Key Takeaways
Dr. Brown explained that progesterone is naturally a large molecule, but micronization changes its structure to make it more absorbable through the skin. She noted that Winona has used the same compounded formulation safely and effectively across thousands of patients since 2021.
DHEA is used instead of testosterone because no FDA-approved testosterone product exists for women in menopause
Dr. Brown clarified that testosterone is treated as a controlled substance and is only manufactured for men. Prescribing it for women involves micro-dosing modifications of a male dose, which requires closer patient monitoring than what telehealth allows. She explained that DHEA is a gentler, low-dose alternative that can help raise testosterone levels without those regulatory and safety concerns.
Hormone pellets can cause inconsistent symptom relief because doses cannot be adjusted once inserted
Dr. Brown explained that unlike creams, patches, and pills, hormone pellets release a preset three-month dose that can't be changed or removed if side effects occur. She noted that some doctors may use high doses of testosterone in pellets, which carries a risk of masculinizing side effects if the body doesn't convert enough of it into estrogen.
Hormone lab testing isn't recommended by major medical organizations for starting or adjusting HRT
Dr. Brown explained that because hormone levels fluctuate significantly throughout the day, there's no defined lab value that reflects symptoms severity or therapeutic response in individual patients. She noted that the American College of Obstetricians and Gynecologists (ACOG) and Menopause Society both recommend against routine hormone testing, stating that patient-reported symptoms are a more reliable tool for guiding treatment decisions.
Hormone therapy is best indicated for symptom relief, not solely for preventive benefits
Dr. Brown emphasized that starting HRT purely for secondary preventative benefits like bone or muscle protection without any bothersome symptoms present can lead to side effects without tangible benefits to weigh them against. She recommended discussing the full risk-benefit treatment picture with a doctor rather than seeking HRT for prevention alone.
