Dear Doc,

I am a male on hormone therapy, but I am still struggling with Erectile Dysfunction (ED). As my testosterone levels improve, will that help with ED? What else can I do?

Testosterone replacement therapy may not immediately improve the symptoms of ED. Erectile Dysfunction is commonly a circulatory problem.  After we normalize your testosterone levels, we can treat the ED symptoms with medications and/or in-office treatments.

There are a few other ways to treat it.

We can address this with ED medicine:

  • daily Cialis
  • Tadalafil
  • Sildenafil
  • Viagra
  • Levitra

In-office treatments:

  • P-Shot
  • His Wave.

To hear more about His Wave, check out this podcast that is all about it.



Dear Doc,

I am a woman experiencing weight gain. How do I know if it is a thyroid problem or a hormone imbalance?

I would say, 1 out of 3 women that I see that are in their 40’s and 50’s has suboptimal thyroid function.

I treat symptoms, not just a number on the lab work. If you are losing hair, constipated, have brain fog, cold hands and feet, you probably have a sub-optimal thyroid.

Get lab work done for the Cleveland Heart Lab to get a complete picture of your health (including hormone and thyroid levels).



Dear Doc,

I recently started doing hormone pellets with Performance Medicine. How often do I need to come in to get pellets? Do I just go by symptoms? I am a 45-year-old woman.

Every person metabolizes hormone pellets at a different rate. On average, most women replace their pellets every 4 months. Some women can wait 5-6 months. One or two of my patients need them replaced every three months!

Your estrogen and progesterone balance is important to monitor and, in my opinion, testosterone pellets make you feel the best. However, it is not good to give a woman testosterone alone if she does not have adequate estrogen and progesterone support. It can cause plaque in the arteries.

You need the estrogen and progesterone for bone health and heart protection.

By checking lab work and paying attention to your symptoms, I can usually get you on a pattern so I can tell how long the pellets will last. When you start having symptoms, I know you are ready for more pellets.


Dear Doc,

Why do you like pellets more than creams for women?

For men AND women, I prefer pellets because it gives you a consistent release of hormones. You do not have to worry about applying creams and possibly missing a dose. Plus, some people do not absorb creams well, so pellets are an easy solution.

I hardly EVER have a person go back to creams after they try pellets.



Dear Doc,

What are your thoughts on the Pfizer vaccine that could be coming out soon?

It was certainly great for the stock market! Supposedly, it is 90% effective and Pfizer has gotten it out in 6 months! There is another vaccine by Moderna that is going to be released. I think the Pfizer vaccine is going to be a two-shot regime, one shot at first and then another three weeks later. I have read that after the second shot, you may have some mild, flu-like symptoms.

For the past 6-8 months, we have had the brightest minds working on these vaccines. Still, we will need to wait and see the results of these trials. They seem encouraging.

The most vulnerable patient population [the elderly, people with diabetes, people with cardiovascular or pulmonary disease] should take this vaccine if it is proven to be effective so we can develop herd immunity.

I trust that the people making the vaccines are putting in all the work and developing the safeguards.