HRT Overview | Women’s HRT | Men’s TRT | EvexiPEL | Your HRT Journey | Patient Stories | Myths and Facts | FAQs
Personalized HRT and Bioidentical Hormone Therapy for Women and Men
You deserve to feel at home in your body again.
At Metamorphosis Holistic MedSpa, we provide personalized Hormone Replacement Therapy (HRT) and Bioidentical Hormone Replacement Therapy (BHRT) for women and men experiencing symptoms associated with hormonal changes or clinically identified hormone deficiencies.
Conveniently located in Issaquah, we serve patients throughout Bellevue, Seattle, Sammamish, Redmond, Mercer Island, Renton, North Bend, Snoqualmie, and the greater Eastside.
Your individualized hormone wellness plan may include:
- EvexiPEL® hormone pellet therapy
- Testosterone, estrogen, or progesterone therapy
- Hormone injections, oral medications, topical creams or gels, and transdermal patches
- Targeted nutraceuticals and lifestyle support
- Ongoing laboratory testing and monitoring
What Is Hormone Replacement Therapy?
Hormone Replacement Therapy is a medically supervised treatment used to supplement hormones that are deficient, declining, or contributing to bothersome symptoms.
Hormonal changes may occur during perimenopause, menopause, andropause, aging, certain medical treatments, or other health transitions. Depending on the individual, treatment may involve testosterone, estrogen, progesterone, or a carefully selected combination.
HRT may be considered for symptoms such as:
- Persistent fatigue or reduced stamina
- Hot flashes or night sweats
- Difficulty falling or staying asleep
- Brain fog or difficulty concentrating
- Mood changes, anxiety, or irritability
- Reduced motivation
- Decreased libido
- Vaginal dryness or discomfort with intimacy
- Changes in erections or sexual performance
- Reduced muscle mass or exercise recovery
- Changes in weight or body composition
- Menstrual changes
- Thinning hair or changes in skin quality
- A general sense of no longer feeling like yourself
These symptoms can have many potential causes. That is why we evaluate the complete clinical picture rather than treating a laboratory number alone.
Choose Your Path
Women’s HRT
Hormonal changes can begin well before a woman’s final menstrual period.
Men’s TRT
Testosterone may decline gradually with age, but symptoms alone do not confirm testosterone deficiency.
EvexiPEL
EvexiPEL is a personalized approach to bioidentical hormone pellet therapy for women and men.
Hormone Replacement Therapy for Women
Hormonal changes can begin well before a woman’s final menstrual period. During perimenopause, estrogen and progesterone may fluctuate significantly, while testosterone may also decline over time.
These changes can affect sleep, mood, energy, cognition, temperature regulation, sexual wellness, muscle mass, bone health, skin quality, and overall quality of life.
Common Symptoms of Hormonal Imbalance in Women
Women may experience:
- Hot flashes and night sweats
- Irregular or changing menstrual cycles
- Fatigue or reduced stamina
- Brain fog and difficulty concentrating
- Anxiety, irritability, or mood changes
- Difficulty falling or staying asleep
- Reduced libido
- Vaginal dryness
- Pain or discomfort with intimacy
- Changes in weight or body composition
- Decreased muscle tone
- Hair thinning
- Dry or less resilient skin
The Importance of Testosterone in Women
Testosterone is not exclusively a male hormone. Women naturally produce testosterone, although in smaller amounts than men.
Testosterone contributes to sexual function, muscle maintenance, bone health, energy, and other important physiological functions. Clinically low levels may contribute to reduced libido, changes in strength, decreased motivation, or a diminished sense of well-being.
Testosterone therapy is not appropriate for every woman. Whether it should be considered requires a comprehensive medical evaluation, laboratory testing, informed consent, and ongoing monitoring.
HRT Options for Women
Depending on your symptoms, laboratory findings, health history, and preferences, your personalized treatment may include:
- Estrogen patches, creams, gels, oral therapy, injections, or pellets
- Progesterone provided orally, topically, or through another prescribed method
- Testosterone creams, gels, injections, or EvexiPEL pellets
- Combination hormone therapy
- Targeted nutraceuticals
- Lifestyle and wellness recommendations
If a patient has a uterus and receives systemic estrogen, progesterone or another form of endometrial protection is generally considered to help protect the uterine lining. Jennifer will determine what is appropriate based on your individual medical needs.
Testosterone Replacement Therapy (TRT) for Men
Personalized Low Testosterone Care in Issaquah, WA
Testosterone may decline gradually with age, but symptoms alone do not confirm testosterone deficiency. Diagnosis requires a thoughtful review of symptoms, health history, physical considerations, and appropriately timed laboratory testing.
Common Symptoms of Low Testosterone in Men
Men may experience:
- Low energy or reduced stamina
- Decreased libido
- Changes in erections or sexual performance
- Reduced muscle mass or strength
- Increased body fat
- Reduced motivation
- Irritability or mood changes
- Brain fog or difficulty concentrating
- Poor recovery after exercise
- Changes in sleep
- Thinning hair or changes in skin quality
Testosterone Replacement Therapy Options for Men
When medically appropriate, Testosterone Replacement Therapy may be provided through:
- EvexiPEL testosterone pellets
- Testosterone injections
- Topical testosterone creams or gels
- Oral medications when appropriate
- Other prescribed delivery methods
- Targeted nutraceuticals
- Lifestyle and wellness support
Testosterone therapy requires ongoing monitoring. Follow-up may include testosterone levels, blood counts, symptom response, potential side effects, prostate-related screening when appropriate, and other individualized laboratory markers.
An Important Fertility Consideration
External testosterone can suppress sperm production and may reduce fertility. Men who are currently trying to conceive—or may want biological children in the future—should discuss fertility preservation and possible baseline semen testing before beginning testosterone therapy.
Sperm production may recover after testosterone is discontinued, but the amount of time required varies and recovery cannot be guaranteed.
The EvexiPEL Method
What Is EvexiPEL?
EvexiPEL is a personalized approach to bioidentical hormone pellet therapy for women and men.
Small hormone pellets are placed beneath the skin during a brief in-office procedure. The pellets gradually release the prescribed hormone over time, providing an alternative to daily pills, creams, patches, or frequent injections.
Is Pellet Therapy Right for Everyone?
Pellets are not the right option for everyone. Because the dose cannot be easily adjusted after placement, careful patient selection, comprehensive laboratory review, informed consent, and follow-up are essential.
What We Review Before Treatment
Before choosing pellets, you will receive information about:
• The expected benefits and limitations
• Alternative hormone delivery methods
• Potential side effects and procedural risks
• Expected duration
• Activity restrictions and aftercare
• Follow-up laboratory testing
• When to contact our clinical team
What EvexiPEL Patients Are Saying
“People can’t believe I’m 61. I feel great. My energy levels are back.”
— Melinda, EvexiPEL Patient“When you have that extra energy, you spend more time together, you enjoy each other more.”
— Don, EvexiPEL Patient“I just came out of a fog. Hot flashes went away. My anxiety subsided. The results are real.”
— Heather, EvexiPEL Patient“I don’t have to wake up a big mess from hot flashes at night, and I can sleep all through the evening.”
— Nicole, EvexiPEL Patient“With EvexiPEL, I actually look forward to intimacy again rather than thinking, ‘This is a chore,’ or that it’s painful.”
— Holly, EvexiPEL Patient“I feel like I have a life again… it’s made me appreciate things, like just being able to play with my kids or run around with them again.”
— Lauren, EvexiPEL Patient“There’s nothing I won’t do. I just did a triathlon. I promise you, I wouldn’t have done that triathlon if it wasn’t for EvexiPEL.”
— Gina, EvexiPEL Patient
Your Personalized HRT Journey
01. Complimentary Consultation
Your journey begins with a complimentary consultation at Metamorphosis Holistic MedSpa.
During this visit, we will:
• Discuss your symptoms and wellness goals
• Review your relevant health and medication history
• Explain available HRT and BHRT options
• Introduce the EvexiPEL Method when appropriate
• Determine which laboratory testing may be needed
• Review the anticipated process and personalized pricing
• Answer your general questions
The complimentary consultation is educational and preparatory. It does not replace the required medical evaluation or guarantee that hormone therapy will be prescribed.
02. Laboratory Testing and Health Assessment
Before your Good Faith Exam, we will gather the information Jennifer needs to complete a thoughtful medical evaluation.
This may include:
• A comprehensive health history
• Current medications and supplements
• A hormone symptom checklist
• Personal and family medical history
• Previous hormone therapy experience
• Recent laboratory results
• Additional laboratory testing when needed
• Reproductive or fertility goals
• Age- and risk-appropriate health screenings
Laboratory testing is selected according to your symptoms, age, sex, medications, health history, and treatment goals. Results are interpreted alongside your symptoms and medical history—not as isolated numbers.
03. $75 Good Faith Exam With Jennifer
After the preliminary consultation and required information are complete, you will have a comprehensive Good Faith Exam with Medical Director Jennifer Graves, MSN, ARNP, FNP-C.
During the GFE, Jennifer will:
• Review your health history and symptoms
• Evaluate your laboratory findings
• Assess medical eligibility and individual risk factors
• Review current medications and possible interactions
• Discuss potential benefits, risks, limitations, and alternatives
• Answer your remaining medical questions
• Provide final medical recommendations
• Prescribe treatment when clinically appropriate
• Establish your monitoring and follow-up plan
The $75 Good Faith Exam is required before beginning medical hormone therapy.
Completion of a consultation, laboratory testing, or GFE does not guarantee medical clearance or a prescription.
04. Begin Your Personalized Treatment
Once Jennifer has completed your Good Faith Exam, medically cleared you, and prescribed your individualized plan, Christopher Kepler, BS, LPN, will coordinate and administer your care.
Depending on your prescription, treatment may include:
• EvexiPEL testosterone or estrogen pellet insertion
• Testosterone injections
• Estrogen or progesterone therapy
• Oral hormone medications
• Topical hormone creams or gels
• Transdermal hormone patches
• Prescribed nutraceuticals
• IV or IM wellness support
Christopher will review treatment instructions, administer in-office therapies, dispense prescribed medications as ordered, provide pellet aftercare, and coordinate follow-up testing and communication with Jennifer.
05. Follow-Up and Monitoring
Hormone therapy is an ongoing clinical process—not a one-time treatment.
Follow-up appointments and repeat laboratory testing help us:
• Evaluate symptom improvement
• Review your experience with treatment
• Identify possible side effects
• Monitor hormone levels and relevant safety markers
• Determine whether adjustments are appropriate
• Evaluate whether the benefits continue to outweigh potential risks
Meet Your Hormone Wellness Team
Jennifer Graves, MSN, ARNP, FNP-C
Medical Director and Prescribing Provider
Jennifer Graves is a board-certified Family Nurse Practitioner and the Medical Director of Metamorphosis Holistic MedSpa.
Following your initial consultation, laboratory testing, and symptom assessment, Jennifer performs the required Good Faith Exam.
During this medical evaluation, Jennifer:
• Reviews your health history, symptoms, medications, and laboratory results
• Evaluates your medical eligibility and individual risk factors
• Discusses potential benefits, risks, limitations, and alternatives
• Answers your medical questions
• Provides final treatment recommendations
• Prescribes testosterone, estrogen, progesterone, nutraceuticals, or other therapies when medically appropriate
• Establishes your monitoring and follow-up plan
No hormone medication or medical treatment is initiated until Jennifer has completed the Good Faith Exam and provided the appropriate medical order or prescription.
Christopher Kepler, BS, LPN
Owner, Hormone Wellness Nurse and EvexiPEL Provider
Christopher Kepler is the owner of Metamorphosis Holistic MedSpa and the nurse who guides patients through the hands-on portion of their hormone wellness experience.
After Jennifer completes the medical evaluation and prescribes an individualized treatment plan, Christopher carries out the ordered care.
Depending on the prescribed treatment, Christopher may:
• Perform EvexiPEL hormone pellet insertion procedures
• Administer prescribed testosterone or other hormone injections
• Provide ordered IV and IM wellness therapies
• Dispense prescribed hormone medications according to the treatment plan
• Review medication administration and treatment instructions
• Coordinate laboratory testing and follow-up appointments
• Monitor patient-reported progress
• Communicate clinical concerns to Jennifer
• Provide pellet aftercare and continuing patient support
Christopher began his healthcare career as a United States Army Medic in 2009. He later served as a Sergeant and Charge Nurse in ER and ICU settings with the 396th Combat Support Hospital.
He earned a Bachelor of Science in Biology-Physiology from the University of Washington and brings experience across acute care, oncology, psychology, dermatology, wellness, and aesthetics.
Together, Jennifer and Christopher provide a coordinated model of care: Jennifer evaluates, medically clears, and prescribes treatment, while Christopher administers the prescribed therapies and supports patients throughout their HRT journey.
HRT Myth vs. Fact
Myth: Hormone Therapy Is Only for Women Going Through Menopause
Fact: Hormone therapy may be considered for women and men with symptoms and laboratory findings consistent with a clinically significant hormone deficiency or menopausal transition.
The appropriate medication, dose, delivery method, and monitoring plan will differ for every patient.
Myth: Testosterone Is Only Important for Men
Fact: Women naturally produce testosterone, although in smaller amounts than men. Testosterone contributes to sexual function, muscle health, bone health, and other physiological functions.
Testosterone therapy for women requires an individualized evaluation, informed consent, and careful monitoring. There are currently no FDA-approved testosterone formulations specifically indicated for women in the United States.
Myth: Hormone Therapy Automatically Causes Breast Cancer
Fact: The relationship between hormone therapy and breast cancer is more complex.
Risk depends on several factors, including:
- The hormone or combination prescribed
- The dose and delivery method
- Duration of treatment
- Age and timing of treatment initiation
- Personal medical history
- Breast health and screening history
- Family history
- Genetic risk factors
- Other health and lifestyle consideration
Patients with a personal history of breast cancer require specialized evaluation and collaboration with their oncology team. Systemic hormone therapy is generally not recommended for breast cancer survivors, except in uncommon situations involving careful shared decision-making.
Myth: “Bioidentical” Means Risk-Free
Fact: Bioidentical describes a hormone’s molecular structure. It does not mean the treatment is natural for every patient, free from side effects, or appropriate without medical supervision.
Both FDA-approved and compounded hormone therapies require appropriate screening, informed consent, and monitoring.
Myth: Everyone With Fatigue or Weight Gain Needs Hormone Therapy
Fact: Fatigue, brain fog, low libido, sleep disruption, mood changes, and weight changes can have many potential causes.
Other considerations may include:
- Thyroid disorders
- Nutritional deficiencies
- Sleep disorders
- Medication effects
- Mental health conditions
- Metabolic concerns
- Chronic stress
- Other medical conditions
Our goal is to understand the complete clinical picture—not assume that every symptom is caused by hormones.
Myth: Once You Begin HRT, You Can Never Stop
Fact: Hormone therapy should be reassessed over time.
Some patients continue because the benefits remain meaningful, while others adjust or discontinue treatment with medical guidance. Pellet therapy is different because an inserted dose cannot simply be stopped in the same way as a pill, cream, patch, or injection.
Frequently Asked Questions
Hormone therapy does not carry one universal level of breast cancer risk.
Risk considerations depend on the hormone prescribed, whether estrogen is used alone or with progesterone, the dose, delivery method, duration, age at initiation, personal medical history, and individual breast cancer risk factors.
Your evaluation will include a review of your personal and family history and whether you are current with recommended breast screening.
A family history of breast cancer does not automatically mean that you can never use hormone therapy, but it may change the screening and decision-making process.
Jennifer may consider:
- Which relatives were affected
- Their ages at diagnosis
- Whether multiple relatives have been diagnosed
- Known BRCA or other genetic mutations
- Your personal breast history
- Previous breast biopsies
- Your current mammogram or screening status
- Other individual risk factors
Patients with potentially increased hereditary risk may be referred for additional breast evaluation, genetic counseling, or consultation with another specialist before treatment.
Systemic hormone therapy is generally avoided in individuals with a personal history of breast cancer.
Rare exceptions may be considered only through careful shared decision-making involving the patient’s oncologist and other qualified medical providers. Nonhormonal options may be recommended depending on the symptoms being treated.
Yes, it is possible.
Men naturally have both testosterone and estrogen. Some testosterone can convert into estradiol through a process called aromatization. If the relationship between testosterone and estrogen becomes imbalanced, some men may experience breast tenderness or gynecomastia, which is a benign increase in male breast tissue.
This does not mean that every man taking testosterone will develop breast enlargement. Symptoms should be reported so the provider can evaluate hormone levels, medications, dosing, body composition, liver health, and other possible causes.
Testosterone Replacement Therapy (TRT) requires individualized prostate-related screening and monitoring.
Treatment decisions may include consideration of:
- Age
- Urinary symptoms
- Personal prostate history
- Family history
- PSA results
- Previous prostate evaluations
- Specialist recommendations when appropriate
Men should report difficulty urinating, blood in the urine or semen, pelvic symptoms, or other concerning changes.
It can.
External testosterone may suppress the body’s natural signaling to the testicles, reducing sperm production and sometimes causing infertility.
Sperm production may recover after testosterone is discontinued, but the amount of time required varies and recovery cannot be guaranteed.
Men who currently want children—or may want children in the future—should discuss fertility preservation and possible semen testing before beginning testosterone.
Yes. Hormone therapy is not birth control.
Women who may become pregnant should discuss contraception and fertility plans with Jennifer. Hormone therapy may need to be discontinued if pregnancy occurs or is planned.
The timeline varies depending on the symptoms being treated, hormone prescribed, delivery method, dose, and individual response.
Some patients notice changes within several weeks, while others require more time, follow-up testing, or adjustments. Results are not immediate or guaranteed.
Pellet duration varies according to the patient, hormone, dose, activity level, metabolism, and other clinical factors.
Jennifer and Christopher will explain the anticipated treatment interval and follow-up laboratory schedule before placement.
Pellets are designed to dissolve gradually and are not routinely removed.
Removal may sometimes be possible, but it requires another procedure and may not be simple or complete. This is an important consideration when comparing pellets with pills, creams, patches, or injections that can be stopped or adjusted more quickly.
Potential side effects depend on the hormone, dose, delivery method, and individual patient.
Possible effects may include:
- Acne or oily skin
- Hair growth or hair changes
- Scalp hair thinning
- Mood changes
- Fluid retention
- Breast tenderness
- Spotting or bleeding
- Application-site reactions
- Changes in blood count
- Changes in fertility
- Symptoms associated with hormone levels being too high or too low
Pellet placement also carries procedural risks such as bruising, bleeding, tenderness, infection, scarring, extrusion, or delayed healing.
Your provider will review the risks specific to your prescribed treatment before you provide consent.
Laboratory results are only one part of the evaluation.
We also consider symptoms, health history, medications, sleep, nutrition, thyroid function, metabolic health, mental health, reproductive goals, and other possible contributors.
Hormone therapy may not be recommended if your evaluation suggests another condition should be addressed first.
Your initial educational HRT consultation is complimentary.
The required medical Good Faith Exam with Jennifer Graves is $75.
Laboratory testing, medications, pellet insertion, injections, nutraceuticals, and follow-up services are priced according to your individualized plan. You will receive personalized pricing before committing to treatment.
Take the First Step Toward Feeling Like Yourself Again
If fatigue, brain fog, sleep disruption, hot flashes, low libido, reduced strength, mood changes, or other symptoms are affecting your quality of life, a comprehensive hormone evaluation may help identify what is happening.
Begin with a complimentary HRT consultation at Metamorphosis Holistic MedSpa in Issaquah.
Complimentary Initial HRT Consultation
Comprehensive Good Faith Exam: $75
Personalized Hormone Therapy for Women and Men
Call or text 425-626-2436.
