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Female Hormone Optimization

Three hormones.
One physiology.

Fatigue. Weight gain. Low libido. Brain fog. Night sweats. These aren’t things to “just deal with” — they’re measurable physiology. We test testosterone, estradiol, and progesterone together, because that’s how they work.

Testosterone · Estradiol · Progesterone

LC-MS/MS testing

FDA-approved medications

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THE PROBLEM

Real symptoms. Real mechanism.

Across the menopause transition, estradiol and progesterone don’t decline in a straight line — they swing, sometimes for years, while testosterone falls quietly alongside them. The effects show up everywhere those hormones work: sleep, mood, metabolism, bone density, cardiovascular risk, body composition.

Most of it gets treated one symptom at a time — a sleep aid here, an antidepressant there — or waved off as aging. At Peak it gets measured: three hormones, tested together, interpreted against your symptoms and your stage of transition.

The hormones

What we optimize.

01

Testosterone

Energy, libido, muscle tone, motivation, and cognitive clarity. The hormone most often skipped in women’s panels — and often the first one symptoms point to.

02

Estradiol

Brain health, bone density, cardiovascular protection, vaginal health, and metabolic regulation. The reason “hormone therapy” is a long-term health conversation, not just a symptom conversation.

03

Progesterone

Sleep, mood stability, cycle regulation, and balance with estrogen. The quiet half of the pair — dosed to work with your estradiol, not against it.

Who this is for

Perimenopause, menopause — or just not yourself.

  • Perimenopause symptoms your labs keep calling “normal”
  • Menopause — recent or years in — with sleep, mood, or energy that never recovered
  • Low libido, fatigue, or brain fog without a clear explanation
  • Weight that resists real effort, especially through the midsection
  • A long-term view — bone density, cardiovascular health, and healthspan, not just symptom relief
Age isn’t the criterion — symptoms, labs, and cycle status are. And hormone therapy isn’t the answer for every woman: the testing is what tells us whether it’s yours.

THE PROCESS

This is not a hormone clinic. This is precision medicine.

STEP 01
ASSESSMENT
It starts with listening — symptoms, cycle history, stage of transition, sleep, goals. Then we measure: a comprehensive panel by LC-MS/MS, with DEXA body composition, resting metabolic rate, and VO₂ max when indicated.
STEP 02
PROTOCOL
Dr. Lyall reviews everything directly — hormone ratios, transition stage, cardiometabolic and bone-health risk, symptom-to-biomarker correlation — and builds the plan from FDA-approved medications, with the delivery method matched to your physiology and your preference.
STEP 03
MONITORING
Labs repeat roughly every three months during optimization, with dose adjustments as your data and symptoms change. Once stable, monitoring settles to the cadence your biology calls for — not the calendar.

THE PANEL

Ratios matter as much as ranges.

A single hormone in a reference range says little about how the system is working together. We test the pair-wise balances — estradiol to progesterone, free to total testosterone — alongside the metabolic markers that move with them.
  • Testosterone, free and total LC-MS/MS
  • Sensitive estradiol LC-MS/MS
  • Progesterone
  • SHBG
    The carrier protein that sets how much hormone is actually available
  • LH & FSH
    The pituitary signals that date your stage of transition
  • DHEA-S, thyroid panel, vitamin D
    The systems symptoms get attributed to first
  • Metabolic, lipid, and insulin-resistance markers
    Because hormones and metabolism move together

If therapy is indicated

The right hormone. The right delivery.

We prescribe FDA-approved, bioidentical medications — molecularly identical to the hormones your body makes — and choose the delivery method with you, based on your physiology, your labs, and your preference.

Transdermal estradiol

Patches or creams; steady dosing with strong long-term evidence.

Vaginal estrogen

Rings and local options for genitourinary symptoms.

Oral micronized progesterone

Taken at night; supports sleep while protecting the uterine lining.

Testosterone

Cream or injection, dosed for women and monitored by LC-MS/MS.

Bioidentical pellets

A long-acting option when it fits — chosen for your physiology, never as a default.

Adjunctive therapies

When the data indicates them.

WHERE IT LIVES

One system, or all six.

Card A

Peak Foundations

The starting point. A targeted hormone panel, single-area optimization, and physician review of results — hormone optimization is exactly what Foundations was built for.
Explore Foundations
Card B

Peak Longevity

The full picture. Hormones managed alongside cardiovascular, metabolic, and strength data — all six systems — with comprehensive re-testing and continuous oversight built in.
Explore Longevity
We don’t bill insurance — that’s intentional. Superbills are available to submit on your own, and most services are HSA / FSA eligible.

“Deal with it” was never a treatment plan.

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Treatment is guided from our Meridian office, serving women across Boise, Meridian, and Eagle.