Hormonal MOTs: Menopause & Andropause Checks at Lambert Medical Practice

Understanding Hormonal Transitions: Why They Matter

Hormones act as chemical messengers that regulate virtually every bodily function. When hormone levels decline or become imbalanced—whether due to natural ageing, lifestyle factors, or underlying health conditions—the effects can significantly impact quality of life.

For women, the perimenopausal and menopausal transition typically begins in the mid-40s, though it can start earlier or later. This transition involves declining ovarian function and fluctuating hormone levels, particularly oestrogen and progesterone. The process can span several years and produces a wide range of symptoms that affect physical health, mental wellbeing, and daily functioning.

For men, testosterone levels naturally decline from around age 30, dropping approximately 1-2% per year. Whilst this is a gradual process unlike the more abrupt female menopause, it can result in noticeable symptoms collectively termed andropause or late-onset hypogonadism. Not all men experience problematic symptoms, but for those who do, the impact on vitality, mood, and metabolic health can be substantial.

The Case for Proactive Hormonal Assessment

Traditional medical approaches often wait until symptoms become severe before investigating hormonal health. Lambert Medical Practice advocates a more proactive stance. A hormonal MOT provides baseline measurements, identifies early changes, and enables timely intervention before symptoms significantly impair quality of life.

Early assessment is particularly valuable because:

• Hormonal symptoms often develop gradually and can be attributed to stress, ageing, or other factors
• Establishing baseline hormone levels helps interpret future changes
• Early intervention may prevent progression of symptoms and associated health risks
• Non-hormonal and lifestyle interventions are most effective when started early
• Cardiovascular and bone health considerations can be addressed proactively

Women's Hormonal MOT: Perimenopause and Menopause Pathways

Menopause is defined as the permanent cessation of menstruation, confirmed after 12 consecutive months without a period. However, the perimenopause—the transitional years leading to menopause—often produces the most troublesome symptoms and can last 4-10 years.

Recognising Perimenopausal and Menopausal Symptoms

Women experiencing hormonal transition may encounter a diverse range of symptoms, though not everyone experiences all of them. Common manifestations include:

Vasomotor Symptoms: Hot flushes and night sweats affecting sleep and daily activities, intensity varying from mild warmth to profuse sweating, frequency ranging from occasional to multiple times hourly, and often triggered by stress, alcohol, caffeine, or warm environments.

Psychological Symptoms: Mood changes including irritability, anxiety, or low mood, difficulty concentrating and memory problems ("brain fog"), reduced motivation and energy levels, and increased emotional sensitivity.

Physical Symptoms: Irregular periods—heavier, lighter, more or less frequent, vaginal dryness and discomfort during intercourse, reduced libido, joint and muscle aches, headaches, breast tenderness, and changes in skin and hair quality.

Sleep Disturbance: Insomnia or difficulty staying asleep, often compounded by night sweats and racing thoughts.

Metabolic Changes: Weight gain, particularly around the abdomen, changes in cholesterol levels, and increased cardiovascular risk.

Long-term Health Risks: Accelerated bone density loss increasing osteoporosis risk and increased cardiovascular disease risk post-menopause.

What's Included in Women's Hormonal MOT?

Our comprehensive women's hormonal assessment includes:

Initial Consultation (30 minutes): Detailed symptom history including type, severity, and impact on daily life, menstrual history and pattern changes, family history of menopause, osteoporosis, cardiovascular disease, and breast cancer, current medications and contraception, lifestyle factors including diet, exercise, alcohol, and smoking, and discussion of treatment goals and preferences.

Hormone Blood Tests: FSH (Follicle Stimulating Hormone) and LH (Luteinising Hormone) to assess ovarian function, oestradiol levels, thyroid function tests (TSH, T4, T3) as thyroid disorders can mimic menopausal symptoms, testosterone levels (yes, it's important for women too), DHEA-S (adrenal hormone), and prolactin if indicated.

Metabolic and Cardiovascular Screening: Lipid profile (cholesterol and triglycerides), fasting glucose and HbA1c (diabetes screening), liver and kidney function, and vitamin D levels (important for bone health).

Risk Assessment: Bone density (DEXA scan) if appropriate risk factors present, cardiovascular risk calculation using age, blood pressure, cholesterol, and other factors, and breast cancer risk assessment.

Follow-up Consultation (20-30 minutes): Detailed explanation of blood results, discussion of diagnosis and prognosis, exploration of treatment options including HRT, non-hormonal medications, and lifestyle interventions, shared decision-making about management plan, and prescription or referral as appropriate.

Hormone Replacement Therapy (HRT): Evidence-Based Prescribing

When appropriate, Lambert Medical Practice prescribes body-identical HRT following National Institute for Health and Care Excellence (NICE) and British Menopause Society guidelines. Our approach is individualised based on your symptoms, medical history, and preferences.

Types of HRT Available: Oestrogen-only HRT for women who have had a hysterectomy, combined oestrogen and progesterone HRT for women with a uterus (progesterone protects the womb lining), transdermal preparations (patches or gels) often preferred to reduce clot risk, and testosterone supplementation for women with persistent low libido despite adequate oestrogen.

Benefits of HRT: Highly effective relief of hot flushes and night sweats (often 80-90% reduction), improvement in mood, sleep, and concentration, prevention of bone density loss and fracture risk reduction, relief of vaginal dryness and genitourinary symptoms, possible cardiovascular benefit when started early in menopause, and improved quality of life across multiple domains.

Risks and Considerations: Small increase in breast cancer risk with combined HRT used long-term (less than 1 extra case per 1000 women per year), very small increased risk of blood clots with oral oestrogen (transdermal has lower risk), small stroke risk increase in older women, and individual risk profile varies based on age, time since menopause, and personal/family history.

We discuss these risks and benefits in detail, using absolute risk numbers rather than relative percentages to help you make an informed decision. For many women, the benefits substantially outweigh the small risks, particularly when HRT is started within 10 years of menopause and continued for the duration needed to control symptoms.

Non-Hormonal and Lifestyle Approaches

Not all women wish to take HRT, and some have contraindications. Lambert Medical Practice offers comprehensive advice on alternative approaches:

Lifestyle Modifications: Regular exercise (particularly weight-bearing for bone health), Mediterranean-style diet rich in phytoestrogens, calcium and vitamin D optimisation, weight management to reduce hot flush severity, stress management techniques, alcohol and caffeine reduction, and smoking cessation.

Non-Hormonal Medications: SSRIs or SNRIs (antidepressants at low dose) for hot flushes and mood, gabapentin for vasomotor symptoms, vaginal moisturisers and lubricants for genitourinary symptoms, and cognitive behavioural therapy (CBT) for mood and hot flush management.

For patients seeking additional support, our medical weight-loss programme can help address menopausal weight changes, whilst advanced blood testing provides deeper insight into metabolic health.

Men's Hormonal MOT: Andropause and Testosterone Assessment

Male hormonal health receives less attention than female menopause, yet testosterone decline and associated symptoms affect a substantial proportion of middle-aged and older men. Lambert Medical Practice provides comprehensive andropause assessment in a supportive, judgement-free environment.

Recognising Andropause and Low Testosterone Symptoms

Testosterone affects multiple body systems, and deficiency can manifest in various ways:

Physical Symptoms: Reduced energy and persistent fatigue despite adequate sleep, decreased muscle mass and strength, increased body fat, particularly abdominal obesity, reduced bone density (osteoporosis risk), and gynaecomastia (breast tissue enlargement) in some cases.

Sexual Symptoms: Reduced libido or sexual desire, erectile dysfunction, reduced spontaneous erections (particularly morning erections), and difficulties achieving orgasm or reduced intensity.

Psychological Symptoms: Low mood, irritability, or depression, reduced motivation and drive, difficulty concentrating and memory problems, increased anxiety, and loss of confidence.

Sleep Disturbances: Poor sleep quality, increased daytime sleepiness, and sleep apnoea (which can itself cause low testosterone).

It's crucial to note that these symptoms have many potential causes beyond testosterone deficiency. Depression, sleep disorders, obesity, diabetes, thyroid disease, and various medications can all produce similar symptoms. Thorough assessment is essential to identify the true cause.

What's Included in Men's Hormonal MOT?

Our comprehensive men's hormonal assessment includes:

Initial Consultation (30 minutes): Detailed symptom assessment using validated questionnaires, sexual health history, energy and mood evaluation, assessment of muscle mass changes and exercise capacity, medical history including chronic conditions, medications, and previous hormone testing, lifestyle factors including stress, sleep quality, diet, alcohol, and exercise, and family history of hormonal or metabolic conditions.

Comprehensive Hormone Blood Tests: Total testosterone (must be taken fasting between 7-11am when levels peak), free testosterone or calculated free testosterone, sex hormone binding globulin (SHBG), LH and FSH to determine if deficiency is primary (testicular) or secondary (pituitary), prolactin (elevated levels suppress testosterone), oestradiol (aromatisation of testosterone to oestrogen), and DHEA-S (adrenal androgen).

Related Health Markers: Thyroid function tests (hypothyroidism mimics low testosterone), full blood count (testosterone affects red blood cell production), lipid profile and cardiovascular risk assessment, liver and kidney function, fasting glucose and HbA1c (diabetes commonly coexists with low testosterone), PSA (prostate specific antigen) for men over 40, and vitamin D levels.

Physical Examination: Blood pressure and BMI measurement, assessment of body composition and fat distribution, testicular examination if clinically indicated, breast examination if gynaecomastia present, and signs of other endocrine disorders.

Follow-up Consultation (20-30 minutes): Comprehensive review of blood results with clear explanation, confirmation or exclusion of testosterone deficiency, discussion of underlying causes (primary vs secondary hypogonadism), exploration of treatment options, risks, and benefits, and development of personalised management plan.

Testosterone Replacement Therapy (TRT): When and How

Testosterone replacement is only appropriate when biochemical deficiency is confirmed (typically total testosterone consistently below 12 nmol/L with symptoms, though thresholds vary between laboratories). We never prescribe testosterone for "optimisation" in men with normal levels.

Forms of TRT Available: Transdermal testosterone gel (daily application, maintains stable levels), intramuscular testosterone injections (typically every 10-14 weeks, administered in clinic), testosterone undecanoate injection (less common, longer duration), and transdermal patches (less commonly used due to skin reactions).

Expected Benefits of TRT: Improved energy and reduced fatigue (often the earliest benefit), increased libido and sexual function, improved mood and sense of wellbeing, increased muscle mass and strength (especially with resistance exercise), reduced body fat, improved bone density, and possible cardiovascular benefits (research ongoing).

Benefits typically emerge gradually over 3-6 months, with maximal effects at 12 months. Not all symptoms necessarily improve, particularly if other factors are contributing.

Risks and Monitoring Requirements: Increased haematocrit (red blood cell concentration) requiring monitoring, possible worsening of sleep apnoea, acne and oily skin in some men, testicular atrophy (reduced size), suppression of sperm production (TRT is not suitable for men trying to conceive), possible acceleration of pre-existing prostate cancer (though TRT doesn't cause prostate cancer), and rarely, mood changes or increased aggression.

Regular monitoring is essential and includes testosterone levels (checked at 3 months, then 6-monthly), full blood count (haematocrit monitoring), liver function tests, PSA (prostate monitoring for men over 40), lipid profile, and clinical symptom review.

Non-Hormonal Approaches to Andropause Symptoms

Not all men require or wish to start TRT. Many symptoms can be improved through lifestyle optimisation:

Weight Management: Fat tissue converts testosterone to oestrogen, creating a vicious cycle. Weight loss alone can significantly improve testosterone levels. Our structured weight-loss programme provides comprehensive support.

Exercise: Resistance training increases muscle mass and can boost testosterone, whilst aerobic exercise improves cardiovascular health and metabolic function.

Sleep Optimisation: Most testosterone is produced during deep sleep. Addressing sleep disorders (particularly sleep apnoea) can substantially improve levels and symptoms.

Stress Reduction: Chronic stress elevates cortisol, which suppresses testosterone production. Stress management techniques, adequate rest, and addressing work-life balance are important.

Medication Review: Certain medications suppress testosterone, including opioids, steroids, and some antidepressants. Where possible, we review and optimise medications.

Treatment of Underlying Conditions: Type 2 diabetes, obesity, thyroid disorders, and depression all affect testosterone and should be managed optimally.

Interpreting Hormone Results: More Than Just Numbers

Hormone test results must always be interpreted in clinical context. At Lambert Medical Practice, we never diagnose or treat based on numbers alone. Instead, we consider:

• Symptom correlation: Do the results explain your symptoms?
• Reference ranges: These are population averages, not personal optimal levels.
• Timing of tests: Hormones fluctuate throughout the day and month.
• Age-appropriate expectations: A 50-year-old won't have the hormone levels of a 20-year-old.
• Other contributing factors: Medications, stress, illness, and lifestyle all affect results.
• Repeat testing: A single abnormal result may not be significant; confirmation is often needed.

We provide clear, written explanations of your results during follow-up consultations, ensuring you understand what they mean for your health and what actions, if any, are appropriate.

Follow-up and Ongoing Hormonal Health Management

Hormonal health management is not a one-off intervention but an ongoing process. Lambert Medical Practice provides structured follow-up tailored to your needs:

If Starting Hormone Treatment

Regular reviews ensure treatment is effective and safe:

• 3-month review: Symptom response assessment, blood tests to check hormone levels and safety markers, dose adjustment if needed, and side effect management.
• 6-month review: Continued symptom monitoring, repeat safety bloods, and refinement of treatment regimen.
• Annual reviews thereafter: Once stable, annual appointments with blood tests ensure ongoing appropriateness and safety of treatment.

If Pursuing Non-Hormonal Management

Lifestyle interventions benefit from clinical oversight:

• 6-month symptom and lifestyle review
• Repeat blood tests annually to monitor natural hormone changes
• Reassessment of treatment options if symptoms progress

Our flexible appointment system, detailed in our private GP services article, ensures you can access timely reviews without extended waits.

Integration with Broader Health Optimisation

Hormonal health doesn't exist in isolation. At Lambert Medical Practice, we integrate hormonal assessment into comprehensive health strategies:

For patients interested in detailed metabolic profiling, our AI-enhanced blood testing provides extensive analysis beyond standard hormone panels. Those experiencing persistent fatigue may benefit from exploring NAD⁺ therapy alongside hormone optimisation.

Athletes and active individuals seeking performance optimisation can combine hormonal assessment with our medical IV therapy programmes. All interventions are medically supervised and evidence-based.

Evidence-Based Practice: Our Commitment

Hormonal health is an area unfortunately prone to misinformation and over-treatment. Lambert Medical Practice commits to:

• Following national and international clinical guidelines (NICE, BMS, Endocrine Society)
• Prescribing only when clinically appropriate based on symptoms and biochemical confirmation
• Providing balanced information about benefits and risks
• Never exaggerating benefits or minimising risks of treatments
• Respecting patient autonomy in treatment decisions
• Maintaining ongoing professional development in endocrinology and hormonal health

We recognise that informed patients make better health decisions. Our consultations provide time for detailed discussion, questions, and shared decision-making, as outlined in our approach to comprehensive private GP care.

Booking Your Hormonal MOT in Surbiton

If you're experiencing symptoms that may be hormonal, or simply wish to understand your hormonal health status as part of proactive wellness, booking a hormonal MOT is straightforward. The process typically involves an initial consultation (which can be arranged within one week), followed by blood tests (taken at a convenient local laboratory or in our clinic), and a follow-up appointment once results are available (usually 7-10 days later).

Lambert Medical Practice is located in Surbiton with excellent access from Kingston upon Thames and across South-West London. We offer flexible appointment times including early morning and evening slots to accommodate working schedules. All fees are transparently displayed in our booking system, with no hidden charges.