The OS for hormone therapy — because two people on one dose can land far apart
iksa is the harness for n‑of‑1 medicine. Every titration runs like a dose-finding trial of one, and your nurse asks about the draw before a surprising level ever moves the dose.
Route, timing and assay decide what a level means for the next dose, and on menopausal therapy a progesterone level tells you very little
You titrate each woman and each man as a trial of one, watching what this dose did to this level and to how they feel. A woman’s testosterone runs below where direct assays hold up. You set men toward the middle of their range and keep women under the top of theirs.
- After each step, then every six months in women; in men, three to six months after starting, then at their yearly reviewTestosterone: One transdermal label asks for the draw before the morning dose and another two hours after it. An injection runs high early and low late, so the Endocrine Society draws midway between injections. The first re-test comes three to six weeks after a change in women, and in men two to four weeks by the AUA or three to six months by the Endocrine Society.
- Every draw in a woman, with a stop at six months without benefitTestosterone in women: Trials back it only for hypoactive sexual desire after menopause, a modest gain in a meta-analysis of 36 (The Lancet Diabetes & Endocrinology), given off-label by a non-oral route. You read its level, by mass spectrometry, as a guard against too much, not a target.
- Before the first dose, and when the total and the symptoms disagreeSHBG and free testosterone: Oral estrogen pushes SHBG up and leaves less testosterone free while a transdermal route barely moves it, so a change of route earns a new draw. Direct free assays mislead and the equations disagree, so you keep to one method.
- When symptoms persist or the route changesEstradiol and progesterone: Symptoms set the estradiol dose, and a serum level earns its place when they persist on a transdermal route or, in men, when breast symptoms appear. Progesterone follows the estrogen dose and the bleeding, because serum doesn’t show what the endometrium is getting. Endometrial cancer is the one boxed warning FDA is keeping, on systemic estrogen alone.
- At every dose reviewSafety labs: In men, hematocrit, which injections push hardest, blood pressure, a new class-label warning, and PSA against their first value, three to twelve months after starting and then as their screening calls for. In women on testosterone, lipids and liver tests before the first dose, then acne, hair and voice, which no panel shows. Moving on or off an oral estrogen brings triglycerides back into it, and clot risk, which rose on oral and not transdermal estrogen in a large observational study (The BMJ).
The patient’s testosterone was still inside the female range when their acne made the doctor cut the dose by a third
Their SHBG had come down, which may leave a little more of their testosterone free, and the acne on their jaw told the doctor the dose was already too much.
A level drawn before the morning dose and one drawn hours after it are different numbers, so we’d want to see which your protocol asks for, and at which lab.
Request a walkthroughRequest a walkthrough for hormone therapyA dose-finding trial draws every level on a clock at one central lab, while your patients draw when and where they can
Keeping one person on that clock for years would take a coordinator. In a clinic, the next step rests on your reading of the draw, its hour and its lab.
Sample timing
Which morning someone on injections comes in, whether they take that day’s dose before the draw and which re-test follows which step all get settled one message at a time.
Dose records
A lab report gives you a date and sometimes a collection time. The hours since the patient’s last dose, their route and that they applied near the draw site all live in your memory or your note.
Safety reporting
Acne, new hair or a lower voice in a woman, and swollen ankles or worse snoring in a man, tend to surface months after the step behind them. A trial’s safety log pairs each one with its step.
Assay comparison
Three testosterones from two labs, one by immunoassay, on two doses and at three hours: a trial pays a statistician to separate the step, the assay and the clock, and here your reading of the reports does.
A testosterone far above the patient’s last one starts with a question about the draw, and only then a question about the dose
A transdermal dose applied near the needle can spike the sample, so the test is a redraw from the other arm. The harness has their levels and your notes on their skin and desire, and the next step stays the doctor’s.
Each testosterone since the first dose comes back beside what the note said about the dose at the time
Clinical Intelligence lists each level with its date, quotes the notes on the dose and says so if nobody wrote down when the patient applied before a draw.
Clinical Intelligence: clinical AI and lab trackingThe nurse sees a testosterone flagged on the list and can ask the patient about the draw before the doctor weighs the dose
One click opens that marker onto its trend against its reference range. When someone writes in asking what dose a saliva panel calls for, Agentic CRM drafts from what you’ve already said about saliva testing, says where that stops and leaves the dose to a person.
Agentic CRM: scheduling and follow-upThe patient asks why the dose fell with their level in range, and Patient AI goes back to the acne the doctor noted
Patient AI explains what the doctor wrote, down to what the plan says about the patient’s dose on the morning of a draw, if it says anything. A message about new hair or a change in their voice goes through safety questions and can reach the nurse or doctor.
Patient AI: the treatment companion
The long-term safety record for testosterone in women is still to come, and the women on panels like yours could start it
When someone asks in Year 5 what the patient’s dose was when the acne started, the level, its report and the note are still there. De-identified and consented patient by patient, that history across your panel is the denominator a safety study with a research group would start from. What a first study on your dosing would take →
What a prescriber who reads each level with its route and its hour asks first
Does iksa know how long after the dose a level was drawn?
If someone wrote it.Each level keeps its date and its report, which is where a collection time sits if the lab printed one. The hours since the dose, the route and the arm are your reading, kept in your note, and Clinical Intelligence quotes them from there or says nobody wrote them down.
My patient’s last testosterone was mass spectrometry and this one is an immunoassay. Will it catch that?
No, the report shows it.Both sit on one trend line as total testosterone, with the method wherever the lab printed it, on the report each value cites. Each is checked against its source page first, and one that fails is held back. iksa won’t judge between two assays, so that reading stays yours.
Does it calculate free testosterone from the total and SHBG?
Not on its own.Total, SHBG and any free testosterone your lab reports each keep their own line and their report, and iksa doesn’t run an equation over them. If you calculate one, put the number and method in your note, and Clinical Intelligence quotes it back.
Will a woman’s testosterone sit on a man’s range?
The lab’s range and your target.Each value keeps the range the lab printed on its report, so check that the lab read her as a woman, and the line in your note is what Clinical Intelligence places her against.
Can anything here change a dose?
Only a prescriber.A step up, a step down or a stop is written by the prescriber in a note, and iksa reads the plan from that note. If the patient asks to go back up, Patient AI explains what you wrote, tells them that’s your call and, if they agree, flags it to your nurse.
I already pay for hormone therapy clinic software. What happens to it?
It stays.Your EHR keeps the chart, your booking system keeps the calendar and your prescribing stays wherever you do it today. iksa reads those charts by connection or by upload, then holds each patient’s years of levels, the reports behind them and your notes on each dose.
My HRT clinic software already runs the refills. Why would I want an OS for hormone therapy?
Refills aren’t the hard part.We call it the harness for n‑of‑1 medicine, because the best evidence for one patient’s next dose is what the last dose did to that patient, and it keeps that easy to find, with the draw and the note behind it.
What is n‑of‑1 medicine?All practicesiksa beside your EHRProtocol management softwareWhat iksa adds
What we’d ask first is how you set a dose: when you draw, and which lab you’d trust with a woman’s testosterone
Bring a protocol you run. We’ll walk one patient through it.