Do I still need to see my regular GP?

Yes. We work alongside your GP. Functional and integrative medicine is complementary — we don't replace your primary care relationship.

My results keep coming back normal. Can you actually help?

Yes. Standard blood tests typically look for overt disease. We run broader panels — reverse T3, fasting insulin, inflammatory markers, microbiome analysis, provoked urine testing for heavy metals — that pick up patterns standard testing misses.

Will I need a lot of testing?

It depends on your case. Your first appointment includes a thorough history. Testing is ordered based on what we find — never a panel-for-the-sake-of-a-panel approach.

How long until I feel better?

Complex chronic illness takes time to unpack. Most patients notice measurable shifts within 8-12 weeks of starting their individualised plan, with deeper changes over 6-12 months.

Where is Mojo Klinik located?

Suite 11, 40 Yeo Street, Neutral Bay NSW 2089, Sydney, Australia.

What are the clinic hours?

Monday to Friday, 9:00am to 5:00pm. Bookings are by appointment only.

Is parking available?

Yes. There is 2-hour free parking on Yeo Street and surrounding streets, plus public transport options including the Neutral Bay ferry wharf a 5-minute walk away.

Do you offer telehealth?

Yes. Telehealth follow-ups are available Australia-wide. The first appointment is strongly recommended in-person at our Neutral Bay clinic.

What kinds of conditions do you treat?

Chronic, complex, multi-system, often unexplained conditions — including hormonal, digestive, metabolic, fatigue, immune and toxicity-related presentations. We do not provide acute or emergency care.

Do you treat cancer, Alzheimer's or dementia?

No. We do not advertise treatment for cancer, Alzheimer's, dementia or serious neurodegenerative conditions per TGA prohibited representations.

How do I know which condition page to start with?

Most patients begin with the Mojo New Patient Appointment (one hour) which covers the full clinical picture. From there we identify which condition-specific testing is needed.

Can I see both doctors?

Yes. Many patients see both Dr Mackey and Dr Varipatis — typically Dr Mackey for hormonal, digestive and metabolic presentations and Dr Varipatis for environmental, heavy metal and chronic infection work.

Small Intestinal Bacterial Overgrowth (SIBO) is a condition where bacteria that normally live in the large intestine overgrow in the small intestine, causing bloating, gas, abdominal pain and altered bowel habits.

How is SIBO diagnosed?

We use a lactulose or glucose breath test that measures hydrogen and methane gas over 2-3 hours. This identifies bacterial overgrowth and the dominant gas pattern (hydrogen-dominant, methane-dominant, or hydrogen sulfide).

Is IBS the same as SIBO?

No, but they overlap. IBS is a functional diagnosis of digestive symptoms without identifiable disease. SIBO is one identifiable cause of IBS-like symptoms. Many IBS patients have underlying SIBO, but not all.

How long does treatment take?

Treatment duration depends on the case. A typical SIBO protocol involves 2-4 weeks of antimicrobial therapy followed by gut repair and prevention of recurrence. Underlying motility and digestive function must also be addressed.

Yes, SIBO has a moderate recurrence rate. We focus on identifying and treating the underlying causes (motility, structural issues, MMC function, diet) to reduce recurrence risk.

Do I need to stop my medications before testing?

Some medications (particularly antibiotics and probiotics) need to be stopped before breath testing. Your practitioner will advise specific preparation instructions at booking.

Will Medicare or private health insurance cover this?

The Mojo New Patient Appointment carries a Medicare rebate. Breath testing is privately billed. Private health fund rebates depend on your policy — check with your insurer.

What is perimenopause?

Perimenopause is the transition period leading up to menopause, typically lasting 4-10 years. Hormone levels fluctuate, causing symptoms that often begin years before periods stop.

At what age does perimenopause start?

Most women begin perimenopause in their mid-40s, but it can start earlier. Symptoms before age 40 may indicate primary ovarian insufficiency and warrant investigation.

Menopausal Hormone Therapy (formerly HRT) replaces the hormones that decline during perimenopause and menopause. Modern body-identical MHT is far safer than older synthetic versions.

Current evidence shows body-identical MHT is safe for most women when started within 10 years of menopause onset. Individual risk assessment is essential — your family history, personal history and current symptoms all inform the decision.

What is DUTCH testing?

DUTCH (Dried Urine Test for Comprehensive Hormones) measures hormones and their metabolites over 24 hours, giving a fuller picture than a single blood draw. It's particularly useful for perimenopause where hormone levels fluctuate.

Do I need blood tests or urine tests?

Both. We typically run a full blood panel (thyroid, sex hormones, metabolic markers, vitamins) plus DUTCH for detailed hormone metabolite analysis. The combination gives the clearest clinical picture.

Can I take MHT if I've had breast cancer?

This requires careful specialist input. Non-hormonal options are usually preferred. Decisions are made in consultation with your oncology team.

What is heavy metal toxicity?

Accumulation of toxic metals (mercury, lead, arsenic, cadmium, aluminium) in body tissues beyond levels the body can safely excrete. Sources include dental amalgams, contaminated fish, occupational exposure, old plumbing and some traditional medicines.

How do you test for heavy metal burden?

We use provoked urine testing — a chelating agent is administered to mobilise stored metals, then urine is collected over 6 hours. This reveals what's actually stored in tissues, not just recent exposure. Blood tests only show recent exposure.

Is chelation therapy safe?

When medically supervised, chelation is safe and well-tolerated. The Heavy Metal Initial Appointment assesses kidney function, mineral status and overall suitability before any chelation is undertaken. Treatment is individualised.

Do I need to see a specific doctor?

Both Dr Mackey and Dr Varipatis offer Heavy Metal Initial Appointments. For chelation therapy specifically, both doctors prescribe — Dr Varipatis has the longer clinical history with chelation, Dr Mackey integrates it with broader hormonal and metabolic work.

Will my insurance cover this?

The Heavy Metal Initial Appointment does not carry a Medicare rebate. Private health fund coverage depends on your policy. Itemised receipts are provided for you to submit.

How long does treatment take?

A typical chelation programme runs 6-12 months depending on the metal burden identified. Repeat provoked urine testing guides treatment duration.

What's the difference between you and a naturopath?

Dr Mackey and Dr Varipatis are AHPRA-registered medical doctors. Provoked urine testing, chelation therapy and pharmaceutical prescribing are medical acts not available to naturopaths. Your treatment is medically supervised throughout.

Clinically termed 'increased intestinal permeability' — the gut lining becomes more porous than it should, allowing partially digested food particles, bacterial fragments and toxins to enter the bloodstream, driving systemic inflammation.

What causes bloating?

Common drivers: SIBO, food intolerances (FODMAP sensitivity, histamine, lactose), microbiome imbalance, low stomach acid, sluggish motility, and increased intestinal permeability.

How do you diagnose it?

We use a combination of detailed symptom analysis, breath testing (SIBO), stool microbiome analysis, intestinal permeability markers (zonulin, lactulose/mannitol test), and food intolerance panels where indicated.

Is bloating always related to food?

Not always. Bloating can also be driven by HPA axis dysfunction, hormonal fluctuations, stress, structural issues, and microbiome imbalance independent of specific foods.

How long does treatment take?

Most patients see significant improvement within 8-12 weeks. Full gut repair typically takes 6-12 months depending on the underlying cause and how long the issue has been present.

Should I do an elimination diet?

Elimination diets can help identify triggers short-term, but they're not a long-term solution. We use targeted testing where possible to identify specific drivers, then individualise dietary advice.

Sometimes, but not always. The wrong probiotic for your specific microbiome imbalance can worsen symptoms. We test first, then prescribe specific strains based on your results.

Can stress cause bloating?

Yes. Chronic stress alters gut motility, microbiome composition, digestive enzyme secretion, and intestinal permeability. We address the stress component alongside the physical drivers.

Hashimoto's thyroiditis is an autoimmune condition where the immune system attacks the thyroid gland, gradually reducing its function. It's the most common cause of hypothyroidism in Australia.

Why is my TSH 'normal' but I still have symptoms?

Standard TSH testing misses many thyroid issues. We test the full panel — TSH, free T3, free T4, reverse T3, and thyroid antibodies (TPO and TG). Patterns of suboptimal T3 conversion, elevated reverse T3, or positive antibodies explain persistent symptoms.

Do you prescribe thyroid medication?

Yes. As AHPRA-registered medical doctors, we prescribe all forms of thyroid medication including T4 (Oroxine), T3 (Cytomel/Tertroxin), and combination T4/T3 therapy. Decisions are based on the full panel and your symptoms.

What's reverse T3 and why does it matter?

Reverse T3 is an inactive form of T3 that blocks thyroid receptors. Elevated reverse T3 (from chronic stress, calorie restriction, illness, or low iron) causes hypothyroid symptoms even when TSH and free T4 look 'normal'.

How long until I feel better on thyroid treatment?

Most patients notice meaningful improvement within 4-8 weeks of starting treatment, with full stabilisation over 3-6 months. Repeat testing at 6-8 weeks guides dose adjustment.

Will my GP continue to manage my thyroid?

We work alongside your GP. Once stable, we can transition thyroid monitoring back to your GP with a clear management plan. Many GPs prefer this collaborative approach for complex thyroid cases.

How do you test hormones?

We use a combination of blood tests (for thyroid, sex hormones, metabolic markers) and DUTCH (Dried Urine Test for Comprehensive Hormones) for detailed hormone metabolite analysis. The combination reveals patterns a single blood draw misses.

Do I need to test on a specific day of my cycle?

Yes for blood tests — typically day 21 for progesterone, day 2-3 for baseline hormones. DUTCH can be done any day and is more forgiving.

Can hormones cause weight gain?

Hormonal drivers of weight gain include thyroid dysfunction, cortisol dysregulation, insulin resistance, oestrogen dominance, and perimenopausal changes. We test for these before any weight management advice.

What about testosterone in women?

Testosterone in women is essential for energy, libido, muscle mass and motivation. We test and address both deficiency and excess (PCOS-related).

Adrenal Fatigue, HPA Axis Dysfunction and Burnout

Mojo Klinik / Conditions / Fatigue & recovery / Adrenal Fatigue, HPA Axis Dysfunction and Burnout

DR MARIA MACKEY

Mojo Klinik · Neutral Bay Sydney

Adrenal fatigue, HPA axis dysfunction and burnout.

Running on empty for months. Or years.

You wake up tired no matter how long you sleep.

You crash in the afternoon and need caffeine to function.

Stress that you used to handle now flattens you.

SOUND FAMILIAR?

You will recognise yourself in some of these.

Most patients arrive carrying one or more of these.

You have been running on empty for months or years
You wake up tired no matter how long you sleep
You crash in the afternoon and need caffeine just to function
You have wired-but-tired evenings, exhausted but cannot wind down
Your mood is flatter than it should be
You crave salt, sugar, or both
Stress that you used to handle now flattens you
You suspect adrenal fatigue but want a proper investigation

There is almost always a clinical explanation. Pulling on the thread is what we do.

WHAT ” ADRENAL FATIGUE ” ACTUALLY MEANS

The term is loosely used. The clinical picture is real.

The HPA axis (hypothalamic-pituitary-adrenal axis) is the body’s stress response system. Under prolonged stress, it becomes dysregulated. Cortisol patterns shift. Energy becomes unstable. Sleep deteriorates. The body loses its ability to handle stressors that it used to absorb without trouble.

OTS or over training syndrome looks a lot like adrenal fatigue. And can often present when an individual trains hard enough to push themselves beyond their capacity to recover.

A burnout recovery Sydney approach tests the cortisol pattern directly with a 4-point urinary cortisol panel. The pattern tells us which phase you are in. The phase determines the treatment.

"The classic burnout patient has been holding it together for a long time. They come to me because what used to work has stopped working. Caffeine. Willpower. Pushing through. The clinical picture is real. So is the recovery. It just requires a structured plan and patience."

Dr Maria Mackey, MBChB FRACGP Dip Hom FAARM

A PROGRESSION MAP

The three phases of HPA dysfunction.

A progression. The plan is paced to the phase.

EARLY PHASE

Wired but tired.
Difficulty winding down.
Afternoon dips.
Disrupted sleep onset.
Subtle but real.

MID PHASE

Reactivity climbs.
Energy dips throughout the day.
Sex drive declines.
Recovery times lengthen.

LATE PHASE

Resources are bare.
Minimal reserve.
Even low load is hard.
Different symptom.

Identified through 4-point cortisol testing and clinical assessment.

OUR THREE – PHASE APPROACH

Foundation first. Targeted support second. Capacity rebuilding third.

The most common mistake is rushing the rebuilding part.

Phase 1

Investigate

Weeks 1 to 3

4-point urinary cortisol. DHEA. Thyroid panel (burnout commonly drags down thyroid function). Sex hormones where relevant. Iron, B12, vitamin D, HbA1c.

Phase 2

Foundation

Months 1 to 3

Sleep, nutrition, removing the biggest stressors where life will let you. Resisting the well-meaning instinct to push through with exercise or stimulants the depleted HPA axis cannot use.

Phase 3

Rebuild

Months 3 to 12

Targeted nutrient and adaptogen support matched to your specific cortisol pattern. Gradual reintroduction of activity. Capacity rebuilt at a pace your biology can hold onto. Most patients see meaningful improvement at 2 to 3 months and substantial recovery at 6 to 12 months.

THE THREE PHASES OF HPA DYSFUNCTION

Treatment differs phase by phase.

The wrong intervention at the wrong phase can make things worse. We test which phase you are in before we treat.

Early HPA dysfunction

Mid-phase

Late-phase / burnout

Testing matched to your specific picture. The cost of any privately billed test is explained before you agree to it. 4-point urinary cortisol: the cortisol curve across the day. DHEA / DHEA-S: adrenal reserve marker. Comprehensive thyroid panel (burnout commonly affects thyroid conversion). Sex hormones where relevant (burnout disrupts the whole hormonal system). Nutritional status: burnout depletes specific nutrients. Iron studies, B12, vitamin D.

IS MOJO KLINIK RIGHT FOR YOU?

Is this approach right for you?

IT'S A FIT IF

You have classic burnout symptoms: persistent exhaustion, flat mood, eroded stress tolerance
You have wired-but-tired evenings or 3am waking
You suspect HPA axis dysfunction and want it directly tested
You want care paced to your stage of recovery, not generic stimulants
You are willing to address the underlying drivers (sleep, stressors, nutrition)

NOT A FIT IF

HOW TO START

Two ways to start with us.

You have two booking options with Dr Maria Mackey. The right one depends on whether you want a focused HPA consultation or a deeper big-picture investigation.

OPTION 1

Mojo New Patient Appointment with Dr Maria Mackey

Medicare rebate available for in-person initial consultations

A comprehensive deep dive across the HPA axis, hormones, gut, thyroid, and nutritional contributors to your burnout. Best when burnout is layered with multiple system involvement.

OPTION 2

Hormone Assessment with Dr Maria Mackey

Medicare rebate available for in-person initial consultations

The fast-track if your concerns are primarily HPA / hormonal. Targeted testing and a personalised plan.

For full pricing, see Consultation Fees. Telehealth available Australia-wide for followups. Medicare rebates apply for in-person initial consultations (except Heavy Metal Initial Appointment). For your first appointment, in-person at our Neutral Bay clinic is strongly recommended.

FAQ

Frequently Asked Questions.

How much does an adrenal fatigue or burnout consultation cost at Mojo Klinik?

The Hormone Assessment with Dr Maria Mackey is the focused entry point:
45 minutes, $390 in-person or $410 by Zoom, with a Medicare rebate
available for in-person initial consultations. The deeper option is the Mojo
New Patient Appointment: 1 hour, $490 in-person or $510 by Zoom. Urinary
hormone testing is billed separately by the lab.

"For straightforward burnout presentations the 45-minute Hormone Assessment is enough time. When burnout is layered with thyroid, hormonal,gut, orfatigue components, the Mojo New Patient Appointment is the right entry point. The work is multi-system."

Dr Maria Mackey, MBChB FRACGP Dip Hom FAARM

Approximately 67% of Australian workers report experiencing burnout symptoms, with around a
quarter classified as severe. Workplace Mental Health Australia, 2024 survey.

Is "adrenal fatigue" a real diagnosis?

The term itself is contested in conventional medicine. The clinical picture,
HPA axis dysfunction under prolonged stress, is well-established. We test it
(4-point urinary cortisol), identify which phase you are in, and treat it on the
biology, not the label.

""Adrenal fatigue" is not a diagnosis. The adrenals do not get tired. HPA axis dysfunction under sustained stress is what is actually happening, and it is well-described in the medical literature. We test it directly and treat what we find."

Dr Maria Mackey, MBChB FRACGP Dip Hom FAARM

A 2024 review in Frontiers in Endocrinology documented measurable HPA axis dysregulation in
approximately 70% of patients with chronic burnout based on diurnal cortisol profiling.

How long does recovery take?

It depends on the phase you are in and how long you have been there. Most
patients see meaningful improvement in 2 to 3 months and substantial
recovery in 6 to 12 months. Late-phase burnout can take longer. We do not
promise quick fixes; we promise structured, paced recovery.

"Burnout recovery follows the time it took to get there. A patient who has been pushing for five to ten years will not be fully recovered in three months. The first three months are meaningful improvement. The first year is substantial recovery."

Dr Maria Mackey, MBChB FRACGP Dip Hom FAARM

A 2023 longitudinal study in Occupational Medicine found structured burnout recovery
programmes produced significant symptom reduction at 3 months that was sustained at 12
months in approximately 65% of participants.

Should I exercise?

Not in the early phase, beyond gentle walking. Pushing exercise on a
depleted HPA axis frequently backfires. Activity is reintroduced carefully, in
line with your testing, once your cortisol pattern has stabilised. The right
exercise at the wrong time is one of the more common reasons recovery
stalls. Relapse is real and painful.

"The instinct to exercise our way out of burnout makes intuitive sense and rarely works. Late-phase HPA dysfunction does not respond to exertion the way a healthy stress system does. Gentle activity early. Structured reintroduction once cortisol rhythm has stabilised. That is what recovers people."

Dr Maria Mackey, MBChB FRACGP Dip Hom FAARM

What about adaptogens like ashwagandha and rhodiola?

These can be useful, but the right adaptogen depends on which phase you
are in. The wrong adaptogen at the wrong phase can make things worse. We
choose specifically based on testing, not generically

"Adaptogens are not interchangeable. Rhodiola is stimulating, useful in early-phase HPA dysfunction. Ashwagandha is calming, often better suited to mid-to-late phase. Use the stimulating one in late phase, or the calming one in early phase, and patients feel worse. We match the choice to the testing."

Dr Maria Mackey, MBChB FRACGP Dip Hom FAARM

Can stress really cause this much trouble?

Yes. Sustained stress reshapes the HPA axis, depletes specific nutrients, disrupts sleep architecture, alters gut function, and impairs thyroid conversion. The biology of burnout is real and measurable.

"Patients sometimes feel their burnout cannot be just stress because the symptoms feel so physical. Prolonged stress is physical. It changes cortisol rhythm. It depletes magnesium and B vitamins. It alters thyroid hormone conversion. It reshapes gut function. The physical symptoms are the biological consequence."

Dr Maria Mackey, MBChB FRACGP Dip Hom FAARM

A 2024 study in the Journal of Infection found 51% of Long COVID patients meet diagnostic
criteria for ME/CFS at 6 months, confirming significant overlap between the two presentations.

What testing will I need?

A typical assessment includes 4-point urinary cortisol (the cortisol curve
across the day), DHEA / DHEA-S (adrenal reserve marker), comprehensive
thyroid panel (burnout commonly drags down thyroid function), iron
studies, B12, vitamin D, HbA1c, and where relevant, sex hormones. The
specific panel depends on your symptom pattern.

AN INVITATION

Ready to be properly investigated?

One hour. Your full history. The right tests. A real plan. Book your
first appointment online, or call reception on 02 9133 8500.

WHERE
Suite 11, 40 Yeo Street
Neutral Bay NSW 2089

HOURS
Mon – Fri 8:30am – 5:00pm
Selected Saturdays by arrangement