How to prepare for HRT
We all know by now how vital hormone replacement therapy is for long-term positive health outcomes for women entering menopause. But there isn't enough conversation about the importance of our health as we enter menopause. Emerging research underscores a profound link between the overall state of female health—across metabolic, psychological, sexual, and urogenital domains—and the severity of menopause symptoms as well as the response to hormone replacement therapy (HRT).
Optimizing all body systems before initiating hormone replacement therapy (HRT) is a pillar of the functional and personalized medicine framework. This approach stems from the understanding that hormones act as messengers within an intricately connected web of physiological systems, and the successful, safe, and sustained effects of HRT require that these systems are functioning harmoniously.
Why Optimize All Systems First?
Hormone therapies amplify underlying dysfunction. If systems like digestion, detoxification, or immune defense are compromised, introducing hormones can exacerbate inflammation, metabolic stress, or create unpredictable symptom patterns.
Hormone metabolism and signaling depend on the health of multiple systems. For example, poor gut function can impair estrogen metabolism and lead to excess estrogenic symptoms. At the same time, chronic inflammation or toxin overload can hinder hormone receptor sensitivity, blunting the benefits of HRT.
There is a higher risk of side effects if systems are not prepared. Imbalances in insulin, adrenal, or thyroid function, unchecked inflammation, or micronutrient deficiencies significantly increase the risk of adverse reactions or diminished therapeutic outcomes.
What to Prioritize for HRT Success:
Digestion and microbiome health affect hormone metabolism and elimination. Dysbiosis (leaky gut) may alter estrogen recycling and absorption of key nutrients needed for hormone action. The Liver metabolizes and detoxifies hormones. Impaired detox leads to hormone accumulation. Chronic inflammation and infection, or autoimmune activity, can alter hormone signaling and increase the risk of HRT side effects. HRT's benefits are maximized with robust mitochondrial function and balanced insulin, cortisol, and thyroid hormone levels. Dysfunction here can inhibit hormone action. It is essential to evaluate for insulin resistance, thyroid/adrenal issues , and optimize metabolic flexibility with movement, intermittent fasting, and low glycemic foods.
All hormones work synergistically. Thyroid, adrenal (cortisol/DHEA), and insulin resistance amplify or blunt HRT effects. This is where comprehensive hormone testing (thyroid, cortisol, insulin, sex steroids), balancing stress, aligning circadian rhythm, and monitoring your blood sugar are essential.
How we help get you ready for HRT:
Comprehensive Assessment: we run functional labs to screen gut, detox, thyroid/adrenal, oxidative stress, and inflammation (zonulin, LPS, CRP, hs-CRP).
Gut Restoration Protocol: when indicated, we use the 5R method (Remove, Replace, Reinoculate, Repair, Rebalance) to heal digestion and microbiome issues.
Liver Detox Optimized: we focus on supporting both phases of detox with adequate nutrition, phytonutrients, hydration, and regular bowel movements.
Identify/Resolve Inflammation: We treat any underlying stealth infections, food sensitivities, or autoimmunity before starting HRT.
Stabilize Blood Sugar and Insulin: We check for and address insulin resistance through diet, movement, and stress management, as insulin disrupts sex hormone balance.
Address Stress/Adrenal Dysfunction: We gently encourage you to implement restorative practices (yoga, nature, mindfulness) and implement the right adaptogens if indicated.
Correct Micronutrient Deficiency: We test for nutrient deficiencies to ensure optimal magnesium, zinc, selenium, B vitamins (especially B6, B12, folate), and vitamin D.
Holistic Lifestyle: We always encourage consistent sleep, movement, balanced nutrition, toxin avoidance, and meaningful relationships as foundations.
If all of the above sound overwhelming, start here: Gut and Liver are foundational, since all steroid hormones are processed and excreted through these systems. Imbalances in these systems will lead to an impaired hormone balance.
By following these steps, you will create a healthy foundation where hormone therapy is not only safer but delivers transformative results for quality of life, longevity, and resilience.
Interested in learning more?
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Be well,
Dr. Talina Hermann