Dr. James Alexander Graham

Dr. James Graham diagnoses and treats a wide range of hormonal and metabolic disorders, including:

Reproductive Health & Infertility (Endocrine Aspects)

• Female Infertility (Ovulatory Dysfunction, PCOS-related, Luteal Phase Defect): Hormonal imbalances that can impair a woman's ability to conceive, such as problems with ovulation (e.g., due to PCOS), or issues with the uterine lining preparation.
• Hyperprolactinemia: Elevated levels of prolactin hormone in the blood, which can cause irregular periods, infertility, and milky nipple discharge (galactorrhea) in women, and low libido or erectile dysfunction in men.
• Male Infertility (Hormonal Causes, e.g., Hypogonadotropic Hypogonadism): Endocrine disorders contributing to male infertility, such as low testosterone production due to pituitary or testicular issues, affecting sperm production and function.

Thyroid & Parathyroid Gland Disorders

• Thyroid Nodules & Multinodular Goiter: Solid or fluid-filled lumps (nodules) that form within the thyroid gland, or an enlarged thyroid gland with multiple nodules. Most are benign but require evaluation for cancer risk.
• Hypercalcemia & Hypocalcemia (Disorders of Calcium Metabolism): Evaluation and management of abnormally high or low levels of calcium in the blood, which can have various underlying endocrine or non-endocrine causes.
• Hypothyroidism (Underactive Thyroid - e.g., Hashimoto's Thyroiditis, Post-Ablation): A common condition where the thyroid gland doesn't produce enough thyroid hormone, leading to symptoms like fatigue, weight gain, cold intolerance, constipation, and dry skin.

Pituitary, Adrenal & Gonadal Axis Disorders

• Adrenal Nodules (Incidentalomas) & Adrenal Tumors (e.g., Pheochromocytoma, Aldosteronoma): Masses found on the adrenal glands, often discovered incidentally. Evaluation is needed to determine if they are hormonally active or potentially malignant.
• Cushing's Syndrome & Cushing's Disease (Hypercortisolism): A hormonal disorder caused by prolonged exposure of the body's tissues to high levels of cortisol, either from medication (exogenous) or due to overproduction by the body (endogenous - e.g., pituitary or adrenal tumor).
• Female Hypogonadism & Premature Ovarian Insufficiency (POI): Conditions involving low estrogen levels in women, leading to symptoms like amenorrhea, infertility, and menopausal symptoms, occurring before the typical age of menopause in POI.

This list is not exhaustive. For personalized advice regarding your specific endocrine condition, please consult with Dr. James Graham.

• Inpatient & Outpatient Management of Endocrine Emergencies & Crises: Acute diagnosis and management of potentially life-threatening hormonal imbalances such as diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar state (HHS), thyroid storm, myxedema coma, adrenal crisis, severe hypoglycemia, and acute hyper/hypocalcemia, typically initiated in an emergency or hospital setting with ongoing outpatient follow-up.
• Interpretation of Complex Hormonal Assays, Dynamic Endocrine Function Tests & Genetic Markers: Expert analysis and clinical correlation of specialized blood, urine, and saliva tests measuring various hormone levels. Includes interpretation of dynamic stimulation and suppression tests (e.g., ACTH stimulation, dexamethasone suppression, oral glucose tolerance test for acromegaly) to precisely evaluate endocrine gland function and identify genetic predispositions.
• Comprehensive Endocrine System Consultation & Hormonal Health Evaluation: In-depth clinical assessment of potential hormonal imbalances and disorders affecting the endocrine glands (e.g., thyroid, pituitary, adrenal, pancreas, parathyroid, gonads). Includes detailed medical history, family history review, targeted physical examination, analysis of symptoms, and formulation of a personalized diagnostic and management plan.
• Expert Second Opinion Consultations for Complex or Rare Endocrine Disorders: Providing specialized second opinions on challenging endocrine diagnoses, interpretation of ambiguous hormone test results, or evaluation of complex or multi-faceted treatment plans.
• Genetic Counseling Coordination & Testing for Hereditary Endocrine Neoplasia Syndromes & Familial Disorders: Risk assessment and coordination of genetic testing and counseling for individuals and families with suspected hereditary endocrine tumor syndromes (e.g., Multiple Endocrine Neoplasia - MEN1, MEN2; Von Hippel-Lindau), familial thyroid cancer, or other inherited endocrine conditions.
• Transitional Care for Young Adults with Chronic Endocrine Conditions: Facilitating the smooth transition of adolescents and young adults with lifelong endocrine disorders (e.g., Type 1 diabetes, congenital adrenal hyperplasia, hypopituitarism) from pediatric to adult endocrine care services.

Note: This list provides a general overview. Specific tests and treatments are determined after a thorough evaluation. Discuss with Dr. Graham for care relevant to your specific condition.

All medical services are provided in accordance with the standards of practice set by the College of Physicians and Surgeons of British Columbia (CPSBC) and relevant endocrinological care guidelines. Contact the clinic or your referring physician regarding new patient intake and referral processes.

Olive Fertility Centre - Victoria is situated in the vibrant James Bay neighbourhood of Victoria, BC, within walking distance of scenic parks and waterfront. The centre is conveniently accessible via the Victoria Regional Transit System (BC Transit), with multiple bus stops nearby. For those arriving by car, parking is available at or near the facility. The building is wheelchair accessible, ensuring ease of access for all patients. The centre's location offers a welcoming environment close to local amenities, making it an ideal setting for sensitive reproductive and hormonal health care.

Are consultations, hormone tests, and treatments with Dr. Graham, an Reproductive Endocrinologist (Fertility Specialist), covered by Medical Services Plan (MSP) in BC?

Medically necessary consultations with a licensed Reproductive Endocrinologist (Fertility Specialist) like Dr. Graham, most standard diagnostic hormone blood tests, dynamic endocrine function tests when indicated, and treatments for provincially insured endocrine conditions (e.g., diabetes, thyroid disorders, adrenal insufficiency, osteoporosis management as per guidelines) are generally covered by Medical Services Plan (MSP) in BC when a referral from a family doctor or another specialist is in place. Some newer or specialized medications (e.g., certain advanced diabetes drugs, some growth hormone therapies, specific osteoporosis agents), medical devices (like some insulin pumps or continuous glucose monitors and their supplies), or treatments considered primarily for lifestyle or cosmetic reasons may have different coverage criteria or require special authorization. It's crucial to discuss coverage specifics for any proposed investigation or treatment with Dr. Graham's office, the hospital/clinic, or Medical Services Plan (MSP) directly.

Is a referral required to see Dr. Graham, an Reproductive Endocrinologist (Fertility Specialist)?

Yes, for services covered by the provincial health plan, a referral from your family physician or another specialist (e.g., an internist, pediatrician, or gynecologist) is almost always required to schedule an appointment with an Reproductive Endocrinologist (Fertility Specialist) such as Dr. Graham. Endocrine system disorders often involve complex interactions and can have wide-ranging effects, so an initial assessment by your primary care provider helps determine if specialist care is needed and ensures that relevant preliminary tests and medical history are available to the endocrinologist. This facilitates a more focused and efficient consultation.

How does Dr. Graham typically approach managing diabetes (Type 1 or Type 2)?

Dr. Graham's approach to diabetes management is comprehensive and individualized. For Type 1 diabetes, the focus is on intensive insulin therapy (using multiple daily injections or an insulin pump), continuous glucose monitoring (CGM), carbohydrate counting, and education on managing blood sugar fluctuations and preventing hypoglycemia. For Type 2 diabetes, management often starts with lifestyle modifications (diet, exercise, weight loss), followed by oral medications if needed. Newer injectable medications (like GLP-1 receptor agonists or SGLT2 inhibitors) or insulin may be added as the disease progresses or if blood sugar targets aren't met. In both types, a key goal is to achieve optimal glycemic control (measured by HbA1c and glucose monitoring) while minimizing side effects and preventing long-term complications affecting the eyes, kidneys, nerves, and cardiovascular system. This often involves a multidisciplinary team approach.

What types of diagnostic tests are commonly used by an Reproductive Endocrinologist (Fertility Specialist) like Dr. Graham?

An Reproductive Endocrinologist (Fertility Specialist) like Dr. Graham utilizes a variety of tests to diagnose endocrine disorders. Blood tests are fundamental for measuring levels of specific hormones (e.g., TSH, free T4, cortisol, ACTH, testosterone, estrogen, LH, FSH, insulin, HbA1c, prolactin, PTH, calcium, vitamin D). He often orders dynamic endocrine function tests, where hormone levels are measured after administering a stimulating or suppressing agent (e.g., ACTH stimulation test for adrenal function, oral glucose tolerance test for diabetes/acromegaly, dexamethasone suppression test for Cushing's). Imaging studies like thyroid ultrasounds, CT scans, or MRIs of the pituitary or adrenal glands are common. Bone mineral density (DXA) scans assess for osteoporosis. For thyroid nodules, a fine-needle aspiration (FNA) biopsy might be performed or arranged.

Olive Fertility Centre - Victoria
210-545 Superior St
Victoria, BC V8V 0C5

Phone: (250) 410-1664 | Fax: (604) 559-9951 | Website: https://www.olivefertility.com/locations/victoria

The facility is wheelchair accessible.

Dr. Graham is a licensed Reproductive Endocrinologist (Fertility Specialist) regulated by the College of Physicians and Surgeons of British Columbia (CPSBC) under the Health Professions Act in BC. A referral is typically required for consultations with Dr. Graham for services covered by the provincial health plan. Patients seeking fertility assessment may also be referred by their family physician or gynecologist.

Verify registration with the College of Physicians and Surgeons of British Columbia (CPSBC): https://www.cpsbc.ca/public/registrant-directory/search-result/326738/Graham%2CJames