Key Takeaways
Routine hormone testing isn't needed to start or guide HRT
Dr. Green explained that because hormone blood levels fluctuate throughout the day, lab values provide only a temporary snapshot of what hormones are doing at that moment. Winona instead uses patient-reported symptoms as a more reliable treatment guide, which the doctors noted spares patients unnecessary and sometimes costly lab work.
Breast cancer risk with HRT is tied specifically to progesterone, not estrogen
Research cited by Dr. Green indicates that estrogen alone has not been shown to increase breast cancer risk, including in women who no longer have a uterus and take estrogen-only therapy. Combined estrogen and progesterone treatment is associated with a small increase in risk, but individual patient risk levels vary based on treatment regimen and medical history.
Starting HRT earlier is associated with added cardiovascular and bone health benefits
Separately from the breast cancer discussion, the doctors noted that when HRT is started within an appropriate age window, it is associated with reduced cardiovascular and osteoporosis risk. The greatest benefits are observed in patients who start earlier in the menopause transition rather than years later.
Transdermal HRT (patches and creams) may carry a lower clot risk than pills
Dr. Perman and Dr. Green explained that transdermal delivery methods avoid first-pass metabolism through the liver, which is associated with a lower blood clot risk compared to oral estrogen. Both doctors emphasized that the absolute risk across standard HRT methods remains low.
DHEA supports testosterone levels at a safe, low dose without requiring blood work
The doctors explained that Winona's standard, low-dose DHEA treatment is formulated to support testosterone levels that fall within a physiologically normal female range. This helps prevent side effects associated with higher levels, such as acne or unwanted hair growth, which is why routine testosterone testing isn't required for standard DHEA use.
