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Let’s start with the reality most women run into at some point in their 40s:
You’re exhausted.
Your sleep is a mess.
Your mood feels… unpredictable at best.
And your body is doing things that make you question if it’s still on your team.
So you start hearing about hormone replacement therapy (HRT).
Then immediately get hit with:

• “Synthetic hormones are dangerous!”
• “Only bioidentical is safe!”
• “Hormones cause cancer!”
• “Hormones will fix everything!”

Cool. Super helpful. Very clear. 🙃
Let’s simplify this—because the truth is a lot less dramatic and a lot more nuanced. Also, before we dive in, let me be very clear that Coach Kayli and I are both taking HRT, but that doesn't mean you have to. We want you to have good information to make informed decisions about your body so you can make the best decisions for you.

First: What Is Hormone Replacement Therapy?Hormone replacement therapy (HRT) is used to restore declining hormone levels, primarily:

• Estrogen
• Progesterone
• Sometimes testosterone

It’s most commonly used during perimenopause and menopause to help manage symptoms and protect long-term health.
According to the North American Menopause Society, HRT is the most effective treatment for menopausal symptoms and can also provide protective health benefits when used appropriately.

Synthetic vs. Bioidentical Hormones: What’s the Difference?This is where things get confusing—and where the internet tends to spiral.
Synthetic HormonesSynthetic hormones are chemically altered and not identical to the hormones your body naturally produces.
Examples include:

• Certain forms of progestins
• Older oral estrogen formulations

Some early studies (like the Women’s Health Initiative) raised concerns about risks with specific synthetic combinations—but those results don’t apply to all modern therapies.  However, it is important to noted that while these are generally safe, they do carry more risk of side effects than bioidentical options.

Bioidentical HormonesBioidentical hormones are structurally identical to the hormones your body makes.
They can be derived from plant sources (like yams or soy) but are processed to match human hormones exactly.
Here’s the important part most people don’t realize:
👉 Many FDA-approved hormone therapies are already bioidentical.
This includes forms of:

• Estradiol (estrogen)
• Micronized progesterone

So “bioidentical” doesn’t automatically mean “custom” or “compounded.”

FDA-Approved vs. Compounded HormonesThis is where things really matter.
FDA-Approved Hormone TherapyThese are regulated, tested, and standardized for:

• Safety
• Dosage consistency
• Effectiveness

Examples include:

• Estradiol patches
• Oral progesterone
• Estrogen gels

The U.S. Food and Drug Administration supports these therapies because they’ve undergone clinical testing.

Compounded HormonesCompounded hormones are custom-mixed by a pharmacy based on a provider’s prescription.
They’re often marketed as:

• “More natural”
• “Personalized”
• “Safer”

But here’s the catch:
They are not FDA-approved, meaning:

• Doses can vary
• Quality isn’t standardized
• Safety data is limited

According to the American College of Obstetricians and Gynecologists, compounded hormone therapy should generally be used only when FDA-approved options are not suitable. Compounded hormones are not necessarily dangerous, but you need to make sure you are trusting a reputable pharmacy. I am currently taking a compounded testosterone cream and I like it. However, testosterone is not FDA approved for women and can be difficult to get an FDA approved version from a normal pharmacy. It is possible, but there are usually questions raised.

Different Types of Hormone Therapy (And Why It Matters)HRT isn’t one-size-fits-all. The delivery method can affect how your body absorbs and responds.
1. Patches (Transdermal Estrogen)

• Applied to the skin
• Steady hormone delivery
• Lower risk of blood clots compared to oral estrogen

2. Pills (Oral Estrogen/Progesterone)

• Convenient
• Processed through the liver
• May slightly increase clotting risk in some women

3. Gels & Creams

• Absorbed through the skin
• Flexible dosing
• Often used for estrogen

4. Vaginal Estrogen (Creams, Rings, Tablets)

• Targets local symptoms (dryness, discomfort)
• Minimal systemic absorption

5. Pellets (Implanted Hormones)

• Inserted under the skin
• Long-lasting
• Often compounded (not FDA-approved)

Signs You Might Benefit from HRTNot every woman needs HRT—but many could benefit from at least exploring it.
Common symptoms include:

• Persistent fatigue
• Hot flashes or night sweats
• Poor sleep or insomnia
• Mood swings, anxiety, or irritability
• Brain fog or memory issues
• Low libido
• Vaginal dryness
• Weight gain, especially around the midsection

If you’re reading this thinking, “Okay wow, that’s… all of them,” you’re not alone.

Benefits of Hormone Replacement TherapyWhen prescribed appropriately, HRT can offer significant benefits:
1. Relief from Menopausal SymptomsHRT is the most effective treatment for hot flashes and night sweats (NAMS, 2022).
2. Improved Bone HealthEstrogen helps maintain bone density and reduces the risk of osteoporosis.
3. Better Sleep and MoodHormone balance can improve sleep quality and reduce mood swings.
4. Cardiovascular Support (When Started Early)Research suggests starting HRT near menopause may support heart health (Hodis & Mack, 2011).
5. Improved Quality of LifeThis one gets overlooked—but feeling like yourself again matters.

Important: HRT Isn’t One-Size-Fits-AllHRT is highly individualized.
Factors that matter include:

• Age
• Health history
• Time since menopause
• Personal risk factors

The North American Menopause Society states that for healthy women under 60 or within 10 years of menopause onset, the benefits of HRT often outweigh the risks.
Translation: timing matters.

Where Fitness and Nutrition Still Come InHRT is powerful—but it’s not magic.
To get the full benefit, it should be paired with:

• Strength training
• Adequate protein intake
• Daily movement
• Stress management
• Sleep support

Because hormones + lifestyle = results.

If You Want Help Navigating ThisIf you’re trying to figure out how to support your body through midlife—whether that includes HRT or not—you don’t have to guess.
You can:
👉 Apply for coaching for a personalized plan around training, nutrition, and lifestyle
👉 Join the Ascend app for structured strength programs designed for women navigating hormonal changes
Because feeling strong, energized, and like yourself again shouldn’t feel this complicated.

Final ThoughtsThe conversation around hormone therapy has been confusing for years.
But here’s the bottom line:

• Not all hormones are the same
• “Bioidentical” doesn’t always mean better
• FDA-approved options are often the safest starting point
• The right approach is individualized

And most importantly:
You deserve to understand your options—and make informed decisions about your body.

Sources

• North American Menopause Society
• American College of Obstetricians and Gynecologists
• U.S. Food and Drug Administration
• Hodis HN, Mack WJ. Menopause, 2011
• Rossouw JE et al. JAMA, 2002

When you hear “testosterone,” you probably think of it as a male hormone. But here’s the truth — testosterone plays a critical role in women’s health too, especially during and after menopause. In fact, it’s essential for everything from energy and muscle strength to bone density and mood stability. Unfortunately, many women have never been told how important this hormone really is, or what happens when it’s too low.
Today, we’re diving into testosterone’s function in the female body, the symptoms of low testosterone in women, and the benefits of testosterone therapy.
Testosterone’s Role in the Female BodyWhile men produce much more testosterone, women’s bodies naturally make it in smaller amounts — mainly in the ovaries, adrenal glands, and peripheral tissues.
Testosterone helps regulate:

• Muscle mass and strength – Supports lean muscle growth and maintenance.
  
• Bone density – Works with estrogen to protect against osteoporosis.
  
• Libido and sexual function – Plays a major role in sexual desire and satisfaction.
  
• Mood and cognitive function – Influences memory, focus, and emotional well-being.
  
• Energy and stamina – Helps combat fatigue and improves endurance.
  

According to the Endocrine Society, testosterone is present in women’s bodies at about one-tenth to one-twentieth the levels found in men — but that small amount is vital for maintaining health and vitality.
Symptoms of Low Testosterone in WomenTestosterone levels naturally decline with age, particularly during and after menopause. However, certain medical conditions, medications, or lifestyle factors can accelerate the drop.
Common signs of low testosterone include:

• Persistent fatigue and low energy
  
• Loss of muscle tone or increased body fat
  
• Decreased libido or sexual satisfaction
  
• Reduced bone density (osteopenia/osteoporosis)
  
• Mood swings, irritability, or depression
  
• Difficulty concentrating or brain fog
  

If you’re experiencing several of these symptoms, it’s worth speaking with your healthcare provider about testing your hormone levels.
Benefits of Testosterone Therapy for WomenResearch suggests that testosterone therapy can provide multiple benefits for women with clinically low levels — especially those in peri- or post-menopause.
Potential benefits include:

1. Improved Sexual Health – Studies show testosterone therapy can significantly improve sexual desire, arousal, and satisfaction in postmenopausal women (The Journal of Clinical Endocrinology & Metabolism, 2019).
   
2. Increased Muscle Strength – Testosterone helps preserve lean muscle mass, which supports metabolism and functional independence.
   
3. Enhanced Bone Health – By working with estrogen, testosterone can slow bone loss and reduce fracture risk (National Institutes of Health).
   
4. Better Mood and Cognitive Function – Some women report improved mental clarity, focus, and reduced feelings of depression.
   
5. Boosted Energy Levels – Helps restore vitality and reduce chronic fatigue.
   

Important ConsiderationsTestosterone therapy isn’t for everyone, and it should only be prescribed and monitored by a qualified healthcare professional. Overuse or improper dosing can cause side effects such as acne, hair changes, or voice deepening.
Before starting therapy, your provider will likely recommend:

• Comprehensive hormone testing
  
• Reviewing your full health history
  
• Discussing non-hormonal options such as nutrition, resistance training, and stress management
  

Supporting Healthy Testosterone NaturallyEven if you’re not a candidate for therapy, lifestyle habits can help support healthy testosterone levels:

• Strength training at least 2–3 times a week
  
• Adequate protein intake (0.8–1g per pound of lean body mass)
  
• Healthy fats from sources like avocado, nuts, and olive oil
  
• Quality sleep (7–9 hours per night)
  
• Stress management to reduce cortisol, which can suppress testosterone
  

Final ThoughtsTestosterone is not just a “male” hormone — it’s a crucial part of women’s health, especially as you age. If you’re noticing symptoms of low testosterone, don’t ignore them. Talk to your healthcare provider, explore testing, and consider all your options for keeping your hormones balanced.
And remember — exercise is one of the most powerful hormone balancers you have at your disposal. That’s why we created the Ascend Fitness App — giving you access to a full year’s worth of progressive strength training programs designed to support healthy hormones, muscle mass, and overall vitality.
Sources:

• Davis, S.R., et al. “Global Consensus Position Statement on the Use of Testosterone Therapy for Women.” The Journal of Clinical Endocrinology & Metabolism, 2019.
  
• National Institutes of Health. “Testosterone and Women’s Health.” NIH.gov.
  
• Endocrine Society. “Testosterone Therapy in Women.” Endocrine.org.
  

What Is Menopausal Hormone Replacement Therapy?Menopausal Hormone Replacement Therapy (MHRT), often referred to simply as HRT, involves the use of estrogen or a combination of estrogen and progesterone to relieve symptoms of menopause and improve long-term health outcomes. It’s one of the most effective treatments for managing menopausal symptoms—yet it remains widely misunderstood.
Common Menopause SymptomsAs estrogen levels decline during perimenopause and menopause, women may experience:

• Hot flashes and night sweats
  
• Mood changes
  
• Vaginal dryness
  
• Sleep disturbances
  
• Brain fog and fatigue
  
• Bone loss
  
• Increased abdominal fat
  

According to the North American Menopause Society (NAMS), over 80% of women will experience some of these symptoms, and for many, they can last for a decade or more.

Is MHRT Safe? What the Research Really SaysFor years, MHRT was overshadowed by fears stemming from the 2002 Women's Health Initiative (WHI) study, which suggested increased risks of breast cancer and heart disease. However, subsequent reanalysis of the data has clarified that MHRT is actually safe and beneficial for the majority of women, especially when started early in the menopausal transition.
Key Findings:

• A 2017 review in JAMA found that women who started hormone therapy before age 60 or within 10 years of menopause had reduced risks of heart disease and mortality.
  
• The NAMS 2022 position statement confirms that for healthy women under age 60, or within 10 years of menopause, the benefits of hormone therapy outweigh the risks.
  
• A 2020 study in the American Journal of Public Health suggested that up to 90,000 premature deaths could have been prevented if women had continued using MHRT.
  

Dr. Mary Claire Haver’s PerspectiveDr. Mary Claire Haver, OB-GYN and founder of The Galveston Diet, is a vocal advocate for hormone therapy in midlife women. She stresses that:
"We now have clear, evidence-based data showing that hormone therapy is not only safe but extremely beneficial for women when used appropriately."
Dr. Haver recommends that women discuss MHRT with their healthcare provider early in their menopause journey, especially if symptoms are interfering with quality of life.

Benefits of MHRTFor most women, MHRT offers a wide range of health benefits:
Relief from Hot Flashes and Night SweatsEstrogen therapy is the gold standard treatment for vasomotor symptoms (like hot flashes), which affect up to 75% of women in menopause.
Improved Sleep and Mental ClarityHormone therapy has been shown to improve sleep quality and reduce brain fog, helping women feel more like themselves again.
Bone Health SupportPostmenopausal women are at increased risk for osteoporosis. Estrogen helps maintain bone density and reduce fracture risk, according to a 2019 review in Osteoporosis International.
Heart Health and LongevityWhen started early, MHRT has been linked to reduced coronary artery disease risk and increased life expectancy in women.
Improved Genitourinary HealthEstrogen helps with vaginal dryness, painful intercourse, and urinary symptoms—issues that can severely affect intimacy and quality of life.

Who Should Avoid MHRT?While MHRT is safe for many, there are exceptions. Women with a history of the following should discuss alternatives with their doctor:

• Breast cancer
  
• Active liver disease
  
• Blood clots
  
• Undiagnosed vaginal bleeding
  

Final Thoughts: Empowered, Not AfraidIt’s time to shift the narrative. MHRT is a safe, science-backed tool for improving quality of life, longevity, and overall health for millions of women navigating menopause.
As Dr. Mary Claire Haver says:
“Menopause is not the end—it's a new beginning. Women deserve to have the tools and knowledge to thrive through this stage of life.”