What I prescribe — and why
Modern menopausal hormone therapy, delivered to your door.
Every protocol starts as bioidentical estradiol plus progesterone. From there, we tailor — based on your symptoms, your history, and what actually fits your life.
The foundation
Estradiol (bioidentical estrogen)
The foundation of modern menopause care. I strongly prefer transdermal estradiol — the patch, a gel, or a cream — over oral pills. Transdermal delivery bypasses the liver, which cuts clotting risk dramatically and is the formulation the major menopause societies now recommend first-line.
For women who can’t tolerate adhesive or prefer something else, we’ll work through options together.
The partner
Micronized progesterone
If you have a uterus and take estrogen, you also need progesterone — this is non-negotiable. I use oral micronized progesterone (Prometrium and its generics), which doubles as a sleep aid for most women because of how it metabolizes.
Most patients take it at bedtime and notice the sleep effect within a week.
Where indicated
Low-dose testosterone
Women make testosterone too — and it crashes in perimenopause. For the right patient, low-dose topical testosterone can restore libido, improve energy, and help maintain muscle mass. The evidence is strongest for hypoactive sexual desire.
Available where state law allows; we’ll walk through it in your intake.
Under-prescribed
Vaginal estrogen
A separate prescription from your systemic estrogen — and one of the most under-prescribed medications in modern medicine. For vaginal dryness, painful sex, and recurrent UTIs, topical vaginal estrogen is extraordinarily effective and extraordinarily safe.
It can be used long-term even in women who don’t want systemic HRT.
The honesty section
What I don’t prescribe
I don’t prescribe untested “bioidentical pellet” therapy from compounding pharmacies — the dosing is inconsistent and you can’t take it out if something goes wrong.
I don’t prescribe GLP-1s for weight loss at this clinic (plenty of good places do; it’s just not my lane).
And I don’t prescribe anything I wouldn’t take myself or give to my own mother.