Dr. Pratt FM

Dr. Pratt FM At Dr. Pratt FM, we offer personalized lasting care for type 2 diabetes, hormonal imbalances, weight loss, and digestive health.

With our 25+ years of experience, we deliver science-driven solutions for sustainable results. At Dr. Pratt Functional Medicine, we are dedicated to providing personalized, science-driven solutions for optimal wellness. Founded in December 2023 by Dr. Nicholas Pratt and Megan Pratt, our virtual practice combines cutting-edge research with compassionate care to help clients achieve sustainable heal

th transformations. Our expert team, with over 25 years of combined experience and advanced degrees in nutrition and functional medicine, specializes in addressing type 2 diabetes, metabolic conditions, hormonal imbalances, digestive health, and cellular function. We dive deep to uncover root causes and develop personalized care plans that integrate clinical experience with the latest research findings. Our fully virtual consultation model and flexible scheduling ensure that clients receive personalized attention and direct access to Dr. Nicholas and Megan Pratt throughout their journey. We empower our clients with the knowledge and tools they need to take control of their health and maintain long-term success. Our Food to Thrive weight loss program, co-created by Megan Pratt, offers a comprehensive support system to help clients develop healthy habits that last a lifetime. We understand that every client is unique, and we strive to provide the individualized guidance and support needed for sustainable results. At the heart of our practice lie our core values: root-cause focus, personalized care, science-driven solutions, client empowerment, compassionate connection, sustainable results, and professional integrity. We are constantly expanding our knowledge and refining our approach to better serve our clients and help them achieve their health goals. With Dr. Pratt Functional Medicine, you can trust that you are in expert hands, receiving the personalized care and science-backed solutions you need to thrive.

You ran the panel. Estradiol normal. Progesterone normal. TSH normal.You still feel off.Cycle migraines. Breast tenderne...
04/29/2026

You ran the panel. Estradiol normal. Progesterone normal. TSH normal.

You still feel off.

Cycle migraines. Breast tenderness. PMS that gets worse, not better. Caffeine you used to tolerate. Alcohol that wrecks you. None of it shows up on the bloodwork your doctor ordered, and none of it is in your head.

Hormones do not disappear. The liver clears them. It runs a two phase pipeline. Phase 1 breaks hormones into intermediates that are sometimes more reactive than the parent hormone. Phase 2 tags those intermediates so they can leave the body. When Phase 2 falls behind Phase 1, the reactive intermediates pile up. That is the bottleneck the standard panel was never built to find.

A urine metabolite panel reads the pipeline. It tells you whether your body is clearing estrogen down a clean pathway or a reactive one. It tells you whether methylation is keeping up. It tells you whether your symptoms have a target.

Save this for the friend whose labs are normal but whose body is not.

DM the word CLEAR and I'll send you the panel I run when bloodwork misses what the body is screaming.

You added more sessions. You cleaned up the diet. You doubled down.So why are your hormones worse than they were six mon...
04/28/2026

You added more sessions. You cleaned up the diet. You doubled down.

So why are your hormones worse than they were six months ago?

Cycles short or missing. Libido flat. Wired at 11pm and crashing by 3pm. Cold hands. Hair thinning at the crown. Resting heart rate drifting up while HRV trends down. These are not random. They're the signature of an HPG axis that has stopped trusting the environment you keep putting it in.

Past a threshold, training stops building you. It starts rationing you. Your body reads chronic under fueling plus over training as a famine, and it down regulates reproduction, thyroid, and repair to keep you alive. The IOC has a name for it. Conventional labs almost never catch it.

Swipe through. The pattern is clearer than you think, and the fix is not what fitness culture is selling.
Save this for the friend who is grinding themself into worse health.

DM the word RECOVER and I'll send you the exact lab panel I run for athletes whose training has turned catabolic.

Most estrogen dominance is not an ovarian problem. It is an intestinal problem.Here is the mechanism that almost nobody ...
04/24/2026

Most estrogen dominance is not an ovarian problem. It is an intestinal problem.

Here is the mechanism that almost nobody is explaining.

Estrogen that has been used by the body is packaged in the liver, conjugated to glucuronic acid, and sent to the intestine for excretion. Under normal circumstances it leaves the body in the stool. That is the intended pathway.

The estrobolome changes that calculation.

The estrobolome is the collective of gut microbes that produce beta-glucuronidase, an enzyme that cleaves the glucuronic acid bond and deconjugates estrogen in the intestinal lumen. Once deconjugated, estrogen is no longer bound and becomes available for reabsorption through the intestinal wall back into portal circulation. From there it re-enters systemic blood flow and recirculates as biologically active estrogen — unregulated, outside normal HPG feedback rhythms, and additive to whatever the ovaries are already producing.
When the microbiome is diverse and balanced, beta-glucuronidase activity is regulated. Reabsorption is controlled. Excretion dominates.

When gut dysbiosis is present, beta-glucuronidase output rises without regulation. Reabsorption increases. Circulating estrogen climbs independent of ovarian production. The clinical presentation is estrogen dominance. The lab work confirms elevated estrogen. The treatment targets the hormone.

Nobody measured the gut.

Intestinal permeability compounds the problem further. A compromised gut barrier allows endotoxin translocation into systemic circulation, directly suppressing HPG axis output and creating a simultaneous pattern of estrogen excess and suppressed progesterone production.

The result is a hormonal picture that looks purely endocrine. The cause is entirely microbial. Standard hormone panels were never designed to find it.

A stool test measuring beta-glucuronidase activity tells you more about estrogen dominance than an estradiol panel ever will.

Your hormone panel is not just a hormone story. It is a gut story.The microbes living in your intestine right now are ma...
04/24/2026

Your hormone panel is not just a hormone story. It is a gut story.

The microbes living in your intestine right now are making decisions about how much estrogen stays in your blood versus gets eliminated. When that microbial colony is disrupted, estrogen that should be excreted gets reabsorbed instead. Levels rise. Symptoms follow. And every treatment aimed at the hormone itself misses the system running it.

This plate was built to address that system directly. Live cultures that regulate estrogen excretion. Prebiotic fibers that feed the specific bacterial species responsible for gut barrier integrity. An anti-inflammatory spice compound with documented effects on the intestinal environment your microbiome needs to function.

46 grams of protein. Under 450 calories. A miso glaze that makes it taste like anything but a functional medicine protocol.

Full recipe attached.

Your hormone panel came back showing elevated estrogen. So you tried progesterone. You tried DIM. You cleaned up your di...
04/24/2026

Your hormone panel came back showing elevated estrogen. So you tried progesterone. You tried DIM. You cleaned up your diet. And the symptoms keep coming back.

Nobody asked about your gut.

There is a colony of microbes in your intestine that controls how much estrogen circulates in your body. Not your ovaries. Not your liver alone. Your microbiome. When that colony is disrupted, estrogen that should be excreted gets reabsorbed back into circulation instead. Your levels rise. Your symptoms worsen. And every treatment aimed at the hormone itself misses the system driving it.

This is one of the most overlooked connections in women's health. The gut and the hormone system are not separate conversations. They are the same conversation and most practitioners are only hearing half of it.

Swipe through to see exactly how your gut is controlling your estrogen and the four signs it is already happening to you.

Your thyroid panel came back normal. Your cycle is still irregular. Your doctor has no explanation.Here is what was not ...
04/23/2026

Your thyroid panel came back normal. Your cycle is still irregular. Your doctor has no explanation.

Here is what was not tested.

TSH measures pituitary output. It does not measure what is happening at the tissue level. Free T3 is the biologically active thyroid hormone. It is the form that binds to receptors in the hypothalamus, the pituitary, and the ovarian granulosa cells that drive follicular development. When free T3 is suboptimal, even with a normal TSH, reproductive signaling breaks down at every level of the axis simultaneously.

The mechanism is direct. T3 regulates s*x hormone binding globulin production in the liver. When T3 drops, SHBG drops with it. Free estrogen rises disproportionately, disrupting the precise estrogen-to-progesterone ratio the luteal phase requires. Simultaneously, elevated TSH suppresses GnRH pulse frequency through direct hypothalamic receptor interference, reducing LH and FSH output and impairing follicular maturation. Ovulation becomes irregular. The luteal phase shortens. PMS intensifies.

None of this shows up as an abnormal TSH.

The clinical failure is a testing failure. Standard panels were designed to identify overt hypothyroidism. They were not designed to assess the free T3 availability that reproductive tissue depends on for normal signaling. You can have a TSH of 2.1, be told your thyroid is fine, and have free T3 levels low enough to suppress ovulation, shorten your luteal phase, and drive estrogen dominance through SHBG dysregulation.

The cycle is a downstream readout of thyroid hormone status. When the cycle breaks down without a structural explanation, free T3 is almost always part of the answer.

Test the full panel. Not just TSH.

Your thyroid does not just control your metabolism. It controls your cycle, your mood, your energy, and your ability to ...
04/23/2026

Your thyroid does not just control your metabolism. It controls your cycle, your mood, your energy, and your ability to convert the hormones your body is already making into the form that actually works.

And most people are never told that one mineral is the rate-limiting step in that entire process.

This plate was built around that mineral. Every ingredient has a role that goes beyond the macro count. The protein
supports the HPG axis. The greens provide the cofactors your thyroid receptors need to respond. And the one ingredient most people would never think to add to a salmon recipe is doing more for your active thyroid hormone levels than any supplement protocol most practitioners ever recommend.

42 grams of protein. Under 500 calories. Ready in 40 minutes. And built to support the thyroid function that your cycle, your energy, and your hormones depend on every single day.

Full recipe attached.

Your thyroid was checked. It came back normal. And your cycle is still a mess.This is one of the most common and most fr...
04/23/2026

Your thyroid was checked. It came back normal. And your cycle is still a mess.

This is one of the most common and most frustrating patterns in women's hormone health. TSH falls within the reference range so the conversation ends there. Nobody checks free T3. Nobody checks reverse T3. Nobody measures whether your body is actually converting thyroid hormone into the active form your HPG axis needs to run a normal cycle.

Here is what most women are never told. Your thyroid does not just control your metabolism. It regulates the binding protein that determines how much estrogen and testosterone are biologically active in your blood. It directly influences the hypothalamic signal that triggers ovulation. When thyroid output drops even subtly, the entire reproductive axis feels it long before your labs look abnormal.

A normal TSH is not the same as optimal thyroid function. And your cycle has been trying to tell you that for a long time.

Swipe through to see exactly how the connection works and the four signs your thyroid is breaking your cycle right now.

Your menstrual cycle does not start in your ovaries. It starts in your hypothalamus. And your hypothalamus will not send...
04/22/2026

Your menstrual cycle does not start in your ovaries. It starts in your hypothalamus. And your hypothalamus will not send the signal until it knows you have enough energy to sustain a pregnancy.

Leptin is the messenger that delivers that information.

Leptin is produced by adipose tissue in direct proportion to energy availability and fat mass. When caloric intake is adequate and body fat is within a functional range, leptin levels remain sufficient to maintain GnRH pulse frequency from the hypothalamus. GnRH drives LH and FSH release from the pituitary. LH and FSH drive ovarian follicle development and estrogen production. The cycle runs.

When leptin falls below a critical threshold, whether from caloric restriction, excessive exercise, low body fat, or chronic physiological stress, the hypothalamus reads the signal as an energy-deficient environment and reduces GnRH pulse frequency. LH drops. FSH drops. Follicular development stalls. Ovulation does not occur. The cycle becomes irregular, lengthened, or disappears entirely.

This is hypothalamic amenorrhea. It is not a cycle disorder. It is a survival response.

The clinical failure here is straightforward. Patients present with irregular or absent cycles, receive a hormone panel showing low estrogen and low LH, and are prescribed hormonal therapy or referred for fertility evaluation. Nobody measures leptin. Nobody assesses energy availability, resting metabolic rate, or the gap between caloric intake and expenditure.

The hypothalamus is not broken. It is responding rationally to the data it is receiving.

Restore energy availability, normalize leptin signaling, and GnRH pulse frequency returns. The cycle follows. This is not a complicated fix. It is a misdiagnosed one.

41 grams of protein. A spice profile that works directly on your hormone pathways. And a finishing sauce that ties it al...
04/22/2026

41 grams of protein. A spice profile that works directly on your hormone pathways. And a finishing sauce that ties it all together in under 30 minutes.

This bowl was built around one question most people never think to ask when they sit down to eat. What is this meal actually doing for my hormones right now?

Grass fed beef provides the zinc your body requires to produce testosterone. Sweet potato replenishes the glycogen that keeps cortisol from cannibalizing your s*x hormone production. Turmeric works directly on aromatase activity. And the ginger in this bowl has clinical research behind it that most people in the nutrition space have never read.

This is what eating for hormone health actually looks like. Bold, filling, and built with a purpose that goes far deeper than the macro count.

Full recipe attached.

Your body is not broken. It made a decision.When energy availability drops below a critical threshold your hypothalamus ...
04/22/2026

Your body is not broken. It made a decision.

When energy availability drops below a critical threshold your hypothalamus reads the environment and does something most doctors never explain to their patients. It shuts reproduction down. Not because something failed. Because survival came first.

Estrogen drops. Progesterone falls. Testosterone follows. And the lab work comes back showing low hormones with no clear cause. So you get a diagnosis that treats the output and never once asks the question that actually matters.

Does your body have enough energy to reproduce right now?

This is one of the most underdiagnosed and mismanaged patterns in functional medicine. And it is being missed every single day because the standard fertility panel was never designed to find it.

Swipe through to understand what is actually happening and the four signs your body has already made the call.

Most people think estrogen dominance is a hormone problem. It is actually an insulin problem.Here is the mechanism nobod...
04/21/2026

Most people think estrogen dominance is a hormone problem. It is actually an insulin problem.

Here is the mechanism nobody is explaining.

Insulin directly upregulates aromatase, the enzyme responsible for converting androgens into estrogen. When insulin is chronically elevated, aromatase activity increases proportionally. More aromatase means more conversion. More conversion means more circulating estrogen, independent of what your ovaries are producing.

This matters for two reasons.

First, the estrogen being produced through aromatase upregulation is unregulated. It does not follow the normal feedback rhythms of the HPG axis. It does not cycle. It simply accumulates. Second, the tissues with the highest aromatase density are adipose tissue and the liver, both of which expand their activity significantly under hyperinsulinemic conditions. The more insulin-resistant you become, the more aromatase activity you drive, and the more estrogen you produce outside of normal hormonal regulation.

The result is a clinical picture that looks like estrogen dominance. Heavy or irregular cycles. Mood instability. Breast tenderness. Water retention. Difficulty losing fat around the hips and thighs. And when patients present with these symptoms the standard workup measures circulating estradiol, finds it elevated, and treats the estrogen.

Nobody measured the fasting insulin that caused it.

This is why estrogen dominance that does not respond to progesterone therapy, DIM supplementation, or liver support almost always has hyperinsulinemia sitting underneath it. You cannot suppress aromatase activity while the insulin signal driving it remains uncorrected.

The root is metabolic. The symptom is hormonal. Standard panels are measuring the wrong layer.
A fasting insulin and HOMA-IR tells you more about estrogen dominance than an estradiol panel ever will.

FM

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Rochester, MN

Telephone

+5072511143

Website

https://drprattfm.com/, https://go.drprattfm.com/food-to-thrive-home

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