Rosenheimer Str. 6-8, 83043 Bad Aibling, Germany · info@clinicum-stgeorg.de
Hormonal Health
St. George Hospital tests the full hormone panel before anything is prescribed: thyroid, adrenal, sex hormones, IGF-1, melatonin and insulin, with free fractions and binding proteins. Where a deficiency matches your symptoms, we replace it with bioidentical preparations at physiological doses and repeat the blood work at 6–12 week intervals.
Sleep that does not restore. Weight that will not move. A libido you barely remember. You raised it once and were told it is part of getting older, or you were handed a prescription that treated one symptom and created two. Hormone assessment is one part of our longevity and preventive medicine program, and it starts with measurement rather than with a product.
Hormones are the body's chemical messengers. They regulate metabolism, energy production, mood, cognition, sleep, immune function and body composition. Their levels change with age: estradiol and progesterone fall sharply at menopause, testosterone declines gradually in men, DHEA falls from the thirties onward, melatonin output decreases and thyroid regulation becomes less reliable.
The symptoms that bring patients to us are fatigue, weight gain, brain fog, mood changes, decreased libido, poor sleep, muscle loss and reduced stress tolerance. Some of these are hormonal deficiencies that respond to replacement. Some are not, and a hormone prescribed for a non-hormonal problem is a wasted year. The difference is made in the laboratory, not in the consultation room.
Our testing therefore goes beyond total levels: free fractions, binding proteins (SHBG, thyroid-binding globulin), metabolites and ratios are measured, and the physician reads them against your symptoms before deciding whether a hormone is the cause.
The panel is the same for everyone; the therapy is not. The evidence grade in each card refers to replacement in people with a measured deficiency and matching symptoms.
TSH, free T3, free T4, reverse T3 and thyroid antibodies. Overt hypothyroidism is replaced with levothyroxine, where needed with T3; the evidence is strong. For a normal TSH with symptoms, the evidence that thyroid hormone helps is limited, and we look for other causes first.
For women around and after menopause: estradiol, transdermal where possible, with micronized progesterone when the uterus is present. The evidence for relief of hot flushes and night sweats and for prevention of bone loss is strong; the risks are known and are discussed before the first prescription.
In men with low morning testosterone on two measurements and symptoms, replacement is standard endocrinology and is covered on our men's hormone page. In postmenopausal women, low-dose testosterone has moderate evidence for low sexual desire and limited evidence for anything else.
Morning cortisol, a diurnal cortisol curve where the history suggests it, and DHEA-S. Adrenal insufficiency is a medical diagnosis and is treated as one. DHEA replacement in older adults has limited evidence; see below.
IGF-1 is measured as a marker. We do not prescribe growth hormone for aging; the evidence does not support it and the risks are real. Sleep, resistance training and protein intake are the levers we use for IGF-1.
Melatonin for circadian disturbance and sleep onset, at low doses. Fasting insulin and HbA1c are part of every panel because insulin resistance changes how every other hormone behaves; it is treated with diet, exercise and, where needed, medication.
Therapy is prescribed on the ward, after the panel is in, and adjusted while you are here so that the first response can be seen before you travel home. The rules we hold to:
The practical side of prescriptions, routes and monitoring is described on the hormone therapy page.
The evidence for menopausal hormone therapy is strong for vasomotor symptoms and bone. The 2022 position statement of the North American Menopause Society confirms hormone therapy as the most effective treatment for hot flushes and night sweats and for prevention of bone loss, with the most favorable benefit-risk ratio in women under 60 or within ten years of menopause onset (The 2022 Hormone Therapy Position Statement Advisory Panel, Menopause, 2022). The Endocrine Society guideline reaches the same conclusion and recommends individualizing the decision by age, time since menopause and cardiovascular and breast-cancer risk (Stuenkel et al., Journal of Clinical Endocrinology and Metabolism, 2015).
The risks are also well measured. In the Women's Health Initiative, the combined estrogen plus progestin arm in 16,608 postmenopausal women was stopped early because invasive breast cancer, coronary events, stroke and pulmonary embolism were more frequent than with placebo, while hip fractures and colorectal cancer were less frequent (Rossouw et al., JAMA, 2002). The women in that trial were on average 63 years old; later analyses by age are the reason the guidelines now distinguish early from late starters.
The evidence for custom-compounded "bioidentical" mixtures is limited and the Endocrine Society's scientific statement finds no rationale for prescribing them routinely, because their dose and purity are not tested (Santoro et al., Journal of Clinical Endocrinology and Metabolism, 2016). We use regulated bioidentical products for that reason.
The evidence for DHEA in older adults is limited. In a two-year placebo-controlled trial of 87 elderly men and 57 elderly women, DHEA (and low-dose testosterone in men) raised blood levels but produced no physiologically relevant change in body composition, physical performance, insulin sensitivity or quality of life (Nair et al., New England Journal of Medicine, 2006). We prescribe DHEA only for a measured deficiency with a specific indication, and we tell you what that trial found.
What the evidence does not show: no trial has shown that raising a hormone from the lower part of the normal range into the upper part extends life, prevents dementia or reverses aging.
The panel is drawn on the morning of day one, fasting, between 07:00 and 09:00 because testosterone and cortisol follow a daily rhythm. Results are in within two to three days; the physician discusses them with you and, where a therapy is indicated, starts it during the stay. Most patients combine hormone assessment with the healthy-aging program or with treatment for the condition that brought them here. At discharge you receive the prescription, the monitoring schedule and a letter for your own physician.
Two articles from our journal go deeper: what a full hormone panel tests and what it means, and a guide to bioidentical hormone therapy for men and women.
Costs are individual: a package price plus individual add-ons. After a physician has reviewed your findings, you receive a written, itemized cost overview: a package price plus individual add-ons. Treatment is self-pay; the invoice is itemized in English with diagnoses and procedure descriptions for out-of-network review. See Costs and insurance and, for travel and the video consultation before you come, Information for international patients.
Related pages
Prescriptions, routes, monitoring schedule and contraindications for bioidentical replacement.
Testosterone testing and replacement in men, with the TRAVERSE and Testosterone Trials evidence.
The laboratory behind the panel: methods, turnaround and what we measure alongside hormones.
How hormones, gut, mitochondria and inflammation are read together in one consultation.
Used alongside hormone therapy in the longevity program when mitochondrial markers are low.
Interval hypoxia-hyperoxia training for mitochondrial capacity, 10–15 sessions per course.
A bioidentical hormone has the same molecular structure as the hormone your body makes, for example estradiol, micronized progesterone or testosterone. Many are regulated pharmaceutical products. The term says nothing about dose or safety on its own; a bioidentical hormone at the wrong dose carries the same risks as any other.
For healthy women under 60 or within ten years of menopause, current guidelines judge the benefits for hot flushes, night sweats and bone loss to outweigh the risks. Combined estrogen plus progestin raises the risk of breast cancer, stroke and blood clots with longer use, which is why we review the indication every year.
Sometimes, but we say so plainly when the evidence is limited. A value inside the reference range with symptoms is a reason to look for another cause first: thyroid antibodies, iron, sleep, medication. Prescribing a hormone to push a normal value higher has not been shown to help in trials and can do harm.
Blood work is repeated 6–12 weeks after each dose change, then every six to twelve months. Men on testosterone have hematocrit and PSA checked; women on estrogen have breast and endometrial checks with their own physician. We write the monitoring schedule into the discharge letter so it can be continued at home.
Costs are individual: a package price plus individual add-ons. After a physician has reviewed your findings, you receive a written, itemized cost overview: a package price plus individual add-ons. Treatment is self-pay; the invoice is itemized in English with diagnoses and procedure descriptions for out-of-network review.
If you already have hormone results, send them with a short history. A physician reads them before the video consultation and tells you whether a repeat panel or a therapy is the next step.
The initial inquiry is free of charge. The International Office reviews your message and your case directly and gets back to you.
Munich Airport (MUC), about 60 minutes by car.
