Harmony HRT Blog
Labs are Overrated!
Written by, Dr. Amy Bratteli, Owner of Harmony HRT
- Labs Are Overrated - Labs are an important part of hormone care at Harmony HRT, but they are only a part of the process. At Harmony HRT, we treat the patient’s symptoms first. Labs are a tool to help us manage symptoms and improve health outcomes. We’re focusing on labs and some of the caveats of using them in today’s post. Labs are useful for determining if someone’s baseline hormones are low. We also use them to ensure levels are where research shows maximum helpful benefits occur. They can also help us figure out the problem – is it estrogen dominance? Perimenopause? Menopause? Thyroid deficiency? Low testosterone? Vitamin D deficiency? - Basic things to know about labs: - • Lab Process: In the laboratory, there a different chemicals and machines used to read levels in a patient’s blood sample. Some times there are shortages in the chemicals or problems discovered with certain machines. Different methods, and even different labs, have different “normal values”. When there are reagent shortages, labs will “batch” test results, meaning they will wait until their trays are full before running a test. If your sample is at the beginning of a tray, it will take longer (sometimes 2 weeks for testosterone and estradiol). If your sample is lucky enough to be at the end of a try, it will be run within a few days. • Normal Ranges: “Normal Values” are statistical and determined by sampling a large number of folks to get the average normal values. These become the low and high levels (Remember the bell curve from school?). Unless specified, these normal values are from folks not on the meds we prescribe in our clinic. So, their “normal” and our “optimal” can be very different. Different labs in different parts of the country have different levels. For example, folks in Colorado tend to have higher hemoglobin levels because a lot of us live at altitude. So labs drawn in Boulder will have different normal values than labs drawn in the plains. • Things that Affect Lab Results: Testosterone: Right now, the reagent used to measure testosterone has changed and it seems to be a bit wonky. We are seeing crazy high levels that don’t make sense, particularly with testosterone but sometimes with estradiol as well. I’ve discussed this with other physicians across the country and they are experiencing the same thing. Even the organization I trained under, doesn’t really use testosterone levels except to show an increase in levels. We can’t rely on levels. What do we do? Look at other factors. If a patient feels well without side effects of too much testosterone (acne, mood irritability, unwanted hair growth, clitoromegaly), if their SHBG (Sex Hormone Binding Globulin) is low, if their hemoglobin and hematocrit levels are normal, we can infer that this is not an accurate level. These are all the things our physician and providers will use to determine the validity of the testosterone result. This highlights how important it is for a patient to be aware of what is happening with their body on the HRT and medications we provide. It is also important to have a provider who understands the nuances. • Thyroid Labs: Thyroid results can be affected by supplements, particularly B vitamins, and most specifically biotin. These mainly affect the TSH levels. Usually by holding these 1-2 weeks before lab draws that effect can be negated. Timing of the labs doesn’t really matter. Some clinics will have a patient fast before a thyroid blood draw. At Harmony HRT, that doesn’t matter as much as being consistent with what you do before blood draws. If your thyroid is always checked on an empty stomach, then make sure to get all your labs drawn like that. If you have always eaten then make sure that is the same every time. Consistency is more important than being fasting or not. • Other Factors: Stress, lack of sleep, illness, hard work-outs, recent intercourse, can have effects on the hormone levels we monitor. Try not to have labs drawn during these times that can increase cortisol levels which compete with hormones at the same receptor types, causing levels to go down. At minimum, let us know if any of these are at play when we look at your labs. • Bottom-line: What can help you the most, is to pay attention to how you feel and how your body responds to the prescriptions we have given you. That will give us far more assistance in managing your care than the labs themselves. Make note of timing of your last meds, if you ate, if anything unusual is happening prior to your lab tests, and how you feel. We will use this information along with any lab results to determine the right course for each person. Schedule a consult today to discuss symptoms and start making a plan towards feeling better with Harmony HRT.
Real Patients - Real Stories - Real Change
Written by, Ezra Bell, RMA
“My health isn’t just about hormones or procedures. It’s about being listened to, having my body autonomy respected, and knowing my provider sees me as a whole person seeking their expertise and medical care, not their social beliefs or cultural expectations.” - A Harmony HRT Patient ～ “When healthcare is evidence-based, and collaborative, it allows me to focus on living my life rather than navigating barriers. Good care does not ask me to educate my providers or defend my identity. It meets me where I am, respects my autonomy, and supports my health goals across my lifespan.” - A Harmony HRT Patient ～ High-quality care begins with listening, and that is at the core of everything we do. The first-person narrative below reflects the real experience of a Harmony HRT patient and demonstrates the difference compassionate, evidence-based, trauma-informed care can make. Ready for care that truly centers you? Reach out to our clinic and let’s take the next steps together. • A Patient’s Voice • "When I walk into a healthcare setting, my goals are simple: to be heard, to feel safe, and to receive care grounded in evidence and respect. My health is not defined by a single diagnosis or medication—it is shaped by my whole life, my values, and my future plans. For me, good care starts before any prescription is written or exam is performed. It starts with a provider who genuinely listens and understands my specific situation and goals. Those conversations aren’t “extra” or superficial; they directly affect my willingness to engage in care, disclose symptoms, and return for follow-up visits. Informed consent is essential to my sense of safety. I want clear, honest information about risks, benefits, alternatives, and uncertainties—without pressure or assumptions about what choices I should make. When clinicians take time to explain options and ask about my goals, I feel like a partner in my care rather than someone decisions are made for. Trauma-informed care is part of that partnership. When providers move at my pace, explain what they’re doing before they do it, and give me space to pause or decline, it builds trust. These aren’t special favors; they are best practices that improve care for everyone. My long-term health is broader than hormone therapy alone. Preventive screenings, cardiovascular health, mental health, sexual and reproductive care—all of these matter. I am far more likely to engage in this care when it is tailored to my actual anatomy, risks, and priorities rather than assumptions or stereotypes. When care is collaborative and grounded in evidence, I can focus on living my life—not fighting barriers. Good care does not ask me to educate my providers or defend who I am. It meets me where I am, respects my autonomy, and supports my goals across my lifespan. • Clinical Standards & Evidence Base • The principles reflected in this narrative are supported by established clinical guidelines and public health frameworks, including: • Informed Consent • Endocrine Society Clinical Practice Guidelines - Evidence-based recommendations for gender-affirming hormone therapy, monitoring, and long-term health considerations. • Trauma-Informed & Patient-Centered Care • • Substance Abuse and Mental Health Services Administration (SAMHSA) • Trauma-Informed Care Framework - Highlights safety, trust, collaboration, empowerment, and patient choice as core elements of quality care. • Agency for Healthcare Research and Quality (AHRQ) - Supports shared decision-making and patient-centered communication as drivers of improved outcomes and engagement. • Preventive & Whole-Person Health • • Centers for Disease Control and Prevention (CDC) - Preventive screening and risk-based care recommendations applicable to transgender patients based on anatomy and individual risk factors. • U.S. Preventive Services Task Force (USPSTF) - Evidence-based preventive screening guidelines adapted using anatomy- and risk-informed approaches.
Vitamin B12 Injections: Who, How, Why?
Written by, Ezra Bell, RMA
Vitamin B12 Injections at Harmony HRT offer targeted support for energy, nerve health, and hormonal balance across ages and health needs. Vitamin B12 is an essential nutrient that supports energy production, red blood cell formation, nerve health, and cognitive function. While many people obtain B12 through diet or oral supplements, injections can be a more reliable and effective option for individuals who have difficulty absorbing B12 or who have increased physiological needs. Vitamin B12 injections deliver the vitamin directly into the bloodstream, allowing for faster replenishment and more consistent therapeutic levels. This approach is especially helpful for patients with confirmed deficiency, chronic conditions, ongoing fatigue or neurologic symptoms, or for those taking medications—such as metformin or long-term acid-reducing drugs—that interfere with B12 absorption. At Harmony HRT, vitamin B12 injections are not offered as a blanket wellness service. Our goal is to provide evidence-informed, patient-centered treatment that supports long-term health, function, and hormone balance. Why does Vitamin B12 Matters in Hormone-Focused Care? Hormone systems do not function in isolation. Adequate vitamin and micronutrient status is essential for hormones to work effectively at the cellular level. Suboptimal B12 levels can contribute to symptoms that overlap with hormonal imbalance, including: ● Persistent fatigue or low energy ● Brain fog or difficulty concentrating ● Mood changes ● Neuropathy, numbness, or tingling ● Exercise intolerance or poor recovery For patients receiving hormone therapy—including testosterone or estrogen-based care—optimizing B12 status may support energy utilization, nervous system health, and overall treatment tolerance. Who May Benefit From Vitamin B12 Injections? Adults (18–64) Vitamin B12 injections may help support: ● Sustained energy and reduced fatigue ● Focus, memory, and mood regulation ● Muscle function and exercise tolerance Busy lifestyles, chronic stress, dietary patterns, and certain medications can all contribute to lower B12 levels during adulthood. Older Adults (65+) As we age, the body’s ability to absorb B12 from food often declines. In older adults, B12 injections may help: ● Reduce fatigue and weakness ● Support balance and nerve health ● Maintain cognitive function ● Prevent or correct B12-related anemia For many older adults, injections are the most effective way to maintain adequate B12 levels. Vitamin B12 injections may support: ● Energy and stamina ● Muscle recovery and physical performance ● Nerve and cardiovascular health ● Fatigue related to menstruation, pregnancy, or postpartum changes ● Anemia or combined iron and B12 deficiency ● Mood changes or brain fog Care is always individualized and guided by clinical assessment. What to Expect From Vitamin B12 Injections B12 injections are generally well tolerated and administered quickly in a clinical setting. Treatment frequency varies based on symptoms, individual response, and may range from weekly injections to monthly maintenance dosing. Many patients report improvements in energy, mental clarity, and overall well-being within days to weeks, though response varies. Some patients begin with an initial loading phase followed by maintenance dosing as levels stabilize. • Do I need labs before starting B12 injections? No. B12 medications can be given based on clinic evaluation of symptoms and providers can prescribe to you based on that. • How quickly will I feel results? Some patients notice improvements within days to weeks, while others experience more gradual changes over time. • Are B12 injections safe long term? When clinically indicated and monitored, vitamin B12 injections are considered safe. Ongoing assessment helps ensure dosing remains appropriate. • Can B12 replace hormone therapy? No. Vitamin B12 does not replace hormone therapy. It may, however, support overall energy and neurologic health as part of a comprehensive hormone care plan. • How often will I need injections? Frequency depends on your lab results, diagnosis, and response to treatment. This may range from weekly injections initially to monthly maintenance dosing. Our Clinical Approach At Harmony HRT, we are committed to whole-person care that is evidence-informed, affirming, and transparent. Vitamin B12 injections are one of many tools we may use to help patients feel better, function better, and engage more fully in their hormone care. If you are experiencing fatigue, neurologic symptoms, or have risk factors for vitamin B12 deficiency, our care team can help determine whether vitamin B12 injections are appropriate for you through individualized evaluation and clinical decision making.
“Don’t Blow Them Off…” — Perimenopause and Women’s Health - An Interview with Eleanor Diamse, NP
Written by, Ezra Bell, RMA
Too often, women are underserved in their healthcare—whether it’s dismissive providers saying, “It’s just menopause,” before sending them on their way without help or answers, or outdated myths perpetuated by the 2002 Women’s Health Initiative and overextended providers who don’t have time to address every patient’s needs. The result? Too many women continue suffering from symptoms that can be effectively managed with the right provider. At Harmony HRT, we’re honored to work with providers who not only spend their weekends at continuing education conferences to better serve their patients but who also walk their own HRT journeys. Eleanor Diamse, NP, is Harmony’s newest provider. I sat down with her to hear her story and her perspective on the important topic of perimenopause and women’s hormone health. A common myth around hormones is that you must already be in menopause before seeking treatment—or that it’s too late to start once symptoms appear. So we asked the expert: When is it too early or too late to talk to a provider about perimenopause or menopausal symptoms? Eleanor’s thoughtful response encapsulates the philosophy of Harmony HRT perfectly: “It’s never too early or too late to be seen for any symptoms. Symptoms of perimenopause can start years before full menopause (12 months without a period), and they might overlap with conditions like PCOS, PMS, endometriosis, or even thyroid issues—all of which can be helped with hormone treatment. So any sign or symptom is never too minor or something you should be expected to ‘just deal with.’ Plus, if you have one symptom, like hot flashes, you likely have others that just need time to explore with your provider.” Perimenopause affects every woman differently. One woman might experience hot flashes, while another may never have them at all. With that in mind, Eleanor encourages anyone who believes they may be experiencing symptoms to seek care. “All different body systems and symptoms can be helped or improved with hormone therapy,” she says. “That includes mood, mental resiliency, sleep, aging skin, lower back pain, and other vasomotor symptoms, among others.” When looking for a good hormone provider, Eleanor emphasizes the importance of a strong patient–provider relationship—someone who truly listens. “I’ve been that dismissed patient before, and you don’t want to wake up one day and realize you missed out on years of your life. You shouldn’t have to grieve over how much better things could have been.” The knowledge and personal experience Eleanor brings to the team make her a brilliant addition to Harmony HRT’s already strong group of hormone specialists. We’re lucky to have her. You can schedule with Eleanor or any of our providers at HarmonyHRT.com or by calling (970) 639-2677.
What does Biologically Identical Hormone Therapy Mean and Why Does it Matter?
Written by, Dr. Amy Bratteli, Owner of Harmony HRT
At Harmony HRT, we only prescribe hormones that are classified as biologically identical. What does that mean? It means the hormones are biochemically identical to those hormones that are found in our bodies. We frequently refer to these as BHRT (Bio-identical Hormone Replacement Therapy). Why does this matter? When we take medications that our body does not recognize, metabolites are made, especially if they go through the liver, that may trigger unwanted responses in our physiology. A perfect example of this is conjugated estrogens, aka Premarin, and medroxyprogesterone (Provera). These are not biochemically identical estradiol (the main estrogen in the human body), or progesterone, they are molecules that were made similar to our natural estradiol and progesterone, so they have effect at the same receptor sites as estradiol and progesterone. The problem with this is that when these chemicals go through the liver (when they are swallowed in a tablet form), the metabolites made in the liver seem to trigger negative consequences, like blood clots and even triggering cancer genes. We see this with other estrogens and progestins as well. In my cynical opinion, the only reason these hormones exist is because pharmaceutical companies cannot patent things that occur in nature (like hormones) so they have to tweak it to make it unique, giving up the safety benefit of a natural hormone, but making them a lot more money. The Women’s Health Initiative, published in 2001, proved that these non-identical hormones cause health issues, although there were a lot of problems with the study (another post to come later), it resulted in a lot of women getting taken off their hormones, instead of switched to something safer. There are many studies proving the efficacy and safety of biologically identical hormones (estradiol, progesterone, testosterone) so we do have options That means these biologically identical hormones work. They help our symptoms without causing more health issues down the road. They definitely can still have side effects but these are not life-threatening like those that are created in a lab. On the internet, you can find lots of information about HRT. Please make sure to look at the source and if they have actual studies cited before deciding to try something. When in doubt ask us (or your provider, if it isn’t us).
