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Book with Dr. Gissella Rivera, APRN

Evaluation

Clear, practical information for your next step.

Topics to discuss

  • Symptoms, how long they have lasted and how they affect daily life
  • Cycle, bleeding and sexual health history
  • Medicines, supplements, and personal and family history
  • Targeted labs such as TSH, fasting early-morning testosterone and A1C when they answer a question
  • Individual risks before any hormone treatment

When we refer

Viva Hormone Clinic is primary care. Your clinician coordinates endocrinology for an overactive thyroid, thyroid nodules or goiter, thyroid problems in pregnancy, suspected pituitary or adrenal causes, or premature ovarian insufficiency; urology for a prostate nodule or high PSA before any testosterone decision; and gynecology for abnormal bleeding or any bleeding after menopause.

Questions patients ask

What are the 5 most common signs of a hormonal imbalance?

No single list fits everyone, because the body makes many different hormones and each one acts on different organs. Still, when people feel their hormones are "out of balance" or "out of whack", five groups of signs bring most people to a hormone visit. Every one of them can also come from causes that have nothing to do with hormones, which is why a careful history comes before any test or treatment.

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Hormone labs: which test answers which question

Good lab work starts with a question. A large "full hormone panel" ordered without one can produce results that are hard to interpret, because many hormones change by the hour, by the day of the cycle, or with medicines and supplements. A result outside the range does not always mean a problem, and a single normal result does not always rule one out. A testosterone result alone, for example, cannot diagnose a condition.

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Thyroid: underactive, overactive and how it is tested

The thyroid is a small, butterfly-shaped gland in the front of the neck. Its hormones control how the body uses energy, so they affect nearly every organ, even the heartbeat. An underactive thyroid (hypothyroidism) affects nearly 5 in 100 Americans aged 12 and older, and an overactive thyroid (hyperthyroidism) about 1 in 100. Both are more common in women and after age 60, and a thyroid problem is more likely in the 6 months after a pregnancy.

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Men: low testosterone is a diagnosis, not just a number

Testosterone tends to fall slowly with age, about 1% a year from the late 30s. A level below 300 ng/dL is generally considered low, but low testosterone (often called "low T"), medically hypogonadism, is diagnosed only when a low level comes with symptoms. The most specific symptoms are lower sex drive, fewer morning erections and trouble with erections. Others include less muscle, more body fat, less endurance, trouble concentrating and low mood.

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Your visit with Gissella Rivera in Doral

Your first visit is a conversation. Gissella Rivera, who sees patients in English and Spanish, listens to your symptoms and how they affect your sleep, work and relationships. Then she reviews your medicines and supplements, your cycle or sexual health history, and your personal and family history.

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Prepare for your visit

Bring a list of your medicines, vitamins, and supplements, including how often you take each one. Include allergies and any past reactions. If you have recent test results, discharge papers, or notes from another care team, bring them or ask how to share them before the visit. You do not need to order your own tests to prepare.

Write down your main questions and what has changed since your last visit. Note when symptoms began, how they affect your daily activities, and what you have already tried. If you track readings or symptoms at home, bring that record. Tell the team if you need help with language, transportation, or getting records so those needs can be discussed.

Decide on a plan together

Your provider starts with your priorities and reviews the history and information available. An examination may be needed before deciding on the next step. The lists on this page describe the program's general scope; they are not a promise that every test or treatment is needed or available for your situation. Ask what each proposed step is meant to answer.

When an option is discussed, ask about its possible benefits, risks, alternatives, and practical demands. Mention cost or coverage concerns before scheduling a test or referral. Some care is coordinated with an outside center, and availability must be confirmed. Do not stop or change a medicine based only on this page. Your plan should fit your health history and preferences.

Results and follow-up

Before you leave, ask how results will reach you and who will review them. Confirm the next appointment or the reason to return sooner. A referral request does not mean an appointment has been scheduled. Ask whom to contact if you have not heard back, and keep copies of outside results when possible so your care team can review them.

The follow-up schedule depends on what is found, any care started, and whether symptoms change. Ask for the next steps in a form you can use at home. Telehealth may suit some conversations when the program allows it, but an in-person examination may still be needed. For sudden or severe symptoms, use the urgent guidance rather than waiting for a routine follow-up.

Content approved by Viva Centers

Sources

Evaluation | Viva Hormone Clinic | Viva Centers