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Your health deserves to be heard. Real conversations about hormones, weight loss, and feeling like yourself again — with the clinicians at Top Form Care.
The Top Form Care podcast is for
educational and informational purposes only. Nothing you hear on this show is medical advice and listening to it does not
create a provider-patient relationship. Treatments we discuss, including peptides, hormone therapy, and other clinical
options are only appropriate when prescribed and monitored by a licensed provider for your specific situation. Always talk
to your own health care provider before starting, stopping, or changing any treatment. With that, welcome to the podcast.
Angie, how are you today?
Tom: I'm doing great. How are you, Tom?
Speaker 2: I'm doing very well. Thank you. So let's get into it. For the listeners who don't know yet, when did you start Top
Forum Care and why?
Tom: So I started it initially all on my own in July of 2022. I had worked as a hospitalist previous to that, which is a nurse
practitioner in the hospital who takes care of acutely ill patients. And I worked through COVID and I worked nights. So the
combination of those two things burned me out pretty badly. So after COVID kind of settled, I started to think about other
things I could do with my qualifications. And one thing I had always struggled with throughout my adult life was being
overweight, obesity, kind of yo-yo dieting kind of stuff. You know, you would do things to lose some weight and it would
work, but then it would kind of just always come back. So a friend and I, she actually has a similar company, but we got
together and we started thinking, gosh, you know, what can we do? Well, so GLPs had just been kind of... I guess onto the,
to the market. And we thought, well, let's try these on each other. You know, she's another practitioner. So we prescribed
them for each other and monitored each other. We were each other's patients. And behold, we really started to like lose
weight and it stayed off. And with GLP is one of the amazing things is that it kind of kills that like hunger noise. And that had
never happened for me or her before. So at that point we were like, gosh, we need to like, help other people find this
because it was incredibly difficult. And a lot of people still have trouble talking with like their PCPs about weight loss
medication and things like that. You know, we often hear eat less, move more, right. But for a lot of people, it's just not that
simple. So That's what called me to start my own medical clinic. And initially I was telehealth only. But then the next year in
May of 2023, I moved into an office space in downtown Papillion and started to see some patients in person as well. So
through the telehealth, I am licensed to see patients in North and South Dakota, Nebraska and Iowa. I have nurse
practitioners that are additionally licensed in Colorado and Kansas and I think Missouri. So we see people all over, but I see
a lot of local patients local to the Omaha Metro.
Speaker 2: That's a great story. Thank you for the background. I think what's important and an important distinction here is
that you're a trained clinician. You're a hospitalist. And you also have nurse practitioners working for you. So even from my
own particular research, I wasn't aware of the breadth of medical information, the depth of education that supports your
clinic. So that's a really important distinction from just somebody coming in to get a consultation on, let's just say, for
instance, GLPs. Would you agree?
Tom: Yeah, absolutely.
Speaker 2: So why did you build... You mentioned COVID, you mentioned telehealth, but with the business structure that
you have now, why did you build... Why is Topform in its current form? How did you build it? Why did you build it this way?
Tom: Yeah. So what initially started as kind of just a fun side gig that was allowing me to help people with weight loss in
particular, what that grew into was... you know, a lot of people, once they lose the weight with a GLP, find that, yeah, maybe
they've lost some weight, but they just still don't feel great. So I started learning more and more that there are so many other
things that play into how you feel and weight loss and difficulty with weight gain, particularly in change of life for women. So
that led me to really learning and getting rather passionate about hormone replacement in women and men. And so we do
an awful lot of that. And then from that even grew kind of a... a drive to look even deeper than just hormones and look at it
more from a functional health
Speaker 4: standpoint
Tom: uh where we're looking at like your nutrition and vitamin and mineral gaps um oftentimes you know iron deficiency
plays into a lot of people's problems thyroid issues you know all of it plays together um and you know when you get
everything working the way it should um you know weight loss is part of that oftentimes but not always so there's just a lot
more to it than just losing weight to help people feel better.
Speaker 2: You did mention personally that you had struggled with weight, which is a very honest and open thing to say.
But what you're also describing here is, I guess, the future of medicine in personalized care. And would you say that that's
the basis for your health needs or your health deserves to be heard?
Tom: Yeah, absolutely. So what I hear over and over and over again, whether a patient's coming to me for weight loss or to
talk about hormones or like, I just don't feel good. You know, a big complaint patients often have is I'm just so tired. You
know, what I often hear is that they'll tell me seriously over and over again, my PCP or whoever they typically see says
everything's fine. My labs are in normal ranges. but something's not right. You know, and then the other thing about too,
you know, we are a cash based business. So that allows us some flexibility to spend as much time as we want with our
patients. We're not under the constraints of insurance reimbursement. So But a lot of PCPs are. So they really kind of have
to turn and turn you through the clinic. You know, you get one complaint with every visit and you get 15 minutes to talk
about it and decide on a plan and answer your ask and answer your questions. So what I love about this is that I'm able to
really sit down like an initial consultation for a functional patient. health and hormones is 60 to 90 minutes of sitting and
going through your labs, really explaining what each lab result means, talking about your symptoms in depth, your medical
history in depth, medications and how they could be playing into your symptoms. I mean, we really take a lot of time and I
pride myself on not letting a patient walk out the door without answers to their questions and some sort of plan going
forward.
Speaker 2: So
Tom: that's your question. It totally does.
Speaker 2: And what I find interesting is just from a personal level and my age and my life and the change of life elements
that I've either witnessed or experienced at this particular time. It's it's a it's an emotional decision for them, for someone to
decide to come and work with you. And you're dealing with those at the intake stage, I assume. Well, I mean, how much
does the I guess. The changes that they're going through, the emotions that they're experiencing play into a strong
onboarding, for lack of a better term, experience into your program.
Tom: So do you mean like developing the like provider patient relationship?
Speaker 2: Yeah, because you were mentioning, so a good point of clarification, you're mentioning kind of like the rigidity, if
I may paraphrase on a standard intake with a primary care provider, right? In this scenario, you're saying your health
deserves to be heard. And by what you're describing to me, the time and the care that you put into a personalization
process, that would, my assumption is that would elicit a connection, like an emotional connection with their care.
Tom: Oh yeah. I mean, people, people cry sometimes, you know, and, and they often, you know, they will often say that, you
know, nobody's ever sat down and listened to me like this before, you know, so that's, that's a pretty common thing that
happens. And that's, and that's really what we mean, right. Is that, you know, we really try hard to listen to what the patient's
telling us, not just the labs, not just the medications they're on, but like what they're actually telling us matters to them.
That's the most important thing to us.
Speaker 2: Excellent. And that helps me dovetail into some of the questions that I assume that you're getting because most
pharmaceutical questions, commercials ask these questions about being pointed about the things that they ask about in
their therapy. And how much do you have to deal with the misinformation or disinformation about the particular care that
someone is trying to obtain from you at the stage of just educating or onboarding a patient into your practice?
Tom: You know, there's almost always some sort of misconception that they have about really anything. So GLPs, to take
one example, you know, often they hear, oh, I don't want to do a GLP, just the side effects are awful. And I hear these awful
things, you know, but really... you know, you sit down, I mean, we, there are side effects, obviously with any medication,
there are side effects. What I make sure they understand is what the side effects typically look like, how to avoid them, how
we together try to develop a plan to avoid the most severe side effects, and then what to look for if there's ever something
really bad that's happening, what the plan is at that point. So like if they're having abdominal pain, you know, one of the
risks is gallbladder disease with GLP medications and weight loss. You know, I tell them, don't don't mess around and wait
for me to call you back. Go to an ER. That's that's an emergency. So, you know, so I think that they feel better knowing what
to expect, knowing, you know, what, you know, it's with anything online. The the people who are the loudest tend to be the
most unhappy for whatever reason it is. And for every person that had an awful experience. I tell them just to keep in mind,
there are a hundred people who have had an awesome experience. They just don't write about it because, well, for one
thing, there's, you know, a little bit of shame still around obesity treatment, but, but also, I mean, you know, it works for
them. They just don't feel a need to shout it from the rooftops, you know, and you hear from the people who had problems.
So it's important to set appropriate expectations, but also temper some of the fears that they might be having surrounding a
given therapy. Yeah.
Speaker 2: Yeah, the vocal minority carries a lot of weight when it comes down to what you're discussing. And let's kind of
go towards some hot topics, if you don't mind. Like, for instance, I've heard, most patients have heard, there's a black box
warning around hormone therapy, right? What does that... When you hear about a black box, we know how that might affect
people's opinions, be about the medications that they might already be on. It doesn't affect them. It takes some education.
So in respect to a hot topic like hormone therapy, help your listeners, your patients. What does a black box morning
warning mean? How does it affect it? Let's just say hormone therapy in this case.
Tom: So basically a black box warning is a serious, um, a serious consequence of whatever medication or therapy that
you're prescribing at that time. So for instance, if we're going to talk about hormones, so there were recently some black
box warnings removed by the FDA on estrogen and testosterone. Those black box warnings were on estrogen. It was that it
could cause heart disease. it could cause breast cancer and blood clots. Those were the big warning signs with estrogen
therapy in particular. That's because there was a study that was published in 2002 called the Women's Health Initiative. And
I really believe that while the study wasn't wrong, it was really, they took a headline and it kind of disseminated through the
media and scared a lot of PCPs and providers from prescribing hormone therapy. Um, and it scared patients. It made, I
mean, it was all over the news, you know, estrogen can cause breast cancer and we still hear patients come to us with these
concerns today, you know, like, oh, well, my mom had breast cancer. I can't do hormone therapy, you know, like, hold on,
you know, that is not necessarily the case. So, um, I firmly believe that study set us. I mean, it's. Was it
Speaker 2: ad hoc or was it a controlled clinical trial?
Tom: It was a small trial. The average age of the women in that study was, I believe it was 69 or 67 years old. So hormone
therapy, the ideal patient. for women would be someone under 60 years old who is less than 10 years from menopause. So
that's your like ideal patient to start on hormone therapy. After that, their risks do increase if you're outside of those
parameters, but that's not necessarily an absolute contraindication to starting hormone therapy. It does involve, you know,
there's some nuance there and it does involve kind of a different discussion surrounding risks and versus benefit. But it
really, you know, this scared people from, so the women in this study, first of all, were older than most women who start to
seek hormone therapy. I mean, most women who kind of start to look into it are in their forties, you know, they're
perimenopausal, they're starting to have some of these symptoms. So they haven't even hit menopause yet. So they're ideal
candidates for this kind of stuff, but everybody just saw hormone therapy causes breast cancer. The other important thing
to note with this one was that it's studied Not bioidentical hormones. So there was progestin, which is a synthetic
progesterone and a synthetic estrogen derived from like horse urine is what it is. So completely different from the
bioidentical things we have now. Bioidentical hormones now are there. um, cellularly the same as the hormones that you
make in your own body, whereas these words are like synthetic. So they also, um, you know, some of the women in this
study were on an, an estrogen, synthetic estrogen alone without a progesterone or progestin, um, which can certainly
increase your risk for endometrial cancer and breast cancer. So it was just, it was just kind of a, not very well done study
maybe. Um, and then, but really where, um, The problem came in is that the media took it and kind of just put this headline
out there that HRT is dangerous and it really got some traction and was just disseminated all over the place. So people got
very scared. So in 2025, they've done since done some studies with bioidentical and studies in you know, controlled studies
in the proper population of women and hormone therapy. And what they found really was that all other things being equal, if
you are started appropriately on bioidenticals, you don't have a higher risk of breast cancer than the normal population. You
don't have a higher risk of cardiovascular disease. You don't have a higher risk of blood clots. The only F the FDA did leave
on the black box warning for endometrial cancer was um, for estrogen, but only if it's not given with the progesterone. So
anytime you take estrogen and you have a uterus, you must have progesterone to protect your uterus, but that's the only
black box warning that's left. The others were taken off in 2025, which was huge. So that's a big deal.
Speaker 2: But the trauma always remains, right? People hear things and they don't get the updates on these. And what you,
that was brilliantly articulated. And I personally spent 25 years in pharmaceuticals and medical devices. And what would
blow me away was you could take a 55,000 patient trial with reproducible P values, but an eight person trial from the middle
of nowhere could totally blow up an entire standard of care.
Tom: Yeah. There's like, so there's like one, you know, it's interesting. So in the testosterone side of things in the forties,
there was, I'm not sure if he was even a physician or maybe he was, his name was Huggins. I can't remember, but he kind of
postulated that maybe testosterone therapy was tied to causing prostate cancer.
Speaker 4: And
Tom: that myth like still persists today. Uh, testosterone does not cause prostate cancer. There's a theoretical risk that it
could kind of accelerate it if you already have it, but people still think that it will cause, I hear it all the time that it will cause
prostate cancer. So it's pretty crazy. It's crazy how things that happened literally 80 years ago could still be influencing how
people feel about this stuff today.
Speaker 2: Yeah, it's urban legends and myths baked into, I guess, culture for that matter. But you brought up something
right there that was interesting is, you know, we're focused on so far on the women's health, which is vitally important,
especially when you consider all of the nuance around change of life and the types of patients that you're talking about. But
men do compose a certain amount of your patient base, correct? Correct. And what are the treatments that men are typically
seeking at Topform?
Tom: Um, usually, um, they, it has to do with, uh, testosterone, low testosterone is the main thing that we see. We do see
like a, you know, we have a kind of an athlete population that's after like really maximizing performance and things like that.
But honestly, our typical guy patient is. is either weight loss or like they're a dude in their forties. Who's noticed that they
just have lost motivation or libido or problems with erections, you know, and things like that. So that's our typical patient.
We don't see a lot of like super performers that want to be super ripped. We see normal dads that you probably run into like
at the baseball game. Right. So.
Speaker 2: But to be fair, you can, you're promising that you can make somebody ripped. Is that what you're
Tom: saying? No, no, I can't. You can. Okay. Okay. Yourself, but I can't promise that I can help you. I can help you along the
way, but I can't make it happen.
Speaker 2: Do I have to be in Nebraska or am I
Tom: okay? Well, you have to. So for testosterone, I do like my testosterone patients to come see me at least once. Um,
testosterone is a controlled substance actually. So, uh, Yeah. So we try to see them in person once if we can. For right now,
it's not required by the DEA, but I think they loosened it up during COVID for telehealth purposes. But I think at some point
that'll probably go away and we'll have to see them in person again.
Speaker 2: It's interesting you bring that up because there's so many infomercials for low T that you see if you leave the TV
on for too long after a game. And I was under the impression that it was a controlled substance, but I thought maybe
something had changed. So thanks for clearing up that myth as you have. I have a list of myths that I in front of me that I
was going to dive into, but you've actually discussed all of them and kind of nailed it from my perspective. I feel educated.
But let's let me let me change the subjects more towards your practice. And maybe if you could just tell us what a patient
should expect. We did talk about their intake, but like what a what a patient journey looks like or what you feel the best
patient journey is for someone coming to Topform.
Tom: Yeah. So a lot of times people reach out to us through our website or they just call our office or sometimes people just
walk in, you know, and say, hey, I heard about you guys. You know, I'm feeling tired all the time or I'd like to lose 50 pounds
or, you know, whatever it is. you know, how can I get started? Well, if they call one of our staff here, one of our nurses or
our clinic managers, sometimes myself get that call. And we kind of just try to figure out like kind of what they're after from
that initial call. And then, you know, we ask about like, do you have any pertinent labs that are recent? We don't make
everyone get brand new labs all the time if they have very recent ones, but often they don't. So kind of the first step most of
the time is to have them do kind of a comprehensive lab panel. that looks at some of the common drivers of some of these,
you know, very common symptoms, you know, fatigue, hormone stuff, iron deficiency, you know, things related to insulin
resistance that would play into weight loss, we would want to look at your liver and kidney health, of course, and things like
that. So oftentimes, we'll start with let's just get a lab draw. And let's see, you know, what what that looks like. So they can
get the lab draw. And then once they have those results, they can, they have kind of two options. So they, well, three
options. So they could just take the lab results and take them to their PCP or whoever they'd like, because they're armed
now with some, you know, a lot of patients have trouble getting their providers to even draw hormone labs or iron labs,
which is kind of a strange problem in and of itself. But some patients do, they come to us just to get labs drawn and they
take them to their, their provider. Option two would be, you know, I'll sometimes do like if a patient isn't sure or doesn't
know what their labs mean. A lot of times I'll do what's called like a lab interpretation visit, which is they sit and talk with me.
They usually take about 20 minutes and we just go over the labs and I tell them kind of what they all are, what they're
looking at and what their results might mean. Obviously, at this point, we haven't gone through like a big consult yet. I'm
just kind of giving them an idea of Yeah, you might benefit from some hormone therapy or you might benefit from some iron
supplementation or like whatever I kind of see on the labs. And then at that point, they again can be armed with that
information and go back to their primary practitioner or whoever. Or they could choose to schedule a consult with me. And
then, you know, at that point, obviously, we'd go through all again. And we would, you know, start with a couple things. I
don't like to throw like too much at a patient all the time. But I try to find out what their most, you know, concerning one,
two, three symptoms are. And then we start there. So then they have a consult. Like I said, it's usually 60 to 90 minutes
somewhere in that realm. where we talk about the labs or history. We talk about, you know, the symptoms that they're
having, what's most distressing to them, you know, get some vital signs and do stuff like that. And then, you know, we
develop a plan of care. And we go from there. After that, and I think this is one of the things that kind of differentiates us
from a lot of clinics is we do quite a few check ins. So I have one of my nurses, Jamie, primarily is responsible for part of her
role is to check in on patients after they start. So a couple of weeks after every patient starts, they get a text or a phone call
from her that says, Hey, how are you doing? I heard you started testosterone. How's that working for you? Are you having
any trouble injecting it? Are you having any side effects, anything we should know any way we can support you? So they
get that initial support. We do a formal follow up visit every two to three months with me, like with the provider. But in
between times, if something comes up, they can always just request a visit if they need one. We can have a quick video chat
or they can have a nurse visit or none of that is any additional cost in our program. So I think that that is. Um, something
that a lot of places overlook is just really that support on the backend. You know, we do a lot of supplement
recommendations. Um, we have a, like a hormone education kind of email that goes out to them daily that talks about
different aspects of whatever it is. Like, you know, if they're a male kind of more testosterone related things, if it's a female.
There's daily education about like perimenopause and menopause and weird symptoms and things like that. So. So, yeah,
that's kind of kind of our process. How many people do you have on staff? I have one full time nurse, one part time nurse,
and I have myself and three other nurse practitioners and then a clinic manager.
Speaker 2: So no disrespect to actually going to see a PCP or anything when people do need to, of course that's, but with, I
mean, when we talk about personalized medicine, it seems like everybody is involved with the care and there's education
going in both directions.
Tom: Correct. Yeah. Yeah. It's, it's very important to us.
Speaker 2: Excellent. What would you like people to know about Topform? I've been asking the questions and I want to
know what you, what you feel is the most important things for us to know.
Tom: I think the most important thing that you should know about us is that most of us have been on whatever journey that
you're on. I mean, most of us, you know, have been each other's patients.
Speaker 4: So,
Tom: I mean, I'm 47, almost 48, you know, perimenopause is crazy. right there for me. And so I'm like living the hormone
swings and getting those managed and everything. So, you know, I've been there with the weight loss, I've been there, and I
get it. And, you know, my staff has been there, and they get it. So I think that's different than a lot of places. You know, I
think, you know, you see people who just have not been through your same journey and don't understand the nuances and
things that might actually concern you versus what they think should concern you, if that makes sense.
Speaker 2: No, it's a very human one-to-one type element of care. And you don't sometimes get to choose who you're,
through insurance, who your providers are, right? Especially through referral bases. It's on availability, who's in network, so
on and so forth. And wait
Tom: times to get in some places is months. So we can get somebody in within the next week or two. So yeah, we have
short wait times.
Speaker 2: This has been an exceptional learning experience for me. And I want to thank you for your time. As a husband of
a wife who is the same age as you going through perimenopause, I've had to educate myself and become more sensitive to
the things that you're mentioning. Not, I guess, more of a sense of education, which... I think is vital to your practice and the
way that you're approaching it. And I am grateful for your time. With that, is there anything else that you can think of that
you'd like to discuss?
Tom: Nothing that I can think of right at the moment, but I'm sure we'll have more to talk about next time.
Speaker 2: Absolutely. Thank you so much for your time, Angie. It was a pleasure.
Tom: Thank you, Tom.
Speaker 2: Bye-bye.
Tom: Bye-bye.
Angela Vogel: Let me try again. The Top Form Care Podcast is for educational and informational purposes only. Nothing
you hear on this show is medical advice, and listening to it does not create a provider-patient relationship. Treatments we
discuss, including peptides, hormone therapy, and other clinical options, are only appropriate when prescribed and
monitored by a licensed provider for your specific situation. Always talk to your own health care provider before starting,
stopping, or changing any treatment. With that, welcome to the podcast. Angie, how are you today?
Tom: I'm doing great. How are you, Tom?
Angela Vogel: I'm doing very well. Thank you. So let's get into it. For the listeners who don't know yet, when did you start
Top Form Care and why?
Tom: So I started it initially all on my own in July of 2022. I had worked as a hospitalist previous to that, which is, you know,
a nurse practitioner in the hospital who takes care of acutely ill patients. And I worked through COVID and I worked nights.
So the combination of those two things burned me out pretty badly. So after COVID kind of settled, I started to think about,
you know, other things I could do with my qualifications. And one thing I had always struggled with throughout my adult life
was being overweight, obesity, kind of yo-yo dieting kind of stuff. You know, you would do things to lose some weight and it
would work, but then it would kind of just always come back. So a friend and I, she actually has a similar company, but we
got together and we started thinking, gosh, you know, what can we do? Well, so GLPs had just been kind of like, released, I
guess, onto the, to the market. Um, and we thought, well, let's try these on each other. You know, she's another practitioner.
So we, uh, prescribed them for each other and monitored each other. We were each other's patients. Um, and behold, we
really started to like lose weight and it stayed off. And with GLP is one of the amazing things is that it kind of kills that like
hunger noise. Um, and that had never happened for me or her before. Um, so at that point we were like, gosh, we need to
like, um, help other people find this because it was incredibly difficult. And a lot of people still have trouble talking with like
their PCPs about weight loss medication and things like that. You know, we often hear eat less, move more, right. But for a
lot of people, it's just not that simple. So That's what called me to start my own medical clinic. And initially I was telehealth
only, but then the next year in May of 2023, I moved into an office space in downtown Papillion and started to see some
patients in person as well. So through the telehealth, I am licensed to see patients in North and South Dakota, Nebraska, and
Iowa. I have nurse practitioners that are additionally licensed in Colorado and Kansas, and I think Missouri. Um, so we see
people all over, but I see a lot of local patients local to the Omaha Metro.
Angela Vogel: That's a great story. Thank you for the background. I think what's important and an important distinction here
is that you're a trained clinician, you're a hospitalist, and you also have nurse practitioners working for you. So even from
my own particular research, I wasn't aware of the breadth of medical information, the depth of education that supports your
clinic. So that's a really important distinction from just somebody coming in to get a consultation on, let's just say, for
instance, GLPs. Would you agree?
Tom: Yeah, absolutely.
Angela Vogel: So why did you build, you mentioned COVID, you mentioned telehealth, but with the business structure that
you have now, why did you build, why is Topform in its current form? Like, how did you build it? Why did you build it this
way?
Tom: Yeah, so what initially started as kind of just a fun side gig that was allowing me to help people, you know, with weight
loss in particular, what that grew into was, You know, a lot of people, once they lose the weight with a GLP, um, find that,
yeah, maybe they've lost some weight, but they just like still don't feel great. So there's, I started learning more and more
that there are so many other things that play into how you feel and weight loss and difficulty with weight gain, particularly in
change of life for women. So that led me to, um, really learning and getting rather passionate about hormone replacement
and women and men. Um, and so we do an awful lot of that. And then from that even grew, uh, kind of a, a a drive to look
even deeper than just hormones and look at it more from a functional health standpoint uh where we're looking at like your
nutrition and vitamin and mineral gaps um oftentimes you know iron deficiency plays into a lot of people's problems thyroid
issues you know all of it plays together um and you know when you get everything working the way it should um you know
weight loss is part of that oftentimes but not always so there's just a lot more to it than just losing weight to help people feel
better.
Angela Vogel: You did mention personally that you had struggled with weight, which is a very honest and open thing to say.
But what you're also describing here is, I guess, the future of medicine in personalized care. And would you say that that's
the basis for your health needs or your health deserves to be heard?
Tom: Yeah, absolutely. So, you know, what I hear over and over and over again, whether a patient is coming to me for
weight loss or to talk about hormones or like, I just don't feel good. You know, a big complaint patients often have is I'm just
so tired. You know, what I often hear is that they'll tell me seriously over and over again, my, my PCP or whoever they
typically see says, everything's fine. My labs are in normal ranges. but something's not right. And then the other thing about
too, we are a cash-based business, so that allows us some flexibility to spend as much time as we want with our patients.
We're not under the constraints of insurance reimbursement. So but a lot of PCPs are. So they really kind of have to turn
and turn you through the clinic. You get one complaint with every visit and you get 15 minutes to talk about it and decide on
a plan and ask and answer your questions. So what I love about this is that I'm able to really sit down, like an initial
consultation for functional health and hormones, is 60 to 90 minutes of sitting and going through your labs, really
explaining what each lab result means, talking about your symptoms in depth, your medical history in depth, medications
and how they could be playing into your symptoms. I mean, we really take a lot of time and I pride myself on not letting a
patient walk out the door without answers to their questions and some sort of plan going forward.
Angela Vogel: answer
Tom: your question.
Angela Vogel: It totally does. And what I find interesting is just from a personal level and my age and my life and the change
of life elements that I've either witnessed or experienced at this particular time, it's an emotional decision for them, for
someone to decide to come and work with you. And you're dealing with those at the intake stage, I assume. Well, I mean,
how much does the, I guess the the changes that they're going through the emotions that they're experiencing play into a
strong, like onboarding for lack of a better term experience into your program.
Tom: So do you mean like developing the provider-patient relationship? Is that
Angela Vogel: true? Yeah, because you were mentioning, so a good point of clarification, you were mentioning kind of like
the rigidity, if I may paraphrase, on a standard intake with a primary care provider, right? In this scenario, you're saying your
health deserves to be heard. And by what you're describing to me, the time and the care that you put into a personalization
process, that would, my assumption is that would elicit a connection, like an emotional connection with their care?
Tom: Oh yeah. I mean, people, people cry sometimes, you know, and, and they often, you know, they will often say that, you
know, nobody's ever sat down and listened to me like this before, you know, so that's, that's a pretty common thing that
happens. And that's, and that's really what we mean, right. Is that, you know, we really try hard to listen to what the patient's
telling us, not just the labs, not just the medications they're on, But like what they're actually telling us matters to them.
That's the most important thing to us.
Angela Vogel: Excellent. And that helps me dovetail into some of the questions that I assume that you're getting because
most pharmaceutical questions, commercials ask these questions about being pointed about the things that they ask about
in their therapy. And how much do you have to deal with the misinformation or disinformation about the particular care that
someone is trying to obtain from you at the stage of just educating or onboarding a patient into your practice?
Tom: You know, there's almost always some sort of misconception that they have about really anything. So, GLPs, to take
one example, you know, often they hear, oh, I don't want to do a GLP, just the side effects are awful, and I hear these awful
things, you know, but really... You know, you sit down. I mean, there are side effects. Obviously, with any medication, there
are side effects. What I make sure they understand is what the side effects typically look like, how to avoid them, how we
together try to develop a plan to avoid the most severe side effects, and then what to look for if there's ever something really
bad that's happening, what the plan is at that point. So, like, if they're having abdominal pain, you know, one of the risks is
gallbladder disease with GLP medications and weight loss. I tell them, don't mess around and wait for me to call you back,
go to an ER, that's an emergency. So I think that they feel better knowing what to expect, knowing what, it's with anything
online, the people who are the loudest tend to be the most unhappy for whatever reason it is. And for every person that had
an awful experience, I tell them just to keep in mind, there are 100 people who have had an awesome experience. They just
don't write about it because, well, for one thing, there's a little bit of shame still around obesity treatment. But also, I mean, it
works for them. They just don't feel a need to shout it from the rooftops. You hear from the people who had problems. So it's
important to set appropriate expectations, but also temper some of the fears that they might be having surrounding a given
therapy.
Angela Vogel: Yeah, the vocal minority carries a lot of weight when it comes down to what you're discussing. And let's kind
of go towards some hot topics, if you don't mind. Like, for instance, I've heard, most patients have heard, there's a black box
warning around hormone therapy, right? What does that... When you hear about a black box, we know how that might affect
people's opinions, even about the medications that they might already be on. It doesn't affect them. It takes some education.
So in respect to a hot topic like hormone therapy, help your listeners, your patients. What does a black box warning mean?
How does it affect, let's just say, hormone therapy in this case?
Tom: So basically, a black box warning is a serious... a serious consequence of whatever medication or therapy that you're
prescribing at that time. Um, so for instance, um, if we're going to talk about hormones, um, so there were recently some
black box warnings removed by the FDA on estrogen and testosterone. Um, those black box warnings were, um, on
estrogen. It was that it could cause heart disease. it could cause breast cancer and blood clots. Those were the big warning
signs with estrogen therapy in particular. That's because there was a study that was published in 2002 called the Women's
Health Initiative. And I really believe that while the study wasn't wrong. It was really, they took a headline and it kind of
disseminated through the media and scared a lot of PCPs and providers from prescribing on Medicaid or hormone therapy.
Um, and it scared patients. It made, I mean, it was all over the news, you know, estrogen can cause breast cancer and we
still hear patients come to us with these concerns today, you know, like, oh, well, my mom had breast cancer. I can't do
hormone therapy. you know, like, hold on, you know, that is not necessarily the case. So I firmly believe that study set us, I
mean, it's really
Angela Vogel: Was it ad hoc or was it a controlled clinical trial?
Tom: It was a small trial. The average age of the women in that study was, I believe it was 69 or 67 years old. So hormone
therapy, the ideal patient, Uh, for women would be someone under 60 years old who is less than 10 years from menopause.
So that's your like ideal patient, um, to start on hormone therapy. Um, after that, their risks do increase if you're outside of
those parameters, but that's not necessarily an absolute contra indication to starting hormone therapy. It does involve, you
know, there's some nuance there. And it does involve kind of a different discussion surrounding risks and versus benefit.
But it really, you know, this scared people from so the women in this study, first of all, were older than most women who
start to seek hormone therapy. I mean, most women kind of start to look into it are in their 40s, you know, they're
perimenopausal, they're starting to have some of these symptoms. So they haven't even hit menopause yet. So they're ideal
candidates for this kind of stuff, but everybody just saw hormone therapy causes breast cancer. Um, the other important
thing to note with this one was that it's, um, studied, um, not bioidentical hormones. So there was progestin, which is a
synthetic progesterone and, um, a synthetic estrogen, um, derived from like horse urine is, is what it is. So completely
different from the bioidentical things we have now. Bioidentical hormones now are, they're cellularly the same as the
hormones that you make in your own body, whereas these are like synthetic. So They also, you know, some of the women in
this study were on an estrogen, synthetic estrogen alone without a progesterone or progestin, which can certainly increase
your risk for endometrial cancer and breast cancer. So it was just kind of a not very well done study maybe. And then, but
really where the problem came in is that the media took it and kind of just put this headline out there that HRT is dangerous.
And it really got some traction and was just disseminated all over the place. So people got very scared. So in 2025, they've
done since done some studies with bioidentical and studies in controlled studies in the proper population of women and
hormone therapy. And what they found really was that all other things being equal, if you are started appropriately on
bioidenticals, you don't have a higher risk of breast cancer than the normal population. You don't have a higher risk of
cardiovascular disease. You don't have a higher risk of blood clots. The only, the FDA did leave on the black box warning
for endometrial cancer for estrogen, but only if it's not given with the progesterone. So anytime you take estrogen and you
have a uterus, you must have progesterone to protect your uterus. But that's the only black box warning that's left. The
others were taken off in 2025, which was huge. So that's a big deal.
Angela Vogel: But the trauma always remains, right? People hear things and they don't get the updates on these. And that
was brilliantly articulated. And I personally spent 25 years in pharmaceuticals and medical devices. And what would blow
me away was you could take a 55,000 patient trial with reproducible P values, but an eight person trial from the middle of
nowhere could totally blow up an entire standard of care.
Tom: Yeah. There's like, so there's like one, you know, it's interesting. So in the testosterone side of things in the forties,
there was, I'm not sure if he was even a physician or maybe he was, his name was Huggins. I can't remember, but he kind of
postulated that maybe testosterone therapy was tied to causing prostate cancer.
Angela Vogel: And
Tom: that myth like still persists today. Uh, testosterone does not cause prostate cancer. There's a theoretical risk that it
could kind of accelerate it if you already have it, but people still think that it will cause, I hear it all the time that it will cause
prostate cancer. So it's pretty crazy. It's crazy how things that happened literally 80 years ago could still be influencing how
people feel about this stuff today.
Angela Vogel: Yeah, it's urban legends and myths baked into, I guess, culture for that matter. But you brought up something
right there that was interesting is, you know, we're focused on so far on the women's health, which is vitally important,
especially when you consider all of the nuance around change of life and the types of patients that you're talking about. But
men do compose a certain amount of your patient base, correct? Correct. And what are the treatments that men are typically
seeking at Topform?
Tom: Um, usually, they, it has to do with testosterone, low testosterone is the main thing that we see that we do see, like,
you know, we have a kind of an athlete population that's after like, really maximizing performance and things like that. But
honestly, our typical guy patient is either weight loss or like they're a dude in their 40s who's noticed that they just have lost
motivation or libido or problems with erections you know and things like that so that's our typical patient we don't see a lot
of like super performers that want to be super ripped we see normal dads that you probably run into like at the baseball
game right so
Angela Vogel: But to be fair, you can, you're promising that you can make somebody ripped. Is that what you're
Tom: saying? No, no, I can't. You can. Okay. Okay. Yourself, but I can't know. Okay. I can help you. I can help you along the
way, but I can't make it happen.
Angela Vogel: Do I have to be in Nebraska or am I
Tom: okay? Well, you have to. So for testosterone, I do like my testosterone patients to come see me at least once. Um,
testosterone is a controlled substance actually. So, um, Yeah. So we try to see them in person once if we can. For right now,
it's not required by the DEA, but I think they loosened it up during COVID for telehealth purposes. But I think at some point
that'll probably go away and we'll have to see them in person again.
Angela Vogel: it's interesting you bring that up because there's so many infomercials for low t that you see if you're leave
the tv on for too long after a after a game and uh i was under the impression that it was a controlled substance but i thought
maybe something had changed so thanks for clearing up that myth as you have i have a list of myths that i in front of me
that i was going to dive into but you've actually discussed all of them uh and kind of nailed it from my perspective i feel
educated uh but let's let me uh let me change the subjects more towards your practice and um maybe if you could just tell
us what a patient should expect we did talk about their intake but like what a what a patient journey looks like or what you
feel the best patient journey is for someone coming to top form
Tom: Yeah. So a lot of times people reach out to us through our website or they just call our office or sometimes people just
walk in, you know, and say, hey, I heard about you guys. You know, I'm feeling tired all the time or I'd like to lose 50 pounds
or, you know, whatever it is. You know, how can I get started? Well, um, if they call, um, one of our staff here, one of our
nurses or our clinic managers, sometimes myself get that call and we kind of just try to figure out like kind of what they're
after from that initial call. And then, you know, we ask about like, do you have any. Pertinent labs that are recent. We don't
make everyone get brand new labs all the time if they have very recent ones, but often they don't. Um, so kind of the first
step most of the time is to have them do kind of a comprehensive lab panel. that looks at some of the common drivers of
some of these, you know, very common symptoms, you know, fatigue, hormone stuff, iron deficiency, you know, things
related to insulin resistance that would play into weight loss. We want to look at your liver and kidney health, of course, and
things like that. So oftentimes we'll start with, let's just get a lab draw and let's see, you know, what that looks like. So they
can get the lab draw. And then once they have those results, they can, they have kind of two options. So they, well, three
options. So they could just take the lab results and take them to their PCP or whoever they'd like, because they're armed
now with some, you know, a lot of patients have trouble getting their providers to even draw hormone labs or iron labs,
which is kind of a strange problem in and of itself. But some patients do, they come to us just to get labs drawn and they
take them to their, their provider. Option two would be, you know, I'll sometimes do like if a patient isn't sure or doesn't
know what their labs mean. A lot of times I'll do what's called like a lab interpretation visit, which is they sit and talk with me.
They usually take about 20 minutes and we just go over the labs and I tell them kind of what they all are, what they're
looking at and what their results might mean. Obviously at this point, we haven't gone through like a big consult yet. I'm just
kind of giving them an idea of Yeah, you might benefit from some hormone therapy or you might benefit from some iron
supplementation or whatever I kind of see on the labs. And then at that point, they again can be armed with that information
and go back to their primary practitioner or whoever, or they could choose to schedule a consult with me. And then, you
know, at that point, obviously we'd go through all again and we would, you know, start with a couple of things. I don't like to
throw like too much at a patient all the time, but I try to find out what their most, you know, concerning one, two, three
symptoms are. And then we start there. Um, so then they, they have a consult. Like I said, it's usually 60 to 90 minutes
somewhere in that realm, uh, where we talk about the labs or history. Uh, we talk about, um, you know, the symptoms that
they're having, what's most distressing to them, uh, you know, get some vital signs and do stuff like that. And then, you
know, we develop a plan of care and we go from there. After that, and I think this is one of the things that kind of
differentiates us from a lot of clinics, is we do quite a few check-ins. So I have one of my nurses, Jamie, primarily is
responsible for part of her role is to check in on patients after they start. So a couple of weeks after every patient starts,
They get a text or a phone call from her that says, hey, how are you doing? I heard you started testosterone. How's that
working for you? Are you having any trouble injecting it? Are you having any side effects, anything we should know, any
way we can support you? So they get that initial support. We do a formal follow-up visit every two to three months with me,
like with the provider. But in between times, if something comes up, they can always just request a visit if they need one. We
can have a quick video chat or they can have a nurse visit or none of that is any additional cost in our program. So I think
that that is um, something that a lot of places overlook is just really that support on the back end. You know, we do a lot of
supplement recommendations. Um, we have a, like a hormone education kind of email that goes out to them daily that talks
about different aspects of whatever it is. Like, you know, if they're a male kind of more testosterone related things, if it's a
female, um, there's daily education about like perimenopause and menopause and weird symptoms and things like that. So,
So yeah, that's kind of our process. How many people do you have on staff? I have one full-time nurse, one part-time nurse,
and I have myself and three other nurse practitioners, and then a clinic manager.
Angela Vogel: So no disrespect to actually going to see a PCP or anything when people do need to, of course, that's, but
with, I mean, when we talk about personalized medicine, it seems like everybody is involved with the care and there's
education going in both directions.
Tom: Correct. Yeah. Yeah. It's, it's very important to us.
Angela Vogel: Excellent. What would you like people to know about Topform? I've been asking the questions and I want to
know what you, what you feel is the most important things for us to know.
Tom: I think the most important thing that you should know about us is that most of us have been on whatever journey that
you're on. I mean, most of us, you know, have been each other's patients. So, I mean, I'm 47, almost 48, you know,
perimenopause is, right there for me. Um, and so I'm like living the hormone swings and getting those managed and
everything. Um, so, you know, I've been there with the weight loss. I I've been there and I get it. And, um, you know, my staff
has been there and they get it. So, um, I think that's different than a lot of places, you know, I think, you know, you see
people who just have, have not been through your same journey and don't understand, the nuances and things that might
actually concern you versus what they think should concern you, if that makes sense.
Angela Vogel: No, it's a very human one-to-one type element of care. And you don't sometimes get to choose who you're,
through insurance, who your providers are, right? Especially through referral bases. It's on availability, who's in network, so
on and so forth. And wait times
Tom: to get in some places is months. So we can get somebody in within the next week or two. So yeah, we have short wait
times.
Angela Vogel: This has been an exceptional learning experience for me. And I want to thank you for your time. As a husband
of a wife who is the same age as you going through perimenopause, I've had to educate myself and become more sensitive
to the things that you're mentioning. Not, I guess, more of a sense of education, which I think is vital to your practice and
the way that you're approaching it. And I am grateful for your time. With that, is there anything else that you can think of that
you'd like to discuss?
Tom: Nothing that I can think of right at the moment, but I'm sure we'll have more to talk about next time.
Angela Vogel: Absolutely. Thank you so much for your time, Angie. It was a pleasure.
Tom: Thank you, Tom.
Angela Vogel: Bye-bye.
Tom: Bye-bye.
Top Form Care: then there's more there you go okay wow
Speaker 5: How long do you think it's going to take?
Speaker 2: I don't know, but can you email Angie? She's... How do we eliminate you guys from being seen?
Speaker 4: There's an option in Zoom
Speaker 5: where you pin people and hide other people.
Speaker 2: I'm going to stop your video. Okay. I stopped your video, but you're still there, right?
Top Form Care: Yeah.
Speaker 5: Now you can see me, right?
Speaker 2: I can't see you now.
Top Form Care: I'm going to mute myself, obviously, for the podcast.
Speaker 2: Hang on a second.
Angela Vogel: What do you mean, what? Why? Now, what do you mean, what's gonna be hard? Just be quiet.
Tom: And so on.
Speaker 2: That was a last minute change on our part. So that's on me, because I wanted to do this on a different format,
because I believe this will be better. So it's on zoom. So thanks for making yourself available. I am recording at this point.
Okay, so did you get a chance to take a look at the questions that I sent across?
Tom: I did,
Speaker 2: yes. Are they on point? Can we work with those?
Tom: Yep, I think they're pretty good.
Speaker 2: Okay. And I know, Dani, you're not on camera. Do you want to talk at all? Do you want me to throw it to you for
those, any questions? Or do you just want me to go on with Angie here? I know that you're in a, it looks like you're in a
hospital, so I don't want to put you on the spot.
Tom: Your mic's off, Dani.
Speaker 4: Okay. Okay.
Tom: Um, also, uh, my nurse, Melissa will be back. If Danny's not going to talk, maybe she could sit down and answer just a
couple of questions about herself or whatever, just for you to use wherever, if you want to make use of
Speaker 2: time. Yeah. Is she going to join the screen with you or is she going to join from like somewhere else?
Tom: No, she'll come. She's here. Um, she went on her lunch, but she's here so she can sit down and do her own thing just
by herself. If you just want to. ask her a couple softballs or whatever, just introduce herself and whatever. So
Speaker 2: yeah, yeah, absolutely. We'll be able to, we'll have it sliced and diced and work out everything. Okay. Okay.
Sounds good. Okay. Terrific. Okay. So let me read, let's get started by me reading that, that disclaimer and then we'll, we're
going to get into it. Okay.
Tom: Okay.
Speaker 2: Okay. All right. So here we go. The Top Form Care, let me try again. The Top Form Care podcast is for
educational and informational purposes only. Nothing you hear on this show is medical advice and listening to it does not
create a provider-patient relationship. Treatments we discuss, including peptides, hormone therapy, and other clinical
options are only appropriate when prescribed and monitored by a licensed provider for your specific situation. Always talk
to your own health care provider before starting, stopping, or changing any treatment. With that, welcome to the podcast.
Angie, how are you today?
Tom: I'm doing great. How are you, Tom?
Speaker 2: I'm doing very well. Thank you. So let's get into it. For the listeners who don't know yet, when did you start Top
Forum Care and why?
Tom: So I started it initially all on my own in July of 2022. I had worked as a hospitalist previous to that, which is a nurse
practitioner in the hospital who takes care of acutely ill patients. And I worked through COVID and I worked nights. So the
combination of those two things burned me out pretty badly. So after COVID kind of settled, I started to think about other
things I could do with my qualifications. And one thing I had always struggled with throughout my adult life was being
overweight, obesity, kind of yo-yo dieting kind of stuff. You know, you would do things to lose some weight and it would
work, but then it would kind of just always come back. So a friend and I, she actually has a similar company, but we got
together and we started thinking, gosh, you know, what can we do? Well, so GLPs had just been kind of... I guess onto the,
to the market. And we thought, well, let's try these on each other. You know, she's another practitioner. So we prescribed
them for each other and monitored each other. We were each other's patients. And behold, we really started to like lose
weight and it stayed off. And with GLP is one of the amazing things is that it kind of kills that like hunger noise. And that had
never happened for me or her before. So at that point we were like, gosh, we need to like, help other people find this
because it was incredibly difficult. And a lot of people still have trouble talking with like their PCPs about weight loss
medication and things like that. You know, we often hear eat less, move more, right. But for a lot of people, it's just not that
simple. So That's what called me to start my own medical clinic. And initially I was telehealth only. But then the next year in
May of 2023, I moved into an office space in downtown Papillion and started to see some patients in person as well. So
through the telehealth, I am licensed to see patients in North and South Dakota, Nebraska and Iowa. I have nurse
practitioners that are additionally licensed in Colorado and Kansas and I think Missouri. So we see people all over, but I see
a lot of local patients local to the Omaha Metro.
Speaker 2: That's a great story. Thank you for the background. I think what's important and an important distinction here is
that you're a trained clinician. You're a hospitalist. And you also have nurse practitioners working for you. So even from my
own particular research, I wasn't aware of the breadth of medical information, the depth of education that supports your
clinic. So that's a really important distinction from just somebody coming in to get a consultation on, let's just say, for
instance, GLPs. Would you agree?
Tom: Yeah, absolutely.
Speaker 2: So why did you build... You mentioned COVID, you mentioned telehealth, but with the business structure that
you have now, why did you build... Why is Topform in its current form? How did you build it? Why did you build it this way?
Tom: Yeah. So what initially started as kind of just a fun side gig that was allowing me to help people with weight loss in
particular, what that grew into was... you know, a lot of people, once they lose the weight with a GLP, find that, yeah, maybe
they've lost some weight, but they just still don't feel great. So I started learning more and more that there are so many other
things that play into how you feel and weight loss and difficulty with weight gain, particularly in change of life for women. So
that led me to really learning and getting rather passionate about hormone replacement in women and men. And so we do
an awful lot of that. And then from that even grew kind of a... a drive to look even deeper than just hormones and look at it
more from a functional health
Speaker 4: standpoint
Tom: uh where we're looking at like your nutrition and vitamin and mineral gaps um oftentimes you know iron deficiency
plays into a lot of people's problems thyroid issues you know all of it plays together um and you know when you get
everything working the way it should um you know weight loss is part of that oftentimes but not always so there's just a lot
more to it than just losing weight to help people feel better.
Speaker 2: You did mention personally that you had struggled with weight, which is a very honest and open thing to say.
But what you're also describing here is, I guess, the future of medicine in personalized care. And would you say that that's
the basis for your health needs or your health deserves to be heard?
Tom: Yeah, absolutely. So what I hear over and over and over again, whether a patient's coming to me for weight loss or to
talk about hormones or like, I just don't feel good. You know, a big complaint patients often have is I'm just so tired. You
know, what I often hear is that they'll tell me seriously over and over again, my PCP or whoever they typically see says
everything's fine. My labs are in normal ranges. but something's not right. You know, and then the other thing about too,
you know, we are a cash based business. So that allows us some flexibility to spend as much time as we want with our
patients. We're not under the constraints of insurance reimbursement. So But a lot of PCPs are. So they really kind of have
to turn and turn you through the clinic. You know, you get one complaint with every visit and you get 15 minutes to talk
about it and decide on a plan and answer your ask and answer your questions. So what I love about this is that I'm able to
really sit down like an initial consultation for a functional patient. health and hormones is 60 to 90 minutes of sitting and
going through your labs, really explaining what each lab result means, talking about your symptoms in depth, your medical
history in depth, medications and how they could be playing into your symptoms. I mean, we really take a lot of time and I
pride myself on not letting a patient walk out the door without answers to their questions and some sort of plan going
forward.
Speaker 2: So
Tom: that's your question. It totally does.
Speaker 2: And what I find interesting is just from a personal level and my age and my life and the change of life elements
that I've either witnessed or experienced at this particular time. It's it's a it's an emotional decision for them, for someone to
decide to come and work with you. And you're dealing with those at the intake stage, I assume. Well, I mean, how much
does the I guess. The changes that they're going through, the emotions that they're experiencing play into a strong
onboarding, for lack of a better term, experience into your program.
Tom: So do you mean like developing the like provider patient relationship?
Speaker 2: Yeah, because you were mentioning, so a good point of clarification, you're mentioning kind of like the rigidity, if
I may paraphrase on a standard intake with a primary care provider, right? In this scenario, you're saying your health
deserves to be heard. And by what you're describing to me, the time and the care that you put into a personalization
process, that would, my assumption is that would elicit a connection, like an emotional connection with their care.
Tom: Oh yeah. I mean, people, people cry sometimes, you know, and, and they often, you know, they will often say that, you
know, nobody's ever sat down and listened to me like this before, you know, so that's, that's a pretty common thing that
happens. And that's, and that's really what we mean, right. Is that, you know, we really try hard to listen to what the patient's
telling us, not just the labs, not just the medications they're on, but like what they're actually telling us matters to them.
That's the most important thing to us.
Speaker 2: Excellent. And that helps me dovetail into some of the questions that I assume that you're getting because most
pharmaceutical questions, commercials ask these questions about being pointed about the things that they ask about in
their therapy. And how much do you have to deal with the misinformation or disinformation about the particular care that
someone is trying to obtain from you at the stage of just educating or onboarding a patient into your practice?
Tom: You know, there's almost always some sort of misconception that they have about really anything. So GLPs, to take
one example, you know, often they hear, oh, I don't want to do a GLP, just the side effects are awful. And I hear these awful
things, you know, but really... you know, you sit down, I mean, we, there are side effects, obviously with any medication,
there are side effects. What I make sure they understand is what the side effects typically look like, how to avoid them, how
we together try to develop a plan to avoid the most severe side effects, and then what to look for if there's ever something
really bad that's happening, what the plan is at that point. So like if they're having abdominal pain, you know, one of the
risks is gallbladder disease with GLP medications and weight loss. You know, I tell them, don't don't mess around and wait
for me to call you back. Go to an ER. That's that's an emergency. So, you know, so I think that they feel better knowing what
to expect, knowing, you know, what, you know, it's with anything online. The the people who are the loudest tend to be the
most unhappy for whatever reason it is. And for every person that had an awful experience. I tell them just to keep in mind,
there are a hundred people who have had an awesome experience. They just don't write about it because, well, for one
thing, there's, you know, a little bit of shame still around obesity treatment, but, but also, I mean, you know, it works for
them. They just don't feel a need to shout it from the rooftops, you know, and you hear from the people who had problems.
So it's important to set appropriate expectations, but also temper some of the fears that they might be having surrounding a
given therapy. Yeah.
Speaker 2: Yeah, the vocal minority carries a lot of weight when it comes down to what you're discussing. And let's kind of
go towards some hot topics, if you don't mind. Like, for instance, I've heard, most patients have heard, there's a black box
warning around hormone therapy, right? What does that... When you hear about a black box, we know how that might affect
people's opinions, be about the medications that they might already be on. It doesn't affect them. It takes some education.
So in respect to a hot topic like hormone therapy, help your listeners, your patients. What does a black box morning
warning mean? How does it affect it? Let's just say hormone therapy in this case.
Tom: So basically a black box warning is a serious, um, a serious consequence of whatever medication or therapy that
you're prescribing at that time. So for instance, if we're going to talk about hormones, so there were recently some black
box warnings removed by the FDA on estrogen and testosterone. Those black box warnings were on estrogen. It was that it
could cause heart disease. it could cause breast cancer and blood clots. Those were the big warning signs with estrogen
therapy in particular. That's because there was a study that was published in 2002 called the Women's Health Initiative. And
I really believe that while the study wasn't wrong, it was really, they took a headline and it kind of disseminated through the
media and scared a lot of PCPs and providers from prescribing hormone therapy. Um, and it scared patients. It made, I
mean, it was all over the news, you know, estrogen can cause breast cancer and we still hear patients come to us with these
concerns today, you know, like, oh, well, my mom had breast cancer. I can't do hormone therapy, you know, like, hold on,
you know, that is not necessarily the case. So, um, I firmly believe that study set us. I mean, it's. Was it
Speaker 2: ad hoc or was it a controlled clinical trial?
Tom: It was a small trial. The average age of the women in that study was, I believe it was 69 or 67 years old. So hormone
therapy, the ideal patient. for women would be someone under 60 years old who is less than 10 years from menopause. So
that's your like ideal patient to start on hormone therapy. After that, their risks do increase if you're outside of those
parameters, but that's not necessarily an absolute contraindication to starting hormone therapy. It does involve, you know,
there's some nuance there and it does involve kind of a different discussion surrounding risks and versus benefit. But it
really, you know, this scared people from, so the women in this study, first of all, were older than most women who start to
seek hormone therapy. I mean, most women who kind of start to look into it are in their forties, you know, they're
perimenopausal, they're starting to have some of these symptoms. So they haven't even hit menopause yet. So they're ideal
candidates for this kind of stuff, but everybody just saw hormone therapy causes breast cancer. The other important thing
to note with this one was that it's studied Not bioidentical hormones. So there was progestin, which is a synthetic
progesterone and a synthetic estrogen derived from like horse urine is what it is. So completely different from the
bioidentical things we have now. Bioidentical hormones now are there. um, cellularly the same as the hormones that you
make in your own body, whereas these words are like synthetic. So they also, um, you know, some of the women in this
study were on an, an estrogen, synthetic estrogen alone without a progesterone or progestin, um, which can certainly
increase your risk for endometrial cancer and breast cancer. So it was just, it was just kind of a, not very well done study
maybe. Um, and then, but really where, um, The problem came in is that the media took it and kind of just put this headline
out there that HRT is dangerous and it really got some traction and was just disseminated all over the place. So people got
very scared. So in 2025, they've done since done some studies with bioidentical and studies in you know, controlled studies
in the proper population of women and hormone therapy. And what they found really was that all other things being equal, if
you are started appropriately on bioidenticals, you don't have a higher risk of breast cancer than the normal population. You
don't have a higher risk of cardiovascular disease. You don't have a higher risk of blood clots. The only F the FDA did leave
on the black box warning for endometrial cancer was um, for estrogen, but only if it's not given with the progesterone. So
anytime you take estrogen and you have a uterus, you must have progesterone to protect your uterus, but that's the only
black box warning that's left. The others were taken off in 2025, which was huge. So that's a big deal.
Speaker 2: But the trauma always remains, right? People hear things and they don't get the updates on these. And what you,
that was brilliantly articulated. And I personally spent 25 years in pharmaceuticals and medical devices. And what would
blow me away was you could take a 55,000 patient trial with reproducible P values, but an eight person trial from the middle
of nowhere could totally blow up an entire standard of care.
Tom: Yeah. There's like, so there's like one, you know, it's interesting. So in the testosterone side of things in the forties,
there was, I'm not sure if he was even a physician or maybe he was, his name was Huggins. I can't remember, but he kind of
postulated that maybe testosterone therapy was tied to causing prostate cancer.
Speaker 4: And
Tom: that myth like still persists today. Uh, testosterone does not cause prostate cancer. There's a theoretical risk that it
could kind of accelerate it if you already have it, but people still think that it will cause, I hear it all the time that it will cause
prostate cancer. So it's pretty crazy. It's crazy how things that happened literally 80 years ago could still be influencing how
people feel about this stuff today.
Speaker 2: Yeah, it's urban legends and myths baked into, I guess, culture for that matter. But you brought up something
right there that was interesting is, you know, we're focused on so far on the women's health, which is vitally important,
especially when you consider all of the nuance around change of life and the types of patients that you're talking about. But
men do compose a certain amount of your patient base, correct? Correct. And what are the treatments that men are typically
seeking at Topform?
Tom: Um, usually, um, they, it has to do with, uh, testosterone, low testosterone is the main thing that we see. We do see
like a, you know, we have a kind of an athlete population that's after like really maximizing performance and things like that.
But honestly, our typical guy patient is. is either weight loss or like they're a dude in their forties. Who's noticed that they
just have lost motivation or libido or problems with erections, you know, and things like that. So that's our typical patient.
We don't see a lot of like super performers that want to be super ripped. We see normal dads that you probably run into like
at the baseball game. Right. So.
Speaker 2: But to be fair, you can, you're promising that you can make somebody ripped. Is that what you're
Tom: saying? No, no, I can't. You can. Okay. Okay. Yourself, but I can't promise that I can help you. I can help you along the
way, but I can't make it happen.
Speaker 2: Do I have to be in Nebraska or am I
Tom: okay? Well, you have to. So for testosterone, I do like my testosterone patients to come see me at least once. Um,
testosterone is a controlled substance actually. So, uh, Yeah. So we try to see them in person once if we can. For right now,
it's not required by the DEA, but I think they loosened it up during COVID for telehealth purposes. But I think at some point
that'll probably go away and we'll have to see them in person again.
Speaker 2: It's interesting you bring that up because there's so many infomercials for low T that you see if you leave the TV
on for too long after a game. And I was under the impression that it was a controlled substance, but I thought maybe
something had changed. So thanks for clearing up that myth as you have. I have a list of myths that I in front of me that I
was going to dive into, but you've actually discussed all of them and kind of nailed it from my perspective. I feel educated.
But let's let me let me change the subjects more towards your practice. And maybe if you could just tell us what a patient
should expect. We did talk about their intake, but like what a what a patient journey looks like or what you feel the best
patient journey is for someone coming to Topform.
Tom: Yeah. So a lot of times people reach out to us through our website or they just call our office or sometimes people just
walk in, you know, and say, hey, I heard about you guys. You know, I'm feeling tired all the time or I'd like to lose 50 pounds
or, you know, whatever it is. you know, how can I get started? Well, if they call one of our staff here, one of our nurses or
our clinic managers, sometimes myself get that call. And we kind of just try to figure out like kind of what they're after from
that initial call. And then, you know, we ask about like, do you have any pertinent labs that are recent? We don't make
everyone get brand new labs all the time if they have very recent ones, but often they don't. So kind of the first step most of
the time is to have them do kind of a comprehensive lab panel. that looks at some of the common drivers of some of these,
you know, very common symptoms, you know, fatigue, hormone stuff, iron deficiency, you know, things related to insulin
resistance that would play into weight loss, we would want to look at your liver and kidney health, of course, and things like
that. So oftentimes, we'll start with let's just get a lab draw. And let's see, you know, what what that looks like. So they can
get the lab draw. And then once they have those results, they can, they have kind of two options. So they, well, three
options. So they could just take the lab results and take them to their PCP or whoever they'd like, because they're armed
now with some, you know, a lot of patients have trouble getting their providers to even draw hormone labs or iron labs,
which is kind of a strange problem in and of itself. But some patients do, they come to us just to get labs drawn and they
take them to their, their provider. Option two would be, you know, I'll sometimes do like if a patient isn't sure or doesn't
know what their labs mean. A lot of times I'll do what's called like a lab interpretation visit, which is they sit and talk with me.
They usually take about 20 minutes and we just go over the labs and I tell them kind of what they all are, what they're
looking at and what their results might mean. Obviously, at this point, we haven't gone through like a big consult yet. I'm
just kind of giving them an idea of Yeah, you might benefit from some hormone therapy or you might benefit from some iron
supplementation or like whatever I kind of see on the labs. And then at that point, they again can be armed with that
information and go back to their primary practitioner or whoever. Or they could choose to schedule a consult with me. And
then, you know, at that point, obviously, we'd go through all again. And we would, you know, start with a couple things. I
don't like to throw like too much at a patient all the time. But I try to find out what their most, you know, concerning one,
two, three symptoms are. And then we start there. So then they have a consult. Like I said, it's usually 60 to 90 minutes
somewhere in that realm. where we talk about the labs or history. We talk about, you know, the symptoms that they're
having, what's most distressing to them, you know, get some vital signs and do stuff like that. And then, you know, we
develop a plan of care. And we go from there. After that, and I think this is one of the things that kind of differentiates us
from a lot of clinics is we do quite a few check ins. So I have one of my nurses, Jamie, primarily is responsible for part of her
role is to check in on patients after they start. So a couple of weeks after every patient starts, they get a text or a phone call
from her that says, Hey, how are you doing? I heard you started testosterone. How's that working for you? Are you having
any trouble injecting it? Are you having any side effects, anything we should know any way we can support you? So they
get that initial support. We do a formal follow up visit every two to three months with me, like with the provider. But in
between times, if something comes up, they can always just request a visit if they need one. We can have a quick video chat
or they can have a nurse visit or none of that is any additional cost in our program. So I think that that is. Um, something
that a lot of places overlook is just really that support on the backend. You know, we do a lot of supplement
recommendations. Um, we have a, like a hormone education kind of email that goes out to them daily that talks about
different aspects of whatever it is. Like, you know, if they're a male kind of more testosterone related things, if it's a female.
There's daily education about like perimenopause and menopause and weird symptoms and things like that. So. So, yeah,
that's kind of kind of our process. How many people do you have on staff? I have one full time nurse, one part time nurse,
and I have myself and three other nurse practitioners and then a clinic manager.
Speaker 2: So no disrespect to actually going to see a PCP or anything when people do need to, of course that's, but with, I
mean, when we talk about personalized medicine, it seems like everybody is involved with the care and there's education
going in both directions.
Tom: Correct. Yeah. Yeah. It's, it's very important to us.
Speaker 2: Excellent. What would you like people to know about Topform? I've been asking the questions and I want to
know what you, what you feel is the most important things for us to know.
Tom: I think the most important thing that you should know about us is that most of us have been on whatever journey that
you're on. I mean, most of us, you know, have been each other's patients.
Speaker 4: So,
Tom: I mean, I'm 47, almost 48, you know, perimenopause is crazy. right there for me. And so I'm like living the hormone
swings and getting those managed and everything. So, you know, I've been there with the weight loss, I've been there, and I
get it. And, you know, my staff has been there, and they get it. So I think that's different than a lot of places. You know, I
think, you know, you see people who just have not been through your same journey and don't understand the nuances and
things that might actually concern you versus what they think should concern you, if that makes sense.
Speaker 2: No, it's a very human one-to-one type element of care. And you don't sometimes get to choose who you're,
through insurance, who your providers are, right? Especially through referral bases. It's on availability, who's in network, so
on and so forth. And wait
Tom: times to get in some places is months. So we can get somebody in within the next week or two. So yeah, we have
short wait times.
Speaker 2: This has been an exceptional learning experience for me. And I want to thank you for your time. As a husband of
a wife who is the same age as you going through perimenopause, I've had to educate myself and become more sensitive to
the things that you're mentioning. Not, I guess, more of a sense of education, which... I think is vital to your practice and the
way that you're approaching it. And I am grateful for your time. With that, is there anything else that you can think of that
you'd like to discuss?
Tom: Nothing that I can think of right at the moment, but I'm sure we'll have more to talk about next time.
Speaker 2: Absolutely. Thank you so much for your time, Angie. It was a pleasure.
Tom: Thank you, Tom.
Speaker 2: Bye-bye.
Tom: Bye-bye.