Hormone Optimization Program
Membership Information & Informed Consent

Purpose of This Consent

This document provides education and consent for participation in Navara Health's Hormone Optimization Program, a monthly membership for evaluation, treatment, and ongoing monitoring of hormone-related symptoms in women and men. It addresses program structure, membership terms, financial obligations, monitoring requirements, expected benefits, risks, alternatives, and the practitioner-patient relationship.

Understanding Hormone Imbalance & Treatment Rationale

Hormone levels can change due to aging, perimenopause, menopause, andropause, chronic stress, thyroid dysfunction, adrenal imbalance, metabolic dysfunction, illness, pregnancy and postpartum changes, certain medications, or lifestyle factors. Hormone Optimization Therapy at Navara Health aims to support physiologic hormone balance through individualized treatment using bioidentical hormones, lifestyle guidance, and ongoing laboratory monitoring.

I understand that hormone optimization is:

• Not an anti-aging cure or "fountain of youth" treatment
• Not disease-curative
• Intended to support symptom improvement and quality of life through evidence-informed clinical practice
• Provided alongside, not in place of, routine primary care and age-appropriate health screening

Program Overview & Membership Tiers

Optional Add-Ons (Either Program)

I understand that medication type, dose, and route of administration are determined by my provider's clinical judgment based on labs, symptoms, response, and safety considerations, and may change over the course of therapy.

Membership Terms & Billing

I acknowledge and agree that:

• This is a recurring monthly membership
• Auto-pay is required, and a valid payment method must remain on file
• A minimum 3-month commitment applies to allow adequate time for initial labs, dose titration, and clinical response
• After the initial 3-month commitment, 7 days' written notice is required to cancel; cancellations are processed at the end of the current billing cycle
• Cancellation requests must be submitted in writing to contact@navarahealthtx.com
• Membership fees cover provider time, expertise, monitoring, prescription management, and direct access — not guaranteed outcomes
• Failure to maintain an active payment method may result in paused or terminated care; in such cases, refills will be held until the account is current
• Missed payments do not constitute cancellation; written cancellation notice is required
• Reactivation after termination may require a new evaluation and is subject to provider acceptance

What Is Not Included

• Lab tests outside the program-included panel
• Specialty referrals or care outside the scope of hormone optimization
• Procedures, aesthetic services, or other services available at Navara Health (eligible for 10% member discount)
• Brand-name pharmacy medications obtained through external pharmacies (such as commercial estradiol patches or branded testosterone gels) — pricing follows the dispensing pharmacy
• Compounding pharmacy fees not included in the standard membership formulation

Monitoring & Follow-Up Requirements

Hormone therapy requires ongoing monitoring for safety and effectiveness. I agree to:

• Complete baseline labs prior to initiation
• Complete quarterly follow-up labs (every 12 weeks) during the titration phase while dose and protocol are being adjusted to achieve target therapeutic levels
• Transition to annual labs once optimized — once dose is stable and therapeutic levels are confirmed, monitoring moves to a yearly cadence with relevant safety markers
• Resume more frequent monitoring if labs become abnormal, dose changes are required, or new symptoms develop
• Attend scheduled follow-up visits (virtual or in-person)
• Promptly report symptoms, side effects, or concerns through the patient portal or phone
• Continue routine primary care and age-appropriate screenings, including but not limited to mammograms, pelvic exams and gynecologic care (women), prostate exams and PSA testing (men), colorectal cancer screening, dermatologic skin checks, bone density screening when indicated, and cardiovascular risk assessment
• Disclose any new medical diagnosis, hospitalization, or significant medical event during therapy
• Notify Navara Health if I become pregnant or am planning pregnancy

Potential Benefits (Not Guaranteed)

Individual responses vary, and no specific outcome is guaranteed. Potential benefits described in clinical literature may include:

• Improved mood, energy, libido, and overall quality of life
• Improved sleep quality
• Improved cognitive function and reduction in brain fog
• Reduction in hot flashes and night sweats (women)
• Improved muscle strength and recovery (especially men)
• Improved body composition and metabolic health
• Improvement in genitourinary symptoms of perimenopause and menopause (women)
• Improved sexual function

General Risks Applicable to All Patients

Sex-specific risks are addressed in the respective sections below.

Compounded Bioidentical Hormones

Many medications prescribed under this program are compounded preparations, including but not limited to compounded estradiol/progesterone capsules and topicals, low-dose testosterone for women, oxytocin, pregnenolone, and DHEA. I acknowledge that:

• Compounded preparations are not FDA-approved as finished drug products
• Compounded preparations are dispensed by licensed 503A or 503B compounding pharmacies pursuant to the Federal Food, Drug, and Cosmetic Act
• FDA-approved alternatives exist for some hormones and will be discussed with my provider when clinically appropriate
• A separate Compounding Pharmacy Authorization & Informed Consent applies and is incorporated by reference
• Pharmacy availability, sourcing, and pricing can change; my prescribed medication may need to be transitioned mid-therapy

Women's BHRT Program · Sex-Specific Section

Common Symptoms Addressed

• Hot flashes or night sweats
• Menstrual irregularity, perimenopausal cycles, or loss of periods
• Weight gain or difficulty losing weight
• Low libido or painful intercourse
• Fatigue, insomnia, or poor sleep quality
• Mood changes, anxiety, or depression
• Brain fog, memory issues, or difficulty concentrating
• Genitourinary symptoms of menopause (vaginal dryness, urinary frequency, recurrent UTIs)
• Bone health and muscle preservation

Medications & Routes

Women's BHRT may include one or more of the following, individualized to my clinical picture, menopausal status, and risk profile:

• Estradiol — commonly via transdermal patch, topical cream, oral, or vaginal route. The route of administration affects the cardiovascular and clotting risk profile.
• Progesterone — commonly oral micronized progesterone (Prometrium or compounded), prescribed for endometrial protection in women with a uterus receiving estrogen, and/or for sleep and mood benefit
• Testosterone (low-dose, for women) — at Navara Health, women's testosterone is prescribed as either subcutaneous or intramuscular injection (testosterone cypionate or enanthate) or as a compounded topical cream. Pellets are not used in our practice due to dose inconsistency and irreversibility concerns.
• DHEA, pregnenolone, oxytocin, and other supportive hormones as clinically indicated
• Vaginal estrogen (cream, tablet, or ring) for genitourinary syndrome of menopause

Women's HRT Risks

Women's HRT Contraindications & Cautions

• Personal history of estrogen-sensitive breast cancer, endometrial cancer, or other hormone-sensitive malignancy
• Personal history of venous thromboembolism (DVT, pulmonary embolism), stroke, or known thrombophilia
• Active liver disease
• Unexplained vaginal bleeding (must be evaluated before initiation)
• Pregnancy or planned pregnancy
• Known hypersensitivity to any component
• Caution with significant cardiovascular disease, smoking, severe migraines with aura, uncontrolled hypertension

Women's Lab Monitoring

Recommended labs may include, but are not limited to:

• Estradiol, progesterone, testosterone (total and free), SHBG
• DHEA-S, cortisol, pregnenolone (when indicated)
• FSH, LH (when indicated)
• Prolactin (at baseline; repeat as clinically indicated)
• TSH, free T3, free T4, thyroid antibodies (if thyroid optimization)
• CBC, CMP, lipid panel, hs-CRP, HbA1c, fasting insulin
• Vitamin D, B12, ferritin

I agree to ongoing age-appropriate breast and gynecologic screening with my primary care provider or gynecologist, including mammograms and pelvic exams.

Men's HRT Program · Sex-Specific Section

Common Symptoms Addressed

• Fatigue or low energy
• Reduced muscle mass or strength
• Increased abdominal fat or weight gain
• Low libido or erectile dysfunction
• Mood changes, irritability, or low motivation
• Brain fog or reduced mental clarity
• Poor sleep or sleep apnea (caution required)
• Loss of morning erections, reduced sexual function

Medications & Routes

• Testosterone cypionate or enanthate — injectable, intramuscular or subcutaneous, typically dosed up to 200 mg weekly (with weekly or twice-weekly administration to maintain physiologic levels)
• Compounded topical testosterone — cream or gel applied daily
• Adjunctive medications as clinically indicated, which may include HCG (to preserve testicular function and fertility), anastrozole or other aromatase inhibitors (used sparingly, only when clinically necessary — Navara prefers dose/frequency optimization over routine aromatase inhibition), enclomiphene (as an alternative pathway for testosterone restoration with fertility preservation)
• DHEA, pregnenolone, and other supportive hormones as clinically indicated

Men's HRT Risks

Men's TRT Contraindications & Cautions

• Active prostate cancer or untreated prostate cancer history
• Breast cancer (rare in men)
• Severe untreated obstructive sleep apnea
• Uncontrolled congestive heart failure
• Hematocrit greater than the safe threshold without correction
• Untreated severe lower urinary tract symptoms / BPH
• Recent cardiovascular event (within 6 months) — case-by-case
• Untreated severe depression with suicidality
• Desire for fertility without HCG / enclomiphene support
• Pregnancy of partner — testosterone gel/cream transfer to a pregnant partner can be harmful to the fetus
• History of opioid use disorder or active substance use disorder (additional caution and monitoring required)

Men's Lab Monitoring

Required baseline and follow-up labs include, but are not limited to:

• Total and free testosterone, SHBG
• Estradiol (sensitive assay)
• LH and FSH (baseline, to characterize primary vs. secondary hypogonadism)
• Prolactin (baseline, to rule out pituitary contribution; repeat as clinically indicated)
• PSA — at baseline, then yearly with annual prostate assessment
• CBC (with attention to hemoglobin and hematocrit) — at baseline, then quarterly during titration, then yearly once optimized
• CMP, lipid panel, HbA1c
• TSH and additional thyroid markers if applicable
• DHEA-S, cortisol, pregnenolone (when indicated)
• Vitamin D

Lab cadence: baseline, quarterly during titration, yearly once optimized. More frequent monitoring may be reinstated if labs become abnormal or new symptoms develop.

Fertility Disclosure

I understand that exogenous testosterone suppresses sperm production and can cause infertility, which may be reversible after discontinuation but is not guaranteed to return to baseline. If I wish to preserve fertility now or in the future, I will discuss adjunctive HCG, enclomiphene, or sperm banking with my provider before starting therapy.

Alternatives to Hormone Optimization

Alternatives may include, but are not limited to:

• No treatment
• Lifestyle modification (nutrition, exercise, sleep, stress management)
• Conventional medical management through primary care or specialty care
• Non-hormonal prescription therapies (e.g., SSRIs for vasomotor symptoms in women, PDE5 inhibitors for ED in men)
• FDA-approved hormone alternatives (e.g., FDA-approved estradiol patches, oral micronized progesterone, branded testosterone gels)
• Supplements or herbal approaches (limited evidence)
• Mental health counseling, sleep optimization, or nutritional therapy

I may decline or discontinue hormone therapy at any time, subject to the membership cancellation terms in Section 3.

Communication & HIPAA Authorization

I authorize Navara Health to communicate with me regarding scheduling, prescription management, lab results, monitoring, billing, and follow-up through:

• The secure HIPAA-compliant patient portal
• Email to the address I have provided
• SMS / text message to the mobile number I have provided
• Telephone calls to the number I have provided

I understand that email and SMS are not fully secure channels. I may revoke authorization for any specific channel in writing to contact@navarahealthtx.com, except where required for legally mandated notices.

Financial Policy & No-Refund Agreement

• Membership fees are non-refundable, regardless of symptom response or outcomes
• Lab tests outside the included panel may incur additional charges
• Navara Health does not bill insurance for hormone optimization services or compounded medications; superbills may be provided upon request
• I am financially responsible for all charges associated with my care
• Membership fees during the 3-month commitment period are non-refundable except as required by law
• Unused medication is non-refundable per dispensing pharmacy policy

Termination of the Membership

Navara Health reserves the right to terminate the membership and practitioner-patient relationship with written notice for:

• Non-payment of fees after written notice
• Repeated non-compliance with monitoring or treatment plan
• Failure to complete required lab monitoring
• Misrepresentation of medical history
• Diversion, misuse, or attempted diversion of controlled substances (men's TRT)
• Abusive, threatening, or harassing behavior toward providers, staff, or other patients
• Conduct that creates a clinical, legal, or safety risk for the practice

Where required by law, the practice will provide written notice and a reasonable continuity-of-care period (typically 30 days) for the patient to establish care elsewhere, except where immediate termination is warranted by safety concerns.

Assumption of Risk & Release of Liability

I voluntarily assume all known, unknown, and unforeseen risks associated with hormone optimization therapy. To the fullest extent permitted by law, I agree to release, indemnify, and hold harmless Navara Health, PLLC, Jessica Boggs APRN, the medical director, and all affiliated providers, nurses, staff, contractors, and agents from liability for:

• Adverse reactions or complications
• Side effects
• Lack of improvement or treatment failure
• Dissatisfaction with outcomes
• Long-term or delayed effects not yet known to medicine
• Effects related to FDA regulatory changes that affect compounding availability

This release does not apply to cases of gross negligence or willful misconduct, and does not waive any right that cannot lawfully be waived under the laws of my state of residence.

Dispute Resolution & Binding Arbitration

Any dispute, controversy, or claim arising out of or relating to this Consent, the Hormone Optimization Program, prescription of hormones, or the practitioner-patient relationship — including any claim of medical malpractice, billing dispute, or breach of contract — shall first be addressed by good-faith negotiation between the parties.

If the matter cannot be resolved through negotiation within thirty (30) days, the parties agree to submit the dispute to binding arbitration administered by a recognized arbitration body (such as the American Arbitration Association) under its applicable rules, with the arbitration to take place in Dallas County, Texas, unless otherwise required by the laws of the patient's state of residence.

The parties acknowledge that by agreeing to arbitration, they are waiving the right to a jury trial. This provision does not waive any right that cannot lawfully be waived under the patient's state law. Either party retains the right to seek injunctive or equitable relief in court where appropriate.

Governing Law & Severability

This Consent shall be governed by and construed under the laws of the State of Texas, except where the laws of the patient's state of residence require otherwise. If any provision is found unenforceable, the remaining provisions shall remain in full force and effect.

Emergency Disclaimer