Hormone changes in midlife are treatable, and treatment is a medical decision, not a marketing category. At Lakewood Primary Care and Wellness, testosterone replacement therapy (TRT) and hormone pellet therapy are prescribed and monitored by Dr. Rajan Kohli — board certified in Family Medicine, fellowship trained in Functional, Integrative and Regenerative Medicine through A4M, and in practice for more than twenty years. Hormone care here sits inside a full primary care relationship: your labs, your cardiovascular risk, your sleep, and your medications are all part of the same chart.
How we evaluate low testosterone
Fatigue, low libido, reduced morning erections, loss of muscle, irritability and poor concentration are common reasons men come in. None of them proves low testosterone on its own — each has other causes worth ruling out. Our workup follows standard endocrine practice:
- Morning total and free testosterone, repeated to confirm — a single low reading is not a diagnosis
- LH, FSH, prolactin and estradiol to understand why levels are low
- PSA, hematocrit, lipids and metabolic labs before any prescription is written
- A review of sleep apnea, thyroid disease, medications and other conditions that lower testosterone or mimic its symptoms
If testing does not support treatment, we say so. Treating normal levels exposes you to risk with no expected benefit, and it is not something we do.
Treatment options we prescribe and monitor
Injections — the most studied and most adjustable form, FDA-approved, typically weekly, self-administered or in office.
Topical gels and creams — FDA-approved daily options; steady levels, with transfer precautions around children and partners.
Subcutaneous hormone pellets — small implants placed under the skin in a brief office procedure, releasing hormone steadily for roughly three to five months, with no daily dosing to remember. Many patients choose pellets for the convenience and the steady levels, and pellet therapy here comes with the same laboratory monitoring we apply to every form of treatment.
Oral testosterone capsules — a newer class of daily capsule absorbed through the intestinal lymphatic system rather than processed by the liver — the limitation that made older oral forms unsuitable. Taken with food, they can be a good fit for men who want neither injections nor an office procedure.
Hormone replacement therapy for women
Many women who would benefit from hormone replacement therapy never receive it. After the early-2000s Women's Health Initiative headlines, a generation of patients and physicians stepped away from HRT altogether. The evidence since then has been re-read carefully: for most healthy women who begin treatment near the onset of menopause and under age 60, the benefit-to-risk balance for treating menopausal symptoms is favorable. That is now the position of the major menopause and endocrine societies. We think a lot of women have been left to endure symptoms that are treatable, and we evaluate each woman on her own history rather than on a headline.
Hot flashes and night sweats, disrupted sleep, mood and irritability, brain fog, low libido, vaginal dryness and painful intimacy, and accelerating bone loss are the symptoms we see most. They are not something to simply outlast. Treatment starts with labs and a full history — including a personal and family history of breast cancer, clots and cardiovascular disease — so the plan fits the individual.
How we prescribe women's HRT
There is no single correct formulation; the right one depends on your symptoms, your anatomy and your preferences. The components we work with are:
- Estradiol — the estrogen that addresses hot flashes, sleep, vaginal symptoms and bone loss. We prescribe it as a pellet, a topical patch, gel or cream, or a combination, depending on how steady a level you want and how you prefer to take it.
- Progesterone — for any woman who still has her uterus, estrogen is paired with progesterone to protect the uterine lining. We most often use oral micronized progesterone, taken at night, which many women find also helps sleep.
- Testosterone — not only a men's hormone. For women with low sexual desire, and often for energy and sense of well-being, low-dose testosterone has a recognized role. We prescribe it as a pellet or a topical, dosed to female physiology and followed with labs.
A common approach in our practice is an estradiol pellet paired with a testosterone pellet, plus oral micronized progesterone for women with a uterus — steady levels from the pellets, endometrial protection from the progesterone, and no daily estrogen dosing to remember. For women who prefer to avoid a procedure, an all-topical regimen — estradiol patch or gel with oral progesterone — achieves the same goals, and many women do well on a combination of oral and topical forms. The point is that the regimen is built around you, then adjusted from how you feel and what your labs show.
Every plan is monitored. We recheck symptoms and, where relevant, hormone levels; we keep mammography and other age-appropriate screening on schedule; and we revisit the plan over time, because a woman's needs at 51 are not her needs at 61. Because this care sits inside a primary care practice, the same physician managing your hormones also sees your blood pressure, your bone density and your cardiovascular risk.
What monitoring looks like
TRT is not a prescription you pick up and forget. We recheck levels and safety labs after initiation, then on a regular schedule: testosterone, hematocrit (which TRT can raise), PSA in men, and symptom review. Dosing changes are driven by labs and how you feel — both, not either alone. This is also why hormone therapy belongs with a physician who is genuinely your doctor rather than a dispensary: if your blood pressure, prostate or sleep picture changes, the same practice sees it.
Insurance and cost
The evaluation visit and laboratory testing are generally billable to insurance, including Medicare and the major commercial plans we accept. FDA-approved injections and gels are often covered by pharmacy benefits. Pellet therapy is typically a cash service — we will tell you the cost before anything is scheduled, and there is no membership required.
Where patients come from
The practice is at 8210 Walnut Hill Lane at US 75, on the Texas Health Presbyterian Dallas campus in North Dallas — minutes from University Park, Highland Park and Preston Hollow, and convenient to Uptown, Richardson, Lake Highlands, the M Streets and the wider metroplex.
