Women’s care

For most women the shift begins in the early to mid-forties, sometimes earlier, and runs for several years before periods stop for good. Estrogen and progesterone do not decline in a neat line. They swing, and the swings are what you feel first.

• Waking at three in the morning for no reason
• Night sweats
• Cycles that were regular for twenty-five years turning heavy or unpredictable
• A low mood or a new anxiety that does not match anything happening in your life

The list grows from there. Hot flashes reach about eight in ten women, and the median woman has them for more than seven years. Weight moves to the middle when nothing about eating or exercise has changed. Joints ache, and words go missing halfway through a sentence. Desire fades, and sex can become uncomfortable in a way it never was before. Any one of these on its own is easy to live with. Together, they can take the colour out of a decade.

What makes this hard is that each symptom looks like something else. Poor sleep looks like stress. Low mood looks like depression. Weight gain looks like a discipline problem. So women are given sleeping pills, antidepressants and diet advice, and the cause goes untouched. The risk of a depressive episode roughly doubles during the transition, yet in a twelve-month trial, women given transdermal estradiol and progesterone were about half as likely to develop depressive symptoms as women on placebo. Treating the hormones is not a detour around the mood problem. Often it is the direct route.

The most common story we hear is a woman who felt wrong, asked for bloodwork, and was told everything was fine. Often it was, in the narrow sense. In perimenopause, hormone levels can be high one week and low the next, so a single reading proves very little. The diagnosis is made from the pattern of symptoms and the pattern of cycles, not from a number on one day. A normal panel does not mean nothing is wrong. It means the test was not the right tool for the question.

Only about one in four women with menopausal symptoms receives any treatment at all. Much of the reason traces back to 2002, when a large trial called the Women’s Health Initiative reported that hormone therapy raised the risk of breast cancer, stroke and heart disease. Hormone therapy use fell from roughly a quarter of postmenopausal women to about five percent, and a generation of doctors was trained to avoid it.

The picture has changed considerably since. The women in that trial were 63 on average, more than a decade past menopause, and were given oral conjugated estrogens with a synthetic progestin. Later analysis showed that for healthy women who start within ten years of their last period, the benefits outweigh the risks for most, and that transdermal estradiol paired with micronized progesterone carries a different safety profile from the regimen studied in 2002. In November 2025 the FDA removed the black box warnings on cardiovascular disease, breast cancer and dementia from these medications. The medicine caught up. Much of the profession has not yet.

We treat women, mostly between 35 and 60, whose energy, sleep, mood, weight or sex drive have changed, and who want the cause addressed rather than the symptoms managed. That includes women in perimenopause, women past menopause, and women whose symptoms have been put down to something else for years.

We do not treat everyone. Any of the following rules out systemic hormone therapy, and we will say so on the first call.

• A history of hormone-sensitive breast cancer
• A prior clot or stroke
• Active liver disease
• Bleeding that has not yet been diagnosed

I am board-certified in psychiatry and obesity medicine, with fellowship training in anti-aging and functional medicine. My practice began with patients coming to me for depression, anxiety and exhaustion. Past forty, a striking number of them got better when we treated their hormones directly. That experience is why mood, sleep and weight are treated here as primary symptoms rather than side notes, and why the first question is always what is driving them.

This is a physician-led clinic that specializes in fixing your hormones. Medications are passed on at cost and we do not make money on them, so there is no incentive to prescribe more than you need. You see the same physician every visit, you can message your physician directly between visits, and you are seen within days, from home.

We use bio-identical hormones only, meaning estradiol, micronized progesterone and testosterone in the same molecular form your body makes. We do not use pellets. A pellet cannot be adjusted once it is under the skin, and women on them have been found with estradiol levels two and a half times higher than on approved therapies, with abnormal bleeding in more than half. We prefer forms that can be turned up or down.

We also prescribe testosterone for women, which most clinics do not. At about a tenth of a male dose, it is the best-supported treatment for low desire after menopause, and in our patients it often helps energy and mood as well.

Everything begins with a full panel. Estradiol, progesterone, testosterone, thyroid, iron, blood count, blood sugar, lipids, vitamin D and the rest. We want the whole picture, because thyroid and iron problems commonly sit alongside hormonal ones and are easy to miss when only one thing is tested.

For most women the protocol has three parts, adjusted to your symptoms and your labs. Transdermal estradiol, as a twice-weekly patch or a daily gel, carries most of the benefit and, unlike oral estrogen, has not shown an increase in clot risk. Micronized progesterone at night protects the uterus and tends to improve sleep on its own. Where dryness or urinary symptoms persist, a low-dose vaginal estrogen adds local relief without raising blood levels. Around four in ten of our patients also use a low-dose testosterone cream for desire that has not returned with estrogen alone.

• Week 0. A free fifteen-minute call, then the baseline panel.
• Week 2. Your results are reviewed with you and a protocol is agreed.
• Weeks 6 to 8. Labs rechecked and doses adjusted. This is where most of the real work happens, since almost nobody’s first protocol is their final one.
• Month 3. Most women are at a steady state, with reviews twice a year from there.

Hot flashes and night sweats usually drop by around three quarters within two to four weeks. Everything else moves on its own clock.

Strength training two or three times a week does more for bone, muscle and belly fat in this decade than any other habit.

Early side effects are usually minor and settle. Breast tenderness and some spotting in the first weeks are common and typically resolve with a dose adjustment. Testosterone at the doses we use can cause mild acne or extra hair growth in a small minority, which is why levels are kept in the premenopausal range and rechecked.

Monitoring is deliberately simple. Labs at six to eight weeks, a check-in at six months, and once a year a mammogram, a blood pressure check and bloodwork. Any bleeding after menopause is evaluated, without exception. There is no age at which therapy must stop. It continues as long as it is helping and the balance stays in your favour, which for most women is years.

The cost is simple too. The first call is free. Starting covers the baseline panel, your consultation, your protocol and your first month. After that, membership includes all labs, all consultations and direct messaging, with medications at cost.

• Estrogen and progesteronePerimenopause and menopause, what hormone therapy changes, and how we prescribe it.
• Low testosteroneWhat low testosterone feels like, how it is diagnosed, and the protocol we use for men and women.
• How it worksWhat happens, in order, and what each part costs.