Dr. Roscoe Nelson Says Normal Is Not Optimal in Hormone Care
A Utah urologist with 30-plus years in practice says a normal lab result should start the conversation, and medicine should admit when it gets things wrong.
Picture a patient sitting across from a physician with a list of complaints she has carried for months. She sleeps badly. Her mood swings. Intimacy has become painful, and the urinary infections keep coming back. The labs come back, the numbers sit inside the printed range, and she is told she is normal. For Dr. Roscoe S. Nelson, a urologist in Draper, Utah, that moment is where the conversation should begin, not where it ends.
"Normal is not the same as optimal. You can be inside the reference range and still be miserable," says Dr. Nelson, founder of Peri Health & Hormones.
Hormone care is finally getting serious attention, he says, especially for women in perimenopause and menopause. But in his view, patients are often stuck between two poor choices. On one side are clinicians who treat a lab reference range as the final word. On the other are wellness influencers selling untested products under the label natural. Dr. Nelson wants to work in the space between them, with a clear account of what the evidence shows, where it is weak, and why a lab number should open a conversation rather than close it.
He points to the Women's Health Initiative as an example of how that gap forms. What the 2002 headlines implied, what the trial actually studied and what is known now are not the same thing, he says, and many women are still paying for the difference. Federal regulators have since revisited how menopausal hormone therapy is labeled, a shift The Script Pad has covered, but Dr. Nelson's larger point is about how medicine handles its own revisions.
"I still believe in medicine. I just think we can do better, and that starts with being willing to say, 'We got that wrong,'" he says.
That belief comes from more than 30 years in urology, most of them in Arizona before he moved to Utah in 2024. Over those decades he kept seeing the same patterns. Men with real symptoms were dismissed because their testosterone sat just above a cutoff. Women with recurrent urinary infections, sexual pain, insomnia or mood changes never got a real conversation about menopause.
He is candid that his own view had to change, and that the change came early. He once doubted that women's symptoms were being overlooked in a meaningful way, he says. His patients changed his mind, and so did family members who struggled to find answers within traditional medicine. By 2009 he was treating women for hormonal insufficiency related to perimenopause and menopause, and over the years since, he says, he has seen patients' health and quality of life improve with the right approach.
Peri Health & Hormones is the culmination of that nearly two decades of experience, not a recent change of heart. At this stage of his career, Dr. Nelson says, he wanted a practice where he could spend more meaningful time with each patient and focus on the care he has become passionate about.
It is a physician-led hormone and longevity practice that treats men and women with the same seriousness. The approach weighs symptoms, history, timing and goals alongside the labs, rather than asking only whether a number clears a cutoff. Dr. Nelson is a conventionally trained, board-certified urologist, and he says the practice relies on evidence-based tools, including FDA-approved hormone options where appropriate. Patients are told what is proven, what is uncertain and what is not worth their money. Sleep, stress, nutrition and exercise are part of the treatment plan rather than an afterthought at the end of the visit.
"Guidelines are a map, not a GPS that thinks for you," Dr. Nelson says. "If following them were the whole job, why did I spend all those years learning how to think?"
Three misconceptions come up again and again in his exam room. The first is that hormones belong to one sex. Men and women both make testosterone and estrogen, he explains. The amounts and effects differ, but testosterone is not a men-only hormone. The second is that a result inside the reference range means a patient is healthy. A reference interval describes a population, he says. It does not interview the person in front of you. The third is that natural means safe. Plenty of natural things are harmful, in his view, and dose, quality and evidence are what matter.
His work now extends beyond the clinic. Alongside Peri Health & Hormones, Dr. Nelson serves as chief medical officer of Options Wellness, formerly Options Medical Weight Loss. He is also relaunching PeeDoc, a physician education site meant to help patients ask their own doctors better questions.
For patients who feel unwell and have been told everything is normal, his advice is direct. They deserve a doctor who will look at the whole picture, he says, including their symptoms, their stage of life and the evidence, and who will tell them plainly what is known, what is not, and what is still a guess.
For physicians, the message is quieter but just as pointed. The reference range is a starting point built from a population. The patient in the chair is one person, and Dr. Nelson's argument is that good medicine has always meant treating that person rather than the printout.
About Dr. Roscoe S. Nelson
Dr. Roscoe S. Nelson, MD, FACS, is founder of Peri Health & Hormones in Draper, Utah, and chief medical officer of Options Wellness.
Urology, with a focus on hormones, sexual health, menopause and men's health. Board certified by the American Board of Urology. Fellow, American College of Surgeons. More than 30 years in practice.
Reported, fact-checked and edited by The Script Pad's editorial staff. See How we use AI.
This article is for professional education and does not replace clinical judgment. Treatment decisions should be based on the individual patient and current guidelines.
