Tier 1: Guided by the Mission to Help Others Lead Healthier, Fulfilling Lives


The leading cause of death and disability in the United States is chronic disease, yet we know that nearly 85% of the chronic diseases today are caused by unhealthy lifestyle decisions in regard to sufficient physical activity, quality nutrition and hormone deficiencies. In preventative medicine, the importance of correcting hormone imbalances and lifestyle modification cannot be understated. These aspects are vitally important components of health and paramount to leading a truly optimal, healthier and longer life.

At Tier 1 Health and Wellness, our mission is to assist individuals in achieving an improved quality of life and health through disease prevention and hormone optimization. We have a motto that guides us in this mission each day, a slogan born out of a story of struggle and success. 

Our motto: Iron Sharpens Iron, brings us comfort each time we face adversity, just like every Chattanoogan has experienced this year with COVID-19 restrictions, especially local entrepreneurs. Our motto summarizes our core beliefs surrounding our business and starting and growing a successful preventative medicine practice. 

Seeking a Healthier Quality of Life

Each of our staff came from very different backgrounds, our own unique struggles that shaped our paradigms of life, value and work ethic. These varied backgrounds and struggles converged in preventative medicine, molding us to become advocates of optimal hormones and lifestyle. 

For Angie Nichols, her indoctrination into the world of hormones started at 36, working as a school nurse who one day began experiencing irritability, feeling severely fatigued at the end of the day. After delaying the inevitable and becoming desperate for relief, she visited her gynecologist, who told her that her symptoms were hormone related. He referred her to another gynecologist who put her on one hormone, progesterone. Still, something wasn’t right, and Nichols wasn’t yet back to being herself. 

While Nichols was battling her issues, Dr. Keith Nichols was also struggling. Dr. Nichols has always led an independent life, serving as the team physician of the Nashville Predators. That eventually came to a screeching halt after several years of fatigue, lack of motivation, becoming physically weaker and mentally drained. These symptoms made it difficult for him to get out of bed, and to practice his specialty in physical medicine and rehabilitation. He consulted another physician, who told him his testosterone levels were normal. To rule out cancer and other diseases, Dr. Nichols had what is known as a ‘Million Dollar Workup,’ which consisted of an array of diagnostics to rule everything out. All tests returned negative, and at this point he knew he would have to find a solution for himself. 

Humble Beginnings of Tier 1

When Dr. Nichols and Angie met, they were both battling what they believed to be normal changes of growing older. After discussing what they were experiencing with one another, they began searching for solutions, seeking out world experts who specialized in the gray space between well-being and continual suffering and frustration. 

Finally, after searching relentlessly for effective answers to their problems, they eventually found Dr. Neal Rouzier and attended their first lecture together. The initial lectures changed their whole paradigm of medicine and challenged them to apply to principles learned. 

Both had their hormones replaced and optimized, making them feel rejuvenated and functional. They felt like themselves again. This prompted Nichols and Dr. Nichols to pay it forward, to supply a need in their communities. They attended every one of Dr. Rouzier’s lectures throughout a ten-year period, becoming hormone experts in their own right. 

They incorporated hormone treatment into a spine and sport practice for the community of Cookeville. Despite starting off with word-of-mouth advertising, the patient load quickly grew, and requests for treatment began coming in from around the country and the world. Given this response, they identified a larger need in an underserved population of patients with hormone deficiencies, so they closed their spine and sport practice and decided it was time to pour their energies into their true passion: preventative medicine. They relocated from Cookeville to Chattanooga and welcomed Dr. Scott Howell to the team, a scientist and researcher, to open the Tier 1 Center for Research. 

Dr. Howell Joins Tier 1

Dr. Howell is no stranger to struggle, especially after serving in the military at a young age. After leaving the military and using anabolic steroids as a young man, he became focused on the scope of adverse effects related to the use of anabolic steroids, and knew that the only way he could address the issue was to become a scientist. It was a journey that took the better part of 15 years of doctoral education in several disciplines, particularly androgen metabolism. 

Dr. Howell felt a need to overcome his limitations to find answers, and over a 10-year period, he mapped out seven distinct types of injury related to anabolic steroid abuse. This led him to discover the harmful effects of estrogen blockers in men’s hormone replacement therapy. So he sent multiple emails to practitioners for 3 years, urging them to stop prescribing estrogen blockers. This series of emails is what led Dr. Howell to Dr. Nichols, and the two quickly bonded over their common passion for addressing hormone misinformation in patient care. 

Growing Patient Base 

For women who live long enough to complete the menopausal transition, there is a continual decline in health and an increased risk of cardiovascular disease, some types of breast cancer, Type 2 diabetes, increased visceral and central body fat, osteoporosis, loss of mobility and frailty. 

These deleterious conditions are treatable through preventative medicine with proper hormone therapy. It became apparent that individuals, especially women, were willing to travel great distances to obtain proper treatment. 

Given these points, the Tier 1 team became more driven to inform and spread the word that people do not have to accept physical and mental decline, believing this is just an inevitable consequence of aging. 

Dr. Nichols and his team reassessed the traditional methods used to provide information to prospective patients, realizing that the most powerful tool available to inform and educate an even wider group of men and women was to leverage the use of technology and social media platforms. With each educational video, our patient base grew.

Navigating the Pandemic 

In March 2020, the COVID-19 pandemic struck, which had a tremendous impact on how we interacted with and managed patients. No longer were prospective patients flying in from different states, Europe and beyond. Even worse, after several months of quarantine, many patients could not afford to stay on treatment given the financial hurdles most of us have experienced. As a necessity, we had to see our patients solely through telemedicine, and postponed the face-to-face interaction that grounded our medical practice with a higher standard and quality of medical care.

We would be remiss to say that everyone, including ourselves, have emerged unscathed by COVID-19, but we managed to keep going. We all have a mutual mission to help others who suffer from hormone deficiency get their lives back and lead healthier, more fulfilling lives. We surround ourselves with like-minded people, take action beyond what others would do, adapt to the situation, and take ownership of our roles in the practice. 

Our motto, Iron Sharpens Iron, means that we continually challenge ourselves and our beliefs about literature evidence on a daily basis, using quality clinical evidence to guide us in the most effective care of patients. These principles are what drive us each day to challenge ourselves and provide a higher standard of care to men and women of all ages. 

To learn more about Tier 1, visit their website and check out their podcast