Ur·gent Primary Care for Men and Women

/ˈərjənt/ adjective

(of a state or situation) requiring immediate action or attention.

(of action or an event) done or arranged in response to a pressing or critical situation.

(of a person or their manner) earnest and persistent in response to a pressing situation.

Like our TRT services, we bring Consistent, Quality, and More Enjoyable General Medical Care to Your Mobile Device or Desktop With Our Online Video Platform

Treatments covered by Texas health insurance or self pay

Between the Ears

Listen to your Heart

Between the Sheets

I just need some Primary Care Help

Primary Care: illness + Aliment + Symptoms


Itchy eyes


Seasonal allergies

Sinus congestion

Cold & Flu





Nausea & vomiting


Sore throat




Pink eye

Yeast Infections






Acid Reflux

Bitter taste and dry cough



Stomach Issues





Stomach ache



Shortness of breath

Tight chest


Fungal Infections

Athlete's Foot

Jock Itch


Yeast infections


A1C Blood Sugar Test

What is A1C?

The A1C test shows you and our MyCare providers a picture of your average blood glucose (blood sugar) levels for the past 2 to 3 months. The test is used to identify prediabetes, determine if you have diabetes or used to monitor the effectiveness of your diabetes treatment. This is an important test.

Some may call the A1C test a hemoglobin A1C, HbA1c, glycated hemoglobin, or glycohemoglobin test.

Hemoglobin /ˈhēməˌɡlōbən/ is the part of a red blood cell that carries oxygen from the lungs to cells all over the body.

Glucose attaches to hemoglobin in your blood cells.

  • The A1C test show how much glucose is attaching to hemoglobin.
  • The A1C test shows you the average percentage of blood glucose levels over the past 3 months.
  • Low hemoglobin levels may indicate that a person has anemia.

A normal A1C level is below 5.7%.

There is a standard Hemoglobin A1C Reference range that all providers use to determine diabetic risk.

  • Normal: <5.7%
  • Prediabetes: 5.7%–6.4%

If your A1C level is between 5.7 and less than 6.5%, your levels have been in the prediabetes range.

  • Diabetes: >6.4%

If you have an A1C level of 6.5% or higher, your levels were in the diabetes range.

Why should a person get the A1C test?

  • The A1c test can not only help determine prediabetes but the test can identify if lifestyle changes should be made to delay or prevent type 2 diabetes.
  • It is the primary diagnostic test to find out if someone has diabetes.
  • The test is used by providers to monitor diabetics on treatment.

According to the CDC, 50.0% for those diagnosed with diabetes have a A1c value of 7% or higher. The prevalence report shows that 16.3% of adults between 18 to 44 years had A1C levels of 10% or higher, 12.7% of those between 45 to 64 years and 4.3% of those aged 65 years or older.

What causes diabetes?

Diabetes (Type 1, Type 2, and prediabetes) has a stronger link to family history and genetics play a role in the onsite of prediabetes and type 2.

Type 1 diabetes is when your body doesn’t produce insulin. (less prevalent at 5% of all diabetes cases).

Type 2 diabetes is when your body doesn’t use insulin properly.

What is prediabetes?

Prediabetes is when your blood sugar (blood glucose) levels are higher than they should be, but not high enough to be diagnosed as diabetes. High blood glucose (Hyperglycemia) can damage the blood vessels that send blood to organs increasing chances for heart disease, stroke, kidney disease, vision and nerve damage.

Having prediabetes is serious because long-term high blood sugar increases your chance of developing type 2 diabetes.

Most of the risk factors that increase the chance of developing type 2 diabetes are the same for prediabetes.

Reference, Reference, Reference


If your family has a history of diabetes, lifestyle can accelerate the development and severity of type 2 diabetes. Obesity is a common trait that influences the onset of diabetes as families tend to have similar eating and exercise habits.

If you have a family history of type 2 diabetes, you are not guaranteed to develop type 2 diabetes, but you are certainly susceptible. Many researchers confirm that exercising and losing weight can delay or prevent prediabetes and type 2 diabetes.

  • Being overweight is a primary cause for prediabetes and diabetes. The more fat you have inside and around the muscle or belly the more resistant your cells become to insulin. An indication of insulin resistance is a large waist line. Resistance goes up for men with waist lines that are larger than 40 inches and 35 inches for women.

According to the CDC, 89.0% for those diagnosed with diabetes are overweight.

  • The less active you are, the more susceptible you are to the development of diabetes. Physical activity like exercise or house chores helps you control your weight by using sugar in the body for energy and makes the body use insulin.

According to the CDC, 38.0% for those diagnosed with diabetes are less active.

  • Eating processed or red meats and drinking sugary drinks is associated with a higher risk of prediabetes.
  • While diabetes can develop at any age, the chances increases after age 45.
  • People of certain races including African Americans, Hispanics, Native Americans, Asian Americans and Pacific Islanders are more prone to developing diabetes. It’s unclear as to why among the medical research community.
  • Women with irregular menstrual periods (polycystic ovary syndrome) a higher risk of the development of diabetes.
  • People who snore or suffer from obstructive sleep apnea have an increased risk of insulin resistance.
  • Smoking or dipping may increase how to body uses insulin.

68.4% of Americans with diabetes also have high blood pressure.

43.5% of Americans with diabetes also have high cholesterol.


What are the signs of diabetes?

The signs and symptoms of both type 1 and 2 diabetes do not differ.

Type 1 diabetes is typically diagnosed in younger children and type 2 diabetes is primarily diagnosed in adults.

Early diabetes may not produce any symptoms at all. With the increasing numbers of obesity in children and adolescents has natural influence in the development of type 2 diabetes in young people. Some researchers have found that adults with diabetes may be diagnosed with a form of late onset type 1 diabetes.

  • Frequent urinating
  • Constant fatigue / tiredness
  • Feeling thirsty constantly
  • Increased appetite even though you are eating normally
  • Tingling, pain, or numbness in fingers and toes (possibly type 2)
  • Blurry vision
  • Cuts/bruises that are slow to heal
  • Weight loss—even though you are eating more (possibly type 1)

For women, gestational diabetes often has no symptoms, so it's important for at-risk women (family history or preexisting) to be tested at the right time during pregnancy.

Reference, Reference

How can you prevent diabetes?

The best preventive tool to stop or delay type 2 diabetes is weight loss or management and increasing daily physical activity. Anyone can get started with weight management by eating fewer calories each day.

The primary goal for weight loss and management is to stay calorie deficit regularly for a period of time. Calories are the units of energy you get from food and drink. When consuming fewer calories the body taps into the fatty areas to find energy to stay running.

There are 3 ways the body uses calories:

  • Resting energy expenditure: the calories your body uses functions that keep you alive and alert, such as heart pumping, breathing and blood circulation.
  • Effect of food: These are calories the body expends while processes food through digesting, absorbing, and metabolizing nutrients.
  • Activity energy expenditure: This is moving or working out. These are the calories you expend during exercise and non-exercise related activities, walking the dog or household chores.

If diet and exercise isn’t enough, your provider will start you on medication. Not everyone with diabetes needs the same types of medication.

Diabetes medication can supply insulin (injectable insulin) or the medication can help the body respond better to existing insulin (oral medication). If prescribed insulin either your body doesn’t produce it or your body doesn’t use it correctly.

Metformin is usually the starting medication for most patients but some people cannot tolerant the medication or have a bad reaction. There are many formulas of oral diabetes medication so you might take one or a few. There are several types of injectable insulin available for your provider to prescribe. Each type starts to work at a different “onset” speed.

  • Rapid-acting starts working after 15 minutes, peaks at 1hous and lasts 2 to 4 hours.
  • Short-acting starts working within 30 minutes, peaks at 2 to 3 hours and lasts 3 to 6 hours.
  • Intermediate-acting starts working within 2 to 4 hours, peaks at 4 to 12 hours and lasts 12 to 18 hours.
  • Long-acting starts working several hours after injection with no peak.


How to start A1c testing and diabetes risk assessments?

Our MyCare providers will order a test to a lab near you. Once we have the results, they can make recommendations on lifestyle and diet changes to improve your A1c levels. Routine lab tests are necessary for anyone that has diabetes regardless of whether it is being managed by lifestyle changes or by medication. The MyCare provider will recommend timing of lab tests to make sure your A1c levels are under control.

Acid Reflux, Heartburn, GERD

What is acid reflux?​

Acid reflux occurs when stomach acid is allowed to enter the esophagus. The esophagus and stomach are separated by a seal consisting of a group of muscles called the esophageal sphincter. The sphincter usually remains closed until you swallow. With acid reflux, the muscles of the sphincter are relaxed and remains open. This can allow stomach acid into the lower esophagus and cause irritation.

With Rise MyCare, Acid reflux, heartburn, or GERD (gastroesophageal reflux disease) is made seamless. No need for a waiting room to treat these very common conditions.

We offer coupons and help you find the most cost-effective RX. These medications can get expensive and we do not like that.

Prescribes are effective at preventing acid reflux. While antacids provide relief, it's temporary. After a quick medical evaluation from one of our Board Certified Medical Providers, we'll have your prescription ordered. We'll connect you with the experts.

What is Gastroesophageal Reflux Disease?​

Gastroesophageal Reflux Disease (or GERD) is when acid reflux occurs two or more times a week. GERD is more serious than periodic acid reflux, and can lead to more severe complications if left untreated.

What causes GERD?​

GERD is caused by a weakening of the muscles that control the esophageal sphincter that separates the stomach from the esophagus. Several things can cause this weakening:

  • Obesity
  • Medications like antihistamines, calcium-channel blockers, asthma medications, and painkillers
  • Smoking
  • Pregnancy
  • Hiatal hernia – a tear in the diaphragm that allows the stomach to move into the chest, unlike the more common hernia that can happen in the groin.

What are the symptoms of GERD?​

  • Heartburn – pain in the middle of the chest or upper abdomen
  • Difficulty swallowing or a lump in the throat
  • Nausea or vomiting
  • Acidic taste or bad breath
  • Shortness of breath

Diagnosis and Treatment of GERD​

Our Providers will evaluate your symptoms and health history from our online questionnaire.

If symptoms are severe enough or persist once treated, our providers can discuss how an endoscopy or an X-ray barium swallow may be required.

GERD symptoms can be improved with lifestyle or dietary changes:

  • Stay upright for several hours after meals. Laying down or reclining can allow food and acid into the esophagus.
  • Avoid acid causing foods like fatty foods, alcohol, tomatoes, citrus fruit, etc.
  • Avoid over-eating. Stretching the stomach will put strain on the esophageal sphincter
  • Lose weight if needed
  • Quit smoking

Antacids neutralize stomach acid and may help with heartburn and indigestion symptoms. They are available over-the-counter but may not work as well as other treatment options that our providers can discuss with you.

Some examples of antacids include:

  • TUMS
  • Milk of magnesia
  • Alka-seltzer
  • Pepto-bismol

H2 blockers help decrease acid production in the stomach. H2 blockers are used for faster or as needed relief than Proton Pump Inhibitors (see below). They are available over-the-counter in smaller doses or by prescription, which may work more efficiently.

Some examples of H2 blockers include:

  • Ranitidine (Zantac)
  • Cimetidine (Tagamet)
  • Famotidine (Pepcid AC)

Proton Pump Inhibitors (PPIs) are medications that help reduce the amount of acid produced in the stomach and are used for long-term treatment compared to H2 blockers. They also help heal the lining of the esophagus. They are available over-the-counter in smaller doses or by prescription, which are which may work more efficiently.

Some examples of PPIs include:

  • Omeprazole (Prilosec)
  • Pantoprazole (Protonix)
  • Esomeprazole (Nexium)

There are also surgical options to improve symptoms if the GERD is severe.


Complication with GERD everyone should be aware of:

  • Esophageal stricture (narrowing) occurs when scar tissue develops where stomach acid has damaged the esophagus. The scar tissue leads to a narrowing of the esophagus and can make it difficult to swallow.
  • Esophageal ulcers are caused by stomach acid damaging the tissue of the esophagus and causing sores. These ulcers can cause bleeding and pain, as well as difficulty swallowing.
  • Barrett’s esophagus is a condition where the tissue on the esophagus becomes damaged by long-term GERD and is replaced by intestine-like tissue. Barrett’s esophagus increases the risk of esophageal cancer.

Acne Treatment and Prevention

What is acne?

Acne is a skin condition that occurs when hair follicles in the skin become clogged. Follicles are tubes that connect the pore on the surface of the skin to oil glands that secrete an oil called sebum. Sebum helps lubricate skin and hair and protects them from drying out. The sebum can clump together with dead skin cells and hair and plug the follicle. Bacteria in the plug can cause swelling and irritation in the skin.

Acne is most prevalent on the forehead, face, chest, back, and shoulders because there are a lot of oil glands in these areas.

While usually attributed to young people going through puberty, acne can happen to people of all ages, even infants.

What causes acne?

Hormones are one of the most common causes of acne. Testosterone stimulates the skin’s oil glands to produce sebum – this is why acne is so prevalent in teens, puberty increases androgen levels (males hormones including testosterone) in both adolescentboys and girls.

Medication can also cause acne. Some birth control pills can cause increased sebum production, increasing the risk of developing acne. That being said, some acne in women can be treated with birth control as well.

Corticosteroids, like prednisone, can also increase the risk of acne. Corticosteroids mimic androgens produced in the body and can cause increased sebum production in the skin.

High-glycemic foods like white breads, white rice, donuts and pastries, and potatoes can cause increases in sebum production as well.

Family history can also increase the risk of acne. If your parents had or have acne, you are at an increased risk. There is no specific gene mutation that has been identified to cause acne, however, some families tend to produce more dead skin cells which can clog pores.

What does not cause acne?

  • Hygiene – acne is not caused by dirty skin
  • Greasy foods do not increase the risk of having acne
  • Cosmetics – especially oil-free make up, it also helps to remove makeup regularly

What are the signs of acne?

  • Whiteheads (plug that remains under the skin)
  • Blackheads (plug at the surface, the dark color is a reaction to the air)
  • Papules (red bumps, they can be painful)
  • Pustules (pimples - papules with pus on top)
  • Nodules (solid lumps in the skin, often painful)
  • Cystic lesions (pus-filled lumps in the skin, often painful)

Symptoms vary depending on severity of the condition.

Reference, Reference, Reference, Reference, Reference

How to start acne treatment?

Our MyCare providers will evaluate your symptoms and the history of your condition. They will ask you how long you’ve had acne, any medications you are taking, what skin products you are using, and if you have a family history of acne.

From there, they can make recommendations on how to improve your acne and write prescriptions if needed.


If you’ve been trying to manage acne on your own for several weeks without success, you may need prescription medication to clear up your skin. Acne medications can reduce oil production, promote health skin cell growth, treat skin infections, or reduce skin inflammation.

The goal of these medications are to control and clear acne, avoid scarring, and make existing scars less noticeable. It may take several weeks or months for you to see improvement in your skin, and it may take years for the acne to completely resolve. Treatments will depend on age and severity of your acne.

What are treatment options for acne?

Topical medications for acne treatment

  • Retinoids and retinoid-like drugs are derived from vitamin A and help exfoliate dead skin cells. They also promote the production of new skin cells. Medications include Retin-A, Differin, Tazorac, and others.
  • Antibiotics kill excess bacteria on the skin and help reduce redness. Topical antibiotics often include benzoyl peroxide. Medications include Benzaclin, Duac, and Benzamycin. Topical antibiotics may be combined with retinoids.
  • Benzoyl peroxide is used to reduce the amount of bacteria that cause acne and dry the skin to prevent excess of oil in the skin.
  • Azelaic acid has been shown to have antibacterial properties. Prescription options of Azelex and Fiancea are an option during pregnancy or for breast-feeding mothers.
  • Salicylic acid helps prevent hair follicles from plugging up.
  • Aczone is a gel used for inflammatory acne. It is used mostly in adult females.

Oral medications for acne treatment

  • Oral antibiotics are used for more severe cases of acne. They are used to reduce bacteria and inflammation and are often used in combination with a topical treatments like Benzoyl Peroxide to improve results and prevent the risk of developing antibiotic resistance. Medications include tetracyclines like minocycline or doxycycline or a class of antibiotic called macrolides.
  • Combined oral contraceptives are used for acne in women who also want a contraceptive. These medications contain estrogen and progestin and help lower the amount of androgens in the body. Medications include Ortho Tri-cyclen, Estrostep, and Yaz. There is an increased risk of blood clots with these medications, so it is important to thoroughly discuss all options with your Rise MyCare provider before starting these medications.
  • Spironolactone is an anti-androgen agent that blocks the effects of androgens on the oil glands in the skin. It can also reduce the production of androgens by the body. It is used in women and adolescent girls if antibiotics aren’t working.

Erectile Dysfunction or Premature Ejaculation Treatment

What is erectile dysfunction (ED)?

Erectile Dysfunction (ED) is the inability to get or maintain an erection suitable for satisfying sex. In short, ED occurs when there is not enough blood flow into the penis and too much blood flow out. The Lack of blood flow happens in part by an enzyme called PDE5. The goal of our treatment is to increase blood flow into the penis helping you get and maintain an erection.


Before ED was ED, the term impotence was first reported in 1948 by researchers from the University of Indiana where they addressed the occurrence of sexual dysfunction in the general population. They surveyed 12,000 males who self-reported ED – at the time, 1% in men were under 19 years of age, 3% of men under 45 years, 7% younger than 55 years and 25% showed signs by age 75. In a follow up study in 1979, a similar survey revealed over 5000 men (42%) admitted to erectile dysfunction. Reference

What causes erectile dysfunction (ED)?​

An erection is a sequence of events where the brain sends signals throughout the body triggering psychological and physical actions to send blood flow to the penis. If any one of those triggers are off, you have ED. Erectile dysfunction causes by a number of medical conditions or psychological issues.

Performance anxiety, depression, schizophrenia, other psychological disorders.

Remember back when you were younger and just the thought of sex gave you an erection thinking about sex. Negative thoughts in general can prevent an erection from popping up.

Erectile dysfunction is generally considered to be primarily mental and less physical if erections continue during sleep or when men wake up with morning wood. Depression, anxiety, or other problems can affect both erections and sex drive. Outside factors like issues at home or work certainly impact your thoughts. One of the more common phycological roadblocks for men both young and old is performance anxiety.

Performance anxiety is a complex topic that may be as simple a worry how you look or a more intense situation when worrying about premature ejaculation. Some men worry about pleasing their partner. Others may worry about being a novice in the bedroom. All of these phycological issues can be addressed and reversed.

Physical issues may be tougher to identify on your own, but they can show themselves in your daily life or in the bedroom.

Frequent or worsening ED may be a sign of more serious conditions commonly found in men like:

  • Cardiovascular disease, stroke, diabetes, obesity, or high blood pressure. ED may also be a sign of hormone imbalance and low testosterone, which are both bothersome, but treatable conditions.
  • Neurological Causes: Multiple sclerosis, Parkinson’s disease, Spinal cord and nerve injuries may lead to loss of nerve signals from the brain to the penis.
  • Certain medications account for 25% of all cases of ED. High blood pressure medications and some antidepressants some and painkillers may be to blame. It’s important to list all mediations when you are filling out our providers diagnostic and medical history online surveys.
  • Surgery around the groin may impact nerves and blood flow to the penis causing ED.
  • In extreme cause, penile abnormalities may surface after an accident like a fall or hard impact to the groin.
  • Obesity and excess fat is linked to ED and more common in men with high blood pressure and diabetes.
  • High cholesterol in the blood can damage the blood vessels impacting blood flow to the penis causing ED.
  • ED is 64% more common in men with sleep apnea. Studies show that the sleep disruption may be related to low blood oxygen levels while men sleep. ED caused by sleep apnea can be treated and reserved with a CPAP or other treatment devices to improve sexual function. Snoring is a telling sign that you may have sleep apnea.

What Are the signs and symptoms of ED?​

ED may start with softer or less frequent erections. Some men may experience erections that don’t last long enough for satisfying sex while other men are unable to get an erection at all. Aside from these noticeable experiences, a common sign of ED is the lack of morning erections.

If you’re unable to have satisfying sex for any of these reasons, you may have ED. If you’re experiencing low sex drive or premature ejaculation, those may not be corrected by ED treatment but we can go over those conditions during your evaluation.

Like many things that decrease with age, erections are one of those conditions on the list to look after for men. While it is normal for life to get in the way of sex, it’s important to be aware when stress, financial constraints, or relationship issues can decrease your desire for sex and impact your erections.

Unhappy sex life or loss of intimacy with partners can lead to anxiety and depression.

What causes a weak erection?

To sum up the above, erection problems can have many causes.

  • Physical or psychological problems disrupt communication between the brain and penis as detailed above.
  • Other health problems, such as diabetes, high blood pressure, anxiety, stress, and depression impact the trigger portion of the erection sequence.
  • Side effects of certain medicines.
  • Drinking too much alcohol or smoking.
  • Surgery below the waist, such for prostate cancer, can impact erections.

Does erectile dysfunction last forever?

Depending on the cause, erectile dysfunction can be “cured” meaning an improved for good or avoided without the need for ED medication, surgery, injections, or implants. With the right diagnosis, support, and treatment, it’s possible for ED to go away without the need for ED mediation. Men should not have issues spontaneously getting an erection.

At what age does ED start?

There is no specific age where ED starts hindering men, but there is plenty of data showing that problems start showing themselves over 50 years old. According to several studies, the curve increases to 26% in age group 50 to 59 years and 40% in men age 60 to 69 years.

Men in their 20s and 30s are usually in their sexual peak with no issues in the bedroom; however, some men under the age of 40 can certainly experience ED. The numbers show it. The numbers of younger men experiencing ED has grown over the last decade. While most younger men may have psychogenic symptoms, physical issues can hinder a healthy erection.  Reference, Reference

Erectile dysfunction in fit and healthy young men: psychological or pathological?

Sexual dysfunction in the United States: prevalence and predictors

Erectile Dysfunction in Young Men

One patient out of four with newly diagnosed erectile dysfunction is a young man

How to start ED treatment?​

The standard and most effective treatment for ED is oral PDE-5 inhibitors but, on average, 30-35% of men do not see positive outcomes from the oral medication. Intracavernosal injections are proven secondary options for men who experience ED.

The body is supposed to releases nitric oxide (NO) when its sexually stimulation sets in but when experiencing ED, that mechanism does not fire off.

Oral ED medication helps increase the effects of nitric oxide (NO) to assist men who have trouble getting or keeping an erection.

The medication stops the enzyme called phosphodiesterase-5 (PDE-5) from hindering the levels of cGMP, the chemical to makes the penis hard.

ED mediation helps relax the muscles in the penis allowing blood to flow in and become erect. Reference, Reference

What is sildenafil?

Sildenafil citrate has been the de facto medication to treat erectile dysfunction for many years. Sildenafil is the generic form of name brand Viagra. This ED mediation is part of the oral PDE-5 inhibitors family. If someone says they are on Viagra, there is a high probability that they are simply on generic sildenafil.

Generic Viagra® should be taken without food 30 minutes to an hour before sex and its effects last up to 6-8 hours.

What is tadalafil?

Tadalafil is active ingredient in name brand Cialis®. Tadalafil is the generic form. This ED of medication works similar to sildenafil but Tadalafil stays active in the body for 36 hours (commonly called “the weekend pill.” This ED mediation is part of the oral PDE-5 inhibitors family and is also used to treat benign prostatic hyperplasia.

Is sildenafil the same as tadalafil?

Sildenafil has been around the longest and cheaper than tadalafil for several reasons. Sildenafil works well for occasional sex and “when the time is right.”  It begins to work after 30 minutes must be taken on an empty stomach.

Tadalafil is more expensive because it’s provides more flexibility for spontaneous erection lasting 36 hours. It’s better for men that want to be prepared. Flexibility is nice when you’re going out on a date or hitting the town. It can be taken with or without a meal.

Many men alternate between sildenafil and tadalafil, depending on the occasion.

Vardenafil and Avnafil are other PDE-5 inhibitors to treat ED. These two generics can be found under their brand names: Levitra, Staxyn, and Stendra. Each medication has the same goal in mind, but they provide varies levels of potency and advantages. It’s good to have options if standard medications do not improve your symptoms.

Vardenafil is more expensive than sildenafil, because it is 10 times more potent and has shown to result in less side effects.

What are some alternatives to Oral ED Medication?

Intracavernosal injections (penile self-injection) include prescription TriMix or BiMix medicines that men self-inject directly into the penis.

Most men begin injection therapy with Trimix, which is a mixture of 3 ingredients: alprostadil, phentolamine, and papaverine. These ingredients work by relaxing the smooth muscle and opening the blood vessels in your penis, causing an erection.

TriMix therapy is recognized as a viable treatment for erectile dysfunction by the American Urological Society and has a 90% success rate.

TriMix is standard and effective treatment, especially for those patients who have not had positive results, or experience moderate to severe side effects from oral PDE-5 inhibitors, (sildenafil, tadalafil, etc). Reference

How to start ED treatment?

Our Board-Certified Providers will evaluate your symptoms you report through our online forms and medical history then setup a telehealth video chat to diagnose your symptoms. If they determine that a prescription is necessary, they will call a script into your local pharmacy or we will mail the ED prescription directly to you.

What should I tell my Provider?

The online forms will prompt you to answer all of the questions needed to determine if you are experiencing ED. However, it is important to disclose any problems with your heart, liver, kidneys, vision disorders, bleeding disorders, or penile deformities.

Our Providers have designed the forms based on the latest guidelines issued by the regulating medical boards.

American Urological Association Guidelines

European Association or Urology Guidelines

Mayo Clinic's: The Princeton III Consensus Recommendations for the Management of Erectile Dysfunction and Cardiovascular Disease

Is prescribing ED medication online safe?

Yes, our Board-Certified Providers review your symptoms and medical history to determine the best treatment option. If there is a diagnosis of erectile dysfunction, they may prescribe one of the PDE-5 inhibitors to treat ED (Sildenafil, Tadalafil, Vardenafil or injectables). Providers can call in a script to your local pharmacy or we can mail your prescription directly to you. We only use FDA 503B Registered and PCAB Accredited Pharmacy’s to source any medication. All medications are manufactured by pharmaceutical companies that are regulated by the FDA.



What is the First Pass Metabolism?

First Pass Metabolism is a phenomenon that occur in our body when we’re digesting medication while it absorbs through our blood stream and liver before taking effect. In turn, we are able to reap the benefits much faster!  Source

The Many Benefits of Tadalafil:

While treating Erectile Dysfunction with Tadalafil (Generic Cialis) is common place, there are many other incredible benefits as well.

It’s been known to help with:

  • Enlarged Prostate – (BPH: benign prostatic hyperplasia)
  • Pulmonary Hypertension: Tadalafil has been shown to treat high blood pressure in the lungs as the active ingredient reduces blood flow in certain areas of the body allowing blood to flow freely.
  • Diabetes: Erectile dysfunction is one of the most common complications of diabetes and also one of the most underdiagnosed. Source
  • Depression & Stress: Tadalafil simply improves Quality of Life. Source
  • Memory Function

Common side effects of ED Medication:

The most common side effects of ED medication may lead to headache, flushing, stuffy nose, upset stomach, indigestion.

More Serious side effects that are rare include an erection that will not resolve even after 3–4 hours (priapism), hearing loss, which can be sudden, and vision loss in one or both eyes. For more information about side effects, see sildenafil side effects below.

ED mediations should never be used with nitrates, such as nitroglycerin, because they reduce low blood pressure. Alpha blockers, such as alfuzosin, terazosin, or tamsulosin, can cause the same effect of low blood pressure when taken with ED mediations. Any antihypertensives (medications to lower blood pressure) in combination with ED mediations can also interact, causing low blood pressure.

ED medications may interact with similar medications like bosentan, cimetidine, conivaptan, imatinib, isoniazid, antidepressants, antibiotics, antifungals, drugs to treat high blood pressure or a prostate disorder, heart or blood pressure medications, hepatitis C medications, or HIV/AIDS medicines. Reference, Reference

In a 2003 survey of 31,742 men from across the U.S. ages 53 to 90 were polled to understand how age and other common aging factors affect rates of erectile dysfunction in the male population. The findings showed the following results for those who experience ED:

Moderate or severe ED issues were reported by 12% in men younger than 59, 22% in men 60-69 years old, and 30% of the men over 69 years old.

Problems increased with age. The report shows men over 50 years old had more severe ED issues due to inactive lifestyle, obesity, and other medical conditions or medications.

How often should I use Tadalafil?

The tablets will dissolve sublingually in about 4-5 minutes and goes into effect in about an hour.

The tablets can be stored at room temperature and are good for 180 days from the date made.

Tadalafil (Generic for Cialis) dissolvable tablets are now available to the public and 50% cheaper than name brand Cialis. The benefits of Tadalafil typically last about 36 hours and equally as effective as name brand. This is great news, gentleman! Higher doses of Cialis can cost almost $2000 for 30 tablets….

(Pronounced tə-DAL-ə-fil)

The reason we prescribe these dissolvable tablets is to skip what is called - First Pass Metabolism.

By skipping First Pass Metabolism you get a quicker and more effective response to the medication.

We prescribe Tadalafil Dissolvable Tablets online.

Our Board Certified Providers will review all of the above with you. If you are currently on high blood pressure medication, you may not be eligible for treatment.

Why are there so many benefits (what’s in Tadalafil (Generic Cialis)?

Tadalafil and sildenafil are classified as “PDE-5 Inhibitors” (phosphodiesterase type 5 inhibitor), which relax muscles and increase blood flow to specific areas of the body.

Here is an extreme example to help you understand increased blood flow.

When should I use Tadalafil?

Low-dose tadalafil can be taken on a daily basis giving you more control of the action between the sheets… formally, more spontaneity.

Our generic does of Viagra lasts for around four hours.

Sleep Apnea

What is Sleep Apnea?

  • In 1910, American’s slept 9 hours a night.
  • It’s important to get 8 to 8.5 hours of sleep. 7 hours should be the minimum hours at rest.
  • 20-30% of Americans sleep less than 6 hours per night.
  • 40% of adults in the U.S. snore.
  • 90 million American’s snore and 37 million each night.
  • 22 million Americans suffer from sleep apnea yet 80% of moderate and severe obstructive sleep apnea go undiagnosed.

Sleep apnea is a sleep disorder that happens during the night when muscles in upper throat fail to keep the airway open causing breathing to start and stop as the airway opens and closes repeatedly disrupting necessary sleep cycles and normal breathing patterns.

Apnea literally means ‘breathless’ or ‘without breath’ deriving it’s use in medicine from the Greek word ‘apnoia.’ Many sufferers from sleep apnea will stop breathing repeatedly several hundreds of times during the night and often for a minute or longer.

As breathing starts and stops during sleep, the repetitive drop blood oxygen levels and small breaks during the light, deep, and REM sleep cycles impacts the body's natural healing and dreaming patterns.

Long term sleep apnea is a serious condition leading to life impacting conditions like high blood pressure, heath issues, sexual dysfunction, diabetes, and many more due to the continuous drop in blood oxygen levels.

Untreated sleep apnea can cause damage to the brain due to the suppression of oxygen enter the airway. Treating sleep apnea is important because the brain is just 2% of body weight but uses 20% of the body’s oxygen supply.

Technically speaking, no damage will occur when depriving the brain of oxygen for less than a minute, but continuously being deprived of oxygen throughout the night disrupts the natural processes of the body in the most critical part of life - sleep.

There are three types of sleep apnea: obstructive, central, and mixed.

Obstructive sleep apnea (OSA) is the most common but all three are tough to self-diagnosis because OSA does not trigger full awakening during the night. OSA is more a ‘mechanical’ problem when the tongue falls back against the soft palate applying pressure on the uvula pressing against the back of the throat, effectively closing the airway.

Central and mixed sleep apnea occur when the brain does not communicate with your throat and lung muscles to keep airways flowing properly.  These two are generally associated with more serious illness affecting your lower brain stem. Central is common among those that suffer from heart or kidney conditions, opioid users, or those who are in high altitudes temporarily. In rare cases 5-15% of people who have OSA develop CSA.

What is a typical sleep pattern?

A normal sleep cycle follows several phases through the night:

Light non-REM sleep, deep non-REM sleep, light REM sleep as an example. The first REM cycle occurs 90 minutes falling asleep and lasts 15 minutes.

Lots of bodily functions critical for general health happens during REM. The REM cycle initiates dreaming and the body goes limp paralyzing legs and arms. The REM cycle alternates between light and deep phases where blood pressure drops and heart rate slows down allowing the body to cool down. Reaching the deep phases of REM is considered to be the most refreshing and healing cycle of sleep.

Most adults have 5 phases where three-fifths of a night’s sleep is light non-REM, one-fifth is deep non-REM sleep, and one-fifth is REM sleep. Sleep Apnea can start during any phase, but is usually its worst during deep REM cycle due to the natural drop in blood pressure and relaxed muscles.

According to the National Sleep Foundation, over 47 million adults do not get a full restorative night of sleep.

Sleep deprivation is linked to sleep apnea can result in injuries at work and decrease productivity.

  • It’s estimated that lack of sleep causes US companies $18 billion dollars each year.
  • Some studies show that sleep deprivation causes 1.2 million car crashes each year.

While sleep apnea is not always the cause for sleep deprivation it is certainly a factor and clear indicator for the condition.

Meir Kryger, the first sleep doctor to diagnose sleep apnea, found that long term OSA causes damage to vital organs and hormonal functions due to chronic insomnia and other risk factors.

His studies lead to an understanding around why sleep apnea in women has an impact on normal hormonal menstrual cycle leading to changes to menopause. Specifically, insomnia induced by sleep apnea will impact hormonal levels in women and men.

Insomnia induced by sleep apnea also leads to Restless Leg syndrome (RLS), also called Willis-Ekbom Disease, which causes legs to spontaneously move and shake. RLS is associated with certain vitamin deficiencies, which are not fully understood by researcher but a hypothesis believes there is an association between lack of sleep and the disruption in the body’s natural restoration of organs during sleep.

Reference, Reference, Reference, Reference, Reference

What causes Sleep Apnea?

  • Weight: Excess body weight and obesity is a primary cause for sleep apnea.
  • Body type and Physical features: Certain features like small upper airway; large tongue, tonsils or uvula; small jaw, overbite, receding chin and larger neck raise the risk for OSA.
  • Lifestyle: Using alcohol or sedatives relax the upper airway breathing muscles.
  • Genetics: data shows that OSA is passed on from parents that suffer from OSA.
  • Gender and age: Sleep Apnea is more common among men and post-menopausal women. The condition is more prevalent among people are over 40 years old.
  • Race / ethnicity: According to research, OSA is more prevalent among African-Americans, Pacific-Islanders, and Hispanics.

Reference, Reference

What are the warning signs of sleep apnea?

  • Snoring is the most telling sign that you may have sleep apnea. Snoring usually becomes more serious as people get older.
  • Daytime sleepiness
  • Episodes of stopped breathing during sleep (observed by someone else usually)
  • Waking up gasping or choking during rest
  • Dry mouth or sore throat through the night
  • Morning headache
  • Difficulty concentrating and attentiveness
  • High blood pressure
  • Nighttime sweating
  • Decreased libido
  • Sleep apnea can cause mood swings, irritability, and even lead to depression.
  • Waking up in the morning not feeling rested
  • Unexplained weight gain
  • Awaking at night feeling confused

Reference, Reference

How do you test for sleep apnea at home?

Mild snoring and insomnia can be easily treated with simple changes to lifestyle or correcting bad habits to get back to a state of health and restfulness. Managing things like your weight, exercising and eating healthy are proven methods to eliminate snoring. Sleeping on your side or elevating your head at night can help eliminate snoring and lead to more quality sleep.

Obstructive sleep apnea is broken into three categories depending on your frequency of sleep interruptions in breathing:

  • Mild OSA– experiences 5-14 episodes of interruptions in breathing in an hour.
  • Moderate OSA- experiences 15-30 episodes of interruptions in breathing in an hour.
  • Severe OSA- experiences 30 or more interruptions in breathing in an hour.

Can I cure sleep apnea with over-the-counter supplements?

While Melatonin cannot fix sleep apnea, it is considered the “go-to” sleep aid can help promote healthier sleep.

Melatonin is a hormone secreted during sleep from the pineal gland. It’s main job in the body is to regulate night and day cycles or sleep-wakefulness. Over 3 million Americans use Melatonin to help them get to sleep quicker and find deeper sleep during the night. People have success using Melatonin to stop insomnia and improving sleep when traveling abroad (jet lag) or adjusting to sleep-wake cycles in people whose work schedule change frequently.

Do you scroll through social media before bed?

Going to bed should be a non-stimulated and peaceful process. “Checking your phone stimulates the brain so we are more active and awake,” says Dr. Walia of the Cleveland Clinic. “Even just a quick check can engage your brain and prolong sleep.”

Looking at your phone screen while lying in bed can affect your internal body clock and throwing off your sleep. Sleep doctors recommend 1 hour without looking screen time before bed. Even 30 minutes before bed can be beneficial.


Continuous positive airway pressure therapy uses a machine to help a person who has obstructive sleep apnea (OSA) which is the most common form of sleep apnea. A CPAP machine increases air pressure in your throat as you’re sleeping so that your airway doesn’t collapse when you breathe in. Approximately 50% of people that are diagnosed with sleep apnea and prescribed a CPAP to correct their OSA.


Involves removing and repositioning excess tissue in the throat to increase the width of the airway. Uvulopalatopharyngoplasty, or UPPP is a surgery to open the upper airways by taking out extra tissue in the throat and other soft palate procedures.

It is the go-to type of surgery for sleep apnea.

Oral Appliance Therapy

These are convenient and portable, and not only do they treat sleep apnea, they are effective to stop snoring. Mandibular Advancement Devices (MAD) are sleep apnea mouthpieces that are custom-crafted using a plastic-like mold that forms to the shape of the patient’s teeth and mouth.

There are several self-check tests to help understand if you may be experiencing a sleep disorder and are in need of further care.

Are you struggling to Breathe when you are sleeping?

Even if you don’t THINK you have a problem, take this quick self-check:

  1. Do you SNORE?
  2. Are you TIRED during the day?
  3. Has anyone seen you CHOKING or GASPING when you sleep?
  4. Have you been told you have HIGH BLOOD PRESSURE?
  5. Do you have ACID REFLUX?
  6. Do you have DIABETES?

What is the Epworth Sleepiness Scale?

The Epworth Sleepiness Scale is used across in the field of sleep medicine to help diagnosis sleep disorders like sleep apnea.

The test is a list of eight situations in which you rate your tendency to become sleepy on a scale of 0, no chance of dozing, to 3, high chance of dozing. When you finish the test, add up the values of your responses. Your total score is based on a scale of 0 to 24. The scale estimates whether you are experiencing excessive sleepiness that possibly requires medical attention.

How likely are you to doze off or fall asleep in the following situations?

You should rate your chances of dozing off, not just feeling tired. Even if you have not done some of these things recently try to determine how they would have affected you. For each situation, decide whether or not you would have:

  • No chance of dozing =0
  • Slight chance of dozing =1
  • Moderate chance of dozing =2
  • High chance of dozing =3

  • Sitting and reading
  • Watching TV
  • Sitting inactive in a public place (e.g a theater or a meeting)
  • As a passenger in a car for an hour without a break
  • Lying down to rest in the afternoon when circumstances permit
  • Sitting and talking to someone
  • Sitting quietly after a lunch without alcohol
  • In a car, while stopped for a few minutes in traffic

Your total score can range from 0 to 24. A higher score is associated with increased sleepiness. A score of 11 or higher is an indicator that you may need medical attention.

  • 0 to 10 = normal range of sleepiness in healthy adults
  • 11 to 14 = mild sleepiness
  • 15 to 17 = moderate sleepiness
  • 18 to 24 = severe sleepiness

Another tool to help screen for OSA is called the STOP BANG questionnaire. The STOP-BANG screens for obstructive sleep apnea (OSA) only.

  • Do you snore? Loud enough to be heard through closed doors or loud enough to disturb your partner
  • Do you often feel tired, fatigued or sleepy during the daytime?
  • Has anyone observed you stop breathing, choking or gasping while you were sleeping?
  • Are you being treated for high blood pressure?
  • What is your Body Mass Index (BMI)?
  • Are you older than 50?
  • Is your neck size larger than 43cm if male or 41cm if female?
  • Are you male?

If you answer YES at least 3 of the above, we recommend speaking with one of our network providers.


What are treatment options for Sleep Apnea?

After filling out your online questions about your symptoms, you will setup a video consult with one of our Board-Certified providers to review your medical history, sleep quality, and lifestyle. If Appropriate, the provider will prescribe an at-home sleep study to be mailed to you.

Diagnosing sleep apnea is an overnight process that requires you to do an overnight sleep study in the comfort of your own home.

The at-home sleep study is an alternative to an in-clinic sleep study and the most popular method for patients. The home sleep study will measure your airflow, pulse oximetry, heart rate, and respiration effort in the comfort of your own bed.

The at-home sleep study tracks your breathing, oxygen levels, and breathing effort giving our providers and sleep specialists an apnea index. The sleep study comes in a kit with a few different sensors, each measuring different things. Typically, you will get:

  • A small oxygen sensor probe
  • A chest belt measuring breaths and sometimes sleep position
  • A nasal cannula to measure airflow

Reference, Reference, Reference, Reference, Reference, Reference

Vitamin D Screening and Care

With Rise MyCare, we can order Vitamin D testing to a lab near you!

We look at Vitamin D, 25 Hydroxy; this test measures the amount of vitamin D. Vitamin D is important to sustain strong, healthy bones and teeth. We primarily absorb this from sunlight.

The testing order can but done online after a quick medical evaluation from one of our Board Certified Medical Providers. We'll connect you with the experts.

Stop Smoking, Dipping, or Snus

If you're goals are to stop smoking or dipping, we can recommend medicines and strategies that will help you quit for good. Zyban helps decrease nicotine cravings and is a cheaper alternative to Chantix. Both prescriptions are proven to be more effective than nicotine patches, gum and lozenges.

We offer coupons and help you find the most cost-effective RX. These medications can get expensive and we do not like that.

RX refills can be done online after a quick medical evaluation from one of our Board Certified Medical Providers. We'll connect you with the experts.

Metabolism Performance Testing and Analysis

With Rise MyCare, we can order metabolism performance test to a lab near you!

Our online visits help you get access to modern metabolism test then you'll take a look with our Board Certified Providers. - $100.

Comprehensive Metabolic Panel 16 (CMP16)

Our CMP blood test measures levels of 16 individual components to assess overall health. This checkup includes tests for aspartate aminotransferase (AST) test - liver damage indicators + Alanine aminotransferase (ALT), which show us signs of liver damage, such as jaundice (yellow skin/eyes).

The Basic Total Lab Test helps you identify whether your body is functioning correctly or not. This Lab Test is an important tool in our wellness routine. The Basic Total Lab Test is the next level of routine with the addition of a few more testing measurements.

Our providers commonly order this lab test as it shows how our body is functioning. The Basic Total Lab Test helps detect illnesses that could be life threatening if left untreated. It can screen for early stages of major common conditions; and therefore, helps you stay on top of your health by getting the proper treatment and management plan.

This package assesses your cardiovascular health, function and possible malfunction of your kidneys and liver, as well as any sign of infections.

The testing order can but done online after a quick medical evaluation from one of our Board Certified Medical Providers. We'll connect you with the experts.

Hypothyroidism Treatment

What is hypothyroidism?

With Rise MyCare, we can help test your TSH and treat or refill your thyroid replacement medicines.

After a thorough medical evaluation from one of our Board Certified Medical Providers online, we'll discuss your thyroid function, current symptoms, and if appropriate provide a refill of thyroid medicine.

We offer coupons and help you find the most cost-effective RX. These medications can get expensive and we do not like that.

  • Roughly 4% of the U.S. population have hypothyroidism, although most cases are mild.
  • Low or high thyroid hormones affect close to 20 million Americans with a large majority being women and elderly due to their higher risk of autoimmune disease.
  • An estimated one woman in five aged 60 and older has some form of thyroid issues.

Hypothyroidism, underactive thyroid or low thyroid, is condition where glands in your neck do produce enough thyroid hormones that help your body function normally.

The thyroid is a small gland in the neck near your vocal cords and larynx which regulates energy usage and metabolism throughout the body. The small gland impacts organ function all the way down to how our heat beats. When thyroid hormones are low or imbalanced, organs in the body begin to slow down.

What causes low or underactive thyroid levels?

  • Hashimoto's disease is the most common– this autoimmune disease causes your thyroid to attack your immune system. The disease makes white blood cells make antibodies.
  • Thyroiditis, inflammation of the thyroid
  • Congenital hypothyroidism, hypothyroidism that is present at birth
  • Surgical removal of part or all of the thyroid
  • Radiation treatment of the thyroid

Certain medicines affect thyroid function. Most of these medicines act at the level of the thyroid in patients with normal thyroid function, or at the level of thyroid hormone absorption or metabolism in patients requiring Levothyroxine sodium, which is a thyroid medicine that replaces the thyroxine hormone normally produced by your thyroid gland to regulate the body's energy and metabolism.

Levothyroxine sodium is one of the most commonly prescribed medications in the world.

Iodine deficiency can lead to underactive thyroid. The body needs iodine to create thyroxine hormone. Reference, Reference

Getting enough iodine from food is important (Adults need 150 mcg per day), but may not be the underlaying cause of your thyroid issues. This is where a TSH test will show our providers determine the full picture. Reference

What are the hormones produced by the thyroid?

The thyroid converts two hormones from the iodine found in food. These two hormones T3 (triiodothyronine) and T4(thyroxine, which is the main thyroid hormone in the blood) are regulated by thyroid-stimulating hormone (TSH).

TSH secretes from the pituitary gland under the direction of the key regulatory part within the brain or the hypothalamus.

It’s important to get enough iodine rich foods like salt, seafood, bread, and milk but in some cases it’s not enough due to permanent or temporary hypothyroidism. A TSH blood test can determine what intervention is needed, if any.

  • High TSH means you have an underactive thyroid or Hypothyroidism.
  • Low TSH means you have an overactive thyroid or Hyperthyroidism.

Glad our bodies could make this nice and confusing for us. Hormones are complex.

Our goal from treatment is to lower your TSH to about the midpoint of the normal range and maintain it at that level. Once your dosage is dialed in, a TSH levels should be checked every 6 to 12 months.

Why Is Hypothyroidism Less Common in Men?

Men are roughly 80% less likely to experience hypothyroidism because autoimmune diseases are more common in women but the test processes and treatment is the same.

An underactive thyroid gland can cause: extreme fatigue, weight gain, dry skin or hair, and abnormal chills due low energy.

Commons signs of underactive thyroid includes:

  • Feeling cold
  • High cholesterol levels. Low thyroid levels can lead to increased levels of total and LDL cholesterol.
  • Sleepiness
  • Depression
  • Low Sex Drive
  • Trouble concentrating
  • Sore muscles or joint pain
  • Weight gain and appetite due to poor conversion of calories to energy
  • Heavy or irregular menstrual periods and impaired fertility
  • Slow heart rate
  • Dry skin and brittle nails
  • Constipation
  • Swelling or enlargement of the thyroid gland, called goiter (GOI-tur)

Signs and Symptoms can be similar to low testosterone, so our provider may order a full blood panel to determine what is causing your symptoms. Reference

What is Levothyroxine sodium?

If you've been diagnosed with hypothyroidism, our providers may prescribe levothyroxine sodium (or pure synthetic T4). This medication works exactly like your own body's thyroid hormone.

Levothyroxine is the generic form of various brand names (Levothroid, Levoxyl, Synthroid, and Unithroid, Euthyrox, Levo-T)

All formulations contain the same active ingredient, T4.

If you are current on treatment with a specific brand, it’s important to tell our providers. If your hypothyroidism is permanent and you are taking daily pills, there are certain medication guidelines to help us tailor your treatment plans.

Some people cannot tolerant levothyroxine sodium, so our providers may have you consider a natural alternative (Armour Thyroid or Nature Throid) which is derived synthesized dry pig thyroid glands. This is not to dissuade you from using the nature alternative, these are facts.

Can levothyroxine sodium cure hypothyroidism?

Permanent hypothyroidism can be effectively treated, but there is not currently a cure.

How to start hypothyroidism treatment?

We will examine your questionnaire answers and medical history to determine if a blood test for thyroid stimulating hormone (TSH) is appropriate.

A TSH test is the most effective test for thyroid disease. If TSH is elevated, the test should be repeated to confirm the finding, and at the same time, the level of circulating "free" T4 should be checked.

Our goal is to get your TSH back to Normal level.

If your TSH level is between 0.4 and 5 per milliliter (mIU/L), your thyroid is functioning as it should. Our providers will evaluate other possibilities if symptoms are still bothersome.

If your TSH is elevated (above 5 mIU/L) and your free T4 level is normal, you may have mild borderline hypothyroidism. Our providers will evaluate treatment plans or alternative options if symptoms are still bothersome.

Primary hypothyroidism. If your TSH is elevated and your free T4 is low, you have an underactive thyroid and will require treatment - Our providers will consult and prescribe the right treatment plan either medication or guidance.

Possible Side Effects

Side effects may include irregular heart rhythms, insomnia, and loss of bone density.

Replacement with desiccated thyroid creates dosing problems because there is no way to standardize the exact amount of the dose for each batch. Thyroid hormones, including levothyroxine or nature alternatives, should not be used to treatment of obesity or weight loss.

Call your provider right away if any of the following side effects continue or are bothersome. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency.

High Cholesterol Treatment or Testing

What is cholesterol?

Cholesterol is a waxy substance found in the blood and cells of the body and is used in many important functions throughout the body. Cholesterol is a main component in the cell membranes of your cells, vitamin D, and hormones like testosterone and estrogen. It is also helps in nerve function.

The liver produces all the cholesterol your body needs but it is also found in many common foods like meat, egg yolk, and cheese.

What is hypercholesterolemia?

Hypercholesterolemia, or high cholesterol, is an excess of cholesterol in your blood. This is usually caused by poor diet and lack of exercise, but can also be genetic. High cholesterol levels can cause fatty deposits to build up on the walls of your arteries called plaque – a condition called atherosclerosis. If buildup becomes severe enough it can narrow or harden your arteries which increases the risk of heart attack, stroke, and peripheral artery disease.

Are there different types of cholesterol?

Cholesterol is carried to and from your liver in lipoproteins, which are basically packages of cholesterol and fat created to transport cholesterol through the body. For simplicity’s sake, lipoproteins are often referred to as “cholesterol’ as they are what is measured in the blood tests done to diagnose and treat high cholesterol. There are three different types of lipoproteins, or “cholesterol”:

  • High-Density Lipoproteins (HDL) is known as good cholesterol because its function is to bring excess cholesterol from other parts of the body back to the liver to be recycled.
  • Low-Density Lipoproteins (LDL) makes up most of the cholesterol in your body. It is known as bad cholesterol because a high level of LDL can lead to plaque buildup in your arteries.
  • Very Low-Density Lipoproteins (VLDL) contain more fat, called triglycerides, than the other forms of cholesterol. High levels of VLDL can also lead to plaque buildup in your arteries.

Cholesterol lab test ranges and diagnosis?

There are no symptoms from high cholesterol. The only way to know if you have it is with a blood test.

What causes high cholesterol?

  • Diet has a major impact on your risk for high cholesterol. Foods with high levels of saturated fat such as red meat, processed meat, milk, butter, and baked good like pies and pastries can all increase cholesterol levels in your body.
  • Genetics can also play a large role in your risk for high cholesterol. Genetics may make it difficult for your cells to remove LDL (bad cholesterol) from the blood as easily as other people or may cause your liver to make more cholesterol than you need.
  • Obesity (a body mass index of 30 or above) puts you at risk of high cholesterol.
  • Smoking damages the walls of the blood vessels and can allow LDL buildup and form plaque (atherosclerosis). It also deceases the HDL (good cholesterol) levels in your blood.
  • Age increases the risks of high cholesterol. As your body ages, organ function decreases. In the case of cholesterol, your liver becomes less able to process LDL.
  • Diabetes, and high blood sugar, increases the amount of VLDL in the blood and decreases HDL levels. High blood sugar can also damage the walls of your arteries and increase the risk for atherosclerosis.


Increased cholesterol levels can cause atherosclerosis, an buildup of fatty deposits called plaques in your arteries. This can reduce the blood flow through the arteries which can cause chest pain, heart attack or stroke.

How to start high cholesterol treatment?

Our MyCare providers will discuss your health history, family history, and lifestyle to determine your risk for high cholesterol. Lab testing is recommended for almost everyone to monitor cholesterol levels, and the MyCare provider will order lab testing if necessary.

A cholesterol panel will check your total testosterone level, your HDL and LDL levels, and your triglyceride level.

Cholesterol lab test ranges:

  • Total cholesterol levels less than 200 milligrams per deciliter (mg/dL) are considered normal.
  • High-density lipoprotein levels above 40mg/dL are acceptable. The ideal HDL level is around 60mg/dL
  • Low-density lipoprotein levels below 100mg/dL are ideal. LDL levels between 100-129mg/dL are acceptable if there are no other health conditions. Levels between 130-159mg/dL are borderline high. LDL levels above 160mg/dL are considered high.
  • Triglyceride levels less than 150mg/dL are considered normal. Levels between 150-199mg/dL are considered borderline high. Triglyceride levels from 200-499mg/dL are high and levels above 500mg/dL are very high.

The MyCare provider may also check your liver function with additional lab tests.

What are the symptoms of high cholesterol?

Our MyCare providers can make recommendations on lifestyle and diet changes to improve your cholesterol levels.

Routine lab tests are necessary for anyone that has high cholesterol regardless of whether it is being managed by lifestyle changes or by medication. The MyCare provider will recommend timing of lab tests to make sure your cholesterol levels are under control.

Some cholesterol-controlling lifestyle changes may include:

  • Limit the amount of red meat you eat
  • Decrease dairy intake
  • Limit saturated fats to 5-6% of your daily calorie intake – and minimize trans fats
  • Increase a diet of fruits, vegetables, and whole grains
  • Lose weight
  • Exercise 150 minutes a week. Exercise increases HDL and decreases the size of LDL
  • Quit smoking
  • Decrease alcohol intake

Sometimes lifestyle changes alone cannot improve cholesterol levels enough. You made need a prescription medication to decrease your cholesterol. Our MyCare providers will be able to determine if a prescription is necessary and find the right medication to meet your needs.

Statins work to decrease LDL and triglycerides and slightly increase HDL.

  • Rosuvastatin (Crestor)
  • Atorvastatin (Lipitor)
  • Simvastatin (Zocor)
  • Pravastatin (Pravachol)

Bile acid binding resins work to decrease LDL.

  • Cholesevelam (Whelcol)
  • Cholestyramine (Pravalite)

Fibrates decrease triglycerides and can increase HDL.

  • Fenofibrate (Lipofen)
  • Gemfibrozil (Lopid)

Niacin can decrease LDL and triglycerides and may increase HDL.

  • Prescription niacin (Niaspan)

Omega-3 fatty acids decrease triglycerides and can increase HDL.

  • Supplement (Lovaza)
  • Icosapent ethyl (Vascepa)

Injectable medications can decrease LDL, especially for difficult to control cholesterol levels

  • Alirocumab (Praluent)
  • Evolocumab (Repatha)

Reference, Reference, Reference, Reference, Reference, Reference

Hair Loss Prevention and Regrowth

What is male pattern baldness?​

Male Pattern Baldness is a condition where men experience a receding hairline and hair thinning on the crown / top of their head. Male pattern baldness is caused by hormonal imbalances and genetics. You can find balding in medical text books under it’s fancier name, androgenetic alopecia.

Balding starts with hair follicle shrinking over time, resulting in shorter and finer hair. After several months or years, the weakening follicle do not grow new hair. The follicles remain alive, which suggests that it is still possible to grow new hair. Source, Source

What causes your hair to fall out?

We can blame the hormone called Dihydrotestosterone (DHT). The Testosterone pulsating through our body converts to DHT with the help of an enzyme called Type II 5-alpha-reductace. The enzyme is chilling in small oil glands at the base of the hair follicle.

  • Dihydrotestosterone (DHT) naturally shrink hair follicles.
  • IF DHT is suppressed, THEN hair follicles continue to thrive.
  • Hair follicles around the sides of the head aren’t sensitive to the reduction caused by DHT.

As it relates to hair follicles, prolonged exposure to DHT causes the follicles to reduce down to nothing.

Can a man's hair grow back?

Prevention: Quick intervention can be slow or even stop thinning if caught early enough. Even if you’re starting late with no hair, it might not be too late...

Recovery: There is a chance that under your shiny bald head that there are some remaining hair follicles holding on for dear-life.

Why DHT shrinks follicles is not well understood by the experts but is this is the known and confirmed cause of hair loss and male pattern baldness.

In some cases, dry scalp, over shampooing, over brushing, or natural remedies may accelerate hair loss but one thing is for certain - you are all genetically predisposed to male pattern baldness if this condition runs in your family. Source

Why do some guys go bald early?

A common rule of thumb says that if your mom’s grandpa is bald then you are going to be bald. While somewhat true, researchers suggest that men who inherited the alleged balding "gene" from their moms may just have more androgen (the base-male hormone) receptors on their scalp, which naturally increases chances for baldness if testosterone convert to DHT reducing hair follicles to dust. There are genes in all chromosomes that have an impact in the undoing our baldness or androgenetic alopecia. Source, Source

Smoking and drinking has a clear impact how fast younger men lose their hair. Source

What is finasteride?

1mg Finasteride (generic Propecia) is an oral medication that stops your body from producing DHT. It works by preventing the production of the enzyme, 5α-Reductase, that converts testosterone into DHT. 9 times out of 10, if someone say they are taking Propecia today they are actually taking a generic finasteride 1 mg pill. Finasteride is the active ingredient in Propecia.

Can finasteride regrow hair?

Finasteride can lower your DHT production by almost 71.4% when taken at a hair loss prevention dose (1mg). Studies prove that this hair loss dosage can actually stimulate the growth of lost hair follicles. Source

5mg Finasteride is used to prevent or delay the appearance of prostate cancer.

Without getting too complex, finasteride is used clinically to treat BPH and baldness with their ability to reduce circulating DHT.

DHT (Dihydrotestosterone) stimulates the growth for certain part of the body including prostate cells. In older men excess production of DHT contributing to benign prostatic hyperplasia (BPH) aka enlarged prostate.

Finasteride blocks an enzyme called “Type II 5α-reductase” responsible for producing DHT.

Androgens are involved in the development of prostate cancer. Finasteride inhibits the conversion of testosterone to dihydrotestosterone, the primary androgen in the prostate, and may reduce the risk of prostate cancer. Study

What is Minoxidil?

Minoxidil is the generic formulation of name-brand Rogaine®. There are now many FDA approved generic versions of minoxidil. It was originally used for treating high blood pressure, but patients reported hair growth as a side effect. Pfizer (Upjohn at the time) quickly trailed and released a topical solution to stimulate the hair follicles (because the oral pill did not work well for hypertension). It slows hair loss for many men and helps some men grow new hair. Please note, hair loss returns when you stop using this medicine. Source

Is Minoxidil the same as finasteride?

Unlike finasteride, minoxidil doesn’t affect DHT and has no effects on the production of DHT. Both medications are backed by many medical evaluations and studies showing an increase in hair growth after a few months of use. Source, Source

Currently, these are the only two FDA approved medications for treating hair loss in men.

What Are the signs of pattern baldness?

A receding hairline.

Most men can tell when they are going bald, but a typical pattern of male baldness begins at the hairline around the forehead. The hairline gradually recedes moving back to form an "M" shape, like a peninsula of hair – Cape Bald. Thinning usually begins at the top of the crown so you may see finer, shorter hairs in the shower.

Notice more hair falling out than usual.

While it’s common to have hair falling out periodically like in the shower or in your comb, if you notice more and more shedding hair, this could be a sign that your hair is thinning and you are going bald.

Thinning hair on the crown top of your head.

Thinning hair on the top of your head is usually another sign that you are entering male pattern baldness. It’s tough to see, so we suggest using a hand-held mirror to help aid in your reach.

Dry or itchy Scalp.

While a dry and itchy scalp does not mean you are balding, your scalp thrives on moisture to sustain follicle texture and thickness. It’s important to keep the conditions up-to pristine in order to keep a healthy head of hair. Scratching can damage hair follicles and can promote hair loss. If you have a persistent itching, we can refer you to a dermatologist that can diagnosis your symptoms if they are severe.

Gradual thinning overall.

One common but tough marker for the onset of balding happens all over the head as DHT attacks the hair follicles all-at-once causing thinning across the scalp. If hair loss is rapid, you may see thin hair on your hands in the shower. Hair will look fine and weak in your hands.

Photographic Evidence.

If you think you might be balding, scrolling through social media is a good tool to use to determine if your scalp is receding. Prospective is everything when you are considering treatment.

Others can see it.

There is the rare situation where you cannot tell if you’re balding. If you feel unsure, ask your significant other, friend, family, barber or hair dresser - A professional can suggest some hair products to keep your dome hydrated while you consider medical advice for your thinning hair.

How to start hair loss treatment?

We will examine your scalp over video chat or a series of pictures to determine if hair loss / recovery medication is right for you.

Most medical provider classify male pattern baldness using a medical scoring system. This scale shows reference diagrams for a variety of hair loss patterns, starting at receding hairline to almost complete hair loss.

Norwood scale for hair loss and baldness

How quickly does Finasteride for hair loss work?

In order to see best results 1mg of Finasteride is taken daily. You should expect to see visible results after 2 months and noticeable results after 6 months. If you experience noticeable results, take a monthly photo to track your progress.

In some guys, it can take up to a year to see the maximum results. It is important to stay positive. Commitment to daily pills is absolutely critical to producing lushes locks and increase your chance of hair regrowth. Reference

As long as you don’t experience side effects, it’s recommended to continue the medication for one full year before deciding on whether the medication is working for you.

Common and Rare Side Effects

It is important to understand all potential side effect of Finasteride. The most common side effects of finasteride include:

Decrease in your blood Prostate Specific Antigen (PSA) levels. You should notify your provider before having your PSAs tested because finasteride decreases PSA levels.

Trouble getting or keeping an erection and Decreased libido (2-4% reported)

Decrease in semen production. (Reports show that 1mg does not negatively impact sperm). (5mg finasteride dosage for PSA does show a decrease).

Call your provider right away if any of the following side effects continue or are bothersome. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency.

More common


cold sweats


dizziness, faintness, or lightheadedness when getting up from a lying or sitting position.

Less common

Swell, Rash, Redness, Hives

Breast Tenderness, unusual lumps or sores on you skin.

Runny nose, sneezing


Abdominal, stomach, or back pain

decreased amount of semen

diarrhea, dizziness, headache, Testicular pain

Keep all medicines out of the reach of children. Do not give finasteride to others - It may harm them.

Finasteride is not available without a prescription from a medical practitioner.

Oral finasteride in the 1 mg FDA-approved medications dose is to treat male pattern hair loss while oral finasteride 5 mg FDA-approved medications to treat BPH.

Topical finasteride is not FDA-approved and can be manufactured by a compounding pharmacy. We do not recommend using finasteride without a consultation or prescription from one of our providers.