So, you’re considering Hormone Replacement Therapy (HRT). Maybe you’ve read about the benefits, or you’ve started experiencing symptoms like fatigue, brain fog, insomnia, weight gain, anxiety, irritability, or low libido and want to take control of your health. Maybe you are considering it because you have heard the anti-aging potential and you want to feel and look your best as you get older. You have decided that you won’t accept the status quo of just feeling terrible and aging. Whatever led you here, you’re in the right place.
I’m a longevity, hormone and peptide specialist, and I’ve helped thousands of women navigate biohacking, anti-aging, peptide optimization and using hormone replacement therapy to maximize their health, wellness and definitely stop their symptoms. Hormone replacement therapy is the foundation to healthy aging — to keeping the body as fit as possible to prevent disease.
Hormone replacement therapy with bioidenticals is not just a treatment for menopausal symptoms anymore. Yes, it works great as a treatment, but hormones are more than a treatment. They truly are the fountain of youth and the key to aging well. We can use hormones to increase our Healthspan — which is the number of years that we are healthy.
In other words, hormone replacement therapy just doesn’t increase our lifespan, but HRT increases healthspan as well.
You DO NOT need to wait until you are menopausal to get started. You DO NOT need to wait for your period to stop.
Menopause is literally just one day — when your period finally stops. It doesn’t mean that you make hormones up to that point! Most women’s hormones decline at age 30 and more and more women younger and younger are faced with issues from low hormones. There are many factors for this including environmental toxins (pesticides), plastics, fragrances (phthalates), chemicals (BPA) and even birth control. Whether you’re in your 20s, 30s, 40s, 50s, or beyond, this guide will walk you through everything you need to know about getting started with HRT so you can make informed decisions about your health and aging journey.
Getting Started with Bioidentical HRT
Age Considerations: When Should You Start?
Many women assume bioidentical HRT is only for menopause or postmenopause, but symptoms can happen at any age! It is very common for women to start to see a decline in the 30s as progesterone and estrogen levels sharply fall. They experience symptoms like high cortisol, declining GUT health, anxiety, insomnia, acne, hair loss, wrinkles, dry skin and weight gain. These symptoms aren’t typically recognized as menopausal symptoms, so women don’t think of their hormones and instead they chase their diet and exercise to try and fix these symptoms.
Women continue to “run in place” trying to fix these issues and they notice that no matter how much they work out at the gym, or restrict their diet, do cold plunges, meditate, or use hair and face serums, everything continues to decline. They are spinning their wheels because they are told that their hormones are normal. And lab testing often is misleading in these early stages. Traditionally trained doctors tell women that they are too young to be experiencing menopausal symptoms, so we brush it off as if the woman isn’t doing enough. This goes on for years.
The problem with this approach is that the body declines and ages significantly from the time these early symptoms start to the time she finally gets on hormone replacement therapy. Estradiol, progesterone, and testosterone are extremely protective — protecting bones, the heart, skin & hair, digestion, metabolism, muscles and joints, and the brain. Early intervention can help not only alleviate symptoms, but also protect against aging quickly and the diseases of aging like heart disease, dementia and diabetes.
What Are Your Options for Bioidentical HRT?
Not all HRT is created equal! There are multiple ways to get started, and choosing the right approach depends on what you want to get from your regimen:
- Traditional Clinic Providers – Traditional OB-GYNs, endocrinologists, primary care physicians are NOT trained in longevity medicine, hormone replacement therapy or peptides. Their approach is generally to wait until the period fully stops for one year. They also will only prescribe birth control up until that point as well.
- Online Companies – Telehealth platforms (like Inner Balance</a >) offer consultations and prescriptions from the comfort of home.
- Longevity Clinics – Anti-aging and hormone replacement therapy clinics have specialists that have training outside of medical school. However, they are expensive ($5,000-$10,000 per year) and require very expensive and unnecessary lab testing.
- Over-the-Counter Options – Very, very low dose hormone options are available online (without a prescription). They are yam creams, estriol, or progesterone. They are ineffective for symptom relief because of insufficient dosing, poor bioavailability, and lack of regulation.
How to Start Bioidentical HRT: The Process Explained
Every physician will be different. Typically, if labs are done by a physician and they tell you the labs are normal but you are still experiencing symptoms, then you need to get a second opinion. Low hormones is a clinical diagnosis, not a laboratory one. Labs are variable, misleading and often the right ones are not even ordered!
If you have already seen multiple doctors and been told your hormone levels are normal, but you know that something is off and want to just try HRT to see if it works for you — then here is what you can expect from an online process like Inner Balance:
1. Online health quiz to see if it’s a good fit</b >
Your first step is completing a required health quiz to see if it’s a good fit for you. Experts use this assessment to ensure you are a candidate.
2. Lab Testing
Most providers who are specialists know how misleading hormone testing really is. Even expensive urine metabolite testing is not a true reflection of what is going on. You do not need lab testing to try HRT and see if you feel better. You will know within a few weeks if it is working or not.
3. Personalized experience
There is no way to predict what dose will be perfect for any woman! You just have to get started on something — typically a starting dose — and see how your body adjusts and heals. With Inner Balance, we wait to raise the dose until month 4. This gives you 3 months to adjust and see if the starting dose works for you. Our experts help guide you — if you need less, we will recommend it. Sometimes supplements are needed if you get side effects like bleeding, breast tenderness and bloating.
4. Obtaining Your Prescription
We ship your prescription to you from a 503B FDA regulated national compounding pharmacy</a >. It is important that you trust the pharmacy your online company works with, so that potency, quality and safety can be ensured.
Bioidentical HRT Methods: How Is It Administered?
Pills – Taken orally, often daily. Pills are metabolized by the liver, so they have very poor bioavailability — only 20-30%. That means that a 200 mg oral progesterone is effectively just 20 mg of progesterone, and the rest forms metabolites that can cause side effects like daytime drowsiness.
Patches – Applied to the skin and replaced weekly. The downside to patches is the residue left on the skin, they’re not customizable, and the dose is very low. A younger woman will likely not get all of her symptoms covered with a patch.
Creams & Gels – DO NOT Absorb through the skin!</a >. Progesterone topical cream doesn’t protect the uterus</a >. This form also has a very poor bioavailability (20-30%). And what happens to the rest that doesn’t absorb? It gets all over the house — kids, pets, and spouses! Topical creams are a huge contamination risk!
Pellets – Have to be inserted every 3 months and no way to adjust dosing once they are placed. Many women have a bad experience with pellets given that the testosterone gets way too high!
Vaginal cream</b >
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High bioavailability, systemic results, and customizable dosing! Vaginas are a true superpower for women. This is one of the best ways to take HRT!</b ></i >
Dosage Considerations: Finding the Right Balance
There is no way to predict what dose is right for you. Every physician has a starting dose</a >. Then expect adjustments as your body responds to treatment. You may need less or more depending on your age, rate of metabolism, and state of health. You can continue to fine-tune your dosing with your provider. You do not need labs to adjust dosing — in fact, doing so can cause confusion! Keeping your levels within a reference range that is considered “normal” isn’t personalized medicine. The only truly personalized approach is making sure that all your symptoms improve and you feel better day to day.
When You Start Therapy
The First Few Weeks
It’s normal to experience some initial changes as your body adapts. Common experiences include:
- Improved sleep and energy
- Mood stabilization
- Resolution of vaginal dryness
- Periods getting lighter and shorter
How Long Does It Take for Bioidentical HRT to Work?
Some women notice improvements within a few weeks, while others may take a few months to feel the full benefits. Patience and consistency is key.
When to Start Bioidentical HRT in Your Cycle
If you still have menstrual cycles, you can start at any point as long as you are not on your period when you start a vaginal cream. Here are some of our most frequently asked questions. Our experts can help guide you with our formulation. If you are working with another provider, then you need to make sure they guide you as well.
Hormonal balance and optimization is possible, and you don’t have to navigate this journey alone. Inner Balance is here to support you every step of the way.
