Bioidentical Hormones: A Complete Guide for Patient Wellness

Discover the connection between bioidentical hormones and patient wellness to promote a healthier, more balanced life.

Abstract

In this educational post, I, Dr. Alexander Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, ATN, CCST, synthesize a wide-ranging conversation into a clear, actionable guide for clinicians and patients. We will explore bioidentical hormone sourcing and compounding, libido support and topical options, perimenopause and menopause diagnostics, contraception transitions, transgender care boundaries and referral pathways, thyroid laboratory accuracy, PMS and menstrual migraine strategies, IUD considerations in midlife, anxiolytic and sleep strategies for adolescents, and safety communications with oncology teams. Throughout, I integrate current literature from leading researchers and add clinical insights from my practice to demonstrate how integrative chiropractic care complements endocrine balance by improving autonomic tone, sleep, pain modulation, and metabolic resilience. You will learn why specific protocols are chosen, the physiology that underlies their effectiveness, and how to stage care safely and effectively across diverse patient presentations.

Evidence-based bioidenticals and the science behind plant precursors

When we discuss bioidentical hormones, patients often ask, “What is this made from?” The short answer is: modern compounding pharmacies typically start with plant sterol precursors, most commonly derived from wild yam (Dioscorea species) rather than soy. The critical point is biochemical conversion. The raw plant contains sterols like diosgenin—this is not human estrogen or progesterone. Pharmaceutical-grade manufacturing chemically transforms these sterols into molecules that are structurally identical to human estradiol (E2), estriol (E3), estrone (E1), progesterone, and sometimes testosterone. The value of “bioidentical” lies in receptor specificity and downstream metabolism that mirror endogenous hormones.

• Key physiology

• • Steroid hormones bind nuclear receptors (ER?, ER?, PR, AR) that act as transcription factors. Minute changes in molecular structure alter receptor affinity and gene expression patterns.
  • Bioidentical progesterone differs meaningfully from synthetic progestins in vascular tone, breast tissue signaling, and neurosteroid conversion to allopregnanolone, influencing GABAergic calming and sleep quality (Prior, 2015).
  • Estradiol’s hepatic effects on coagulation differ by route: oral first-pass increases clotting factors more than transdermal routes (Scarabin, 2018).

• Clinical implications

• • Plant origin is a manufacturing starting point; the end product’s identity and purity are what matter for patient physiology and safety.
  • I often prefer transdermal estradiol for vasomotor symptoms in appropriate patients due to lower venous thromboembolism risk than oral estrogen, particularly in those with risk factors.
  • Compounded creams can be tailored for individuals with absorption or tolerance issues, though we base decisions on validated outcomes and, when feasible, on FDA-approved baselines.

Libido support in women: layered, multimodal strategies

Libido is multidimensional—neuroendocrine, vascular, psychosocial, and relational. Pharmacologic support may include compounded creams tailored to the patient’s phenotype.

• Options I discuss with patients

• • Topical combination creams: Some formulas include low-dose testosterone and non-hormonal adjuncts (e.g., L-arginine for nitric oxide support or botanical nervines), sometimes with agents colloquially referred to as “tangy” aphrodisiacs. I clarify the exact ingredients and dosing with the compounding pharmacist to ensure transparency and safety.
  • Androgen therapy: Low-dose transdermal testosterone may help hypoactive sexual desire in select peri/postmenopausal women (with informed consent, baseline labs, and monitoring of lipids, LFTs, and androgens) (Islam et al., 2019).
  • Pellets and layering: If a patient uses hormone pellets, layering a topical libido cream may be reasonable because local dermal routes and systemic pellets can have different pharmacokinetics. I adjust to avoid supraphysiologic androgen levels and monitor for acne, hirsutism, or voice changes.

• Why it works biologically

• • Testosterone supports dopaminergic reward pathways, sexual motivation, and genital tissue trophicity.
  • Estradiol contributes to vaginal blood flow, lubrication via mucosal health, and central arousal circuits.
  • Pelvic floor biomechanics matter: Integrative chiropractic care, pelvic floor-focused rehab, and myofascial work can reduce pelvic pain and improve blood flow, thereby enhancing sexual function.

• Integrative chiropractic fit

• • By addressing lumbopelvic alignment, sacral nerve irritation, and sympathetic overdrive, chiropractic care can reduce nociceptive input and improve parasympathetic tone—both key to sexual function. My experience in the clinic shows that when pelvic mechanics and ribcage/diaphragm function are improved, patients often report better arousal and reduced dyspareunia. See my case reflections and patient-facing notes on these patterns on my clinical pages (Jimenez, n.d.-a; Jimenez, n.d.-b).

Contraception transitions and the problem with staying on the pill too long

A common clinical scenario: a patient remains on combined oral contraceptives (COCs) into their late 40s or early 50s. The historical practice of “ride the pill until 51” is outdated. COCs have established risks: venous thromboembolism, pulmonary embolism, and ischemic stroke. These risks rise with age, smoking, hypertension, and migraine with aura (Curtis et al., 2016; Lidegaard et al., 2012).

• Clinical reasoning

• • Purpose alignment: “Birth control pills are for birth control.” If pregnancy prevention is no longer needed due to an IUD, tubal ligation, vasectomy, or sexual inactivity, the benefit/risk ratio often shifts toward discontinuation.
  • Masking physiology: COCs suppress endogenous gonadotropins, masking follicle-stimulating hormone (FSH) patterns that help stage menopause. I will not rely on FSH taken while on COCs to diagnose menopause status.
  • Better alternatives for non-contraceptive needs: For menstrual migraine, perimenopausal vasomotor symptoms, or endometriosis, targeted therapies—bioidentical hormones, non-hormonal options, or intrauterine progestogens—may be safer in many cases.

• My protocol for determining menopausal status
  • If a patient is on COCs and we need menopausal staging, I pause COCs for approximately 3 weeks, use barrier contraception, then measure FSH.

• FSH ? 23 IU/L off the pill suggests menopausal ovarian insufficiency.
• FSH ? 5 IU/L suggests premenopausal status.
• FSH 6–9 IU/L is gray; extend the washout and reassess if the cycle history is unclear.

• • Once confirmed, I can transition to individualized estradiol, progesterone, and, if indicated, testosterone on the same day, starting with conservative doses and titrating to symptom relief and physiologic targets.
• Integrative chiropractic fit

• • Transition symptoms—sleep disruption, headaches, neck stiffness, and myofascial pain—often respond to sympathetic downshifting through spinal manipulation, breathing retraining, and vagal stimulation. This reduces central sensitization and can decrease the intensity of vasomotor symptoms. Clinically, I find that patients who receive manual care during the transition phase tolerate dose adjustments more smoothly.

Perimenopause dosing and the art of starting low

When ovarian function is fluctuating, a cautious start avoids provoking bleeding and side effects.

• Why start low

• • Estrogen reintroduction during perimenopause can stimulate the endometrium if ovulatory status is inconsistent. Starting with a perimenopausal dose (for example, a lower transdermal estradiol dose like 0.025–0.0375 mg/day equivalent or a modest oral/transdermal equivalent) reduces the risk of heavy bleeding and mastalgia.
  • Reassess at 6 weeks and adjust. Physiology changes quickly in perimenopause; incremental titration respects the individual’s estrogen threshold for symptom control without overshoot.

• Progesterone protection

• • In women with a uterus using systemic estrogen, endometrial protection with progesterone is non-negotiable. While some topical progesterone may be used adjunctively for skin, there is no robust evidence that low-dose topical progesterone delivers consistent intrauterine protection. I use oral micronized progesterone (100–200 mg nightly) or equivalent cyclic strategies based on bleeding patterns and tolerance (NAMS, 2022).

• Integrative chiropractic fit

• • Gentle thoracic/rib mobilization enhances respiratory mechanics and CO2 tolerance, thereby decreasing panic-like intensification of hot flashes. I often pair early hormone therapy with a structured sleep-wake schedule, cervical/thoracic myofascial release, and guided movement to stabilize autonomic rhythms.

Menstrual migraines: the estrogen trough strategy

Menstrual migraines—triggered by the precipitous drop in estradiol in the late luteal phase—respond to brief “bridging” estrogen.

• Mechanism

• • Rapid estrogen withdrawal alters trigeminovascular tone, CGRP release, and cortical excitability. Providing a tiny peri-menstrual estrogen supplement blunts the trough, preventing the trigger without meaningfully altering monthly estrogen exposure.
  • Low doses, often transdermal, are used for 3–5 days around the expected onset to flatten the nadir.

• Why is this safe and effective

• • Properly dosed, the added estrogen is “a drop in the bucket” over the month and generally does not require cycle suppression or added progesterone because endogenous ovarian cycling proceeds. However, clear instructions and calendar tracking are essential.

• Integrative chiropractic fit

• • Cervicogenic contributions to migraine matter. Suboccipital tension, trigeminal-cervical complex sensitization, and forward head posture elevate migraine load. Spinal adjustments, soft tissue work, and breathing retraining reduce pericranial muscle tone and nociceptive input. Clinically, I observe faster response when patients combine estrogen-bridging with neck and jaw decompression, sleep optimization, hydration, and magnesium repletion.

Topical estrogens in cosmetics and systemic considerations

Patients increasingly use over-the-counter cosmeceuticals with phytoestrogens or compounded estriol/estradiol blends.

• What we know

• • Skin is an absorptive tissue. Applying estrogen-containing products broadly (e.g., face, neck, chest) can produce measurable serum changes, depending on concentration and vehicle.
  • Estriol (E3) is considered “weaker” at the ER? but still bioactive. Applying high-surface-area estrogen products risks supraphysiologic exposure, especially if combined with systemic therapy.

• Clinical guidance

• • If a patient is on systemic estrogen, avoid widespread application of estrogen-containing cosmetic creams. If facial dermatologic concerns are present, consider low-dose, localized estriol preparations and monitor symptoms and labs. Monitor for breast tenderness, uterine bleeding, or mood shifts.
  • Always document the specific compound, strength, and application surface area. Educate patients that “topical” does not mean “local only.”

• Integrative chiropractic fit

• • Dermatologic health intersects with stress biology. Chronic sympathetic activation impairs skin barrier repair and microcirculation. Parasympathetic-promoting care (spinal manipulation, diaphragmatic breathing, light aerobic activity) may subtly improve skin recovery while reducing the urge to use excessive hormone-laden topicals.

IUDs in midlife: advantages and caveats

Levonorgestrel-releasing intrauterine systems (IUS) provide powerful local endometrial suppression with minimal systemic progestin levels.

• Why I use IUDs in perimenopause

• • Levonorgestrel IUS does not significantly elevate VTE risk and is excellent for controlling heavy bleeding and dysmenorrhea.
  • Unlike COCs, IUS do not obscure menopausal staging via FSH since ovarian axis suppression is not systemic in the same way. FSH remains interpretable.
  • In patients already tolerating a well-placed IUS, I often maintain it through the menopausal transition and add systemic estradiol as needed, then reassess removal once 12 months of amenorrhea is confirmed or after a clinically appropriate window.

• Practical pearls

• • Do not remove a well-tolerated IUS solely because estrogen therapy is started; sudden removal can provoke bleeding and disrupt symptom control. In cases of hard-to-remove devices or postmenopausal retention, coordinate with gynecology to assess risks and benefits.
  • If using systemic estrogen with an IUS, many patients receive sufficient endometrial protection from the IUS; however, verify with current guidance and ultrasound if bleeding occurs.

• Integrative chiropractic fit

• • Pelvic alignment and diaphragmatic mechanics influence pelvic floor tension and uterine position. I have seen improvements in cramping and pelvic pressure when patients receive pelvic stabilization and core coordination training alongside gynecologic care.

Transgender care: scope, collaboration, and specialized pathways

Patients and clinicians asked about initiating or managing gender transition therapy. It is essential to recognize the scope and ensure safety.

• My stance

• • I do not initiate gender transition therapy within a general menopause/andropause framework. Transition care requires specialized protocols, mental health evaluation, and multidisciplinary monitoring. I refer to endocrinologists or clinics that follow Endocrine Society and WPATH-aligned guidelines (Hembree et al., 2017; Coleman et al., 2022).
  • If a patient is already stable on a regimen managed by a specialist, I can provide supportive care (musculoskeletal, sleep, metabolic, nutritional) and coordinate with the team.

• Integrative chiropractic fit

• • Musculoskeletal adaptations occur with androgen or estrogen therapy (e.g., changes in muscle mass or ligament laxity). Chiropractic care helps manage evolving biomechanics, reduce overuse injuries during body composition changes, and support autonomic stability.

Thyroid testing: LC-MS/MS accuracy and timing of labs

Questions arose about assay reliability. For thyroid and sex steroids, method matters.

• Why I favor LC-MS/MS

• • Liquid chromatography–tandem mass spectrometry (LC-MS/MS) provides higher specificity for small molecules like estradiol and T3, with fewer cross-reactivities than immunoassays. Immunoassays may be confounded by biotin, heterophile antibodies, and metabolite cross-reactivity, producing spuriously high or low results (Stanczyk & Clarke, 2014).

• T3 timing nuance

• • T3 has a short half-life. If a patient takes liothyronine (T3) shortly before phlebotomy, serum T3 may appear transiently elevated. Always document the medication time relative to the draw. I prefer standardized morning lab draws, 12–24 hours after the last T3 dose when clinically appropriate, to avoid misinterpretation.

• Integrative chiropractic fit

• • Thyroid symptoms—fatigue, myalgias, neck and back discomfort—interact with physical performance. Gentle spinal care, pacing, and graded movement help patients tolerate the phases of thyroid titration. Autonomic optimization can improve GI absorption of thyroid medications by reducing stress-related hypoperfusion.

Anxiety, PMS, and adolescents: sleep physiology, nutrition, and gentle pharmacology

Severe PMS and cyclic anxiety can be debilitating. In teens, wide hormonal swings amplify vulnerabilities. The first interventions are physiologic.

• Sleep as endocrine medicine

• • Growth hormone (GH) and IGF-1 peaks occur during early night slow-wave sleep. Teens who remain on screens until 1–2 a.m. experience blunted GH secretion, with downstream impacts on mood regulation, recovery, and metabolic health (Owens et al., 2014).
  • I coach strict sleep hygiene: screens off 60–90 minutes before bed, a dark, cool room, a consistent schedule, and daytime light exposure. In refractory cases, low-dose clonidine at night can be considered short-term to consolidate sleep in adolescents with hyperarousal, with careful monitoring and shared decision-making.

• Nutritional/lifestyle changes that move the needle

• • Reduce ultra-processed foods and high-sugar beverages (the ubiquitous 40–60 g sugar coffee drinks are frequent culprits). Dysglycemia destabilizes mood and HPA axis tone.
  • Magnesium glycinate at night and omega-3s support neuromodulation and reduce cramps and anxiety in some patients.
  • Probiotics and fiber support the gut-brain axis; dysbiosis is linked with anxiety and depressive symptoms via inflammatory and serotonergic pathways (Foster et al., 2021).

• Hormonal options

• • For adults with luteal-phase anxiety or severe PMS, nighttime oral micronized progesterone can leverage neurosteroid conversion to allopregnanolone, enhancing GABAergic tone and sleep. Start low and monitor daytime somnolence.
  • In adolescents, I prioritize non-hormonal foundations first and collaborate with pediatrics and adolescent medicine.

• Integrative chiropractic fit

• • Cervical and thoracic adjustments, rib mobility, and breathing coaching reduce sympathetic arousal. In my clinic, teens with anxiety often show elevated upper trapezius tone, forward head posture, and paradoxical breathing; correcting these improves sleep onset and mood stability. See my clinical commentary for examples of posture-linked anxiety patterns and sleep strategies (Jimenez, n.d.-a; Jimenez, n.d.-b).

The gut-brain axis and mental health medications

Several participants described patients on multiple anxiolytics or antidepressants with persistent symptoms until gut health was addressed.

• Physiology

• • Gut dysbiosis drives low-grade inflammation, alters short-chain fatty acid production, and modulates tryptophan metabolism toward kynurenine pathways—dampening serotonergic tone and increasing neuroinflammation (Maes et al., 2022).
  • Addressing diet quality, fiber intake, and probiotics, and eliminating excess sugars often improves mood, reduces cravings, and stabilizes energy.

• Clinical strategy

• • I start with dietary cleanup, microbiome-supportive nutrition, and sleep restoration before medication changes. As symptoms improve, I coordinate with psychiatry to rationalize polypharmacy, avoiding abrupt discontinuation.
  • For patients reporting “nothing works,” I screen for iron deficiency, B12/folate status, vitamin D insufficiency, and thyroid dysfunction—common silent aggravators of mood symptoms.

• Integrative chiropractic fit

• • Vagal tone is a key bridge. Thoracic and cervical interventions, along with diaphragmatic pacing, enhance vagal efferent activity, thereby promoting gastric motility and anti-inflammatory signaling. Clinically, patients frequently report improved bowel regularity and reduced abdominal pain after ribcage mechanics are restored.

Protecting the endometrium: topical progesterone is not enough

A critical safety point: while transdermal progesterone may be present in serum, reliable endometrial protection requires sufficient intrauterine exposure. The variability of dermal absorption and first-pass hepatic metabolism means low-dose topical progesterone is not consistently protective at the uterus.

• Clinical stance

• • If a patient uses systemic estrogen and retains a uterus, I use oral micronized progesterone or an intrauterine progestin for endometrial protection. I do not rely on low-dose topical progesterone alone. This is about protecting the patient and your license, and it aligns with positions from major societies (NAMS, 2022).

• Integrative chiropractic fit

• • Pelvic and lumbar dysfunction can amplify cramping and abnormal bleeding experiences. Aligning musculoskeletal function during hormonal adjustments often improves tolerance and adherence.

Working with oncologists: data-driven conversations about hormones

Tension sometimes arises when discussing menopausal hormone therapy or testosterone use in patients with a history of cancer. The right approach: shared decision-making anchored in data.

• Communication strategy

• • Ask the oncology team to share the specific literature that informs their concerns. Offer a curated, peer-reviewed evidence packet relevant to your proposed therapy and the patient’s tumor type, receptor status, and treatment history.
  • Leverage open-access repositories and leading clinician-researchers who maintain up-to-date bibliographies on menopausal therapy and survivorship. Maintain a respectful posture: “If we’re not up on it, we’re down on it.” Invite collaboration.

• Evidence contours

• • For genitourinary syndrome of menopause in breast cancer survivors, low-dose vaginal estrogen may be considered with oncologist input when nonhormonals fail, given minimal systemic absorption with certain products (NAMS, 2022; Santen et al., 2020).
  • Systemic therapy decisions must be individualized; risk varies by tumor type, stage, and endocrine therapy status.

• Integrative chiropractic fit

• • Cancer survivors often suffer from arthralgias, neuropathy, sleep disturbance, and anxiety. Non-pharmacologic autonomic and biomechanical care can substantially improve quality of life and may reduce the need for systemic hormone exposure to relieve symptoms.

Testosterone and lipid idiosyncrasies: patient-specific risk management

Some patients have genetically driven hyperlipidemia patterns—low HDL or high triglycerides—that can be familial and not directly caused by testosterone therapy.

• Clinical pearls

• • If a patient’s cardiologist flags lipids while on testosterone, review family history, baseline pre-therapy labs, and lifestyle factors. Optimize exercise, nutrition (including omega-3s), sleep, and weight management. Consider coronary calcium scoring for risk stratification where appropriate.
  • There is no universal need to stop testosterone solely due to inherited lipid patterns if the overall risk-benefit remains favorable and alternatives have been weighed. Coordinate with cardiology.

• Integrative chiropractic fit

• • Resistance training guidance and back/hip care help patients safely build lean mass—improving insulin sensitivity and lipid profiles. I often counsel on programming and recovery to match endocrine goals.

Practical questions: needles, delivery systems, and comfort

Patients often ask about injection comfort and needle gauge for viscous solutions.

• My approach

• • For oil-based injectables, smaller-bore needles (27–31G) can be used with patience and warmed solutions; 30–31G may be preferable for comfort with low-volume subcutaneous testosterone protocols. A 27G may be necessary for higher-viscosity oils, but technique (slow push, proper site, warming)  may mitigate discomfort.
  • Rotating sites and using topical anesthetics for sensitive patients improves adherence.

• Integrative chiropractic fit

• • Addressing myofascial tenderness and trigger points in the deltoid, ventrogluteal, or abdominal regions can reduce post-injection soreness and fear, improving compliance.

Dietary sugar and caffeine overload: the invisible hormone disruptors

A recurring theme in the clinic: patients arrive with high-sugar beverages in hand. Acute hyperglycemia spikes insulin, followed by reactive hypoglycemia, worsening fatigue, anxiety, and cravings. Chronic intake promotes visceral adiposity, aromatase activity, and altered sex steroid balance.

• Action plan

• • Replace sugar-laden drinks with water, unsweetened teas, or black coffee. Introduce protein-forward breakfasts and color-rich produce. Within 2–4 weeks, many patients report steadier energy, fewer hot flashes, and reduced anxiety.
  • Pair with magnesium (especially for those with cramps or sleep issues) and a balanced B-complex if diet is suboptimal.

• Integrative chiropractic fit

• • When patients feel better physically (less pain, better sleep), nutrition adherence improves. Manual care can provide early wins that unlock lifestyle momentum.

Putting it all together: a stepwise, integrative workflow

Here is how I weave these elements into a cohesive plan.

• Initial assessment

• • History: cycle patterns, contraception, migraines, mood/sleep, sexual function, metabolic risks, family history.
  • Labs: consider LC-MS/MS for estradiol and T3/T4 where available; check FSH post-pill when staging menopause; include lipids, A1c, ferritin, B12/folate, vitamin D, and thyroid panel. Time thyroid meds relative to lab draws.
  • Physical exam: posture, breathing, cervical/thoracic mobility, pelvic alignment, abdominal wall, and pelvic floor tone.

• Foundational care

• • Sleep: strict hygiene, circadian light exposure, and if needed,d short-term aids with caution.
  • Nutrition: remove excess sugar and ultra-processed foods; add protein, fiber, and omega-3s; support the microbiome.
  • Movement: resistance plus aerobic training; correct biomechanics via chiropractic/manual therapy.

• Targeted therapeutics

• • Menstrual migraine: peri-menstrual micro-dose estrogen bridging.
  • Perimenopause: start low-dose estrogen, add oral micronized progesterone for endometrial protection; consider IUS for heavy bleeding.
  • Libido: consider low-dose transdermal testosterone with monitoring; adjunct topical combinations as appropriate.
  • Thyroid: dose timing, symptom-guided titration, avoid lab misreads.
  • Adolescents with anxiety/PMS: emphasize sleep and lifestyle; reserve pharmacology; coordinate with pediatric specialists.
  • Oncology/special risks: individualized, data-driven collaboration; prioritize non-hormonal measures.

• Monitoring

• • Symptom scales every 6–8 weeks initially.
  • Labs at 8–12 weeks for dose changes; annually once stable.
  • Adverse effect surveillance: bleeding, breast changes, mood shifts, acne, hirsutism, BP, and lipid trends.

Clinical observations from my practice

Across thousands of visits, I have seen that:

• Patients transitioning off COCs do better when we concurrently address sleep and neck/thoracic tension. Hot flashes and headaches often lessen within weeks when autonomic balance is restored.
• Libido improvements correlate with pelvic floor relaxation and better sacroiliac mechanics as much as with androgen adjustments—mechanical pain inhibition liberates desire.
• Adolescents with severe anxiety frequently have late-night screen use; changing this single variable can significantly improve IGF-1-related recovery and mood within one to two menstrual cycles.
• Patients with “treatment-resistant” anxiety or depression commonly improve when we remove liquid sugars and repair gut function, even before changing psychotropics.
• In perimenopause, starting low and titrating avoids the whiplash of bleeding and breast pain—slow is smooth, smooth is fast.

Closing thoughts: precision, collaboration, and the nervous system

Hormone care is not merely about numbers; it is about physiology in motion—receptors, enzymes, and networks that respond to environment and behavior. The spine and autonomic nervous system sit at the crossroads of perception, pain, and endocrine resilience. Integrative chiropractic care is not a substitute for hormone therapy when indicated; it is the amplifier that helps the body use hormones well by calming overactive circuits, restoring sleep, and enabling movement.

If you are a clinician, I encourage you to pair evidence-based bioidentical hormone strategies with foundational lifestyle and manual care. If you are a patient, know that your daily choices and your nervous system’s balance are potent medicines. Together, we can craft plans that are safe, effective, and sustainable.

References

• Coleman, E., Radix, A. E., Bouman, W. P., et al. (2022). Standards of care for the health of transgender and gender diverse people, version 8. International Journal of Transgender Health, 23(Suppl 1), S1–S259. https://doi.org/10.1080/26895269.2022.2100644
• Curtis, K. M., Tepper, N. K., Jatlaoui, T. C., et al. (2016). U.S. medical eligibility criteria for contraceptive use, 2016. MMWR Recommendations and Reports, 65(3), 1–103. https://www.cdc.gov/mmwr/volumes/65/rr/rr6503a1.htm
• Foster, J. A., Rinaman, L., & Cryan, J. F. (2021). Stress and the gut-brain axis: Regulation by the microbiome. Neurobiology of Stress, 15, 100277. https://doi.org/10.1016/j.ynstr.2021.100277
• Hembree, W. C., Cohen-Kettenis, P. T., Gooren, L., et al. (2017). Endocrine treatment of gender-dysphoric/gender-incongruent persons: An Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 102(11), 3869–3903. https://doi.org/10.1210/jc.2017-01658
• Islam, R. M., Bell, R. J., Green, S., Page, M. J., & Davis, S. R. (2019). Safety and efficacy of testosterone for women: A systematic review and meta-analysis of randomized controlled trial data. The Lancet Diabetes & Endocrinology, 7(10), 754–766. https://doi.org/10.1016/S2213-8587(19)30189-5
• Lidegaard, Ø., Løkkegaard, E., Jensen, A., Skovlund, C. W., & Keiding, N. (2012). Thrombotic stroke and myocardial infarction with hormonal contraception. New England Journal of Medicine, 366(24), 2257–2266. https://doi.org/10.1056/NEJMoa1111840
• (2022). The 2022 hormone therapy position statement of The North American Menopause Society. Menopause, 29(7), 767–794. https://doi.org/10.1097/GME.0000000000002028
• Owens, J., Adolescent Sleep Working Group, & Committee on Adolescence. (2014). Insufficient sleep in adolescents: Causes and consequences. Pediatrics, 134(3), e921–e932. https://doi.org/10.1542/peds.2014-1696
• Prior, J. C. (2015). Progesterone for symptomatic perimenopause treatment—Progesterone politics, physiology, and potential for perimenopause. Gynecological Endocrinology, 31(10), 774–779. https://doi.org/10.3109/09513590.2015.1045973
• Santen, R. J., Stuenkel, C. A., Burger, H. G., et al. (2020). Managing menopausal symptoms and associated clinical issues in breast cancer survivors. Journal of Clinical Endocrinology & Metabolism, 105(9), 2851–2869. https://doi.org/10.1210/clinem/dgaa390
• Scarabin, P.-Y. (2018). Progestogens and venous thromboembolism among postmenopausal women using hormone therapy. Maturitas, 112, 84–89. https://doi.org/10.1016/j.maturitas.2018.03.009
• Stanczyk, F. Z., & Clarke, N. J. (2014). Measurement of estradiol—Challenges ahead. The Journal of Clinical Endocrinology & Metabolism, 99(1), 56–58. https://doi.org/10.1210/jc.2013-2905

Additional clinical resources by Dr. Alexander Jimenez

• Jimenez, A. (n.d.-a). Clinical insights and patient education on integrative musculoskeletal and metabolic care. Personal Injury Doctor Group. https://personalinjurydoctorgroup.com/
• Jimenez, A. (n.d.-b). Professional updates and case reflections. LinkedIn. https://www.linkedin.com/in/dralexjimenez/

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