Hormone Optimization
Training

• Symptoms of low testosterone in men: fatigue, cognitive decline, reduced libido, erectile dysfunction, body composition changes, mood changes, and the symptom scoring tools (ADAM, AMS) used in clinical practice
• The lab workup for male testosterone deficiency: total T, free T, SHBG, estradiol, LH, FSH, PSA, CBC, CMP — how to order the right panel and interpret results in clinical context
• Testosterone therapy delivery selection for men: pellets vs. topical gels vs. weekly vs. biweekly injections — the clinical reasoning behind each choice and how patient lifestyle drives the decision
• Initiation, titration, and monitoring: starting doses for each delivery method, timeline to follow-up labs, target therapeutic ranges (total T, free T, estradiol), and when and how to adjust
• Estradiol management in male TRT: when aromatization becomes a clinical concern, anastrozole use (when appropriate and when to avoid), and estrogen's protective cardiovascular and bone effects in men
• Fertility considerations: testicular atrophy, sperm suppression, hCG use for preservation — the protocol and the patient conversation
• Hematocrit management in TRT: the frequency with which erythrocytosis occurs, the threshold for phlebotomy vs. dose reduction, and the documentation

• Why testosterone is a primary hormone in women — the physiology that explains why female testosterone deficiency is systematically under-diagnosed and under-treated
• Symptoms of low testosterone in women: sexual dysfunction, fatigue, cognitive fog, mood dysregulation, loss of muscle, and how to differentiate from estrogen deficiency symptoms clinically
• Lab interpretation for female testosterone: why reference ranges on standard lab reports are clinically misleading, the total T and free T levels that correspond with symptom relief, and the role of SHBG in determining free (active) testosterone
• Female testosterone therapeutic ranges: the evidence-based target window, dose initiation, and titration protocol for transdermal and pellet delivery in women
• Breast cancer risk and testosterone: a thorough review of the evidence base, why testosterone has a neutral-to-protective relationship with breast tissue, and how to communicate this confidently to patients who raise the question
• Androgenic side effects: hair thinning, acne, clitoral sensitivity changes — incidence, dose thresholds, and management

• The three estrogens: estradiol (E2), estrone (E1), and estriol (E3) — their relative potency, production sites, and the clinical relevance of each in BHRT prescribing
• Perimenopause vs. menopause: formal clinical definitions, FSH/estradiol thresholds, and managing the perimenopausal patient whose labs may be confusingly variable
• Estrogen delivery for menopause: transdermal vs. oral — why transdermal is preferred for cardiovascular and clot risk, dosing equivalencies, and the evidence behind timing of therapy initiation (the "timing hypothesis")
• Progesterone vs. progestins: the distinction that changes risk profiles — why bioidentical progesterone (Prometrium) does not carry the breast cancer risk of synthetic progestins, and how to use this in patient conversations and consent
• Endometrial protection: the standard protocol for combined estrogen + progesterone therapy in women with an intact uterus — dose, timing, and monitoring
• Vasomotor symptoms, genitourinary syndrome of menopause (GSM), sleep disruption, cognitive symptoms — the clinical approach to each and the HRT interventions mapped to symptom type
• Cardiovascular, bone, and cognitive protectiveness of HRT initiated within the therapeutic window — the evidence for starting HRT before age 60 and within 10 years of menopause

• Pregnenolone — the "mother hormone": its position at the top of the steroidogenesis cascade, the clinical symptoms of pregnenolone deficiency, and how to prescribe and monitor it as foundational support for a hormone protocol
• DHEA and DHEA-S: their role as precursors to both testosterone and estrogen, the symptoms of deficiency (fatigue, low libido, reduced resilience), dosing for men and women, and the clinical rule about correcting DHEA before adding downstream hormones
• Melatonin in hormone optimization: beyond sleep — melatonin's role as an antioxidant, its interaction with the reproductive axis, and dosing strategies for the context of comprehensive hormone care
• Cortisol and adrenal function: the relationship between HPA axis dysfunction ("adrenal fatigue") and sex hormone imbalance — when adrenal support should precede or accompany sex hormone replacement, and what testing is appropriate

• The hypothalamic-pituitary-thyroid axis: T4 synthesis, T4-to-T3 conversion (the role of deiodinase and its nutritional cofactors), and reverse T3 as a competitive inhibitor
• Why "normal TSH" does not mean optimal thyroid function — the functional medicine threshold for TSH (0.5–2.5 mU/L), and the clinical significance of free T3 and free T4 within range but at low-normal
• Hypothyroidism workup: TSH, free T3, free T4, reverse T3, anti-TPO, anti-thyroglobulin — which markers to order, what to look for, and the Hashimoto's patient presentation and management
• Levothyroxine monotherapy vs. combination T4/T3 therapy: the evidence for poor T4-to-T3 converters, desiccated thyroid (NDT, e.g., Armour Thyroid, NP Thyroid), liothyronine, and compounded T4/T3 combinations
• Thyroid and sex hormones: how unoptimized thyroid blunts the response to testosterone and estrogen therapy — the clinical sequencing that produces better overall outcomes
• TSH target ranges, dose titration, and the monitoring schedule for patients on thyroid optimization therapy

• The GH/IGF-1 axis: somatotroph cells in the anterior pituitary, pulsatile GH secretion, liver IGF-1 production, and the physiological effects of growth hormone on muscle, fat, bone, and cognition
• Growth hormone decline with age: the clinical presentation (body composition shift, sleep disruption, decreased recovery, cognitive changes) and when to measure IGF-1 as a screening marker
• GH peptide secretagogues: sermorelin, ipamorelin, CJC-1295 — mechanisms of action (GHRH receptor stimulation vs. ghrelin receptor stimulation), dosing, injection protocol, and clinical expectations
• IGF-1 target ranges for optimization (not acromegaly): how to dose-titrate to the upper quartile of age-adjusted normal and why this is different from supraphysiologic GH therapy
• Tesamorelin and FDA-approved GH therapy: the approved indications (HIV lipodystrophy), off-label use considerations, and the regulatory framework that governs GH prescribing differently from peptides
• Contraindications and monitoring: active malignancy and GH therapy, insulin resistance as a side effect of GH and how to screen, and the monitoring protocol for patients on long-term peptide therapy

• A systematic dosing review for every hormone covered in the course: testosterone (men and women), estradiol (transdermal and oral), progesterone, DHEA, pregnenolone, melatonin, thyroid (T4 and T3), and GH peptides
• Starting doses vs. therapeutic targets: the dosing ladder approach — where you start, how you assess response, and when to make an adjustment vs. wait for labs
• Lab timing relative to delivery method: when to draw labs for pellets (4–6 weeks post-insertion) vs. injections (trough or mid-cycle) vs. transdermal (8–12 hours post-application), and why incorrect timing produces misleading results
• Drug interaction review: CYP3A4 interactions with estrogens, thyroid medication absorption interactions (calcium, iron, antacids, coffee), and polypharmacy risk assessment for the typical hormone optimization patient over 50
• Pellet dosing specifics: BioTE and custom compounded pellet calculators, conversion from injection or cream to pellet equivalent dose, and the 3–4 month re-insertion cycle and how to manage mid-cycle symptomatic patients

• Setting up a hormone optimization practice from scratch: what licenses, oversight, and compounding pharmacy relationships you need before seeing your first patient
• Compounding pharmacy relationships: what to look for (PCAB-accredited pharmacies), what quality controls matter, and how to evaluate a compounding pharmacy's documentation and sterility testing
• Necessary equipment for pellet insertions: the trocar kit and pellet insertion set, sterile technique setup, local anesthetic, wound closure, and post-procedure care supplies — a complete equipment list for new providers
• Pricing a hormone optimization practice: cash-pay membership structures, per-visit vs. annual subscription models, lab management fees, and how Naomi structures pricing at Beso Wellness
• Patient intake and onboarding: the hormone consultation structure, intake form design, and the documentation workflow that creates a compliant, legally defensible record from day one
• Telehealth vs. in-person: what Arizona law allows for hormone prescribing via telehealth and the practical limits of remote-only hormone optimization care

• Lab panel interpretation: working through actual panels — interpreting free T vs. total T in context of SHBG, estradiol in the context of a male TRT patient, thyroid panels in a symptomatic patient with lab values in the "normal" range
• The difficult patient: the patient who feels worse on HRT, the patient whose labs look great but symptoms persist, the patient on conflicting medications, the patient who stops therapy without telling you — structured approaches to each
• Side effect troubleshooting: edema on testosterone, mood instability mid-cycle on pellets, sleep disturbance on progesterone at the wrong time, hair thinning from elevated androgens — the diagnostic logic and management for each
• The 100 written Q&A case studies: Naomi's curated library of real clinical decision-point scenarios covering every hormone class, delivery method, and common complication. Attendees work through cases, compare reasoning, and debrief as a group — the closest simulation to real clinic decision-making outside of seeing patients

The case study session is where the two days converge into clinical judgment. Most providers describe this session as the highest-value component of the course.