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A significant decline at 3 months predicts continued depletion if left unaddressed

The Cochrane Collaboration, Chichester, UK: John Wiley & Sons

[4] At the cellular level, free estradiol diffuses through cell membranes and binds to intracellular estrogen receptors and , which upon ligand activation dimerize and translocate to estrogen-response elements on nuclear DNA, modulating transcription of genes governing reproductive tract integrity, thermoregulation, bone metabolism, and vascular endothelial function

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The International Peptide Society membership and multi-location presence (Boca, Miami, Delray, Jacksonville) indicate a mature operation rather than a single practitioner experiment