A Guide to Health Optimization for Energy, Mood & Aging in Women
From lab testing to tailored supplements and BHRT treatments, explore how optimization supports better health for women at every stage of life
What is optimization?
Health optimization is a process of identifying imbalances and/or deficiencies that may be causing symptoms of fatigue and other markers of poor health. At All About Women, we then use lifestyle and dietary changes along with supplements and bioidentical hormone replacement therapy (BHRT) to support and balance your natural physiological processes. The goal of optimization is to improve your overall health and well-being, which is key to healthy aging.
About BioTE: BioTE is a comprehensive, holistic approach to patient wellness and health. The BHRT-BioTE program at All About Women is aimed to optimize women’s health, helping them to feel their best throughout all stages of life. It all starts with a lab panel, ordered by one of our providers, that is normally covered by insurance. Learn more about BioTE
What labs do we check during optimization?
There is an initial panel of labs that we order to evaluate your current health state and begin the process of optimization.
Hormones
- FSH (follicle stimulating hormone) – This tells us whether you are premenopausal (stage prior to the cessation of menses) versus postmenopausal (one year of no menses)
- Estradiol (E2), estrogen – See notes about estrogen symptoms.
- Total testosterone and free testosterone – See section about testosterone.
- SHBG (sex hormone binding globulin) – This is a carrier molecule (think bus with empty seats) for the above hormones
- Progesterone – This is the balancing hormone to estrogen. Helps with sleep and menstrual regulation. Occasionally can cause depression or mood swings.
Thyroid function testing
- TSH – Also called thyroid stimulating hormone.
- T4 – The storage form of thyroid hormone.
- Free T3 – The active part of the thyroid.
- TPO – Thyroid peroxidase (TPO) antibodies are a marker of Hashimoto‘s thyroiditis. That is an autoimmune condition that affects multiple areas of the body.
- TG – Thyroglobulin (TG) antibodies are a marker for Graves’ disease.
- Reverse T3 – Just like it sounds: T3, but in reverse. Makes the thyroid unhappy on a functional level.
Metabolic and nutritional status
- CMP – A comprehensive metabolic panel (CMP) shows your electrolytes and liver function, as well as kidney function and blood glucose. We like to check these things prior to any medication or hormone administration.
- CBC – A complete blood count is an evaluation for anemia and infection, among many other things.
- Ferritin – Iron stores.
- Vitamin D3 – This is the active vitamin D form. It’s important for bone health and immune function and possibly helps protect against some cancers.
- B12 and folate – Two of many vitamin B’s. Crucial for energy, mood, nervous system function, and metabolism.
See supplement section below for more detailed information.
If you are experiencing chronic debilitating fatigue, or if you are not responding to the optimization program, we will recommend additional laboratory tests, including early A.M. cortisol, ACTH, HIV, hepatitis, EBV antibodies, and Lyme disease antibodies.
Sometimes we order additional labs if women are having symptoms of excessive hair loss, hirsutism (hair/chin hair), or polycystic ovarian syndrome.
These additional labs include:
- DHEA-S
- DHT
- A.M. fasting insulin
- HbA1c
- PRL
- LH/FSH
- Zinc
- Heavy metals
What hormones do we use in bioidentical balancing?
When balancing hormones, we optimize: Testosterone, Estrogen and Progesterone
Our goal when balancing your hormone levels: LAGOM – not too much and not too little, just the right amount. More is not better. Balanced and optimized is key.
Testosterone myths
There are a few misconceptions surrounding the role that testosterone plays in women. Below are the 5 most common myths and questions we hear from women.
1. Is testosterone exclusively a male hormone?
No, men’s and women’s bodies naturally produce testosterone, and it plays an essential role in women’s health similarly to the better-known hormones like estrogen. Optimizing testosterone can have a great overall effect on a woman’s health.
2. Will testosterone make me masculine?
No, when administered properly at the correct therapeutic dose, testosterone does not masculinize you. While some women worry that testosterone will deepen their voice, testosterone administered in the recommended therapeutic window will not deepen or change a woman’s voice.
3. Will I grow a beard?
The reality is abnormal hair growth is common in perimenopause and in menopause. However, we do observe a small percentage (about 2%) of women will experience an increase in midline hair growth (lip, chin, happy trail, etc.) secondary to optimizing their testosterone levels. And, the hair growth can be treated with many different modalities.
4. Are the main functions of testosterone in women libido and sex drive?
While many women report an improvement of libido after optimizing hormones, testosterone is absolutely essential for many more things than just sex drive. (Although that is a nice benefit/side effect of testosterone therapy, wink, wink). Testosterone helps to regulate/enhance several different systems that affect mood, energy, physical fitness, and overall physical and mental health as women age.
5. Does testosterone cause hair loss?
Less than 1% of women experience hair loss while following our protocols. The most common cause of hair loss in women is thyroid deficiency. Fortunately, we also optimize thyroid function and health to help ensure a whole-body approach to better health.
Thyroid optimization
I like to tell my patients, “You have a thyroid receptor on every cell in your body, from hair to skin to heart and brain. So we really want this perfect.”
In fact, (on a personal note) I remember thinking to myself while in med school and residency, “I wish my thyroid was off, so I could have some thyroid medicine.” I was told that my thyroid was “fine” (in actuality, we were probably checking the wrong thing) because my TSH was “fine.”
TSH measurements only give part of the picture.
Thyroid stimulating hormone is secreted by the pituitary gland, which is in your brain. In response, the thyroid gland produces T3 and T4. T4 has 4 iodine molecules, T3 has 3 iodine molecules. There is a critical enzyme called De-Iodinase that is required to remove one iodine molecule, thereby converting T4, (the storage molecule) to T3, (the active molecule).
Some people are iodine deficient, and some people have a gene defect in their enzyme. Either way, the patient ends up having hypothyroid symptoms, and TSH can remain in the reference range.
This is now being recognized as “low T3 syndrome.”
There are over 200 symptoms related to low T3 syndrome, including:
- Weak, cold, tired, fatigued
- Thin hair, skin, and nails
- Weight gain, increased body fat
- Loss of energy and motivation
- Poor sense of well-being, depression
- Constipation/compromised gut motility
Optimum free T3 is 4.0 to 4.4. Some references say 3.5 to 4.4. But I like the 4.0 mark. Ok, go back to high school. Do you want a 3.0 GPA? Or a 4.0 GPA? Both are “normal” GPAs; however, one is clearly better. Which one do you want?
I live in a 4.0 world… so do you. We need our brains and metabolism clicking along at 4.0.
Supplements
Why do we need supplements?
- Poor food choices, poor food nutritional content, and depleted soil content.
- Stress, i.e., drains B vitamins.
- Medications
- Statins drain CoQ10.
- Metformin and hormones drain B vitamins.
Why NOT over-the-counter nutraceuticals?
- Don’t know who and how they were manufactured.
- Manufacturers may not have tested for common allergens and toxins.
- Doses may be inconsistent.
- Absorption may be an issue.
1. DIM
Diindolylmethane (DIM) is a phytochemical found in plants (cruciferous vegetables like broccoli, Brussels sprouts, and kale) that helps to support hormonal metabolic pathways in both men and women. DIM can also affect estrogen metabolism and may play a role in cell regulation.
- Increases effectiveness of T therapy.
- Increases free T.
- Decreases conversion of T to E (natural aromatase inhibitor-breast protection).
- Helps reduce PMS/menopausal-related symptoms, including hormonal acne, bloating, fluid retention, breast tenderness, mood swings, irregular menses, and migraines.
- Support weight management.
- Supports breast health.
2. ADK5/10
Contains vitamins A, D3, and K2.
- Support bone health by stimulating growth and maintenance of healthy bone. Support calcium absorption and metabolism.
- Boost immune system.
- Support the brain and mental health.
- Support the cardiovascular system.
- Support healthy thyroid function.
- Healthy skin and hair.
- Boost energy.
3. Methyl factors
(Methyl) = activated Vitamin B
Up to 50-70% of people have a gene defect/abnormality for the enzyme that activates dietary vitamin B. So, if you take regular vitamin B many times, it cannot be used by your body. AKA: look for methylated vitamin B.
Action of Vitamin B
- Supports healthy estrogen, metabolism.
- Boosts energy
- Promotes cardiovascular health and neurologic health.
- Supports maintaining normal homocysteine level.
- Supports mood, production of serotonin and dopamine, norepinephrine and epinephrine.
4. Omega 3
- Promotes cardiovascular health.
- Promotes healthy skin and nails.
- Boosts mood and energy.
- Promotes healthy joints and eye function.
- Anti-inflammatory.
5. Probiotic
- Promotes healthy digestion and G.I. health.
- Boosts immune system.
- Supports vaginal health/vaginal microbiome.
- Supports vitamin production and absorption in the gut.
6. VH balance probiotic
This is a specialized probiotic for women who suffer with recurrent vaginal infections.
Possible side effects of BHRT and optimization
Post-pellet symptoms can include:
- Acne – Easily treated with topical salicylic acid, oral spironolactone, or sometimes minocycline.
- Hair growth – Can be treated with waxing, shaving, or medication. Occasionally, we decrease your testosterone dose.
- Hair loss – We recheck several labs and start medication, spironolactone and minoxidil.
- Breast tenderness – DIM, iodine BID, evening primrose.
- PMS/mood swings – Methyl factors, 5-HTP 100 mg 1-2 times a day.
- Hematoma – Rare complication.
Post-insertion instructions for BHRT with pellets
- Your insertion site has been covered with two layers of bandages. Keep both bandages on for 3 days.
- You may experience bruising, swelling, and/or redness of the insertion site, which may last from a few days up to 2 to 3 weeks. If the redness worsens after the first 2-3 days, please contact the office.
- Do not take tub baths or get into a hot tub or swimming pool for 3-4 days. You may shower, but do not remove the bandage or steri-strips for 3 days.
- No heavy lifting or major exercises for the incision area for the next 3-4 days, which includes running, elliptical, squats, lunges, etc.
- Walking is fine.
- The insertion site may be uncomfortable for up to 2 to 3 weeks. If there is itching or redness, contact the office.
- You may notice some pinkish or bloody discoloration of the outer bandage. This is normal.
- If you experience bleeding from the incision, apply firm pressure for 5 minutes.
- Please call if you have any bleeding not relieved with pressure (not oozing), as this is NOT normal.
- Please call if you have any pus coming out of the insertion site, as this is NOT normal.
- Please call if the area becomes red and warm to the touch.
- We recommend putting an ice pack on the area where the pellets are located a couple of times for about 20 minutes each time over the next 4 to 5 hours.
- You can continue this for swelling, if needed. Be sure to place something between the ice pack and your bandages/skin. Do not place ice packs directly on bare skin.
Important reminders after BHRT with pellets
Remember to have your post-insertion blood work done 1-2 weeks prior to your next insertion. If you are not feeling any better by 4 weeks, however, please call the office to have your labs drawn early.
It may take 2-3 rounds for some to see symptom improvement.
Most women will need re-insertion of their pellets 3-4 months after their initial insertion. If you experience symptoms prior to this, please call the office.
Please call as soon as symptoms that were relieved from the pellets start to return to make an appointment for your next insertion.
Start your health optimization journey at All About Women
At All About Women, your treatment is built around your individual results. From there, our experienced well-woman providers can guide you through options that may include customized BHRT and targeted supplements designed to support balance and overall wellness.
Whether you’re dealing with ongoing fatigue, mood changes, or other concerns, having a plan based on your body—not guesswork—can make all the difference.
To get started, schedule an appointment at our Gainesville or Lake City location and take the first step toward feeling more like yourself again.
About the author
Dr. Sheyna Carroccio joined All About Women in 2025 and brings years of experience caring for women in the Gainesville community. A graduate of the University of Florida College of Medicine, she also completed her OB/GYN residency at UF Shands Hospital. Dr. Carroccio is known for her expertise in minimally invasive gynecologic surgery and her focus on hormone replacement therapy, with a commitment to helping women feel their best at every stage of life.
