No two individuals are alike.  Many factors come into play that can influence the dose of hormones required to put balance back into your life.  Many centers use a fixed protocol based only on lab data to treat everyone.  It takes much more than just lab tests to guide any treatment.  This is very evident when it comes to hormone imbalance.  Our practice looks at each individual and their life style and needs in order to design their perfect therapy.  Osteoporosis, thin skin, sexual dysfunction, night sweats, and insomnia can be easily avoided.  Many safe and healthy hormone therapies are available for you.

Low Libido

Sexual desire naturally fluctuates over the years. Highs and lows commonly coincide with the beginning or end of a relationship or with major life changes, such as pregnancy, menopause, andropause or illness. Some antidepressants and anti-seizure medications also can cause low sex drive.

If a woman or man has a persistent or recurrent lack of interest in sex that causes personal distress, you may have hypoactive sexual desire disorder – a medical term for Low Libido.

If you want to have sex less often than your partner does, neither one of you is necessarily outside the norm for people at your stage in life — although your differences may cause distress. Similarly, even if your sex drive is weaker than it once was, your relationship may be stronger than ever. Bottom line: There is no magic number to define low sex drive. It varies from person to person.

Low sex drive can be very difficult for you and your partner. It's natural to feel frustrated or sad if you aren't able to be as sexy and romantic as you want — or you used to be. At the same time, low sex drive can make your partner feel rejected, which can lead to conflicts and strife. And this type of relationship turmoil can further reduce desire for sex.

A woman's desire for sex is based on a complex interaction of many components affecting intimacy, including physical well-being, emotional well-being, experiences, beliefs, lifestyle and current relationship. If you're experiencing a problem in any of these areas, it can affect your sexual desire.

A man’s desire for sex is also based on many factors.  Testosterone levels vary greatly among men. In general, however, older men tend to have lower testosterone levels than do younger men. Testosterone levels gradually decline throughout adulthood — about 1 percent a year after age 30 on average.



A wide range of illnesses, physical changes and medications can cause a low sex drive, including:

-  If you experience pain during sex or an inability to orgasm, or erectile dysfunction it can hamper your desire for sex.

-  Numerous nonsexual diseases can also affect desire for sex, including arthritis, cancer, diabetes, high blood pressure, coronary artery disease and neurological diseases.

-  Many prescription medications — including some antidepressants and anti-seizure medications — are notorious libido killers.

-  A glass of wine may make you feel amorous, but too much alcohol can spoil your sex drive; the same is true of street drugs.

-· Any surgery related to your breasts or your genital tract can affect your body image, sexual function and desire for sex.

- The exhaustion of caring for aging parents or young children can contribute to low sex drive.

- Changes in your hormone levels may alter your desire for sex.

    • For  women, estrogen levels drop during the transition to menopause. This can cause decreased interest in sex and dryer vaginal tissues, resulting in painful or uncomfortable sex. At the same time, women may also experience a decrease in the hormone testosterone, which boosts sex drive in men and women alike. Although many women continue to have satisfying sex during menopause and beyond, some women experience a lagging libido during this hormonal change.
    • Hormone changes during pregnancy, just after having a baby and during breast-feeding can put a damper on sex drive. Of course, hormones aren't the only factor affecting intimacy during these times. Fatigue, changes in body image and the pressures of carrying — or caring for — a new baby can all contribute to changes in your sexual desire.
    • For Men - A blood test is the only way to diagnose a low testosterone level or a reduction in the availability of testosterone. Some men have a lower than normal testosterone level without signs or symptoms. In this case, no treatment is needed. For others, low testosterone might cause changes in sexual function, sleep patterns, emotions and the body’s fat distribution.


-   There are many psychological causes of low sex drive, including:

-   Anxiety or depression

-   Stress, such as financial stress or work stress

-   Poor body image

-   Low self-esteem

-   History of physical or sexual abuse

Other causes

Emotional closeness, especially for women, is an essential prelude to sexual intimacy. So problems in your relationship can be a major factor in low sex drive. Decreased interest in sex is often a result of ongoing issues, such as:

- Lack of connection with your partner

  • Unresolved conflicts or fights
  • Poor communication of sexual needs and preferences
  • Infidelity or breach of trust


When you visit the office

Be candid about your sexual concerns. Feel free to bring it up. There is no need to feel embarrassed.  This topic is perfectly appropriate, in fact, it is clearly understood in modern society that your sexual satisfaction is a vital part of your overall health and well-being.

To help us help you:

- Take note of any sexual problems you're experiencing, including when and how often you usually experience them.

- Make a list of your key medical information, including any conditions for which you're being treated, and the names of all medications, vitamins or supplements you're taking. For example, antidepressants such as paroxetine (Paxil, Pexeva) and fluoxetine (Prozac, Sarafem) often lower sex drive. Switching to bupropion (Aplenzin, Wellbutrin) — a different variety of antidepressant — usually improves sex drive.

- Consider questions to ask and write them down. Bring along notepaper and a pen to jot down information as we addresses your questions.

    • Some basic questions to think about before your visit: 
    • Do you have trouble becoming aroused?
    • Do you experience vaginal dryness?
    • Are you able to have an orgasm?
    • Do you have any pain or discomfort during sex?
    • How much distress do you feel about your sexual concerns?

-  How long have you experienced this problem?

-  Are you still having menstrual periods?

-  Have you ever been treated for cancer? Have you had any surgeries?

-  What medications or vitamin supplements do you take?

-  What could be causing my problem?

-  Will my level of desire ever get back to what it once was?

-  What lifestyle changes can I make to improve my situation?

 What treatments are available?

-  Hormone therapy - Estrogen delivered throughout your whole body — by pill, patch, injection, gel or pellet — can have a positive effect on brain function and mood factors that affect sexual response.  They may be appropriate for you.

-  Smaller doses of estrogen — in the form of a vaginal cream or a slow-releasing suppository or ring that you place in your vagina — can increase blood flow to the vagina and help improve desire without the risks associated with systemic estrogen.

- In some cases, a combination of estrogen and progesterone may be necessary.

  • Testosterone, plays an important role in female sexual function, even though testosterone occurs in much lower amounts in women than in men.  It may be appropriate for you.

-  Counseling - Talking with a sex therapist or counselor skilled in addressing sexual concerns can help with low sex drive. Therapy often includes education about sexual response and techniques and recommendations for reading materials or couples' exercises.

-  Healthy lifestyle changes can make a big difference in your desire for sex:

-  Regular aerobic exercise and strength training can increase your stamina, improve your body image, elevate your mood and boost your libido.

    • Finding a better way to cope with work stress, financial stress and daily hassles can enhance your sex drive.
    • Couples who learn to communicate in an open, honest way usually maintain a stronger emotional connection, which can lead to better sex.
    • Communicating about sex also is important. Talking about your likes and dislikes can set the stage for greater sexual intimacy.
    • Scheduling sex into your calendar may seem contrived and boring. But making intimacy a priority can help put your sex drive back on track.
    • Try a different sexual position, a different time of day or a different location for sex. If you and your partner are open to experimentation, sex toys and fantasy can help rekindle your sexual sizzle.

- Try not to focus all of your attention on sex. Instead, spend some time nurturing yourself and your relationship. Go for a long walk. Get a little extra sleep. Kiss your partner goodbye before you head out the door. Make a date night at your favorite restaurant. Feeling good about yourself and your partner can actually be the best foreplay. 

Low-T (Low Testosterone)

Testosterone is the most important sex hormone in men.  It produces and maintains adult male features.  It can affect sex drive, muscle mass and fat distribution, and mood.  Low testosterone can be due to aging but it also may be cause by diseases of the glands that produce and control testosterone levels. 

Testosterone replacement therapy can:

-       Increase interest in sex

-        Produce erections more frequently

-        Reduce depression, anger and fatigue

-       Maintain masculine traits such as beard growth

-       Increase muscle mass and bone density

Testosterone replacement may be right for you depending on how low your testosterone level is, why it is low and any other medical condition you may have.

A normal testosterone level is 300-1200 ng/dl.  Not all testosterone is available tor tissues.  About 40% is bound to protein, 58% is available to most tissue, and 2% circulates freely in the blood.  Testosterone levels are highest in the morning.

Testosterone replacement can be done with:

Pellets, injections, gels and patches.  Testosterone pills can cause liver damage and should not be used.

The most appropriate method must be individualized based on laboratory, physical examination, and medical history.



Hypothyroidism (underactive thyroid) is a condition in which your thyroid gland doesn't produce enough hormones. Women, especially those older than age 60, are more likely to have hypothyroidism. Hypothyroidism upsets the normal balance of chemical reactions in your body. It seldom causes symptoms in the early stages, but, over time, untreated hypothyroidism can cause a number of health problems, such as obesity, joint pain, infertility and heart disease.

Hyperthyroidism (overactive thyroid) is a condition in which your thyroid gland produces too much of the hormone thyroxine. Hyperthyroidism can accelerate your body's metabolism significantly, causing sudden weight loss, a rapid or irregular heartbeat, sweating, and nervousness or irritability.

The good news is that accurate thyroid function tests are available to diagnose hypothyroidism and hyperthyroidism.  Treatments are readily available for both.  Although hyperthyroidism can be serious if you ignore it, most people respond well once hyperthyroidism is diagnosed and treated.  By far the more common condition is hypothyroidism which often leads to weight gain. 

The treatment of hypothyroidism is with oral thyroid hormone.  It is usually simple, safe and effective once you find the right dose.

At first, you may barely notice the symptoms of hypothyroidism, such as fatigue and weight gain, or you may simply attribute them to getting older. But as your metabolism continues to slow, you may develop more obvious signs and symptoms. Hypothyroidism signs and symptom may include:

-        Fatigue

-        Increased sensitivity to cold

-        Constipation

-        Dry skin

-        Unexplained weight gain

-        Puffy face

-        Hoarseness

-        Muscle weakness

-        Elevated blood cholesterol level

-        Muscle aches, tenderness and stiffness

-        Pain, stiffness or swelling in your joints

-        Heavier than normal or irregular menstrual periods

-        Thinning hair

-        Slowed heart rate

-        Depression

-        Impaired memory

When hypothyroidism isn't treated, signs and symptoms can gradually become more severe.

In general, you may test for an underactive thyroid if you're feeling increasingly tired, have dry skin, constipation and weight gain.

Diagnosis of hypothyroidism is based on your symptoms and the results of blood tests that measure the level of TSH and the level of the thyroid hormone thyroxine. A low level of thyroxine and high level of TSH indicate an underactive thyroid. That's because your pituitary produces more TSH in an effort to stimulate your thyroid gland into producing more thyroid hormone.  We will interpret the blood tests and make treatment recommendations.

STD Screening

STD Testing (Safe Partners)

If you're sexually active, particularly with multiple partners, you've probably heard the following advice many times: Use protection and make sure you get tested. This is important because people can have a sexually transmitted disease (STD) without knowing it. In many cases, no signs or symptoms occur.

But what types of STD testing do you need? And how often should you be screened? .

If you're a woman, don't assume that you're receiving STD testing every time you have a Pap test.  Also, PAP smears are no longer done every year and routine annual examinations are no longer recommended for women.  Regardless of your gender and age, if you think you need STD testing, get it!

Here are some guidelines for STD testing for specific sexually transmitted diseases.

Chlamydia and gonorrhea
Get tested annually if:

-       You're a sexually active girl or woman under age 25

  • You're a woman older than 25 and at risk of STDs — for example, if you're having sex with a new partner or multiple partners
  • You're a man who has sex with men

Chlamydia and gonorrhea screening is done either through a urine test. The sample is then analyzed in a laboratory. Screening is important, because if you don't have signs or symptoms, you can be unaware that you have either infection.

HIV, syphilis and hepatitis

Get testing for HIV, syphilis and hepatitis if you:

-        Test positive for gonorrhea or chlamydia, which puts you at greater risk of other STDs

-        Have had more than one sexual partner since your last test

-        Use intravenous (IV) drugs

-        Are a man who has sex with men

A blood sample is taken to test for syphilis, HIV and hepatitis.

Genital herpes

A blood test also may help detect a herpes infection or a history of infection.  Blood tests can help differentiate between the two main types of the herpes virus. Type 1 is the virus that more typically causes cold sores, although it can also cause genital sores. Type 2 is the virus that more typically causes genital sores. Still, the results may not be totally clear, depending on the sensitivity of the test and the stage of the infection. 

Certain types of human papillomavirus (HPV) can cause cervical cancer while other varieties of HPV can cause genital warts. Most sexually active people become infected with HPV at some point in their lives, but never develop symptoms. The virus typically disappears within two years.

Screening for HPV requires an examination.  In men the infection is diagnosed by visual inspection or biopsy of genital warts. In women, HPV testing involves:

-        Pap test. Pap tests, which check the cervix for abnormal cells, are recommended every two years for women between ages 21 and 30. Women age 30 and older can wait three years between Pap tests if their past three tests have been normal.

-        HPV test. Samples for the HPV test are collected from the cervical canal. In women under 30, HPV infections that will ultimately clear up on their own.

HPV has also been linked to cancer of the vulva, vagina, penis and anus. Vaccines can protect both men and women from some types of HPV, but they are most effective when administered before sexual activity begins. 

Weight Management

Insulin – a hormone that is fantastically efficient at storing fat is produced in increasing amounts as we gain weight.  Insulin resistance plays a central role in weight gain, obesity, and the metabolic syndrome; an epidemic with our abundant life style.  As Minney has learned, insulin resistance can be reversed with intermittent fasting.  This is a lifestyle change that involves taking a break from eating twice a week.

Try this to lower insulin resistance:

For two days a week reduce intake to less than 500 cal.

- Select two convenient days – Monday and Thursday seem to be the most logical. 

-     Have dinner Sunday night and eat less than 500 cal until dinner on Monday night – most think it is easier to just skip breakfast and lunch and wait for Monday dinner.

-      Have dinner Wednesday night and eat less than 500 cal until dinner on Thursday – or just skip breakfast and lunch and have Thursday dinner.

-      Eat your normal amounts and foods on the remaining days.   Avoid a high sugar diet which increases appetite, and over time leads to diabetes and heart disease.

-     If you need an appetite suppressant to get through the fasting days, call us. 

-      If this does not give good results, the addition of Metformin can lower insulin resistance.  Other special medication such as Adiponectin injections can be used to break insulin resistance and the metabolic syndrome.