We are a physician-led practice that tests your hormones properly, tells you what’s actually going on, and builds a treatment plan around your labs, your symptoms, and your life.
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Asheville • Hendersonville • Greensboro • Winston-Salem • North Charlotte • South Charlotte • Mooresville-Lake Norman
★★★★
Fred L, Charlotte
★★★★
Five different doctors couldn’t get my thyroid under control I suffered for years until I found Blue Sky.
Rachel L, Asheville
★★★★
My initial impression is very good. At my first appointment (labs) I had a more thorough exam than my PCP does for an annual physical. When I came in for my initial consultation that theme continued with the FNP taking the time to explain my lab results and what they meant to my health journey. At this time I am moving my TRT from my PCP.
Richard, Asheville
Most programs start with a prescription or a brief questionnaire. We start with your blood work. Here’s the path from “I’ve tried everything” to lasting results.
If your labs and symptoms point to hormone therapy, we’ll find a delivery method that works best for you. The route we choose depends on your levels, your goals, and how you want treatment to fit into your life. Here are some options we’ll walk through it together.
Steadiest levels · women & men
Tiny pellets of bioidentical testosterone or estradiol (about the size of a grain of rice) placed just under the skin during a simple in-office visit that takes about 15 minutes under local anesthetic. The pellets release small, steady, physiologic doses around the clock and then dissolve completely on their own; nothing is removed.
FOR
Women and men
HOW OFTEN
Every 3–4 months (women) or 4–5 months (men)
WHY IT’S CHOSEN
The steadiest levels of any method. No daily step, no weekly peaks and crashes. Many patients who never felt right on other delivery methods do well on pellets.
TRADE-OFFS
A brief in-office procedure each cycle; minor bruising at the site is common, and the dose can’t be adjusted until the next insertion.
Precise & adjustable
Bioidentical testosterone (cypionate or enanthate) injected once or twice a week. We teach you to self-administer at home. Most patients are surprised how easy it is.
FOR
Men (and select women at micro-doses, when clinically appropriate)
HOW OFTEN
Weekly or twice-weekly
WHY IT’S CHOSEN
Precise dosing that’s easy to fine-tune from your follow-up labs, no procedure required.
TRADE-OFFS
It’s on you to stay consistent, and levels dip slightly between doses compared to pellets.
Fertility-preserving · oral
Not ready for testosterone replacement or planning to have kids? Clomid is an oral medication that signals your body to increase its own testosterone production rather than replacing it. Because it preserves natural production and fertility, it’s often the right first option for younger men.
FOR
Men, especially those who want to protect fertility
HOW OFTEN
Oral, taken per your provider’s protocol
WHY IT’S CHOSEN
No injections, no replacement. Your own production does the work, and fertility is maintained.
TRADE-OFFS
It depends on how your body responds; your provider will monitor your labs and adjust.
Daily & adjustable
Compounded bioidentical creams and gels (applied daily) and oral progesterone are often part of a woman’s plan, and sometimes the gentlest way to start. Doses are easy to adjust; the trade-off is a daily routine and, for topicals, care to avoid skin transfer.
FOR
Often part of a woman’s plan; topicals for men in select cases
HOW OFTEN
Daily
WHY IT’S CHOSEN
Gentle starting point; doses are easy to adjust.
TRADE-OFFS
A daily routine, and care with topicals to avoid skin transfer.
In-network with most major primary-care plans; we'll help verify your benefits.
Clear, affordable options if you're uninsured, have a high deductible, or prefer not to use insurance.
Put pre-tax dollars toward your care.
Plenty of places will sell you testosterone or a pellet after a questionnaire. That’s not this. Blue Sky MD was founded by Dr. David LaMond, MD in 2008, and our physicians, nurse practitioners, and clinicians have spent nearly two decades helping North Carolinians understand their hormones. And most importantly, treating them only when the labs say it will help.
Medical Director & Founder
Program Director
★★★★
Everyone is so caring at BlueSky! This place has been life changing for me! Thank you for all that you do! Strongly recommend for anyone looking for help with weight management or hormone replacement treatment.
Selina M., Charlotte
★★★★
I’m down almost 30 lbs . I feel So much better . Thank you blue sky !
Debra L., Asheville
★★★★
I was a little nervous cuz it was my first time, talking about weight loss management. Even for a grown man it’s not always easy to talk about or being transparent. They did a wonderful job, helping me relax and they were very open in the communication process of how things work and id recommend them to anyone who wants to lose weight and get there life back on track!!
Scott M., Asheville
Hormones regulate your energy, weight, mood, sleep, focus, and sex drive. When they decline or drift out of balance (as they do for nearly everyone with age) the symptoms creep in slowly enough that most people blame stress, work, or age. Hormone imbalance is one possible explanation, and it’s one we can measure.
Often perimenopause or menopause
Often low testosterone
Bioidentical hormone replacement therapy restores the hormones your body is no longer making enough of. Most often this means testosterone, estrogen (estradiol), and progesterone.
BHRT uses hormones that are molecule-for-molecule identical to the ones your body produces. They’re derived from plant sources and formulated so your body processes them exactly like its own. That’s the difference the word bioidentical is pointing at: older synthetic hormones are chemically similar to yours; bioidentical hormones are chemically the same.
What BHRT is not: it isn’t a quick fix, an anti-aging miracle, or something we prescribe from a questionnaire. It’s medical treatment for a measurable deficiency, which is why everything at Blue Sky MD starts with comprehensive lab work, and why treatment is only recommended when your labs and symptoms support it.
SAFETY AND RESEARCH
For two decades, many women were told hormone therapy was dangerous. Much of that fear came from a 2002 study of older women, most of them years past menopause, taking synthetic hormones. Newer research tells a different story. In November 2025, the FDA began removing heart disease, breast cancer and dementia from the boxed warning on menopause hormone labels.
Here is what we know now about healthy women who start hormone therapy before age 60, or within 10 years of menopause:
Estrogen prevents bone loss and lowers fracture risk. It is one of the most effective tools we have against osteoporosis.
Starting early is favorable for heart health. Women who began near menopause had no increase in heart disease, and some studies showed lower risk and slower plaque buildup in the arteries. Starting more than 10 years after menopause can raise risk in some individuals.
Started early, hormone therapy does not harm memory, and some studies suggest a lower risk of Alzheimer's disease. Many women also notice better sleep, mood and focus once hot flashes settle.
In the largest trial, estrogen alone did not raise breast cancer risk. It lowered it. Estrogen combined with a progestin carries a small increase with longer use, less than 1 extra case per 1,000 women per year. Some research suggests bioidentical progesterone may carry less risk than synthetic progestins. Your personal and family history matters, so we review it before you start.
These are mostly a concern with estrogen pills. Patches, gels and creams carry a lower clot risk.
If you still have a uterus, estrogen alone raises the risk of uterine cancer. Adding progesterone protects the uterine lining.
This is more common with estrogen pills.
That is why we test first, use the lowest dose that controls your symptoms, and keep checking your labs.
Testosterone lowers sperm production, so it is not a fit if you are trying to conceive. It can also raise red blood cell levels, so we check your blood counts and PSA as part of your regular labs.
• have had blood clots, a clotting disorder, a stroke or a heart attack
• have had breast cancer or another hormone-sensitive cancer
• have active liver disease
• have unexplained vaginal bleeding
• are or might be pregnant
Sources: FDA, Nov 2025; The Menopause Society 2022 Hormone Therapy Position Statement; Endocrine Society testosterone guideline. Reviewed by Dr. David LaMond, MD, Medical Director.
Low energy, stubborn weight, mood swings and other symptoms are often tied to hormone and metabolic imbalances a standard physical won’t catch. Our advanced hormone panels & metabolic tests find the cause, so your hormone therapy or weight loss plan actually works.
See us in person or meet your provider by video. Lab draws, pellet insertions, and follow-ups happen at whichever clinic is local to you.
Most people assume hormone care is a cash-only luxury. At Blue Sky MD it usually isn’t. Because we’re a physician-led medical practice, many office visits, lab tests, and treatments may be billed through your primary-care insurance, depending on your plan, like any other medical care. And we check for you before you commit, so there are no surprises.
In-network with most major primary-care plans; we help verify your benefits first.
Clear, affordable options if you're uninsured, have a high deductible, or prefer not to use insurance.
Put pre-tax dollars toward your care.
Don’t let a guess about cost keep you from an answer about your health. The assessment is free; we’ll explain your coverage before you spend anything.
Effective menopause relief customized for your symptoms.
During menopause, women may experience insomnia, low energy, anxiety and depression, mood swings, sudden weight gain, and low libido.
Low estrogen after menopause speeds up bone loss. Hormone therapy can ease symptoms and help protect bone density for the right patient.
Increase your confidence and restore vitality.
Many men experience imbalanced levels of testosterone, estrogen, and thyroid hormones as they age. As men age, a natural decline in testosterone, in particular, can lead to bone loss, fatigue, depression, erectile dysfunction, and difficulty sleeping.
BHRT for men offers a holistic approach that helps restore balance to the hormones that control cognition, weight gain, libido, and lean muscle growth.
Bioidentical Hormone Replacement Therapy Pellets
Testosterone Self-Injections
Clomid Medication
Symptoms & conditions related to hormone imbalances
When we aren't feeling well physically, we tend to also feel tired or depressed...
Anxiety can be one of the first signs of an underlying thyroid issue...
Loss of lean muscle mass, increased appetite, and lower metabolism are all symptoms that affect weight gain.
A lack of key hormones can make us feel sluggish or low on energy...
From metabolism to heart rate, sleep cycles, reproductive cycles, body temperature, and mood, hormones...
Hair loss isn't just genetic—it can also be the sign of a treatable hormone imbalance...
Joint tissues contain estrogen receptors, and as menopause progresses, estrogen levels also drop...
HRT can help reduce the frequency and severity of hot flashes, which are a common symptom of menopause...
Hormones play a huge role in sexual arousal. A lack of sex hormones can cause dryness or erectile dysfunction...
During menopause, hot flashes can interrupt sleep and begin a cascade of additional problems...
As we age and our hormone levels decline, our mental clarity declines as well...
Estrogen therapy can help prevent bone loss and reduce the risk of osteoporosis...
It depends. If we’re able to bill insurance, out-of-pocket costs may vary. If you have insurance, we are happy to file for your office visit and the procedure (which will require a co-pay).
Self-pay options are available if you do not have insurance or have a high deductible.
HRT (hormone replacement therapy) is the general term for replacing hormones your body is no longer making enough of. BHRT (bioidentical hormone replacement therapy) uses hormones that are molecularly identical to the ones your body makes, such as estradiol, progesterone and testosterone. At Blue Sky MD, your provider recommends the type, dose and delivery method (pellets, injections or other options) based on your labs, symptoms and goals.
It varies. Some patients feel a difference within a few days, while others notice changes over a week or two as their levels rise. Your provider rechecks your labs and adjusts your dose during your first 90 days, and most patients feel the full benefit once their levels are dialed in.
Take the Hormone Quiz or Health Assessment, then we schedule your comprehensive labs and consult at the location nearest you or by telehealth.
Often, yes. Many office visits, labs and treatments can be billed through your primary-care insurance, depending on your plan. We check your benefits before you commit.
There are several types of hormone therapy available. The type prescribed a physician will depend on a patient’s symptoms and particular needs. Some common types of hormone therapy include:
Estrogen Therapy
This is the most commonly prescribed type of HT and is used to relieve symptoms of menopause such as hot flashes and vaginal dryness. It can be taken in the form of pills, patches, gels, or creams.
Progestin Therapy
Progestin is a synthetic form of progesterone. When a woman needs progesterone, we usually use bioidentical progesterone.
Testosterone Therapy
This type of therapy is typically prescribed for men who have low levels of testosterone, a condition known as hypogonadism. Testosterone therapy can be administered in the form of gels, patches, or injections.
Thyroid Hormone Replacement Therapy
This type of therapy is used to treat low thyroid hormone levels, a condition known as hypothyroidism. Thyroid hormone replacement therapy can be taken in the form of pills.
Bioidentical Hormone Therapy
This type of therapy uses hormones that are chemically identical to those naturally produced by the body. They are usually customized to the individual patient based on their hormone levels and symptoms.
Hormone therapy isn’t a weight loss treatment on its own, but correcting a measurable hormone deficiency can make weight easier to lose. Low estrogen or testosterone can slow metabolism, increase fat storage around the midsection and make it harder to keep lean muscle.
In a review of Blue Sky MD patient data led by our medical director, Dr. David LaMond, men who combined hormone therapy with our nutrition program lost on average 20–25% more weight than men on the nutrition program alone, and women lost about 10% more.
Individual results vary, and we only recommend hormone therapy when your labs and symptoms support it.
Lower estrogen after menopause is also linked to bone loss and a higher risk of osteoporosis. For many women, hormone therapy relieves hot flashes, night sweats, sleep problems and other symptoms, and estrogen therapy can help protect bone density. Your provider will review the benefits and risks for your health history.
Pellets are made up of either estradiol or testosterone. The hormones are pressed or fused into very small solid cylinders. These pellets are larger than a grain of rice and smaller than a ‘Tic-Tac’.
In the United States, the majority of pellets are made by compounding pharmacists and delivered in sterile glass vials. There is an ‘FDA approved’ 75 mg testosterone pellet.
Many patients prefer pellets because they release a steady dose of hormones over several months, with no daily pills, creams or injections.
Implants, placed under the skin, consistently release small, physiologic doses of hormones providing optimal therapy.
Because they release hormones steadily, pellets avoid the daily or weekly ups and downs some patients notice with other methods. Many patients report better relief from hot flashes, sleep problems and low libido once their levels are steady.
The insertion of pellets is a simple, relatively painless procedure done under local anesthesia. The pellets are usually inserted in the lower abdominal wall or upper buttocks through a small incision, which is then taped, closed.
Complications from the insertion of pellets include; minor bleeding or bruising, discoloration of the skin, infection, and the possible extrusion of the pellet. Other than slight bruising, or discoloration of the skin, these complications are very rare. Testosterone may cause a slight increase in facial hair in some women. Testosterone stimulates the bone marrow and increases the production of red blood cells.
Some patients begin to ‘feel better’ within 24-48 hours while others may take a week or two to notice a difference. Diet and lifestyle, along with hormone balance are critical for optimal health. Stress is a major contributor to hormone imbalance and illness. Weight loss is often helpful to optimize the effectiveness of pellet therapy.
If you have insurance, we are happy to file for your office visit and the procedure (which will require a co-pay). Self pay options are available if you do not have insurance or a have a high deductible.
Most side effects are mild and show up in the first few weeks while your dose is adjusted. They can include acne, bloating, breast tenderness, headaches and mood changes. Your 4-week lab check is where we fine-tune your dose to ease them. Call us if a side effect is severe or does not go away.
Yes. Hormones often start to shift years before your last period. Menopause is when you have gone 12 months in a row without a period, usually between ages 45 and 55. Many women feel symptoms like poor sleep, hot flashes and mood changes during the years before that. Testing during perimenopause helps us see what is changing and whether treatment makes sense.
