Checklist for Biomarker-Based Hormone Therapy

Hormone therapy has shifted from generalized treatments to personalized approaches using biomarkers. These measurable indicators help identify hormonal imbalances, predict risks, and monitor treatment effectiveness. For conditions like PCOS and menopause, this method enables precise, tailored care.

Key Points:

Biomarkers guide hormone therapy by analyzing hormone levels, inflammation markers, and genetic risks.
Testing includes hormones like testosterone, estradiol, progesterone, FSH, and DHEA.
Risk factors such as cardiovascular health and inflammation markers (e.g., CRP) are also evaluated.
Costs: Basic hormone panels start at $225, with follow-ups ensuring safety and effectiveness.

Treatment Process:

Initial Assessment: Medical history, symptoms, and lifestyle factors guide biomarker selection.
Testing: Hormone levels and risk markers are measured through blood or saliva.
Personalized Therapy: Results inform dosage, hormone type, and delivery methods.
Monitoring: Regular follow-ups adjust treatment and ensure safety.

Telehealth platforms like Oana Health simplify access to biomarker-based treatments, offering online consultations, at-home tests, and medication delivery.

Why It Matters:

This approach improves symptom management, reduces risks, and ensures therapy aligns with individual health needs. Regular testing and professional oversight are crucial for effective, safe treatment.

Checklist: Key Biomarkers to Test Before Starting Therapy

Thorough biomarker testing is a critical step for ensuring that hormone therapy is both safe and effective. Every year in the U.S., over a million women enter menopause, with roughly 80% experiencing symptoms like hot flashes, mood swings, and sleep disturbances. Beyond menopause, conditions like PCOS impact 8–13% of women, with an alarming 70% remaining undiagnosed. Testing these biomarkers not only helps create a personalized therapy plan but also allows for better monitoring of potential risks over time.

For accurate results, measure progesterone during the luteal phase (about a week after ovulation) and check FSH levels on day three of the menstrual cycle for fertility insights. Women who are perimenopausal or menopausal can undergo testing at any time.

Hormone Level Biomarkers

Total and Free Testosterone: These hormones play an essential role in maintaining energy, muscle tone, and libido. Optimal levels are:
- Total Testosterone: 50–80 ng/dL
- Free Testosterone: 6.7–9 pg/mL
Estradiol: This hormone supports reproductive health, skin and hair quality, metabolism, and sleep. For menopausal women on hormone therapy, the ideal range is 50–100 pg/mL.
Progesterone: Crucial for regulating the menstrual cycle, aiding pregnancy, and promoting restful sleep. The optimal range is 1.5–8 ng/mL during the luteal phase and 10–20 ng/mL for those on hormone therapy.
Follicle-Stimulating Hormone (FSH): Key for fertility and menstrual regularity, with an ideal range of 0–7 mIU/mL for women on hormone therapy.
DHEA (Dehydroepiandrosterone): Supports bone strength, muscle mass, sexual health, and cognitive function. Ideal levels for women generally fall between 250–350 ug/dL.

Routine hormone testing can also help detect underlying conditions such as PCOS, ensuring that treatments are fine-tuned for each individual.

Risk Assessment Biomarkers

After evaluating hormone levels, it’s equally important to assess additional health risks. Cardiovascular health should be a top priority, as declining estrogen levels during menopause can negatively influence cholesterol, blood pressure, and overall vascular health.

Markers of inflammation, like C-reactive protein (CRP) and interleukin-6 (IL-6), are linked to heightened cardiovascular risk. Research shows that women who go through early menopause often have elevated levels of these markers. Additionally, lipoprotein(a) is a genetic factor associated with heart attack and stroke risks, and some studies suggest that hormone therapy may help reduce its levels.

Testing costs can vary, with a basic hormone panel typically priced at $225, plus a $6 service fee. While this may seem like an upfront expense, identifying key biomarkers can significantly reduce therapy-related complications and long-term costs. Healthcare providers are encouraged to focus on tests that directly inform treatment decisions. As Dr. Harris S. Goodman explains:

"The main thing is that the patient gets the right testing on the right tissue for the right reasons." - Harris S. Goodman, MD

Step-by-Step Process for Biomarker-Based Hormone Therapy

Achieving effective hormone therapy involves a structured approach that includes careful assessments, accurate interpretation of data, and ongoing adjustments to meet individual needs.

Initial Assessment and Patient History

A detailed evaluation helps ensure the right biomarkers are selected and interpreted correctly.

Your medical history plays a critical role in determining which biomarkers to focus on. For instance, surgeries like a hysterectomy or oophorectomy can have a significant impact on hormone levels and testing strategies. A family history of conditions such as breast cancer, heart disease, or blood clots may highlight genetic risks that influence the safety of treatment. Additionally, medications like birth control or antidepressants can affect hormone levels, so it’s important to account for these when planning tests.

Documenting symptoms such as hot flashes, sleep disturbances, or irregular periods can guide biomarker selection and point to specific hormonal imbalances that may need closer attention.

Lifestyle factors also matter. Stress levels, exercise routines, sleep quality, and diet all influence hormone production and metabolism. For example, intense exercise can affect testosterone and estrogen levels differently than a sedentary lifestyle.

The timing of your menstrual cycle is another key consideration. For women with regular cycles, some biomarkers are best measured at specific points in the cycle. For those in perimenopause or menopause, there’s more flexibility in test timing, though the results still require careful interpretation.

By gathering this comprehensive health history, you’ll set the stage for accurate biomarker analysis.

How to Read Biomarker Results

Interpreting biomarker results involves more than just comparing numbers to standard reference ranges. Optimal hormone levels vary depending on factors like age, menopausal status, symptoms, and personal health goals.

It’s important to note that lab reference ranges may not always reflect what’s ideal for you. These ranges often include values from a broad population, encompassing both healthy and less healthy individuals.

Estradiol levels: These should be interpreted based on life stage. Premenopausal women typically have levels between 30–400 pg/mL depending on the phase of their cycle, while postmenopausal women not on hormone therapy usually have levels below 30 pg/mL. For those undergoing therapy, a target range of 50–100 pg/mL often balances symptom relief with safety considerations.
Testosterone results: Total testosterone includes both bound and free forms, but it’s the free testosterone that’s biologically active. If total testosterone appears normal but free testosterone is low, a different approach may be required.
FSH (Follicle-Stimulating Hormone): Rising FSH levels often indicate that the ovaries are working harder, a common sign of perimenopause. However, since FSH levels can fluctuate during this transition, a single elevated reading isn’t enough to confirm menopause.

Other biomarkers, like C-reactive protein (CRP), can provide additional insights. Elevated CRP levels may indicate inflammation, which could influence the safety and choice of hormone therapy.

Accurate interpretation of these results is essential for tailoring treatment strategies.

Adjusting Treatment Based on Biomarkers

Biomarker-guided hormone therapy requires regular monitoring to fine-tune treatment. Initial test results establish a baseline, while follow-up tests help track progress and response to therapy.

Adjustments may include changes to dosage if hormone levels fall outside the target range. Sometimes, switching the delivery method - like moving from oral estrogen to transdermal patches or gels - can improve outcomes. For example, transdermal options often provide more stable hormone levels and have less impact on liver metabolism compared to oral forms.

In some cases, combination therapy may be necessary. Adding progesterone to estrogen therapy can protect the uterine lining and may also improve sleep and mood. If energy levels or libido remain low despite adequate estrogen, testosterone supplementation might be considered.

Treatment timing can also play a role. While some individuals benefit from mimicking natural hormone fluctuations with alternating regimens, others may need continuous therapy for consistent symptom relief.

It’s also crucial to monitor safety markers beyond hormone levels. Regular checks of lipid panels, liver function, and inflammation markers help ensure that the therapy doesn’t introduce new health risks. If concerning changes arise, adjustments or even temporary discontinuation of therapy might be needed.

The process of regular monitoring and open communication ensures that hormone therapy remains effective and safe, adapting to your evolving needs while balancing symptom relief with overall health.

Monitoring and Risk Management

Keeping a close eye on biomarkers is key to ensuring hormone therapy stays both safe and effective. Regular monitoring helps detect when adjustments are needed, allowing for timely interventions.

Follow-Up Testing Schedule

The frequency of follow-up testing depends on the stage of treatment. During the first three months, tests are more frequent to track how the treatment is working and to make any necessary adjustments. For menopause and perimenopause treatments, a follow-up review is typically scheduled three months after starting therapy to check progress and address concerns.

Once hormone levels stabilize, annual checkups become the norm. These reviews help confirm symptom control, monitor for side effects, and reassess the overall therapy plan.

Some biomarkers, however, require closer attention. For instance:

Hematocrit and Hemoglobin: These should be checked every 3–6 months during the first year of therapy, especially for those on testosterone replacement therapy. Testosterone can increase red blood cell production, potentially leading to elevated hematocrit levels or secondary erythrocytosis. Keeping hematocrit levels below 54% and hemoglobin below 17 g/dL helps avoid complications.
Liver Enzymes (ALT and AST): Testing is recommended every 6–12 months. Normal ranges are 7–56 U/L for ALT and 10–40 U/L for AST.
Lipid Profiles: An annual check is advised, with goals including LDL cholesterol below 100 mg/dL, HDL cholesterol above 40 mg/dL for men, and triglycerides under 150 mg/dL.
Prostate-Specific Antigen (PSA): For men on testosterone therapy, regular monitoring ensures PSA levels stay below 4.0 ng/mL.
Inflammatory Markers (CRP): An annual test is suggested, aiming for levels below 1 mg/L.

Beyond these regular schedules, some biomarkers may signal higher risks and demand extra attention.

Using Biomarkers to Identify High-Risk Patients

Certain biomarker patterns can highlight patients who may face increased risks from hormone therapy. For example, cardiovascular risk is a critical area of focus. The Women's Health Initiative trials found that women with elevated D-dimer levels had a six-fold higher risk of complications when on hormone therapy compared to those with lower levels on placebo.

Monitoring blood clotting markers, like D-dimer, can help identify individuals at higher thrombotic risk. Similarly, metabolic health needs careful oversight. Fasting blood glucose levels should stay below 100 mg/dL, and HbA1c levels for non-diabetics should remain under 5.7% to reduce the risk of diabetes and cardiovascular disease.

Bone health is another priority, particularly for postmenopausal women. Maintaining serum Vitamin D levels between 30–50 ng/mL supports bone density. Estradiol levels also play a crucial role, as changes can predict shifts in bone mineral density, libido, hemoglobin, and HDL cholesterol levels.

sbb-itb-6dba428

How Telehealth Supports Biomarker-Guided Therapy

The rise of telehealth during the pandemic has transformed access to biomarker-based hormone therapy, breaking down barriers that once made specialized care challenging. This shift has made it easier for patients to access treatment and has also improved therapy adherence.

In the past, hormone therapy often required numerous in-person appointments, lab visits, and pharmacy trips. Telehealth platforms have simplified this process, allowing patients to receive comprehensive care without leaving their homes.

One major obstacle for many Americans is living in "pharmacy deserts", which account for nearly a quarter of U.S. neighborhoods. These areas make obtaining medications difficult. However, home delivery services have proven to increase adherence to prescribed therapies. Studies show that patients are 20% more likely to stick to their treatment when they receive a 3-month supply of medication delivered directly to their homes.

Oana Health's Approach to Hormonal Care

Oana Health

Oana Health builds on telehealth's advantages to deliver personalized hormone therapy. By offering online consultations and in-depth health history reviews, the platform specializes in biomarker-guided treatments for conditions like PCOS and female hormonal imbalances.

Licensed medical professionals carefully evaluate each patient’s health history and symptoms to identify which biomarkers need testing and which treatments are most suitable. For conditions like PCOS, where multiple biomarkers often need monitoring, this tailored approach ensures a more precise treatment plan.

Instead of generic solutions, Oana Health customizes treatments based on each patient’s unique biomarker data and symptom patterns. All prescriptions are provided by licensed professionals and delivered directly to patients with free shipping, eliminating the need for travel or frequent pharmacy visits.

Available Prescription Options

Telehealth platforms like Oana Health demonstrate how biomarker-driven therapies can connect lab results with targeted treatments. Below are some of the prescription options they offer:

For Insulin Resistance and Metabolic Health:

Oral Metformin ER ($22/month) – Supports insulin resistance management for PCOS patients.
Metformin & Spironolactone Combination ($32/month) – Promotes hormonal balance.
Oral GLP-1 & Metformin ($199/month) – Advanced option for managing complex PCOS cases.
Topical Metformin HCL Lotion 20% ($43/month) – Reduces insulin resistance with fewer side effects.

For Hair-Related Concerns:

Oral Minoxidil ($25/month) – Encourages hair regrowth and reduces thinning.
Topical Spironolactone ($43/month) – Addresses hair loss by managing androgen levels.
Hair Plus Plus ($40/month) – Comprehensive support for hair regrowth.

For Unwanted Hair Growth:

Spironolactone ($14/month) – Blocks androgen receptors to reduce unwanted hair growth.
Eflornithine 12% ($69/month) – Slows the growth of unwanted facial hair.
Hairless Hype ($69/month) – Combines prescription-grade ingredients for effective management.

For Weight Management:

Oral Semaglutide GLP-1 ($199/month) – Helps manage insulin resistance and PCOS symptoms.
Ozempic ($1,299/month) – Advanced weight management for complex cases.

For Mental Health Support:

Bupropion XL ($25/month) – Supports overall mental health and well-being.

Oana Health’s approach ensures treatments are tailored to individual biomarker profiles, addressing multiple symptoms in a coordinated way. The telehealth model also allows for ongoing monitoring and adjustments to keep therapies effective as hormone levels change over time. Through this streamlined, personalized care, patients gain access to comprehensive and convenient hormonal treatments.

Key Takeaways for Biomarker-Based Hormone Therapy

Biomarker-based hormone therapy is transforming personalized care by improving health outcomes and cutting costs. Studies reveal that the savings from broad biomarker testing often outweigh the initial expenses, making it a cost-effective option for many patients and healthcare providers. Plus, as biomarker testing becomes more widely available across the globe, these therapies are becoming more accessible and affordable.

The clinical advantages are equally impressive. Biomarker-guided treatments have been shown to lower premature mortality rates. This is largely due to their ability to pinpoint specific genetic mutations or protein markers, allowing for earlier detection and tailored interventions. By addressing conditions at their root cause, these therapies make timely and effective treatment possible.

Another benefit is the simplicity of blood-based biomarker testing, which is far less invasive than traditional methods while still offering a thorough health assessment.

Telehealth is also playing a major role in expanding access to these therapies. With telehealth platforms, patients can complete at-home tests and receive remote monitoring, making the process more convenient. Companies like Oana Health are leading the way by integrating telehealth with biomarker-based hormone therapy, offering personalized care plans and real-time adjustments as hormone levels shift.

Regular blood tests are essential in this approach, as they allow healthcare providers to fine-tune treatments. For example, changes in estradiol levels can signal shifts in bone density, libido, hemoglobin, and HDL cholesterol. This kind of ongoing monitoring ensures that patients maintain optimal hormone levels over time.

For those considering biomarker-based hormone therapy, the combination of better outcomes, lower costs, and greater convenience - especially through telehealth - makes it a highly appealing option. Working closely with licensed medical professionals who can interpret biomarker data and adjust treatments is crucial for ensuring safety and effectiveness throughout the process.

FAQs

What makes biomarker-based hormone therapy a better option than traditional methods?

Biomarker-based hormone therapy offers a tailored approach, adjusting treatments to match your specific hormonal needs. This method often results in better symptom relief and fewer side effects compared to the standard, generalized treatments.

By analyzing specific biomarkers, healthcare providers can closely monitor your body's response to the therapy. This allows for safer, more precise adjustments as needed. The result is a more targeted treatment strategy that enhances outcomes and supports long-term health, making hormone therapy both personalized and dependable.

How often should follow-up tests be done during biomarker-based hormone therapy, and why are they important?

After beginning biomarker-based hormone therapy, follow-up tests are generally suggested around three months later. Once the treatment is balanced and delivering results, yearly check-ins are usually enough.

These regular evaluations are key to assessing the therapy's effectiveness, spotting any side effects early, and making adjustments as needed. This approach helps keep the treatment safe, effective, and tailored specifically to you.

How does telehealth improve access to biomarker-based hormone therapy and support patients in following their treatment plans?

Telehealth has revolutionized the way patients access biomarker-based hormone therapy, making it far easier for individuals to connect with healthcare providers without leaving their homes. For those living in rural areas, juggling packed schedules, or dealing with mobility challenges, this approach removes the hassle of traveling to appointments. Instead, patients can receive care in a setting that’s both familiar and comfortable, ensuring they get the support they need without unnecessary delays.

What’s more, telehealth plays a big role in helping patients stick to their treatment plans. By offering customized care and real-time monitoring, it keeps patients engaged and on track. Flexible appointment options and consistent communication with medical professionals mean patients are more likely to follow through with their therapy. This blend of ease and personalized attention not only makes the process smoother but also improves overall health outcomes.