ACCE Alzheimer's anastrozole aromatase inhibitors breast cancer cancer risk cash based practice concierge medicine CVD deep venous thrombosis dementia direct primary care DPC DVT e2 estrogen in men healthcare burnout hormones low free T3 medical business model medical practice model melatonin natural hormones nurse practitioner oral estradiol PCSK-9 Inhibitors PE physician burnout polypharmacy practice transition pulmonary embolism root cause sickness medicine sleep synthetic hormones T4 Monotherapy testosterone testosterone in men thyroid thyroid optimization transdermal estrogen treatments TSH wellness medicine women's health initiative