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