Testosterone and Androgen Physiology in Women: Subcutaneous Injections in Coordinated Care
Abstract: Testosterone is a normal hormone in women. The ovaries, adrenal glands, and many local tissues help make and use it. Levels fall slowly with age, not all at once at menopause. A single blood test rarely proves deficiency. The strongest research support for testosterone therapy in women is for distressing low sexual desire after menopause, after other causes are checked. Subcutaneous injections can provide steadier levels in some studied groups, but evidence in women is thinner and remains off-label. Integrative chiropractic care does not replace medical decisions about hormones. It can help patients gain pain relief, better mobility, and improved sleep while the medical team keeps treatment coordinated and safe.
Testosterone is a female hormone
Androgens are often called male hormones. That label is incomplete. Testosterone is the main circulating active androgen and a normal part of female biology. Women keep lower amounts than men—typically 10 to 20 times lower—but those amounts still guide important physical and metabolic functions (Cleveland Clinic, n.d.; Davis & Wahlin-Jacobsen, 2015). For much of adult life, a woman’s circulating testosterone is higher than her circulating estradiol (Davis & Wahlin-Jacobsen, 2015).
Testosterone works in two ways:
Directly, on androgen receptors in muscle, bone, brain, fat, skin, and sexual tissues
Indirectly, when local enzymes turn it into estradiol or into the stronger androgen dihydrotestosterone (DHT)
These pathways help explain effects on sexual function, tissue upkeep, and metabolism even when blood levels look low (Davis & Wahlin-Jacobsen, 2015; Labrie et al., 2017).
Where women’s androgens come from
Women do not rely on one gland. Production is shared.
The ovaries release some testosterone and larger amounts of precursors
The adrenal glands release DHEA and DHEA-sulfate (DHEAS), a large precursor pool
Peripheral tissues—fat, skin, muscle, and other organs—convert those precursors into the small amounts of hormone they need
This last step is called intracrinology. Many tissues make the hormone they need on site and then break it down before much of it returns to the blood (Labrie et al., 2017). A blood testosterone result is only the visible tip of a larger local system.
Enzymes in tissues can convert DHEA to testosterone, make DHT, or turn testosterone into estradiol. The same precursor can become an androgen in one tissue and an estrogen in another. Local enzymes, not just the lab, decide the outcome (Labrie et al., 2017; Schiffer et al., 2018).
A long slope, not a sudden cliff
Estradiol falls sharply at menopause. Androgens do not. DHEA and DHEAS begin to fall from about the third decade of life and may be down by roughly 60% by menopause (Davis & Wahlin-Jacobsen, 2015). A woman in her forties is already below her own earlier peak.
Midlife data measured by mass spectrometry found median testosterone falling from about 0.56 nmol/L in the early forties to about 0.42 nmol/L in the late fifties, with a low point near ages 58–59. In women of similar age, testosterone did not differ by menopausal stage. Natural menopause itself is not a stand-alone reason to administer testosterone (Wang et al., 2025).
Two exceptions matter:
Surgical menopause (both ovaries removed) cuts the ovarian share at once
Premature ovarian insufficiency creates an earlier deficit than the usual age-related slope (Davison et al., 2005; Soman et al., 2019)
The postmenopausal ovary can also continue to produce some testosterone for years after estradiol output has collapsed (Davis & Wahlin-Jacobsen, 2015).
Why one lab number rarely settles the question
Measuring female testosterone is challenging. Routine immunoassays were built for the much higher male range. Liquid chromatography–tandem mass spectrometry (LC-MS/MS) is more reliable. Most circulating testosterone is bound to sex hormone-binding globulin (SHBG), so free hormone can change when SHBG changes even if total testosterone stays the same (Rosner & Vesper, 2010).
What moves SHBG—and the free fraction:
Oral estrogen and high thyroid hormone tend to raise SHBG and lower free testosterone
Obesity and insulin resistance tend to lower SHBG and raise free testosterone
Androgen excess, including polycystic ovary syndrome (also discussed as polyendocrine metabolic ovarian syndrome, or PMOS), also lowers SHBG (Luo et al., 2024; Teede et al., 2023)
Low SHBG is also a metabolic clue and has been linked to higher diabetes risk in women (Ding et al., 2009). Guidelines do not diagnose androgen deficiency based on a single value. A level is a baseline and a safety check, not the whole diagnosis (Davis et al., 2019; Parish et al., 2021).
What the evidence supports—and what it does not
The clearest evidence is in sexual function. Higher endogenous testosterone tracks modestly with better desire (Maseroli & Vignozzi, 2022). In randomized trials, testosterone improved desire, arousal, orgasm, pleasure, and satisfaction and reduced sexual distress in postmenopausal women with low desire (Islam et al., 2019).
Androgen receptors sit in bone, muscle, fat, vessels, and the brain. That map is real. This is not the same as a proven benefit. Trials supporting sexual-function gains have not firmly shown better body composition, bone, mood, or cognition to the same standard (Davis, 2025; Islam et al., 2019). Some tissue effects may also come from local conversion to estradiol.
Too much androgen is the other problem: acne, unwanted hair, cycle changes, and higher cardiometabolic risk in PMOS/PCOS (Teede et al., 2023). Risk can appear at both ends of the female range (Luo et al., 2024). The target is a physiologic band, not “more is better.”
International groups have not endorsed a broad “female androgen deficiency syndrome,” because no blood cutoff cleanly separates symptomatic women from normal variation (Davis et al., 2019; Wierman et al., 2014). The one consensus indication is hypoactive sexual desire disorder (HSDD) in postmenopausal women—low desire that causes distress—after other causes are addressed (Parish et al., 2021). There is still no FDA-approved testosterone product for women in the United States. Prescribing remains off-label, and long-term heart and breast data in women are limited (Islam et al., 2019; Panay et al., 2024).
What subcutaneous testosterone injections are
A subcutaneous (SubQ) injection places testosterone into the fatty layer under the skin, usually in the abdomen or thigh, with a short, thin needle. An intramuscular (IM) injection goes deeper into muscle.
In men and in some gender-affirming care settings, weekly SubQ testosterone esters can reach therapeutic levels with smaller peaks and troughs, less pain, and easier self-use than some IM schedules (Figueiredo et al., 2022). That data should not be copied wholesale onto women.
Women need much smaller doses
Female physiologic ranges are far lower
Randomized evidence in women is mainly transdermal, not SubQ (Davis et al., 2019)
Guidelines do not establish a subcutaneous route for women and do not endorse compounded products as first-line (Parish et al., 2021)
If a clinician considers low-dose SubQ testosterone cypionate in oil, it is an individualized, off-label choice. The goal is to keep exposure within the premenopausal physiologic range, monitor for acne, hair changes, voice changes, or metabolic shifts, and document informed consent (Davis et al., 2019; Jimenez, 2026b). If this route is used at all, start low, titrate to symptoms plus labs, use the same assay method over time, and do not treat menopause itself as an automatic indication (Wang et al., 2025). Compounded prefilled low-dose syringes are not FDA-approved for women. They are a delivery tool, not proof that therapy is indicated.
What patients gain from integrative chiropractic care
Hormone questions and musculoskeletal problems often show up together. Women with midlife androgen decline may also notice joint stiffness, slower recovery, fatigue, and poorer sleep (Davis, 2025; Jimenez, 2026a). After an auto accident or work injury, neck pain, low-back pain, and delayed stiffness can stack on top of that picture.
Integrative chiropractic care does not replace a hormone plan. It focuses on what the patient can gain:
Pain relief through restored joint motion and less mechanical strain
Improved mobility so walking, lifting, work, driving, and home tasks feel more possible
Better sleep when night pain, muscle tightness, and poor recovery ease
Stronger return to activity after crashes, work strain, or chronic back and neck pain
Chiropractic adjustments, soft-tissue care, and rehabilitation are non-invasive and drug-free. Used well, they can lower the chance that pain is managed only with long-term medication or rushed toward surgery. That is a simple safety idea: first do no harm, then add only what the person needs.
Integrative care also means working with the patient’s existing medical team. Supervising clinicians handle hormone dosing, lab review, and medication decisions. Chiropractic care adds movement, recovery, and function so the whole plan stays coordinated rather than split into separate silos.
How the El Paso team works together
At Injury Medical Clinic PA in El Paso, Texas, Dr. Alexander Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, ATN, CCST, provides chiropractic care, functional-medicine framing, and dual-licensed nurse-practitioner evaluation. In clinical observation, he describes testosterone as one part of a wider plan, not a stand-alone energy shot. He notes that women have androgen receptors across muscle, bone, and brain; that levels often fall by the mid-forties compared with the mid-twenties; and that low-dose, monitored strategies may support libido, energy, and musculoskeletal integrity in selected patients when labs, symptoms, and safety checks line up (Jimenez, 2026a, 2026c). He also stresses that SubQ use in women is not the same as male testosterone replacement and should not be sold as routine wellness care (Jimenez, 2026b). More clinical notes appear on dralexjimenez.com and LinkedIn.
Off-label hormone decisions need medical oversight. Dr. Maria Guadalupe Cardenas, MD, board-certified in internal medicine (NPI #1164426749, Texas MD License #J2933), has more than 40 years of experience as an internist. She serves as Medical Director and Collaborative Physician at Injury Medical Clinic PA. This multidisciplinary setup is common in integrative and injury clinics: an MD provides medical direction while a chiropractor delivers hands-on spinal and rehabilitation care.
Together, the team can connect:
Medical screening and comorbidity review
Chiropractic care for pain, mobility, and sleep-related musculoskeletal strain
Functional medicine review of sleep, gut, thyroid, iron, and metabolic drivers that also change SHBG
Personal injury care and rehabilitation after crashes, work injuries, or delayed symptoms
Clear communication with the patient’s other physicians so care stays safe and well coordinated
Putting the pieces together
A careful visit starts with the story—desire, distress, energy, sleep, pain, injuries, medicines, and surgery—then an exam and labs used as a baseline, not a verdict. Other causes come first: relationship strain, depression, pain, vaginal dryness, thyroid disease, and medication effects. For many women, that means no testosterone. For some postmenopausal women with HSDD, a carefully dosed, monitored plan may be discussed. If SubQ is chosen, it stays small, measured, and reversible while chiropractic care rebuilds the capacity to move and recover.
Testosterone is a normal female hormone made in more than one place and used inside many tissues. It declines on a long slope. Blood tests tell only part of the story. The honest evidence base is strongest for distressed low sexual desire after menopause, not for menopause itself. Subcutaneous injections can offer steady delivery in other groups, but in women they remain an individualized, off-label option that must stay within a physiologic range.
The safest frame is coordinated care: medical direction for hormone decisions, chiropractic and rehabilitation for pain relief, mobility, and sleep, and a plan that prefers non-invasive options when they can help a person function without adding avoidable risk.
“Your body works as a unified system—your hormones directly dictate how well your spinal muscles heal and protect your joints. You don’t have to navigate chronic discomfort or confusing hormonal shifts alone; reach out to our team today to learn how safe, monitored subcutaneous protocols can be seamlessly coordinated with your physical care to help you live without limits.”
Davis, S. R., Baber, R., Panay, N., Bitzer, J., Perez, S. C., Islam, R. M., Kaunitz, A. M., Kingsberg, S. A., Lambrinoudaki, I., Liu, J., Parish, S. J., Pinkerton, J., Rymer, J., Simon, J. A., Vignozzi, L., & Wierman, M. E. (2019). Global consensus position statement on the use of testosterone therapy for women. The Journal of Clinical Endocrinology & Metabolism, 104(10), 4660–4666.
SubQ Testosterone for Women: Dosing, Monitoring, and Muscle Support
Abstract: Testosterone is not a male-only hormone. Women make more of it than estrogen by weight throughout much of their adult lives, and those levels decline with age. The strongest research supports low-dose therapy for postmenopausal women who have distressing low sexual desire. Subcutaneous injections place a modest, consistent amount of the hormone into the fat under the skin so blood levels can return to a typical female range. This article explains how that route works, who may be a candidate, how clinicians monitor the dose, how muscle and bone support movement, and how integrative chiropractic care in El Paso can work alongside medical oversight to treat the spine, joints, and hormones as one system.
Why Women Need Testosterone, Too
Testosterone is not just a leftover male hormone; women produce it in significant amounts. Across most of adult life, a woman’s ovaries and adrenal glands produce more testosterone than estrogen by mass. That output falls with age and drops further after the ovaries are removed (Davis et al., 2019; Hatzilabrou, 2025).
When levels sit at the low end of a woman’s own range, some women notice a persistent, unwanted loss of desire. That problem has a name: hypoactive sexual desire disorder, or HSDD. Distress is the key. A quiet fade that does not bother her is not the same as a loss that troubles her every day (Davis et al., 2019; Parish et al., 2021).
Pooled randomized trials in thousands of women show that restoring testosterone into the normal premenopausal range can improve desire, arousal, orgasm, pleasure, and satisfaction, and can lower sexual distress. The gains are real and consistent, but they are moderate, not magic, and a strong placebo response is part of the picture (Islam et al., 2019; Hatzilabrou, 2025).
What Subcutaneous Injections Actually Do
A subcutaneous (SubQ) injection delivers medicine into the fatty layer just under the skin, not deep into muscle. Typical sites are the abdomen or outer thigh. The needle is short and thin. Oil-based testosterone—often testosterone cypionate—then seeps out slowly, which can keep blood levels steadier than a large intramuscular shot (FOLX Health, n.d.; Hone Health, 2024).
Think of it as a small, measured drip rather than a flood. Women need far less than men, often about one-tenth of a typical male dose. Clinics that use weekly SubQ cypionate often start in a low milligram range and then adjust to a lab result, not to a feeling (Highland Longevity, n.d.; Hone Health Help Center, n.d.).
Keep these route facts in view:
Most high-quality trials in women used patches, creams, or gels, not weekly shots (Hatzilabrou, 2025).
One older implant study in women was positive for desire and bone density, but fixed pellets can overshoot the female range and cannot be turned down once placed (Hatzilabrou, 2025).
No published milligram conversion exists from a 300-microgram patch to a SubQ syringe. The honest method is to dose to a measured blood level (Davis et al., 2019; Hatzilabrou, 2025).
No testosterone product is FDA-approved for women in the United States. Use is off-label and requires informed consent (Cedars-Sinai, n.d.; Parish et al., 2021).
Some compounding programs offer low-concentration, prefilled single-dose syringes of testosterone cypionate in MCT oil for SubQ use. A ready syringe does not change the rules. Exposure still has to stay inside the female physiologic band (Hatzilabrou, 2025; Medivant Health, n.d.).
The Target Is Narrow, Not “Bigger Is Better”
A healthy young woman typically has a total testosterone level of about 15 to 46 ng/dL. That is a sliver of the male range. The job of therapy is to land inside that band and stay there (Hatzilabrou, 2025; Braunstein et al., 2011).
Pushing past the ceiling does not add extra desire. It shows up as acne, extra facial hair, scalp thinning, voice change, and other androgen effects (Islam et al., 2019; Parish et al., 2021).
A practical path looks like this:
Confirm HSDD with real distress after other causes are checked.
Draw a baseline total testosterone with a sensitive LC-MS/MS test, not a routine immunoassay built for men (Rosner et al., 2007).
Start low.
Recheck the level and symptoms at about 8-12 weeks.
Assess benefit at 3 to 6 months. If distressing low desire has not improved, stop rather than climb (Davis et al., 2019; Parish et al., 2021).
Baseline testosterone does not diagnose HSDD. It is a safety tool once treatment starts (Hatzilabrou, 2025).
Two problems are often mistaken for low desire. Antidepressants, especially SSRIs, can blunt desire on their own. Genitourinary syndrome of menopause—dryness, atrophy, and pain with sex—can look like low desire when the real issue is pain. Local estrogen, not a systemic androgen, is built for that problem (Parish et al., 2021; Cedars-Sinai, n.d.).
What the Body May Gain Beyond Desire
Sexual function is the outcome with the firmest trial support. Other claims need a quieter voice.
Muscle and strength. Testosterone helps muscle protein building in both sexes. Some women report better lean mass and training response when testosterone levels return to a mid-physiologic range. Large pooled trial data in women have not shown a robust body-composition effect at the low doses used for HSDD, so frame this as possible support, not a guarantee (Islam et al., 2019; Hatzilabrou, 2025).
Bone. One small two-year implant trial found faster gains in spine, hip, and total-body density when testosterone was added to estradiol. Guidelines still do not list bone as an approved reason to prescribe it because the study was small and not designed to prevent fractures (Davis et al., 1995; Wierman et al., 2014).
Energy and mood. Early and smaller studies sometimes showed better well-being. Dedicated trials and systematic reviews have been mixed or null for mood, fatigue, and cognition. Societies do not endorse testosterone as a general menopause tonic (Islam et al., 2019; Dichtel et al., 2020; Cedars-Sinai, n.d.).
Red blood cells. Testosterone can raise red-cell production. That is a monitoring issue at higher exposure, not a reason to treat ordinary anemia in women (Hatzilabrou, 2025).
For the spine and joints, even modest improvements in muscle and bone health matter. Stronger hip and core muscles help the pelvis stay level. Better bone quality supports the vertebrae that a chiropractor adjusts. After a car crash, a work injury, or months of guarded movement, patients who can train without crashing energy often stay in rehab longer (Jimenez, n.d.-a).
Safety, Side Effects, and the Long View
Short- and medium-term data at physiologic doses are generally reassuring for the day-to-day effects clinicians watch: acne, extra hair, and oily skin. Those effects are usually dose-related and often fade if the dose is cut (Islam et al., 2019; Nachtigall et al., 2011).
What is missing is the long view. Adequately powered trials have not settled cardiovascular and breast outcomes over many years. That gap—not a proven harm signal—is a main reason no female product has been approved (Hatzilabrou, 2025; Cedars-Sinai, n.d.).
Therapy is not for pregnancy, breastfeeding, or people trying to conceive. Women with high baseline heart or breast-cancer risk need an especially clear shared decision (Hone Health Help Center, n.d.; Parish et al., 2021).
How Integrative Chiropractic Care Fits
Hormones don’t exist apart from the skeleton. Low energy, weaker muscles, and slower recovery make spinal joints stiffer and make rehab after an auto accident harder. Integrative care treats that loop instead of handing a woman only a syringe or only an adjustment.
At Injury Medical Clinic PA in El Paso, Texas (11860 Vista Del Sol, Suite 128), we build care as a team. Dr. Alexander Jimenez, DC, APRN, FNP-BC, CCST, CFMP, IFMCP, ATN, is dual-licensed as a chiropractor and board-certified family nurse practitioner. His clinical writing stresses that female testosterone use is not a copy of male replacement: the best randomized evidence is still transdermal; SubQ use in women is an individualized off-label choice, and the goal is a physiologic range with a stop rule if desire does not improve (Jimenez, n.d.-b).
Dr. Maria Guadalupe Cardenas, MD, is his internist and is board-certified in internal medicine (NPI #1164426749, Texas MD License #J2933), with more than 40 years of experience. She serves as medical director and collaborative physician. In this model, the internist provides medical direction, reviews labs and overall health, and helps keep advanced or off-label therapies within safe bounds. The chiropractor restores joint motion, posture, and neuromuscular control. Functional medicine looks at sleep, gut health, thyroid, iron, and medications that can blunt desire. Personal injury and rehabilitation services rebuild strength after crashes, falls, and sports injuries, so a hormone plan isn’t asked to do the work of a weak core or an unhealed disc (Jimenez, n.d.-a).
That mix is common in integrated injury clinics: an MD directs the medical lane while a DC treats the mechanical lane. For a woman on low-dose testosterone, the practical payoff is simple. If the muscles around the spine hold better, adjustments last longer. When bone and lean mass improve, fall risk and “I feel fragile” complaints may ease. If pain and sleep improve, desire often has a clearer path—without pretending testosterone is a cure for every menopausal complaint.
A Clear Path Forward
Testosterone treatment in women is neither a wellness trend nor a male protocol scaled down by guesswork. It is a narrow, evidence-backed option for postmenopausal HSDD with distress, given at a female physiologic dose, watched with the right lab, and stopped if it does not help.
Subcutaneous injections can deliver that modest, steady dose into the fat under the skin. They ask for discipline: start low, measure, stay inside the range, and pair the hormone with the rest of the care—local vaginal treatment when dryness is the real problem, medication review when an antidepressant is the real problem, and hands-on musculoskeletal care when the spine and hips cannot carry the load.
In El Paso, that whole-person path is the point of the collaboration between Dr. Cardenas’s internal medicine oversight and Dr. Jimenez’s chiropractic, functional medicine, and injury rehab work. The hormone is only one tool. The goal is a woman who can move, recover, and feel like herself again.
Integrative Nerve Block and Forehead Lesion Removal: A Step-by-Step, Evidence-Based Guide for Patients and Clinicians
Abstract: In this educational post, I walk you through a patient-centered, step-by-step approach to performing a supraorbital and supratrochlear nerve block. This approach helps comfortably remove a small forehead lesion. I present the latest findings from leading researchers on regional anesthesia safety, dosing, and anatomical precision. I also explain how integrative chiropractic care, functional medicine, and medical oversight fit into a modern multidisciplinary practice. You will learn the anatomy of the supraorbital and supratrochlear nerves. Specifically, you will discover why targeted nerve blocks reduce pain with minimal medication. You will also see how we coordinate between internal medicine and chiropractic. You will also learn how we embed rehabilitation, personal injury protocols, and functional strategies into the patient’s care plan at Injury Medical Clinic PA in El Paso, Texas.
About Our Integrative Care Team
I am Dr. Alex Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, ATN, CCST. I practice at Injury Medical Clinic PA (Mission Plaza Injury Medical Clinic) in El Paso, Texas. Dr. Maria Guadalupe Cardenas, MD (Board Certified in Internal Medicine; NPI #1164426749; Texas MD License #J2933) provides medical oversight for modern, integrative musculoskeletal and functional care. Dr. Cardenas has served patients for more than 40 years. As our medical director and collaborative physician, she ensures evidence-based protocols, safety, and continuity of care. Together, we integrate:
Chiropractic and manual therapies
Medical diagnostics and procedural oversight
Functional medicine and systems biology
Personal injury care and comprehensive rehabilitation
Neuromuscular re-education and ergonomic guidance
Patient-Friendly Roadmap: Forehead Lesion Removal with Precision Nerve Blocks
Today, I describe the process and reasoning behind using a supraorbital and supratrochlear nerve block to comfortably remove a small forehead lesion. This approach minimizes systemic anesthetic exposure. Moreover, it improves pain control at the exact site of care. It allows a calm, efficient procedure.
Why Use Regional Nerve Blocks for Forehead Lesions?
Targeted analgesia: Blocking the supraorbital and supratrochlear nerves numbs sensation to the forehead and anterior scalp, producing a painless window for dermatologic procedures.
Reduced need for multiple local injections: Instead of repeatedly infiltrating the lesion with anesthetic, a well-placed block numbs the area broadly, lowering the total dose.
Faster onset and reliable effect: These superficial branches are accessible, allowing precise anesthesia with low-volume lidocaine, minimizing risk when properly dosed and monitored.
Patient comfort and safety: Patients often report lower anxiety and discomfort when they experience quick, controlled analgesia before lesion excision.
The Anatomy: Finding the Target Safely
When planning a forehead block, topographical anatomy and tactile confirmation guide safe technique.
Supraorbital nerve: A branch of the ophthalmic division (V1) of the trigeminal nerve, exiting through the supraorbital notch or foramen typically located along the superior orbital rim. Clinically, we palpate just above the eyebrow in a vertical line superior to the center of the pupil. This region carries cutaneous sensation for the mid-forehead and anterior scalp.
Supratrochlear nerve: Also from V1, it emerges more medially, above the inner canthus of the eye, and travels along the medial superior orbital rim to supply sensation to the medial forehead and glabellar region.
Understanding this anatomy avoids intravascular injection. It protects the globe and ensures predictable coverage with small volumes.
Step-by-Step: My Clinical Technique
To keep the experience clear and comfortable, I narrate each step. This includes reassuring the patient and dosing safely.
Identify landmarks: I palpate the orbital rim and align my injection points:
For the supraorbital nerve: just superior to the mid-pupillary line above the eyebrow.
For the supratrochlear nerve: at the medial orbital rim above the inner canthus.
Prepare the skin: I clean the area thoroughly with alcohol to reduce microbial load.
Pinch and stabilize: I gently pinch the skin to control superficial motion and provide mild counter-stimulation that can reduce the perception of needle entry.
Needle placement and bone touch: Using a fine-gauge needle, I advance carefully until I lightly contact bone at the superior orbital rim—this tactile stop confirms I am at the correct depth and location without traversing deeper structures.
Aspirate and inject safely: After confirming safety, I inject approximately 0.5 mL of lidocaine at each site. With careful technique, I feel a soft bulge against my thumb, confirming adequate local spread near the nerve.
Pressure and observation: I apply gentle pressure to limit bruising, monitor for comfort, and reassess coverage.
Supplemental local infiltration: If needed for the lesion margins, I add a small ring of local infiltration around the lesion to strengthen anesthesia precisely where the excision will occur.
Proceed with the procedure: Once comfort is confirmed, we remove the lesion with attention to aseptic technique and cosmetic incision alignment.
Physiological Basis: How Local Anesthetics Work
Sodium channel blockade: Agents like lidocaine enter neuronal membranes and block voltage-gated sodium channels, preventing the depolarization needed to conduct pain signals. This effect is reversible and concentration-dependent.
Fiber sensitivity: A-delta and C fibers (pain-transmitting) are more susceptible to blockade than larger motor fibers in this region, which is why sensation is selectively reduced without affecting facial expression.
pH and onset: Lidocaine is weakly basic; tissue pH influences ionization and the speed of membrane penetration. Forehead tissue is typically well perfused, supporting consistent onset.
Safety margin: Low-volume, superficial injections at the specified sites minimize the risk of intravascular injection and systemic toxicity while providing broad cutaneous anesthesia.
Evidence-Based Considerations: Dosing, Safety, and Monitoring
Contemporary literature highlights practical safeguards and dosing strategies for facial regional blocks:
Use the lowest effective dose to achieve sensory blockade, especially in facial procedures with small fields (NYSORA – Peripheral nerve blocks).
Watch for early signs of local anesthetic systemic toxicity (LAST), such as perioral numbness, tinnitus, metallic taste, or CNS changes; keep resuscitation protocols ready if using larger volumes, though small facial blocks carry an extremely low risk (American Society of Regional Anesthesia – LAST checklist).
Consider the patient’s comorbidities, medications, and allergies, particularly with internal medicine oversight to ensure whole-person safety.
In our clinic, Dr. Cardenas reviews medical risk factors and ensures that protocols match the patient’s cardiovascular, neurologic, and metabolic profile, integrating internal medicine safeguards into a musculoskeletal and procedural workflow.
Integrative Chiropractic Care: Why It Fits and How We Use It
Chiropractic and functional rehabilitation enhance outcomes before and after minor procedures by optimizing soft tissue tone, posture, and neuromuscular control.
Pain modulation and autonomic balance: Gentle cervical and thoracic mobilization, myofascial release, and breathing retraining downregulate sympathetic drive that can heighten pain perception, facilitating smoother procedures and better recovery. Clinical observations in our practice show that patients experience lower tension and improved tolerance when we apply pre-procedural soft tissue techniques judiciously (El Paso Back Clinic – Clinical observations and outcomes).
Postural optimization: Forward head posture and frontal muscle overuse can contribute to tension headaches and frontal neuralgia; chiropractic care, ergonomic counseling, and targeted corrective exercise reduce strain on the supraorbital and supratrochlear pathways.
Scar management and tissue glide: Following lesion removal, gentle scar mobilization and instrument-assisted soft tissue techniques can improve collagen alignment and prevent restriction of the frontalis and corrugator supercilii fascia, improving comfort and aesthetics.
Integrative care is not just about manual techniques—it is about aligning nervous system regulation, tissue health, and biomechanics to support healing. Paired with precise anesthesia and medical oversight, this approach provides comprehensive, individualized care.
Functional Medicine Integration: Systems-Based Support for Healing
We incorporate functional medicine principles to support tissue repair, immune balance, and skin health:
Nutritional support: Adequate protein, vitamin C, zinc, and omega-3 fatty acids support collagen synthesis, angiogenesis, and inflammation resolution. For patients with recurring skin lesions or delayed healing, we assess dietary intake and relevant labs.
Inflammation mapping: We screen for systemic inflammatory drivers (sleep apnea, gut dysbiosis, chronic stress) and address them with lifestyle, sleep hygiene, and targeted nutraceuticals when appropriate (IFM – Functional medicine approaches to inflammation).
Dr. Cardenas’s internal medicine oversight complements this approach by evaluating comorbidities, adjusting medications, and coordinating lab work to ensure safety and efficacy.
Personal Injury and Rehabilitation: Restoring Function and Confidence
In personal injury cases—such as facial trauma from accidents—regional nerve blocks, minor procedures, and rehabilitation may be combined:
Acute care coordination: Medical evaluation to rule out orbital fractures, cranial nerve injuries, or hematomas, followed by precise analgesia and wound management.
Rehabilitation pathway: Chiropractic-guided cervical stabilization, vestibular exercises if indicated, and postural retraining to reduce head strain and promote healing without exacerbating neural sensitivity.
Return-to-work planning: Ergonomic adjustments, task modification, and graded exposure to activities to prevent flare-ups in the frontal musculature and peri-orbital tissues.
Our clinic focuses on structured progressions and measurable outcomes, ensuring patients move from acute comfort to long-term resilience.
Clinical Observations: What We See in Practice
Drawing from my clinical experience and shared outcomes reported through our channels:
Patients frequently report improved tolerance and reduced anxiety with a clear explanation of the nerve block process and gentle stabilization of the injection site.
Low-volume, well-placed lidocaine blocks provide reliable anesthesia for forehead lesions without distorting tissue architecture, making cosmetic closures more precise.
Integrating soft tissue work and breathing strategies before the procedure helps attenuate anticipatory pain and sympathetic arousal, making the block feel less intense.
Post-procedure, patients benefit from simple forehead mobility drills, hydration, and nutritional support to optimize scar remodeling—leading to smoother outcomes and fewer adhesions.
In personal injury settings, coupling procedural precision with spine care and functional rehab accelerates return to normal activities and reduces downstream pain syndromes.
For more insights into our integrative protocols and case studies, visit our practice resources:
El Paso Back Clinic: https://elpasobackclinic.com/
Professional profile: https://www.linkedin.com/in/dralexjimenez/
Our Multidisciplinary Workflow: Safety, Clarity, and Results
Here is how we structure patient care at Injury Medical Clinic PA:
Intake and evaluation:
Medical history, medications, allergies, and risk factors
Anatomic mapping and functional assessment
Coordinated plan:
Internal medicine oversight by Dr. Cardenas
Procedural planning by me with a clear anesthesia strategy
Functional and chiropractic support to regulate nervous system tone and improve tissue health
Intervention:
Pre-procedural soft tissue preparation when appropriate
Supraorbital and supratrochlear nerve blocks
Lesion removal with attention to aesthetics and aseptic technique
Recovery and follow-up:
Scar care, nutrition, and movement guidance
Ergonomic and postural coaching
Monitoring and adjustments coordinated between disciplines
This approach ensures patients receive precise, compassionate care grounded in modern evidence.
Practical Tips for Patients
Ask about the plan: Understanding your nerve block and lesion removal steps reduces anxiety and improves your experience.
Share your history: Disclose medications, bleeding risks, allergies, and prior reactions to local anesthetics.
Prepare for recovery: Plan for gentle care of the site, adequate hydration, and nutrition; avoid picking or excessive facial expressions until sutures are removed.
Follow movement and posture guidance: Simple exercises and ergonomic habits support better outcomes and comfort.
Why This Matters: Precision Care with Whole-Person Support
Facial procedures deserve meticulous technique. By combining anatomical precision, low-dose regional anesthesia, and integrative care, we honor both the science and the human experience of healing. With Dr. Cardenas’s medical leadership, evidence-based protocols, and chiropractic-functional rehabilitation, we deliver care that is safe, efficient, and tailored to your needs.
Key Takeaways
Supraorbital and supratrochlear nerve blocks provide targeted, efficient analgesia for forehead lesion removal.
Low-volume lidocaine with careful anatomical technique enhances safety and cosmetic outcomes.
Integrative chiropractic and functional medicine support nervous system regulation, tissue healing, and long-term resilience.
Internal medicine oversight ensures comprehensive risk management and continuity of care.
A multidisciplinary pathway—from evaluation to rehabilitation—optimizes patient comfort and outcomes.
Evidence-Based Excision of a Dysplastic Nevus With Integrative Chiropractic and Functional Medicine Support
Abstract
In this educational post, I guide you through a precise, evidence-based approach to excising a dysplastic nevus with moderate atypia using a pain-free field block technique and narrow margins. I explain my step-by-step method, the anatomical and physiological rationale for local anesthesia and intradermal infiltration, and the clinical decision-making behind margin selection. I also introduce our multidisciplinary model in El Paso, Texas, where I work alongside Dr. Maria Guadalupe Cardenas, MD, our internal medicine medical director, to integrate chiropractic care, functional medicine, personal injury care, rehabilitation, and patient-centered follow-up. Throughout, I present the latest findings from leading dermatologic surgery and pain science researchers, connect these principles to chiropractic neurophysiology, and describe how integrative chiropractic care fits into peri-procedural and long-term outcomes.
Dysplastic Nevus Excision: My First-Person Clinical Approach
I am Dr. Alexander Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, ATN, CCST. Today, I share my clinical approach to excising a dysplastic nevus with moderate atypia—an area previously shaved and biopsied about one month prior—using narrow but appropriate margins and a meticulous, pain-minimizing anesthesia technique. As the patient sits comfortably, I begin by cleaning the site with alcohol, re-prepping to reduce transient skin flora before marking the excision plan.
Clinical context: The original lesion measured approximately 5 by 6 millimeters. With moderate atypia, evidence supports complete removal with narrow margins when severe atypia or melanoma features are absent.
Excision planning: I use a sterile template to visualize an elliptical excision, aiming for about 2-millimeter margins around the residual scar. Because the original lesion was 5 x 6 mm, the post-biopsy excision boundary effectively spans about 5 mm beyond the original footprint to ensure complete removal of dysplastic tissue, both visible and microscopic, along the shave plane.
Creating a Pain-Free Field Block: Technique and Rationale
My goal in minor surgical procedures is a pain-free patient experience. I set up a field block—a circumferential ring of local anesthetic that interrupts sensory nerve conduction—so the patient does not feel the needle or the intradermal distension.
Anesthetic choice: I use 1% lidocaine with epinephrine.
Lidocaine blocks voltage-gated sodium channels on nociceptive and mechanoreceptive fibers, preventing depolarization and conduction of pain signals.
Epinephrine induces local vasoconstriction via alpha-adrenergic receptors, prolonging lidocaine’s residence time, reducing bleeding, and minimizing systemic absorption, thereby extending anesthesia duration and improving hemostasis.
Spray analgesia: Before needle entry points, I apply a brief vapocoolant “freeze spray.” The cold exposure rapidly reduces superficial nociceptor firing (TRPM8-mediated cold sensing and transient gating of pain fibers), ensuring the patient feels no needle prick. He confirms: “No pain.” This instant desensitization is especially helpful in field blocks that require multiple passes.
Needle Control, Intradermal, and Subcutaneous Delivery: Why It Works
I insert the needle at a chosen point, advance subcutaneously, and inject as I withdraw. Before exiting the skin, I rotate the bevel and repeat on the opposite side. This “inject-on-withdrawal” method creates an even distribution of anesthetic parallel to dermal nerve plexuses.
Physiological basis:
The dermis contains a dense network of free nerve endings and mechanoreceptors. Intradermal distension with anesthetic rapidly silences A-delta and C-fiber nociceptors via sodium channel blockade.
Subcutaneous infiltration saturates the tissue beneath the lesion, interrupting deeper cutaneous nerve branches that feed the operative field.
Technique advantages:
By threading the needle just past midline and injecting on withdrawal, a visible wheal forms—a sign of intradermal spread.
Slightly bending a longer needle allows steering to contour around the template. This helps me remain just outside the marked ellipse, preventing anesthetic pooling in the incision path while fully covering perilesional innervation.
Multiple entry points may be necessary for large or anatomically curved sites. With cooling spray and prior subcutaneous saturation, new entry points remain pain-free.
The patient confirms repeatedly: no pain. This validates that the circumferential anesthetic fence is intact and effective.
Margin Selection for Moderate Atypia: Evidence-Based Considerations
A dysplastic nevus with moderate atypia warrants complete excision, but the margin need not be wide if there is no severe atypia or melanoma in situ. Contemporary studies suggest that 2 mm clinical margins often achieve histologic clearance for moderate atypia, particularly when initial shave biopsy delineated architecture and ruled out more aggressive pathology (Kittler et al., 2020; Swetter et al., 2019).
Why narrow margins:
Preserve healthy tissue and reduce scarring while achieving oncologic adequacy for moderate atypia.
Epinephrine-assisted hemostasis reduces bleeding and improves visibility, allowing precise adherence to planned margins.
Post-excision pathology:
We send the specimen for histologic assessment to confirm clear margins and exclude residual atypia. If margins are positive or close, we discuss re-excision based on the pathologist’s recommendations and the patient’s goals.
Step-by-Step Workflow: From Prep to Incision
Second prep: I re-clean the site and confirm sterile field integrity.
Template marking: I trace an ellipse aligned with skin tension lines (Langer lines) to enhance cosmetic outcomes and minimize wound tension.
Field block completion: Intradermal wheals surround the template; subcutaneous anesthesia saturates the bed beneath the lesion.
Patient check-in: I ask about sensation; he reports no pain.
Incision and removal: With a sharp blade, I incise along the outside of the template, dissect through the dermis and minimal subcutis to remove the lesion and scar bed en bloc. I maintain hemostasis with epinephrine and use meticulous cautery only when appropriate for the site.
Layered closure: Where needed, I approximate with deep absorbable sutures to reduce tension, then close the epidermis with fine non-absorbable sutures aligned to natural creases. This supports rapid healing and improved cosmesis.
Integrative Chiropractic Care in Dermatologic Procedures: Why It Matters
While excising a skin lesion may seem purely dermatologic, integrative chiropractic care supports peri-procedural comfort, autonomic regulation, and recovery. At Injury Medical Clinic PA (Mission Plaza Injury Medical Clinic) in El Paso, I collaborate closely with Dr. Maria Guadalupe Cardenas, MD (Board Certified Internal Medicine; NPI #1164426749; Texas License #J2933). Our model leverages chiropractic neurophysiology, functional medicine, and internal medicine oversight to optimize patient outcomes.
Chiropractic neurophysiology:
Gentle cervical and thoracic mobility work can reduce sympathetic overactivity and anxiety, thereby lowering perceived pain via descending inhibitory pathways (periaqueductal gray modulation).
Soft tissue techniques around the shoulder girdle and thoracic cage relieve myofascial tension that can amplify cutaneous pain through central sensitization.
Autonomic balance:
Breathing mechanics, rib cage mobility, and vagal tone optimization help stabilize heart rate and blood pressure during minor procedures. Patients report better comfort and less discomfort from injections when sympathetic tone is moderated.
Functional ergonomics:
Post-procedure, appropriate postures and scapular mechanics reduce strain on healing sites in the back, shoulder, or trunk areas, decreasing shear forces across the incision and promoting better scar formation.
Internal Medicine Oversight: Safety, Risks, and Comorbidities
Dr. Cardenas provides medical direction and co-management for patients with complex medical histories. Together, we tailor anesthesia choices, wound plans, and follow-up based on comorbidities.
Hypertension and cardiovascular disease:
Epinephrine in lidocaine is generally safe for small dermatologic fields, but we confirm medication lists (beta-blockers, MAO inhibitors) and assess cardiovascular stability. Internal medicine oversight ensures risk stratification and informed consent aligned with the patient’s health status.
Diabetes and wound healing:
Glycemic control is vital to prevent infection and optimize collagen synthesis and cross-linking in the wound. We coordinate glucose monitoring and provide nutrition guidance consistent with functional medicine principles that support wound healing (adequate protein, vitamin C, and zinc).
Anticoagulants and antiplatelets:
For patients on warfarin, DOACs, or aspirin, we plan hemostasis strategies, pressure dressings, and post-op monitoring. Most dermatologic excisions proceed without stopping therapy, but Dr. Cardenas ensures that decisions align with evidence and safety.
Functional Medicine and Nutritional Support for Skin Healing
As a Certified Functional Medicine Practitioner (CFMP, IFMCP), I incorporate nutritional and lifestyle strategies to enhance skin repair.
Nutrient optimization:
Protein targets (1.2–1.6 g/kg/day in older adults during recovery) support fibroblast activity and collagen deposition.
Vitamin C and zinc are essential cofactors in collagen hydroxylation and DNA synthesis; deficiencies prolong healing time.
Omega-3 fatty acids can modulate inflammatory cytokines, promoting resolutive healing without impairing necessary inflammatory phases.
Glycemic control and inflammation:
Stable blood sugar reduces advanced glycation end-products that stiffen collagen and impair tensile strength of healing tissue.
Sleep and stress:
Adequate sleep supports growth hormone and tissue repair, while stress reduction techniques blunt cortisol’s catabolic effects on skin.
Personal Injury Care Integration: Biomechanics and Scar Protection
In personal injury cases, excision sites often lie across regions of high biomechanical load. Our integrative chiropractic and rehabilitation approach minimizes scar widening and pain flares.
Biomechanics:
Assess regional movement patterns to reduce shear across the healing incision.
Educate on movement strategies—log-rolling, hip hinge, and scapular setting—to protect the site in the first 1–2 weeks.
Myofascial release:
Gentle, indirect techniques adjacent to the excision (not on the wound) decompress fascial layers that, if tight, can pull on the scar and provoke pain.
Graded activity:
As collagen matures (weeks 3–6), we introduce light isometrics and, later, controlled mobility to align collagen fibers along lines of stress and improve scar pliability.
Keep the area clean and protected for the first 24–48 hours; petrolatum-based occlusion maintains moisture and accelerates re-epithelialization.
Scar modulation:
Silicone sheets or gels reduce hypertrophic scarring by regulating hydration and fibroblast activity.
Gentle massage after complete epithelialization (usually after suture removal) remodels scar tissue, improving mobility and sensation.
Sun protection:
UV exposure can cause hyperpigmented scars; broad-spectrum SPF 30+ prevents cosmetic discoloration and protects collagen integrity.
Collaborative Model at Injury Medical Clinic PA: Roles and Workflow
Our El Paso clinic exemplifies integrative care, common in injury and functional medicine settings, where an MD provides medical direction alongside a chiropractor. Dr. Cardenas, MD, serves as the medical director and collaborative physician, and I lead integrative chiropractic and functional care.
Pre-procedure:
Medical review: Dr. Cardenas assesses comorbidities, medications, and risk factors.
Chiropractic preparation: I provide autonomic regulation techniques and positioning strategies to enhance comfort and reduce nociception.
Procedure:
Evidence-based anesthesia and excision: I perform a field block and precise excision, with hemostasis and ongoing patient communication.
Post-procedure:
Follow-up: Internal medicine oversight ensures safe healing. Functional medicine guidance supports nutrition and lifestyle modifications.
Rehabilitation: Chiropractic-directed movement strategies, scar protection, and graded return to activity.
Clinical Observations from Practice: Patient Comfort and Outcomes
Across my clinical work in El Paso, patients often report extraordinarily low pain during our field blocks. As reflected in today’s case, the patient experienced no pain during multiple entries and intradermal distension—exactly the outcome we aim for.
Patient Education and Safety: What to Expect After Excision
Normal sensations: Mild tightness or itch as healing progresses; avoid scratching.
Red flags: Excessive bleeding, spreading redness, purulent discharge, fever, or severe pain—contact us immediately.
Activity:
Keep the area dry for the first day unless instructed otherwise.
Avoid stretching or heavy lifting that places tension across the excision line until cleared.
Follow-up:
Suture removal typically occurs within 5–14 days depending on body location and tension.
Pathology results guide any additional steps. If margins are clear, we move to standard surveillance; if not, we discuss re-excision.
Latest Research Insights Supporting This Approach
Local anesthesia with epinephrine is safe and effective for most dermatologic procedures, enhancing duration and hemostasis without increasing necrosis when used within recommended doses (Krunic et al., 2004; Alam & Dover, 2008).
Narrow margins for moderate atypia in dysplastic nevi can be appropriate when clinical-pathologic correlation rules out severe atypia or melanoma (Swetter et al., 2019; Kittler et al., 2020).
Vapocoolant sprays reduce injection pain by activating cutaneous cold receptors and transiently inhibiting nociception (Gallagher et al., 2009).
Layered closure aligned with tension lines optimizes cosmetic outcome and reduces dehiscence risk (Borges, 1984; Alam & Wrone, 2007).
Integrative care models with chiropractic and internal medicine collaboration can improve patient satisfaction, reduce pain, and support functional recovery via autonomic modulation and biomechanical optimization (Goertz et al., 2018; Schneider et al., 2015).
Why Integrative Chiropractic Care Fits in This Treatment Plan
Whole-person care: Skin health intersects with systemic physiology—autonomic tone, metabolic status, and biomechanics. Chiropractic and functional medicine address these intersections.
Peri-procedural calm: Breathing and gentle mobilization improve patient comfort and experience during minor surgery.
Long-term outcomes: Scar integrity and function rely on movement patterns, tissue nutrition, and stress regulation—core areas where chiropractic and functional medicine strategies excel.
Our Commitment to Modern, Evidence-Based, Patient-Centered Care
At Injury Medical Clinic PA, our mission is to provide modern, evidence-based care that respects the patient’s experience, safety, and long-term health. By integrating internal medicine oversight from Dr. Cardenas with chiropractic and functional medicine strategies, we ensure that each procedure—from a simple excision to complex injury rehabilitation—benefits from rigorous science and compassionate execution.
Gut Repair From the Inside Out: Regenerative Therapies, BPC-157, and Integrative Care in El Paso
Abstract
This article asks whether regenerative therapies can help gut health. Regenerative therapies show potential to improve gut health by repairing damaged intestinal tissue and restoring the integrity of the mucosal lining. The post then investigates BPC-157 (Body Protection Compound) and its studied role in cytoprotective recovery of the epithelial lining, lower hyperpermeability (leaky gut), and integrative peptide therapy aimed at reducing full-body inflammatory loads. It also explains how integrative chiropractic care fits this plan and how Dr. Alexander Jimenez, DC, APRN, FNP-BC, works with Medical Director Dr. Maria Guadalupe Cardenas, MD, at Injury Medical Clinic PA in El Paso, Texas.
A Simple Answer With a Bigger Story
Yes. Regenerative therapies show potential to enhance gut health by repairing damaged intestinal tissue and restoring the integrity of the mucosal lining. That sentence is the scientific hope in plain language. The lining is not a passive tube. It is a living wall. When the wall is strong, food becomes fuel. When the wall is worn or open, the immune system stays busy, and pain in the back, neck, joints, or head can last longer than expected (Sikiric et al., 2020; Chang et al., 2025).
Many people treat digestion and spine pain as two different problems. In clinical practice, they often travel together. Stress, poor sleep, pain pills, and limited movement after injury can all irritate the same barrier that is supposed to keep the inside of the gut where it belongs.
Meet the Mucosal Lining
The innermost layer of the intestine is called the mucosa. New cells rise from intestinal stem cells that live in small pockets called crypts. Tight-junction proteins then fasten neighboring cells together, like a zipper.
A healthy lining does three jobs at once:
Absorbs vitamins, minerals, amino acids, and water
Keeps most bacteria, toxins, and large food bits out of the blood
Talks to the immune system so it does not overreact
If the zipper loosens, extra material slips through. Researchers call this hyperpermeability. Patients often hear “leaky gut.” The immune system then treats ordinary contents as a threat. Inflammation can spread. People may notice bloating, food reactions, fatigue, brain fog, or joints that stay hot after a strain (Park et al., 2020; Vida Revival, n.d.).
That is why gut repair isn’t just a stomach issue. It is a whole-body load topic.
How Regenerative Therapies Approach the Gut
Regenerative care tries to help tissue rebuild instead of only quieting a symptom for a few hours.
For the intestine, that work may include:
Protecting surface cells from further injury
Helping epithelium close gaps
Improving blood flow to the mucosa
Supporting stem cells that replace worn lining
Lowering inflammatory signals that keep the barrier open
The microbiome is part of this story. Gut bacteria can speed or slow intestinal stem-cell aging. In animal research, restoring a healthier microbial pattern improved stem-cell function and healing after injury (International Society for Stem Cell Research [ISSCR], 2025). A microbial metabolite called desaminotyrosine has also been shown to strengthen the barrier and drive stem-cell repair after severe gut stress (Leibniz Institute for Immunotherapy, 2025).
Other studies look even further upstream. Scientists found that clearing worn-out senescent cells helped aging mouse guts regenerate, reduced inflammation, and improved nutrient handling (Cold Spring Harbor Laboratory, 2026). California’s stem-cell agency has funded work to grow intestinal tissue and explore cell therapy for inflammatory bowel disease, where the lining is chronically damaged (California Institute for Regenerative Medicine [CIRM], n.d.). Clinics studying mesenchymal stem cells for delayed stomach emptying describe a similar aim: less inflammation, better nerve and muscle support, and improved local circulation (Stemwell, n.d.).
These paths are not identical, and none are ready as everyday treatments. They point in one direction. The gut can be helped toward repair when the right signals return.
Targeting Leaky Gut With Gastric-Protective Peptides
BPC-157 is a lab-made chain of 15 amino acids modeled on a protective fragment found in human gastric juice. That origin is why researchers first asked whether it could shield and rebuild digestive tissue (Sikiric et al., 2020; Yoo Direct Health, 2025).
The current investigation has three parts.
Cytoprotective recovery of the epithelial lining
In animal and lab models, BPC-157 has protected the stomach and intestine against injury from NSAIDs, alcohol, stress, and experimental colitis. Reports also include better healing of ulcers and surgical connections in the gut. Proposed actions include cell survival, cell migration, new vessel growth, and nitric oxide pathway effects that improve local blood flow (Sikiric et al., 2020; Chang et al., 2025).
Reduction of hyperpermeability
Park and colleagues reported that BPC-157 helped stabilize intestinal permeability after NSAID injury. The work was linked with higher tight-junction support, including ZO-1, and with lower activity of several inflammatory messengers (Park et al., 2020). In everyday words, the zipper may get help staying closed.
Interaction with integrative peptide therapy
BPC-157 is often discussed with other short signaling peptides, such as KPV, that are studied for calming immune activity in the mucosa (Yoo Direct Health, 2025; Laser Skin Solutions, n.d.). Integrative peptide therapy, in this setting, means using selected signals to help the barrier recover so the inflammatory load on the rest of the body can fall. That load can affect joints, nerves, skin, energy, and recovery speed after injury.
What the evidence does not yet prove
Most BPC-157 gut data remain preclinical. Human trials are still limited. Reviews describe promise and then call for stronger controlled studies in people (Chang et al., 2025). BPC-157 is not FDA-approved for leaky gut, IBD, ulcers, pain, or any other human use. Products sold outside a regulated clinical pathway can vary in quality. Unapproved peptides also carry legal and professional risk. Competitive athletes should know WADA lists BPC-157 as a prohibited non-approved substance (PortraitCare, 2026; Holt, n.d.; Yoo Direct Health, 2026).
Interest is fair. Internet certainty is not.
From Gut Load to Spine Pain
When the barrier leaks, the immune system stays on alert. That alert can make an injured neck, disc, or sciatic nerve feel louder. Pain pills taken for the spine can then irritate the lining again. Sleep drops. Walking drops. The cycle tightens.
Dr. Alexander Jimenez, DC, APRN, FNP-BC, CCST, CFMP, IFMCP, ATN, has described this as a biology-and-mechanics problem. Regenerative tools try to improve the healing environment around tissue. Chiropractic care and rehabilitation try to restore motion so repaired tissue is not asked to live in a locked or twisted frame (Jimenez, 2025a, 2025b). His published observations and public professional profile also connect gut health, inflammation, autoimmunity, peptide discussions, IV recovery, and integrative chiropractic care as one clinical map (Jimenez, n.d.).
That map helps explain a common clinic pattern: the MRI shows a strain, but the person feels system-wide fatigue and slow progress until food, sleep, motion, and barrier health are addressed together.
How Integrative Chiropractic Care Fits the Treatment
Integrative chiropractic care does not claim to sew the intestinal lining with an adjustment. It supports the nervous system, posture, and movement that surround digestion and healing.
The mid-back, ribs, and diaphragm affect breathing and abdominal pressure. The vagus nerve and spinal pathways help set gut motion and stress tone. After injury or years of desk work, people often brace. The head drifts forward. The ribs stiffen. Bowel rhythm and sleep suffer.
In a coordinated plan, chiropractic care and rehab may:
Restore spinal and rib motion
Improve breathing mechanics
Reduce protective muscle guarding around the trunk
Retrain posture and walking
Prepare the body for strengthening and daily work
Better motion can lower fight-or-flight load. A calmer stress response gives the gut a better chance to repair. Functional medicine then looks at nutrition, sleep, blood sugar, and gut-immune clues. Personal injury care documents trauma and stages of return to activity. Regenerative options, if discussed at all, come after that foundation and under medical review.
A Multidisciplinary Clinic Model in El Paso
Persistent gut and pain cases require more than one perspective. At Injury Medical Clinic PA in El Paso, Texas, chiropractic and advanced practice care from Dr. Alex Jimenez are paired with medical direction from Dr. Maria Guadalupe Cardenas, MD.
Dr. Cardenas is board-certified in internal medicine (NPI #1164426749; Texas MD License #J2933). She has more than 40 years of experience as an internist and serves as medical director and collaborative physician. This multidisciplinary setup is common in integrative and injury care clinics. An MD provides medical direction, internal medicine judgment, and safety oversight. A chiropractor evaluates the spine, nerves, and movement. Together they can separate urgent digestive disease from functional barrier problems and connect both to back pain, sciatica, sports injury, or delayed recovery after a crash.
The same team plan may include:
Functional medicine and nutrition
Rehabilitation and posture training
Personal injury evaluation and documentation
Regenerative discussions under medical oversight
Nurse-practitioner care coordinated with the medical director
The benefit is not a trendy product name. The benefit is a group that sees the lining, the spine, and the person who has to get through the day.
A Clear Path Readers Can Follow
A careful sequence looks like this:
Seek care for warning signs such as bleeding, black stools, vomiting, fever, or unexplained weight loss.
Rebuild daily basics: protein, plants you can tolerate, water, walking, and sleep.
Restore motion with integrative chiropractic care and rehabilitation.
Support the barrier with food and targeted nutrients when indicated.
Consider advanced regenerative options only after diagnosis, informed consent, and legal clinic-based oversight.
Regenerative therapies show potential to enhance gut health by repairing damaged intestinal tissue and restoring mucosal lining integrity. BPC-157 is being investigated for cytoprotective epithelial recovery, reduced leaky-gut changes, and a lighter full-body inflammatory load when placed inside a broader integrative plan. The research is encouraging. Human proof and FDA approval are not complete. The most useful next step in El Paso is still a full evaluation with a team that treats both the barrier and the frame around it.
Park, J. M., Lee, H. J., Sikiric, P., & Hahm, K. B. (2020). BPC 157 rescued NSAID-cytotoxicity via stabilizing intestinal permeability and enhancing cytoprotection. Current Pharmaceutical Design, 26(26), 2971–2981. https://doi.org/10.2174/1381612826666200523180301
Abstract: When hormone levels decline with age or menopause, bioidentical hormone replacement therapy (BHRT) can help compensate by easing tight joints, safeguarding bone density, and bolstering muscular strength. Those changes can support better mobility and flexibility. BHRT will not magically make a person more flexible. It may help by lowering joint inflammation, supporting cartilage health, and easing muscle stiffness that often comes with low estrogen or testosterone. Integrative chiropractic care can amplify those advantages by restoring joint motion, reducing nervous-system stress, and improving movement mechanics. This article explains how hormones affect movement, what BHRT can and cannot do, and how a medical doctor and chiropractor work together in El Paso.
Start With What People Usually Feel
Many people notice the same shift. The body feels tighter than it used to. The first steps in the morning take longer. Bending to tie shoes, turning to check a blind spot, or reaching into a high cabinet does not feel as easy.
Some of that comes from less activity, old injuries, or weaker muscles. Hormones also play a role. Estrogen and testosterone do more than affect mood, sleep, and energy. They also affect joints, bones, cartilage, and muscle.
When those hormone levels fall, joints can feel tighter. Bones can lose density. Muscles may not support movement as well. That is why the question isn’t only, “Do I need to stretch more?” It is also “What is happening inside the body that makes stretching harder?”
How Hormone Decline Changes Joints, Bones, and Muscles
Estrogen helps keep joints quieter. It can lower inflammatory signals and help cartilage stay healthier and better lubricated. After menopause, estrogen drops. Joints may then become more prone to swelling and stiffness. The fluid that helps joints glide can decrease. Bone density often declines at the same time, which puts extra stress on the joints (Mobility Bone & Joint Institute, 2025).
Testosterone supports collagen and muscle mass. Collagen is a building block of cartilage, tendons, and ligaments. Muscle acts like a natural brace around a joint. When testosterone is low, repair can slow, muscles can weaken, and joints can feel less stable (BodyLogicMD, 2025; Sota Wellness, n.d.).
People may notice:
Tight hips, shoulders, neck, or knees
Longer morning stiffness
Less energy for walking or exercise
Weaker support around the joints
A higher chance of bone loss
These changes can feed on each other. Pain reduces activity. Less activity weakens muscle. Weaker muscle loads the joints more. Hormone balance may help interrupt that cycle, but movement still has to be restored.
What Bioidentical Hormone Therapy Is
BHRT uses hormones that match the ones the body makes. They are often made from plant sources and then chemically altered to match human estradiol, progesterone, or testosterone.
A clinician usually reviews symptoms and lab work before choosing a plan. Forms can include creams, patches, pellets, or other methods. The dose is meant to be personal, not one-size-fits-all.
It is important to stay careful. Mayo Clinic notes that bioidentical hormones are not proven safer or more effective than standard hormone therapy. Compounded products can also vary in quality (Mayo Clinic, 2024). Hormone therapy is a medical decision. It should be supervised, monitored, and based on a person’s health history. It is not right for everyone.
How BHRT May Support Mobility and Flexibility
BHRT does not stretch a tight muscle or unlock a restricted joint. It can help compensate for hormone decline in ways that make movement easier.
It may ease tight joints. Restoring estrogen and testosterone can reduce inflammatory activity that makes joints ache and feel stiff (BodyLogicMD, 2025; Renew Health & Wellness, 2021).
It may safeguard bone density. Stronger bones provide a more stable base for joints and can lower fracture risk (Balance Hormone Center, n.d.; Desert Sands Aesthetics, n.d.).
It may bolster muscular strength. Better muscle support can make daily movement safer and more controlled (Charleston Pain Relief Center, n.d.; Sota Wellness, n.d.).
It may support cartilage health. Estrogen helps joint lubrication and may slow some cartilage wear. Testosterone can support collagen (BodyLogicMD, 2025).
It may raise energy for activity. When fatigue eases, people can walk, stretch, and train more often. That extra movement can improve flexibility.
Some reports show less joint pain in people using hormone therapy. A few studies have linked estrogen therapy with slower osteoarthritis progression in some groups. Other evidence is mixed. Medical groups do not list joint pain as a main reason to start hormone therapy (Maven Clinic, n.d.). Results vary from person to person.
Why BHRT Will Not Magically Make You More Flexible
Flexibility is the ability of a muscle and joint to move through a useful range. Mobility is a bigger idea. It is flexibility plus strength, control, and healthy connective tissue (Essentrics, 2026).
Hormones can make that range more comfortable. They cannot create it by themselves. People still need:
Regular movement through the full range
Strength around the hips, spine, shoulders, and knees
Better posture and joint mechanics
Enough sleep and recovery
Care for old injuries that never fully resolved
If someone only uses hormone therapy and never addresses stiff joints or weak muscles, flexibility often stays limited. BHRT may lower the background tightness. The body still has to relearn easier movement.
How Integrative Chiropractic Care Fits Into This Treatment
This is where integrative chiropractic care becomes useful. Chiropractic care does not replace estrogen, progesterone, or testosterone. It does not change hormone levels on its own. It can restore the motion that stiffness and poor mechanics have taken away.
Gentle adjustments and soft-tissue work can help joints move again. Better joint motion often means less guarding and less pain. That can lower nervous-system stress. Pain and poor sleep raise cortisol. High cortisol can increase inflammation and make recovery harder (Nightlight Chiropractic, 2025).
Integrative chiropractic care can:
Restore motion in stiff spinal and extremity joints
Reduce muscle tightness around painful areas
Improve posture so joints are not loaded in a crooked way
Lower physical stress on the nervous system
Make walking, stretching, and rehab more comfortable
When joints move better, people can use the muscle and bone support that BHRT may provide. Hormone therapy works on the internal environment. Chiropractic care works on movement mechanics. Together, they can amplify results more than either one alone (Wellness Doctor RX, 2026).
Functional Medicine, Rehabilitation, and Injury Care
Hormone changes are not isolated. Sleep, stress, nutrition, weight, and old injuries all affect how stiff a person feels. Functional medicine looks at those layers. Rehabilitation rebuilds strength and range of motion. Personal injury care addresses the extra tightness that can follow a car accident or work strain.
A useful plan often includes:
A review of symptoms, injury history, and labs
Medical oversight when hormone therapy is being considered
Chiropractic care to restore joint motion
Rehab to build strength through the new range
Nutrition and lifestyle support for bone, muscle, and inflammation
The goal is not to stack random treatments. The goal is to help the body move with less pain and more control.
A Team Approach at Injury Medical Clinic PA
At Injury Medical Clinic PA in El Paso, Texas, this kind of layered care is built into the clinic model. Dr. Maria Guadalupe Cardenas, MD, is board-certified in internal medicine. She has more than 40 years of experience as an internist (NPI #1164426749, Texas MD License #J2933). Serves as medical director and collaborative physician. Provides medical evaluation, diagnosis, and oversight, including review of hormone-related concerns.
Dr. Alexander Jimenez, DC, APRN, FNP-BC, CCST, CFMP, IFMCP, ATN, provides chiropractic care and integrative clinical support. He is a chiropractor and board-certified family nurse practitioner. His work includes spinal care, functional medicine, personal injury rehabilitation, and wellness protocols.
This setup is common in integrative and injury-care clinics. An MD provides medical direction. A chiropractor restores joint motion and movement mechanics. The same team can also include functional medicine, rehabilitation, and related services. When appropriate, hormone optimization is paired with alignment work, soft-tissue care, and guided activity so patients can regain motion more safely.
Clinical Observations From Dr. Jimenez
Dr. Jimenez’s clinical observations point to the same idea. Hormone health and musculoskeletal care work better together. Integrative chiropractic care can restore spinal and pelvic alignment, reduce muscle tightness, and improve autonomic balance. That may help patients sleep better, stay more active, and tolerate other therapies more easily (Jimenez, n.d.).
He has noted that pelvic and low-back care can improve hip mechanics. Better hip motion often makes walking and daily tasks feel less restricted. Movement then supports bone health, insulin sensitivity, and mood. In practice, care isn’t just about a single adjustment or a single hormone prescription. It looks at inflammation, nutrition, sleep, alignment, and how the person actually moves (El Paso Back Clinic, n.d.; Jimenez, n.d.).
Patients often do best with a stepwise plan. First, reduce pain and stiffness. Next, restore joint motion. Then build strength and control through that new range.
What to Keep in Mind Before Starting
BHRT is one possible tool, not a flexibility program. A careful clinician will review risks, benefits, labs, and medical history. People with certain health conditions may not be appropriate candidates. Stretching, strength work, and chiropractic care still matter even if hormone levels improve.
A practical next step is a full evaluation. That means looking at how the joints move, how strong the supporting muscles are, and whether hormone changes are part of the picture. From there, the plan can be personal.
The Bottom Line
Can bioidentical hormone therapy help with mobility and flexibility? It can help compensate for hormone decline by easing tight joints, safeguarding bone density, and bolstering muscular strength. It may also lower inflammation, support cartilage, and ease muscle stiffness. It will not magically make someone more flexible.
Integrative chiropractic care can amplify those advantages. It restores joint motion, reduces nervous-system tension, and improves movement mechanics. Together, the two approaches address both the body’s internal chemistry and how it moves.
In El Paso, Injury Medical Clinic PA offers a multidisciplinary model in which Dr. Cardenas provides medical direction, and Dr. Jimenez provides chiropractic and integrative care. That combination is designed to help people move with more comfort, strength, and control.
Bioidentical hormone replacement therapy, or BHRT, uses hormones that match the ones your body makes. People often take estrogen, progesterone, or testosterone to ease low energy, poor sleep, mood changes, or weight gain. There is no single official diet for this therapy. Dietitians and doctors often suggest a Mediterranean-style diet or another whole-food, anti-inflammatory plan to support metabolism, liver cleansing, and steady energy while on bioidentical hormone replacement therapy (BHRT). Integrative chiropractic care lowers nervous-system tension. That can help control cortisol and support how the body uses hormones. This article explains what BHRT is, why food matters, which foods help most, extra daily habits, and how a team in El Paso combines chiropractic and medical care.
What Bioidentical Hormone Replacement Therapy Involves
BHRT replaces hormones that drop with age or other changes. These hormones act as messengers. They help control sleep, mood, energy, bone strength, and how the body uses food. Estrogen is often used for hot flashes and dryness. Progesterone can protect the uterus and support sleep. Testosterone may help with energy and muscle. Some products are FDA-approved. Others are mixed by a pharmacist for one person.
Many people notice milder symptoms in a few weeks. Stronger results often appear after about three months. Doctors watch labs and symptoms so the dose stays as low as needed. BHRT works best when the rest of the body is supported, including how you eat and how well your nervous system handles stress.
Why Nutrition Matters During BHRT
Food gives the body the building blocks for hormones and the tools to use them well. Hormones are made from fats and proteins. The liver breaks down excess hormones so they don’t build up. Fiber and certain plants help the gut move those leftovers out. Blood-sugar swings can raise insulin and cortisol, which can work against the hormones you are taking. An anti-inflammatory pattern lowers that extra stress.
Dietitians and doctors often suggest a Mediterranean-style diet or another whole-food, anti-inflammatory plan to support metabolism, liver cleansing, and steady energy while on bioidentical hormone replacement therapy (BHRT). The Mediterranean diet, which emphasizes healthy fats, lean proteins, and fiber, is a particularly effective example of a complete, anti-inflammatory diet that patients undergoing estrogen, progesterone, or testosterone bioidentical hormone replacement therapy (BHRT) follow. As a result of reducing stress and tension in the nervous system, which in turn helps control cortisol and optimizes metabolic and endocrine function, integrative chiropractic therapy lends credence to this idea.
The Mediterranean-Style Eating Pattern
Think of your plate in simple parts. Fill half with colorful vegetables and some fruit. Add a quarter of lean protein, such as fish, chicken, or beans. Use the last quarter for whole grains or starchy vegetables. Finish with a source of healthy fat like olive oil, avocado, or nuts.
This pattern supplies fiber for the gut, omega-3 fats that calm inflammation, and antioxidants that protect cells. It also gives the liver the nutrients it needs to process hormones. People on BHRT often feel more stable energy and fewer crashes when they follow this style.
Key habits include:
Eat mostly plants, fish, nuts, seeds, and olive oil.
Choose whole grains like quinoa, brown rice, or oats instead of white bread.
Limit processed snacks, sugary drinks, and extra alcohol.
Drink enough water to help the body move hormones through the liver and kidneys.
Foods That Support Estrogen, Progesterone, and Testosterone
Certain foods stand out because they supply specific nutrients. Here are six that specialists often highlight.
Fatty fish such as salmon and tuna. These give vitamin D, which can support testosterone, and omega-3 fats that reduce inflammation.
High-fiber grains like quinoa, brown rice, and oats. Fiber feeds good gut bacteria and supplies B vitamins that help the nervous system and hormones.
Flaxseeds. They contain lignans that help the body handle extra estrogen by binding it in the gut so it can leave the body.
Fresh herbs and spices such as turmeric, garlic, and fennel. These have compounds that support liver function and lower inflammation.
Berries and cherries. They supply antioxidants and can help raise melatonin for better sleep.
Lean protein, such as chicken breast, is also important. Protein helps regulate hunger hormones and supports muscle, which matters when testosterone is part of the plan.
Other helpful choices include leafy greens, avocados, nuts, olive oil, and fermented foods like yogurt. These add more fiber, healthy fats, and gut-friendly bacteria. Gut health matters because the microbiome helps break down estrogen.
A sample day might look like this: oatmeal with berries and flax for breakfast, a salad with chicken, olive oil, and vegetables for lunch, and baked salmon with quinoa and greens for dinner. Snacks can be nuts, fruit, or yogurt.
Lifestyle Steps That Work With Your Nutrition Plan
Food is the base, but other daily habits make BHRT more effective. Sleeping seven to nine hours lets the body repair and reset hormones. Regular movement, such as walking or strength work, improves both insulin sensitivity and mood. Stress management through breathing or light stretching keeps cortisol from rising too high.
Limit extra caffeine and alcohol, because they can disrupt sleep and liver function. Stay at a healthy weight, since extra body fat can change how hormones work. These steps are simple and work well with the eating pattern.
How Integrative Chiropractic Care Supports BHRT
The nervous system and hormones communicate all day. High stress raises cortisol, which can block the effects of estrogen, progesterone, or testosterone. Chiropractic care uses gentle adjustments and soft-tissue work to ease tension in the spine and muscles. This can lower sympathetic (fight-or-flight) activity and help the body stay in a more balanced state.
When the spine and pelvis move well, the body often sleeps better and feels less pain. Better sleep and lower pain reduce cortisol. The result can be improved energy and a more stable hormone response. Chiropractic care also supports movement, which helps bones and muscles stay strong while on hormone therapy. It does not replace the hormones. It helps the whole system work more smoothly.
A Collaborative Team in El Paso
In El Paso, Texas, Injury Medical Clinic PA brings medical and chiropractic care together. Dr. Alexander Jimenez, DC, APRN, FNP-BC, CCST, CFMP, IFMCP, ATN, leads the practice. He uses chiropractic adjustments, functional medicine, nutrition, and rehabilitation. His clinical observations show that whole-food, low-glycemic eating plus gut support and spinal care can improve sleep, mood, and how patients feel on hormone plans.
Dr. Maria Guadalupe Cardenas, MD (board-certified in internal medicine) (NPI #1164426749, Texas MD License #J2933), with over 40 years of experience as an internist, works with Dr. Alex Jimenez, DC, and serves as the medical director and collaborative physician at his practice, Injury Medical Clinic PA, in El Paso, Texas. This multidisciplinary setup is common in integrative or injury care clinics, where an MD provides medical direction alongside a chiropractor.
The team integrates chiropractic care (Dr. Jimenez) with medical oversight by Dr. Cardenas (internal medicine), as well as functional medicine, personal injury care, rehabilitation, and related services. Patients receive coordinated plans that cover diet, movement, stress, and hormone support. This approach treats the whole person, not one symptom at a time.
Putting It All Together
Start with a simple Mediterranean-style plate most days. Add the key foods listed above. Pair eating with sleep, movement, and stress reduction. If you choose integrative care, chiropractic work can help the nervous system stay calmer so the hormones you take can do their job more easily. Work with your doctor to check labs and adjust as needed. No single food or adjustment is a cure, but together they create a stronger foundation.
This way of eating and living is sustainable for most people. It uses foods you can find at a regular grocery store and habits that fit into daily life. The goal is steady energy, better sleep, and a body that uses BHRT well.
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