Decisions We Make
Specific questions. Specific reasoning.
Functional medicine attracts marketing. These are examples of the actual clinical decisions behind the labels — what we choose, when, and why.
When do we order a Dutch test vs. a standard hormone panel?
The Dutch is a dried urine test that measures hormone metabolites — how your body processes estrogen and cortisol, not just their levels. We order it when the question is metabolism (estrogen dominance subtypes, cortisol rhythm disruption, methylation status) rather than simple replacement. The cost is higher; the data answers a specific question. We don’t run it on every patient because every patient doesn’t need it.
When do we use pellets vs. injections vs. topicals for testosterone?
Pellets for stable long-term replacement in patients who tolerate them well and prefer a low-maintenance approach. Injections when we need to titrate frequently, when pellets haven’t been the right fit, or in patients whose response is highly variable. Topicals for patients who prefer a lower-intervention approach and don’t mind daily application. The decision is matched to the patient, not defaulted to what the practice sells most of.
When do we order a GI-MAP vs. a standard stool test?
When the clinical history suggests pathogens, dysbiosis, parasitic infection, or intestinal permeability that won’t show on a basic panel. We don’t order advanced GI testing reflexively. The test is expensive, and most patients with digestive symptoms don’t need it as a first step. We order it when the picture justifies the cost and the likely treatment plan will change based on the result.
When do we use GLP-1 medications — and when don’t we?
When a patient’s metabolic profile, history of weight struggle, and goals align with what the medication can actually do. Not as a shortcut for someone whose issue is structural or behavioral. Not without body composition tracking. Not without an exit plan. Our MAWL program puts GLP-1s in a full clinical context: labs, supervision, body composition, nutrition, and an explicit off-ramp. A prescription without that context is a missed opportunity, and sometimes a harm.
When do we refer out?
When the problem is primarily surgical. When imaging suggests something a radiologist or specialist is better positioned to interpret. When the patient needs a second opinion on a significant decision. When the condition is outside our scope — pediatrics, obstetrics, active cancer care, post-event cardiology. Recognizing when we’re not the right physician is part of being the right physician.