may be at higher risk for complications. Fluid Restriction: Patients advised to limit fluid intake for medical reasons should avoid elective IV hydration. Pregnancy: Though not a complete contraindication for IV fluids alone, no additives will be offered.
What is NAD+ supplementation and what are the benefits? NAD+ (Nicotinamide adenine dinucleotide) is a coenzyme found in all living cells and plays a crucial role in cellular metabolism, energy production, and various biological processes. NAD+ supplementation refers to taking products that aim to increase NAD+ levels in the body. Benefits of NAD+ Supplementation: Energy Production: NAD+ is essential for converting food into energy through cellular respiration. Cellular Repair: It assists in DNA repair and maintenance, which can be beneficial for overall cellular health. Anti-Aging Effects: Some studies suggest that increased NAD+ levels may promote longevity and mitigate age-related decline in cellular function. Improved Metabolism: NAD+ may enhance metabolic function, potentially aiding in weight management and energy utilization. Neuroprotection: Preliminary research indicates that NAD+ supplementation may help protect against neurodegenerative diseases by supporting neuronal health. Enhanced Athletic Performance: Some athletes use NAD+ supplements to improve stamina and recovery.
Who should avoid NAD+? NAD+ (Nicotinamide Adenine Dinucleotide) supplements are generally considered safe for most people, but there are certain individuals who should exercise caution or avoid taking them. These include: Pregnant or Breastfeeding Women: There is insufficient research on the safety of NAD+ supplements during pregnancy or breastfeeding, so it is best to avoid them unless advised by a healthcare professional. Individuals with Certain Medical Conditions: People with conditions such as cancer, autoimmune diseases, or chronic illnesses should consult their doctor before taking NAD+ supplements, as they may interfere with treatments or exacerbate symptoms. Those on Medications: NAD+ supplements may interact with certain medications, such as chemotherapy drugs, immunosuppressants, or blood pressure medications. Always consult a healthcare provider before starting NAD+ if you are on medication. People with Allergies or Sensitivities: If you have a known allergy or sensitivity to any of the ingredients in NAD+ supplements, you should avoid them. Children and Adolescents: The safety and efficacy of NAD+ supplements in individuals under 18 have not been well studied, so they are generally not recommended for this age group. Individuals with Liver or Kidney Issues: Since NAD+ is metabolized in the liver and kidneys, those with impaired liver or kidney function should consult a doctor before use.
What is Sermorelin? What is it used for? Sermorelin is a synthetic peptide that acts as a growth hormone-releasing hormone (GHRH) analog. It is designed to stimulate the pituitary gland to produce and release more growth hormone (GH) in the body. Sermorelin mimics the action of natural GHRH, which signals the pituitary gland to release growth hormone. This, in turn, stimulates the liver to produce insulin-like growth factor 1 (IGF-1), which plays a key role in growth and metabolism. Anti-Aging: Some people use sermorelin as part of anti-aging therapies, as increased growth hormone levels may help improve muscle mass, reduce body fat, and enhance skin elasticity. Recovery and Performance: Athletes and fitness enthusiasts sometimes use sermorelin to aid in recovery, improve muscle strength, and enhance physical performance (though this use is controversial and not FDA-approved). Administration: Sermorelin is typically administered as a subcutaneous injection, often daily, and must be prescribed by a healthcare provider. Potential Side Effects: While generally well-tolerated, sermorelin may cause side effects such as: Injection site reactions (redness, swelling, or pain) Headache Dizziness Nausea Flushing In rare cases, it may lead to more serious side effects like increased intracranial pressure or allergic reactions. Who Should Avoid Sermorelin: Individuals with Active Cancer: Growth hormone can stimulate the growth of certain cancers. Pregnant or Breastfeeding Women: Safety during pregnancy or lactation has not been established. Those with Severe Obesity or Respiratory Issues: Growth hormone can exacerbate conditions like sleep apnea. People with Allergies to Sermorelin or Its Components.
What conditions qualify for medical cannabis certification in New Hampshire?
What conditions qualify for medical cannabis certification in Maine? Maine gives the prescriber discretion on qualifying conditions based on risks and benefits of certification.
Can certification be completed over telehealth? New Hampshire: Initial Consults MUST be performed in the clinic office in person. RECERTIFICATIONS thereafter can be done by telehealth. Maine: Yes, Telehealth evaluations (initial and renewals) can be completed.
Is there a fee required to the state? In New Hampshire there is a $50 fee associated with the therapeutic cannabis program application that is paid directly to the state of New Hampshire with submission of application. This fee is separate from the fee charged for evaluation. In Maine, there is no additional state fee required.
When will I receive my medical card? In NH: you will be evaluated, the provider will certify your application, you will submit your application to the State of New Hampshire. If based on their evaluation of your records and application, you qualify, they will issue a card by mail directly to you within a few weeks. In Maine: If you meet qualification, you will be issued a card same day. If you are evaluated in person you will be issued a card in hand. If you are evaluated by telehealth, you will receive a PDF copy of your card, and a physical card will be mailed to your home address within 7 days.
I lost my medical card, how do I get a new copy? ME card holders: Please reach out to the clinic by email or phone for lost cards. One will be re-issued to you for an administrative fee of $50.00. In New Hampshire: you must file a lost card form to the state, this form can be found on the NH DHHS website.
How long is my card good for? In Maine: Cards are written for 12 months. After 12 months you must be re-certified. In New Hampshire: Cards are written for 12 months by default. However, after 12 months a re-certification will be performed and if completed before expiration date of your card, we can issue an extension for an additional 12 months without having to file a new state application. This can be done every year for 3 years before a new application and fee must be completed.
Labs FAQs
What labs are included on initial TRT panel? Your initial TRT labs will cover: Thyroid function Adrenal health Liver function/kidney function Electrolytes Testosterone levels (both free and total) Metabolic health Prostate health Glucose Cholesterol levels
What labs are included on my TRT follow up panel required every 8-12 weeks for monitoring? CBC CMP Testosterone, total Testosterone, free Sex hormone binding globulin (SHBG) Estradiol Prostate specific antigen (PSA) Lipid panel (cholesterol levels)
What labs are included in the weight loss follow up panel? Every 3 months on treatment is is important to check the following labs CBC CMP Thyroid panel HgbA1c Insulin Lipid panel This shows progress, as well as evaluates for any potential adverse effects.
Can I use insurance for my required lab work? If you would like to try and submit your blood work through insurance, you are welcome to do so. We will provide a lab order form to you, and you may get your blood work done. However, we cannot guarantee your labs will be covered by insurance and cannot guarantee the price you will be charged if your insurance does not cover it for any reason. You should verify with your insurance what is covered before trying this. If you use our cash-based prices, you a guaranteed to receive the ordered labs at the price you paid.