Hormone Therapy
Most of what goes wrong after 35 starts with hormones. Most doctors don't look until it's already gone wrong.
Bioidentical Hormone Therapy for Men and Women
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Hormones don't fail overnight. They drift.
Progesterone starts to slip in your late 30s, sometimes earlier if you're under chronic stress. Testosterone declines about one percent a year in men after 30. Cortisol, the stress hormone, gets pushed out of its natural rhythm by modern life and stays there. Thyroid function follows.
None of that shows up as a disease. It shows up as sleep that isn't restorative. Weight that won't move. Energy that used to be there. Brain fog. Anxiety that seems to come from nowhere. Libido that quietly disappears. And a doctor who runs a basic panel and tells you everything looks normal.
I take a different approach. I test how your hormones actually behave across a full day, not at one moment. I look at what your body does with them, not just how much is present. And when replacement makes sense, I use hormones that are molecularly identical to your own.
The cascade nobody explains
Each system gets treated alone. The cascade does not.
Chronic stress raises cortisol. Sustained cortisol suppresses the thyroid signal and slows the conversion of thyroid hormone into its active form. It impairs the liver's ability to clear estrogen, and excess estrogen raises the protein that binds thyroid hormone, locking up what little active hormone you have. It disrupts progesterone production. It drives insulin resistance. So a person who started with a stressful job and poor sleep ends up, five years later, with low thyroid function, no progesterone, rising blood sugar, and a body that stores fat no matter what they eat.
Each of those gets treated as its own problem. A thyroid pill. A diabetes drug. An antidepressant for the mood. Nobody addresses the cascade. Nobody asks what happened upstream.
That's the work. Find where the cascade started and interrupt it there. For a lot of women in their 40s, that means replacing progesterone so they sleep again, which lowers cortisol, which lets the thyroid recover, which improves metabolism. One intervention, four systems. That's what it looks like when you treat the person instead of the lab value.
Why a blood test is not enough
The pattern is where the problem usually lives.
A blood test measures your hormone level at one moment. But hormones move. Cortisol should peak in the morning and fall by evening. Estrogen and progesterone shift across a woman's cycle. A single draw at 9am tells you almost nothing about the pattern.
Stacy Sims, the exercise physiologist who has become one of the most-listened-to voices on women's health, put it this way on the Huberman Lab podcast: all of our hormones flux through the day, and you have to look at where the cortisol peak is, how estrogen moves, how progesterone moves, and how all of it interacts.
That's why I use dried urine testing that maps your cortisol curve across a full day and shows how your body is metabolizing its sex hormones. It tells me things a blood draw structurally cannot: whether you're clearing estrogen down a protective pathway or a risky one, whether your cortisol rhythm is intact, whether your body is producing hormones but failing to activate them.
Bioidentical vs. synthetic
The two are not interchangeable.
Bioidentical hormones have the same molecular structure as the ones your body makes. Synthetic versions are chemically altered so they can be patented, and they bind to your receptors differently.
That difference shows up in outcomes. In one of the largest studies ever done on hormone therapy, a French cohort of more than 50,000 women, synthetic progestins were associated with increased breast cancer risk, while bioidentical micronized progesterone was not. It matters which one you're given.
There's a smaller practical issue that catches a surprising number of women. The FDA-approved oral progesterone is suspended in peanut oil. If you have a peanut allergy or sensitivity, you react to the carrier and assume the hormone doesn't agree with you. Compounded progesterone in a different base often resolves that entirely.
For men
More than one way to address low testosterone.
Testosterone declines with age, and low testosterone affects energy, muscle, mood, sleep, and libido. But there's more than one way to address it, and the right way depends on where you are in life.
Direct testosterone replacement works. It also tells your body to stop making its own, which affects fertility and requires ongoing monitoring. For men who want to raise their own production instead, I often use a medication that signals the body to make more testosterone rather than replacing it from outside. It preserves fertility and most men tolerate it well.
Either way, I test first. Total and free testosterone, the binding protein that determines how much is actually available, estradiol, and the pituitary signals. Then we decide together.
Neuroendocrine disruptors
Your hormones don't operate in a vacuum.
They're exposed, every day, to chemicals that interfere with them. BPA in plastics and receipts. Phthalates in fragrances and soft plastics. Parabens in personal care products. Pesticide residues. PFAS in water and nonstick coatings. These are called endocrine-disrupting chemicals, and the research linking them to hormone disruption, fertility issues, thyroid dysfunction, and metabolic problems is extensive and growing.
Part of hormone therapy is figuring out what's disrupting yours. That can mean environmental toxin testing, and it always means a conversation about what's in your house, your water, and your bathroom cabinet.
For women in midlife
For Women in Midlife
Perimenopause can begin in your late thirties and last ten years. Sleep fragments. Weight redistributes to the middle and stops responding to what used to work. Anxiety arrives without a reason attached. Cognition feels different in a way that is difficult to describe to anyone and easy to dismiss. Most women are told this is normal and sent home, and it is normal, and that is not the same as untreatable.
What changed
For twenty years, hormone therapy carried a boxed warning that frightened a generation of women and their doctors away from it. That warning came from a 2002 study whose findings have been substantially reinterpreted since, particularly for women who begin therapy within ten years of menopause.
In November 2025 the FDA announced the removal of those boxed warnings from menopausal hormone therapy products. In February 2026 the first label changes were approved.
Prescribing has roughly doubled since 2018. Among women aged 45 to 54 it has risen 184 percent. That is not a trend. That is twenty years of unnecessary suffering correcting itself.
Hormone therapy is not right for everyone, and I will tell you if it is not right for you. But the reflexive no that many women received for two decades was not good medicine, and it is no longer the standard.
Where to start
Perimenopause and menopause
Vasomotor symptoms, sleep disruption, mood and anxiety changes, cognitive complaints, genitourinary symptoms, bone health, and cardiovascular risk in the transition. Evaluation includes symptom mapping, relevant labs, and a review of what you have already tried and why it did or did not work.
Metabolic health
Insulin resistance, lipids, visceral fat, blood pressure, and the metabolic shift that accompanies the hormonal one. Midlife weight change is not a willpower problem and is not treated as one here.
After a GLP-1
More than half of people who start a GLP-1 stop within a year, and many regain. If you have come off one, or you are considering coming off, that transition deserves an actual plan: protein and resistance training to protect lean mass, metabolic labs, and an honest conversation about what maintenance looks like. This is one of the least well served situations in medicine right now.
What's included
What the care looks like.
- Initial consultation by video, 60 minutes
- Comprehensive hormone panel with full-day cortisol mapping and metabolite pathways
- Thyroid panel including the markers most doctors skip
- Metabolic markers that show how hormones are affecting your blood sugar and insulin
- A written plan specific to your results
- Bioidentical hormone prescriptions where appropriate, through compounding pharmacies I trust
- Ongoing physician access by secure message and quarterly reviews
FAQ
Questions I get asked most.
How do I know if my hormones are off?
Common signs: sleep that doesn't restore you, weight that won't shift, fatigue, brain fog, anxiety or low mood, lost libido, irregular cycles, hot flashes, night sweats, joint pain, thinning hair. If you're over 35 and three or more of those sound familiar, it's worth looking.
Is bioidentical hormone therapy safe?
For most people, yes, when it's done with proper testing and monitoring. The concerns you've heard about hormone therapy came largely from a 2002 study using synthetic hormones in women who started them a decade or more after menopause. Bioidentical hormones started at the right time, at the right dose, with the right monitoring, have a much better safety profile. I'll go through your specific risk factors with you.
Why not just get a blood test from my regular doctor?
You can, and it's a fine starting point. But a single blood draw measures one moment. Hormones move across the day and across the month. I use testing that shows the pattern and shows how your body is processing what it makes. That's where the useful information usually is.
Do you treat men?
Yes. Low testosterone, thyroid dysfunction, cortisol disruption, and metabolic issues affect men just as much. And men have options beyond testosterone replacement that most clinics don't offer.
How do I get started?
Book a free consultation. We'll talk about what you're experiencing, what's been tried, and whether this is the right fit. If it is, I'll tell you exactly what testing I'd recommend and why. No pressure, no commitment from the call.
Where are you licensed?
Hawaii, Washington, Colorado, Texas, Florida, Illinois, Nebraska, Missouri, Louisiana, Nevada, Wisconsin, and Montana, with more being added.
Start with a conversation.
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