Lecture Notes From Chicago: Precision Hormone And Brain Car In The Spotlight

High-level insights from A4M’s latest educational launches.

Chicago hosted the debut of two new clinical programs last weekend — Cognition 360: Where Innovation Meets Brain Health and the Hormone Dosing Therapy Masterclass — bringing together a dynamic group of practitioners for a weekend of advanced, systems-based education. Kudos to the many attendees who built on momentum from Spring Congress, continuing their training across back-to-back events.

Designed to meet the evolving demands of modern clinical practice, both courses delivered practical, protocol-driven content with direct relevance to patient care balancing innovation with immediate application. While the full scope of insights can’t be captured in one recap, the curated lecture notes below highlight some of the most thought-provoking, protocol-driven, and practice-elevating perspectives shared throughout the weekend.

Cognition 360: Where Innovation Met Brain Health And Advanced The Clinical Paradigm

Cognition 360 explored the latest strategies for identifying, preventing, and reversing cognitive decline while bridging innovation and clinical relevance to combat one of medicine’s most urgent challenges.

Neuroinflammation: Environmental Mechanisms and Opportunities | Austin Perlmutter, MD

Neuroinflammation is increasingly recognized as a driver of both cognitive dysfunction and mood disturbance — yet it remains poorly understood, under-assessed, and rarely addressed in clinical practice. In this session, board-certified internal medicine physician and leading brain health expert and precision medicine strategist Austin Perlmutter, MD reframed neuroinflammation as a dynamic, modifiable setpoint — shaped by a constellation of lifestyle, environmental, and systemic factors that influence everything from cognitive clarity to emotional resilience.

Dr. Perlmutter emphasized that neuroinflammation isn’t a singular disease or diagnosis, but rather a spectrum of dysfunction shaped by systemic inputs: infection, trauma, metabolic imbalance, and persistent immune activation. What happens in the body — gut, blood, immune system — doesn’t stay there. Instead, it becomes a neurologic issue, with implications for cognition, emotional resilience, sleep, empathy, and long-term neurologic integrity.

From Our Lecture Notes:

Neuroinflammation is characterized by multiple interwoven features, including microglial activation, increased glial polarization (M1 subtype), blood-brain barrier permeability, and infiltration of peripheral immune cells.
→ “We don’t have one perfect definition — but we do have a strong aggregate of indicators.”
→ This makes inflammatory labs a critical anchor for early brain health interventions.
Peripheral inflammation has direct cognitive and emotional effects. Higher levels of systemic cytokines (like IL-6 and CRP) are associated with mood disorders, altered decision-making, social withdrawal, and depressive symptoms.
→ “Your brain’s immune state is part of what makes you who you are.”
Not all inflammation is bad. Dr. Perlmutter reminded clinicians that low levels of inflammatory cytokines are essential for sleep regulation and neuroplasticity.
→ “The goal isn’t to eliminate inflammation — it’s to contextualize it.”
Inflammation contributes to, but doesn’t explain, all depression. SSRIs may target serotonin, but inflammation-related depression often resists this model and requires different intervention strategies.
→ “Depression isn’t one thing — and inflammation may be key in the subset we’ve been missing.”
Environmental inputs — including air quality, infection, trauma, and even childhood inflammatory load — shape neuroimmune tone across the lifespan. Early-life inflammatory disorders increase the risk of neurodevelopmental challenges by 44%.
→ “Modify the inflammation, and you modify the brain.”
Interventions targeting environmental inputs — including air filtration, vagus nerve activation, anti-inflammatory dietary patterns, and resistance exercise — may help shift the neuroinflammatory setpoint and should be considered standard tools in brain-focused clinical care.
→ These are accessible, underutilized levers for modulating neuroinflammatory tone.

Biohacking the Brain: Tools for Longevity & Mental Performance | Daniel Stickler, MD

Dr. Daniel Stickler, co-founder of the Apeiron Center for Human Potential and a leader in precision performance medicine, presented a high-level framework for enhancing brain function through a personalized, systems-based approach. His session combined foundational lifestyle strategies with emerging therapeutics and targeted technology, repositioning “biohacking” as a logical extension of precision medicine. The focus: optimizing mental performance, neuroprotection, and resilience through measurable, modifiable tools.

From hyperbaric oxygen therapy and peptides to photobiomodulation and advanced cognitive testing, the strategies outlined by Dr. Stickler are both forward-facing and clinically relevant — offering a model that evolves alongside the patient.

From Our Lecture Notes:

Hyperbaric oxygen therapy (HBOT) enhances cerebral blood flow, neurogenesis, and mitochondrial function. Research shows cognitive benefits across populations — from Alzheimer’s and MCI to post-stroke and post-COVID patients.
→ In healthy older adults, 40–60 HBOT sessions improved executive function and episodic memory.
Photobiomodulation (PBM), particularly 1070 nm light, supports neuroplasticity, vascular remodeling, and amyloid clearance in animal models. Early human data suggest improvements in memory, mood, and motor symptoms.
→ Transcranial and intranasal delivery routes are being explored in clinical protocols.
Peptides and next-generation molecules, including Cerebrolysin, Dihexa, BPC-157, and CDK5-inhibiting peptides, show promise for cognitive enhancement and neuroprotection — especially in models of TBI, Alzheimer’s, and neuroinflammation.
→ Clinical application is currently limited by regulatory status, sourcing, and evidence gaps.
Assessment and personalization are central to intervention success. Tools such as CNSVS, EEG, p300, NeuroQuant, microbiome sequencing, and IntellXXDNA testing support ongoing evaluation and protocol refinement.
→ Pair advanced interventions with foundational practices: sleep, movement, nutrition, stress regulation, and meaning.
→ “Continuous monitoring is key to optimizing function.”
Foundational lifestyle inputs remain central to outcomes. Dr. Stickler reinforced that no advanced tool replaces the core pillars of health: sleep, movement, nutrition, stress regulation, and meaning.
→ “Everything begins with lifestyle.”

Keynote Spotlight

The Tech Solution: Navigating The Fire Of Our Time | Shimi Kang, MD

In a dynamic and deeply human closing keynote, Shimi Kang, MD, Harvard-trained psychiatrist, bestselling author, and international speaker, reframed our modern relationship with technology as the defining challenge—and opportunity—of our time. Drawing from neuroscience, behavioral health, and decades of clinical practice, she explored how digital overload is reshaping mood, motivation, cognitive performance, and development across the lifespan.

Dr. Kang introduced a suite of practical models designed to help clinicians translate the science into everyday care: the “tech diet” (toxic, junk, and healthy tech consumption), the “life diet” (daily activities that activate endorphin, oxytocin, and serotonin), and the “dolphin model” of therapeutic leadership—an empathic, flexible alternative to authoritarian or avoidant communication. Her message emphasized not just what to reduce, but what to restore.

From Our Lecture Notes:

Tech acts like fire: it can fuel growth or destruction. The same tool that connects patients to information and care can also drive rising rates of anxiety, depression, addiction, and social isolation—particularly among young people.
→ “Those who use it wisely go further. Those who don’t, get burned.”
Digital overstimulation is reshaping the brain. Chronic screen use is now linked to disruption of myelin integrity—a structural change not seen in autism, schizophrenia, or traumatic brain injury.
→ Behavioral and neurologic symptoms that resemble developmental disorders may reverse with tech detox.
We need a “tech diet” model for clinical conversations.
- Toxic tech: comparison, cyberbullying, compulsive use → cortisol, shutdown
- Junk tech: passive scrolling, overstimulation → dopamine dysregulation
- Healthy tech: creativity, connection, learning → neurotransmitter balance
  → “Like nutrition, it’s not about abstinence—it’s about quality.”
Empathy, play, and presence are antidotes to digital stress.
- Endorphin = nature, music, physical self-care
- Oxytocin = eye contact, gratitude, relational trust
- Serotonin = creativity, trying new things, learning from mistakes
  → “You’d never do these things if you were being chased by a tiger. That’s how you know they’re healing.”
The “dolphin model” offers a new clinical posture. Neither authoritarian (shark) nor avoidant (jellyfish), dolphin-style clinicians challenge patients firmly but flexibly, with empathy and engagement.
→ Motivational therapy works best shoulder-to-shoulder — not head-on.

Clinicians can model resilience. Small shifts including screen-time screening, tech-free staff zones, playlist prescriptions can help guide patients from reactivity to regulation.

Hormone Dosing Therapy Masterclass: Lessons In Precision Endocrinology

This course provided an in-depth exploration of personalized hormone therapy, emphasizing diagnostic precision, dosing strategies, and therapeutic decision-making across patient populations.

Understanding Hormone Function: Hypothalamic, Sex Hormones, Adrenal, Oxytocin, SHBG | Sahar Swidan, PharmD

Hormonal balance is foundational to whole-person health optimization, influencing everything from energy, immunity, and metabolism to cognitive performance and healthy aging. In this session, Sahar Swidan, PharmD, clinical pharmacist and educator in advanced functional endocrinology, delivered a comprehensive overview of hormone regulation across multiple systems—emphasizing interdependence, diagnostic clarity, and clinical application.

Swidan walked attendees through the layers of hormonal complexity, from hypothalamic control and HPA feedback to adrenal, sex, and bonding hormones, while spotlighting how dysregulation can quietly drive chronic disease. Drawing from current research, she introduced assessment strategies, biomarkers, and therapeutic targets that span from SHBG to sirtuins to oxytocin—making the case for system-wide hormone optimization that goes far beyond basic HRT.

From Our Lecture Notes:

The hypothalamus acts as the master hormonal regulator, influencing stress, hunger, reproduction, and circadian rhythm. Inflammation and aging impair its function — with downstream effects on weight, cognition, and immune resilience.
→ Protecting hypothalamic function is foundational to hormone optimization.
The HPA axis regulates cortisol and stress responses via negative feedback. Chronic stress flattens this loop, increasing vulnerability to depression, fatigue, and autoimmunity.
→ Sleep quality and rhythm are critical levers for restoring HPA balance.
The cortisol-to-DHEA ratio (CDR) is a high-impact clinical marker. Elevated CDR correlates with immune suppression, metabolic syndrome, and mood disorders.
→ Physical activity helps rebalance this ratio and improve adaptive capacity.
Sex hormones drive system-wide effects: estrogen supports vascular and bone health; progesterone aids CNS myelination and calm; testosterone impacts cognition and metabolic integrity in all sexes.
→ “Hormonal imbalances are not usually a cause of disease – they are a symptom of deeper dysfunction.”
SHBG (Sex Hormone–Binding Globulin) is a key diagnostic and metabolic marker. Low SHBG is linked to insulin resistance, PCOS, stroke risk, and hormone-sensitive cancers.
→ Evaluating SHBG can reveal hidden metabolic and inflammatory load.
→ “Low SHBG is an early warning sign for metabolic dysfunction.”
Oxytocin and prolactin modulate more than bonding. Oxytocin influences inflammation, pain, and metabolic health; prolactin is emerging as a metabolic and behavioral regulator.
→ These are underutilized targets in mood, pain, and cardiometabolic care.

Individualizing BHRT Protocols: The Female Patient | Dian Ginsberg, MD

Hormone replacement therapy is not one-size-fits-all—especially for women navigating the complex and fluctuating stages of perimenopause and menopause. In this session, Dian Ginsberg, MD, board-certified OB/GYN and educator in functional hormone therapy, broke down how to personalize BHRT protocols using a patient’s cycle status, clinical symptoms, and objective testing across blood, saliva, and urine.

Dr. Ginsberg emphasized the importance of identifying metabolic contributors before assuming hormone dysfunction, and of aligning delivery methods and dosages with where a patient is in her hormonal trajectory. Her presentation highlighted real-world dosing strategies, lab interpretation pearls, and the critical role of estrogen, progesterone, and testosterone in supporting neurological and vascular health throughout aging.

From Our Lecture Notes:

Hormone dysfunction is often a communication failure, not a depletion issue. Perimenopausal symptoms can arise despite regular cycles, driven by breakdowns in hypothalamic-pituitary-ovarian signaling.
→ “Don’t assume the cycle means everything’s fine.”
Test interpretation must be individualized. Blood, saliva, and urine each provide different insights. Saliva can reveal estrogen dominance or detox challenges, while 24-hour urine offers a comprehensive view of total hormone output and replacement absorption.
→ “No single test gives the full picture—use what the patient needs.”
BHRT pulsing strategies should shift based on symptoms and hormone clearance.
- Start with daily hormones for one month, then pulse one day off every other week (e.g., the 1st and 15th).
- Weekly pulsing caused hormone levels to drop too dramatically.
  → “One day off per week is too much—the system can’t recover.”
  → This pattern mimics physiologic rhythm while supporting hippocampal neuroplasticity.
Expect to increase dosing with age. Capillary density decreases over time, requiring gradual dose adjustments.
→ “Your skin, your hair—they’re showing you your blood supply is changing. The same goes for hormones.”
Start BHRT based on cycle pattern and phase:
- Early perimenopause: Biest 0.8–1 mg/mL + oral progesterone 100 mg
- Late perimenopause: Biest 1.5–3 mg/mL + oral progesterone 100–150 mg
- Menopause: Biest 3–4.5 mg/mL + daily progesterone 100–150 mg
  → Dose upward slowly and let symptoms guide adjustments.
Application site affects hormone absorption.
- Thigh, wrist, and behind the knee showed consistent uptake in her own trials.
- Avoid belly and butt due to low capillary density.
  → “You’re rubbing it into a slab of fat. That’s not absorption—it’s storage.”
  → Consistency and capillary access matter more than rotating sites daily.
Estrogen levels should support cerebral circulation. Estradiol improves cerebral blood flow and reduces vascular tone through nitric oxide pathways. Cyclic dosing may prevent receptor desensitization.
→ Back off the Biest if symptoms worsen—more is not always better.

Individualizing BHRT Protocols: The Male Patient | Tracy Gapin, MD

As testosterone levels in men continue to decline across populations, the need for personalized hormone replacement protocols has become increasingly urgent. In this session, Tracy Gapin, MD, board-certified urologist and founder of the Gapin Institute for Precision Medicine, detailed a comprehensive and pragmatic approach to BHRT in male patients, one that prioritizes optimization over normalization.

Dr. Gapin outlined the wide-ranging physiological consequences of testosterone deficiency and the limitations of current diagnostic thresholds. He emphasized the importance of free testosterone, not just total levels, as well as context-driven test interpretation and individualized dosing across injectable, topical, oral, and alternative therapies. He also addressed fertility-preserving strategies and highlighted key considerations for monitoring, safety, and long-term outcomes.

From Our Lecture Notes:

Symptoms of low testosterone are often nonspecific or absent, yet carry substantial health risks. These include mood changes, fatigue, erectile dysfunction, and body composition changes, along with increased cardiovascular, metabolic, and all-cause mortality.
→ “Most men have no symptoms at all, but that doesn’t mean they’re not at risk.”
Free testosterone is the most clinically relevant marker, and lab values vary by methodology. Dr. Gapin recommends targeting ~20 pg/mL (Labcorp) or ~200 pg/mL (Quest) as therapeutic goals.
→ “Do not sacrifice testosterone for the sake of estrogen.”
Routes of TRT should align with patient needs and preferences:
- Injectables are cost-effective and predictable, especially when microdosed 2–3x/week
- Topicals (especially scrotal application) have 5–8x better absorption but carry transference risk
- Pellets offer long-acting stability but are harder to titrate
- Oral testosterone (e.g., Kyzatrex) is emerging as an effective option if dosed with fat
  → All methods require ongoing lab monitoring and symptom tracking.
Fertility-preserving strategies include:
- hCG (5,000 IU SQ 2x/week), which stimulates endogenous testosterone and maintains testicular function
- SERMs (Clomiphene or Enclomiphene), which increase LH and FSH by blocking estrogen at the hypothalamus
  → Dr. Gapin prefers Enclomiphene due to better mood and libido outcomes.
DHEA, thyroid, and lifestyle factors play essential roles in male hormone optimization. DHEA supports mood, metabolism, and libido; thyroid dysfunction is often under-recognized in men; and stress, sleep, toxins, and nutrition all modulate endocrine health.
→ “TRT alone is never enough. The body isn’t operating in a vacuum.”

The launch of Cognition 360 and the Hormone Dosing Therapy Masterclass introduced two new additions to A4M’s growing portfolio of advanced clinical programs. Each was designed to meet the layered realities of today’s clinical practice with depth, clarity, and real-world application.

Both were engineered to deliver hands-on, customizable strategies for brain health, hormone care, and adaptive clinical decision-making.

Patients are presenting with increasingly complex patterns of dysfunction. Practitioners need systems built to hold that complexity without compromising precision.

More targeted training launches are on the horizon as A4M spearheads the shift toward deeper learning, sharper tools, and a new standard in functional education.

Cognition 360: Where Innovation Met Brain Health And Advanced The Clinical Paradigm

Neuroinflammation: Environmental Mechanisms and Opportunities | Austin Perlmutter, MD

From Our Lecture Notes:

Neuroinflammation is characterized by multiple interwoven features, including microglial activation, increased glial polarization (M1 subtype), blood-brain barrier permeability, and infiltration of peripheral immune cells.
→ “We don’t have one perfect definition — but we do have a strong aggregate of indicators.”
→ This makes inflammatory labs a critical anchor for early brain health interventions.
Peripheral inflammation has direct cognitive and emotional effects. Higher levels of systemic cytokines (like IL-6 and CRP) are associated with mood disorders, altered decision-making, social withdrawal, and depressive symptoms.
→ “Your brain’s immune state is part of what makes you who you are.”
Not all inflammation is bad. Dr. Perlmutter reminded clinicians that low levels of inflammatory cytokines are essential for sleep regulation and neuroplasticity.
→ “The goal isn’t to eliminate inflammation — it’s to contextualize it.”
Inflammation contributes to, but doesn’t explain, all depression. SSRIs may target serotonin, but inflammation-related depression often resists this model and requires different intervention strategies.
→ “Depression isn’t one thing — and inflammation may be key in the subset we’ve been missing.”
Environmental inputs — including air quality, infection, trauma, and even childhood inflammatory load — shape neuroimmune tone across the lifespan. Early-life inflammatory disorders increase the risk of neurodevelopmental challenges by 44%.
→ “Modify the inflammation, and you modify the brain.”
Interventions targeting environmental inputs — including air filtration, vagus nerve activation, anti-inflammatory dietary patterns, and resistance exercise — may help shift the neuroinflammatory setpoint and should be considered standard tools in brain-focused clinical care.
→ These are accessible, underutilized levers for modulating neuroinflammatory tone.

Biohacking the Brain: Tools for Longevity & Mental Performance | Daniel Stickler, MD

From Our Lecture Notes:

Hyperbaric oxygen therapy (HBOT) enhances cerebral blood flow, neurogenesis, and mitochondrial function. Research shows cognitive benefits across populations — from Alzheimer’s and MCI to post-stroke and post-COVID patients.
→ In healthy older adults, 40–60 HBOT sessions improved executive function and episodic memory.
Photobiomodulation (PBM), particularly 1070 nm light, supports neuroplasticity, vascular remodeling, and amyloid clearance in animal models. Early human data suggest improvements in memory, mood, and motor symptoms.
→ Transcranial and intranasal delivery routes are being explored in clinical protocols.
Peptides and next-generation molecules, including Cerebrolysin, Dihexa, BPC-157, and CDK5-inhibiting peptides, show promise for cognitive enhancement and neuroprotection — especially in models of TBI, Alzheimer’s, and neuroinflammation.
→ Clinical application is currently limited by regulatory status, sourcing, and evidence gaps.
Assessment and personalization are central to intervention success. Tools such as CNSVS, EEG, p300, NeuroQuant, microbiome sequencing, and IntellXXDNA testing support ongoing evaluation and protocol refinement.
→ Pair advanced interventions with foundational practices: sleep, movement, nutrition, stress regulation, and meaning.
→ “Continuous monitoring is key to optimizing function.”
Foundational lifestyle inputs remain central to outcomes. Dr. Stickler reinforced that no advanced tool replaces the core pillars of health: sleep, movement, nutrition, stress regulation, and meaning.
→ “Everything begins with lifestyle.”

Keynote Spotlight

The Tech Solution: Navigating The Fire Of Our Time | Shimi Kang, MD

From Our Lecture Notes:

Tech acts like fire: it can fuel growth or destruction. The same tool that connects patients to information and care can also drive rising rates of anxiety, depression, addiction, and social isolation—particularly among young people.
→ “Those who use it wisely go further. Those who don’t, get burned.”
Digital overstimulation is reshaping the brain. Chronic screen use is now linked to disruption of myelin integrity—a structural change not seen in autism, schizophrenia, or traumatic brain injury.
→ Behavioral and neurologic symptoms that resemble developmental disorders may reverse with tech detox.
We need a “tech diet” model for clinical conversations.
- Toxic tech: comparison, cyberbullying, compulsive use → cortisol, shutdown
- Junk tech: passive scrolling, overstimulation → dopamine dysregulation
- Healthy tech: creativity, connection, learning → neurotransmitter balance
  → “Like nutrition, it’s not about abstinence—it’s about quality.”
Empathy, play, and presence are antidotes to digital stress.
- Endorphin = nature, music, physical self-care
- Oxytocin = eye contact, gratitude, relational trust
- Serotonin = creativity, trying new things, learning from mistakes
  → “You’d never do these things if you were being chased by a tiger. That’s how you know they’re healing.”
The “dolphin model” offers a new clinical posture. Neither authoritarian (shark) nor avoidant (jellyfish), dolphin-style clinicians challenge patients firmly but flexibly, with empathy and engagement.
→ Motivational therapy works best shoulder-to-shoulder — not head-on.

Clinicians can model resilience. Small shifts including screen-time screening, tech-free staff zones, playlist prescriptions can help guide patients from reactivity to regulation.

Hormone Dosing Therapy Masterclass: Lessons In Precision Endocrinology

This course provided an in-depth exploration of personalized hormone therapy, emphasizing diagnostic precision, dosing strategies, and therapeutic decision-making across patient populations.

Understanding Hormone Function: Hypothalamic, Sex Hormones, Adrenal, Oxytocin, SHBG | Sahar Swidan, PharmD

From Our Lecture Notes:

The hypothalamus acts as the master hormonal regulator, influencing stress, hunger, reproduction, and circadian rhythm. Inflammation and aging impair its function — with downstream effects on weight, cognition, and immune resilience.
→ Protecting hypothalamic function is foundational to hormone optimization.
The HPA axis regulates cortisol and stress responses via negative feedback. Chronic stress flattens this loop, increasing vulnerability to depression, fatigue, and autoimmunity.
→ Sleep quality and rhythm are critical levers for restoring HPA balance.
The cortisol-to-DHEA ratio (CDR) is a high-impact clinical marker. Elevated CDR correlates with immune suppression, metabolic syndrome, and mood disorders.
→ Physical activity helps rebalance this ratio and improve adaptive capacity.
Sex hormones drive system-wide effects: estrogen supports vascular and bone health; progesterone aids CNS myelination and calm; testosterone impacts cognition and metabolic integrity in all sexes.
→ “Hormonal imbalances are not usually a cause of disease – they are a symptom of deeper dysfunction.”
SHBG (Sex Hormone–Binding Globulin) is a key diagnostic and metabolic marker. Low SHBG is linked to insulin resistance, PCOS, stroke risk, and hormone-sensitive cancers.
→ Evaluating SHBG can reveal hidden metabolic and inflammatory load.
→ “Low SHBG is an early warning sign for metabolic dysfunction.”
Oxytocin and prolactin modulate more than bonding. Oxytocin influences inflammation, pain, and metabolic health; prolactin is emerging as a metabolic and behavioral regulator.
→ These are underutilized targets in mood, pain, and cardiometabolic care.

Individualizing BHRT Protocols: The Female Patient | Dian Ginsberg, MD

From Our Lecture Notes:

Hormone dysfunction is often a communication failure, not a depletion issue. Perimenopausal symptoms can arise despite regular cycles, driven by breakdowns in hypothalamic-pituitary-ovarian signaling.
→ “Don’t assume the cycle means everything’s fine.”
Test interpretation must be individualized. Blood, saliva, and urine each provide different insights. Saliva can reveal estrogen dominance or detox challenges, while 24-hour urine offers a comprehensive view of total hormone output and replacement absorption.
→ “No single test gives the full picture—use what the patient needs.”
BHRT pulsing strategies should shift based on symptoms and hormone clearance.
- Start with daily hormones for one month, then pulse one day off every other week (e.g., the 1st and 15th).
- Weekly pulsing caused hormone levels to drop too dramatically.
  → “One day off per week is too much—the system can’t recover.”
  → This pattern mimics physiologic rhythm while supporting hippocampal neuroplasticity.
Expect to increase dosing with age. Capillary density decreases over time, requiring gradual dose adjustments.
→ “Your skin, your hair—they’re showing you your blood supply is changing. The same goes for hormones.”
Start BHRT based on cycle pattern and phase:
- Early perimenopause: Biest 0.8–1 mg/mL + oral progesterone 100 mg
- Late perimenopause: Biest 1.5–3 mg/mL + oral progesterone 100–150 mg
- Menopause: Biest 3–4.5 mg/mL + daily progesterone 100–150 mg
  → Dose upward slowly and let symptoms guide adjustments.
Application site affects hormone absorption.
- Thigh, wrist, and behind the knee showed consistent uptake in her own trials.
- Avoid belly and butt due to low capillary density.
  → “You’re rubbing it into a slab of fat. That’s not absorption—it’s storage.”
  → Consistency and capillary access matter more than rotating sites daily.
Estrogen levels should support cerebral circulation. Estradiol improves cerebral blood flow and reduces vascular tone through nitric oxide pathways. Cyclic dosing may prevent receptor desensitization.
→ Back off the Biest if symptoms worsen—more is not always better.

Individualizing BHRT Protocols: The Male Patient | Tracy Gapin, MD

From Our Lecture Notes:

Symptoms of low testosterone are often nonspecific or absent, yet carry substantial health risks. These include mood changes, fatigue, erectile dysfunction, and body composition changes, along with increased cardiovascular, metabolic, and all-cause mortality.
→ “Most men have no symptoms at all, but that doesn’t mean they’re not at risk.”
Free testosterone is the most clinically relevant marker, and lab values vary by methodology. Dr. Gapin recommends targeting ~20 pg/mL (Labcorp) or ~200 pg/mL (Quest) as therapeutic goals.
→ “Do not sacrifice testosterone for the sake of estrogen.”
Routes of TRT should align with patient needs and preferences:
- Injectables are cost-effective and predictable, especially when microdosed 2–3x/week
- Topicals (especially scrotal application) have 5–8x better absorption but carry transference risk
- Pellets offer long-acting stability but are harder to titrate
- Oral testosterone (e.g., Kyzatrex) is emerging as an effective option if dosed with fat
  → All methods require ongoing lab monitoring and symptom tracking.
Fertility-preserving strategies include:
- hCG (5,000 IU SQ 2x/week), which stimulates endogenous testosterone and maintains testicular function
- SERMs (Clomiphene or Enclomiphene), which increase LH and FSH by blocking estrogen at the hypothalamus
  → Dr. Gapin prefers Enclomiphene due to better mood and libido outcomes.
DHEA, thyroid, and lifestyle factors play essential roles in male hormone optimization. DHEA supports mood, metabolism, and libido; thyroid dysfunction is often under-recognized in men; and stress, sleep, toxins, and nutrition all modulate endocrine health.
→ “TRT alone is never enough. The body isn’t operating in a vacuum.”

Both were engineered to deliver hands-on, customizable strategies for brain health, hormone care, and adaptive clinical decision-making.

Patients are presenting with increasingly complex patterns of dysfunction. Practitioners need systems built to hold that complexity without compromising precision.

More targeted training launches are on the horizon as A4M spearheads the shift toward deeper learning, sharper tools, and a new standard in functional education.

A4M Blog

From Our Lecture Notes:

Individualizing BHRT Protocols: The Female Patient | Dian Ginsberg, MD

Individualizing BHRT Protocols: The Male Patient | Tracy Gapin, MD

From Our Lecture Notes: